New policy on methadone maintenance treatment in prisons established in Alberta

The right of a prisoner to access methadone maintenance treatment (MMT) while incarcerated in a correctional institution has recently been raised and examined in the Alberta Court of Queen's Bench case of Milton Cardinal v The Director of the Edmonton Remand Centre and the Director of the Fort Saskatchewan Correctional Centre. This is a significant, precedent-setting case. For the first time, a Canadian court has ordered that a prisoner be provided with MMT during his or her period of incarceration. As a result of the case, and just before it was to proceed to trial, Alberta changed its policy and is now providing MMT to its provincial prisoners--at least when they had been receiving MMT prior to their incarceration.     

Irish prison guards call for expansion of methadone access

In many Western countries, including Canada, seroprevalence rates in prisons have reached epidemic levels, with infection rates among prisoners many times higher than among people outside prisons.     

The effect of outpatient methadone maintenance treatment facilities on place-based crime

Journal of Experimental Criminology - This study evaluates the effect of outpatient methadone maintenance treatment (OMMT) facilities on crime in surrounding areas. Between 2007 and 2017 in...     

Assault in prison and assault in prison psychiatric treatment

Studies have described measures associated with assault in the community, but few have identified measures associated with assault in prison or prison psychiatric treatment. In this study, prison assault histories and assaults while in prison psychiatric treatment for 222 randomly selected male inmates were evaluated. Using record reviews, interviews, neuropsychological, Rorschach, and psychopathy measures, risk factors for assault in prison and in prison psychiatric treatment were identified. Youth Authority placement, inhalant use, antisocial lifestyle, neurological injury, neuropsychological impairment, and higher PCL-R Factor II ratings were associated with assault in prison. Absence of major mental disorder, neurological impairment, or psychotic thinking, but presence of psychopathy was associated with assault in prison psychiatric treatment. In identifying risk for violence, the importance of (1) the context in which violence occurs; (2) the need for clear admission criteria for prison psychiatric treatment; and (3) the need to develop risk assessments that are specific to prison environments are emphasized.     

The effectiveness of art therapy in reducing depression in prison populations

Major obstacles block the effectiveness of therapy in prison. Many inmates have an inherent mistrust for verbal disclosure. Rigid defenses exist for basic survival. Despite these defenses, there has been support for art therapy as a valuable tool. Unfortunately, there has been little research to measure the effectiveness of art therapy in prison. Two quantitative studies were initiated in a North Florida prison to measure the effectiveness of art therapy with inmates, specifically in decreasing depressive symptoms. This article will present a pilot and follow-up study. The methods, including the Formal Elements Art Therapy Scale (FEATS) and the Beck Depression Inventory-Short Form, will be delineated. What was revealed was that although the FEATS proved more effective as a measurement tool for the pilot than for the follow-up study, ultimately, the results reflected a significant decrease in depressive symptoms in those inmates who participated in the program.     

Perceived positive aspects of intimate relationships among abused women in methadone maintenance treatment programs (MMTP)

This study examines the positive aspects of intimate relationships perceived by drug-involved women victims of intimate partner violence (IPV). The article examines the association of psychological distress, childhood abuse, and severity of IPV with the different positive aspects the women indicated. Most analyses were conducted on a subsample of 149 women in methadone maintenance treatment who intended to continue their relationship with their abusive partner. The women most frequently valued fulfillment of the role of an intimate partner such as "he takes care of me, loves me, makes me laugh" (29.7%). Fewer than one tenth of the women valued their partners' role as economic provider; however, these women reported more physical IPV. Women intending to continue the relationship (more than two thirds of the participants) reported less physical or sexual IPV and experienced less psychological distress. Policy and practice implications are discussed.     

A randomized controlled trial of the effectiveness of multisystemic therapy in the Netherlands: post-treatment changes and moderator effects

Objective

In the present randomized controlled trial, the effectiveness of multisystemic therapy (MST) in The Netherlands was examined. Moderator tests were conducted for ethnicity, age and gender.

Methods

The sample consisted of N?=?256 adolescents, referred because of conduct problems, and randomized to MST or treatment as usual (TAU). Assessments (questionnaires and observational ratings) took place before and immediately after the treatment.

