Characteristics Associated with a History of Physical and Sexual Abuse in a Community Corrections Sample.

Background: Most predictors of future criminal justice involvement are gender neutral. However, recent research has stressed the importance of physical and sexual abuse as a precursor of incarceration for women. Purpose: The aim of the present study was to assess the influence of a history of physical and sexual abuse on mental health, substance use, and criminal justice history for men and women under community corrections supervision. Methods: A sample of 613 (203 women and 410 men) participants completed structured clinical interviews and questionnaires assessing demographics, mental health and abuse history (physical vs. sexual), substance use, and criminal justice involvement. Results: Results of multivariate analyses indicated that for men, physical abuse was linked to White race, a higher number of arrests, history of a person offense, family problems, and suicidality; while sexual abuse was linked to White race, family problems, suicidality, and antisocial personality disorder. For women, physical abuse was only associated with meeting criteria for an anxiety or depressive disorder; while sexual abuse was linked to reporting a history of a substance offense, meeting criteria for an anxiety or depressive disorder, and increased suicidality. Substance use was not associated with any form of abuse in either gender. Conclusions: In general, abuse was associated with worse mental health and more severe criminal justice involvement. Women reported much greater rates of abuse and our results provide some support for the idea that a history of abuse may be an important precursor to criminal justice involvement for individuals under community corrections supervision.

Examining the link between facial affect recognition and violent offending: A comparison between web-recruited volunteers with histories of violent and non-violent offending.

BACKGROUND: The link between facial affect recognition and criminal justice involvement has been extensively researched, yet there are virtually no data on the capacity for facial affect recognition in post-incar+cerated individuals, and the results of many studies are limited due to a narrow focus on psychopathy rather than offence category. AIMS: To test the first hypothesis that individuals reporting a history of a violent offence would show a deficit in facial affect recognition and the second hypothesis that the violent offender's deficit would be exclusive to recognition of negative expressions, not affecting positive or neutral expressions. METHOD: Post-incarcerated individuals (N = 298) were recruited online through Qualtrics and completed questionnaires assessing their criminal justice background and demographics. They completed measures of facial affect recognition, anxiety and depression, and components of aggression. RESULTS: A logistic regression, including sex, ethnicity, age and years of education and depression/anxiety scores, indicated that committing a violent offence was independently associated with lower facial affect recognition scores as well as male gender and a trait-based propensity towards physical aggression, but no other co-variable. These data provided no evidence that this deficit was specific to negative emotions. CONCLUSIONS AND IMPLICATIONS FOR FUTURE RESEARCH/PRACTICE: Our study is one of the first to examine facial affect recognition in a post-incarcerated sample. It suggests that deficits in facial affect recognition, already well documented among violent prisoners, persist. While acknowledging that these may be relatively fixed characteristics, this study also suggests that, for these people, nothing happening during their imprisonment was touching this. Improving capacity in facial affect recognition should be considered as a target of intervention for violent offenders, developing or revising in-prison programmes as required.

Expectancies for the effectiveness of different tobacco interventions account for racial and gender differences in motivation to quit and abstinence self-efficacy.

INTRODUCTION: Racial and gender disparities for smoking cessation might be accounted for by differences in expectancies for tobacco interventions, but few studies have investigated such differences or their relationships with motivation to quit and abstinence self-efficacy. METHODS: In this cross-sectional study, 673 smokers (African American: n = 443, 65.8%; women: n = 222, 33.0%) under criminal justice supervision who enrolled in a clinical smoking cessation trial in which all received bupropion and half received counseling. All participants completed pretreatment measures of expectancies for different tobacco interventions, motivation to quit, and abstinence self-efficacy. The indirect effects of race and gender on motivation to quit and abstinence self-efficacy through expectancies for different tobacco interventions were evaluated. RESULTS: African Americans' stronger expectancies that behavioral interventions would be effective accounted for their greater motivation to quit and abstinence self-efficacy. Women's stronger expectancies for the effectiveness of pharmacotherapy accounted for their greater motivation to quit, whereas their stronger expectancies for the effectiveness of behavioral treatments accounted for their greater abstinence self-efficacy. CONCLUSIONS: Findings point to the mediating role of expectancies for treatment effectiveness and suggest the importance of exploring expectancies among African Americans and women as a way to augment motivation and self-efficacy.

