Incarceration of offenders has proven to be a serious and persistent problem for criminal justice and public health systems. These systems must balance punishment and rehabilitation while simultaneously dealing with a high prevalence of psychosocial problems among criminal offenders, which contribute to the likelihood of ending up back in prison (i.e., recidivism). The cycle of recidivism is an economically and socially damaging problem and can be partially blamed on a lack of standard protocols for behavioral health, education, and other services both in prison and after release. Central to these challenges are concerns about the economic impact of rehabilitation interventions for offenders. In the face of unprecedented local, state, and federal budget crises, policy makers struggle to identify programs that are not only cost-effective in reducing recidivism but also save money over time by reducing broader societal costs associated with substance use, criminality, homelessness, unemployment, and other disadvantages faced by criminal offenders. This article presents data related to adults involved in the U.S. correctional system (during and after incarceration) and highlights some of the programmatic issues associated with attempts at rehabilitating these individuals and thereby reducing reoffending.
The U.S. Adult Corrections Population
The Bureau of Justice Statistics reported that an estimated 6.7 million individuals were involved in the adult correctional system in the United States as of year-end 2015. The number of incarcerated individuals equated to approximately 1 in 36 adults or roughly 3% of the total U.S. population. The overall number of adults involved in the correctional system has shown a decreasing trend over the past few decades, primarily due to reductions in the probation and incarcerated population. The parole population showed a modest increase (1.5%) in 2015. The National Institute on Drug Abuse, through a survey conducted by the U.S. Department of Justice in 2002, has concluded that approximately 70% of state and 64% of federal prisoners regularly used drugs, including alcohol and illicit substances, prior to their incarceration and as many as one in four violent crime offenders committed their offenses under the influence of drugs. Not only do many offenders commit crimes as a result of using substances and in order to finance their substance use but also many incarcerated persons with substance use disorders find it difficult to reintegrate into society upon release from prisons or jails.
In addition to a history of mental illness and substance use, factors such as the seriousness of offenses committed and low socioeconomic status perpetuate the recidivism and reincarceration cycle, also known as the revolving door between jail or prison and the community. Based on data from 2005, the National Institute of Justice has reported that nearly two out of three prisoners will be rearrested within 3 years post-release, and nearly three out of four prisoners will be rearrested within 5 years. With respect to total recidivism, more than half of those prisoners will be rearrested during the first year post-release. These rates are even higher among drug offenders and violent offenders—76.9% of drug offenders and 71.3% of violent offenders with histories of substance use are reincarcerated.
Economic Concerns
According to the Bureau of Prisons, the average cost of incarceration for a federal inmate in fiscal year 2014 was US$30,620 (US$83.89 per day). While the average cost per state inmate varies drastically by state, a 2012 Vera Institute of Justice Survey estimates that the average state prisoner costs taxpayers US$31,286 per year (US$86 per day). In addition to the direct costs of incarceration, the societal cost of crime includes direct losses to victims, such as medical expenditures and the value of stolen property, policing and legal/adjudication costs, lost productivity, the risk of homicide for certain offenses, and the intangible losses associated with a victim’s pain and suffering. Some offenses, such as rape/sexual assault, carry a societal cost per offense of more than US$200,000. Due to such high societal costs of criminal activity, rehabilitation and reentry programs that generate even modest reductions in crime—especially costly violent offenses—have the potential to be cost saving.
Rehabilitation Programs in Criminal Justice Settings
Rehabilitation programs in criminal justice settings are numerous and target the unique behavioral, social, and environmental needs of the offender population. Many of these programs feature mental health or substance use disorder treatment (e.g., in-prison therapeutic communities for co-occurring disorders); others focus on vocational training, on education, or, more specifically, on reducing the risk of reoffending by addressing criminogenic tendencies (e.g., Risk-Need-Responsivity). These programs have been implemented within correctional institutions, after incarceration, or, in the case of specialty courts, as alternatives to incarceration for nonviolent and/or first-time offenders.
