Prison-based Treatment Research Articles

The influence of familial networks and stigma on prison-based medication initiation for individuals with opioid use disorder: Clinicians' perceptions

IntroductionIndividuals with criminal legal system (CLS) involvement experience opioid use disorder (OUD) at elevated rates when compared to their non-justice involved counterparts. Medications for opioid use disorder (MOUD) are efficacious but underutilized within this population. Interpersonal relationships and stigma play salient roles in the outcomes of OUD treatment. This study examines prison-based treatment staff perspectives on how familial networks and stigma interact to impact one's decision of whether to initiate MOUD while in prison in Kentucky. MethodsA coding team analyzed qualitative interviews with prison-based clinicians (n = 23) and administrators (n = 9) collected from the Geographic variation in Addiction Treatment Experiences (GATE) study using NVivo software. The study analyzed excerpts associated with the primary codes of “stigma” and “social networks” and the secondary code of “family” in order to assess the relationship between familial stigma and MOUD initiation from treatment staff viewpoints. ResultsArising themes suggest that clients' families' lack of MOUD knowledge plays a crucial role in perpetuating related stigma, that this stigma often materializes as a belief that MOUD is a continuation of illicit substance use and that stigma levels vary across MOUD forms (e.g., more stigma towards agonists than antagonists). ConclusionsThese findings carry implications for better understanding how intervention stigma within one's familial network impacts prison-based medication initiation decisions. Resulting themes suggest support for continued expansion of efforts by Kentucky Department of Corrections to involve participant families in education and treatment initiatives to reduce intervention stigma and increase treatment utilization.

Met and unmet prison-based treatment needs for people who are incarcerated with a history of substance use disorder: A nationwide cohort study

BackgroundSubstance use disorders (SUD) are highly prevalent among incarcerated people. However, in some prisons, only a small percentage of those who need treatment receive it. The aims of this study were to examine coverage of treatment for SUD in Danish prisons and assess whether treatment differed by substance class. Further, we examined factors associated with receiving treatment for SUD, and types of services received. Data and methodsWe linked multiple Danish register data using unique personal identification numbers. This study retrospectively analysed data for 49,330 individuals (aged 18–90) incarcerated in Danish prisons between 2008 and 2018. We used a multivariable logistic regression model to predict enrolment in treatment for SUD in prison. ResultsOf incarcerated people with a history of SUD, 34.6 % received treatment care during incarceration. We observed only minor variations in terms of substance classes concerning the type of treatment. Those who were women, immigrants, had higher education, or were married were less likely to receive treatment. ConclusionsImproving access and increasing treatment coverage in the Danish Prison and Probation Services is crucial to reduce the burden of SUD in incarcerated populations.

Social ecological factors and medication treatment for opioid use disorder among justice-involved rural and urban persons: the Geographic variation in Addiction Treatment Experiences (GATE) longitudinal cohort study protocol

IntroductionThree medications are Food and Drug Administration approved for the treatment of opioid use disorder (OUD); however, these medications are underused within prisons, which elevates the risk of relapse and...

Development and application of an offense severity index in the evaluation of treatment of individuals convicted of sexual crimes

ABSTRACT Dichotomous recidivism criteria are the main measure of success in forensic treatment studies. However, there is wide agreement that binary outcome measures are too undifferentiated, particularly when official reoffending rates are rather low. Considering previous research on offense severity and the Cambridge Crime Harm Index, we addressed this issue by developing a severity index based on sentencing provisions in the German law. Based on a large dataset of males convicted of sexual crimes who had been released from Bavarian prisons between 2004 and 2008, we analyzed the subgroup of n = 48 individuals who recidivated with a sexual offense. About half of the sample had received treatment during imprisonment. Whereas prior analyses did not reveal a significant treatment effect on dichotomous sexual reoffending, the present harm analyses showed a stronger decrease of sex offense severity for treated compared to untreated participants. Despite some limitations of our study, the results indicate that prison-based treatment might decrease the severity of sexual reoffending in males convicted of sexual offenses. From a harm reduction perspective, our findings support the use of severity measures complementary to dichotomous outcome criteria. The applicability of our severity index and implications for future research on prison-based treatment are discussed.

