Brief motivation enhancing intervention to prevent criminal recidivism in substance-abusing offenders under supervision: a randomized trial

The goal of this study was to assess the effect of a brief motivation enhancing intervention (MEI) on criminal recidivism. This was a multi-site, cluster-randomized clinical trial in six addiction probation offices. We randomized 73 probation officers (37 to intervention, 36 to control) and followed 220 substance-abusing repeat offenders that were allocated to them (111 intervention, 109 control). We report three measures of recidivism rate (self-report, police records, and combination of either of the two) and time to re-offending (police records) during a 12-month follow-up period. The proportion of re-offending and time to re-offending was not significantly different between offenders that received supervision plus intervention and those that received supervision-as-usual (SAU, no intervention). Our findings provide no evidence that supervision plus a brief MEI is more effective than SAU.     

Effectiveness of modified therapeutic community treatment within a medium-secure service for personality-disordered offenders

There is debate as to whether secure hospital treatment for offenders with personality disorder can be effective relative to criminal justice interventions. This study examines the evidence for long-term treatment of such offenders in hospital within in a modified therapeutic community model including accredited offending behaviour programmes. A panel sample of 47 patients were followed up on measures of violence risk (HCR-20, VRS) and symptom severity (SCL90-R). Intention-to-treat analysis with reliability thresholds showed significant positive change between assessment and discharge in both violence risk (VRS) and symptoms (SCL90-R) indicating a positive treatment effect. Threshold effects for treatment effectiveness seemed to occur at 1?year of treatment for risk and 3?years for symptom reduction.     

Predicting the effect of substance abuse treatment on probationer recidivism

Support for the effectiveness of substance abuse treatment to reduce substance use and recidivism among populations supervised by the criminal justice system continues to grow in substance abuse and criminal justice literature. Recent studies show that a variety of programs including the Breaking the Cycle program and drug courts appear to result in improved outcomes for offenders. In this paper, we examine the effect of non-residential substance abuse treatment on arrest. Our data are for almost 134,000 ‘drug-involved’ individuals sentenced to probation in Florida between July 1995 and June 2000. Nearly 52,000 of these individuals received non-residential substance abuse treatment, while 81,797 did not. Our approach is a methodologically simple one that entails stratifying our data by treatment status, estimating logit and negative binomial models of arrest for each of the two datasets, and then applying each model to both datasets. This approach, which requires that both groups include subjects for whom treatment is appropriate, is analogous to using regression models to predict outcomes for new values of independent variables. For each observation in the dataset, we use the models to predict the expected outcomes for each individual under two scenarios – receiving non-residential treatment and receiving no treatment. Summing over these individual estimates provides an estimate of the total numbers of arrests that would be expected under different levels of population exposure to treatment. Results suggest that non-residential treatment reduced both the expected numbers of individuals who recidivated (i.e., were arrested) and the expected total numbers of arrests in the 12 and 24 months following placement on supervision.**RTI is an independent organization dedicated to conducting innovative, multidisciplinary research that improves the human condition.     

Evaluation of the assessment and treatment of a child sex offender: A case study

Abstract

There is indisputable necessity for engaging child sex offenders in effective therapy to reduce recidivist rates. However, it is becoming increasingly recognised that, to do this, more contemporary psychological methods of treatment are being utilised instead of, or as well as, imprisonment.

To establish what constitutes effective therapy requires the constant search for new and successful treatments. To achieve this, it is advantageous to follow preexisting successful methods of treatment but to acknowledge that therapy must be adapted according to an individual's unique presenting difficulties and therapeutic needs.

This paper details assessment techniques, evaluation of psychological dysfunctions, the therapy plan and treatment outcome of a convicted child sex offender. Specifically, Mr X's background history, psychological dysfunctions and progress, using a functional analysis approach, are examined in detail with critical review of the therapeutic intervention.     

