Interventions for drug-using offenders with co-occurring mental illness

  • Review
  • Intervention

Authors


Abstract

Background

This is an updated version of an original Cochrane review published in Issue 3 2006 (Perry 2006). The review represents one from a family of four reviews focusing on interventions for drug-using offenders. This specific review considers interventions aimed at reducing drug use or criminal activity, or both for drug-using offenders with co-occurring mental illness.

Objectives

To assess the effectiveness of interventions for drug-using offenders with co-occurring mental illness in reducing criminal activity or drug use, or both.

Search methods

We searched 14 electronic bibliographic databases (searched between 2004 and 21 March 2013) and five internet resources (searched between 2004 and 11 November 2009). We contacted experts in the field for further information.

Selection criteria

We included randomised controlled trials designed to reduce, eliminate or prevent relapse in drug-using offenders with co-occurring mental illness. We also reported data on the cost and cost effectiveness of interventions.

Data collection and analysis

We used standard methodological procedures expected by The Cochrane Collaboration.

Main results

We identified 76 trials across the four reviews. Following a process of pre-screening, we judged eight trials to meet the inclusion criteria for this specific review (three of the five trials are awaiting classification). The five included 1502 participants. The interventions reported on case management via a mental health drugs court, a therapeutic community, and an evaluation of a motivational interviewing technique and cognitive skills in comparison to relaxation training. The methodological quality of the trials was generally difficult to rate due to a lack of clear reporting. On most risk of bias items, we rated the majority of studies as unclear. Overall, the combined interventions did not show a statistically significant reduction in self reported drug use (2 studies, 715 participants; risk ratio (RR) 0.82, 95% confidence interval (CI) 0.44 to 1.55). A statistically significantly reduction was shown for re-incarceration (4 studies, 627 participants; RR 0.40, 95% CI 0.24 to 0.67 and mean difference (MD) 28.72, 95% CI 5.89 to 51.54) but not re-arrest (2 studies, 518 participants; RR 1.00, 95% CI 0.90 to 1.12). A specific subgroup analysis combining studies using therapeutic community interventions showed a statistically significant reduction in re-incarceration (2 studies, 266 participants; RR 0.29, 95% CI 0.16 to 0.54) but not re-arrest (1 study, 428 participants; RR 0.90, 95% CI 0.61 to 1.33). Case management via a mental health court and motivational interviewing with cognitive skills did not show a statistically significant reduction in criminal activity (1 study, 235 participants; RR 1.05, 95% CI 0.90 to 1.22) or self reported drug misuse (1 study, 162 participants; MD -7.42, 95% CI -20.12 to 5.28). Due to the small number of studies, we were unable to analyse the impact of setting on outcome. Some cost information was provided in the trials but not sufficient to be able to evaluate the cost effectiveness of the interventions.

Authors' conclusions

This review highlights the paucity of evidence for drug misusing offenders with co-occurring mental health problems. Two of the five trials showed some promising results for the use of therapeutic communities and aftercare, but only in relation to reducing subsequent re-incarceration. The studies overall, showed a high degree of statistical variation demonstrating a degree of caution in the interpretation of the magnitude of effect and direction of benefit for treatment outcomes. More evaluations are required to assess the effectiveness of interventions for drug-using offenders with co-occurring mental health problems.

Résumé scientifique

Interventions destinées aux délinquants toxicomanes souffrant parallèlement de troubles mentaux

Contexte

Ceci est une version mise à jour d'une revue originale Cochrane publiée dans le numéro 3 de 2006 (Perry 2006). La revue représente l'une de quatre revues portant sur des interventions destinées aux délinquants toxicomanes. Cette revue porte sur des interventions spécifiques visant à réduire la consommation de drogue ou l'activité criminelle, ou les deux, des délinquants toxicomanes souffrant parallèlement de troubles mentaux.

Objectifs

Évaluer l'efficacité des interventions destinées aux délinquants toxicomanes souffrant parallèlement de troubles mentaux dans la réduction de l'activité criminelle ou de l'utilisation de médicaments, ou les deux.

Stratégie de recherche documentaire

Nous avons effectué des recherches dans 14 bases de données bibliographiques électroniques (entre 2004 et le 21 mars 2013) et dans cinq ressources Internet (consulté entre 2004 et le 11 novembre 2009). Nous avons contacté des experts dans le domaine pour obtenir des informations supplémentaires.

Critères de sélection

Nous avons inclus des essais contrôlés randomisés visant à réduire, supprimer ou prévenir la rechute des délinquants toxicomanes souffrant parallèlement de troubles mentaux. Nous avons également rapporté des données sur le coût et le coût-efficacité des interventions.

Recueil et analyse des données

Nous avons utilisé des procédures méthodologiques standard prévues par la Collaboration Cochrane.

Résultats principaux

Nous avons identifié 76 essais dans les quatre revues. Suite à un processus d'examen préalable, nous avons jugé que huit essais remplissaient les critères d'inclusion pour cette revue spécifique (trois des cinq essais sont en attente de classification). Les cinq essais incluaient 1 502 participants. Les interventions rendaient compte de la gestion de cas par un tribunal en santé mentale et en drogue, une communauté thérapeutique et une évaluation des techniques d'entretien motivationnel et des capacités cognitives par rapport à une formation à la relaxation. La qualité méthodologique des essais était généralement difficile à évaluer en raison d'un manque de notification claire. Sur la plupart des éléments de risques de biais, nous avons évalué la majorité des études comme étant incertaines. Dans l'ensemble, les interventions combinées ne montraient pas de réduction statistiquement significative sur l'utilisation de drogue (2 études, 715 participants; risque relatif (RR) 0,82, intervalle de confiance à 95% (IC) de 0,44 à 1,55). Une réduction statistiquement significative a été démontrée au niveau de la réincarcération (4 études, 627 participants ; RR 0,40, IC à 95% 0,24 à 0,67 et de la différence moyenne (DM) 28,72, IC à 95% 5,89 à 51,54), mais pas au niveau des nouvelles arrestations (2 études, 518 participants ; RR 1,00, IC à 95% 0,90 à 1,12). Une analyse spécifique en sous-groupes combinant les études utilisant les interventions communautaires thérapeutiques ont montré une réduction statistiquement significative des réincarcérations (2 études, 266 participants ; RR 0,29, IC à 95% 0,16 à 0,54), mais pas des nouvelles arrestations (1 étude, 428 participants ; RR 0,90, IC à 95% 0,61 à 1,33). La prise en charge de cas par un tribunal en santé mentale et des entretiens motivationnels avec des capacités cognitives n'ont pas montré de réduction statistiquement significative sur l'activité criminelle (1 étude, 235 participants ; RR 1,05, IC à 95% 0,90 à 1,22) ou sur l'abus de drogues rapporté (1 étude, 162 participants ; DM -7,42, IC à 95% -20,12 à 5,28). En raison du petit nombre d'études, nous ne sommes pas en mesure d'analyser les répercussions sur le résultat. Certaines informations sur le coût ont été fournies dans les essais, mais elles ne sont pas suffisantes pour être en mesure d'évaluer le rapport coût-efficacité des interventions.

Conclusions des auteurs

Cette revue met en évidence la rareté des preuves pour les délinquants toxicomanes souffrant parallèlement de troubles mentaux. Deux des cinq essais ont montré des résultats prometteurs pour le recours aux communautés thérapeutiques et aux suivis, mais seulement en termes de réduction de réincarcérations. Dans l'ensemble, les études ont montré un degré élevé d'hétérogénéité statistique démontrant un degré de prudence dans l'interprétation de l'ampleur de l'effet et de la direction du bénéfice pour les résultats thérapeutiques. D'autres évaluations sont nécessaires pour évaluer l'efficacité des interventions destinées aux délinquants toxicomanes souffrant parallèlement de troubles mentaux.

Plain language summary

Interventions for drug-using offenders with co-occurring mental illness

Background

A number of policy directives are aimed at enabling people with drug problems to live healthy, crime-free lives. Drug-using offenders with co-occurring mental health problems represent a group of people who access treatment for a variety of different reasons. The complexity of the two problems makes the treatment and rehabilitation of this group of people particularly challenging.

Study characteristics

The review authors searched scientific databases and internet resources to identify randomised controlled trials (where participants are allocated at random to one of two or more treatment groups) of interventions to reduce, eliminate, or prevent relapse or criminal activity of drug-using offenders with co-occurring mental illness. We included people of any gender, age or ethnicity.

Key results

We identified eight trials (three of which are awaiting classification) evaluating treatments for drug-using offenders with co-occurring mental illness. The interventions included case management via a mental health court, a therapeutic community and an evaluation of motivational interviewing techniques and cognitive skills (a person's ability to process thoughts) in comparison to relaxation training. Overall, the combined interventions were not found to reduce self report drug use, but did have some impact on re-incarceration rates, but not re-arrest. A specific analysis of therapeutic community interventions did subsequently reduce re-incarceration but proved to be less effective for re-arrest and self report drug use. Two single studies evaluating case management via a mental health drug court and motivational interviewing and cognitive skills did not show significant reductions in criminal activity and self report drug use respectively. Little information is provided on the costs and cost-effectiveness of such interventions and trial evaluations focusing specifically on the needs of drug misusing offenders with co-occurring mental health problems are required.

Quality of the evidence

This review was limited by the lack of information reported in this group of trials and the quality of the evidence is unclear. The evidence is current to March 2013.

Résumé simplifié

Interventions destinées aux délinquants toxicomanes souffrant parallèlement de troubles mentaux

Contexte

Un certain nombre de directives visent à permettre aux toxicomanes de mener une vie paisible et en bonne santé. Les délinquants toxicomanes souffrant parallèlement de troubles mentaux représentent un groupe de personnes recevant un traitement pour différentes raisons. La complexité des deux problèmes rend le traitement et la rééducation de ce groupe de personnes particulièrement difficile.

Les caractéristiques de l'étude

Les auteurs de la revue ont effectué des recherches dans des bases de données scientifiques et dans les ressources Internet pour identifier des essais contrôlés randomisés (dans lesquels les participants sont assignés au hasard à l'un des deux ou à plusieurs groupes de traitement) des interventions visant à réduire, éliminer, ou prévenir la rechute ou l'activité criminelle des délinquants toxicomanes souffrant parallèlement de troubles mentaux. Nous avons inclus des personnes de tout âge, de tout sexe ou de toute origine ethnique.

Résultats principaux

Nous avons identifié huit essais (dont trois sont en attente de classification) évaluant les traitements destinés aux délinquants toxicomanes souffrant parallèlement de troubles mentaux. Les interventions incluaient la prise en charge par un tribunal en santé mentale, une communauté thérapeutique et une évaluation des techniques d'entretien motivationnel et des capacités cognitives (la capacité d'une personne à penser) par rapport à une formation à la relaxation. Dans l'ensemble, les interventions combinées ne réduisaient pas l'utilisation de médicaments auto-déclarés, mais avaient un impact sur les taux de réincarcération, mais pas sur les nouvelles arrestations. Une analyse spécifique sur les interventions communautaires thérapeutiques réduisait par la suite la réincarcération mais s'avérait être moins efficace pour les nouvelles arrestations et la consommation de drogue auto-déclarée. Deux études individuelles évaluant la gestion de cas via un tribunal en santé mentale et en drogue, les entretiens motivationnels et les capacités cognitives ne montraient pas de réductions significatives dans les activités criminelles et la consommation de drogue auto-déclarée, respectivement. Peu d'informations ont été fournies sur les coûts et le rapport coût-efficacité de ces interventions et des évaluations d'essais portant spécifiquement sur les besoins des délinquants toxicomanes souffrant parallèlement de troubles mentaux sont nécessaires.

Qualité des preuves

Cette revue était limitée suite au manque d'informations rapportées dans ce groupe d'essais et la qualité des preuves n'est pas claire. Les preuves sont à jour en mars 2013.

Notes de traduction

Traduit par: French Cochrane Centre 15th June, 2014
Traduction financée par: Financeurs pour le Canada : Instituts de Recherche en Santé du Canada, Ministère de la Santé et des Services Sociaux du Québec, Fonds de recherche du Québec-Santé et Institut National d'Excellence en Santé et en Services Sociaux; pour la France : Ministère en charge de la Santé

Background

This review forms part of a family of four reviews providing a close examination of what works in reducing drug use and criminal activity in drug-using offenders. Overall, the four reviews contain 76 trials, generating 99 publications and 58 different comparisons (Perry 2013b; Perry 2013a; Perry 2013c). The four reviews represent a specific interest in pharmacological interventions, non-pharmacological interventions, female offenders and offenders with co-occurring mental illness. All four reviews stem from an updated previous Cochrane systematic review (Perry 2006). In this set of four reviews, we consider not only the effectiveness of interventions based on two key outcomes but also analyse the impact of setting and intervention type. Presented here is the revised methodology for this individual review focusing on the impact of interventions for drug-using offenders with co-occurring mental illness.

Description of the condition

Mental health issues in offenders are common with nearly 321,884 of the 2.1 million prisoners having a serious mental illness (Lamb 2007). One study of mental illness in jails found that more women than men (14.5% men and 31% of women) have a serious mental illness (Steadman 2009). Other studies have reported that a greater proportion of mentally ill people are arrested compared with the general population (Lamb 1998). Factors cited as causes include a lack of support in the community, problems accessing treatment, and the attitudes of police and society. In the US, individuals incarcerated to jails are generally on remand awaiting trial, while those in prison have been sentenced within the criminal justice system. One systematic review of 62 surveys in western prisons found that prisoners were several times more likely to have psychosis or major depression and 10 times more likely to have an antisocial personality disorder than the general population. It is unknown how well the prison service is addressing these problems (Fazel 2002).

In the UK, renewed emphasis from Clarke's green paper, Breaking the Cycle, recognises that the justice system is not always the best place to manage the problems of less serious offenders where their criminal behaviour is related to their mental health problems. As a result, several diversionary schemes are to be established by 2014 (Ministry of Justice 2010). This has been supported by previous systematic reviews and meta-analytical techniques that have evaluated diversion programmes (e.g. mental health courts) providing a mechanism for diverting individuals with severe mental illness into treatment programmes instead of the prison system (e.g. Sarteschi 2011). Findings from such studies generally show positive improvements on a small number of clinical outcomes. However, the conclusions are often limited by the research design (i.e. quasi-experimental studies) introducing potential bias about the relative effectiveness of such schemes. Evidence from one systematic review of serious mentally disordered adult offenders identified seven trials but the evidence was insufficient to draw conclusions. The authors called for more comparative trials to increase their confidence in the findings (Fontanarosa 2013).

Description of the intervention

Many different treatments for substance misuse (e.g. detoxification and therapeutic communities) have been adopted for use in the criminal justice system. This review included any intervention that was designed to reduce, eliminate or prevent relapse to drug use or criminal activity, or both. This resulted in the inclusion of a wide range of treatments focusing on: case management via a mental health drug court, therapeutic communities and motivational interviewing (MI) with cognitive skills in comparison to relaxation training. The evidence to support the effectiveness of these interventions differs, and is dependent upon the quality of the experimental evaluations employed to assess whether they are successful in reducing drug use or criminal activity, or both.

Case management, supervision evolved traditionally to address the needs of prisoner re-entry programmes covering employment, education, health, housing and family support via assessment and connecting clients with the appropriate services (Austin 1994). Case management in the US has been applied in Treatment Accountability for Safer Communities (TASC) programmes (Marlowe 2003b), and has shown initial effectiveness but without systematic evidence in support of the process.

Previous meta-analyses and systematic reviews of therapeutic community (TC) interventions specifically with aftercare have been shown to have modest effects in the reduction of recidivism and drug use (e.g. Mitchell 2012a; Pearson 1999).

Cognitive-behavioural approaches, including self monitoring, goal setting, self control training, interpersonal skills training, relapse prevention, group work and lifestyle modification have shown signs of success with offenders generally (Lipsey 2007), but the evidence has been based on systematic reviews that have excluded evaluations focusing specifically on the needs of drug-using offenders. Two previous systematic review of motivational interviewing (MI) found that MI can lead to improved retention in treatment, enhanced motivation to change and reduced offending, although there are variations across studies (McMurran 2009; Smedslund 2011).

Policy interests have also placed an increasing demand on knowing more about the cost and cost-effectiveness of such interventions. Some evidence can be drawn from systematic reviews completed in the area. Despite the growing knowledge about the effectiveness of treatment programmes for offenders, in general there has been no recent systematic review evidence focusing on the effectiveness of treatment for offenders with drug misuse and co-occurring mental health problems.

How the intervention might work

Interventions delivered to drug-using offenders under the care of the criminal justice system have varied over time. Case management has been used to describe a problematic term that amounts to a range of diverse practices and supervision models spanning several different services including probation. These are generally used to co-ordinate and integrate all aspects of community supervision, from the initial offender needs assessment, through to programme delivery and the intended completion of the order or sentencing requirement (Partridge 2004).

TCs have been used in the US since the 1960s and combined with work release programmes to rehabilitate offenders via a supportive environment over a relatively long period. This usually encompasses the transition between the prison and working within the community (e.g. Prendergast 2011). The ethos of a TC is to focus on treatment on the whole self (and not on the drug abuse per se) and the underlying symptomatic problems in which the residents are instrumental in running the TC (Mitchell 2012a).

Cognitive behavioural approaches using programmes based on psychological theory have been employed to try and help people address their offending behaviour and generally have good support from the literature in their reduction of recidivism, but have previously excluded drug-involved offenders (e.g. Andrews 1990; Lipsey 1998; Lipsey 2007).

