1
|
Paola R, Pavel S, Tatiana D, Hagit BN, Joseph M, Ronny B, Barak S. Impact of opioid maintenance therapy in the community on re-incarceration in individuals with opioid use disorder-A linked cohort study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 163:209393. [PMID: 38754555 DOI: 10.1016/j.josat.2024.209393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 04/05/2024] [Accepted: 05/09/2024] [Indexed: 05/18/2024]
Abstract
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.
Collapse
Affiliation(s)
- Rosca Paola
- Department for the Treatment of Substance Abuse, Israel Ministry of Health, Jerusalem, Israel; Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel
| | - Spivak Pavel
- Department for the Treatment of Substance Abuse, Israel Ministry of Health, Jerusalem, Israel
| | - Dudkinski Tatiana
- Department for the Treatment of Substance Abuse, Israel Ministry of Health, Jerusalem, Israel
| | | | - Mendlovic Joseph
- Israel Ministry of Health, Jerusalem, Israel; Department of Pediatrics, Shaare Zedek Medical Center, affiliated with Haddasah-Hebrew University School of Medicine, Jerusalem, Israel
| | - Berkovitz Ronny
- Division of Enforcement and Inspection, Israel Ministry of Health, Jerusalem, Israel
| | | |
Collapse
|
2
|
Bøhle K, Otterholt E, Bjørkly SK. A Prospective Biopsychosocial Repeated Measures Study of Stress and Dropout from Substance Addiction Treatment. Subst Abuse Rehabil 2023; 14:61-75. [PMID: 37465017 PMCID: PMC10351681 DOI: 10.2147/sar.s376389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 05/02/2023] [Indexed: 07/20/2023] Open
Abstract
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 (AUCG). 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 AUCG. Conclusion The results support monitoring motivation during treatment and further investigating biopsychosocial variables when assessing dropout risk together with SUD diagnosis.
Collapse
Affiliation(s)
- Kari Bøhle
- Faculty of Health and Social Science, Molde University College, Molde, Norway
- Clinic of Mental Health and Addiction, Møre and Romsdal Hospital Trust, Molde, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Eli Otterholt
- Faculty of Health and Social Science, Molde University College, Molde, Norway
- Clinic of Mental Health and Addiction, Møre and Romsdal Hospital Trust, Molde, Norway
| | - Stål Kapstø Bjørkly
- Faculty of Health and Social Science, Molde University College, Molde, Norway
- Regional Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
3
|
Andersen SN, Hyatt JM, Lobmaier P, Stavseth MR, Bukten A. Leaving Their Drugs at the Gate? Exploring Changes in Drug Use From Before to During Incarceration in Norway. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2023:306624X231168596. [PMID: 37312513 DOI: 10.1177/0306624x231168596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
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.
Collapse
Affiliation(s)
| | | | | | | | - Anne Bukten
- University of Oslo, Norway
- Oslo University Hospital, Norway
| |
Collapse
|
4
|
Brooks O, Hayashi K, Cui Z, Milloy MJ, Kerr T, Fairbairn N. Re-incarceration and associated social, structural and behavioural factors among people who use drugs in an urban Canadian setting. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 115:104018. [PMID: 37060885 PMCID: PMC10683765 DOI: 10.1016/j.drugpo.2023.104018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/18/2023] [Accepted: 03/21/2023] [Indexed: 04/17/2023]
Abstract
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.
Collapse
Affiliation(s)
- Olivia Brooks
- British Columbia Centre on Substance Use, Vancouver, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Zishan Cui
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, Vancouver, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
| |
Collapse
|
5
|
Praus P, Biebinger E, Bepler R, Kubath-Heimann S, Funk B, Dreßing H. [Shortened Treatment Concepts in Forensic Commitment According to Section 64 of the German Penal Code: A Tailored Treatment Pathway?]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2023; 91:88-94. [PMID: 35196715 DOI: 10.1055/a-1728-6708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
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.
Collapse
Affiliation(s)
- Peter Praus
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Mannheim, Germany.,Klinik für Forensische Psychiatrie, Pfalzklinikum, Klingenmünster, Germany
| | - Eva Biebinger
- Klinik für Forensische Psychiatrie, Pfalzklinikum, Klingenmünster, Germany
| | - Ralf Bepler
- Klinik für Forensische Psychiatrie, Pfalzklinikum, Klingenmünster, Germany
| | | | - Beate Funk
- Klinik für Forensische Psychiatrie, Pfalzklinikum, Klingenmünster, Germany
| | - Harald Dreßing
- Forensische Psychiatrie, Zentralinstitut für Seelische Gesundheit, Mannheim, Germany
| |
Collapse
|
6
|
Shoham E, Efodi R, Haviv N, Gross Shader C. Dropout from Treatment and Desistance from Crime among Released Prisoners in Jerusalem Halfway House for Prisoners with Substance Misuse Disorder. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2022; 66:1109-1133. [PMID: 33899532 DOI: 10.1177/0306624x211010291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
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.
Collapse
Affiliation(s)
| | - Rotem Efodi
- Prisoner Rehabilitation Authority, Jerusalem, Israel
| | | | | |
Collapse
|
7
|
Kovalsky S, Hasisi B, Haviv N, Elisha E. Can Yoga Overcome Criminality? The Impact of Yoga on Recidivism in Israeli Prisons. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2021; 65:671-691. [PMID: 32285720 DOI: 10.1177/0306624x20914494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
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.
Collapse
Affiliation(s)
| | | | - Noam Haviv
- The Hebrew University of Jerusalem, Israel
- Ashkelon Academic College, Israel
| | - Ety Elisha
- The Max Stern Yezreel Valley College, Israel
| |
Collapse
|
8
|
Peled-Laskov R, Shoham E, Cojocaru L, Cohen H. Does the Enlightened Youth Project See the Light? A New Enterprise for Youths at Risk. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2021; 65:571-589. [PMID: 32449623 PMCID: PMC7970308 DOI: 10.1177/0306624x20923263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
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.
Collapse
Affiliation(s)
| | | | | | - Hanit Cohen
- Ashkelon Municipality Youth
Rehabilitation Service, Israel
| |
Collapse
|
9
|
Kovalsky S, Hasisi B, Haviv N, Elisha E. Can Yoga Overcome Criminality? The Impact of Yoga on Recidivism in Israeli Prisons. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2020; 64:1461-1481. [PMID: 32336185 DOI: 10.1177/0306624x20911899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
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.
Collapse
Affiliation(s)
| | | | | | - Ety Elisha
- The Max Stern Yezreel Valley College, Israel
| |
Collapse
|