An unusual case of accidental poisoning: fatal methadone inhalation

In this report, the authors present a case of unusual, accidental methadone intoxication in a 40-year-old man, who had inhaled methadone powder. The drug dealer was a pharmacy technician; methadone had been stolen from a pharmacy and sold as cocaine. After having inhaled methadone powder, he suffered cardiopulmonary arrest. He was admitted to hospital where he died after 24 h of intensive care. The autopsy revealed congestion of internal organs and cerebral and pulmonary edema. Microscopically, the heart showed no changes. The toxicological analyses performed on blood and urine taken at the hospital revealed methadone, cannabinoids, and ethanol. The blood methadone concentration was 290 μg/L. The urine methadone concentration was 160 μg/L. Midazolam and lidocaine, which were administered to the patient at the hospital, were also detected in the blood. The cause of death was determined to be methadone intoxication. The literature has been reviewed and discussed. To date, and to our knowledge, only very few cases of accidental death resulting from methadone inhalation have been described up to the case presented herein.     

A prospective study of pathways to hospital readmission in Canadian forensic psychiatric patients

Individuals admitted to secure care often experience lengthy hospitalizations and are likely to be admitted on more than one occasion. In the context of growing demand and costs associated with secure care, the current study investigates the frequency and reasons for readmission among 87 forensic patients recently discharged into the community. We identify risk factors that are associated with the likelihood of readmission and describe areas of overlap and discordance with the existing literature in civil and forensic samples. Using a prospective design that included patient follow-up interviews and records review, we found that 28% of patients were readmitted on one or more occasions over a 12-month period. Psychiatric decompensation, substance use, and treatment non-adherence were the central reasons prompting readmission. Patients with one or more readmissions were found to have spent significantly more time in the forensic mental health system as compared to patients not readmitted. They were more likely to have a substance use disorder and were estimated to be at higher risk for violence. Results replicate the finding of low rates of serious violence and reoffending among discharged forensic patients, and substantiate the centrality of substance use as a growing and clinically important treatment issue.     

The impact of an intensive inpatient violent offender treatment programme on intermediary treatment targets,violence risk and aggressive behaviour in a sample of mentally disordered offenders*

This study examined the impact of an intensive inpatient violent offender treatment programme, Life Minus Violence-Enhanced (LMV-E), on intermediary treatment targets, risk for violence, and aggressive behaviour during treatment in a sample of male mentally disordered offenders. Using quasi-experimental design, offenders who completed LMV-E and a comparison group showed reduced problems with impulsivity and anger regulation and improvements in social problem solving. Aggregate risk for future violence lessened in both treatment and comparison groups, although by a significantly greater degree for the comparison group. The aggressive behaviour of both groups reduced. Completion of the LMV-E conferred additional improvements in some facets of social problem solving and anger regulation. Neither group showed improvements in empathic responses, coping skills or problematic interpersonal style. Overall, these results suggest anger regulation, impulsivity and social problem solving are most amenable to change, that reductions in certain facets of these dynamic risk factors transpires with nonspecific psychiatric inpatient treatment, but that the LMV-E, a cognitive behavioural violence specific psychological treatment, confers greater change in some facets of social problem solving and anger regulation.     

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.     

Poisoning deaths in Central China (Hubei): A 10-year retrospective study of forensic autopsy cases

A retrospective study of autopsy cases was conducted at the Department of Forensic Medicine, Tongji Medical College (DFM-TMC), in Hubei, China to describe the characteristics of poisoning deaths from 1999 to 2008. A total of 212 poisoning deaths were investigated by DFM-TMC during the 10-year period. The poisoning deaths ranged from 17 cases in 1999 to 27 cases in 2008. Of the 212 cases, 82 deaths (38.7%) were from pesticides, 36 deaths (17.0%) from carbon monoxide, 34 deaths (16.0%) from drugs, 22 deaths (10.4%) from alcohol, 17 deaths (8.0%) from other chemicals, 15 deaths (7.1%) from poisonous plants and animals, and six deaths (2.8%) from heavy metals. Of the 82 pesticide poisoning deaths, 43 (52.4%) cases were caused by rodenticides, mainly tetramine (N = 39). The majority of poisoning deaths were accidents (63.7%), followed by suicides (25.9%) and homicides (3.8%). The manner of death could not be determined in 14 cases (6.6%).     

