Prospective randomised controlled study design Outcomes 6 and 12 months after release
115 female offenders with documented history of substance abuse FU: 83% after 6 months FU: 76% after 12 months
Gender-responsive MTC in prison () 6 month program Controls: standard prison TC () 6 month program
Months in aftercare: 2.6 versus 1.8* MTC group had higher OR (4.60*) of successful aftercare completion
No ≠ regard. alcohol and drug ASI composite scores + self-efficacy
No ≠ in (time to) return to custody: 31 versus 45%
No ≠ regard. family and psychological ASI composite scores
Greater reduction in drug use among MTC group*, when controlling for race, employ. + marital status Return to custody less likely among MTC group, when controlling for race, employ. + living status
Prospective controlled study design (QES in 5 state prisons) Outcomes up to 2 years after release (on average after 17 months)
708 male inmates admitted to drug Tx in prison FU: 100% (based on official records)
5 prison TCs () Length varied from 9 () to 12 () and 16 months (); controls (): 3 other types of drug Tx (drug education, outpatient Tx, self-help groups)
No ≠ in number of pos. drug tests (35 versus 38%)
Lower reincarc and rearrest rates, respectively 30 and 24% versus 41 and 34%* Reincarc. and rearrest respectively 1.6* and 1.5* times higher among controls
Higher employ.: 39.2 versus 25.9%***
Reincarc. predicted by post-release employment status Drug relapse predicted by age and employment (older and employed persons less likely to relapse)
Prospective randomized controlled study design Outcomes 12 months post-release
139 male inmates with substance use and other psychiatric disorders FU: 75% (82 versus 69%)
Prison MTC () 12 month program Controls: standard mental health Tx in prison ()
Rates of any substance use: 31 versus 56%**; any illicit drug use: 25 versus 44%*; alcohol intox.: 21 versus 39%* Time to relapse: 3.7 versus 2.6 months*
Sign. association between relapse and committing new (nondrug) offences Increased OR for reoffending (4.2*) and reincarc. (5.8*) among persons who relapsed in substance use
Prospective controlled study design (no true randomisation, since 51 subjects moved from one condition to another) Outcomes 12 months after prison release
185 male inmates with substance use and other psychiatric disorders FU: 75% (82 versus 69%)
Prison MTC () 12 months Controls: standard mental health Tx ()
Lower reincarc. rates: 9 versus 33%**; no ≠ regarding other criminal outcomes
MTC aftercare participants had superior outcomes regarding rates of reincarc.*, crim. activity* and drug-related crim activity* compared with controls Time in Tx predicted absence of reincarc** and crim activity**
Prospective controlled study design (group assignment by correctional staff) Outcomes 42 and 60 months after baseline
690 male inmates with substance abuse problems, eligible for work release FU: 69.8% after 48 months FU: 63.8% after 60 months
Work-release (transitional) TC () 6 month program Controls: standard work release, without Tx ()
TC participation strongest predictor of drug-free status after 42 (OR 4.49***) and 60 months (OR 3.54***)
TC participation strongest predictor of absence of rearrest after 42 (OR 1.71**) and 60 months (OR 1.61*)
Older age predicted drug-free** and no rearrest status***, while frequency of prior drug use predicted relapse** after 48 months No previous Tx experience predicted relapse after 60 months, while older age* and being female* predicted no rearrest TC completion associated with no rearrest and being drug free after 42 and 60 months, with superior outcomes for persons who attended additional aftercare
Prospective controlled study design (partial randomization, since KEY program autom. followed by CREST) Outcomes 6, 18, and 42 months after baseline (i.e., 1 and 3 years after TC period)
428 inmates with drug abuse problems FU: approx. 80%
Transitional TC (CREST) () 6 month program Controls: prison TC (KEY) () 12 month program Prison TC + transitional TC () Regular work release ()