The role of substance use disorder treatment in the rehabilitation process is a major area of focus among criminal justice and public policy stakeholders, but consensus regarding a standard set of evidence-based treatment models for offenders is unreconciled. Evidence of effectiveness from randomized trials and quasi-experimental studies of treatment interventions for criminal offenders is mixed. Many studies have found that in-prison treatment, for example, is effective in reducing substance use and criminal recidivism in the short run but only for offenders who are engaged in aftercare programs upon release from prison. Other studies have found that differences in substance use and criminal activity between treated and untreated offenders evaporate over time.
Evidence supporting post-incarceration interventions is less tenable. Randomized trials of interventions targeting relapse prevention and improved linkage to substance use treatment services through parole or probation-based case management programs or intensive supervision did not find statistically significant differences in substance use, recidivism, or service utilization among intervention participants relative to standard community supervision. The interventions did show some promise, however, among subgroups of participants such as women offenders or those using specific substances (e.g., marijuana).
Drug courts have a solid base of support among policy makers and researchers in terms of their effectiveness in curbing reoffending. The National Association of Drug Court Professionals cites numerous facts promoting expanded support for these programs. Notably, scientific studies have shown that approximately three quarters of drug court participants remain arrest-free in the 2 years following participation in a drug court program. Moreover, relative to incarceration or other sentencing options, drug courts have been shown to reduce self-reported crime (that may or may not have led to arrest and incarceration) by as much as 45%.
Expanded implementation of rehabilitation interventions for criminal offenders requires not only clinical evidence of best practices but also consideration for the additional costs and cost-effectiveness of these programs. While economic studies examining corrections-based interventions are relatively scarce, a few studies have estimated the cost-effectiveness or net economic benefits of rehabilitation programs for adult and juvenile offenders, including Risk-Need-Responsivity, work release programs, vocational training, specialty court programs, and substance use disorder treatment. For instance, using data from randomized trials conducted between 1998 and 2004, studies investigating the cost-effectiveness of in-prison therapeutic communities in California state prisons found that in-prison treatment alone was not cost-effective relative to a no-treatment comparison group, but in-prison treatment plus post-incarceration aftercare was cost-effective in reducing reincarceration and also cost saving when compared to the daily cost of housing an inmate in state prison. Other sources of savings associated with in-prison rehabilitation programs include reduced prison management costs. An economic analysis conducted in 2006 of prison-based therapeutic community programs at the California Substance Abuse Treatment Facility found that compared to nontreatment prison yards, the in-prison treatment yards generated lower administrative costs for disciplinary actions, inmate grievances, and major disruptive incidents resulting in lockdowns.
Benefit–cost analyses have also been conducted on education and vocational training programs, probation and parole-based programs, and specialty courts. An economic evaluation of adult drug court programs in Kentucky, conducted in 2004, found that among program graduates, US$3.8 in economic benefits were generated for every US$1 invested in the programs. Drug court evaluations in several other states have demonstrated similar cost-savings results. According to primary evaluations and meta-analyses across numerous rehabilitation programs by the Washington State Institute for Public Policy (updated in 2017), most rehabilitation programs for offenders generate positive net economic benefits. Exceptions include life skills education programs, domestic violence perpetrator treatment, police diversion for individuals with mental illness, intensive supervision for juvenile offenders, as well as policies such as sex offender registration and community notification.
Nonmeasured Cost Savings
Most of the economic studies summarized herein do not capture the full range of outcomes that can be used to assess the economic benefits of rehabilitation interventions for criminal offenders. The consequences of criminal offending and incarceration impact other domains such as physical and mental health services utilization, employment and educational outcomes, dependence on social services, risky sexual behavior including HIV and hepatitis C risk, and quality of life. If corrections-based rehabilitation programs can be linked to reduced emergency department visits, reductions in criminal activity, improved productivity, and reduced HIV risk, desired changes in many of these outcomes can be translated into dollars and used to calculate the economic benefits and cost savings. For instance, based on estimates using national data, the average cost per emergency department visit (treat and release) is US$389 (from 2016 data), and the average cost per robbery is US$45,118 (from 2008 data). If a corrections-based intervention generates on average 20 fewer emergency department visits and five fewer robberies per year relative to a nontreatment comparison condition, this would generate $233,370 [(20 × $389) + (5 × $45,118)] in medical and crime-related savings to society.
