Publication guide: Substance abuse treatment in correctional facilities

Below are some abstracts from publications from the library collection. Please contact us for more information.

Davidson, K. M., & Young, J. T. (2019). Treatment engagement in a prison-based Therapeutic Community: A mixed-methods approach. Journal of Substance Abuse Treatment, 103, 33-42.

Given the high proportion of inmates with histories of substance use disorders in the era of mass incarceration, many correctional institutions have integrated the prison based Therapeutic Community (TC) into their programming. While most evaluations provide evidence of lowered rates of relapse and recidivism, the majority of TC graduates still have negative outcomes post-release. Filling an important gap in the TC treatment literature, we analyse quantitative measures of treatment engagement alongside qualitative narratives from prison-based TC residents, providing an essential look into the black box of TC treatment mechanisms. Quantitative results show more between-person variation than within-person change, reflecting trivial increases in treatment engagement throughout time in the program. Qualitative results unpack these findings, pointing to processes of selection bias, heterogeneous treatment effects, and program fidelity lapses. In combination, our mixed data identify tangible modifications to program implementation that could strengthen desired post-release outcomes.

Doyle, M. F., Shakeshaft, A., Guthrie, J., Snijder, M., & Butler, T. (2019). A systematic review of evaluations of prison‐based alcohol and other drug use behavioural treatment for men. Australian and New Zealand Journal of Public Health, 43(2), 120-130.

Objective: A history of alcohol and other drug (AoD) use is common among men entering prison and often linked to the crime for which they are imprisoned. This is the first systematic review of prison‐based, behavioural AoD treatment programs for more than a decade and the first that reviews the methodological quality of evaluations. This review aims to create an understanding of the quality of research in this field and identify the most effective AoD use treatment for men in prison. Methods: A PRISMA-compliant systematic review of international, peer‐reviewed research published between January 1995 and December 2015. The Dictionary for Effective Public Health Practice Project was used to assess the methodological quality of papers. Results: A total of 25 relevant papers were identified, of which 12 were rated as methodologically sound. Four of these measured post‐release AoD use and three reported statistically significant reductions in AoD use. Conclusions: Although there is relatively little methodologically strong evidence of the impact of prison‐based AoD treatment, and no Australian papers studies, current best‐evidence practice is Cognitive behavioural therapy delivered in Therapeutic Community (TC) settings. Implications for public health: Prison‐based TC treatment should be available to people in prison who have a history of AoD use.

Durbeej, N., Palmstierna, T., Berman, A. H., Kristiansson, M., & Gumpert, C. H. (2014). Offenders with mental health problems and problematic substance use: Affective psychopathic personality traits as potential barriers to participation in substance abuse interventions. Journal of Substance Abuse Treatment, 46(5), 574-583.

Substance abuse is related to re-offending, and treatment of substance abuse may reduce criminal recidivism. Offender characteristics including problem severity, violence risk and psychopathic personality traits may be positively or negatively associated with participation in substance abuse treatment. We explored the relationships between such characteristics and participation in substance abuse interventions among Swedish offenders with mental health problems and problematic substance use. Our analyses revealed that problem severity regarding drugs, employment, and family/social situations predicted intervention participation, and that affective psychopathic personality traits were negatively associated with such participation. Thus, affective psychopathic personality traits could be considered as potential barriers to participation in substance abuse interventions. Among offenders with mental health problems and problematic substance use, such personality traits should be taken into account in order to optimize treatment participation and treatment outcome. Approaches used in cognitive-behavioural therapy (CBT) and dialectical behavioural therapy (DBT) could be applicable for these patients.

Joe, G. W., Lehman, W. E., Rowan, G. A., Knight, K., & Flynn, P. M. (2019). The role of physical and psychological health problems in the drug use treatment process. Journal of Substance Abuse Treatment, 102, 23-32.

The role of physical and psychological health is examined as a predictor of client engagement in prison-based drug treatment. A treatment process model was expanded to include physical and mental health issues. The sample included 6009 offenders in prison-based drug treatment, comprised of 67% male, 26% African American, 51% white, and 22% Hispanic; average age was 34.6. Half reported “some physical health concerns” and mentioned a variety of ailments. A fifth reported moderate stress on the Kessler Psychological Distress Scale (K10) and 15% reported PTSD based on the PTSD Check List (PCL). Structural equation modelling was used to model treatment engagement in terms of demographics, physical health concerns, psychological distress, HIV risky behaviours, self-esteem, decision making, and treatment motivation. Two random samples were created, with one used for estimation and the other for cross-validation. The findings suggested physical health and HIV risky behaviours have effects on client engagement through psychological functioning, and that psychological functioning has direct effects on treatment engagement.

