Organizational Readiness for Change in Correctional and Community Substance Abuse Programs

Significant needs exist for increased and better substance abuse treatment services in our nation's prisons. The TCU Organizational Readiness for Change (ORC) survey has been widely used in community-based treatment programs and evidence is accumulating for relationships between readiness for change and implementation of new clinical practices. Results of organizational surveys of correctional counselors from 12 programs in two states are compared with samples of community-based counselors. Correctional counselors perceived strong needs for new evidence-based practices but, compared to community counselors, reported fewer resources and less favorable organizational climates. These results have important implications for successfully implementing new practices.     

Intellectual abilities and motivation toward substance abuse treatment in drug-involved offenders: a pilot study in the Belgian criminal justice system

A sample of Belgian drug-involved inmates (N=116) completed the European Addiction Severity Index, the Raven Standard Progressive Matrices (SPM), and the Circumstances, Motivation, and Readiness Scales. The pilot results demonstrate that nearly 50% of the participating drug-involved offenders display low intellectual abilities (SPM score definitely below average). Legal difficulties, drug abuse, and psychological problems are identified as the most severe problem areas for the total group. The participants display low to moderately low scores regarding motivation, readiness, and external reasons to stay in or leave treatment. No to very limited correlations between motivational attributes and other variables such as the length of the prison sentence and the number of violent crimes are found. Participants with high intellectual abilities are less motivated to enter substance abuse treatment compared to their counterparts with average and low intellectual abilities. Implications for treatment are discussed.     

African American Women’s Readiness to Change Abusive Relationships

This study explores 178 low-income, abused African American women’s readiness to change abusive relationships and achieve safety. We explore stages of change using Prochaska and DiClemente’s transtheoretical model (TM; Precontemplation, Contemplation, Action, Preparation, and Maintenance). Results reveal that: for abused women, the stages fall along a continuum (versus discreet and linear stages); abused women are primarily in the Contemplation stage; and multiple factors (perception of current abuse, number of children in her home, symptoms of general anxiety and posttraumatic stress disorder [PTSD], substance use, spiritual well-being, self-esteem, and social support) affect women’s total readiness to change intimate partner violence (IPV). Current IPV, anxiety, PTSD, substance abuse, and spirituality were positively correlated with readiness to change, and children in the home and self-esteem were negatively correlated with readiness to change. Multiple regression analysis revealed that PTSD and spiritual well-being are positive predictors of readiness to change. Findings contribute to the growing body of literature supporting the TM as applied to IPV. Results are discussed in terms of applicability to interventionists, policy makers, and community leaders as they consider the plight of abused women and their efforts towards violence-free relationships.     

Taking Action to Stop Violence: A Study on Readiness to Change Among Male Batterers

The Transtheoretical Model of Change (TTM) predicts that matching interventions with a person’s readiness to change should improve treatment outcomes. This cross-sectional correlational study examined characteristics that affected self-reported readiness to change abusive behavior among a sample of 109 men in a 52-week batterer treatment program. Participants completed measures of anger/hostility, readiness to change, manipulative parenting, and self-esteem. Results indicated that contemplation of the impact of abuse has the highest unique relationship with self-reported taking action to stop violence. Moreover, physical aggression and manipulative parenting account for significant variance in the scores associated with self-reported taking action to stop violence as well. These findings suggest that interventions aimed at moving clients into contemplation, and reducing physical aggression and manipulative parenting styles, may increase the likelihood that batterers will take action to stop violence.     

ASSESSING OFFENDER READINESS TO CHANGE PROBLEMS WITH ANGER

It is widely acknowledged that offender rehabilitation outcomes can be improved by attending to responsivity issues, including the readiness and motivation of offenders to undertake and engage in treatment. The measurement of responsivity, readiness and motivation in offenders, however, has received relatively little research attention. In this paper we focus on anger management programmes and evaluate the utility and psychometric properties of a measure of stages of change in relation to changing anger – the Anger Readiness to Change Questionnaire (ARCQ). Using data from a large sample of offenders undergoing anger management interventions, we investigated the construct validity, convergent validity and predictive validity of the ARCQ. We conclude the ARCQ may have utility as a measure for selecting offenders who are suitable for anger management interventions.     

A cognitive therapy treatment program for repeat DUI offenders

Driving under the influence is a devastating problem in the United States, killing almost 17,000 people in 2005. The present article describes a cognitive treatment program aimed at repeat drinking and driving offenders. Sixty-three participants were court mandated to the four-month outpatient treatment program. Before entering and after completing treatment, participants were administered self-report instruments measuring alcohol problems, readiness to change, self-esteem/efficacy, and criminal thinking patterns. Additionally, arrest histories were examined. Findings suggested that participants were characterized not only by repeated arrests, but elevated blood alcohol content and high levels of self-reported alcohol dependency and problem-drinking behaviors. The majority of clients expressed a readiness to change their drinking and driving behaviors with 87 percent graduating from the program. A DUI recidivism rate of 13 percent was found for graduates of the program at a twenty-one month follow-up. The results demonstrate that the treatment program is a valuable tool in the battle to reduce criminal recidivism.     

