Modified TC for MICA offenders: crime outcomes

The study randomly assigned male inmates with co-occurring serious mental illness and chemical abuse (MICA) disorders to either modified therapeutic community (MTC) or mental health (MH) treatment programs. On their release from prison, MICA inmates who completed the prison MTC program could enter the MTC aftercare program. The results, obtained from an intent-to-treat analysis of all study entries, showed that inmates randomized into the MTC group had significantly lower rates of reincarceration compared with those in the MH group. The results also show that differences between the MTC + aftercare and comparison group across a variety of crime outcomes (i.e. any criminal activity, and alcohol or drug related criminal activity) are consistent and significant, and persist after an examination of various threats to validity (e.g. initial motivation, duration of treatment, exposure to risk). This study provides some support for the effectiveness of the prison TC only condition. The findings are encouraging and consonant with other studies of integrated prison and aftercare TC programs for substance abusing non-MICA offenders, although qualified by the possibility that selection bias (i.e. differences in motivation on entry into aftercare) may be operating. Nevertheless, given the available evidence and the need for effective programming for MICA offenders, program and policy makers should strongly consider developing integrated prison and aftercare modified TC programs for MICA offenders.     

Gender differences in comorbid disorders among offenders in prison substance abuse treatment programs

This study examined gender differences in a range of lifetime psychiatric disorders in a sample of 272 offenders newly admitted to a prison substance abuse program. Although these men and women did not differ in severity of substance use in the six months prior to incarceration, women were significantly more likely than men to report a lifetime psychiatric disorder and a lifetime severe disorder. Furthermore, gender differences emerged in the pattern of lifetime psychiatric comorbidity. Women reported greater lifetime major depression, posttraumatic stress disorder, eating disorder, and borderline personality disorder; men were more likely than women to meet criteria for antisocial personality disorder. Additionally, female offenders were found to have a higher degree of internalizing disorders than male offenders, but there were no gender differences in degree of externalizing disorders. The study concluded that women offenders newly admitted to a prison substance abuse program present with a greater psychiatric vulnerability and a different pattern of psychiatric comorbidity than their male counterparts.     

Community-based co-occurring disorder (COD) intermediate and advanced treatment for offenders

Against a backdrop of increasing concern about the adequacy of treatment for co-occurring substance use and mental disorders (typically known as "co-occurring disorders," or COD) in the criminal justice system, this article attempts to provide empirical evidence for a typology of levels of COD treatment for offenders in both prison and community settings. The paper investigates two levels of treatment programs for COD; "intermediate" programs, in which treatment programming has been designed primarily for offenders with a single disorder, and "advanced" programs, in which programming has been designed to provide integrated substance abuse treatment and mental health services. Findings from a national survey of program directors indicated that both intermediate and advanced COD treatment programs were similar in their general approach to substance abuse treatment, but differed considerably in their treatment of mental disorders, where the advanced programs employed significantly more evidence- and consensus-based practices. Results provide support for the distinction between intermediate- and advanced-level services for offenders with COD and support a typology that defines advanced programs as integrating a range of evidence- and consensus-based practices so as to modify treatment sufficiently to address both diseases.     

Treatment outcomes for female offenders: relationship to number of Axis I diagnoses

This article describes a study that examined the relationship between multiple Axis I mental health diagnoses and treatment outcomes for female offenders in prison substance abuse treatment programs. Preliminary findings of the effectiveness of therapeutic community (TC) treatment, modified for female offenders, relative to a control cognitive behavioral treatment condition, are presented. The hypothesis--that participants who fit into multiple diagnostic categories have more dysfunctional symptoms and behaviors at baseline--was confirmed; however, a hypothesized relationship between the number of Axis I diagnoses and 6 month treatment outcomes across five domains (mental health, trauma exposure, substance use, HIV needle risk behaviors, and HIV sexual risk) was not supported. Across all Axis I mental health groups, TC treatment was significantly more effective than the control condition overall, as well as on measures of mental health symptoms and HIV sexual risk. These findings suggest that this TC treatment program, as modified, is an effective model for women with varied diagnoses and diagnostic complexities.     