Miller and Rollnick developed MI as a process to motivate change in substance abusers (Miller 1991). The technique uses different strategies such as expressing empathy, avoiding arguing for change and working on ambivalence to strengthen commitment to change. Meta-analyses evidence supports the use of MI as a stand-alone treatment and in combination with more intensive programmes (e.g. Vasilaki 2006).

Why it is important to do this review

Many people have co-occurring mental illness and drug-misuse problems while under the care of the criminal justice system. While previous research has evaluated treatment programmes for offenders (more broadly), we know little about the challenges, treatment and rehabilitation opportunities for offenders with co-occurring mental health and drug-misuse problems. For this reason, we believe the evaluation of existing evidence might be helpful in identifying what treatment opportunities are available in reducing subsequent drug use and criminal activity for this vulnerable population. Where possible, the review will also report descriptively on the costs of such treatment programmes.

Objectives

To assess the effectiveness of interventions for drug-using offenders with co-occurring mental illness in reducing criminal activity or drug misuse, or both.

The review addressed the following questions:

  1. Do treatments for drug-using offenders with co-occurring mental illness reduce drug use?

  2. Do treatments for drug-using offenders with co-occurring mental illness reduce criminal activity?

  3. Does the treatment setting (court, community, prison/secure establishment) affect the intervention outcome(s)?

  4. Does the type of treatment affect the outcome(s)?

In addition, this review aimed to report on the cost and cost effectiveness of interventions.

Methods

Criteria for considering studies for this review

Types of studies

We included randomised controlled trials (RCTs) evaluating interventions to reduce, eliminate, or prevent relapse or criminal activity, or both, in drug-using offenders with co-occurring mental illness. We defined relapse as individuals who may have returned to an incarcerated setting, or had subsequently been arrested or had relapsed back into drug misuse, or both.

Types of participants

We included drug-using offenders with co-occurring mental illness regardless of gender, age or ethnicity. Drug misuse included any study that referred to individuals using occasional, dependent or were known to abuse drugs. We defined offenders as individuals who were involved in the criminal justice system. Offenders were judged to have co-occurring mental illness where this was explicitly stated in the paper. We used several different mechanisms to identify study samples with mental health problems including; i) use of diagnostic gold standard tests such as Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) criteria, or ii) the nature of the intervention (e.g. mental health court), or iii) where the demographic participant details were described as having a 'history of psychiatric illness' or a 'serious mental disorder' with co-occurring substance misuse (or both), or a combination of these.

Types of interventions

Included interventions were designed, wholly or in part, to eliminate or prevent relapse to drug-use or criminal activity, or both, among participants. We included a range of different types of interventions in the review.

Experimental interventions included in the review

  1. Case management (via mental health drug court).

  2. Therapeutic communities (TC)

  3. Motivational interviewing and cognitive skills

Control interventions included in the review

  1. No treatment.

  2. Minimal treatment.

  3. Waiting list.

  4. Treatment as usual.

  5. Other treatment.

Types of outcome measures

Primary outcomes

For the purpose of our review, we categorised our primary outcomes into those relating to dichotomous and continuous drug use or criminal activity, or both. Where papers reported a number of different follow-up periods, we reported the longest period. We considered that such measures provided the most conservative estimate of effectiveness. For specific meta-analyses of subgroupings, we reviewed all reported follow-up periods to select the most appropriate period for combining comparable studies.

  1. Drug use measures were reported as:

    1. self report drug use (unspecified drug, specific drug use not including alcohol, Addiction Severity Index Drug Composite Scores);

    2. biological drug use (measured by drugs testing by either urine or hair analysis);

  2. Criminal activity as measured by:

    1. self report or official report of criminal activity (including arrest for any offence, drug offences, re-incarceration, convictions, charges and recidivism).

Secondary outcomes

Our secondary outcome reported on cost or cost-effectiveness information. We used a descriptive narrative to describe these findings. We undertook a full critical appraisal based on the Drummond 1997 checklist for those studies with sufficient information presented.

Search methods for identification of studies

Electronic searches

The update searches identified records from 2004 to March 2013.

  • Cochrane Central Register of Controlled Trials (CENTRAL) (1980 to March 2013) (Appendix 1).

  • MEDLINE (1966 to March 2013) (Appendix 2).

  • EMBASE (1980 to March 2013) (Appendix 3).

  • PsycINFO (1978 to March 2013) (Appendix 4).

  • PASCAL (1973 to November 2004)a (Appendix 5).

  • SciSearch (Science Citation Index) (1974 to March 2013) (Appendix 5).

  • Social SciSearch (Social Science Citation Index) (1972 to March 2013) (Appendix 5).

  • ASSIA (1987 to March 2013) (Appendix 6).

  • Wilson Applied Science and Technology Abstracts (1983 to October 2004)a.

  • Inside Conferences (1993 to November 2004)a.

  • Dissertation Abstracts (1961 to October 2004)a.

  • NTIS (1964 to March 2013).

  • Sociological Abstracts (1963 to March 2013) (Appendix 7).

  • HMIC (to March 2013) (Appendix 8).

  • PAIS (1972 to March 2013) (Appendix 9).

  • SIGLE (1980 to June 2004)b (Appendix 10).

  • Criminal Justice Abstracts (1968 to March 2013) (Appendix 11).

  • LILACS (2004 to March 2013).

  • National Research Register (March 2004)c (Appendix 12).

  • Current Controlled Trials (December 2009).

  • DrugScope (February 2004) - unable to access.

  • SPECTRA (March 2004)d (Appendix 13).

aUnable to access further to 2004 search.
bDatabase not updated since original 2004 search.
cNo longer exists.
dNow Campbell Collaboration searched online.

To update the original review (Perry 2006), we restricted the search strategy to studies that were published or unpublished from 2004 onwards. We did not search several of the original databases for this update (indicated by the key at the end of the database list). We did not search Pascal, ASSIA, Wilson Applied Science and Technology Abstracts, Inside Conferences and Dissertation Abstracts. These databases are available only via the fee-charging DIALOG online host service. We did not have the resources to undertake these searches. The National Research Register no longer exists, and SIGLE has not been updated since 2005. DrugScope is available only to subscribing members. The original searches were undertaken by DrugScope employees.

We developed search strategies for each database to employ the search engine most effectively and to make use of any controlled vocabulary. We designed search strategies to restrict the results to RCTs and placed no language restrictions. We included methodological search filters designed to identify trials. Whenever possible, we used filters retrieved from the InterTASC Information Specialists' Sub-Group (ISSG) Search Filter Resource site (www.york.ac.uk/inst/crd/intertasc/). If filters were unavailable from this site, we used search terms based on existing filters instead.

In addition to the electronic databases, we searched relevant Internet sites (Home Office, National Institute of Drug Abuse (NIDA) and European Association of Libraries and Information Services on Alcohol and Other Drugs (ELISAD)). We searched directory websites up to November 2011. We placed no language restrictions on identification and inclusion of studies in the review.

Details of the update search strategies and results, and of the Internet sites searched are listed in Appendix 1; Appendix 2; Appendix 3; Appendix 4; Appendix 5; Appendix 6; Appendix 7; Appendix 8; Appendix 9; Appendix 10; Appendix 11; Appendix 12; Appendix 13.

Searching other resources

Reference checking

We scrutinised the reference lists of all retrieved articles for further references. We also searched the catalogues of relevant organisations and research founders.

Personnel communication

We contacted experts and asked of their knowledge of other studies, published or unpublished, relevant to the review article.

Data collection and analysis

Selection of studies

Two review authors independently inspected the search hits by reading the titles and abstracts. We obtained each potentially relevant study located in the search as a full article and two review authors independently assessed them for inclusion. In the case of discordance, a third independent review author arbitrated. One review author undertook translation of articles not written in the English language.

The screening process was divided into two key phases. Phase one used the initial eight key questions reported in the original Perry 2006 review.

Pre-screening criteria: phase one
  1. Is the document written in 2004 or later? [If "no" exclude document]

  2. Is the document an empirical study? [If "no" exclude document]

  3. Does the study evaluate an intervention, a component of which is designed to reduce, eliminate or prevent relapse with drug-using offenders?

  4. Are the participants referred by the criminal justice system at baseline?

  5. Does the study report pre- and post-programme measures of drug use?

  6. Does the study report pre- and post-programme measures of criminal behaviour?

  7. Does the study include a comparison group?

  8. Do the outcome measures refer to the same length of follow-up for two groups?

Following identification of relevant papers from phase one, phase two screening sought to identify those papers describing offenders with a mental illness. This information was primarily obtained from the participant description and the type of intervention (e.g. mental health drug court).

Pre-screening: phase two
  1. Is the study population comprised wholly of participants with diagnosed mental illness using DSM-IV or ICD-10 diagnostic criteria? [if yes, include document]

  2. Is the study population comprised wholly of participants identified on screening to have a mental health problem(s) based on intervention eligibility (e.g. mental health court)? [if yes, include document]

  3. Where the full study population does not comprise of offenders with diagnosed or presumed mental illness, are separate results given for those participants with mental illness? [if no, exclude document]

Drug-using interventions were implied if the programme was targeted at reducing drug use in a group of individuals or could be ascertained from the background characteristics of the group. Offenders were individuals residing in special hospitals, prisons, the community or who were diverted from court or placed on arrest referral schemes for treatment. We did accept papers in the review where the entire sample were not using drugs, but reported pre and post measures needed to be the same at both time points. The study setting could change throughout the process of the study. For example, offenders could begin in prison but progress through a work release project into a community setting. Finally, studies did not need to report both drug and criminal activity outcomes. If either of these were reported, we included the study in the review.

Data extraction and management

We used data extraction forms to standardise the reporting of data from all studies obtained as potentially relevant. Two review authors independently extracted data.

Assessment of risk of bias in included studies

Four review authors (AEP, JMG, MMSJ, MJN) independently assessed risk of bias of all included studies using the 'Risk of bias' assessment criteria recommended in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011).

The recommended approach for assessing risk of bias in studies included in Cochrane reviews is a two-part tool, addressing seven specific domains, namely sequence generation and allocation concealment (selection bias), blinding of participants and providers (performance bias), blinding of outcome assessor (detection bias), incomplete outcome data (attrition bias), selective outcome reporting (reporting bias), and other source of bias. The first part of the tool involves describing what was reported to have happened in the study. The second part of the tool involves assigning a judgement relating to the risk of bias for that entry, in terms of low, high or unclear risk. To make these judgements, we used the criteria indicated by the handbook adapted to the addiction field. See Appendix 14 for details.

The domains of sequence generation and allocation concealment (avoidance of selection bias) were addressed in the tool by a single entry for each study.

Blinding of participants, personnel and outcome assessor (avoidance of performance bias and detection bias) were considered separately for objective outcomes (e.g. drop-out, use of substance of abuse measured by urine analysis, participants relapsed at the end of follow-up, participants engaged in further treatments) and subjective outcomes (e.g. duration and severity of signs and symptoms of withdrawal, patient self reported use of substance, side effects, social functioning as integration at school or at work, family relationship).

Incomplete outcome data (avoidance of attrition bias) was considered for all outcomes except for the drop-out from the treatment, which is very often the primary outcome measure in trials on addiction.

For studies identified in the most recent search, the review authors attempted to contact study authors to establish whether a study protocol was available.

Measures of treatment effect

For outcomes measured on different scales, we used mean difference (MD) with 95% confidence intervals (CI). We presented dichotomous outcomes as risk ratios (RR), with 95% CIs.

Dealing with missing data

We attempted to contact study authors via email where missing data occurred in the original publication.

Assessment of heterogeneity

We assessed heterogeneity using the I2 and Q statistics.

Data synthesis

We performed a series of meta-analyses using the Review Manager software (RevMan 2012) and applied random-effects models alongside a narrative review to address each of the key questions outlined in the objectives. The narrative tables included a presentation of the study details (e.g. author, year of publication and country of study origin), study methods (e.g. random assignment), participants (e.g. number in sample, age, gender, ethnicity, age, mental health status), interventions (e.g. description, duration, intensity and setting), outcomes (e.g. description, follow-up period and reporting mechanism), resource and cost information and resource savings (e.g. number of staff, intervention delivery, estimated costs and estimated savings) and notes (e.g. methodological and quality assessment information). For outcomes of criminal activity, enough data allowed us to divide this into re-arrest and re incarceration.

Subgroup analysis and investigation of heterogeneity

We conducted a subgroup analysis of re-arrest and re-incarceration and combined the TC intervention studies to allow us to examine the impact in this manner.

Sensitivity analysis

When appropriate, we planned sensitivity analyses to assess the impact of studies with high risk of bias. However, because of the overall high risk of bias of the included studies, we did not conduct this analysis.

Results

Description of studies

Results of the search

The updated searches to 21 March 2013 produced 3885 new records. Submissions from expert authors provided a further 15 records. An assessment of the titles and abstracts in phase one screening excluded 3761 records, leaving 139 potentially relevant RCT publications. In phase two, we excluded a further 131 papers, leaving eight trials. Three of the eight trials are awaiting classification, therefore we included data from the remaining five trials, containing 1502 participants (Figure 1).

Figure 1.

Study flow diagram of paper selection process.

Included studies

Treatment regimens and settings
  • Two studies were conducted in a court setting. The evaluations compared assertive case management versus treatment as usual in a mental health drug court (Cosden 2003), and MI with relaxation training with a group of adolescents with significant depression (Stein 2011).

  • No studies were identified in the community.

Countries in which the studies were conducted
  • All the studies were published in the US.

Duration of trials
Participants
  • Seven of the eight comparisons included adult drug-using offenders. One study investigated the impact of MI with adolescents aged 14 to 19 years (Stein 2011).

  • Two studies included female offenders (Cosden 2003; Stein 2011). For the majority of studies, adult male offenders were the focus of the study populations with a mean age of 30 years.

  • In all study populations, the majority of participants were of white ethnic origin.

  • Mental health diagnoses varied across the studies (for more information see Table 1).

    Table 1. Mental health diagnoses
    1. CED-D: Centre for Epidemiological Studies - Depression; DSM-IV: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; DIS: Diagnostic Interview Schedule; PTSD: post-traumatic stress disorder.

    Study, yearCriteria used for diagnosesDescription of mental health problem
    Stein 2011CES-D Scale

    Scores > 16 indicate presence of significant depression. 69.8% had

    significant depressive symptoms

    Sacks 2004a TC; Sacks 2004b TC + AC; Sullivan 2007DIS

    Diagnoses of lifetime Axis I or Axis II mental disorder

    Antisocial personality disorder

    Cosden 2003Determined by a psychiatrist/psychologist on the basis of a clinical interview and observations

    Mood disorder

    Schizophrenia

    Bipolar disorder

    Other

    Dual diagnosis

    Prendergast 2003; Prendergast 2004; Wexler 1999a; Wexler 1999bNot specified

    Antisocial personality disorder

    Phobias

    PTSD

    Depression

    Dysthymia

    Attention deficit

    hyperactivity disorder

    Sacks 2011

    DSM-IV diagnostic criteria

    Beck Depression Inventory

    Post Traumatic Stress Disorder Symptom Scale

    Brief Symptom Inventory

    Global Severity Index

    Depression

    PTSD

    Psychological distress

Excluded studies

We excluded 127 study comparisons. Reasons for exclusion included a lack of criminal justice involvement in referral to the intervention: 24 studies; not reporting relevant drug or crime outcome (or both) measures at both the pre- and post-intervention periods: 20 studies; allocation of participants to study groups that were not strictly randomised or did not contain original trial data: 11 studies. We excluded one study where follow-up periods were not equivalent across study groups (Di Nitto 2002), and one study was excluded because the intervention (acupuncture) was not included for evaluation in the present review (Berman 2004). We excluded 67 study comparisons because the study population did not include participants with a co-occurring mental illness or were not offenders. One study reported the protocol of a trial only (Baldus 2011), the other study only contained conference proceedings (Kinlock 2009). We were unable to obtain the data for one paper (Cogswell 2011).

Risk of bias in included studies

Allocation

Randomisation

All of the nine included comparisons were described as randomised. Three of the included studies reported on the randomisation sequence was generated and were judged at low risk of bias (Cosden 2003; Sacks 2011; Stein 2011). The remaining seven comparisons did not report how the randomisation sequence of participants was generated (Prendergast 2003; Prendergast 2004; Sacks 2004a TC; Sacks 2004b TC + AC; Sullivan 2007; Wexler 1999a; Wexler 1999b).

Characteristics at baseline

Six comparisons reported that groups were similar on drug-use history (Prendergast 2003; Prendergast 2004; Sacks 2004a TC; Sacks 2011; Wexler 1999b; Stein 2011), and seven comparisons reported also on baseline criminal history (Cosden 2003; Prendergast 2003; Prendergast 2004; Sacks 2011; Sullivan 2007; Wexler 1999b; Stein 2011).

Allocation concealment

Of the nine included comparisons, only one adequately reported that the allocation process was concealed (Sacks 2011).

Blinding

Blinding was assessed across four dimensions considering performance and detection bias across subjective and objective measures (see Appendix 14). In all but one study, blinding was considered unclear on all four measures of blinding (Prendergast 2003; Prendergast 2004; Sacks 2004a TC; Sacks 2004b TC + AC; Stein 2011; Sullivan 2007; Wexler 1999a; Wexler 1999b). One study was rated at high risk of bias (Cosden 2003).