Anxiety and suicidal ideation predict successful completion of substance abuse treatment in a criminal justice sample.

The goal of this study was to identify predictors of successful substance abuse treatment in an out-patient clinic for individuals being monitored under community corrections supervision. Of the 615 participants, 117 (19%) successfully completed treatment. The results of a multivariate logistic regression analysis indicated that successful treatment was associated with several baseline characteristics including: older age, White race, having greater than a high school education, lower level of care, meeting criteria for an anxiety disorder, reporting suicidal ideation, and not having a history of opioid use. The value of self-report of problems and its influence on treatment in the culture of the criminal justice population is discussed in this article.

An exploration of the link between narcissism, masochism, and crime in a post-incarcerated sample.

This study examined the relationship between narcissism, masochism, and violent criminal justice involvement. Current interventions used with offender populations target traits such as antisocial personality but typically ignore narcissism and masochism. Understanding the connection between violent crime, narcissism, and masochism can help us develop a more indepth understanding of which personality features contribute to an increased proclivity towards criminal action. The participants (N = 494) were post-incarcerated individuals. To assess individuals' degree of narcissistic and masochistic thinking, the Narcissistic Personality Inventory and the underserving self-image subscale of the Self-Defeating Interpersonal Style Scale were administered via a Qualtrics survey. Basic demographic information, psychopathy, intelligence, and personality were also measured and controlled for in the analyses. A logistic regression indicated that high levels masochistic thinking were associated with violent criminal justice involvement, even when relevant covariates were controlled for. High levels of narcissism were not found to exhibit a statically significant relationship with violent criminal justice involvement when psychopathy was controlled for. These findings suggest that masochistic characteristics may be a potential target for treatment in rehabilitating offenders.

The unmet medical needs of correctional populations in the United States.

The goal of this study was to document the health needs of members in the criminal justice system and the capacity of the system to meet those needs. Using data from the National Criminal Justice Treatment Practices survey, we estimated the number of adults under correctional control who need medical care and the capacity of the correctional system to provide needed care. A mailed survey of 431 adult correctional agencies and administrators was used to define the capacity and techniques of the correctional system to meet the medical needs of the offender population. Most offenders in jail and prison received tuberculosis screening, physical health services, and mental health screening and treatment. Screening for sexually transmitted diseases (STDs) and provision of detoxification or methadone maintenance were universally absent, regardless of criminal justice setting. Community corrections settings were lacking in most health care areas. Prisons and jails are constitutionally mandated to provide health care; however, community corrections agencies are not federally required to provide health services. While community correction settings have the lowest provision of health care services, prisons and jails also demonstrate a deficiency in most services, but particularly for STD screening, substance abuse detoxification, and opioid maintenance therapies.

Normal cognitive test scores cannot be interpreted as accurate measures of ability in the context of failed performance validity testing: A symptom- and detection-coached simulation study.

