Correctional Boot Camps: A Tough Intermediate Sanction - Chapter 13. Substance Abuse Programming in Adult Correctional Boot Camps: A National Overview MENU TITLE: Substance Abuse Programs in Boot Camps Series: NIJ Reports Published: February 1996 27 pages 60,450 bytes Substance Abuse Programming in Adult Correctional Boot Camps: A National Overview by Ernest L. Cowles, Ph.D., and Thomas C. Castellano, Ph.D. Ernest L. Cowles is the Director of the Center for Legal Studies and an Associate Professor of Criminal Justice at the University of Illinois at Springfield. His present research interests focus on alternative sanctions, special offender populations, and strategies for improving correctional management. Thomas C. Castellano is an Associate Professor of Administration of Justice in the Center for the Study of Crime, Delinquency, and Corrections at Southern Illinois University at Carbondale. He is currently a Visiting Fellow at the National Institute of Justice, where he is dedicated to the identification and evaluation of innovative boot camp programs. A survey of adult boot camps, preceded by a literature review, indicates a strong trend toward making drug education and treatment a part of shock incarceration programming. Questionnaires were sent in the fall of 1992 to the directors or commissioners of departments of corrections in all 50 States plus the Virgin Islands, the District of Columbia, and the Federal Bureau of Prisons, followed up with telephone interviews with 31 administrators. A second survey targeted facility-level administrators and staff members responsible for the facilities' substance abuse treatment or education programs. All the boot camps surveyed said they offered at least substance abuse education, and more than 75 percent offered treatment as well. Various treatment methods were found to be in use, but they were rarely individualized to meet specific inmate needs. Methods of assessing inmates' need for treatment primarily consisted of screening interviews, case history information, and psychological testing rather than diagnostic processes that would allow a clinically based decision of need, treatment amenability, or potential effectiveness. New York, Georgia, and Oklahoma emphasized drug treatment but did not participate in the survey. Many supporters of correctional boot camp programs and the officials who administer them contend that such programs have the potential to be a powerful mechanism for positive offender change. The strict regimen of the boot camp environment, coupled with a variety of treatment-oriented program components, can provide not only a greater level of internal discipline, self-esteem, and confidence to participants but also an array of skills that may promote successful reintegration into the community. These notions are quite consistent with the fact that correctional administrators commonly report rehabilitation of criminal offenders, not deterrence or retribution, as a primary goal of boot camps (MacKenzie, 1990; Elis, MacKenzie, and Souryal, 1992; MacKenzie, 1993; U.S. General Accounting Office, 1993). A rehabilitative program component often associated with the boot camp movement is substance abuse programming. Because many boot camps exclude violent offenders and some actively target drug offenders, institutions have reported that substance abusers constitute a greater proportion of the boot camp population than of the general inmate population (Florida Department of Corrections, 1990; New York State Department of Correctional Services and Division of Parole, 1991). Arguably some boot camps have been designed with the intention of making positive impacts on drug-abusing offenders, and even those not designed this way often include substance abuse programming as an integral part of their programs. Many available studies have reported information on the degree to which shock incarceration facilities target drug offenders or incorporate at least some form of substance abuse programming into the boot camp regimen. These studies tend to indicate that the targeting of drug offenders and the presence of substance abuse programming are common characteristics of boot camps. Unfortunately, little detailed descriptive or relevant evaluative information is presented within these studies. For instance, it is generally impossible to ascertain from the literature whether current drug treatment programming is clinically relevant and theoretically informed. This is a central question, since it is becoming increasingly apparent that correctional treatment programs are more likely to have desired outcomes if specific interventions are based on valid approaches appropriate to the target population (Andrews et al., 1990). To fill this gap, the National Institute of Justice (NIJ) awarded a research grant in the fall of 1991 to the Center for the Study of Crime, Delinquency, and Corrections at Southern Illinois University at Carbondale to assess the quality of drug treatment and aftercare programs for offenders in adult boot camp prisons. This chapter reports some of the major findings from that study, preceded by a review of the literature. Literature Review Warnock and Hunzeker (1991) conducted a literature and statutory review of correctional boot camps at a time when 23 States operated them. They reported that New Mexico and Wisconsin specifically targeted certain drug offenders for participation in their boot camps and that in Tennessee certain drug offenders were statutorily excluded from participation. They also reported that statutes in at least 10 States specified that drug and alcohol education or treatment was to be provided in boot camps. In a related vein, Elis, MacKenzie, and Souryal's telephone survey of State and Federal correctional officials in March 1991 identified two boot camps specifically designed for drug offenders (Elis, MacKenzie, and Souryal, 1992). An article published in Corrections Compendium in January 1991 included survey results from the 27 existing State boot camps. It was reported that 26 of the 27 facilities included or planned to include alcohol and drug treatment programs, 24 offered counseling, and 23 offered educational programming. The only State program that did not offer alcohol or drug treatment was Georgia, while Louisiana and South Carolina provided alcohol or drug education instead (Marlette, 1991). The Evolution of Substance Abuse Programming in Boot Camps The recently released U.S. General Accounting Office's review of correctional boot camps included some information on the value accorded substance abuse programming by boot