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Therapeutic communities (in the community) for individuals with co-occurring disorders

Adult Criminal Justice
Benefit-cost methods last updated December 2023.  Literature review updated November 2016.
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Therapeutic communities are an intensive form of substance use disorder treatment generally provided to individuals with substance use disorders involved in the criminal justice system. Participants live in a continuous therapeutic environment apart from the general population. Therapeutic communities use a hierarchical social learning model, wherein participants earn increased social and personal responsibility as they progress through stages of treatment. Treatment involves a highly structured therapeutic environment, peer support and peer accountability intended to teach participants prosocial norms and behaviors.

This meta-analysis includes only therapeutic communities designed for persons with co-occurring substance use and mental health disorders in the community. Participants in the programs in this meta-analysis remained in therapeutic communities for 3 to 12 months with treatment on weekdays and live-in staff.
 
ALL
BENEFIT-COST
META-ANALYSIS
CITATIONS
For an overview of WSIPP's Benefit-Cost Model, please see this guide. The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2022). The chance the benefits exceed the costs are derived from a Monte Carlo risk analysis. The details on this, as well as the economic discount rates and other relevant parameters are described in our Technical Documentation.
Benefit-Cost Summary Statistics Per Participant
Benefits to:
Taxpayers $5,774 Benefits minus costs $13,488
Participants $157 Benefit to cost ratio $3.25
Others $12,780 Chance the program will produce
Indirect $783 benefits greater than the costs 65%
Total benefits $19,495
Net program cost ($6,007)
Benefits minus cost $13,488

^WSIPP’s benefit-cost model does not monetize this outcome.

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic in order to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the types of program impacts that were measured in the research literature (for example, crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases. See Estimating Program Effects Using Effect Sizes for additional information.

Adjusted effect sizes are used to calculate the benefits from our benefit cost model. WSIPP may adjust effect sizes based on methodological characteristics of the study. For example, we may adjust effect sizes when a study has a weak research design or when the program developer is involved in the research. The magnitude of these adjustments varies depending on the topic area.

WSIPP may also adjust the second ES measurement. Research shows the magnitude of some effect sizes decrease over time. For those effect sizes, we estimate outcome-based adjustments which we apply between the first time ES is estimated and the second time ES is estimated. We also report the unadjusted effect size to show the effect sizes before any adjustments have been made. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured Treatment age No. of effect sizes Treatment N Adjusted effect sizes(ES) and standard errors(SE) used in the benefit - cost analysis Unadjusted effect size (random effects model)
First time ES is estimated Second time ES is estimated
ES SE Age ES SE Age ES p-value
Crime
Any criminal conviction according to court records, sometimes measured through charges, arrests, incarceration, or self-report.
 38 6 588 -0.160 0.078 40 -0.160 0.078 50 -0.303 0.001
Illicit drug use disorder
Clinical diagnosis of illicit drug use disorder or symptoms measured on a validated scale. When possible, we exclude cannabis/marijuana use disorder from this outcome.
 38 4 447 -0.066 0.091 38 0.000 0.187 41 -0.214 0.134
Substance use^
Nonspecified substance use (i.e., alcohol, cannabis, or illicit drugs) that does not rise to the level of "disordered."
 38 1 70 -0.240 0.249 38 n/a n/a n/a -0.240 0.335
1In addition to the outcomes measured in the meta-analysis table, WSIPP measures benefits and costs estimated from other outcomes associated with those reported in the evaluation literature. For example, empirical research demonstrates that high school graduation leads to reduced crime. These associated measures provide a more complete picture of the detailed costs and benefits of the program.

2“Others” includes benefits to people other than taxpayers and participants. Depending on the program, it could include reductions in crime victimization, the economic benefits from a more educated workforce, and the benefits from employer-paid health insurance.

3“Indirect benefits” includes estimates of the net changes in the value of a statistical life and net changes in the deadweight costs of taxation.
Detailed Monetary Benefit Estimates Per Participant
Affected outcome: Resulting benefits:1 Benefits accrue to:
Taxpayers Participants Others2 Indirect3 Total
Crime Criminal justice system $5,601 $0 $12,663 $2,801 $21,065
Illicit drug use disorder Labor market earnings associated with illicit drug abuse or dependence $44 $105 $0 $0 $149
Health care associated with illicit drug abuse or dependence $114 $18 $117 $57 $305
Mortality associated with illicit drugs $15 $35 $0 $929 $978
Program cost Adjustment for deadweight cost of program $0 $0 $0 ($3,003) ($3,003)
Totals $5,774 $157 $12,780 $783 $19,495
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Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $5,093 2016 Present value of net program costs (in 2022 dollars) ($6,007)
Comparison costs $1 2016 Cost range (+ or -) 10%
Per-participant cost estimate provided by the Washington State Department of Corrections.
The figures shown are estimates of the costs to implement programs in Washington. The comparison group costs reflect either no treatment or treatment as usual, depending on how effect sizes were calculated in the meta-analysis. The cost range reported above reflects potential variation or uncertainty in the cost estimate; more detail can be found in our Technical Documentation.
Benefits Minus Costs
Benefits by Perspective
Taxpayer Benefits by Source of Value
Benefits Minus Costs Over Time (Cumulative Discounted Dollars)
The graph above illustrates the estimated cumulative net benefits per-participant for the first fifty years beyond the initial investment in the program. We present these cash flows in discounted dollars. If the dollars are negative (bars below $0 line), the cumulative benefits do not outweigh the cost of the program up to that point in time. The program breaks even when the dollars reach $0. At this point, the total benefits to participants, taxpayers, and others, are equal to the cost of the program. If the dollars are above $0, the benefits of the program exceed the initial investment.

Citations Used in the Meta-Analysis

French, M.T., Sacks, S., De Leon, G., Staines, G. & McKendrick, K. (1999). Modified therapeutic community for mentally ill chemical abusers: Outcomes and costs. Evaluation & the Health Professions, 22(1), 60-85.

Sacks, S., McKendrick, K., Sacks, J.A.Y., Banks, S., & Harle, M. (2008). Enhanced outpatient treatment for co-occurring disorders: Main outcomes. Journal of Substance Abuse Treatment, 34(1), 48-60.

Sacks, S., McKendrick, K., Vazan, P., Sacks, J.Y., & Cleland, C.M. (2011). Modified therapeutic community aftercare for clients triply diagnosed with HIV/AIDS and co-occurring mental and substance use disorders. Aids Care, 23(12), 1676-1686.

Sacks, S., Sacks, J.Y., McKendrick, K., Banks, S., & Stommel, J. (2004). Modified TC for MICA offenders: Crime outcomes. Behavioral Sciences and the Law, 22(4), 477-501.

Sacks, S., Chaple, M., Sacks, J.Y., McKendrick, K., & Cleland, C.M. (2012). Randomized trial of a reentry modified therapeutic community for offenders with co-occurring disorders: Crime outcomes. Journal of Substance Abuse Treatment, 42(3), 247-259.

Sullivan, C.J., Sullivan, C.J., McKendrick, K., Sacks, S., & Banks, S. (2007). Modified therapeutic community treatment for offenders with MICA disorders: Substance use outcomes. The American Journal of Drug and Alcohol Abuse, 33(6), 823-832.

Van Stelle, K.R., & Moberg, D.P. (2004). Outcome data for MICA clients after participation in an institutional therapeutic community. Journal of Offender Rehabilitation, 39(1), 37-62.