Introduction: While use of performance validity tests (PVTs) has become a standard of practice in neuropsychology, there are differing opinions regarding whether to interpret cognitive test data when standard scores fall within normal limits despite PVTs being failed. This study is the first to empirically determine whether normal cognitive test scores underrepresent functioning when PVTs are failed.Method: Participants, randomly assigned to either a simulated malingering group (n = 50) instructed to mildly suppress test performances or a best-effort/control group (n = 50), completed neuropsychological tests which included the North American Adult Reading Test (NAART), California Verbal Learning Test - 2nd Edition (CVLT-II), and Test of Memory Malingering (TOMM).Results: Groups were not significantly different in age, sex, education, or NAART predicted intellectual ability, but simulators performed significantly worse than controls on the TOMM, CVLT-II Forced Choice Recognition, and CVLT-II Short Delay Free Recall. The groups did not significantly differ on other examined CVLT-II measures. Of simulators who failed validity testing, 36% scored no worse than average and 73% scored no worse than low average on any of the examined CVLT-II indices.Conclusions: Of simulated malingerers who failed validity testing, nearly three-fourths were able to produce cognitive test scores that were within normal limits, which indicates that normal cognitive performances cannot be interpreted as accurately reflecting an individual's capabilities when obtained in the presence of validity test failure. At the same time, only 2 of 50 simulators were successful in passing validity testing while scoring within an impaired range on cognitive testing. This latter finding indicates that successfully feigning cognitive deficits is difficult when PVTs are utilized within the examination.

Narcissistic subtypes and contingent self-esteem: do all narcissists base their self-esteem on the same domains?

It has been suggested that there are two forms of narcissism: a grandiose subtype and a vulnerable subtype. Although these forms of narcissism share certain similarities, it is believed that these subtypes may differ in the domains upon which their self-esteem is based. To explore this possibility, the present study examined the associations between these narcissistic subtypes and domain-specific contingencies of self-worth. The results show that vulnerable narcissism was positively associated with contingencies of self-worth across a variety of domains. In contrast, the associations between grandiose narcissism and domain-specific contingencies of self-worth were more complex and included both positive and negative relationships. These results provide additional support for the distinction between grandiose and vulnerable narcissism by showing that the domains of contingent self-esteem associated with grandiose narcissism may be more limited in scope than those associated with vulnerable narcissism.

Gaging the impact of multiple substance use on community corrections involvement.

Historically, research has demonstrated that multiple substance use, compared to single substance use, poses additional challenges for treatment throughout the continuum of care including referrals, interventions, and relapse prevention. However, it appears that this pattern cannot be easily generalized to all criminal justice settings as evidenced by mixed findings across criminal justice samples. The purpose of the current study is to investigate possible differences in legal and substance-related outcomes between multiple substance users and single substance users within a community corrections sample. Structured clinical interviews were conducted to divide 531 individuals under community corrections supervision into three groups including multiple substance users, single substance users, and non-substance users. Results indicated that while multiple substance users were arrested more frequently and had more problems with family members, there were no differences compared to their single substance using counterparts in terms of depressive disorders, anxiety disorders, or types of offense. These findings contrast with previous research on samples outside of community corrections suggesting that multiple substance use requires tailored interventions with consideration to context of their use. Discussion includes limitations to generalizability and assessment of substance use as well as implications for treatment and future research.

Factors associated with early marijuana initiation in a criminal justice population.

PURPOSE: Initiation of marijuana during adolescence is associated with negative outcomes and is more common among those with criminal justice involvement. We sought to determine demographics, psychosocial factors, mental health factors, and criminal outcomes associated with earlier age at first marijuana use in a criminal justice population. METHODS: Data from structured, in-person interviews of adults in a criminal corrections program were analyzed. Participants (689 men and women ages 19 and older) were recruited for a larger smoking cessation trial (2009-2013) as a volunteer sample by flyers at a community corrections site. 516 had smoked both nicotine and marijuana and were included in the analysis. We determined associations between self-reported age at first marijuana use and sex, race, income, educational attainment, history of abuse, family problems, psychiatric problems, criminal record, and age of nicotine and alcohol initiation. RESULTS: Of 516 participants, 68% were men, and 64.5% were Black. No participants were of Hispanic ethnicity. Average age of marijuana initiation was 15.1years (SD 3.7years). After linear regression, earlier age at marijuana initiation was associated with male sex and more criminal offenses (person/violent and court). Race and psychiatric problems were not associated with earlier marijuana initiation. CONCLUSIONS: Earlier adolescent marijuana initiation is associated with more criminal offenses in a criminal justice population. Men initiate marijuana earlier than women. Adolescents at high risk of justice involvement may benefit from delayed initiation of marijuana, specifically men. Additional studies should examine prevention strategies for adolescent marijuana use that target those at highest risk.

