Twelve-month employment intervention outcomes for drug-involved offenders.
25 Apr 2014-American Journal of Drug and Alcohol Abuse (Taylor & Francis)-Vol. 40, Iss: 3, pp 200-205
TL;DR: The efficacy of an innovative employment intervention tailored for drug-involved offenders is demonstrated by showing positive changes in 12-month employment outcomes, most strongly for those who have not had recent employment success.
Abstract: Background: Employment has been identified as an important part of substance abuse treatment and is a predictor of treatment retention, treatment completion, and decreased relapse. Although employment interventions have been designed for substance abusers, few interventions have focused specifically on drug-involved offenders. Objectives: The purpose of this study was to examine employment outcomes for drug-involved offenders who received a tailored employment intervention. Methods: In a randomized controlled trial, baseline and follow-up data were collected from 500 drug-involved offenders who were enrolled in a drug court program. Participants were randomly assigned to drug court as usual (control group) or to the employment intervention in addition to drug court. Results: Intent-to-treat analyses found that the tailored intervention was associated only with more days of paid employment at follow-up (210.1 vs. 199.9 days). When focusing on those with greater employment assistance needs, a work t...
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TL;DR: Low quality evidence that agonist treatments are not effective in reducing drug use or criminal activity is found when compared to non-pharmacological treatments, and results on the effects of individual pharmacological interventions on drug use and criminal activity showed mixed results.
Abstract: BACKGROUND: The review represents one in a family of four reviews focusing on a range of different interventions for drug-using offenders. This specific review considers pharmacological interventions aimed at reducing drug use or criminal activity, or both, for illicit drug-using offenders.
OBJECTIVES: To assess the effectiveness of pharmacological interventions for drug-using offenders in reducing criminal activity or drug use, or both.
SEARCH METHODS: We searched Fourteen electronic bibliographic databases up to May 2014 and five additional Web resources (between 2004 and November 2011). We contacted experts in the field for further information.
SELECTION CRITERIA: We included randomised controlled trials assessing the efficacy of any pharmacological intervention a component of which is designed to reduce, eliminate or prevent relapse of drug use or criminal activity, or both, in drug-using offenders. We also report data on the cost and cost-effectiveness of interventions.
DATA COLLECTION AND ANALYSIS: We used standard methodological procedures as expected by Cochrane.
MAIN RESULTS: Fourteen trials with 2647 participants met the inclusion criteria. The interventions included in this review report on agonistic pharmacological interventions (buprenorphine, methadone and naltrexone) compared to no intervention, other non-pharmacological treatments (e.g. counselling) and other pharmacological drugs. The methodological trial quality was poorly described, and most studies were rated as 'unclear' by the reviewers. The biggest threats to risk of bias were generated through blinding (performance and detection bias) and incomplete outcome data (attrition bias). Studies could not be combined all together because the comparisons were too different. Only subgroup analysis for type of pharmacological treatment were done. When compared to non-pharmacological, we found low quality evidence that agonist treatments are not effective in reducing drug use or criminal activity, objective results (biological) (two studies, 237 participants (RR 0.72 (95% CI 0.51 to 1.00); subjective (self-report), (three studies, 317 participants (RR 0.61 95% CI 0.31 to 1.18); self-report drug use (three studies, 510 participants (SMD: -0.62 (95% CI -0.85 to -0.39). We found low quality of evidence that antagonist treatment was not effective in reducing drug use (one study, 63 participants (RR 0.69, 95% CI 0.28 to 1.70) but we found moderate quality of evidence that they significantly reduced criminal activity (two studies, 114 participants, (RR 0.40, 95% CI 0.21 to 0.74).Findings on the effects of individual pharmacological interventions on drug use and criminal activity showed mixed results. In the comparison of methadone to buprenorphine, diamorphine and naltrexone, no significant differences were displayed for either treatment for self report dichotomous drug use (two studies, 370 participants (RR 1.04, 95% CI 0.69 to 1.55), continuous measures of drug use (one study, 81 participants, (mean difference (MD) 0.70, 95% CI -5.33 to 6.73); or criminal activity (one study, 116 participants, (RR 1.25, 95% CI 0.83 to 1.88) between methadone and buprenorphine. Similar results were found for comparisons with diamorphine with no significant differences between the drugs for self report dichotomous drug use for arrest (one study, 825 participants, (RR 1.25, 95% CI 1.03 to 1.51) or naltrexone for dichotomous measures of reincarceration (one study, 44 participants, (RR 1.10, 95% CI 0.37 to 3.26), and continuous outcome measure of crime, (MD -0.50, 95% CI -8.04 to 7.04) or self report drug use (MD 4.60, 95% CI -3.54 to 12.74).
