Modeling Recovery Housing Retention and Program Outcomes by Justice Involvement among Residents in Virginia, USA: An Observational Study.

Living in recovery housing can improve addiction recovery and desistance outcomes. This study examined whether retention in recovery housing and types of discharge outcomes (completed, "neutral," and "negative" outcomes) differed for clients with recent criminal legal system (CLS) involvement. Using data from 101 recovery residences certified by the Virginia Association of Recovery Residences based on 1,978 individuals completing the REC-CAP assessment, competing risk analyses (cumulative incidence function, restricted mean survival time, and restricted mean time lost) followed by the marginalization of effects were implemented to examine program outcomes at final discharge. Residents with recent CLS involvement were more likely to be discharged for positive reasons (successful completion of their goals) and premature/negative reasons (e.g., disciplinary releases) than for neutral reasons. Findings indicate that retention for 6-18 months is essential to establish and maintain positive discharge outcomes, and interventions should be developed to enhance retention in recovery residents with recent justice involvement.

Exploring Reasons for Non-Engagement From a Peer-Led Diversionary Intervention for Veterans in Police Custody.

UK veterans with complex needs arrested in police custody can access support through pre-charge diversion into treatment and ancillary services. We consider why veterans in police custody disengaged from a peer-led criminal justice diversionary support service in one UK region that adopted a continuous case management approach. Seven hundred and fifty-seven veterans were assessed to have high levels of comorbid health needs and socio-economic harms, with one-quarter (26.7%, n = 202) subsequently disengaging from the service. A logistic regression model using Multivariate Imputation by Chained Equations identified that veterans of a younger age, no-fixed-abode, a history of incarceration, and those from a Royal Navy background were likelier to disengage from the intervention. We conclude that this peer-based diversionary model has some efficacy in maintaining the engagement of a highly complex, comorbid segment of criminally-justice-exposed UK military veterans. The perceived benefits of an integrated peer-based model predicated on continuous case-management techniques are discussed.

Assessing a pilot scheme of intensive support and assertive linkage in levels of engagement, retention, and recovery capital for people in recovery housing using quasi-experimental methods.

INTRODUCTION: Strong and ever-growing evidence highlights the effectiveness of recovery housing in supporting and sustaining substance use disorder (SUD) recovery, especially when augmented by intensive support that includes assertive linkages to community services. This study aims to evaluate a pilot intensive recovery support (IRS) intervention for individuals (n = 175) entering certified Level II and III recovery residences. These individuals met at least three out of five conditions (no health insurance; no driving license; substance use in the last 14 days; current unemployment; possession of less than $75 capital). The study assesses the impact of the IRS on engagement, retention, and changes in recovery capital, compared to the business-as-usual Standard Recovery Support (SRS) approach (n = 1758). METHODS: The study employed quasi-experimental techniques to create weighted and balanced counterfactual groups. These groups, derived from the Recovery Capital assessment tool (REC-CAP), enabled comparison of outcomes between people receiving IRS and those undergoing SRS. RESULTS: After reweighting for resident demographics, service needs, and barriers to recovery, those receiving IRS exhibited improved retention rates, reduced likelihood of disengagement, and growth in recovery capital after living in the residence for 6-9 months. CONCLUSION: The results from this pilot intervention indicate that intensive recovery support, which integrates assertive community linkages and enhanced recovery coaching, outperforms a balanced counterfactual group in engagement, length of stay, and recovery capital growth. We suggest that this model may be particularly beneficial to those entering Level II and Level III recovery housing with lower levels of recovery capital at admission.

The growth of recovery capital in clients of recovery residences in Florida, USA: a quantitative pilot study of changes in REC-CAP profile scores.

