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FORUM on Corrections Research
Factors influencing the outcome of offender substance abuse treatment
Unfortunately, much of the assessment and treatment of offenders with substance abuse problems fails to
recognize the varying severity of these problems.
Recent research has demonstrated that about 30% of offenders do not have substance abuse problems, 30%
have low-severity problems, 17% have intermediate problems, 13% have substantial problems, and 10% have
severe problems.(2)
These wide differences suggest that a range of programming is needed to meet the treatment needs of all
offenders. Some individuals may need relatively little treatment to control or eliminate their substance
use, while others may require more extensive intervention, administered over a longer time period, with
formal maintenance and follow-up.(3) In short, not everyone needs the same amount or type of
treatment.
Researchers also often fail to consider the risk of recidivism, despite the fact that research has
repeatedly demonstrated a strong link between substance use and criminal behaviour.(4) The
risk of recidivism may, therefore, be another important variable in predicting treatment outcome and
offender post-release behaviour.
Finally, treatment performance may be crucial to predicting an offender's likelihood of controlling or
eliminating their substance use. However, there are few, if any, Canadia correctional substance abuse
treatment programs that comprehensively and objectively assess each participant's performance. As a
result, little research has examined whether offender treatment performance influences post-release
behaviour.
This article, therefore, examines the impact of these three potentially key factors (severity of the
substance abuse problem, risk of recidivism and treatment performance) on the substance abuse treatment
outcome of inmates who are subsequently released. The Offender Substance Abuse Pre-release program The
treatment program used in this study was the prototype for a program that has since been modified and
implemented nationally by the Correctional Service of Canada as the Offender Substance Abuse Pre-release
(OSAP) program.(5)
Although this program was designed for offenders with intermediate alcohol and drug problems, offenders
with problems of all seventies (from low severity to severe) went through the program during the study
period because of the lack of other available programming.
The program is highly structured and makes active use of various behavioural and cognitive behavioural
approaches that have promise in changing substance abuse behaviour.(6) More specifically, the
program addresses alcohol and drug education, self-management, problem solving, cognitive and
behavioural skills training, social skills, job skills refresher training, leisure and lifestyle
planning, relapse prevention, and pre-release planning.
The program also contains a comprehensive battery of measures designed to assess offender progress,
both individually and collectively, from before entering the program to after its completion.
Methodology A total of 324 adult offenders (315 men and 9 women), ranging in age from 18 to 66,
participated in the Offender Substance Abuse Pre-release program at Bath Institution between January
1990 and August 1992. Bath Institution was a minimum-security institution at the time of the study.
The final sample was ultimately made up of 317 offenders, as seven offenders did not complete the
program. The average offender sentence length was 40.5 months. Just 2.5% of the sample were serving a
life sentence, while almost 82% were experiencing their first term of federal incarceration (a sentence
of two years or longer). Just over 37% of the sample had been convicted of a violent crime, with 28.4%
having been convicted of a nonviolent offence and 34.1% having been convicted of a drug-or
alcohol-related offence.
The small number of female participants precluded any analysis of potential gender differences.
The severity of offender alcohol and drug problems was assessed before offenders entered the program
with three screening instruments (that were originally developed and standardized using non-offender
populations): the Alcohol Dependence Scale,(7) the Drug Abuse Screening Test(8)
and the Michigan Alcohol Screening Test.(9)
The Community Risk / Needs Management Scale(10) was used to determine the risk of
recidivism, while offender program performance was assessed using a battery of eight measures that were
administered before and after offender program participation.(11)
Four of these measures focused specifically on aspects of alcohol use, including the negative effects
of alcohol, strategies for declining offers of alcohol and ways of consuming alcohol responsibly. A
fifth measure focused on the negative consequences of drug use, while the remaining three measures
consisted of questions relating to both alcohol and drug use, such as the impact of substance use on
employment.
The Offender Information System (which has since been replaced by the Offender Management System)
provided all information on offender post-release criminal behaviour.
The system provided extensive quantitative information on release, conditional release revocations,
reconvictions and offence types.
