CURRENT SUBSTANCE ABUSE INTERVENTIONS, RESEARCH AND
EMERGING DEVELOPMENTS

Brian A. Grant, Ph.D.*
I. INTRODUCTION
Recently, a number of new approaches to the treatment of addiction and substance abuse have beendeveloped. Many of these approaches work well within the correctional context and the following section
provides an overview of these approaches. The purpose is not to provide a detailed explanation of any one ofthese approaches, but to provide a description and sense of how they are applicable to working withoffenders who have substance problems.
The paper also presents the results of new research and development activities that are underway within
the Correctional Service Canada. These examples are presented in part to highlight the concepts discussed inthis, and the other papers in this series, and partly to demonstrate how a research programme can be involvedin the development of programming. These examples should bring together many of the concepts that havebeen discussed and provide concrete examples of their use. It is hoped that through these examples, theimportance of research for both developing and maintaining substance abuse interventions within acorrectional system will be evident.
II. GENERAL STRATEGIES IN TREATMENT
Four treatment approaches will be presented in this section, harm reduction, stages of change, relapse
prevention, and motivational interviewing.
A. Harm Reduction
Harm reduction is a concept that grew from awareness of the deadly consequences of injection drug use
following the appearance of HIV/AIDS. Through the very common practice of sharing syringes and otherdrug paraphernalia it became possible for an individual to suddenly have an incurable, fatal disease. People
working with drug abusers recognized the need to take some action that would lessen the probability of the
spread of disease without passing judgment on the drug using behaviour. Since those origins, harm reduction
has become a strategy for dealing with the behaviour and consequences of all types of substance abuse. The
approach is often misunderstood and rejected outright by some decision makers and programme delivery
experts. Usually, the rejection of the approach results from seeing it as simply a call for needle exchange
programmes and safe injection sites.
Harm reduction is more than a number of specific interventions. It is an approach to intervention thatseeks to reduce the negative consequences of substance abuse to the individual and to the society. Rather
than looking at drug or alcohol misuse as an inherently bad thing, harm reduction takes no position on theacceptability of the behaviour. However, it recognizes that substance abuse has negative effects and therefore
actions can be taken to reduce those harms. Simply reducing the harms may help to stabilize the behaviour ofindividuals, assist in keeping them alive and reduce the negative consequence for the community in which
the substance abusing individual lives.
Harm reduction is not a treatment programme, but an intervention. However, one of the values of harm
reduction is that it can provide opportunities for further intervention with addicted individuals that may leadto their participation in more traditional programming, thereby leading to a reduction in their use of drugs
and alcohol, and in many cases to their total abstinence from drug and alcohol use if that is warranted.