camp administrators. GAO researchers asked them to rank the various objectives of boot camps on a scale of "very great importance" to "little or no importance." On this scale "drug treatment and education" was rated very highly by the respondents and was almost as highly valued as "meeting the need for alternatives to traditional incarceration" and "improving self-esteem." Of the 53 respondents, 32 rated drug treatment and education as a "very great" objective, 13 as a "great" objective, 7 as a "moderate" objective, and 1 rated it as having only "some" importance. No one accorded it a rating of "little or no importance" (U.S. General Accounting Office, 1993, pp. 19-20). This report suggests that making positive impacts on the behavior of program participants, especially in terms of reducing substance-abusing behavior, is a primary goal of most correctional boot camps. Austin, Jones, and Bolyard's 1993 study of jail boot camps reveals goals similar to those that have been reported with regard to adult boot camps. All the jail programs reported rehabilitation as a goal. Drug education and drug treatment were also listed as important goals by all the responding agencies, and all agencies reported drug education or counseling as a program component. The amount of time residents spent in drug education or counseling ranged from 4 hours a day at Nassau and Ontario, New York, to 4 hours a week at Travis, Texas (Austin et al., 1993). Literature on boot camp programming suggests that the program content of early boot camps was generally consistent across facilities and that changes have been made over time. Early programs tended to feature a strong military design in which offenders participated in physical training, drill and ceremony, and hard labor (Parent, 1989; MacKenzie, 1990; Coyle, 1990). As these programs emerged, basic rehabilitative elements such as substance abuse treatment and education (although commonly present) were overshadowed by a strong emphasis on structure and discipline. Because of the deemphasis on treatment and training, the early programs were criticized by some observers (Sechrest, 1989; Osler, 1991). Correctional system officials responsible for boot camp programming in some States have acknowledged these concerns. For example, Florida officials conceded that for some inmates "these unmet needs [substance abuse treatment and education, basic education, and job training]...may have negated any rehabilitative success in other areas" (Florida Department of Corrections, 1990, p. 25). In a 1991 evaluation of Georgia's Special Alternative Incarceration (SAI) program, the necessity of enhanced substance abuse programming was also highlighted: At least 75 percent of the offenders who have gone through SAI have a problem with drugs and/or alcohol. They committed crimes while under the influence or to support their habits, or they were convicted of DUI or drug possession or sale. Strong substance abuse programs were needed, both in SAI and during the followup period of supervision and treatment. (Georgia Department of Corrections, 1991, p. xi). It became clear that little evidence existed to support the idea that discipline and hard work by themselves would lead to lasting behavioral changes; enhanced substance abuse programming might be needed. In addition to the lack of emphasis on standard rehabilitative elements within early boot camp programs, researchers expressed concern about lack of aftercare services, especially for the substance-abusing client, as programs grew more popular. For example, in a study examining the postrelease experiences of boot camp inmates from Louisiana, Shaw and MacKenzie noted that "the behavior of problem drinkers as a group was more varied than that of nonproblem drinkers, emphasizing the importance of and the need for programs such as this to provide adequate support and aftercare for problem drinkers and substance abusers" (Shaw and MacKenzie, 1991, p. 63). Since the initial introduction of boot camp programs, changes in program structure appear to have taken place. Although early shock incarceration programs emphasized structure and discipline, newer programs appear to be incorporating more substance abuse treatment into daily inmate programming, and a stronger aftercare component as well (see also Gransky, Castellano, and Cowles, 1995). Although they started with an emphasis on military drills, physical training, and work, an increasingly larger number of facilities appear to be giving at least equal emphasis to more traditional forms of treatment programming. Most boot camps today stress rehabilitation as a primary program goal, with substance abuse programming appearing to be highly valued by correctional officials in charge of operating these facilities. The overwhelming majority of boot camps include programming aimed at promoting the successful community reintegration of graduates. This is to be accomplished, at least in part, by promoting the ability of program participants to refrain from abuse of drugs or alcohol. Beyond these broad trends and patterns, however, more needs to be known about the details of substance abuse programming associated with the boot camp experience. The Impact of Boot Camps on the Lives of Substance Abusers The only studies that have examined the impact of boot camps on the lives of substance abusers (and their potential differential impacts on substance abusers versus nonabusers) are evaluations of Louisiana's boot camp program. Problem drinkers. One relevant examination involved an analysis of boot camp effects on the lives of problem drinkers (Shaw and MacKenzie, 1991). This study involved 112 shock incarceration inmates who entered the program between October 1987 and October 1988 and eventually graduated, and a comparison group of 98 prison inmates legally eligible but not recommended for placement in the program. The two groups were fairly similar in demographic characteristics (except for age), criminal histories, and measures of neuroticism, but the prison inmates showed more signs of social maladjustment, alienation, and manifest aggression. A total of 58 inmates from across the 2 groups (20 percent of the total) were identified as problem drinkers. Researchers found that problem drinkers in the boot camp sample became more prosocial after 3 months, but the prison sample showed no change in antisocial attitudes. Problem drinkers in the shock incarceration sample also became less alienated than when they entered the program, while those in the prison sample became more alienated during incarceration. For each of the first 6 months