Incomplete outcome data

Loss to follow-up was reported to differing extents in all of the included studies. Of these, five were graded with partial information (Cosden 2003; Prendergast 2003; Prendergast 2004; Sacks 2011; Stein 2011), and five provided adequate information (Sacks 2004a TC; Sacks 2004b TC + AC; Sullivan 2007; Wexler 1999a; Wexler 1999b). Only two reported reasons for drop-out of participants (Wexler 1999a; Wexler 1999b).

Selective reporting

The review authors rated all nine comparisons as unclear as they could not be rated appropriately because none of the nine comparisons reported the outcomes in a pre-specified manner using the primary and secondary outcome format.

Other potential sources of bias

Of the nine comparisons, six were rated a high risk of other bias (Cosden 2003; Prendergast 2003; Prendergast 2004; Stein 2011; Wexler 1999a; Wexler 1999b). One study was rated at low risk of potential bias (Sacks 2011), and the remainder were rated as unclear (Sacks 2004a TC; Sacks 2004b TC + AC; Sullivan 2007).

See Figure 2 and Figure 3 for more details.

Figure 2.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Figure 3.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Effects of interventions

We included five trials in a series of four meta-analyses (for more details see Table 2).

Table 2. Summary research evidence for the meta-analyses
  1. SD: standard deviation.

Paper, yearinterventionComparisonFollow-upOutcome typeMeasurementActual outcome
Cosden 2003Sentencing and case management (mental health treatment court and assertive community treatment case management)Treatment as usual

6 months

12 months

Criminal activity dichotomous

Self report drug use continuous

% and total

mean and SD

% arrested and spent some time in jail

% convicted of a new crime

mean Addiction Severity Index (drug) composite score

Prendergast 2003

Prendergast 2004

Wexler 1999a; Wexler 1999b

Therapeutic community, counselling and aftercareTreatment as usual and waiting list control

12, 24, 36 months

up to 5 years

Biological drug use dichotomous

Criminal activity continuous

Criminal activity dichotomous

Self report drug use dichotomous

% and total

mean and SD

% testing positive for illicit drugs at 12 months' follow-up

Mean months incarcerated in the year following release

% any arrest

% arrested for drug crime

% arrested for property crime

% arrested for violent crime

% arrested for other crime

% used drugs heavily in past year at 5 years

Mean days until re-incarceration

% re-incarcerated

Mean days on parole to first return to custody

% returned to prison within 3 years post parole

Sacks 2004a TC therapeutic community only

Sacks 2004b TC + AC therapeutic community plus aftercare

Sullivan 2007

Modified therapeutic community (personal reflections therapeutic community and voluntary residential aftercare)Intensive psychiatric services12 months

Criminal activity continuous

Criminal activity dichotomous

Self report drug use dichotomous

Mean and SD

% and total

Mean number of days until incarceration

Mean number of days until first crime

% re-incarceration

% criminal activity

% alcohol/drug offence

% other (non-alcohol/drug) offence

% illegal drug use

Sacks 2011Therapeutic community (re-entry modified)Parole supervision case management12 monthsCriminal activity dichotomous% with total

% re-incarcerated

% self reported criminal activity

Stein 2011 (high depression score)Motivational interviewingRelaxation training3 monthsSelf report drug use continuousMean and SD

Mean joins per day

Mean % days used marijuana

Do treatments for drug-using offenders with co-occurring mental illness reduce drug use?

For drug use, two studies found no statistically significant reduction in self report drug use (715 participants; RR 0.82, 95% CI 0.44 to 1.55) (Prendergast 2004; Sullivan 2007). The two studies were highly heterogeneous (I2 = 80%) (Analysis 1.1).

Do treatments for drug-using offenders with co-occurring mental illness reduce criminal activity?

For the criminal activity outcomes, two studies found no statistically significant reduction in re-arrest 663 participants; RR 1.00, 95% CI 0.90 to 1.12) (Cosden 2003; Prendergast 2003). For measures of dichotomous re-incarceration, two studies demonstrated a significant reduction in the number of individuals re-incarcerated following treatment (266 participants; RR 0.40, 95% CI 0.24 to 0.67) (Analysis 2.1) (Sacks 2004a TC; Sacks 2011). For measures of continuous re-incarceration, two studies showed a significant reduction on criminal behaviour (361 participants; MD 28.72, 95% CI 5.89 to 51.54) (Analysis 2.2) (Sacks 2004a TC; Wexler 1999a).

Does the type of treatment affect the outcome(s)?

1. Therapeutic community versus treatment as usual
Impact on criminal activity

One subanalysis of two studies evaluating the impact of TC treatment found a statistically significant reduction in re-incarceration (266 participants; RR 0.29, 95% CI 0.16 to 0.54) (Analysis 3.1) (Sacks 2004a TC; Sacks 2011). One study found no statistically significant reduction in re-arrest following treatment (428 participants; RR 0.90, 95% CI 0.61 to 1.33) (Analysis 3.1) (Prendergast 2003).

2. Mental health court and case management versus treatment as usual (standard court proceedings)
Impact on self report criminal activity

One study found no statistically significant reduction in criminal activity (235 participants; RR 1.05, 95% CI 0.90 to 1.22) (Analysis 4.1) (Cosden 2003).

3. Motivational interviewing and cognitive skills versus relaxation therapy
Impact on self report drug use

One study found no statistically significant reduction in self report drug use (162 participants; MD -7.42, 95% CI -20.12 to 5.28) (Analysis 5.1) (Stein 2011).

Cost and cost effectiveness

Four papers referred to the costs or cost effectiveness of the TC programmes. The Sacks 2011 paper suggested that cost-beneficial analyses associated with each intervention in achieving the desired outcome would greatly assist how best to allocate scarce resources. The Prendergast five-year evaluation is currently involved in an economic analysis with important differences noted in the one-year AMITY outcome study suggests that optimal cost savings appear to require prison treatment plus aftercare rater than prison treatment alone (McCollister 2013). One study contained some information about the cost (but not sufficient to conduct a cost-effectiveness appraisal) (Sacks 2004a TC; Sacks 2004b TC + AC). For this intervention, the authors noted that the additional marginal costs on top of the specific incarceration costs were USD7.37 per day compared with the USD148.19 cost of a prison day. This suggests a substantial cost saving of using TCs as opposed to prison.

Discussion

Summary of main results

This systematic review provided evidence from five trials, with seven comparisons included in a series of meta-analyses. The trials were conducted in secure settings and the court judicial system. We did not identify any studies that evaluated interventions for offenders in the community who were on parole or under the care of the probation service. For this reason, we do not know whether such interventions work better in one setting as opposed to another. Three different types of treatment interventions were classified across the seven comparisons. These were divided into: case management via a mental health drug court, TC and MI with cognitive skills in comparison to relaxation training. Overall, the combined interventions were not found to reduce self report drug use, but did significantly reduce subsequent re-incarceration rates but not re-arrests. A specific subgroup analysis combining studies using TC interventions showed a statistically significant reduction in re-incarceration, but not for re-arrest. This finding also supports previous research that demonstrates that the combined effects of TC and aftercare release seem to show the most consistent and successful results. In addition (and not addressed within this review) those clients also remained in treatment for the longest period appeared to benefit most (e.g. Prendergast 2004; Sacks 2004a TC; Sacks 2004b TC + AC). No statistically significant reductions were noted for criminal activity or self report drug use with the use of case management via a mental health court or MI with cognitive skills over relaxation training (Cosden 2003; Stein 2011). In summary, the studies showed a high degree of statistical variation suggesting that caution is needed in interpretation of these results.

Overall, the impact on criminal activity outcome measures varied and the differences noted between the reductions in re-incarceration but not re-arrest could be reflected in the measurement processes. For example, re-incarceration to prison is a longer process and will sometimes involve a court case; and as a numerical outcome measure is less likely to be recorded within the time frame of an experimental evaluation. In comparison, an arrest is more frequent and can be recorded onto the criminal justice system within a shorter period. Sacks 2011 also argues that participation in different treatment options does not necessarily lead to less involvement with the criminal justice system, but that the severity of the offences are reduced such that re-incarceration is less likely. The Prendergast 2003 study also commented on differential effectiveness of treatment outcomes. They argue that focusing on only one or two outcomes may mask the impact of treatment on other outcome domains that are of interest to various stakeholders. For example, measuring re-arrest or re-incarceration conceals the behaviour of treatment that may lead to an individual's return to correctional supervision. Questions that remain unanswered through such measurement include (i) the length of time an offender remains in the community until re-arrest, (ii) knowledge about what crimes are committed and (iii) the reasons for return.

In terms of addressing some of the complex issues of individuals with mental illness and co-occurring substance abuse the evidence from this systematic review provides little information. Only two studies discussed the differential treatment effects on the severity of depression (Cosden 2003; Stein 2011). The Cosden 2003 study noted that further understanding of how to help clients with serious mental illness with different levels of treatment is needed.

Several successful treatment elements were reported throughout the five trials with a number of key themes identified. First, the issue of treatment engagement was noted as important. In the mental health court trial, the informal support from family and friends had an impact in encouraging the engagement of clients within the community to longer term gain (Cosden 2003). Second, programmes that were specifically adapted to the needs of mental health clients showed improved effects in which a cognitive behavioural curriculum that emphasised criminal thinking and behaviour alongside psychoeducational classes to foster recognition and understanding of substance use, mental illness and criminality and sustained aftercare (Sacks 2004a TC). Third, the longer an individual is engaged in treatment the better the outcome(s) (Prendergast 2004).

Overall completeness and applicability of evidence

The paucity of evidence within the review is covered in three key areas: general applicability, mental health information and cost information.

General applicability

The applicability of this evidence is hindered in general by a lack of trials covering a range of different treatment options for offenders with drug misuse and co-occurring mental health problems. The trials were conducted in the US judicial system and are, therefore, limited in their generalisation to other criminal justice systems outside of the US. The current evidence suggests that TC treatment may have some effect in reducing re-incarceration rates, but we do not know how such treatment facilitates the specific rehabilitation requirements of offenders with drug misuse and mental health problems. The review only reports on self report drug use as not enough information using biological outcome measures of drug use (e.g. hair and urine analysis) was available. As a result, the self report information must be interpreted with caution. In addition, we can say nothing about whether such treatments are effective in reducing drug use and subsequent criminal behaviour while on parole or on probation in the community.

Mental health information

Although the review specifically sought to identify studies including participants with co-occurring mental illness, the study descriptions of mental ill health varied. The Cosden 2003 study used a psychiatrist or psychologist to conduct a clinical interview to identify mental health diagnosis alongside substance misuse. This resulted in a mental health court sample of individuals diagnosed with a range of mental health problems including mood disorder, schizophrenia, bipolar disorder and dual diagnosis. Other papers referred to use of the DSM-IV diagnostic criteria (e.g. Sacks 2011), but subsequently provided little information with regards to individual mental illness needs. Demographic information in the Sacks study reported on other aspects of mental health prognosis. Such examples include, lifetime mental health treatment, lifetime in patient care and prescribed medication. The Prendergast 2003 study reported a range of diagnoses including anti-social personality disorder, phobias, post-traumatic stress disorder, depression, dysthymia and attention deficit disorder but did not describe how these diagnoses were confirmed or assessed within the population. As a result, it is difficult to identify which treatments might best benefit different types of mental health problems, for example, someone with a psychotic illness as opposed to depression may require very different treatment approaches.

Cost information

Cost information within the studies remained sparse. This lack of information allowed for little comparison of cost effectiveness between different types of drug treatment programmes. Additional time spent in programmes also raises questions about re-incarceration and days until first incarceration generating important cost-avoidance implications that require further examination. Regular report of effect sizes would aid calculations for power analysis and provide estimates of the magnitude of treatment effect needed for cost benefit and cost-effectiveness analysis.

Quality of the evidence

Overall, the assessment of risk of bias was limited by the lack of information reported in this group of trials. As a result, we rated most of the studies on the majority of risk of bias measures as unclear. In addition, a number of specific limitations were described relating to the study design (and leading to problems of selection bias) and small sample sizes. The Stein 2011 study was noted as being relatively underpowered. Replication of the study is required to enhance the generalisation and external validity of the study findings. Similar modest sample sizes were reported by Sacks 2011 and Cosden 2003, who suggested that larger samples should be used to provide a more precise estimate of effect. The Cosden 2003 study also reported on the possibility of outcome bias as the interviewer was not blind to the outcome condition for the client, and loss to follow-up (25% of the study sample were lost to follow-up) at 12 months.

Another possible selection bias was a concern in the Wexler 1999b and Prendergast 2003 studies whereby participants were randomly assigned to the prison TC and regular prison conditions but not to aftercare. The authors noted that possible differences in personal motivation may account for some of the positive outcomes associated with participants continued support for aftercare services. Subsequently these participants were noted as having the highest 'readiness scores', which suggests that motivation creates an important consideration on client selection (Prendergast 2003; Wexler 1999b).

Potential biases in the review process

Besides the limitations associated with the literature, there are also two limitations of the review methodology. Specifically the original review included an additional five fee-paying databases and one search using DrugScope. In this current review, resources did not allow such extensive searching. While the electronic database searches were updated to March 2013, the website information has only been updated to November 2011. As a result, the literature will require further extensive searching when the review is next updated.

Authors' conclusions

Implications for practice

This review highlights the paucity of evidence for drug-using offenders with co-occurring mental health problems. Two of the five trials showed some promising results for the use of therapeutic community and aftercare, but only in relation to reducing subsequent re-incarceration. Overall, the studies showed a high degree of statistical variation demonstrating a degree of caution in the interpretation of the magnitude of effect and direction of benefit for treatment outcomes. More evaluations are required to assess the effectiveness of interventions for drug-using offenders with co-occurring mental health problems.

Implications for research

This review has identified several research implications:

1. Generally good-quality research is required to evaluate the effectiveness of interventions (other than therapeutic communities) with offenders with substance-misuse problems and co-occurring mental illness. Of particular interest is the extended long-term effects of aftercare following an intervention in prison. Further research to enhance the stronger causal relationships could be resolved if participants were randomly assigned to community treatment or routine parole supervision or to a different intensity of community treatment.

2. Improved descriptions of the participants' mental health problems and more detailed information about mental health diagnoses is required to enable the transferability of information to clinical practice and development of mental health diagnoses as a moderator within the analysis of the outcomes.

3. Trial interventions specifically focusing on females and adolescents are required. In the current review, only one study contained females and one study reported on adolescents with depression.

4. Little is known about the interaction and nature of mental illness and success with different diagnoses. In terms of depression, the Stein 2011 paper attempted to explore some of the differences between participants with few and many depressive symptoms. However, future studies should consider assessing for lifetime and current major depressive disorder and other mental illnesses alongside changes in mental illness over time that might be related to intervention efforts.

5. Cost and cost-effectiveness information should be standardised within trial evaluations, which will help policy makers to decide upon health versus criminal justice costs and benefit in quality of life and mental health outcomes. Additional outcome evaluations should take into consideration the length of time to a parolees re-arrest or re-incarceration as this has implications for costs. For example, the Prendergast 2003 study found that community residential treatment kept parolees out of trouble so long as they remained in treatment. As soon as treatment was dropped (prior to the intended dose) this tended to lead to relapse or recidivism at rates equivalent to those who received prison treatment only. Such evaluations provide potential important information for stakeholders and funding bodies involved in the costing of such programmes and the associated societal costs.

Acknowledgements

We would like to acknowledge the help of the York Health Economics Consortium and The Health Sciences Department at the University of York and the continued support of the Cochrane Drugs and Alcohol Group.

Data and analyses

Download statistical data

Comparison 1. Self report drug use
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
1 Self report drug use dichotomous2715Risk Ratio (M-H, Random, 95% CI)0.82 [0.44, 1.55]
Analysis 1.1.

Comparison 1 Self report drug use, Outcome 1 Self report drug use dichotomous.

Comparison 2. Criminal activity
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
1 Criminal activity dichotomous4 Risk Ratio (M-H, Random, 95% CI)Subtotals only
1.1 Re-arrests2663Risk Ratio (M-H, Random, 95% CI)1.00 [0.90, 1.12]
1.2 Re-incarceration2266Risk Ratio (M-H, Random, 95% CI)0.40 [0.24, 0.67]
2 Criminal activity continuous2361Mean Difference (IV, Random, 95% CI)28.72 [5.89, 51.54]
Analysis 2.1.

Comparison 2 Criminal activity, Outcome 1 Criminal activity dichotomous.

Analysis 2.2.

Comparison 2 Criminal activity, Outcome 2 Criminal activity continuous.

Comparison 3. Therapeutic community
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
1 Criminal activity3 Odds Ratio (M-H, Random, 95% CI)Subtotals only
1.1 Re-arrests1428Odds Ratio (M-H, Random, 95% CI)0.90 [0.61, 1.33]
1.2 Re-incarceration2266Odds Ratio (M-H, Random, 95% CI)0.29 [0.16, 0.54]
Analysis 3.1.

Comparison 3 Therapeutic community, Outcome 1 Criminal activity.

Comparison 4. Mental health court
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
1 Self report dichotomous criminal activity1235Risk Ratio (M-H, Random, 95% CI)1.05 [0.90, 1.22]
Analysis 4.1.

Comparison 4 Mental health court, Outcome 1 Self report dichotomous criminal activity.

Comparison 5. Motivational interviewing and cognitive skills
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
1 Self report drug use1162Mean Difference (IV, Random, 95% CI)-7.42 [-20.12, 5.28]
Analysis 5.1.

Comparison 5 Motivational interviewing and cognitive skills, Outcome 1 Self report drug use.

