Perceptions of COVID-19 vaccine side effects by political affiliation

BACKGROUND

We sought to assess the extent to which subjective experiences of COVID-19 vaccine side effects among US adults are associated with political party identification.

METHODS

An online survey was conducted of a national sample of US adults (N = 1259) identifying as either Republican or Democrat.

RESULTS

There was no significant difference by party identification in the perceived severity of vaccination side effects; however, Republicans were significantly less likely to recommend the vaccine to others in light of their experience (OR = 0.40; 95% CI, 0.31-0.51; P < 0.001). Republicans also reported having a larger share of COVID-19-vaccinated friends and family who experienced notable side effects (OR = 1.31; 95% CI, 1.02-1.68; P < 0.05). There was a positive association between respondents' perceived side-effect severity and the proportion of peers who also reported notable side effects (r = 0.43; P < 0.001).

CONCLUSION

Subjective appraisals of the vaccinated may affect broader vaccine acceptability.

Validation of Two Diagnostic Assessments for Opioid and Stimulant Use Disorder for Use by Non-Clinicians

Objective

The United States is in the fourth wave of the opioid epidemic marked by the increase in fentanyl and co-occurring stimulant use related overdose deaths. Measures are needed to quickly diagnose opioid and stimulant use disorders, yet current traditional diagnostic assessments pose barriers to providing rapid diagnoses.

Methods

This study aimed to (1) validate an updated version of the Rapid Opioid Dependence Screen (RODS) from DSM-IV criteria for opioid dependence to the now DSM-5 moderate-to-severe opioid use disorder, the Rapid Opioid Use Disorder Assessment (ROUDA); and (2) create and validate the Rapid Stimulant Use Disorder Assessment to DSM-5 stimulant use disorder (RSUDA) when compared to the substance use disorder module from the DSM-5 version of the Mini International Neuropsychiatric Interview.

Results

One-hundred and fifty adults completed study assessments, 122 reported opioid misuse and 140 reported stimulant misuse within their lifetime. The ROUDA had a sensitivity of 82.5% (95% confidence interval [CI] 75.7, 89.2), specificity of 100.0% (95% CI: 100, 100), and strong internal consistency α = 0.94. The RSUDA had similarly high sensitivity (83.8%, 95% CI: 77.7, 89.9), specificity (91.4%, 95% CI: 86.8, 96.1), and internal consistency α = 0.87. The ROUDA and RSUDA are efficient and valid measures that can be administered in various settings by non-clinical staff to rapidly diagnose opioid and stimulant use disorders and allow for immediate treatment and harm reduction interventions.

Conclusions

The ROUDA and RSUDA are efficient and valid measures that can be administered by non-clinicians to rapidly diagnose opioid and stimulant use disorders.

Characteristics of Substance Use Screening at Intake in a Sample of U.S. Jails

BACKGROUND

Despite high rates of substance use among justice-involved populations, the use of substance screening tools in justice settings varies.

METHODS

Data are from the National Jail Health Care Study, which surveyed jails across the U.S. about their health care practices (n=371). Jails were asked to voluntarily submit their medical intake forms. A content analysis of intake forms (n=63) specific to questions about substance use was completed.

RESULTS

Seventy-three percent (73%) of intake forms used non-standardized questions to assess current substance use, and 27% did not ask any questions about substance use. Alcohol use was most assessed (52%), followed by tobacco (30%), and marijuana (22%). Less than 11% of jails asked about use of opioids and 40% of forms asked about withdrawal history.

CONCLUSIONS

The lack of adequate substance use screening in jails hinders identification of substance use disorders, potential for withdrawal symptoms, and appropriate connection to treatment resources.

The impact of COVID-19 on the treatment of opioid use disorder in carceral facilities: a cross-sectional study

While the COVID-19 pandemic disrupted healthcare delivery everywhere, persons with carceral system involvement and opioid use disorder (OUD) were disproportionately impacted and vulnerable to severe COVID-associated illness. Carceral settings and community treatment programs (CTPs) rapidly developed protocols to sustain healthcare delivery while reducing risk of COVID-19 transmission. This survey study assessed changes to OUD treatment, telemedicine use, and re-entry support services among carceral and CTPs participating in the National Institute on Drug Abuse (NIDA)-funded study, Long-Acting Buprenorphine vs. Naltrexone Opioid Treatments in Criminal Justice System-Involved Adults (EXIT-CJS) study. In December 2020, carceral sites (n = 6; median pre-COVID 2020 monthly census = 3468 people) and CTPs (n = 7; median pre-COVID 2020 monthly census = 550 patients) participating in EXIT-CJS completed a cross-sectional web-based survey. The survey assessed changes pre- (January-March 2020) and post- (April-September 2020) COVID-19 in OUD treatment, telemedicine use, re-entry supports and referral practices. Compared to January-March 2020, half of carceral sites (n = 3) increased the total number of persons initiating medication for opioid use disorder (MOUD) from April-September 2020, while a third (n = 2) decreased the number of persons initiated. Most CTPs (n = 4) reported a decrease in the number of new admissions from April-September 2020, with two programs stopping or pausing MOUD programs due to COVID-19. All carceral sites with pre-COVID telemedicine use (n = 5) increased or maintained telemedicine use, and all CTPs providing MOUD (n = 6) increased telemedicine use. While expansion of telemedicine services supported MOUD service delivery, the majority of sites experienced challenges providing community support post-release, including referrals to housing, employment, and transportation services. During the COVID-19 pandemic, this small sample of carceral and CTP sites innovated to continue delivery of treatment for OUD. Expansion of telemedicine services was critical to support MOUD service delivery. Despite these innovations, sites experienced challenges providing reintegration supports for persons in the community. Pre-COVID strategies for identifying and engaging individuals while incarcerated may be less effective since the pandemic. In addition to expanding research on the most effective telemedicine practices for carceral settings, research exploring strategies to expand housing and employment support during reintegration are critical.

