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CORK Bibliography: Prisoners

83 citations. January 2008 to present

Prepared: September 2009

Adams S; Leukefeld CG; Peden AR. Substance abuse treatment for women offenders: A research review. (review). Journal of Addictions Nursing 19(2): 61-75, 2008. (134 refs.)

Substance abuse is a major contributing factor to women being incarcerated in the United States, and substance abuse is a critical factor in recidivism. Although women offenders have different reasons for drug use, drug use patterns, life circumstances, and parental responsibilities than men, treatment approaches for women offenders have been largely developed from studies of treatment for incarcerated men and non-offending women in the general community. The purpose of this article is to summarize the recent literature on the treatment needs of women offenders with substance abuse problems and critically examine the six empirical studies that evaluate gender-specific programmatic interventions designed for women offenders. A systematic review of these six empirical studies assessed design, methods, measures, and outcomes. While these studies contribute to the knowledge base, five areas were identified to advance research and improve treatment outcomes for women offenders: 1) randomized controlled design, 2) larger sample size, 3) clear description of program elements and interventions, 4) consistent definition of outcomes and measurement of outcomes, and 5) statistical analyses to control for multiple program elements in determining contribution to treatment outcomes. Implications for practice, program development, and future research to improve treatment outcomes for women offenders are discussed.

Allnutt S; Wedgwood L; Wilhelm K; Butler T. Temperament, substance use and psychopathology in a prisoner population: Implications for treatment. Australian and New Zealand Journal of Psychiatry 42(11): 969-975, 2008. (38 refs.)

Objective: The association between temperament and drug use or temperament and psychopathology has previously been restricted to community clinical or non-clinical samples. The aim of the present study was therefore to examine these associations in a large cohort of Australian offenders using Cloninger's Temperament and Character Inventory (TCI). Methods: A total of 1322 prisoners from New South Wales (NSW) who completed all dimensions of the TCI and were screened for mental illness using the Australian National Survey of Mental Health and Wellbeing were included in the study. Results: A total of 15% of the sample fulfilled the criteria for a diagnosis for depression, 36% for anxiety disorders and 54% for a substance abuse disorder. Using logistic regression analysis, the TCI dimensions of harm-avoidance and low self-direction predicted depression. Being female, a poly-substance user and having high harm-avoidance, persistence, self-direction and self-transcendence predicted anxiety disorders. Significant stepped trends across age, gender, and type of drug use were found for all TCI dimensions. Conclusions: The TCI is useful in identifying prisoners with a history of psychopathology and substance misuse. This tool also provides clinically relevant information about at-risk individuals and has the potential to guide the development of intervention programmes for inmates.

Baltieri DA; de Andrade AG. Alcohol and drug consumption among sexual offenders. Forensic Science International 175(1): 31-35, 2008. (30 refs.)

Purpose: To evaluate the role of alcohol and drug consumption between sexual offenders against boys and girls. Method: It was an observational, retrospective and cross-sectional study carried out by the Ambulatory for the treatment of sexual disorders of ABC Medical College, Santo Andre, Sao Paulo, Brazil (ABSex). The sample comprised 104 convicts, over 18 years old, sentenced only for sexual crimes against children (below 11 years old). Alcohol and drug consumption, sexual abuse history, sexual impulsivity, and risk of recidivism were evaluated. Results: The sexual offenders against boys showed higher alcohol consumption problems than sexual offenders against girls (chi(2) = 19.76, 1 d.f., p < 0.01). The severity of alcohol consumption was also significantly higher in the sexual offenders against non-related boys than in the sexual offenders against non-related girls (p = 0.037, ANOVA). After adjustment for other variables, such as monthly income before the penalty and alcohol consumption at the moment of the crime, the alcohol consumption severity in sexual offenders against boys was significantly higher than in sexual offenders against girls (OR = 1.05, CI 1.01-1.08, p < 0.01). Conclusions: Alcohol use or abuse is associated with the perpetration of sexual aggression. The role of alcohol consumption seems to be greater in sexual offenders against boys than in girls and this can contribute to criminal recidivism.

Best D; Day E; Campbell A; Flynn PM; Simpson DD. Relationship between drug treatment engagement and criminal thinking style among drug-using offenders. European Addiction Research 15(2): 71-77, 2009. (33 refs.)

There has been considerable debate about the effectiveness of drug treatment in reducing offending and drug use, with limited support for the effectiveness of the UK Drug Intervention Programme to reduce offending through diversion into treatment. The current paper examines drug users diverted into treatment in one UK city to assess their treatment engagement and criminal thinking styles. There is an association between higher criminal thinking and both poorer engagement in treatment and worse client functioning. The key implication is that to address offending-prone behaviour as a determinant of ongoing drug use, it is essential that criminal thinking styles are addressed.

Bird SM. Database linkage: Outside reflections on health care in prisons. (commentary). Addiction 104(7): 1241-1242, 2009. (12 refs.)

This commentary addresses the article by JN Marzo, M.Rotily, F Meroueh, M Varastet, C Hunault C., et al. " RECAMS Study Group. Maintenance therapy and 3-year outcome of opioid-dependent prisoners: a prospective study in France (2003-06). Addiction 2009; 104: 1233-40. The commentary addresses issures related to data analysis and the sample size required for statistical power and ability to generalize.

Brocato J; Wagner EF. Predictors of retention in an alternative-to-prison substance abuse treatment program. Criminal Justice and Behavior 35(1): 99-119, 2008. (82 refs.)

This longitudinal study examines predictors of retention among alternative-to-prison substance abuse treatment clients. The roles of motivational factors and the client-therapist relationship are examined. The sample was composed of 141 male felony offenders who were legally mandated to a community-based, long-term residential drug treatment program. Results support the following conclusions: (a) retention in treatment is positively related to motivation to change; (b) motivation to change, particularly recognition of a drug problem, is positively related to the therapeutic alliance; and (c) changes in motivation in response to treatment are positively related to the therapeutic alliance. Implications of these findings for treatment and research are discussed.

Bruce RD; Schleifer RA. Ethical and human rights imperatives to ensure medication-assisted treatment for opioid dependence in prisons and pre-trial detention. (editorial). International Journal of Drug Policy 19(1): 17-23, 2008. (66 refs.)

Opioid dependence is a complex medical condition affecting neurocognitive and physical functioning. Forced or abrupt opioid withdrawal may cause profound physical and psychological suffering, including nausea, vomiting, diarrhoea, extreme agitation and/or anxiety. Opioid-dependent individuals are especially vulnerable at the time of arrest or initial detention, when they may, as a result of their chemical dependency, be coerced into providing incriminating testimony, or be driven to engage in risky behaviour (such as sharing needles in detention) in order to avoid painful withdrawal symptoms. Upon incarceration, many opioid-dependent prisoners are forced to undergo abrupt opioid withdrawal (both from legally prescribed agonist therapy such as methadone as well as illicit opioids). Physical and psychological symptoms attendant to withdrawal may impair capacity to make informed legal decisions, and cause prisoners to risk HIV and other blood-borne diseases by sharing injection equipment. Although prisons must provide at least the standard of care to prisoners that is available in the general population, medication-assisted treatment, endorsed by international health and drug agencies as an integral part of HIV prevention and care strategies for opioid-dependent drug users, is unavailable to most prisoners. Medication-assisted treatment is a well-studied and validated pharmacological therapy for the medical condition known as opioid dependence. The failure to ensure prisoner access to this medical therapy threatens fundamental human rights protections against cruel, inhuman or degrading treatment and rights to health and to life. It also poses serious ethical problems for health care providers, violating basic principles of beneficence and non-maleficence (i.e., do good/do no harm). Governments must take immediate action to ensure access to opioid substitution to prisoners to ensure fulfilment of ethical and human rights obligations.

Bulten E; Nijman H; van der Staak C. Psychiatric disorders and personality characteristics of prisoners at regular prison wards. International Journal of Law and Psychiatry 32(2): 115-119, 2009. (12 refs.)

Background: Dutch correctional officers are trained to observe prisoners with severe mental disorder. This 'behavioural' approach is assumed to detect psychiatrically disordered prisoners with striking symptoms. On the basis of this screening procedure about 10% of the Dutch prison population is classified as needing special care or control. In the current study, what psychopathology can still be found among the remaining 90% prisoners residing at regular wards is investigated and which personality Wits characterize them. When the prevalence of major mental illness would still turn out to be high in this group, the question arises whether the current, rather unstandardized, way of screening prisoners is sufficient. Aims: To assess the prevalence of psychiatric disorders among adult Dutch prisoners on regular wards, and to determine the concurrent and convergent validity of self-report measures and their screening characteristics in such a sample. Method: 191 randomly selected prisoners admitted to the general wards were administered a number of tests (SCL-90, NEO-PI-R, MINI) during the first weeks of their incarceration. Results: Including substance abuse, 57% of the participants suffered from one or more Axis I disorders. About seven out of ten detainees with psychopathology as assessed with the MINI did not receive professional help, The concurrent and convergent validity of the SCL-90 and the NEO-PI-R turned out to be reasonable. The predictive validity of self-report measures in detecting prisoners with an Axis I disorders or suicide risks was moderate. Conclusions: The Dutch 'behavioural approach' seems to be quite accurate in detecting prisoners with psychotic disorders. Most prisoners with other mental disorders on regular wards, however, did not receive professional help. The current study suggests that self report scales such as the SCL-90 and the NEO-PI-R may be helpful in screening detainees an important DSM-IV disorders.

Burns KA. Commentary: The Top Ten reasons to limit presription of controlled substance in prisons. (editorial). Journal of the American Academy of Psychiatry and the Law 37(1): 50-52, 2009. (4 refs.)

Implementation of a treatment protocol for prescribing stimulant medications in adult prisons where such a protocol and oversight did not previously exist is prudent management, clinically relevant, and appropriate. There are multiple challenges to using controlled substances in correctional settings, many of them a consequence of the very high prevalence of substance use disorders among inmates. This article describes 10 of the reasons to limit the prescription of controlled substances in prison, among them the implications for nursing and correctional security staff and the overwhelming of the already limited psychiatric resources available in most prisons.

Cartier JJ; Greenwell L; Prendergast ML. The persistence of HIV risk behaviors among methamphetamine-using offenders. Journal of Psychoactive Drugs 40(4): 437-446, 2008. (31 refs.)

Studies have shown that methamphetamine (MA) is rapidly becoming the drug of choice for a large number of substance-abusing offenders and is associated with significantly higher levels of HIV risk behaviors prior to their incarceration. Despite these findings, there has been little follow-up research to determine whether these patterns persist among recently paroled offenders after attendance in an in-prison treatment program. This study uses the self-reported data from 812 substance-abusing offenders in a multisite NIDA-funded project to determine whether, either before incarceration or nine months after release from an in-prison substance abuse program, MA use in the past 30 days was associated with increased HIV risk behaviors. The findings indicate that offenders who used MA prior to and after incarceration and treatment report higher levels of HIV risk behaviors compared with offenders with no MA use. Clinical and policy implications of the findings are discussed.

Caviness CM; Hatgis C; Anderson BJ; Rosengard C; Kiene SM; Friedmann PD et al. Three brief alcohol screens for detecting hazardous drinking in incarcerated women. Journal of Studies on Alcohol and Drugs 70(1): 50-54, 2009. (28 refs.)

