Describing the feasibility of using case management in a specialist forensic substance misuse intervention for UK veterans: a case study

Veterans with mental health problems are a high-risk group for substance misuse difficulties and are over-represented in forensic settings. Yet, there are few substance misuse services available for this population. Evidence suggests that case management can provide effective interventions for veterans with substance misuse problems. However, there is little research to show its effectiveness in the UK. The present study reported on the implementation and preliminary outcomes of the Veterans Forensic Substance Misuses Service (VFSMS), piloted within a prison setting, to demonstrate the feasibility of the service. The VFSMS operated in four stages: Assessing needs, developing case management plans, providing bespoke support and developing discharge plans. Case studies were used to demonstrate this process, with measures of alcohol use and recovery showing outcomes for each case. Findings from three case studies suggested that case management was a feasible approach, with a range of interventions being used, including substance misuse and mental health services, plus housing and employment services. Outcome measures suggested that alcohol and substance misuse recovery improved following the VFSMS intervention. While the scope of the findings is limited, they suggested that case management is a feasible substance misuse intervention, with preliminary findings showing improvements in substance misuse outcomes.     

Rehabilitating serious violent adult offenders: an empirical and theoretical stocktake

Extensive meta-analyses of the correctional programme evaluation literature have generated developments in the technology of programme design. However, the risk, need and responsivity principles do not constitute a rehabilitation theory and cannot answer specialist offender programme design questions. After more than a decade of involvement in programmes for seriously violent offenders, we decided to reassess the empirical evidence underpinning violence rehabilitation in adult men. We focused on both mixed and violent offender samples, reviewing the outcome data from nine evaluations of cognitive–behavioural interventions. Despite a plethora of methodological difficulties, it appears that most of the programmes had small to large effects on violent and non-violent recidivism. Little could be concluded from these evaluations about the most promising theoretical framework for future programme development. Most programmes contained only scant information on their underlying theory base. None referred to multivariate aggression or crime theories. We conclude that there is a pressing need for additional evaluative research, and theory development. To date, the case for specialist violent offending programmes has not been made.     

Opponent Process Theory for Substance Abuse Treatment

This article examines problems and issues of the juvenile justice and drug & alcohol systems in the context of treatment resistant, substance dependent, delinquent youth. The evaluation research on traditional medical model treatment shows high drop-out and relapse rates along with limited impact on polydrug users. Outdoor challenge programs are reviewed as an alternative within the context of Opponent-Process Theory and the therapeutic use of stress. These forms of stressful challenge may produce improved self-esteem and positive affect which may be useful as alternative forms of substance abuse treatment, especially for resistant delinquent youth who have not benefitted from more traditional forms of treatment.     

Community Wise: Paving the way for empowerment in community reentry

Theoretical approaches traditionally applied in mental health and criminal justice interventions fail to address the historical and structural context that partially explains health disparities. Community Wise was developed to address this gap. It is a 12 week group intervention informed by Critical Consciousness Theory and designed to prevent substance abuse, related health risk behaviors, psychological distress, and reoffending among individuals with a history of incarceration and substance abuse. This paper reports findings from the first implementation and pilot evaluation of Community Wise in two community-based organizations. This pre–posttest evaluation pilot-tested Community Wise and used findings to improve the intervention. Twenty-six participants completed a phone and clinical screening, baseline, 6- and 12-week follow-ups, and a focus group at the end of the intervention. Measures assessed participants' demographic information, psychological distress, substance use, criminal offending, HIV risk behaviors, community cohesion, community support, civic engagement, critical consciousness, ethnic identification, group cohesion, client satisfaction, and acquired treatment skills. Research methods were found to be feasible and useful in assessing the intervention. Results indicated that while Community Wise is a promising intervention, several changes need to be made in order to enhance the intervention. Community Wise is a new approach where oppressed individuals join in critical dialogue, tap into existing community resources, and devise, implement and evaluate their own community solutions to structural barriers.     

The most important things learned about violence and trauma in the past 20 years

In the past 2 decades, important insights have been gained regarding violence and trauma. Complications occur in how violence and trauma, their causes, and their effects on victims should be defined. Violence and abuse to women--physical, sexual, and emotional--are not rare events and are most often perpetrated by partners or acquaintances rather than strangers and occur in nonmarital as well as marital relationships, including same-sex relationships. A promising methodological innovation in the study of violence and trauma is the use of longitudinal designs. Innovations in treatments for victims such as evidence-based interventions have been slow to emerge; they include eye movement desensitization and reprocessing (EMDR) and the Seeking Safety group intervention for drug-abusing women with trauma histories. Future research should address increased understanding of variation in individual responses to violence and trauma, matching of treatment to different types of male offenders, better understanding of how culture affects violence perpetration and victimization, and evaluation of domestic violence interventions.     

