CJDATS is funded by NIDA in collaboration with SAMHSA and DOJ

1. Medication Assisted Treatment: Examining Criminal Justice Client Outcomes Kevin Knight, Ph.D.1, Julie Gray, Ph.D. 1, Amy Cohn, Ph.D. 2, Sarah Desmarais, Ph.D.3, Jennifer Pankow, Ph.D. 1, Grace Rowan-Szal Ph.D.1, Stephen Doherty, M.Ed.4, & Pat Flynn, Ph.D. 1 1Texas Christian University 2 University of South Florida 3 North Carolina State University 4 Gateway Foundation CJDATS is funded by NIDA in collaboration with SAMHSA and DOJ

2. Problem Background • Persistent skepticism exists within the criminal justice (CJ) system – including among criminal justice partner agencies – about the feasibility and impact of promoting medication‐assisted treatment (MAT). • Substantial evidence suggests MAT helps patients reduce opioid and alcohol use (Amato et al., 2005; Johnson, 2008), criminal behavior and arrest (Schwartz et al., 2009), and HIV risk behavior and infection (Metzger et al., 1993).

3. Specific Aim of This Study • Aim: To identify MAT clinic visit predictors based on patient self-report the day prior to the visit. • Sub-Aim: Assess relationship of Violence and Victimization on patient participation in MAT.

4. Study Design • Recruit a minimum of 75 “MAT eligible” parolees & probationers participating in a community-based treatment program in the greater St. Louis area. • As part of the study, participants call into an interactive voice response (IVR) survey system daily over a 2-week period. The survey asks questions about previous day events, including stressors, psychological functioning, substance use, and problems attending treatment.

5. Data Collection • Baseline survey conducted in face-to-face interview after client is referred to MAT. • IVR training conducted with clients at baseline. The expectation for each participant is 2 weeks of consecutive daily calls (14 total). • Follow-up survey conducted as face-to-face interview with each participant after 90 days.

6. Measures: IVR Daily Interview • Interactive Voice Response (IVR) Technology • affordable and easy to use automated survey technology • uses recorded voice prompts to ask questions that clients answer by using the touchtone keypad on the telephone or by speaking open ended responses. • Software: SmartQ by TeleSage (www.telesage.com/SmartQ.html)

7. Measures: IVR Daily Interview For the next several questions, I'm going to ask you about things that you've done since this time yesterday. Answer each questions using a scale of 0 to 3 where: • 0 = no, • 1 = yes, but yesterday only • 2 = yes, but today only, or • 3 = yes, both yesterday & today. • Did you have stress about an argument with someone? • Did you have any stress aboutwork or unemployment? • Did you have any stress about money problems? • Did you have any stress about your health? • Did you have any stress about probation or parole? Today, please rate how strong is your craving to drink or use drugs? 0 = not at all 1 = slightly 2 = moderately 3 = very 4 = extremely

8. Measures: Victimization & Violence In 3 months prior to incarceration, • Adapted from MacArthur Community Violence Inventory (Steadman et al., 1998)

9. Study Sample (n=75) Demographic Characteristics • Mean age = 35.5 years (SD = 10.2) • Range = 20 to 66 years • Race/ethnicity • 78.4% African American/Black • 18.9% Caucasian/White • 2.7% Other • Relationship status • 37.3% living with a spouse/partner • Children • 29.3% have children that live with them • Education • 22.7% graduated from high school, 37.3% completed GED

10. Study Sample Service Use and System Contact Criminal Justice History • # of lifetime arrests • M = 16.2 (SD = 15.1) Range = 1 – 85 • # of arrests while using/seeking drugs • M = 11.9 (SD = 13.8) Range = 0 – 85 • Age at first arrest • M = 16.9 years (SD = 3.8) Range = 11 – 32 • # of times in jail, prison or juvenile lockup • M = 11.3 (SD = 11.7) Range = 1 – 60

11. Study Sample Service Use and System Contact Treatment History • # of times received treatment for substance use • M = 3.6 (SD = 4.8) Range = 0 – 30 • Drug of choice • 82% Opiates, 8% Alcohol, 10% poly-drug use, other • # of times hospitalized for psychiatric problems (Range = 0 – 10) • n = 68 (91%) never hospitalized for psychiatric problems • n = 2 (3%) one time • n = 5 ( 7%) 2 times or more • # of times hospitalized for other health problems • M = 2.37 (SD = 3.3) Range 0 – 15

12. Participant Characteristics:IVR Responses From Call Prior to MAT Appointment

13. Preliminary Findings Using Alcohol or Drugs to Cope with Stress

14. Preliminary Findings (n=75) Correlates of keeping MAT appointment *p < .05 **p < .01 ***p< .001

15. Preliminary Findings (n=75) Correlates of Vivitrol prescription *p < .05 **p < .01 ***p < .001

16. Preliminary Findings Keeping Scheduled MAT Appointment and Previous Day’s Stressors “Did you have any stress about your health?”

17. Preliminary Findings Keeping scheduled MAT appointment and Use of illegal Drugs to cope with Stress “Did you take illegal drugs because of stress” X2(1, n=75) = 9.0, p< .01

18. Preliminary Findings Associations between previous psychiatric hospitalizations and keeping MAT appointment

19. Preliminary Findings Prevalence and Co-occurrence of Violence & Victimization x2(1, n=75) = 18.62, p< .001

20. Preliminary Findings Prevalence of violent outcomes reported at baseline (n = 75) & follow-up (n = 47) *p< .05.

21. Conclusions • Need to explore impact of MAT on violence and victimization. • Will continue to examine measurement of MAT treatment satisfaction, barriers to MAT treatment, and support for MAT treatment.

22. Questions and Comments The study team gratefully acknowledges the support of the following organizations: National Institute on Drug Abuse Department of Justice Substance Abuse and Mental Health Services Administration