Objective: Screening methods for hazardous drinking have not been evaluated in a population of incarcerated women. This study examines abbreviated versions of the Alcohol Use Disorders Identification Test (AUDIT) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) heavy episodic drinking criterion in a sample of female detainees. Method: A total of 2,079 women at the Adult Correctional Institute in Rhode Island were approached for screening between February 2004 and June 2007. The AUDIT-consumption (AUDIT-C), AUDIT-3, and the NIAAA heavy episodic drinking criterion (four or more drinks on one occasion for women) were compared with the full AUDIT at different cut points. Results: More than 55% of the sample endorsed an AUDIT score of 4 or greater-the NIAAA recommended threshold for detecting hazardous drinking. The three-item AUDIT-C with a cut score of 3 yielded a classification most consistent with the AUDIT score of 4 or more; sensitivity and specificity exceeded .9, and 91.5% of participants were correctly classified. The AUDIT-3 and NIAAA episodic drinking criteria were less sensitive measures. We found no evidence of interactions between the screening instruments and age or ethnicity. Conclusions: The three-item AUDIT-C has robust test characteristics for detecting hazardous drinking in female inmates. Universal screening for hazardous drinking is recommended for incarcerated women, given their high rates of alcohol misuse.

Chandler RK; Fletcher BW; Volkow ND. Treating drug abuse and addiction in the criminal justice system improving public health and safety. Journal of the American Medical Association 301(2): 183-190, 2009. (82 refs.)

Despite increasing evidence that addiction is a treatable disease of the brain, most individuals do not receive treatment. Involvement in the criminal justice system often results from illegal drug- seeking behavior and participation in illegal activities that reflect, in part, disrupted behavior ensuing from brain changes triggered by repeated drug use. Treating drug- involved offenders provides a unique opportunity to decrease substance abuse and reduce associated criminal behavior. Emerging neuroscience has the potential to transform traditional sanction- oriented public safety approaches by providing new therapeutic strategies against addiction that could be used in the criminal justice system. We summarize relevant neuroscientific findings and evidence- based principles of addiction treatment that, if implemented in the criminal justice system, could help improve public heath and reduce criminal behavior.

Cohen JE; Amon JJ. Health and human rights concerns of drug users in detention in Guangxi Province, China. PLOS Medicine 5(12): 1682-1688, 2008. (46 refs.)

Background: Although confinement in drug detoxification ("detox'') and re-education through labor (RTL) centers is the most common form of treatment for drug dependence in China, little has been published about the experience of drug users in such settings. We conducted an assessment of the impact of detention on drug users' access to HIV prevention and treatment services and consequent threats to fundamental human rights protections. Methods and Findings Chinese government HIV and anti-narcotics legislation and policy documents were reviewed, and in-depth and key informant interviews were conducted with 19 injection drug users (IDUs) and 20 government and nongovernmental organization officials in Nanning and Baise, Guangxi Province. Significant contradictions were found in HIV and antinarcotics policies, exemplified by the simultaneous expansion of community-based methadone maintenance therapy and the increasing number of drug users detained in detox and RTL center facilities. IDU study participants reported, on average, having used drugs for 14 y (range 8-23 y) and had been confined to detox four times (range one to eight times) and to RTL centers once (range zero to three times). IDUs expressed an intense fear of being recognized by the police and being detained, regardless of current drug use. Key informants and IDUs reported that routine HIV testing, without consent and without disclosure of the result, was the standard policy of detox and RTL center facilities, and that HIV-infected detainees were not routinely provided medical or drug dependency treatment, including antiretroviral therapy. IDUs received little or no information or means of HIV prevention, but reported numerous risk behaviors for HIV transmission while detained. Conclusions Legal and policy review, and interviews with recently detained IDUs and key informants in Guangxi Province, China, found evidence of anti-narcotics policies and practices that appear to violate human rights and imperil drug users' health.

Cropsey KL; Weaver MF; Eldridge GD; Villalobos GC; Best AM; Stitzer ML. Differential success rates in racial groups: Results of a clinical trial of smoking cessation among female prisoners. Nicotine & Tobacco Research 11(6): 690-697, 2009. (31 refs.)

This study replicated prior observations of racial differences in smoking cessation in which Black smokers have demonstrated lower smoking cessation rates than White smokers. The study used data from a smoking cessation intervention and compared White and Black female prisoners (N = 233) on a 10-week intervention of group psychotherapy and nicotine replacement (patch). Generalized estimating equations were used to model smoking cessation across the 12-month follow-up. Compared with an untreated control group, both Black and White smokers benefited from the cessation treatment. However, after controlling for potential confounds, White smokers had significantly higher overall smoking cessation rates across time compared with Black smokers (e.g., 30% vs. 24% abstinent at 6 weeks; 13% vs. 10% abstinent at 12 months). Smoking mentholated cigarettes was not associated with these differences in quit rates. Understanding differential treatment responses can lead to the development of more tailored and efficacious smoking cessation interventions that may reduce the morbidity and mortality associated with smoking in prison populations.

Cuomo C; Sarchiapone M; Di Giannantonio M; Mancini M; Roy A. Aggression, impulsivity, personality traits, and childhood trauma of prisoners with substance abuse and addiction. American Journal of Drug and Alcohol Abuse 34(3): 339-345, 2008. (21 refs.)

Introduction: The aim of our study is then to analyze psychological and judicial features of a subgroup of inmates with substance abuse. Methods: Prisoners with substance abuse (n = 312) were compared to prisoners without substance abuse (n = 591). Recruited inmates completed a semistructured interview for collection of sociodemographic and judicial data and a battery of psychometric tests for assessement of aggression, impulsivity, depression, personality traits, hostility, resilience, and childhood trauma. Results: Substance abusers had on average multiple incarcerations (78.8%), more juvenile convictions (60.2%), more violent behaviors during detention (29.8%), and a history of one or more suicide attempts (20.8%). They also had higher scores on subscales for childhood trauma, higher scores for psychoticism and neuroticism, higher impulsivity levels, worse resilience, increased hostility, and prevalent suicidal ideation. Conclusion: Prisoners with substance abuse constitute a subgroup with increased judiciary and psychiatric issues, possibly due to early life history and psychological characteristics, such as high impulsivity and aggressiveness, poor resilience, and higher suicidal risk.

Darke S. From the can to the coffin: Deaths among recently released prisoners. (editorial). Addiction 103(2): 256-257, 2008. (13 refs.)

Dave D. Illicit drug use among arrestees, prices and policy. Journal of Urban Economics 63(2): 694-714, 2008. (29 refs.)

Prior studies, by relying on nationally representative surveys, have overlooked the important fact that use of addictive substances is not uniformly distributed; subgroups of hardcore users account for most of the drug consumption. This study employs the Arrestee Drug Abuse Monitoring system to analyze the demand for cocaine and heroin by urban arrestees, employing objective indicators of use based on urinalysis. The data are repeated city cross sections, and panel data methodology is employed to account for endogeneity. Cocaine and heroin prices have a negative effect on the probability of use even among this group of heavy users. Results indicate that subjective, self-reported measures of participation are likely to be under-reported, which may impart bias to estimates of the price elasticity. The own-price cocaine participation elasticity is about -0.15, and the own-price heroin participation elasticity is about -0.10 for arrestees. This contemporaneous elasticity understates the full effect, and the long-run price elasticity is about twice the magnitude. The magnitude of the price response is substantially smaller relative to the estimates in the prior literature, and calculations suggest that further enforcement and interdiction-driven increases in drug prices may not be cost-effective.

Dolan K. Prison research (commentary). Addiction 104(2): 223-223, 2009. (6 refs.)

Douglas N; Plugge E; Fitzpatrick R. The impact of imprisonment on health: What do women prisoners say? Journal of Epidemiology And Community Health 63(9): 749-754, 2009. (57 refs.)

Background: Women prisoners tend to suffer poor health on a range of indicators. This study sought to explore women prisoners' perceptions of the impact of imprisonment on their health. Methods: This qualitative study involved adult women prisoners in two closed local prisons. Focus groups and individual interviews were conducted. Results: Women prisoners reported that imprisonment impacted negatively upon their health. The initial shock of imprisonment, separation from families and enforced living with other women suffering drug withdrawal and serious mental health problems affected their own mental health. Over the longer term, women complained of detention in unhygienic facilities by regimes that operated to disempower them, including in the management of their own health. Women described responses to imprisonment that were also health negating such as increased smoking, eating poorly and seeking psychotropic medication. However, imprisonment could also offer a respite from lives characterised by poverty, social exclusion, substance misuse and violence, with perceived improvements in health. Conclusion: The impact of imprisonment on women's health was mixed but was largely perceived to be negative. Despite policy initiatives to introduce health promotion in prisons, there is little evidence of the extent to which this has been effective. The current policy climate in the UK makes it especially timely to examine the reported experience of women prisoners themselves about the impact of imprisonment on their health and to re-evaluate health promotion in women's prisons.

Duvall JL; Oser CB; Leukefeld CG. Readiness to change as a predictor of drug-related behaviors in a sample of rural felony probationers. American Journal of Drug and Alcohol Abuse 34(6): 741-748, 2008. (20 refs.)

Objective: Relationships between readiness to change and common drug-related behaviors were explored in a sample (N = 776) of rural probationers in the state of Kentucky. Methods: Self-reported data was gathered on measures of readiness to change, frequency of marijuana use, possession of drugs/related paraphernalia, and driving while under the influence of drugs/alcohol at time periods before and after arrest. Results: Independent of the influence of demographic characteristics such as age, gender, race, and treatment history, increases in readiness to change scores were accompanied by reductions in all three drug-related behaviors. Conclusion: Readiness to change has important implications for treatment involving rural probationers.

Eldridge GD; Cropsey KL. Smoking bans and restrictions in US prisons, and jails: Consequences for incarcerated women. (editorial). American Journal of Preventive Medicine 37(2, Supplement S): S179-S180, 2009. (16 refs.)

Elger BS. Prisoners' insomnia: To treat or not to treat? Medical decision-making in places of detention. Medicine, Science and the Law 48(4): 307-316, 2008. (43 refs.)

Insomnia is a frequent reason for medical and psychiatric consultation in prisons. Medical decision-making in correctional health care should be based on the same principles as outside correctional institutions. In places of detention, principles should be balanced according to the same criteria as outside correctional institutions, while taking into account the unique harm-benefit ratios related to the specific context. The aim of this paper was to examine the existing attitudes and ethical issues related to decision-making about insomnia evaluation and treatment in places of detention. An analysis of the ethical issues and an evidence-based review of the consequences of different attitudes and treatments with regard to prison medicine were carried out. Insomnia is a public health problem and requires adequate evaluation and treatment to avoid more serious health consequences both within and outside correctional institutions. Insomnia treatment in places of detention is an ethical dilemma, but there is no evidence-based reason to avoid benzodiazepines in prison completely and to use only neuroleptics and antidepressants, which might represent more dangerous and less efficient treatment. In prison medicine, should we even treat insomnia? Widely accepted ethical strategies of decision-making indicate that we should. Institutional guidelines on insomnia should be based on ethically sound decision-making that takes into account the available evidence.

Eshrati B; Taghizadeh Asl R; Dell C; Afshar P; Millson P; Kamali M et al. Preventing HIV transmission among Iranian prisoners: Initial support for providing education on the benefits of harm reduction practices. Harm Reduction Journal 5(1): e-article 21, 2008. (34 refs.)

Background: Harm reduction is a health-centred approach that seeks to reduce the health and social harms associated with high-risk behaviors, such as illicit drug use. The objective of this study is to determine the association between the beliefs of a group of adult, male prisoners in Iran about the transmission of HIV and their high-risk practices while in prison. Methods: A cross-sectional study was conducted in 2004. The study population was a random selection of 100 men incarcerated at Rajaei-Shahr prison. The data were collected through a self-administered questionnaire. Focus group discussions were held at the prison to guide the design of the questionnaire. The relationship between components of the Health Belief Model (HBM) and prisoners' risky HIV-related behaviors was examined. Results: Calculating Pearson's correlation coefficient, a significant, positive association was found between the benefit component of the HBM and prisoners not engaging in HIV high-risk behaviors. Conclusion: Educational harm reduction initiatives that promote the effectiveness of strategies designed to reduce the risk of HIV transmission may decrease prisoners' high-risk behaviors. This finding provides initial support for the Iran prison system's current offering of HIV/AIDS harm reduction programming and suggests the need to offer increased education about the effectiveness of HIV prevention practices.

