The Treatment Group and Recidivism: A Multilevel Analysis of Prison-Based Substance Abuse Treatment

• Published date: 01 November 2019
• Date: 01 November 2019
• DOI: 10.1177/0032885519875002
• Subject Matter: Articles

https://doi.org/10.1177/0032885519875002

The Prison Journal

2019, Vol. 99(5) 515 –534

© 2019 SAGE Publications

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DOI: 10.1177/0032885519875002

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Article

The Treatment Group

and Recidivism: A

Multilevel Analysis of

Prison-Based Substance

Abuse Treatment

Christopher E. Kelly1, Wayne N. Welsh2,

and Jennifer N. Stanley3

Abstract

This study contributes to the substance abuse treatment literature by

examining recidivism across treatment groups, the level of aggregation

between the individual and the program. The sample consisted of 618

drug-involved offenders who participated in 12 different treatment groups

within a single prison. Reincarceration significantly varied across groups,

controlling for time at risk and treatment modality. This between-unit

variation was explained by individual level treatment response measures

and control variables. Results demonstrated that treatment effectiveness is

impacted by the group in which the individual participates. These findings

have substantial implications for correctional treatment theory, research,

and policy.

Keywords

correctional treatment, recidivism, substance abuse, treatment group

1Saint Joseph’s University, Philadelphia, PA, USA

2Temple University, Philadelphia, PA, USA

3Rowan University, Glassboro, NJ, USA

Corresponding Author:

Christopher E. Kelly, Department of Sociology and Criminal Justice, Saint Joseph’s University,

5600 City Avenue, Post Hall 138, Philadelphia, PA 19131, USA.

Email: c.kelly@sju.edu

875002TPJXXX10.1177/0032885519875002The Prison JournalKelly et al.

research-article2019

516 The Prison Journal 99(5)

Introduction

The research on correctional treatment, including prison-based substance

abuse treatment, has matured over the past several decades. Scholars have

been dedicated to discovering the relative effectiveness of treatment inter-

ventions, for which individuals or groups they are effective, and under what

conditions. The breadth of factors, for instance, in the Texas Christian

University treatment process model (Simpson, 2004) and the research sup-

porting it demonstrates how far the field has come in understanding what

works in substance abuse treatment. In this study, we sought to contribute to

the correctional intervention literature by examining how the social context

of prison-based treatment may influence postrelease recidivism among a

sample of inmates who participated in a 12-month treatment program.

Research has generally demonstrated the effectiveness of prison-based

therapeutic community (TC) drug treatment followed by community after-

care in reducing recidivism (e.g., Inciardi, Martin, & Butzin, 2004; Knight,

Simpson, & Hiller, 1999; Prendergast, Hall, Wexler, Melnick, & Cao, 2004;

Welsh, 2007, 2011). To better assess client-level factors on treatment prog-

ress, some studies have examined self-reports of psychosocial variables dur-

ing treatment (Welsh, 2010), while others have examined treatment process

variables such as duration (Joe, Knezek, Watson, & Simpson, 1991), thera-

peutic engagement (Hiller, Knight, Leukefeld, & Simpson, 2002), relation-

ships with others (Broome, Knight, Knight, Hiller, & Simpson, 1997; Welsh,

2010; Welsh & McGrain, 2008), and counselor-reported measures (Stanley,

Kelly, & Welsh, 2017). More recently, a randomized field experiment exam-

ined interactions between treatment modality and individual characteristics

to account for variations in treatment outcomes, although this study found

that prison-based TC participants had higher rates of reincarceration com-

pared with their group counseling counterparts (Welsh, Zajac, & Bucklen,

2014).

Several studies have examined the group context of the treatment experi-

ence using multilevel statistical methods to simultaneously model and con-

trol for individual and contextual factors (e.g., Broome, Flynn, Knight, &

Simpson, 2007), including the Dimensions of Change Instrument (DCI)

within TCs (Mandell, Edelen, Wenzel, Dahl, & Ebener, 2008), client perspec-

tives on treatment motivation and readiness across two treatment modalities

(Melnick, Hawke, & De Leon, 2014), treatment and program level factors on

posttreatment drug use (Ghose, 2008), and psychosocial and behavioral

changes post treatment (Joe et al., 2012; Rowan-Szal, Joe, Simpson, Greener,

& Vance, 2009). Others have assessed client-level asociality (e.g., lack of

motivation) as a predictor of treatment engagement by using nested analysis