Estimating a treatment effect on reoffending by people in prison with an alcohol use disorder: a national matched propensity score analysis

Little is known as to the efficacy of treatment interventions for an alcohol use disorder (AUD) to reduce reoffending. A quasi-experimental propensity score matched observational study was deployed to calculate the average treatment effect on reoffending for people in prison with an AUD exposed to prison-based treatment compared to a matched control group. A one-to-one match without replacement followed by a marginal Cox proportional hazards time-to-event model with the treatment group only were also run. No statistically significant difference in reoffending rates and risk of reoffending on release were noted. Analyses suggest that the treatment group were more likely to be treated for binge drinking than individuals assessed who commit crime due to their consumption of alcohol. The English treatment model is an opportunity to create an enhanced system that integrates public health whilst addressing recidivism. Further work is required assessing the effect of multiple treatments on reoffending.

Are prison-based therapeutic communities effective? Challenges and considerations.

The purpose of this paper is to detail the impact and efficacy of Her Majesty's Prison and Probation Service ((HMPPS) Therapeutic Communities (TCs) (both democratic and hierarchical). This paper outlines recent developments in the TC literature, to provide readers with an up-to-date overview of the outcomes of prison-based TC treatment, while highlighting the strengths and challenges of this treatment approach. Trends within the research are discussed, and the authors draw attention to any gaps in the current knowledge. This paper uses a narrative literature review approach to review the most current literature around the effectiveness of prison-based TCs in HMPPS. Academic literature published predominantly from 2010 onwards is discussed because of limited literature review publications on this topic post-2010. To obtain literature, searches of relevant databases were conducted, and/or clinical leads at prison sites were contacted for relevant publications. There is a body of research which demonstrates that TCs are an effective form of treatment for people with an offending history and personality difficulties. Evidence indicates that Democratic TC treatment plays a part in reducing reoffending rates, as well as improving psychological features. Further research is needed in a number of areas, specifically with female offenders and individuals who undertake treatment in hierarchical TCs in the UK. It is also suggested that TC treatment aftercare may help to further the positive outcomes identified. To the best of the authors' knowledge, there is no up-to-date review of the impact and efficacy of HMPPS TC treatment. This paper reflects on available research within the current context of TC treatment and provides an original overview of the current UK TC practice. It has value in recommending areas for further research and consideration.

Assessing diversionary approaches for drug misusers in police custody in London: engagement and treatment outcomes as part of the Drug Intervention Programme

Aims To describe detainee engagement with the Drug Intervention Programme (DIP) and to assess the efficacy of operational practice models on treatment outcomes in London. Methods A prospective data linkage study matching 9910 detainees who tested positive for opiates and/or cocaine in 2017 to diversion services and to community or prison-based treatment. Logistic regression models examined factors associated with engagement and to understand prognostics correlated to a successful treatment outcome. Results Opiate users (adjusted odds ratio (AOR) 1.48, 95% confidence interval (CI) 1.14–1.92) and detainees with housing needs (AOR 1.32, 95% CI 1.05–1.66) were associated with initial engagement following a positive test. Detainees who tested positive for both opiates and cocaine (AOR 0.38, 95% CI 0.16–0.91), with severe housing needs (AOR 0.53, 95% CI 0.29–0.99) and who were female (AOR 0.41, 95% CI 0.22–0.77) were more likely to report an unsuccessful treatment outcome. Case-managed approaches were more likely to engage detainees into treatment and utilization of this model is significantly associated with positive treatment outcomes (AOR 1.60, 95% CI 1.07–2.38). Conclusions Pretrial diversionary schemes for drug misusers should consider enhancing existing case-managed approaches although the model remains geared toward opiate rather than stimulant users. The importance of housing was highlighted. Tailored packages of care are required to support individuals from the point of arrest through to treatment, for those with complex needs especially for female detainees, poly-drug users and those with acute housing needs.

