Improving Substance Abuse Treatment in the Criminal Justice System

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1 Improving Substance Abuse Treatment in the Criminal Justice System Elizabeth Ressler Jennifer Lerch Faye Taxman Scott Walters Funded by R01 DA

2 Two thirds of probationers are drug involved but less than half participate in treatment Mumola, 1995

3 Program Wish List 1. Bridge criminological and psychological theories. 2. Place no additional demands on the probation system of care. 3. Target multiple behaviors that occur together. 4. Tailored to the individual. 5. Very easy/intuitive to use. 6. Included material that would actually increase motivation.?

4 2-session program targeting drug-using probationers. About MAPIT Targets motivation to change substance use, criminal behavior, and HIV risk. Includes risk assessment, planning, social support, automated reminders. Simple, intuitive layout. Responsive synthetic narration. Compatible with system of care.

5 Theoretical Background Theory Extended Parallel Process Model Social Cognitive Theory Motivational Interviewing Application Risk of probation violation based on static and dynamic factors; Future behaviors most likely to reduce risk. How clients compare to others; Framing suggestions in terms of what other people do; Videos of model responses. Affirmations, Reflections, Summaries; Interactive tone that emphasizes autonomy, collaboration, evocation.

6 MAPIT Visit 1 Static risk estimate Dynamic risk estimate Examples of risk reduction Offending Substance Abuse Norm comparison Risk estimate Consequences Risk behaviors Testing recommendation Risk reduction strategies HIV Risk Setting Goals Summary; example goals 30 day goals Text/ reminders

7 Go here to view MAPIT criminal justice risk video example

8 Go here to view MAPIT substance use risk video example

9 Making MAPIT Smart TTS engine can read (almost) everything on demand. Tailored reflections based on single-item responses. Tailored reflections/information/suggestions based on multi-question response patterns. Responses can connect to earlier material, or push a little bit beyond what the person said. The program can dial up or dial down the language based on response strength.

10 Thanks for sticking with me. You said that your most important reasons for completing probation had to do with your relationships and the hassle of paying probation fees. Based on this, you are fairly committed to completing probation. One thing you thought you could do in the next week is to get rid of all your drug equipment so that you re not tempted to use. I ll make sure to text you, and remind you about your goal. Thanks for sticking with me. You said that your most important reasons for completing probation had to do with the shame of being on probation and wanting to avoid future legal trouble. Based on this, you are very committed to completing probation. You re willing to do whatever it takes. One thing you thought you could do in the next week is to put a phone number in your phone of someone you could call if you needed to talk. I ll make sure to text you, and remind you about your goal.

11 MAPIT Visit 2 Review of motivation Review of progress New goals Identifying preferred strategies Managing cravings Managing Cravings List of helpful people Plan for accessing social support Setting Goals 30 day goals Text/ reminders Follow-up Checking In Social Support

12 Go here to view MAPIT goal setting and texting video example

13 Most important reasons for wanting to finish probation? Shame Financial Relationships Freedom Time Legal Moving On % Rated as Very Important Reason Initial data, n=38

14 Early probation goals? Write down and questions I have Get a binder to keep my probation documents in Write down date and time of first visit. Make a list of my biggest worries and share with PO % Selected Goal Initial data, n=38

15 Early treatment goals? Look through my house and vehicle and throw out drugs and drug equipment. Put a number in my phone of someone I could call if I needed to talk. Ask someone with clean time how they did it. Make a list of things I could do to stay sober % Selected Goal Initial data, n=38

16 Wanted reminders? Text or ? Yes 59% Text 59% 31%

17

18 Basic Demographics Both sites primarily older, black, males Dallas= m=33 yrs old; Baltimore= m=40 yrs old More high risk females in Baltimore Small number of Hispanics recruited in Dallas Homelessness more prevalent among Baltimore probationers Average arrests in lifetime except for low/moderate Dallas probationers (mean= 5.8)

19 100% Baseline drug test results 90% 80% 70% 60% 50% 40% 30% Poly Marijuana Criminogenic* Negative 20% 10% 0% Baltimore: Low/Moderate (41% condition for tx) Baltimore: High (58% condition for tx) Dallas: Low/Moderate (28% condition for tx) Dallas: High (43% condition for tx) * Criminogenic drugs are harder drugs that exhibit a direct link with offending behavior such as amphetamines, opiates, and crack/cocaine.

20 Prior substance abuse treatment history Dallas: Low/Moderate Dallas: High 17.4% 82.6% 50% 50% Baltimore: Low/Moderate Baltimore: High 41.2% 58.8% 76.9% 23.1% No Prior Treatment Prior Treatment

21 100 STD diagnoses and HIV testing Baltimore: Low/Moderate Baltimore: High Diagnosed with STD Dallas: Low/Moderate Tested for HIV in last 12 months Dallas: High

22 Where HIV tested in last 12 months Baltimore Dallas Hospital ER Jail/prison Outpatient/ 15.6% community program 65.6% Other 40% Donating blood Jail/prison 16.7% Hospital Outpatient/ community program No one selected home testing, drug treatment, or syringe exchange.

23 Criminal Cognitions, Social Support, and Treatment Motivation Average scores on criminal cognitions, desire for help, and problem recognition High levels of social support Overall, higher scores on desire for help as compared to problem recognition

24 Factors predicting desire for help (N= 91) B SE Beta Homeless * Lifetime prior treatment *** Positive for criminogenic drug Positive for marijuana Positive for multiple drugs Risk level Site *p <.10; **p <.05; ***p <.01

25 Unable to locate (n=4) Factors predicting problem recognition (N= 89) B SE Beta Lifetime prior treatment *** Positive for criminogenic drug Positive for marijuana Positive for multiple drugs Risk level Site Age *p <.10; **p <.05; ***p <.01

26 Improving Substance Abuse Treatment in the Criminal Justice System Elizabeth Ressler Jennifer Lerch Faye Taxman Scott Walters Funded by R01 DA

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