Farrell M; Marsden J. Acute risk of drug-related death among newly released prisoners in England and Wales. Addiction 103(2): 251-255, 2008. (18 refs.)

Aims: To investigate drug-related deaths among newly released prisoners in England and Wales. Design Database linkage study. Participants National sample of 48 771 male and female sentenced prisoners released during 1998-2000 with all recorded deaths included to November 2003. Findings There were 442 recorded deaths, of which 261 (59%) were drug-related. In the year following index release, the drug-related mortality rate was 5.2 per 1000 among men and 5.9 per 1000 among women. All-cause mortality in the first and second weeks following release for men was 37 and 26 deaths per 1000 per annum, respectively (95% of which were drug-related). There were 47 and 38 deaths per 1000 per annum, respectively, among women, all of which were drug-related. In the first year after prison release, there were 342 male deaths (45.8 were expected in the general population) and there were 100 female deaths (8.3 expected in the general population). Drug-related deaths were attributed mainly to substance use disorders and drug overdose. Coronial records cited the involvement of opioids in 95% of deaths, benzodiazepines in 20%, cocaine in 14% and tricyclic antidepressants in 10%. Drug-related deaths among men were more likely to involve heroin and deaths among women were more likely to involve benzodiazepines, cocaine and tricyclic antidepressants. Conclusions: Newly released male and female prisoners are at acute risk of drug-related death. Appropriate prevention measures include overdose awareness education, opioid maintenance pharmacotherapy, planned referral to community-based treatment services and a community overdose-response using opioid antagonists.

Friedmann PD; Melnick G; Jiang L; Hamilton Z. Violent and disruptive behavior among drug-involved prisoners: Relationship with psychiatric symptoms. Behavioral Sciences and the Law 26(4): 389-401, 2008. (45 refs.)

This study examines the relationship between psychiatric symptoms and violent/disruptive behavior among 192 inmates who participated in prison-based substance abuse treatment. Participants came from two sites able to provide narrative reports of disciplinary actions in the Criminal justice Drug Abuse Treatment Studies' Co-Occurring Disorders Screening Instrument study. In multivariate logistic models, a lifetime history of thought insertion/control ideation (OR, 11.6; 95% CI, 1.8-75.2), antisocial personality disorder (OR, 3.3; 95% CI, 1.2-8.9), and disciplinary action related to possession of controlled substances or contraband (OR, 4.9; 95% CI, 1.9-12.3) were associated with increased risk for violent or disruptive behavior while in prison, whereas lifetime phobic symptoms (OR, 0.2; 95% CI, 0.1-0.54) and high school graduation (OR, 0.4; 95% CI, 0.2-1.0) were associated with a decreased risk of violence and disruptive behavior in general. We conclude that, among inmates in substance abuse treatment, symptoms that increase risk for violence or disruptive behavior include thought control/insertion ideation and disciplinary infractions related to controlled substances, contraband, or failure to participate in assigned programs, as well a history of antisocial personality disorder.

Frisman L; Prendergast M; Lin HJ; Rodis E; Greenwell L. Applying classification and regression tree analysis to identify prisoners with high HIV risk behaviors. Journal of Psychoactive Drugs 40(4): 447-458, 2008. (47 refs.)

Among prisoners, past research has associated several factors with HIV risk behaviors, including illicit drug use, engaging in sex trade, older age (for drug-related risk), younger age (for sex-related risk), low education, low income, type of offense, history of abuse, mental health disorders. vulnerability and low self-perceived efficacy. This study employs data collected through the Transitional Case Management study of the Criminal Justice Drug Abuse Treatment Studies collaborative to analyze characteristics of prisoners who engaged in high-risk behaviors prior to incarceration. For the first 787 participants of this study, we employed recursive partitioning techniques to better identify groups at varying levels of HIV risk behaviors. Those more likely to engage in risky needle use were White and either unemployed and less likely to justify their behavior, or employed with poor decision making capacity. Risky sexual behavior was associated with a general tendency toward risk-taking or a history of unstable housing. Those engaging in any type of HIV risk behavior were risk-takers in general and were aged 25 to 47 with a history of unstable housing. Recursive partitioning, a technique seldom used previously, offers a useful method for identifying subpopulations at elevated risk for HIV risk behaviors.

Gordon MS; Kinlock TW; Schwartz RP; O'Grady KE. A randomized clinical trial of methadone maintenance for prisoners: Findings at 6 months post-release. Addiction 103(8): 1333-1342, 2008. (57 refs.)

Aims: This study examined the effectiveness of methadone maintenance initiated prior to or just after release from prison at 6 months post-release. Design: A three-group randomized controlled trial was conducted between September 2003 and June 2005. Setting A Baltimore pre-release prison. Participants Two hundred and eleven adult pre-release inmates who were heroin-dependent during the year prior to incarceration. Intervention Participants were assigned randomly to the following: counseling only: counseling in prison, with passive referral to treatment upon release (n = 70); counseling + transfer: counseling in prison with transfer to methadone maintenance treatment upon release (n = 70); and counseling + methadone: methadone maintenance and counseling in prison, continued in a community-based methadone maintenance program upon release (n = 71). Measurements: Addiction Severity Index at study entry and follow-up. Additional assessments at 6 months post-release were treatment record review; urine drug testing for opioids, cocaine and other illicit drugs. Findings Counseling + methadone participants were significantly more likely than both counseling only and counseling + transfer participants to be retained in drug abuse treatment (P = 0.0001) and significantly less likely to have an opioid-positive urine specimen compared to counseling only (P = 0.002). Furthermore, counseling + methadone participants reported significantly fewer days of involvement in self-reported heroin use and criminal activity than counseling only participants. Conclusions: Methadone maintenance, initiated prior to or immediately after release from prison, increases treatment entry and reduces heroin use at 6 months post-release compared to counseling only. This intervention may be able to fill an urgent treatment need for prisoners with heroin addiction histories.

Greenberg GA; Rosenheck RA. Jail incarceration, homelessness, and mental health: A national study. Psychiatric Services 59(2): 170-177, 2008. (43 refs.)

Objective: This study sought to investigate the rates and correlates of homelessness, especially mental illness, among adult jail inmates. Methods: Data from a national survey of jail inmates (N= 6,953) were used to compare the proportion of jail inmates who had been homeless in the previous year with the proportion of persons in the general population who had been homeless in the previous year, after standardization to the age, race and ethnicity, and gender distribution of the jail sample. Logistic regression was then used to examine the extent to which homelessness among jail inmates was associated with factors such as symptoms or treatment of mental illness, previous criminal justice involvement, specific recent crimes, and demographic characteristics. Results: Inmates who had been homeless (that is, those who reported an episode of homelessness anytime in the year before incarceration) made up 15.3% of the U. S. jail population, or 7.5 to 11.3 times the standardized estimate of 1.36% to 2.03% in the general U. S. adult population. In comparison with other inmates, those who had been homeless were more likely to be currently incarcerated for a property crime, but they were also more likely to have past criminal justice system involvement for both nonviolent and violent offenses, to have mental health and substance abuse problems, to be less educated, and to be unemployed. Conclusions: Recent homelessness was 7.5 to 11.3 times more common among jail inmates than in the general population. Homelessness and incarceration appear to increase the risk of each other, and these factors seem to be mediated by mental illness and substance abuse, as well as by disadvantageous sociodemographic characteristics.

Grella CE; Greenwell L; Prendergast M; Sacks S; Melnick G. Diagnostic profiles of offenders in substance abuse treatment programs. Behavioral Sciences and the Law 26(4): 369-388, 2008. (46 refs.)

This study examined the association of Axis I and Axis II disorders among offenders who were in prison-based substance abuse treatment in a national multi-site study. Participants (N = 280) received a psychosocial assessment and a structured diagnostic interview in two separate sessions. Logistic regression models examined the association between lifetime mood and anxiety disorders with two personality disorders, and the relationship of Axis I and A-xis II disorders (alone and in combination) to pretreatment psychosocial functioning. Over two-thirds of the sample met criteria for at least one mental disorder. Borderline personality disorder was strongly associated with having a lifetime mood disorder (odds ratio = 7.5) or lifetime anxiety disorder (odds ratio - 8.7). Individuals with only an Axis 11 disorder, or who had both Axis I and A,xis 11 disorders, had more severe problems in psychosocial functioning than those without any disorder. Clinical treatment approaches need to address this heterogeneity in diagnostic profiles, symptom severity, and psychosocial functioning.

Hiller ML; Narevic E; Webster JM; Rosen P; Staton M; Leukefeld C et al. Problem severity and motivation for treatment in incarcerated substance abusers. Substance Use & Misuse 44(1): 28-41, 2009. (35 refs.)

Studies of community-based treatment programs for substance users document that motivation for treatment is a consistent predictor of clients remaining under treatment for a longer period of time. Recent research has replicated this in prison-based treatment programs, implying that motivation is clinically important regardless of setting. The current study examines predictors of treatment motivation using data collected from 661 male drug-involved inmates during in-depth interviews that include components of the Addiction Severity Index, TCU Motivation Scale, and the Heath Services Research Instrument. Findings showed treatment motivation can be measured effectively in prison-based settings. Motivation scores were not significantly different between individuals in a prison-based treatment program and those in the general prison population. Furthermore, higher motivation for treatment scores were associated with greater levels of problem severity, suggesting that individuals with more drug-use related life problems may recognize this need and desire help for beginning long-term recovery.

Howard MO; Balster RL; Cottler LB; Wu LT; Vaughn MG. Inhalant use among incarcerated adolescents in the United States: Prevalence, characteristics, and correlates of use. Drug and Alcohol Dependence 93(3): 197-209, 2008. (31 refs.)

Objective: To characterize patterns and correlates of inhalant use among incarcerated youth. Method: Residents (N=723) of 27 Missouri Division of Youth Services facilities completed interviews assessing substance use, psychiatric symptoms, antisocial traits, trauma, suicidality, and criminality. Results: Participants averaged 15.5 (S.D. = 1.2) years of age, wereethnically diverse, and predominantly male. More than one-third (36.9%) reported lifetime inhalant use; 47.9% of users had tried four or more inhalant products. Comparatively high rates of use were observed for Hispanic and small town/rural youth. Commonly abused agents included gasoline (22%), permanent markers (15%), computer "air duster," (15%) and spray paint (12%). Inhalant users evidenced significantly higher levels of criminal behavior, antisocial attitudes, current psychiatric symptoms, earlier onset of offending and substance use, and more extensive histories of head injury, kidney disease, hormonal problems, mental illness, suicidality, trauma, and SUbstance-related problems than nonusers. In multiple logistic regression models, race/ethnicity, geographic area of residence, fearlessness, suicidality, and polydrug use distinguished inhalant users and nonusers. Measures of cognitive impairment, impulsivity, fearlessness, blame externalization, polydrug use, and substance-related problems were positively associated with lifetime frequency of inhalant use. Conclusions: Inhalant use was widespread in this sample and associated with serious physical and mental health impairments.

Karnik NS; Soller M; Redlich A; Silverman M; Kraemer HC; Haapanen R et al. Prevalence of and gender differences in psychiatric disorders among juvenile delinquents incarcerated for nine months. Psychiatric Services 60(6): 838-841, 2009. (15 refs.)

