Daniel J. O'Connell

Medication-assisted treatment in criminal justice agencies affiliated with the criminal justice-drug abuse treatment studies (CJ-DATS): availability, barriers, and intentions.

Medication-assisted treatment (MAT) is underutilized in the treatment of drug-dependent, criminal justice populations. This study surveyed criminal justice agencies affiliated with the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) to assess use of MAT and factors influencing use of MAT. A convenience sample (N = 50) of criminal justice agency respondents (e.g., jails, prisons, parole/probation, and drug courts) completed a survey on MAT practices and attitudes. Pregnant women and individuals experiencing withdrawal were most likely to receive MAT for opiate dependence in jail or prison, whereas those reentering the community from jail or prison were the least likely to receive MAT. Factors influencing use of MAT included criminal justice preferences for drug-free treatment, limited knowledge of the benefits of MAT, security concerns, regulations prohibiting use of MAT for certain agencies, and lack of qualified medical staff. Differences across agency type in the factors influencing use and perceptions of MAT were also examined. MAT use is largely limited to detoxification and maintenance of pregnant women in criminal justice settings. Use of MAT during the community reentry period is minimal. Addressing inadequate knowledge and negative attitudes about MAT may increase its adoption, but better linkages to community pharmacotherapy during the reentry period might overcome other issues, including security, liability, staffing, and regulatory concerns. The CJ-DATS collaborative MAT implementation study to address inadequate knowledge, attitudes, and linkage will be described.

Differences in Prevalence of Prescription Opiate Misuse Among Rural and Urban Probationers

We compared the prevalence of prescription opiate misuse among 2 cohorts of felony probationers (N = 1525). Multiple logistic regression was utilized to determine the independent correlates of prescription opiate misuse among rural (n = 782) and urban (n = 743) probationers participating in an HIV-intervention study. After adjustment for differences in demographic and drug use characteristics, rural participants were almost five times more likely than their urban counterparts to have misused prescription opiates. The prevalence of prescription opiate misuse was significantly higher among the rural probationers; however, given the paucity of illicit opiates and relatively recent emergence of prescription opiates in rural areas, rural substance abuse treatment may be ill-prepared to treat prescription opiate misuse.

The Impact of Intimate Partner Violence on Women’s Condom Negotiation Efficacy:

HIV prevention efforts promote the use of condoms to prevent the spread of HIV and other STDs. Thus, a woman’s agency to practice healthy sexual behaviors necessarily involves negotiation with another person. This poses unique challenges for women who have limited power in relationships. The current study explores how the experience of intimate partner violence (IPV) impacts a woman’s confidence in her ability to negotiate condom use with a sexual partner (i.e., condom use self-efficacy), using data from incarcerated females in three states, who were interviewed just prior to release back into the community. The direct effect of experiencing IPV as an adult, controlling for other risk factors, on condom use self-efficacy has not previously been empirically tested. Results show that IPV experiences among women significantly decreases their confidence in negotiating condom use with a partner, putting them at a higher risk of HIV infection than women who do not report having recently experienced IPV.

Investigating latent trait and life course theories as predictors of recidivism among an offender sample

This research used data from a drug treatment follow-up study to investigate the predictive utility of factors associated with latent trait and life-course models of criminal offending among a sample of serious drug users. A sample of 577 incarcerated drug offenders was interviewed prior to release from prison and again at six and eighteen months after release. Structural equation models were used to investigate to what extent sensation seeking and aggression scales predicted marriage, employment, or enrollment in an educational program and, in turn, how both sets of variables predicted drug use and arrest. Results indicated that while aggression was negatively associated with social bonds and positively related to drug use and arrest, sensation seeking was nonsignificant in predicting bonds and negatively associated with drug use. Employment and school were negatively associated with drug use and arrest, while marriage was nonsignificant.

Developing a Multimedia HIV and Hepatitis Intervention for Drug-Involved Offenders Reentering the Community

Estimates of HIV and hepatitis rates in correctional populations are 8 to 10 times higher than in the general population, the result of risky drug-using and sexual behaviors prior to incarceration. Many offenders resume these risk behaviors after release from the institution, attempting to “make up for lost time.” Thus, reentry is a pivotal period for prevention, yet effective programs for offenders in transitional correctional settings are lacking. Based on past research and with guidance from qualitative studies, a peer-facilitated, multimedia HIV and hepatitis protocol was developed to address risk reduction and barriers of concern to correctional populations. The rationale, theoretical underpinnings, and current study design are described.

