Substance abuse among sexual offenders: review of research and clinical implications*

Substance abuse, and in particular alcohol abuse, has been linked to the aetiology and maintenance of violent offending generally and sexual offending specifically. The current paper reviews the literature pertaining to substance abuse among sexual offenders and highlights theoretical developments in the area. An emphasis on issues associated with the therapeutic alliance is stressed when working with high-risk clients who present with multiple needs, including alcohol abuse. The discussion concludes with some practical suggestions regarding assessment and treatment of groups of moderate- to high-risk offenders.     

The predictive and convergent validity of a psychometric battery used to assess sexual offenders in a treatment programme: an 18-year follow-up

Abstract

This study examined sex offender risk and treatment change based on a battery of psychometric assessment measures administered to 267 treated adult Canadian federal sex offenders followed up an average 18 years post release. Several significant pre–post changes that were frequently moderate in magnitude (d>.50) were observed across these measures. A factor analysis of the psychometric battery generated three broad need domains consistent with the extant literature that were labelled Socioemotional Functioning, Anger/Hostility, and Misogynist Attitudes. The three need domains and a Need Total, created by their summation, converged with the Violence Risk Scale—Sexual Offender version (VRS-SO; Wong, Olver, Nicholaichuk, & Gordon, 2003) in conceptually meaningful ways and predicted sexual and violent recidivism to varying degrees. Raw measurements of change obtained from pre-to posttreatment frequently bore weak and non-significant relationships to outcome. However, after creating standardised residual change scores to control for pre-treatment score, treatment changes in the individual measures, need domains and Need Total improved significantly in their prediction of reductions in general and sexual violence.     

The paraphilia-related disorders: an investigation of the relevance of the concept in sexual murderers

Paraphilic disorders (PAs) and sexual preoccupation are known risk factors for recidivism in sexual offenders. Nonparaphilic sexual excessive behaviors-so-called paraphilia-related disorders (PRDs), like paraphilias, are also characterized by sexual preoccupation and volitional impairment and can be diagnosed in paraphilic men. The prevalence and clinical significance of PRDs in sexual homicide perpetrators, however, is unknown. We investigated the relationship between PAs and PRDs retrospectively in a sample of 161 sexual murderers. Four groups were compared: men without a PA or a PRD diagnosis, men with at least one PRD but no PA, men with at least one PA but no PRD, and finally, those with a combination of both (PA+PRD). The PA+PRD group had the most lifetime cumulative sexual impulsivity disorders, more developmental problems, the highest persistent frequency of sexual activity, the highest number of previous sexual offences, more sexual sadism, and compulsive masturbation. Men of the PRD subsample had suffered more from childhood sexual abuse, showed more promiscuity, psychopathy, and alcohol problems. The use of the PRD concept in this special offender group should be further investigated with prospectively designed studies.     

Juvenile sex offenders: a complex population

Individuals who engage in sexual offending behavior represent a heterogeneous population. Recent research has found some success in categorizing sexual offenders based on a number of variables, particularly the type of victim. For example, differences have been found between those offenders who victimize adults when compared with those who victimize children. However, the research in this area has been conducted predominantly with adult samples. As the adult sex offender literature has progressed, it has become evident that risk assessment, treatment effectiveness, and risk management are dependent on such offender characteristics. Unfortunately, the relevance to juveniles of characteristics deemed to be important with adult sex offenders is limited due to the complexity of developmental processes, particularly with respect to mental disorders and personality formation. As such, the formulation and implementation of treatment and risk management strategies that will be effective with juvenile sex offenders are challenging. The goal of this paper is to review some of the complexities inherent in the juvenile sex offender population by focusing on specific areas of complication, including: classification systems, comorbid paraphilias and other mental illnesses, and maladaptive personality traits.     

The violent reconvictions of sexual offenders

The violent reconvictions of a sample of sexual offenders discharged from prison between 1992 and 1996 (who had not been reconvicted of a sexual offence) were examined. The hypothesis was that a proportion of these violent reconvictions would have a sexual motivation. The sample consisted of 104 adult male sexual offenders for whom detailed information regarding their violent reconviction was available. The sample was categorized according to the motivation of the violent reconviction. It was found that a proportion of the violent reconvictions were sexually motivated (12%) and that some of these had resulted from an original charge for a sexual offence. Significant differences were found between the sexual motivation and violent motivation group on the number of criminal history and victim characteristic variables. It was concluded that, in the case of sexual offenders, violent convictions might mask the true motivation of the offence.     

Alcohol and drug consumption among sexual offenders

Purpose

To evaluate the role of alcohol and drug consumption between sexual offenders against boys and girls.

