CJDATS is funded by NIDA in collaboration with SAMHSA and DOJ

Medication Assisted Treatment: Examining Criminal Justice Client Outcomes

Kevin Knight, Ph.D.1, Julie Gray, Ph.D. 1,

Amy Cohn, Ph.D. 2, Sarah Desmarais, Ph.D. 3,

Jennifer Pankow, Ph.D. 1, Grace Rowan-Szal Ph.D. 1,

Stephen Doherty, M.Ed. 4, & Pat Flynn, Ph.D. 1

1Texas Christian University 2 University of South Florida

3 North Carolina State University4 Gateway Foundation

Problem Background

Persistent skepticism exists within the criminal justice (CJ) system – including among criminal justice partner agencies – about the feasibility and impact of promoting medication‐assisted treatment (MAT).

Substantial evidence suggests MAT helps patients reduce opioid and alcohol use (Amato et al., 2005; Johnson, 2008), criminal behavior and arrest (Schwartz et al., 2009), and HIV risk behavior and infection (Metzger et al., 1993).

Specific Aim of This Study

Aim: To identify MAT clinic visit predictors based on patient self-report the day prior to the visit.

Sub-Aim: Assess relationship of Violence and Victimization on patient participation in MAT.

Study Design

Recruit a minimum of 75 “MAT eligible” parolees & probationers participating in a community-based treatment program in the greater St. Louis area.

As part of the study, participants call into an interactive voice response (IVR) survey system daily over a 2-week period. The survey asks questions about previous day events, including stressors, psychological functioning, substance use, and problems attending treatment.

Data Collection

Baseline survey conducted in face-to-face interview after client is referred to MAT.

IVR training conducted with clients at baseline. The expectation for each participant is 2 weeks of consecutive daily calls (14 total).

Follow-up survey conducted as face-to-face interview with each participant after 90 days.

Baseline

assessment

2 weeks of daily

IVR assessm

ents

10 weeks of MAT

treatment as usual

Follow-up

assessment

Interactive Voice Response (IVR) Technology affordable and easy to use automated survey technology uses recorded voice prompts to ask questions that clients

answer by using the touchtone keypad on the telephone or by speaking open ended responses.

Software: SmartQ by TeleSage (www.telesage.com/SmartQ.html)

Measures: IVR Daily Interview

Measures: IVR Daily Interview

Today, please rate how strong is your craving to drink or use drugs? 0 = not at all1 = slightly2 = moderately3 = very4 = extremely

For the next several questions, I'm going to ask you about things that you've done since this time yesterday. Answer each questions using a scale of 0 to 3 where:

0 = no,1 = yes, but yesterday only2 = yes, but today only, or 3 = yes, both yesterday & today.

Did you have stress about an argument with someone? Did you have any stress about work or unemployment? Did you have any stress about money problems? Did you have any stress about your health? Did you have any stress about probation or parole?

Measures: Victimization & Violence

In 3 months prior to incarceration,Victimization Violence

has anyone… have you…1. thrown something at you? 1. thrown something at someone?

2. pushed, grabbed, or shoved you? 2. pushed, grabbed or shoved anyone?

3. slapped you? 3. slapped anyone?

4. kicked, bitten, or choked you? 4. kicked, bitten or choked anyone?

5. hit you with a fist or object or beaten you up?

5. hit anyone with a fist or object or beaten up anyone?

6. tried to physically force you to have sex against your will?

6. tried to physically force anyone to have sex against their will?

7. threatened you with a knife or gun or other lethal weapon?

7. threatened anyone with a knife or gun or other lethal weapon?

8. used a knife or fired a gun at you? 8. used a knife or fired a gun at anyone?

Adapted from MacArthur Community Violence Inventory (Steadman et al., 1998)

Demographic Characteristics

Mean age = 35.5 years (SD = 10.2) Range = 20 to 66 years

Race/ethnicity 78.4% African American/Black 18.9% Caucasian/White 2.7% Other

Relationship status 37.3% living with a spouse/partner

Children 29.3% have children that live with them

Education 22.7% graduated from high school, 37.3% completed GED

Study Sample (n=75)

