A Study of Methadone Maintenance For Male Prisoners: 3-Month Postrelease Outcomes

This study examined benefits of methadone maintenance among prerelease prison inmates. Incarcerated males with preincarceration heroin dependence (n = 197) were randomly assigned to (a) group educational counseling (counseling only); (b) counseling, with opportunity to begin methadone maintenance on release (counseling + transfer); or (c) counseling and methadone maintenance in prison, with opportunity to continue methadone maintenance on release (counseling + methadone). At 90-day follow-up, counseling + methadone participants were significantly more likely than counseling-only and counseling + transfer participants to attend drug treatment (p = .0001) and less likely to be reincarcerated (p = .019). Counseling + methadone and counseling + transfer participants were significantly less likely (all ps < .05) to report heroin use, cocaine use, and criminal involvement than counseling-only participants. Follow-up is needed to determine whether these findings hold over a longer period.     

Comparing inmate perceptions of two residential substance abuse treatment programs

Drug and alcohol abuse by criminal offenders remains at an all time high. Residential substance abuse and treatment (RSAT) programs were developed to address the drug and alcohol treatment needs of inmates in prisons. Typically, such programs range in length from 6 to 12 months, have an Alcoholics Anonymous and/or Narcotics Anonymous component, and occur in a therapeutic community environment. Some programs also include a cognitive self-change component. Inmate participation in their programming is crucial to the success of a therapeutic community treatment environment, yet there is little research on the perceptions of RSAT inmates regarding their programming. In this research, the authors describe, compare, and contrast the perceptions of inmate clients of two RSAT programs in a rural mountain state.     

Offenders as victims: post-traumatic stress disorder and substance use disorder among male prisoners

Background: Comorbid substance use disorder(s) and post-traumatic stress disorder (SUD-PTSD) is common among prisoners and linked to an increased risk of criminal recidivism; however, little is known about the characteristics of prisoners with this comorbidity. Aim: This study provides a preliminary examination of the clinical and criminal profile of male inmates with symptoms of SUD-PTSD, and examines whether this profile differs according to whether a person has experienced a trauma while in prison. Methods: Thirty male inmates from two correctional centres in Sydney, Australia, were recruited and assessed using a structured interview. Results: The sample reported extensive criminal, substance use and trauma histories. A history of substance dependence was almost universal (90%) and 56.7% met diagnostic criteria for PTSD with the remainder experiencing sub-threshold symptoms. Forty-three per cent reported a traumatic event while in prison. Those who had experienced trauma in prison, compared to those who had not, were more likely to nominate heroin as their main drug of concern and to be receiving drug treatment in prison. There was also a trend toward inmates who had experienced a trauma in prison being more likely than inmates who had no prison trauma to have experienced a physical assault. Conclusion: Male prisoners with SUD-PTSD are a high-needs group yet treatment responses are poor. Further research examining treatment options for this comorbidity may improve prisoner well-being and reduce recidivism.     

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.     

The mental health and substance misuse needs of male ex-armed forces personnel in prison

Ex-armed forces personnel constitute the largest known occupational group in prison but there is little evidence regarding their mental health, or substance misuse, needs. A total of 105 participants were interviewed and measures assessing symptoms of common mental health (CMH) problems and substance misuse were completed along with a review of their health care records. Forty (38%) participants screened for current CMH problems (CCMH) and high levels of dual symptomology and alcohol misuse were assessed. Thirty-nine (37%) had a mental health diagnosis recorded, most commonly for post-traumatic stress disorder (PTSD), depression and personality disorder. Those who screened for a CCMH problem were more likely to have pre-service vulnerability to negative health outcomes and those with dual symptomology were more likely to have experienced deployment during their service. Findings suggest the mental health needs of this group are similar to the general prison population. Potentially higher prevalences of PTSD and alcohol misuse may direct service provision.     

