Forensic and Mental Health - 2 lectures (Interventions for YO, Interventions for CD and substance abuse)

INTERVENTIONS FOR SUBSTANCE ABUSE AND CONDUCT
DISORDER


Offending & Substance Abuse

 40% of offences are committed under the influence of drugs / alcohol = strong
relationship
 Drug classification - A,B,C
 High prevalence of substance problems in young offenders
 Co-morbidity - especially with Conduct Disorder (CD)
 Abuse vs. Dependence

DSM-IV criteria for abuse:
- Failure to fulfil obligations - at home, work, school
- Alcohol related legal problems (drink driving, theft)
- Social or interpersonal problems
- Continued use of dangerous substance

DSM-IV criteria for dependence: 3 or more:
- Tolerance - need more to get same effect
- Withdrawal
- Larger amounts and for longer
- Persistent attempts to control / cut down
- Effort /time spent to obtain, use and recover from
- Social /recreational activities
- Continued use despite psychological problems

Importance of treatment for substance abuse in young offenders:
 Psychiatric and behavioural disorders - co-morbid with CD
 High risk of suicide
 Criminal behaviour - more aggressive and violent crime
 Recidivism
 Societal costs - of processing, incarcerating and managing young people, not enough on
treatment or education

Psychological & Social factors for substance abuse:
 Violence
 Coping theory - drugs are a way of coping with negative emotions
 Kilpatrick et al. (2000):
- 4,023 adolescents
- Telephone study of a nationally representative sample
- Significant increased risk if:
 Sexually /physically assaulted

,  Witnessed violence
 Patients with substance abuse problems
 PTSD linked to cannabis and hard drugs
 Co morbidity

Interventions for substance abuse
 MST
 Family therapy
 Group therapy - group CBT is useful for young offenders but it is possible they may learn
bad habits from each other
 Motivational interviewing - client centred, encourage motivation to change behaviour,
non judgemental, non confrontational
 No systematic review for young offenders

Perry (2006):
- systematic review on all offenders - all RCTs
- 24 studies, 8936 pps
- Assess effectiveness of interventions for drug using offenders in reducing drug use
and criminal activity
- Wide range of studies, varied methodological quality
- Promising results for therapeutic communities with aftercare
- Limited conclusions can be drawn
- Broad range of studies and heterogeneity of outcome measures
- Most studies had a moderate risk of bias

Henggeler et al. (1999):
- MST vs. Usual care
- 118 met DSM criteria for substance abuse (56%) or dependence (44%)
- 4 year follow up - good - 80 pps (69%)
- 72% had psychiatric co-morbidity
- Effective in biological markers, not in self report
- No diff in psychiatric symptoms, but MST associated with a reduction in aggressive
criminal behaviour, no differences in non violent crimes

Henggeler et al. (2002):
- Follow up 4 years after Henggeler et al (1999)
- 80 pps
- Significant long term treatment effects for aggressive criminal activity (not for
property crimes)
- No long term treatment effects on psychiatric symptoms
- Some support for long term effectiveness of MST, but needs adapting
- Attrition analyses - drop out were not significantly different to completers - good

Stein et al. (2006):
- Motivational interviewing (MI) vs. Relaxation training (RT)
- In a correctional facility - not community
- 130 pps (large)