The Therapeutic Community Movement in Corrections.
A 1988 study by the Idaho Department of Corrections (DOG) revealed that about 80 percent of its inmate population had significant drug and alcohol abuse problems. These numbers have continued to grow over the years. While some substance-abusing offenders can and will benefit from regular drug and alcohol programming, along with Cognitive Self-Change (CSC) or programming within institutions, others with more severe addictions must be placed in the nine- to 12-month residential treatment environment that TCs offer. Already, many of Idaho's probation and parole officers who have received TC training are beginning to form specialized caseloads of TC graduates. TC halfway houses are on the horizon as well.
I am the program manager for the FRIENDS (Finding Recovery in Each New Day's Sunrise) TC program at the Idaho Correctional Institution-Orofino, located in Northern Central Idaho. The program, which began in July 1998, alter a dedicated housing unit was secured within the prison, most resembles an inpatient, residential substance abuse treatment unit housing 39 inmates. FRIENDS was initiated by a small group of correctional officers and line program staff who worked together to define and build the program after touring and observing TCs in other states.
As the program developed, the Idaho DOG began to study and then design appropriate aftercare services. Research studies have shown that the provision of aftercare services to TC program graduates greatly enhances graduates' potential for success while reducing recidivism rates to no more than 30 percent nationwide. Without treatment of any type, it is estimated that 70 percent of all inmates released in this country eventually are reincarcerated.
A Brief History of TC
In 1968, Gateway Houses Foundation became the first TC in the state of Illinois. (The first known TC was founded in 1958 by Charles E. Dederich, a graduate of Alcoholics Anonymous, in Ocean Park, Calif.) Gateway was the outcome of the Council of the Understanding and Rehabilitation of Addicts' four-year effort to learn how to fight the growing problem of addiction. The initial $180,000 operating grant from the Illinois Drug Abuse Program established a 24-hour-a-day residential setting in which former drug addicts could help other drug abusers find a way to live drug-free, responsible and useful lives in the community. Most accepted into the center were long-time addicts who had failed at other treatments attempts. As it became known that this residential center was helping addicts stay clean and sober, the demand for these types of residential centers grew. By 1972, three more centers opened in Chicago and Springfield, Ill.
By 1992, then Texas Gov. Ann Richards (D), who was a recovering alcoholic herself, was urging the Texas Legislature to address the problem of prison crowding, recidivism and the growing number of alcohol- and substance-abusing offenders entering the prison system. Like many states, Texas had two problems -- a burgeoning prison population and a high recidivism rate. At the same time, it was under fire from the federal government to improve conditions and programs within the state while reducing crowding.
Richards and the state Legislature asked Gateway to initiate treatment programs in correctional centers throughout Texas. The Treatment Alternatives to Incarceration Program (TAIP) centers initially were located in the six largest cities in Texas. To intervene in offenders' criminal behavior patterns and to reduce recidivism, corrections professionals and some of the state's leading substance abuse treatment specialists joined together to develop a structured, secure environment with appropriate services and resources for treatment within the Texas Department of Criminal Justices' correctional facilities.
The first part of the initiative called for the creation of in-prison TCs. The second part called for treatment facilities for thousands of inmates called Substance Abuse Felony Punishment Facilities (SAFPF). In addition, halfway houses were developed to enable inmates to receive a continuum of care for up to 12 months following their release. This includes an initial transitional residential phase of about three months and an outpatient phase of about nine months. During the outpatient phase, residents still live at the halfway house, but have jobs in the community.
Visiting Texas TCs
TAIP is credited with having targeted cost-effective alternatives to incarcerating nonviolent substance-abusing offenders in Texas. The philosophy of the initiative is to provide treatment to people whose criminal activity is related primarily to their substance abuse so that jails and prisons can be used for violent offenders and career criminals who present the most danger to their communities. TAIP operates in 109 counties throughout Texas. Currently, Gateway is operating eight SAFPFs, including dual diagnosis units at Hackberry, Jester and Estelle.
In April 1999, I, along with a multidisciplinary group of representatives from the Idaho DOC, spent two days touring several TCs and halfway houses in and around Houston in an attempt to observe their aftercare services and the continuum of care they provide to inmates who graduate. The Texas TC system was chosen because it is one of the most highly developed prison-based TC systems in the world. The main objective of the trip was to learn about aftercare for long-term drug offenders because these services are essential in helping former addicts get out and stay out of prison.
In Texas, as well as many other states, TC is mandatory. The TC programs we visited were under the auspices of the Texas Jail Division. Judges sentence inmates to TC or offer them hard time in a maximum-security institution if they refuse. We first visited the women's TC in Henley (outside Houston). In this TC, new residents initially are not considered family members. They must pass proficiency tests while being guided by a senior inmate mentor or "big sister." They are not allowed commissary privileges and cannot talk to family members -- only to one another -- for one month. After this month, they officially are welcomed as new members. Groups of women of many different ethnicities are housed together in "pods" of about 40 women each. Each pod has its own morning development meetings and evening development meetings.