Differential outcomes of court-supervised substance abuse treatment among California parolees and probationers

To explore the effectiveness of court-supervised drug treatment for California parolees, offender characteristics, treatment experiences, and outcomes were examined and contrasted to those of probationers. The analysis used statewide administrative data on 4,507 parolees and 22,701 probationers referred to treatment by Proposition 36 during fiscal year 2006-2007. Compared with probationers, parolee problems were more severe at treatment entry, more were treated in residential settings, treatment retention was shorter, and fewer completed treatment. Regarding outcomes, fewer parolees were successful at treatment discharge and more recidivated over 12-months post admission. Both groups improved in many areas by treatment discharge, but improvements were generally smaller among parolees. Significant interaction effects indicated that parolees benefited from residential care and more treatment days, even after controlling for covariates. Court-supervised drug treatment for parolees can "work;" however, parolees have more frequent and diverse needs, and their outcomes are enhanced by more intensive treatment. Findings suggest methods for optimizing the effectiveness of criminal-justice-supervised programs for treating drug-dependent offenders.     

NIPPING IT IN THE BUD®: ADOPTING A FAMILY DRUG COURT APPROACH TO FIGHTING THE CYCLE OF ALCOHOL ADDICTION FOR CHILDREN WHEN PARENTS ARE CONVICTED OF DUI

Many states have implemented Drug Courts in recent years by combining drug and alcohol treatment with ongoing judicial supervision. Through the use of incentives such as reduced and dismissed charges and fines combined with supervised treatment, Drug Courts have been shown to be very effective in helping to break the cycle of addiction, crime, and repeat incarceration for those involved. However, these courts do little to address situations in which the addict is the custodial parent of a minor child, who is exponentially more at‐risk for future alcohol addiction simply by being the child of an alcoholic, due to both environmental and biological factors. Thus, while the parent's addiction is theoretically being addressed by the courts, little is being done, absent a showing of abuse or neglect, by the judicial system to combat the seeds of addiction that have already been planted in these children. Therefore, this Note advocates for states to include an alcohol education and counseling program aimed at children of alcohol‐related offenders based on the Drug Court Model. Participation in this program would then act as a mitigating factor for the addicted offender when receiving their final sentence. This proposed program would then serve as a model for other states to adopt in the near future.     

Toward a criminal justice epidemiology: Behavioral and physical health of probationers and parolees in the United States

Objective

This study explicitly articulates a criminal justice epidemiology by examining the behavioral and physical health of probationers and parolees derived from a nationally representative sample of adults in the United States.

Methods

Using public-use data from the 2009 National Survey on Drug Use and Health (NSDUH), this study employed binary logistic regression with adjustments for complex survey sampling and compared probationers and parolees to the general population with respect to past-year substance use, risk perception, treatment experiences, and health.

Results

After controlling for the effects of age, gender, race, income, and education probationers and parolees are far more likely to report using alcohol and drugs in the past year, have reduced risk perception, and are far more likely to have had some kind of treatment for substance abuse or dependence. Probationers and parolees are also significantly more likely to experience anxiety and depression, asthma, and sexually transmitted diseases.

Conclusions

This criminal justice epidemiology study indicates that the behavioral health of probationers and parolees hamper efforts to increase public safety goals. Forging closer ties between criminal justice and public health systems is necessary to reach these goals.     

EXPLAINING THE ASSOCIATION BETWEEN INCARCERATION AND DIVORCE

Recent studies have suggested that incarceration dramatically increases the odds of divorce, but we know little about the mechanisms that explain the association. This study uses prospective longitudinal data from a subset of married young adults in the National Longitudinal Study of Adolescent Health (N = 1,919) to examine whether incarceration is associated with divorce indirectly via low marital love, economic strain, relationship violence, and extramarital sex. The findings confirmed that incarcerations occurring during, but not before, a marriage were associated with an increased hazard of divorce. Incarcerations occurring during marriage also were associated with less marital love, more relationship violence, more economic strain, and greater odds of extramarital sex. Above‐average levels of economic strain were visible among respondents observed preincarceration, but only respondents observed postincarceration showed less marital love, more relationship violence, and higher odds of extramarital sex than did respondents who were not incarcerated during marriage. These relationship problems explained approximately 40 percent of the association between incarceration and marital dissolution. These findings are consistent with theoretical predictions that a spouse's incarceration alters the rewards and costs of the marriage and the relative attractiveness of alternative partners.     