Objective: This study examined prevalence rates of psychiatric disorders among young offenders after they were incarcerated for nine months. Methods: A total of 790 youths were surveyed, including a significant proportion of females (N=140, 18%), nine months after incarceration. The Structured Clinical Interview for DSM-IV with portions of the Diagnostic Interview for Children and Adolescents and the Structured Interview for DSM-IV Personality were used. Results: Even when conduct disorder and oppositional defiant disorder were excluded, 88% of males and 92% of females had a psychiatric disorder (including substance use disorder); more than 80% of offenders met criteria for some type of substance use disorder. Gender differences were found for anxiety disorders (males 26%, females 55%, p<.01), marijuana dependence (males 32%, females 24%, p=.04), marijuana abuse (males 19%, females 11%, p=.04), and stimulant dependence (males 25%, females 44%, p<.01). Conclusions: Despite nine months of incarceration, young offenders continued to show high levels of psychiatric and substance use disorders.

Kauffman RM; Ferketich AK; Wewers ME. Tobacco policy in American prisons, 2007. Tobacco Control 17(5): 357-360, 2008. (27 refs.)

Objective: To examine current tobacco policy in US prisons and explore changes in prison tobacco policies over time. Data source: Telephone survey of the 52 US departments of correction. Main outcome measures: Current tobacco policy; distribution of free tobacco; availability of smoking cessation programming and cessation aids. Participants: Complete responses were received from 51 of 52 (98%) departments, while one provided partial information. Results: The majority of correctional systems (60%) reported total tobacco bans on prison grounds, with most remaining facilities (27%) having an indoor ban on tobacco use. No prisons distributed free tobacco. No major violence was reported relating to the implementation of stricter tobacco policies; however many respondents noted that tobacco became a major contraband item following the implementation of a total ban. While most prison systems with an indoor tobacco ban (86%) reported having tobacco cessation programmes, few of those with total bans (39%) continued such programmes after the initial transition period. Conclusion: Total tobacco bans have often been accompanied by the termination of tobacco cessation programmes. Such actions undermine efforts to promote long-term cessation resulting in a missed public health opportunity.

Kenny DT; Schreiner I. Predictors of high-risk alcohol consumption in young offenders on community orders: Policy and treatment implications. Psychology, Public Policy and Law 51(1): 54-79, 2009. (83 refs.)

The present study examined the relationship between a set of individual and contextual variables and high-risk alcohol use among young offenders placed on community orders in New South Wales, Australia. Participants (n = 777) were compared on a set of factors known to be strong predictors of high-risk alcohol use among adolescents. The authors assessed the strength of the relationship between gender, age, ethnicity, geographical region of residence, school attendance, father absence, history of childhood trauma, and the presence of severe conduct disorder on weekly levels of alcohol use. Living in rural locations, not currently attending school, being female, and not having been raised with a biological father present were associated with significantly increased odds of alcohol abuse. Father absence was a more important risk factor for rural young offenders, but school dropout was associated with more hazardous drinking among young offenders in urban areas. Accordingly, the authors suggest family-focused intervention programs for young offenders living in rural areas and school-based programs for vulnerable young people living in urban areas, although programs should consider including both factors for both groups if feasible and warranted.

Kerridge BT. A comparison of U.S. jail inmates and the U.S. general population with Diagnostic and Statistical Manual of Mental Disorders IV alcohol use disorders: Sociodemographic and symptom profiles. Alcohol 42(1): 55-60, 2008. (34 refs.)

The objective of this study was to compare sociodemographic and symptom profiles between U.S. jail inmates and the U.S. general population with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) alcohol use disorder. Data for the study were derived from two large nationally representative surveys, the 2002 Survey of Inmates in Local Jails and the 2001e2002 National Epidemiologic Survey on Alcohol and Related Conditions. U.S. inmates were significantly more likely (P!.007) to be younger, male, Black or Hispanic, to have lower education, and to be separated/divorced/widowed or never married relative to their U.S. general population counterparts.Inmates were also more likely to have more severe alcohol abuse and dependence. Implications of this study are discussed in terms of meeting the unique alcohol treatment needs of U.S. jail inmates including implementation of more intensive alcohol treatment and intervention programs targeting specific needs of inmates with alcohol use disorder as revealed from unique sociodemographic profiles.

Kerridge BT. Sociological, social psychological, and psychopathological correlates of substance use disorders in the US jail population. International Journal of Offender Therapy and Comparative Criminology 53(2): 168-190, 2009. (58 refs.)

The objective of this study was to examine sociological, social psychological, and psychopathological correlates of substance abuse disorders in a nationally representative sample of jail inmates. Criminal history and clinical factors most strongly differentiated convicted inmates with and without substance use disorders regardless of current index offense. Policy implications are discussed in terms of targeting antisocial attitudes and peer associations and more effective clinical treatments for substance use disorders among the inmate population. High rates of co-occurring depression symptoms and anger dyscontrol found among inmates with substance use disorders in this study underscore the need for assessment and evaluation of specialized programs for co-occurring disorders and anger management programs among U. S. inmates.

Kinlock TW; Gordon MS; Schwartz RP; O'Grady KE. A study of methadone maintenance for male prisoners. Criminal Justice and Behavior 35(1): 34-47, 2008. (54 refs.)

This study examined benefits of methadone maintenance among prerelease prison inmates. Incarcerated males with preincarceration heroin dependence (n = 197) were randomly assigned to (a) group educational counseling (counseling only); (b) counseling, with opportunity to begin methadone maintenance on release (counseling + transfer); or (c) counseling and methadone maintenance in prison, with opportunity to continue methadone maintenance on release (counseling + methadone). At 90-day follow-up, counseling + methadone participants were significantly more likely than counseling-only and counseling + transfer participants to attend drug treatment (p = .0001) and less likely to be reincarcerated (p = .019). Counseling + methadone and counseling + transfer participants were significantly less likely (all ps < .05) to report heroin use, cocaine use, and criminal involvement than counseling-only participants. Follow-up is needed to determine whether these findings hold over a longer period.

Knudsen HK; Leukefeld C; Havens JR; Duvall JL; Oser CB et al. Partner relationships and HIV risk behaviors among women offenders. Journal of Psychoactive Drugs 40(4): 471-481, 2008. (52 refs.)

The HIV infection rate is increasing among women in general and for female inmates specifically (Maruschak 2004), which makes understanding the correlates of risky sexual behaviors critical for this population, Partner relationships, particularly the extent to which women perceive they have power within the relationship, may be important in modeling risk behaviors. Few studies have considered the association between relationship power and HIV risk behaviors among women offenders. This study examines women's perceptions of their relationships using the Sexual Relationship Power Scale (Pulerwitz, Gortmaker, & DeJong 2000) and NIDA's HIV Risk Behavior Assessment (NIDA 1995). Data were collected from female inmates in four prisons as part of the Reducing Risky Relationships for HIV protocol being conducted through the NIDA's Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) cooperative agreement. Women reported whether they had engaged in five types of unprotected sex in the month prior to incarceration. Logistic regression models of the associations between relationship power and five types of unprotected sex revealed some support for the importance of power as a protective factor in reducing the odds of unprotected sexual behaviors. Implications and findings are presented to add to understanding of partner relationship, and HIV risk behaviors.

Ko NY; Hsu ST; Chen CH; Tsai CY; Chu PJ; Huang CJ et al. A pilot study of HIV education on readiness to change on substance use, AIDS knowledge, self-efficacy for risk reduction among male drug-dependent inmates. Substance Use & Misuse 44(3): 322-331, 2009. (25 refs.)

Taiwan is experiencing an outbreak of human immunodeficiency virus infection among injection drug users. The purpose of the study was to determine the impact of a Transtheoretical Model-based HIV education program among drug-dependent inmates. A single group pre/post design was used to evaluate shortened impacts among 136 inmates who were arrested for illicit drug use and had attended a brief HIV education program in 2005. A repeated-measures analysis of variance indicated positive changes in AIDS knowledge (F = 104.16, p 0.001), self-efficacy to reduce HIV-risk behaviors (F = 26.5, p 0.001), and readiness of change on substance use (F = 4.83, p = 0.03). The study findings showed that a brief TTM-based HIV education program can be effective for drug-dependent inmates.

Kugu N; Akyuz G; Dogan O. Psychiatric morbidity in murder and attempted murder crime convicts: A Turkey study. Forensic Science International 175(2-3): 107-112, 2008. (43 refs.)

In the present, the morbidity of psychiatric disorders of homicide/attempted homicide crime convicts imprisoned in Turkey, Sivas maximum security prison was investigated. Seventy imprisoned homicide/attempted homicide crime convicts included in this study. Sociodemographic information form, structured clinical interview for DSM-IV Axis-I disorders and structured clinical interview for DSM-III-R personality disorders applied to the participants. Most commonly diagnosed disorders among those convicts were current Axis-I disorders, depressive disorders (7.1%) and anxiety disorders (5.7%). Among Axis-I disorders, the most diagnosed one was the substance use disorders (45.7%). The most diagnosed Axis-II disorder was found as to be antisocial personality disorder (48.6%). The rate of convicts who were diagnosed as having both Axis-I and Axis-II disorders was 51.4%. The most prevalently accompanying lifetime Axis-I disorders to antisocial personality disorder with respect to Axis-I, and Axis-II comorbidity was substance use disorders. As a result, it was thought that the substance use disorders and antisocial personality disorder among the homicide/attempted homicide crime convicts were the most prevalent lifetime psychiatric disorders.

Larney S; Dolan K. A literature review of international implementation of opioid substitution treatment in prisons: Equivalence of care? (review). European Addiction Research 15(2): 107-112, 2009. (52 refs.)

Background/Aims: Opioid substitution treatment (OST) is an effective treatment for heroin dependence. The World Health Organization has recommended that OST be implemented in prisons because of its role in reducing drug injection and associated problems such as HIV transmission. The aim of this paper was to examine the extent to which OST has been implemented in prisons internationally. Methods: Literature review. Results: As of January 2008, OST had been implemented in prisons in at least 29 countries or territories. For 20 of those countries, the proportion of all prisoners in OST could be calculated, with results ranging from less than 1% to over 14%. At least 37 countries offer OST in community settings, but not prisons. Conclusion: This study has identified an increase in the international implementation of OST in prisons. However, there remain large numbers of prisoners who are unable to access OST, even in countries that provide such programs. This raises issues of equivalence of care for prisoners and HIV prevention in prisons.

Lukasiewicz M; Blecha L; Falissard B; Neveu X; Benyamina A; Reynaud M et al. Dual diagnosis: Prevalence, risk factors, and relationship with suicide risk in a nationwide sample of French prisoners. Alcoholism: Clinical and Experimental Research 33(1): 160-168, 2009. (41 refs.)

Axis I psychiatric disorders (PD) and substance use disorders (SUD) are common in prison, but only few studies have focused on their association in this setting. Dual diagnosis (DD) (the co-occurrence of a SUD and any axis I disorder) is known to have a poorer prognosis and to require more intense supportive care. The objectives of this study were (1) to describe prisoners with DD (prevalence and characteristics); (2) to compare DD prisoners with 3 other groups of prisoners: no diagnosis (ND), SUD alone, or other isolated PD; and (3) to evaluate the impact of DD on suicide risk in prison. A random stratified strategy was used to select 23 various types of prisons and 998 prisoners. Diagnoses were assessed using a unique procedure, each prisoner being evaluated by 2 psychiatrists, 1 junior, using a structured interview (MINI 5 plus), and 1 senior, using an open clinical interview. Following interviews, clinicians met to establish a list of diagnoses. Cloninger's temperament and character inventory was also used. Of the prisoners, 26.3% had a DD. DD prevalence was almost 80% in prisoners with SUD, while only one-third of the prisoners with an axis I PD had co-morbid SUD. No significant differences were observed in drug use patterns between DD and SUD without co-morbid PDs. DD showed the strongest association with suicide risk [OR = 5.7 (1.7-4.6)]. DD is very frequent in prison and is a major risk factor for suicide. Systematic psychiatric/SUD screening of prisoners with either a SUD or an axis I PD should be encouraged.

