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From Residential Treatment through Aftercare— South Carolina's Collaborative Approach

—Milan O'Bradovich, Chief of Special Programs, South Carolina Department of Corrections

In South Carolina, more than 60 percent of inmate offenses are related to alcohol and other drug abuse in some measure. Substance abuse directly accounts for at least 35 percent of arrests. In addition, almost 2/3 of all burglaries and more than 1/2 of all murders and rapes are committed while under the influence of alcohol or other drugs.

Prior to 1989, South Carolina inmates with substance abuse problems had limited resources available. They received educational services, individual and group counseling, and were encouraged to participate in Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) groups. In part because their addiction problems received minimal treatment, the inmates had a high probability of recidivism—a problem that contributed to South Carolina's high rate of incarceration. Since 1989, however, eligible inmates in South Carolina have had a better alternative—a program that provides residential alcohol and other drug addiction treatment services just prior to their release from corrections and then provides aftercare services when they return to the community.

This program is making a real difference in the lives of treated offenders after their return to their communities. An outcome study of 2nd- and 3rd-year participants in the program, as compared to a comparison group, showed that program participants have fewer relapses and that their odds of reoffending are reduced by 51 percent.

In addition, the program graduates are better citizens: they have more full-time jobs; higher average earnings; fewer job changes, firings, and financial problems; and are more satisfied with their post-incarceration living arrangements. Almost 9 of every 10 participants in the residential program receive three or more sessions of aftercare—an impressive figure considering that these services are delivered at 37 different substance abuse agencies spread throughout South Carolina.

The South Carolina collaborative effort

In 1988, Commissioner Parker Evatt initiated a meeting with two other State agencies to discuss ways to reduce the problem of escalating admissions to the State correctional system and the growing number of incarcerated substance abusers.

The involved agencies include South Carolina's Department of Corrections; the Commission on Alcohol and Drug Abuse—the single State agency for substance abuse; and the Department of Probation, Parole, and Pardon Services. Because the program's success would be contingent upon each agency's willingness to accept ownership for the program and to ensure open communication and teamwork, an Interagency Committee was established during the planning phase. This committee continues to meet regularly to oversee the program's operation.

The collaborative model created by the three South Carolina agencies is designed to provide vital services to a previously underserved and rapidly growing population without creating a new level of bureaucracy in the process. The program reduces duplication of effort by relying on the specific expertise of staff in each of the three agencies. The program contains two components: a residential treatment unit for substance-abusing offenders just prior to their release from incarceration, and a coordinated aftercare program. Women offenders participate in the treatment unit on an outpatient basis.

One of the greatest strengths of the program is its aftercare component, which provides inmates with continuing outpatient treatment services as necessary. The Commission on Alcohol and Drug Abuse provides aftercare services through its statewide system of 37 county alcohol and drug abuse agencies; these were established in 1975 to provide prevention, intervention, and treatment services to residents of all 46 counties.

The residential component

After a year of planning, the three agencies opened the doors of the Addictions Treatment Unit (ATU), the State's first residential treatment program for incarcerated alcohol and other drug abusing offenders. Through a 3-year start-up grant from the Governor's Office, Division of Public Safety Programs, the ATU opened in August 1989 and since that time has graduated 950 inmates.

The ATU, housed at the Watkins Pre-Release Center, is based on a collaborative model involving all three State agencies, with the Commission on Alcohol and Drug Abuse being responsible for the day-to-day operation of the treatment program itself through a contract with the Lexington/Richland Alcohol and Drug Abuse Council. The ATU provides residential treatment to offenders who have histories of chronic problems with alcohol and other drugs as a means of reducing these problems as well as reducing their criminal and other self-destructive behaviors.

Inmates who are eligible for admission to the ATU must have an identifiable problem with alcohol and/or other drugs, must be willing to participate in the program, and must be able to undergo at least 1 year of supervised parole upon their successful completion of the ATU.

Inmates are screened for eligibility by staff of the Department of Probation, Parole, and Pardon Services with assistance from Department of Corrections personnel. Following this initial screening, the State Parole Board reviews potential candidates for eligibility, and, if approved, inmates are given a conditional parole pending successful completion of the ATU. Inmates are released from the correctional system only after they have:

Successfully completed the ATU
Provided verification of employment
Made appropriate living arrangements with relatives or in a group home
Agreed to participate in aftercare services in the community

The aftercare component

Prior to graduation, ATU staff contact the respective county alcohol and drug abuse agency to make initial appointments for each client to receive outpatient services. Staff of the Department of Probation, Parole, and Pardon Services also meet with the inmates to define the conditions of release and to set up initial appointments with local parole officers.

Once released, each client's progress is monitored by the three systems through a comprehensive tracking mechanism. Graduates also receive supervision from their parole officers and are required to undergo routine urinalyses.