Co-morbid psychological distress groups among incarcerated men

Purpose This study aims to examine the behavioral health disorders and trauma exposure are disproportionately represented among incarcerated men. Historically, prisons have been inadequately equipped to respond to the behavioral health needs of incarcerated people. Given the abundance of behavioral health need and the relatively limited availability of prison-based treatment resources, population health management strategies, particularly need stratification, are vital. Design/methodology/approach A sample of 943 male inmates from three Spanish prisons completed a structured questionnaire. Need groups are based on current depression, anxiety and stress symptoms assessed by the DASS-21 and were validated using adverse childhood experiences (ACE), prison-based abuse, prison-based substance use, social support and resilience. Findings Three need groups were identified, namely, minimal, mild/moderate and severe, each representing about one-third of the sample. The severe group had the highest level of all three types of psychological distress, ACE and prison-based adversity and substance use. No statistical differences in social support and resilience were found among the groups. These findings provide a platform for future research to explore how the complexity of behavioral health care need can be identified and stratified for strategic and rational treatment matching. Proving whether a population health management approach improves behavioral health and personal safety outcomes within funding-constrained carceral environments is the next research priority. Originality/value This study is the first to group co-morbid psychological distress into need categories using a social determinants of health framework for validation.

Recidivism After a Prison-Based Treatment Program: a Comparison Between a Treatment and Control Group Using Proportional Weighting Within Strata

Given the large potential of prison-based treatment programs, it is highly important to empirically evaluate such programs in various populations in various geographic regions. The current study focused on the Dutch Prevention of Recidivism Program, a prison-based treatment program that aims to lower re-offending rates among participants by administering an individualized treatment program that addresses the criminogenic needs of an individual offender. It aimed to assess the extent to which the program was effective in reducing the post-release re-offending rates of program participants. This was studied by analyzing official prison data, risk assessment data, and re-offending records of a population-based sample of males incarcerated in The Netherlands. Proportional weighting within strata was applied to minimize selection effects. Study results showed that prisoners who completed a standard treatment program (which only consisted of phased re-entry), re-offended less in the 24 months post-release, compared to offenders in the control condition. This treatment effect was, however, not found when comparing prisoners who had completed a standard program plus cognitive skill training or substance abuse treatment, to those who had not. It was consequently concluded that participation in the prison-based Prevention of Recidivism program had a positive effect on post-release re-offending, for offenders who had engaged in a standard program that did not include any behavioral treatment modules. Results were discussed in light of theoretical and empirical considerations.

Psychodrama in attenuated custody prison-based treatment of substance dependence: The promotion of changes in wellbeing, spontaneity, perceived self-efficacy, and alexithymia

This paper presents the results of a six-month psychodrama intervention for the prison-based treatment of people with substance dependence, held in an attenuated custody institution in Northern Italy (Istituto a Custodia Attenuata per il Trattamento delle Tossicodipendenze – ICATT). Seven patients participated in the psychodrama intervention (21 weekly sessions) and were monitored through an idiographic change process using a mixed methods design. The longitudinal quantitative assessment employed the Clinical Outcomes in Routine Evaluation − Outcome Measure (CORE-OM), the Revised Spontaneity Assessment Inventory (SAI-R), the General Self-Efficacy Scale (GSE), and the Toronto Alexithymia Scale (TAS-20). The qualitative assessment was based on the Client Change Interview Schedule (CCS) and the Helpful Aspects of Therapy Form (HAT). The quantitative and qualitative results supported the effectiveness of psychodrama as a treatment method for this group of patients, showing a decrease in psychological distress; a related decrease in depressive, anxious, physical, and/or traumatic symptoms; and a relative increase in the patients’ general emotional and social functioning.

Effectiveness of a Prison-Based Treatment Program for Male Perpetrators of Intimate Partner Violence: A Quasi-Experimental Study of Criminal Recidivism.

