The contribution of psychopathic traits and substance use in the prediction of recidivism of sexual offenders.

Substance use and dependence may play an essential role in the risk of reoffending by sex offenders. Research examining the influence of substance use and dependence on the criminal behaviour of psychopathic sex offenders is limited. Alcohol and drug use have been identified as factors which promote criminal behaviour and are suspected to contribute, at least partially, to the probability of reoffending. For instance, previous research showed that elevated scores on the Michigan Alcohol Screening Test (MAST) contribute to the predictability of the Hare Psychopathy Checklist - Revised (PCL-R) on recidivism. The current study retrospectively evaluated a database of incarcerated high-risk offenders registered in the Regional Treatment Center, Sex Offender Treatment Program (RTCSOTP); in order to assess the contribution of self-disclosed histories of alcohol and substance use and dependency have, in concert with measures of psychopathic characteristics, on the predictability of recidivism. Results of the retrospective data identified PCL-R and DAST (Drug Abuse Screening Test) scores as significant predictors of sexual and violent recidivism of male inmates undergoing treatment in RTCSOTP within 5 years of their release. MAST scores, however, did not significantly contribute to the predictability of sexual and violent recidivism in this population. We conclude, drug use should be considered as an important factor when addressing recidivism in sexual offenders who demonstrate psychopathic characteristics.

To Reoffend or Not to Reoffend? An Investigation of Recidivism Among Individuals With Sexual Offense Histories and Psychopathy.

Although psychopathy is a well-established risk factor for recidivism among those who have committed sexual offenses, there are nonetheless some individuals with sexual offense histories who are high in psychopathy but do not recidivate. This population-nonrecidivating psychopathic sex offenders (NRP-SOs)-was the focus of the current investigation. Data from 111 individuals with sexual offense histories who received a Hare Psychopathy Checklist-Revised (PCL-R) rating of at least 25 (suggesting the presence of psychopathy) were analyzed. With recidivism operationalized as the accrual of any new serious-that is, violent or sexual-charges, 39 recidivated (RP-SOs), whereas 72 did not (NRP-SOs). A logistic regression was conducted to assess whether NRP-SOs could be differentiated from RP-SOs. Being older at the time of release, a lesser criminal history, and being married predicted nonrecidivism. PCL-R factor scores and sexual deviance were not predictive. These findings highlight the heterogeneity that exists, even among those high in psychopathy.

The Use of Leuprolide Acetate in the Management of High-Risk Sex Offenders.

The present study investigates whether leuprolide acetate (Lupron) adds to the efficacy of traditional sex offender treatment. A group of sex offenders receiving both Lupron and cognitive behavioral therapy (CBT; n = 25) were compared with a group of sex offenders receiving only CBT (n = 22). Treated subjects were compared with norms available with reference to the Static-99R, as well as compared with a sample of untreated, nonsexual violent offenders (n = 81), to provide baseline data regarding risk of violent recidivism. Results indicated that subjects receiving Lupron were at significantly higher risk of recidivism and significantly more likely to be diagnosed with a paraphilia than subjects receiving only CBT, a priori. Both treated groups of sexual offenders recidivated at substantially lower rates than predicted by the Static-99R. Currently, this study represents the only, long-term outcome study on Lupron administration using officially recorded recidivism as the primary dependent measure.

Individual Community-Based Treatment of Offenders With Mental Illness: Relationship to Recidivism.

This study explores the effectiveness of psychological intervention at reducing the risk of recidivism among a group of high-risk, high-need offenders housed in a Community Correctional Centre (CCC) operated by the Correctional Service of Canada (CSC). File reviews on 136 male federal offenders living in a CCC in a large metropolitan area were included in the present investigation. Previous research on this sample by our team indicated that the majority of this sample met diagnostic criteria for a variety of psychiatric conditions. Data on the number of individual counseling sessions received and progress in treatment were collected from official file information for the purpose of the present investigation. After accounting for actuarially assessed risk, moderate doses of treatment were found to be associated with 7.7 times less likelihood of recidivism, and high doses of treatment were found to be associated with 11.6 times less likelihood of recidivism, when compared with offenders who received no treatment or were only assessed for treatment. These results are discussed in the context of correctional models of offender risk assessment and rehabilitation. It is notable that a very simple measure of global mental health treatment attendance, with no consideration of such factors as responsiveness, added considerable incremental predictive validity to the results after having statistically accounted for actuarially assessed risk of recidivism.