AUTHORS' CONCLUSIONS: When compared to non-pharmacological treatment, agonist treatments did not seem effective in reducing drug use or criminal activity. Antagonist treatments were not effective in reducing drug use but significantly reduced criminal activity. When comparing the drugs to one another we found no significant differences between the drug comparisons (methadone versus buprenorphine, diamorphine and naltrexone) on any of the outcome measures. Caution should be taken when interpreting these findings, as the conclusions are based on a small number of trials, and generalisation of these study findings should be limited mainly to male adult offenders. Additionally, many studies were rated at high risk of bias.
58 citations
TL;DR: A systematic review of studies that have used experimental or quasi-experimental designs to evaluate vocational training and employment program outcomes for adult offenders identifies key features of those programs associated with the best outcomes and recommends selection criteria for those who are most likely to benefit from prison vocational education and training.
Abstract: Although the association between unemployment and offending is well established, relatively little is known about the impact of vocational education and training programs on re-offending, with much of the previous work in this area failing to control for, or correct, selection bias. This article reports the findings of a systematic review, which considers the findings of only those studies that have used experimental or quasi-experimental designs to evaluate vocational training and employment program outcomes for adult offenders. The analysis identifies key features, based on these studies, of those programs associated with the best outcomes and recommends selection criteria for those who are most likely to benefit from prison vocational education and training.
53 citations
Cites background or methods from "Twelve-month employment interventio..."
...Data from this study were further analyzed by Webster et al. (2014) using intent-totreat analyses to examine 12-month differences in employment outcomes between the intervention group and the control group....
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...Following participation in the program, those individuals with a negative pre-baseline work trajectory were more likely to be in the workforce and earn more income than similar individuals who did not receive the program (Webster et al., 2014)....
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TL;DR: Three single studies evaluating case management via a mental health drug court, motivational interviewing and cognitive skills and interpersonal psychotherapy did not report significant reductions in criminal activity and self report drug use respectively, and more evaluations are required to assess the effectiveness of interventions for drug-using offenders with co-occurring mental health problems.
Abstract: Background
This is an updated version of an original Cochrane review published in Issue 3 2006 (Perry 2006). The review represents one from a family of four reviews focusing on interventions for drug-using offenders. This specific review considers interventions aimed at reducing drug use or criminal activity, or both for drug-using offenders with co-occurring mental illness.
Objectives
To assess the effectiveness of interventions for drug-using offenders with co-occurring mental illness in reducing criminal activity or drug use, or both.
Search methods
We searched 14 electronic bibliographic databases up to May 2014 and 5 Internet resources (searched between 2004 and 11 November 2009). We contacted experts in the field for further information.
Selection criteria
We included randomised controlled trials designed to reduce, eliminate, or prevent relapse of drug use and criminal activity, or both in drug-using offenders with co-occurring mental illness. We also reported data on the cost and cost-effectiveness of interventions.
Data collection and analysis
We used standard methodological procedures expected by The Cochrane Collaboration.
