I. 30 Years

At the age of 24, Chelsey Cain was facing up to 30 years in prison for selling her roommate’s guns to buy drugs.

With the help of her family and a lawyer, Cain received a reduced sentence and used her time in prison to seek recovery through programs — like the therapeutic community at the SCI Cambridge Springs prison in Crawford County, Pennsylvania. She was released after 18 months and has been in recovery ever since.   

Cain, now 33, is a doctoral student in Temple University’s criminal justice program and hopes to reform prison treatment centers and drug policies.

Chelsey Cain, a doctoral student in Temple University’s criminal justice program, poses for a portrait in Temple’s Gladfelter Hall. PHOTO BY SYDNEY SCHAEFER

For Cain, prison was a life-saver. But incarceration doesn’t always positively affect people with addiction.

The criminal justice system’s response to substance use is mostly punitive — it often puts people with addiction into prison instead of treatment. According to the Brookings Institute, 3 million people were admitted to federal and state prisons in the United States for drug offenses from 1993 to 2011.

The National Center on Addiction and Substance Abuse reported that more than half of all people who are incarcerated met the criteria for a substance use disorder diagnosis in 2010 — but less than 11 percent received treatment.

In an effort to help people with addiction who are incarcerated, some prisons provide group-based residential treatment called therapeutic communities.

The Philadelphia Industrial Correctional Center is located on State Road in Northeast Philadelphia. PHOTO BY SYDNEY SCHAEFER

II. Prison as a Means of Reform

During the 1980s and ’90s, the war on drugs drove up the incarceration rate and length of sentences for drug offenses. Research from the Sentencing Project reported that there are more people behind bars for drug crimes today than there were in 1980.

But tougher drug laws and longer sentences did not prove to be a strong enough deterrent — a 2015 Pew research study found harsher drug sentencing laws had no effect on drug use.

Evan Figueroa-Vargas, a program manager at Mental Health Partnerships, said the eight months he spent in jail in 2008 had little influence on whether he would continue using drugs.

“I came out, and I relapsed,” Figueroa-Vargas said. “And it was interesting because I was on house arrest, and [the judge] told me, ‘If you come back in front of me, we’re going to give you seven to 15 years upstate.’ And none of that deterred me, or made me say like, ‘OK, I’m not going to do that.’”

Evan Figueroa-Vargas, a program manager at Mental Health Partnerships, poses for a portrait. PHOTO BY AUSTIN AMPELOQUIO

According to a 2014 report from the Journal of Drug Issues, “the strongest predictor of criminal recidivism is substance use.”

The most recent federal data from a 2014 Bureau of Justice Statistics report tracked 400,000 people who were released from prison between 2005 and 2010. Within three years, 67.8 percent were rearrested. And within five years, 76.6 percent were rearrested.

In Philadelphia, about 34 percent of people were rearrested within one year of release and 58 percent within 3 years.

Every time Cain hears the sound of a walkie-talkie, she’s reminded of the trauma she experienced while incarcerated. She saw people sell drugs that had been smuggled into the facility, which made it hard for her to focus on her recovery.

“A chill goes down my spine,” she said. “Just that feeling of always being watched and being monitored by corrections officers and by other inmates that want to prey on you, I think those were the biggest struggles for me.”

Christopher Cruz, 29, poses for a portrait on Kensington Avenue. PHOTO BY SYDNEY SCHAEFER

III. Therapeutic Communities

When prisons do provide drug treatment, it often looks something like this: a series of classes and workshops that provide people with information on substance use disorder and identify who may need further treatment.

“In prison, they generally get drug education, which is not really treatment,” said Steve Belenko, a criminal justice professor at Temple who specializes in substance use treatment and prisons. “There is some outpatient and counseling, but not a lot. And then there are 12-step programs, which are not bad, but that’s not clinical treatment.”

Some prisons are trying to change that by implementing long-term treatment programs.

One of the most common models is the therapeutic community, which encourages structured living and lifestyle changes in addition to abstinence from drug use. Stays in TCs can range from three to 18 months, but people stay for about a year on average.

In TCs, people participate in individual counseling sessions and group activities — which include community meetings, group counseling, group games and role-playing — that aim to correct negative behaviors like antisocial thinking, denial and a compulsion for instant gratification. Often, these programs are separated from the general prison population in order to maintain a controlled environment where people can focus on recovery.

Due to funding by the Bureau of Justice Assistance Residential Substance Abuse Treatment for State Prisoners program and the Residential Drug Abuse Program, the TC model has been incorporated into state and federal prisons across the country.

“Prior to going upstate, I had never been in a rehab before,” Cain said. “The regimented schedule was helpful for me, coming from a lifestyle prior to prison that had absolutely no schedule.”

Anthony Alonzo, 36, poses for a portrait on Kensington Avenue. PHOTO BY SYDNEY SCHAEFER

Christopher Cruz, 29, and Anthony Alonzo, 36, were cellmates for six months in Chester County Prison and participated in the same TC program.

“It was alright,” Alonzo said. “You have to go to school and get a job in there, and that was a good thing.”

“I just went to get parole off my back,” Cruz said. “But I’ll tell you what, you sit there and listen to people long enough, telling their stories…it can change your heart.”

Over the years, TCs have begun to accept people who take medication-assisted treatment. The program also phased out confrontation therapy, in which individuals are encouraged to call someone out for bad behavior and confront them in front of others.  

Research shows those who complete TC programs have a better chance of staying out of correctional facilities after release, and many people are offered a sentence reduction for participating in and completing the program.

But it’s still not offered at all facilities, and some only offer Vivitrol. Even those who take MAT as part of their TC program aren’t guaranteed access to it during re-entry.

“Each location is going to run a little bit differently, especially depending on how many counselors are on the caseload,” Cain said.

Philadelphia Department of Prisons House of Corrections is located on State Road in Northeast Philadelphia. PHOTO BY SYDNEY SCHAEFER

IV. Effectiveness

According to a report from the Journal of American Medical Association, TC participants were seven times more likely to remain drug free and three times less likely to be arrested again than those not receiving treatment while incarcerated.

But if people leave TCs and return to the prison’s general population, it doesn’t always help. According to The Office of National Drug Control Policy, therapeutic community treatment is less effective for people who are then released back into the general prison population for three months or more.

In Pennsylvania, prisons offer a TC program that separates people from the general population, but they return after completing the program.

Federally funded TCs send people to aftercare, which helps them transition out of the correctional facility and connects them to services to help continue their recovery.

Despite the effectiveness of TC, there is one major downside: the capacity. There is only room for so many people in the program, which can create a lack of access.

“I was in pre-TC for like two or three months, but it felt like forever because you’d be seeing all these people in the program, and you’re just kind of waiting,” Cain said. “Because there were only three or four counselors for the four-month program.”

The counselors can only take about 20 people each, and Cain said getting into TC depended on whether people graduated or got kicked out. Plus some people don’t qualify, like those convicted of violent offenses.

“If somebody wants the help, we need to give it to them right now, not tomorrow, not next weekend,” Cain said. “We have to really jump on that.”