1. Predicting offending after residential rehabilitation

2. No conflicts of interest

3. Criminal involvement and behavior
Criminal involvement is common among people with drug use disorders
Result of the drug problems themselves (Donmall et al., 2012)
Expression of underlying problems with externalizing behavior often present before onset of drug use (Fergusson et al., 2013)

4. Predictors
Previous criminal history strong predictor of general criminal recidivism Others: previous violent behavior, psychiatric hospital admissions, poor living conditions, male gender, younger age, and antisocial personality disorder (Bonta et al., 1998, Gardner et al., 2015)

5. Study aim
To assess the predictive validity of self-reported criminal behavior in terms of registered criminal offending following patients after discharge from their first registered DUD residential rehabilitation
With colleague Kristine Rømer Thomsen and Morten Hesse
Funded by a block grant for the Danish Ministry for Social Affairs and the Interior

6. methods Retrospective cohort study using secondary data from DanRIS
Danish national monitoring and quality assurance database for public and private residential treatment of DUD since 2000
Brief demographic information, the 30-day version of the EuropASI, dates of admission and discharge
Sample
Received care at facilities, for which EuropASI data were available from , between years at admission, valid Danish personal identification no., valid dates of admission/discharge, data on outcomes of interest
Patients were followed over the entire observation period beginning from first stay. When multiple episodes were recorded for a patient, we used the first episode for that patient

7. Additional data
The Danish National Crime Register (NCR) to identify offences after discharge
Since 1978 all charges and decisions on any reported offence in Denmark registered almost immediately (max. delay of 1-2 days), and all solved crimes committed
In Denmark, the minimum age of criminal responsibility is 15 years old
The Danish Central Psychiatric Research Register (PCR) to identify episodes of psychiatric care after discharge
Records since 1970, include dates of beginning and end of treatment, diagnoses, type of referral, treatment place, residence, mode of admission

8. measures
European Addiction Severity Index (EuropASI) - semi-structured interview based on ASI-5
Assesses recent events and behaviors 30 days prior to treatment entry within 9 areas:
Medical, Employment, Financial, Drug, Alcohol, Legal, Family, Social, Psychiatric
Excellent inter-rater and test-retest reliability, discriminant and concurrent validity (Kokkevi & Hartgers, 1995)

9. Europ-ASI legal area 1. Criminal activities as main income
2. Whether the patient is presently awaiting charges, trial, or sentencing
3. Number of days the patient engaged in illegal activities for profit
4. Perceived seriousness of present legal problems (5-point Likert scale from 0/not at all to 4/extremely)
5. Importance of counselling or referral for legal problems (same Likert scale)
Information on alcohol and drug use past 30 days from the Drug and Alcohol areas of the EuropASI

10. findings

11. sociodemographics

12. Criminal and psychiatric history

13. Legal Europ-ASI items Income from criminal activities as main income
18%
Presently awaiting charges, trial, or sentence
24%
Days of illegal activities for profit, mean (standard deviation)
7.66(11.54)
Perceived seriousness of legal problems, mean
1.13
Perceived importance of counselling/help with legal problems, mean
1.10

14. reoffending (time to event)
2,987 patients reoffended (60%)
238 died without having been charged (5%)
1,786 were never observed to have offended (36%)
Median time to offending 774 days

15. links between legal problems and reoffending

16. three out of five
Patients would me more likely to offend post treatment, if they prior to treatment had:
1. Criminal activities as main income
2. Whether the patient is presently awaiting charges, trial, or sentencing
3. Number of days the patient engaged in illegal activities for profit
4. Perceived seriousness of present legal problems (5-point Likert scale from 0/not at all to 4/extremely)
5. Importance of counselling or referral for legal problems (same Likert scale)

17. conclusion
Persistent pattern of offending has important implications for clinical practice, quality improvement, and clinical administrators
Underlines usefulness of taking time to ask a few simple questions at treatment intake concerning criminal activities and concerns about own offending behavior
Legal items have been left out in ASI-6, which emphasizes the importance of relevant treatment services taking the time to ask questions about offending behavior
Prevalence of offending behavior stresses the importance of offering specially tailored help to patients who acknowledge legal problems/problems with offending behavior
Tailored treatments can reduce risk of dropout from both residential and outpatient treatment and support outcome
Check out poster tomorrow on Reaching out to patients with ASPD on testing The Impulsive Lifestyle Counselling program (ILC, workbook on researchgate)

18. literature on ILC
Thylstrup, B., Schroder, S., Fridell, M., & Hesse, M. (2017). Did you get any help? A post-hoc secondary analysis of a randomized controlled trial of psychoeducation for patients with antisocial personality disorder in outpatient substance abuse treatment programs. BMC Psychiatry, 17(1), 7. doi: /s
Hesse, M. & Thylstrup, B. (2016) Reaching out to patients with antisocial personality disorder in substance use disorder treatment: Interactions between counsellors and patients in a psychoeducational intervention. Advances in Dual Diagnosis. 9:2/3. doi.org/ /ADD
Thylstrup, B., & Hesse, M. (2016). Impulsive lifestyle counseling to prevent dropout from treatment for substance use disorders in people with antisocial personality disorder: A randomized study. Addictive Behaviors. doi: /j.addbeh
Thylstrup, B., Hesse, M., Thomsen, M., & Heerwagen, L. (2015). Experiences and narratives – Drug users with antisocial personality disorder retelling the process of treatment and change. Drugs: Education, Prevention and Policy, 22(3), doi: /

19. literature
Bonta, J., Law, M., & Hanson, K. (1998). The prediction of criminal and violent recidivism among mentally disordered offenders: A meta-analysis. Psychol Bull, 123(2),
Donmall, M., Jones, A., Weston, S., Davies, L., Hayhurst, K. P., & Millar, T. (2012). Open Access The Drug Treatment Outcomes Research Study (DTORS): Research Design and Baseline Data. The Open Addiction Journal, 5, 1-11.
Fergusson, D. M., Boden, J. M., & Horwood, L. J. (2013). Childhood Self-Control and Adult Outcomes: Results From a 30-Year Longitudinal Study. Journal of the American Academy of Child and Adolescent Psychiatry, 52(7), doi: /j.jaac
Gardner, B. O., Boccaccini, M. T., Bitting, B. S., & Edens, J. F. (2015). Personality Assessment Inventory Scores as Predictors of Misconduct, Recidivism, and Violence: A Meta-Analytic Review. Psychological Assessment, 27(2), doi: /pas
Kokkevi, A. & Hartgers, C. (1995). EuropASI: European Adaptation of a Multidimensional Assessment Instrument for Drug and Alcohol Dependence. European Addiction Research, 1(4). Doi: /