BACKGROUND: There is a growing evidence base around predictors of retention and completion in a range of recovery residence models, particularly Oxford Houses and Sober Living Houses, and recovery housing is recognized as a clearly evidenced area of recovery intervention. The aim of the study was to quantitatively assess recovery capital in a sample of recovery residence clients. METHOD: The study used a repeated measures self-completion of a standardized recovery capital instrument (REC-CAP) for clients retained across various houses within one Level 2 recovery residence provider whose program was based on a 12-step approach. While 823 clients participated in the baseline assessment, a sample of 267 clients was achieved for six-month follow-up interview, based on those retained in the residence. A logistic regression model examined factors associated with retention and a repeated measures marginal mixed model evaluated the factors associated with changes in recovery capital between the baseline and the follow-up assessment. RESULTS: Members of the group that remained in recovery residences were more likely to be older with a record of high participation in recovery groups, with greater drop-out among younger residents, female residents and those with an identified housing need. For those retained to follow-up, greater recovery capital growth was associated with employment, higher levels of social support and more recovery group involvement, as well as age and a higher quality of life. The need for family support was shown to reduce levels of recovery capital. However, those younger people who were retained reported better recovery capital growth during the initial six months of residence. CONCLUSION: The key conclusion is that while recovery capital generally increases during a stay in a recovery residence, it does not do so consistently across the sample population. This has implications for how pathways to recovery group engagement are supported for women and young people and how social support (encompassing housing, employment and family issues) is provided to those populations during periods of residence. This suggests the potential need for training and guidance for house managers working with these groups.

A Small Area Estimation Method for Investigating the Relationship between Public Perception of Drug Problems with Neighborhood Prognostics: Trends in London between 2012 and 2019.

The correlation of the public's perception of drug problems with neighborhood characteristics has rarely been studied. The aim of this study was to investigate factors that correlate with public perceptions in London boroughs using the Mayor's Office for Policing and Crime (MOPAC) Public Attitude Survey between 2012 and 2019. A subject-specific random effect deploying a Generalized Linear Mixed Model (GLMM) using an Adaptive Gaussian Quadrature method with 10 integration points was applied. To obtain time trends across inner and outer London areas, the GLMM was fitted using a Restricted Marginal Pseudo Likelihood method. The perception of drug problems increased with statistical significance in 17 out of 32 London boroughs between 2012 and 2019. These boroughs were geographically clustered across the north of London. Levels of deprivation, as measured by the English Index of Multiple Deprivation, as well as the percentage of local population who were non-UK-born and recorded vehicle crime rates were shown to be positively associated with the public's perception of drug problems. Conversely, recorded burglary rate was negatively associated with the public's perception of drug problems in their area. The public are influenced in their perception of drug problems by neighborhood factors including deprivation and visible manifestations of antisocial behavior.

The Strengths and Barriers Recovery Scale (SABRS): Relationships Matter in Building Strengths and Overcoming Barriers.

There is a well-established relationship between isolation and both morbidity and mortality in the context of addiction recovery, yet the protective effects of intimate and familial relationships have not been adequately assessed. The current paper uses the European Life In Recovery database to assess the association between relationship status and living with dependent children on recovery capital of people in recovery from drug addiction, operationalised by the Strengths And Barriers Recovery Scale (SABRS). The study participants were drawn from the REC-PATH study and supplemented by a second sample recruited by the Recovered Users Network (RUN) across various European countries, resulting in a combined sample of 1,313 individuals completing the survey, primarily online. The results show that, in recovery, those who are married or co-habiting reported significantly greater recovery strengths and fewer barriers to recovery, and reported greater gains in recovery capital across their recovery journeys. Similar associations are found for participants who have dependent children living with them. There is also some indication that this association is stronger for female than for male participants. Finally, having more people that one can rely on and a greater proportion of people in recovery in the social network are both linked to greater recovery capital and greater self-reported growth in recovery capital. We conclude that this study provides further evidence in favour of a "social cure" in recovery, in which close familial ties are associated with stronger recovery resources.

Multiple Morbidities in an Inner-City English Substance Misuse Treatment Service: Hierarchical Cluster Analysis to Derive Treatment Segments.

OBJECTIVES: Comorbid needs of people attending substance use treatment has been well documented although there is an assumption of heterogeneity in the treated population. This study utilized hierarchical cluster analysis to explore the extent and nature of client segments within the treated population. Methods: A retrospective review of comorbid health and social needs of a random sample of client case-notes (n = 300) was undertaken on all people known to treatment in an urban, inner-London community out-patient treatment service during 2018-2019. A hierarchical cluster analysis using Ward's linkage method was implemented to explore the data to determine and describe emergent clusters. Inter cluster differences were investigated further by modeling methods. Results: High rates of physical health (63%) and mental health (50%) need were noted across the entire treatment population. The hierarchical clustering identified three discrete segments of the treatment population. The largest segment (46% of clients) was complex, socially impacted chaotic heroin and crack misusers exhibiting a wide range of multiple morbidities including social needs such as housing, unemployment and offending. This cluster also were more likely to report acute needs such as Emergency Department attendance, utilization of ambulatory services and will and episodic disengagement disengage episodically from treatment. A second segment (24% of clients) exhibited similar drug using profiles to the largest cluster, although with fewer comorbid issues. This cluster tended to be older and more likely to report respiratory conditions. A third cluster (25% of clients) was more likely to be alcohol misusers who were new to treatment. Conclusions: Treated populations are likely to be relatively heterogeneous across a range of social harms, physical and mental health needs. Identifying multidimensional needs of segments within treatment services allows for the creation of tailored treatment interventions.