Integrating an HIV/HCV Brief Intervention in Prisoner Reentry: Results of a Multisite Prospective Study

Abstract Brief interventions to reduce harmful or problem behaviors have become increasingly popular in a variety of health fields, including HIV and hepatitis risk reduction. A central issue in intervention research involves the evaluation of what constitutes an effective “dose” of an intervention. This research examines the relative effectiveness of three alternative brief interventions of varying intensity designed to change the risk behaviors of inmates who are reentering society: a DVD-based, peer delivered intervention; the N1DA Standard HIV Intervention; and a standard practice condition (HIV educational video). All participants randomly received one of the interventions and were tested for HIV and HCV prior to release from custody. Thirty and ninety-day follow-ups examined changes in high-risk behaviors. Results reported here for 343 subjects who have completed the 90-day follow up indicate significant reductions in reported sexual risk behaviors for those participating the DVD intervention, compared to the other two brief interventions. This study is among the first to report any positive impacts on sexual behaviors among a population of inmates returning to the community.

Decide Your Time

Research Summary This study used a randomized controlled trial approach with a sample of 400 high-risk probationers to test the hypothesis that a program incorporating principles of deterrence, graduated sanctions, and coerced abstinence would reduce recidivism rates among drug-using offenders. Bivariate and multilevel modeling strategies were implemented. Findings revealed no discernable difference across multiple drug use, probationary, and recidivism measures between those randomized into the treatment condition and those receiving standard probation. In multivariate models, probationer age, employment status, and treatment participation improved some recidivism outcomes. Programmatic and sample characteristics are discussed regarding the lack of experimental effect. Policy Implications These findings suggest that in designing and implementing deterrence-informed community supervision approaches, policy makers and practitioners should consider offender attributes, the addition of employment and treatment-based programs and supports, and local justice system structures. The findings of this study fit well with other emerging models of offender supervision, in particular, those that match services and programs based on offender risks and needs and those that recognize and address the heterogeneity of the offender population in developing supervision and service plans. Swift, certain, and fair supervision approaches for individuals under community supervision do not seem to be a “one-size-fits-all” strategy. Understanding for whom they work and under what conditions has not yet been determined. In the meantime, policy makers and practitioners should endeavor to understand the risks and needs of their local offender population and the community supports that are available to improve offender outcomes and increase public safety.

Policies and practices in the delivery of HIV services in correctional agencies and facilities: results from a multisite survey.

HIV risk is disproportionately high among incarcerated individuals. Corrections agencies have been slow to implement evidence-based guidelines and interventions for HIV prevention, testing, and treatment. The emerging field of implementation science focuses on organizational interventions to facilitate adoption and implementation of evidence-based practices. A survey of correctional agency partners from the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) revealed that HIV policies and practices in prevention, detection, and medical care varied widely, with some corrections agencies and facilities closely matching national guidelines and/or implementing evidence-based interventions. Others, principally attributed to limited resources, had numerous gaps in delivery of best HIV service practices. A brief overview is provided of a new CJ-DATS cooperative research protocol, informed by the survey findings, to test an organization-level intervention to reduce HIV service delivery gaps in corrections.

The Long and Winding Road to Desistance from Crime for Drug-Involved Offenders: The Long-Term Influence of TC Treatment on Re-Arrest

Earlier research by Inciardi and colleagues established the long-term positive effects of a therapeutic community (TC) continuum of treatment for drug-involved offenders. Using data from his original longitudinal study and archival records of criminal justice re-arrest and recidivism, this paper extends these analyses to examine the effects of TC treatment on the long-term success of offenders, up to 18 years after release from prison. Multivariate trajectory analysis is used to examine patterns of re-arrest and desistance among a sample of 1363 clients followed up in person for five years and subsequently with record checks through state and NCIC criminal justice systems. Results indicate significant reductions in new arrests for those who received TC treatment in each of the five trajectories modeled for patterns of persistence and desistance. Discussion centers on the strengths of the relationships in each modeled trajectory and the implications for long-term understanding of drug offenders and criminal behavior.

The Complex Relationship Between Motherhood and Desistance

Using a sample of 118 drug-involved women originally released from prison in the 1990s and re-interviewed between 2010 and 2011, this paper examines the role motherhood played in the desistance process from crime and substance abuse. Interview narratives revealed that motherhood rarely functioned as a turning point per se that activated desistance, but caring for children did serve to solidify prosocial identities once offenders had transformed their addict/criminal identities. Despite their identity transformations, however, the journey of desistance for the majority of mothers was still a long and arduous path. The reality for these mothers most often resembled a hostile terrain marked by the competing demands of battling addiction, finding employment and suitable housing with a criminal record, establishing visitation and custody rights in family court, and regaining the trust of children and family members who had long ago lost faith in their commitment to their families. This research illuminates the complexities inherent in the desistance process for a contemporary sample of drug involved adult women entrenched within the criminal justice system.