The Journal of Drug Issues 24(2), 349-360 1994

PROGRESS IN PRISON SUBSTANCE ABUSE TREATMENT: A FIVE YEAR REPORT Harry K. Wexler Within the recent years there has been a paradigmatic shift in the direction of correctional policy - a movement away from an exclusive concern with security and control toward a more comprehensive approach that includes rehabilitation and treatment. Looking for ways to reduce recidivism and to control overcrowding (and recognizing the close connection between substance abuse and crime), correctional authorities have begun expanding prison-based drug treatment programs. This movement toward a corrections-treatment perspective has been based upon a growing body of research that has indicated that intensive prisonbased drug treatment programs are an effective means of controlling recidivism. Progress in prison substance abuse treatment that has transpired over the last five years is described, along with a brief description of correctional substance abuse treatment approaches. Recommendationsfor the future of correctional drug treatment and some critical cautions are presented as well. Within the past 5 years there has been a paradigmatic shift in the direction of corrections in the United States - a movement away from the model emphasizing security and control and toward a model emphasizing rehabilitation and treatment (Wexler and Lipton 1993). Looking for ways to reduce recidivism and to control overcrowding (and recognizing the close connection between substance abuse and crime), correctional authorities have begun expanding prison-based drug treatment programs during the last few years. The movement toward a correctionstreatment perspective has been based upon a growing body of research that has supported intensive prison-based drug treatment programs as well suited for incarcerated drug abusers and as an effective means of controlling recidivism. This article will describe the progress in prison substance abuse treatment that has transpired over the last five years. Both the historical context for the shift toward correctional rehabilitation and the recent developments in correctional drug treatment will be discussed. An overview of correctional substance abuse treatment approaches is also provided, followed by an important set of recommendations for the future of correctional drug treatment. A comprehensive review of correctional drug treatment research literature has been provided by Falkin, Wexler, and Lipton (1992) and will not be addressed in this paper.

Harry K. Wexler. Ph.D .• has achieved a national reputation in the areas of substance abuse and criminal justice policy. treatment. and research. He has conducted many landmark evaluation studies and has become a vocal supporter of prison drug treatment. Dr. Wexler currently serves as principal investigator on several major federally funded projects. Address correspondence to Harry K. Wexler. 380 Glenneyre, Suite D. Laguna Beach. Ca.• 9265\.

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Recent Developments The idea of rehabilitating prisoners has traditionally been considered largely futile. This strong belief that corrections could not rehabilitate the offender was fueled by research studies that essentially concluded that "nothing works" to reduce recidivism (Lipton, Martinson, and Wilks 1975). Prison treatment was seen as an ill-fated liberal attempt to help irredeemable offenders. In the 1970s, rehabilitation was replaced by a retributive philosophy of "Just Deserts," in which deterrence and punishment are seen as the primary goal of corrections. With this change in sentencing philosophy, prison populations have climbed dramatically without a commensurate decline in crime. One source of the increasing numbers of individuals requiring incarceration was the rise in serious drug involvement among offenders. The public outcry against sharply rising crime rates during the early 1970s led politicians to call for more certain and severe sentences through the enactment of determinant sentencing and persistent felony offender laws. Also, the public concern in 1986 regarding the spread of "crack" created a demand for action. Legislators responded by mandating tougher sentences against drug dealers and users. As a result of these new sentencing laws, the nation's prisons became full of serious drug-abusing offenders, many of whom are recidivists (Falkin, et al. 1992). It has become evident that, for criminals, incarceration is neither adequate as a deterrent nor as a means of controlling recidivism. The majority of inmates. especially the most serious among them, have severe lifestyle problems manifested most significantly by chronic substance abuse. Without appropriate treatment while in prison, a high percentage will relapse to drug use and criminal behavior after release. During the 1980s, a growing body of research findings demonstrated recidivism reductions for inmates who participated in prison therapeutic communities. This research generated considerable interest at the federal level and contributed to the support for prison drug treatment (Falkin, et al. 1992). The above factors set the stage in the mid 1980s for several federal laws that appropriated millions of dollars for drug enforcement, prevention, education, and treatment. In particular, interest in correctional rehabilitation for drug-abusing offenders was reflected in the "Anti-Drug Abuse Act of 1986" that included substantial funding for substance abuse treatment of which a large proportion was directed at correctional drug treatment. During this same time period, a team of researchers at the National Development and Research Institutes, Inc. (NDRI) reexamined correctional rehabilitation and drug abuse treatment in prisons across the country. A set of guiding principles emerged for effective rehabilitation with drug-abusing offenders and with offenders generally (Wexler, Lipton, and Johnson 1988; Falkin, et al. 1992). Based on the available scientific evidence, it appears that drug treatment in correctional settings can curb recidivism provided the programs have the following central features:

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Treatment services should be based on a clear and consistent treatment philosophy.

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An atmosphere of empathy and safety.

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Clear and unambiguous rules of conduct.

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Use of ex-offenders and ex-addicts as role models, staff, and volunteers.

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Use of peer role models and peer pressure.

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Provision of relapse prevention programs.

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Establishment of continuity of care throughout custody and community aftercare.

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Integration of treatment evaluations into the design of the program.

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Maintaining treatment program integrity, autonomy, flexibility, and openness (Wexler n.d.),

With the proper program elements in place, treatment programs can achieve a significantly greater reduction in recidivism than by continuing a policy of imprisonment without adequate treatment. These findings and principles were shared with the staff of the Bureau of Justice Administration (BJA) who were charged with guiding the administration and funding of the "Anti-Drug Abuse Act" and whose purpose included the implementation and expansion of correctional drug treatment. BJA's strategy. included funding an array of technical assistance projects to guide the implementation of this part of the law. One of these projects was Project REFORM ("Comprehensive State Department of Corrections Treatment Strategy for Drug Abuse" project). During the five years of its operations (1987-1991), eleven participating state departments of correction developed state plans and implemented many substance abuse initiatives (Wexler, Blackmore, and Lipton 1991). When the BJA funding of REFORM was completed, the Center for Substance Abuse Treatment (CSAT) established Project RECOVERY (Technical Assistance and Training Services to Demonstration Prison Drug Treatment Programs) to continue these technical assistance activities for eighteen months (1991-1992) in a total of fourteen states. Participants in Projects REFORM and RECOVERY believe that a primary goal for corrections is the reduction of recidivism; that is, to intervene in the lives of offenders so that they do not return to prior patterns of criminal behavior (Wexler and Lipton 1993). A large number of drug treatment programs were implemented by the states that participated in these two projects. Many of these treatment programs are being evaluated and effectiveness data will be available in the near future (Wexler 1992). The Center for Substance Abuse Treatment has since replaced the Bureau of Justice Administration as the primary federal agency that funds correctional substance abuse treatment. CSAT took an important step when it began requiring states to have comprehensive correctional state treatment plans to be eligible for CSAT grants. 'The comprehensive planning process (which was begun with the states who participated in Project REFORM) helps states incorporate substance abuse treatment into long-term planning efforts so that programs have a greater chance of continuing after CSAT funds are exhausted. Projects in Alabama and Spring 1994