that a parolee was under community supervision, parole officers filled out a standardized evaluation form (the Prosocial Living Index), which attempted to measure each parolee's community adjustment. To have a much broader focus than just on recidivism, the Index contains such measures as employment status, school status, performance in treatment programs, as well as arrests and reconvictions. The community adjustment of boot camp parolees was found to be much more positive than the adjustment of inmate parolees, but there was no difference in the adjustments of problem and nonproblem drinkers. No link was found between sample and drinker type, indicating that problem drinkers in the shock incarceration sample did not fare better while under community supervision than problem drinkers in the inmate sample. In general the performance of problem drinkers was more sporadic over the 6-month period than the performance of nonproblem drinkers. The evaluators underscored the desirability of implementing stronger aftercare components to address the specific needs of problem drinkers. Other drug abusers. Another study of the Louisiana program examined its effect on drug-involved offenders (Shaw and MacKenzie, 1992). In this study the performance of offenders with a drug history, that is, prior drug arrests and convictions, was compared to that of offenders who were merely identified by corrections officials as in need of community counseling for substance abuse. The adjustments of a group of 74 paroled boot camp offenders were compared to those of a group of 92 shock incarceration dropouts, 108 probationers, and 74 inmate parolees. Thirty-eight percent of all subjects were in the group with histories of prior drug arrests or convictions, and 28 percent were in the group that was considered to need substance abuse counseling. Although there was much overlap between these two groups, it is noteworthy that 52 percent of the offenders with drug histories were not required to attend community drug treatment. There was no difference across samples in the percentage of subjects with drug histories, but both boot camp graduates and the regular parolees were more likely than the probationers to be required to get drug treatment. Evaluators examined program dropout rates to see whether drug offenders adjusted to the boot camp experience more negatively than nondrug offenders. No difference in dropout rates was found between those with and without drug histories. Self-reported drug history information also appeared unrelated to dropout rates. Thus, in-program adjustment patterns did not appear to be a function of prior drug abuse. Four measures of failure were used to assess community performance, including positive drug screens, drug arrests, any arrest, and jailing or revocation. Sample subjects were followed for 1 year after release. A series of logistic regressions run on each measure of community adjustment revealed complex patterns in the community adjustment of the offenders. First (and consistent with the research discussed above), the prison parolee sample and the probation sample did not display failure patterns significantly different from those of the boot camp sample. Second, offenders with drug histories were less likely to fail while under community supervision than other drug offenders, especially when the effect of required treatment was statistically controlled in the analysis. That is, offenders arrested or convicted of a drug offense who were not also judged to need treatment were less likely to fail while under community supervision than those who were also judged in need of treatment. Moreover, they were less likely to fail than offenders without drug histories who were judged to need treatment. Thus participation in treatment may have actually resulted in higher failure rates. A third finding may help explain this apparent anomaly. Although supervision level was controlled in the logistic regression models, it is possible that individuals in treatment had higher failure rates because of some aspect of supervision related to the requirement to attend treatment. In fact, higher failure rates in terms of jailing or revocation among those receiving community treatment were limited to those in treatment who were not making satisfactory progress (Shaw and MacKenzie, 1992, pp. 514-515). In summary, the Louisiana boot camp experience itself did not seem to have any differential or positive impact on the community adjustments of either problem drinkers or drug-involved offenders. Although Louisiana's boot camp did provide some drug treatment programming such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), it did not have a formal drug treatment component. Inferences about the efficacy of boot camp programming as a vehicle of change on the lives of substance abusers should await rigorous tests of programs with substance abuse treatment components that parallel those found in the community. Methodology for the Survey of Boot Camp Drug Treatment Programs The present research includes within its scope the identified universe of shock incarceration programs for adult offenders at the beginning of 1993. These include facilities operated by the Federal and State governments. Excluded from the study are juvenile programs and boot camps operated by local governments. Since the beginning of 1993, many additional boot camps have opened their doors. These newer programs may exhibit characteristics quite different from those typically found in older ones. Thus, findings from this survey may not be generalizable to all adult boot camp facilities. In the fall of 1992, letters asking about the existence of boot camp facilities were sent to the directors or commissioners of the departments of corrections in all 50 States plus the Virgin Islands, the District of Columbia, and the Federal Bureau of Prisons.1 At the beginning of 1993, the survey indicated that there were 43 State boot camps operating in 29 States. In addition, two Federal programs were in operation.2 Survey efforts also revealed 12 planned boot camps in 5 States (7 in Georgia, 2 in Iowa, and 1 each in Illinois, Kentucky, and Oregon) which were due to be operational within the next 2 years. Survey data on substance abuse programming provided by the above facilities were collected in two distinct stages. During the first stage, telephone interviews were conducted with the person at the level of the correctional system most directly responsible for planning, implementation, or oversight of boot camp programming, such as the department of correction's central