Despite increasing interest in programming for perpetrators of intimate partner violence (IPV), the literature provides weak support for the effectiveness of these interventions. However, there are few studies that evaluate programs offered to felony IPV offenders who are serving prison sentences. This study uses a quasi-experimental design to evaluate the effectiveness of a prison-based implementation of a popular IPV intervention in reducing general and offense-specific recidivism among 169 men released from state prison in 2017. Because recidivism data were collected through early March 2019, the average follow-up period was approximately 20 months for both the control group and experimental group. Observable selection bias was minimized by using propensity score matching to create a comparison group of 169 nonparticipants released in 2017 who were not significantly different from the program participants. Cox regression models were used to predict general rearrest, reconviction, reincarceration, and supervised release revocation, as well as rearrest and reconviction for any violent offenses and rearrest and reconviction for domestic violence offenses in particular. No significant differences in any type of recidivism were found between the comparison group and those who participated in treatment, regardless of whether the participant completed or failed to complete the program. The findings suggest that the intervention is no more successful when offered within prisons than when offered in the community. The study concludes by making recommendations for increasing the effectiveness of prison-based domestic violence programming.

Mathematical modeling of hepatitis c virus (HCV) prevention among people who inject drugs: A review of the literature and insights for elimination strategies

In 2016, the World Health Organization issued global elimination targets for hepatitis C virus (HCV), including an 80% reduction in HCV incidence by 2030. The vast majority of new HCV infections occur among people who inject drugs (PWID), and as such elimination strategies require particular focus on this population. As governments urgently require guidance on how to achieve elimination among PWID, mathematical modeling can provide critical information on the level and targeting of intervention are required. In this paper we review the epidemic modeling literature on HCV transmission and prevention among PWID, highlight main differences in mathematical formulation, and discuss key insights provided by these models in terms of achieving WHO elimination targets among PWID. Overall, the vast majority of modeling studies utilized a deterministic compartmental susceptible-infected-susceptible structure, with select studies utilizing individual-based network transmission models. In general, these studies found that harm reduction alone is unlikely to achieve elimination targets among PWID. However, modeling indicates elimination is achievable in a wide variety of epidemic settings with harm reduction scale-up combined with modest levels of HCV treatment for PWID. Unfortunately, current levels of testing and treatment are generally insufficient to achieve elimination in most settings, and require further scale-up. Additionally, network-based treatment strategies as well as prison-based treatment and harm reduction provision could provide important additional population benefits. Overall, epidemic modeling has and continues to play a critical role in informing HCV elimination strategies worldwide.

Substance use disorder and associated factors among prisoners in a correctional institution in Jimma, Southwest Ethiopia: a cross-sectional study

BackgroundSubstance use disorder is an important public health problem and one of the major causes of disability worldwide. Substance use and criminal behavior are closely related and there is a significant association between substance misuse and crime, but little is known about substance use disorder among prisoners, in particular in low-income countries. Therefore, we investigated substance use disorder and associated factors in inmates of a correctional institution in Jimma, Southwest Ethiopia.MethodsWe used a cross-sectional study design to collect data from 336 prisoners from June 5 to July 5, 2017. Study participants were selected from the total of 1460 prisoners eligible for the study by a systematic random sampling technique, i.e., one participant was randomly selected from every four consecutive admissions in the registration book. Alcohol use disorder, nicotine dependence, khat abuse, cannabis use disorder, psychopathy, adverse traumatic life events, and social support were assessed. Data were entered into EpiData version 3.1 and analyzed in bivariate and multivariable logistic regression models with the Statistical Package for Social Science version 21. Variables with a P value < 0.05 in the final fitting model were declared to be associated with the outcome variable.ResultsThe overall prevalence of substance use disorder was 55.9%. The prevalence of khat abuse was 41.9%; alcohol use disorder, 36.2%; nicotine dependence, 19.8%; and cannabis use disorder, 3.6%. Poor social support, living in urban areas, psychopathy, and a family history of substance use were positively associated with substance use disorder.ConclusionsSubstance use disorder is prevalent among prisoners. The increased morbidity and unpleasant psychosocial consequences associated with substance use disorder, together with our finding that 66.3% of prisoners with substance use disorder were interested in obtaining treatment, suggest a need to establish prison-based treatment in this correctional institution in Jimma.

