RCT on the effect of a protocollized short motivation enhancing intervention on motivation for change, motivation for treatment, treatment entering and treatment retention amongst judicial supervised criminal addicts

Although relation between drug use and criminality is complex and drug use certainly not always lead to criminality, there are strong indications that problematic drug use fuels criminal activity. Existing criminal behavior is intensified by drug use. This so called multiplier effect is confirmed by the fact that a large part of the prolific offenders (in the Netherlands about 70%) and the inmates (in the Netherlands about 60%) report substantial drug or alcohol problems. 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 (sometimes substantial) drug related problems like social marginalization, physical, psychosocial, and psychiatric problems experienced by the drug user himself. Legal pressure such as diversion programs can function as an external incentive to push a person in treatment. However, it is not only important that the problematic drug user enters the treatment program, but it is even more relevant that he stays in treatment and finishes the treatment program (retention). In the Netherlands legal pressure alone, however, proved to be insufficient for offenders to enter and retain in treatment. A substantial part of the criminal offender preferred a short prison sentence over a longer treatment period. Those who actually started treatment under legal pressure for a large part drop out of treatment prematurely. One of the main challenges facing mandated substance abuse treatment is the lack of engagement on the part of the participant. 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. Client motivation and readiness for treatment as well as interventions to enhance treatment readiness and engagement are considered key factors in determining treatment effectiveness. In particular, high levels of treatment readiness are considered important predictors of participation and ultimately success in substance abuse treatment. Problems are even more pronounced for several thousand drug abusing offenders who are under a judicial supervision order executed by the addiction probation office in the framework of a court order, (partially) suspended sentence, parole, probation, conditionally suspended pre-trial detention, or a conditional decision not to prosecute and who do not belong yet to the category of chronic addicted repeat offenders on whom policies have been focusing until now. But who might profit greatly from interventions, even from less intensive interventions. In order to increase the willingness of this group to enter treatment and finish it in the absence of strong legal pressure, special interventions are needed. They should focus on increasing problem awareness and motivation for change and as such induce and or enhance internal motivation. The interventions should be short and low threshold. Applied motivational interventions (ami’s) based on motivational interview techniques fulfill these criteria. We developed a protocollized short motivation enhancing intervention (two sessions of two hours) based on the “A spiral upwards”, the latter an intervention shown to be feasible and highly attractive for counselors, in particular for use with criminal offenders. Our motivation enhancing intervention 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. This pre treatment intervention might be a valuable and necessary addition to the toolbox of the workers of the addiction probation service. In the proposed research project we assess in an RCT the effect of this short motivation enhancing intervention on problem recognition, motivation for change, motivation for treatment, treatment retention, addictive behavior, and criminal behavior among 340 judicial supervised drug using offenders in the Netherlands. Changes in criminal and addictive behavior are assessed by comparing the behavior in the year after treatment entry with the behavior the year before treatment entry. 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. This information may be used to tailor intervention to specific subgroups.