Māori Men's Experiences of Rehabilitation in the Moana House Therapeutic Community in Aotearoa/New Zealand: A Qualitative Enquiry

[What is effective in forensic addiction treatment? A non-systematic look into the evidence base for treatment approaches and interventions in the context of Sect. 64 of the German Criminal Code]

Forensic addiction treatment according to Section 64 of the German Criminal Code is playing an increasingly important role in the German system of correctional institutions. In recent years, the question of the effectiveness of treatment as a whole has been the focus of numerous studies. Less frequently, however, research has addressed the evidence base of therapeutic interventions and efficacy factors. Since this article takes a non-systematic look into the current state of knowledge on specific interventions and factors that play a role in the effective treatment of addicted offenders, the question of what exactly works can only be answered in a rudimentary way. The concept of Therapeutic Community appears to be largely empirically supported. Based on such evidence as is currently available, motivational interviewing and dialectical-behavioral therapy can be considered the most promising forms of therapy. The effectiveness of forensic addiction treatment lies possibly less in the application of individual approaches than in questions of the setting and the attitude of those providing treatment.

A realist review of residential treatment for adults with substance use disorder

ISSUES

Completion of residential treatment for substance use disorder (SUD) relates to improvements in substance use and mental health. Findings from systematic reviews have been equivocal about which interventions work best for clients. There has been limited attention to the theories that explain the effectiveness of residential treatment.

APPROACH

We conducted a realist review of the literature to identify program theories that would explain successful and unsuccessful outcomes from residential treatment for SUD. The unit of analysis was context-mechanism-outcome (CMO). Inclusion criteria were studies of residential treatment of more than 30 days for adults with SUD. Pharmacological studies were excluded.

KEY FINDINGS

We identified 24 studies from 5748 screened. The studies were from settings comprising Indigenous programs, faith-based programs, psycho-social interventions and therapeutic communities and were conducted in North America, Scandinavia, Continental Europe and Australasia. We chose six CMO configurations as the best explanations for outcomes from residential treatment. Theories that best explained the mechanisms of change were the need to belong, meaning in life, and self-determination theory.

IMPLICATIONS

Previous research has noted similar outcomes from different residential treatment interventions, but has not been able to explain these similarities. In contrast, our findings suggest that the outcomes can be explained by causal mechanisms that apply across all programs, regardless of the philosophy of treatment.

CONCLUSION

We identified six CMO configurations whose mechanisms of change could be explained by three overarching theories-the need to belong, meaning in life and self-determination theory. The findings apply across ethnicities and genders.

Well-being and mental health interventions for Indigenous people in prison: systematic review

BACKGROUND

Indigenous people are overrepresented in prison populations of colonised justice systems, and Indigenous prisoners in these countries are at a particularly high risk of poor mental health and well-being. There is an acute need to ensure the access of these groups to culturally appropriate, evidence-based interventions.

AIMS

To conduct a systematic review, evaluating quantitative and qualitative evaluations of mental health and well-being interventions designed for Indigenous people in custody.

METHOD

A search of relevant peer-reviewed journal articles to August 2019 was conducted. The focus was on colonised countries under a Western model of justice and health, including Canada, Australia, New Zealand and the USA. The review utilised Scopus, Web of Science, PubMed, PsycNET, EBSCO, Proquest Criminal Justice Database and Informit.

RESULTS

Of the 9283 articles initially found, only three quantitative and two qualitative evaluations of mental health or well-being interventions for Indigenous people in custody were identified. None were randomised controlled trials. Culturally based interventions appeared to have high acceptability and potential for increased recovery from trauma, reduced alcohol-related problems and lower reoffending. However, no studies quantitatively assessed mental health or well-being outcomes.

CONCLUSIONS

As yet there is no high-quality evidence on the impact on mental health and well-being from interventions specifically for Indigenous prisoners, although existing studies suggest programme features that may maximise acceptability and impact. There is a moral, social and practical imperative to build a strong evidence base on this topic.