Lukasiewicz M; Neveu X; Blecha L; Falissard B; Reynaud M; Gasquet I. Pathways to substance-related disorder: A structural model approach exploring the influence of temperament, character, and childhood adversity in a national cohort of prisoners. Alcohol and Alcoholism 43(3): 287-295, 2008. (43 refs.)

Aims: Using Cloninger's model of personality, we aimed to specify the relative influence of the more biologically determined variables, temperament and character and more environmentally driven influence, childhood adversity in the development of addiction; and to compare patterns found among alcoholics with those found among drug addicts. Methods: We studied a group of prisoners, at a high risk of substance abuse and past history of childhood adversity. Using a stratified random strategy we selected (i) 23 prisons among the different types of prison in France, (ii) 998 prisoners. Each prisoner was assessed by two psychiatrists-one junior, using a structured interview (MINI 5 plus), and one senior, completing the procedure with an open clinical interview. At the end of the interview the clinicians met and agreed on a list of diagnoses. Cloninger's Temperament and Character Inventory was used to measure personality. Structural equations models, which have been advocated to disentangle the respective influence of complex risk factors, were used. Results: the "novelty seeking" temperament was a crucial vulnerability factor, for both alcoholics and drug addicts, in the same proportion. Character and childhood adversity played a significant part only in the development of drug abuse. Conclusions: In a prison population, a common biological loaded factor, novelty seeking is found both at the core of alcohol- and drug-related disorder whereas environmentally loaded factors play a greater role in drug problems.

McGovern B. A golden opportunity: The treatment of hepatitis C in HIV-infected inmates. Journal of Addictive Diseases 27(2): 69-73, 2008. (20 refs.)

Encouraging results have been demonstrated in large clinical trials in HIV-infected patients taking pegylated interferon and ribavirin for the treatment of hepatitis C virus (HCV) infection. However, only a minority of patients are being treated in the community. Medical providers cite chaotic lifestyles, unstable living situations, and ongoing substance abuse as barriers to these complicated therapies. The stable environment of the correctional system affords a path for intensive education, screening, and treatment of these hard-to-reach patients. Since HIV/HCV coinfected patients are at risk for cirrhosis, end-stage live disease, and hepatocellular carcinoma, incarceration should be viewed as a golden opportunity for important medical interventions.

McMillan GP; Lapham S; Lackey M. The effect of a jail methadone maintenance therapy (MMT) program on inmate recidivism. Addiction 103(12): 2017-2023, 2008. (21 refs.)

To evaluate the effects of a jail-based continuation of methadone maintenance therapy (MMT) on subsequent inmate recidivism risks. Prospective, longitudinal, observational study. A large, Southwestern United States jail that continues MMT for heroin-addicted inmates on MMT at the time of booking. A total of 589 inmates booked between 22 November 2005 (the start date for the MMT program) and 31 October 2006. The outcome measure was time from release to subsequent re-booking in the jail. Predictors included binary dosing with methadone in the jail, final dose received (mg), age, gender, race/ethnicity, previous bookings and days in jail. Random effects Weibull proportional hazards models were fit to the recidivism times to estimate the impact of treatment with MMT in the jail on re-booking risks. There was no statistically significant effect of receiving methadone in the jail or dosage on subsequent recidivism risks (hazard ratio = 1.16; 95% confidence interval = 0.8-1.68). Offering jail-based MMT does not increase recidivism risks by eliminating the deterrent effect of imposed withdrawal, nor does it reduce recidivism in this high-risk population.

Michel L; Carrieri M; Wodak A. Harm reduction and equity of access to care for French prisoners: A review. Harm Reduction Journal 5(1): e-article 17, 2008. (70 refs.)

Background: Despite France being regarded as a model of efficient harm reduction policy and equity of access to care in the general community, the health of French inmates is a critical issue, as harm reduction measures are either inaccessible or only partially implemented in French prisons. Method: Using specific inclusion and exclusion criteria, information was collected and analyzed about HIV, HBV and HCV prevalence, risk practices, mortality, access to harm reduction measures and care for French prison inmates. Results: Data about the occurrence of bloodborne diseases, drug use and access to care in prisons remain limited and need urgent updating. Needle exchange programs are not yet available in French prisons and harm reduction interventions and access to OST remain limited or are heterogeneous across prisons. The continuity of care at prison entry and after release remains problematic and should be among the primary public health priorities for French prisoners. Conclusion: Preventive and harm reduction measures should be urgently introduced at least as pilot programs. The implementation of such measures, not yet available in French prisons, is not only a human right for prison inmates but can also provide important public health benefits for the general population.

Milloy MJ; Wood E; Small W; Tyndall M; Lai C; Montaner J et al. Incarceration experiences in a cohort of active injection drug users. Drug and Alcohol Review 27(6): 693-699, 2008. (61 refs.)

Background. Incarceration has been associated with a number of health-related harms among injection drug users (IDU). However, little is known about the prevalence and correlates of incarceration among community-based samples of IDU. Methods. We examined the prevalence and correlates of recent incarceration among IDU in the Scientific Evaluation of Supervised Injecting (SEOSI) cohort examined between 1 July 2004 and 30 June 2006 using generalised estimating equations (GEE). Results. A total of 902 individuals were included in the analysis, of whom 255 (28.72%) were female and 536 (59.42%) reported a history of incarceration. In a multivariate GEE model, recent incarceration was associated positively and independently with a number of high-risk drug using behaviours, including syringe sharing. Conclusions. An alarmingly high proportion of active IDU reported recent incarceration and injecting while incarcerated. Recent incarceration was associated independently with syringe sharing. These findings add further evidence to repeated demands for an expansion of appropriate harm-reduction measures in Canada's prisons.

Milloy MJS; Buxton J; Wood E; Li K; Montaner JSG; Kerr T. Elevated HIV risk behaviour among recently incarcerated injection drug users in a Canadian setting: A longitudinal analysis. BMC Public Health 9: article 156, 2009. (50 refs.)

Background: While incarceration has consistently been associated with a higher risk of HIV infection for individuals who use injection drugs (IDU), the effect of incarceration on the post-release risk environment remains poorly described. We sought to assess the impact of incarceration on risk factors for HIV infection after release from prison in a sample of active IDU in Vancouver, Canada. Methods: Using a prospective cohort of community-recruited IDU followed from May 1, 1996 to November 30, 2005, we examined contingency tables and performed linear growth curve analyses to assess changes in the prevalence of independent risk factors for HIV infection from before to after a period of incarceration among participants reporting incarceration and a matched control group. Results: Of the 1603 participants followed-up over the study period, 147 (9.2%) were eligible for an analysis of post-incarceration risk behaviours and 742 (46.3%) were used as matched controls. Significant differences were found in one or both groups for the prevalence of frequent cocaine injection, requiring help injecting, binge drug use, residence in the HIV outbreak epicentre, sex-trade participation and syringe sharing (all p < 0.05) after incarceration. In linear growth curve adjusted for age, gender and ethnicity, syringe sharing was significantly more common in those recently released from prison (p = 0.03) than in the control group. Conclusion: In a sample of Canadian IDU, we did not observe any effect of incarceration on the prevalence of several behaviours that are risk factors for HIV infection, including intensity of drug use or participation in the sex trade. However, those recently released from prison were more likely to report syringe sharing that those in a matched control group.

Mitchell SG; Kelly SM; Brown BS; Reisinger HS; Peterson JA; Ruhf A et al. Incarceration and opioid withdrawal: The experiences of methadone patients and out-of-treatment heroin users. Journal of Psychoactive Drugs 41(2): 145-152, 2009. (43 refs.)

Both heroin-addicted individuals and methadone maintenance patients are likely to face untreated opioid withdrawal while incarcerated. Limited research exists concerning the withdrawal experiences of addicted inmates and their impact on individuals' attitudes and plans concerning drug abuse treatment. In the present study, 53 opioid dependent adults (32 in methadone treatment and 2 1 out of treatment) were interviewed in an ethnographic investigation of withdrawal experiences during incarceration. When treatment for opioid withdrawal was unavailable, detoxification experiences were usually described as negative and were often associated with a variety of unhealthy behaviors designed to relieve withdrawal symptoms. Negative methadone withdrawal experiences also negatively influenced participants' receptivity to seeking methadone treatment upon release. A minority of participants took a positive view of their withdrawal experience and saw it its an opportunity to detox from heroin or discontinue methadone. Findings support the importance of providing appropriate opioid detoxification and/or maintenance therapy to opioid-dependent inmates.

Mooney JL; Minor KI; Wells JB; Leukefeld C; Oser CB; Tindall MS. The relationship of stress, impulsivity, and beliefs to drug use severity in a sample of women prison inmates. International Journal of Offender Therapy and Comparative Criminology 52(6): 686-697, 2008. (33 refs.)

There is a paucity of research examining substance abuse issues among women prisoners. This study explored relationships between perceived stress, impulsivity, and beliefs in the efficacy of drugs as these variables pertain to self-reported drug use severity. Women prisoners (N = 100) participated in structured face-to-face interviews based on established research instruments. Although there was no significant correlation between demographic characteristics and substance use severity, positive relationships were found between substance use severity, perceived stress, impulsivity, and beliefs. A multiple linear model was estimated regressing drug use severity on beliefs, impulsivity, and perceived stress. Only the measures of beliefs and impulsivity were significant correlates of drug use severity. Implications are discussed for prison substance abuse programming and future research.

Morris C; Moore E. An evaluation of group work as an intervention to reduce the impact of substance misuse for offender patients in a high security hospital. Journal of Forensic Psychiatry & Psychology 20(4): 559-576, 2009. (42 refs.)

Despite established epidemiological links between substance misuse, mental illness, and violent behaviour, the impact of interventions for offender patients is not well understood. The high security hospital is a unique environment which restricts access to substances while attempting to address substance misuse behaviours. In this study, 22 high secure patients with a history of substance misuse participated in a CBT group-work programme. They were assessed pre and post with the Stages of Change Readiness and Treatment Eagerness Scale, and the Psychological Inventory of Drug-Based Thinking Styles. A small number also engaged in a qualitative review of the impact of participation. Treatment had a positive significant effect on patients' perceptions and awareness of substance misuse behaviours and associated problems. Some patients reported particular benefits from engaging in psycho-drama relapse prevention skills training. One of the patients who refused the group subsequently tested positive for a urine drug screen test. Overall, results indicate some positive aspects of a substance misuse intervention with male high secure patients. However, acknowledged limitations highlight the need for further research to support these findings, to monitor the behaviours in high security of former substance misusers, and for maintenance/ongoing work for those transferred to conditions of lower security.

Niveau G; Ritter C. Route of administration of illicit drugs among remand prison entrants. European Addiction Research 14(2): 92-98, 2008. (30 refs.)

Aims: To describe the self-reported routes of administration of illicit drugs among subjects entering a remand prison and the different drugs used by this population. Methods: A cross-sectional study, with a sample of 770 subjects, was conducted in Geneva ( Switzerland). Participants were assessed with the semi-structured interview from the Council of Europe Pompidou Group multi-city study. Results: 428 (55.6%) subjects admitted to having used illicit drugs during the 3 months prior to entry. Amongst these illicit drug users, 54.7% took several drugs. Injectable drugs ( heroin, cocaine or illicit benzodiazepines) were taken by 75.7% of drug users but the majority (84.1%) declared that they had not injected drugs during the 3 months prior to entering prison. 68 subjects (8.8% of the total sample) declared that they had injected drugs during the 3 months prior to entering prison, either alone or in association with other methods. Conclusion: By extrapolation it is possible to suggest that about 200 intravenous drug users entered the remand prison in Geneva in 1 year. This confirms the need for prison health services to implement a policy of treatment, prevention and education adapted to patterns of drug use in the local context.

O'Brien CP. Modern treatment for prisoners. (editorial). Addiction 103(8): 1343-1343, 2008. (1 refs.)

