Behavioral management to reduce substance abuse, crime and re-arrest for drug-involved parolees

A study from Rhode Island Hospital has found that collaborative behavioral management may be effective in reducing substance abuse among convicted marijuana users who are paroled. The findings have important implications for the management of a substantial proportion of the U.S. community correctional population. The study is published in Addiction and is available online in advance of print.

In the U.S., over 700,000 inmates leave prisons each year and over two-thirds of those inmates have a drug problem. The return of these inmates to the community is a critical issue for public health and safety. Relapse following release contributes to the re-arrest of more than two-thirds of parolees and re-incarceration of over half of inmates in the three years after release. While treatment can reduce relapse, drug-involved ex-inmates give limited priority to addiction treatment. Surveillance with the threat of sanction by parole officers is the traditional method of following parolees, yet many ex-offenders fall into the same pattern and are arrested again.

Knowing that contingency management can be an effective treatment for drug abuse and addiction, researchers at Rhode Island Hospital and nationwide, led by Peter D. Friedmann, M.D., performed a clinical trial called "Step 'n Out" to determine whether collaborative behavioral management would be effective in reducing substance abuse, crime and re-arrest among drug-involved parolees. This study was funded by the National Institute on Drug Abuse of the National Institutes of Health.

Friedmann, a physician and an addiction health services researcher at Rhode Island Hospital, explains, "Because of the so-called War on Drugs, an unprecedented number of people have been put in prison for drug use and the great majority of them return to the community. Community reentry is a difficult period – having a criminal record makes it hard to get a job and you usually return to the same environment you came from with the same people and temptations. Thus, a large proportion of drug-involved ex-offenders return to drugs and crime."

Addiction treatment during the transition period can reduce relapse, but competing priorities such as the need for housing and finding work often limit ex-offenders willingness to participate in treatment. Parole and probation are supposed to encourage treatment and prevent a return drugs and crime, but they are poorly designed to do so. Probation and parole are based on supervision and punishment for bad behavior. For example, if a parolee tests positive for drugs, he/she might be returned to jail.

Behavioral theory holds that effective reinforcers or punishments must be both immediate (close in time to the behavior) and reliable (happen every time the behavior happens). "Any parent knows that punishment alone is not the optimal way to motivate behavior – it is best to have both carrots and sticks," Friedmann says. "The problem is that punishment is neither immediate nor reliable - in part because of due process, but also because surveillance is imperfect and offenders have a disincentive to get caught. Conversely, drug use produces both immediate and reliable reinforcement, where a user gets a good feeling with every use."