Substantial drop-out has been observed in most long-term TC programs, especially in the early phases of treatment [48]. Studies that have compared longer and shorter TC programs usually found lower completion rates in longer and more intensive programs [38, 51]. Five out of six studies that have reported employment outcomes selleck chemical found significantly better employment rates among TC participants. Also, five studies (out of 7) showed superior outcomes on psychological symptoms, as compared with controls. Other outcomes that were studied are risk behavior (n = 1) and family and social relations (n = 2), which were found to be better in two studies [32, 48].3.2. Substance Use OutcomesAlthough TC participants had at some point posttreatment better substance use outcomes than controls in 10 studies, substance use levels varied greatly and overall, between 25% and 55% of the respondents relapsed to drug use after 12 to 18 months.

Some studies found very low initial relapse rates (e.g., 4% [38], 9% [42] and 15% [43]), while others found much higher relapse rates (e.g., 53% [34] and 69% [29]). Usually, time to relapse was longer among TC participants [52]. One of the few controlled studies that followed prison TC-participants up to three years after their release found a relapse rate of 77% in the TC and 94% in the control condition [29]. Lower relapse rates were usually associated with longer treatment exposure (length of stay in treatment/retention) [24, 31, 39, 41, 52] and participation in subsequent treatment or aftercare [32, 35].

Treatment drop-out and relapse after treatment were predicted in at least two studies by the severity of substance use at baseline [28, 38].3.3. Legal OutcomesThe majority of studies found a positive impact of TC treatment on diverse legal outcomes, such as recidivism, rearrest, and reincarceration. Recidivism rates (self-reported criminal involvement) of TC participants after one year are usually around 40%�C50% [19, 31], as well as rearrest rates [29, 44], although one study reported a rearrest rate of only 17% 18 months after the start of TC treatment [42]. Reincarceration rates 12 to 18 months after release are between 30% and 55% in most studies, although Sacks and colleagues have reported clearly lower rates (19% and 9%, resp.) in two studies [19, 36]. Long-term follow-up measurements of prison TC participants indicate rearrest rates of 63% after three years [29] and 80% after five years [44] and reincarceration rates of over 70% after 5 years Dacomitinib [33, 44]. Again, time to reincarceration was lower in the TC group and treatment completion and/or time in treatment predicted absence of recidivism [28, 31, 33, 36, 42, 49].