Information on offender post-release alcohol and drug use was obtained by examining parole officer
reports in files maintained by the National Parole Board.
More than 90% of the offenders who completed the program ultimately received some form of conditional
release. Of these offenders, 72.1% were released on day parole, 7.7% on full parole and 20.2% on
statutory release.
The follow-up period was, on average, about 15 months, post-release. During this period, 31.4% of the
sample were returned to custody -19.9% because of technical conditional release violations and 13.6% for
new offences (2.1% returned because of both a technical violation and a new offence).
Review of the National Parole Board files revealed that about 73% of the offenders who were returned to
custody had used alcohol and/or drugs while on release and that substance use had contributed to the
termination of their release. Severity of the substance abuse problem Offender alcohol and drug severity
scores were pooled to classify each offender according to their most severe substance abuse problem
(alcohol, drugs or both).
Under this classification, 16.2% of the offenders were identified as having a low-level substance abuse
problem, 19.7% had an intermediate problem, 40.5% had a substantial problem, and 20.1% had a severe
problem. Interestingly, 3.5% of the sample were not assessed as having either an alcohol or drug
problem.
These findings indicate that approximately 80% of the offenders had alcohol problems, drug problems or
combined alcohol and drug problems of sufficient severity to warrant their participation in the Offender
Substance Abuse Pre-release program. The remaining 20% (those without a substance abuse problem or with
a low-level problem) probably gained admittance to the program because of other information (such as
case file information or interviews) identifying them as appropriate candidates.
The rate of readmission into custody (for any reason) increased dramatically according to the severity
of offender substance abuse problems (see Figure 1). These differences were statistically significant
(p < .05).
Figure 1
Risk of recidivism Approximately 38.2% of the offenders released were assessed as being at low risk of recidivism, while the remaining 61.8% were determined to be high risk. The ultimate offender readmission rate differed significantly according to risk level (p < .0001). Just 14% of low-risk offenders were returned to custody (for any reason), compared to 39.4% of high-risk offenders (see Figure 2).
Figure 2
A similar pattern emerged in a subgroup of high-risk / high-need offenders with intermediate to severe
substance abuse problems. Program performance Most of the offenders who participated in the program
improved significantly on almost all assessment measures. However, a simple analysis of changes in
offender responses to the battery of assessment measures (from pre- to post-program participation)
revealed nothing about offender release behaviour.
A five-level performance index was, therefore, created by classifying offenders based on the number of
measures on which they demonstrated improvement from the beginning to the end of the program.
Interestingly, offender program performance was found to be unrelated to the rate of readmission for
technical conditional release violations.
However, program performance was significantly related to the readmission rate for new offences
(p < .05). This readmission rate dropped from 46% for the offenders with the poorest program
performance to 11% for the offenders with the best performance (see Figure 3).
Figure 3
Offender post-release "survival" rates (those not returned to custody) were also examined by tracking offenders after release. The offenders who scored poorest on the performance index had the worst survival rate after the initial seven to eight months of release (see Figure 4). The differences were again statistically significant (p < .05). Key factors This study demonstrates that three important factors influence offender post-release behaviour (as measured by readmission into custody for technical conditional release violations or new offences). First, offenders with more serious substance abuse problems (alcohol and/or drugs) were returned to custody at a significantly higher rate than offenders with less severe problems.
Figure 4
Second, offenders identified as being at higher risk of returning to their criminal ways returned to
custody at a higher rate than low-risk offenders. Similar patterns were secured for even the highest
risk/highest need offenders.
Finally, offender program performance (based on pre- and post-program assessment measures) was related
to offender post-release outcome. Specifically, program performance was related to the likelihood of
conviction for new offences.
Unfortunately, this study lacked a comparison group of offenders who did not receive substance abuse
treatment. This would have allowed for a determination of the relative outcome improvement of treated
offenders as compared to those without treatment.
Nevertheless, these findings clearly indicate that differences in the severity of offender substance
abuse problems, their risk of recidivism and their program performance are important factors in
predicting who is likely to return to custody after release.
The results underscore the need for a range of correctional treatment options, as well as the need for
close monitoring and assessment of offender program performance during treatment.