Larney, S., Zador, D., Sindicich, N., & Dolan, K. (2017). A qualitative study of reasons for seeking and ceasing opioid substitution treatment in prisons in New South Wales, Australia. Drug and Alcohol Review, 36(3), 305-310.

Opioid substitution treatment (OST) reduces drug‐related harms in custody and after release. However, OST providers in prisons have reported that some patients prefer to cease treatment prior to release, placing them at risk of fatal overdose. We aimed to examine reasons for seeking OST in custody, and intentions regarding continuation or cessation of treatment prior to and following release. This qualitative study employed semi‐structured interviews with opioid‐dependent people currently incarcerated in New South Wales, Australia. Of 46 participants, 27 were currently in OST. Reported benefits of OST included withdrawal management and avoidance of high‐risk injecting. Over a third of participants in OST stated their intention to withdraw from OST prior to release. Reasons included concerns that attending community OST clinics could lead to drug use or offending, family opposition, inconvenience of clinic attendance, stigma and a perception that prison provided an opportunity to withdraw from OST more easily than in the community. Nineteen participants had already ceased OST in custody or had declined it, citing preferences to ‘be clean’ and the long‐term nature of OST. Balancing the preference of many patients to cease OST prior to release against patient safety post‐release is a substantial challenge for opioid treatment providers in correctional settings. These findings indicate the need for research on how best to attract and retain opioid‐dependent prisoners in treatment and the need to provide other interventions for prisoners uninterested in post‐release OST, such as take‐home naloxone.

Owens, M. D., Chen, J. A., Simpson, T. L., Timko, C., & Williams, E. C. (2018). Barriers to addiction treatment among formerly incarcerated adults with substance use disorders. Addiction Science & Clinical Practice, 13(1), 19.

Addiction treatment improves substance use and criminal recidivism outcomes among justice-involved individuals with substance use disorders, but is underutilized. Although information exists regarding barriers to addiction treatment among individuals with substance use disorders more generally, less is known about barriers among individuals with previous justice involvement. The purpose of this pilot study was to describe barriers to addiction treatment in a sample of adults with a substance use disorder who participated in a pilot trial of brief interventions and were recently released from jail. Incarcerated individuals who were arrested for an alcohol- or drug related crime and reported moderate or high alcohol use on the ASSIST (n = 28; 96.4% men) were recruited for a pilot trial of brief interventions to reduce substance use, which were delivered just prior to release from jail. After their release, participants completed the Barriers to Treatment Inventory (BTI), which included 25 numerical items and one open-ended question on additional barriers that provided qualitative data. We described frequency of quantitative responses and qualitatively coded open ended data using seven previously identified domains of the BTI. The most commonly reported barriers assessed quantitatively were items related to Absence of Problem: “I do not think I have a problem with drugs” (42.8%), Privacy Concerns: “I do not like to talk about my personal life with other people” (35.8%), and Admission Difficulty: “I will have to be on a waiting list for treatment” (28.6%). Items related to Negative Social Support (e.g., “Friends tell me not to go to treatment”) were rarely endorsed in this sample. Responses to the open-ended question also related to Absence of Problem, Privacy Concerns, and Admission Difficulty. Additional categories of barriers emerged from the qualitative data, including Ambivalence and Seeking Informal Assistance. In this small sample of adults with a substance use disorder recently released from jail, barriers to treatment were frequently endorsed. Future research on larger samples is needed to understand barriers to treatment specific to justice-involved populations. Clinicians may consider using open-ended questions to explore and address barriers to addiction treatment among individuals with current or recent justice involvement.

White, N., Ali, R., Larance, B., Zador, D., Mattick, R. P., & Degenhardt, L. (2016). The extramedical use and diversion of opioid substitution medications and other medications in prison settings in Australia following the introduction of buprenorphine–naloxone film. Drug and Alcohol Review, 35(1), 76-82.