A two-arm parallel-group individually randomised prison pilot study of a male remand alcohol intervention for self-efficacy enhancement: the APPRAISE study protocol.

INTRODUCTION: The prevalence of at-risk drinking is far higher among those in contact with the criminal justice system (73%) than the general population (35%). However, there is little evidence on the effectiveness of alcohol brief interventions (ABIs) in reducing risky drinking among those in the criminal justice system, including the prison system and, in particular, those on remand. Building on earlier work, A two-arm parallel group individually randomised Prison Pilot study of a male Remand Alcohol Intervention for Self-efficacy Enhancement (APPRAISE) is a pilot study designed to assess the feasibility and acceptability of an ABI, delivered to male prisoners on remand. The findings of APPRAISE should provide the information required to design a future definitive randomised controlled trial (RCT). METHODS AND ANALYSIS: APPRAISE will use mixed methods, with two linked phases, across two prisons in the UK, recruiting 180 adult men on remand: 90 from Scotland and 90 from England. Phase I will involve a two-arm, parallel-group, individually randomised pilot study. The pilot evaluation will provide data on the likely impact of A two-arm parallel group individually randomised Prison Pilot study of a male Remand Alcohol Intervention for Self-efficacy Enhancement (APPRAISE), which will be used to inform a future definitive multicentre RCT. Phase II will be a process evaluation assessing how the ABI has been implemented to explore the change mechanisms underpinning the ABI (figure 1) and to assess the context within which the ABI is delivered. ETHICS AND DISSEMINATION: The APPRAISE protocol has been approved by the East of Scotland Research Ethics Committee (19/ES/0068), National Offender Management System (2019-240), Health Board Research and Development (2019/0268), Scottish Prison Service research and ethics committee, and by the University of Edinburgh's internal ethics department. The findings will be disseminated via peer-reviewed journal publications, presentations at local, national and international conferences, infographics and shared with relevant stakeholders through meetings and events. TRIAL REGISTRATION NUMBER: ISRCTN27417180.

Estimating a treatment effect on recidivism for correctional multiple component treatment for people in prison with an alcohol use disorder in England.

BACKGROUND: There is an emerging literature on the impact of correctional substance abuse treatment (SAT) on reoffending for people in prison with substance misuse issues. This study estimates a pathway effect for people in prison receiving multiple component treatments for an alcohol use disorder (AUD) to reduce reoffending by applying treatment effect estimation techniques for observational studies. Treatment groups comprised pharmacological treatments, psychosocial interventions (PSIs) and interventions that incorporate Risk Need Responsivity (RNR) programming. RNR compliant treatment matches treatment dose to the risk of reoffending, targets criminogenic need and is tailored to a person's learning style. METHODS: Multiple treatment effect estimators are provided for people in prison diagnosed with an AUD in England when compared to a derived control group for: Pharmacological treatment only; RNR compliant treatment and PSIs. RESULTS: The outcomes for RNR compliant treatment suggest a lower recidivism rate compared to the control group. Pharmacological only treatment results in a statistically significant higher level of reoffending relative to the control group. CONCLUSIONS: The creation of a universal system of 'equivalence of care' framed within a public health context in English correctional SAT may have had an unintended consequence of diluting approaches that reduce recidivism. There is an opportunity to develop an integrated, cross-disciplinary model for correctional SAT that unites public health and RNR compliant approaches.

Drug testing on arrest-who benefits?