18 month outcomes
31% drug-free versus 16%* in work-release group (versus 47% in KEY + CREST group)
57% not rearrested versus 46%* in work-release group (versus 77% in KEY + CREST group)
While greater exposure to TC Tx led to better outcomes after 1 year, at 3 years after discharge no ≠ were found between various TC modalities CREST drop-outs as likely to be rearrested as work-release group, but CREST completers** + CREST-completers who followed subsequent aftercare*** were least likely to be arrested CREST drop-outs more likely to be drug free than work-release group*, but CREST completers** + CREST-completers who followed subsequent aftercare*** even more likely to be drug free
42 month outcomes
OR for being drug free 8.2 times higher in CREST-group**, 7.4 times in KEY-group**, and 6.7 times in KEY-CREST group* compared with work release group; 23% drug-free versus 6%* in work-release group
37% not rearrested versus 30% in work-release group after 42 months
Prospective controlled study design (QES) Outcomes after 6 and 18 months
689 inmates with history of substance abuse FU: 77 versus 72.6% after 6 months FU: 58.5 versus 36.7% after 18 months
Transitional TC (CREST) () 6 month program Controls: conventional work release ()
Sign. lower relapse after 6 (16.2 versus 62.2)*** and 18 months (51.7 versus 79%)***
Sign. lower recidivism after 6 (14.7 versus 35.4)*** and 18 months (38.2 versus 63%)***
Age, race, and gender do not affect outcomes, but length of time in program reduced relapse and recidivism rates (ns) Program completion associated with fewer relapse*** after 6 and fewer recidivism after 6*** and 18 months*
Probability of being drug free the highest among CREST (0.84)*** and KEY + CREST group (0.94)***
Prob. of being arrest free the highest among CREST (0.86)*** and KEY + CREST group (0.97)***
Prob. of no longer injecting the highest in CREST (0.97)*** and KEY + CREST group (0.97)
No ≠ between TC only and work release group on any of the outcome measures Longer time in (subsequent) Tx the best predictor of drug-free*** and arrest-free* status after Tx, as well as participation in a longer TC program
(8) Prendergast et al., 2004 (California, USA) [33]
Prospective randomized controlled study design Outcomes 5 years after release
715 male inmates with substance abuse problems FU: 81.2%
Amity prison TC () 9–12 month program Controls: no Tx condition (waitlist) ()
Months receiving Tx post-release: 4.6 versus 1.7***
Heavy drug use past year: 24.9 versus 22.6%
Reincarcerated within 5 years: 75.7 versus 83.4%* Days to reincarc: 809 versus 634***
Stable job in past year: 54.8 versus 52.3%
Psychologic. distress: 31.8 versus 44.6
Reincarc. predicted by younger age* and fewer months in Tx after release*** Completion of TC and aftercare predicted absence of reincarc.***
(8) Prendergast et al., 2003 (California, USA) [34]
Prospective randomized controlled study Outcomes 12 months after release
715 male inmates with substance abuse problems FU: 74%
Amity prison TC () 9–12 month program Controls: no Tx condition (waitlist) ()
Longer time to first drug use: 77 versus 31 days*** No ≠ in pos. drug tests (52.9 versus 61%)
1 year reincarc. rate: 33.9 versus 49.7%*; more days to first illegal act. (138 versus 71 days)***; no ≠ in type of arrest; more days to first incarcer. (285 versus 243 days)***; fewer months in prison (3 versus 4.7)***
Participation in Tx associated with more days to reincarc. Aftercare completers had the lowest reincarc rate + the longest time to first illegal activity and to reincarceration and fewer days in prison Prison TC drop-outs had the shortest time to SR drug use (32 days), followed by TC completers (62 days), aftercare dropouts (91 days), and aftercare completers (184 days) + more pos. drug tests
Prospective randomised controlled study design Outcomes 12 and 24 months after release
