For whom does prison-based drug treatment work? Results from a randomized experiment

Objectives: Prison-based therapeutic community (TC) drug treatment followed by community aftercare is widely recognized as the most effective treatment paradigm for drug-dependent offenders. However, few randomized experiments have addressed this question and fewer studies have examined how interactions between treatment modality and individual characteristics may explain variations in outcomes. Methods: Using a randomized experimental design, this study examined the effects of treatment modality [TC vs. Outpatient (OP) group counseling], individual psychosocial characteristics (e.g., risk, negative affect), and interactions on reincarceration over a 3-year follow-up period. Survival analysis using Cox regression with covariates was used to analyze data obtained from 604 subjects at a specialized drug treatment prison. Results: The expected advantage of TC failed to emerge. Critical and heretofore unexamined interactions between treatment modality (TC vs. OP), inmate levels of risk, and negative effect help explain these unexpected findings. Conclusion: The superiority of prison TC to less intensive OP counseling was not supported. The effects of TC appear to be conditioned by critical responsivity factors that have received little empirical attention.