For whom does prison-based drug treatment work? Results from a randomized experiment

Objectives

Prison-based therapeutic community (TC) drug treatment followed by community aftercare is widely recognized as the most effective treatment paradigm for drug-dependent offenders. However, few randomized experiments have addressed this question and fewer studies have examined how interactions between treatment modality and individual characteristics may explain variations in outcomes.

Methods

Using a randomized experimental design, this study examined the effects of treatment modality [TC vs. Outpatient (OP) group counseling], individual psychosocial characteristics (e.g., risk, negative affect), and interactions on reincarceration over a 3-year follow-up period. Survival analysis using Cox regression with covariates was used to analyze data obtained from 604 subjects at a specialized drug treatment prison.

Results

The expected advantage of TC failed to emerge. Critical and heretofore unexamined interactions between treatment modality (TC vs. OP), inmate levels of risk, and negative effect help explain these unexpected findings.

Conclusion

The superiority of prison TC to less intensive OP counseling was not supported. The effects of TC appear to be conditioned by critical responsivity factors that have received little empirical attention.     

Constellations of Interpersonal Trauma and Symptoms in Child Welfare: Implications for a Developmental Trauma Framework

Patterns of trauma exposure and symptoms were examined in a sample of 16,212 children in Illinois child welfare. Data were collected on trauma histories, child and caregiver needs and strengths, and analyzed in light of the proposed Developmental Trauma Disorder diagnostic criteria. Youth exposed to both interpersonal violence and attachment-based (“non-violent”) traumas within the caregiving system had significantly higher levels of affective/physiological, attentional/behavioral, and self/relational dysregulation in addition to posttraumatic stress symptoms compared to youth with either type of trauma alone or in relation to other trauma experiences. These complexly traumatized children exhibited higher levels of functional impairment and were more likely to have placement disruptions and psychiatric hospitalizations. Findings suggest a developmental trauma framework can more adequately capture the spectrum of needs of these multiply traumatized youth than existing diagnostic formulations. Utilizing this framework for assessment, treatment planning, and intervention can lead to more targeted and effective services for these children.     

Revolving Roles in Drug-Related Crime: The Cost of Chronic Drug Users as Victims and Perpetrators

Numerous studies have established a strong connection between the use of illicit drugs and the commission of other illegal activities, including both predatory and property crimes. No study, however, has examined the cost of crimes associated with drug users both as victims and as perpetrators. In the present study, recent data were analyzed from a targeted sample of chronic drug users (CDUs) and a matched sample of non-drug users (NDUs) in Miami-Dade County, Florida, to estimate the incremental cost of crime associated with CDU. Two separate models were employed to estimate (1) the probability of being a victim or a perpetrator of crime and (2) the cost of crime for both situations. The cost measures were transformed to reduce the influence of extreme outliers, and a smearing technique was used to compare the cost of crime for CDUs relative to NDUs. The findings illustrate that criminal activity among CDUs is circular, extensive, and costly. Implications for law enforcement, criminal justice policy, and substance abuse treatment are discussed.     

The Role of Death Qualification in Venirepersons' Evaluations of Aggravating and Mitigating Circumstances in Capital Trials

Previous research has found that death qualification impacts jurors' receptiveness to aggravating and mitigating circumstances (e.g., J. Luginbuhl & K. Middendorf, 1988). However, the purpose of this study was to investigate whether death qualification affects jurors' endorsements of aggravating and mitigating circumstances when Witt, rather than Witherspoon, is the legal standard for death qualification. Four hundred and fifty venirepersons from the 11th Judicial Circuit in Miami, Florida completed a booklet of stimulus materials that contained the following: two death qualification questions; a case scenario that included a summary of the guilt and penalty phases of a capital case; a 26-item measure that required participants to endorse aggravators, nonstatutory mitigators, and statutory mitigators on a 6-point Likert scale; and standard demographic questions. Results indicated that death-qualified venirepersons, when compared to excludables, were more likely to endorse aggravating circumstances. Excludable participants, when compared to death-qualified venirepersons, were more likely to endorse nonstatutory mitigators. There was no significant difference between death-qualified and excludable venirepersons with respect to their endorsement of 6 out of 7 statutory mitigators. It would appear that the Gregg v. Georgia (1976) decision to declare the death penalty unconstitutional is frustrated by the Lockhart v. McCree (1986) affirmation of death qualification.     

Massive systemic fat embolism detected by postmortem imaging and biopsy*

Postmortem computed tomography (pmCT) and pmCT angiography (pmCTA) provide a minimally invasive method to determine the cause of death. Postmortem image-guided biopsy allows for precise sampling of histological specimens. This case study describes the findings of lethal systemic fat embolism (FE) on whole-body unenhanced pmCT, pmCTA, and image-guided biopsy, with autopsy and histopathologic correlation. Unenhanced pmCT revealed a distinct fat level on top of sedimented layers of corpuscular blood particles and serum in the arterial system and pulmonary trunk. Subsequent pmCTA showed reproducible results, and image-guided biopsy confirmed fatal FE. pm CT/pmCTA combined with image-guided biopsy established the cause of death as right heart failure as a result of systemic fatal FE prior to autopsy. All imaging findings were consistent with traditional autopsy and histological specimens. This unique case demonstrates new imaging findings in massive, fatal FE and highlights that postmortem imaging, supplemented by image-guided biopsy, may detect the cause of death prior to traditional autopsy.     

Raz on Responsibility

Standard treatments of responsibility have been preoccupied with issues of blame and punishment, and concerns about free will. In contrast, Raz is concerned with problems about responsibility that arise from the “puzzle of moral luck,” puzzles that lead to misguided skepticism about negligence. We are responsible not only for conduct that is successfully guided by what we take to be our reasons for action, but also for misexercises of our rational capacities that escape our rational control. To deny this is to lose sight of the ways “moral luck” is an inescapable feature of our agential engagement in the world. The present essay attempts to set out Raz’s argument as sympathetically as possible. Raz’s shift of focus is a powerful counter to current tendencies and points us in new and promising directions. Nonetheless, as it stands, it may just relocate skepticism about negligence to a different place.     

Tamsin Phillipa Paige,Petulant and Contrary: Approaches by the Permanent Five Members of the UN Security Council to the Concept of ‘threat to the peace’ under Article 39 of the UN Charter

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