Feasibility of a computerized intervention for offenders with substance use disorders: a research note

Objectives

Despite evidence that treatment is effective in reducing recidivism among inmates with substance use problems, scarce resources mean that few of those in need of treatment actually receive it. Computerized substance abuse interventions could be used to expand access to treatment in prisons without placing an undue burden on resources. The major aim of the study was to compare treatment conditions in terms of their service utilization, skills acquisition, and treatment satisfaction.

Methods

The study recruited men and women with substance use disorders from 10 prisons in 4 states. In an open label clinical trial, 494 subjects were randomly assigned either to the Experimental condition, a computerized drug treatment intervention, the Therapeutic Education System (TES; n?=?249), or to the Control condition, Standard Care (n?=?245). Chi-square tests compared groups on categorical variables and independent samples t tests were used for interval level continuous variables.

Results

Initial evidence demonstrated: (1) comparable group rates of session attendance and high rates of TES module completion for experimental subjects; (2) comparable group gains in the development of coping skills; and (3) a more favorable view of TES than of Standard Care.

Conclusions

Collectively, these results show that a computerized intervention, such as TES, can be implemented successfully in prison. Given the barriers to the delivery of substance abuse treatment typically encountered in correctional settings, computerized interventions have the potential to fill a significant treatment gap and are particularly well suited to inmates with mild to moderate substance use disorders who often are not treated.     

Co-occurring psychiatric and substance use disorders among male detainees in Italy

This paper presents data on the prevalence of co-occurring substance use and psychiatric disorders among newly imprisoned males in Italy. Interviewers conducted semi-structured clinical interviews with n = 302 male detainees seven days after their admission to the prison of Perugia from August 2005 through July 2006. Over half of male detainees (54.3%) had either a substance use disorder or another psychiatric disorder. One of every five detainees (20.9%) had comorbid substance use and psychiatric disorders. Compared to detainees with psychiatric disorder only, substance use disorder only, or no disorder, detainees with comorbid substance use and psychiatric disorders were significantly more likely to have severe impairment in the areas of employment, substance abuse, family and social functioning, and psychiatric symptoms. Findings underscore the need for careful diagnostic screening at intake, access to treatment during detention, and an effective transition to services at the time of release.     

Court outcomes for clients referred to a community mental health court liaison service

Court liaison and diversion services come in a variety of forms, but the similarities and differences between these services are not well characterized. Findings from a six-year audit of the Newcastle (Australia) Mental Health Court Liaison (MHCL) service are reported, including client characteristics, offence and service contact profiles, court outcomes, and interrelationships among these variables. During the audit period, there were 2383 service episodes by 1858 clients (1478 males, 380 females). Drug and alcohol disorders (40.9%) and psychotic disorders (17.0%) were the most prevalent mental health problems, while assault (23.1%), theft (23.1%), offences against justice procedures (15.4%), driving offences (13.4%) and malicious damage to property (8.3%) were the most frequently recorded charges. Among service episodes with a finalized court outcome, 70.0% involved a punishment (bond: 49.5%; jail term: 29.7%). Females were less likely to be punished, but more likely to have their case dismissed under sections of the relevant Act that required further assessment and monitoring. Being married, or having an adjustment or drug and alcohol disorder, were also associated with an increased likelihood of punishment, while clients with a psychotic or bipolar disorder were less likely to be punished. Among clients who were punished, those referred from inpatient mental health services were more likely to receive a non-jail punishment, while unemployed clients were more likely to be jailed. A substantial proportion of clients had court outcomes that required an ongoing involvement with local mental health services. By being part of community mental health services, our MHCL service is able to work efficiently and effectively with the criminal justice system, while facilitating ready access to existing mental health services and continuation of care.     

