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Follow-up interview data for 1,155 opioid addicts, based on a 4-year period after leaving community-based drug abuse treatment programs, showed that levels of employment and productive activities (a composite measure reflecting employment, school, and homemaking) were generally stable over time. Almost half of the males and females were involved in some type of productive activities in all 12 months of each year examined, and only about one-fourth reported no productive activities at all each year. As expected, males reported higher rates of employment and females were higher in homemaking activities. Employment was associated with lower opioid drug use and criminal involvement during the follow-up period, suggesting the need for continued support and development of community training and employment placement programs as part of a comprehensive treatment system for drug abusers.

Innovate and adapt are watchwords for substance abuse treatment programs in today's environment of legislative mandates, effective new interventions, and competition. Organizations are having to evolve—ready or not—and those that are ready have superior chances for success and survival. The Texas Christian University Organizational Readiness for Change (ORC) survey is a free instrument, with supporting materials, that substance abuse treatment programs use to assess organizational traits that can facilitate or hinder efforts at transition. This article presents organizational change as a three-stage process of adopting, implementing, and routinizing new procedures; describes the use of the ORC; and outlines a step-by-step procedure for clearing away potential obstacles before setting forth on the road to improved practices and outcomes.

This article reviews the history of substance abuse treatment and its evaluation. The authors comment on key aspects of this history and its implications for the future. Research has been a key factor in the support of substance abuse treatment and the expansion and improvement of treatment options. Despite the progress in the field, organizational structure and functioning, ambivalence on the moral/medical basis of addiction, and narrow perspectives on evidence-based practice have presented barriers for advancement. Future improvement of treatment is seen as dependent on the partnership of researchers and real world providers, studies of evidence- based practice in a wide variety of community based settings and the consideration of complex and changing real-world environments, particularly for rural, uninsured and under-served populations.

Substance abuse is common among probationers, and treatment programs have become an integral part of community corrections. The current study presents findings from a modified therapeutic community (TC) serving drug abusing probationers in a large metropolitan area. Findings show that treatment dropouts were more likely to be rearrested for a serious felony within 2 years of leaving the TC program than were treatment graduates and probationers from an untreated comparison group. Also, a significantly smaller proportion of graduates were rearrested during the 2nd year after release compared to those who drop out of treatment or who do not receive treatment. Logistic regression analysis that adjusted for pre-existing group differences suggests there was a small impact of the TC program on recidivism, with treatment graduates only slightly less likely to be arrested within 2 years of leaving the program.

Motivational readiness for engaging in drug treatment is a common problem for probationers mandated to criminal justice programs, particularly for those with limited educational experience. This study presents initial findings on the impact of a new four-session treatment readiness program that includes an array of cognitive engagement strategies. Probationers in a 4-month mandated residential program were randomly assigned to receive a standard (n = 244) or enhanced treatment readiness program (n = 249). The enhanced program was given favorable overall ratings, and the low education group in this condition rated their midterm improvements in motivation and confidence as being higher than did the group receiving the standard program.

Early dropout or failure to engage in drug abuse treatment is a common problem in correctional settings. This study presents findings from 339 felony probationers mandated to a 6-month modified therapeutic community in lieu of imprisonment. Early dropout was related to cocaine dependence, having a history of psychiatric treatment, being unemployed before adjudication to treatment, and to higher levels of depression, anxiety, and hostility. Dropout rates also were higher for probationers with deviant peer networks and lower ratings of self-efficacy. However, multivariate analyses showed that scoring high on a criminality risk index was the strongest predictor of leaving treatment early and appears to represent a good composite risk measure. These findings can help identify who needs residential treatment, and who is at greatest risk for not completing it.

Longer term in-prison therapeutic community (ITC) outcome studies are needed, along with more attention on who benefits most from these programs. This study examined reincarceration records for 394 nonviolent offenders during the 3 years following prison. Those who completed both ITC and aftercare were the least likely to be reincarcerated (25%), compared to 64% of the aftercare dropouts and 42% of the untreated comparison groups. Furthermore, high-severity aftercare completers were reincarcerated only half as often as those in the aftercare dropout and comparison groups (26% vs. 66% and 52%). The findings support the effectiveness of intensive treatment when it is integrated with aftercare, and the benefits are most apparent for offenders with more serious crime and drug-related problems.