Improving Substance
Abuse Treatment in the
Criminal Justice System
Elizabeth Ressler
Jennifer Lerch
Faye Taxman
Scott Walters
Funded by R01 DA029010-01
Mumola, 1995
Two thirds of probationers
are drug involved…
…but less than
half participate
Program Wish List
1. Bridge criminological and
psychological theories.
2. Place no additional demands on the
probation system of care.
3. Target multiple behaviors that occur
together.
4. Tailored to the individual.
5. Very easy/intuitive to use.
6. Included material that would
actually increase motivation.
☐
?
About MAPIT
•
2-session program targeting
drug-using probationers.
•
Targets motivation to change
substance use, criminal behavior,
and HIV risk.
•
Includes risk assessment,
planning, social support,
automated reminders.
•
Simple, intuitive layout.
•
Responsive “synthetic” narration.
•
Compatible with system of care.
Theoretical Background
Theory
Application
Extended Parallel
Process Model
Risk of probation violation based on static
and dynamic factors; Future behaviors most
likely to reduce risk.
Social Cognitive
Theory
How clients compare to others; Framing
suggestions in terms of what other people
do; Videos of model responses.
Motivational
Interviewing
Affirmations, Reflections, Summaries;
Interactive tone that emphasizes autonomy,
collaboration, evocation.
MAPIT Visit 1
•Static risk estimate •Dynamic risk estimate •Examples of risk reduction Offending •Norm comparison •Risk estimate •Consequences Substance Abuse •Risk behaviors •Testing recom-mendation •Risk reduction strategies HIV Risk •Summary; example goals •30 day goals •Text/email reminders Setting GoalsGo here to view MAPIT criminal justice risk
video example
Go here to view MAPIT substance use risk
video example
Making MAPIT “Smart”
•
TTS engine can read (almost) everything on
demand.
•
Tailored reflections based on single-item
responses.
•
Tailored reflections/information/suggestions
based on multi-question response patterns.
•
Responses can connect to earlier material, or
push a little bit beyond what the person said.
•
The program can “dial up” or “dial down” the
Thanks for sticking with me. You said that your most important reasons for completing probation had to do with your relationships and the hassle of paying
probation fees. Based on this, you are fairly committed to completing probation. One thing you thought you could do in the next week is to get rid of all your drug equipment so that you’re not tempted to use. I’ll make sure to text you, and remind you about your goal.
Thanks for sticking with me. You said that your most important reasons for completing probation had to do with the shame of being on probation and wanting to avoid future legal trouble. Based on this, you are very committed to completing probation. You’re willing to do whatever it takes. One thing you thought you could do in the next week is to put a phone number in your
phone of someone you could call if you needed to talk. I’ll make sure to text you, and remind you about your goal.
MAPIT Visit 2
•Review of motivation •Review of progress •New goals Checking In •Identifying preferred strategies •Managing cravings ManagingCravings • List of helpful people • Plan for accessing social support Social Support • 30 day goals • Text/email reminders • Follow-up Setting Goals
Go here to view MAPIT goal setting and
texting video example
Most important reasons for wanting to finish
probation?
0 20 40 60 80 100
% Rated as “Very Important” Reason
Shame Financial Relationships Freedom Time Legal Moving On Initial data, n=38
Early probation goals?
0 10 20 30 40 50 60 70
% Selected Goal
Write down and questions I have
Get a binder to keep my probation documents in
Write down date and time of first visit.
Make a list of my biggest worries and share with PO.
Early treatment goals?
0 10 20 30 40 50 60 70 80
% Selected Goal
Look through my house and vehicle and throw out drugs and drug equipment.
Put a number in my phone of someone I could call if I needed to talk.
Ask someone with clean time how they did it.
Make a list of things I could do to stay sober.
Wanted reminders?
Text or email?
Yes
59%
31%
Text
59%
Basic Demographics
•
Both sites primarily older, black, males
–
Dallas= m=33 yrs old; Baltimore= m=40 yrs old
–
More high risk females in Baltimore
•
Small number of Hispanics recruited in Dallas
•
Homelessness more prevalent among
Baltimore probationers
•
Average 11-15 arrests in lifetime except for
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Baltimore:
Low/Moderate Baltimore: High Low/Moderate Dallas: Dallas: High
Baseline drug test results
Poly Marijuana Criminogenic* Negative (41% condition for tx) (58% condition for tx) (28% condition for tx) (43% condition for tx)
* Criminogenic drugs are harder drugs that exhibit a direct link with offending behavior such as
58.8% 41.2%
Baltimore: Low/Moderate
23.1% 76.9%Baltimore: High
82.6% 17.4%Dallas: Low/Moderate
50% 50%Dallas: High
No Prior Treatment Prior Treatment
0 10 20 30 40 50 60 70 80 90 100 Baltimore:
Low/Moderate Baltimore: High Low/Moderate Dallas: Dallas: High
STD diagnoses and HIV testing
Dallas
Hospital 16.7% 40%
Baltimore
Where HIV tested in last 12 months
No one selected home testing, drug treatment, or syringe exchange.
Outpatient/ community program Outpatient/ community program Jail/prison Jail/prison Hospital Donating blood ER Other 65.6% 15.6%
Criminal Cognitions, Social Support,
and Treatment Motivation
•
Average scores on criminal cognitions, desire
for help, and problem recognition
•
High levels of social support
•
Overall, higher scores on desire for help as
Factors predicting desire for help (N= 91)
B SE Beta
Homeless 3.32 1.71 .18*
Lifetime prior treatment 6.75 1.46 .48***
Positive for criminogenic drug 2.70 1.74 .14
Positive for marijuana -3.01 2.42 -.11
Positive for multiple drugs .74 3.61 .02
Risk level .40 .36 .12
Site 1.37 1. 47 .10
Factors predicting problem recognition (N= 89)
B SE Beta
Lifetime prior treatment 8.59 1.94 .52***
Positive for criminogenic drug 3.09 2.11 .04
Positive for marijuana -1.54 2.91 -.05
Positive for multiple drugs 1.61 4.33 .04
Risk level .28 .43 .07 Site 1.96 1.80 .12 Age .06 .08 .02 *p < .10; **p <.05; ***p <.01 ¨ Unable to locate (n=4) ¨ Unable to locate (n=4)