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One hundred ninety-two convicted extrafamilial child molesters were followed for an average of 7.8 years after their conviction. The percentage of men who had committed a sexual, a violent, or any criminal offense by the 12th year was 15.1, 20.3, and 41.6, respectively. The sexual recidivists, compared with the nonrecidivists; demonstrated more problems with alcohol and showed greater sexual arousal to assaultive stimuli involving children than to mutually consenting stimuli with children. The violent recidivists, compared with the nonrecidivists, were more likely to have a history of violence in the families in which they were raised and were rated significantly more psychopathic on the Psychopathy Checklist--Revised (PCL-R). They also showed more sexual arousal to stimuli depicting mutually consenting sexual interactions with children than to adult stimuli. In terms of any criminal recidivism, recidivists were younger, had completed fewer years of school, and were raised in psychologically more harmful family environments compared with nonrecidivists. They also reported that, before 16 years of age, they were more likely to have been physically abused and were more likely to have been removed from their homes compared to those that did not recidivate. In addition, recidivists demonstrated more general hostility on the Buss-Durkee Hostility Inventory and were rated significantly more psychopathic on the PCL-R. The phallometric assessments revealed, that the criminal recidivists, compared to the nonrecidivists, showed more sexual arousal to stimuli depicting coercive sexual activity with children than consenting sexual activities with children. In addition, they showed more sexual arousal to scenes depicting adult rape then adult mutually consenting sex. Finally, the recidivists also had more charges or convictions for violence and any criminal acts. The small number of significant differences between recidivists and nonrecidivists in the sexual and violent categories precluded an attempt to determine which combination of factors meaningfully predicted reoffending. However, for criminal recidivism, a stepwise discriminant function analysis to assess the combination of factors that most successfully distinguished between groups in terms of criminal recidivism was significant, with subjects' age, total number of criminal convictions, and pedophile assault index being retained for optimal prediction. The procedure correctly classified 70.6% of the original group, 82.8% of the nonrecidivists, and 52.6% of the recidivists. PCL-R Total Score alone was equally successful in a similar discriminant function.
Sex Abuse 2000 Jul
PMID:Prediction of recidivism in extrafamilial child molesters based on court-related assessments. 1090 92

Over the last few years, there has been a growing tendency for opioid addicts to abuse multiple drugs, although many patients are in substitution therapy with methadone. Abuse of multiple drugs leads to a more complicated withdrawal syndrome; it is therefore necessary to investigate new drug strategies as a treatment for detoxification. Buprenorphine appears to be an effective and safe drug in opioid-addicted patient detoxification. In this study, we have compared the short-term efficacy of an 11-day low-dose buprenorphine/14-day carbamazepine regime [BPN/CBZ] (n = 14) to an 11-day methadone/14-day carbamazepine regime [MET/CBZ] (n = 12) in a double-dummy, randomized 14-day inpatient detoxification treatment study. Twenty-six inpatients met the DSM-IV criteria for opioid dependence and were included in this study. All patients abused various additional drugs. Fourteen of 26 patients (53.8 %) completed the study. Seven non-completers (seven of 12 = 58.3 %) were treated with methadone/carbamazepine and five non-completers (five of 14 = 35.7 %) received buprenorphine/carbamazepine, but the difference in the dropout rate was not significant. However, patients with buprenorphine/carbamazepine showed significantly fewer withdrawal symptoms after the first two weeks of treatment. The present study supports the hypothesis that buprenorphine/carbamazepine is more effective than methadone/carbamazepine in detoxification strategies for opioid addict with additional multiple drug abuse. No severe side effects occurred during treatment in either group.
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PMID:Detoxification of opiate addicts with multiple drug abuse: a comparison of buprenorphine vs. methadone. 1223 86

Exhibitionists have traditionally been regarded as nuisance offenders. However, empirical studies show that some offenders can be highly recidivistic and can escalate to incidents of Hands-on sexual assault. The objective of this study was to investigate predictors of recidivism in exhibitionists and clarify the differences between Hands-on and Hands-off sexual recidivists. The hundred and twenty-one exhibitionists were assessed at a university teaching hospital between 1983 and 1996. Archival data came from medical files and police files. The Psychopathy Checklist-Revised (PCL-R) was assessed retrospectively. Results indicated that over a mean follow-up period of 6.84 years, 11.7, 16.8, and 32.7% of exhibitionists were charged with or convicted of sexual, violent, or criminal offenses, respectively. Sexual reoffending recidivists were less educated, and had more prior sexual and criminal offenses. Violent, recidivists were also less educated, had lower Derogatis Sexual Functioning Inventory (DSFI) scores, higher PCL-R Totals, and more prior sexual, violent, and criminal offenses. Criminal recidivists were younger, less educated, had lower DSFI scores, higher PCL-R scores, higher Pedophile Indices, and more prior sexual, violent, and criminal offenses. Hands-on sexual recidivists demonstrated higher PCL-R ratings, higher Pedophile and Rape indices, and more prior sexual, violent, and criminal offenses than did Hands-off counterparts.
Sex Abuse 2002 Oct
PMID:Prediction of recidivism in exhibitionists: psychological, phallometric, and offense factors. 1237 91

