2014 FADAA/FCCMH Annual Conference Orlando, Florida; August 6, 2014 Roger H. Peters, Ph.D., University of South Florida rhp@usf.edu - PowerPoint PPT Presentation

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2014 FADAA/FCCMH Annual Conference Orlando, Florida; August 6, 2014 Roger H. Peters, Ph.D., University of South Florida rhp@usf.edu

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What Does the Research Tell Us about Treating Offenders with Substance Use or Co-Occurring Mental Disorders? 2014 FADAA/FCCMH Annual Conference – PowerPoint PPT presentation

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Title: 2014 FADAA/FCCMH Annual Conference Orlando, Florida; August 6, 2014 Roger H. Peters, Ph.D., University of South Florida rhp@usf.edu


1
2014 FADAA/FCCMH Annual ConferenceOrlando,
Florida August 6, 2014Roger H. Peters, Ph.D.,
University of South Florida rhp_at_usf.edu
What Does the Research Tell Us about Treating
Offenders with Substance Use or Co-Occurring
Mental Disorders?

2
Goals of this Presentation
  • Review
  • Evidence-based interventions for treating
    offenders who are substance-involved or who have
    co-occurring mental disorders
  • Review risk-need-responsivity, cognitive-behaviora
    l, and social learning approaches for treating
    offenders who have behavioral health disorders
  • Identify practice implications of using these
    approaches with offenders

3
Resources
  • NDCI/NADCP http//www.ndci.org/
  • SAMHSAs GAINS Center http//gainscenter.samhsa.go
    v/
  • CSAT TIP 42 and 44 http//www.ncbi.nlm.nih.gov/b
    ooks/NBK82999/
  • Council of State Governments - Justice Center
    http//csgjusticecenter.org/

4
Resources
  • SAMHSA/CMHS Toolkit on Integrated Treatment for
    Co-Occurring Disorders http//store.samhsa.gov/pro
    duct/Integrated-Treatment-for-Co-Occurring-Disorde
    rs-Evidence-Based-Practices-EBP-KIT/SMA08-4367
  • National Institute on Drug Abuse (NIDA)
    http//www.drugabuse.gov/

5
What Doesnt Work in Offender Treatment?
  • Incarceration without treatment
  • Supervision without intensive treatment
  • Self-help without intensive treatment
  • Drug education
  • Films
  • Building self-esteem as primary focus
  • Targeting participants with low criminal risk or
    with mild substance use disorders
  • Mixing high risk and low risk participants
  • Non-manualized treatment

6
Evidence-Based Models for Offender Treatment
7
Evidence-Based Models to Guide Offender Treatment
  • Integrated Dual Diagnosis Treatment (IDDT)
  • Risk-Need-Responsivity (RNR) Model
  • Cognitive-Behavioral Treatment (CBT)
  • Social Learning Model
  • Combining several models produces larger
    reductions in recidivism (26-30 Dowden
    Andrews, 2004)

8
Common Features of CBT and Social Learning Models
  • Focus on skill-building (e.g., coping strategies)
  • Use of role play, modeling, feedback
  • Repetition of material, rehearsal of skills
  • Behavior modification
  • Interpersonal problem-solving
  • Cognitive strategies used to address criminal
    thinking

9
Using Risk and Needs to Guide Offender Treatment
  • Focus resources on Moderate to High Risk cases
    (risk for criminal recidivism)
  • Interventions should target Dynamic Risk Factors
    for criminal recidivism (e.g., antisocial
    attitudes, criminal peers, substance abuse)
  • Focus on those who have High Needs for substance
    abuse treatment
  • Providing intensive treatment and supervision for
    low risk drug offenders can increase recidivism
  • Mixing risk levels is contraindicated

10
Dynamic Risk Factors for Criminal Recidivism
  • Antisocial attitudes
  • Antisocial friends and peers
  • Antisocial personality pattern
  • Substance abuse
  • Family and/or marital problems
  • Lack of education
  • Poor employment history
  • Lack of prosocial leisure activities

11
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12
Responsivity
  • Strategies to tailor treatment and supervision to
    help offenders engage in evidence-based
    interventions that address dynamic risk factors
  • Mental health treatment
  • Trauma/PTSD services, gender-specific treatment
  • Motivational enhancement techniques
  • Address language and literacy issues
  • Use of cognitive-behavioral approaches

13
How is Level of Risk Determined?
  • Risk for criminal recidivism
  • Use of risk assessment
  • - Static factors (e.g., criminal history)
  • - Dynamicor changeable factors that are
    targets of
  • interventions in the criminal justice
    system

14
Risk Assessment Instruments
15
Integrating Treatment and Supervision Reduces
Risk
National Reentry Resource Center, 2012
16
Evidence-Based Screening and Assessment
17
Importance of Screening and Assessment for CODs
  • High prevalence rates of behavioral health and
    related disorders in justice settings
  • Persons with undetected disorders are likely to
    cycle back through the justice system
  • Allows for treatment planning and linking to
    appropriate treatment services
  • Offender programs using comprehensive assessment
    have better outcomes