office. Interview questions sought to elicit information on the correctional aims, program goals, and program elements of the boot camp. As used in this research, correctional aims refer to broad constructs that underlie correctional interventions (e.g., deterrence, retribution, rehabilitation, incapacitation). Program goals are more narrowly defined (e.g., reduced recidivism, reduced crowding) and can be subsumed by the larger correctional aim (e.g., rehabilitation includes reduced recidivism). Of the 30 jurisdictions previously identified as operating a boot camp program, 2 States indicated that their boot camps served specialized functions and thus had different program operations (i.e., Oklahoma with 4 and Georgia with 2 distinct program types). The officials surveyed from these States were asked to report on aims, goals, and elements separately for each type of facility within their jurisdiction. This added to the number of interviews to be conducted, but three States declined to participate in the study. A total of 31 interviews were conducted, representing 26 States and the Federal system, a response rate of 91 percent. The second stage of data collection began early in 1993. Two questionnaires aimed at collecting information from facility-level personnel were mailed to each facility. The first, directed to the facility administrator, sought the administrator's views as to the facility's correctional aims, program goals, and program elements, as well as a description of the target population and selection criteria, daily scheduling, costs, and staffing. This survey was designed to capture detailed information on the facility contexts in which substance abuse programming was provided. Sixty-nine percent of the administrative questionnaires were returned. A second survey form was included in the packet with the first, with instructions for the facility administrator to forward the second questionnaire to the staff member responsible for the facility's substance abuse treatment or education program, if such a program existed. The second survey instrument asked about substance abuse assessment procedures, treatment modalities and interventions, hours of education and treatment provided, aftercare programs, and information regarding the staff providing substance abuse treatment or education. As with the facility administrator's questionnaire, this survey solicited the substance abuse provider's perceptions of the program's correctional aims, goals, and elements. The purpose of the two-stage data collection on these issues was to measure congruence in the perceptions held by individuals responsible for programming at different levels in the correctional systems. Sixty-four percent of these questionnaires were returned. Nonresponses for the administrative and substance abuse surveys were primarily due to response patterns from three States. New York State, which had five facilities at the time of this survey effort, refused to participate in the facility-based survey component. Officials from that State explained that all of their facilities have identical substance abuse programming and so there was no need to ask facility-level personnel to respond to the questionnaire. Only three of Georgia's six facilities responded to both surveys, and only one administrative questionnaire was returned from among Oklahoma's four programs. Thus, these States represent 11 of the 14 administrative questionnaire nonresponses and 12 of the 15 substance abuse questionnaire nonresponses. Fortunately, these programs have been well documented (for example, see Clark and Aziz in this volume and Clark, Aziz, and MacKenzie, 1993) so that the nature of nonresponse bias can be estimated. These programs are discussed in the following analyses if they displayed substance abuse programming characteristics distinct from patterns gleaned from the survey data received. Survey Findings The survey findings presented below show the extent to which drug education and treatment have been made part of boot camp programming and the different forms they have taken. The survey also elicited information on how inmates were screened for treatment, how long the treatment lasted, and how boot camps staffed their education and treatment programs. The Extent of Substance Abuse Programming All of the system-level officials indicated that alcohol and other drug treatments were being provided in their facilities, although this was true for only 75 percent of the facility-level respondents.3 There appears to be confusion among some respondents as to whether a drug treatment program existed at certain facilities. Prior surveys that indicated almost uniform drug treatment programming in boot camps may have overrepresented the reality of the situation because they tended to report responses generated by system-level officials. Responses from individuals closest to the delivery of such programming efforts indicate that a quarter of adult boot camps had no such programming. Most respondents also indicated that physical training, physical labor, basic education, and prerelease programming were facility program components. Conversely, vocational education was not commonly found in boot camps, with only slightly more than 40 percent of the system-level respondents and 30 percent of the facility administrators indicating vocational education to be a facility program element. Drug treatment in most boot camps is one of a variety of components to balance military-oriented activity, exercise, and work with more traditional treatment-related activities such as education and prerelease programming. It is also noteworthy that despite the great emphasis placed on aftercare services as a necessary component to ease community reintegration of graduates, about a quarter of the respondents reported no postrelease service delivery. Substance abuse programming appeared to be more available to the boot camp participant than to the general prison inmate. All of the responding boot camps had either a substance abuse treatment or a substance abuse education program. Most boot camps provide drug treatment (as distinct from drug education only), and virtually all offenders in such facilities participate in substance abuse treatment. In contrast, Lipton, Falkin, and Wexler (1992) indicate that the percentage of State correctional systems offering different types of substance abuse programming ranged from around 62 to 88 percent, with substance abuse education being the most popular. In a study 4 years earlier, Chaiken (1989) estimated that about 11.1 percent of the inmates in the 50 States were