Latinos and Latinas in Communal Settings: A Grounded Theory of Recovery

Semi-structured interviews were conducted with 12 Latino/a residents of a mutual help residential recovery program (Oxford House) in order to elicit their experiences of the program’s therapeutic elements. A model of recovery emerged from the analysis including several themes supported by existing literature: personal motivation and readiness to change, mutual help, sober environment, social support, and accountability. Consistent with a broad conceptualization of recovery, outcomes included abstinence, new life skills, and increased self-esteem/sense of purpose. Most participants were the only Latino/a in their Houses; however, cultural differences did not emerge as salient issues. The study’s findings highlight potential therapeutic aspects of mutual-help communal recovery programs and suggest that English-speaking, bicultural Latinos/as have positive experiences and may benefit from participating in these programs

Interventions for female drug-using offenders

Key results: We identified nine trials of female drug-using offenders. Three studies included evaluations of therapeutic communities in comparison to: i) an alternative sentencing option; ii) a substance misuse educational cognitive skills programme; and iii) gender-responsive substance abuse treatment for women in prison in comparison to standard therapeutic communities. Two studies evaluated community-based management; one compared to standard probation and the other compared to standard parole supervision. Two studies evaluated a cognitive behavioural programme versus treatment as usual and combined cognitive behavioural treatment and acceptance and commitment therapy versus waiting list control. One study of a pharmacological intervention in comparison to a placebo or treatment as usual. One study compared interpersonal psychotherapy to an attention matched control psychoeducational control. Overall, the findings suggest that any psychosocial treatment in comparison to treatment as usual had an impact on reducing subsequent reincarceration, but not rearrest or drug misuse. We found individual treatment interventions had differing effects. We identified too few studies to evaluate whether the treatment setting (for example, court or community) had an impact on the success of such programmes. Promising results highlight the use of psychosocial treatments in the reduction of reincarceration. No information is provided on the cost and cost-effectiveness of these studies. In conclusion, high quality research is required to evaluate the effectiveness of different treatment options for female drug-using offenders. Further information on the processes involved in the engagement of women mandated to substance abuse programmes, together with evaluations of cost-effectiveness research, will enable policy makers to make informed choices about commissioning the use of adapted programmes specifically targeted at female offenders

Pharmacological interventions for drug-using offenders.

BACKGROUND: The review represents one in a family of four reviews focusing on a range of different interventions for drug-using offenders. This specific review considers pharmacological interventions aimed at reducing drug use or criminal activity, or both, for illicit drug-using offenders. OBJECTIVES: To assess the effectiveness of pharmacological interventions for drug-using offenders in reducing criminal activity or drug use, or both. SEARCH METHODS: We searched Fourteen electronic bibliographic databases up to May 2014 and five additional Web resources (between 2004 and November 2011). We contacted experts in the field for further information. SELECTION CRITERIA: We included randomised controlled trials assessing the efficacy of any pharmacological intervention a component of which is designed to reduce, eliminate or prevent relapse of drug use or criminal activity, or both, in drug-using offenders. We also report data on the cost and cost-effectiveness of interventions. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures as expected by Cochrane. MAIN RESULTS: Fourteen trials with 2647 participants met the inclusion criteria. The interventions included in this review report on agonistic pharmacological interventions (buprenorphine, methadone and naltrexone) compared to no intervention, other non-pharmacological treatments (e.g. counselling) and other pharmacological drugs. The methodological trial quality was poorly described, and most studies were rated as 'unclear' by the reviewers. The biggest threats to risk of bias were generated through blinding (performance and detection bias) and incomplete outcome data (attrition bias). Studies could not be combined all together because the comparisons were too different. Only subgroup analysis for type of pharmacological treatment were done. When compared to non-pharmacological, we found low quality evidence that agonist treatments are not effective in reducing drug use or criminal activity, objective results (biological) (two studies, 237 participants (RR 0.72 (95% CI 0.51 to 1.00); subjective (self-report), (three studies, 317 participants (RR 0.61 95% CI 0.31 to 1.18); self-report drug use (three studies, 510 participants (SMD: -0.62 (95% CI -0.85 to -0.39). We found low quality of evidence that antagonist treatment was not effective in reducing drug use (one study, 63 participants (RR 0.69, 95% CI 0.28 to 1.70) but we found moderate quality of evidence that they significantly reduced criminal activity (two studies, 114 participants, (RR 0.40, 95% CI 0.21 to 0.74).Findings on the effects of individual pharmacological interventions on drug use and criminal activity showed mixed results. In the comparison of methadone to buprenorphine, diamorphine and naltrexone, no significant differences were displayed for either treatment for self report dichotomous drug use (two studies, 370 participants (RR 1.04, 95% CI 0.69 to 1.55), continuous measures of drug use (one study, 81 participants, (mean difference (MD) 0.70, 95% CI -5.33 to 6.73); or criminal activity (one study, 116 participants, (RR 1.25, 95% CI 0.83 to 1.88) between methadone and buprenorphine. Similar results were found for comparisons with diamorphine with no significant differences between the drugs for self report dichotomous drug use for arrest (one study, 825 participants, (RR 1.25, 95% CI 1.03 to 1.51) or naltrexone for dichotomous measures of reincarceration (one study, 44 participants, (RR 1.10, 95% CI 0.37 to 3.26), and continuous outcome measure of crime, (MD -0.50, 95% CI -8.04 to 7.04) or self report drug use (MD 4.60, 95% CI -3.54 to 12.74). AUTHORS' CONCLUSIONS: When compared to non-pharmacological treatment, agonist treatments did not seem effective in reducing drug use or criminal activity. Antagonist treatments were not effective in reducing drug use but significantly reduced criminal activity. When comparing the drugs to one another we found no significant differences between the drug comparisons (methadone versus buprenorphine, diamorphine and naltrexone) on any of the outcome measures. Caution should be taken when interpreting these findings, as the conclusions are based on a small number of trials, and generalisation of these study findings should be limited mainly to male adult offenders. Additionally, many studies were rated at high risk of bias

Contingency management strategies and ideas.

This manual includes a series of “topic-focused modular applications” designed particularly for counselors and group facilitators working in substance abuse treatment programs. The collection of applications contains focused, easily accessible, and brief adaptive strategies for using rewards and star charts to reinforce goal setting, early engagement, and retention in treatment settings. Modular applications in this manual include: • Part 1 -- CM: Getting Started provides background and considerations for developing simple contingency management (CM) or reinforcement protocols for use in substance abuse treatment settings. Information from research-based interventions developed for the National Institute on Drug Abuse (NIDA) is included, along with issues to consider for protocol design, implementation, and management. This chapter is designed as a primer for treatment staff interested in simple, yet effective reinforcement strategies to strengthen motivation and engagement in treatment. • Part 2 -- StarCharts and Rewards presents ideas for a sample protocol for implementing CM with existing clients using simple incentive charts (StarCharts) and prizes. This section provides counselors and caseworkers with guidelines for getting ready for the protocol and for introducing and discussing CM participation with clients. Samples of client information sheets and informed consent forms are included, along with examples of incentive chart templates. • Part 3 -- Rewarding Effort and Initiative provides a framework for conducting a goal-setting counseling session with clients to help identify tasks related to accomplishing goals as part of a CM protocol. The client and counselor work together to set a star “value” for each task, along with timelines and how accomplishment will be objectively assessed. A scripted sample interview is included, along with a planning template for charting agreed upon tasks and how stars will be awarded. • CM Bibliograph