Assessing Readiness to Change among Perpetrators of Intimate Partner Violence: Analysis of Two Self-report Measures

Recent interest in the construct of motivation to change among male perpetrators of intimate partner violence (IPV) has led to development of two self-report measures of this construct: the University of Rhode Island Change Assessment for Domestic Violence (URICA-DV; Levesque et al. 2000) and the Safe at Home Inventory (SAH; Begun et al. 2003). We examined the internal structure of these instruments using confirmatory and exploratory factor analyses in a sample of 199 male IPV perpetrators waiting to begin court-mandated batterer intervention programs. Results indicated that the scales had adequate internal consistency. However, using confirmatory factor analyses, the hypothesized structural models of each instrument fit the data poorly. Subsequent models suggested by a series of exploratory factor analyses failed to improve model fit substantially for both scales. For the URICA-DV, a 3-factor model including items from the Precontemplation, Contemplation, and Action subscales fit the data adequately. No acceptable model fit could be found for the SAH. Intercorrelations among similar subscales across the two inventories suggested only a modest degree of intercorrelation (r’s = 0.16–0.52), and a factor structure more dependent on scale of origin than item latent content, suggesting that the scales assess different facets of the readiness to change construct. These results suggest that before the stages of change construct can be fully applied to the IPV area, more research and evaluation are needed on how to accurately assess abuser readiness to change.     

How do offenders move through the stages of change?

This study sought to investigate the way in which offenders moved through the stages of change. The University of Rhode Island Change Assessment Scale (URICA) was administered to a group of general offenders (N = 371) who participated in the Short Motivational Programme (SMP), a brief motivational interviewing programme administered to medium-risk offenders in New Zealand. The offenders' URICA responses were subjected to a cross-lagged panel analysis using structural equation modelling. Four models specifying different prospective associations between stage engagements were examined. It was hypothesised that there would be support for sequential transitions through the stages as proposed by the Stages of Change model. However, the analysis rendered support for and against sequential transitions, in that offenders regressed to earlier stages or skipped a stage post-SMP. Offenders who skipped to an adjacent stage after the SMP may have actually passed through an intermediary stage during the intervention, and those who regressed to an earlier stage post-SMP may have gained a more realistic awareness of their problem behaviour. This finding also raises questions about the practical utility of the model with offenders and highlights the need for more rigorous studies investigating the way offenders move through the stages of change.     

Examining the relationship among substance abuse, negative emotionality and impulsivity across subtypes of antisocial and psychopathic substance abusers

Growing evidence suggests that individuals with Antisocial Personality Disorder (ASPD) can be categorized into theoretically meaningful subtypes. This study builds on earlier cluster-analytic research (Poythress et al., 2010) that identified four subtypes of ASPD in a large sample of prison inmates and offenders ordered into mandatory substance abuse treatment. These four subtypes (primary, secondary, and “fearful” psychopathic and non-psychopathic ASPD) differed in theoretically important ways on various criterion measures. Of those participants in substance abuse treatment (N = 571), we compare the four clusters, as well as non-ASPD substance abusers, in terms of (a) the severity of their self-reported alcohol and drug problems and (b) whether the severity of their substance abuse is predicted by similar etiologically important correlates (i.e., negative emotionality, impulsivity). There were modest subgroup differences in abuse, although as expected secondary psychopaths reported more severe misuse than primary psychopaths. Associations between impulsivity and negative emotionality and drug use for the total sample were in the expected direction, though relatively modest in magnitude. Unexpectedly, these associations were weaker among psychopathic subtypes relative to the non-psychopathic subgroups. These findings suggest that the etiology of drug use may differ across subgroups of chronically antisocial individuals.     

Identifying subgroups at high risk of dropping out of domestic batterer treatment: the buffering effects of a high school education

This study identifies the subgroups of domestic batterers who are at a low or high risk of failing to complete domestic batterer cognitive behavioral treatment. The sample is composed of 355 domestic batterers ordered to complete treatment, with 31.8% not completing treatment. Three subgroups of batterers were identified as having at least a 60% chance of treatment failure: (a) unemployed generalized aggressors, (b) high school dropouts ordered into substance abuse treatment, and (c) unemployed offenders ordered into substance abuse treatment. Furthermore, a high school education, even when offenders are unemployed or living in poverty, buffers the negative effects of a substance abuse problem among court-mandated batterers required to participate in both domestic violence treatment and substance abuse treatment. Two thirds of substance-abusing high school graduates completed both domestic violence and substance abuse treatment, compared to only one third of the substance-abusing high school dropouts. Implications are discussed.     