Appendices

Appendix 1. Cochrane Central Register of Controlled Trials(CENTRAL) search strategy

CENTRAL search
1. prison*
2. offender*
3. (criminal* or probation or court*)
4. (secure next establishment*)
5. reoffend*
6. reincarcerat*
7. recidiv*
8. exoffend*
9. (jail or jails or incarcerat*)
10. (secure next facilit*)
11. (convict* or revocation or inmate* or (high next security))
12. PRISONERS
13. LAW ENFORCEMENT
14. JURISPRUDENCE
15. CRIME
16. #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15
17. SUBSTANCE-RELATED DISORDERS
18. ((substance or drug*) next (abuse* or misuse* or dependen*or use* or addict*))
19. (narcotics or chemical or opiate) next (dependen* or addict* or abuse* or misuse*))
20. ((heroin) next (addict* or dependen* or misuse* or abuse*))
21. ((crack) next (addict* or dependen* or misuse* or abuse* or use*))
22. ((cocaine next addict*) or (cocaine next dependenc*) or (cocaine next misuse*) or (cocaine next abuse*) or (cocaine next use*))
23. ((amphetamine*) next (addict* or dependen* or misuse* or abuse* or use*))
24. (addicts or (dependence next disorder) or (drug next involved))
25. (street next drugs)
26. STREET DRUGS
27. DESIGNER DRUGS
28. NARCOTICS
29. COCAINE
30. AMPHETAMINES
31. ANALGESICS ADDICTIVE
32. ANALGESICS OPIOID
33. PSYCHOTROPIC DRUGS
34. opioid* or opiat*
35. #17 or #18 or #19 or #20 or #21 or #22 or #23 or #24 or #25 or #26 or #27 or #28 or #29 or #30 or #31 or #32 or #33 or #34
35. (#16 and #35)

Appendix 2. MEDLINE search strategy

MEDLINE search
1. exp "Substance-Related-Disorders"/
2. ((drug or substance) adj (abuse* or addict* or dependen* or misuse*)).ti,ab
3. (drug* adj (treat* or intervention* or program*)
4. substance near (treat* or intervention* or program*)
5.(detox* or methadone) in ti,ab
6. narcotic* near (treat* or intervention* or program*)
7. 1 or 2 or 3 or 4 or 5 or 6
8. prison*. ti,ab
9. exp "Prisoners"/
10. offender* or criminal* or inmate* or convict* or probation* or remand or felon*).ti,ab
11. exp "Prisons"/
12. 8 or 9 or 10 or 11
13. 7 and 12

Appendix 3. EMBASE search strategy

Embase search
1. (detox$ or methadone or antagonist prescri$).ti,ab.
2. detoxification/ or drug detoxification/ or drug withdrawal/ or drug dependence treatment/ or methadone/ or methadone treatment/ or diamorphine/ or naltrexone/
3. (diamorphine or naltrexone or therapeutic communit$).ti,ab.
4. morality/
5. (motivational interview$ or motivational enhancement).ti,ab.
6. (counselling or counseling).ti,ab.
7. exp counseling/
8. (psychotherap$ or cognitive behavioral or cognitive behavioural).ti,ab.
9. exp psychotherapy/
10. (moral adj3 training).ti,ab.
11. (cognitive restructuring or assertiveness training).ti,ab.
12. reinforcement/ or self monitoring/ or self control/
13. (relaxation training or rational emotive or family relationship therap$).ti,ab.
14. social learning/ or withdrawal syndrome/ or coping behavior/
15. (community reinforcement or self monitoring or self control or self management or interpersonal skills).ti,ab.
16. (goal$ adj3 setting).ti,ab.
17. (social skills adj3 training).ti,ab.
18. anger/ or lifestyle/
19. (basic skills adj3 training).ti,ab.
20. (relapse adj3 prevent$).ti,ab.
21. (craving adj3 (minimi$ or reduc$)).ti,ab.
22. (trigger or triggers or coping skills or anger management or group work).ti,ab.
23. (lifestyle adj3 modifi$).ti,ab.
24. (high intensity training or resettlement or throughcare or aftercare or after care).ti,ab.
25. aftercare/ or halfway house/
26. (brief solution or brief intervention$ or minnesota program$ or 12 step$ or twelve step$).ti,ab.
27. (needle exchange or nes or syringe exchange or dual diagnosis or narcotics anonymous).ti,ab.
28. self help/ or support group/
29. (self-help or selfhelp or self help or outreach or bail support or arrest referral$).ti,ab.
30. exp urinalysis/ or rehabilitation/ or rehabilitation center/
31. (diversion or dtto or dttos or drug treatment or testing order$ or carat or carats).ti,ab
32. (combined orders or drug-free or drug free).ti,ab.
33. (peer support or evaluation$ or urinalysis or drug testing or drug test or drug tests).ti,ab.
34. ((rehab or rehabilitation or residential or discrete) adj2 (service$ or program$)).ti,ab.
35. (asro or addressing substance$ or pasro or prisons addressing or acupuncture or shock or boot camp or boot camps).ti,ab.
36. (work ethic camp$ or drug education or tasc or treatment accountability).ti,ab
37. exp acupuncture/
38. or/1-36
39. (remand or prison or prisoner or prisoners or offender$ or criminal$ or probation or court or courts).ti,ab.
40. (secure establishment$ or secure facilit$).ti,ab.
41. (reoffend$ or reincarcerat$ or recidivi$ or ex-offender$ or jail or jails or goal or goals).ti,ab.
42. (incarcerat$ or convict or convicts or convicted or felon or felons or conviction$ or revocation or inmate$ or high security).ti,ab.
43. criminal justice/ or custody/ or detention/ or prison/ or prisoner/ or offender/ or probation/ or court/ or recidivism/ or crime/ or criminal behavior/ or punishment/
44. or/39-43
45. 38 and 44
46. (substance abuse$ or substance misuse$ or substance use$).ti,ab.
47. (drug dependanc$ or drug abuse$ or drug use$ or drug misuse$ or drug addict$).ti,ab.
48. (narcotics adj3 (addict$ or use$ or misuse$ or abuse$)).ti,ab.
49. (chemical dependanc$ or opiates or heroin or crack or cocaine or amphetamines or addiction or dependance disorder or drug involved).ti,ab.
50. substance abuse/ or drug abuse/ or analgesic agent abuse/ or drug abuse pattern/ or drug misuse/ or intravenous drug abuse/ or multiple drug abuse/
51. addiction/ or drug dependence/ or narcotic dependence/ or exp narcotic agent/ or narcotic analgesic agent/
52. opiate addiction/ or heroin dependence/ or morphine addiction/
53. cocaine/ or amphetamine derivative/ or psychotropic agent/
54. or/46-53
55. 45 and 54
56. limit 55 to yr=1980-2004

Appendix 4. PsycINFO search strategy

PsycINFO
1. (detoxification in de) or (drug withdrawal in de)
2. (drug usage screening in de) or (methadone maintenance) in de
3. explode "Narcotic-Antagonists" in DE
4. 1 or 2 or 3
5. (counseling in de) or (explode "psychotherapeutic-counseling" in de)
6. (explode "cognitive-therapy" in de) or (explode "psychotherapeutic-techniques" in de)
7. (cognitive restructuring in de) or (assertiveness training in de)
8. explode "relaxation-therapy" in de
9. (rational emotive therapy in de) or (rational-emotive therapy in de)
10. (explode "self monitoring" in de) or (explode self-monitoring) in de
11. (goal setting in de) or (self control in de) or (explode "self-management" in de)
12. (social skills in de) or (relapse prevention in de) or (craving in de) or (coping behavior in de)
13. (anger control in de) or (explode "group-psychotherapy" in de) or (brief psychotherapy in de)
14. (explode "behavior-modification" in de) or (posttreatment followup in de) or (aftercare in de)
15. (halfway houses in de) or (twelve step programs in de)
16. (dual diagnoses in de) or (explode "self help techniques" in de) or (outreach programs in de) or (court referrals in de)
17. (peer pressure in de) or (urinalysis in de)
18. (drug rehabilitation in de) or (residential care institutions in de) or (acupuncture in de) or (drug education in de)
19. (detox* or methadone or antagonist prescri* or diamorphine or naltrexone or therapeutic communit*) in ti,ab
20. (motivational interview* or motivational enhancemen* or counseling or psychotherapy or psychotherapies) in ti,ab
21. (cognitive behav* or cognitive therapy or cognitive therapies or moral training or cognitive restructuring) in ti,ab
22. (assertiveness training or relaxation training or relaxation therapy or relaxation therapies) in ti,ab
23. (rational emotive therap* or rational emotive behav* therap* or family relationship therap* or community reinforcement) in ti,ab
24. (self-monitor* or self monitor* or goal setting or self control or self-control or self management or self-management) in ti,ab
25. (interpersonal skills training or social skills training or basic skills training) in ti,ab
26. (relapse with prevent*) in ti,ab
27. (craving near reduc*) in ti,ab
28. craving with (reduc* in ti,ab)
29. (trigger* or coping skills or anger management or group work or lifestyle modif* or high intensity training or resettlement) in ti,ab
30. (throughcare or aftercare or after care or brief solution* or brief intervention*) in ti,ab
31. (minnesota or 12 step* or twelve step* or needle exchange or nes or syringe exchange or dual diagnosis) in ti,ab
32. (narcotics anonymous or self-help or self help or outreach or bail support or arrest referral*) in ti,ab
33. (diversion or dtto* or testing order* or carat* or counseling assessment referral or combined order or combined orders or drug free wing* or drug free environment*) in ti,ab
34. (peer support or user evaluations or urinalysis or urinalyses or mandatory drug test* or rehabilitation or discrete service* or discrete program*) in ti,ab
35. (residential program* or residential scheme* or asro or addressing substance* or pasro or prisons addressing substance) in ti,ab
36. (acupuncture or shock or boot camp* or work ethic or drug education or tasc or treatment accountability) in ti,ab
37. or/4-36
38. (secure facilities or convict* or revocation or inmate* or high security) in ti,ab
39. (prisoners in de) or (explode "correctional-institutions" in de)
40. (perpetrators in de) or (explode criminals in de)
41. (probation in de) or (parole in de) or (incarceration in de) or (recidivism in de) or (criminal conviction in de) or (crime in de)
42. (remand or prison* or offender* or criminal* or probation or court or courts or secure establishment* or reoffend* or reincarcerat* or recidivi* or ex-offender* or jail or jails or incarcerat*) in ti,ab
43. (drug abuse in de) or (explode "inhalant-abuse" in de) or (explode "drug-dependency" in de)
44. (polydrug abuse in de) or (drug abuse in de) or (intravenous drug usage in de)
45. (narcotic drugs in de) or (heroin in de) or (cocaine in de) or (explode amphetamine in de)
46. (substance abuse* or substance misuse* or substance user*) in ti,ab
47. (drug dependen* or drug abuse* or drug misuse* or drug addict* or drug use) in ti,ab
48. (narcotic abuse* or narcotic misuse* or chemical dependen* or opiate misuse* or opiate abuse*) in ti,ab
49. (heroin use* or heroin addict* or heroin misuse* or heroin abuse*) in ti,ab
50. (crack use* or crack addict* or crack misuse* or crack abuse*) in ti,ab
51. (cocaine use* or cocaine addict* or cocaine misuse* or cocaine abuse*) in ti,ab
52. (amphetamine* use* or amphetamine* addict* or amphetamine* misuse* or amphetamine* abuse*) in ti,ab
53. (dependence disorder or drug involved or dug-involved) in ti,ab
54. #38 or #39 or #40 or #41 or #42
55. #4 or #43 or #44 or #45 or #46 or #47 or #48 or #49 or #50 or #51 or #52 or #53
56. #37 and #54 and #55

Appendix 5. PASCAL. SciSearch, Social SciSSciSearch, Wilson Applied Science and Technology Abstracts search strategy

