Steven S. Martin

An Effective Model of Prison-Based Treatment for Drug-Involved Offenders

A multistage therapeutic community treatment system has been instituted in the Delaware correctional system, and its effectiveness has captured the attention of the National Institutes of Health, the Department of Justice, members of Congress, and the White House. Treatment occurs in a three-stage system, with each phase corresponding to the clients changing correctional status—incarceration, work release, and parole. In this paper, 18 month follow-up data are analyzed for those who received treatment in: (1) a prison-based therapeutic community only, (2) a work release therapeutic community followed by aftercare, and (3) the prison-based therapeutic community followed by the work release therapeutic community and aftercare. These groups are compared with a no-treatment group. Those receiving treatment in the two-stage (work release and aftercare) and three-stage (prison, work release, and aftercare) models had significantly lower rates of drug relapse and criminal recidivism, even when adjusted for other risk factors. The results support the effectiveness of a multistage therapeutic community model for drug-involved offenders, and the importance of a work release transitional therapeutic community as a component of this model.

Three-Year Outcomes of Therapeutic Community Treatment for Drug-Involved Offenders in Delaware: From Prison to Work Release to Aftercare

Delaware researchers have argued for a continuum of primary (in prison), secondary (work release), and tertiary (aftercare) therapeutic community (TC) treatment for drug-involved offenders. Previous work has demonstrated significant reductions in relapse and recidivism for offenders who received primary and secondary TC treatment 1 year after leaving work release. However, much of the effect declines significantly when the time at risk moves to 3 years after release. Further analyses reveal that program effects remain significant when the model takes into account not simply exposure to the TC program, but, more importantly, program participation, program completion, and aftercare. Clients who complete secondary treatment do better than those with no treatment or program dropouts, and those who receive aftercare do even better in remaining drug- and arrest-free.

Five-Year Outcomes of Therapeutic Community Treatment of Drug-Involved Offenders after Release from Prison

With growing numbers of drug-involved offenders, substance abuse treatment has become a critical part of corrections. A multistage therapeutic community implemented in the Delaware correctional system has as its centerpiece a residential treatment program during work release—the transition between prison and community. An evaluation of this program followed 690 individuals. At 5 years, those who participated in the program were significantly more likely to be drug and arrest free. Furthermore, treatment graduates with or without aftercare had significantly greater probabilities of remaining both arrest free and drug free than did ano treatment comparison group in regular work release. Dropouts also were significantly more likely to be drug free, although not significantly less likely to have a new arrest than those without treatment. These data show that the implementation of such programs could bring about significant reductions in both drug use and drug-related crime.

Application of a general theory of deviant behavior: self-derogation and adolescent drug use.

The applicability of a general theory of deviant behavior to explaining drug use among junior high school students (N=3,148) is tested using data from a three-wave panel. The five-stage path model consists of eleven constructs measured at two points in time and one construct (drug use) measured at three points in time. The results of the analyses are consistent with the representation of drug use as the outcome of: (1) students recognition of the self-devaluing implications of membership group experiences, (2) exacerbation of the self-esteem motive; and of the effects of these two concurrent processes, including decreased identification with the normative structure, increased perception of the self-enhancing potential of deviant responses, increased perception of the prevalence of drug use, and increased association with friends who use drugs.

Antecedents of Psychological Distress in Young Adults: Self-Rejection, Deprivation of Social Support, and Life Events

We test models predicting psychological distress as a function of the main effects of selfrejection, deprivation of social support, and life events and as a function of buffering effects of self-esteem and social support with life events. Data are from 1,633 subjects interviewed in the seventh grade and again ten years later. Measures of self-rejection and of deprivation of social support come from the earlier data. Measures of life events refer to events in the ten years that are perceived as (1) bad, (2) disruptive of routine, and (3) imposing expectations that the subject failed to meet. Psychological distress is also measured at the later interview. Regression analyses support the predicted main effects. As well, interactions between self-derogation and life events are significant net of the main effects. However, only one of six social-support by life-events interactions is significant. After considering the contribution of the main effects, we discuss the pattern of interactions. Possible explanations relate to either the meaning offamily support and the substitutability of supportive relationships.

