Effect of a short motivation enhancing intervention for judicial supervised criminal addicts on entering addiction treatment and treatment drop out.

Although the relation between drug use and criminality is complex and drug use does not always lead to criminality, there are strong indications that problematic drug use fuels criminal activity. There is also evidence that various forms of drug treatment can help drug users to reduce their offending.

Getting problematic drug using offenders into treatment is an effective way to both reduce drug related crime and other societal nuisance caused by the problematic drug user and to reduce the drug related problems experienced by the drug user himself.

Legal pressure can function as an external incentive to push a person into treatment. However, in the Netherlands this proved to be not enough to get people into treatment and to keep them in treatment for a sufficient time period.
Clients who are legally coerced into substance abuse treatment often have low intrinsic motivation to participate, are less ready for treatment, and are consequently more problematic to treat and less satisfied with their treatment than are voluntary clients. In order to increase the willingness of this group to enter treatment and finish it in the absence of strong legal pressure, we developed a short pre-treatment intervention based on motivational interviewing techniques, to enhance internal motivation to change in people who are under judicial supervision.
We assess in an RCT the effect of augmentation of regular judicial supervision with this short motivation enhancing intervention on motivation for change, motivation for treatment, treatment retention, addictive behaviour, criminal behaviour and social integration in a sample of 300 judicial supervised addicted offenders in the Netherlands. In addition we will investigate the role of criminogenic factors, cognitive abilities and neuropsychological characteristics (specifically the role of diminished executive functioning) on the effectiveness of the intervention. The latter information may be used to tailor the intervention to specific subgroups.

In our study, we use a cluster randomization procedure with probation officer as cluster variable: per probation office, all probation workers are allocated at random to the intervention group or the control group. Randomization is stratified on ‘experience’, (3 categories: relatively inexperienced, experienced and very experienced). Clients are allocated to probation workers by the normal procedure of the probation office. Using this procedure has several advantages: first, it causes less inconvenience for supervisors and clients because the usual allocation of clients to supervisors will not be changed by the study. Second, supervisors either have to apply the motivation enhancing intervention or supervision as usual. This minimizes the possibility that workers will use techniques of the motivation enhancing intervention with clients in the control group, which would weaken the experimental contrast between the study groups.

Compared to standard judicial supervision, judicial supervision augmented with a short motivation enhancing intervention will lead to:

1. An increased motivation for change and motivation for treatment;

2. An increased probability to enter treatment and treatment retention;

3. More positive change in addictive behaviour;

4. A stronger decrease in criminal behaviour;

5. Better social integration in terms of housing, financial situation and work.

1. Baseline measurement: In the beginning of the supervision period, before the start of the short motivational intervention, usually between 2nd and 3rd supervision meeting;

2. First follow-up measurement: Experimental condition at the end of the short motivational intervention, control condition at the end of the sixth or seventh supervision meeting;

3. Second follow-up measurement: One year after the baseline measurement.



Baseline:

1. Motivation for change (Readiness to change questionnaire, RCQ);

2. Motivation for treatment (Motivation for Treatment scale, Mft);

3. Criminal behavior (structured interview and judicial records);

4. Criminal thinking (Psychological Inventory of Criminal Thinking Styles, PICTS);

5. Addictive behavior (Measurement of Addiction for Triage and Evaluation, MATE);

6. Social integration (structured interview);

7. Relationship between drug use and criminal behavior (MATE-crimi);

8. Neuropsychological functioning: Behavioral impulsivity (stop signal task), delay discounting (delay discounting task), risk-taking (balloon analogue risk task), behavioral inhibition/behavioral activation (BIS/BAS scales);

9. Personality (Standardized Assessment of Personality Abbreviated Scale, SAPAS);

10. Depression, anxiety, and stress (Depression Anxiety Stress Scale, DASS.



First follow-up:

1. Motivation for change;

2. Motivation for treatment.



Second follow-up:

1. Proportion of clients that stayed in treatment for at least two months (self-report and treatment records);

2. Percentage of persons reoffending (self-report and judicial records);

3. Criminal behavior;

4. Criminal thinking;

5. Addictive behavior;

6. Social integration;

7. Cognitive capacities (Raven progressive matrices).

Experimental condition: Judicial supervision augmented with a protocollized short motivation enhancing intervention. The motivation enhancing intervention is a so called applied motivational intervention (ami) based on the motivational interviewing technique. The intervention consists of 3-4 sessions of about 45 minutes which takes place in the beginning of the judicial supervision period and is integrated in the regular supervision meetings. It consists of personalized feedback on the life situation of the clients, as presented and reflected upon by themselves in a self-confrontational way and aims at problem recognition and motivation for change. The intervention is given by the probation worker who uses a client workbook and a manual.

Probation workers allocated to the experimental condition receive a one-day-training in motivational interviewing and two days of training in the protocollized intervention “Motivational Approach”. The latter training consists of 1 full day training and 2 half-day booster sessions.

To ensure treatment integrity, a random selection of 15 sessions will be observed and scored on a treatment integrity list comprising the key ingredients of the intervention. Results will be fed back to the supervisors.



Control condition: Standard judicial supervision. In the control condition judicial supervised criminal addicts receive regular supervision throughout their entire supervision period. Probation workers in the control condition only receive a one-day training in motivational interviewing.