The validity and utility of a typology of homicides based on Megargee's theory of control

Controlled (N = 10) and undercontrolled homicides (N = 30) produced by a cluster analysis of Minnesota Multiphasic Personality Inventory profiles were contrasted on five sets of variables: intellectual, background, Prison Officer's ratings, indices of institutional discontent and attitudes toward prison. No significant differences were found between the groups on the intellectual and attitudinal variables. However, as predicted, the controlled homicides in contrast to the undercontrolled homicides come from stable backgrounds with no history of previous psychiatric treatment or assaultive behaviour. In prison they reported sick less frequently, committed fewer offences against discipline and made fewer requests concerning the conditions of their containment to prison governors that the undercontrolled group. Prison Officers rated the controlled subjects as more self sufficient and having fewer training needs than the undercontrolled individuals. The implications of the results are discussed in terms of differential treatment and the allocation of resources to two types of prison regime.     

Psychosis in German prisoners: Comparison of the clinical appearance of psychotic disorder of an imprisoned population with a not detained community group

Surveys confirm risk factors for the incarceration of patients with psychosis including homelessness and comorbidity. There is also agreement that severe psychosis can lead to violence. Data describing prisoners with psychosis in Germany are scarce. We aimed to compare patients with psychosis in a prison hospital and patients with psychosis in a community hospital. Demographic data were collected, as well as comorbidity in the form of substance dependence and a psychiatric assessment using the German version of the 18-item Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Syndrome Scale (PANSS). In the prison hospital group more patients were homeless (17 versus 2%) and non-German (36 versus 4%). There were also more patients with substance dependence or abuse in the prison hospital group. The total scores of BPRS and PANSS were lower in the prison hospital group (BPRS, 43.8 versus 51.2; PANSS, 71.5 versus 83.7). We assume that social disintegration for mentally disturbed offenders prior to incarceration hindered effective treatment. To avoid further social disintegration and possible further deterioration of mental health status of released offenders, which may lead to reoffending after imprisonment, discharge management after release from prison should be improved.     

Medicalizing the drug war

Recent findings in the field of psychopharmacology pertain to the abuse of drugs and alcohol among criminal offenders and have implications for new management techniques. Drugs of abuse exert their effects on areas of the brain responsible for pleasure, providing a powerful reinforcement for drug usage. Furthermore, there is a prevalence of psychological, psychiatric and social dysfunctions that antedate drug use which are identifiable at an early age. It is suggested that drugs of abuse differentially influence users via these biological, psychological and social mechanisms, reinforcing the development of serious and chronic abuse in a vulnerable subgroup. Studies of drug abuse specially indicate that within this subgroup, antisocial behavior precedes and exacerbates drug abuse, and multiple risk factors contribute to the concomitant development of criminality and drug abuse. Early detection and comprehensive treatment of underlying disorders that may both precipitate and result from drug abuse promise to improve possibilities for prevention and reducing relapse rates. Furthermore, the inclusion of pharmacologic treatments may further enhance the success of conventional drug treatments. This article proposes that incorporating scientific data and medicalizing our approach to drug abuse is essential to win the war against drugs.     

