André Ivanoff

DBT with an inpatient forensic population: The CMHIP forensic model

Implementation of Dialectical Behavior Therapy (DBT) in a forensic or criminal justice setting differs dramatically from standard outpatient DBT. Forensic patients are multiproblem patients with violent histories and multiple diagnoses including borderline personality disorder (BPD), antisocial personality disorder (ASPD), and concomitant Axis I psychotic or mood disorders. DBT was selected for this population because of its emphasis on treating life-threatening behaviors of patients and therapy-interfering behaviors of both patients and staff. The forensic inpatient DBT model described here includes modification of agreements, targets, skills training groups, and dialectical dilemmas. An additional skills module, the Crime Review, was developed to supplement standard DBT. Conclusions and recommendations for applying DBT in a forensic setting are presented.

Sexual risk behavior of incarcerated, drug-using women, 1992

In this study, sexual risk behavior of 104 incarcerated female drug users is examined. Findings demonstrate that incarcerated women who use drugs are at high risk for human immunodeficiency virus (HIV) infection because of their behavior prior to arrest. During the month prior to arrest, the majority of respondents were sexually active. Half reported past sexual contacts with injecting drug users, and more than one-third had traded sex for money or drugs. Consistent with other studies, condom use was more frequent with casual or commercial partners. Those who traded sex for money were less likely to be white Anglo or regular heroin users, and more likely to be regular crack users and alcoholic, have fathers who were drug or alcohol users, and perceive themselves as at-risk for contracting HIV and other sexually transmitted diseases.

Correlates of Crack Abuse Among Drug-Using Incarcerated Women: Psychological Trauma, Social Support, and Coping Behavior

This investigation examines the relationship between psychological trauma and crack abuse among 158 women with a recent history of drug use who were incarcerated in a New York City jail facility. Interviewers obtained data on demographics, drug use, psychological trauma history, criminal history, social support, and coping behavior variables. Three-fourths of the total sample had used crack three or more times a week for a month in the past; a quarter had used other drugs, predominantly heroin, three or more times a week for a month in the past. Multiple logistic regression analysis was used to assess the association between adult psychological trauma variables (loss of custody of youngest child and lived in streets prior to arrest) and regular crack use in three sequential models. After adjusting for social support, coping behavior, demographics, and criminal history variables, women who had lost custody of their youngest child were 3.3 times more likely to be regular crack uses. Women who demonstrated more negative coping behavior and perceived themselves as having less emotional support were also more likely to be regular crack users. The association between childhood traumas (i.e., childhood sexual abuse, childhood physical abuse, parental alcohol abuse) and regular crack use was also assessed using multiple logistic regression; however, no significant associations were found between these childhood psychological traumas and regular crack use in both the unadjusted and adjusted models. Study findings underscore the importance of assessing environmental, interpersonal, and intrapersonal factors in tailoring treatment strategies for users of crack and other drugs.

The Role of Hopelessness and Social Desirability in Predicting Suicidal Behavior: A Study of Prison Inmates

The purpose of this study is to further examine the relationships among hopelessness, social desirability, and suicidal behavior in the decade-long dispute about the role of social desirability and the ability of the Beck Hopelessness Scale to predict suicidal behavior. Using a stratified random sample of state prison inmates, we found that hopelessness and suicidal behavior remain significantly correlated even after social desirability is held constant, failing to replicate Linehan and Nielsens (1981, 1983) findings. In addition, a multivariate regression analysis demonstrated that the utility of hopelessness in predicting suicidal behavior varies with the level of social desirability, consistent with Holden, Mendonca, and Serins (1989) results describing an interaction between hopelessness and social desirability. Implications for the assessment of suicidality incorporating the role of social desirability are discussed.

