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Almost 90% of all State and Federal prisons in the U.S. offer some form of substance abuse counseling, and one in eight prisoners have participated in a substance abuse treatment program while incarcerated. Evidence indicates that these programs can be successful in stopping prisoners' substance abuse. While some data are available about the success of these programs, little is known about program administrators', counselors' and participants' experiences with and perceptions of these treatment programs. These experiences and perceptions remain important because they may be helpful for understanding areas of agreement and conflict in staff-participant relationships. The more understanding we have for these relationships, the more likely it is that we will be able to improve staff-participant communications, program effectiveness, and participant success. The results suggest similarities and differences between staff and participants in the areas of participant motivation, staff-participant communication, race, institutional support, and counselor contacts. Implications of the results of this inquiry for prison-based substance abuse treatment programs are discussed.

This article reviews the recent literature on health services use by drug abusers. A revised Andersen-Newman model is posited as a theoretical orientation for health service initiatives focused on drug abuse. The model highlights specific predisposing factors, historical health factors, current illness factors, and enabling/mediating factors associated with drug abuse. The limited number of cost-effectiveness studies have demonstrated that publicly funded drug treatment can produce savings by reducing selected health care costs and decreasing crime. However, short-term costs related to drug abuse can be greater to realize than long-term savings. The criminal justice system can serve as a point of contact and provides a concentrated reservoir of drug users. However, drug-abusing offenders are more likely to present a variety of health problems including hepatitis, tuberculosis, and HIV/AIDS. From a managed care and health services use perspective, drug abuse treatment in the criminal justice system should minimize long-term health care- and crime-related costs., Bringing drug treatment services into the mainstream of health services and targeting drug abusers have been priorities of the National Drug Strategy (Office of the National Drug Control Policy [ONDCP], [...]