Umgang mit gefährlichen Straftätern in England und Wales

Forensic psychiatric institutions exist in all western European countries. Their organisation depends on a number of factors including the legal framework and societal attitudes towards mentally disordered offenders. This article describes and critically comments on the forensic psychiatric system in England and Wales, its legal framework and approaches to dealing with dangerous offenders. England and Wales have a long forensic psychiatric tradition with the first high security hospital, Broadmoor hospital, having been established in 1863. Evidence-based treatment approaches in forensic hospitals as well as in prisons, training of forensic psychiatrists and research in the field of forensic psychiatry have gained international recognition. However, there are some worrying aspects in the system of forensic psychiatric care and the criminal justice system more generally, in particular the high and still increasing number of prisoners in comparison with other European countries, the low age of criminal responsibility, long sentences, increasing length of stay in forensic care and the increasingly risk averse culture. A number of differences to the German system can be found; one such difference relates to the role of criminal responsibility which is irrelevant for decisions regarding commitment in England and Wales. Only the mental state and need for treatment at the time of trial (or later assessment in prison) determine whether an offender is admitted to psychiatric care or receives a prison sentence. A number of new initiatives have been launched in recent years resulting in an increasing number of individuals being detained in forensic psychiatric and criminal justice institutions, in particular the initiative for the detention and treatment of individuals with so-called dangerous and severe personality disorders, the sexual offenders register and the new sentence of indeterminate imprisonment for public protection. These initiatives have been the subject of a number of complaints to the European Court of Human Rights. Nevertheless, the trend towards a more and more risk averse culture continues.     

Violent offenses associated with co‐occurring substance use and mental health problems: Evidence from CJDATS

The present study examines the relationship between substance use, mental health problems, and violence in a sample of offenders released from prison and referred to substance abuse treatment programs. Data from 34 sites (n = 1,349) in a federally funded cooperative, the Criminal Justice Drug Abuse Treatment Studies (CJDATS), were analyzed. Among parolees referred to substance abuse treatment, self‐reports for the six‐month period before the arrest resulting in their incarceration revealed frequent problems with both substance use and mental health. For most offenders with substance use problems, the quantity of alcohol consumed and the frequency of drug use were associated with a greater probability of self‐reported violence. Mental health problems were not indicative of increases in violent behavior, with the exception of antisocial personality problems, which were associated with violence. The paper emphasizes the importance of providing substance abuse treatment in relation to violent behavior among offenders with mental health problems being discharged to the community. Copyright © 2009 John Wiley & Sons, Ltd.     

Development of psychiatric comorbidity with substance abuse in adolescents: effects of timing and sex.

Examined the impact of childhood psychiatric disorders on the prevalence and timing of substance use and abuse and tested for sex differences. A representative population sample of 1,420 children, ages 9, 11, and 13 at intake, were interviewed annually. American Indians and youth with behavioral problems were oversampled; data were weighted back to population levels for analysis. By age 16, more than half the sample reported substance use, and 6% had abuse or dependence. Alcohol use began by age 9, and smoking in the 13th year. Mean onset of dependence was 14.8 years, and mean onset of abuse was 15.1 years. Substance use began earlier in boys, but not girls, who later developed abuse or dependence. Disruptive behavior disorders and depression were associated with a higher rate and earlier onset of substance use and abuse in both sexes, but anxiety predicted later onset of smoking. Family drug problems were the strongest correlate of early onset. Despite differences in prevalence of psychopathology, boys and girls showed more similarities than differences in the course of early substance use and abuse, and its associations with psychopathology.     

Der Behandlungsbedarf bei jungen Straftätern (BB-JuSt)

The BB-JuSt is a newly developed standardized instrument used in juvenile correctional settings to document the results of the inital assessment of treatment and educational needs of young offenders. It is made up of 23 items with 5-point rating scales (with the exception of the item caring for a child) which refer to specific needs and responsivity factors relating to educational attainments and basic reading/writing and mathematic skills, alcohol/drug/gambling problems, criminogenic disposition (e.g., aggressiveness), psychological disorders, lifestyle and social environment (e.g. associates and family). To determine the interrater reliability of this instrument 42 young offenders were classified by professional prison staff as usual, and additionally by 2 external researchers. Whereas excellent agreement between the external researchers was achieved on all items, the comparison between staff and researchers showed only moderate correlations. These results indicate that the BB-JuSt is a reliable instrument that can be used for treatment planning decisions and for research purposes but extensive training is required for users.     