Around 65% of people incarcerated in prisons in Australia, America and Europe have a history of drug dependence, sometimes treated with opioid substitution treatment (OST) medications. Studies report that those in treatment in prison do engage in some level of diversion to others, whether on a voluntary or coerced basis. We aimed to examine the use of prescribed and non‐prescribed OST medications by those in prisons, especially buprenorphine–naloxone film (BNX‐F); the extent of non-adherence and diversion and reasons for such practices; and the impact of the introduction of BNX‐F into the prison system. Mixed methods study drawing on: (i) structured interviews with current OST clients (n= 60) who reported being incarcerated in the 12 months prior to being interviewed and (ii) qualitative interviews with key experts working in corrections and prison (or justice) health settings. The majority were prescribed OST medications in prison, with 25% removing all or part of their supervised dose on at least one occasion, and 44% reporting use of non‐prescribed medications. Some reported intravenous use (14% injected). One‐third of OST recipients reported selling/sharing OST medications with others in prison. The introduction of BNX‐F into the prison system saw different diversion methods used and removal from dosing within prison. Despite prison being a highly regulated and controlled environment, some level of diversion and sharing of psychoactive medication occurs among prisoners. The buprenorphine formulations used in OST present particular challenges with respect to supervised dosing in this setting.

Winter, R. J., Stoové, M., Agius, P. A., Hellard, M. E., & Kinner, S. A. (2019). Injecting drug use is an independent risk factor for reincarceration after release from prison: A prospective cohort study. Drug and Alcohol Review, 38(3), 254-263.

Once involved in the criminal justice system, people who inject drugs (PWID) have a high probability of multiple system encounters. Imprisonment typically fails to rehabilitate PWID, who upon return to the community are at considerable risk of returning to injecting drug use (IDU) and poor health and social outcomes. We examined the effect of IDU resumption, and a suite of other sociodemographic, criminogenic, health and behavioural indicators, on the timing of reincarceration among adults with a history of IDU following release from prison. Structured interviews were conducted with 561 PWID in Queensland, Australia prior to release from prison and approximately 1, 3 and 6 months post‐release. Data were linked prospectively with correctional records and the National Death Index. Data collected at multiple time points were treated as time‐varying covariates. Kaplan–Meier survival estimates and Cox proportional hazards models were used to estimate the rate and hazards of reincarceration. Sixty‐eight percent of participants (n= 350) were reincarcerated over a combined observation time of 1043.5 years, representing a rate of 33.5 per 100 person‐years (95% confidence interval [CI] 30.2–37.2). Time‐invariant predictors of reincarceration in PWID were: male gender (adjusted hazard ratio [AHR] = 1.62, 95% CI 1.19–2.21), older age at release (AHR = 0.97, 95% CI 0.95–1.00), previous adult (AHR = 2.00, 95% CI 1.41–2.84) or juvenile (AHR = 1.78, 95% CI 1.27–2.49) imprisonment, shorter imprisonment (≤90 days vs. >365 days, AHR = 2.09, 95% CI 1.30–3.34), release on parole (AHR = 2.29, 95% CI 1.82–2.88) and drug‐related sentence (AHR = 1.84, 95% CI 1.34–2.53). Time‐varying predictors included resumption of IDU (AHR = 2.04, 95% CI 1.60–2.61), unemployment (AHR = 1.53, 95% CI 1.07–2.19) and low perceived social support (AHR = 1.41, 95% CI 1.05–1.90). Very‐high psychological distress at the most recent interview was protective against reincarceration (AHR = 0.65, 95% CI 0.44–0.95). Efforts to prevent resumption of IDU and address disadvantage, social inclusion and health service access in ex‐prisoners through the scale‐up and integration of prison‐based and post‐release interventions are likely to reap both public health and criminal justice benefits.

Yang, Y., Knight, K., Joe, G. W., Rowan, G. A., Lehman, W. E., & Flynn, P. M. (2015). Gender as a moderator in predicting re-arrest among treated drug-involved offenders. Journal of Substance Abuse Treatment, 49, 65-70.

The primary aim of the current study is to explore gender differences on the relationships of pre-treatment risk factors and psychosocial functioning with time to rearrest following termination from prison. The sample consisted of 384 males and 313 females who were admitted to four prison-based substance abuse treatment programs. Results showed that female inmates experienced a longer time to re-arrest than male inmates. Higher self-reported ratings of decision making confidence and peer support were associated with a lower likelihood of re-arrest for males. Males with higher self-esteem ratings were more likely to be re-arrested than males who reported lower self-esteem. Females with more self-reported criminal involvement had a higher rate of re-arrest than did those with less criminal involvement. In contrast to males, females with relatively high self-reported self-esteem had a lower rate of re-arrest than their counterparts who reported low self-esteem. Clinical implications include the importance of enhancing decision-making confidence and peer support for males and self-esteem for females

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