715 male inmates who volunteered for TC treatment in prison FU: 100% after 12 months FU: 36.8% after 24 months
Amity prison TC () 8–12 month program Controls: no Tx condition (waitlist) ()
Lower reincarc rates after 12 (33.9 versus 49.7%)*** and 24 months (43.3 versus 67.1%)*** More days to reincarc after 12 (192 versus 172*) months OR for reincarc sign lower: 0.52*** after 12 and 0.63** after 24 months
Reincarc. rates sign lower after 12 and 24 months among TC + aftercare completers, as opposed to persons who dropped out previously Aftercare completion positively related to time to reincarc. + the strongest predictor of positive outcomes
(9) Greenwood et al., 2001 (San Francisco, USA) [25]
Prospective controlled study design (only partial randomisation, since sign. drop-out among control before Tx start) Outcomes 6, 12, and 18 months after admission
261 substance abusers seeking treatment at Walden House FU: 82.4% at 6 months FU: 82.7% at 12 months FU: 82.7% at 18 months
Residential TC () 12 month program Controls: day TC program (same TC, but returned home at the end of the day) ()
Time in program: 109.8 versus 102.7 days
Total abstinence after 6 (62.6 versus 47%), 12 (47.9 versus 49%) and 18 months (50.4 versus 55.2%) OR for relapse at 6 months = 3.06*, not sign. at 12 and 18 months
Relapse after 18 months predicted by employment status prior to Tx start***, injecting drug use** and having >1 sexual partner**
Prospective controlled study design (only partial randomisation, since sign. drop-out among controls before Tx start) Outcomes at 6, 12, and 18 months
188 substance abusers seeking treatment at Walden House who participated in all 3 FU-interviews
Residential TC () 12 month program Controls: day TC program (same TC, but returned home at the end the day) ()
No ≠ in time to drop-out (119.7 versus 108.1 days) 12 month retention in day TC: 17% versus 9%
Lower SCL scores at 6**, 12*, and 18* months, lower BDI scores after 12 months*, higher social support scores at 18 months*; lower social problem severity (ASI)*
Most changes observed during first months of Tx, followed by maintenance of change
Prospective controlled study design (only partial randomisation) Outcomes at 6 months
261 substance abusers starting treatment at Walden House FU: 82.4% at 6 months
Residential TC () 12 month program Controls: day TC 12 month program ()
Tx adherence after 6 months: 29 versus 34% in day TC; Time in Tx: 109.8 versus 102.7 days
Lower ASI severity scores for social* and psychological problems**
Persons who stayed >6 months in Tx had sign lower legal, alcohol, drug, and social severity scores Alcohol severity reduced sign. if persons stayed >6 months in residential TC
Prospective, randomised controlled study design Outcomes 18 months after admission
412 substance users seeking Tx at a central intake unit FU: 93%
Standard TC () 12 month program (10 months inpatient, 2 outpatient) Controls: abbreviated TC (): 12 month program (6 month inpatient, 6 month outpatient + extra services)
Completion rates: 33 versus 38% (ns), and similar time in Tx (8.2 versus 8.6 months)
Lower SR heroin use: 9 versus 15%*
Lower rearrest rates: 17 versus 26%** + longer time to arrest (9.4 versus 6.9 months)*
Employment rate higher in standard TC: 72 versus 56%**
Lower heroin and cocaine use levels + lower rearrest rates among treatment completers versus noncompleters Positive cocaine tests were associated with premature Tx drop-out Treatment completion was predicted by age, single heroin dependence, and parole status
Prospective controlled study design (no real randomisation, since ≠ interventions at both study sites) Outcomes 3 months after discharge and 18 months after admission
539 drug abusers entering residential Tx at 2 sites FU: 86% after 18 months
Traditional TC program (6 () and 12 month alternative ()) Controls: MTC program (relapse prevention) 3 () and 6 month () alternatives
Tx completion: 23% in long TC, 34% in shorter TC, 31% in long MTC and 56% in short MTC