Mental health diagnoses and recidivism in paroled offenders.

Although the issue of mental illness among offender populations has received attention in the last number of years, there are a number of issues related to mental illness among such groups that require more study. One such topic relates to the association between mental illness, actuarially assessed risk of recidivism, and observed rates of reoffending. In the present investigation, file information was reviewed to determine the presence of a variety of mental health conditions. Actuarially based risk assessment data were also collected for participants as well as information regarding suspension, new charges, and convictions. A sample of 136 offenders housed in a halfway house operated by Correctional Service of Canada was included in the present investigation. Results indicated very high rates of serious mental illness in this high-risk population. Offenders with borderline personality disorder and attention deficit hyperactivity disorder were significantly more likely to recidivate or be suspended. Suspensions refer to administrative decisions to place an offender in jail due to problematic behaviour (typically involving a breach of his release conditions or new charges/convictions). Offenders with a diagnosis of paraphilic disorder were significantly less likely to recidivate or be suspended. Results are discussed in light of the available literature.

Comparing sexual offenders at the Regional Treatment Centre (Ontario) and the Florida Civil Commitment Center.

Sexual offender civil commitment (SOCC) continues to be a popular means of managing risk to the community in many U.S. jurisdictions. Most SOCC states report few releases, due in large part to the reluctance of the courts to release sexually violent persons/predators (SVPs). Contemporary risk prediction methods require suitable comparison groups, in addition to knowledge of postrelease behavior. Low SVP release rates makes production of local base rates difficult. This article compares descriptive statistics on two populations of sexual offenders: (a) participants in high-intensity treatment at the Regional Treatment Centre (RTC), a secure, prison-based treatment facility in Canada, and (b) SVP residents of the Florida Civil Commitment Center. Results show that these two samples are virtually identical. These groups are best described as "preselected for high risk/need," according to Static-99R normative sample research. It is suggested that reoffense rates of released RTC participants may serve as a comparison group for U.S. SVPs. Given current release practices associated with U.S. SOCC, these findings are of prospective value to clinicians, researchers, policy makers, and triers of fact.

The Static-99R: are there really differences between the normative groups?

A sample of 348 high-risk sexual offenders was divided into two groups based on the level of preselection (detained, n = 211, and nondetained, n = 137) and the groups were compared on a number of measures which were related to dynamic risk. The hypothesis was that the detained group would score as being higher need on these instruments than the nondetained group. This hypothesis was supported with the detained group reporting greater levels of hostility, cognitive distortions supportive of offending, sexual obsessions, and sexually deviant behaviours. They also scored as being less assertive and as having a more extensive psychiatric history. These findings were interpreted as being supportive of the assertion that the new Static-99R normative groups are related to preselection based on the differences on dynamic factors.

Substance abuse among high-risk sexual offenders: do measures of lifetime history of substance abuse add to the prediction of recidivism over actuarial risk assessment instruments?

There has been relatively little research on the degree to which measures of lifetime history of substance abuse add to the prediction of risk based on actuarial measures alone among sexual offenders. This issue is of relevance in that a history of substance abuse is related to relapse to substance using behavior. Furthermore, substance use has been found to be related to recidivism among sexual offenders. To investigate whether lifetime history of substance abuse adds to prediction over and above actuarial instruments alone, several measures of substance abuse were administered in conjunction with the Sex Offender Risk Appraisal Guide (SORAG). The SORAG was found to be the most accurate actuarial instrument for the prediction of serious recidivism (i.e., sexual or violent) among the sample included in the present investigation. Complete information, including follow-up data, were available for 250 offenders who attended the Regional Treatment Centre Sex Offender Treatment Program (RTCSOTP). The Michigan Alcohol Screening Test (MAST) and the Drug Abuse Screening Test (DAST) were used to assess lifetime history of substance abuse. The results of logistic regression procedures indicated that both the SORAG and the MAST independently added to the prediction of serious recidivism. The DAST did not add to prediction over the use of the SORAG alone. Implications for both the assessment and treatment of sexual offenders are discussed.

