This article is related directly to the First European Conference on Law Enforcement and Public Health (LEPH) held in Umea, Sweden in May 2023.
ABSTRACT
Crime associated with problematic substance use remains a defining characteristic in the United States criminal justice system. In Alaska, a perennial leader in US criminal recidivism rates, thousands of formerly incarcerated individuals continue to commit crimes and misuse drugs and alcohol following their release from incarceration. The total cost of these crimes to victims and Alaska’s criminal justice system is over $2.3 billion annually.
The Set Free Model is a comprehensive intervention addressing the primary risk factors of criminal recidivism within an innovative therapeutic campus environment. Occurring within a four-phase operational framework for an average of 6 to 18 months, participants engage in a suite of services proven to reduce further criminal recidivism. These services include certified peer support, supportive housing, co-occurring substance use disorder treatment, career placement, intensive case management, and positive community reintegration.
Over an 18-month period, the nonprofit treatment agency Set Free Alaska provided the Set Free Model to a sample of 32 formerly incarcerated adults at high risk of criminal recidivism. Participants displayed a 21.8% recidivism rate compared with the current rate of 66.4%. Treatment engagement rates significantly improved compared with traditional outpatient rates (94.7% vs. 66.7%). Employment rates were also remarkable compared with national employment rates at 1-year post-release (100% vs. 37%). Validated calculations indicate the sample population may achieve $6.25 million in cost savings and net economic benefits. Evaluation results indicate the model possesses significant potential to reduce criminal recidivism and should be further expanded and evaluated.
Key Words: Recovery, treatment, therapeutic campus, criminogenic needs
Despite recent reforms, drug-related offenses remain a defining characteristic of the US criminal justice system. Over 451,000 Americans are incarcerated for a nonviolent drug offense every day (Sawyer & Wagner, 2019). Nearly 63% of all incarcerated individuals in the United States, approximately 1.5 million people, meet the criteria for a substance use disorder (Bronson et al., 2017; Epperson et al., 2018). Unfortunately, a large disconnect continues to exist between the treatment of substance use disorders and the criminal justice system. Almost 85% of inmates who could benefit from treatment do not receive it within a US correctional facility (Chandler et al., 2009). To reduce the incarceration of individuals with substance use disorders, innovative approaches must be implemented that specifically address the relationship between problematic substance use and criminal recidivism.
Currently, thousands of formerly incarcerated individuals engage in problematic substance use and commit new crimes following their release from incarceration in Alaska. However, the state significantly lacks the community-based infrastructure and service capacity to effectively meet the needs of individuals with substance use disorders who are at risk of ongoing criminal activity.
The relationship between problematic substance use and incarceration in Alaska is clear: 80% of all individuals in the state’s correctional system report a substance use disorder (Alaska Department of Corrections, 2017). Upon exiting the institution, these individuals are often given the same soiled clothes they wore upon admission and are required to redefine their entire lives while somehow maintaining their sobriety. As most formerly incarcerated individuals are unable to effectively access appropriate treatment, secure safe and sober housing, achieve economic viability, and connect with supportive peer networks (Mallik-Kane & Visher, 2008), a return to criminal activity and substance use relapse is highly probable.
Within the first 2 weeks after release, formerly incarcerated individuals with substance use disorders are 129 times more likely to die of a drug overdose (Kinner & Binswanger, 2018; Rich et al., 2011). Should they survive this period, 66% of these individuals in Alaska will be reincarcerated within the next 3 years (Alaska Department of Corrections Reentry, 2019). Beyond 3 years, the US Bureau of Justice Statistics reports that 83% of these individuals will likely be rearrested (Alper et al., 2018).
The economic cost and social impact of crime attributed to problematic substance use in Alaska is substantial. The Alaska Mental Health Trust Authority (2020) recently reported that 25,450 Alaskans were victims of crimes directly attributed to drug and alcohol misuse in 2017. The total cost of these crimes to the victims and to Alaska’s criminal justice system was over $2.3 billion, with an average total cost per crime of $90,923 (Alaska Mental Health Trust Authority, 2020).
Unfortunately, 92% of all individuals returning to incarceration in Alaska still require treatment for substance use disorders (Alaska Department of Corrections Reentry, 2019). A viable, community-based option capable of addressing all criminogenic needs within one model does not currently exist in Alaska. Until community-based service capacity is increased, these Alaskans will continue to be trapped in a vicious and costly cycle of criminal activity and relapse resulting in more victims, longer incarceration, and even death. Successfully addressing this challenge as a strategy to promote smart decarceration will result in profound social, health, and economic benefits (Epperson et al., 2018; McCollister et al, 2010).