involved in drug treatment. The Mix of Substance Abuse Education and Treatment There is some disagreement in the literature on whether it is appropriate to consider drug education as a drug treatment modality. Many argue that substance abuse education or information programs do not constitute treatment (e.g., Lipton, Falkin, and Wexler, 1992) but that education or information programs may, at best, be considered to provide basic support for treatment. To learn how substance abuse program providers in boot camp facilities viewed this issue, a number of survey questions sought to find out if drug education was considered a totally separate program from drug treatment or a component of treatment. The responses reveal three distinct program groupings for substance abuse education in boot camps. In the first group are those that provided only substance abuse education, defined in the survey questionnaire as "a separate, clearly identifiable substance abuse education program." Seven of the 29 responses (24 percent) indicated this approach. A second group of equal size (seven) maintained that substance abuse treatment was provided but that there was no education program as defined above. That is, substance abuse education was intertwined with the treatment component in such a manner that it was not considered a distinguishable program offering. Finally, a third, larger group of 15 facilities (52 percent) indicated the presence of both an identifiable education program and a substance abuse treatment program. Beyond these fairly crude distinctions lies an interesting finding. When facilities with treatment programs were asked to identify the approaches that were used in their programs, all 22 identified education as one. Thus it would seem that education has played an important role in substance abuse programming in boot camp facilities whether it constituted the only program component or was integrated into a broader treatment approach. These data tend to indicate that the perceptions of providers of substance abuse programming varied considerably due to the framework under which substance abuse programming is provided in the boot camp environment. For instance, although rehabilitation had a higher priority than the other correctional aims across all types of facilities, those locations that had separate substance abuse education and treatment programs gave rehabilitation a higher priority than those facilities providing only substance abuse education. Additionally, for programs in which substance abuse education is incorporated into substance abuse treatment (as opposed to being a distinct and separate program), alcohol and drug treatment elements were rated a higher priority than in programs in which drug education and drug treatment are separate and distinct portions of the inmate programming. Further, the presence of drug treatment programming appears strongly related to the incorporation of other rehabilitative programming found in association with boot camps. For example, a greater proportion of boot camps that have substance abuse treatment programming indicated the presence of postrelease programming (6 of 7 and 12 of 15, respectively) than those that had only substance abuse education (3 of 7). As these discussions illustrate, the presence of substance abuse treatment as a program element may be a defining characteristic of boot camps that most forcefully articulate and seek the goal of offender rehabilitation. However, programs that merge treatment and education programming may see the dilution of the former, at least in the eyes of substance abuse programming providers. Education For those 22 boot camps with a separate substance abuse education program, either provided in conjunction with treatment or alone, 20 (91 percent) mandated inmate participation in their educational programming. The total number of hours of instruction ranged from 6 to 358 hours, with the average at just over 61 hours. Facilities with both identified education programs and treatment programs provided an average of nearly 30 more hours of substance abuse education instruction than programs that had only an education program (70 versus 42), suggesting a more intensive program effort in facilities that had both substance abuse education and treatment. Over half (54 percent) of the programs providing a separate education program used in-house staff to provide the educational programming. Eighteen percent had external educators, while about 9 percent contracted with an outside organization to provide education. The remainder used multiple providers or other sources. The ratio of inmates to education staff ranged from about 15 to 1 at the low end to around 200 to 1 at the high end. The most common inmate-staff ratios were about 30 to 1 reported by 18 percent of the facilities, and 50 to 1 reported by 14 percent of the facilities. Eight of the facilities (36 percent) required that their education staff be certified as substance abuse treatment providers in their respective States. Four facilities reported that half of their staff were certified; one facility indicated that 70 percent of its staff had certification; and four reported that their entire education staff were certified. The remaining 13 facilities did not indicate levels of staff certification. Treatment The literature identifies a variety of ways to incorporate substance abuse treatment in correctional settings. According to Brown (1992), five types of program models are available for drug abusers in correctional settings: o Incarceration without specialized services. o Incarceration with drug education or drug abuse counseling or both. o Incarceration with residential units dedicated to drug abuse treatment. o Incarceration with client-initiated or client-maintained services or both. o Incarceration with specialized services that do not directly target users' drug abuse problems. Using this taxonomy, the majority of boot camp substance abuse programs operating at the time of this study would fall into the second category, since all the programs featured either substance abuse education or treatment or both. A minimal number with well-integrated substance abuse program elements along the lines of a therapeutic community might even be placed in the third category, incarceration with residential units dedicated to drug abuse treatment.4 Further, substance abuse treatment provided in boot camp facilities best fits into what may be termed a short-term (less than 3 months) residential treatment program, although a few notable exceptions existed (such as Minnesota's and New York's