A Person-centered Approach to Risk and Need Classification in Drug Court

A sample of 265 New York City drug court participants completed the Level of Service Inventory—Revised (LSI-R) and Texas Christian University Drug Screen II (TCUDS). Three participant clusters were identified through a person-centered analysis of their LSI-R and TCUDS responses: low risk (LR), criminogenic risk (CR), and complex behavioral health needs (CBHN). Although CBHN scored higher than CR and LR on the LSI-R and TCUDS, they were no more likely to be re-arrested at 24 months and no higher in their rate of positive drug tests. The CR cluster predicted re-arrest beyond the LSI-R and rate of positive drug tests beyond the LSI-R and TCUDS. CBHN participants placed in a residential (vs. non-residential) setting were disproportionately likely to be re-arrested. Results point to a sub-population of drug court participants not captured in variable-centered summary risk scores, who might require intensive case management or referral to suitable treatment.     

Adaptive Programming Improves Outcomes in Drug Court: An Experimental Trial

Prior studies in Drug Courts reported improved outcomes when participants were matched to schedules of judicial status hearings based on their criminological risk level. The current experiment determined whether incremental efficacy could be gained by periodically adjusting the schedule of status hearings and clinical case-management sessions in response to participants' ensuing performance in the program. The adjustments were made pursuant to a priori criteria specified in an adaptive algorithm. Results confirmed that participants in the full adaptive condition (n = 62) were more than twice as likely as those assigned to baseline-matching only (n = 63) to be drug-abstinent during the first 18 weeks of the program; however, graduation rates and the average time to case resolution were not significantly different. The positive effects of the adaptive program appear to have stemmed from holding noncompliant participants more accountable for meeting their attendance obligations in the program. Directions for future research and practice implications are discussed.     

Citizenship status and arrest patterns in the United States: evidence from the arrestee drug abuse monitoring program

The purpose of the study was to estimate associations between citizenship status and arrest for crimes among male arrestees. The primary hypothesis was that citizenship status (a rough proxy for immigration) has significant effects on arrest for violent personal crimes, property crimes, and four other selected offenses. Data were derived from the Arrestee Drug Abuse Monitoring (ADAM) Program for the years 2000 through 2002 inclusive. Our sample comprised male arrestees only. Logistic regression models were fitted to the data to estimate the citizenship status-crime relationship. Results showed no significant association between citizenship status and arrest for violent crimes. Non-citizens were 15% less likely than citizens to be arrested for property crimes; they were also less likely to be arrested for weapons offenses and drug offenses. Non-citizens were much less likely to test positive on NIDA-5 drugs than citizens. Non-citizens were, however, 50% more likely than citizens to be arrested for forgery/counterfeiting. It was concluded that public perceptions about the relationship of citizenship status to criminal behavior may be exaggerated and may not be borne out by empirical evidence. Limitations of the study are pointed out, including the fact that in the ADAM data, naturalized immigrants are lumped together with native born citizens.     

Collaborative behavioral management: integration and intensification of parole and outpatient addiction treatment services in the Step’n Out study

Integration of community parole and addiction treatment holds promise for optimizing the participation of drug-involved parolees in re-entry services, but intensification of services might yield greater rates of technical violations. Collaborative behavioral management (CBM) integrates the roles of parole officers and treatment counselors to provide role induction counseling, contract for pro-social behavior, and to deliver contingent reinforcement of behaviors consistent with contracted objectives. Attendance at both parole and addiction treatment are specifically reinforced. The Step’n Out study of the Criminal Justice–Drug Abuse Treatment Studies (CJ-DATS) randomly allocated 486 drug-involved parolees to either collaborative behavioral management or traditional parole with 3-month and 9-month follow-up. Bivariate and multivariate regression models found that, in the first 3 months, the CBM group had more parole sessions, face-to-face parole sessions, days on which parole and treatment occurred on the same day, treatment utilization and individual counseling, without an increase in parole violations. We conclude that CBM integrated parole and treatment as planned, and intensified parolees’ utilization of these services, without increasing violations.     