Gender, Styles of Deviance, and Drinking Problems*

The analyses reported here draw on recent work on gender and deviance to derive hypotheses concerning sex differences in drinking behavior, reactions of significant others to male and female intoxication, and the psychological consequences of drinking experiences. The hypotheses are evaluated in structural equation models with recent national data on drinking behavior and consequences. Consistent with the gendered deviance perspective, the results suggest that sex differences in style as well as frequency of intoxication mitigate the adverse consequences of female drinking commonly presumed on the basis of biological vulnerability or societal disapproval of female drunkenness. Compared to males, females become intoxicated less frequently and are less likely to abandon personal control while drinking (as indicated by aggression, blackouts, and rapid ingestion). As expected, these sex differences in drinking behavior are smaller among adolescents than among adults. Partly as a result of this different drinking style, significant others are no more likely to criticize girls or women for their drinking than they are to criticize boys or men. Two hypotheses concerning the greater psychological vulnerability of females to depression as a result of drinking or criticism of drinking by significant others are supported among youths but not among adults.

Sensation seeking needs among 8th and 11th graders: characteristics associated with cigarette and marijuana use

This cross-sectional school-based study explored the relationship between adolescent use of cigarettes and marijuana and the sensation seeking personality factors of (1) Disinhibition and (2) Thrill and Adventure Seeking. The study population included a representative sample of both male and female 8th and 11th graders in the state of Delaware. Analytic methods utilized included correlational analysis and multivariate logistic regression. In the multivariate logistic regression models, the Disinhibition personality factor accounted for cigarette and marijuana using behaviors with odds ratios ranging between 2 and 3. Thrill and Adventure Seeking was not a significant explanatory variable in any of the final multivariate models. Potential confounders (age, gender and race) were considered in all analyses. Of all the two-way interactions assessed, none was significant. The findings from this study utilizing a large general community sample indicate that sensation seeking needs are a potential risk factor for adolescent substance use.

Antecedents of Pregnancy among Unmarried Adolescents.

Using data from 2158 young adults who were 1st surveyed as 7th grade students in a random half of the junior high schools in the Independent School District of Houston Texas in 1971 multivariate casual models were tested to predict out-of-wedlock adolescent pregnancy. Among the males having a girlfriend become pregnant is associated with school difficulties low parental socioeconomic status and high popularity. Among females pregnancy risk is related to race (black women more likely than white women to experience early nonmarital pregnancy; Hispanic women are less likely) low socioeconomic status father absence number of siblings school difficulties family stress and popularity. The 1981-83 followup study found 26% of the women but only 15% of the men reporting that they (or their girlfriends) had experienced adolescent pregnancies with most of the sex difference probably explained by the tendency of adolescent girls to date older males. The analyses do not support culture-of-poverty assumptions that culturally transmitted feelings of self-esteem and fatalism cause the disadvantaged to have more unplanned pregnancies. Powerlessness is weakly related to 18 to 20-year-old males involvement in nonmarital pregnancies; surprisingly it was found that powerlessness is inversely related to pregnancy risk for girls in father-present families possibly because girls who feel powerless may be more submissive to parental authority that discourages sexual activity. Further research might explain why family experiences can affect a girls pregnancy risk more than a boys and how school experiences influence pregnancy susceptibility.

The “Black Box” of Prescription Drug Diversion

ABSTRACT A variety of surveys and studies are examined in an effort to better understand the scope of prescription drug diversion and to determine whether there are consistent patterns of diversion among various populations of prescription drug abusers. Data are drawn from the RADARS System, the National Survey of Drug Use and Health, the Delaware School Survey, and a series of quantitative and qualitative studies conducted in Miami, Florida. The data suggest that the major sources of diversion include drug dealers, friends and relatives, smugglers, pain patients, and the elderly, but these vary by the population being targeted. In all of the studies examined, the use of the Internet as a source for prescription drugs is insignificant. Little is known about where drug dealers are obtaining their supplies, and as such, prescription drug diversion is a “black box” requiring concentrated, systematic study.

Evaluating component effects of a prison-based treatment continuum.

A continuum of correctional-based therapeutic community (TC) treatment programs for drug-involved offenders has been functioning for several years in Delaware. Previous evaluations have shown the efficacy of the full continuum for up to three years posttreatment, though there has been some question of the benefits of treatment within prison. The particular focus here is on the relative impact of the within-prison, transitional, and aftercare treatment components upon criminal recidivism and relapse to illicit drug use. The relative benefit of participation in each component is supported, over and above the effects of differences in demographics and histories of criminal behavior and illicit substance use. However, the residential transitional program effects are generally larger and more long lasting. Additionally, the two outcomes appear differentially sensitive to the degree of completion of the continuum.