18
Key Screening Domains for Co-Occurring Disorders
  • Mental disorders
  • Substance use disorders
  • Trauma/PTSD
  • Suicide risk
  • Motivation
  • Criminal risk level

19
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21
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22
Screening for Trauma and PTSD
  • All offenders should be screened for trauma
    history rates of trauma gt 75 among female
    offenders and gt 50 among male offenders
  • The initial screen does not have to be conducted
    by a licensed clinician
  • Many non-proprietary screens are available
  • Positive screens should be referred for more
    comprehensive assessment

23
Trauma and PTSD Screening Issues
  • PTSD and trauma are often overlooked in screening
  • Other diagnoses are used to explain symptoms
  • Result - lack of specialized treatment, symptoms
    masked, poor outcomes

24
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26
Evidence-Based Offender Treatment for SUDs
and CODs
27
Evidence-Based Treatment Interventions for
Offenders
  • Integrated MH and SA treatment
  • Cognitive-behavioral treatments
  • Relapse prevention
  • Motivational interventions (MI/MET)
  • Contingency management
  • Behavioral skills training
  • Medications (for both disorders)
  • Trauma-focused treatment
  • Family interventions (psychoeducational)

28
Drug Courts
  • Meta-analyses indicate that drug courts lead to
    reductions in recidivism from 8-26 vs.
    comparisons
  • - Drug court effects on recidivism extend to at
    least 36 months (Mitchell et al., 2012)
  • - Wide variation in effect size 15 of programs
    ineffective
  • Drug courts produce cost benefits of 4,767 -
    5,680 per participant (Aos et al., 2006 Rossman
    et al., 2011)

29
Prison Treatment and Reentry
33
MH
TC after-care
16
5
TC only
Total n139 n64 n32
n43
Sacks et al. 2004
30
31
Kelly, Finney, Moos, 2005
31
Effectiveness of Outpatient Treatment with
Offenders
  • Outpatient treatment of probationers leads to
    fewer arrests at 12 and 24 month follow-up
    (Lattimore et al., 2005) vs. untreated
    probationers
  • High-risk probationers in outpatient treatment
    experience 10-20 reductions in recidivism
    (Petersilia Turner, 1990, 1993)
  • Reductions in recidivism durable for 72 months
    after treatment (Krebs et al., 2009)

32
Optimal Duration of Outpatient Treatment
  • At least 3 months of outpatient treatment needed
  • Greatest effects for outpatient treatment of 6-12
    months
  • Diminishing outcomes for treatment lasting gt 1
    year
  • Best outcomes for persons completing treatment

33
Outpatient vs. Residential Treatment
  • Both outpatient and residential treatment are
    effective for offenders
  • Outpatient treatment is more effective than
    residential treatment for drug-involved
    probationers (Krebs et al., 2009) and during
    reentry (Burdon et al., 2004)
  • Cost-benefit analysis
  • Greater benefits for outpatient treatment in
    non-offender samples (e.g., CALDATA, French et
    al., 2000, 2002)
  • Excellent benefit-cost ratio for intensive
    supervision treatment, community TC, community
    outpatient, and drug court programs (Aos et al.,
    2001 Drake et al., 2009)

34
Aftercare/Continuing Care
  • Aftercare services among drug-involved offenders
    can significantly reduce substance use and
    rearrest (Butzin et al., 2006)
  • Outpatient aftercare services can reduce
    likelihood of reincarceration by 63 (Burdon et
    al., 2004)
  • Aftercare services provide 4.4 - 9 return for
    every dollar invested (Roman Chalfin, 2006)
  • Promising interventions for high risk/high need
    offenders
  • Recovery management checkups (Rush et al., 2008)
  • Critical time intervention (Kasprow Rosenheck,
    2007)

35
Adaptations for COD Treatment
  • Destigmatize mental illness
  • Focus on symptom management vs. cure
  • Focus on education/support vs. compliance/sanction
    s
  • Higher staff-to-participant ratio, more structure
  • Dually credentialed staff
  • Increased length of services ( gt 1 year)
  • Pace of treatment slower
  • Motivational interventions
  • Cognitive and memory enhancement strategies
  • Focus on housing, employment, medication needs

36
Evidence-Based Integrated COD Treatment Curricula
  • Illness Management and Recovery (IMR)
  • Integrated Group Therapy for Bipolar Disorder and
    Substance Abuse
  • Integrated Cognitive-Behavior Therapy (ICBT)
  • Seeking Safety (SA and trauma/PTSD)

37
Structural COD Interventions
  • Assertive Community Treatment (ACT)
  • Residential Treatment (Therapeutic Communities
    TCs) modified for CODs
  • More flexibility
  • Less confrontation
  • Greater individualization of services
  • More staff involvement
  • Longer duration
  • Case management and legal coercion assist in
    treatment retention
  • Supported housing

38
Specialized Supervision Caseloads
  • Specialized MH/COD caseloads
  • Smaller caseloads with more intensive services
    (e.g., lt 45)
  • Sustained and specialized officer training
  • Dual focus on treatment and surveillance
  • Active engagement in SA and MH services
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