Opening Pandora’s Box: How Does Defendant Race Influence Plea Bargaining?

Minority overrepresentation in the criminal justice system has long been an important topic of research and policy debate. In New York City, recent changes in the Rockefeller Drug Laws and the controversy around police stop-and-frisk practices have placed an even greater emphasis on the need for studying the possible impact of defendants’ race and ethnicity on criminal justice outcomes. Relatively little contemporary research, though, examines plea-bargaining outcomes. Using unique data on misdemeanor marijuana cases, this study examines the impact of defendants’ race on prosecutors’ decisions to make (a) plea offers for a lesser charge and (b) sentence offers for non-custodial punishments. Preliminary findings indicated that black defendants were less likely to receive reduced charge offers, and both black and Latino defendants were more likely to receive custodial sentence offers. However, these disparities were largely explained by legal factors, evidence, arrest circumstances, and court actor characteristics, though black defendants were still more likely to receive custodial sentence offers after including these controls. No differences were found between white and Asian defendants. Implications for research and prosecutorial practices are discussed.     

Correlates of handgun carrying among adolescents in the United States

Weapon-related violence, especially the use of handguns, among adolescents is a serious public health concern. Using public-use data file from the adolescent sample (N = 17,842) in the 2008 National Survey on Drug Use and Health (NSDUH), this study examines the behavioral, parental involvement, and prevention correlates of handgun carrying. Overall, 3.1% of adolescents between the ages of 12 and 17 reported carrying a handgun in the past year. Results from a series of logistic regression models indicated that males, selling and using illicit drugs, were robustly associated with an increased probability of handgun carrying among adolescents. Furthermore, youth who carry handguns were significantly less likely to report a parent being involved in their lives and were significantly more likely to have encountered violence and drug prevention programming compared with youth who did not carry handguns. Implications of these results for prevention and policy are discussed.     

Characteristics of abstainers from substance use and antisocial behavior in the United States

Purpose

Whether lifetime abstainer's antisocial behavior is maladjusted or well-adjusted is unresolved. The aim of this study was to compare abstainers (defined as persons with no lifetime use of alcohol and other drugs and non-engagement in antisocial or delinquent behavior) with non-abstainers across a range of sociodemographic and mental health characteristics in the United States.

Methods

Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative sample of U.S. adults. Structured psychiatric interviews (N = 43,093) using the Alcohol Use Disorder and Associated Disabilities Interview Schedule — DSM-IV version (AUDADIS-IV) were completed by trained lay interviewers between 2001 and 2002.

Results

The prevalence of abstaining was 11 percent. Abstainers were significantly more likely to be female, Asian and African-American, born outside the U.S., and less likely to be unemployed. Multivariate logistic regression analyses revealed that abstainers were significantly less likely to evidence lifetime mood, anxiety, or personality disorder compared to non-abstainers.

Conclusions

Findings indicate that abstainers are not maladapted and are comparatively more functional than non-abstainers.     

Racial differences in desistance from substance abuse: the impact of religious involvement on recovery

This study examines variations by race in the relationship between religiosity and desistance from substance abuse. Although most studies have included race as a control variable, only a few studies compared the equivalence of associations among religiosity, delinquency, recovery from substance abuse, and other variables between Black and White samples. Using data from the intake and 12-month follow-up survey of the Drug Abuse Treatment Outcome Study, this study examines levels of religious involvement of Black and White drug treatment clients. In addition, it empirically tests whether religious involvement exerts differential effects on Black and White clients' recovery from substance abuse. It was found that Black clients reported higher levels of religious involvement (measured by church attendance) than did White clients. Data indicated that religious behavior at 1-year follow-up was positively associated with Black clients' recovery from substance abuse. In contrast, religious behavior was not a significant predictor of White clients' desistance from substance abuse. Directions for future research and policy implications are discussed.