**Profile: South Carolina's Addiction Treatment Unit (ATU)**
The ATU residential program is designed to provide a therapeutic community-style environment that helps inmates internalize positive social behaviors that lead to a drug-free lifestyle. The program facilitates a healthy re-entry into the community and provides a structured continuum of care to prevent relapse with regard to alcohol and other drug use and other criminal behaviors. The ATU offers five 60-day residential treatment cycles each year. Each cycle involves 60 inmates—48 males who reside on campus and 12 females who reside at the State Park Correctional Center and participate as outpatients. Inmates participate in a variety of activities, including: Individual, group, and family counseling Lectures/films, meditation, and journal writing Recreational, health, and wellness activities Involvement in the 12-step programs of AA and NA Urinalysis testing Each treatment cycle ends with a commencement type exercise which allows the new "graduates" to express what the treatment experience has meant to them. The exercise is attended by previous graduates and representatives of the sponsoring agencies.

**Recommended Strategies for Linking Corrections and Community Resources**
—From National Institute of Corrections, Intervening with Substance-Abusing Offenders: A Framework for Action; The Report of the National Task Force on Correctional Substance Abuse Strategies.U.S. Department of Justice, June 1991. This 168-page report is the outcome of a project co-sponsored by the National Institute of Corrections and the Bureau of Justice Assistance. These agencies brought together a task force composed of correctional practitioners representing jails, prisons, and community corrections, as well as researchers and substance abuse specialists and representatives from six Federal agencies. This task force developed a visionary and wide-ranging group of recommendations—some highlighted here—to help their peers in corrections create effective substance abuse programs for offenders. 1. The loose-knit cluster of independent entities making up the "correctional system" needs to provide linkages to assure effective communication across the entire system, including community-based agencies, for transmitting information and coordinating services. The Task Force recommends: Cumulative information should follow the offender from the earliest impact point throughout the system (impact points include pre-trial, probation, jail, prison, and parole). Relevant assessment and treatment information should be shared with all substance abuse treatment programs providing service to the offender. Offenders should have continuing care plans prior to transitioning between and from correctional agencies. Formalized agreements should be developed among State and local agencies in the correctional system and the treatment community that detail areas of responsibility, services provided, and mechanisms for information exchange. Combined case planning should be accomplished among correctional and treatment agencies when working with the same substance-abusing offender and when transferring the offender from one agency to another or from one part of the correctional system to another. Ongoing professional forums among correctional representatives and community treatment providers, especially at the policy-making level, should be held to address common concerns and issues. Cross-training (training across disciplines and agencies) covering a wide array of treatment techniques, case management issues, and criminal justice concerns should be conducted on an ongoing basis for professionals and paraprofessionals working with substance-abusing offenders. A management information system, preferably automated, should be established and used within and across systems to monitor the delivery of appropriate substance abuse programming to offenders, collect data for program evaluation, and establish a rationale for additional interventions and staff. 2. Each State should develop a correctional substance abuse program action plan to guide the development and implementation of programs for substance-abusing offenders throughout State and local correctional jurisdictions. 3. Correctional substance abuse treatment program managers and administrators are encouraged to develop linkages with [the many] State and local public and private resources that can frequently provide needed resources and needed skills in substance abuse treatment, programming, and evaluation.

A National Need—Linking Corrections with Treatment/Community Resources

—Parker Evatt, Commissioner, South Carolina Department of Corrections and former director, Substance Abuse Committee of the American Correctional Association.

This Nation has built more prisons in the past 15 years than were built in the previous 200 years. One of the major reasons for prison expansion is the increased crime that involves substance abuse. In meetings with other prison administrators, we agree that the present overcrowding in prisons relates in large part to the problem of substance abuse.

When about 75 percent of all incoming public offenders to prison have a substance abuse problem, there is clearly a need to provide treatment in prison. I consider it most advantageous to meet this dilemma with a coordinated effort. Across the country, all agencies involved with substance-abusing offenders need to work together in planning—and then implementing—comprehensive programs for treating these offenders. To involve corrections and community agencies in programming and coordination is a must.

No single model of coordination will work in every State. We must each develop a plan that fits the needs of the particular offenders in our State and that builds on the strengths of our State's people, resources, and departmental structures.

In South Carolina, we undertook a new coordinated approach in 1989. Our coordinated effort involves three agencies that jointly attack the substance abuse problem—the Department of Corrections; the Department of Probation, Parole, and Pardon Services; and the Commission on Alcohol and Drug Abuse. For our State, these agencies create a linkage designed to provide a comprehensive treatment program for offenders. This treatment begins in the prison setting and continues through community substance abuse agencies after the offender is released.

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