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Not All Substance Dependence Problems are Recognized as Risks—Comparing a Medical Health Study with Prison Assessments

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Abstract

Substance abuse is viewed as one of the main factors (criminogenic needs) to be assessed and targeted in prison. Prison assessments of risk and needs are known to validly predict reoffending. However, there seems to be lacking research in how reliably the individual prisoner’s problems, such as substance abuse, are represented in the assessments. In this study, we compare an independent medical health study (N = 510) with in-prison assessments for the same persons to see whether some of the inmates’ substance abuse disorders were overlooked in prison. We found that sentence plans (257) were in poor agreement with the health study (Kappa 0.315); they recognized only 65 % of all diagnoses. The risk and needs assessments (178) were in closer agreement with the health study, however, alcoholism diagnoses were recognized less accurately (Kappa 0.519) and less frequently (78 %) than drug diagnoses (Kappa 0.627, 87 %). The main factors predicting an assessment of substance abuse risks in prison, analysed through logistic regression were: longer stay in prison and one or more dependence diagnoses. We conclude that, a number of potentially criminogenic dependence problems remain unrecognized since some groups of prisoners are either completely left out from the more thorough instrument, the risk-and-needs assessment, or are not assessed thoroughly enough. This puts prisoners in unequal positions, since all interventions in prison are based on assessments. The study alerts us of the selectiveness of prisoner assessments in practical settings; the unrecognition of problems of shorter sentenced prisoners and prisoners with alcohol dependence.

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Notes

  1. A criminogenic need is defined as a factor that according to research raises the risk for recidivism, and thus should be tackled in prison in order to reduce the probability for recidivism (Andrews et al. 1990).

  2. We excluded fine defaulters, who are serving time due to non-payment of a fine, since prison assessments are not made for this group. It is also important to notice that the relative share of both women and, especially, life-imprisoned persons is much larger in our sample than on any given day in prison; the aim of the sampling was to enable analysis of the lifers’ and women’s health as a group, since otherwise, their relative share would have become too small for making conclusions.

  3. Alcohol dependence: F10.2X. For drugs, a summarized variable (α = 0.657) of dependence to any of the following substances was used: F11.2X Opioids, F12.2X Cannabinoids, F13.2X Sedatives, F13.2X Cocaine, F15.2X Stimulants, F16.2X Hallucinogens, F19.2X Poly drug dependence.

  4. The keywords in Finnish and in Swedish (the other official language in Finland) were ‘päih’ ‘alkoh’ ‘humal’. ‘huum’ ‘ amfet’ ‘bentso’ ‘ rusning’ ‘ berus’ ‘rusmedel’ ‘ kannabi’ ‘rait’ ‘subute’ ‘narko’. We also looked for a number of other keywords, such as suboxone, and different slang words for drugs, such as ‘grass’ (‘ruoho’), without hits. It seems that prison officials use quite conservative language in the assessments. The prison officials’ knowledge of Swedish was sometimes limited, so some of the keywords are not proper Swedish.

  5. Central numerically coded needs are: Housing and managing daily life, Income and financial situation, Education, Work, Social contacts and lifestyle, Alcohol/Drug problems, Attitudes, Antisocial patterns, Health problems, and others. The main codes are sometimes replaced by specifications. Concerning substance use, the specifications (used here) are: “intoxicants and other addictions,” “staying substance-free,” “to lessen harm from intoxicant abuse,” “the use of alcohol,” and “the use of drugs.”

  6. Using only the value 2 (severe problem) for the analyses was motivated by the nature of our research assignment; we aimed at critically assessing the consistency between the clinical and actuarial measurements and we wanted to use a measurement from the prison that did not exaggerate the inconsistency. The value 1 might sometimes be given for use of substances that may not indicate use of dependence character. Value 2 indicates problematic use more clearly (see Table 1).

  7. In practice, a lifetime sentence in Finland means a sentence of 12 years or more

  8. All 510 study subjects were included in the logistic analyses, although not all of these prisoners had been assessed with sentence plans risk and needs assessments. This was motivated by our research assignment: to investigate what factors contribute to being assessed with problems in the entire prison population. We also ran the same analyses for only those who had received the assessments in question (not shown). The results went in the same direction as the (final) analyses that included all cases, but the effects were more modest due to the small number of observations.