While visiting, I watched all 200-plus residents assemble and use their creative energy to line-dance to 1950s and 1960s songs altered to include words about rehabilitation. Their presentation and dancing were quite loud and energetic and the participants' enthusiasm was obvious.
We also observed Therapeutic Peer Reprimand (TPR) and confrontation groups. TPR is a final attempt by inmates and staff to bring negative and destructive behaviors to an individual's attention. During a TPR for an inmate who continually refused to make her bed each morning, one confronter stated, "Girlfriend, first it's loose sheets, then it's a loose life!" Another confronter offered some encouragement to stay with the program and deal with the setbacks.
Although this TC has a full staff with a staff member to inmate ratio of 1-to-16, the staff delegate nearly everything possible to other inmate family members, especially those far along in recovery. Staff guide but do not necessarily do for inmates, except when absolutely necessary.
At the facility in Jester, inmates are not divided into pods. This 200-plus men's facility is a dual-diagnosis facility. Those with special needs (physical or emotional) who are stabilized with medication are placed there. Frankly, if someone had not told me it was a dual-diagnosis facility, I would not have known. There is a high degree of accountability; all booking slips are investigated and there is an appeals process. TPRs are given frequently and routinely. According to Sandra Cornelius, manager of the substance abuse treatment programs for Texas, staff only have "a short while to help these guys confront and change a lifetime of behaviors. The program, therefore, is highly confrontational and is designed to be that way." Interestingly, the TC inmate housing was a hot and humid cellblock. In the building used for programming, the air conditioning made it quite comfortable. Thus, inmates have the choice to either lay on their bunks and sweat or get themselves some programming and be cool.
Newly paroled inmates transition to the New Directions Center, located in a quiet residential neighborhood in Houston, where they live for up to one year. It is run as a TC with morning and evening meetings, a structure board and a high accountability for one's actions. Following an initial 90-day residential stay, inmates may get jobs in the community. Drug testing is random and continual. The center also is used for visits by probation and parole officers and treatment team meetings so all service providers can meet to discuss cases. If an inmate violates the rules of the center or of his or her probation or parole, staff do not hesitate to call inmates' probation or parole officers to report it. This also gives probation and parole officers a secure feeling that their standards are being met by center residents.
The Winner's Circle is another outpatient program in which TC graduates meet to discuss recovery and hold themselves accountable. It was created and is administered by former inmate TC graduates and is similar to AA meetings, but is more interactive and confrontational. At the meeting we observed, one former inmate complained that although he was clean and sober, he could not seem to get his checks cashed. He continued on that he always would look like a drug addict and, therefore, would be distrusted by others. He was well on his way to having his own "pity party" when another member answered, "Quit trying to cash your checks at midnight when store owners are suspicious. Try going to the bank in the daytime instead."
Does TC work? According to Douglas Lipton, an outcome study of prison-based treatment compared and contrasted four different therapeutic communities nationwide. In one such a study, Cornerstone TC in Oregon found that in the three years following an inmate's release from prison, 74 percent who did not receive TC treatment had been subsequently re-incarcerated. Only 29 percent of TC graduates were reincarcerated. In a study of the Amity TC program in California, 63 percent returned to jail within one year fob lowing release, while only 26 percent of TC graduates were re-incarcerated. The other two group studies produced similar results, as did studies of federal TCs, which have existed nationwide for some time.
In summary, it appears that TC is here to stay. Already implemented in states such as Alaska, California, Maine, Nevada, North Carolina, Oregon, Texas, Virginia and Washington, these programs continue to grow as they are seen as the most effective treatment available for long-term criminal alcohol and substance abusers. Few programs such as these exist on the streets, and the ones that do are beyond the economic reach of those who need it most.
While it is unfortunate that many have ended up in prison, partially due to a lack of availability of such programs on the streets, it appears that their time incarcerated can be put to good use in terms of helping them rehabilitate themselves as TC residents. Older, more experienced inmates help younger, less experienced inmates learn from their mistakes and avoid the common pitfalls of relapse, especially on the streets. Future generations will be positively impacted by inmates who can learn to lead clean and sober lives and be role models to their children and others in their communities. Institutional staff merely are the guides, so to speak, on this journey of rehabilitation - we can offer the skills and tools needed. The real work, however, is done by the inmates themselves, with the help of other inmates, all working together toward continued sobriety.
Brian Shapiro, MS., is a clinician and therapeutic community program manager at Idaho Correctional Institution-Orofino.