Criminal Behavior

The current study proposes to use a Hybrid Type 3 implementation research strategy to: 1) Significantly enhance our understanding of public health outcomes \[e.g., overdose incidents and substance-use (SU)-related Emergency Medical Service (EMS) contacts\] and public safety outcomes (e.g., drug-related arrests) associated with Deflection and Pre-Arrest Diversion initiatives (DPAD, hereafter referred to as Deflection); and 2) Create a lasting contribution to the fields of research focused on SU and the criminal legal system (CLS) by advancing knowledge of effective implementation strategies involving the critical role of community engagement in Deflection. The highly experienced team of Multiple PIs, senior-level collaborators from both Deflection and Community Behavioral Health (CBH), state-level evaluation partners, a national stakeholder advisory group, and CLS and behavioral health partners within each community have teamed up to carry out the proposed project. The study approach uses a hybrid implementation-effectiveness design to examine strategies to improve opioid and stimulant relevant outcomes, and specifically proposes to test the implementation-effectiveness of 2 strategy bundles to promote Deflection models through a CORE community engagement bundle (designed to facilitate community stakeholder engagement) and ENHANCED community engagement bundle (CORE plus a component to systematically involve community advocates) on improving implementation as well as public safety and health outcomes. The proposed randomized control trial includes a total of 20 geographically distinct clinical research performance sites (i.e., 20 communities spanning 5 states; New Mexico, Illinois, Wisconsin, Colorado, and Pennsylvania), with 3-5 communities per state and the inclusion of key CLS and CBH stakeholders within each site. The large scope of the project will maximize potential generalizability of study results and sustainability of implementation strategies.

In this project the investigators want to test whether a new method FIT (Feedback informed treatment) can improve the interventions people receive through social services. The FIT method involves regularly providing information about how the client think things are going and what the client thinks about the help and care they receive.

Dialectical Behavior Therapy for Justice-Involved Veterans (DBT-J) is a comprehensive, integrative program distinctively designed to address the range of mental health, substance use, case management, and legal needs of Veterans with current or ongoing criminal justice involvement. Data from two prior clinical trials attest to the program's feasibility and acceptability and preliminarily suggest participation in the program may yield meaningful improvements in risk for criminal behavior and resolution of high-priority case management needs. However, continued research is needed to further investigate the program's efficacy. This Phase III clinical trial aims to investigate the superiority of DBT-J over a supportive group therapy treatment in decreasing risk of future criminal behavior and increasing psychosocial functioning. Secondary and exploratory aims will also investigate superiority of DBT-J in improving secondary treatment targets, potential differential efficacy across special-interest Veteran subgroups, and long-term consequences of program participation.

Substance use disorders and psychopathy are serious and costly mental health issues. Psychopathy is known to be associated with aberrant moral decision making and there is considerable interest in determining whether substance use disorders lead to impairments in these same cognitive processes. Recent large-scale research initiatives in forensic settings have begun to identify substance abuse and psychopathy-related disruption in the neural mechanisms involved in moral decision-making processes, and associations between these neural networks and future relapse and antisocial behavior. Here the investigators extend prior work (with incarcerated men) to examine these issues among incarcerated women in order to better understand sex differences. This project addresses the overall lack of neurocognitive research in criminal offenders with substance use disorders, thereby focusing on a major public health issue in an underserved and understudied population.

The opioid epidemic has become one of America's deadliest crises, surpassing car crashes, firearms, and HIV/AIDS as a leading cause of death for Americans under fifty years of age. People trying to recover from opioid-use disorder face many obstacles. Obstacles such as minor legal problems (e.g., arrest warrants for failure to pay a fine, failure to appear in court, or late child support payments) can undermine the stability needed to overcome opioid dependence. Outstanding legal obligations make it difficult to find jobs and to secure housing. They can result in removal from treatment programs as well as incarceration. Resolving these legal problems requires coordination, organization, preparation, travel, and time-expectations that may be problematic for many people in the early stages of recovery. Technology has the potential to make resolving these legal problems much easier. Online platform technology is now available that can guide people in recovery through the resolution of many legal problems at no cost and without an attorney, potentially doing so quickly, remotely, and at any time of day. This study of individuals in treatment in Michigan tests whether resolving outstanding legal issues improves drug treatment outcomes. The research also examines whether and to what extent resolving legal issues supports family reunification, reduces future criminal behavior, and improves access to jobs and housing for clients in treatment for opioid use disorder. A randomized controlled trial (RCT) is used to determine the effects of resolving legal issues on these outcomes. For identification, the investigators leverage the random assignment of legal services to treatment center clients, along with the random assignment of clients to treatment centers by birth month. We assemble a novel longitudinal dataset of hundreds of clients in treatment for substance use disorder and link these clients to several administrative datasets and qualitative data, which allows for measurement of: (1) substance use behaviors and (2) justice-system involvement, including civil and criminal legal system encounters. This study also uses linked client and administrative data to research the population in opioid treatment centers, follow-up behaviors, and whether the consequences of providing no-cost legal services differ by client background. Findings from this research will improve America's understanding of the acute socio-legal needs faced by those experiencing opioid use disorder and provide recommendations to help target resources toward the areas that best support long-term abstinence from opioids and other drugs.