BACKGROUND: Drugs and crime are linked and diversion from the criminal justice system into drug treatment is a well-established policy response. The point of arrest is a pivotal moment to initiate a drug-specific intervention. This paper assesses the impact of the introduction of drug testing on arrest (DToA) into a low crime area in England. Our mixed methods study analysed performance data collected by the National Drug Treatment Monitoring/Drug Test Recorder datasets and feedback from a series of semi-structured interviews with both clients and professionals. RESULTS: In total, 2210 people were tested 2861 times of which 42.0% (n = 928) tested positive. Of those, 3% subsequently engaged with effective treatment. However, throughout the criminal justice system, treatment engagements increased year on year from 20% (n = 77) to 26% (n = 131). Clients (n = 19) and professionals (n = 14) reported that DToA was an acceptable/tolerable addition to the treatment pathway. Interviews suggested that the point of arrest may help primary desistance from further offending. CONCLUSIONS: The staggered introduction of the DToA made direct measure of impact difficult and there appears to have been a 'displacement' effect in response to the extra investment. However, DToA appears to have contributed towards an overall uplift in criminal justice drug treatment system performance activities (identification, assessment, referral etc.) and may have served to help strengthen care pathways. Barriers were noted about engagement with DToA by entrenched opiate users, suggesting that the effectiveness of DToA was limited within that group. This study is the first to investigate the impact of the introduction of DToA into a low crime area.

Non-cancer pain clinic in three English prisons: understanding prisoner needs and prescribing practice in relation to chronic non-cancer pain (CNCP).

PURPOSE: Prisoner access to opiate-based analgesics and gabapentinoids is a concern to prisons through illicit trading. The purpose of this paper is to describe patient needs following introduction of nine pilot chronic non-cancer pain (CNCP) clinics for chronic pain in three prisons (two male and one female) in the South of England. The study evaluated the effectiveness of this model and assessed the wider practical implementation issues. DESIGN/METHODOLOGY/APPROACH: Clinical notes were reviewed for 63 consultations, anonymised and recorded for secondary analysis. FINDINGS: Alongside CNCP, high levels of substance misuse, physical and mental health histories were noted, especially for female patients. Amitriptyline, pregabalin, gabapentin were the main frontline analgesics prescribed prior to assessment. A total of 41 per cent of patients did not change their medication following the consultation; 25 per cent had their medication increased or reintroduced (greater for women prisoners); with one-third (33 per cent) of patients reducing the prescription of strong opioids and gabapentinoids. Significant differences were noted between male and female patients. Prisoners were amenable to changes in medication to facilitate access to work and other therapeutic interventions. SOCIAL IMPLICATIONS: The prescribing of analgesics has largely been couched in terms of disruption to the prison regime through illicit trading. This study highlights the need to place CNCP within wider contexts of substance misuse, physical and emotional health. There is an opportunity to develop a rehabilitative rather than palliative approach to pain management. Gender specific approaches for female patients should be considered. ORIGINALITY/VALUE: Few studies of CNCP have been conducted within a prison environment.

Health needs and co-morbidity among detainees in contact with healthcare professionals within police custody across the London Metropolitan Police Service area.

AIMS: Detainees requiring access to healthcare services in police custody have been shown to suffer from poor physical and mental health, often exacerbated by substance misuse. This study examines the extent and nature of health needs in police custody across the Metropolitan Police Service (MPS), London. METHODS: A survey (n = 1657) was administered by Healthcare Professionals (HCP) for one month in 2015 across all MPS custody suites representing a 73% response rate. A logistic regression model was created using four binary outcomes (whether a detainee was a drug user, had mental health issues including self-harm and had an alcohol use disorder) with ten prognostics to test for co-morbid associations. A multiple imputation method using chained equations was used to manage missing cases. FINDINGS: High rates of physical health conditions, drug use, problematic alcohol use were noted but are within the upper range of existing studies. Mental health, self-harm and overall substance misuse levels (illicit drug user and a current drinker) were shown to be higher than other published studies. The logistic regression model found statistically significant associations between drug use, alcohol consumption and mental health including self-harm. Age was also found to be a key confounding factor. Physical health was broadly negatively associated with the four main outcomes. DISCUSSION: Levels of need for health interventions among the detainee population in London are broadly consistent with other European centres. There is a need for police custody staff to consider detainees' dual diagnosis needs. The development of integrated interventions alongside the enhanced clinical management of alcohol, drug use and mental health was considered.

Patient perspectives of being detained under section 136 of the Mental Health Act: Findings from a qualitative study in London.

