Drug Treatment Programs

Development

Correctional drug treatment programs in the United States originated in the 1930s with “narcotics farms” in Lexington, Kentucky, and Fort Worth, Texas. Treatment in these institutions was based on therapeutic withdrawal using gradually declining doses of methadone. Diversionary programs such as these, which placed offenders in civil substance abuse institutions rather than in correctional facilities, continued to be the primary means of dealing with drug-using offenders until the 1960s. In the 1960s and 1970s, the idea of treating offenders through psychological counseling and programming gained popularity. Treatment options incorporating programs such as detoxification, 12-step programs, counseling, and residential treatment developed and spread. In the late 1970s, however, meta-analyses of existing programs showing limited effects on recidivism led to the adoption of a “nothing works” approach to penal rehabilitation. [Page 266]Diminished faith in the treatment of offenders resulted in a swift decline in correctional drug treatment programs that lasted until the mid-1980s.

Recent Funding Initiatives

The declaration of a “cocaine epidemic” and the “war on drugs” in 1986 led to unprecedented numbers of drug offenders in U.S. prisons. In response, the Anti-Drug Abuse Act of 1986 called for the development of new resources for correctional drug treatment. Initiatives such as projects REFORM and RECOVERY were implemented to provide the research and training needed for the development of nationwide treatment programs. These initiatives originated in the Bureau of Justice Assistance, but were soon passed to the Department of Health and Human Services's newly developed Center for Substance Abuse Treatment. Currently, program funding is provided by a variety of sources, including the Bureau of Justice, Department of Health, research organizations such as the National Institute on Drug Abuse, correctional psychological services, and individual states and correctional facilities.

Program Admission

Offenders are referred to treatment programs through institutional admissions screening, staff, judge, or case manager recommendation, parole requirements, or, more rarely, through volunteering. Offenders are often initially identified for suitability based on reported substance abuse history, drug-related offenses, or standardized psychological tests such as the Addiction Severity Index. Many institutions also require individual interviews with psychology staff or social workers to confirm motivation and personal suitability for treatment. As a general rule, more intensive programs have more stringent admission criteria. Additional requirements vary by treatment program, but often include documented history of drug use, drug-related recidivism, and a clean institutional disciplinary file. Most programs do not admit inmates who have a history of violent or sexual offenses, mental illness, or in-custody disturbances. Sentence length also determines program participation as some treatment modalities require up to one year to complete or are offered only to inmates approaching parole or release dates.

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