Prison Addiction Program and the Role of Integrative Treatment and Program Completion on Recidivism

Impact of opioid maintenance therapy in the community on re-incarceration in individuals with opioid use disorder-A linked cohort study

INTRODUCTION

Studies have found associations between Opioid Agonist Maintenance Treatment during incarceration and reduced recidivism among recently released formerly incarcerated persons. However, the role of community-based Opioid Agonist Maintenance Treatment in reducing recidivism post-release remains less explored. This study examines whether pre-release arranged, prison-to-rehabilitation Opioid Agonist Maintenance Treatment in the community following release is associated with reduced rates and lengths of re-incarceration among justice-involved individuals with Opioid Use Disorder.

METHODS

A retrospective matched cohort study was conducted using linked records of 208 individuals with a history of Opioid Use Disorder and treatment during their incarceration. The primary predictor variable was the duration of Opioid Agonist Maintenance Treatment, with re-incarceration rates and lengths of stay after re-incarceration being the primary outcomes examined.

RESULTS

Analysis showed a significant decrease in re-incarcerations and or lengths of stay in prison among those who have been re-incarcerated and have undergone Opioid Agonist Maintenance Treatment in the community for >24 months.

CONCLUSIONS

Maintaining Opioid Agonist Maintenance Treatment over 24 months may reduce re-incarcerations, and may be significantly associated with a reduction in the length of prison stay for re-incarcerated individuals. The effects were consistent across the overall population and the individuals receiving the treatment. Various other unmeasured factors, including judicial discretion, individual motivation, type of offense, and employment status, could influence this association.

A Prospective Biopsychosocial Repeated Measures Study of Stress and Dropout from Substance Addiction Treatment

Introduction

This prospective, repeated-measures observational study tested biopsychosocial variables as risk factors for dropping out of inpatient substance addiction treatment. Substance use disorder (SUD) is viewed as a chronic relapsing disease caused by an interaction between biological, psychological, and social factors. However, there is a lack of prospective studies that combine biopsychosocial variables when assessing dropout. The aims of this study were to investigate whether there was 1) An association between biopsychosocial factors and dropping out of inpatient substance addiction treatment, 2) An interaction with SUD diagnosis and cortisol, and 3) Different dropout rates between short-term and long-term institutions.

Materials and Methods

Patients (n = 173) were recruited from two inpatient treatment centers in Norway between 2018 and 2021. The following biopsychosocial variables were measured at four timepoints: ward atmosphere (Ward Atmosphere Scale, WAS), psychological distress (Hopkins Symptom Checklist 10, HSCL-10), motivation (M-scale of the Circumstances, Motivation, Readiness, and Suitability questionnaire), and concentration of salivary cortisol (CORT- nmol/L). Cortisol levels were measured for two consecutive days at each timepoint and calculated by two cortisol indices, daytime cortisol slope (DCS) and area under the curve with respect to the ground (AUC_G). A multivariate logistic regression analysis was performed to find an association between dropout rates and the biopsychosocial variables.

Results

The results suggest a lower dropout odds for patients with high motivation (OR = 0.76, p = 0.022) and patients admitted to short-term treatment (OR = 0.06, p = 0.005). An interaction with stimulant SUD and DCS (OR = 13.74, p = 0.024) also revealed higher dropout odds. No statistical significance was found for psychological distress, WAS, and cortisol AUC_G.

Conclusion

The results support monitoring motivation during treatment and further investigating biopsychosocial variables when assessing dropout risk together with SUD diagnosis.

Leaving Their Drugs at the Gate? Exploring Changes in Drug Use From Before to During Incarceration in Norway

As the number of incarcerated persons who use drugs increases in many countries, it is important to understand the nature of drug use in prison by exploring how substance use patterns change from before to during incarceration. In this study, we rely on cross-sectional, self-report data from The Norwegian Offender Mental Health and Addiction (NorMA) study to identify the nature of changes in drug use among incarcerated respondents who reported having used either narcotics, non-prescribed medications, or both, during the 6 months before their incarceration (n = 824). Results show that about 60% (n = 490) stop using drugs. Of the remaining 40% (n = 324), about 86% changed their use patterns. Most commonly, incarcerated people stopped using stimulants and started using opioids; switching from cannabis to stimulants was the least common change. Overall, the study illustrates that the prison context leads most individuals to change their use patterns, some in unanticipated ways.

