Computerized Psychosocial Treatment for Offenders with Substance Use

Disorders: Study Outcomes

Michael Chaple , PhD Center for the Integration of Research & Practice (CIRP) National Development & Research Institutes, Inc. (NDRI)

Stanley Sacks, PhD Center for the Integration of Research & Practice (CIRP) National Development & Research Institutes, Inc. (NDRI)

Lisa Marsch, PhD Dartmouth Medical School, Dartmouth Psychiatric Research Center

2014 National Frontier and Rural ATTC Addiction Treatment Technology Summit August 26-27, 2014— Chicago, Illinois

Supported by The Department of Health and Human Services National Institutes of Health (NIH), National Institute on Drug Abuse (NIDA) grant: 5RC2DA028967. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute On Drug Abuse or the National Institutes of Health.

Conflict of Interest

Neither Dr. Chaple nor Dr. Sacks, have any financial relationships that relate to the topic of this presentation.

Dr. Marsch is affiliated with HealthSim, LLC, the developer of the computer-based Therapeutic Education System.

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ResearchAgency Principal Investigator

National Development & Research Institutes (NDRI) Stanley Sacks Lisa A. Marsch

University of California – Los Angeles (UCLA) Michael Prendergast

Temple University Steven Belenko

University of Kentucky Carl Leukefeld

University of Miami Michael French

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Collaborating Agencies

Background Despite the high prevalence of substance use

disorders among prisoners (53% in State, 45% in Federal1), about ¼ of prisoners in need of drug treatment actually receive it while incarcerated2

To increase the number of inmates receiving services, a computer-based, psychosocial treatment program, the Therapeutic Education System (TES) was developed.

This study evaluated the comparative effectiveness of TES relative to Standard Care.

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1 Mumola, C. &Karberg, J. (2006). Drug use and dependence, state and federal prisoners, 2006. Bureau of Justice Statistics, Office of Justice Programs.

2 Taxman, F.S., Perdoni, M.L., & Harrison, L.D. (2007a). Drug treatment services for adult offenders: The state of the state. Journal of Substance Abuse Treatment, 32(3), 239-254. Chandler, R.K., Fletcher, B.W., &Volkow, N.D. (2009). Treating drug abuse and addiction in the criminal justice system. Journal of the American Medical Association, 301(2), 183-190.

TES Technology Theoretically grounded in the Community

Reinforcement Approach (CRA) & Cognitive Behavioral Therapy (CBT)

Uses “fluency-based” Computer-Assisted Instruction (CAI) based in the “precision teaching” approach3

Experiential learning environment, using interactive videos & exercises

5 3 Binder, C. (1993). Behavioral fluency: A new paradigm. Educational Technology, 33, 8-14.

TES Content 12-week intervention; typically once a week for 2 hours

Thirty-two (32) Core modules broadly classified as: • Substance Use/Abuse (e.g., Drug Refusal Skills) • Risk Reduction for HIV/AIDS, Sexually Transmitted Infections (e.g.,

Drug Use, Triggers for Risky Sex) • Cognitive and Emotional Modulation (e.g., Managing Negative

Thinking, Anger Management) • Psychosocial Functioning (e.g., Effective Problem Solving,

Communication Skills)

Sixteen (16) optional modules provide more advanced information on risk reduction and psychosocial functioning

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Control Condition

The Control condition (or Standard Care) consisted of the interventions usually offered for drug treatment at the prison.

Curriculum consisted primarily of psycho-education and relapse prevention approaches

Typically once per week for 2 hours for a total of 8-12 weeks

Groups were conducted by staff members who specialize in substance abuse treatment, and who have a minimum credential certifying their advanced training (e.g. CAC)

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Study AIMS Evaluation of TES relative to Standard Care examining:

AIM 1. Comparative effectiveness

AIM 2. Cost and cost-effectiveness

Key Outcomes for both AIMS include: Substance use (e.g. any use, weeks of abstinence) HIV risk behavior (i.e. drug and sex-related) Self-reported Criminal Activity & Reincarceration rates

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Study Design

TES (E) N=258

Random Assignment

Correctional Facility* N=513

* 10 sites in 4 research centers linked to the NIDA funded CJDATS network

Standard Services (C) N=255

Eligibility criteria for the study:

1) Identified by Department of Corrections as needing SUD Tx; 2) Nearing prison release; 3) Minimum or minimum-restricted security risk; 4) Voluntarily consented to enter the study.