  9. Basic education is to be seen as a control variable. However, it was entered in model 3 (and not in the first model as typical for control variables). Basic education (entered in model 3) and the dependence diagnosis (entered in model 4) were both obtained from the prisoner health study and we wanted to include the variables from the prison registers first, before proceeding to explore the effects of controlling for information about the prisoner that we gained from the prisoner health study.

  10. We also fitted the same series of nested models using linear probability models. This was done to check that the changes in the variable coefficients could indeed be attributed to the inclusion of the new variables in the nested models. Coefficient comparisons between nested logistic regression models are problematic due to the so-called scale identification issue (cf. Mood 2010). The findings (not shown) were similar. We checked for multicollinearity using variance inflation factor (VIF); no multicollinearity was found. We also checked for interactions between the independent variables in the logistic analyses: they were not significant.

  11. This was also true for sentence plans, but since sentence plan nowadays are made for all prisoners, this result is no longer valid.

References

  • Act on Imprisonment 767/2005

  • Andersen, H. S. (2004). Mental health in prison populations: a review—with special emphasis on a study of Danish prisoners on remand. Acta Psychiatrica Scandinavica, 110(Suppl. 424), 5–59. doi:10.1111/j.1600-0447.2004.00436_2.x.

    Article  Google Scholar 

  • Andrews, D. A., Bonta, J., & Hoge, R. D. (1990). Classification for effective rehabilitation: rediscovering psychology. Criminal Justice and Behavior, 17, 19–52. doi:10.1177/0093854890017001004.

    Article  Google Scholar 

  • Andrews, D. A., & Bonta, J. (2003). The psychology of criminal conduct (3rd ed.). Cincinnati: Anderson.

    Google Scholar 

  • Andrews, D., Bonta, J., & Wormith, J. (2006). The recent past and near future of risk and/or need assessment. Crime and Delinquency, 52(1), 7–27.

    Article  Google Scholar 

  • Arola-Järvi, A. (2012) Suunnitelmallisen vankeusajan käsikirja. Rikosseuraamusalan koulutuskeskus. Oppikirja. [A guide to a planned prison term. The Training Institute for Prison and Probation Services. A textbook.] 1/2012.

  • Belenko, S. (2006). Assessing released inmates for substance-abuse-related service needs. Crime and Delinquency, 52(1), 94–113.

    Article  Google Scholar 

  • Bosker, J., Witteman, C., & Hermanns, J. (2013). Agreement about intervention plans by probation officers. Criminal Justice and Behavior, 40, 569–581. doi:10.1177/0093854812464220. first published on February 4, 2013.

    Article  Google Scholar 

  • Brochu, S., Guyon, L., & Desjardins, L. (2001). Crime careers and substance use among incarcerated men and women. Canadian Journal of Criminology, 43, 173–196.

    Google Scholar 

  • Chandler, R., Fletcher, B., & Volkow, N. (2009). Treating drug abuse and addiction in the criminal justice system. Journal of the American Medical Association, 301, 183–190. doi:10.1001/jama.2008.976.

  • Chamberlain, A. (2012). Offender rehabilitation: examining changes in inmate treatment characteristics, program participation, and institutional behavior. JQ: Justice Quarterly, 29(2), 183–228.

    Article  Google Scholar 

  • Christie, N. & Bruun, K. (1968). Hyvä vihollinen: Huumausainepolitiikka Pohjolassa. [Suitable enemies: drug policies in the northern countries]. Espoo: Weilin + Göös.

  • Crewe, B. (2011). Soft power in prison: implications for staff-prisoner relationships, liberty and legitimacy’. European Journal of Criminology, 8(6), 455–468.

    Article  Google Scholar 

  • Cooper, A. (2005). Surface and depth in the victoria climbié inquiry report. Child and Family Social Work, 10(1), 1–9. doi:10.1111/j.1365-2206.2005.00350.x.