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WEXLER New York are excellent examples of current CSAT funded demonstration projects. CSAT funding has enabled the Alabama Department of Corrections to develop the Ventress Treatment Prison, an 8oo-bed correctional facility dedicated entirely to drug treatment. This program has been recognized as a national model. Also, CSAT funds a therapeutic community for women at the New York Department of Correction's Taconic Facility serving 300 substance abusing females, including those with infants. A long term CSAT goal is to develop documented models of service delivery and case management that can be replicated in other correctional systems. All projects incorporate the CSAT comprehensive care model by including transition planning and continuing care in the community. CSAT strongly emphasizes the need for model programs to include treatment for related health problems such as HIV/AIDS and sexually transmitted diseases, as well as for screening for mental health disorders. For the 1993-1994 fiscal year, CSAT has allotted $12.5 million for the establishment of seventeen to twenty-five new model comprehensive substance abuse treatment programs for correctional populations (CSAT 1993). Parallel changes in substance abuse initiatives have also been occurring at the federal level in the Bureau of Prisons (BOP). In the late 1970s, BOP called for the establishment of unit-based drug treatment programs in all federal prisons. Due to lack of resources, these programs have been of low-intensity with an emphasis on drug education, twelve-step programs, and group therapy. Many observers believe that the BOP provided limited support and that it was highly skeptical of the efficacy of prison-based drug and alcohol treatment. This was understandable, because there was almost no research during these years that suggested correctional substance abuse treatment was effective. In 1988, BOP held an important conference with leaders in the substance abuse field who were asked to review current research and discuss effective approaches to correctional substance abuse treatment. The work of Project REFORM in state correctional drug and alcohol treatment was reviewed at this meeting (Wexler 1988) and was instrumental in the formulation of a new comprehensive federal approach. The BOP approach relies heavily on therapeutic community procedures and includes one level of drug education, three levels of treatment (outpatient counseling, comprehensive residential programs, and residential pilot programs), and one level of transitional services (community reentry and continuing care in the community) (Murray 1992). A preliminary 1991 evaluation of BOP's progress found that intensive residential programs specifically designed for these inmates are substantially under-enrolled, typically running at less than half capacity. The programs rely on voluntary participation and there is little incentive to join (Human Resource Division 1991). (State programs often offer in exchange for participation an improved chance of parole, but parole was abolished in the federal system by the Sentencing Reform Act of 1984). Also, because BOP does not utilize recovering counselors who can serve as credible rehabilitated role models, it is difficult to convince prospective participants that treatment can work. This reduces the effectiveness of BOP recruitment efforts and may weaken long-term outcomes. The important shift in correctional policy emphasis from deterrence to rehabilitation is dramatically demonstrated in Texas. As a direct outgrowth of the REFORM and RECOVERY initiatives and of the growing body of evidence supporting the effectiveness of prison therapeutic community drug treatment, Texas Governor Anne Richards has made correctional drug treatment a major goal

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PROGRESS IN PRISON SUBSTANCE ABUSE TREATMENT of her administration. In 1991, landmark legislation passed in Texas which called for the development of a comprehensive treatment system for chemically dependent offenders. Under this plan, three criminal justice substance abuse treatment programs are to be established by 1995. The Treatment Alternatives to Incarceration Program (TAlP) provides screening and assessment for chemical dependency and refers offenders to appropriate community-based treatment. The In-Prison Therapeutic Community Treatment (IPTC) Program dedicates 2,000 prison beds to long-term intensive substance abuse treatment prior to the inmate's release and, in conjunction with community services, provides continuing care in the community upon re-entry. The Substance Abuse Felony Punishment (SAFP) Program offers 12,000 secure treatment beds for an indeterminate sentence of six to twelve months to offenders who are convicted of non-violent felonies and who have crime-related substance abuse problems. Together these programs are intended to service all levels of substance abusing adult offenders, from the nonviolent to those with long histories of crime and drug use. This effort represents the largest correctional substance abuse treatment program in the world, and elevates Texas to a national model in prison-based treatment. Reflecting the shift in federal policy from security and control toward rehabilitation, two important guidebooks for prison drug treatment have been produced by federal agencies. The U.S. Department of Justice has published Intervening with Substance-Abusing Offenders: A Framework for Action (National Institute of Corrections 1991), which provides a detailed context for understanding correctional drug treatment issues. The Center for Substance Abuse Treatment is publishing Establishing Substance Abuse Treatment Programs in Prisons: A Practitioner's Handbook (Wexler n.d.), which describes prison drug treatment planning and implementation. Correctional Substance Abuse Treatment Approaches Two major approaches to correctional substance abuse treatment are the selfhelp movement and the cognitive behavioral model. (Discussion of treatment approaches is adopted from Wexler n.d.), While the self-help movement has been led primarily by recovering persons, academically trained professionals have advanced the cognitive behavioral model. Still, each are consistent in their underlying principles. A third approach based on theories of personality are less frequently applied in the prison setting and will not be reviewed here.