Predictors of medication adherence and smoking cessation among smokers under community corrections supervision.

INTRODUCTION: Individuals in the U.S. criminal justice system now represent over 12% of all current U.S. smokers. With smoking banned in most U.S. jails and prisons, the cessation focus for this population has shifted to individuals who are under community correction supervision (e.g., probation, parole). The aim of this study was to examine predictors of successful smoking cessation among criminal justice individuals supervised in the community. METHODS: Five hundred participants under community corrections supervision were randomized to receive either four sessions of smoking cessation counseling or no counseling in conjunction with 12weeks of bupropion treatment plus brief physician advice to quit. Logistic regression analyses examined associations of smoking variables with medication adherence and successful abstinence. Mediation analysis evaluated the indirect effects of medication adherence on smoking abstinence. RESULTS: The strongest associate of medication adherence was previous use of bupropion, while the strongest associate of smoking abstinence was medication adherence. Mediation analysis indicated that previous use of bupropion indirectly increased cessation rates through the pathway of increased medication adherence. CONCLUSIONS: These results highlight the importance of medication adherence for smoking cessation among community corrections smokers. Providing exposure to medication may be a promising intervention to increase medication adherence and subsequent cessation rates in this population.

Family Dysfunction and Suicide Risk in a Community Corrections Sample.

BACKGROUND: When comparted with the general population, the suicide rate in correctional populations is elevated. While predictors of suicide are well researched in jail and prison populations, much less work has been done to examine predictors of suicide in community corrections samples where 80% of the US correctional population is currently supervised. AIMS: The goal of this study was to determine factors associated with suicide risk in a community corrections sample. METHOD: Self-reported current ideation was examined in a sample of 512 individuals under supervision. RESULTS: When univariate associations between current suicidal ideation and predictor variables were examined, current suicidal ideation was associated with being female, being White, reporting an increased level of stress, reporting an increased level of depression, meeting criteria for an anxiety disorder, an increased number of physical health complaints, and self-report of family dysfunction. In a multivariate analysis predicting suicide risk, only meeting criteria for an anxiety disorder, an increased number of physical health complaints, and self-report of family dysfunction were significant. CONCLUSION: Mental and physical health complaints as well as self-report of family dysfunction are salient predictors of suicide risk in the community corrections population.

The impact of non-concordant self-report of substance use in clinical trials research.

BACKGROUND: Studies comparing self-report substance use data to biochemical verification generally demonstrate high rates of concordance. We argue that these rates are due to the relatively high true negative rate in the general population, and high degree of honestly in treatment seeking individuals. We hypothesized that high risk individuals not seeking treatment would demonstrate low concordance and a high false negative rate of self-reported substance use. METHODS: A sample of 500 individuals from a smoking cessation clinical trial was assessed over 1 year. Assessments included semi-structured interviews, questionnaires (e.g. Addiction Severity Index, etc.), and urine drug screen assays (UDS). Generalized estimating equations (GEEs) were used to predict false negative reports for various substances across the study and determine the influence of substance use on the primary study outcome of smoking cessation. RESULTS: Participants demonstrated high false negative rates in reporting substances use, and the false negative rates increased as the study progressed. Established predictors of false negatives generalized to the current sample. High concordance and low false negative rates were found in self-report of nicotine use. A small but significant relationship was found in for effect of biochemically verified substance use on smoking cessation. CONCLUSIONS: Biochemical verification of substance use is needed in high risk populations involved in studies not directly related to the treatment of substance use, especially in populations with high threat of stigmatization. Testing should continue through the time period of the study for maximal identification of substance use.

The Minority Are the Majority: Today's Smoker.

