Factors associated with rapid failure in a Treatment Alternatives for Safer Communities (TASC) program

Exploring Reasons for Non-Engagement From a Peer-Led Diversionary Intervention for Veterans in Police Custody

UK veterans with complex needs arrested in police custody can access support through pre-charge diversion into treatment and ancillary services. We consider why veterans in police custody disengaged from a peer-led criminal justice diversionary support service in one UK region that adopted a continuous case management approach. Seven hundred and fifty-seven veterans were assessed to have high levels of comorbid health needs and socio-economic harms, with one-quarter (26.7%, n = 202) subsequently disengaging from the service. A logistic regression model using Multivariate Imputation by Chained Equations identified that veterans of a younger age, no-fixed-abode, a history of incarceration, and those from a Royal Navy background were likelier to disengage from the intervention. We conclude that this peer-based diversionary model has some efficacy in maintaining the engagement of a highly complex, comorbid segment of criminally-justice-exposed UK military veterans. The perceived benefits of an integrated peer-based model predicated on continuous case-management techniques are discussed.

Diversion Programs for Individuals Who Use Substances: A Review of the Literature

Diversion programs connect individuals to treatment instead of criminal sanctions and are used more frequently to address substance use. This systematic scoping review included 31 published empirical studies to examine evaluations of diversion programs that address substance use and misuse. We assessed the program characteristics and implementation settings, as well as the outcomes measured and study methods used. We identified five prevalent study outcomes categories: (a) Service utilization (program retention and completion), (b) Recidivism/criminality, (c) Substance use, (d) Psychosocial functioning, and (e) Other outcomes (e.g., trauma, quality of life, and housing). Findings demonstrated limited but promising evidence for improvements in recidivism, substance use, and psychosocial outcomes. The limited evidence may be partly due to heterogeneity in diversion program implementation, study designs used, and differences among subpopulations. Most studies examined postbooking diversion programs; therefore, further examination of alternative approaches such as prebooking diversion programs is needed to fully understand diversion program impacts.

The Effect of Treatment Completion on Recidivism Among TASC Program Clients

Despite the enormous resources spent by states in the United States on bridging the gap between criminal justice and behavioral health services, there have been relatively few statewide evaluations of drug treatment client recidivism. We present the results of an evaluation of recidivism outcomes for a sample of individuals ( n = 1,274) referred to the Treatment Accountability for Safer Communities (TASC) program in North Carolina from 2007 to 2008. The methodology accounted for both client and offense characteristics drawn from TASC, court, and corrections records. Multivariate analyses indicated that program completion is the most important predictor of re-arrest in the 3-year follow-up period, followed by a number of protective and risk factors. More specifically, being female, older at the time of program entry, as well as higher levels of educational attainment decreased the odds of re-arrest, whereas using crack/cocaine increased the odds of re-arrest. Suggestions for future research and policy implications are provided.

Gaging the impact of multiple substance use on community corrections involvement

Historically, research has demonstrated that multiple substance use, compared to single substance use, poses additional challenges for treatment throughout the continuum of care including referrals, interventions, and relapse prevention. However, it appears that this pattern cannot be easily generalized to all criminal justice settings as evidenced by mixed findings across criminal justice samples. The purpose of the current study is to investigate possible differences in legal and substance-related outcomes between multiple substance users and single substance users within a community corrections sample. Structured clinical interviews were conducted to divide 531 individuals under community corrections supervision into three groups including multiple substance users, single substance users, and non-substance users. Results indicated that while multiple substance users were arrested more frequently and had more problems with family members, there were no differences compared to their single substance using counterparts in terms of depressive disorders, anxiety disorders, or types of offense. These findings contrast with previous research on samples outside of community corrections suggesting that multiple substance use requires tailored interventions with consideration to context of their use. Discussion includes limitations to generalizability and assessment of substance use as well as implications for treatment and future research.

The Adverse Effects of Motherhood on Substance Use Treatment Program Outcomes Among Adolescent Women

OBJECTIVES

Adolescent mothers have differing risks and responsibilities compared to adolescent women without children that may impact substance use treatment. This study sought to describe characteristics of adolescent women in a substance use treatment program and determine the effect of adolescent motherhood on treatment program outcomes.