    Article  Google Scholar 

  • Day, A., Howells, K., Heseltine, K., & Casey, S. (2003). Alcohol use and negative affect in the offence cycle. Criminal Behaviour and Mental Health, 13(1), 45–58.

    Article  Google Scholar 

  • Dixon, J. (2012). Mentally disordered offenders’ views of ‘their’ risk assessment and management plans. Health, Risk and Society, 14(7/8), 667–680. doi:10.1080/13698575.2012.720965.

    Article  Google Scholar 

  • Fazel, S., Bains, P., & Doll, H. (2006). Substance abuse and dependence in prisoners: a systematic review. Addiction, 101(2), 181–191. doi:10.1111/j.1360-0443.2006.01316.x.

    Article  Google Scholar 

  • First, M., Williams, J., & Spitzer, R. (1997). Structured clinical interview for DSM-IV axis I disorders (SCID-I), clinician version, administration booklet. New York: American Psychiatric Publishing.

    Google Scholar 

  • Flores, A. W., Lowenkamp, C. T., Smith, P., & Latessa, E. J. (2006). Validating the level of service inventory—revised on a sample of federal probationers. Federal Probation, 70(2), 44–48.

    Google Scholar 

  • Frank, V. A., & Kolind, T. (2012). Prison based drug treatment and rehabilitation in the Nordic countries. Editorial. Nordisk Alkohol- & Narkotikatidskrift, 29(6), 543–546.

    Google Scholar 

  • Green, C. A., Polen, M. R., Dickinson, D. M., Lynch, F. L., & Bennett, M. D. (2002). Gender differences in predictors of initiation, retention, and completion in an HMO-based substance abuse treatment program. Journal of Substance Abuse Treatment, 23(4), 285–295.

    Article  Google Scholar 

  • Hanson, R., & Morton-Bourgon, K. E. (2009). The accuracy of recidivism risk assessments for sexual offenders: a meta-analysis of 118 prediction studies. Psychological Assessment, 21(1), 1–21. doi:10.1037/a0014421.

    Article  Google Scholar 

  • Hare, R. D. (2003). The psychopathy checklist—revised (2nd edn.). Toronto: Multi-Health Systems.

    Google Scholar 

  • Harrison, L. D. (2001). The revolving prison door for drug-involved offenders: Challenges and opportunities. Crime & Delinquency, 47(3), 462.

  • Home Office (2002) OASys User Manual, Volume 2. London: National ProbationDirectorate.

  • Joukamaa, M., Aarnio, J., von Gruenewaldt, V., Hakamäki, S, Hypén, K., Lauerma H., Lintonen, T., Mattila, A., Tyni, S., Vartiainen, H., Viitanen, P and Wuolijoki, T. (2010). Rikosseuraamusasiakkaiden terveys, työkyky ja hoidontarve. Rikosseuraamuslaitoksen julkaisuja 1/2010. [The health, working ability and treatment needs of criminal sanctions clients.] Criminal Sanctions Finland Reports 1/2010

  • Kemshall, H. (2010). Risk rationalities in contemporary social work policy and practice. British Journal of Social Work, 40(4), 1247–1262. doi:10.1093/bjsw/bcp157.

    Article  Google Scholar 

  • Killias, M., Aebi, M., & Ribeaud, D. (2000). Does community service rehabilitate better than short-term imprisonment? Results of a controlled experiment. The Howard Journal, 39(1), 40–57.

    Article  Google Scholar 

  • Kivivuori, J., & Linderborg, H. (2010). Negative life events and self-control as correlates of self-assessed re-offending probability among Finnish prisoners. European Journal of Criminology, 7(2), 123–139. doi:10.1177/1477370809354139.

    Article  Google Scholar 

  • Kivivuori, J., & Lehti, M. (2006). The social composition of homicide in Finland, 1960–2000. Acta Sociologica, 49(1), 67–82.

    Article  Google Scholar 

  • van der Knaap, L. M., Leenarts, L. W., Born, M. H., & Oosterveld, P. (2012). Reevaluating interrater reliability in offender risk assessment. Crime and Delinquency, 58(1), 147–163. doi:10.1177/0011128710382347.