programs) which had longer (180 days) and more extensive programming. Models offered for similar correctional substance abuse treatment programs can be distilled into three primary components: an assessment phase including evaluation and development of a treatment plan, a treatment program, and an aftercare component (see Finn and Newlyn, 1993; Sherron, 1991; Wexler and Lipton, 1993). This review of boot camp substance abuse treatment programming examined the first two of these three components. Assessment Assessment of substance abuse problems of inmates was a fairly common practice in the shock incarceration programs surveyed. Of the 29 State and Federal programs responding to the substance abuse survey, 20 (69 percent) indicated that some type of substance abuse assessment was conducted while 9 (31 percent) stated that no assessment took place. All facilities doing such substance abuse assessment indicated they did so routinely for all inmates entering the facility. Despite this common use of substance abuse assessment, there appeared to be a lack of clear links between substance abuse assessment and subsequent treatment programming. Of the 29 programs responding, 22 reported that they had substance abuse treatment, but only 18 of this group conducted a substance abuse assessment. Further evidence of a lack of integration between assessment of substance abuse problems and subsequent treatment was reflected in the fact that of the 18 programs that conducted assessments, only half indicated using the assessment data to classify inmates for treatment programs. The lack of articulation between substance abuse assessment processes and treatment decisions has been clearly driven by the large number of programs that require all boot camp inmates to participate in substance abuse treatment. In addition to the four facilities that place offenders in treatment without the substance abuse assessment mentioned above, six of the facilities indicated drug treatment was mandated by statute; in two the judge could mandate participation; in three others the facility mandated treatment after assessment; and two facilities had different mechanisms for mandating substance abuse treatment. One typical boot camp treatment provider indicated, "Any inmate that meets general criteria for shock incarceration receives substance abuse treatment." A variety of tools, screening instruments, and classification systems were available to identify individuals with alcohol and substance abuse problems. Respondents were asked to identify the techniques they used to determine which inmates had substance abuse problems. All except one of the responding agencies reported using face-to-face interviews. Beyond a screening interview, two other methods were widely used to assess inmates' substance abuse difficulties. The first was examination of case history information (beyond the present offense) gleaned from sources such as presentence investigations, prior evaluations or treatment records, and self-reported information provided by the offender. Eighty-three percent of the programs reported using such information for assessment. The second popular tool consisted of psychological and behavioral testing instruments, with 78 percent of those conducting assessments indicating the use of such tests. However, there did not appear to be a clear favorite among the instruments identified by respondents. The most commonly used instrument was the Michigan Alcoholism Screen Test (MAST), which was identified by nearly 40 percent of those using such tests. The Inventory of Drinking Situations was used by slightly more than a third (38 percent), and the Alcohol Use Inventory was employed by about one quarter (28 percent) of those using tests. Six other scales were identified by less than 20 percent of this group. It is noted that 56 percent of those indicating the use of such assessment instruments indicated they used tests other than the 14 that were listed on the survey instrument. In this regard several facilities indicated the use of substance abuse screening instruments apparently developed as part of their admission and diagnostic screening process. The two other identified methods appeared to have limited use among boot camp programs. The use of urine and blood tests was reported by only one-third of the respondents, and case history reviews to determine if drugs were involved in the present offense were used by only 17 percent of the responding programs. These data indicate that despite the rather extensive assessment efforts in place at many boot camps, the predominant means of placing boot camp offenders in substance abuse treatment has not been through a diagnostic process and clinically based decision of need, treatment amenability, or potential effectiveness. Rather, it has been done through legally mandated or nonclinical decision processes. Treatment Modalities and Interventions Respondents were asked to identify treatment modalities used in their programs from among six commonly associated with correctional substance abuse programs: substance abuse education; the Alcoholics Anonymous/Narcotics Anonymous model; individual counseling; therapeutic communities; group counseling; and milieu therapy. (Findings from this study indicate that neither pharmacological approaches nor detoxification were in use in boot camp programs at the time of the survey.) "Modality" was used to mean the general treatment delivery approach employed by the program. Additionally, respondents were asked to select the interventions they used from among a list of 21 commonplace therapeutic interventions. Space was also provided for the respondents to list two interventions not included in the listing. Here "intervention" denotes the specific type or style of treatment offered. All but one of the reporting boot camps employed multiple modalities in their treatment programming. This means that some combination of substance abuse education, group counseling, AA 12-Step models, and milieu therapy was used to deliver substance abuse services. In fact, a combination of four modalities was the most prevalent grouping, seen in 36 percent of the programs. Twenty-seven percent used five of the listed modalities, and one reported using all six modalities. This finding provides a central theme in the data reported by substance abuse treatment providers. Substance abuse treatment offered in boot camps has been eclectic. While eclecticism may be a positive attribute, it may also reflect a lack of clarity and specificity as to the theoretical orientation or treatment approach. This eclecticism is