Pedophilia: an evaluation of diagnostic and risk prediction methods.

One hundred thirty child sexual abusers were diagnosed using each of following four methods: (a) phallometric testing, (b) strict application of Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision [DSM-IV-TR]) criteria, (c) Rapid Risk Assessment of Sex Offender Recidivism (RRASOR) scores, and (d) "expert" diagnoses rendered by a seasoned clinician. Comparative utility and intermethod consistency of these methods are reported, along with recidivism data indicating predictive validity for risk management. Results suggest that inconsistency exists in diagnosing pedophilia, leading to diminished accuracy in risk assessment. Although the RRASOR and DSM-IV-TR methods were significantly correlated with expert ratings, RRASOR and DSM-IV-TR were unrelated to each other. Deviant arousal was not associated with any of the other methods. Only the expert ratings and RRASOR scores were predictive of sexual recidivism. Logistic regression analyses showed that expert diagnosis did not add to prediction of sexual offence recidivism over and above RRASOR alone. Findings are discussed within a context of encouragement of clinical consistency and evidence-based practice regarding treatment and risk management of those who sexually abuse children.

Comparison of measures of risk for recidivism in sexual offenders.

Data for both sexual and violent recidivism for the Static-99, Risk Matrix 2000 (RM 2000), Rapid Risk Assessment for Sex Offense Recidivism (RRASOR), and Static-2002 are reported for 419 released sexual offenders assessed at the Regional Treatment Centre Sexual Offender Treatment Program. Data are analyzed by offender type as well as the group as a whole. Overall, the Static-2002 performed best for both outcomes, although differences between measures were not significant. The one exception to this was the RRASOR, which overall performed poorly. For rapists, the Static-2002 performed best for sexual recidivism, and the Risk Matrix 2000 performed best for violent recidivism. None of the measures performed well in predicting recidivism for child molesters. The components of the Static-2002 were examined in a regression analysis predicting sexual recidivism. Persistence of Sexual Offending and Age at Release were the only significant predictors for the group as a whole and for rapists. For child molesters, only the Deviant Sexual Interests component was significant. Results are discussed in terms of the current debate concerning age and risk for reoffence.

Treatment of sexual offenders with psychopathic traits: recent research developments and clinical implications.

This article provides a review of recent literature related to the treatment of psychopathy in forensic settings, with particular focus on studies with sexual offenders. The lack of empirical support for the position that psychopaths are untreatable is noted, and data suggesting optimism is discussed. Research demonstrating an interaction between psychopathy and substance abuse and between psychopathy and sexual deviance is also presented. Both substance abuse disorders and inappropriate arousal are frequently encountered in high-risk groups of sexual offenders. These topics are of relevance, in that the question of whether treatment is beneficial with high-risk sexual offenders, including those who are psychopathic, cannot be answered unless groups presenting with typical concurrent disorders (paraphilias, substance abuse, dependence) are discussed. It is argued that, although the evidence is still preliminary, there is reason for optimism with reference to whether psychopathic sexual offenders are responsive to treatment, including offenders presenting with concurrent disorders.

Sexual offenders' state-of-mind regarding childhood attachment: a controlled investigation.