Therapeutic Engagement and Treatment Progress: Developing and Testing an In-Treatment Measure of Client Engagement Among Sex Offenders in a Group Program.

The engagement process of sexual offenders in group-based cognitive-behavioral treatment is an important area of study. Disclosure management style (DMS), a model developed from grounded-theory research of men undertaking a prototypical program, provides a framework to assess engagement in treatment. Our goal was to develop a quantitative measure of DMS, to test its reliability and validity, and to evaluate its utility as a measure of treatment progress by examining relationships between DMS and established measures of treatment change. We studied a sample of men (N = 93) who undertook an intensive prison-based treatment program in New Zealand. Variables included DMS measures, psychometric measures of dynamic risk and treatment change, static risk, clinician rating of treatment progress, and recidivism outcomes. We found that (a) DMS shows an acceptable level of agreement between independent raters, (b) DMS-based ratings of engagement changed over the course of treatment and were correlated with measures of change based on offender self-reports, and (c) offenders showed heterogeneity in terms of their trajectories of change as assessed by DMS ratings.

Real-world outcomes of unrestricted direct-acting antiviral treatment for hepatitis C in Australia: The South Australian statewide experience.

In March 2016, the Australian government offered unrestricted access to direct-acting antiviral (DAA) therapy for chronic hepatitis C virus (HCV) to the entire population. This included prescription by any medical practitioner in consultation with specialists until sufficient experience was attained. We sought to determine the outcomes and experience over the first twelve months for the entire state of South Australia. We performed a prospective, observational study following outcomes of all treatments associated with the state's four main tertiary centres. A total of 1909 subjects initiating DAA therapy were included, representing an estimated 90% of all treatments in the state. Overall, SVR12 was 80.4% in all subjects intended for treatment and 95.7% in those completing treatment and follow-up. 14.2% were lost to follow-up (LTFU) and did not complete SVR12 testing. LTFU was independently associated with community treatment via remote consultation (OR 1.50, 95% CI 1.04-2.18, P=.03), prison-based treatment (OR 2.02, 95% CI 1.08-3.79, P=.03) and younger age (OR 0.98, 95% CI 0.97-0.99, P=.05). Of the 1534 subjects completing treatment and follow-up, decreased likelihood of SVR12 was associated with genotype 2 (OR 0.23, 95% CI 0.07-0.74, P=.01) and genotype 3 (OR 0.23, 95% CI 0.12-0.43, P≤.01). A significant decrease in treatment initiation was observed over the twelve-month period in conjunction with a shift from hospital to community-based treatment. Our findings support the high responses observed in clinical trials; however, a significant gap exists in SVR12 in our real-world cohort due to LTFU. A declining treatment initiation rate and shift to community-based treatment highlight the need to explore additional strategies to identify, treat and follow-up remaining patients in order to achieve elimination targets.

Targeting recidivism, an evaluation study into the functioning and effectiveness of a prison-based treatment program

Targeting recidivism, an evaluation study into the functioning and effectiveness of a prison-based treatment program

Social Media Usage and Incarcerated Women: A Pilot Study

The purpose of this pilot study was to explore social media usage among incarcerated women in a modified therapeutic community. An author-developed social media questionnaire was administered to 89 incarcerated women. Participants reported high levels of social media usage, and many had used social media to engage in criminal behavior. Although most of the women identified seeing pictures of friends actively using substances on social media as a trigger for relapse, they still planned to reactive their social media accounts upon release. The role and power of social media in these women’s lives must be understood and planned for in prison-based treatment programs.