The successful dissemination of empirically supported addiction therapies to community providers requires an appreciation of the characteristics of those practitioners who might be willing participants in this process of technology transfer. Clinicians (N = 66) from 11 community treatment programs associated with six research-clinic partnerships of the National Drug Abuse Clinical Trials Network volunteered to be trained in Motivational Interviewing or Motivational Enhancement Therapy (MET/MI) and were assessed prior to training. The sample of clinicians was heterogeneous in education and credentials, had a high level of counseling experience, reported using a wide range of counseling techniques and orientations, but had limited prior exposure to MET/MI or to the use of treatment manuals of empirically supported therapies. In general, many of the clinicians reported beliefs and techniques that were consistent with their stated theoretical orientation and recovery status. Relatively few participants reported relying on one dominant orientation or set of techniques.
J Subst Abuse Treat 2002 Dec
PMID:Characteristics, beliefs, and practices of community clinicians trained to provide manual-guided therapy for substance abusers. 1249 92

The purpose of the present study was to compare the responses of 27 incarcerated rapists and 27 incarcerated nonsexual offenders using the Rapist Empathy Measure (targeting victim specific empathy deficits) and to examine the relationship between empathy with self-esteem and psychopathy for both groups. The Social Self-Esteem Inventory was used as a measure of perceived social competence and the Psychopathy Checklist-Revised (PCL-R; Hare, 1991) was used as a measure of psychopathy. All participants completed the two self-report questionnaires on empathy and self-esteem; in addition, the rapists were required to complete an extra section of the empathy measure that assessed their empathic responses to their own victims. Demographic information and psychopathy scores were obtained by reviewing institutional files. When psychopathy scores were not available, subjects participated in a semi-structured interview and were scored on the Psychopathy Checklist-Revised by the researcher. Rapists demonstrated more empathy than the nonsexual offenders toward women in general and the same degree of empathy as the nonsexual offenders toward a woman who had been a victim of a sexual assault by another male. Of particular importance were the within-group comparisons across victim type for the rapists which revealed significant empathy deficits toward their own victim(s). Interestingly, no differences were found between the rapists and nonsexual offenders in terms of self-esteem and psychopathy, and neither self-esteem nor psychopathy significantly predicted empathy for either group. It was concluded from the present study that rapists may suppress empathy primarily toward their own victim rather than suffer from a generalized empathy deficit. It is suggested that empathy deficits in rapists might better be construed as cognitive distortions specific to their victims and should be addressed in that manner in treatment.
Sex Abuse 2003 Jan
PMID:Victim empathy, social self-esteem, and psychopathy in rapists. 1261 26

This study examined the role of the Psychopathy Checklist-Revised (PCL-R; R. D. Hare, 1991) and sexual deviance scores in predicting recidivism in a sample of 94 convicted rapists involuntarily admitted to a Dutch forensic psychiatric hospital between 1975 and 1996. The predictive utility of grouping offenders based on the combination of psychopathy and sexual deviance was also investigated. Measures were coded from pre-release institutional records. Recidivism (reconviction) data were retrieved from the Judicial Documentation Register of the Ministry of Justice and were related to PCL-R and sexual deviance scores. The follow-up period after release ranged up to 23.5 years (M = 11.8 years). Base rates for sexual, violent nonsexual, violent (including sexual), and general recidivism were 34%, 47%, 55%, and 73%, respectively. For all types of offending, offenders scoring high on the PCL-R (> or = 26) were significantly more often reconvicted than other offenders. The sexual deviance score was found to be a significant predictor of sexual reconviction. Survival analyses provided considerable evidence that psychopathic sex offenders with sexual deviant preferences are at substantially greater risk of committing new sexual offenses than psychopathic offenders without deviant preferences or nonpsychopathic offenders with or without sexual deviance. The findings are discussed in terms of their practical and clinical implications.
Sex Abuse 2004 Jan
PMID:Psychopathy and sexual deviance in treated rapists: association with sexual and nonsexual recidivism. 1501 23