Self-Help Approaches Historically, most self-help programs were started by members of society who believed conventional help was inadequate or unavailable. These individuals shared common problems and a personal commitment to do something about their condition. Self-help programs are not considered "services" that require client dependence on providers. Instead, they are programs based on a philosophy of self-responsibility. By taking responsibility for one's own problems, individuals can gain control over their situation and develop a new sense of self-respect and competence. Support and guidance is provided by credible role models who have experienced the changes they profess. In addition, extensive personal support is provided by peer group networks. The two most prominent approaches based on self-help principles that influence treatment efforts in corrections are Alcoholics Anonymous and Spring 1994

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WEXLER Therapeutic Communities. The Oxford House Network represents a promising self-help effort to provide drug-free living environments for recovering offenders upon release into the community.

Alcoholics Anonymous Of all the self-help approaches, Alcoholics Anonymous (AA) is the most widely accepted and is considered by many to be effective. However, no largescale empirical evaluations of this approach have been conducted due to the restrictions of participant anonymity, a core component of AA, which presents a major obstacle to follow-up studies. AA groups are based on the philosophy of the "twelve-steps" which claims that recovery begins with personal recognition of an inherent intolerance to alcohol or other drugs. New members are instructed to accept the basic tenets of AA and to thereby take responsibility for and control of their alcohol problems. The sense of helplessness commonly felt by alcoholics often disappears at this point. AA programs are geared for individuals in all stages of recovery. Active program participation, peer and sponsor support, and adherence to the tenets of AA helps many addicts overcome their compulsive behavior. The AA model has been adopted by over two dozen twelve-step groups which use similar methods. Among the groups that focus on criminals and drug abusers are: Narcotics Anonymous, Cocaine Anonymous, Pills Anonymous, Marijuana Anonymous, Parents of Youth in Trouble Anonymous, and Sexual Child Abusers Anonymous. Prison-based twelve-step groups meet on a non-residential basis or as part of a residential program, such as a therapeutic community. Some prison-based programs are staffed by volunteer community groups of recovering drug abusers whose rehabilitated lives are demonstrations of what can be accomplished. Some prison systems have developed strong relationships with twelve-step organizations that provide volunteer speakers from the community on a regular basis. This approach helps the inmate transition to the community by providing community role models ready to provide practical assistance to inmates upon release.

Therapeutic Communities Therapeutic Communities are preferable for more severely addicted offenders. They developed out of the community-based self-help movement as an alternative to traditional AA groups. Therapeutic Communities differ from AA in not being limited primarily to alcoholics. They differ from other treatment programs in not being based on the medical model which sets up a dichotomy between those in need and their helpers. In Therapeutic Community programs, the treatment experience promotes a sense of camaraderie, safety, and communication as keys to transformation from degradation to dignity. Therapeutic Communities are the most complex model to implement and operate in a prison, and they require the highest level of commitment from prison administration and staff. While residents must take responsibility for their own recovery process, treatment staff, including ex-offenders, act as role models and provide support and guidance. Individual counseling, encounter groups, peer pressure, role models, and a system of incentives and sanctions form the core of treatment interventions in a Therapeutic Community. Residents of the community must live together, participate in groups, and study together. In the process, inmates learn to control their behavior, to become more honest with themselves

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PROGRESS IN PRISON SUBSTANCE ABUSE TREATMENT and others, and to develop self-reliance and responsibility. Therapeutic Communities are most often implemented in a residential structure to provide enough safety and sense of belonging to begin the process of change. States of anxiety, secrecy, fear, and alienation - conditions permeating the antisocial inmate subculture of the general prison population - are not conducive to positive change. The safe environment, coupled with gains in interpersonal skills, helps offenders relate to the general prison population with the inner strength needed to combat the negative cues of the prison environment. In fact, separation from the prison subculture during treatment has been found to be most conducive to achieving major changes in attitudes and behavior (Wexler and Williams 1986; Wexler, et aI. 1988). Practitioners note that there can be no "watchers" in a Therapeutic Community, only active participants. Therapeutic Communities demand the participation of the inmates in the emotional, physical, and intellectual work required for the process of change and personal growth. Work in a therapeutic community involves an increasing set of responsibilities designed to build self-confidence and coping skills. As active participants in their own recovery process, inmates learn selfsufficiency and competence. Practitioners often cite a maxim which captures the essence of the Therapeutic Community philosophy: "Give people a fish and they have food for a day. Teach them to fish and they can obtain food for a lifetime." There is evidence that prison-based Therapeutic Community programs may provide their best results for those whose residency extends from nine to twelve months (Wexler, Falkin, and Lipton 1990). Relapse can be relatively high if there is no continuity of care provided after release from custody. Many addiction and criminal justice practitioners believe that the best results are achieved with aftercare interventions that connect the offender with continued programming in the community. However, the impact of community treatment following prison treatment has only recently begun to be systematically studied (Wexler and Graham 1992).

