Substance Abuse Treatment Study

Treatment Behind Bars: Substance Abuse Treatment in New York State Prisons, 2007-2010

PRINCIPAL FINDINGS

Overly broad and unclear screening process - The State uses broad and unclear standards for what constitutes a substance abuse treatment need.  Also, the screening instruments used by the Department are set at a low threshold, identifying many individuals for substance abuse treatment who have minimal need for such services.  As a result of such screening policies, the Department has determined that 83% of the prison population, regardless of severity of substance abuse problems, needs the State's intensive, residential substance abuse treatment programs.

One-size-fits-all treatment programs - The majority of New York's prison-based substance abuse treatment programs are six-month residential Alcohol and Substance Abuse Treatment (ASAT) programs.  The severity of inmates' substance abuse problems varies greatly, and less intensive, outpatient treatment would more effectively serve many inmates.

Variability among treatment programs - The 23 treatment programs visited by the CA demonstrate little consistency with regard to treatment modality, curriculum, treatment delivery and program removal policies.  The range of variability extends from impressive programs with treatment staff creating a genuine therapeutic environment to more punitive programs providing little support or up-to-date information to treatment participants.

Treatment staff with varying skills, experience and commitment - While some treatment staff have extensive substance abuse training and backgrounds, others possess considerably less relevant experience.  Overall, a minority of treatment staff have higher-level degrees or are credentialed alcoholism and substance abuse counselors (CASAC).   We observed treatment staff who were enthusiastic and engaged with program participants, and others who were indifferent and who spoke and treated participants in a disrespectful and, at times, threatening manner.

Limited clinical supervision and oversight - A notable absence of qualified staff were available to perform clinical supervision of treatment personnel.  No clear process is in place to monitor staff performance or treatment records, and the yearly visit from DOCS Central Office representatives provides minimal oversight.

Insufficient discharge planning and reentry services - Treatment participants reported receiving little to no assistance from treatment staff regarding their aftercare plans.  The majority of participants with whom we spoke had no appointments with community-based treatment agencies when released and were discharged without paperwork that could demonstrate to community treatment staff their participation in prison-based treatment.

Role for Office of Alcoholism and Substance Abuse Treatment Services (OASAS) - The 2009 Rockefeller Drug Law reforms resulted in an increased role for OASAS, the agency responsible for overseeing the State’s addiction, prevention and treatment system, in monitoring and providing guidelines for New York's prison-based substance abuse treatment programs. 

The opportunity that OASAS' new role provides to positively impact and improve treatment services for this generally overlooked population is considerable, and we are encouraged that DOCS, in collaboration with OASAS, appears to be actively addressing many of the findings identified in the report.  It is clear that the Department is committed to improving substance abuse treatment in its prisons and the CA hopes to work closely with both DOCS and OASAS as this process continues.

RECOMMENDATIONS

The CA’s report presents several key recommendations for State policymakers to consider, including:

  • Implement a comprehensive system of screening and assessment to identify the severity of each inmate’s substance abuse and corresponding treatment needs.
  • Develop a continuum of treatment options, from education to intensive residential treatment, and place each inmate in the program that best addresses his/her needs.
  • Develop a more comprehensive curriculum for each program and implement an effective system of monitoring programs and staff.
  • Improve the quality and skill levels of treatment staff.
  • Enhance and coordinate discharge planning to connect inmates with appropriate community-based treatment and other support services upon release.

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