* Director,
Addictions Research Centre,
Correctional Service Canada

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Marlatt (1998a) provides a more detailed picture of harm reduction approaches in different countries as it
relates to different substances, populations and challenges. Marlatt (1998b) provides a set of five principles
for harm reduction (pp. 49 - 58):(i) Harm reduction is a public health alternative to the moral/criminal and disease models of drug use andaddiction
Harm reduction does not presume that substance abuse is morally wrong and must therefore be punishedusing criminal sanctions, nor does it take the view that substance abuse is a disease that requires treatment.
However, given the negative consequences of substance abuse, encouraging people to stop using is a goal as
indicated in the next principle.
(ii) Harm reduction recognizes abstinence as an ideal outcome, but accepts alternatives that reduce harm
Harm reduction can be viewed as having a continuum of responses. At one end of the continuum is the
cessation of all substance abusing behaviours, thereby eliminating all of the harms associated with substanceabuse. At the other end of the continuum is any small reduction in the harms caused by substance abuse.
Frequently, harm reduction becomes associated with only the most controversial options such as safe
injection sites. While safe injection sites are at the leading edge of harm reduction, they are not the place tostart developing a harm reduction policy. A Correctional system can take a harm reduction approach byensuring that its policies and procedures go as far as they can to reduce the harms associated with substanceabuse.
(iii)Harm reduction has emerged primarily as a "bottom up" approach based on addict advocacy, rather
than a "top-down" policy promoted by drug policy makers
As a result of how the harm reduction approach was developed, it is well accepted and meets the needs ofpeople who require intervention.
(iv) Harm reduction promotes low-threshold access to services as an alternative to traditional, highthreshold approaches
Traditionally, many programmes required a commitment to total abstinence before a person could be
accepted into treatment. If there was drug or alcohol use during the programme the person was removed
from treatment. These types of strict rules set high-thresholds for participation. Programmes that have lowthreshold access have very few rules for initiating and participating in the intervention. Effective needle
exchange programmes do not require anything of the substance abuser other than collecting clean syringes. It
is easy to image a needle exchange programme that required participation in treatment, completion of forms,
etc. to obtain clean needles. Experience has shown that any of these requirements reduces the effectivenessof needle exchange. Another example of a low threshold programme is a methadone treatment programme
offered in Halifax, Canada, in which there are a minimum number of requirements for participation, unlike
most methadone programmes. Individuals in this programme must obtain their methadone each day, andmust undergo urinalysis to check for the presence of other drugs. The presence of other drugs results incounselling, and cessation of methadone only occurs if the level of use of other drugs is seen as a threat tohealth.
(v) Harm reduction is based on the tenets of compassionate pragmatism versus moralistic idealism
Making condoms available in correctional settings is one example of compassionate pragmatism. We
recognize that sexual activities will occur in prison, we want to prevent the spread of diseases, and providing
condoms does not provide any security risk, therefore they are made available.
Harm reduction approaches are not only applicable to treatment after an addiction or problem behaviour
has occurred. Harm reduction approaches can be applied to prevention programmes as well. Recognizingthat there are safe and unsafe behaviours associated with an activity and promoting the safer methods is one
way to reduce harm. Programmes to reduce drinking and driving are an example of harm reduction
programmes at the prevention level. These programmes recognize that the consumption of alcohol will occur
away from home and provide alternative behaviours to driving to reduce the likelihood of accidents.
Alternatives include, taking a taxi, arranging for a designated driver, or staying overnight at the location of
the event.

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B. Stages of Change
Prochaska and DiClemente (1992) propose a model of readiness to change that allows treatment
providers to match treatment to an individual's willingness to change. In their model, they propose fivestages of change and provide examples of what should be addressed at each stage and what is required forthe person to move to the next stage (Connors, Donovan & DiClemente, 2001). These stages are meant to be
representative of what happens and individuals will not pass through the stages as if they were discrete
events.
1. Pre-contemplation
In the pre-contemplation phase an individual has no intent to change behaviour and current substanceabuse may be viewed as being both positive and negative for the individual. During this phase it is not useful
to focus on changing behaviour, but rather to use motivational techniques that will move the person to thenext phase. The person may need to acknowledge that there is a problem, develop a better understanding of
the negative consequences of the substance abuse behaviour and develop an understanding of the factors thattrigger drug or alcohol use. An individual at this stage may believe they are in control and can stop anytime
and believe that the benefits of using outweigh the benefits of not using.
2. Contemplation
In the contemplation stage the individual is thinking about their problem and is looking for informationthat will help them to understand it. They are looking at the positive and negative characteristics of theirsubstance abuse problem, but they are not yet prepared to stop using drugs or alcohol. Intervention at thisstage involves providing increased understanding of the effects of substance abuse, evaluation of life goals
and consideration of the context in which the person may be living. In the case of offenders, if they areincarcerated it is a good opportunity to point out the negative impacts that being in prison have on their life
and what the alternatives might be.
At this stage, the person must make a decision to act if they are to move to the next stage. They might
begin to take some preliminary action such as meeting with a counselor, changing behaviour to reduce
consumption, or to reduce the risk associated with drugs and alcohol use.
3. Preparation
The third stage is preparation to change. Persons in this stage are prepared to change both their attitudes
and their behaviour. They may have taken some early steps to monitor their use of alcohol or drugs with thegoal of reducing consumption. They are ready to be encouraged to participate in treatment so intervention
should work to increase their commitment to stopping their use of drugs or alcohol. This can be done byfurther development of information on the consequences of substance abuse and the positive benefits they
may experience by reducing their use of substances or stopping completely.
At this stage individuals will need to establish goals and priorities that can be set to help them stop
abusing substances. They will need to develop a change plan that can guide them to stopping their use.
4. Action
In the action stage individuals have begun to change their behaviour. They are learning new skills that
help them to remain free from drug and alcohol use. Their desire to change at this stage makes them ideal
candidates for programmes that apply behaviour change practices in treatment. Treatment needs to provide
skills development that will assist in the cessation of the drug and alcohol use and while providing
alternatives to their former life-style. Participants also need to learn about what may trigger their desire touse drugs and alcohol so they can avoid these situations.
Prochask and DiClemente (1992) suggest that interventions in this stage should last for an average of six
months, and work is needed with the individual to increase their belief that they can maintain the desiredchanges in behaviour.
5. Maintenance
The final stage in this model is maintenance, the process by which the individual maintains their desired
behaviour. This is a critical phase as it is the one that must last for the remainder of a person’s life if they are
to avoid returning to an addictive state. They must have in place practices that will allow them to avoid

