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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TL;DR: It is suggested that unprofessional behavior in the workplace could contribute to chronic unemployment in this population of chronically unemployed adults with long histories of illicit drug use.
Abstract: This study assesses the frequency that users of illicit drugs display unprofessional behaviors in an employment setting. This research was conducted in the therapeutic workplace, a model employment-based treatment program for chronically unemployed adults with long histories of illicit drug use in 2003. Fifty-three unemployed adults in methadone treatment, who were opiate and cocaine dependent, showed signs of injection drug use, and recently used cocaine were hired to work for 4 hours every weekday for 7 months. Results show that while the overall incidence of many undesirable behaviors is low, a small percentage of participants had serious workplace behavior problems that might limit their success in community workplaces. This study suggests that unprofessional behavior in the workplace could contribute to chronic unemployment in this population. The study's limitations are noted and future needed research is suggested.
16 citations
"Twelve-month employment interventio..." refers background in this paper
...These individuals often have poor work habits, including regular absences, tardiness, sleeping on the job, using vulgar language in the workplace (10,11), and have difficulties staying organized, handling stress, meeting deadlines, and maintaining stamina during the day (12)....
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TL;DR: Latent class trajectories of work demonstrated a stronger association with incident hypertension than did measures of current work, and clearly mediated the effects of race on hypertension.
Abstract: Objective: To determine whether a life-course model of work may explain racial or ethnic differentials in health. Occupational characteristics are relevant socioeconomic indicators of health disparities and essential determinants of health. Methods: Growth mixture modeling (GMM) was used to construct longitudinal trajectories of work characteristics from the ages of 20 to 32 years. Path analyses were used to evaluate the association of race, ethnicity, education, and work trajectory on incident hypertension. Results: Growth mixture modeling yielded three latent class trajectories. Black subjects with postsecondary education were 2.5 times more likely to be found in the lowest occupational trajectory. The three-class trajectory model mediated 43.6% of the direct effect of race on incident hypertension. Conclusions: Latent class trajectories of work demonstrated a stronger association with incident hypertension than did measures of current work, and clearly mediated the effects of race on hypertension.
10 citations
"Twelve-month employment interventio..." refers methods in this paper
...Previous studies have used work or employment trajectories as a predictor or outcome variable (29,30), and some have applied concepts similar to the negative and positive work trajectories used in the current study (e....
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