Oxford House Network When recovering offenders are released from prison, they face the daunting tasks of maintaining their sobriety, developing positive and productive lifestyles, and integrating themselves into the community. Most return to old neighborhoods and familiar drug-using social groups. These stressful environments are full of high risk trigger situations that make relapse to drug use highly probable. Oxford Houses, first established in 1975 in Maryland, represent a unique alternative to this sad cycle. Typically located in low crime and drug neighborhoods, these houses afford recovering addicts and alcoholics the opportunity to live in a safe and supportive environment upon release into the community. Oxford Houses are independent, self-governing residences based on the twelvestep philosophy. Although these houses do not provide drug treatment, they do have a self-help recovery atmosphere that reinforces positive behavior changes. Self-esteem is renewed through the exercise of responsibility, helping others, resocialization, and constructive pride in maintaining an independent recovery house without dependency on outside authority. The average length of stay in an Oxford House is thirteen months, but an individual can stay as long as he or she would like as long as they pay rent and obey house rules of sobriety and responsibility (Molloy 1992). In response to lobbying efforts by Molloy and others, the Anti-Drug Abuse Act Spring 1994

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WEXLER of 1988 included a provision requiring each state to provide a $100,000 revolving fund to encourage recovering individuals to establish self-run, self-supported recovery houses that utilize no paid staff, operate democratically, and expel residents who relapse into using alcohol or drugs. Today there are nearly 400 houses for men and women (there are no coed homes) in thirty-five states.

Cognitive Behavioral Approach Behavioral and cognitive behavioral theorists maintain that desired behaviors can be learned by reinforcing them with any reward that increases their frequency, such as money or its substitute (for example, tokens or points), social attention, commendations, or approval. Reinforced behavior tends to be repeated. One of the most widely-adopted cognitive behavioral strategies in the substance abuse treatment field is relapse prevention. Formulated by Marlatt and Gordon (1985), relapse prevention holds that changing an individual's perceptions and underlying beliefs are potential means of altering behavior. Relapse prevention emphasizes the difference between a lapse in sobriety and a full relapse or return to addiction. The strategies are aimed at both preventing the first lapse and at preventing any lapse from growing into full relapse. Although the main application of this work has been in community treatment, many of the concepts can be adopted to correctional treatment. Building on Marlatt and Gordon's work, Rawson and partners (in press) developed seven basic components of the relapse prevention model, which can be delivered in both individual and group sessions: •

To understand issues of drugs and drug use, clients are educated in a classroom setting on the biology of addiction, drug effects, AIDS, etc.

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Clients are taught to identify the behaviors, environments and cognitive and emotional states that can serve as high risk trigger situations for relapse.

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Clients learn new coping skills to replace the ineffective coping strategy of drug abuse.

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Clients learn to develop new lifestyle behaviors.

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Clients develop an increased sense of competence and self-efficacy.

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To confront feelings of shame, clients are taught to view a return to substance use as "slips" or "lapses" that do not necessarily lead to a full relapse.

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To promote client accountability, clients are required to partake in drug and alcohol monitoring through urine tests.

Recommendations for the Future Within the past few years, there has been a growing impetus for action in this field of substance abuse treatment in the correctional system. In July 1992, the 356

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PROGRESS IN PRISON SUBSTANCE ABUSE TREATMENT Center for Substance Abuse Treatment explored "The Promise of Correctional Substance Abuse Treatment: Moving the Agenda Forward" by gathering a panel of national leaders, policy makers, and practitioners who represented the fields of corrections, social service, and substance abuse (see Wexler and Lipton 1993, for a detailed description of the meeting). A list of recommendations for the future was developed and included the following: •

Create a new mission for corrections - where correctional practitioners at all levels, from security officers and program staff to top management - accept the responsibility for and direct their efforts to reducing crime and substance abuse.