Providing substance use disorder treatment in correctional settings: knowledge gaps and proposed research priorities-overview and commentary

This manuscript is the product of the authors' discussions, literature overview, and consultation with experts in the field, and identifies important gaps in the evidence base for substance use disorder (SUD) treatment effectiveness within criminal justice (CJ) settings. Lacking from the extant literature are longitudinal investigations of treatment related outcomes during and after incarceration. Such studies could provide rich contextual data about treatment delivery and effectiveness across the CJ continuum, and would provide important insight into individual characteristics (e.g., motivation, treatment modality preferences, treatment completion rates, etc.) as well as institutional and environmental factors (e.g., appropriate staffing, space limitations for individual treatment sessions, distribution of medications, etc.). We also identified the importance of reproducibility within CJ research, and the unfortunate reality of too many single studies conducted in single (or relatively few) correctional facilities. Some of this has been because the studies designed to produce that evidence are not prioritized for funding, which has continually placed researchers in a position where we cannot make firm conclusions or recommendations based on available evidence. The importance of replicating the foundational studies in this field cannot be overstated. We hope this article spurs other researchers to join in the healthy process of questioning the existing state of the CJ-based SUD treatment research, what should be re-examined, and how we can lay a stronger foundation for the future.

Long-acting buprenorphine vs. naltrexone opioid treatments in CJS-involved adults (EXIT-CJS)

The EXIT-CJS (N = 1005) multisite open-label randomized controlled trial will compare retention and effectiveness of extended-release buprenorphine (XR-B) vs. extended-release naltrexone (XR-NTX) to treat opioid use disorder (OUD) among criminal justice system (CJS)-involved adults in six U.S. locales (New Jersey, New York City, Delaware, Oregon, Connecticut, and New Hampshire). With a pragmatic, noninferiority design, this study hypothesizes that XR-B (n = 335) will be noninferior to XR-NTX (n = 335) in retention-in-study-medication treatment (the primary outcome), self-reported opioid use, opioid-positive urine samples, opioid overdose events, and CJS recidivism. In addition, persons with OUD not eligible or interested in the RCT will be recruited into an enhanced treatment as usual arm (n = 335) to examine usual care outcomes in a quasi-experimental observational cohort.

A randomized comparison of extended-release naltrexone with or without patient navigation vs enhanced treatment-as-usual for incarcerated adults with opioid use disorder

The high prevalence of opioid use among justice-involved adults make jails an exceptional setting to initiate opioid use disorder (OUD) treatment, but optimal strategies for delivering these interventions are still not well understood. The objective of this study was to conduct a randomized controlled trial to assess the effectiveness of extended-release naltrexone (XR-NTX, Vivitrol®; Alkermes Inc) alone or in conjunction with patient navigation (XR-NTX + PN) for jail inmates with OUD. We randomized a sample of 135 sentenced jail inmates with moderate to severe OUD to (1) XR-NTX only; (2) XR-NTX + PN; or (3) enhanced treatment-as-usual (ETAU) with drug education, each initiated prior to release from jail. We scheduled follow-up data assessments at 1, 3, 6, and 12 months post-release. Primary outcomes were opioid use (based on Timeline Followback Interview and Addiction Severity Index) and meeting CIDI DSM-5 criteria for OUD 6 months postrelease. We also measured treatment adherence, HIV risk, and recidivism. XR-NTX participants received a mean of 2.26 of 7 possible injections compared to XR-NTX + PN participants, who received a mean of 2.93 injections (Cohen's d = 0.33, 95% CI: -0.09 to 0.74). Thirty-six percent of patients in XR-NTX + PN attended at least one postrelease PN session. We found no significant differences by study condition six months after release from jail for the primary outcomes of any opioid use (ETAU: 17%, XR-NTX: 16%, XR-NTX + PN: 29%) and past 30-day OUD (ETAU: 8%, XR-NTX: 11%, XR-NTX + PN: 10%). Secondary outcomes of rearrest and HIV risk also were similar across groups, with the exception of lower sex-related HIV risk among those in the XR-NTX condition at 12 months. This study did not show superior outcomes of XR-NTX or XR-NTX + PN with regard to opioid use or recidivism outcomes, relative to ETAU. It did, however, highlight the difficulties with adherence to XR-NTX and PN interventions in OUD patients initiating treatment in jail.

Substance Use, Mental Health, and Child Welfare Profiles of Juvenile Justice-Involved Commercially Sexually Exploited Youth

Objectives: To describe the substance use profiles of youth impacted by commercial sexual exploitation (CSE) and explore associations between substance use with mental health diagnoses and child welfare involvement. Methods: Data were systematically extracted from the court files of 364 youth who participated between 2012 and 2016 in Los Angeles County's Succeeding Through Achievement and Resilience (STAR) Court, a juvenile delinquency specialty court for youth impacted by CSE. Descriptive statistics and multivariate regression analyses were conducted to quantify associations between youths' substance use with mental health diagnoses and child welfare involvement. Results: Of the 364 youth impacted by CSE involved in the STAR Court, 265 youth had documented contact with a psychiatrist while in court-of whom, 73% were diagnosed with at least one mental health challenge. Before STAR Court participation, 74% of youth were the subject of one or more child welfare referral; of these youth, 75% had prior out-of-home care. Eighty-eight percent of youth reported substance use, the most prevalent illicit substances were marijuana (87%), alcohol (54%), and methamphetamine (33%). Controlling for age and race, youth impacted by CSE with a diagnosed general mood disorder had more than five times the odds of reporting substance use compared with those without a mood disorder diagnosis (adjusted odds ratio [AOR]: 5.80; 95% confidence interval CI: 2.22-18.52; p < 0.001); and youth impacted by CSE with prior child welfare placements had more than two times the odds of reporting substance use (AOR: 2.24; 95% CI: 1.04-4.86; p = 0.039) compared with youth without prior placements. The association between substance use and general mood disorder was significant and positive for all substance use types (AOR = 3.3, p = 0.033 marijuana; AOR = 4.01, p = 0.011 concurrent alcohol and marijuana; AOR = 9.2, p < 0.001, polysubstance use). Conclusions: High prevalence of substance use among juvenile justice-involved youth impacted by CSE combined with strong associations between substance use with both mental health diagnoses and child welfare system history underscores the need for comprehensive, specialized substance use treatment. Findings suggest an important opportunity for multidisciplinary collaboration among mental health providers, child welfare professionals, juvenile justice practitioners, and other care providers for these youth.