PASCAL search
1. (DETOX? OR METHADONE OR ANTAGONIST()PRESCRI?)/TI,AB
2. METHADONE/DE OR NALTREXONE/DE
3. (DIAMORPHINE OR NALTREXONE)/TI,AB
4. THERAPEUTIC()COMMUNITY/DE OR THERAPEUTIC()COMMUNIT?)/TI,AB
5. (MOTIVATIONAL()INTERVIEW? OR MOTIVATIONAL()ENHANCEMENT)/TI,AB
6. (COUNSELLING OR COUNSELING)/TI,AB
7. COUNSELING/DE
8. (PSYCHOTHERAP? OR COGNITIVE()BEHAVIORAL OR COGNITIVE()BEHAVIOURAL)/TI,AB
9. PSYCHOTHERAPY!/DE
10. (MORAL(3W)TRAINING)/TI,AB
11. (COGNITIVE()RESTRUCTURING OR ASSERTIVENESS()TRAINING)/TI,AB
12. ASSERTIVENESS/DE OR RELAXATION()TECHNIQUES/DE
13. (RELAXATION()TRAINING OR RATIONAL()EMOTIVE OR FAMILY()RELATIONSHIP()THERAP?)/TI,AB
14. FAMILY()RELATIONS/DE
15. (COMMUNITY()REINFORCEMENT OR SELF()MONITORING OR SELF()CONTROL OR SELF()MANAGEMENT OR INTERPERSONAL()SKILLS)/TI,AB
16. (GOAL?(3W)SETTING)/TI,AB
17. (SOCIAL(3W)TRAINING)/TI,AB
18. SOCIAL RESPONSIBILITY/DE
19. (BASIC()SKILLS(3W)TRAINING)/TI,AB
20. (RELAPSE(3W)PREVENT?)/TI,AB
21. (CRAVING(3W)(MINIMI? OR REDUC?))/TI,AB
22. (TRIGGER OR TRIGGERS OR COPING()SKILLS OR ANGER()MANAGEMENT OR GROUP()WORK)/TI,AB
23. (LIFESTYLE(3W)MODIFI?)/TI,AB
24. (HIGH()INTENSITY()TRAINING OR RESETTLEMENT OR THROUGHCARE OR AFTERCARE OR AFTER()CARE)/TI,AB
25. ADAPTATION,-PSYCHOLOGICAL!/DE OR ANGER/DE OR LIFE()STYLE/DE OR AFTER()CARE/DE OR HALFWAY()HOUSES/DE
26. (BRIEF()SOLUTION OR BRIEF()INTERVENTION? OR MINNESOTA()PROGRAM? OR 12()STEP? OR TWELVE()STEP?)/TI,AB
27. (NEEDLE()EXCHANGE OR NES OR SYRINGE()EXCHANGE OR DUAL()DIAGNOSIS OR NARCOTICS()ANONYMOUS)/TI,AB
28. NEEDLE-EXCHANGE()PROGRAMS/DE
29. (SELF-HELP OR SELFHELP OR SELF()HELP OR OUTREACH OR BAIL()SUPPORT OR ARREST()REFERRAL?)/TI,AB
30. SELF-HELP()GROUPS/DE OR URINALYSIS/DE OR SUBSTANCE()ABUSE()DETECTION/DE
31. (DIVERSION OR DTTO OR DTTOS OR DRUG()TREATMENT OR TESTING()ORDER? ? OR CARAT OR CARATS)/TI,AB
32. (COMBINED()ORDERS OR DRUG-FREE OR DRUG()FREE)/TI,AB
33. (PEER()SUPPORT OR EVALUATION? ? OR URINALYSIS OR DRUG()TESTING OR DRUG()TEST? ?)/TI,AB
34. ((REHAB OR REHABILITATION OR RESIDENTIAL OR DISCRETE)(2W)(SERVICE? ? OR PROGRAM?))/TI,AB
35. (ASRO OR ADDRESSING()SUBSTANCE? OR PASRO OR PRISONS()ADDRESSING OR ACUPUNCTURE OR SHOCK OR BOOT()CAMP OR BOOT()CAMPS)/TI,AB
36. (WORK()ETHIC()CAMP? ? OR DRUG()EDUCATION OR TASC OR TREATMENT()ACCOUNTABILITY)/TI,AB
37. ACUPUNCTURE-THERAPY!/DE OR ACUPUNCTURE/DE OR HEALTH()EDUCATION/DE OR SUBSTANCE()ABUSE()TREATMENT()CENTERS/DE
38. S1:S3
39. S4:S37
40. S38 AND S39
40. (REMAND OR PRISON OR PRISONER OR PRISONERS OR OFFENDER? ? OR CRIMINAL? ? OR PROBATION OR COURT OR COURTS)/TI,AB
41. (SECURE()ESTABLISHMENT? ? OR SECURE()FACILIT?)/TI,AB
42. (REOFFEND? OR REINCARCERAT? OR RECIDIVI? OR EX()OFFENDER? ? OR JAIL OR JAILS)/TI,AB
43. (INCARCERAT? OR CONVICT OR CONVICTS OR CONVICTED OR FELON? ? OR CONVICTION? ? OR REVOCATION OR INMATE? ? OR HIGH()SECURITY)/TI,AB
44. PRISONERS/DE OR LAW()ENFORCEMENT/DE OR JURISPRUDENCE/DE
45. S40:S44
46. S40 AND S45
47. (SUBSTANCE()ABUSE? OR SUBSTANCE()MISUSE? OR SUBSTANCE()USE?)/TI,AB
48. (DRUG()DEPENDANC? OR DRUG()ABUSE? OR DRUG()USE? OR DRUG()MISUSE? OR DRUG()ADDICT?)/TI,AB
49. (NARCOTICS(3W)(ADDICT? OR USE? OR MISUSE? OR ABUSE?))/TI,AB
50. (CHEMICAL()DEPENDANC? OR OPIATES OR HEROIN OR CRACK OR COCAINE OR AMPHETAMINES OR ADDICTION OR DEPENDENCE()DISORDER OR DRUG()INVOLVED)/TI,AB
51. SUBSTANCE-RELATED()DISORDERS/DE OR AMPHETAMINE-RELATED()DISORDERS/DE OR COCAINE-RELATED()DISORDERS/DE OR MARIJUANA ()ABUSE/DE
52. OPIOID-RELATED-DISORDERS!/DE OR PHENCYCLIDINE()ABUSE/DE OR SUBSTANCE()ABUSE()INTRAVENOUS/DE
53. STREET()DRUGS/DE OR DESIGNER()DRUGS/DE OR NARCOTICS/DE
54. COCAINE!/DE OR AMPHETAMINES!/DE OR ANALGESICS()OPIOID/DE
55. S47:S54
56. S46 AND S55
57. (DETOXIFICATION OR METHADONE OR ANTAGONIST-PRESCRIBING)/DE FROM 144,34,434,7,99,65,35,6
58. (DIAMORPHINE OR NALTREXONE)/DE FROM 144,34,434,7,99,65,35,6
59. THERAPEUTIC-COMMUNITY)/DE FROM 144,34,434,7,99,65,35,6
60. (MOTIVATIONAL-INTERVIEW OR MOTIVATIONAL-ENHANCEMENT)/DE FROM 144,34,434,7,99,65,35,6
61. (COUNSELLING OR COUNSELING)/DE FROM 144,34,434,7,99,65,35,6
62. (PSYCHOTHERAPY! OR COGNITIVE-BEHAVIORAL OR COGNITIVE-BEHAVIOURAL)/DE FROM 144,34,434,7,99,65,35,6
63. (MORAL-TRAINING)/DE FROM 144,34,434,7,99,65,35,6
64. (COGNITIVE-RESTRUCTURING OR ASSERTIVENESS-TRAINING)/DE FROM 144,34,434,7,99,65,35,6
65. (RELAXATION-TRAINING OR RATIONAL-EMOTIVE OR FAMILY-RELATIONSHIP-THERAPY)/DE FROM 144,34,434,7,99,65,35,6
66. FAMILY-RELATIONS/DE
67. (COMMUNITY-REINFORCEMENT OR SELF-MONITORING OR SELF-CONTROL OR SELF-MANAGEMENT OR INTERPERSONAL-SKILLS)/DE FROM 44,34,434,7,99,65,35,6
68. (GOAL-SETTING)/DE FROM 144,34,434,7,99,65,35,6
69. (SOCIAL-SKILLS-TRAINING)/DE FROM 144,34,434,7,99,65,35,6
70. SOCIAL-RESPONSIBILITY/DE
71. (BASIC-SKILLS-TRAINING)/DE FROM 144,34,434,7,99,65,35,6
72. (RELAPSE-PREVENTION)/DE FROM 144,34,434,7,99,65,35,6
73. CRAVING/DE FROM 144,34,434,7,99,65,35,6
74. (TRIGGER OR COPING-SKILLS OR ANGER-MANAGEMENT OR GROUP-WORK)/DE FROM 144,34,434,7,99,65,35,6
75. (LIFESTYLE-MODIFICATION)/DE FROM 144,34,434,7,99,65,35,6
76. (HIGH-INTENSITY-TRAINING OR RESETTLEMENT OR THROUGHCARE OR AFTERCARE OR AFTER-CARE)/DE FROM 144,34,434,7,99,65,35,6
77. (BRIEF-SOLUTION OR BRIEF-INTERVENTIONS OR MINNESOTA-PROGRAM OR 12-STEP-PROGRAM OR TWELVE-STEP-PROGRAM)/DE FROM 144,34,434,7,99,65,35,6
77. (NEEDLE-EXCHANGE OR SYRINGE-EXCHANGE OR DUAL-DIAGNOSIS OR NARCOTICS-ANONYMOUS)/DE FROM 144,34,434,7,99,65,35,6
79. (SELF-HELP OR OUTREACH OR BAIL-SUPPORT OR ARREST-REFERRAL)/DE FROM 144,34,434,7,99,65,35,6
80. (DRUG-TREATMENT OR TESTING-ORDERS OR CARAT)/DE FROM 144,34,434,7,99,65,35,6
81. (COMBINED-ORDERS OR DRUG-FREE)/DE FROM 144,34,434,7,99,65,35,6
82. (PEER-SUPPORT OR EVALUATION OR URINALYSIS OR DRUG-TESTING OR DRUG-TESTS)/DE FROM 144,34,434,7,99,65,35,6
83. (REHABILITATION OR RESIDENTIAL OR DISCRETE-SERVICES)/DE FROM 144,34,434,7,99,65,35,6
84. (ASRO OR PASRO ACUPUNCTURE OR BOOT-CAMP)/DE FROM 144,34,434,7,99,65,35,6
85. (WORK-ETHIC-CAMP OR DRUG-EDUCATION OR TASC OR TREATMENT-ACCOUNTABILITY)/DE FROM 144,34,434,7,99,65,35,6
86. (REMAND OR PRISON OR PRISONER OR PRISONERS OR OFFENDER OR OFFENDERS OR CRIMINAL OR CRIMINALS OR PROBATION OR COURT OR COURTS)/DE FROM 144,34,434,7,99,65,35,6
87. (SECURE-ESTABLISHMENTS OR SECURE-FACILITY)/DE FROM 144,34,434,7,99,65,35,6
88. (REOFFENDERS OR REINCARCERATION OR RECIDIVISM OR EX-OFFENDERS OR JAILS)/DE FROM 144,34,434,7,99,65,35,6
89. (INCARCERATION OR CONVICT OR CONVICTS OR FELON OR FELONS OR CONVICTIONS OR REVOCATION OR INMATE OR INMATES OR HIGH-SECURITY)/DE FROM 144,34,434,7,99,65,35,6
90. (SUBSTANCE-ABUSE OR SUBSTANCE-MISUSE OR SUBSTANCE-USE)/DE FROM 144,34,434,7,99,65,35,6
91. (DRUG-DEPENDANCE OR DRUG-DEPENDENCY OR DRUG-ABUSE OR DRUG-MISUSE OR DRUG-ADDICT OR DRUG-ADDICTION)/DE FROM 144,34,434,7,99,65,35,6
92. (CHEMICAL-DEPENDANCY OR OPIATE-DEPENDENCY OR HEROIN-DEPENDENCY OR CRACK-DEPENDENCY OR COCAINE-DEPENDENCY OR AMPHETAMINES OR ADDICTION OR DEPENDENCE-DISORDER OR DRUG-INVOLVED)/DE FROM 144,34,434,7,99,65,35,6
93. S40 OR S57:S85
94. S45 OR S86:S89
95. S55 OR S90:S92
96. S93 AND S94 AND S95
97. S96/1980-2004

Appendix 6. ASSIA search strategy

ASSIA search
1. remand
2. prison or prisoner or prisoners
3. offender*
4. criminal*
5. probation
6. court or courts
7. tribunal or tribunals
8. secure establishment*
9. secure facilit*
10. reoffend*
11. reincarcerat*
12. recidivi*
13. ex-offender*
14. jail or jails
15. incarcerat*
16. convict or convicts
17. convicted
18. felon or felons
19. conviction*
20. reconviction*
21. high security
22. law enforcement
23. Substance abuse* or substance misuse* or substance use*
24. drug dependanc* or drug abuse* or drug use*
25. drug misuse* or drug addict*
26. narcotics addict* narcotics use* narcotics misuse* narcotics abuse*
27. chemical dependanc*
28. opiates
29. heroin
30. crack
31. cocaine
32. amphetamines
33. cocaine
34. addiction
35. dependence disorder*
36. drug involved
37. Substance-related disorders
38. amphetamine-related disorders
39. cocaine-related disorders
40. marijuana abuse
41. opioid-related disorders
42. street drugs
43. designer drugs
44. 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22
45. 23 or 24 or 25 or 26 or 27 or 28 or 29 or 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37 or 38 or 39 or 40 or 41 or 42 or 43
46. 44 and 45

Appendix 7. Sociological Abstracts search strategy

Sociological Abstrac
1. remand in de
2. detention in de
3. prisoners in de
4. prisons in de
5. offenders in de
6. parole in de
7. probation in de
8. correctional system in de
9. courts in de
10. imprisonment in de
11. criminal justice in de
12. criminal proceedings in de
13. recidivism in de
14. jail in de
15. institutionalization (persons) in de
16. conviction/convictions in de
17. (remand or prison* or offender* or criminal* or probation or court or courts or secure establishment*) in ti,ab
18. (reoffend* or reincarcerat* or recidivi* or ex-offend* or jail or jails or incarcerat* or secure facilit* or convict* or revocation or inmate*) in ti,ab
19. #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16 or #17 or #18 or #19
20. substance abuse in de
21. explode "Drug-Abuse" in DE
22. "Drug-Injection" in DE
23. explode "Narcotic-Drugs" in DE
24. "Cocaine-" in DE
25. "Addiction-" in DE
26. explode "Psychedelic-Drugs" in DE
27. (substance abuse* or substance misuse* or substance use*) in ti,ab
28. (drug abuse* or drug misuse* or drug use*) in ti,ab
29. (drug dependenc* or drug addict* or narcotics abuse* or narcotics use* or narcotics misuse* or narcotics addict*) in ti,ab
30. (chemical dependenc* or opiate abuse* or opiate misuse* or opiate use* or opiate addict*) in ti,ab
31. (heroin abuse* or heroin misuse* or heroin use* or heroin addict*) in ti,ab
32. (crack abuse* or crack misuse* or crack use* or crack addict*) in ti,ab
33. (cocaine abuse* or cocaine misuse* or cocaine use* or cocaine addict*) in ti,ab
34. (amphetamine* abuse* or amphetamine* misuse* or amphetamine* use* or amphetamine* addict*) in ti,ab
35. (dependence disorder or drug involved) in ti,ab
36. #22 or #23 or #24 or #25 or #26 or #27 or #28 or #29 or #30 or #31 or #32 or #33 or #34 or #35
37. #19 and #36
38. "Detoxification-" in DE
39. "Methadone-Maintenance" in DE
40. "Counseling-" in DE
41. "Psychotherapy-" in DE
42. "Assertiveness-" in DE
43. (detoxification in de) or (methadone maintenance in de) or (treatment programs in de)
44. (counseling in de) or (psychotherapy in de) or (assertiveness in de) or (group therapy in de) or (goals in de) or (self control in de)
45. (interpersonal communication in de) or (social interaction in de) or (social competence in de) or (coping in de)
46. (social behavior in de) or (group work in de) or (lifestyle in de)
47. (after care in de) or (support networks in de) or (self help in de) or (self help groups in de) or (outreach programmes in de)
48. (outreach programs in de) or (referral in de) or (delinquency prevention in de) or (diversion/diversions in de)
49. (peer groups in de) or (peer influence in de) or (drug use screening in de) or (rehabilitation in de) or (work experience in de)
50. (detox* or methadone maintenance or methadone prescri* or antagonist prescri* or dimorphine or naltrexone) in ti,ab
51. (therapeutic communit* or motivational interview* or motivational enhance* or counseling or counselling or psychotherapy or cognitive behavi*) in ti,ab
52. (moral training or cognitive restructuring or assertiveness training or relaxation training) in ti,ab
53. (rational-emotive or rational emotive or family relationship therap* or community reinforcement or self monitoring or goal setting or self control training) in ti,ab
54. (self management or interpersonal skills or social skills or basic skills or relapse prevent* or prevent* relapse or craving reduc* or reduc* craving) in ti,ab
55. (trigger* or coping skills or anger management or group work or lifestyle modif* or high intensity training or resettlement or throughcare) in ti,ab
56. (aftercare or after care or brief solution or brief intervention* or 12 step* or twelve step* or minnesota program* or needle exchange or nes) in ti,ab
57. (syringe exchange or dual diagnosis or narcotics anonymous or self help or selfhelp or outreach or bail support) in ti,ab
58. (arrest referral* or diversion or dtto or dttos or drug treatment or carat or carats or counseling assessment or combined orders) in ti,ab
59. (drug-free or drug free or peer support or evaluation* or urinalysis or drug testing or drug use screen* or rehabilitation or discrete service* or discrete program*) in ti,ab
60. (residential program* or residential scheme* or residential service*) in ti,ab
61. (asro or addressing substance or pasro or prisons addressing or acupuncture or shock or boot camp*) in ti,ab
62. (work ethic or drug education or tasc or treatment accountability) in ti,ab
63. #38 or #39 #or #40 or #41 or #42 or #43 or #44 or #45 or #46 or #47 or #48 or #49 or #50 or #51 or #52 or #53 or #54 or #55 or #56 or #57 or #58 or #59 or #60 or #61 or #62
64. #37 and #63

Appendix 8. HMIC search strategy

HMIC
1. remand in de
2. detention in de
3. prisoners in de
4. prisons in de
5. offenders in de
6. parole in de
7. probation in de
8. correctional system in de
9. courts in de
10. imprisonment in de
11. criminal justice in de
12. criminal proceedings in de
13. recidivism in de
14. jail in de
15. institutionalization (persons) in de
16. conviction/convictions in de
17. (remand or prison* or offender* or criminal* or probation or court or courts or secure establishment*) in ti,ab
18. (reoffend* or reincarcerat* or recidivi* or ex-offend* or jail or jails or incarcerat* or secure facilit* or convict* or revocation or inmate*) in ti,ab
19. #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16 or #17 or #18
20. substance abuse in de
21. explode "Drug-Abuse" in DE
22. "Drug-Injection" in DE
23. explode "Narcotic-Drugs" in DE
24. "Cocaine-" in DE
25. "Addiction-" in DE
26. explode "Psychedelic-Drugs" in DE
27. (substance abuse* or substance misuse* or substance use*) in ti,ab
28. (drug abuse* or drug misuse* or drug use*) in ti,ab
29. (drug dependenc* or drug addict* or narcotics abuse* or narcotics use* or narcotics misuse* or narcotics addict*) in ti,ab
30. (chemical dependenc* or opiate abuse* or opiate misuse* or opiate use* or opiate addict*) in ti,ab
31. (heroin abuse* or heroin misuse* or heroin use* or heroin addict*) in ti,ab
32. (crack abuse* or crack misuse* or crack use* or crack addict*) in ti,ab
33. (cocaine abuse* or cocaine misuse* or cocaine use* or cocaine addict*) in ti,ab
34. (amphetamine* abuse* or amphetamine* misuse* or amphetamine* use* or amphetamine* addict*) in ti,ab
35. (dependence disorder or drug involved) in ti,ab
36. #20 or #21 or #22 or #23 or #24 or #25 or #26 or #27 or #28 or #29 or #30 or #31 or #32 or #33 or #34 or #35
37. #19 and #36

Appendix 9. PAIS search strategy

PAIS
1. ((reoffend* or reincarcerat* or recidivi* or ex-offend* or jail or jails or incarcerat* or secure facilit* or convict* or revocation or inmate*) in ti,ab)
2. ((remand or prison* or offender* or criminal* or probation or court or courts or secure establishment*) in ti,ab)
3. ((drug dependenc* or drug addict* or narcotics abuse* or narcotics use* or narcotics misuse* or narcotics addict*) in ti,ab)
4. ((drug abuse* or drug misuse* or drug use*) in ti,ab) or ((substance abuse* or substance misuse* or substance use*) in ti,ab)
5. ((detox* or methadone maintenance or methadone prescri* or antagonist prescri* or dimorphine or naltrexone) in ti,ab)
6. ((dependence disorder or drug involved) in ti,ab)
7. ((amphetamine* abuse* or amphetamine* misuse* or amphetamine* use* or amphetamine* addict*) in ti,ab)
8. ((cocaine abuse* or cocaine misuse* or cocaine use* or cocaine addict*) in ti,ab)
9. ((crack abuse* or crack misuse* or crack use* or crack addict*) in ti,ab)
10. ((heroin abuse* or heroin misuse* or heroin use* or heroin addict*) in ti,ab)
11. ((chemical dependenc* or opiate abuse* or opiate misuse* or opiate use* or opiate addict*) in ti,ab)
12. ((moral training or cognitive restructuring or assertiveness training or relaxation training) in ti,ab)
13. ((therapeutic communit* or motivational interview* or motivational enhance* or counseling or counselling or psychotherapy or cognitive behavi*) in ti,ab)
14. ((work ethic or drug education or tasc or treatment accountability) in ti,ab)
15. ((asro or addressing substance or pasro or prisons addressing or acupuncture or shock or boot camp*) in ti,ab)
16. ((arrest referral* or diversion or dtto or dttos or drug treatment or carat or carats or counseling assessment or combined orders) in ti,ab)
17. ((residential program* or residential scheme* or residential service*) in ti,ab)
18. ((syringe exchange or dual diagnosis or narcotics anonymous or self help or selfhelp or outreach or bail support) in ti,ab)
19. ((drug-free or drug free or peer support or evaluation* or urinalysis or drug testing or drug use screen* or rehabilitation or discrete service* or discrete program*) in ti,ab)
20. ((aftercare or after care or brief solution or brief intervention* or 12 step* or twelve step* or minnesota program* or needle exchange or nes) in ti,ab)
21. ((trigger* or coping skills or anger management or group work or lifestyle modif* or high intensity training or resettlement or throughcare) in ti,ab)
22. ((self management or interpersonal skills or social skills or basic skills or relapse prevent* or prevent* relapse or craving reduc* or reduc* craving) in ti,ab)
24. ((rational-emotive or rational emotive or family relationship therap* or community reinforcement or self monitoring or goal setting or self control training) in ti,ab)
25. #1 or #2
26. #3 or #4 or #5 or #6 or #7 or #8 or 9 or #10 or #11
27. #12 or #13 or #14 or #15 or #16 or #17 or #18 or #19 or #20 or #21 or #22 or #23 or #24
28. 25 and #26 and #27