The Set Free Model for reducing criminal recidivism is a comprehensive intervention addressing the primary risk factors of ongoing criminal activity within an innovative therapeutic campus environment. The innovative model is primarily designed to effectively address criminogenic needs and mitigate problematic substance use relapse among formerly incarcerated adults with substance use disorders.
The Set Free Model is built upon the Criminogenic Needs Theory. Established by Andrews and Bonta (1998), the Criminogenic Needs Theory is grounded in substantial amounts of empirical evidence that suggest it is possible to reduce reoffending rates by treating or rehabilitating offenders rather than simply punishing them. Criminogenic needs are defined as dynamic attributes of offenders and their circumstances that, when changed, are associated with reduced rates of recidivism (Andrews & Bonta, 1998; Ward & Stewart, 2003). Andrews and Bonta (1998) identify criminogenic needs important to reducing offending as: substance use, antisocial cognition, antisocial associates, family and marital relations, education, employment, and leisure and recreational activities. Wooditch et al. (2014) particularly highlight access to substance use disorder treatment, positive relational networks, economic viability, and increased recreational activities as important factors in reducing a return to problematic substance use and criminal behaviours. Wooditch et al. (2014) conclude that participation in treatment programs for a 6- to 12-month time period can likely facilitate changes in criminogenic needs.
The Set Free Model occurs within a unique, four-phase operational framework: Reentry, Recovery, Reintegration, and Restoration. Living on a therapeutic campus for an average of 6 to 18 months, participants engage in a suite of services proven to reduce further criminal recidivism and problematic substance use. These services include: certified peer support (Boman & Mowen, 2017; Gonzales et al., 2019), supportive housing (Fontaine, 2013; Mericle et al., 2015), co-occurring substance use disorder treatment (Chandler et al., 2009; Jewell et al., 2017; Kohn, 2018), education, training, and career placement (Jilani, 2018; Mullaney, 2018; Smith, 2018), intensive case management (Prendergast, 2009), and positive community reintegration (Boman & Mowen, 2017; Spooner & Hetherington, 2004). As participants begin transitioning out of the therapeutic campus, they receive assistance in establishing their own stable housing, are supported in gaining or maintaining viable employment, and continue participating in community-based social activities. Participants also have access to case management and recovery support as needed.
Over an 18-month period, Set Free Alaska, a leading nonprofit treatment provider certified in the state of Alaska, provided the Set Free Model prototype to 32 formerly incarcerated adults who were at high risk of problematic substance use and ongoing criminal behavior.
Demographic analysis suggests those in most need of recidivism reduction interventions in Alaska are adults aged 18 to 44 with substance use disorders who are incarcerated for less than 2 years (Alaska Department of Corrections, 2019). The US Sentencing Commission (2016) further identifies individuals with a high school diploma or less and a lower socio-economic status as the most likely to be rearrested. Individuals at high risk for recidivism and problematic substance use have typically experienced substantial amounts of childhood and adult trauma (Wolff & Shi, 2012). Further, they usually lack stable housing within a supportive social and cultural environment (Moore & Elkavich, 2008; Spooner & Hetherington, 2004).
Gender demographics of incarcerated individuals in Alaska indicate a distribution of 90.63% male and 9.37% female (Alaska Department of Corrections, 2019). The race/ethnicity demographics within the Alaska Department of Corrections (2019) include: Caucasian (43.10%); Alaska Native (37.32%); Black (10.37%); Asian/Pacific Islander (5.03%); Hispanic/Latino (3.48%); and Other (0.70%).
All participants received services in line with the Set Free Model’s four-phase operational framework. These services and their operational justifications are described as follows:
Certified Peer Support – Direct connection with an individual with lived experience and peer groups who have successfully overcome addiction and criminal behaviours. Research indicates that a positive connection to peers with lived experience provides an array of benefits to individuals at risk of criminal recidivism and problematic substance use (Boman & Mowen, 2017; Gonzales et al., 2019; Mallik & Visher, 2008; Rocha, 2019). Upon release, peer support workers assisted formerly incarcerated individuals with aspects of psychosocial adjustment related to subverting prison social norms identified as the convict code (Mitchell et al., 2020). Garland et al. (2011) relate that nearly 60% of formerly incarcerated individuals report general anxiety and disorientation due to the social adjustments required with living outside of the correctional facility. Peer support workers helped participants mitigate potential culture shock as they transitioned from incarceration into living on Set Free Alaska’s therapeutic campus.
Supportive Housing Environment – Access to living in a safe and stable recovery residence. Access to a sustainable housing environment that reinforces healthy behaviours is a critical component in reducing recidivism and relapse (Fontaine, 2013; Jason et al., 2013; Mallik & Visher, 2008; Mericle et al., 2015). Participants lived on the therapeutic campus and engaged in a suite of individualized services for an average of 6 to 18 months. Jason et al. (2013) relate that transitioning directly to a recovery-based environment immediately after release from incarceration promotes a stronger likelihood of abstinence self-efficacy than reintegrating back into former residences or unstable settings that lack oversight and support. Set Free Alaska’s therapeutic campus provided a structured, therapeutic setting that facilitated a healthy transition to stable long-term housing, a robust sober community connection, and easy access to critical services.