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substance abuse and continue to practice the skills learned in treatment. Very often, treatment programmes
do not provide for maintenance support. Rather, the programme is delivered, the person successfullycompletes it and then is expected to maintain the change without any additional support. Effective
programmes have maintenance components that provide support and skills reinforcement during themaintenance stage.
An individual does not move through these stages in a straight line. They may move fromprecontemplation to preparation, only to slip back to the contemplation stage. Or, they move all the way tomaintenance, but as a result of life circumstances, may find themselves starting the process again (Connors,
Donovan & DiClemente, 2001). This is both expected and normal and is one of the reasons that effective
programmes stress the need for understanding of lapses in drug and alcohol use during and after treatment.
C. Relapse Prevention
Relapse prevention should be an important component of treatment programmes. As noted earlier,relapse is a common occurrence and the individual who abuses substances needs to be prepared for it when it
occurs. The goals of relapse prevention are to provide information useful in recognizing high risk situations
that may lead to relapse and providing the skills needed to deal with the relapse when it does occur. At thetime of a relapse, it is important that the client does not give up.
Seven models of relapse are identified by Connors, Donvovan and DiClemente (2001), but there is aconsistency across the approaches they present. The model presented by Marlatt and Gordon (1985) is basedon cognitive behavioural principles and is a good example to use here. In this model, relapse is seen as theinteraction between the high risk situations associated with drug or alcohol use and the individual's
perceptions of his/her ability to control the situation and therefore, avoid using drugs and alcohol. The
individuals’ expectations about the usefulness of drugs and alcohol in the particular situation will also play arole in whether or not they choose to relapse (Connors, Donovan & DiClemente, 2001).
When the high risk situation arises, the individual who has learned coping skills to deal with the event or
environment will be more likely to resist the relapse. The coping skills that have been learned will provide
alternative courses of action, that hopefully will avoid the relapse. Individuals who have not learned
appropriate coping skills will be less able to choose alternative behaviours and therefore will be more likely
to return to substance use.
For the Marlatt model, there are two key components that must be addressed during treatment,
identifying the high risk situations and developing coping skills to deal with the situations in a positive way.
Treatment programmes that use relapse prevention spend time helping the offender to identify their uniquehigh risk situations through review of past events and their outcomes. Events that consistently lead to drug
and alcohol use become the targets for developing coping strategies.
Developing coping strategies follow the identification of the high risk situations. For each high risk
situation the offender must identify a number of alternative ways of dealing with the risk created. For
example, if meeting with friends in a large group is a high risk situation, then coping strategies might include
avoiding being with friends in large groups, leaving the group when it gets large, or finding alternative
activities that are normally done only in small groups of two or three people. Other coping strategies thathave been identified in the research literature include, reminders of the consequence of drug or alcohol use,
thinking about the positive effects of not using drugs or alcohol, recalling periods of non-use that werepositive, and remembering that avoiding use is an important personal goal.
The coping strategies are identified on an individual basis following discussion in groups. After
identification of coping strategies, they must be practiced in role play activities. Through the identification of
the high risk situations, development of coping strategies and practicing the strategies the offender is better
prepared to deal with the situations when they occur.
Relapses are to be expected and may be viewed as learning experiences. Analysis of the relapse events,
the antecedent behaviours and the results will assist in the development of more effective coping strategies
that can be used during the next high risk situation. Following the relapse, or lapse, the client needs to bereassured that they can continue without using drugs and alcohol. The treatment programme should include