Appendix 10. SIGLE search strategy

SIGLE
1. ((reoffend* or reincarcerat* or recidivi* or ex-offend* or jail or jails or incarcerat* or secure facilit* or convict* or revocation or inmate*) in ti,ab)
2. ((remand or prison* or offender* or criminal* or probation or court or courts or secure establishment*) in ti,ab
3. ((drug dependenc* or drug addict* or narcotics abuse* or narcotics use* or narcotics misuse* or narcotics addict*) in ti,ab
4. ((drug abuse* or drug misuse* or drug use*) in ti,ab
5. ((substance abuse* or substance misuse* or substance use*) in ti,ab
6. ((detox* or methadone maintenance or methadone prescri* or antagonist prescri* or dimorphine or naltrexone) in ti,ab
7. ((dependence disorder or drug involved) in ti,ab
8. ((amphetamine* abuse* or amphetamine* misuse* or amphetamine* use* or amphetamine* addict*) in ti,ab
9. ((cocaine abuse* or cocaine misuse* or cocaine use* or cocaine addict*) in ti,ab
10. ((crack abuse* or crack misuse* or crack use* or crack addict*) in ti,ab
11. ((heroin abuse* or heroin misuse* or heroin use* or heroin addict*) in ti,ab
12. ((chemical dependenc* or opiate abuse* or opiate misuse* or opiate use* or opiate addict*) in ti,ab
13. #1 or #2
14. #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12
15. #13 and #14

Appendix 11. Criminal Justice Abstracts search strategy

CJA search
1. (substance abuse* or substance misuse* or substance use or substance users) in ti,ab,de
2. substance related in ti,ab,de
3. drug related in ti,ab,de
4. (drug dependenc* or drug abuse* or drug misuse* or drug use or drug users or drug addiction) in ti,ab,de
5. (narcotics use or narcotics users or narcotics abuse* or narcotics misuse* or chemical dependenc*) in ti,ab,de
6. (opiates or heroin or crack or cocaine or amphetamines or addict or addicts or addicted or dependence disorder* or drug involved) in ti,ab,de
7. (designer drugs or street drugs or polydrug misuse* or polydrug abuse*) in ti,ab,de
8. #1 or #2 or #3 or #4 or #5 or #6 or #7
9. ((antagonist near prescri*) or diamorphine or naltrexone) in ti,ab,de
10. (therapeutic communit* or (motivational near interview*)) in ti,ab,de
11. (motivational near enhancement) in ti,ab,de
12. (counselling or counseling) in ti,ab,de
13. (psychotherap* or cognitive behav* or behav* therap* or (moral near training)) in ti,ab,de
14. (cognitive restructuring or (assertiveness near train*) or relaxation training) in ti,ab,de
15. (rational emotive or family relationship therap*) in ti,ab,de
16. (community reinforcement or self monitoring or goal setting or goalsetting) in ti,ab,de
17. (self control near training) in ti,ab,de
18. (self management) in ti,ab,de
19. (interpersonal skills near training) in ti,ab,de
20. ((social skills or basic skills) near training) in ti,ab,de
21. ((relapse near prevent*) or (craving near reduc*)) in ti,ab,de
22. (trigger* or coping skills or anger management or group work or (lifestyle near modif*)) in ti,ab,de
23. (high intensity training or resettlement or throughcare or aftercare or after care) in ti,ab,de
24. (brief solution* or brief intervention*) in ti,ab,de
25. (minnesota in ti,ab) in ti,ab,de
26. (12 step* or twelve step*) in ti,ab,de
27. (needle exchange or nes or syringe exchange) in ti,ab,de
28. (dual diagnosis or narcotics anonymous or self help or selfhelp or outreach) in ti,ab,de
29. (bail support or bail program* or arrest referral* or diversion or dtto* or drug treatment) in ti,ab,de
30. (carat or counselling assessment or counseling assessment) in ti,ab,de
31. (combined order* or drug free wing* or drug free environment* or peer support) in ti,ab,de
32. (user evaluations or urinalys* or urinanalys* or drug test* or rehab* or discrete service*) in ti,ab,de
33. (discrete program* or residential program* or residential scheme*) in ti,ab,de
34. (asro or addressing substance*) in ti,ab,de
35. (pasro or prisons addressing) in ti,ab,de
36. (acupuncture or shock or boot camp or boot camps or work ethic camp*) in ti,ab,de
37. (drug education or tasc or treatment accountability) in ti,ab,de
38. (detoxification or detox or methadone maintenance or (methadone near prescri*)) in ti,ab,de
39. #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16 or #17 or #18 or #19 or #20 or #21 or #22 or #23 or #24 or #25 or #26 or #27 or #28 or #29
40. #30 or #31 or #32 or #33 or #34 or #35 or #36 or #37 or #38 or #39
41. #39 or #40
42. #8 and #41

Appendix 12. National Research Register search strategy

NRR search
1. REMAND
2. PRISON*
3. OFFENDER*
4. ((CRIMINAL* or PROBATION) or COURT) or COURTS)
5. (SECURE next ESTABLISHMENT*)
6. REOFFEND*
7. REINCARCERAT*
8. RECIDIV*
9. EXOFFEND*
10. ((JAIL or JAILS) or INCARCERAT*)
11. (SECURE next FACILIT*)
12. (((CONVICT* or REVOCATION) or INMATE*) OR (HIGH next SECURITY))
13. PRISONERS:ME
14. LAW-ENFORCEMENT:ME
15. JURISPRUDENCE:ME
16. CRIME:ME
17. #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10
18. #11 or #12 or #13 or #14 or #15 or #16
19. #17 or #18
20. ((SUBSTANCE next ABUSE*) or (SUBSTANCE next MISUSE*)) OR (DRUG NEXT DEPENDENC*)) OR (DRUG NEXT ABUSE*)) OR (DRUG NEXT MISUSE*)) OR (DRUG NEXT USE*)) OR (DRUG NEXT ADDICTION))
21. ((NARCOTICS or (CHEMICAL next DEPENDENC*)) OR (OPIATE NEXT ADDICT*)) OR (OPIATE NEXT DEPENDENC*)) OR (OPIATE NEXT ABUSE*)) OR (OPIATE NEXT MISUSE*))
22. ((HEROIN next ADDICT*) or (HEROIN next DEPENDENC*)) OR (HEROIN NEXT MISUSE*)) OR (HEROIN NEXT ABUSE*))
23. ((CRACK next ADDICT*) or (CRACK next DEPENDENC*)) OR (CRACK NEXT MISUSE*)) OR (CRACK NEXT ABUSE*)) OR (CRACK NEXT USE*))
24. ((COCAINE next ADDICT*) or (COCAINE next DEPENDENC*)) OR (COCAINE NEXT MISUSE*)) OR (COCAINE NEXT ABUSE*)) OR (COCAINE NEXT USE*))
25. ((AMPHETAMINE* next ADDICT*) or (AMPHETAMINE* next DEPENDENC*)) OR (AMPHETAMINE* NEXT MISUSE*)) OR (AMPHETAMINE* NEXT ABUSE*)) OR (AMPHETAMINE* NEXT USE*))
26. ((ADDICTS or (DEPENDENCE next DISORDER)) OR (DRUG NEXT INVOLVED))
27. (SUBSTANCE-RELATED and DISORDERS:ME)
28. SUBSTANCE-RELATED-DISORDERS:ME
29. AMPHETAMINE-ABUSE:ME
30. COCAINE-ABUSE:ME
31. MARIJUANA-ABUSE:ME
32. OPIOID-RELATED-DISORDERS:ME
33. PHENCYCLIDINE-ABUSE:ME
34. SUBSTANCE-ABUSE-INTRAVENOUS:ME
35. SUBSTANCE-WITHDRAWAL-SYNDROME:ME
36. (STREET next DRUGS)
38. STREET-DRUGS:ME
39. DESIGNER-DRUGS:ME
40. NARCOTICS:ME
41. (COCAINE:ME or AMPHETAMINES:ME)
42. ANALGESICS-ADDICTIVE:ME
43. ANALGESICS-OPIOID:ME
44. PSYCHOTROPIC-DRUGS:ME
45. #20 or #21 or #22 or #23 or #24 or #25 or #26 or #27 or #28 or #29 or #30 or #31 or #32 or #33 or #34 or #35 or #36 or #37 or #38 or #39 or #40 or #41 or #42 or #43 or #44
46. 19 and 45

Appendix 13. SPECTRA search strategy

SPECTRA search
1. {remand} or {prison} or {offender} or {criminal} or {probation} or {court} or {tribunal} or {secure establishment} or {secure facilit} or {reoffend} or {reincarcerat} or {recidivi} or {ex-offender} or {jail} or {incarcerat} or {convict} or {felon} or {reconvict} or {high security} or {law enforcement}
{remand} or {prison} or {offender} or {criminal} or {probation} or {court} or {tribunal} or {secure establishment} or {secure facilit} or {reoffend} or {reincarcerat} or {recidivi} or {ex-offender} or {jail} or {incarcerat} or {convict} or {felon} or {reconvict} or {high security} or {law enforcement}
2. {substance} or {dependenc} or {drug abuse} or {drug use} or {drug misuse} or {addict}
All indexed fields: {remand} or {prison} or {offender} or {criminal} or {probation} or {court} or {tribunal} or {secure establishment} or {secure facilit} or {reoffend} or {reincarcerat} or {recidivi} or {ex-offender} or {jail} or {incarcerat} or {convict} or {felon} or {reconvict} or {high security} or {law enforcement}
OR
All unindexed fields: {remand} or {prison} or {offender} or {criminal} or {probation} or {court} or {tribunal} or {secure establishment} or {secure facilit} or {reoffend} or {reincarcerat} or {recidivi} or {ex-offender} or {jail} or {incarcerat} or {convict} or {felon} or {reconvict} or {high security} or {law enforcement}
AND
All unindexed fields: {substance} or {dependenc} or {drug abuse} or {drug use} or {drug misuse} or {addict} or {narcotics} or {opiates} or {heroin} or {crack} or {cocaine} or {amphetamines} or {drug involved} or {substance-related} or {amphetamine-related} or {cocaine-related} or {marijuana} or {opioid} or {street drug} or {designer drug}
3. narcotics
4. opiates
5. heroin
6. {crack}
7. cocaine
8. amphetamines
9. drug involved
10. substance-related
11. amphetamine-related
12. cocaine-related
13. marijuana
14. opioid
15. street drug
16. designer drug
17. 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16
18. 1 AND 17

Appendix 14. Criteria for assessing risk of bias

 Item  Judgement  Description

1. Random sequence generation (selection bias)

 

 

Low riskThe investigators describe a random component in the sequence generation process such as: random number table; computer random number generator; coin tossing; shuffling cards or envelopes; throwing dice; drawing of lots; minimisation
High riskThe investigators describe a non-random component in the sequence generation process such as: odd or even date of birth; date (or day) of admission; hospital or clinic record number; alternation; judgement of the clinician; results of a laboratory test or a series of tests; availability of the intervention
Unclear riskInsufficient information about the sequence generation process to permit judgement of low or high risk

2. Allocation concealment (selection bias)

 

 

Low riskInvestigators enrolling participants could not foresee assignment because 1 of the following, or an equivalent method, was used to conceal allocation: central allocation (including telephone, web-based, and pharmacy-controlled, randomisation); sequentially numbered drug containers of identical appearance; sequentially numbered, opaque, sealed envelopes
High riskInvestigators enrolling participants could possibly foresee assignments because 1 of the following method was used: open random allocation schedule (e.g. a list of random numbers); assignment envelopes without appropriate safeguards (e.g. if envelopes were unsealed or non­opaque or not sequentially numbered); alternation or rotation; date of birth; case record number; any other explicitly unconcealed procedure
Unclear riskInsufficient information to permit judgement of low or high risk This is usually the case if the method of concealment is not described or not described in sufficient detail to allow a definite judgement

3. Blinding of participants and providers (performance bias)

Objective outcomes 

Low risk

 

 

No blinding or incomplete blinding, but the review authors judge that the outcome is not likely to be influenced by lack of blinding;

blinding of participants and key study personnel ensured, and unlikely that the blinding could have been broken

 

4. Blinding of participants and providers (performance bias)

Subjective outcomes

 

 

Low risk

 

Blinding of participants and  providers and unlikely that the blinding could have been broken

 

High risk

No blinding or incomplete blinding, and the outcome is likely to be influenced by lack of blinding

Blinding of key study participants and personnel attempted, but likely that the blinding could have been broken, and the outcome is likely to be influenced by lack of blinding

Unclear riskInsufficient information to permit judgement of low or high risk

5. Blinding of outcome assessor (detection bias)

Objective outcomes 

Low risk

 

 

No blinding of outcome assessment, but the review authors judge that the outcome measurement is not likely to be influenced by lack of blinding

Blinding of outcome assessment ensured, and unlikely that the blinding could have been broken

6. Blinding of outcome assessor (detection  bias)

Subjective outcomes

 

 

Low risk

 

No blinding of outcome assessment, but the review authors judge that the outcome measurement is not likely to be influenced by lack of blinding

Blinding of outcome assessment ensured, and unlikely that the blinding could have been broken

High risk

No blinding of outcome assessment, and the outcome measurement is likely to be influenced by lack of blinding

Blinding of outcome assessment, but likely that the blinding could have been broken, and the outcome measurement is likely to be influenced by lack of blinding

Unclear riskInsufficient information to permit judgement of low or high risk

7. Incomplete outcome data (attrition bias)

For all outcomes except retention in treatment or drop-out

 

 

Low risk

 

 

 

No missing outcome data

Reasons for missing outcome data unlikely to be related to true outcome (for survival data, censoring unlikely to be introducing bias)

Missing outcome data balanced in numbers across intervention groups, with similar reasons for missing data across groups

For dichotomous outcome data, the proportion of missing outcomes compared with observed event risk not enough to have a clinically relevant impact on the intervention effect estimate

For continuous outcome data, plausible effect size (difference in means or standardised difference in means) among missing outcomes not enough to have a clinically relevant impact on observed effect size

Missing data have been imputed using appropriate methods

All randomised patients are reported/analysed in the group they were allocated to by randomisation irrespective of non-compliance and co-interventions (intention to treat)

High risk

Reason for missing outcome data likely to be related to true outcome, with either imbalance in numbers or reasons for missing data across intervention groups

For dichotomous outcome data, the proportion of missing outcomes compared with observed event risk enough to induce clinically relevant bias in intervention effect estimate

For continuous outcome data, plausible effect size (difference in means or standardised difference in means) among missing outcomes enough to induce clinically relevant bias in observed effect size

'As-treated' analysis done with substantial departure of the intervention received from that assigned at randomisation

Unclear riskInsufficient information to permit judgement of low or high risk (e.g. number randomised not stated, no reasons for missing data provided; number of drop-out not reported for each group)

8. Selective reporting (reporting bias)

 

 

Low risk

The study protocol is available and all of the study's pre-specified (primary and secondary) outcomes that are of interest in the review have been reported in the pre-specified way

The study protocol is not available but it is clear that the published reports include all expected outcomes, including those that were pre-specified (convincing text of this nature may be uncommon)

High risk

Not all of the study’s pre-specified primary outcomes have been reported

1 or more primary outcomes is reported using measurements, analysis methods or subsets of the data (e.g. subscales) that were not pre-specified

1 or more reported primary outcomes were not pre-specified (unless clear justification for their reporting is provided, such as an unexpected adverse effect)

1 or more outcomes of interest in the review are reported incompletely so that they cannot be entered in a meta-analysis

The study report fails to include results for a key outcome that would be expected to have been reported for such a study

Unclear riskInsufficient information to permit judgement of low or high risk

9. Other bias *

 

 

Low risk Evidence to suggest other problems identified with the study which might threaten the validity of the random allocation, attrition or data integrity and results of the trial
High risk Evidence to suggest that the trial might be underpowered/problems with the random allocation process leading to potential self selection bias/issues of analysis not conducted using intent to treat analysis or evidence of missing data. Concerns of attrition and measurement error including reliance on self report measures
Unclear risk Insufficient information to permit judgement of low or high risk

What's new

DateEventDescription
28 May 2012New search has been performedThis review has been updated using searches to 21st March 2013. The review represents one in a family of four reviews. The reviews cover pharmacological, non pharmacological and drug using female offenders. This review of interventions with drug-using offenders with co-occurring mental illness contains eight randomised controlled trials. Three of the eight trials are awaiting classification to the review, the remaining five represent a total of 1,502 participants.
2 October 2011New search has been performedThe updated edit of this review produced a new document with additional findings with searches up to 11th November 2011. Five new authors have been added to this version of the review. These include Steven Duffy, Rachael McCool, Matthew Neilson, Catherine Hewitt and Marrissa Martyn-St James.
1 July 2011AmendedConverted to new review format.
8 June 2011New search has been performedReview has been substantially updated

History

Review first published: Issue 1, 2014

DateEventDescription
19 May 2006New citation required and conclusions have changedSubstantive amendment

Contributions of authors

JMG and SBD constructed and conducted searches.