A specialty court for U.S. youth impacted by commercial sexual exploitation

BACKGROUND

Specialty courts have emerged as a model of care for U.S. youth impacted by commercial sexual exploitation (CSE) to ensure comprehensive service provision. However, there is a lack of published research that documents the extent to which these programs achieve this goal.

OBJECTIVE

We sought to understand a specialty juvenile justice court's role in identifying mental health and substance use treatment needs, providing linkages to services, and facilitating stability for youth with histories of CSE.

PARTICIPANTS AND SETTING

We conducted an exhaustive court file review of the 364 participants in a U.S. based juvenile delinquency specialty court for youth affected by CSE. The observation period spanned 2012-2017.

METHODS

The research team systematically transferred data from court files into a secure, electronic database. Descriptive statistics and Chisquared tests were calculated to explore potential associations.

RESULTS

Participation in the specialty court for youth impacted by CSE suggests an increase in identification of mental health and substance use needs and linkages and referrals to mental health and substance use treatment services. In addition, there was increased stabilization as indicated by decreased substantiated child welfare allegations, fewer running away episodes, and placements and criminal involvement.

CONCLUSIONS

Specialty courts that incorporate a multidisciplinary, trauma-informed approach offer a promising intervention model for meeting the high treatment needs of youth impacted by CSE.

Measuring recovery in opioid use disorder: clinical utility and psychometric properties of the Treatment Effectiveness Assessment

Purpose: The Treatment Effectiveness Assessment (TEA) is a patient-centered instrument for evaluating treatment progress and recovery from substance use disorders, including opioid use disorder (OUD). We assessed the TEA's reliability and validity and determined minimal clinically important differences (MIDs) in participants with moderate to severe OUD. Patients and methods: The TEA measures change in four single-item domains (substance use, health, lifestyle, community involvement) from treatment initiation across the duration of a treatment program. Self-reported responses range from 1 ("none or not much") to 10 ("much better") with items summed to a total score ranging from 4-40. We assessed floor and ceiling effects, internal consistency, test-retest reliability, known-groups validity (ANOVA stratified by current health status [36-Item Short Form Health Survey item 1]), convergent/divergent validity, and MIDs using data from a phase 3, open-label clinical trial of buprenorphine extended-release monthly injection for subcutaneous use (BUP-XR). Participants with OUD completed the TEA at screening and before monthly injections for up to 12 months. Results: Among 410 participants (mean age 38 years; 64% male), the mean baseline (pre-injection 1) TEA total score was 25.4 (SD 9.7), with <10% of participants at the measure floor and 10%-20% at the ceiling across domains. Internal consistency was high (Cronbach's α=0.90), with marginal test-retest reliability (intraclass correlation coefficient =0.69). Mean TEA total score consistently increased from baseline (n=410; mean 25.4 [SD 9.7]) to end of study (n=337; 35.0 [6.7]) and differentiated between current health status groups (P<0.001); it was weakly correlated with other measures of health-related quality of life/severity. MIDs ranged from 5-8 for the TEA total score across anchor- and distribution-based approaches. Conclusion: The TEA exhibited acceptable reliability and validity in a cohort of participants with moderate to severe OUD treated with BUP-XR. Given its brevity and psychometric properties, the TEA is a promising tool for use in clinical practice and research.

The impact of perceived stigma on psychiatric care and outcomes for correctional mental health patients

The purpose of this study was to examine factors related to the delivery and effectiveness of psychiatric care prior to and following prison release. Particular attention was placed on patients' self-reported needs, psychiatric medication adherence, and perceived stigma related to mental health treatment, and how these factors related to post-release clinical and recidivism outcomes. Participants (N = 103) with serious psychiatric disorders (SPD; global assessment of functioning scores below 50) were recruited within 60 days of scheduled release from prison, and provided pre-release and six monthly follow-up interviews. Seventy eight percent of the released sample had at least one follow-up contact. Baseline interviews revealed low social stability prior to the current term of incarceration, and forty five percent of the sample had been returned to jail or prison within six months of release. Regression models revealed that perceived psychiatric stigma was a significant (negative) predictor of medication adherence in the community and even in prison. A path analysis showed that perceived stigma predicted responses on the K-6 psychological distress measure and recidivism both directly and indirectly via its influence on medication adherence. Mitigating the effects of this real or perceived stigma may significantly improve post-release outcomes for this high-risk population.

Mobile Health (mHealth): Building the Case for Adapting Emerging Technologies for Justice-Involved Youth

The term justice-involved youth encompasses a broad range of youth. It can include youth who have not been detained and have been placed on probation or diversion programs, as well re-entry populations transitioning out of detention facilities or stated custody and placed on probation or parole. There are more than 1.3 million juvenile arrests per year, and on any given day there are 50,821 youth incarcerated in the United States. Of the 716,000 delinquency cases, probation is court-ordered for approximately half.¹ Even among these youth who are supervised in the community, rates of mental health and substance use disorders are high, with more than two-thirds reporting substance use problems or other mental health disorders.² However, these youth often have a hard time connecting to and staying in treatment,³ and recidivism is high-most commonly for failing to satisfy the myriad (and well intentioned) conditions of their probation.⁴ Dual diagnosis (ie, co-occurring psychiatric and substance use disorders) in justice-involved youth is one of the most significant predictors of recidivism,⁵ and, as such, closing the gap between need and receipt of substance use and mental health treatment for justice-involved youth could potentially offset rates of re-offending into adulthood.⁶ Despite high rates of mental health and substance use disorders among justice-involved adolescents, only 15% of detained youth receive mental health treatment for their condition(s); this number falls to 8% once these youth re-enter the community.⁷ These statistics regarding treatment receipt among justice-involved youth are important to consider not only from a health care perspective but also in terms of public health significance and policy.