evidenced by the number of interventions being employed in each facility-- ranging from 1 to 14 with 5 and 7 the most common numbers. Further, the type of modality used seemed to have little effect on the number of interventions. The mean number of interventions ranged from 7.41 for therapeutic communities to 9.00 for milieu therapy. (Because there were only two therapeutic communities, interpretation of this finding is difficult.) For each of the treatment modalities except the therapeutic community approach, three interventions (AA 12-Step, reality therapy, and stress management) were consistently ranked as the most frequently used interventions. The use of several modalities and the predominance of the same interventions across modalities (slight variations are noted for milieu therapy and individual counseling) seem to indicate a strong similarity, at least in orientation, among boot camp substance abuse treatment programs. This is not surprising given the relative newness and rapid expansion of boot camp facilities. The few more established programs frequently served as models for those that were newly established. Treatment components found in programs with developed substance abuse approaches, such as the Alcohol and Substance Abuse Treatment model (ASAT) in New York, appear to be replicated again and again. Examination of the most and least often employed treatment interventions offered at boot camp facilities suggests that most programs have been taking a pragmatic, skill-building orientation to help offenders cope with the problems and stressors they would face on return to the community. Traditional psychotherapeutic approaches designed to deal with offenders' underlying psychological and emotional problems, particularly those associated with more serious substance abuse, have been used relatively infrequently. Length of Treatment Research over the years has consistently shown a relationship between time in treatment and treatment outcomes (e.g., Hubbard et al., 1989; Wexler et al., 1992). Two factors can affect the length of time an individual stays in a treatment program: whether or not someone completes the program and the actual length of the program. As mentioned earlier, for the majority of boot camp facilities with substance abuse treatment programs, participation was set in motion through legal or administrative mechanisms rather than assessment procedures. Of the 22 reporting facilities with treatment, in only 1 was treatment voluntary. In six programs, treatment was required for certain inmates, such as those with drug offense convictions or those for whom the judge mandated participation. In the remaining programs, all inmates were required to participate. Once in the substance abuse program, an inmate had little opportunity to quit treatment without being removed from the facility. In only 5 of the 22 facilities providing treatment could an inmate be administratively removed from treatment but remain in the boot camp, and in only 3 of the facilities could the inmate voluntarily quit the substance abuse treatment program without leaving the boot camp. These considerations, coupled with the reluctance or inability of respondents to indicate how much time a boot camp devotes to drug treatment, have made it difficult to estimate the average length of time a boot camp inmate spent in treatment and its intensity. Because of the eclectic nature of the treatments and the common lack of boundaries between what drug treatment is and what it is not, the most that can be said is that the length of drug treatment in boot camps paralleled the average length of boot camp programs (slightly over 5 months). The statement of one boot camp psychologist as reported in Burns (1991) reflects much boot camp programming in this regard: ...(what I do)...probably does not come across as a very specific alcohol and drug component to the inmates. I don't separate it out. When I teach the 12 steps, I show them that the 12 steps are good for whatever their problem happens to be. And I view crime as an addictive behavior, just as drugs are addictive. So that these 12 steps, properly used, can get you over your addiction to crime" (Burns, 1991, p. 22). In effect, a day in boot camp has been viewed by many boot camp treatment providers as a day in drug treatment. Treatment Staff As Lipton et al. noted in their review of correctional drug treatment, "staffing is one of the keys to successful programming whatever the modality" (1992, p. 23). There are two predominant issues when considering treatment staff: the quality and size of the staff relative to the client population and the type of treatment offered. The survey responses revealed considerable diversity in the way treatment programs were staffed, but three models predominated. In the first, treatment programming is provided by full- or part-time agency staff, essentially an in-house program delivery. The second is a mixed model in which individuals are contracted to supplement agency staff in providing the program. The third model involves contracting all services through individuals or an outside treatment provider. The in-house model was by far the most common single approach, with about two-thirds of the facilities relying solely on agency staff. Only two reporting facilities used contracted staff solely, and less than a third used the mixed model of both agency staff and contracted personnel. These findings indicate that full-time contracted staff were more likely to be certified and to have had formal training in substance abuse treatment than full-time correctional agency treatment staff. Boot camp programs also differed widely in the ratio of client offenders to substance abuse treatment providers. One program had a ratio of 4 clients for every treatment provider; at the other end of the spectrum, one had a ratio of 90 participants for every treatment staff member. The most common ratios were 10 to 1, 30 to 1, 45 to 1, and 50 to 1, each seen at two facilities. It seems difficult to imagine that a substance abuse counselor could have much individualized interaction with offenders at ratios nearing 100 or even 50 clients per staff member. However, inmate-staff ratios in boot camp treatment programs average in the range of 30 to 1 across types of modalities. Summary and Conclusions In general, adult boot camps provide substance abuse programming to a greater percentage of their clients than do correctional facilities. All of the surveyed programs offered at least substance abuse education, and over 75 percent offered substance abuse treatment. Interestingly, respondents