Outcome evaluation of a high-intensity inpatient sex offender treatment program

The treatment outcome of a high-intensity inpatient sex offender treatment program was evaluated by comparing the sexual recidivism rates of 472 treated and 282 untreated sex offenders. The program is designed for moderate- to high-risk sex offenders and follows the principles of effective correctional treatment. The current investigation is an extension of an earlier study (Nicholaichuk et al., 2000) with the addition of 176 participants, an extra 4 years follow-up, and the use of Cox regression survival analysis to control for three potentially confounding variables: age of release, sexual offending history, and length of follow-up. Treated offenders sexually recidivated significantly less than the comparison group over nearly 20 years of follow-up, even after controlling for the aforementioned variables. The substantive findings suggest that treatment adhering to the what works principles can reduce long-term sexual recidivism for a moderate- to high-risk group of sex offenders.     

Violent behaviors in drug addiction: differential profiles of drug-addicted patients with and without violence problems

This study explored the prevalence of violent behaviors in patients who are addicted to drugs. A sample of 252 addicted patients (203 male and 49 female) who sought outpatient treatment was assessed. Information on violent behaviors, sociodemographic factors, consumption factors (assessed by the European version of the Addiction Severity Index [EuropASI]), psychopathological factors (assessed by Symptom Checklist-90-Revised [SCL-90-R]), and personality variables (assessed by Millon Clinical Multiaxial Inventory [MCMI-II]) was collected. Drug-addicted patients who were associated with violent behaviors were compared on all variables with patients who were not associated with violent behaviors. The rate of drug-addicted patients with violent behaviors in this sample was 39.68% (n = 100). There were significant differences between the numbers of patients who did and did not demonstrate violence on some variables. Patients with violence problems were younger than those without violence problems and were more likely to report having been a victim of abuse. Moreover, they were significantly more likely to have experienced an overdose and showed a significantly higher score on several EuropASI, SCL-90-R and MCMI-II variables. According to these results, patients with violence control problems present with both a more severe addiction and several comorbid problems. The implications of these results for further research and clinical practice are discussed.     

Medicaid program; time limitation on recordkeeping requirements under the drug rebate program. Final rule

This final rule finalizes 10-year recordkeeping requirements for drug manufacturers under the Medicaid drug rebate program. Manufacturers must retain records for 10 years from the date the manufacturer reports data to us for a rebate period. This final rule also finalizes the requirement that manufacturers must retain records beyond the 10-year period if the records are known by the manufacturer to be the subject of an audit or a government investigation. Furthermore, this final rule responds to public comments on the January 6, 2004 interim final rule with comment period and the proposed rule pertaining to the 10-year recordkeeping requirements, respectively.     

Medicaid program; time limitation on record keeping requirements under the drug rebate program. Interim final rule with comment period

On August 29, 2003, we published a final rule with comment period in the Federal Register that finalized two specific provisions: it established new 3-year recordkeeping requirements for drug manufacturers under the Medicaid drug rebate program and set a 3-year time limitation during which manufacturers must report changes to average manufacturer price and best price for purposes of reporting data to us. In addition, it announced the pressing need for codification of fundamental recordkeeping requirements. On September 26, 2003, we issued a correction notice to change the effective date of the August 29, 2003 rule from October 1, 2003 to January 1, 2004. In this interim final rule with comment period, we are removing the 3-year recordkeeping requirements, replacing them with 10-year recordkeeping requirements on a temporary basis, and soliciting comments on the 10-year requirements. Manufacturers must retain records beyond the 10-year period if the records are the subject of an audit or a government investigation of which the manufacturer is aware. These provisions contain a sunset date with respect to the record retention requirements to ensure that we reexamine whether the retention rule remain necessary and effective. This interim final rule with comment period also responds to public comments on the August 29, 2003 final rule with comment period that pertain to the 3-year recordkeeping requirement at Sec. 447.534(h).     

The effect of federal drug law on the incidence of drug abuse

The Controlled Substances Act (CSA) is the prevailing "drug abuse" control statute in the United States. Its manifest objective is to prevent or reduce drug use's "substantial and detrimental effect on the health and general welfare of the American people." Evaluating CSA's effectiveness in 1975, a Domestic Council Task Force reported in a White Paper to President Gerald Ford that its control measures do "reduce abuse of dangerous drugs." The Task Force's evidence was based upon a before-and-after analysis of the frequency of "drug abuse episodes" reported to the nation's Drug Abuse Warning Network (DAWN). This research note challenges the conclusion of the Domestic Council Task Force, subjecting the DAWN evidence to more rigorous scrutiny, and concluding that we do not presently have adequate materials to assess whether CSA meets its health objectives. The context of this conclusion is that of drug control, but its implications apply to health policy and health policy evaluation in general.     