Time to drug use not ≠ between TCs and than MTC Stronger effect of long TC versus short TC and MTCs regard. drug and alcohol severity (ns)
Stronger effect of long TC versus short TC and MTCs regarding legal problems
Effect of TC on employm. stronger than in MTC*
Small effects of long TC versus short TC and MTCs regard. other ASI domains
(13) McCusker et al., 1996 (Massachusetts, USA) [52]
Prospective randomized controlled study design Outcomes 6 months after Tx
444 drug abusers entering one residential Tx facility FU: 74%
Long MTC () 6 month program Controls: short MTC () 3 month program
Program completion: 30 versus 56% in short TC program
Relapse to drug use in first week after leaving Tx: 33 versus 70%* No group ≠ in heroin or cocaine use
Greater improvement in levels of depression among persons staying >80 days in TC*** Length of stay in TC** + program completion* pos. associated with levels of precontemplation Persons staying >80 days in TC had lower drug use***
(13) McCusker et al., 1995 (New England, USA) [53]
Prospective controlled study design Outcomes 3–6 months after discharge
628 drug abusers entering residential Tx at 2 sites FU: 84% in TC versus 74% in MTC
Traditional TC program (6 () and 12 month () alternative) Controls: MTC 3 () and 6 month program ()
40 day retention: respectively, 70, 85, 73, and 72%; Tx completion: respectively, 33, 21, 56, 30% (ns ≠ in 4 groups)
Relapse: 50% in TC versus 44% in MTC No ≠ in number of days of drug use
Prospective controlled study design (only partial randomization due to substantial drop-out after group allocation) Outcomes after 2 years
363 male veterans addicted to heroin entering withdrawal Tx FU: 95.6%
3 TCs (): standard TC () + two MTCs ( and ) 6 month programs Controls: 5-day withdrawal Tx ()
Mean TIP longer in TC 1 (10.4 weeks) and TC3 (11.5 weeks)* than in TC2 (6.0 weeks)
No heroin use: 40, 48.1, and 35.4% versus 33.3% of controls; No other illegal drug use: 40, 41.6, and 53.3%* versus 39.3% of controls More alcohol problems: 40, 47.3** and 30.8% versus 22.4% of controls
No conviction: 44*, 32.5 and 59.5%** versus 31.3% of controls
Employed/attending school: 48*, 46.8 and 51.9%** versus 34% of controls
Mortality: 1.7% in TCs versus 6.6% among controls
The 3 TCs differed largely on program characteristics Heroin use + other major outcomes sign. better among subjects staying longer in Tx
Prospective controlled study design (as treated analyses) Outcomes after 1 year
585 male veterans addicted to heroin entering withdrawal Tx FU: 93.2%
Veterans staying long (≥50 days) () or short in TC program (<50 days) () Controls: MMT (); detox only (); detox + other Tx ()
1-year retention rate: <5% in TC versus 74.5% in MMT
Recent heroin use + any illicit drug use lower in long TC subjects (37.3 and 29.3) than detox only-group (65.5 and 46.9)**, but not than MMT group (46.6 and 38.6%)
Arrest (37.3%), conviction (21.3%) and reincarc (4%) rate sign lower than in detox only-group (54.5**, 38** and 21.1%***, resp.), but not than MMT group (49.2, 22, and 10.2%)
Employm./school attendance: 65.3% of long TC group, 50.9% of MMT and 38.4%*** of detox only-group
Sign. more subjects had good global outcome score in long TC (64%) and MMT (54.45%) versus detox only-group (33.8%)
TC with confrontational style least successful Short TC group did not score sign better than detox only-group Twice the number of long TC subjects (29.3%) had the max. global outcome score than MMT clients (14%)
Prospective controlled study design (group allocation by self-selection) Outcomes 11–18 months after leaving TC
207 heroin addicts starting treatment in one of 2 TCs FU: 78.5%
Long-term TC () 12 month program Controls: short-term TC () 3 month program
Program completion: 63.6 versus 74.6%
Total abstinence: 4.3 versus 0%; Return to heroin use: 28.6 versus 53%
Program graduates used less often illicit drugs and were less likely to have relapsed or to be rearrested compared with splittees. Also higher employment rates among graduates
