Often, low-level offenders with substance abuse issues come before a judge and are sentenced to a treatment center and program. While these alternatives to incarceration are utilized with treatment in mind, some offenders are remanded to programs that don't actually produce what the courts are looking for – rehabilitation results.

In Iowa, officials decided to look further into the effectiveness of substance abuse treatment programs that are recommended to their offenders and they were surprised by what they found.

“There aren't a lot of evidence-based practices out there,” says Stephan Arndt, Director of Iowa's Consortium for Substance Abuse. “Some treatment programs use evidence-based language in their manuals simply for advertisement. But people in community corrections need to know -- for sure -- that they are sending people to the right programs.”

The difference between programs that use proven practices and those that do not can be the crucial difference between treatment that works and treatment that does not. And, according to Arndt, referring offenders to programs that aren't proven to work not only hurts the offender – it hurts the community when that offender relapses. In an effort to reduce referrals to programs that aren't evidence based, the Iowa Consortium for Substance Abuse created the guide Evidence-Based Practices: An Implementation Guide for Community-Based Substance Abuse Treatment Agencies.

“When we look at treatment programs within this manual, we're trying to go for the highest standards,” Arndt says. “By ‘evidence-based', we mean that the program works and it's been documented that the program works. It's basic accountability for government agencies that are referring someone to a treatment agency.”

Evidence-Based Rehabilitation

In order to foster that accountability, a group of state researchers – including Arndt, a staff from treatment centers and a corrections representative – began to investigate and evaluate treatment programs in Iowa. Although the research for the guide was done in Iowa, Arndt says it can be used anywhere in the country.

“We created this guide broadly. Basically, a program is not evidence-based unless it produces an outcome, such as recidivism,” says Arndt. “If it doesn't do that, it shouldn't be referred to an offender. This guide was written as a precursor, mainly for states and administrators to begin to think about how they can set up something like this in their own state.”

Moreover, the guide suggests ways of identifying and implementing evidence-based practices, as well as maintaining those practices. In an attempt to link research and proven practice, the guide defines evidence-based practices, and suggests criteria for evaluating programs that already exist. In addition, the guide provides a review on evidence-based practices, and focuses on adoption strategy. The guide also outlines outcome measures.

“If you or I went to an agency because we had a problem, we'd want to go to a good one,” Arndt explains. “That doesn't necessarily mean they serve good food while you're there – it means that you want to get better. You go there with the expectation of rehabilitation. The agency needs to be able to document that they can provide results.”

Arndt hopes these guidelines will enable agencies to weed out programs that do not offer treatment that is been proven to be effective. Arndt is hopeful that treatment programs will start to adopt proper procedures.

“Agencies need to adapt to evidence-based procedures,” Arndt says. “Twenty years ago, the confrontational therapy method was considered to be clinically proper. But we've found over the years that confrontational therapy just makes people angry and results in a high dropout rate. If you're a community corrections client, dropping out often means you've violated your parole. In essence, that particular kind of therapy fostered failure – not success.”

Arndt cites motivational interviewing as a practice that has been proven to work. By using a non-confrontational approach, offenders can often realize – for themselves – that their substance abuse was related to their crime. By helping a person recognize the need for change, rehabilitation is more likely, he says.

Broad Guidelines Find Better Results

Aside from replacing treatment programs that aren't proven to work, the guide was also created to foster a new relationship between the state, corrections agencies and treatment programs.

“Sometimes, you get the sense that corrections and treatment programs do not always work together,” says Arndt. “But when we were actually talking to these people it became obvious that everyone involved – from the state to corrections to the treatment agencies – wanted people to get better.”

With the new relationships established between the state, corrections and treatment agencies, Arndt expects that a new collaboration between the three will result in better programs and standards. Arndt says that while the guide helps judges, corrections officials and the general public, it also puts a certain strain on research communities to produce more.

“There has been precious little research about this,” Arndt says. “This does put a burden on the research communities because people wonder where the evidence comes from. Sure, you can try to edge around this with terms like ‘best practices.' but those are not clinical judgements. What we were actually looking for was hard, scientific evidence that something works.”

By referencing offenders to programs that provide proven results, offenders have a better chance to truly rehabilitate themselves – rather than falling back into their old ways. Arndt says it's crucial to help offenders avoid returning to their bad habits – and hopefully Evidence-Based Practices: An Implementation Guide for Community-Based Substance Abuse Treatment Agencies can point administrators and offenders in the right direction.

Resource:
http://www.jointogether.org/sa/resources/database/reader/0%2C1884%2C566528%2C00.html