Effects of admission and treatment strategies of DWI courts on offender outcomes.

PURPOSE: The purpose of this study is to classify DWI courts on the basis of the mix of difficult cases participating in the court (casemix severity) and the amount of involvement between the court and participant (service intensity). Using our classification typology, we assessed how casemix severity and service intensity are associated with program outcomes. We expected that holding other factors constant, greater service intensity would improve program outcomes while a relatively severe casemix would result in worse program outcomes. METHODS: The study used data from 8 DWI courts, 7 from Michigan and 1 from North Carolina. Using a 2-way classification system based on court casemix severity and program intensity, we selected participants in 1 of the courts, and alternatively 2 courts as reference groups. Reference group courts had relatively severe casemixes and high service intensity. We used propensity score matching to match participants in the other courts to participants in the reference group court programs. Program outcome measures were the probabilities of participants': failing to complete the court's program; increasing educational attainment; participants improving employment from time of program enrollment; and re-arrest. RESULTS: For most outcomes, our main finding was that higher service intensity is associated with better outcomes for court participants, as anticipated, but a court's casemix severity was unrelated to study outcomes. CONCLUSIONS: Our results imply that devoting more resources to increasing duration of treatment is productive in terms of better outcomes, irrespective of the mix of participants in the court's program.

Preliminary evaluation of extended-release naltrexone in Michigan and Missouri drug courts.

This pilot study, a retrospective case series analysis, examined the feasibility and effectiveness of treating alcohol dependence with extended-release naltrexone (XR-NTX) in the drug court setting. In two Michigan courts and in one Missouri court, 32 clients were treated with XR-NTX and were matched with 32 clients with standard care in an open-label, voluntary recruitment design. Treatment with XR-NTX was associated with relative risk reductions (RRRs; p = ns) of 57% fewer missed drug court sessions, a 35% reduction in the monthly ratio of positive drug and alcohol tests to total tests, and 35% fewer individuals with greater than 25% overall positive alcohol or drug tests. In the principal end-point analysis of annualized number of new arrests, 26% of standard-care clients were rearrested versus 8% on XR-NTX (RRR = 69%; p < .05). Treatment with XR-NTX appeared to be feasible and was associated with a consistently large treatment effect across multiple outcomes relevant to the drug court setting.

Risk factors for recurrent episodes of work-related low back disorders in an industrial population.

STUDY DESIGN: An observational longitudinal design. OBJECTIVES: To characterize the rate of and risk factors for recurrent episodes of work-related low back disorder in industrial workers. SUMMARY OF BACKGROUND DATA: Little data exist on risk factors for recurrent episodes of work-related low back disorders in employed persons. METHODS: A total of 352 active hourly union employees who were diagnosed with a recent work-related low back disorder and who had at least one follow-up visit within 12 months enrolled for participation in a rehabilitation intervention study at the workplace. Information on clinical and job factors was obtained at each study visit. Job risk for low back disorder was quantified using the Lumbar Motion Monitor. The main outcome measure, recurrence of work-related low back pain, was derived from a computerized file of administrative records of visits to the plant's medical department. RESULTS: The rate of repeated episodes was 24.4%; an additional episode occurred in 2.3%. Adjusting for age, gender, health status and job exposures, lower levels of physical health, increasing back pain disability, spinal deformity, high stress, and increasing number of different jobs worked at the same plant were risk factors for a recurrent episodes of low back pain. CONCLUSIONS: Early identification of risk factors for a work-related low back disorder may signal the need for early and intense rehabilitation to prevent recurrent episodes. Because these findings were based on jobs with medium risk of low back disorders, other factors may be significant in higher risk jobs.

Factors affecting recovery from work-related, low back disorders in autoworkers.

OBJECTIVE: To simultaneously evaluate personal, medical, and job factors that could affect recovery from work-related, low back disorders, specifically focusing on an active working sample. DESIGN: Observational, longitudinal study. SETTING: Two US automotive plants. PARTICIPANTS: Employees (N=352; 289 men, 63 women; mean age +/- standard deviation, 45.1+/-7.5 y) who were active hourly autoworkers, diagnosed with work-related, low back disorder by the plant's medical department. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Oswestry Disability Questionnaire for back pain was used to evaluate recovery. RESULTS: Factors associated with better recovery were lower stress levels (P<.001) and exercise or physical activity outside work (P<.001); factors associated with higher disability levels over time were current cigarette smoking (P<.01) and bedrest (P<.001). CONCLUSIONS: Personal modifiable factors are major influences in the recovery from work-related, low back disorders, even in active working populations. Interventions aimed at increasing exercise and decreasing stress should also be considered as a part of rehabilitation in employed persons with low levels of disability.