Date of Award

8-2009

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Sociology

First Advisor

Robert Ackerman, Ph.D.

Second Advisor

Edward Gondolf, Ph.D.

Third Advisor

Cara Renzelli, Ph.D.

Abstract

Increasing attention in the criminal justice system has been on the large portion of offenders that have alcohol and drug-related problems or addictions. Despite collaboration between the criminal justice system and treatment service providers, there are differences in organization, objectives, and approaches to assessment. A mismatch may result between the criminal justice referral placements, based largely on the limited contractual referral options. This mismatch is an issue because undertreating individuals can be clinically harmful and overtreatment can be a waste of resources. In order to determine the extent and nature of the potential mismatches, this study conducted a content analysis of treatment records from a residential community corrections program in Western Pennsylvania (N=153). Raters reviewed intake material in patient records to determine the appropriate treatment recommendation based on patient placement criteria. This “level of care” recommendation was compared to the actual placement referral made by the criminal justice system. Two hypotheses were examined : 1) a large percentage of offenders are referred to levels of care that are not clinically appropriate and 2) a substantial portion of offenders is referred to lower levels of treatment than is clinically appropriate and thus are undertreated. VAR by VAR were cross-tabulated to determine the extent and nature of the mismatch. Logistic regressions were computed to explore the possible influences of referral source and co-occurring diagnosis on the mismatch. Demographics of the offenders were also entered into the equation as control variables. This study demonstrated that offenders referred from the criminal justice system were mismatched with clinical recommendations 64% of the time and lead to the undertreatment of offenders. The group of greatest concern was offenders who were referred for work-release but clinically recommended for inpatient. Referral source and existing co-occurring psychiatric conditions were not significant predictors of mismatch as expected. Significant implications exist for the substance abuse treatment of addicted offenders, use of public resources, and criminal justice policy. For instance, a primary recommendation is made for an expansion to a wider range of treatment service options, varying in intensity, to be offered to offenders with substance abuse problems.

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