Method

It was an observational, retrospective and cross-sectional study carried out by the Ambulatory for the treatment of sexual disorders of ABC Medical College, Santo André, São Paulo, Brazil (ABSex). The sample comprised 104 convicts, over 18 years old, sentenced only for sexual crimes against children (below 11 years old). Alcohol and drug consumption, sexual abuse history, sexual impulsivity, and risk of recidivism were evaluated.

Results

The sexual offenders against boys showed higher alcohol consumption problems than sexual offenders against girls (χ² = 19.76, 1 d.f., p < 0.01). The severity of alcohol consumption was also significantly higher in the sexual offenders against non-related boys than in the sexual offenders against non-related girls (p = 0.037, ANOVA). After adjustment for other variables, such as monthly income before the penalty and alcohol consumption at the moment of the crime, the alcohol consumption severity in sexual offenders against boys was significantly higher than in sexual offenders against girls (OR = 1.05, CI 1.01–1.08, p < 0.01).

Conclusions

Alcohol use or abuse is associated with the perpetration of sexual aggression. The role of alcohol consumption seems to be greater in sexual offenders against boys than in girls and this can contribute to criminal recidivism.     

Optimizing risk mitigation in management of sexual offenders: a structural model

Sexual violence is an insidious and pervasive problem that insinuates itself into all aspects of contemporary society. It can neither be mitigated nor adequately controlled through current socio-legal practices. A more promising approach must embrace four integrated elements: (1) public policy, (2) primary prevention, (3) statutory management, and (3) secondary intervention. In the present paper we tackle the 3rd and 4th elements by proposing an integrated model for reducing and managing sexual violence among known sex offenders. Relying on the highly effective Risk-Need-Responsivity (RNR) model as the core of our Sex Offender Risk Mitigation and Management Model (SORM³), we draw together evidence based practices from clinical interventions and risk assessment strategies. Developed by Andrews & Bonta (2006), RNR has a strong empirical track record of efficacy when applied to diverse samples of offenders, including sex offenders (Hanson, Bourgon, Helmus, & Hodgson, 2009). We offer a detailed structural model that seeks to provide a more seamless integration of risk assessment with management and discretionary decisions, including a primary focus on RNR-based post-release aftercare. We end with the mantra that sex offender treatment alone will never effectively mitigate sexual violence in society, since the problem is not confined to the handful of offenders who spend time in prison and are offered some limited exposure to treatment. Any truly effective model must go well beyond the management of those known to be violent and embrace a comprehensive and integrated approach that begins by recognizing the seeds of sexual violence sown by society. Such a public health paradigm places victims - not offenders - at the center, forcing society to come to address the full gamut of hazards that fuel sexual violence.     

Understanding how sexual offenders compare across psychiatric and correctional settings: examination of Canadian mentally ill sexual offenders

Abstract

Much of what is known about sexual offenders is based on correctional samples and then applied across settings based on the assumption that this group is homogeneous. In this study, 149 files were compared, including 108 cases from the forensic mental health system (FMH) and 41 cases from the correctional system (COR). Although many similarities were observed between the FMH and COR groups, the results also revealed important differences. The FMH group was characterised by more frequent hospitalisations, higher rates of major mental illness and single status. The COR group was characterised by a history of physical and sexual abuse, family history of addictions, more intrusive sexual offences and higher rates of offending. These results highlight different profiles for sexual offenders in forensic mental health and correctional settings and challenge us to consider the implications for assessment, treatment and risk management of this unique group of sexual offenders.     

Sexual offenders with learning disabilities: risk,recidivism and treatment

Abstract

While the literature on the assessment, treatment and management of non-learning disabled sexual offenders is well established, it is only in recent years that researchers and clinicians have focused on sexual offenders with learning disabilities. In contrast to mainstream sex offender treatment programmes, there are few evaluated community-based treatment programmes for sexual offenders with learning disabilities, and of the small number of published studies that describe treatment programmes, most are based on small samples and few have been validated empirically. Sexual offenders with learning disabilities differ from their non-disabled counterparts in several important ways, having implications for management and treatment. Due to methodological differences between studies, the prevalence of sexual offending by men with learning disabilities is not clear. However, in some studies, the sexual recidivism rate of offenders with learning disabilities is 6.8 times and 3.5 times that of non-disabled sexual offenders at 2- and 4-years’ follow-up, respectively. Sexual offenders with learning disabilities are also at greater risk of re-offending in a shorter time period. There remains an urgent need for further research into the assessment of risk and whether components from mainstream treatment programmes can be adapted to meet the needs of learning disabled sexual offenders. Approaches to working with sexual offenders with learning disabilities and programme development are discussed.     