Policy Recommendations
Any debate that previously existed regarding rehabilitation versus incarceration of criminal offenders has been replaced with a debate about which rehabilitation programs represent the best investments for the criminal justice system. The powerful connections among substance use, crime, and incarceration, coupled with the high costs of imprisonment, indicate there is a potentially cost-saving opportunity to address substance use disorders within the criminal justice population. Most notably, the controlled environment of a prison presents an opportunity to offer substance use treatment and other rehabilitation programs to inmates at a relatively modest cost. As policy makers strive to allocate limited resources across competing programs, better understanding of whether corrections-based rehabilitation programs are both effective and cost-effective is key. Cost-effectiveness analysis is a powerful tool for demonstrating the competing programs that generate the greatest improvement in such desired outcomes as reduced rearrest or reincarceration for the lowest cost. Theoretically, it is expected that more expensive programs will generate greater improvements, a result that was verified in many of the cost effectiveness studies of in-prison therapeutic community treatment plus aftercare. Studies of probation and/or parole-based interventions for offenders with substance use disorders are less encouraging, but research is more limited in this area and further investigation is warranted.
There are some key findings from the existing economic research on rehabilitation programs for criminal offenders. First, providing rehabilitation programs in correctional settings is generally effective in reducing criminal recidivism and substance use relapse, but these effects may disappear over time. Second, a continuum of care featuring in-prison programs plus post-incarceration reentry and recovery support services is cost-effective. Third, post-incarceration programs for offenders play a pivotal role in determining the overall cost-effectiveness of providing rehabilitation services to prisoners. Fourth, broader economic evaluations of rehabilitation programs should include outcomes such as health services utilization, criminal activity (irrespective of arrests or convictions), social services utilization, and employment to demonstrate the extent to which corrections-based rehabilitation is cost saving over time. Finally, as the science on rehabilitation versus incarceration continues to evolve to include protocols such as screening, brief intervention, and referral to treatment, continuing care/recovery management, and e-health technologies, determining the effectiveness and cost-effectiveness of these approaches as they translate to criminal justice settings must be a national research priority.
References:
- McCollister, K. E., French, M. T., Inciardi, J. A., Butzin, C. A., Martin, S. S., & Hooper, R. M. (2003). Postrelease substance abuse treatment for criminal offenders: A cost-effectiveness analysis. Journal of Quantitative Criminology, 19(4), 389−407. doi:10.1023/B:JOQC.0000005441.49529.61
- McCollister, K. E., French, M. T., Prendergast, M. L., Hall, E., & Sacks, S. (2004). Long-term cost-effectiveness of addiction treatment for criminal offenders: Evaluating treatment history and reincarceration five years postparole. Justice Quarterly, 21(3), 659−679. doi:10.1080/ 07418820400095941
- McCollister, K. E., Scott, C. K., Dennis, M. L., Freitas, D. M., French, M. T., & Funk, R. (2014). Economic costs of a post-release intervention for incarcerated female substance abusers: Recovery management checkups for women offenders (RMCWO). Journal of Offender Rehabilitation, 53(7), 543–561.
- Prendergast, M., Frisman, L., Sacks, J. Y., Staton-Tindall, M., Greenwell, L., Lin, H. J., & Cartier, J. (2011). A multi-site, randomized study of strengths-based case management with substance-abusing parolees. Journal of Experimental Criminology, 7(3), 225–253.
- Romani, C. J., Morgan, R. D., Gross, N. R., & McDonald, B. R. (2012). Treating criminal behavior: Is the bang worth the buck? Psychology, Public Policy and Law, 18, 144–165. doi:10.1037/a0024714