AP, MN and RP inspected the search hits by reading the titles and abstracts.

MMSTJ, JMG, RMCc, SBD and MN conducted the data extraction for the papers.

CG conducted a data extraction and narrative summary of the cost-effectiveness studies.

MMSTJ, MN, CH and AP compiled and organised results

All review authors contributed towards the final draft text.

Declarations of interest

None.

Sources of support

Internal sources

  • Reviewer from Cochrane Drugs and Alcohol Group, Not specified.

    A reviewer from the Drugs and Alcohol Group provided the researchers with the results of a search strategy for three databases

External sources

  • The Department of Health funded the original review, UK.

Differences between protocol and review

None.

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Cosden 2003

MethodsAllocation: random assignment
Randomisation method: adequate/low risk
Similar on drug use: unknown/unclear risk
Similar on criminal activity: yes
Blinding methodology: high risk
Loss to follow-up: partial/high risk
Participants235 adults
Age not reported
50.2% male
70.6% European American
Drug use not reported
Alcohol use not reported
100% psychiatric history
Eligibility criteria: adults charged with a crime or misdemeanour who were booked into county jail, had at least 1 prior booking and were diagnosed with a serious and pervasive mental illness and were residents of the county involved. Pre-plea participants were required to have no previous offences involving violence; post-adjudication participants with prior violence were eligible if they were considered to no longer pose a threat
Interventions

Court-based sentencing and case management intervention vs. treatment as usual
(I) MHTC and ACT case management (n = 137) vs. (C) treatment as usual (n = 98)

(I) received weekly or bi-weekly court supervision and frequent contact with case managers, duration 18 months, followed by treatment as usual if required

C received traditional court proceedings and county mental health services as usual for at least 18 months, which was less intensive than (I)

OutcomesDrug use (Addiction Severity Index, self report) during the last 1 month at 12 months' follow-up
Notes 
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Low riskRandom number table
Allocation concealment (selection bias)Unclear riskNot reported
Blinding (performance bias and detection bias)
All outcomes
High riskThe interviewer was not blind to the condition of the
client
Blinding of participants and personnel (performance bias)
subjective outcomes
High riskThe interviewer was not blind to the condition of the
client
Blinding of participants and personnel (performance bias)
objective outcomes
High riskThe interviewer was not blind to the condition of the
client
Blinding of outcome assessment (detection bias)
subjective outcomes
Unclear riskNo information available
Blinding of outcome assessment (detection bias)
objective outcomes
Unclear riskNo information available
Incomplete outcome data (attrition bias)
All outcomes
High risk25% of the initial population could not be relocated at the end of 12 months
Selective reporting (reporting bias)Unclear riskNot reported
Other biasHigh riskThe relatively small number of clients in each group resulted in chance variation on some of the intake measures. Generalisability issues and concerns about self report measures and validity

Prendergast 2003

MethodsAllocation: random assignment
Randomisation method: unclear risk
Similar on drug use: yes
Similar on criminal activity: yes
Blinding methodology: unknown/unclear
Loss to follow-up: partial/high risk
Participants715 adults
Mean age 30.9 years
100% male
37.8% white
100% drug-using
100% psychiatric history
Eligibility criteria: male inmates
InterventionsPrison/secure establishment-based TC, counselling and aftercare vs. treatment as usual
OutcomesArrest for any offence (self report), arrest for a drug offence (self report), incarceration for any offence (official records) 12-months post release
Notes 
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Unclear risk"Random assignment and stratified for equal ethnic proportions". Method not stated
Allocation concealment (selection bias)Unclear riskConcealment method not stated
Blinding (performance bias and detection bias)
All outcomes
Unclear riskNo information reported
Blinding of participants and personnel (performance bias)
subjective outcomes
Unclear riskNo information reported
Blinding of participants and personnel (performance bias)
objective outcomes
Unclear riskNo information reported
Blinding of outcome assessment (detection bias)
subjective outcomes
Unclear riskNo information reported
Blinding of outcome assessment (detection bias)
objective outcomes
Unclear riskNo information reported
Incomplete outcome data (attrition bias)
All outcomes
High risk74% of the original sample were included in the follow-up
Selective reporting (reporting bias)Unclear riskNo information reported
Other biasHigh riskOnly the prison phase was randomised. Aftercare was voluntary and participants self selected. Concerns about prison drop-outs and completers p.87

Prendergast 2004

MethodsAllocation: random assignment
Randomisation method: unclear risk
Similar on drug use: yes
Similar on criminal activity: yes
Blinding methodology: unknown/unclear risk
Loss to follow-up: partial/high risk
Participants715 adults
Mean age 30.9 years (SD 7.4)
100% male
37.8% white
100% drug-using
Alcohol use not reported
100% psychiatric history
Eligibility criteria: offenders with a drug problem who were 9-14 months from parole. Offenders convicted of arson or sexual crimes to minors were not eligible
Interventions

Secure establishment-based TC vs. no treatment.
(I) Amity TC and voluntary residential aftercare vs. (C) waiting-list control.

(I) TC included a 2- to 3-month orientation phase, a 5- to 6-month treatment stage, and a 1- to 3-month re-entry phase; total duration 12 months. (I) included need assessment, education, group work, counselling and prison industry jobs. (I) aftercare duration up to 12 months

(C) duration not applicable

OutcomesIncarceration (official records) during the last 60 months at 60 months' follow-up
Drug use (self report) during the last 60 months at 60 months' follow-up
Notes5-year follow-up to Wexler 1999a and Wexler 1999b
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Unclear risk"Random assignment and stratified for equal ethnic proportions". Method not stated
Allocation concealment (selection bias)Unclear riskConcealment method not stated
Blinding (performance bias and detection bias)
All outcomes
Unclear riskNo information reported
Blinding of participants and personnel (performance bias)
subjective outcomes
Unclear riskNo information reported
Blinding of participants and personnel (performance bias)
objective outcomes
Unclear riskNo information reported
Blinding of outcome assessment (detection bias)
subjective outcomes
Unclear riskNo information reported
Blinding of outcome assessment (detection bias)
objective outcomes
Unclear riskNo information reported
Incomplete outcome data (attrition bias)
All outcomes
High risk74% of the original sample were included in the follow-up
Selective reporting (reporting bias)Unclear riskNo information reported
Other biasHigh riskOnly the prison phase was randomised. Aftercare was voluntary and participants self selected. See comments above for Prendergast 2003

Sacks 2004a TC

MethodsAllocation: random assignment
Randomisation method: unclear
Similar on drug use: no
Similar on criminal activity: yes
Blinding methodology: unknown/unclear risk
Loss to follow-up: adequate/low risk
Participants236 adults
Mean age 34.3 years (SD 8.8)
100% male
49% white
100% drug-using
32% alcohol-using
100% psychiatric history
Eligibility criteria: prisoners who had both a serious mental disorder and a substance-use disorder.
Interventions

Secure establishment-based TC vs. treatment as usual
(I) Personal reflections TC and voluntary residential aftercare (n = 142) vs. (C) mental health programme (n = 94)
(I) TTC included psychoeducational classes, cognitive behavioural methods, medication and group therapy. Activities were attended 5 days per week for 4-5 hours per day with the rest of the day spent working in the prison; duration 12 months. (I) Aftercare included mental health counselling, medication and psychiatric services and basic skills. Activities were attended 3-7 days per week for 3-5 hours per day; duration 6 months

(C) Programme included intensive psychiatric services with medication, weekly individual therapy and counselling and specialised groups of cognitive behavioural work, anger management, therapy and education, domestic violence, parenting and weekly drug/alcohol therapy with a 72-hour course on substance abuse education and relapse prevention; duration 12 months

OutcomesCriminal activity regarding a new offence (official records) during the last 12 months at 12 months follow-up
Incarceration for a new offence (official records) during the last 12 months at 12 months follow-up
NotesDrug use activity at 12-months reported in Sullivan 2007
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Unclear riskNoted as "randomly assigned" on p. 3, no other information provided
Allocation concealment (selection bias)Unclear riskNo information provided
Blinding (performance bias and detection bias)
All outcomes
Unclear riskNo information about blinding provided
Blinding of participants and personnel (performance bias)
subjective outcomes
Unclear riskNo information about blinding provided
Blinding of participants and personnel (performance bias)
objective outcomes
Unclear riskNo information about blinding provided
Blinding of outcome assessment (detection bias)
subjective outcomes
Unclear riskNo information about blinding provided
Blinding of outcome assessment (detection bias)
objective outcomes
Unclear riskNo information about blinding provided
Incomplete outcome data (attrition bias)
All outcomes
Low riskITT analysis performed. Missing data imputation reported
Selective reporting (reporting bias)Unclear riskNo information reported
Other biasUnclear riskThere was a large amount of crossover between the treatment and intervention groups. The cross-overs were removed from the analysis leaving unequal sample sizes p. 482. Difficult to assess to what extent this has caused a threat to validity within the study

Sacks 2004b TC + AC

MethodsAllocation: random assignment
Randomisation method: unclear
Similar on drug use: no
Similar on criminal activity: yes
Blinding methodology: unknown/unclear risk
Loss to follow-up: adequate/low risk
Participants236 adults
Mean age 34.3 years (SD 8.8)
100% male
49% white
100% drug-using
32% alcohol-using
100% psychiatric history
Eligibility criteria: prisoners who have both a serious mental disorder and a substance-use disorder
Interventions

Secure establishment-based TC vs. treatment as usual
(I) Personal reflections TC and voluntary residential aftercare (n = 142) vs. (C) mental health programme (n = 94)
(I) TTC included psychoeducational classes, cognitive behavioural methods, medication and group therapy. Activities were attended 5 days per week for 4-5 hours per day with the rest of the day spent working in the prison; duration 12 months. (I) aftercare included mental health counselling, medication and psychiatric services and basic skills. Activities were attended 3-7 days per week for 3-5 hours per day; duration 6 months

(C) Programme included intensive psychiatric services with medication, weekly individual therapy and counselling, and specialised groups of cognitive behavioural work, anger management, therapy and education, domestic violence, parenting and weekly drug/alcohol therapy with a 72-hour course on substance abuse education and relapse prevention; duration 12 months

OutcomesCriminal activity regarding a new offence (official records) during the last 12 months at 12 months' follow-up
Incarceration for a new offence (official records) during the last 12 months at 12 months' follow-up
NotesDrug use activity at 12-months reported in Sullivan 2007
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Unclear riskNoted as "randomly assigned" on p. 3, no other information provided
Allocation concealment (selection bias)Unclear riskNo information provided
Blinding (performance bias and detection bias)
All outcomes
Unclear riskNo information about blinding provided
Blinding of participants and personnel (performance bias)
subjective outcomes
Unclear riskNo information about blinding provided
Blinding of participants and personnel (performance bias)
objective outcomes
Unclear riskNo information about blinding provided
Blinding of outcome assessment (detection bias)
subjective outcomes
Unclear riskNo information about blinding provided
Blinding of outcome assessment (detection bias)
objective outcomes
Unclear riskNo information about blinding provided
Incomplete outcome data (attrition bias)
All outcomes
Low riskITT analysis performed. Missing data imputation reported
Selective reporting (reporting bias)Unclear riskNo information provided
Other biasUnclear riskThere was a large amount of cross-over between the treatment and intervention groups. The cross-overs were removed from the analysis leaving unequal sample sizes p. 482. Difficult to assess to what extent this has caused a threat to validity within the study

Sacks 2011

MethodsAllocation: random assignment
Randomisation method: random number list
Similar on drug use: yes
Similar on criminal activity: yes
Blinding methodology: open label - no blinding
Loss to follow-up: unclear risk
Participants

127 adults

Mean age 38.2 years (SD 9.9)

100% male

56% white

100% co-occurring substance use and mental illness

Alcohol use unknown

61.8% with clinical level of psychological distress as measured by Global Severity Index

Eligibility criteria: male, diagnosed with co-occurring mental and substance-use disorders, had participated in 1 of 2 prison substance-abuse treatment programmes, were approved for placement in a community corrections facility, were accepted by the provider agency for placement in a community corrections facility

Interventions

Secure establishment based TC vs. parole supervision case management

(I) re-entry modified TC (n = 71) vs. (C) parole supervision case management (n = 56)

(I) was a residential programme of 6 months' duration. Formal programme activities 3-7 days per week, 3-5 hours each day. Participants had progressively increasing independence, eventually being responsible for providing counsel, guidance and coaching for new members. Participants also worked in the community and saved money for independent living. There were weekly group psycho-educational classes to address the inter-relationship between mental disorders and substance abuse, as well as various other group and individual counselling sessions. Medication monitoring and psychiatric services were on site. Participants were given assistance with housing and encouragement for employment

(C) participants were released to a community corrections facility, and left the facility during the day to go to work, have treatment and report to parole officers. The intervention consisted of outreach and engagement activities, brokering community-based services, and direct provision of support and counselling services. There was a weekly relapse prevention group and daily medication monitoring. Psychiatric and substance-abuse services were provided by outside agencies (client helped to choose by community parole officers). Unlike in the intervention, criminal thinking and behaviour were not specifically addressed. The average participant attended 1 group per week and had monthly psychiatric assessment

OutcomesRate of re-incarceration, number of days until re-incarceration, involvement in self reported criminal activity, number of days until self reported criminal activity. Alcohol and drug offences (self reported) %. Other offences (self reported) %. All at 12 months post prison release
Notes 
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Low riskRandom number list
Allocation concealment (selection bias)Unclear riskNot reported
Blinding (performance bias and detection bias)
All outcomes
Unclear risk"Open-label trial", no blinding possible
Blinding of participants and personnel (performance bias)
subjective outcomes
Unclear risk"Open-label trial", no blinding possible
Blinding of participants and personnel (performance bias)
objective outcomes
Unclear risk"Open label trial", no blinding possible
Blinding of outcome assessment (detection bias)
subjective outcomes
Unclear riskNo information about blinding presented
Blinding of outcome assessment (detection bias)
objective outcomes
Unclear riskNo information about blinding presented
Incomplete outcome data (attrition bias)
All outcomes
Unclear riskSome partial loss to follow-up
Selective reporting (reporting bias)Unclear riskNot reported
Other biasLow riskNo other obvious concerns with the study

Stein 2011

MethodsAllocation: random assignment
Randomisation method: random numbers table
Similar on drug use: yes
Similar on criminal activity: unknown/unclear risk
Blinding methodology: unclear/unknown
Loss to follow-up: partial/unclear risk
Participants

189 adolescents

Mean age 17.12 years (SD 1.10). Range 14-19 years

85.7% male

32.8% white

88.9% marijuana use

63% alcohol use

68.5% had significant depressive symptomatology during past week at baseline (CES-D)

Eligibility criteria: 14-19 years old, sentenced to juvenile correctional facility for 4-12 months, engaged in at least monthly marijuana use or binge-drinking in the year before incarceration, used any alcohol or marijuana in the month prior to incarceration (or prior to the offence leading to incarceration)

Interventions

Secure establishment based MI intervention vs. relaxation treatment

(I) MI (n = 96) vs. (C) relaxation training (n = 85)

(I) was MI intervention designed specifically to reduce substance use and its associated risks and consequences. Consisted of 90-minute baseline intervention and 60-minute booster intervention within 2 weeks of release

(C) consisted of 90-minute baseline and 60-minute booster intervention, and involved relaxation techniques as well as advice on risky behaviours associated with substance use

OutcomesMean number of joints per day and mean percentage of days used marijuana at 3 months
Notes

Results presented for both high and low depressive symptom scores. Results used in this review are for those identified as having high depressive symptomatology.