    Article  Google Scholar 

  • Knuuti, U., & Vogt-Airaksinen, T. (2010). Ohjelmatyö rikosseuraamusalalla [Program work in prison and probation services]. Helsinki: Criminal Sanctions Agency.

    Google Scholar 

  • Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33, 159–174.

    Article  Google Scholar 

  • Lenke, L. (1996). Kultur eller frustration? Om orsakerna bakom det alkoholrelaterade våldet. Våld, alkohol och övriga droger. [Culture or frustration? On the reasons behind alcohol-related violence. Violence, alcohol and other drugs.] (p. 114). Stockholm: Folkhälsoinstitutet.

    Google Scholar 

  • Liimatainen, A., Mäkipää, L., & Rantala, K. (2014). Kysely vankiloiden ja arviointikeskusten henkilökunnalle. [Enquiry for the staff in prisons and assessment-centres]. National Research Institute for Legal Policy. Research Communications 42/2014.

  • Lintonen, T., Obstbaum, Y., Aarnio, J., Gruenewaldt, V., Hakamäki, S., Kääriäinen, J., & Joukamaa, M. (2012). The changing picture of substance abuse problems among Finnish prisoners. Social Psychiatry and Psychiatric Epidemiology, 47(5), 835–842. doi:10.1007/s00127-011-0390-8.

    Article  Google Scholar 

  • Lintonen, T., Vartiainen, H., Aarnio, J., von Gruenewaldt, V., Hakamäki, S., Viitanen, P., Wuolijoki, T., & Joukamaa, M. (2011). Drug abuse among prisoners—by any definition, it’s a big problem. Substance Use and Misuse, 46, 440–451.

    Article  Google Scholar 

  • Lowenkamp, C. T., Holsinger, A. M., Brunsman-Lovins, L., & Latessa, E. J. (2004). Assessing the inter-rater agreement of the level of service inventory revisited. Federal Probation, 68, 34–38.

    Google Scholar 

  • Lipsky, M. (1980). Street-level bureaucracy: Dilemmas of the individual in public services. New York: Russel Sage.

    Google Scholar 

  • Miller, J., & Maloney, C. (2013). Practitioner compliance with risk/needs assessment tools: a theoretical and empirical assessment. Criminal Justice and Behavior, 40, 716–736.

    Article  Google Scholar 

  • Mood, C. (2010). Logistic regression: why we cannot do what we think we can do, and what we can do about it. European Sociological Review, 26(1), 67–82. doi:10.1093/esr/jcp006.

    Article  Google Scholar 

  • Mohell, U., & Pajuoja, J. (2006). Vankeuspaketti. Vankeinhohdoin kokonaisuudistus käytännössä. [The prison-package. Practical implication of the priosn-reform.]. Helsinki: Tietosanoma.

    Google Scholar 

  • Nuorvala, Yrjö & Huhtanen, Petri & Ahtola, Raija & Metso, Leena (2008) Huono-osaisuus mutkistuu −kuudes päihdetapauslaskenta [Exclusion becomes even more complicated counting intoxicant cases for the sixth time.] Yhteiskuntapolitiikka 73(6), 659–670

  • Obstbaum, Y., & Tyni, S. (2015). Who receives substance abuse treatment in the ‘real world’ of the prison? A register-based study of Finnish inmates. Journal of Scandinavian Studies in Criminology and crime Prevention. Advance online publication doi:10.1080/14043858.2014.1003709

  • Pratt, J. (2008). Scandinavian exceptionalism in an Era of Penal Excess. Part I: the nature and roots of Scandinavian Exceptionalism. British Journal of Criminology, 48(2), 119–137. doi:10.1093/bjc/azm072.

    Article  Google Scholar 

  • Rounds-Bryant, J. L., & Baker, L. (2007). Substance dependence and level of treatment need among recently incarcerated prisoners. The American Journal of Drug and Alcohol Abuse, 33(4), 557–561. doi:10.1080/00952990701407462.

    Article  Google Scholar 

  • Scott, T., & Ruddell, R. (2011). Canadian female gang inmates: Risk, needs, and the potential for prison rehabilitation Journal of Offender Rehabilitation, 50, 305–326. doi:10.1080/10509674.2011.583717.