A Randomized Trial of Probation Case Management for Drug-Involved Women Offenders

This paper reports findings from a clinical trial of a probation case management (PCM) intervention for drug-involved women offenders. Participants were randomly assigned to either PCM (n=92) or standard probation (n=91), and followed for 12 months using measures of substance abuse, psychiatric symptoms, social support and service utilization. Arrest data were collected from administrative datasets. The sample (N=183) included mostly African American (57%) and White (20%) women, with a mean age of 34.7 (SD = 9.2) and mean education of 11.6 years (SD = 2.1). Cocaine and heroin were the most frequently reported drugs of abuse, 86% reported prior history of incarceration, and 74% had children. Women assigned to both PCM and standard probation showed change over time in the direction of clinical improvement on 7 of 10 outcomes measured. However, changes observed for the PCM group were no different than those observed for the standard probation group. Higher levels of case management, drug abuse treatment, and probationary supervision may be required to achieve improved outcomes in this population.     

The prevalence of mental disorders in a German sample of male incarcerated juvenile offenders

The current study investigated the prevalence of mental disorders among incarcerated juvenile offenders in Germany and sought to identify clinically relevant subgroups. In sum, 149 newly incarcerated male juvenile delinquents (M age = 19 years) were included. Diagnostic tools included the German version of the Structured Clinical Interview for DSM-IV and the Psychopathy Checklist-Screening Version. The most prevalent diagnoses in the sample included conduct disorders (81%), Cluster B personality disorders (up to 62%), and substance-related disorders (up to 60%). Moreover, psychopathic features were found among 21% of the participants. Cluster analysis distinguished three subgroups among this group of young offenders. The most problematic consisted of juveniles with multiple psychopathology, including antisocial traits, personality pathology, higher scores on the Psychopathy Checklist, as well as multiple substance abuse. Study outcomes are discussed in light of their implications for the development of effective treatment for juvenile offenders.     

Motivational interviewing with offenders: A systematic review

Purpose. Offender motivation is one specific responsivity variable in offender treatment and motivational interviewing (MI) is commonly used by corrections personnel. Although evidence for the effectiveness of motivational interviewing is accruing overall, a review of MI specifically with offender populations is required. Method. Relevant databases and websites were searched using terms relating to MI with offenders. Results. In total, 13 published studies and 6 dissertation abstracts were identified. MI is most evaluated in relation to substance misusing offenders (N=10). Other applications are with domestic violence offenders (N=3), drink‐drivers (N=5), and general offending (N=1). In these populations, MI is used to enhance retention and engagement in treatment, improve motivation for change, and change behaviour. Conclusions. MI can lead to improved retention in treatment, enhanced motivation to change, and reduced offending, although there are variations across studies. To advance the study of MI with offenders, a theory of change needs to be articulated on which testable hypotheses may be based. The integrity of treatment in its application needs to be assured. Based on these foundations, more outcome research is needed to examine who responds to what type of MI in relation to treatment retention, readiness to change, and reconviction.     

Evaluating the effectiveness of the Supporting Offenders through Restoration Inside (SORI) Programme delivered in seven prisons in England and Wales

Purpose. Supporting Offenders through Restoration Inside (SORI) is a programme that aims to: increase victim empathy in offenders; motivate offenders to change their offending behaviour; and to take personal responsibility for the harm that he has caused. A 5‐day course based on the SORI principles has been piloted across seven prison sites in the UK. The aim of the study reported here was to evaluate the effectiveness of the programme across these sites. Methods. Three psychometric questionnaires [Victim Concerns, Locus of Control, and Stages of Change (SoC) scales] were administered to the participants immediately before and after the programme had taken place (data were available for 131 participants for the Victim Concern Scale, 82 participants for the Locus of Control measure, and 96 participants for the SoC questionnaire). These psychometric measures were the primary research outcome. Statistical analyses were employed to assess whether any changes had been effected by the programme. Results. The results of this study found that: participants had an enhanced victim concern for all types of victims, were more motivated to change their offending behaviours, and were more willing to take responsibility for their actions, after completion of the course. No change was found in terms of participants seeing themselves as being more in control of their actions/environment. Conclusions. The results lend support for the notion that the 5‐day SORI course is effective in increasing participants’ levels of victim concern and motivation to change, while not really impacting upon levels of ownership for one's ownership for one's actions. Suggestions for future research and limitations of the study are discussed in the paper.     