Substance abuse treatment for juvenile offenders: A review of quasi-experimental and experimental research

Purpose

The purpose of this systematic literature review is to assess the effectiveness of substance abuse treatment on alcohol and marijuana use for juvenile offenders based on existing quasi-experimental and experimental research. Additionally, a secondary aim is to compare the effects of individual-based interventions to family-based interventions.

Methods

A systematic search of literature and electronic databases through 2010 generated five experimental or quasi-experimental studies that assessed alcohol outcomes for juvenile offenders and five experimental or quasi-experimental studies that assessed marijuana outcomes for juvenile offenders.

Results

Overall, substance abuse treatment appears to have a small to moderate effect on alcohol and marijuana reduction for juvenile offenders. Interventions that showed the most promise were Multisystemic Therapy, Multidimensional Treatment Foster Care, Teaching Family, and Life Skills Training. Individual-based interventions and family-based interventions had similar small to moderate effects on alcohol and marijuana use.

Conclusion

This review highlights several promising interventions for this high-risk population; however, further rigorous study is desperately needed to provide a better understanding of what works best in reducing substance use among juvenile offenders.     

Current and Promising Pharmacotherapies for Substance Use Disorders among Justice-Involved Populations

Growing recognition of the biological underpinnings of substance use disorders (SUDs) has led to increased acceptance of pharmacotherapy-based treatments for general populations and, more recently, for individuals under criminal justice supervision, including those in correctional settings. This paper focuses on pharmacotherapies that have been approved by the United States Food and Drug Administration (FDA) for treatment of alcohol use disorder and opioid use disorder. For alcohol use disorder, these medications are disulfiram, naltrexone, and acamprosate; for opioid use disorder, these are methadone, buprenorphine, and naltrexone. Promising pharmacotherapies for stimulant use disorder are also briefly summarized. The paper concludes with three “lessons learned,” specifically: (1) treatment and policy should reflect the fact that substance misuse and addiction is a medical disorder, (2) interventions for SUDs should be integrated into primary care, and (3) reductions in substance use among pharmacotherapy-treated patients do not necessarily lead to concomitant reductions in crime (nor should this be the primary rationale for providing such treatment).     

Can 14,737 women be wrong? A meta‐analysis of the LSI‐R and recidivism for female offenders*

Research Summary Over the past two decades, researchers have been increasingly interested in measuring the risk of offender recidivism as a means of advancing public safety and of directing treatment interventions. In this context, one instrument widely used in assessing offenders is the Level of Service Inventory‐Revised (LSI‐R). Recently, however, the LSI‐R has been criticized for being a male‐specific assessment instrument that is a weak predictor of criminal behavior in females. Through the use of meta‐analytic techniques, we assessed this assertion. A total of 27 effect sizes yielded an average r value of .35 ([confidence interval] CI = .34 to .36) for the relationship of the LSI‐R with recidivism for female offenders (N= 14,737). When available, we also made within‐sample comparisons based on gender. These comparisons produced effect sizes for males and females that were statistically similar. Policy Implications These results are consistent with those generated in previous research on the LSI‐R. They call into question prevailing critiques that the LSI‐R has predictive validity for male but not for female offenders. At this stage, it seems that corrections officials should be advised that the LSI‐R remains an important instrument for assessing all offenders as a prelude to the delivery of treatment services, especially those based on the principles of effective intervention. Critics should be encouraged, however, to construct and validate through research additional gender‐specific instruments that revise, if not rival, the LSI‐R.     

Psychosocial treatment in the 21st century

Over the past 50 years, psychosocial treatment has played an increasingly prominent role in helping persons with mental illness live in communities rather than in institutions. This paper briefly reviews evidence for and discusses three forms of treatment-assertive community treatment, supported employment, and cognitive behavior treatment-which have been studied extensively and are widely accepted as effective interventions. Forces are discussed that have shaped these and other psychosocial treatment over the past five decades. Despite the accumulated evidence, many questions remain about the cost-effectiveness and applicability of these treatments in specific populations and service environments. The development of these and other treatments has been, and continues to be, shaped by concerns about rising health care costs, a heightened emphasis on evidence-based treatment and by consumers taking a more active role in determining the services, and outcomes that are most helpful to them.     

Designing Programming and Interventions for Women in the Criminal Justice System

Women are the fastest growing segment of the criminal justice population, yet the majority of research on criminal justice populations has been focused on men. Programming and interventions that reduce women’s involvement in the criminal justice system and ameliorate the negative consequences associated with criminal justice involvement are urgently needed. The overall aim of this paper is to provide a comprehensive framework for developing evidence-based, gender-specific programming and interventions to reduce criminal justice involvement and its associated consequences among women in the criminal justice system. The first section of the paper offers a conceptually guided review of the three primary factors that facilitate and complicate women’s involvement in the criminal justice system: victimization; mental disorders; and substance use. In the second section of the paper, findings from focus groups conducted with women on probation or parole identify strategies to engage this population in psychosocial interventions. The third and final section of the paper provides comprehensive recommendations for designing programming and interventions for women in the criminal justice system.     