Introduction Detention under section 136(1) of the Mental Health Act 1983 allows for the police to arrest a person from a public place and remove them to a 'place of safety', typically an emergency department or mental-health unit if it is 'in the interests of that person or for the protection of other persons in immediate need of care or control'. Aims/objective: The aim of this study was to describe the views and perceptions of the process for people with lived experience of mental distress who have been detained under section 136 of the Mental Health Act 1983. Method Semi-structured interviews were conducted with a non-probability sample of people with lived experience of mental distress who have been detained under section 136 across Greater London. Interviews were transcribed and thematically analysed using grounded theory. Fifty-eight people with lived experience of mental distress detained under section 136, including four carers, participated in this study. Results Three interwoven themes were identified: (a) process or procedural issues; (b) the professional-patient relationship; and (c) the importance of a supportive therapeutic environment. Conclusion The length of time, multiple assessment points and processes juxtapose against the need for a humane physical environment and supportive therapeutic interactions from all professional agencies. It is unclear how changes proposed in the Policing and Crime Act 2017 will address these patient needs.

A rapid systematic review of what we know about alcohol use disorders and brief interventions in the criminal justice system.

PURPOSE: The purpose of this paper is to review the evidence of alcohol use disorders within the different stages of the criminal justice system in the UK. Furthermore it reviewed the worldwide evidence of alcohol brief interventions in the various stages of the criminal justice system. DESIGN/METHODOLOGY/APPROACH: A rapid systematic review of publications was conducted from the year 2000 to 2014 regarding the prevalence of alcohol use disorders in the various stages of the criminal justice system. The second part of the work was a rapid review of effectiveness studies of interventions for alcohol brief interventions. Studies were included if they had a comparison group. Worldwide evidence was included that consisted of up to three hours of face-to-face brief intervention either in one session or numerous sessions. FINDINGS: This review found that 64-88 per cent of adults in the police custody setting; 95 per cent in the magistrate court setting; 53-69 per cent in the probation setting and 5,913-863 per cent in the prison system and 64 per cent of young people in the criminal justice system in the UK scored positive for an alcohol use disorder. There is very little evidence of effectiveness of brief interventions in the various stages of the criminal justice system mainly due to the lack of follow-up data. SOCIAL IMPLICATIONS: Brief alcohol interventions have a large and robust evidence base for reducing alcohol use in risky drinkers, particularly in primary care settings. However, there is little evidence of effect upon drinking levels in criminal justice settings. Whilst the approach shows promise with some effects being shown on alcohol-related harm as well as with young people in the USA, more robust research is needed to ascertain effectiveness of alcohol brief interventions in this setting. ORIGINALITY/VALUE: This paper provides evidence of alcohol use disorders in the different stages of the criminal justice system in the UK using a validated tool as well as reviewing the worldwide evidence for short ( < three hours) alcohol brief intervention in this setting.

Stakeholder perceptions and operational barriers in the training and distribution of take-home naloxone within prisons in England.

BACKGROUND: The aim of the study was to assess potential barriers and challenges to the implementation of take-home naloxone (THN) across ten prisons in one region of England. METHODS: Qualitative interviews deploying a grounded theory approach were utilised over a 12- to 18-month period that included an on-going structured dialogue with strategic and operational prison staff from the ten prisons and other key stakeholders (n = 17). Prisoner perceptions were addressed through four purposive focus groups belonging to different establishments (n = 26). Document analysis also included report minutes and access to management information and local performance reports. The data were thematically interpreted using visual mapping techniques. RESULTS: The distribution and implementation of THN in a prison setting was characterised by significant barriers and challenges. As a result, four main themes were identified: a wide range of negative and confused perceptions of THN amongst prison staff and prisoners; inherent difficulties with the identification and engagement of eligible prisoners; the need to focus on individual prison processes to enhance the effective distribution of THN; and the need for senior prison staff engagement. CONCLUSIONS: The distribution of THN within a custodial setting requires consideration of a number of important factors which are discussed.

What influences referral to 12-step mutual self-help groups by treatment professionals?

BACKGROUND/AIMS: Twelve-step mutual self-help groups provide cost-effective support for recovery from substance misuse problems. Evidence suggests they are successful as an adjunct to formal treatment and that referral from clinicians is important in fostering engagement. METHODS: This study surveyed substance misuse treatment professionals employed within two agencies in Birmingham (UK). RESULTS: A total of 92 clinicians (79.3%) eligible to participate completed a questionnaire that explored their attitudes, knowledge and referral practices with regard to 12-step groups (TSGs). Most (74%) had a positive attitude, and almost 80% referred at least some of their clients to TSGs. However, 30% had not referred any clients in the past month, and multivariate analysis showed that referral was associated with greater objective knowledge about TSGs when other factors were controlled for. CONCLUSIONS: These results have implications for linking professional treatment to mutual self-help groups, and potential strategies to increase referral are discussed.