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discussion of what to do after a relapse and how to restart the process of remaining drug and alcohol free.
This is one of the main reasons that treatment maintenance programmes are important. It is during themaintenance sessions that lapses and relapses can be addressed in a supportive environment.
D. Motivation Interviewing
Miller and Rollnick (1991) state:
Motivational interviewing is a particular way to help people recognize and do something about theirpresent or potential problem. It is particularly useful with people who are reluctant to change andambivalent about changing. (p. 52).
Many offenders are not willing to commit to changing their drug or alcohol using behaviours. There are
too many positive features associated with their lifestyle. They are in the precontemplative stage of change.
However, treatment providers must work to encourage these individuals to move forward along thecontinuum towards change. Motivational interviewing is one of the methods that have been shown to beeffective for starting the change process.
Miller and Rollnick (1991) present five general principles of motivational interviewing.
1. Express Empathy
For motivational interviewing to be effective the counselor must express empathy with the client. The
client is accepted for what he or she is at the time of counseling, there is no judgment about how they arrived
at that point, or the consequences of their behaviour. Accepting the individuals as they are reduces theirresistance to the counseling setting. Ambivalence about change is acceptable for the client.
2. Develop Discrepancy
Developing discrepancy has to do with gently demonstrating the conflicting values in a person's life andguiding them towards the more appropriate goals. This is different from confrontation that may result in
resistance to change. While discussing the current situation with the client the counselor looks for positive
personal goals that the individual has and contrasts these with the current behaviours that prevent theachievement of these goals. The object is to encourage the client to see the importance of alternative goals
they have and to give these greater priority than the desire to use drugs and alcohol.
3. Avoid Argumentation
The counselor needs to avoid argumentation to maintain a positive therapeutic relationship with theclient. However, this does not mean that the therapeutic interview follows the client’s thoughts. Rather,inconsistences are detected and used to correct judgments and beliefs. Miller and Rollnick (1991) refer tothis as "soft confrontation". They also note that in many treatment settings argumentation can occur aroundthe need to admit to having a problem. This is unnecessary at this early stage of change, and may only berecognized as a goal much later. Recall that the purpose of motivational interviewing is to prepare the client
for change, to move them along the continuum so they are ready to start the change process or in some cases
after a relapse, to re-start the process.
4. Roll with Resistance
It is to be expected that the offender will be resistant to change, and it is the job of the counselor inmotivational interviewing to work with this resistance to find ways to reframe and redirect the resistance.
Redirecting the resistance can motivate offenders to find their own solution which is the ultimate goal.
5. Support Self-Efficacy
The offender will often feel that they are unable to succeed in treatment so why bother trying.
Motivational interviewing helps the offender to believe that they can change; it works with their desire tochange and develops confidence that change is possible. The counselor may encourage small steps towards
change to assist the offender to build on success.
Motivational interviewing is often used as an adjunct to other therapies. An offender who is in theprecontemplative, or even the contemplative stage of change is not ready for a directive behaviouralprogramme. Motivational interviewing can move them along so they better understand the need for change,