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Build accountability into treatment and corrections, so that all agents of treatment and the criminal justice system at all levels and functions are rewarded for achieving success in reducing recidivism, and held accountable for it.

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Make adequate resources available for the comprehensive and effective training of all agents of treatment and habilitation services, to insure that they all understand their roles in promoting recovery, and have the skills and support to insure success.

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Foster an array of rehabilitative programming apart from, but in concert with drug abuse treatment to meet the diverse needs of multi-problem offenders: in literacy, numeracy, vocational preparation, problemsolving skills, life skills, mental health, etc.

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Engender a broad national consensus that treatment works, and is costeffective.

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Orchestrate a diversity of people (judges and prosecutors; wardens, psychologists, and psychiatrists; teachers, counselors and correctional officers) and organizations to work in this common cause.

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Enact comprehensive sentencing reform that is non-racist in intent and effect, and supports recovery and habilitation.

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Acknowledge and support substance abuse treatment as a right for all those who need it, and make adequate resources available to enable this right.

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Empower recovering people to improve their home communities ("giving back") - help the homeless, the aged and the infirm, rebuilding the community. Persons in recovery can assume a central role in reaching out to and treating those not yet in recovery, and, by their actions and example, serve as positive role models - a "Domestic Peace Corps" of recovered persons.

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Acknowledge substance abuse treatment and recovery as an effective

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Educate media representatives and orchestrate media releases so that stories of successful recovery get more press attention and public acknowledgment than stories of crime, violence and failure.

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Develop treatment models and practice that are age, race, class and gender-appropriate.

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Implement an effective, intensive substance abuse therapeutic community in every federal prison and every state prison system.

These considerations and recommendations generated by the panel were similar to those produced by other groups (American Bar Association 1992; American College of Physicians, National Commission on Health Care, and American Correctional Health Services Association 1992; and the National Institute on Drug Abuse, Leukefeld and Tims 1992) which indicate an increasing awareness of a need for change. Caution needs to be exercised when considering recommendations for the expansion of drug treatment so that expectations are not unreasonably elevated. Because addiction is a chronic relapsing problem and substance abusers who are treated in prison often have especially severe criminal and substance abuse histories, elevated expectations can lead to disappointment and potential backlash. Relapse needs to be accepted as a part of the recovery process, and repeated relapses are common along the road to sobriety. For severely impaired individuals, it is important to recognize small prosocial gains and slight decreases in addictive and other antisocial behaviors. Building effective prison treatment programs is a very difficult challenge and successes are achieved in a slow, incremental manner. Failures need to be accepted as part of the building process and as important learning opportunities. Evaluation research, which is a critical element of any comprehensive prison drug treatment initiative, is needed to guide program development and to provide objective information for decision makers. A number of programs that had achieved high visibility and that had been noted for their excellence by practitioners were eliminated during budget cutbacks because of their failure to provide the empirical evidence needed to describe their success in an objective manner. Unless well designed evaluation research that is capable of generating timely results accompanies an expansion of prison drug treatment programs, these efforts will not be able to survive political and administrative pressures. Well designed studies are needed to inform policy makers about programs that work. Considerable progress has been made in correctional drug treatment during the last five years. There is reason to be hopeful that the movement toward rehabilitation and treatment will be continued and that significant gains will be made in the reduction of drug related recidivism. As prison drug treatment gains greater acceptance and programs are expanded, it is very important to support the process of systematically identifying, implementing and empirically testing principles for effective rehabilitation, such as those reported by the researchers at NDRI (see above; Wexler, Lipton, and Johnson 1988; Falkin, et al. 1992).