Office of National Drug Control Policy. Who's Really in Prison for Marijuana?. Washington DC: Office of National Drug Control Policy, undated. (66 refs.)

This government document, directed to the general public, is intended to counter claims of "marijuana legalizers [who] claim that thousands of people are imprisoned for marijuana 'possession' ... whose crime was simply having in their possession a little bit of dope." Rather the document states that in reality those "technically serving time for marijuana possession were actually sent to prison on much more serious charges." In reality it is said, "The [those imprisoned] are criminals who have been found guilty of trafficking, manufacturing, selling or distributing the drug, or who were convicted of multiple offenses that happened to include a marijuana charge." The document discusses both state and federal laws and endeavors to clarify sources of misunderstandings, e.g. by clarifying distinctions between jails and prisons, or possession versus trafficking, the roll of plea bargains in distorting data. Tables are included with data on prison populations and marijuana offenders sentenced in federal courts. Several illustrative cases are included.

Orsi MM; Brochu S. The place of syringe exchange programs among harm reduction strategies in Canadian penitentiaries. Canadian Journal of Public Health 100(1): 29-31, 2009. (20 refs.)

The prevalence rates of illicit drug consumption within the prison system are much higher than those in the Canadian population in general. Of the substances used in detention, those of most concern to prison and public health authorities are injection drugs, as the sharing of injection drug equipment may be responsible for the high prevalence of bloodborne diseases in prison facilities. Faced with this situation, the Correctional Service of Canada put in practice a number of harm reduction strategies targeting injection drug users, such as methadone maintenance programs and access to bleach. However, despite their use in the community, needle-exchange programs are not yet allowed in penitentiaries. This article analyzes the limits of harm reduction strategies approved by the prison authorities and discusses the sources of resistance that continue to impede the realization of a pilot project to assess the feasibility of needle-exchange programs in detention in Canada.

Oser C; Havens J; Staton-Tindall M; Wong C; Leukefeld C; Prendergast M. HIV sexual risk behaviors among ketamine and non-ketamine using criminal offenders prior to prison entry. Addiction Research & Theory 16(3): 289-302, 2008. (52 refs.)

This study is the first to examine ketamine use and its association with HIV sexual risk behaviors among a criminal offending population in the United States. Data were collected from 716 inmates as part of the Transitional Case Management (TCM) protocol within the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) cooperative agreement. Bivariate analyses were used to identify differences between ketamine users (n=44) and nonketamine users (n=672). Three Poisson regression models were used to identify the significant correlates of high risk sexual behaviors in the 30 days prior to incarceration-(1) number of times had unprotected sex while high, (2) number of times had unprotected vaginal sex, and (3) number of times had unprotected anal sex. Results indicate that ketamine was a significant correlate in all of the Poisson regression models. Findings add to the literature and indicate that ketamine use may be a marker for engaging in HIV risk behaviors among criminal offenders.

Oser C; Knudsen H; Staton-Tindall M; Leukefeld C. The adoption of wraparound services among substance abuse treatment organizations serving criminal offenders: The role of a women-specific program. Drug and Alcohol Dependence 103(Supplement 1): S82-S90, 2009. (74 refs.)

Women's substance abuse treatment outcomes are improved when women-specific needs are addressed through wraparound services, such as the provision of child care, employment assistance, or mental health counseling. Despite a higher prevalence of pre-incarceration drug use, women in prison report receiving fewer services than their male counterparts, suggesting they likely have greater service needs upon release. It is unknown whether community-based treatment organizations with a women-specific program offer more wraparound services than programs without a focus on women. This study uses data from the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) research cooperative's National Criminal Justice Treatment Practices Survey (NCJTPS), a nationally representative sample of community-based treatment programs serving predominantly criminal offenders (n = 217). First, bivariate analyses identified differences between organizations with and without a women-specific program on the number of wraparound services adopted as well as organizational-level characteristics (i.e., organizational structure, personnel characteristics, culture, sources of information, and systems integration) related to their adoption. Second, Poisson regression was used to identify the organizational characteristics associated with the number of adopted wraparound services, with having a women-specific program being the primary covariate of interest. Results indicate larger organizations that utilized a greater number of treatment approaches and believed that treatment could reduce crime were more likely to offer a greater assortment of wraparound services. In an effort to improve behavioral treatment outcomes, it is imperative to examine organizational level contextual factors that shape the availability of wraparound services for female offenders in community-based substance abuse treatment settings.

Oser CB; Havens JR; Mooney JL; Staton-Tindall M; Knudsen HK; Duvall JL et al. Racial differences in HIV/AIDS discussion strategies and sexual risk behaviors among drug-abusing female criminal offenders. Journal of Psychoactive Drugs 40(4): 483-492, 2008. (52 refs.)

African-American female inmates are disproportionately affected by the human immunodeficiency virus (HIV), with heterosexual contact as the primary mode of transmission. This could be the result of racial differences in the strategies used by women to persuade a potential sexual partner to discuss HIV/AIDS and engage in condom use. Data were collected from 336 female inmates as part of the Reducing Risky Relationships for HIV (RRR-HIV) protocol within the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) cooperative agreement. Bivariate analyses indicated that African-American drug-using women were more likely than Whites to use the rational, withdrawal, and persistence approaches to discuss HIV/AIDS with a sexual partner. Negative binomial regression models were used to identify which interpersonal discussion strategies were significant correlates of the number of the times White and African-American participants had unprotected vaginal sex in the 30 days before incarceration. Results from the multivariate model indicate that White women who are more likely to use the rational discussion strategy were 15% less likely to engage in unprotected vaginal sex: however. these findings were not replicated in the African-American sample. Findings add to the literature on racial differences in HIV/AIDS discussion strategies and sexual risk behaviors among drug-abusing female criminal offenders.

Pearson FS; Cleland CM; Chaple M; Hamilton Z; Prendergast ML; Rich JD. Substance use, mental health problems, and behavior at risk for HIV: Evidence from CJDATS. Journal of Psychoactive Drugs 40(4): 459-469, 2008. (79 refs.)

This study examined the relationships between substance abuse, mental health problems and HIV risk behavior in offenders discharged from prison and referred to Substance abuse treatment programs. Data from 34 sites (n = 1,358) in a federally-funded cooperative agreement. the Criminal Justice Drug Abuse Treatment Studies (CJDATS). were analyzed. Among parolees referred to substance abuse treatment, self reports for the six-month period before the arrest resulting in their incarceration revealed frequent problems with both substance use and mental health. HIV risk behavior was operationalized as either (a) unsafe injection drug use, e.g.. sharing needles and/or sharing injection equipment, or (b) unsafe sex, e.g., sex without it condom. The findings were that (1) unsafe injection drug use was associated with unsafe sex and vice versa, (2) unsafe sex behavior was related to frequency of drug use. and (3) unsafe sex behavior was related to frequency of alcohol use. In these samples, mental health problems did not have it significant effect on risk behavior, controlling for other variables. Future research should probe this "nonfinding" using standardized diagnostic and symptom measures to provide greater detail on the mental health problems (e.g., age of onset, frequency, and severity of the problem).

Piselli M; Elisei S; Murgia N; Quartesan R; Abram KM. Co-occurring psychiatric and substance use disorders among male detainees in Italy. (review). International Journal of Law and Psychiatry 32(2): 101-107, 2009. (103 refs.)

This paper presents data on the prevalence of co-occurring substance use and psychiatric disorders among newly imprisoned males in Italy Interviewers conducted semi-structured clinical interviews with n-302 male detainees seven days after their admission to the prison of Perugia from August 2005 through July 2006. Over half of male detainees (54.3%) had either a substance use disorder or another psychiatric disorder. One of every five detainees (20.9%) had comorbid substance use and psychiatric disorders. Compared to detainees with psychiatric disorder only, substance use disorder only. or no disorder, detainees with comorbid substance use and psychiatric disorders were significantly more likely to have severe impairment in the areas of employment, substance abuse, family and social functioning, and psychiatric symptoms. Findings underscore the need for careful diagnostic screening at intake, access to treatment during detention, and an effective transition to services at the time of release.

Plugge E; Yudkin P; Douglas N. Changes in women's use of illicit drugs following imprisonment. Addiction 104(2): 215-222, 2009. (44 refs.)

To provide data on changes in illegal drug use in women following imprisonment. Prospective cohort study. Recruitment took place in two prisons in the Midlands and South-East England and follow-up in 13 prisons across England. A total of 505 women prisoners participated, a response rate of 82%. Questions about drug use were contained within a questionnaire which examined broad aspects of health. On entry into prison, women answered questions about daily drug use and injecting drug use prior to imprisonment. One month later the questionnaires examined drug use during this period of imprisonment. Prior to imprisonment, 53% [95% confidence interval (CI): 49-58%] of women took at least one illegal drug daily and 38% (CI: 34-42%) said they had ever injected drugs. Following imprisonment, some women continued to use drugs; 14% (CI: 10-20%) of women reported using at least one illegal drug daily and 2% (CI: 0.7-5%) of women had injected drugs. There were important changes in the types of drugs used; there was a change in use from crack and heroin to benzodiazepines and opiate substitutes. Prior to imprisonment, women most commonly used crack and heroin, but in prison the two most commonly used illegal drugs were benzodiazepines and opiate substitutes. The study provides quantitative evidence of the impact of imprisonment on drug use among women. It highlights the need for enhanced drug treatment services and stronger measures to reduce the availability of illegal drugs to women in prison.

Proescholdbell SK; Foley KL; Johnson J; Malek SH. Indoor air quality in prisons before and after implementation of a smoking ban law. Tobacco Control 17(2): 123-127, 2008. (24 refs.)

Objective: To ascertain whether a new indoor smoking ban law in North Carolina correctional facilities was successfully implemented and whether the indoor air quality has improved as a result. Method: Before the law came into effect, we tested the air quality of 22 dormitory and common areas within six North Carolina prisons using standard protocols for testing particulate matter. We measured particulate matter 2.5 mu m in diameter ( PM2.5) using state of the art TSI SidePak monitors. After the law went into effect, the same locations within each prison were tested again. Written inmate surveys were also conducted at two prisons, one with partial smoking ban ( indoors only) and one with a total smoking ban ( indoors and outdoors). Results: The findings indicate that, on average, levels of respirable suspended particulates ( RSPs), an accepted marker for secondhand smoke ( SHS) levels, decreased 77% in these prisons after the law took effect compared to levels obtained before ban implementation. Several areas were tobacco-free before the implementation of this ban. In those areas no significant decreases in RSPs were noted. Conclusion: Laws banning tobacco use in correctional facilities can significantly reduce indoor SHS exposure among inmates, visitors and staff and potentially lead to reduced use. To date, 24 US states have enacted 100% smoke-free correctional facility polices for all indoor areas even though inmates and staff have much higher tobacco use prevalence rates than the general population. With an estimated nine million people incarcerated worldwide, prison smoking bans could have a substantial impact in terms of health outcomes and long-term costs if they can effectively reduce exposure to secondhand smoke.

Rhodes AG; Taxman FS; Friedmann PD; Cropsey KL. HCV in incarcerated populations: An analysis of gender and criminality on risk. Journal of Psychoactive Drugs 40(4): 493-501, 2008. (20 refs.)

While Studies have explored the prevalence and correlates for hepatitis C (HCV) infection in substance-using and incarcerated Populations these studies have not examined the attributes of criminal histories for those with HCV infection. This study examines the HCV infection rate as it relates to criminal risk factors using baseline data from a randomized trial of re-entering offenders and examines how these risk factors vary by gender. The HCV-positive population had a longer amount of time in confinement (105 vs. 61 months) than those who tested negative. HCV positive men were more likely to currently be receiving drug treatment than women. Criminal risk was positively associated with HCV infection white controlling for major risk factors (OR 1.25, 95% CI: 1.07, 1.46). suggesting that the relationship Was not Spurious. While criminologists tend to examine risk relative to public safety threats. it appears that the public health needs equally require attention. Policy issues are examined regarding how services can be delivered to treat those with HCV infections within the correctional system and address criminal risk factors.