  • Shook, J. J., & Sarri, R. C. (2007). Structured decision making in juvenile justice: Judges’ and probation officers’ perceptions and use. Children and Youth Services Review, 29(10), 1335–1351. doi:10.1016/j.childyouth.2007.05.008.

    Article  Google Scholar 

  • Sirén, R., & Lehti, M. (2006). Musta maaliskuu? Väkivalta ja alkoholin kulutuksen kasvu vuonna 2004. [Did increased alcohol consumption lead to more violence? The impact of 2004 tax cuts and relaxation of import restrictions of alcohol on crimes of violence and disorder] Helsinki National research Institute for Legal Policy.

  • Skardhammar, T. (2003). Inmates’ social background and living-condidtions. Journal of Scandinavian studies in Criminology and Crime Prevention, 4, 39–56.

    Article  Google Scholar 

  • Taxman F.S., Perdoni M.L., Harrison L.D. (2007) Drug treatment services for adult offenders: The state of the state Journal of Substance Abuse Treatment, 32(3), 239–254.

  • Tourunen, J., Weckroth, A., & Kaskela, T. (2012). And Prison-based drug treatment in Finland: History, shifts in policy making and current status. Nordic Studies on Alcohol and Drugs, 29(6), 575–588. doi:10.2478/v10199-012-0048-1.

    Article  Google Scholar 

  • Ugelvik, T., & Dullum, J. (Eds.). (2012). Penal exceptionalism? Nordic prison policy and practice. London: Routledge.

  • Viitanen, P., Vartiainen, H., Aarnio, J., von Gruenewaldt, V., Hakamäki, S., Lintonen, T., & Joukamaa, M. (2012). Work ability and treatment needs among Finnish female prisoners. International Journal of Prisoner Health, 8(3), 99–107.

    Article  Google Scholar 

  • Wormer, K., & Persson, L. (2010). Drug treatment within the U.S. federal prison system: are treatment needs being met? Journal of Offender Rehabilitation, 49(5), 363–375. doi:10.1080/10509674.2010.489472.

    Article  Google Scholar 

  • Wormith, J. S., Oliver, M. E., Stevenson, H. E., & Girard, L. (2007). The long-term prediction of offender recidivism using diagnostic, personality, and risk/need approaches to offender assessment. Psychological Services, 4, 287–305. doi:10.1037/1541-1559.4.4.287.

    Article  Google Scholar 

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Acknowledgments

This work was supported by the Finnish Foundation for Alcohol Studies

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Authors and Affiliations

  1. Foundation for Alcohol Studies, Helsinki, Finland

    Yaira Obstbaum

  2. Department of Social Research, Institute of Criminology and Legal Policy, University of Helsinki, PB 10 00014, Helsinki, Finland

    Yaira Obstbaum

  3. Criminal Sanctions Agency, Helsinki, Finland

    Sasu Tyni

  4. Department of Psychiatry, Tampere University Hospital, Tampere, Finland

    Aino K. Mattila

  5. School of Health Sciences, University of Tampere, Tampere, Finland

    Aino K. Mattila, Tomi P. Lintonen & Matti Joukamaa

  6. Psychiatry and Forensic Psychiatry, Criminal Sanctions Agency Health Care Services, Hämeenlinna, Finland

    Heikki Vartiainen

  7. Prison Hospital, Criminal Sanctions Agency Health Care Services, Hämeenlinna, Finland

    Päivi Viitanen

  8. Criminal Sanctions Agency Health Care Services, Hämeenlinna, Finland

    Terhi Wuolijoki

  9. Finnish Foundation for Alcohol Studies, Helsinki, Finland

    Tomi P. Lintonen

  10. Tampere University Hospital, Tampere, Finland

    Matti Joukamaa

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  1. Yaira Obstbaum
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Obstbaum, Y., Tyni, S., Mattila, A.K. et al. Not All Substance Dependence Problems are Recognized as Risks—Comparing a Medical Health Study with Prison Assessments. Eur J Crim Policy Res 22, 189–210 (2016). https://doi.org/10.1007/s10610-015-9275-9

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