Service Use and System Contact

Criminal Justice History

# of lifetime arrests M = 16.2 (SD = 15.1) Range = 1 – 85

# of arrests while using/seeking drugs M = 11.9 (SD = 13.8) Range = 0 – 85

Age at first arrest M = 16.9 years (SD = 3.8) Range = 11 – 32

# of times in jail, prison or juvenile lockup M = 11.3 (SD = 11.7) Range = 1 – 60

Study Sample

Service Use and System Contact

Treatment History

# of times received treatment for substance use M = 3.6 (SD = 4.8) Range = 0 – 30

Drug of choice 82% Opiates, 8% Alcohol, 10% poly-drug use, other

# of times hospitalized for psychiatric problems (Range = 0 – 10) n = 68 (91%) never hospitalized for psychiatric problems n = 2 (3%) one time n = 5 ( 7%) 2 times or more

# of times hospitalized for other health problems M = 2.37 (SD = 3.3) Range 0 – 15

Study Sample

Participant Characteristics:IVR Responses From Call

Prior to MAT Appointment

Characteristic N (%) or Mean

Receiving medication for alcohol/drug use 35 (47%)

Any alcohol use 18 (24%)

Any illegal drug use 38 (51%)

Any prescription drug use to get high 18 (24%)

Any (other) illegal activities 4 (16%)

Kept MAT appointment 50 (67%)

Using Alcohol or Drugs to Cope with Stress

Alcohol Illegal Drugs Prescription Drugs

0

25

50

75

100

Yesterday and Today

Yesterday, but not Today

None in the last 2 days

% P

art

icip

an

tsPreliminary Findings

Correlates of keeping MAT appointment

Preliminary Findings (n=75)

Correlates of Appointment Kept r Source

Treatment Readiness .29** From TCU CEST

Self-Esteem .04 From TCU CEST

Anxiety .03 From TCU CEST

Personal Irresponsibility -.29** From CTS

Use of drugs for coping with Stress -.27* From IVR

Craving for Alcohol, Illegal or Rx Drugs -.10 From IVR

*p < .05 **p < .01 ***p < .001

Correlates of Vivitrol prescription

Preliminary Findings (n=75)

Correlates of receiving Vivitrol r Source

Self-esteem .28** From TCU CEST

Anxiety -.04 From TCU CEST

Expectancy to refrain from drug use - next 90 days .21* From TCU CEST

Percentage of daily calls to IVR survey .33*** From IVR

Craving for Alcohol, Illegal or Rx Drugs -.20 From IVR

*p < .05 **p < .01 ***p < .001

Keeping Scheduled MAT Appointment and Previous Day’s Stressors

Preliminary Findings

No stress from Health

Stress about Health yesterday, today, or both

N (%) N (%)

Missed scheduled MAT Appointment

16 (21%) 9 (12%)

Kept scheduled MAT Appointment

41 (55%) 9 (12%)

“Did you have any stress about your health?”

Keeping scheduled MAT appointment and Use of illegal Drugs to cope with Stress

Preliminary Findings

“Did you take illegal drugs because of stress”

Did not use of illegal drugs because of

stress

Used illegal drugs because of stress

yesterday, today, or both

N (%) N (%)

Missed scheduled MAT Appointment

9 (12%) 16 (21%)

Kept scheduled MAT Appointment

36 (48%) 14 (19%)

X2(1, n=75) = 9.0, p < .01

Associations between previous psychiatric hospitalizations and

keeping MAT appointment

Preliminary Findings

No previous psychiatric

hospitalizations

One or more psychiatric

hospitalizations

N (%) N (%)

Missed scheduled MAT Appointment

23 (31%) 2 (3%)

Kept scheduled MAT Appointment

45 (60%) 5 (7%)

Prevalence and Co-occurrence of Violence & Victimization

None, 57.3%

Violence only, 2.7%

Victimization only, 6.7%

Violence & Vic-timization, 40%

x2(1, n=75) = 18.62, p < .001

Preliminary Findings

Prevalence of violent outcomes reported at baseline (n = 75) & follow-up (n = 47)

Preliminary Findings

Any Violent Outcome

Perpetration Victimization0

10

20

30

40

50

Baseline

Follow-Up

%

**

*p < .05.

Conclusions

Need to explore impact of MAT on violence and victimization.

Will continue to examine measurement of MAT treatment satisfaction, barriers to MAT treatment, and support for MAT treatment.

Questions and CommentsThe study team gratefully acknowledges the support of the

following organizations:

National Institute on Drug AbuseDepartment of Justice

Substance Abuse and Mental Health Services Administration