The Relative Effects of Three Approaches to the Parole Supervision of Narcotic Addicts and Cocaine Abusers

• Published date: 01 June 1999
• Date: 01 June 1999
• DOI: 10.1177/0032885599079002003
• Subject Matter: Articles

THE PRISON
Hanlon et al. / JOURN
PAR
AL
OLE
/ June
SUPER 1999
VISION
THE RELATIVE EFFECTS OF THREE
APPROACHES TO THE PAROLE
SUPERVISION OF NARCOTIC
ADDICTS AND COCAINE ABUSERS
THOMAS E. HANLON
DAVID N. NURCO
University of Maryland at Baltimore
RICHARD W. BATEMAN
Friends Research Institute, Inc.
KEVIN E. O’GRADY
University of Maryland
This study examined the 1-year parole outcomes of 504 newly released parolees with
a history of heroin and/or cocaine abuse who were randomly assigned , within gender,
race, and primary drug of choice, to one of the following three interventions: a pro-
gram of “social support,” combining weekly urine monitoring with counseling, case
management, and case advocacy; weekly urine monitoring alone; and routine parole.
Results indicated a superiority of social support treatment over the other two com-
parison conditions, particularly urine monitoring alone. Supplemental analyses indi-
cated a general superiority of substance abuse treatment over no treatment, whether
or not treatment was delivered within the social support framework.
It is generally recognized that when released from incarceration, drug
abusing offenders are quickly caught up in a revolving-door phenomenon
characterized by relapse to drug abuse, renewed criminal activity, and rein-
carceration that only a small percentage manage to avoid (Lipton, 1998; Mar-
tin & Inciardi, 1993). Individuals abusing heroin and/or cocaine are at par-
ticularly high risk of becoming repeat offenders. Wexler, Lipton, and
This study was supported by Grant No. R18 DA06988 of the National Institute of Drug
Abuse (David N. Nurco, principal investigator), and was administered by Friends Research In-
stitute, Inc., Baltimore, Maryland. A special note of appreciation is due to the Social Support
counseling staff, including clinical supervisor Einat Toledano, and counselors Mary Fleig, Rob-
ert Goodman, Sharon Lipford, and Neal McLaughlin.
THE PRISON JOURNAL, Vol. 79 No. 2, June 1999 163-181
© 1999 Sage Publications, Inc.
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THE PRISON JOURNAL / June 1999
Johnson (1988) reported that 60% to 75% of newly released, untreated parol-
ees with a history of heroin and/or cocaine use returned to the use of these
drugs within 3 months, and became reinvolved in criminal activity. Under-
standably, the need to devise better methods to interrupt this seemingly inevi-
table cycle of relapse and recidivism has generated considerable research
and clinical interest during the past decade. Because they had the potential to
alleviate prison crowding and represented ways of extending targeted reha-
bilitation and surveillance efforts beyond the period of confinement,
community-based programs for drug abusing parolees were considered espe-
cially promising conditional release alternatives (Petersilia & Turner, 1993a;
Wish, Toborg, & Bellassai, 1988).
The development of effective community-based treatment of newly pa-
roled drug abusing offenders is by no means an easy task, considering the
negative and stressful circumstances faced by such individuals. When re-
leased from incarceration, these high-risk parolees not only must deal with
an increased susceptibility to drug use, they must do so at a point in their lives
in which there is considerable uncertainty and instability associated with re-
entry into the community. For many, it is the repeat of a situation in which
they have been unsuccessful in the past. For almost all, the determination to
remain drug-free, assuming it exists, and the euphoria associated with re-
gained freedom are quickly displaced by familiar temptations and the stark
reality of an untrusting and demanding environment.
The present study examines the feasibility and effectiveness of a drug
abuse treatment program specifically designed for offenders with a history of
heroin and/or cocaine abuse who, on release from incarceration, were re-
quired to participate in drug abuse treatment in the community as a condition
of parole. At the time of the planning of the intervention, intensive supervi-
sion programs (ISPs), employing closer monitoring of drug use (Petersilia &
Turner, 1993b), and case management strategies (Ashery, 1992; Martin & In-
ciardi, 1993), were being critically examined as treatment approaches target-
ing drug abusers under correctional supervision. The intervention adopted in
the present instance, termed the social support approach, incorporated as-
pects of intensive supervision and case management, thereby addressing
both the drug abuse issue and the multiple needs manifested by newly re-
leased parolees at high risk for drug abuse and related criminal activity. The
approach linked weekly urine monitoring with the provision of weekly indi-
vidual counseling emphasizing social work case management procedures
and relapse prevention strategies.
In planning the evaluation of the intervention, an attempt was made to de-
termine the separate effectiveness of the urine monitoring component be-
cause at the time, the deterrent effect of urine monitoring on relapse to drug