This article presents the main outcome findings from two inter-related randomized trials conducted at four sites to evaluate the effectiveness and cost-effectiveness of five short-term outpatient interventions for adolescents with cannabis use disorders. Trial 1 compared five sessions of Motivational Enhancement Therapy plus Cognitive Behavioral Therapy (MET/CBT) with a 12-session regimen of MET and CBT (MET/CBT12) and another that included family education and therapy components (Family Support Network [FSN]). Trial II compared the five-session MET/CBT with the Adolescent Community Reinforcement Approach (ACRA) and Multidimensional Family Therapy (MDFT). The 600 cannabis users were predominately white males, aged 15-16. All five CYT interventions demonstrated significant pre-post treatment during the 12 months after random assignment to a treatment intervention in the two main outcomes: days of abstinence and the percent of adolescents in recovery (no use or abuse/dependence problems and living in the community). Overall, the clinical outcomes were very similar across sites and conditions; however, after controlling for initial severity, the most cost-effective interventions were MET/CBT5 and MET/CBT12 in Trial 1 and ACRA and MET/CBT5 in Trial 2. It is possible that the similar results occurred because outcomes were driven more by general factors beyond the treatment approaches tested in this study; or because of shared, general helping factors across therapies that help these teens attend to and decrease their connection to cannabis and alcohol.
J Subst Abuse Treat 2004 Oct
PMID:The Cannabis Youth Treatment (CYT) Study: main findings from two randomized trials. 1550 72

This study examined the relationship between recidivism and ratings of response to specialized cognitive behavioral treatment conducted in a prison setting among 418 sex offenders released to the community for an average follow-up period of over 5 years. As well as testing for a main effect for treatment ratings, the potential role of psychopathy assessed using the Psychopathy Checklist--Revised (PCL-R) as a moderator of response to treatment was investigated. Ratings of response to treatment failed to predict either serious (violent including sexual) or sexual recidivism. For the more inclusive outcome of serious recidivism, there was no significant interaction between psychopathy and treatment ratings; however, the ubiquitous effect of psychopathy on recidivism was found to be significant. For sexual recidivism, psychopathy was not significant as a main effect, but a significant interaction between psychopathy and treatment ratings was found. Among sex offenders with PCL-R scores of 25 or higher, those with ratings reflecting a more negative response to treatment recidivated sexually at a faster rate than others. This interaction effect was not significant when treatment noncompleters were removed from the data set. The results were discussed in terms of the methodology involved in the assessment of response to treatment among sex offenders.
Sex Abuse 2006 Jan
PMID:Sex offenders' response to treatment and its association with recidivism as a function of psychopathy. 1659 61

The relationships between psychopathy, sex offender type, sexual deviance, and recidivism were examined in 156 federally incarcerated sex offenders in a 10-year follow-up study. The rapists and mixed offenders demonstrated higher psychopathy scores than did the child molesters and incest offenders (total scores and Factor 2 scores on the Psychopathy Checklist--Revised [PCL-R]; R. D. Hare, 2003). Factor 1 scores were approximately the same in all groups. The PCL-R was a weak predictor of sexual recidivism but consistently predicted nonsexual violent recidivism and general recidivism (mainly via Factor 2). Sexual deviance measured by a structured rating scheme predicted sexual recidivism. Sexual deviance, so rated, was a stronger predictor of sexual recidivism than psychopathy but the two interacted significantly suggesting that psychopathy could potentiate sexual recidivism. Although psychopathy was a strong positive predictor of general nonsexual recidivism, sexual deviance was inversely related, and no interaction was observed between psychopathy, sexual deviance, and nonsexual recidivism.
Sex Abuse 2006 Jan
PMID:Psychopathy, sexual deviance, and recidivism among sex offenders. 1676 59

This study investigated differences in recidivism risk factors and traits associated with psychopathy among 3 groups of male adolescent sexual offenders (N=156): offenders against children, offenders against peers or adults, and mixed type offenders. Furthermore, those same variables were examined for their association with sexual and nonsexual recidivism and the 3 groups were compared for differences in rates of recidivism. Based upon both juvenile and adult recidivism data, 6.4% of the sample reoffended sexually and 30.1% reoffended nonsexually. Retrospective risk assessments were completed using the Juvenile Sex Offender Assessment Protocol-II (JSOAP-II) and the Psychopathy Checklist:Youth Version (PCL:YV). Comparisons of the 3 preexisting groups for differences on scale and factor scores were conducted using analyses of variance (ANOVAs). Differences among groups for recidivism were measured using survival curve analysis. Associations between risk scales and recidivism were measured using Cox regression analyses. Results suggest significant differences among the 3 offender groups on multiple scales of the JSOAP-II and PCL:YV, with mixed type offenders consistently producing higher risk scores as compared to those who exclusively offend against children or peers/adults. The Impulsive/Antisocial Behavior scale of the JSOAP-II and the Interpersonal and Antisocial factors of the PCL:YV were significant predictors of sexual recidivism. The Behavioral and Antisocial factors of the PCL:YV were significant predictors of nonsexual recidivism. Results supported previous research indicating that most adolescents who sexually offend do not continue offending into adulthood. Such results can lead to improved treatment by targeting specific risk factors for intervention and better use of risk management resources in the community, while preserving the most restrictive treatment options for the highest risk offenders.
Sex Abuse 2006 Oct
PMID:Risk factors for adolescent sex offender recidivism: evaluation of predictive factors and comparison of three groups based upon victim type. 1713 26


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