who worked at actual boot camp sites were less likely than system-level officials to report that treatment was provided. Substance abuse treatment programming was found to be a key element in establishing a rehabilitative correctional regime. Boot camps with drug treatment programming are not only more strongly oriented to rehabilitation as a primary goal but are also more likely to use the programming often thought necessary to promote the successful community reintegration of offenders (e.g., postrelease programming services). Despite these positive findings, a number of issues have been identified in this chapter that suggest that all is not well with boot camp substance abuse programming. Most boot camps have provided drug treatment in a manner that makes it difficult to readily ascertain the number of treatment hours actually provided to boot camp participants (e.g., hours vary per week, treatment hours are not distinct from education hours). Research does confirm, however, that the relatively short duration of boot camp programs does not bode well for their ability to keep graduates substance free over the long term. Moreover, assessment of inmates' need for treatment appears to be an underdeveloped component of substance abuse programming, for it is infrequently used to classify inmates for treatment or to individualize their treatment plans. Substance abuse treatment programs in adult boot camp facilities were also found to take several forms and to be part of a variety of simultaneously used modalities. While common in the field, multimethod approaches were not used in these boot camp settings to uncover and treat the wide variety of problems underlying drug use and dependence. For instance, individualized treatment has been rare, with individual counseling found to be a modality in only 14 of the 22 boot camps that provided substance abuse treatment. More commonly, all boot camp participants within a facility received the same treatment regardless of their individual needs or situations. Researchers have identified the therapeutic community model as one of the most successful approaches to correctional substance abuse treatment (e.g., Lipton et al., 1992). Somewhat surprising, then, is the fact that only two of the facilities reporting, Massachusetts and Wisconsin, specified the use of a therapeutic community model. If New York's programs are included, the relative percentage of boot camps maintaining that a therapeutic community approach is used increases substantially. Nonetheless, it appears that a therapeutic community model of drug treatment has been underutilized in adult correctional boot camps. This is especially disturbing because such facilities appear ideally suited for the introduction of therapeutic communities. Clearly there appear to be significant shortfalls in the manner by which substance abuse treatment is provided to adult boot camp participants. Although a number of promising programs exist, much can be done to improve the current programming in many States. Such efforts should be guided by the results of further experimentation and evaluation. Notes 1. The responding correctional officials were given the opportunity to self-define whether correctional programming in their system included a "shock incarceration" facility. They were asked if their jurisdiction contained "any program that has an intensive training component, not necessarily based on a military model, that is an incarceration-based alternative to a traditional prison sentence." Rather surprisingly, given the fact that the survey letter did not make reference to boot camps or shock incarceration and the program design of the facility was not constrained to a military model, respondents tended to identify the same facilities that had been identified in contemporaneous boot camp surveys (e.g., MacKenzie, 1993). 2. This count approximates the findings derived from a March 1992 census of boot camps that identified 41 boot camps in 26 States (MacKenzie, Shaw, and Gowdy, 1993). The 45 facilities identified in this survey are also comparable in number to the 46 reported by MacKenzie as existing during 1992 and 1993 (MacKenzie, 1993). Compared to the MacKenzie survey, the present research identified one more shock incarceration program in Georgia and two fewer facilities in Michigan. Both these surveys report far fewer boot camp facilities than either the more recent U.S. General Accounting Office (GAO) or American Correctional Association (ACA, 1993) surveys. These lower counts are not due to a rapid increase in the opening of adult boot camp programs during 1993 but to the GAO's identification of 19 boot camps in Georgia, while the ACA reported 11 boot camps in Georgia and 7 in Missouri. It is questionable whether these latter figures represent the actual number of boot camps in those States, even as they may be defined by correctional officials there. It appears that the present research effort has been successful in identifying the universe of broadly defined adult shock incarceration facilities in the United States at the beginning of 1993. 3. If responses from all of the New York facilities and those from Georgia and Oklahoma were included in this analysis, the percentage of boot camps with a drug treatment component would increase beyond the 75 percent reported above. Each State (but New York in particular) emphasizes drug treatment and has a fairly strong component. For further information on New York's model, see MacKenzie (1993), Clark and Aziz in this volume, and Clark, Aziz, and MacKenzie (1993). This was not true of the original Georgia and Oklahoma programs, but in recent years such programming efforts have been introduced or enhanced in those States. 4. The percentage of boot camps that could be classified in such a manner would increase if New York's boot camps were included in this analysis. New York's drug treatment model is based on a therapeutic community approach. References American Correctional Association. "Development of National Standards for Juvenile and Adult Correctional Boot Camps, Draft Monograph." 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"The Stay `N Out Therapeutic Community: Prison Treatment for Substance Abusers." Journal of Psychoactive Drugs, 18, no. 3 (1986):221-230. Editor's Note: A National Institute of Justice Research Report, Boot Camp Drug Treatment and Aftercare Intervention: An Evaluation Review (NCJ 153918) and a Research in Brief of the same name (NCJ 155062) summarizing the report are available from the National Criminal Justice Reference Service, 800-851-3420.