Results

MST was more effective than TAU in decreasing externalizing behavior, ODD, CD and property offences, but not for violence. Findings were mixed for adolescents’ and parental cognitions: the MST group, compared to TAU, showed an improvement in parental sense of competence, and a decrease in adolescents’ hostility, but no change in self-esteem and an increase in personal failure. MST was effective for positive dimensions of parenting and associations with prosocial peers, but not for relationships with deviant peers. MST was equally effective for adolescents of different ages and with different ethnicities. However, MST showed larger (and more positive) effects for adolescent cognitions for boys than for girls.

Conclusions

Effects of MST in The Netherlands are generally comparable to the positive findings reported in American and Norwegian trials. MST seems equally effective across age and ethnic minority groups, but some gender moderator effects were found for adolescent cognitions.     

Methadone toxicity causing death in ten subjects starting on a methadone maintenance program.

Methadone maintenance therapy is designed to reduce the need for addicts to use heroin or other illegal opiates. Death in patients starting on such a program has not previously been documented. We report the death of 10 persons who died within days of starting a methadone maintenance program administered by general practitioners. Their bodies were subject to a full autopsy by forensic pathologists, with a full toxicological examination. The mean starting dose had been 53 mg, which had been increased to a mean of 57 mg by the final dose. Death occurred after a mean of 3 days. The mean blood methadone concentration at death was 2.1 mumol/L. Complete toxicological analysis showed that six subjects had additional drugs present including two with alcohol, two with benzodiazepines and morphine, and one with benzodiazepines alone. Pathological examination revealed the presence of chronic persistent hepatitis in all subjects and bronchopneumonia in five. The causes of death were given as methadone toxicity or methadone toxicity in combination with bronchopneumonia. Our observations highlight the dangers of methadone in the first days of starting on a maintenance program, particularly when the starting doses are relatively high and subjects have no demonstrated tolerance to opiates.     

The effectiveness of prison for reducing drug offender recidivism: a regression discontinuity analysis

Objectives

An enduring legacy of the 1980s “war on drugs” is the increased use of imprisonment for drug offenders. Advocates anticipated, in part, that prison is more effective than community sanctions in reducing recidivism. Despite the contribution of drug offender incarceration to prison growth nationally, and debates about whether this approach should be curtailed, only limited rigorous research exists that evaluates the effect of imprisonment on drug offender recidivism. To address this gap, this paper uses sentencing and recidivism data from a cohort of individuals convicted of felony drug offenses in Florida to examine the effect of imprisonment—as compared to community sanctions—on recidivism.

Methods

Regression discontinuity analyses are used. These minimize potential selection bias by exogenously assigning cases to conditions based on a rating variable and a cut-off score.

Results

Results indicate that prison has no effect on drug offenders’ rates of reconviction. This finding holds across a range of offender subgroups (racial and ethnic, gender, age, and prior criminal justice system involvement).

Conclusions

Imprisoning individuals convicted of marginally serious drug offenses—that is, those close to a cut-off score for being sent to prison—did not reduce subsequent offending. This finding suggests that curtailing the use of imprisonment for such individuals will not appreciably affect future criminal activity and may have the benefit of reducing correctional system costs.

     

A comparison of rape and molest offenders in prison psychiatric treatment

Differences in offense history, brain functioning, and psychological functioning of rape (n = 45) and molest offenders (n = 15) who were receiving psychiatric treatment while in prison were evaluated. Significant differences were found in each of these domains. Rape offenders were more likely to have histories of high violence offenses other than sexual offense, including murder, serious juvenile offenses, and both juvenile and adult sexual offenses. Rape offenders were more likely to show lower intellectual functioning and diffuse brain dysfunction associated predominantly with temporal and prefrontal brain cortices. Rape offenders were also more likely to display psychological functioning associated with illogical thinking and disordered attachment but less immature self-focus and fewer feelings of alienation than demonstrated by molest offenders. Implications for treatment and social policy for sexual offenders are suggested. Logistic regression demonstrated that these neuropsychological measures resulted in 71.7% accurate prediction and Rorschach measures resulted in 79.2% accurate prediction in differentiating rape from molest offenders. Implications for theoretical understanding of sexual offending are discussed.     