Richmond R; Butler T; Wilhelm K; Wodak A; Cunningham M; Anderson I. Tobacco in prisons: A focus group study. Tobacco Control 18(3): 176-182, 2009. (46 refs.)

Objective: To examine the role of tobacco use in prison and possible influences of the prison environment on smoking among inmates in the context of developing inmate smoking cessation programmes. Method: Qualitative study based on seven focus groups with prisoners and ex-prisoners. Settings: A maximum security prison in rural New South Wales (NSW), Australia, and a community justice restorative centre and accommodation service for ex-prisoners in Sydney, NSW, Australia. Participants: 40 participants (28 men and 12 women) comprising nine prisoners (including four Indigenous inmates) and 31 ex-prisoners. Results: Prisoners reported that tobacco serves as a de facto currency in correctional settings and can be exchanged for goods, used to pay debts and for gambling. Smoking helps manage the stressful situations such as transfers, court appearances and prison visits. Inmate smoking cessation programmes need to address the enmeshment of tobacco in prison life, improve availability of pharmacotherapies (for example, nicotine patches, bupropion) and the quitline (a free telephone helpline providing information on stopping smoking), provide nonsmoking cells and areas within prisons, encourage physical activity for inmates and maintain monitoring of smoking cessation status after release. Conclusions: Tobacco is integrally bound up in the prison "culture". Our findings are relevant to inform prison health authorities concerned with improving the health of prisoners, and for support organisations attempting to facilitate smoking cessation both in prison and after release. Smoking cessation programmes in prisons should be tailored to the unique stresses of the prison environment. Programmes need to acknowledge the difficulties of quitting smoking in prison arising from the stresses posed by this setting.

Robbins CA; Martin SS; Surratt HL. Substance abuse treatment, anticipated maternal roles, and reentry success of drug-involved women prisoners. Crime & Delinquency 55(3): 388-411, 2009. (70 refs.)

This article reports analyses of recidivism and relapse experiences of substance-abusing women inmates as they reenter the community. Outcomes are compared for women who completed a work-release therapeutic community program, women who entered but did not complete the program, and those who did not receive work-release therapeutic community treatment. Additionally, this article compares women who anticipated living with their children following release to those who did not have children with whom they expected to live. Women who completed the treatment program were more likely to remain arrest-free during the first 18 months following prison, and they used drugs less frequently. Women who expected to live with their minor children were significantly more likely to enter the treatment program, but maternal role expectations had no direct effect on reentry outcomes once treatment experience and background factors were controlled.

Rosen DL; Schoenbach VJ; Wohl DA. All-cause and cause-specific mortality among men released from state prison, 1980-2005. American Journal of Public Health 98(12): 2278-2284, 2008. (36 refs.)

Objectives. We compared mortality of ex-prisoners and other state residents to identify unmet health care needs among former prisoners. Methods. We linked North Carolina prison records with state death records for 1980 to 2005 to estimate the number of overall and cause-specific deaths among male ex-prisoners aged 20 to 69 years and used standardized mortality ratios (SMRs) to compare these observed deaths with the number of expected deaths had they experienced the same age-, race-, and cause-specific death rates as other state residents. Results. All-cause mortality among White (SMR =2.08; 95% confidence interval [CI] 2.04, 2.13) and Black (SMR=1.03; 95% CI=1.01, 1.05) ex-prisoners was greater than for other male NC residents. Ex-prisoners' deaths from homicide, accidents, substance use, HIV, liver disease, and liver cancer were greater than the expected number of deaths estimated using death rates among other NC residents. Deaths from cardiovascular disease, lung cancer, respiratory diseases, and diabetes were at least 30% greater than expected for White ex-prisoners, but less than expected for Black ex-prisoners. Conclusions. Ex-prisoners experienced more deaths than would have been expected among other NC residents. Excess deaths from injuries and medical conditions common to prison populations highlight ex-prisoners' medical vulnerability and the need to improve correctional and community preventive health services.

Rowe CL; Wang W; Greenbaum P; Liddle HA. Predicting HIV/STD risk level and substance use disorders among incarcerated adolescents. Journal of Psychoactive Drugs 40(4): 503-512, 2008. (90 refs.)

Incarcerated adolescents are among the most vulnerable groups for STD infection, and substance abuse is prevalent in over half of this population. Substance abuse and HIV/STD-associated risk behaviors are closely linked among juvenile justice-involved youth, but it is unclear whether common antecedents explain these different problems. The current Study examined predictors of HIV/STD risk level and substance use disorders, and investigated whether family variables added unique predictive variance for these problems among incarcerated youth. The sample included 154 substance-involved youth ages 13 to 17 recruited in detention facilities in Miami and Tampa, FL and was primarily male (82%) and African-American (58%). Using a comprehensive assessment strategy with data obtained from youth report, parent report, and laboratory confirmed STD testing, the results show that delinquency is a consistent predictor of both HIV/STD risk level and substance use disorders, and also that substance use directly predicts HIV/STD risk level among incarcerated adolescents. Consistent with previous research, family conflict is an important predictor of substance use disorders even after controlling for other factors. The results suggest the need for integrated family-based interventions addressing delinquency, substance abuse, and HIV/STD-associated risk factors with juvenile justice-involved adolescents.

Rutherford M; Duggan S. Meeting complex health needs in prisons. Public Health 123(6): 415-418, 2009. (15 refs.)

The vast majority of prisoners have several health needs which combine at different levels of severity. This complexity of needs often amalgamates to include mental and physical illnesses, homelessness, unemployment, and drug and alcohol addictions. 'Complexity' can serve as an umbrella term for a number of health and social justice agendas, including public health, primary and secondary care, and social care, and must be fully understood to meet the 'complex needs imperative' that exists in all prisons.

Sacks JY; McKendrick K; Hamilton Z; Cleland CM; Pearson FS; Banks S. Treatment outcomes for female offenders: Relationship to number of axis I diagnoses. Behavioral Sciences and the Law 26(4): 413-434, 2008. (67 refs.)

This article describes a study that examined the relationship between multiple Axis I mental health diagnoses and treatment outcomes for female offenders in prison substance abuse treatment programs. Preliminary findings of the effectiveness of therapeutic community (TC) treatment, modified for female offenders, relative to a control cognitive behavioral treatment condition, are presented. The hypothesis-that participants who fit into multiple diagnostic categories have more dysfunctional symptoms and behaviors at baseline-was confirmed; however, a hypothesized relationship between the number of Axis I diagnoses and 6 month treatment outcomes across five domains (mental health, trauma exposure, substance use, HIV needle risk behaviors, and HIV sexual risk) was not supported. Across all Axis I mental health groups, TC treatment was significantly more effective than the control condition overall, as well as on measures of mental health symptoms and HIV sexual risk. These findings suggest that this TC treatment program, as modified, is an effective model for women with varied diagnoses and diagnostic complexities.

Sarchiapone M; Carli V; Di Giannantonio M; Roy A. Risk factors for attempting suicide in prisoners. Suicide and Life-Threatening Behavior 39(3): 343-350, 2009. (31 refs.)

We wished to examine determinants of suicidal behavior in prisoners. 903 male prisoners had a psychiatric interview which included various psychometric tests. Suicide attempters were compared with prisoners who had never attempted suicide. Significantly more of the attempters had a history of psychiatric disorder, substance abuse, a family history of suicidal behavior, convictions for violent crime, had exhibited aggressive behavior in jail, and had higher BGLHA aggression scores. A similar pattern of risk factors was found for prisoners with suicidal ideation. A lifetime history of attempting suicide, or of having suicidal ideation, is frequent in prisoners. Risk factors include family, developmental, aggression, personality, psychiatric, and substance abuse factors.

Semple SJ; Zians J; Strathdee SA; Patterson TL. Methamphetamine-using felons: Psychosocial and behavioral characteristics. American Journal on Addictions 17(1): 28-35, 2008. (31 refs.)

Methamphetamine (meth) users with felony convictions may be important vectors in the HIV/AIDS pandemic because of their drug and sexual risk histories. This study gathered personal, psychosocial, and behavioral data from 450 HIV-negative, heterosexually identified, meth-using men and women. Significant differences were found between felons and non-felons in meth use patterns, contexts and reasons for use, involvement of social networks in meth use, and certain psychosocial and sexual risk variables. Our findings suggest that targeting meth use patterns and motivations, social networks, and sexual risk behaviors of meth-using felons may help to reduce HIV/AIDS transmission in and outside the prison system.

Severtson SG; Latimer WW. Factors related to correctional facility incarceration among active injection drug users in Baltimore, MD. Drug and Alcohol Dependence 94(1/3): 73-81, 2008. (33 refs.)

Aim: We investigated the moderating effect of impulse control on the association between drug use and incarceration among active injection drug users (IDU). Methods: The study sample consisted of 282 IDUs aged 15-50 years from the Baltimore metropolitan region who reported injection drug use within the past 6 months and indicated that heroin or speedball was their drug of choice. Impulse control was measured using commission error standardized scores from the Test of Variables of Attention (TOVA). Incarceration was obtained using self-reported lifetime history of incarceration in correctional facilities. Results: Findings indicated that impulse control moderated the association between years of injection drug use and incarceration in correctional facilities adjusting for ethnicity, gender, estimated pre-morbid intelligence, and age of first injection use. Specifically, among individuals who were intact in impulse control, four or more years of injection drug use was associated with incarceration (AOR=4.97, 95% Cl: 2.02-12.23). This finding was not observed among individuals with impaired impulse control (AOR = 0.57, 95% CI: 0.10-3.23). Furthermore, impulse control moderated the association between regular cocaine use and incarceration. Among individuals who had a history of cocaine use, individuals with low impulse control but not impaired were more likely to have reported time in a correctional facility (AOR = 6.28, 95% CI: 1.68-23.60). There was no association among individuals with impaired or intact impulse control. Conclusion: Results highlight the importance of considering cognitive measures of impulse control in addressing negative outcomes associated with drug use.

Slade EP; Stuart EA; Alkever DSS; Karakus M; Green KM; Ialongo N. Impacts of age of onset of substance use disorders on risk of adult incarceration among disadvantaged urban youth: A propensity score matching approach. Drug and Alcohol Dependence 95(1/2): 1-13, 2008. (65 refs.)

Background: Age of onset of substance use disorders in adolescence and early adulthood could be associated with higher rates of adult criminal incarceration in the U.S., but evidence of these associations is scarce. Methods: Propensity score matching was used to estimate the association between adolescent-onset substance use disorders and the rate of incarceration, as well as incarceration costs and self-reported criminal arrests and convictions, of young men predominantly from African American, lower income, urban households. Age of onset was differentiated by whether onset of the first disorder occurred by age 16. Results: Onset of a substance use disorder by age 16, but not later onset, was associated with a fourfold greater risk of adult incarceration for substance related offenses as compared to no disorder (0.35 vs. 0.09, P = 0.044). Onset by age 16 and later onset were both positively associated with incarceration costs and risk of arrest and conviction, though associations with crime outcomes were more consistent with respect to onset by age 16. Results were robust to propensity score adjustment for observable predictors of substance use in adolescence and involvement in crime as an adult. Conclusion: Among young men in this high risk minority sample, having a substance use disorder by age 16 was associated with higher risk of incarceration for substance related offenses in early adulthood and with more extensive criminal justice system involvement as compared to having no disorder or having a disorder beginning at a later age.

Sly KA; Sharples J; Lewin TJ; Bench CJ. Court outcomes for clients referred to a community mental health court liaison service. International Journal of Law and Psychiatry 32(2): 92-100, 2009. (47 refs.)