Main results
Eight trials with 2058 participants met the inclusion criteria. The methodological quality of the trials was generally difficult to rate due to a lack of clear reporting. On most 'Risk of bias' items, we rated the majority of studies as unclear. Overall, we could not statistically combine the results due to the heterogenous nature of the different study interventions and comparison groups. A narrative summary of the findings identified that the interventions reported limited success with reducing self report drug use, but did have some impact on re-incarceration rates, but not re-arrest. In the single comparisons, we found moderate-quality evidence that therapeutic communities determine a reduction in re-incarceration but reported less success for outcomes of re-arrest, moderate quality of evidence and self report drug use. Three single studies evaluating case management via a mental health drug court (very low quality of evidence), motivational interviewing and cognitive skills (low and very low quality of evidence) and interpersonal psychotherapy (very low quality of evidence) did not report significant reductions in criminal activity and self report drug use respectively. Quality of evidence for these three types of interventions was low to very low. The trials reported some cost information, but it was not sufficient to be able to evaluate the cost-effectiveness of the interventions.
Authors' conclusions
Two of the five trials showed some promising results for the use of therapeutic communities and aftercare, but only in relation to reducing subsequent re-incarceration. Overall, the studies showed a high degree of variation, warranting a degree of caution in the interpretation of the magnitude of effect and direction of benefit for treatment outcomes. More evaluations are required to assess the effectiveness of interventions for drug-using offenders with co-occurring mental health problems.
28 citations
TL;DR: Three of the nine trials show a positive trend towards the use of any psychosocial treatment in comparison to treatment as usual showing an overall significant reduction in subsequent reincarceration, but not arrest rates or drug use.
Abstract: This is an updated version of a Cochrane review first published in Issue 3, 2006 ([Perry 2006][1]). The review represents one in a family of four reviews focusing on the effectiveness of interventions in reducing drug use and criminal activity for offenders. This specific review considers
26 citations
References
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Journal Article•
TL;DR: Examination of approaches to serving individuals with substance abuse disorders, drawn from two databases, finds differences between clients with Alcoholism vs Drug Addiction and those served by the State/Federal Vocational Rehabilitation System.
Abstract: According to 2007 statistics reported by the Substance Abuse and Mental Health Services Administration (SAMHSA, 2008), there were an estimated 22.3 million individuals in the U.S. aged 12 or older (9% of the population) who met the DSM-IV diagnostic criteria for either substance abuse or dependence. Of those 22.3 million, 15.5 million were classified with alcohol abuse or dependence, 3.7 million were classified with drug abuse or dependence, and approximately 3.2 million had abuse or dependence on both alcohol and drugs. The present study examines employment outcomes and workplace accommodation issues for individuals with substance abuse disorders. Rehabilitation Services Administration (RSA) client service records show the types of employment successfully rehabilitated individuals have attained. Workplace accommodation information, however, is not included in the RSA case-closure record (RSA-911 form). Given the importance of workplace accommodations, data from the Job Accommodation Network (JAN) have been incorporated to provide a more complete picture of the services needed for individuals with substance abuse disorders to retain employment. Thus, the focus of the current article is on approaches to serving individuals with substance abuse disorders, drawn from two databases. Analyses are conducted to examine the rates of successful employment outcomes (case closures) of clients with either alcoholism or drug addictions who were served by the State/Federal Vocational Rehabilitation System across three