METHODS

Data were collected from standardized interviews of female adolescents in a case management criminal justice diversion program for substance-using adolescents and adults. Variables included sociodemographic factors (ie, race/ethnicity, age, financial support, education, insurance, marital status, sexual abuse), Diagnostic and Statistical Manual-IV (DSM-IV) substance use disorder diagnoses, and motherhood (ie, childbirth and residence with a child). Treatment program outcome was documented by case workers at the end of the participants' time in the program. Chi-square analyses and analysis of variances determined associations between variables. Logistic regression was used to assess characteristics associated with negative treatment program outcome.

RESULTS

Data from 1080 adolescent women aged 16-21 years (mean 19.7 years, SD = 1.16) were analyzed; 403 (37%) were mothers. After controlling for sociodemographic factors and substance use disorder diagnoses, adolescent mothers were less likely to successfully complete the treatment program than nonmothers. Adolescent women with reliance on family or friends for financial support, lower education status, and cannabis and cocaine use disorders had worse treatment program outcomes.

CONCLUSIONS

Childbirth and parenting adversely affect substance use treatment outcomes for adolescent women in the criminal justice system. Future research should explore tailored substance use treatments for adolescents with children. Job training and educational support may improve outcomes.

The entanglement between relapse and posttreatment criminal justice involvement

BACKGROUND

Research has established a connection between substance use and criminal activity, but much less is known about the association between posttreatment relapse and related contact with the criminal justice system.

OBJECTIVE

The current study was designed to elucidate this relationship by examining the long-term effects of relapse on arrest. The study also investigated the probability of relapse into substance use as it followed an arrest.

METHOD

Data from 5,822 adults who participated in the Comprehensive Assessment and Treatment Outcome Research (CATOR) system were analyzed. This prospective longitudinal research design included 0-6, 6-12, 12-18, and 18-24 month follow-up data.

RESULTS

A series of logistic regression analyses indicated that relapse was associated with posttreatment arrest within the observed follow-up period, but did not significantly influence the likelihood of arrest in future follow-up periods. In comparison, posttreatment arrest in the 6-12 month follow-up period had lasting effects for relapse to substance use in the 12-18 and 18-24 month periods. Arrest in the 0-6 month posttreatment period was also associated with increased risk for relapse in the 18-24 month period.

CONCLUSIONS

Given the evidence that demonstrated within follow-up period associations between relapse and arrest, relapse prevention is critical to preventing contact with the criminal justice system. In addition, the lasting impact of an arrest must be mitigated to maintain posttreatment recovery from substance use for adults who come into contact with the criminal justice system.

The impact of non-concordant self-report of substance use in clinical trials research

BACKGROUND

Studies comparing self-report substance use data to biochemical verification generally demonstrate high rates of concordance. We argue that these rates are due to the relatively high true negative rate in the general population, and high degree of honestly in treatment seeking individuals. We hypothesized that high risk individuals not seeking treatment would demonstrate low concordance and a high false negative rate of self-reported substance use.

METHODS

A sample of 500 individuals from a smoking cessation clinical trial was assessed over 1 year. Assessments included semi-structured interviews, questionnaires (e.g. Addiction Severity Index, etc.), and urine drug screen assays (UDS). Generalized estimating equations (GEEs) were used to predict false negative reports for various substances across the study and determine the influence of substance use on the primary study outcome of smoking cessation.

RESULTS

Participants demonstrated high false negative rates in reporting substances use, and the false negative rates increased as the study progressed. Established predictors of false negatives generalized to the current sample. High concordance and low false negative rates were found in self-report of nicotine use. A small but significant relationship was found in for effect of biochemically verified substance use on smoking cessation.

CONCLUSIONS

Biochemical verification of substance use is needed in high risk populations involved in studies not directly related to the treatment of substance use, especially in populations with high threat of stigmatization. Testing should continue through the time period of the study for maximal identification of substance use.