Re-incarceration and associated social, structural and behavioural factors among people who use drugs in an urban Canadian setting

BACKGROUND

People who use drugs (PWUD) are disproportionately incarcerated, however little is known about specific substance use, social and structural factors associated with re-incarceration among PWUD. We aimed to identify the socio-structural and substance use factors associated with re-incarceration among structurally-marginalized PWUD.

METHODS

We used longitudinal data from two prospective cohorts of PWUD in Vancouver, Canada. We included adults reporting at least one incarceration event in the last six months and who completed at least one additional follow-up study visit. We performed multivariable extended Cox regression to explore factors associated with re-incarceration.

RESULTS

Among 468 eligible participants, the median age was 40 years (Q1-Q3 = 34-46 years), 346 (73.9%) were men, 177 (37.8%) identified as Indigenous, and 227 (48.5%) experienced at least one re-incarceration event. Incidence rate of re-incarceration was 157 incarceration events per 1000 person years. In multivariable analyses, homelessness (adjusted hazard ratio [AHR] = 2.17; 95% confidence interval [95% CI]: 1.79-2.61), community judicial supervision (AHR = 3.89; 95% CI: 3.21-4.71) and re-incarceration during the study period (once: AHR = 1.95, 95% CI: 1.55-2.44; two or more events: AHR = 1.53, 95% CI: 1.23-1.90) were positively associated with re-incarceration. Among substance use variables that included illicit drugs, only heavy alcohol use remained significantly associated with re-incarceration across analyses after adjustment (AHR = 1.32; 95% CI: 1.06-1.65). Engagement in addiction treatment (AHR = 0.63; 95% CI: 0.53-0.75), mental illness (AHR = 0.70; 95% CI: 0.59-0.84) and age (AHR = 0.96; 95% CI: 0.95-0.97) were negatively associated with re-incarceration.

CONCLUSION

Access to housing and substance use services, including treatment for alcohol use disorder, following incarceration may reduce re-incarceration among PWUD. The high rates of re-incarceration of PWUD in our sample underscores how structural factors-such as homelessness and criminalization of substance use-drive re-incarceration among PWUD.

[Shortened Treatment Concepts in Forensic Commitment According to Section 64 of the German Penal Code: A Tailored Treatment Pathway?]

Die forensische Therapie gemäß §64 StGB zeichnet sich aktuell durch hohe Abbruch- bzw. Erledigungsquoten aus. Das hier vorgestellte verkürzte Therapiekonzept der Klinik für Forensische Psychiatrie des Pfalzklinikums für Patienten mit günstigen Prognosemerkmalen soll durch Förderung von Eigeninitiative, Verantwortung und Motivation sowie eine möglichst individualisierte, störungsorientierte, strafzeit- und tatangemessene Behandlung mit intensiver Erprobung unter Alltagsbedingungen zu einer Verkürzung der stationären Unterbringung führen. Empirische Belege hierfür fehlen jedoch bislang. Erstmals werden hier Pilotdaten aus dem Zeitraum April 2016 bis Mai 2021 vorgestellt. Zusammenfassend hat sich das o.g. Konzept als umsetzbar erwiesen. Die erhobenen Daten weisen darauf hin, dass die im verkürzten Therapieprogramm behandelten Patienten eine geringere Erledigungsquote als der Durchschnitt aller gemäß §64 StGB untergebrachter Patienten aufweist. Eine deutliche Verkürzung der durchschnittlichen Behandlungsdauer ließ sich demgegenüber jedoch nicht belegen. Die vorliegende Arbeit will einen ersten Beitrag zur Diskussion und Weiterentwicklung derartiger Behandlungsoptionen leisten. Mögliche Nachteile derartiger Therapieangebote bei für ungeeignet befundenen Patienten, z. B. eine Abnahme der Therapiemotivation, werden diskutiert.Forensic therapy according to section 64 of the German penal code is currently characterized by high drop-out rates. The shortened therapy concept of the Department of Forensic Psychiatry of the Pfalzklinikum focusing on patients with favorable prognostic characteristics presented here is intended to lead to a shortening of hospital stay by promoting initiative, responsibility and motivation. It is supposed to provide a treatment as individualized and disorder-oriented as possible and appropriate to the individual time of detention as well as the specific kind of offense with intensified testing under everyday conditions. However, so far empirical evidence for this concept is lacking. For the first time, pilot data for the period from April 2016 to May 2021 are presented here. The concept described herein has proven to be feasible. The collected data hint at a lower drop-out rate of patients treated according the shortened therapy concept compared to the average of all patients assigned to forensic treatment according to section 64 of the German penal code. Yet, there was no evidence for a significant shortening of hospital stay. The present work aims at making a first contribution to the discussion and further development of such treatment options. Possible disadvantages for patients who are found to be unsuitable, e. g. those with a decrease in therapeutic motivation, are discussed.

