An outcome evaluation of prison-based treatment programming for substance users

Estimating a treatment effect on recidivism for correctional multiple component treatment for people in prison with an alcohol use disorder in England

Background

There is an emerging literature on the impact of correctional substance abuse treatment (SAT) on reoffending for people in prison with substance misuse issues. This study estimates a pathway effect for people in prison receiving multiple component treatments for an alcohol use disorder (AUD) to reduce reoffending by applying treatment effect estimation techniques for observational studies. Treatment groups comprised pharmacological treatments, psychosocial interventions (PSIs) and interventions that incorporate Risk Need Responsivity (RNR) programming. RNR compliant treatment matches treatment dose to the risk of reoffending, targets criminogenic need and is tailored to a person’s learning style.

Methods

Multiple treatment effect estimators are provided for people in prison diagnosed with an AUD in England when compared to a derived control group for: Pharmacological treatment only; RNR compliant treatment and PSIs.

Results

The outcomes for RNR compliant treatment suggest a lower recidivism rate compared to the control group. Pharmacological only treatment results in a statistically significant higher level of reoffending relative to the control group.

Conclusions

The creation of a universal system of ‘equivalence of care’ framed within a public health context in English correctional SAT may have had an unintended consequence of diluting approaches that reduce recidivism. There is an opportunity to develop an integrated, cross-disciplinary model for correctional SAT that unites public health and RNR compliant approaches.

Preliminary evaluation of a forensic dual diagnosis intervention

Purpose

– This study is a post hoc service level investigation into the efficacy of a forensic dual diagnosis intervention. The treatment programme incorporated the principles of cognitive behavioural therapy and Motivational Interviewing, and was comprised of three stages: psycho-education into the links between mental/physical health, substance use and offending, the cultivation of coping strategies and relapse prevention planning. The paper aims to discuss these issues.

Design/methodology/approach

– Treatment outcome was tracked using pre- and post- stage 1 and 2 measures, and included self-report questionnaires that probed service users’ readiness for change, motivations for treatment and perceived effectiveness of coping strategies (n=80 and 37 patients for stages 1 and 2, respectively). In addition, service users undertook a knowledge “quiz”, which probed information retention.

Findings

– The results show that whilst psycho-education (stage 1) increased service users’ knowledge of key issues, this had no parallel effects on other measures. In contrast, completion of stage 2 led to an increase in external motivation for treatment, although this did not translate into a shift in service users’ readiness for change.

Research limitations/implications

– These findings are consistent with the Motivational Interviewing literature and highlight the need for a shift in internalised motivation for treatment if change is to be elicited. Further, they point towards the viability of using self-report measures to monitor treatment outcome in a secure forensic setting.

Originality/value

– These findings have a number of implications for the design and on-going evaluation of forensic dual diagnosis services, an area of research that is currently under-represented in the literature.

Drug treatment programmes in prison: longitudinal outcome evaluation, policy development and planning interventions

Aims: The aim of this research is to evaluate a seven week abstinence-based drug treatment programme and to use this to assist policy makers in the planning and provision of future programmes.

Methods: Design: Seventy-nine clients were interviewed at two stages. Stage I, prior to the treatment programme, stage II, immediately after the treatment programme. A selected group of 20 clients were followed-up and interviewed at stage III, up to 24 months after the treatment programme.

Setting: All clients were prisoners at Mountjoy Prison, Dublin Ireland.

Participants: Seventy-nine male prisoners were recruited. A sample of 20 of the original cohort of 79 was selected using a snowball sampling method approximately 24 months following treatment. This latter sample of 20 clients consisted of eight prisoners who had re-offended and returned to prison, three prisoners who were still in prison serving their original sentence and nine prisoners who were out of prison. These 20 also participated in a more detailed quantitative and qualitative survey.

Measurements: In order to measure prisoner's criminogenic attitudes and needs the Crime Pics II instrument was used. This is a semantic differential scale which measures attitudes toward offending behaviour. It includes a problem checklist which can be used to measure change over time.

Results: An 82% follow-up rate was achieved on the original group of 79 clients, similarly a follow-up rate of 100% was also achieved for the selected group of 20 clients who were interviewed three times. Regardless of category of client, findings demonstrate an improvement over time for the outcome variables, general attitude to offending, anticipation of re-offending and perception of current life problems. However, the study failed to demonstrate any significant change for the outcome variables victim hurt denial and evaluation of crime as worthwhile.

Conclusions: These results were short lived for many prisoners, who failed to sustain the gains made. Interviews with the cohort of 20 who underwent stage III interviews possibly suggest that those clients who did not receive continuity of treatment post programme, in terms of case management and structured treatment did not fare as well as those who did.

Evaluation of the addressing substance-related offending (ASRO) program for substance-using offenders in the community: a reconviction analysis

This article reports an evaluation of the Addressing Substance-Related Offending program in the English and Welsh Probation Service. Participants were 319 adult male offenders who had a history of substance use and were serving community sentences. A quasi-experimental design was used to compare the reconviction rates of offenders who completed the program, offenders who started but did not complete the program, and a comparison group of offenders who were not allocated to the program. Multivariate analysis showed that at one-year follow-up the completers had a significantly lower rate of reconviction and longer time to reconviction than the non-completers, and the non-completers had a significantly higher rate of reconviction and shorter time to reconviction than the comparison group. No differences were found in reconviction between the completers and comparison group.

What works in substance misuse treatments for offenders?

BACKGROUND

The prevalence of problematic drinkers and drug users in correctional services of England and Wales is high, with implications not only for the health of prisoners, but also for substance-related crime. For most illicit drug users, the biggest criminological concern is acquisitive offending to fund the habit, whereas with alcohol it is violence and disorder. There is clearly a strong need in correctional services for treatment for both drug and alcohol use. What works in substance misuse treatments for offenders?

FINDINGS

This review shows that the evidence is strongest for the effectiveness of therapeutic communities and cognitive-behavioural therapies. Purely behavioural therapies are ineffective, as are boot camps and group counselling. Maintenance prescription for offenders addicted to heroin, especially if combined with psychological treatment, shows promise. Arrest-referral schemes, court-mandated drug rehabilitation and drug courts can be effective, but improvements in multi-agency working are also necessary.

CONCLUSIONS

There is evidence that treatment for substance abuse in correctional settings can work to reduce reoffending, and so it is worth focusing on how the effectiveness of these interventions may be improved. Improving completion rates, developing programmes aimed at specific drug- and alcohol-related offences, introducing stepped care and designing programmes to meet the needs of specific groups of offenders are all considered.