Reducing the use and impact of solitary confinement in corrections

Purpose Although the reform of solitary confinement is underway in many jurisdictions around world, isolation remains in widespread use in many jails and prisons. The purpose of this paper is to discuss opportunities for reform in the USA that could also be applied globally. Design/methodology/approach A review of the evidence on solitary confinement policies and practices in the USA to develop recommendations for reform with global application. Findings Focusing on this evidence, the authors argue that solitary confinement is overused and recommend a multi-level approach available to correctional systems worldwide including: immediately limiting solitary confinement to only those cases in which a violent behavioral infraction has been committed for which safety cannot otherwise be achieved, ensuring the briefest terms of isolation needed to achieve legitimate and immediate correctional goals, prohibiting its use entirely for some populations, regularly reviewing all isolated prisoners for as-soon-as-possible return to general population, including the immediate return of those showing mental and physical health risk factors, assisting individuals who are transitioning out of isolation (either to the general population or to the community), and partnering with medical, public health, and criminal justice experts to develop evidence-based alternatives to solitary confinement for nearly all prisoners. Originality/value This paper provides an overview of the evidence supporting an overhaul of solitary confinement policy in the USA and globally where solitary confinement remains in wide use and offers recommendations for immediate steps that can be taken toward achieving evidence-based solitary confinement reform.

Public health alternatives to incarceration for drug offenders

Drug users are vastly overrepresented in prison populations. Once inside they face increased risks of acquiring infections such as HIV, hepatitis and TB, and on release they face an elevated risk of fatal overdose. Relapse and recidivism are the norm following release from prison. The implementation of evidence-based drug treatment programmes in prison is rare, yet drug treatment in prison reduces the transmission of infections, recidivism and fatal overdose on release. Recognising the negative returns associated with incarceration, many jurisdictions have begun to consider alternatives such as depenalisation of the personal use of illicit drugs, provision of treatment and social reintegration of drug offenders, and a shift in focus from supply reduction to demand and harm reduction measures in the community and in prison. Women with drug problems are twice as likely to have been imprisoned for a drug offence as incarcerated men. Similarly, HIV prevalence is higher among female inmates. Serious attention should be paid to implementation of non-custodial sentences for women, particularly during pregnancy and those with young children.

Impact of Community-Based Programs on Incarceration Outcomes Among Gay and Bisexual Stimulant-Using Homeless Adults

This study was part of a randomized controlled trial designed to improve hepatitis knowledge and health promoting behaviors and subsequently decrease stimulant use and incarceration with 422 (G/B) homeless men between 18 and 46 years of age. Findings revealed that no significant program differences on incarceration in the 4 months following the intervention. However, younger participants (p = .010), and those with prior incarceration (p = .001) were at greater risk for incarceration at 4 months. An additional factor associated with incarceration at 4 months included living on the street for at least 1 week (p = .049).

Technological aids for improving longitudinal research on substance use disorders

Background

There is a broad consensus that addictive behaviors tend to be chronic and relapsing. But for field studies of substance users, successfully tracking, locating, and following up with a representative sample of subjects is a challenge.

Methods

The purpose of this paper is to provide a general overview of how current technological aids can support and improve the quality of longitudinal research on substance use disorders. The review is grouped into four domains: (1) tracking and locating, (2) prompting/engaging, (3) incentivizing, and (4) collecting data.

Results & conclusions

Although the technologies described in this review will be modified or replaced over time, our findings suggest that incorporating some or all of these currently available approaches may improve research efficiency, follow-up rates, and data quality.

Real and Perceived HIV Risk by Population Density: An Exploratory Examination

Little is known about HIV and its primary routes of transmission in less populated areas. The purpose of this exploratory study was to contrast the real and perceived HIV risk among out-of-treatment drug users in a multi-site sample of low-, medium-, and high-population density counties in six states and Washington, D.C. Drug users in medium density areas “perceived” their risk of acquiring HIV/AIDS as lower than those in the high-density areas. A multivariate logistic regression model found that the perceived risk could be predicted primarily as a function of lifetime HIV, lifetime STDs, needle use, having multiple sexual partners, and community population density. Because of different risk patterns and a “false” sense of risk, it is important to expand HIV risk reduction activities to include less populated areas.

The Effect of Drug Treatment on Criminal Behavior among Adolescents in DATOS-A

This study examined criminal activity among 1,167 adolescents who participated in a community-based substance abuse treatment study (Drug Abuse Treatment Outcome Studies for Adolescents) (DATOS-A). The primary goals of this study were to assess the effect of substance abuse treatment on adolescent crime and to identify the patient characteristics that were most closely associated with reductions in crime during the posttreatment period. Results confirmed that among adolescents who had engaged in criminal activity during the 12 months prior to entering DATOS-A treatment, reductions in alcohol or marijuana use were independently associated with significant reductions in the likelihood of committing crimes during the 12-month follow-up period. The present study also provides further support for emphasizing dynamic rather than static patient characteristics to predict the likelihood of continued drug-related offending among substance-abusing adolescents.

Substance Use among Texas Hispanics and Non-Hispanics: Who's Using, Who's Not, and Why

The prevalence ofpast-yearand lifetime substance use, problem indicators, and the most important reasons for abstaining (among nonusers) were compared between Texas Hispanics and non-Hispanics, as well as among three subgroups of Hispanics who represented different levels of acculturation: Mexican born (i.e., least acculturated), U.S. born but relatively unacculturated, and U.S. born/highly acculturated. In general, prevalence rates among Hispanics increased as a function of U.S. acculturation, with the most acculturated group's rates more closely resembling non-Hispanics than Mexicanborn Hispanics. There were also significant variations by level of acculturation in the reasons given for abstinence. Whereas health was the most commonly cited reason for abstinence regardless of ethnicity, other important reasons (e.g., moral reasons versus influence of family and friends) varied significantly by ethnicity and acculturation. Results are interpreted with special regard to prevention.