Fewer reasons for staying alive when you are thinking of killing yourself: The brief reasons for living inventory

The Linehan Reasons for Living Inventory is a 48-item scale on which respondents rate how important each item would be for living if suicide were contemplated. The inventory possesses good psychometric properties and can distinguish suicidal from nonsuicidal people among shoppers, psychiatric inpatients, college students, and adolescents. As its length limits its utility in many institutional and screening settings, the purpose of this study was (1) to develop a brief form of the Reasons for Living Inventory appropriate for clinical use and (2) to examine the predictive validity of this brief measure, named the Brief Reasons for Living Inventory (BRFL), to distinguish suicidal from nonsuicidal prison inmates. Results indicate that the brief form was as good as either the Beck Depression Inventory or the Beck Hopelessness Scale at predicting suicidality in this population. Further study is needed to validate the BRFL with different institutionalized and other populations as well as to assess its ability to discriminate suicide ideators from those engaging in overt suicidal behavior.

Correlates of problem drinking among drug-using incarcerated women

The association between drug use--regular use of crack cocaine or heroin--and problem drinking was examined in a sample of 159 sentenced women at Rikers Island correction facility in New York City. Using logistic regression, this study tested the association between drug use and alcohol use, controlling for psychosocial variables (sexual abuse history, negative and positive coping skills, and depression), familial drug use (number of family members currently abusing drugs, and those currently abusing alcohol), and demographic variables and criminal history. The association between current, regular crack use and problem drinking approached significance in the final model, which adjusted for criminal behavior, demographic, familial abuse, and psychosocial variables. The results of this study point toward childhood sexual abuse, negative coping skills, and familial alcohol abuse as variables related to problem drinking among incarcerated women.

Skills Building and Social Support Enhancement to Reduce HIV Risk among Women in Jail

Despite the scope of the HIV/AIDS epidemic among female offenders, little is known about the risk behaviors of these women and even less about ways in which to reduce HIV/AIDS among this population. This article describes the development of an eight-session group cognitive-behavioral and social support enhancement intervention that aims to reduce HIV risk among drug-using female offenders. The intervention is based on social-cognitive theory and informed by other skills-training approaches with demonstrated efficacy at reducing HIV risk. Both current and former offenders were involved in the development of this intervention. Help-seeking and social support skills are unique to this intervention, as is an eight-session booster conducted after release from jail to enhance transfer of skills to the community.

Dialectical Behavior Therapy for the Treatment of Stalking Offenders

The need for effective mental health interventions for specific offender populations has become clear in recent decades. In particular, individuals who engage in stalking and harassment have increasingly attracted the attention of the public and mental health and criminal justice professionals, however no evidence-based treatment currently exists for this population. We adapted Dialectical Behavior Therapy (DBT) for the treatment of this offender group, in part because of the high prevalence of personality disorders. This study describes the application of a 6-month treatment program to a sample of 29 individuals, 14 of whom completed treatment. Treated offenders were significantly less likely to re-offend with another stalking offense (0 of 14) compared to treatment drop-outs (26.7%) or to published recidivism data (47%). Measures intended to help determine the nature of changes revealed increased thought suppression, but are qualified by the high degree of defensive responding. These preliminary data suggest that DBT holds promise for reducing stalking behaviors and warrants further study.

Clinical Risk Factors Associated with Parasuicide in Prison

The study was conducted to identify risk factors associated with parasuicide in a state prison setting that might provide direction and focus for prevention. A proposed model tested the ability of current clinical and background variables to predict parasuicide during incarceration among male inmates. Psychiatric history, symptomatology, and psychological functioning variables affected parasuicide directly and indirectly through their contribution to suicidal ideation. Among inmates with histories of alcohol abuse, however, hopelessness was a less significant predictor of parasuicide, suggesting that interaction effects may warrant more attention.

Problem solving and suicidality among prison inmates: another look at state versus trait

This research examines the relationships between means-ends problem solving and suicidality among adult male prison inmates in light of new evidence based on inpatient and college student populations suggesting that state, rather than trait, vulnerabilities may be responsible for problem-solving deficits and differences. Using the Means-Ends Problem-Solving Procedure (MEPS) with 93 state prison inmates, we found that among inmates with a history of parasuicide, current suicidality did not affect problem-solving performance. We further found that among nonsuicidal inmates, parasuicide history had no effect on problem solving or affect-suicidality measures. Although these results support new research suggesting that trait problem-solving deficits are not causally linked to suicidality, they raise questions about the potentially unique relationships among suicidality, problem solving, depression, and hopelessness in incarcerated populations.