Comorbidity of drug abuse treatment

Research has suggested that comorbidity, the concurrence of substance abuse disorders with other psychiatric disorders, may have prognostic value and important implications for the treatment of substance abuse. Knowledge of the prevalence of comorbid disorder is important because it will enable treatment services to be appropriately configured and designed for clinical drug treatment populations. The form and duration of comorbidity may be influenced by a variety of factors, which include the class of drug being abused, the duration of drug use, the individual sensitivity to drug effects, and whether the drug effects are acute or due to withdrawal or residual conditions. This paper addresses three important scientific questions: (1) What is the prevalence of comorbid disorders in a drug abuser population? (2) What is the stability of psychiatric diagnoses in a drug abuser population? (3) Does the existence of a comorbid disorder influence the outcome of drug abuse treatment?     

New directions in offender typology design,development, and implementation: Can we balance risk,treatment and control?

It should come as no surprise that there is no “one-stop shopping” offender typology available that can identify the risk level, targeted treatment protocols, and control levels of the offender groups examined in this special issue: murderers, sex offenders, batterers, violent prisoners, and violent mentally ill offenders. We are in desperate need of further research establishing the links between offender risk level, offender treatment needs, and offender control requirements for each of these offender groups. This article provides a “state of the art” discussion of the key issues that must be addressed by policymakers, practitioners, and ultimately, the public, vis-à-vis the design, development, and implementation of typologies for each of these targeted groups of offenders. This is followed by our assessment of the lessons learned from the great prison classification experiment. We conclude by providing an assessment of new directions in the development of typologies of offenders and the communities in which offenders reside, based on the simple notion that offender change–not offender control–needs to be the primary focus of the next generation of correctional classification systems.     

An Examination of Triarchic Psychopathy Constructs in Female Offenders

This study sought to expand scientific knowledge on psychopathic personality traits in female offenders by evaluating the relationship between MMPI–2–RF triarchic scales and self-reported external variables in a sample of 205 female offenders. Results indicated that boldness was inversely related to internalizing dysfunction, including suicidal behavior, psychosis, youth conduct problems, problems stemming from alcohol use, and a history of outpatient mental health treatment. Meanness was positively related to internalizing dysfunction as well as youth conduct problems, anger, prison disciplinary reports, and psychosis. Disinhibition was associated with a history of abuse in childhood, suicidal behavior, internalizing dysfunction, problems associated with alcohol and drug use, family history of mental illness, prison disciplinary reports for violence, number of previous criminal charges, and anger. Consistent with views of psychopathy as a configural condition, interactive effects of boldness with disinhibition and meanness were observed for multiple key external variables (e.g., conduct problems, substance use, nonsuicidal self-injurious behavior). This study provides further evidence for the triarchic conceptualization of psychopathy in female offenders and lends additional support for the validity of MMPI–2–RF triarchic psychopathy scales.     

Die Dauer der Unterbringung in der Entziehungsanstalt

In Germany offenders can be sentenced to forensic addiction treatment which is realized in secure mental hospitals (according to section 64 of the German Penal Code). As a rule the persons concerned are transferred to the treatment institution after having served part of their prison sentence. There is an ongoing debate regarding the appropriate length of time of inpatient treatment. The average time in treatment differs considerably between the States of the Federal Republic of Germany and varies from somewhat over 1 year (Bavaria) to more than 2 years (North-Rhine Westphalia). In the trials mandating the treatment order, psychiatric experts are expected to exactly quantify the appropriate time of treatment for a specific person. For a number of reasons this surpasses expert capabilities as there is little empirical evidence regarding the effects of the duration of long-term treatment on outcome criteria, such as relapse or reoffending. This article discusses relevant aspects and suggests a pragmatic way to handle courts’ expectations in these lawsuits.     