Court liaison and diversion services come in a variety of forms, but the similarities and differences between these services are not well characterized. Findings from a six-year audit of the Newcastle (Australia) Mental Health Court Liaison (MHCL) service are reported, including client characteristics, offence and service contact profiles, Court Outcomes, and interrelationships among these variables. During the audit period, there were 2383 service episodes by 1858 clients (1478 males, 380 females), Drug and alcohol disorders (40.9%) and psychotic disorders (17.0%) were the most prevalent mental health problems, while assault (23.1%), theft (23.1%), offences against justice procedures (15.4%). driving offences (13.4%) and malicious damage to property (8.3%) were the most frequently recorded charges. Among service episodes with a finalized court Outcome, 70.0% involved a punishment (bond: 49.5%: jail term: 29.7%). Females were less likely to be punished, but more likely to have their case dismissed under sections of the relevant Act that required further assessment and monitoring. Being married, or having an adjustment or drug and alcohol disorder, were also associated with an increased likelihood Of punishment, while clients with a psychotic or bipolar disorder were less likely to be punished, Among clients who were Punished, those referred from inpatient mental health services were more likely to receive a non-jail punishment, while unemployed clients were more likely to be jailed. A Substantial proportion of clients had Court outcomes that required ail ongoing involvement with local mental health services. By being part of community mental health services, our MHCL service is able to work efficiently and effectively with the criminal justice system, while facilitating ready access to existing mental health services and continuation of care.

Stein MD; Anderson BJ; Caviness CM; Rosengard C; Kiene S; Friedmann P et al. Relationship of alcohol use and sexual risk taking among hazardously drinking incarcerated women: An event-level analysis. Journal of Studies on Alcohol and Drugs 70(4): 508-515, 2009. (55 refs.)

Objective: To understand the association of alcohol use with sex and unprotected sex among hazardously drinking incarcerated women, we examined the relationship of these behaviors on any given day Method: Participants endorsed unprotected sex and hazardous alcohol consumption (four or more drinks at a time on at least 3 separate days in the previous 3 months or a score of 8 or above on the Alcohol Use Disorders Identification Test). Participants recalled behaviors in the 90 days before incarceration using the Timeline Followback method. Generalized estimating equation models estimated the effect of daily alcohol use and selected covariates on the odds of sexual-risk behavior. Results: The 245 participants averaged 34 years of age and were 71.4% white; 67.8% used cocaine. On most (84.7%) drinking days, women consumed four or more drinks. One hundred forty-one participants (57.6%) reported sex with only main partners, 10.6% with only casual partners, and 30.6% with both casual and main partners. The likelihood of having any sex (odds ratio = 1.78, p < .01) and unprotected sex (odds ratio = 1.95, p < .01) was higher on days when participants consumed alcohol compared with nondrinking days. However, when the analysis was restricted to days on which participants reported having sex, the odds of having unprotected sex was not significantly associated with drinking. Conclusions: Among incarcerated women who reported hazardous drinking, alcohol use was associated with an increased likelihood of sexual activity and a concomitant increase in unprotected sex. However, use of alcohol was not significantly associated with condom use on days when participants were sexually active.

Stuewig J; Tangney JP; Mashek D; Forkner P; Dearing R. The moral emotions, alcohol dependence, and HIV risk behavior in an incarcerated sample. Substance Use & Misuse 44(4): 449-471, 2009. (68 refs.)

This article examines the relationship of shame, guilt, and symptoms of alcohol dependence to pre-incarceration HIV risk behaviors in an ongoing study in a metropolitan jail. Between 2002 and 2004 an ethnically diverse sample of 368 male inmates (mean age = 31, SD = 9.7), were interviewed on a variety of constructs including shame- and guilt-proneness (TOSCA-SD; Hanson and Tangney, 1996), alcohol dependence (TCU-CRTF; Simpson and Knight, 1998), and HIV risk behavior (TCU-ARA; Simpson, 1997). Symptoms of alcohol dependence were associated with elevated levels of HIV risk behavior (risky needle use and unprotected sex) prior to incarceration. Guilt-proneness was negatively related to risky sexual behavior. In addition, there was an interaction between shame and symptoms of alcohol dependence. Specifically, among those who were low on alcohol dependence, shame-proneness was negatively related to risky sexual behavior. The study's limitations are noted and findings are discussed in the context of the importance of considering moral emotions and alcohol dependence when designing programs to reduce HIV risk.

Thomson N; Sutcliffe CG; Sirirojn B; Keawvichit R; Wongworapat K; Sintupat K; Aramrattana A et al. Correlates of incarceration among young methamphetamine users in Chiang Mai, Thailand. American Journal of Public Health 99(7): 1232-1238, 2009. (51 refs.)

Objectives. We examined correlates of incarceration among young methamphetamine users in Chiang Mai, Thailand in 2005 to 2006. Methods. We conducted a cross-sectional study among 1189 young methamphetamine users. Participants were surveyed about their recent drug use, sexual behaviors, and incarceration. Biological samples were obtained to test for sexually transmitted and viral infections. Results. Twenty-two percent of participants reported ever having been incarcerated. In multivariate analysis, risk behaviors including frequent public drunkenness, starting to use illicit drugs at an early age, involvement in the drug economy, tattooing, injecting drugs, and unprotected sex were correlated with a history of incarceration. HIV, HCV, and herpes simplex virus type 2 (HSV-2) infection were also correlated with incarceration. Conclusions. Incarcerated methamphetamine users are engaging in behaviors and being exposed to environments that put them at increased risk of infection and harmful practices. Alternatives to incarceration need to be explored for youths.

Tiburcio NJ. Long-term recovery from heroin use among female ex-offenders: Marisol's story. Substance Use & Misuse 43(12-13): 1950-1970, 2008. (53 refs.)

Ex-offenders experience various difficulties in successfully reentering communities post-incarceration. For those with a history of opioid misuse, despite various interventions, long-term recovery rates are relatively low. Additionally, the difficulties ex-offenders experience reintegrating with their families and communities are further compounded by the stigma and structural barriers posed by prior criminal and drug use histories. This qualitative study, using in-depth interviews conducted during an 18-month period between mid 2004 and late 2005 examines the process of creating and maintaining abstinence among 25 former heroin users, mostly Latino and African American New York City ex-offenders who have remained abstinent from heroin use for a period of 5 yr or longer. Focusing primarily on the story of one female respondent and in participants' own words, the factors that they found to be most salient in enhancing their recovery efforts (positive peer support, motivational tools, exercise, meditation, skills enhancement) are examined. The study findings suggest that reentry programs and policies can help ex-offenders sustain long-term abstinence and prosocial lifestyles by supporting the various coping strategies that they identify as being particularly valuable.

Valera P; Epperson M; Daniels J; Ramaswamy M; Freudenberg N. Substance use and HIV-risk behaviors among young men involved in the criminal justice system. American Journal of Drug and Alcohol Abuse 35(1): 43-47, 2009. (24 refs.)

Objectives: We examined the relationship between substance use and sexual HIV-risk behaviors among young men who have been incarcerated, in order to understand how HIV risks develop for this vulnerable population. Methods: A sample of 552 young men in a New York City jail was interviewed at the time of incarceration. Bivariate analyses were performed to examine demographic and sexual HIV-risk behavior differences between men with and without recent alcohol and marijuana use. Logistic regression was used to examine associations between alcohol and marijuana use and sexual HIV-risk behaviors in the 90 days prior to incarceration. Results: Respondents were predominantly Black (57%) or Latino (37%), with a mean age of 17.4 years. The most common substances used were marijuana (82%) and alcohol (65%). Alcohol use prior to incarceration was significantly associated with having three or more sexual partners in the same time period (OR = 2.40, p .001), as well as with having unprotected sex with a long-term partner (OR = 1.72, p .01). Marijuana use was significantly associated with having multiple sex partners (OR = 1.55, p .01). Heavy alcohol and marijuana use did not result in an increased likelihood of sexual HIV-risk behaviors. Conclusions: High rates of substance use and unprotected sex may have unintended health consequences for incarcerated young men. Severity of substance use is not a significant predictor of risk behaviors, suggesting the importance of contextual and social factors. Results highlight the need for HIV prevention efforts for this population that take into account contextual and social factors.

van Olphen J; Eliason MJ; Freudenberg N; Barnes M. Nowhere to go: How stigma limits the options of female drug users after release from jail. Substance Abuse Treatment, Prevention and Policy 4(10), 2009. (49 refs.)

Background: Drug and alcohol using women leaving prison or jail face many challenges to successful re-integration in the community and are severely hampered in their efforts by the stigma of drug or alcohol use compounded by the stigma of incarceration. Methods: This qualitative study is based on individual semi-structured interviews and focus groups with 17 women who had recently left jail about the challenges they faced on reentry. Results: Our analysis identified three major themes, which are related by the overarching influence of stigma: survival (jobs and housing), access to treatment services, and family and community reintegration. Conclusion: Stigma based on drug use and incarceration works to increase the needs of women for health and social services and at the same time, restricts their access to these services. These specific forms of stigma may amplify gender and race-based stigma. Punitive drug and social policies related to employment, housing, education, welfare, and mental health and substance abuse treatment make it extremely difficult for women to succeed.

Wakeman SE; Bowman SE; McKenzie M; Jeronimo A; Rich JD. Preventing death among the recently incarcerated: An argument for naloxone prescription before release. Journal of Addictive Diseases 28(2): 124-129, 2009. (29 refs.)

Death from opiate overdose is a tremendous source of mortality, with a heightened risk in the weeks following incarceration. The goal of this study is to assess overdose experience and response among long-term opiate users involved in the criminal justice system. One hundred thirty-seven subjects from a project linking opiate-dependent individuals being released from prison with methadone maintenance programs were asked 73 questions regarding overdose. Most had experienced and witnessed multiple overdoses; 911 was often not called. The majority of personal overdoses occurred within 1 month of having been institutionalized. Nearly all participants expressed an interest in being trained in overdose prevention with Naloxone. The risk of death from overdose is greatly increased in the weeks following release from prison. A pre-release program of overdose prevention education, including Naloxone prescription, for inmates with a history of opiate addiction would likely prevent many overdose deaths.

Weatherburn DJ. The role of drug and alcohol policy in reducing Indigenous over-representation in prison. (editorial). Drug and Alcohol Review 27(1): 91-94, 2008. (34 refs.)

Australian Indigenous imprisonment rates are higher now than they were at the time of the Royal Commission into Aboriginal Deaths in Custody. The Commission attributed Indigenous imprisonment to Indigenous cultural, economic and social disadvantage. Noel Pearson has argued that Indigenous drug and alcohol use is a more important cause of Indigenous contact with the justice system than Indigenous disadvantage. In this paper I argue that the available evidence provides strong support for Pearson's view and for the proposition that future efforts to reduce Indigenous imprisonment should place more emphasis on supply-side strategies for reducing Indigenous drug and alcohol abuse.

Welsh WN; McGrain PN. Predictors of therapeutic engagement in prison-based drug treatment. (review). Drug and Alcohol Dependence 96(3): 271-280, 2008. (106 refs.)

Few studies to date have examined predictors of therapeutic engagement (TE) or other indicators of responsiveness to prison drug treatment. Subjects were 347 inmates participating in a 12-month modified therapeutic community (TC) drug treatment program at a specialized treatment prison for convicted, drug-involved offenders. Data were obtained through correctional databases and the administration of the TCU Drug Screen II, the Resident Evaluation of Self and Treatment (REST), and the Counselor Rating of Client (CRC) form. Three main hypotheses were supported: (1) baseline motivation predicted therapeutic engagement net of other inmate characteristics; (2) critical dimensions of the treatment experience (e.g., peer support, counselor rapport) also predicted therapeutic engagement; and (3) dynamic predictors and programmatic characteristics became more important over time. Implications for research, theory and policy are discussed.