Review on female sexual offenders: findings about profile and personality

Introduction

Although in the past sexual abuse was perceived as an issue connected only with males the contemporary literature is placing increasing emphasis on the role of female sexual perpetrators. There is still disagreement about the definition of sexual abuse, the frequency that it occurs and the characteristics of the women that are sexual abusers.

Methods

Thorough research of the main databases (MEDLINE and PsycInfo), for case reviews and studies along with restriction on European and North American literature, is due to perceived culture differences. Further investigation for relevant studies through web search engines such as Google, locates agencies and organizations that are interested and connected to sexual abuse issues.

Results

Distinction between sexual offense and sexual abuse has as a result difference in the characteristics of female sexual perpetrators. They are mainly young (age up to 36 years old), friends or relatives of the victim, using more persuasion and psychological coercion and legally charged in a lesser extent compared with male abusers. However the psychological consequences for the victim can be more severe.

Conclusion

A unanimous view of what is female sexual abuse is difficult to reach. Often it is under reported, unrecognized or considered ethically more acceptable than male abuse. It is also connected with an increased self-report of history of sexual abuse of the perpetrators. A typology of female sexual abusers should be developed. Treatments focusing on different psychological interventions along with prevention and public awareness can be a powerful tool in reduction of sexual abuse perpetrated by females.     

The personal impact of delivering a one-to-one treatment programme with high-risk sexual offenders: Therapists' experiences

Abstract

Previous research suggests that delivering treatment for sexual offenders can have both positive and negative effects on therapists. We know less about the specific impact of conducting such work in different ways; for example, individually rather than in groups. This study aimed to explore the experiences of sexual offender therapists delivering a one-to-one programme with clients. Eleven therapists delivering an individual intervention with high-risk sexual offenders in English prisons took part in interviews and focus groups about the impact this work has had upon them. One participant also completed a diary charting their experiences while delivering the intervention. Content analysis identified that participants felt they experienced changes in how they viewed themselves, others and the therapeutic relationship, in both positive and negative ways. They also described experiencing intrusive thinking and feeling overly responsible for the outcome of treatment. However, positive effects were also identified. Findings suggest that the provision of structured supervisory support was particularly key in mitigating the impact of treatment delivery.     

Examining the relationship between sexual offenders and their victims: Interpersonal differences between stranger and non-stranger sexual offences

Abstract

The present study examined the behavioural differences in sexual assault offences in relation to the offender–victim relationship (stranger versus non-stranger). These differences were examined specifically in the context of four interpersonal themes of interaction: dominance, submission, hostility and cooperation. The details of 100 sexual offence cases (50 stranger and 50 non-stranger) were content-analysed, generating 58 dichotomous variables, covering offender and victim behaviour during the offence. χ² tests comparing the two samples found that offenders who were strangers to their victims were more likely than non-stranger offenders to display behaviours that indicate a hostile, violent offence style. In contrast, those offenders who knew their victims were more likely than strangers to display a less violent and more personal, compliance-gaining offence style. These findings are discussed in terms of their implications for offender rehabilitation and victim support.     

Preliminary evaluation of the use of pharmacological treatment with convicted sexual offenders experiencing high levels of sexual preoccupation,hypersexuality and/or sexual compulsivity

The current study presents the preliminary evaluation of the impact of pharmacological treatment (Selective Serotonin Reuptake Inhibitors and anti-androgens) on hypersexuality, sexual preoccupation and sexual compulsivity. The participant pool comprised 64 convicted UK sexual offenders who had been voluntarily referred for pharmacological treatment to reduce their hypersexual arousal, 51 of whom agreed to take the medication (with a further five individuals on hold or under assessment at the time of data extraction). The preliminary findings were very encouraging; analysis on measures assessing sexual preoccupation, hypersexuality and sexual compulsivity indicated a significant reduction between pre- and post-medication, across both types of medication. Limitations of the current research are discussed.     