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see the value it may provide for them, and provide the belief that they have the ability to stop using drugs andalcohol if they want to. Miller and Rollnick (1991) also point out that results from an assessment process canbe an effective tool during motivational interviewing. A parole office reviewing the results of objective
testing can provide the offender with concrete evidence of how his or her addiction compares to that of otheroffenders.
The report produced by the Correctional Service Canada's Computerized Assessment of Substance
Abuse (CASA) is designed to be shared with the offender for this reason. It is our intention, in the near
future, to include normative data in the report, so offenders can see how their problem compares to that ofother people. This approach should help to address problems of denial that are common among drug andalcohol abusers.
III. CORRECTIONAL SERVICE CANADA RESEARCH AND DEVELOPMENT
A. Women Offenders Substance Abuse Programme
The Women Offenders Substance Abuse Programme (WOSAP) has been developed over two and halfyears and will be implemented in the women's correctional facilities in Canada in June of 2003. The
programme has a number of unique characteristics that represent attempts to design a programme consistent
with evidence based programme development (Hume & Grant, 2001).
First, the programme was designed through consultation with women offenders, experts in women
offender treatment and operational staff at correctional facilities. Early consultations with international
experts indicated the programming we had available did not adequately meet the needs of women offenders.
Following a decision to develop a new programme, additional consultations were held to determine theprogramming model that was to be used and the structure of the programme (Hume & Grant, 2001). In its
design and development, the programme was to be women-centred, not a derivation of a programme formen, and was to address the unique characteristics of women with substance abuse problems.
The second feature of the programme is that it takes account of the entire sentence. Rather than aprogramme that lasts for a set period of time, the programme is designed to deliver elements throughout theentire sentence, and do this in a consistent manner. While we refer to it as a single programme it is actuallyfour programmes.
The third feature of the programme is it tries to combine two approaches to treatment that have in thepast been seen as incompatible. To meet current standards of effective correctional programming the
programme needed to have a cognitive behavioural component that would encourage skill development foraddressing substance abuse problems. However, experts in women's programming advised that the problemsof substance abuse for women are often entangled with relationship issues and if these are not addressed thenit is likely the programme would not be successful. The challenge has been to combine these two approaches
within one programme.
As noted above, the programme has four major components:
1. Education
The education component of the programme has 8 sessions designed to teach women about the negative
effects of substance abuse on their lives, both long and short term effects, provide basic information on how
to deal with triggers that cause cravings, and to motivate them to continue the process of change. It is
anticipated that all women offenders will be assigned to participate in this component of the programme as
almost all women offenders have a connection to the problems of substance abuse either through their own
experience, or through a spouse or family member.
2. Intensive Treatment
The intensive treatment component consists of two parallel programmes one designed from a cognitive
behavioural perspective and one based on relational theory. These programmes proceed in parallel so issues
discussed in one part are also discussed in the other ensuring consistency of message and learning. Each
programme is 20 sessions in length would

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3. Maintenance
The maintenance component is a 20 week follow-up programme with sessions offered once per week. To
ensure continuity with the community the same maintenance programme is available after offenders are
released. This approach ensures there is a consistent experience in both the institution and the community.
One of the major challenges we face with the programme is how to deliver the maintenance session in thecommunity when the women participants are widely dispersed across the country.
4. Community Building
The community building component of the programme is designed to create an environment within theinstitution that promotes a drug and alcohol free lifestyle and provides support to those offenders who aretrying to change their behaviour. This component has two characteristics, peer led discussion groups andinstitution wide activities. The peer led discussions groups have programming material available, but theparticipants choose the topic to be discussed each week. The community building exercises include healthactivities that involve correctional staff, social activities, and community activities in which individuals fromoutside the prison come to present information of relevance to the women.
Unfortunately, this programme has not yet been evaluated as it is too new. However, an evaluation plan
has been established and we should have preliminary results within one to two years. The evaluation willaddress perceptions of the programme, intermediate and long term outcomes, and measures of recidivism.
B. Intensive Support Units
In an effort to provide environments for offenders that will support their efforts to reduce drug andalcohol dependency, Intensive Support Units (ISU) have been established in all prisons (Grant, Varis &Lefebvre, 2004). These units are part of the regular prison environment, but they provided increased
assurance that drugs are not available on the unit. Offenders wishing to live on the units must sign anagreement in which they accept increased testing for the presence of drugs and increased searching for drugs
and alcohol. The staff on these units receive additional training on the problems of substance abuse and thechallenges faced by offenders with an addiction. With the training, staff can provide additional support to theoffenders when they experience problems.
To evaluate the effectiveness of the units, participants completed a number of surveys when they firstjoined the units and again when they moved to other prisons or were released. Data are not yet available on
the recidivism outcomes from participants, but intermidiate measures of impact of the units indicate that bothstaff and inmates believe the units will make a difference in their ability to stay away from drugs and alcohol,that the units will have a positive effect on their lives after release from custody and that the units have fewer
drugs available. Analyses of misconduct and search data for the units indicates that there are increased
searches, but few drugs found and misconduct by offenders on the units are lower than for offenders on otherunits (Varis, 2001).
C. Methadone Maintenance Treatment
Methadone maintenance treatment has been available to offenders in the Correctional Service for anumber of years. However, until recently only those offenders who had been prescribed methadone in thecommunity could receive it in the institution. Recently, a study was conducted to compare the releaseoutcomes of offenders who had participated in the methadone maintenance programme and a comparisongroup consisting of those offenders who had not participated in the methadone programme.
Previous research has indicated that methadone maintenance treatment can produce reductions in illicit
opiate use (Marsch, 1998); reductions in other drug use (Fischer, et.al., 1999); HIV risk behaviours (Darke,
Kaye & Finlay-Jones, 1998); criminal behaviour (Coid, et.al., 2000; Maddux & Desmond, 1997); and accessto health care (Marsch, 1998). The purpose of this study was to determine if we could identify a reduction incriminal behaviour after release from prison for those offenders who participated in the MMT programme.
One of the challenges in research of this type is to determine who should be in the comparison group.
The offenders who receive MMT are the most seriously addicted offenders and generally the mostproblematic. They have a high rate of recidivism so comparing them to the general population of offenders
would certainly indicate the MMT had no effect. We were able, within our data systems, to identify a group88