The Comparability of Male Violent Substance Abusers in Violence or Substance Abuse Treatment

The abuse of alcohol is strongly associated with violent behavior in general and domestic violence in particular. The present study examined the compara-bility of dual-problem (i.e., substance abuse and conjugal violence) men in substance abuse and violence treatment milieus. Thirty males in substance abuse treatment and 33 men in violence treatment were identified as being dual-problematic and were administered the Addiction Severity Index (ASI) to assess psychosocial and substance abuse status, the Conflict Tactics Scale (CTS) for the frequency and type of abusive behavior, the Symptoms Checklist-90 (SCL-90) for psychological distress, and the 16 Personality Factor (16PF) for personality attributes. When dual-problem men from each milieu were compared on these measures, men in the substance abuse-milieu reported not only significantly more severe substance abuse problems, but also more frequent partner sexual abuse. Few other differences emerged. Thus, while current referral procedures may be appropriate in identifying and directing more severe substance abuse problems to the appropriate treatment setting, violent men with difficulties comparable to those seen in violence treatment may also be found in substance abuse treatment. These findings emphasize the need for: (1) routine objective screening for family violence and substance abuse in these two treatment milieus; (2) informed and up-to-date staff in both settings who are sufficiently prepared for the therapeutic challenges such men may present, and (3) more study of how treatment for dual-problem men may be coordinated by the violence and substance abuse treatment communities to optimize their outcome.     

Substance use disorders in forensic psychiatry: differences among different types of offenders

This is the first study that compared different types of offenders in forensic outpatient treatment (i.e., offenders of general violence [GV], intimate partner violence [IPV], sex crimes, and "other offenses" such as drug smuggling and property crimes) regarding the prevalence of substance use disorders at the time of the offense. In total, 35.8% of participants (n = 187) were diagnosed with any substance use disorder. Specifically, 61.5% of GV perpetrators, 30.9% of IPV perpetrators, 9.1% of sex offenders, and 26.7% of "other offenders" were diagnosed with substance abuse or dependence. More GV offenders and less sex offenders fulfilled diagnostic criteria for a substance use disorder. Furthermore, 29.9% of the offenders were intoxicated by substances at the moment they committed the offense (48.5% of GV perpetrators, 25.0% of IPV perpetrators, 17.4% of sex offenders, and 21.0% of other offenders). More GV perpetrators were intoxicated during the offense. As there is a clear association between substance abuse and criminal behavior, substance abuse in offenders should be assessed and, if present, be treated.     

Flashpoint: An Innovative Media Literacy Intervention For High‐Risk Adolescents

This paper describes the development and formative evaluation of a media literacy, media based intervention for high‐risk adolescents. The program described, Flashpoint, was developed to (1) moderate the influence of media presentations of violence, substance abuse and prejudice on adolescents; and t (2) teach participants cognitive skills which would enable them to resist impulses to engage in behavior involving violence, substance abuse or prejudice. The evaluation described studied the pilot testing of the program with three groups of adolescents (N=33) involved in the juvenile justice system: adolescents in a diversion program (first time, nonviolent offenders); adolescents on probation; and adolescents in residential custody of the Department of Youth Services. Qualitative findings are reviewed in detail.     

Factor Structure and Reliability of the Revised Conflict Tactics Scales for Incarcerated Female Substance Abusers

Incarcerated women with a history of substance abuse often experience intimate partner violence (IPV), both as victims and as perpetrators. The issues surrounding partner violence and substance abuse are complex, and accurate assessment of this population's experience is critical to ensure proper treatment planning and program development. One of the most common instruments with which to measure IPV is the Conflict Tactics Scales (CTS). Unfortunately, very little published data exist on the revised version of the Conflict Tactics Scales (CTS2), and no data could be located in the literature using this scale with incarcerated women. The purpose of this investigation was to examine the underlying factor structure and reliability of the CTS2 for 359 incarcerated women who had voluntarily participated in a 1–year long substance abuse treatment program. Item analysis revealed a high level of reliability for the overall scale as well as for the individual subscales. Additionally, results from the confirmatory multiple group factor analysis support the 5 underlying subscales, and taken together indicate that the scale is acceptable to use with this population.     

The Relationship Between Partner Abuse and Substance Use Among Women Mandated to Drug Treatment

This study investigates the relationship between substance use and partner abuse among women (N = 1,025) who entered drug-treatment programs through the criminal justice systems in New York City and Portland, Oregon. Self-report data on substance use and partner abuse indicate that although the rate of partner abuse in both cities is well above the national average, the less substance-involved women in Portland reported more abuse than their New York counterparts. Our analyses suggest that the relationship between partner abuse and substance use during conflicts varies within the population of women offenders who are heavily drug-involved, with women in Portland reporting a greater direct link between partner abuse and substance use. The findings indicate that there is a need for drug-treatment providers to understand their clients' victimization histories and the relationship between partner abuse and substance use in order to engage clients in the treatment process and help them learn how to avoid being victimized in the future.