Young adult sexual offenders with emerging personality disorders: developmental and offence-related characteristics and treatment engagement

ABSTRACT

In the context of the UK Government’s Offender Personality Disorder (OPD) Strategy, large numbers of high-risk young adult sexual offenders with emerging personality disorders are being screened for inclusion onto specialist intervention pathways (the OPD Pathway). However, little is currently known about the clinical and offence-related needs of this population or their impact on treatment engagement. The current study investigated the developmental, personality and offence-related characteristics of 87 incarcerated young adult sexual offenders, comparing those screened in to the pathway and those not screened in. Fifty per cent of the sample were potentially eligible for the OPD pathway. OPD eligible cases were found to have significantly higher rates of parental difficulties, developmental trauma, and childhood behavioural difficulties and to present with significantly higher rates of previous violent and sexual offences, previous allegations of sexual offences, and to have used physical coercion in their offences. The OPD sample was also significantly less likely to have pre-pubescent victims and more likely to refuse treatment, with over 70% failing to engage with the Sex Offender Treatment Programme (SOTP). SOTP non-engagement among OPD cases was most strongly predicted by categorical offence denial. Comparisons are made with the broader adolescent sexual offender literature.     

Child sex tourism: extending the borders of sexual offender legislation

Child sex tourism, the act of traveling to engage in sexual acts with minors, plagues developing nations worldwide. Several laws have been passed internationally in recent years designed to curtail this practice. Government entities and human rights organizations have driven these efforts. United States citizens represent a significant proportion of participants in child sex tourism. The PROTECT Act of 2003 prohibits United States citizens from participating in sexual acts with minors while traveling, and establishes extraterritorial jurisdiction. The case of Michael Lewis Clark, the first United States citizen convicted under this legislation, is highlighted. Child sex tourism poses unique issues to courts that will require ongoing clarification as challenges arise. This article discusses potential future challenges, describes strategies to address this problem, and relates this issue to psychiatry. Mental health providers may have the role of evaluating both the victims and perpetrators of child sex tourism. The authors propose a classification system for offenses and an initial list of topics to discuss with victims. The authors also describe the proper mechanism for reporting United States citizens suspected of participating in child sex tourism.     

Inter-rater reliability of dynamic risk assessment with sexual offenders

Abstract

This paper describes the inter-rater reliability of the Structured Assessment of Risk and Need (SARN, formerly known as Structured Risk Assessment). The SARN is a structured framework for identifying sexual offenders’ dynamic risk factors. The SARN comprises 16 dynamic risk factors, categorized into four domains: Sexual Interests, Distorted Attitudes, Socio-Affective Functioning and Self-Management. Two studies, utilizing three samples, are reported. Study 1 examined the inter-rater reliability of four SARN cases with a sample of seven expert raters. Results indicated high inter-rater reliability amongst these participants. Study 2 examined the reliability of SARN with two samples who had received training before supplying inter-rater data (N=88). Results provided some support for the reliability of SARN. However, strength of reliability was dependent upon the method of analysis applied (percentage agreement, Cohen's Kappa, intra-class correlation coefficients). These results are discussed in terms of their clinical and methodological implications.     

An analysis of self-reported suicide attempts and ideation in a national sample of incarcerated individuals convicted of sexual crimes

ABSTRACT

Suicide is the leading cause of preventable death in US jails and prisons, with rates three to nine times higher than those of the general population. Although suicide in correctional settings has been recognised as a serious problem, the research on suicide among incarcerated individuals remains limited. Individuals who have committed sexual offenses may be at an elevated risk for suicide. Specifically, they have been found to report high rates of hopelessness and depressive mood, and approximately 14% of individuals convicted of sexual offenses have reported a suicide attempt at some point in their lives. Most of these data are based upon official reports and may represent an underreporting of the true prevalence of the problem. The current study provides an analysis of the prevalence and factors associated with self-reported suicidal thoughts and behaviours in a large national sample of individuals convicted of a sexually based crime. Overall, 17.9% of the offenders reported an attempted suicide in their lifetime, 15.1% reported experiencing suicidal ideation but never made an attempt. Risk factors for suicide attempts and ideation for this population are reported. The findings are discussed in the context of suicide prevention and intervention efforts among those who have committed sex offenses.     

A systematic review of the literature comparing male non-serial sexual killers and sexual aggressors: examining homogeneous and heterogeneous characteristics of these groups

ABSTRACT

This systematic review considers what is known about the characteristics of sexual killers and sexual aggressors. The aim was to identify which characteristics have consistently been shown to be similar (homogeneous) and which are different (heterogeneous) across these two groups. Ten studies, including approximately 300 sexual killers, were analysed. Only studies where the samples were directly compared and where sexual killers were male, predominantly non-serial and perpetrated against adult female victims were included. Results indicate that levels of loneliness and anger appear to be more prevalent in the sexual killer sample while mental health disorders, criminal history, family structure and history of sexual abuse as well as some crime scene behaviours seem to be similar across the two groups. The results of this review have also highlighted some methodological problems inherent to these types of studies and these issues are discussed from the perspective of improving research on these crimes.