Co-Occurring Substance Use Disorder Treatment – Rapid access to therapeutic, individualized, and trauma-informed treatment. Access to effective substance use disorder treatment is widely recognized as critical to reducing criminal recidivism (Chandler et al., 2009; Jewell et al., 2017; Kohn, 2018; Roybal, 2011). On the therapeutic campus, Set Free Alaska’s licensed clinical social workers and certified addiction counselors provided a comprehensive therapeutic approach to address the prominent comorbidity of substance use disorders and mental health challenges that often occur. Staff used evidence-based models, including cognitive behavioral therapy, motivational interviewing, dialectical behavioral therapy, client-centered approach, and moral reconation therapy. In addressing the thought distortions and transgressions that present during therapeutic intervention, formerly incarcerated individuals addressed the foundational criminal and addictive thinking patterns that had perpetuated their cycle of problematic substance use and subsequent recidivism.
Intensive Case Management – Assistance in accessing services such as medical care, pain management, dental care, public assistance, and other necessary supports. A comprehensive meta-analysis of interventions for offenders with substance use disorders highlighted intensive case management as a crucial community-based service for the desistance from further criminal behaviours and problematic substance use (Prendergast, 2009). Set Free Alaska’s clinical staff assisted participants with identifying and accessing critical community-based services, completing applications for benefits, and attending scheduled appointments.
Economic Viability – Access to education, training, and career placement opportunities. Recent social enterprises and research findings have highlighted the importance of meaningful employment and socioeconomic stability in achieving and sustaining a crime-free and sober lifestyle (Jilani, 2018; Mullaney, 2018; National Employment Law Project, 2016; US Council of Economic Advisors, 2018). Set Free Alaska’s employment specialists helped participants develop and pursue a viable and sustainable career pathway. Support included access to individualized education, training, and career placement opportunities. Employment specialists also assisted participants in overcoming social norms that often create barriers to meaningful employment (Agan & Starr, 2016; Couloute & Kopf, 2018).
Positive Community Connection – Assistance in overcoming existing social stigmas and barriers to developing meaningful community relationships apart from treatment. To mitigate the potential of trans-institutionalization (Primeau et al., 2013) from correctional environments to the therapeutic campus setting, peer support workers served as strategic relational bridges to positive community support networks outside of the treatment environment. Peer support workers facilitated interaction within the community to promote social and recreational skills, healthy community relationships, and a sense of belonging. The networks and relationships built within the peer support construct offer formerly incarcerated individuals the opportunity to reconnect with their communities, find purpose within their recovery capital, and ultimately reduce the likelihood of recidivating in the future.
Ongoing Support – Developing resilience, stability, and a strong sense of belonging. A sense of community belonging is widely recognized as an important factor in recidivism reduction (Boman & Mowen, 2017; Mallik & Visher, 2008; Moore & Elkavich, 2008; Spooner & Hetherington, 2004). While the presence of ongoing support is essential for long-term success in reintegration and recidivism reduction, the quality and meaningfulness of these connections is particularly influential in goals relating to problematic substance use (Lookatch et al., 2019). Throughout the treatment experience, from reentry to full community reintegration, Set Free Alaska staff used co-created treatment plan goals to identify relationships and activities that were congruent with participants’ individualized goals, core values, and passions. Prior to participants leaving the therapeutic campus, Set Free Alaska staff worked to ensure that a robust long-term restoration strategy was developped and community support networks were in place. As participants transitioned out of the therapeutic campus, they received assistance in establishing their own stable housing and gaining or maintaining viable employment. Participants also continued in the community-based social activities they were introduced to in the earlier phases of the model.
A programmatic evaluation was conducted using a combination of Set Free Alaska’s de-identified treatment records and the publicly available State of Alaska CourtView arrest and remand database. De-identified treatment records included outcome data from co-occurring substance use disorder treatment services, case management and peer support engagement data, active employment status, and service engagement rates. A comparative analysis was then conducted to assess differences, if any, between prototype participants and a control group of similar justice-involved individuals with problematic substance use challenges in Alaska.
Formerly incarcerated individuals who engaged in the Set Free Model presented significantly higher attendance rates to treatment groups, individual counseling sessions, peer support services, and case management sessions. Prototype participants achieved an average attendance rate of 94.7% compared with the existing outpatient and intensive outpatient attendance rate average of approximately 66.7%. Historic reports from outpatient treatment participants consistently indicate the biggest barrier to treatment and meeting attendance is access to reliable and affordable transportation. Transportation challenges appear to be exacerbated in Alaska and other similar locations where great geographic distances exist between limited services and available housing.