Challenges in implementing evidence-based treatment practices for co-occurring disorders in the criminal justice system

The presence of adults with mental health and substance abuse disorders within the criminal justice system has become increasingly evident over the past decade. Interventions and treatment services have been designed and research conducted in an effort to establish evidence-based practices that effectively address the complex needs of this population. However, adopting and implementing these evidence-based interventions and practices within the real-world setting of criminal justice environments is challenging. This article reviews the research literature related to evidence-based treatment practices for offenders with co-occurring mental health and substance abuse disorders and explores the inherent challenges of fitting these interventions and services within criminal justice settings.     

Evaluation of the effectiveness of a prison-based drug treatment

The present study evaluated the effectiveness of a drug-free unit (DFU) in reducing the use of substances by incarcerated adult offenders, and to analyze changes in the addiction severity index, motivation, and personality caused by the program. This is an external evaluation, with an ex post facto design with repeated measures. Eighty-seven prisoners from the DFU were evaluated during the first year of residence in the program. Most are young men, polydrug addicts and mainly serving sentences for public health crimes and property offenses. There is need of psychiatric treatment at the baseline, with 85% comorbid personality disorders. Motivation for treatment is low, and remains stable over 12 month's duration of the study. The DFU was found to have a significant effect in reducing the use of drugs by offenders and to improve the drug and family composite scores, also reducing scores on personality scales. However, it fails to change medical and psychiatric scores, so that the need for intervention in these areas is underscored.     

Dual diagnosis in an Australian forensic psychiatric hospital: prevalence and implications for services

Despite a growing awareness of the unique needs of psychiatric patients with co-occurring substance abuse and dependence disorders (i.e. dual diagnosis), there is a dearth of research investigating the prevalence of dual diagnosis in forensic psychiatric populations. Similarly, little work has been done to determine the implications of dual diagnosis for forensic psychiatric patients. Patients at the Thomas Embling Hospital in Victoria, Australia, were assessed to determine the prevalence of substance abuse disorders and mental illnesses within this population. Results reveal that the majority of patients (approximately 74%) have a lifetime substance abuse or dependence disorder. Information was collected concerning patients' criminal histories and the Level of Service Inventory, Revised, was completed for each patient who participated. Results suggest that patients with both major mental illnesses and substance abuse disorders have more extensive criminal histories and demonstrate a higher level of risks and needs when compared with patients with major mental illness alone. The implications for the development and delivery of effective forensic mental health services that address both co-occurring disorders are also discussed.     

Effects of disclosure of traumatic events on illness behavior among psychiatric prison inmates

To assess the health effects of writing about traumatic events in a clinical population, 98 psychiatric prison inmates were randomly assigned to 1 of 3 conditions in which they were asked to write about their deepest thoughts and feelings surrounding upsetting experiences (trauma writing condition), write about trivial topics (trivial writing control), or go about their daily routine without writing (no-writing control). Both writing groups wrote for 20 min per day for 3 consecutive days. Participants in the trauma condition reported experiencing more physical symptoms subsequent to the intervention relative to those in the other conditions. Despite this, controlling for prewriting infirmary visits, sex offenders in the trauma writing condition decreased their postwriting infirmary visits. These results are congruent with predictions based on stigmatization and inhibition.     

COD services in community correctional settings: an examination of organizational factors that affect service delivery

Little is known about service delivery for those in the correctional system with co-occurring mental health and substance abuse disorders (COD). Using data from the National Criminal Justice Treatment Practices survey (NCJTP) on community corrections and jail agencies, this study found that correctional organizations that offer COD services differ from agencies that do not. Organizations that respond to the needs of COD offenders tend to be more "service friendly," rank higher on measures of various dimensions of organizational climate that embrace learning and goal achievement, and tend to adopt more innovations, particularly those classified as evidence-based practices. These survey findings indicate that correctional agencies who serve COD offenders are in a better position to be responsive to the changing service needs of the populations, and are more likely to be able to balance public safety and treatment goals. Future steps to develop support environments for COD assessment and treatment services are discussed in light of these findings.