Appears to be same study population as Stein 2011b

Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Low risk"Random assignment using a random number table"
Allocation concealment (selection bias)Unclear risk"Random number was placed in an envelope and opened by research staff after the baseline assessment"
Blinding (performance bias and detection bias)
All outcomes
Unclear riskResearchers were blind until after the baseline assessment. Participants were not blinded.
Blinding of participants and personnel (performance bias)
subjective outcomes
Unclear riskResearchers were blind until after the baseline assessment. Participants were not blinded.
Blinding of participants and personnel (performance bias)
objective outcomes
Unclear riskResearchers were blind until after the baseline assessment. Participants were not blinded.
Blinding of outcome assessment (detection bias)
subjective outcomes
Unclear riskFollow-up assessments at 3 months were completed blind by the researchers but not at any other time point
Blinding of outcome assessment (detection bias)
objective outcomes
Unclear riskFollow-up assessments at 3 months were completed blind by the researchers but not at any other time point
Incomplete outcome data (attrition bias)
All outcomes
Unclear riskSome attrition lost particularly for those individuals with more severe depression
Selective reporting (reporting bias)Unclear riskLimited information
Other biasHigh riskUnderpowered and small sample size, with a brief follow-up period and concerns about self report measures

Sullivan 2007

MethodsAllocation: random assignment
Randomisation method: unclear
Similar on drug use: no
Similar on criminal activity: yes
Blinding methodology: unknown/unclear risk
Loss to follow-up: adequate/low risk
Participants236 adults
Mean age 34.3 years (SD 8.8)
100% male
49% white
100% drug-using
32% alcohol-using
100% psychiatric history
Eligibility criteria: prisoners who had both a serious mental disorder and a substance-use disorder
Interventions

Secure establishment-based TC vs. treatment as usual
(I) Personal reflections TC and voluntary residential aftercare (n = 142) vs. (C) mental health programme (n = 94)
(I) TTC included psycho-educational classes, cognitive behavioural methods, medication and group therapy. Activities were attended 5 days per week for 4-5 hours per day with the rest of the day spent working in the prison; duration 12 months. (I) Aftercare included mental health counselling, medication and psychiatric services and basic skills. Activities were attended 3-7 days per week for 3-5 hours per day; duration 6 months

(C) Programme included intensive psychiatric services with medication, weekly individual therapy and counselling and specialised groups of cognitive behavioural work, anger management, therapy and education, domestic violence, parenting and weekly drug/alcohol therapy with a 72-hour course on substance-abuse education and relapse prevention; duration 12 months

OutcomesDrug use (self report) at 12 months
NotesCriminal activity outcomes at 12 months reported in Sacks 2004
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Unclear riskParticipants were randomly assigned p. 824
Allocation concealment (selection bias)Unclear riskMethod of concealment not reported
Blinding (performance bias and detection bias)
All outcomes
Unclear riskNo information on blinding reported
Blinding of participants and personnel (performance bias)
subjective outcomes
Unclear riskNo information on blinding reported
Blinding of participants and personnel (performance bias)
objective outcomes
Unclear riskNo information on blinding reported
Blinding of outcome assessment (detection bias)
subjective outcomes
Unclear riskNo information on blinding reported
Blinding of outcome assessment (detection bias)
objective outcomes
Unclear riskNo information on blinding reported
Incomplete outcome data (attrition bias)
All outcomes
Low riskSome difference between the groups. At follow-up, 82% for the (I) group and 69% for the (C). ITT was performed and missing data computated
Selective reporting (reporting bias)Unclear riskLimited information
Other biasUnclear riskNo other obvious concerns with the study but difficult to assess

Wexler 1999a

MethodsAllocation: random assignment
Randomisation method: unclear/unknown
Similar on drug use: yes
Similar on criminal activity: yes
Blinding methodology: unknown/unclear risk
Loss to follow-up: adequate/low risk
Participants715 adults
Mean age 30.9 years (SD 7.4)
100% male
37.8% white
100% drug-using
Alcohol use not reported
100% psychiatric history
Eligibility criteria: offenders with a drug problem who were 9-14 months from parole. Offenders convicted of arson or sexual crimes to minors were not eligible
Interventions

Secure establishment-based TC vs. no treatment
(I) Amity TC and voluntary residential aftercare (n = 247) vs. (C) waiting-list control (n = 290)
(I) TC included a 2- to 3-month orientation phase, a 5- to 6-month treatment stage, and a 1- to 3-month re-entry phase; total duration 12 months. (I) included need assessment, education, group work, counselling and prison industry jobs. (I) aftercare duration up to 12 months

(C) Duration not applicable

OutcomesIncarceration (official records) during the last 12 months at 12 months' follow-up
Incarceration (official records) during the last 24 months at 24 months' follow-up
Notes36-month follow-up outcome in Wexler 1999b and 5-year outcomes in Prendergast 2004
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Unclear riskIt was noted that the participants were 'randomly' assigned and stratified by ethnic makeup. Randomisation only occurred to the TC and not to aftercare
Allocation concealment (selection bias)Unclear riskNo information provided
Blinding (performance bias and detection bias)
All outcomes
Unclear riskNo blinding was conducted
Blinding of participants and personnel (performance bias)
subjective outcomes
Unclear riskNo information on blinding was provided
Blinding of participants and personnel (performance bias)
objective outcomes
Unclear riskNo information on blinding was provided
Blinding of outcome assessment (detection bias)
subjective outcomes
Unclear riskNo information on blinding was provided
Blinding of outcome assessment (detection bias)
objective outcomes
Unclear riskNo information on blinding was provided
Incomplete outcome data (attrition bias)
All outcomes
Low riskOutcomes for the first 12 months post-release were obtained for all 715 participants, and 12 months were obtained for 263 participants at risk for 24 months at time of record review
Selective reporting (reporting bias)Unclear riskInformation not reported
Other biasHigh riskOnly the prison phase was randomised. Aftercare was voluntary and participants self selected. Concerns about bias in self selection processes p.164-165

Wexler 1999b

  1. a

    ACT: assertive community treatment; CES-D: Center for Epidemiologic Studies Depression Scale; (C): control; (I): intervention; ITT: intention to treat; MHTC: mental health treatment court; MI: motivational interviewing; SD: standard deviation; TC: therapeutic community.

MethodsAllocation: random assignment
Randomisation method: unclear/unknown risk
Similar on drug use: yes
Similar on criminal activity: yes
Blinding methodology: unknown/unclear risk
Loss to follow-up: adequate/low risk
Participants715 adults
Mean age 30.9 years (SD 7.4)
100% male
37.8% white
100% drug-using
Alcohol use not reported
100% psychiatric history
Eligibility criteria: offenders with a drug problem who were 9-14 months from parole. Offenders convicted of arson or sexual crimes to minors were not eligible
Interventions

Secure establishment-based TC vs. no treatment
(I) Amity TC and voluntary residential aftercare (n = 247) vs. (C) waiting-list control (n = 290)
(I) TC included a 2- to 3-month orientation phase, a 5- to 6-month treatment stage, and a 1- to 3-month re-entry phase; total duration 12 months. (I) Included need assessment, education, group work, counselling and prison industry jobs. (I) aftercare duration up to 12 months

(C) Duration not applicable

OutcomesIncarceration (official records) during the last 36 months at 36 months' follow-up
Notes12- and 24-month follow-up outcome in Wexler 1999a and 5-year outcomes in Prendergast 2004
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Unclear riskIt was noted that the participants were 'randomly' assigned and stratified by ethnic makeup. Randomisation only occurred to the TC and not to aftercare
Allocation concealment (selection bias)Unclear riskNo information provided
Blinding (performance bias and detection bias)
All outcomes
Unclear riskNo blinding was conducted
Blinding of participants and personnel (performance bias)
subjective outcomes
Unclear riskNo information on blinding was provided
Blinding of participants and personnel (performance bias)
objective outcomes
Unclear riskNo information on blinding was provided
Blinding of outcome assessment (detection bias)
subjective outcomes
Unclear riskNo information on blinding was provided
Blinding of outcome assessment (detection bias)
objective outcomes
Unclear riskNo information on blinding was provided
Incomplete outcome data (attrition bias)
All outcomes
Low riskOutcomes for the first 12 months post-release were obtained for all 715 participants, and 12 months were obtained for 263 participants at risk for 24 months at time of record review
Selective reporting (reporting bias)Unclear riskInformation not reported
Other biasHigh riskThe study design did not randomly assign inmates to the aftercare. Concerns about bias in self selection processes, pp.164-5

Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion
  1. a

    RCT: randomised controlled trial.

Alemi 2010Study population did not have co-occurring mental illness
Alessi 2011Not original RCT. Data are from previous, older studies
Anglin 1999The study did not report relevant drug or crime outcome (or both) measures at both the pre- and post-intervention periods
Awgu 2010No relevant outcomes reported
Baldus 2011Study protocol only
Banks 2004Study population did not have co-occurring mental illness
Berman 2004The intervention was not appropriate for inclusion
Brady 2010Not RCT
Braithwaite 2005The study did not report relevant drug or crime outcome (or both) measures at both the pre- and post-intervention periods
Britt 1992aStudy population did not have co-occurring mental illness
Britt 1992bStudy population did not have co-occurring mental illness
Britt 1992cStudy population did not have co-occurring mental illness
Britt 1992dStudy population did not have co-occurring mental illness
Brown 20013-arm study in which only 2 arms were randomised - 1 treatment arm and control arm. Results presented as both treatment arms combined vs. control
Carr 2008The population of the study was not 100% drug-using offenders that were specifically referred by the criminal justice system to the intervention
Carroll 2006Study population did not have co-occurring mental illness
Carroll 2011Not offender population
Chandler 2006The study did not report relevant drug or crime outcome (or both) measures at both the pre- and post-intervention periods
Cogswell 2011Paper not available
Cornish 1997Study population did not have co-occurring mental illness
Cosden 2005The study did not report relevant drug or crime outcome (or both) measures at both the pre- and post-intervention periods
Coviello 2010Study population did not have co-occurring mental illness
Coviello 2010bStudy population did not have co-occurring mental illness
Cropsey 2011Study population did not have co-occurring mental illness
Cusack 2010Not a drug use intervention
Dakof 2010Study population is mothers of offenders, not offenders themselves
Dembo 2000The study did not report relevant drug or crime outcome (or both) measures at both the pre- and post-intervention periods
The follow-up periods reported for the different groups were not equivalent
Deschenes 1994Study population did not have co-occurring mental illness
Di Nitto 2002The follow-up periods reported for the different groups were not equivalent
Diamond 2006The study did not report relevant drug or crime outcome (or both) measures at both the pre- and post-intervention periods
Dolan 2003Study population did not have co-occurring mental illness
Dugan 1998The study did not report relevant drug or crime outcome (or both) measures at both the pre- and post-intervention periods
Forsberg 2011Study population did not have co-occurring mental illness
Freudenberg 2010Study population did not have co-occurring mental illness
Gagnon 2010Not offender population
Gil 2004The study did not report relevant drug or crime outcome (or both) measures at both the pre- and post-intervention periods
Gordon 2008Study population did not have co-occurring mental illness
Gottfredson 2002Study population did not have co-occurring mental illness
Gottfredson 2003Study population did not have co-occurring mental illness
Gottfredson 2005Study population did not have co-occurring mental illness
Gottfredson 2006Study population did not have co-occurring mental illness
Grohman 2002The study did not report relevant drug or crime outcome (or both) measures at both the pre- and post-intervention periods
Guydish 2011Study population did not have co-occurring mental illness
Haapanen 2002Study population did not have co-occurring mental illness
Haasen 2010Not offender population
Hall 2009a ST vs. DTStudy population did not have co-occurring mental illness
Hall 2009b ST vs. TPStudy population did not have co-occurring mental illness
Hanlon 1999Study population did not have co-occurring mental illness
Harrell 2001The study did not report relevant drug or crime outcome (or both) measures at both the pre- and post-intervention periods
Henderson 2010No relevant outcomes reported
Henggeler 1991The study did not report relevant drug or crime outcome (or both) measures at both the pre- and post-intervention periods
Henggeler 1999Study population did not have co-occurring mental illness
Henggeler 2002The study did not report relevant drug or crime outcome (or both) measures at both the pre- and post-intervention periods
Henggeler 2006a FC vs. DCStudy population did not have co-occurring mental illness
Henggeler 2006b FCvDCMSTStudy population did not have co-occurring mental illness
Hser 2011Unclear if study looks at offender population
Inciardi 2004Some participants were not randomly selected into the treatment groups
Jain 2011Paper not available and not clear from abstract if looks at offender population
Johnson 2011Study population did not have co-occurring mental illness
Katz 2007The population of the study was not 100% drug-using offenders that were specifically referred by the criminal justice system to the intervention
Kinlock 2005Study population did not have co-occurring mental illness
Kinlock 2007Study population did not have co-occurring mental illness
Kinlock 2008Study population did not have co-occurring mental illness
Kinlock 2009Conference proceedings only
Kinlock 2009a CO vs. CTStudy population did not have co-occurring mental illness
Kinlock 2009b CO vs. CMStudy population did not have co-occurring mental illness
Liddle 2011No relevant outcomes reported
Lobmaier 2010Study population did not have co-occurring mental illness
Lobmann 2007Study population did not have co-occurring mental illness
Magura 2009Study population did not have co-occurring mental illness
Marlowe 2003The study did not report relevant drug or crime outcome (or both) measures at both the pre- and post-intervention periods
Marlowe 2005Study population did not have co-occurring mental illness
Marlowe 2007Participants randomised to receive treatment were not randomised into the different treatment subgroups (selected by level of risk)
Marlowe 2008Study population did not have co-occurring mental illness
Martin 1993Study population did not have co-occurring mental illness
Mbilinyi 2011Participants not recruited through criminal justice system
McCollister 2009aStudy population did not have co-occurring mental illness
McCollister 2009bStudy population did not have co-occurring mental illness
McCollister 2009cStudy population did not have co-occurring mental illness
McKendrick 2007The study did not report relevant drug or crime outcome (or both) measures at both the pre- and post-intervention periods
Messina 2000The population of the study was not 100% drug-using offenders that were specifically referred by the criminal justice system to the intervention
The study did not report relevant drug or crime outcome (or both) measures at both the pre- and post-intervention periods
Milloy 2011Relevant results from original RCT not reported here
Needels 2005The population of the study was not 100% drug- using offenders that were specifically referred by the criminal justice system to the intervention
Nemes 1998The population of the study was not 100% drug-using offenders that were specifically referred by the criminal justice system to the intervention
The study did not report relevant drug or crime outcome (or both) measures at both the pre- and post-intervention periods
Nemes 1999The population of the study was not 100% drug-using offenders that were specifically referred by the criminal justice system to the intervention
The study did not report relevant drug or crime outcome (or both) measures at both the pre- and post-intervention periods
Nielsen 1996Study population did not have co-occurring mental illness
Nosyk 2010Not offender population
Petersilia 1992aStudy population did not have co-occurring mental illness
Petersilia 1992bStudy population did not have co-occurring mental illness
Petersilia 1992cStudy population did not have co-occurring mental illness
Petersilia 1992dStudy population did not have co-occurring mental illness
Petersilia 1992eStudy population did not have co-occurring mental illness
Petersilia 1992fStudy population did not have co-occurring mental illness
Petersilia 1992gStudy population did not have co-occurring mental illness
Petry 2011Not offender population
Polsky 2010Not offender population
Prendergast 2008a STVSDTStudy population did not have co-occurring mental illness
Prendergast 2008b STVSTPStudy population did not have co-occurring mental illness
Prendergast 2009No relevant outcomes reported
Prendergast 2011Study population did not have co-occurring mental illness
Proctor 2012Study population did not have co-occurring mental illness
Reimer 2011Not offender population
Robertson 2006The population of the study was not 100% drug- using offenders that were specifically referred by the criminal justice system to the intervention
Rosengard 2008No relevant outcomes reported
Rossman 1999Study population did not have co-occurring mental illness
Rowan-Szal 2005Paper not available and not clear from abstract if looks at offenders
Rowan-Szal 2009Not RCT
Rowe 2007The population of the study was not 100% drug- using offenders that were specifically referred by the criminal justice system to the intervention
Sacks 2008Study population did not have co-occurring mental illness
Sanchez-Hervas 2010Paper not available and not clear from abstract if looks at offenders
Schwartz 2006Not offender population
Sheard 2009The study did not report relevant drug or crime outcome (or both) measures at both the pre- and post-intervention periods
Siegal 1999Not RCT
Smith 2010Study population did not have co-occurring mental illness
Stanger 2009The population of the study was not 100% drug-using offenders that were specifically referred by the criminal justice system to the intervention
Staton-Tindall 2009No control group
Stein 2010Not offender population
Stevens 1998The study did not include an appropriate comparison group
The population of the study was not 100% drug- using offenders that were specifically referred by the criminal justice system to the intervention
Svikis 2011Not clear if offender population
Taxman 2006Study population did not have co-occurring mental illness
Thanner 2003Study population did not have co-occurring mental illness
Wang 2010Participants not in criminal justice system
White 2006Randomisation broken as 40% of control arm were allowed to receive treatment (acupuncture) outside of the intervention
Williams 2011Not RCT
Winstanley 2011Not clear if offender population
Witkiewitz 2010Not clear if offender population
Zlotnick 2009Study population did not have co-occurring mental illness

Characteristics of studies awaiting assessment [ordered by study ID]

Burdon 2013

MethodsAllocation: random assignment
Randomisation method: not yet assessed
Similar on drug use: not yet assessed
Similar on criminal activity: not yet assessed
Blinding methodology: not yet assessed
Loss to follow-up: not yet assessed
Participants143 female inmates
0% male (all female)
% white
% drug-using
Alcohol use not yet assessed
Eligibility criteria: not yet assessed
Interventions12-week prison-based intensive outpatient drug treatment or standard treatment plus positive behavioural reinforcement
Outcomes

Depression

Criminal thinking

Treatment participation and progress

Treatment satisfaction

Psychosocial functioning

Notes 

Lee 2011

MethodsAllocation: random assignment
Randomisation method: not yet assessed
Similar on drug use: not yet assessed
Similar on criminal activity: not yet assessed
Blinding methodology: not yet assessed
Loss to follow-up: not yet assessed
Participants24 inmates
100% male
% white
% drug-using
Alcohol use not yet assessed
Eligibility criteria: incarcerated individuals with a history of substance abuse
InterventionsMindfulness-based relapse prevention vs. treatment as usual
Outcomes

Drug-use identification disorders

Drug avoidance self efficacy scale

Positive and negative outcome expectancies

Beck Depression Inventory

Notes 

Wolff 2012

MethodsAllocation: random assignment - open trial
Randomisation method: not yet assessed
Similar on drug use: not yet assessed
Similar on criminal activity: not yet assessed
Blinding methodology: not yet assessed
Loss to follow-up: not yet assessed
Participants74 female inmates
0% male (all female)
% white
% drug-using
Alcohol use not yet assessed
Eligibility criteria: incarcerated women with axis I mental health disorder of post-traumatic stress disorder and substance-use disorder who self referred for speciality trauma treatment
InterventionsCognitive behavioural therapy - Seeking Safety vs. standard treatment
OutcomesNot yet assessed
Notes 

Ancillary