years (1996, 2000, 2004). A primary reason for selecting 1996 as the first year for the RSA data was that the available JAN database spanned 1996 to 2005. Counselors in the Rehabilitation Services Administration (RSA) provide counseling and employment-related services to individuals with disabilities to obtain employment and live more independently (Rehabilitation Services Administration, 2006). Analyses are conducted to examine the prevalence of accommodation inquiries made to the Job Accommodation Network (JAN) for clients with substance abuse (alcoholism or drug addiction). JAN is a free resource for information regarding job accommodations and Title I of the ADA. The service is available free of charge to anyone, but the majority of inquiries (68%) are from employers and individuals with disabilities. JAN averages about 32,000 telephone inquiries (cases) per year and provides one-on-one consultation (and follow-up materials and communications, as necessary) to each person about all aspects of job accommodation, including the accommodation process, effective accommodation options, funding sources for accommodations, product information, disability awareness, and legal rights and responsibilities under the employment provisions of the ADA. The following research questions are investigated: 1. What are the demographic characteristics for individuals with substance abuse disorders (Alcoholism vs Drug Addiction) who received Vocational Rehabilitation services? 2. Are there differences between clients (consumers) with Alcoholism vs Drug Addiction, in terms of Vocational Rehabilitation services received and outcome (rehabilitated vs not rehabilitated)? 3. What occupations were involved for those Vocational Rehabilitation consumers whose outcomes were successful (rehabilitated)? 4. In the JAN case data for substance abuse calls from 1996 to 2005, what are the relative proportions of (a) Causative Factor, (b) Caller Industry, (c) Job Function, and (d) Issue Discussed? 5. What commonalities link the findings from the RSA cases to the findings from the JAN cases on substance abuse disorders? In the workplace, individuals with substance abuse disorders often exhibit difficulties with attendance, concentration, staying organized, meeting deadlines, handling stress, and maintaining stamina during the workday (Batiste, 2005a; 2005b). The obligation to provide accommodations for people with substance abuse under the ADA can be confusing to employers because the obligation differs somewhat from the obligation to accommodate employees with other types of disabilities. …
25 citations
TL;DR: The study examined a representative sample of the 1,060,000 individuals discharged from drug user treatment in the United States in the 12 months before September 1990, and compared self-reports of behavior 5 years before to 5 years after treatment, finding that the number of alcohol and drug users declined markedly.
Abstract: The study examined a representative sample of the 1,060,000 individuals discharged from drug user treatment in the United States in the 12 months before September 1990, and compared self-reports of behavior 5 years before to 5 years after treatment. Self-reports about recent drug use were compared with urine samples, and the agreement between self-report and drug-test results was high. The key findings are that the number of alcohol and drug users declined markedly, ranging from one-seventh to more than one half; those who continued using drugs after treatment used them less frequently than before treatment; criminal behavior fell between one-quarter to one-half, and primary criminal support fell by one third; full-time employment did not change; homelessness, drug injection, and suicide attempts decreased by more than one-third.
25 citations
"Twelve-month employment interventio..." refers background in this paper
...Another study examining long-term substance abuse treatment clients and methadone maintenance found that neither group experienced any significant improvement in employment (21)....
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Journal Article•
TL;DR: For example, the authors found that stable employment has a protective role in drug and alcohol treatment retention and is associated with increased post-treatment outcomes with community reintegration, which is important for treatment success.
