The Impact of Psychopathic Traits on a Cocaine Use Intervention for Offenders

描述（由申请人提供）：刑事罪犯使用可卡因构成了一个重大的公共卫生问题，并对罪犯、其家庭和社区造成负面影响。其中最可怕的后果之一是反复监禁；因此，需要采取减少犯罪累犯的干预措施。人们常常以相当悲观的态度看待法医群体。然而，罪犯在人格特征上表现出异质性，对罪犯个体差异的评估可能为指导心理治疗干预的使用提供有价值的信息。在罪犯中，精神病已成为理解暴力和犯罪累犯的重要人格结构。此外，精神病的核心特征，如缺乏同理心、欺骗和缺乏悔恨，可能会对心理社会干预的效果产生负面影响。本研究的一个基本前提是，了解精神病态特征对罪犯药物使用治疗结果的调节作用，对于确定什么有效，对谁有效至关重要。目前的提议是一项二期随机临床试验，旨在检查精神病特征对监狱转移项目中罪犯短暂可卡因使用干预效果的影响。将被检验的假设包括：1)相对于标准治疗组，基于动机性访谈（MI）的治疗将减少可卡因的使用和相关后果；2)相对于标准治疗组，干预组可卡因使用的减少将调解后来犯罪累犯的减少；3)核心精神病特征会调节干预的效果，在一年的随访中，这些特征水平较低的个体在减少可卡因使用、减少吸毒后果和减少犯罪累犯方面会获得更大的好处。这项工作有可能提供重要的数据，说明哪些人可以从对可卡因使用的短暂干预中受益。这些数据将为有效和高效率地分配可卡因吸毒者的治疗资源提供信息。

DESCRIPTION (provided by applicant): Cocaine use among criminal offenders constitutes a major public health problem and is tied to negative consequences for offenders, their families, and their communities. One of the direst of these consequences is repeated incarceration; thus, interventions that reduce criminal recidivism are needed. Forensic populations are often viewed with considerable therapeutic pessimism. However, offenders exhibit heterogeneity in personality traits, and the assessment of individual differences among offenders may provide valuable information that guides the use of psychotherapeutic interventions. Among offenders, psychopathy has emerged as an important personality construct for the understanding of violence and criminal recidivism. Moreover, core traits of psychopathy such as lack of empathy, deceitfulness, and lack of remorse may have negative implications for the efficacy of psychosocial interventions. A foundational premise of the present work is that understanding the moderating role of psychopathic traits on substance use treatment outcomes among offenders is essential to determining what works, and for whom. The current proposal is a Phase II randomized clinical trial that aims to examine the impact of psychopathic traits on the efficacy of a brief cocaine use intervention for offenders in a jail diversion program. Hypotheses that will be examined include: 1) that a Motivational Interviewing (MI) - based treatment will reduce cocaine use and related consequences relative to a Standard Care only condition, 2) that the reduction in cocaine use in the intervention group will mediate a reduction in later criminal recidivism relative to the Standard Care condition, and 3) that core psychopathic traits will moderate the efficacy of the intervention such that individuals with lower levels of these traits will derive greater benefits with regard to decreased cocaine use, decreased drug use consequences, and decreased criminal recidivism at a one-year follow-up. This work has the potential to provide important data regarding which individuals can benefit from a brief intervention for cocaine use. Such data will inform the effective and efficient allocation of treatment resources for cocaine using offenders. PUBLIC HEALTH RELEVANCE: Repeated incarceration is linked to poor emotional health, infectious disease, and diminishing prospects for reintegration into society. The effects of incarceration are felt not only by offenders, but by their families and communities in the form of economic hardship, children with absent parents, and, potentially, individuals who become more ill or dangerous with repeated incarcerations. The present study aims to decrease criminal recidivism by providing information that informs the effective and efficient treatment of cocaine-using offenders.