Dropout from Treatment and Desistance from Crime among Released Prisoners in Jerusalem Halfway House for Prisoners with Substance Misuse Disorder

The study aims to investigate the rates of recidivism among prisoners on parole with a substance misuse disorder who participated in the Jerusalem halfway-house, which combines supervision, employment, and a comprehensive therapeutic program. The study population included all participants who have been treated in the halfway-house (N = 125), whereas the comparison group included all prisoners with a substance misuse disorder who were released after serving their full sentences (N = 321). To reduce possible selection biases, the Propensity Score Matching method was used. Findings show that prisoners, who were treated at the Jerusalem halfway-house, are characterized by higher and frequent rates of recidivism. However, when only completers of the halfway-house were evaluated, it was found that they had lower and slower rates of recidivism. Findings suggest that completing treatment contributes to desistance from crime in the critical post-release years among participants and indicates the importance of optimal diagnostic processes before admitting prisoners to a halfway-house.

Can Yoga Overcome Criminality? The Impact of Yoga on Recidivism in Israeli Prisons

In recent years, yoga practices have been integrated into informal education programs of the Israel Prison Service (IPS), given rise to innovative criminological theories such as positive criminology that emphasize the development of offenders' strengths by facilitating rehabilitation and reintegration processes. The purpose of the present study was to examine the correlation between yoga practice and recidivism among released prisoners who participated in yoga programs during their incarceration in comparison with a matched control group of those who did not participate in yoga programs over a follow-up period of 5 years. To examine the effectiveness of the program, propensity-score matching was used to compile the comparison group from among all convicted prisoners who were released from the Israeli prisons. Study results indicate that yoga may impact recidivism, supported by a finding of lower recidivism rates among released prisoners who had practiced yoga during their incarceration, compared with the matched control group. However, further study is needed including randomized controlled trials (RCTs). In light of these positive results, we recommend policy makers consider introducing alternative practices such as yoga in prisons, in recognition of its contribution to the rehabilitation process through the development of personal and social strengths.

Does the Enlightened Youth Project See the Light? A New Enterprise for Youths at Risk

The aim of the present research is to examine the relationship between participation in the Enlightened Youth project for youths at risk and integration in employment at the end of the process, type of employment, dropout from school, and enlistment in the army. A database was prepared containing information on all the youths (499 in number) who were admitted to a multidisciplinary day Centre for Youths at Risk in Israel, of whom 86 participated in the project. To match a comparison group to the youths participating in the project, the propensity score matching method was operated. The research findings show a significant correlation between participation in the project and all the parameters examined, with implications regarding employment as a contributing factor among youths at risk, in terms of their personal lives, as well as financial and social well-being.

Can Yoga Overcome Criminality? The Impact of Yoga on Recidivism in Israeli Prisons

In recent years, yoga practices have been integrated into formal prison rehabilitation programs of the Israel Prison Service (IPS), as part of the informal education system, giving rise to innovative criminological theories such as positive criminology that emphasize the development of offenders' strengths by facilitating rehabilitation and reintegration processes. The purpose of the present study was to examine the correlation between yoga practice and recidivism among released prisoners who participated in yoga programs during their incarceration in comparison with a matched control group of those who did not participate in yoga programs over a follow-up period of 5 years. To examine the effectiveness of the program, propensity score matching was used to compile the comparison group from among all convicted prisoners who were released from the Israeli prisons. Study results indicate that yoga may affect recidivism, supported by a finding of lower recidivism rates among released prisoners who had practiced yoga during their incarceration, compared with a matched control group. However, further study is needed including randomized controlled trials (RCTs). In light of these positive results, we recommend policy-makers consider expanding alternative practices such as yoga into prisons, in recognition of their contribution to the rehabilitation process through the development of personal and social strengths.