The smoking rate in America has decreased substantially over the past 50 years; however, this decrease is disproportionately accounted for by the high quit rates and lower initiation rates of middle class smokers with no medical or psychiatric comorbidities. The majority of modern smokers' cessations efforts are complicated by one or more forms of "disadvantage, " such as social, economic, legal, or psychiatric problems. The next step in reducing the national smoking prevalence is to reduce the prevalence in the most neglected portions of the population. In this paper, the characteristics of modern smokers are discussed in light of the 2014 Surgeon General's Report and the Affordable Care Act. Implications for current treatment and future research are suggested in an effort to take advantage of the progress that has been made and the new opportunities provided by healthcare reform.

Classic psychedelic use is associated with reduced psychological distress and suicidality in the United States adult population.

Mental health problems are endemic across the globe, and suicide, a strong corollary of poor mental health, is a leading cause of death. Classic psychedelic use may occasion lasting improvements in mental health, but the effects of classic psychedelic use on suicidality are unknown. We evaluated the relationships of classic psychedelic use with psychological distress and suicidality among over 190,000 USA adult respondents pooled from the last five available years of the National Survey on Drug Use and Health (2008-2012) while controlling for a range of covariates. Lifetime classic psychedelic use was associated with a significantly reduced odds of past month psychological distress (weighted odds ratio (OR)=0.81 (0.72-0.91)), past year suicidal thinking (weighted OR=0.86 (0.78-0.94)), past year suicidal planning (weighted OR=0.71 (0.54-0.94)), and past year suicide attempt (weighted OR=0.64 (0.46-0.89)), whereas lifetime illicit use of other drugs was largely associated with an increased likelihood of these outcomes. These findings indicate that classic psychedelics may hold promise in the prevention of suicide, supporting the view that classic psychedelics' most highly restricted legal status should be reconsidered to facilitate scientific study, and suggesting that more extensive clinical research with classic psychedelics is warranted.

The Adverse Effects of Motherhood on Substance Use Treatment Program Outcomes Among Adolescent Women.

OBJECTIVES: Adolescent mothers have differing risks and responsibilities compared to adolescent women without children that may impact substance use treatment. This study sought to describe characteristics of adolescent women in a substance use treatment program and determine the effect of adolescent motherhood on treatment program outcomes. METHODS: Data were collected from standardized interviews of female adolescents in a case management criminal justice diversion program for substance-using adolescents and adults. Variables included sociodemographic factors (ie, race/ethnicity, age, financial support, education, insurance, marital status, sexual abuse), Diagnostic and Statistical Manual-IV (DSM-IV) substance use disorder diagnoses, and motherhood (ie, childbirth and residence with a child). Treatment program outcome was documented by case workers at the end of the participants' time in the program. Chi-square analyses and analysis of variances determined associations between variables. Logistic regression was used to assess characteristics associated with negative treatment program outcome. RESULTS: Data from 1080 adolescent women aged 16-21 years (mean 19.7 years, SD = 1.16) were analyzed; 403 (37%) were mothers. After controlling for sociodemographic factors and substance use disorder diagnoses, adolescent mothers were less likely to successfully complete the treatment program than nonmothers. Adolescent women with reliance on family or friends for financial support, lower education status, and cannabis and cocaine use disorders had worse treatment program outcomes. CONCLUSIONS: Childbirth and parenting adversely affect substance use treatment outcomes for adolescent women in the criminal justice system. Future research should explore tailored substance use treatments for adolescents with children. Job training and educational support may improve outcomes.

An Algorithm Approach to Determining Smoking Cessation Treatment for Persons Living With HIV/AIDS: Results of a Pilot Trial.