Malnutrition, a rare form of child abuse: diagnostic criteria

Infantile malnutrition is often difficult to diagnose as it is rarely observed in industrialized countries. It may be associated with physical violence or occur in isolation. The essential clinical sign is height and weight retardation, but malnutrition also causes a variety of internal and bone lesions, which lead to neuropsychological sequelae and death. We report a rare case of death by malnutrition in a female child aged 6 1/2 months. The infant presented height and weight growth retardation and internal lesions related to prolonged protein-energy malnutrition (fat and muscle wasting, thymic atrophy, liver steatosis) resulting in a picture of marasmus or kwashiorkor. We detail the positive and negative criteria that established the diagnosis of abuse, whereas the parents had claimed a simple dietary error.     

Domestic violence: A national study of the nature, size and effects of domestic violence in the Netherlands

This article reports on a large-scale nation-wide study conducted by Intomart among 1,000 randomly selected Dutch adults (male and female) about their experiences with domestic violence. An important goal of the survey was to generate general information on domestic violence. It turns out that nearly half of the Dutch population (45%) has at one time been a victim of some form of non-incidental domestic violence. It was also demonstrated that both men and women become victims of domestic violence, and the high percentages of victimization during childhood are particularly striking. Furthermore, it turned out that domestic violence often involves a combination of physical, mental and sexual forms of violence.     

Dental shape match rates in selected and orthodontically treated populations in New York State: a two-dimensional study

Forensically identifying a suspect's dentition from a bitemark in an open population requires the supposition that every person's dental alignment is different. There have been few studies that have tested this claim. Four hundred and ten lower anterior dentitions from a selected population and 110 lower anterior dentitions from one that was orthodontically treated were measured using geometric morphometric analysis, allowing comparison of arch shape. Dental match rates of 1.46% and 42.7% of individuals were found in the respective populations, given an established measurement error. Orthodontic treatment had a strong effect on match rate suggesting that treated or naturally well-aligned dentitions may be indistinguishable. Sexual dimorphism was found to be only slightly significant. Principal shape variation in both populations was degree of arch curvature. Results of studying these populations show that dental matches can occur, and that statements of certainty concerning individualization in such populations should be approached with caution.     

The criminal career of men convicted of rape: evidence from a Norwegian national cohort

The extent to which sexual offenders are a group separate from other types of offenders has been debated for many years and investigated from different perspectives. The present study investigated similarities and differences regarding socio-economic background, criminal history and recidivism involving new crimes between rape offenders and three other groups: other sexual offenders, non-sexual violent offenders and other offenders. Data came from Norwegian population registers containing information on all crimes investigated from 1992 to 2012. The sample consisted of all persons convicted in 2002 and 2003 (N = 36,951). Background characteristics and estimated recidivism risk was described using hazard models. Results indicated that men convicted of rape (n = 142) had lower levels of education and that a higher percentage of them were on social benefits compared to the other crime groups. A large majority (79%) of rape-convicted men had previous convictions. Rape offenders were considerably more criminally active and diverse than the other crime groups. Prior criminal record, irrespective of type, increased the risk of recidivism in general. Controlling for other background characteristics did not alter this outcome. Treatment of convicted rapists needs to take into consideration that this offender group has much in common with violent offenders in general.     

Partial bowel obstruction in a 2-month-old child. A delayed diagnosis of anal abuse

We present the case of an anal sexual abuse involving a 2-month-old boy, who was admitted to the Pediatric Surgery Unit of the University of Padua for low bowel obstruction. The infant had been already hospitalized for 3 days in a peripheral hospital and treated with daily rectal wash-outs for a fecaloma. Only after a careful interpretation of the plain abdominal radiograph, along with the performance of a rectoscopy and a laparotomy, a vegetable foreign body (about 3 cm in diameter and 7 cm in length) was discovered in the sigma. The morphology and dimensions of the foreign body, as well as its location, left no doubt about the etiology of the partial bowel obstruction, proving that it was clearly related to an anal sexual abuse.     