Lifting the cover on drug courts: evaluation findings and policy concerns

Drug treatment courts emerged in 1989 as a court-based solution to an enormous increase of drug-related arrests. Since their inception, drug treatment courts have been subject to empirical and process evaluations to provide quantitative and qualitative data regarding their effectiveness. This article reviews the extant literature on the effectiveness of drug treatment courts and discusses findings regarding various components of the criminal justice system. It is argued that based on empirical evaluation findings, drug treatment courts have achieved success in lowering rates of recidivism among drug offenders, despite problematic methodological and analytical concerns. This article also presents key components and agents of drug treatment courts and discusses their impact and relevance to policy creation and adaptation. It is suggested that when combined with empirical evaluations, process evaluations provide great insight into the drug-treatment-court dynamic. This article concludes with a discussion of the implications of drug treatment courts for justice policy.     

Medicaid program; time limitation on price recalculations and recordkeeping requirements under the drug rebate program. Final rule with comment period

On September 19, 1995, we published a proposed rule in the Federal Register that introduced requirements for States and manufacturers pertaining to the Medicaid drug rebate program. We received several comments from States and manufacturers regarding recordkeeping requirements and drug price recalculations. This final rule with comment period finalizes separately, in an accelerated timeframe, two specific provisions of the September 1995 proposed rule. It establishes new recordkeeping requirements for drug manufacturers under the Medicaid drug rebate program. It also sets forth a 3-year time limitation during which manufacturers must report changes to average manufacturer price and best price for purposes of reporting data to us. In addition, it announces the pressing need for codification of fundamental recordkeeping requirements. Furthermore, it announces our intention to continue to work on finalizing the complete drug rebate regulation for the Medicaid drug rebate program.     

Death caused by drug addiction: a review of the experiences in Hamburg and the situation in the Federal Republic of Germany in comparison with the literature

Based on criminological experiences and pathomorphological, serological and toxicological studies of more than 300 fatalities, an overview is given of drugs, their intravenous abuse and drug deaths in Hamburg and the Federal Republic of Germany. The number of drug deaths has increased dramatically in Hamburg, where there were more than 50 cases each year in 1987 and 1988. In the F.R.G. approximately 400 cases are registered per annum. The percentage of female intravenous drug abusers is growing and the age of the decedents is increasing. The mean was formerly 25 years, but is now 30 years. Among the histopathological findings, foreign-body granulomas are of special value; infectious diseases, especially hepatitis B and HIV-infection, have to be investigated serologically and morphologically. The prevalence of HIV-1 antibodies among drug deaths in Hamburg is approximately 15%, in comparison with approximately 50% in Berlin. The "supply" of heroin has apparently become so copious that nearly all deaths are caused by overdosage with this substance. An international agreement about a definition of a drug death is a prerequisite for nationwide analyses.     

The nature and the occurrence of birefringent material in different organs in fatal drug addiction

Insoluble birefringent tablet filler materials commonly found in tablets used in solution by drug addicts as intravenous injections were investigated microscopically. The following filler materials were investigated: talc, potato- and maize-starch, microcrystalline cellulose, magnesium stearate and siliciumoxid. The morphological characteristics of the different materials are described. Tissue sections (lung, liver, spleen, heart, bone-marrow, kidney, lymph-nodes and endocrine glands) from 33 consecutive fatality cases of intravenous drug addicts autopsied at the University Institute of Forensic Medicine in Copenhagen were studied with special reference to the occurrence and nature of birefringent material. Birefringent material was most often demonstrated in lung tissue (94%), followed by spleen (76%), liver (55%), lymph-nodes (portal: 39%) and bone-marrow (24%). The material was always localized intracellularly. Granulomatous reaction was only seen in the lungs. Except for one case, talc was the only foreign material seen in other organs than the lungs, undoubtedly due to its smaller size. The presence of insoluble foreign material in lung tissue of drug addicts indicates a habit of intravenous administration and the amount of the material indicates whether the addict usually injects tablets or only does so occasionally. The presence of birefringent material in the organs have only rarely any obvious clinical implications.     