(1)Correctional Policy and Corporate Planning, Correctional Service of Canada, 4th Floor, 340 Laurier Avenue West, Ottawa, Ontario K1A 0P9. For more information, please seeThe Offender Substance Abuse Pre-release Program: Analysis of Intermediate and Post-release Outcomes (Ottawa: Correctional Service of Canada, 1995). We offer our sincere appreciation to the following individuals, who supported this study and made significant contributions to this line of substance abuse research: Diane Black, John Eno, Elizabeth Fabiano, Greg Graves, Lee Marchildon, Nancy Morin, Larry Motiuk, Frank Porporino, David Robinson, Lois Rosine, Catherine Wenek and Linda Simourd.
(2)J.R. Weekes, E. Fabiano, F.I. Porporino, D. Robinson and W.A. Millson, Paper presented at the Canadian Psychological Association meeting, Montreal, Quebec, 1993.
(3)M.B. Sobell and L.C. Sobell,Problem Drinkers: Guided Self-change Treatment (New York: Guilford Press, 1993).
(4)M.D. Anglin and G. Speckart, "Narcotics Use and Crime: A Multisample, Multimethod Analysis,"Criminology, 26, 2 (1988): 197-233. See also J. C. Ball, I. W. Schaffer, D. N. Nurco, "The Day-to-day Criminality of Heroin Addicts in Baltimore: A Study in the Continuity of Offence Rates,"Drug and Alcohol Dependence, 12 (1983): 119-142. And see J. J. Collins, "The Relationship of Problem Drinking to Individual Offending Sequences,"Criminal Careers and Career Criminals, A. Blumstein, J. Cohen, I. Roth and C. A. Visher, eds. (Washington, DC: National Academy Press, 1986): 89-120. And see J. J. Collins and W. Schienger, "Acute and Chronic Effects of Alcohol Use on Violence,"Journal of Studies on Alcohol, 49 (1988): 516-522. And see P.J. Goldstein, "Drugs and Violent Crime,"Pathways to Criminal Violence, N. A. Weiner and M. E. Wolfgang, eds. (Newbury Park: Sage Publications, 1989): 16-48.
(5)L. O. Lightfoot, "The Offender Substance Abuse Pre-release Program: An Empirically-based Model of Treatment for Offenders,"Addictive Behaviours Across the Lifespan: Prevention, Treatment and Policy, J. S. Baer, G. A. Marlatt and R. I. M. McMahon, eds. (Newbury Park: Sage Publications, 1993).
(6) S. Brochu and C. Forget,Survey of Literature on Substance Abuse Interventions for Inmates, Report submitted to the Task Force on Alcohol and Drug Abuse, Correctional Service of Canada, 1990. See also S.D. Husband and J.J. Platt, "The Cognitive Skills Component in Substance Abuse Treatment in Correctional Settings: A Brief Review,"Journal of Drug Issues, 23 (1993): 3142. And see L. 0. Lightfoot and D. Hodgins, "A Survey of Alcohol and Drug Problems in Incarcerated Offenders,"The International Journal of the Addictions, 23, 7 (1988): 687-706.
(7)H. A. Skinner and B. A. Allen, "Alcohol Dependence Syndrome: Measurement and Validation,"Journal of Abnormal Psychology, 91 (1982): 199-209.
(8)H. A. Skinner, "Drug Abuse Screening Test,"Addictive Behaviors, 7 (1982): 363-371.
(9) M. B. Cannell and A. R. Favazza, "Screening for Drug Abuse Among College Students: Modification of the Michigan Alcoholism Screening Test,"Journal of Drug Education, 8 (1978): 119-123.
(10) L. L. Motiuk and F. I. Porporino,Field Test of the Community Risk/Needs Management Scale: A Study of Offenders on Caseload (Ottawa: Correctional Service of Canada, 1989).
(11) W. J. Gunn, D. Orenstein, D. C. Iverson and P. D. Mullen,An Evaluation Handbook for Health Education Programs in Alcohol and Substance Abuse (Atlanta: Center for Disease Control, 1983).
