Cost and cost-effectiveness of computerized vs. in-person motivational interventions in the criminal justice system

Interventions to prevent alcohol use: systematic review of economic evaluations

BACKGROUND

Alcohol use is a leading risk factor for death and disability worldwide.

AIMS

We conducted a systematic review on the cost-effectiveness evidence for interventions to prevent alcohol use across the lifespan.

METHOD

Electronic databases (EMBASE, Medline, PsycINFO, CINAHL and EconLit) were searched for full economic evaluations and return-on-investment studies of alcohol prevention interventions published up to May 2021. The methods and results of included studies were evaluated with narrative synthesis, and study quality was assessed by the Drummond ten-point checklist.

RESULTS

A total of 69 studies met the inclusion criteria for a full economic evaluation or return-on-investment study. Most studies targeted adults or a combination of age groups, seven studies comprised children/adolescents and one involved older adults. Half of the studies found that alcohol prevention interventions are cost-saving (i.e. more effective and less costly than the comparator). This was especially true for universal prevention interventions designed to restrict exposure to alcohol through taxation or advertising bans; and selective/indicated prevention interventions, which involve screening with or without brief intervention for at-risk adults. School-based interventions combined with parent/carer interventions were cost-effective in preventing alcohol use among those aged under 18 years. No interventions were cost-effective for preventing alcohol use in older adults.

CONCLUSIONS

Alcohol prevention interventions show promising evidence of cost-effectiveness. Further economic analyses are needed to facilitate policy-making in low- and middle-income countries, and among child, adolescent and older adult populations.

Costs attributable to criminal justice involvement in injuries: a systematic review

CONTEXT

Costs related to criminal justice are an important component of the economic burden of injuries; such costs could include police involvement, judicial and corrections costs, among others. If the literature has sufficient information on the criminal justice costs related to injury, it could be added to existing estimates of the economic burden of injury.

OBJECTIVE

To examine research on injury-related criminal justice costs, and what extent cost information is available by type of injury.

DATA SOURCES

Medline, PsycINFO, Sociological Abstracts ProQuest, EconLit and National Criminal Justice Reference Service were searched from 1998 to 2021.

DATA EXTRACTION

Preferred Reporting Items for Systematic reviews and Meta-Analyses was followed for data reporting.

RESULTS

Overall, 29 studies reported criminal justice costs and the costs of crime vary considerably.

CONCLUSIONS

This study illustrates possible touchpoints for cost inputs and outputs in the criminal justice pathway, providing a useful conceptualisation for better estimating criminal justice costs of injury in the future. However, better understanding of all criminal justice costs for injury-related crimes may provide justification for prevention efforts and potentially for groups who are disproportionately affected. Future research may focus on criminal justice cost estimates from injuries by demographics to better understand the impact these costs have on particular populations.

Integrating traditional practices and social network visualization to prevent substance use: study protocol for a randomized controlled trial among urban Native American emerging adults

BACKGROUND

Nonmedical use of prescription opioids (defined as taking opioid medications for hedonic effects or in a manner other than prescribed) and the use of heroin have emerged in recent years as major public health concerns in the United States. Of particular concern is the prevalence of opioid use among emerging adults (ages 18-25), as this is a developmental period of heightened vulnerability and critical social, neurological, and psychological development. Data from 2015 show that American Indian/Alaska Native (AI/AN) people have the highest rates of diagnosis for opioid use disorders (OUDs). One recent study found that the overdose death rate among urban-dwelling AI/AN individuals was 1.4 times higher compared to those living in rural areas. To date, there are no evidence-based prevention programs addressing opioid use among urban AI/AN emerging adults that integrate culturally-appropriate strategies with evidence-based treatment. Traditions and Connections for Urban Native Americans (TACUNA) builds on our prior work with AI/AN communities across California to develop and evaluate culturally appropriate programming to address opioid, alcohol, and cannabis use among urban AI/AN emerging adults.

METHODS/DESIGN

In a randomized controlled trial, 18-25 year old urban AI/AN emerging adults will receive either TACUNA (n = 185), which comprises three virtual workshops utilizing motivational interviewing, social network visualization, and integrating traditional practices and a wellness circle, or one virtual culturally sensitive opioid education workshop (n = 185). We will evaluate intervention effects on primary outcomes of frequency of opioid, alcohol, and cannabis use, as well as secondary outcomes of social network characteristics and cultural connectedness, over a 12-month period.

DISCUSSION

This project has the potential to expand the range and effectiveness of opioid, alcohol, and cannabis services for urban AI/AN emerging adults by addressing the opioid epidemic and use of other substances at both the community and individual level. In addition, it provides important culturally grounded conceptual and practical information to advance the field of substance use interventions and enhance resiliency among this population.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04617938. Registered October 26, 2020 https://clinicaltrials.gov/ct2/show/record/NCT04617938 .

Digital Health Interventions for Mental Health, Substance Use, and Co-occurring Disorders in the Criminal Justice Population: A Scoping Review

BACKGROUND

Substance use disorder (SUD), mental health disorders (MHD), and co-occurring mental health and substance use disorders are common among criminal justice populations. Digital health interventions (DHI) represent an opportunity to expand co-occurring disorder treatment for justice involved populations, but efficacy data are lacking.

OBJECTIVES

The current scoping review aims to address this gap via following objectives: (1) Describe trends involving DHIs for MHD, SUD, or co-occurring disorders studied in criminal justice settings; and (2) review available evidence for the impact of DHIs on criminal justice-, substance-, and mental health-related outcomes.

METHODS

PubMed was searched for relevant articles that met the follow inclusion criteria: (1) focus on criminal justice-involved individuals; (2) description of an intervention focused on SUD, MHD, or co-occurring disorders; and (3) use of DHI. Articles were assessed using standardized data abstraction and quality assessment tools.

RESULTS

Four-hundred unique articles were identified on initial search, and 19 were included in the final review. The most common focus of the intervention was SUDs. The most common modalities were telehealth and computer assisted interventions, with most utilized as an adjunct to treatment as usual. No DHIs used wearable devices, and one included justice involved youth. Feasibility and acceptability were high, and the studies that measured substance and mental health-related outcomes reported equivocal or positive results. No studies focused on long-term justice-related outcomes.

CONCLUSIONS

Literature on DHIs for criminal justice involved populations diagnosed with SUD, MHD and co-occurring disorders is limited, and largely focuses on telehealth or eHealth, with less data on mHealth approaches. Future research should focus on the inclusion of diverse populations and include objective monitoring tools.