Injectable pharmacotherapy for opioid use disorders (IPOD)

BACKGROUND

Despite the growing prevalence of opioid use among offenders, pharmacotherapy remains an underused treatment approach in correctional settings. The aim of this 4-year trial is to assess the clinical utility, effectiveness, and cost implications of extended-release naltrexone (XR-NTX, Vivitrol®; Alkermes Inc.) alone and in conjunction with patient navigation for jail inmates with opioid use disorder (OUD).

METHODS

Opioid-dependent inmates will be randomly assigned to one of three treatment conditions before being released to the community to include: 1) XR-NTX only; 2) XR-NTX plus patient navigation (PN), and 3) enhanced treatment-as-usual (ETAU) with drug education and a community treatment referral. Before release from jail, participants in the XR-NTX and XR-NTX plus PN conditions will receive their first XR-NTX injection. Those in the XR-NTX plus PN condition also will meet with a patient navigator. Participants in both XR-NTX conditions will be scheduled for medical management sessions twice monthly for months 1-3, monthly medical management sessions for months 4-6, with monthly injections for 5months post-release (which, given the pre-release injection, results in a 6-month medication phase). Follow-up data collection will occur at 1, 3, 6, and 12months post release.

RESULTS

We discuss the study's rationale, aims, methods, and anticipated findings. The primary outcome is the presence of a DSM 5 OUD diagnosis 1year after randomization (6months after the end of the active treatment phase).

DISCUSSION

We hypothesize that providing XR-NTX prior to release from jail will be particularly beneficial for this extremely high-risk population by reducing opioid use, associated criminal behavior, and injection-related disease risk. ClinicalTrials.Gov: NCT02110264.

An Experimental Comparison of Telepsychiatry and Conventional Psychiatry for Parolees

OBJECTIVE

Many offenders treated for psychiatric disorders while incarcerated are paroled to counties where psychiatric care is limited, leading some correctional departments to offer psychiatric treatment via videoconferencing ("telepsychiatry"). However, the effectiveness of telepsychiatry for offenders with psychiatric disorders has not been rigorously evaluated.

METHODS

In this randomized field experiment, the authors compared the effectiveness of telepsychiatry and in-person psychiatric sessions (treatment as usual) among 71 parolees receiving outpatient psychiatric treatment over a six-month period. Satisfaction with treatment, therapeutic alliance, medication adherence, and psychological functioning were measured. Follow-up data were collected from 60 of the 71 (85%) patients (N=20, telepsychiatry; N=40, control condition).

RESULTS

Findings revealed high satisfaction with telepsychiatry overall and no significant group differences in medication adherence or psychological functioning. However, telepsychiatry patients reported lower levels of therapeutic alliance at follow-up.

CONCLUSIONS

Telepsychiatry appeared to be an acceptable and effective approach for providing psychiatric care for this population.

A randomized clinical trial of tailored interventions for health promotion and recidivism reduction among homeless parolees: outcomes and cost analysis

OBJECTIVES

This study conducted a randomized controlled trial with 600 recently released homeless men exiting California jails and prisons.

METHODS

The purpose of this study was to primarily ascertain how different levels of intensity in peer coaching and nurse-partnered intervention programs may impact reentry outcomes; specifically: (a) an intensive peer coach and nurse case managed (PC-NCM) program; (b) an intermediate peer coaching (PC) program with brief nurse counseling; and (c) the usual care (UC) program involving limited peer coaching and brief nurse counseling. Secondary outcomes evaluated the operational cost of each program.

RESULTS

When compared to baseline, all three groups made progress on key health-related outcomes during the 12-month intervention period; further, 84.5 % of all participants eligible for hepatitis A/B vaccination completed their vaccine series. The results of the detailed operational cost analysis suggest the least costly approach (i.e., UC), which accounted for only 2.11 % of the total project expenditure, was as effective in achieving comparable outcomes for this parolee population as the PC-NCM and PC approaches, which accounted for 53.98 % and 43.91 %, respectively, of the project budget.

CONCLUSIONS

In this study, all three intervention strategies were found to be comparable in achieving a high rate of vaccine completion, which over time will likely produce tremendous savings to the public health system.

Impact of an intervention for recently released homeless offenders on self-reported re-arrest at 6 and 12 months

A randomized controlled trial was conducted with 600 paroled men, homeless prior to incarceration, to assess varying levels of peer-coach and nurse-partnered interventions on re-arrest at 6 and 12 months. Findings revealed that positive predictors of re-arrest at 12 months included having received social support from drug users and non-drug users, as well as having used marijuana at least once a week prior to their most recent incarceration. In terms of protective factors, those who participated in a substance abuse program contract within a residential drug treatment program or spent 90 days or greater in a residential drug treatment program were less likely to have been re-arrested within 12 months.

Tracking and Locating Itinerant Subjects With a Rechargeable Incentive Card: Results of a Randomized Trial

BACKGROUND

High attrition among research participants undermines the validity and generalizability of field research. This study contrasted two incentivizing methods--money orders (MOs) or rechargeable incentive cards (RICs)--with regard to rates of participants' study engagement and follow-up contact over a 6-month period.

METHODS

Substance abusers (N = 303) in Los Angeles, California were recruited and randomized to either an MO (control) or RIC (experimental) condition. All participants were asked to call the researchers at the beginning of each calendar month for the ensuing 5 months to update their locator information, even if nothing had changed. Each call resulted in a $10 payment, issued immediately via the RIC system or by MO by mail. Research staff located and interviewed all participants at Month 6. Contact logs assessed level of effort required to locate participants and conduct follow-up interviews.

RESULTS

Relative to controls, RIC participants, especially those with low ability to defer gratification, initiated more monthly calls. Six-month follow-up rates did not differ between RIC (75%) and controls (79%), though the RIC condition was associated with an average staff time savings of 39.8 minutes per study participant.