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of offenders who had tested positive for opiates in random drug testing and who were identified at admission
as having a substance abuse problem. This group served as a comparison for the MMT group.
The results of the study are summarized in Figure 1 in the form of a survival analysis. The survival
analysis indicates that both groups had a high probability of failure in the community
Figure 1. Survival Analysis for MMT Study: Readmission Rate
MMT Groupc2 (1) = 6.02, p < 0.05

30

28

26

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12

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8

6

4

2

1
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
0

Proportion not readmitted

Non-MMT GroupMonths

While more than 50% of the MMT group were readmitted to prison within 24 months of their release,almost 65% of the comparison group were readmitted. The observed differences are statistically reliable.
Similar results were identified when a new offence was used as the outcome measure, but the results were
not statistically reliable.
D. Offender Substance Abuse Pre-release Programme (OSAPP)The Offender Substance Abuse Pre-release Programme has been in use within the Correctional Service
for more than ten years. Five years ago a study was conducted to determine how effective the programme
was at reducing recidivism (T3 Associates, 1999).
The programme follows a behavioural model employing cognitive behavioural techniques. Modules in
the programme include alcohol and drug education, self-management, problem-solving skills, social skills,
leisure and lifestyle planning and pre-release planning. In addition to the 26 structured group treatment
sessions of approximately 3 hours each, the programme includes three individual sessions with facilitators.
A summary of session topics are presented in Table 2.
The evaluation of the programme was based on approximately 1,600 offenders, from across the country,
who completed the programme. The completion rate for the programme was 89%. Evaluation ofintermediate measures indicated that participants increased their knowledge of the consequences ofsubstance abuse, improved their understanding of how their use of substances were affected by other people,
increased their ability to communicate effectively with peers about their substance abuse problem andincreased their problem solving skills.
A 12 month follow-up was conducted to determine the programmes effect on recidivism. Almost 800
cases were included in the follow-up and these cases were matched to other offenders to provide acomparison group. Of those offenders who completed the programme, 42% were readmitted after one year,

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compared to 49% of the comparison group. New offences were committed by 15% of the programme groupand 22% of the comparison group (T3 Associates, 1999).
Figure 2. Offender Substance Abuse Pre-release Programme: Units and Sessions
Unit I: Introduction
Session 1: Programme Introduction
Session 2: Orientation and Pretesting
Unit II: Alcohol and Drug Education
Session 3: Alcohol & Drug Education I
Session 4: Alcohol & Drug Education II
Session 5: Alcohol & Drug Education III
Session 6: Alcohol & Drug Education IV
Session 7: Alcohol & Drug Education V
Unit III: Self-Management Training
Session 8: Self-Management Training
Individual Counselling Session I
Session 9: Understanding Your Behaviour
Session 10: Substance Use Self-Management Skills Training
Session 11: Problem Solving
Session 12: Coping by Acting
Session 13: Coping by Thinking
Session 14: A Review of Problem Solving
Individual Counselling Session II
Unit IV: Social Skills Training
Session 15: Basic Communication Skills
Session 16: Assertion Training
Session 17: Using Social Skills in Personal Relationships
Unit V: Job Skills Refresher
Session 18: Employment Readiness
Session 19: Job Finding Skills
Unit VI: Leisure and Lifestyle
Session 20: Leisure and Lifestyle
Unit VII: Pre-Release Planning
Session 21: Pre-Release Planning Exercise
Session 22: Pre-Release Planning (Cont’d)Unit VIII: Relapse Prevention and Management
Session 23: Relapse Prevention
Session 24: Relapse Management
Unit IX: Post Testing and Graduation
Session 25: Programme Review and Post-Testing
Session 26: Graduation
Individual Counselling Session III
Maintenance
Additional results indicate that the combination of the programme with other interventions such as theCorrectional Service's Choices programme offered in the community and pariticipation in self-help
programmes decreased the recidivism rate further.