Social support and one-year outcomes for women participating in prison-based substance abuse treatment programming

In recent decades, the number of women under criminal justice supervision has increased considerably, many of whom are serving time for drug offenses. Furthermore, women in prison are more likely than their non-institutionalized counterparts to suffer from a substance abuse disorder. While there is a growing body of research concerning women offenders’ drug abuse and treatment needs, few studies have examined the substance abuse treatment outcomes of women in the criminal justice system. Using data from Outcome Evaluation of the Forever Free Substance Abuse Treatment Program, this study compared women’s self-reported drug use twelve months after participation in high-intensity (n = 101) and low-intensity (n = 81) prison-based substance abuse treatment programming (N = 182). Women who perceived high levels of emotional social support were less likely to report substance use at 12-month follow-up. Furthermore, perceptions of emotional social support and treatment intensity interacted in their association with relapse, such that the protective effect of social support was strongest for women who participated in high-intensity programming. The results of the analyses highlight the importance of perceived social support for women with substance abuse disorders who are transitioning from prison-based substance abuse treatment programming to the community.

The continuum of hepatitis C care for criminal justice involved adults in the DAA era: a retrospective cohort study demonstrating limited treatment uptake and inconsistent linkage to community-based care

BackgroundIncarcerated populations are disproportionately burdened by hepatitis C virus (HCV) infection. The introduction of highly-effective, direct-acting antiviral (DAA) treatment has potential to substantially reduce the burden of liver disease in this population, but accurate information about access to and utilization of this treatment is currently limited. The goals of this study were to characterize receipt of HCV care and treatment services for a cohort of HCV-infected adults identified in a state prison system, and to describe the complex health needs of this population.MethodsTo estimate the proportion of patients who were treated for HCV while incarcerated, and the proportion linked to HCV care after release from prison, we used a deterministic matching algorithm to link administrative prison data, health care records, and a state public health surveillance database, which captures all positive HCV-related diagnostic test results through automatic laboratory reporting. Individuals not evaluated or treated for HCV while in prison were considered likely to have been linked to care in the community if the HCV surveillance system contained a record of a quantitative HCV RNA or genotype test within 6 months of their release date. Demographic and comorbidity data were manually extracted from the electronic health records for all patients referred for consideration of HCV treatment.ResultsBetween 2011 and 2015, 3126 individuals were known to be living with chronic HCV infection while incarcerated in the state prison system. Of these, 570 (18%) individuals were evaluated for HCV treatment while incarcerated and 328 (10%) initiated treatment with DAAs. Of the 2556 individuals not evaluated for treatment, 1605 (63%) were released from prison during the 5 year study period. Of these, 138 (9%) individuals engaged in HCV care in the community within 6 months. Data describing medical and psychiatric co-morbidities were available for the prison-based treatment cohort, which showed a high prevalence of major depression (39%), anxiety disorder (24%), alcohol misuse (52%), cocaine use (52%) and prior injection drug use (62%).ConclusionDespite HCV treatment advances, linkage to care and treatment rates for criminal-justice involved adults remains low, particularly for those who must seek care in the community after release from prison. Treating criminal-justice involved individuals for HCV during incarceration provides an opportunity to improve linkage to care and treatment rates among this vulnerable population.

Addressing Social Anxiety Concurrently With Prison-Based Sex Offender Treatment

Emotional regulation may be an underaddressed therapeutic target in sex offender treatment. This article presents a case report of "Adam," a Caucasian male referred to a prison-based sex offender treatment program. Adam's social anxiety was recognized as an antecendent to his sexual offending, and treatment of such, as a critical adjunct to sex offender treatment, is discussed herein. Adam's individualized treatment included aspects of rational emotive behavior therapy and time-limited dynamic psychotherapy. Adam showed an increased understanding of his anxiety and improvement in his social interactions, both in the context of treatment groups and with female staff, and was willing to continue follow-up care in the community. This case provides support for the individualized treatment of incarcerated offenders as opposed to exclusively utilizing manualized psychoeducational interventions.