Attachment experiences have been regarded as significant by researchers and clinicians attempting to explain the etiology of sexual offending. Although initial studies have revealed some promising evidence, there are a number of theoretical and methodological problems with this preliminary body of work. While addressing these limitations, the goal of the present study was to investigate state-of-mind regarding childhood attachment among subtypes of sexual offenders, comparing them to both a sample of nonsexual offenders and to the documented patterns of nonoffenders. Sixty-one sexual offenders (extrafamilial child molesters, incest offenders, and rapists) and 40 nonsexual offenders (violent and nonviolent) were administered the "Adult Attachment Interview." Results indicated that the majority of sexual offenders were insecure, representing a marked difference from normative samples. Although insecurity of attachment was common to all groups of offenders, there were important differences in regard to the specific type of insecurity. Most notable were the child molesters, who were significantly more likely to be Preoccupied. Rapists, violent offenders, and, to a lesser degree, incest offenders were more likely to be Dismissing. Although still most likely to be Dismissing, nonviolent offenders were comparatively more Secure.

Responsivity issues in the treatment of sexual offenders.

Andrews and Bonta (2003) have presented a model of effective correctional programming focusing on risk, need, and responsivity factors for a general criminal population. When applied to sexual offenders, the first two issues (risk assessment and treatment targets such as cognitive distortions) have received a great deal of research attention. However, little attention has been paid to responsivity issues: those factors that influence the extent to which clients benefit, or fail to benefit, from treatment programs. This article presents a review of several potential responsivity factors related to sexual offender treatment and outlines areas that require further research attention.

Psychopathy, treatment change, and recidivism in high-risk, high-need sexual offenders.

The present study investigated 154 consecutive admissions to the Regional Treatment Center (Ontario) Sex Offender Treatment Program with reference to psychopathy and outcome. Ratings of treatment behavior, as well as clinical judgments as to whether risk was reduced, were coded based on treatment reports. With reference to Psychopathy Checklist-revised (PCL-R) scores, survival analyses indicated that high scorers recidivated at significantly higher rates than low scorers. However, offenders who received high PCL-R scores and lower scores on measures of treatment behavior recidivated at the same rate as low scorers on the PCL-R. Furthermore, among high PCL-R offenders, those rated as lower risk at post treatment in fact reoffended at a lower rate than those whose risk was rated as unchanged, although this difference failed to reach significance. Findings are discussed in light of the clinical and research literature.

Developments in the assessment and treatment of sexual offenders: looking backward with a view to the future.

This article provides a brief review of a number of key developments within the area of sexual offending over the past two decades. In addition, several directions for future research are discussed. The review presents information concerning several well-validated risk assessment instruments that are available. As well, some of the accumulating evidence concerning the efficacy of contemporary approaches to treatment with sex offenders is mentioned, as are theoretical developments within the field.

Alcohol and drug abuse among sexual and nonsexual offenders: relationship to intimacy deficits and coping strategy.

Three groups of subjects (N = 95) consisting or rapists, child molesters, and a comparison group of violent offenders were examined with reference to history of alcohol abuse, history of drug abuse, intimacy deficits, and emotionally based coping strategies. No differences were found between the two groups of sex offenders on any of the measures examined. Sex offenders were found to be significantly older than the comparison group. When age was entered as a covariate sex offenders were found to have significantly more difficulties with alcohol use as measured by the Michigan Alcohol Screening Test (MAST) and were significantly more likely to use emotionally based coping strategies as measured by the Coping Inventory for Stressful Situations (CISS). No differences were found between any of the groups with reference to drug abuse as measured by the Drug Abuse Screening Test (DAST). Results are discussed in terms of Marshall's theory of intimacy deficits in sexual offenders.

Dosage of treatment to sexual offenders: are we overprescribing?

A sample of 337 offenders who received treatment in a variety of sex offender treatment programs in the Ontario region of Correctional Service Canada between 1993 and 1998 were divided based on the highest intensity sex offender programming that they received (low, moderate, and high). The three groups were compared with reference to a variety of actuarial risk assessment measures, criminogenic factors, and the number and type of treatment programs completed. It was hypothesized that the high-intensity group would have more criminogenic risk factors, higher actuarial scores, and participate in more treatment programs than both the moderate- and low-intensity groups. The results indicate that in general, the hypotheses were supported. Nonetheless, the results suggest that the low-intensity group may be receiving too much sex offender-specific treatment.