Abstract: EMPLOYMENT IS an important part of drug and alcohol treatment as well as a measure of treatment outcome (Institute of Medicine, 1990). Studies have consistently reported that employment contributes to drug and alcohol treatment success (Platt, 1995; Wolkstein and Spiller, 1998). These studies also suggest that daily structure, including employment and cognitive approaches like relapse prevention models (Gorski, 1990; Marlatt and Gordon, 1985), are important for treatment success. Not only does employment establish a source of steady income, but it has also been found to minimize relapse and reduce involvement in criminal activity for the recovering drug addict (Inciardi, et al., 2002; Platt, 1995; Vaillant, 1988). Other studies focused on preand post-treatment employment have consistently shown that employment predicts improved and successful treatment. For example, stable employment has a protective role in drug and alcohol treatment retention (see Platt, 1995 and McLellan, 1983 for literature reviews). Employment also is associated with reduced drug and alcohol use (Hammer et al., 1985;Vaillant, 1988; Zanis et al., 1994); with decreased severity of relapse (Vaillant, 1988); with increased post-treatment outcomes (Comerford, 1999); and with community reintegration (Comerford, 1999; Platt, 1995; Room, 1998). In a longitudinal study of heroin and alcohol patients, Vaillant (1988) concluded that unstable employment was a better predictor of relapse than addiction severity. Stable employment conditions are related to other variables that contribute to treatment outcomes. Employed clients are more likely to report healthier social and professional networks, which are related to improved self-esteem, self-worth, and a sense of independence that contribute to reduced drug and alcohol use (Brewington et al., 1987; Comerford, 1999; Room, 1998). In addition, stable employment is associated with lowered depression scores (Zanis et al., 1994). Overall, the more stable employment, the more likely it is that clients in recovery will have positive treatment outcomes. Since many drug abusers are unemployed when they seek treatment, employment-focused services should complement drug and alcohol treatment (Comerford, 1999; French et al., 1992; Hubbard et al., 1984; Walker and Leukefeld, 2002). Employment services include vocational rehabilitation, which can incorporate case management, job placement, job skills training, education, and vocational training. Each of these approaches focuses on helping clients obtain, maintain, and upgrade employment (Walker and Leukefeld,2002).Employment services,which are frequently not emphasized, are often reported by clients as desirable since employment is a personal goal (Staton, et al., 2002; Zanis et al., 1994). For criminally-involved drug and alcohol abusers, getting a job and keeping a job can be challenging, especially when there are few community-level employment and vocational rehabilitation services available (Walker and Leukefeld, 2002; Platt, 1995). Nevertheless, in a recent study, probation officers reported that helping probationers maintain employment was a key contribution to successful community reentry (Seiter, 2002). With the emergence of Drug Courts, the criminal justice system is targeting employment as an important part of successful drug abuse treatment. The cornerstones of Drug Court programs include the use of treatment services with justice system processing, the use of frequent drug testing to monitor abstinence, mandatory employment, and ongoing judicial interaction with Drug Court participants. The Drug Court model was designed to decrease drug use and to divert nonviolent drug abusers from incarceration. In Kentucky, Drug Court judges were interested in providing employment services to Drug Court clients, since full-time employment is a Drug Court requirement. Judges indicated that stable employment would not only provide a foundation for enhancing job skills, but also would contribute to getting a better job. In this article, the authors will: 1) describe an employment project and the project’s intervention, used in Kentucky Drug Courts, which is grounded in established job readiness and social skills training approaches; and 2) profile project participants by employment history,drug use,criminal involvement, and health service utilization.
20 citations
"Twelve-month employment interventio..." refers background in this paper
...This literature gap led to the development of an employment intervention tailored to drug-involved offenders, which is grounded in established employment interventions and life skills training (23)....
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01 Aug 2008
18 citations
TL;DR: Fact analysis was used to identify commonalities among several employment measures collected from a sample of drug court offenders who entered one of two Kentucky drug courts between March 2000 and November 2002, which produced four employment factors: status, earnings, duration, and stability.
Abstract: Employment has been identified as an important predictor of drug abuse treatment outcome; however, employment has been measured in a variety of different ways in the drug abuse literature and typically with community samples. The present IRB-approved study used factor analysis to identify commonalities among several employment measures collected from a sample of drug court offenders who entered one of two Kentucky drug courts between March 2000 and November 2002. Measures included demographics, employment, substance use, and criminality. The factor analysis produced four employment factors: status, earnings, duration, and stability. These factors had different correlation patterns with substance use and criminality. Study limitations are noted. This study was supported by a grant from the National Institute on Drug Abuse.
18 citations
"Twelve-month employment interventio..." refers background in this paper
...Drug-involved offenders have the additional burden of poor employment history due to incarceration (8) and the stigma associated with a criminal record (13,14) and status as a drug abuser (15) to overcome when pursuing employment opportunities....
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...Other substance abuse research has shown that employment is a multidimensional construct and these dimensions differentially correlate with drug use and criminality (15)....
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