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E. Computerized Assessment of Substance Abuse (CASA)The Computerized Assessment of Substance Abuse is a computerized assessment system provides anassessment of substance abuse severity for both drugs and alcohol, along with measures of the link between
substance abusing behaviour and criminal activities. The system provides a written report to the parole
officer and this can be shared with the offender. Results of the assessment are used to determine the level ofprogramming required by the offender.
The system incorporates a number of unique features that improve its functionality within thecorrectional environment. Literacy is often a challenge with assessment systems but in addition to presenting
the questions in text form, offenders have the option of having the questions read to them along with thepossible responses.
The system also incorporates the Paulhus Deception Scale (Paulhus, 1999) that provides information on
the likelihood that an offender is answering in a manner designed to enhance his image, that is, is responding
untruthfully. The Paulhus Deception scale provides measures of Impression Management and Self-deception
Enhancement.
The system is also designed to be time efficient, so questions that do not apply to an offender are notasked. If at the beginning of the assessment an offender indicates he or she has never consumed alcohol thealcohol questions will not be asked. However, later in the assessment another question will be asked aboutalcohol use, but in a slightly different way. If they respond positively the second time they are asked all of
the alcohol questions.
One additional feature that was added to the system during the testing phase is a brief tracking game thatprovides the offender with the opportunity to practice mouse skills. Some offenders may be unfamiliar withusing a computer mouse so the game was designed to give them practice tracking a bouncing ball on thecomputer screen. After the practice session they are ready to proceed to the test.
Results from the testing are available immediately to the parole officers, but they are also stored in a data
file that is sent electronically to the Addictions Research Centre each month. These data are available foranalysis to develop profiles of offenders and other research activities. Data from the early version of thesystem have been shared with external researchers who have used the information to determine the costs ofcrime associated with drug use (Pernanen, Cousineau, Brochu & Sun, 2002).
F. International Experts ForumThe International Experts Forum was held in May 2002 and brought together 150 researchers, academics
and clinicians from across Canada and 10 other countries. The goal of the Forum was to develop priorities
for research and development in substance abuse for corrections. While the initial hope had been to develop
specific projects that could be worked on together in a collaborative manner, this proved to be an impossible
task. There was too much information to share about current research activities and research needs were toovaried to identify specific projects. The participants identified two broad issues, the need for collaborationand the need for additional research and development. For each of these, three themes emerged as presented
in Table 1. For each of the themes specific project ideas were also identified.
Table 1. Priorities for Research and Development in Substance Abuse and Corrections
Need for Collaboration(i) Provide opportunities for dialogue, networking and collaboration(ii) Communicate relevant and timely research results to a range of audiences(iii)Create a climate to foster dialogue that acknowledges and challenges existing ideologies and practices
Research and Development(iv) Research on the effectiveness of existing and emerging correctional models and interventions(v) Respond to the differing needs of offender populations including gender, culture/ethnicity, and age, as
well as issues related to mental & physical health(vi) Research on the impact of correctional cultures and environments on treatment models and regimes

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The proceedings of the Forum and the summary of the priority setting exercises that were undertaken at
the Forum are due for publication within the next two months (Grant, Hume & Kunic, 2004).
IV. SUMMARY AND CONCLUSIONS
A number of approaches to treating offenders with substance abuse problems have been reviewed anddiscussed. Overall, the most important approach is that of harm reduction that seeks to reduce the harms that
substance abuse causes to individuals and to communities. Using a harm reduction approach, criminal justiceagencies can work to reduce the impact of substance abuse on our communities. Samples of research studies
were presented to highlight various methodological issues and to demonstrate the integration of research andprogramme development within a correctional system.
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