DISCUSSION

For longitudinal public health research involving itinerant study participants, the RIC method produces a modest benefit in study engagement and reduced staff time devoted to participant tracking and payments. However, the overall cost-effectiveness of this approach will depend on the pricing model of the card-issuing vendor (which in turns depends on the scale of the project, with per-unit costs falling for larger projects).

Substance use trends among younger vs. older homeless parolees

This cross-sectional study of 540 homeless ex-offenders exiting prisons and jails assessed sociodemographic, childhood, and drug-related differences. Older ex-offenders from prison were more likely to have been married, come from a two-parent family, and used crack, whereas younger ex-offenders from prison were more likely to have used methamphetamine. Older ex-offenders from jail were more likely to be African American, have children, and report a history of crack and injection drug use, whereas younger ex-offenders from jail were more likely to have engaged in binge drinking and be in a gang. Our findings showcase the need to understand unique correlates of younger and older incarcerated populations.

Correlates of Heroin and Methamphetamine Use among Homeless Male Ex-Jail and Prison Offenders

Homeless men exiting California State jails and prisons are a heterogeneous community with varied childhood, incarceration and drug use histories. This cross-sectional study assessed whether homeless men who were discharged from either jail or prison into a residential substance abuse treatment program, differed in terms of methamphetamine and heroin use. This study utilized baseline data collected on 540 recently paroled men randomized to one of three programs that assessed the impact of a peer coaching intervention on subsequent drug use and re-incarceration. We found that younger ex-offenders exiting prisons and jails were more likely to have used methamphetamine alone, whereas African American ex-offenders were less likely to have used methamphetamine alone when compared to other ethnic groups. Further, ex-offenders exiting jails and self-reporting use of heroin only at baseline were significantly more likely than their counterparts to have been removed from home before age 18. For men exiting jails, there was an association between lower self-esteem and having used methamphetamine but not heroin. However, having used both heroin and methamphetamine was associated with both violent crime and cognitive problems in both jail and prison samples. Our findings showcase the need to understand unique correlates of both heroin and methamphetamine as they relate to jail and prison populations.

Predictors of High Level of Hostility among Homeless Men on Parole

High levels of hostility present a formidable challenge among homeless ex-offenders. This cross-sectional study assessed correlates of high levels of hostility using baseline data collected on recently-released male parolees (N=472; age 18-60) participating in a randomized trial focused on prevention of illicit drug use and recidivism. Predictors of high levels of hostility included greater depressive symptomatology, lower self-esteem, having a mother who was treated for alcohol/drugs, belonging to a gang, more tangible support, having used methamphetamine and having a history of cognitive difficulties. These findings highlight the need to understand predictors of hostility among recently released homeless men and how these predictors may relate to recidivism. Research implications are discussed as these findings will shape future nurse-led harm reduction and community-based interventions.

An analysis of relapse prevention factors and their ability to predict sustained abstinence following treatment completion

BACKGROUND & OBJECTIVES

This study assessed the role of 14 specific relapse-prevention activities and their underlying factors in maintaining abstinence among subjects (N = 302) completing outpatient treatment for stimulant dependence.

METHODS

We examined what broader dimensions might subsume the 14 items constituting the Drug Avoidance Activities checklist (Farabee et al. J Subst Abuse Treat 2002;23:343-350), and how well these derived factors predicted concurrent drug use at baseline and again 3 and 12 months later.

RESULTS

Although four factors were identified consistently for the three time points, only avoidance strategies had sufficient internal consistency to be retained for further analysis. Controlling for age, gender, and ethnicity, the avoidance subscale was a significant predictor of UA results at all time periods: a one-point increase in the avoidance strategies scale was associated with an 86% increase in odds of a negative UA at baseline (OR = 1.86, 95% CI = 1.37-2.53, p < .001), a 77% increase at 3-month follow-up (OR = 1.77, CI = 1.37-2.29, p < .001), and a 37% increase at 12-month follow-up (OR = 1.37, CI = 1.04-1.81, p = .026).

CONCLUSIONS

Although correlations of individual items with UA results showed statistically significant (p < .05) results for 8 of 14 items at one or more observation points, avoidance-related behaviors showed the strongest associations with sustained abstinence.

Patient reactance moderates the effect of directive telephone counseling for methamphetamine users

OBJECTIVE

This study examined the impact of the interaction between patient reactance and treatment directiveness on the effectiveness of telephone aftercare for methamphetamine dependence.

METHOD

Reactance was assessed at baseline, and participants were randomly assigned to directive or nondirective treatment conditions. Logistic regression tested for the significance of the interaction as a predictor of 3-month and 12-month use of methamphetamine and stimulants.

RESULTS

A significant interaction was observed at the 3-month follow-up, in which the directive condition was less effective for patients higher in reactance and was more effective for patients lower in reactance. Among patients at a high level of reactance, the nondirective condition increased the likelihood of abstinence.

CONCLUSIONS

This study suggests that, in the context of telephone-based care, directive interventions offer short-term clinical benefit for methamphetamine users who readily accept influence from authority figures, whereas nondirective interventions offer benefit for patients who do not readily accept influence. The short-term nature of these effects indicates that there is a need for brief but ongoing telephone support to maintain treatment gains.

The Treatment Effectiveness Assessment (TEA): an efficient, patient-centered instrument for evaluating progress in recovery from addiction

The fields of addiction medicine and addiction research have long sought an efficient yet comprehensive instrument to assess patient progress in treatment and recovery. Traditional tools are expensive, time consuming, complex, and based on topics that clinicians or researchers think are important. Thus, they typically do not provide patient-centered information that is meaningful and relevant to the lives of patients with substance use disorders. To improve our ability to understand patients' progress in treatment from their perspectives, the authors and colleagues developed a patient-oriented assessment instrument that has considerable advantages over existing instruments: brevity, simplicity, ease of administration, orientation to the patient, and cost (none). The resulting Treatment Effectiveness Assessment (TEA) elicits patient responses that help the patient and the clinician quickly gauge patient progress in treatment and in recovery, according to the patients' sense of what is important within four domains established by prior research. Patients provide both numerical responses and representative details on their substance use, health, lifestyle, and community. No software is required for data entry or scoring, and no formal training is required to administer the TEA. This article describes the development of the TEA and the initial phases of its application in clinical practice and in research.