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Hanlon et al. / PAROLE SUPERVISION
165
use was still a matter of considerable debate. The evaluation strategy that was
therefore adopted involved a determination of the comparative effectiveness
of the following three conditions: an experimental treatment condition, in-
cluding social support and urine monitoring; a urine monitoring only condi-
tion; and routine parole.1 Our original hypotheses regarding the relative out-
comes of the three study conditions were based on the expectation that
readdiction and recidivism rates would be reduced by more frequent (as op-
posed to random, infrequent) urine monitoring and that the rates would be
further reduced by combining increased urine monitoring with counseling
that focused on relapse prevention and incorporated an enhancement of the
parolees’ social support system.
METHOD
PARTICIPATION SELECTION AND TREATMENT
As described in earlier reports (Hanlon, Nurco, Bateman, & O’Grady,
1998; Nurco, Hanlon, Bateman, & Kinlock, 1995), the participants in this
study were Baltimore City ex-offenders with a history of narcotic addiction
and/or heavy cocaine use who were paroled from the Maryland State Correc-
tional System. African American and White male and female individuals
who were placed on at least 1 year of parole supervision were selected for
study. All of the participants had a history of narcotic addiction and/or heavy
cocaine abuse, as determined by both the Maryland Division of Correction
records and self-reports.2 Although the parolees were required to enroll in a
drug abuse program as a condition of parole, participation in the study was
voluntary, involved informed consent procedures, and was not required for
parole eligibility. Participants were assigned at random, within race, gender,
and primary drug of choice (i.e., heroin or cocaine), to one of the following
three study conditions for a 1-year observation period:
1.
participation in a social support program combining weekly urine monitoring
with counseling, case management, and case advocacy (SSU group);
2.
participation in a program of weekly urine monitoring, along with routine pa-
role (U group); and
3.
participation in routine parole, which includes infrequent urine testing and,
more often than not, involves assignment to another drug treatment program
(C group).
Of the total number of participants selected for the study, approximately one
half were assigned to social support plus urine monitoring (the experimental

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THE PRISON JOURNAL / June 1999
condition), one quarter to urine monitoring plus routine parole, and one quar-
ter to routine parole.
During the year, noncompliance and/or a relapse to continued drug use on
the part of participants in the SSU and U conditions resulted in their discon-
tinuance from treatment and placement on routine parole, which at times, in-
volved subsequent referral by parole agents to a less restrictive substance
abuse program. During the study, the usual parole requirements, including fi-
nal decision making by a parole officer in the parole disposition of each case,
remained in effect for all participants.
Social Support
Our social support approach was prompted by research suggesting that for
substance abuse clients, treatment outcome is more likely to be successful
when drug abuse is viewed in the context of multiple symptom patterns and
life circumstances that are characteristic of a given individual (McLellan,
Luborsky, Woody, O’Brien, & Kron, 1981). In addition to addressing predis-
positional characteristics with regard to drug use and criminal activity, im-
plementing social support treatment in the individual cases was tailored to
meet the specific needs of substance-abusing clients and revolved around the
identification and use of personally relevant social support systems in the
community (Brown, Gauvey, Meyers, & Stark, 1971; Stanton & Todd,
1982). During the 1-year period of parole, case management and client advo-
cacy services were provided to SSU participants by counseling personnel to
facilitate the maximum use of positive social supports.3 Inasmuch as they in-
volved assertively linking consumers to available services (Cohen, Nimic,
Cohen, & Farkas, 1988), these procedures were similar in many respects to
those used by Martin and Inciardi (1993) in their evaluation of a case man-
agement approach to the drug abuse treatment of prison releasees.
URINE MONITORING
For urinalysis drug detection and verification, full drug screening was per-
formed using the following methods: Thin Layer...