Most programs for drug-involved adult offenders employ fewer than 60% of the specified EBPs. Respondents differed as to which settings had more EBPs in place. Correctional administrators reported that adult prisons have instituted EBPs to a greater extent than either jails or community corrections, while treatment agency directors indicated that community-based substance abuse treatment programs use more EBPs than do prison-based programs. Although we cannot be certain which respondent group’s assessment is correct, the sampling design was predicated on the likelihood that correctional administrators would have limited knowledge or understanding of the actual components of the addiction treatment programs operating in their settings. The data appear to support this supposition. For example, correctional administrators’ reports of “comprehensive treatment” in 84% of prisons compared with treatment directors’ report of 34% suggests that correctional administrators are overstating the extent of available programming (Friedmann, Lemon, Durkin, & D’Aunno, 2003
). Social desirability and availability biases, the latter stemming from the notoriety of the Department of Justice’s Residential Substance Abuse Treatment (RSAT) for State Prisoners Program (42 U.S.C. § 3796) and the prevalence of alcohol and drug education sessions are likely sources of correctional officials’ overestimates of EBPs in prisons.
The descriptive findings suggest a number of ideas that warrant exploration in future work. One can speculate that the minimal use of standardized substance abuse and risk assessments suggest that selection of appropriate groups for treatment and comprehensive services is inconsistent and suboptimally targeted (Taxman, et al, under review). In combination with the high prevalence of incentives in prison-based programs, this finding might imply that the widespread use of “good time credit” for treatment enrollment might not be appropriately targeted to clients who would benefit most. Engagement techniques appear to be widely used in community settings, but greater efforts could be made in prison settings to motivate appropriate clients for treatment. Finally, limited systems integration and inaccessibility of continuing care might possibly diminish the overall impact of the RSAT program’s widespread dissemination of effective treatment orientations in prisons (e.g. therapeutic community and cognitive-behavioral approaches).
As hypothesized, adoption of EBPs in correctional settings appears to reflect organizational leadership and culture. Administrators with a background in human services, knowledge about EBPs and a favorable attitude toward rehabilitation have the opportunity and power to set informed priorities and policies to improve services for drug-involved offenders. Relatedly, an organizational culture that fosters performance achievement and backs it up with training and internal support for its employees will likely value and seek to implement higher quality programming, including EBPs.
According to their treatment directors, community-based programs reportedly have greater implementation than prison or jails of EBPs that enhance treatment process, such as engagement techniques to facilitate treatment participation, programs or services that address co-occurring disorders and involve families to meet those important needs, hiring qualified staff to ensure quality counseling, and assessing outcomes to get feedback. Organizational size, program accreditation, the administrator’s experience and belief in the importance of community treatment, and network connectedness with non-correctional community agencies appear associated with the use of these EBPs. Organizational size likely indicates the availability of “slack resources” that facilitate innovative programming (Damanpour, 1991
). Accreditation is a marker for a quality orientation and external requirements that impact comprehensive service delivery and professional staffing (Friedmann et al., 1999b
, Knudsen et al., 2006
). Like the correctional sample, experienced community treatment directors who believe strongly in the value of community substance abuse treatment appear to be more likely to have the vision and staff buy-in necessary to lead innovation and quality improvement efforts.
Network connectedness facilitates diffusion of innovations through processes of coercive, normative and mimetic isomorphism (DiMaggio & Powell, 1991
). For example, local connections with managed care organizations that require particular EBPs might influence local agencies to develop those programs and services (Roman et al., 2002
). Connections with organizations that share similar values and goals, such as other human service organizations, can lead to conformity in response to professional norms. Finally, when organizational technologies are of uncertain efficacy either in truth or perception, as is the case with addiction treatment, organizations commonly mimic the structure and processes of other similar organizations (DiMaggio et al., 1991
). Network connectedness allows information-gathering about the practices of similar institutions (Knudsen & Roman, 2004
), a necessary precursor to their imitation (D’Aunno, Sutton, & Price, 1991
, DiMaggio et al., 1991
). For these reasons, network connectedness with non-criminal justice organizations, which are most similar to the treatment agencies, but not criminal justice organizations, was associated with the extent of EBP use.
Several limitations apply. The response rate of 61% for prison-based treatment programs and 60% for community-based programs leaves open the possibility that respondents represent more motivated, progressive, and interested agencies, which may not generalize to all prison-based treatment programs and community-based programs. Such bias would suggest, for example, that the estimate of programs’ use of EBP is an upper bound. Furthermore, causal direction cannot be inferred from these cross-sectional data, so we cannot discern, for example, whether program accreditation is a cause or result of more implementation of EBPs. In addition, although some work suggests that substance abuse treatment directors can provide valid reports of agency practices (Batten et al., 1993
, D’Aunno et al., 1995
), the validity and reliability of these administrators’ reports is unknown. Medication assisted treatment, another evidence-based practice, was not evaluated because it is so uncommon in criminal justice settings (Rich et al., 2005
). Finally, respondent burden prevented asking detailed questions about the nature, quality, fidelity, and utilization of evidence-based services.
Nonetheless, these findings suggest features of offender treatment organizations more likely to be ready to accept EBPs: large, accredited, network-connected, community programs with a performance-oriented, non-punitive culture, training resources, and an administrator who has a background in human services, high regard for the importance of substance abuse treatment and an understanding of EBPs. This characterization also suggests possible strategies for improving the dissemination of EBPs for drug-involved offenders. For example, state correctional agencies might contract preferentially with agencies that meet standards of accreditation, performance orientation, training resources, leadership characteristics, and community presence. Alternatively, in order to facilitate the successful re-entry of drug-involved adult offenders into the community, federal, state or local initiatives might focus on improving the integration of jail, prison and community systems, and the accessibility of continuing care. This study implies that improving network connectedness with non-criminal justice agencies might be one step toward accomplishing those goals. That said, further research is needed to determine whether interventions to manipulate particular aspects of organizational structure and leadership, culture and climate, administrator attitudes and network connectedness can facilitate the adoption of evidence-based practices among correctional institutions and their affiliated addiction treatment programs. Effectiveness research should also evaluate whether adoption of these evidence-based practices leads to lower rates of recidivism and relapse.