Reducing juvenile recidivism with cognitive training and a cell phone follow-up: an evaluation of the realvictory program

The purpose of this research was to evaluate the effects of a cognitive training and cell phone intervention on the recidivism of 70 juvenile offenders. Median days to rearrest were 106 for the control group, 191 for the class-only group, and 278 for the class plus cell phone group. Using rearrest as the survival criterion, the survival ratios of the class-only and class plus cell phone groups were 2.64 and 2.94 times longer than the control group, respectively. After controlling for gender, prior arrests, and risk score, the Poisson regression indicated that the class-only and class plus cell phone groups were 51% lower in total arrests than the control group. These results suggest that cognitive training supplemented with a cell phone coach is an effective and cost-efficient intervention for reducing recidivism.     

Crime trends and the effect of mandated drug treatment: Evidence from California's Substance Abuse and Crime Prevention Act

The Substance Abuse and Crime Prevention Act (SACPA), implemented statewide in California in July 2001, mandates drug treatment rather than incarceration for certain nonviolent drug offenders. Critics of the legislation suggest that crime increased as a result of the legislation, but researchers have largely ignored this issue. Utilizing time series methodology applied across several independent data sets from Orange County, California, the effects of SACPA on crime were assessed. Results indicate that significant increases in commercial burglaries and paraphernalia arrests may have been attributed to SACPA, but the overall pattern does not support a conclusion that crime increased markedly.     

The forensic medical significance of morphometry of the spleen in drug addiction and chronic alcoholic intoxication

Data on histomorphologic damage to the spleen in chronic narcotic and alcoholic intoxication are described. The below features are recommended for the diagnosis of chronic exogenous intoxication: thickening and sclerosis of the spleen connective structures and a lower count of lymphocytes in the white pulp. The diagnosis criteria of chronic intoxication by intravenously administered opiates are: hyperplasia of the spleen follicles as well as a higher quantity of plasmocytes and of eosinophiles in the white pulp. Hypotrophy of the spleen lymphoid follicles and higher counts of monocytes and macrophages in the lymphoid follicles should be also regarded as a sign of chronic alcoholic intoxication. The obtained data can be used by forensic medical experts in the diagnosis of chronic narcotic intoxication and in its differential diagnosis versus alcoholic intoxication.     

An evaluation of a private alternative probation and counseling program: Predicting program outcomes from client characteristics

The purpose of this evaluation was to determine if client characteristics affected selected program outcomes. The sample consisted of 475 clients admitted into a for-profit, private alternative probation and counseling program between November 1, 1998 and February 28, 1999. Multiple regression analyses identified race, previous alcohol and drug treatment, and employment status as significant predictor variables of client compliance. Being able to target client characteristics that are associated with successful program outcomes can help programs fulfill their goals of diversion and costeffectiveness, thus making the most effective use of scarce resources.     

Acupuncture in drug treatment: Exploring its role and impact on participant behavior in the drug court setting

The originators of the Miami drug court incorporated acupuncture into the substance abuse treatment regimen that has been widely imitated in hundreds of drug courts since 1989. Although there is some evidence to suggest that acupuncture may be an effective adjunct to treatment more generally, research has not yet examined its role and impact in the drug court setting. This paper describes an effort to study the impact of acupuncture on offender behavior and progress in treatment in the Clark County, (Las Vegas) Nevada Drug Court using a prospective modified experiment, where 336 new participants were randomly assigned to acupuncture and no-acupuncture conditions. However, significant treatment contamination hindered straightforward analysis, as nearly 40% of the control group received at least some acupuncture. To compensate for the treatment compliance problem, two-stage least-squares (2SLS) regression is employed with original group assignment as an instrumental variable and acupuncture exposure as a predictor. Results indicate no significant difference along a range of criminal justice and treatment outcomes, with the exception of one measure of treatment progress. The paper concludes with a discussion of the implications of the findings and the need to design studies that are better able to separate the effects of acupuncture from other treatment and court interventions.     

Evaluation of the persistently violent offender treatment program

The treatment of violent offenders has evolved in recent years, shifting from interventions focused on anger management to those incorporating social information processing skills. The present study was a multimethod evaluation of one such program, the Persistently Violent Offender program. A total of 256 Canadian male violent offenders participated in the study; 70 Persistently Violent Offender program completers were compared to two control groups (n(1) = 33, n(2) = 105) who completed an alternate program and to 48 offenders who failed to complete either program. Results demonstrate few differences among groups in terms of changes on measures of treatment targets, involvement in institutional misconducts, and postrelease returns to custody, thus demonstrating that the Persistently Violent Offender program was superior to neither the alternate program nor program noncompletion. These results are discussed in light of the findings from two more promising recent evaluations of similar programs.