"Keepin' my mind right": identity maintenance and religious social support in the prison context

It is not uncommon for inmates to experience religious conversions in prison. These conversions allow inmates to portray themselves in a prosocial light and help them to establish a sense of control in their current lives, regardless of their past. Despite the value of these conversions, maintaining a new outlook of one's self is remarkably difficult. Using semistructured interviews with 63 inmates who had undergone a religious conversion, the authors examine the process that they engaged in to keep these new senses of self. The narratives suggest that they relied on various social support mechanisms to keep themselves focused and inspired. Specifically, they stressed the importance of connecting with positive others in formal and informal settings, sharing their stories with those in need, and reflecting on their daily choices. It is through these strategies that inmates keep the inspiration and focus to "keep their minds right."     

Canada: study demonstrates positive effect of methadone treatment

A recent study on methadone maintenance treatment (MMT) in federal correctional institutions demonstrates that MMT has a positive impact on release outcome and on institutional behaviour. The study provides support for the need to expand access to MMT in prisons. Importantly, it concludes that the CSC may spend less money on offenders who are on MMT in the long term, saying that "the cost of the institutional MMT program may be offset by the cost savings of offenders successfully remaining in the community for a longer period of time than equivalent offenders not receiving MMT."     

An open trial of an anger management treatment in a correctional facility: preliminary effectiveness and predictors of response

Despite the prevalence of anger management programs in correctional settings, there is mixed support for their effectiveness, and little is known about who benefits most. This preliminary study aimed to (1) evaluate the effectiveness of anger management for inmates, and (2) examine baseline psychopathology and midtreatment variables as response predictors. Participants were 30 incarcerated men undergoing 12-session anger management groups. Post-intervention, inmate-reported anger, and disciplinary actions decreased. Increased reported emotion regulation strategies predicted anger reduction.     

Sweat testing in addicts under methadone treatment: an Italian experience

In determining the possibility that a specific weapon was responsible for a specific injury it is often valuable to examine the damage marks left on any clothing worn by a victim. Correlating this damage both to the skin and clothing with the dimensions of the suspect weapon (if available) may help in determining these possibilities. In this work four different types of knives were used to produce damage marks on various different fabrics both stretched and loose over skin. Statistically significant differences were found between the length of wound on the skin and the corresponding damage to the fabrics when the fabric was stretched over the skin while no statistically significant differences were observed when the fabric was loose over the skin. This was true for all of the knives examined.     

Risk of harm: inmates who harm themselves while in prison psychiatric treatment

In this study, 242 randomly selected male offenders who were receiving psychiatric treatment in prison were administered psychological and neuropsychological evaluations and were followed during their treatment in a prison psychiatric hospital. Offenders who harmed themselves in treatment were compared to those who did not harm themselves. Eighteen percent of offenders harmed themselves, the severity of which required medical intervention. Young age, drug abuse, absence of Axis I mental disorder but presence of Axis II borderline personality disorder identified offenders who harmed themselves. Psychopathy checklist-revised (PCL-R) total rating > or = 30 and PCL-R Factor 2 (antisocial lifestyle) rating also identified offenders who harmed themselves. Additionally, offenders who harmed themselves also were 8.36 times more likely than their cohorts to harm treatment staff. Theoretical understanding of offenders who harm themselves, the importance of considering the environmental context in identifying risk factors for self-harm, and implications for treatment are suggested.     

Oral fluid results compared to self reports of recent cocaine and heroin use by methadone maintenance patients

A novel breath-alcohol analyzer based on the standardization of the breath alcohol concentration (BrAC) to the alveolar-air water vapour concentration has been developed and evaluated. The present study compares results with this particular breath analyzer with arterial blood alcohol concentrations (ABAC), the most relevant quantitative measure of brain alcohol exposure. The precision of analysis of alcohol in arterial blood and breath were determined as well as the agreement between ABAC and BrAC over time post-dosing. Twelve healthy volunteers were administered 0.6g alcohol/kg bodyweight via an orogastric tube. Duplicate breath and arterial blood samples were obtained simultaneously during the absorption, distribution and elimination phases of the alcohol metabolism with particular emphasis on the absorption phase. The precision of the breath analyzer was similar to the determination of blood alcohol concentration by headspace gas chromatography (CV 2.40 vs. 2.38%, p=0.43). The ABAC/BrAC ratio stabilized 30min post-dosing (2089±99; mean±SD). Before this the BrAC tended to underestimate the coexisting ABAC. In conclusion, breath alcohol analysis utilizing standardization of alcohol to water vapour was as precise as blood alcohol analysis, the present "gold standard" method. The BrAC reliably predicted the coexisting ABAC from 30min onwards after the intake of alcohol.