A comparison of four telephone-based counseling styles for recovering stimulant users

The continuing development and refinement of empirically supported interventions to increase participation in posttreatment care and promote sustained abstinence from illicit drug use is a priority for the addictions field. The purpose of this study was to assess the combined and relative effectiveness of four types of counseling styles, delivered by telephone, relative to a no call control condition. Stimulant users (N = 302) were randomized to one of four low-cost, telephone support protocols (unstructured/nondirective, unstructured/directive, structured/nondirective, structured/directive) or a standard referral to aftercare without telephone counseling (control). All of the study participants were nearing the completion of (or had completed) an intensive phase of structured, outpatient stimulant abuse treatment. Drug use and aftercare participation were assessed at 3 and 12 months following randomization. Intent-to-treat analyses showed no significant time-by-group interactions for these primary outcomes. Subsequent analyses, however, revealed a significant difference between the aggregated call groups and the control group at the time of the 3-month follow-up. The mean ASI drug use severity composite score for subjects in the call conditions declining from .058 at baseline to .048 at 3 months, whereas the no call/control group average score increased from .053 to .062 (χ (1) = 4.95, p = .026). A similar-and slightly stronger-effect was found when the study sample was restricted to those reporting any use during the month prior to the baseline interview (n = 152). This study provides modest support for the telephone-based counseling approaches strategies examined in this project. Subsequent research will assess interactions between patient characteristics and counseling styles, and improved identification of which treatment graduates might be more likely to benefit from this type of continuing support. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

A preliminary examination of offender needs assessment: are all those questions really necessary?

Criminologists generally agree that offender recidivism can be reduced by addressing the criminogenic needs of this population. Two prominent assessments of offender risks and needs are the Level of Service Inventory-Revised (LSI-R) and the Correctional Offender Management Profiling for Alternative Sanctions (COMPAS). Both predict recidivism, but they are largely based on data from records. In contrast, the determination of inmates' service needs is based on lengthy (and costly) offender interviews. In light of evidence that many correctional systems have not adopted standardized assessments of service needs-and that time burden and costs are typically cited as barriers, the present study examined whether interviews involving complex scales improve the accuracy of offender needs assessment relative to a few single-item measures. To test this, 75 California prison inmates were administered the LSI-R, COMPAS, and a set of four yes/no items asking if they needed help with substance abuse, vocational training, housing, and education. Approximately 70% to 90% of inmates identified as needing these services according to the LSI-R or COMPAS could have been identified using these four supplemental items, though specificity rates were low for the financial and housing domains. The results suggest that simpler, less costly approaches to offender needs assessment might be achievable.

Correlates of serious violent crime for recently released parolees with a history of homelessness

This study used baseline data on recently released paroled men who are homeless (N=157), residing in a residential drug treatment program, and enrolled in a longitudinal study to examine personal, developmental, and social correlates of parolees who are homeless and who have committed serious violent offenses. Having experienced childhood sexual abuse, poor parental relationships, and early-onset incarceration (prior to 21 years of age) were important correlates of serious violent crimes. These findings highlight the need for interventions that address offenders' prior adult and childhood victimization and suggest that policies for reentering violent offenders should encompass an understanding of the broader family contexts in which these patterns of maltreatment often occur.

Correlates of depressive symptoms among homeless men on parole

This study describes correlates of high levels of depressive symptoms among recently paroled men in Los Angeles who reside in a community substance abuse treatment program and report homelessness. Cross-sectional data were obtained from male residents who were released on parole within the last 30 days (N =157) to assess parental relationship, self-esteem, social support, coping behaviors, drug and alcohol use behaviors, depressive symptoms, and sociodemographic information. Results indicated that 40% of the participants were classified as experiencing high levels of depressive symptoms (CES-D ≥ 10). Results of a logistic regression analysis showed that the following were predictors of depressive symptoms (p <.05): physical abuse in childhood, non-residential alcohol treatment, violent behaviors, low self-esteem, and disengagement coping. Being Mexican-American, Mexican, American Indian, or Asian, and not displaying cognitive problems was inversely related to depressive symptoms in the final model (B =-2.39, p <.05). Findings support proper use of both prison and community assessment services to at-risk individuals eligible for parole to increase self-esteem and coping.

Influence of perceived coercion and motivation on treatment completion and re-arrest among substance-abusing offenders

The effects of perceived coercion and motivation on treatment completion and subsequent re-arrest were examined in a sample of substance-abusing offenders assessed for California's Substance Abuse and Crime Prevention Act (SACPA) program. Perceived coercion was measured with the McArthur Perceived Coercion Scale; motivation was measured with the subscales of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). At treatment entry, clients were more likely to believe that they had exercised their choice in entering treatment than that they had been coerced into treatment. SACPA clients scored relatively low on Recognition and Ambivalence regarding their drug use but relatively high on Taking Steps to address their drug problem. Correlations between perceived coercion and motivation measures at treatment entry indicated that these are separate constructs. In logistic regression models, the Recognition subscale of the SOCRATES significantly predicted "any re-arrest," and Ambivalence and Taking Steps predicted "any drug arrest."

Differential effectiveness of residential versus outpatient aftercare for parolees from prison-based therapeutic community treatment programs

BACKGROUND

Research has indicated that more intense treatment is associated with better outcomes among clients who are appropriately matched to treatment intensity level based on the severity of their drug/alcohol problem. This study examined the differential effectiveness of community-based residential and outpatient treatment attended by male and female drug-involved parolees from prison-based therapeutic community substance abuse treatment programs based on the severity of their drug/alcohol problem.