Examining Dose–Response Relationships Between Childhood Victimization,Depression, Symptoms of Psychosis,and Substance Misuse for Incarcerated Women

The current study uses the dose–response model to examine the relationships between childhood victimization events and subsequent depression, symptoms of psychosis, and substance misuse in a sample of 230 randomly selected incarcerated women in the United States. Results on the frequency of victimization were mixed. In this sample, both frequency of physical abuse and frequency of sexual abuse significantly predicted current symptoms of psychosis, but only frequency of physical abuse significantly predicted substance misuse. Incarcerated women who experienced multivictimization were 5.7 times as likely to report depression, 4.2 times as likely to report current symptoms of psychosis, and 3.8 times as likely to meet criteria for a substance use disorder. Results indicate that adjusting prison-based interventions to address multivictimization may improve outcomes and reduce recidivism among this population.     

Experiences of Incarcerated Veterans in an All-Veterans Housing Unit: a Qualitative Study

Many US veterans leave military service with a variety of psychosocial risk factors stemming from readjustment to civilian life, and there is increased public concern about the incarceration of veterans given ongoing conflicts in Iraq and Afghanistan. Prisons are playing instrumental roles in developing interventions to address the problems justice-involved veterans face both psychologically and environmentally in the form of veterans’ service units (VSUs), dormitories developed to assist with community reintegration, and connecting veterans to medical and mental health services. This study uses qualitative data from 87 veterans on a VSU who participated in a program improvement survey asking about their programming and reentry needs, experiences on the unit compared to other units, and any suggestions for improvement. Qualitative analysis of responses identified several themes including veterans’ needs around physical fitness, job training, education, and mental health and substance abuse treatment; positive experiences on the VSU compared to traditional units; the positive partnership role with the State Department of Corrections and the local Veterans Affairs (VA) medical center; and concerns on the unit about VA eligibility, combat status, and “real veterans.” These results are some of the first to capture the experiences of veterans on a VSU and the findings highlight potential benefits and challenges with implementing VSUs. Greater research and evaluation are needed to develop more treatment-oriented, rehabilitative models of justice and to continue to refine the VSU model.     

A steroidomic approach for biomarkers discovery in doping control

Anti-doping authorities have high expectations of the athlete steroidal passport (ASP) for anabolic-androgenic steroids misuse detection. However, it is still limited to the monitoring of known well-established compounds and might greatly benefit from the discovery of new relevant biomarkers candidates. In this context, steroidomics opens the way to the untargeted simultaneous evaluation of a high number of compounds. Analytical platforms associating the performance of ultra-high pressure liquid chromatography (UHPLC) and the high mass-resolving power of quadrupole time-of-flight (QTOF) mass spectrometers are particularly adapted for such purpose. An untargeted steroidomic approach was proposed to analyse urine samples from a clinical trial for the discovery of relevant biomarkers of testosterone undecanoate oral intake. Automatic peak detection was performed and a filter of reference steroid metabolites mass-to-charge ratio (m/z) values was applied to the raw data to ensure the selection of a subset of steroid-related features. Chemometric tools were applied for the filtering and the analysis of UHPLC-QTOF-MS(E) data. Time kinetics could be assessed with N-way projections to latent structures discriminant analysis (N-PLS-DA) and a detection window was confirmed. Orthogonal projections to latent structures discriminant analysis (O-PLS-DA) classification models were evaluated in a second step to assess the predictive power of both known metabolites and unknown compounds. A shared and unique structure plot (SUS-plot) analysis was performed to select the most promising unknown candidates and receiver operating characteristic (ROC) curves were computed to assess specificity criteria applied in routine doping control. This approach underlined the pertinence to monitor both glucuronide and sulphate steroid conjugates and include them in the athletes passport, while promising biomarkers were also highlighted.     

Social support and one-year outcomes for women participating in prison-based substance abuse treatment programming

In recent decades, the number of women under criminal justice supervision has increased considerably, many of whom are serving time for drug offenses. Furthermore, women in prison are more likely than their non-institutionalized counterparts to suffer from a substance abuse disorder. While there is a growing body of research concerning women offenders’ drug abuse and treatment needs, few studies have examined the substance abuse treatment outcomes of women in the criminal justice system. Using data from Outcome Evaluation of the Forever Free Substance Abuse Treatment Program, this study compared women’s self-reported drug use twelve months after participation in high-intensity (n = 101) and low-intensity (n = 81) prison-based substance abuse treatment programming (N = 182). Women who perceived high levels of emotional social support were less likely to report substance use at 12-month follow-up. Furthermore, perceptions of emotional social support and treatment intensity interacted in their association with relapse, such that the protective effect of social support was strongest for women who participated in high-intensity programming. The results of the analyses highlight the importance of perceived social support for women with substance abuse disorders who are transitioning from prison-based substance abuse treatment programming to the community.     