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PROGRESS IN PRISON SUBSTANCE ABUSE TREATMENT ACKNOWLEDGMENTS Many of the ideas expressed in this paper were developed in association with my colleagues at NDRI, especially Douglas S. Lipton, Bruce D. Johnson, and Gregory P. Falkin. Nick Demos and Steve Shapiro of the Center for Substance Abuse Treatment have provided very helpful guidance and support over the years. Tawni Neikirk deserves appreciation for her dedicated assistance in the preparation of this manuscript. REFERENCES American Bar Association 1992 Responding to the problem of drug abuse: Strategies for the criminal justice system. The Report of an Ad Hoc Committee of the Criminal Justice Section of the American Bar Association. American College of Physicians, National Commission on Health Care, and American Correctional Health Services Association 1992 The crisis in correctional health care: The impact of the national drug control strategy on correctional health services. Annals of Internal Medicine 117(1):71-7. Center for Substance Abuse Treatment 1993 Criminal Justice System Branch Program Summary. Rockville, Md.: Substance Abuse and Mental Health Services Administration. Falkin, G. P., Wexler, H. K., and D. S. Lipton 1992 Drug treatment in state prisons. In Treating Drug Problems, vol. 2, 89132. Washington, D.C.: National Academy Press. Graham, W. F. and H. K. Wexler 1992 Evaluation of a Prison Therapeutic Community for Substance Abusers: Preliminary Findings. The World Conference of Therapeutic Community. Human Resource Division 1991 Despite new strategy, few federal inmates receive treatment. Report to the Committee on Government Operations, House of Representatives. Washington, D.C.: United States General Accounting Office. Leukefeld, C. G. and F. M. Tims 1992 Directions for practice and research. In Drug Abuse Treatment in Prisons and Jails, ed. C. G. Leukefeld and F. M. Tims. (NIDA Research Monograph no. 118). Washington, D.C.: National Institute on Drug Abuse. Lipton, D., R. Martinson, and J. Wilks 1975 The Effectiveness of Correctional Treatment. New York: Praeger Publishers. Marlatt, G. A. and J. R. Gordon 1985 Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors. New York: Guilford Press. Molloy, J. P. 1992 Self-Run, Self-Supported Houses for More Effective Recovery from Alcohol and Drug Addiction (Technical Assistance Publication Series no. 5), Spring 1994

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WEXLER Rockville, Md.: U.S. Department of Health and Human Services. Murray, D. W. 1992 Drug abuse treatment programs in the Federal Bureau of Prisons: Initiatives for the 1990s. In Drug Abuse Treatment in Prisons and Jails, ed. C. G. Leukefeld and F. M. Tims (NIDA Research Monograph no. 118). Washington, D.C.: National Institute on Drug Abuse. National Institute of Corrections 1991 Intervening with substance-abusing offenders: A framework for action.

The Report of the National Task Force on Correctional Substance Abuse Strategies. U.S. Department of Justice. Rawson, R. A., G. L. Obert, M. McCami~ and P. Marinelli-Casey n.d. Relapse prevention models for substance abuse treatment. Journal of Psychotherapy. Wexler, H. K. 1988 What works in prison drug treatment: Research and practice. Federal Bureau of Prisons Conference: Developing Drug Treatment Strategies for Federal Offenders, Washington, D.C. September. Wexler, H. K. ' The 1992 Overview of correctional drug treatment evaluation research. Psychotherapy Bulletin 27(1):25-7. Wexler, H. K .. n.d. Establishing Substance Abuse Treatment Programs in Prisons: A Practitioner's Handbook. Center for Substance Abuse Treatment. Wexler, H. K., J. Blackmore, and D. S. Lipton" 1991 Project REFORM: Developing a drug abuse treatment strategy for corrections. Journal of Drug Issues 21(2):473-95. Wexler, H. K., G. P. Falkin, and D. S. Lipton 1990 Outcome evaluation of a prison therapeutic community for substance abuse treatment. Criminal Justice and Behavior 17(1):53-70. Wexler, H. K. and D. S. Lipton 1993 From REFORM to RECOVERY: Advances in prison drug treatment. In Drug Treatment and Criminal Justice, ed. J. Inciardi. Sage Publications. Wexler, H. K., D. S. Lipton, and B. D. Johnson 1988 A Criminal Justice System Strategy for Treating Drug Offenders in Custody. National Institute' of Justice, Issues and Practices. Wexler, H. K. and R. Williams 1986 The Stay'n Out therapeutic community: Prison treatment for substance abusers. Journal of Psychoactive Drugs 18(3):221-30.

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