Although employment and economic viability are identified as critical to maintaining a sober and crime-free lifestyle, only 37% of formerly incarcerated individuals nationally are able to find employment within the first year after their release (Carson et al., 2021). Approximately 83.3% of those participating in the Set Free Model prototype found employment within the first 6 months and 100% found employment prior to transitioning out of the therapeutic campus environment.
Of the 32 formerly incarcerated participants in the Set Free Model prototype, 5 were remanded due to probation violations and 2 were arrested on new criminal charges for an overall recidivism rate of 21.8%. All 7 individuals who were remanded or arrested left the therapeutic campus of their own accord prior to completing the full treatment process. While any occurrence of remand or rearrest is not a desirable outcome, the recidivism rate demonstrated in the prototype evaluation was a marked improvement over the current rate being reported in the state of Alaska of 66.4% (see Table I). According to cost-of-crime and economic benefit calculations provided by the Alaska Mental Health Trust Authority (2020) and McCollister et al. (2010), respectively, the 18-month Set Free Model prototype may result in a combined cost savings and net economic benefit of up to $6.25 million.
TABLE I Comparative analysis results
Due to COVID-19 pandemic protocols, the sample size during the prototype’s 18-month evaluation had to be limited to 32 participants. Other than the sample, it is undetermined whether these protocols had a significant impact, if any, on participant outcomes. It is important to note that throughout the intervention, ethical standards dictated that participation remain on a voluntary basis. As a result, Set Free Alaska staff were limited in their ability to retain an individual in services if that individual desired to leave the therapeutic campus environment prior to the completion of their treatment. The prototype’s recidivism results appear to support Wooditch et al.’s (2014) findings that longer durations of participation in treatment services are correlated with lower recidivism rates. Of the participants that recidivated, all seven voluntarily left services early. This is a highly likely indicator that they did not have sufficient time on the therapeutic campus to make significant changes in their criminogenic need areas. Because length of stay appears to be a critical factor in reducing the risk of criminal recidivism, it is recommended that Set Free Alaska staff continue to pursue additional strategies to maximize participants’ motivation for change while living on the therapeutic campus. However, the 21.8% recidivism rate demonstrated by the Set Free Model is a significant improvement over the existing 66.4% rate in Alaska.
Overall, the Set Free Model appears to provide a substantial opportunity for changing criminogenic needs. In addition to living in a safe, therapeutic environment, participants achieved significantly higher rates of treatment service engagement (94.7% vs. 66.7%) and meaningful employment (100% vs. 37%). These factors have all been attested as critical to reducing criminal recidivism (Mallik & Visher, 2008; Spooner & Hetherington, 2004). In addition to lives changed, the prototype’s potential cost savings and economic benefits of up to $6.25 million is in alignment with the US Council of Economic Advisors (2018) report of $5.27 of value for every $1.00 of taxpayer money spent.
As the intervention continues to grow and the number of graduates increases, it will be imperative for Set Free Alaska to advance strategies that improve participant connectedness in the community beyond the 18-month time period. The development and integration of automated systems to track long-term recidivism of participants should also be pursued.
Given the results displayed within the prototype and the validated success of interventions using the Criminogenic Needs Theory, the European Union’s (2018) Triple-R Model, and the Norway Model of Restorative Justice (Hagstrom, 2016; Janzer, 2019; Sterbenz, 2014), it is reasonable to conclude that the Set Free Model is capable of achieving significant social impact and reduced recidivism rates.
Although the model may have been hindered by a lower sample size due to COVID-19 protocols, results indicate the model possesses a valuable potential to redefine the recidivism reduction landscape. The model should therefore be advanced to serve more individuals and evaluated with a larger sample size over a longer period of time. Effectively reducing criminal recidivism will have tremendous social, health, and economic impacts in Alaska. The state of Alaska will also likely position itself as a national leader in recidivism reduction in the United States.
The authors acknowledge Set Free Alaska CEO Mr. Philip Licht, Dr. Peter Pirnejad, Alaska Senator Shelley Hughes, Alaska Senator Natasha von Imhof, Alaska Representative Chuck Kopp, Alaska Representative Ivy Spohnholz, Mrs. Shareen Crosby, and Mrs. Heather Carpenter for their role in establishing this project. Finally, the authors extend a sincere thank you to the dedicated and caring staff of Set Free Alaska. This project was supported through a direct funding allocation from the Alaska State Legislature.
The authors have no conflicts of interest to declare.
*61Sixty Social Innovation Lab, Palmer, AK, USA;
†Set Free Alaska, Wasilla, AK, USA.
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Journal of CSWB, VOLUME 8, NUMBER 3, September 2023