Interventions with women offenders: a systematic review and meta-analysis of mental health gain

Currently, a conjunction of policy, legislative change in health and social care and the criminal justice system, combined with funding for innovative services make it opportune to assess the evidence base for interventions with women offenders. Women offenders have a distinctive criminological, health and social profile and a gender specific approach to their difficulties is advocated. This systematic review and meta-analysis focus on mental health gain in adult women offenders in forensic health settings, criminal justice institutions and in the community, following therapeutic interventions. Interventions were assessed in terms of specific outcome measures of depression, trauma symptomatology and global mental health status. Comprehensive search strategies yielded 3018 articles, from which we obtained 199 full text articles. Seventeen articles were included in the final review, of which six were excluded from the meta-analysis as there was no comparator group. There is a modest, but increasing, body of evidence for the utility of some interventions, notably those addressing the consequences of earlier trauma, including interventions which also address comorbid substance misuse. This does not amount, to date, to a robust evidence base. Limitations of these studies are discussed and include small sample sizes, their restriction mainly to prison populations and that they were substantially undertaken in the US. Variations in outcome measures follow-up and the difficulties inherent in measuring change in this complex population are also detailed. However, the review delineates definite avenues for further work. To achieve this, those responsible for policy, practice and purchase of services should both be mindful of existing evidence and promote additional, high quality research into interventions which are designed around a coherent, theoretical approach.     

The application of the transtheoretical model to offender populations: Some critical issues

Purpose. Over the past two decades, the transtheoretical model (TTM) of change has become perhaps the most widely used model of behaviour change in the treatment of addictive and/or problem behaviours. More recently, the stages of change component of the TTM has been adopted for use in forensic settings. This paper aims to review the application of the TTM model to offender populations. Arguments. The application of the TTM to offenders raises a number of issues regarding the process of behaviour change for offenders attending treatment programmes. It is argued that while the TTM has been designed to account for high frequency behaviour (e.g. smoking, alcohol misuse), offending behaviour may be less frequent and the process of change less cyclical. Moreover, it is suggested that the most important issue in a treatment context is the proper integration of the TTM constructs. There have been few empirical tests of this aspect of the model. Conclusion. While the TTM may have some value in explaining how rehabilitation programmes help offenders to change their behaviour, the stages of change construct is, by itself, unlikely to adequately explain the process by which offenders desist from offending.     

Naturally Occurring Social Support in Interventions for Former Prisoners with Substance Use Disorders: Conceptual Framework and Program Model

Purpose

Naturally-occurring social support is underutilized in interventions with former prisoners with substance use disorders. This paper proposes a conceptual framework followed by a program model to inform the development of naturally-occurring social support interventions with former prisoners with substance use disorders.

Methods

We reviewed all published social support interventions designed for former prisoners and people with substance use disorders over a ten year period. Building on the implications of this review, empirical literature, professional experience, and theory, we propose a conceptual framework for naturally-occurring social support programs.

Results

Few published programs exist that actively incorporate social support providers into the program model. Of these, even fewer use naturally-occurring support. Expanding on gaps in theory and program approaches, the conceptual model posits that it is the appropriate match of support needs and provision that reinforces emotions, cognitions, and behaviors, that in turn, promote adaptive outcomes.

Conclusions

With mounting pressure to identify interventions that will reduce high re-incarceration rates, this paper draws attention to a neglected, potentially effective, and low cost resource - naturally-occurring social support. The described program, Support Matters, illustrates how social support interventions can be used with former prisoners to promote reduced relapse to substance misuse and crime.     

Are counter-terrorism strategies effective? The results of the Campbell systematic review on counter-terrorism evaluation research

The events of September 11th have led to massive increases in personal, commercial, and governmental expenditures on anti-terrorism strategies, as well as a proliferation of programs designed to fight terrorism. These increases in spending and program development have focused attention on the most significant and central policy question related to these interventions: Are these programs effective? To explore this question, this study reports the results of a Campbell Collaboration systematic review on evaluation research of counter-terrorism strategies. Not only did we discover an almost complete absence of evaluation research on counter-terrorism interventions, but from those evaluations that we could find, it appears that some interventions either did not achieve the outcomes sought or sometimes increased the likelihood of terrorism occurring. The findings dramatically emphasize the need for government leaders, policy makers, researchers, and funding agencies to support both outcome evaluations of these programs as well as efforts to develop an infrastructure to foster counter-terrorism evaluation research.