METHODS

Subjects were 4,165 male and female parolees who received prison-based therapeutic community substance abuse treatment and who subsequently participated in only outpatient or only residential treatment following release from prison. The dependent variable of interest was return to prison within 12 months. The primary independent variables of interest were alcohol/drug problem severity (low, high) and type of aftercare (residential, outpatient). Chi-square analyses were conducted to examine the differences in 12-month RTP rates between and within the two groups of parolees (residential and outpatient parolees) based on alcohol/drug problem severity (low severity, high severity). Logistic regression analyses were performed to determine if aftercare modality (outpatient only vs. residential only) was a significant predictor of 12-month RTP rates for subjects who were classified as low severity versus those who were classified as high severity.

RESULTS

Subjects benefited equally from outpatient and residential aftercare, regardless of the severity of their drug/alcohol problem.

CONCLUSION

As states and the federal prison system further expand prison-based treatment services, the demand and supply of aftercare treatment services will also increase. As this occurs, systems and policies governing the transitioning of individuals from prison- to community-based treatment should include a systematic and validated assessment of post-prison treatment needs and a valid and reliable means to assess the quality of community-based treatment services. They should also ensure that parolees experience a truly uninterrupted continuum of care through appropriate recognition of progress made in prison-based treatment.

Organizational characteristics of drug abuse treatment programs for offenders

This article examines the association between the organizational characteristics of drug abuse treatment programs for offenders and the provision of wraparound services and three types of treatment orientations. Data are from the National Criminal Justice Treatment Practices Survey, which was conducted with program directors (N = 217). A greater number of wraparound services provided were associated with inpatient treatment, specialized treatment facilities, community setting (vs. correctional), services provided for more types of client populations, college-educated staff, and planned treatment for > 180 days. Therapeutic community orientation was associated with prison-based treatment and specialized treatment facilities. Cognitive-behavioral therapy orientation was associated with higher perceived importance of community treatment, more perceived staff influence on treatment, and treatment for 91-180 days. The 12-step orientation was most strongly associated with having staff specialized in substance abuse. Study findings have implications for developing effective reentry programs for offenders that bridge correctional and community treatment.

Methamphetamine use, self-reported violent crime, and recidivism among offenders in California who abuse substances

This study uses data from 641 state prison parolees in California to examine the associations between methamphetamine use and three measures of criminal behavior: (a) self-reported violent criminal behavior, (b) return to prison for a violent offense, and (c) return to prison for any reason during the first 12 months of parole. Methamphetamine use was significantly predictive of self-reported violent criminal behavior and general recidivism (i.e., a return to custody for any reason). However, methamphetamine use was not significantly predictive of being returned to custody for a violent offense. These trends remained even after controlling for involvement in the drug trade (i.e., sales, distribution, or manufacturing).

Program-level predictors of antipsychotic medication adherence among parolees

This study examined the impact of three program-level factors (coercion level, type of antipsychotic prescribed, and guardian supervision) on antipsychotic medication adherence among parolees mandated to an outpatient psychiatric clinic. Overall, 70.7% of the participants tested positive for their prescribed antipsychotic. Older patients were more likely to test positive for their prescribed antipsychotic than younger patients, and African American patients (relative to all other race/ethnic groups) were less likely. With regard to program-level factors, perceived coercion was not significantly associated with medication adherence. However, being prescribed an atypical antipsychotic and having a guardian were independently associated with increased adherence, and combined, these two factors were associated with nearly a tenfold increase in the likelihood of patients testing positive for their prescribed antipsychotic agent, relative to patients who were prescribed conventional antipsychotics and were not under guardian supervision.

Antipsychotic medication adherence, cocaine use, and recidivism among a parolee sample

This study examined the independent and interactive associations between cocaine use and antipsychotic medication adherence in predicting 12 month criminal recidivism among a sample of mentally ill parolees (N = 200). Consistent with prior research, cocaine use (based on hair assays) was associated with more than a threefold increase (relative to non-cocaine users) in the likelihood of a parolee being returned to custody during the follow-up period. Although medication adherence (based on urine specimens) was not independently associated with a significant reduction in recidivism risk, the interaction between cocaine use and medication adherence was significant, revealing a disproportionate impact of medication adherence specific to cocaine users. Prediction models of recidivism based on self-reported measures of medication adherence and cocaine use revealed only marginally significant trends for cocaine use, no effect for adherence, and no significant interaction between these two predictors.

Treating drug-abusing offenders. Initial findings from a five-county study on the impact of California's Proposition 36 on the treatment system and patient outcomes

Five counties (Kern, Riverside, Sacramento, San Diego, San Francisco) that demonstrate both variations and similarities in their implementation of Proposition 36 (e.g., treatment approaches, urine testing) and patient mix have been selected to participate in a study assessing how California's Proposition 36 is affecting the drug treatment system and patient outcomes. Except for San Francisco, treatment admissions increased during the first year of Proposition 36 implementation over the prior year (27% in Kern, 21% in Riverside, 17% in Sacramento, and 16% in San Diego), mostly in outpatient drug-free programs. Compared to non-Proposition 36 patients, Proposition 36 patients were more likely to be men, first-time admissions, treated in outpatient drug-free programs, employed full-time, and users of methamphetamine or marijuana. They were less likely to be treated in residential programs or methadone maintenance programs and fewer reported heroin use or injection drug use. Guided by the multilevel open systems framework, the study examines key issues of Proposition 36 that influence treatment systems and outcomes and empirically identifies "best practice" approaches in treating drug-abusing offenders.

Treatment responsivity of cocaine-dependent patients with antisocial personality disorder to cognitive-behavioral and contingency management interventions

This study compared the efficacy of 2 approaches for the treatment of cocaine dependence among methadone-maintained patients with and without antisocial personality disorder (ASPD). Patients were randomly assigned to 4 study conditions: cognitive-behavioral treatment (CBT), contingency management (CM), CBT with CM, or methadone maintenance. The Structural Clinical Interview for Mental Disorders-IV was administered to 108 patients to assess ASPD. A 2-way analysis of variance showed that patients with ASPD were more likely to abstain from cocaine use during treatment than patients without ASPD. The strong treatment effect for ASPD patients was primarily due to the CM condition. Regression analyses showed that ASPD remained significantly related to CM treatment responsivity while controlling for other factors.