BACKGROUND: Smoking now represents one of the biggest modifiable risk factors for disease and mortality in people living with HIV (PLHIV). To produce significant changes in smoking rates among this population, treatments will need to be both acceptable to the larger segment of PLHIV smokers and feasible to implement in busy HIV clinics. The purpose of this study was to evaluate the feasibility and effects of a novel proactive algorithm-based intervention in an HIV/AIDS clinic. METHODS: PLHIV smokers (N = 100) were proactively identified through their electronic medical records and were subsequently randomized at baseline to receive a 12-week pharmacotherapy-based algorithm treatment or treatment as usual. Participants were tracked in-person for 12 weeks. Participants provided information on smoking behaviors and associated constructs of cessation at each follow-up session. RESULTS: The findings revealed that many smokers reported using prescribed medications when provided with a supply of cessation medication as determined by an algorithm. Compared with smokers receiving treatment as usual, PLHIV smokers prescribed these medications reported more quit attempts and greater reduction in smoking. Proxy measures of cessation readiness (eg, motivation, self-efficacy) also favored participants receiving algorithm treatment. CONCLUSIONS: This algorithm-derived treatment produced positive changes across a number of important clinical markers associated with smoking cessation. Given these promising findings coupled with the brief nature of this treatment, the overall pattern of results suggests strong potential for dissemination into clinical settings and significant promise for further advancing clinical health outcomes in this population.

Race and Medication Adherence Moderate Cessation Outcomes in Criminal Justice Smokers.

INTRODUCTION: Smokers in the criminal justice system represent some of the most disadvantaged smokers in the U.S., as they have high rates of smoking (70%-80%) and are primarily uninsured, with low access to medical interventions. Few studies have examined smoking-cessation interventions in racially diverse smokers, and none have examined these characteristics among individuals supervised in the community. The purpose of this study is to determine if four sessions of standard behavioral counseling for smoking cessation would differentially aid smoking cessation for African American versus non-Hispanic white smokers under community corrections supervision. DESIGN: An RCT. SETTING/PARTICIPANTS: Five hundred smokers under community corrections supervision were recruited between 2009 and 2013 via flyers posted at the community corrections offices. INTERVENTION: All participants received 12 weeks of bupropion plus brief physician advice to quit smoking. Half of the participants received four sessions of 20-30 minutes of smoking-cessation counseling following tobacco treatment guidelines, whereas half received no additional counseling. MAIN OUTCOME MEASURES: Generalized estimating equations were used to determine factors associated with smoking abstinence across time. Analyses were conducted in 2014. RESULTS: The end-of-treatment abstinence rate across groups was 9.4%, with no significant main effects indicating group differences. However, behavioral counseling had a differential effect on cessation: whites who received counseling had higher quit rates than whites who did not receive counseling. Conversely, African Americans who did not receive counseling had higher average cessation rates than African Americans who received counseling. Overall, medication-adherent African American smokers had higher abstinence rates relative to other smokers. CONCLUSIONS: Racial disparities in smoking cessation are not evident among those who are adherent to medication. More research is needed to better understand the differential effect that behavioral counseling might have on treatment outcomes between white and African American smokers under community corrections supervision.

Relationship of trauma exposure and substance abuse to self-reported violence among men and women in substance abuse treatment.

Past research showed a relationship between substance abuse and aggression and past trauma and aggression. The nature of the relationships between substance use, trauma, and aggression is inconclusive. The current research hypothesized greater aggression among those with a history of substance abuse and trauma compared with those without such a history and an additive relationship between substance abuse and trauma on aggression. Participants were 615 individuals in a substance abuse treatment program for individuals under criminal justice supervision. Data were collected from face-to-face interviews and self-report measures. Univariate and multivariate analyses assessed the relationships among substance use, trauma, and aggression. Participants with a history of trauma and regular substance use reported the highest rates of homicidal ideation, problem behaviors, and person offenses. Participants in this group also reported greater desire for help managing their stress and tension, dealing with problems in their intimate relationships, developing healthier relationships in general, and learning prosocial approaches to express their feelings. Substance abusing participants who experienced trauma reported more externalizing behaviors and a greater desire for coping- and social-skills training than participants who abused substances but did not report a history of trauma. This suggests that participants in substance abuse treatment programs may have improved outcomes with the addition of components to address these issues.