Roger H. Peters

Effectiveness of Treatment-Based Drug Courts in Reducing Criminal Recidivism:

This study examined outcomes for two treatment-based drug court programs during a 30-month follow-up period. Outcomes for drug court graduates were contrasted with those of nongraduates and of comparison groups that consisted of offenders who were placed on probation supervision during the same period and did not receive drug court services. Drug court graduates from both programs were significantly less likely to be arrested and had fewer arrests during follow-up in comparison to matched probationers and nongraduates. For both drug courts, the rates of arrest during the 30-month follow-up period declined in direct relationship to the duration of drug court involvement. Drug court graduates had lower rates of substance abuse than comparable groups of treated offenders. The implications for clinical practice and the need for additional drug court outcome research are discussed.

Effectiveness of screening instruments in detecting substance use disorders among prisoners

This study examined the effectiveness of several screening instruments in detecting substance use disorders among prison inmates. A sample of 400 male inmates were administered eight different substance abuse screening instruments and the Structured Clinical Interview for DSM-IV (SCID-IV), Version 2.0, Substance Abuse Disorders module. The latter was used as a diagnostic criterion measure to determine the presence of substance use disorders. Based on positive predictive value, sensitivity, and overall accuracy, the Texas Christian University Drug Screen, the Simple Screening Instrument, and a combined instrument-Alcohol Dependence Scale/Addiction Severity Index-Drug Use section were found to be the most effective in identifying substance abuse and dependence disorders.

Prevalence of DSM-IV Substance Abuse and Dependence Disorders among Prison Inmates

The study examined the 30-day and lifetime prevalence of DSM-IV alcohol and drug disorders among state prison inmates. A sample of 400 inmates consecutively admitted to a state prison reception center were assessed for alcohol and drug disorders using the Structured Clinical Interview for DSM-IV (SCID-IV). Test-retest reliabilities were calculated for the SCID-IV. Lifetime substance abuse or dependence disorders were detected among 74% of inmates, including over half who were dependent on alcohol or drugs. For the 30 days prior to incarceration, over half of the sample were diagnosed as having substance abuse or dependence disorders, including 46% who were dependent on alcohol or drugs. Black inmates were significantly less likely to be diagnosed as alcohol dependent than whites or Hispanics. The high rates of substance use disorders are consistent with previous findings from other studies conducted in correctional settings and reflect the need to expand treatment capacity in prisons.

Development of substance abuse problems among drug-involved offenders: Evidence for the telescoping effect

PURPOSE The present study was designed to evaluate gender differences in the development of substance abuse disorders among drug-involved offenders and to determine whether women in this population exhibit a telescoping effect (i.e., acceleration in the progression from substance use to substance abuse), which has been observed in other setting. METHOD Participants consisted of 160 polysubstance-abusing individuals (118 men, 42 women) who were admitted to two Florida drug court programs. Data were obtained from the Addiction Severity Index, intake interviews, and archival court records. RESULTS Female and male offenders differed significantly in the developmental trajectory of their addiction. Women offenders initiated alcohol and marijuana use significantly later in life than their male cohorts but began using cocaine earlier in the course of their addiction. Women also reported more problems related to cocaine use and significantly more prior treatment episodes. Women were found to have a shorter latency from first use of cocaine to cocaine abuse. Findings are consistent with those of previous studies examining gender differences among individuals referred for substance abuse treatment. Future directions for research and implications for treatment planning are discussed.

Co-Occurring Substance Use and Mental Disorders in the Criminal Justice System: A New Frontier of Clinical Practice and Research

This editorial introduces this special section of the Psychiatric Rehabilitation Journal, which focuses on justice-involved persons with co-occurring mental and substance use disorders (CODs). It contains seven original articles examining CODs among justice-involved populations that vary by gender, age, setting (e.g., community/ court, jail, prison), environment (urban, rural), geographic region, and nationality. (PsycINFO Database Record

Treatment “dosage” effects in drug court programs

Abstract This study assessed whether greater duration of involvement in a drug court program affected criminal justice outcomes. The major research hypothesis was that the length of participation in drug courts would be directly related to outcomes obtained during follow-up. Participants consisted of 226 individuals who entered two Florida drug court programs in Escambia and Okaloosa counties between June 1993 and June 1996. This sampling strategy was developed to insure that at least a one-year follow-up period was provided for each participant after discharge from the drug court program. Results indicate that the duration of time spent in a drug court program is significantly related to criminal justice outcomes, with greater time in the program associated with lower rates of follow-up arrest, and clearly support the importance of lengthy involvement in drug court programs and of expanded efforts to retain participants in these programs.