“Tampering to Death”: A Fatal Codeine Intoxication Due to a Homemade Purification of a Medical Formulation

Many homemade tamper processes of medical codeine formulations are available on selected “forums” on the Internet, where recreational codeine users claim to be able to purify codeine by removing additives, such as acetaminophen, to avoid or limit adverse effects. In this work, it is reported and discussed a fatal case of codeine intoxication. The findings of objects such as jars, filters, and tablets, and amounts of unknown liquid material at the death scene investigation suggested a fatal codeine intoxication after the tampering procedure called “cold water extraction.” Toxicological results obtained from the analysis of both the nonbiological material and the body fluids of the decedent integrated with the information collected at the death scene investigation confirmed the above‐mentioned hypothesis. This report underlines the importance of a tight interconnection between criminalistics and legal medicine to strengthen the identification of the cause of death and the reconstruction of the event.     

Mentalisation-based therapy (MBT) in a high-secure hospital setting: expert by experience feedback on participation

Evidence for mentalisation-based therapy (MBT) is increasing in relation to the treatment of personality disorder. Individuals with personality disorder are over-represented in inpatient, forensic and forensic inpatient mental health services. This study explores MBT within a forensic setting as an intervention designed to moderate deficits linked to violence and to improve adaptive coping. Interpretative phenomenological analysis was conducted on interviews with four patients who completed MBT at a high-secure hospital. Findings suggest that MBT-enhanced participants’ mentalising which had a positive impact upon their capacity to manage their behaviour and emotions. MBT further enabled participants to process past experiences of violence and develop some degree of empathy for others, which led to a trend in abstinence from risk behaviours. Findings contribute a secure inpatient perspective on the experience of MBT and to MBT clinical outcomes.     

Competing ethical paradigms in forensic psychiatry and forensic psychology: Commentary for a special section of legal and criminological psychology

In her paper Gwen Adshead (2013) identifies the principle of respect for justice as the foundation for ethical practice in forensic psychiatry. This commentary discusses how forensic psychologists have approached a key aspect of the justice principle, the ethical imperative to promote the welfare of the individual client. The approaches of the psychiatric and psychological professions are compared and the role of psychologists as allied health professionals working in the forensic setting considered.     

Nail analysis for the assessment of caffeine abuse in Northwest China: A population-based study

Caffeine is the most widely consumed psychoactive agent worldwide and has the potential for abuse, but studies monitoring caffeine abuse in China are scarce. This study aims to estimate the prevalence of caffeine abuse in northwest China and investigate the correlation between caffeine and other drugs in hair and nails using an ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Fingernail clippings were collected from 376 participants in northwest China to detect caffeine and 13 other illicit psychoactive drugs and their metabolites. Paired hair and nail samples were collected from 39 participants to investigate the correlation between caffeine and other drugs in hair and nails. The samples were decontaminated, pulverized, and extracted by a high-throughput nail sample preparation method and analyzed by UPLC-MS/MS. The results showed a risk of caffeine abuse in northwest China, with concentrations ranging from 0.43 to 10.6 ng/mg for healthy volunteers, 0.49–246 ng/mg for caffeine abusers, and 0.25–363 ng/mg for drug addicts in community rehabilitation centers. Caffeine was detected together with other illicit psychoactive drugs and their metabolites. Furthermore, positive detection correlations were found between hair and nail samples. This study provides a current perspective on caffeine abuse in northwest China and demonstrates the practical use of UPLC-MS/MS for the simultaneous detection of caffeine and 13 illicit psychoactive drugs and their metabolites in hair and nails. The results highlight the potential of nails as a supplementary matrix when hair samples are unavailable and emphasize the need for handling caffeine carefully given its potential for abuse.     

A field evaluation of the VIPER system: a new technique for eliciting eyewitness identification evidence

Abstract

The main aim of the study was to investigate the rate of claimed false confession during police questioning and identify variables that best discriminate between false confessors and non-false confessors. The participants were 24 627 high school students in seven countries in Europe. Out of 2726 who had been interrogated by the police as a suspect, 375 (13.8%) claimed to have made false confessions to the police. Logistic regression analyses showed that for both boys and girls, having attended substance abuse therapy, been attacked and bullied, and having committed a burglary, significantly discriminated between the false confessor and non-false confessor. In addition for boys, having been sexually abused by an adult outside the family was the single best predictor. The study shows the importance of history of victimization and substance misuse among adolescents in relation to giving a false confession to police during interrogation.