For the first time in a prison setting a randomised trial rigorously compared intensive residential therapeutic community treatment to outpatient counselling. Confounding expectations, the US prison for problem drug users which hosted the study gained nothing in terms of preventing recidivism by allocating even high-risk prisoners to the more intensive treatment.

In a rare randomised trial, the featured analysis attempted not just to establish the effectiveness of a US prison therapeutic community relative to outpatient treatment, but also what types of inmates may differentially benefit from these modalities.

Key points from summary and commentary
• In a US prison for problem drug users nearly all new arrivals joined a study which for the first time in a prison setting rigorously compared intensive residential therapeutic community treatment to outpatient counselling.
• Over a three-year post-release follow-up period no extra reduction in reimprisonment was found from the intensive option.
• The same finding emerged among prisoners at the highest risk of re-offending, confounding expectations that the more intensive treatment would be particularly suitable for these offenders