The effects of statutory change on the civil commitment of the mentally ill

Several states have revised their civil commitment statutes in recent years. A majority of the recent revisions reflect judicial directives to provide more explicit commitment criteria, but in some instances, criteria have been broadened in reaction to the difficulty of getting some individuals hospitalized under strict criteria. Such statutory changes have impacted considerably on both process and outcome of the civil commitment system. Adoption of explicit commitment criteria has resulted most visibly in substantial reduction of hospital admissions and census. The present study examines the impact of explicit changes in commitment criteria in Florida following the 1982 enactment of amendments to the Baker Act. A total of 80 commitment hearings are reviewed before and after the law took effect to determine procedural effects of the law on degree of defense counsel advocacy, client dispositions, and on the courts adherence to more explicit criteria. State hospital admissions, discharge, and census information is examined in order to identify the larger impact of 1982 statutory changes on the commitment system. Evidence from hearings and state data suggests that changes in the Florida law impacted significantly on both process and outcome of the civil commitment system. Clients referred to commitment hearings are more dangerous, and may represent a new “hard-core” group remaining after more explicit eligibility criteria are applied by local intake, and emergency detention facilities. State hospital admissions and census in Florida declined significantly following enactment of the 1982 law, consistent with findings from other states enacting similar statutory reforms. Implications for deinstitutionalization policy and administration are discussed.

Characteristics of opinion leaders in substance abuse treatment agencies

Objective. This study was part of a larger effort to test the effectiveness of technology transfer approaches related to evidence‐based treatment of co‐occurring substance abuse and mental health disorders. Specifically, this study examined characteristics of “opinion leaders” as technology transfer agents. Method. A network analysis was conducted within four large substance abuse treatment agencies to identify individuals that other counselors sought out for consultation on co‐occurring issues. The identified opinion leaders were then compared with other counselors on demographic variables, education and experience, and attitudes and knowledge about working with individuals with co‐occurring disorders. Results. The analyses demonstrate that opinion leaders differed from other counselors in competency‐related characteristics including more postgraduate education, relevant professional credentials, and years of experience in mental health treatment. They also had greater knowledge of the dynamics and treatment of co‐occurring disorders as well as a greater willingness and confidence in working with such clients. Conclusion. These results suggest that opinion leaders are used within agencies for information and consultation regarding treatment issues. Therefore, opinion leaders may provide an important vehicle for dissemination and adoption of evidence‐based treatment practices in community treatment settings.

COMMENTARY ON WHY NATIONAL EPIDEMIOLOGICAL ESTIMATES OF SUBSTANCE ABUSE BY RACE SHOULD NOT BE USED TO ESTIMATE PREVALENCE AND NEED FOR SUBSTANCE ABUSE SERVICES AT COMMUNITY AND LOCAL LEVELS

Large-scale epidemiological studies suggest substantially lower prevalence rates of substance abuse disorders in Black Americans than in White Americans. This is counterintuitive since indicators of socioeconomic status, which on an average are lower in Blacks than Whites, are inversely associated with the prevalence of psychiatric disorders. Herein, we recommend against the use of race-specific national epidemiological data to estimate prevalence of substance abuse disorders and need for services at community/local levels. This is important so that catchment areas with high proportions of minorities receive equitable levels of substance abuse prevention and treatment resources. We illustrate our recommendation through observations and potential biases (e.g., reporting bias) identified from large-scale epidemiological studies of the prevalence of substance use disorders between Black and White Americans.

Referral and screening for substance abuse treatment in jails

As jails and prisons have become filled to capacity with inmates arrested and convicted for drug-related offenses, efforts have intensified to reduce subsequent drug use, drug-related crime, and recidivism among this population. Faced with the drug abuse epidemic, treatment resources in the community have expanded more quickly than in detention and corrections facilities. Many large jails and prisons do not presently have a substance abuse treatment program despite clear evidence of widespread drug and alcohol dependence problems among inmate populations. Where substance abuse treatment resources are available, administrators face difficult choices in determining which inmates will receive services. This paper provides a discussion of issues related to referral and screening procedures for in-jail substance abuse treatment programs. Referral and screening systems implemented in several jails across the country are reviewed.