Sample

State Field Site Prisons Total E C CO NDRI 7 327 165 162 WA UCLA 1 62 31 31

PA Temple University 1 57 29 28

KY University of Kentucky 1 67 33 34

Total N 10 513 258 255

Baseline Recruitment:

15 subjects were not released from prison as expected; thus final sample = 498

Methods

Prospective, longitudinal, repeated measures study with randomization

Self-Report Data collected at Baseline (in prison) and 3- and 6-months post-prison release Criminal Activity, Illegal Drug Use, HIV Risk Behavior,

Reincarceration data (DOC) collected at 12-months

Follow-up Interview Rates: 3-months = 86.1% (88.4% Experimental; 83.4% Control) 6-months = 80.0% (81.2% Experimental; 78.2% Control)

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Any Illegal Drug Use

0102030405060708090

100

Baseline 6MPP

78

36

82

38 E-TES

C

Perc

ent

Days Abstinent

0

30

60

90

120

150

180

Baseline 6MPP

E-TES

C

Num

ber o

f Day

s

HIV Sex Risk*

0102030405060708090

100

Baseline 6MPP

64.1

18.2

71.7

19.9 E-TES C

* Unprotected sex while high/partner is high, in exchange for money/drugs, with an HIV+ partner or status of partner is unknown.

Perc

ent

Any Drug Injection

0102030405060708090

100

Baseline 6MPP

16.52.5

23.4

6.2

E-TES C

Perc

ent

Any Criminal Activity

0102030405060708090

100

Baseline 6MPP

80

46

80

46E-TES

C

Perc

ent

Reincarceration: 12M PP

0102030405060708090

100

Any Offense New Offense Violation

27.5

7.420.121.4

6.715.1

E-TES

C

Perc

ent

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Summary

Preliminary findings indicate • Both groups improved after prison release • No significant differences between TES and

Standard Care for criminal activity, substance use, and HIV risk behavior on any of the key outcome measures post prison release

• Therefore, further economic analysis will be concentrated on cost minimization

Additional Related Publications Marsch, L.A., Bickel, W.K. (2004). Efficacy of computer-based HIV/AIDS education for injection drug users.

American Journal of Health Behavior, 28(4), 316-327. DOI: 10.5993/AJHB.28.4.3

Bickel, W.K., Marsch, L.A., Buchhalter, A., & Badger, G. (2008). Computerized behavior therapy for opioiddependent outpatients: A randomized, controlled trial. Exp Clin Psychopharmacol, 16, 132-143.

Marsch, L.A., Bickel, W.K., &Grabinski, M.J. (2007). Application of interactive, computer technology to adolescent substance abuse prevention and treatment. In Cohall, A.T., Rickert, V. & Ryan, O. (Eds.), Harnessing Technology for Adolescent Health Promotion, pp. 342-356. American Academy of Pediatrics.

Marsch, L.A., Grabinski, M.J., Bickel, W.K., Desrosiers, A., Guarino, H., Muehlbach, B., Solhkhah, R., Talfique, S., & Acosta, M. (2011). Computer-Assisted HIV Prevention for Youth with Substance Use Disorders. In Special Issue on Technology and Substance Use Disorders (Guest Editor: Marsch, L.A.). Substance Use and Misuse, 46, 46-56.

Marsch, L.A. Guarino, H., Acosta, M., Aponte-Melendez, Y., Cleland, C., Grabinski, M., Brady, R., & Edwards, J.A. (2014). Web-based behavioral treatment for substance use disorders as a partial replacement of standard methadone maintenance treatment. Journal of Substance Abuse Treatment, 46: 43-51.

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Study Publications Chaple, M., Sacks,S., McKendrick, M., Marsch, L.A., Belenko, S., Leukefeld, C., Prendergast ,

M. & French, M (2014). Feasibility of a computerized intervention for offenders with substance use disorders: A research note. Journal of Experimental Criminology, 10: 105-127. doi: 10.1007/s11292-013-9187-y

Chaple, M., Sacks,S., McKendrick, M., Marsch, L.A., Belenko, S., Leukefeld, C., Prendergast , M. & French, M (2014).(2014). A comparative study of the therapeutic education system for incarcerated substance abusing offenders. Accepted for publication in Prison Journal.

Contact information:

Michael Chaple, PhD Co-Principal Investigator

National Development & Research Institutes, Inc. 71 W 23rd Street, 8th Floor

New York, NY 10010 tel212.845.4539 fax 212.845.4650

http://www.ndri.org chaple@ndri.org

Acknowledgements: The authors wish to acknowledge the important collaboration with the

Dept. of Corrections in Colorado, Kentucky, Pennsylvania and Washington State in the conduct of this study.

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