Evaluation of substance abuse assessments in forensic-correctional settings
Recent investigations have shown extremely significant relationships between substance abuse and violent crime (Lindqvist, 1991). Evaluations have indicated that post-treatment outcomes of substance abuse recidivism, criminal activity, and employment are all predicted by pre-treatment evaluations of these areas (Anglin & Hser, 1990). Although clearly an essential element of correctional treatment and risk-prediction, the ideal instrument has yet to be developed. Validity concerns have been identified for virtually all assessment techniques to date, with the weaknesses of face validity and the usage of improperly applied base rates being just two of the more apparent problems. Areas of specific concern, along with recent attempts to overcome these weaknesses, are explored.
Evaluation of Substance Abuse Assessments in Forensic-Correctional Settings
Substance abuse has long been associated with violence and criminal behavior. Lindqvist (1991) examined the criminal and substance abuse patterns of violent offenders identified as alcohol abusers. In a noteworthy finding, not a single offender identified within the study as an alcohol-abuser was sober during the commission of their crime. This well replicated finding generalizes beyond the extreme abuse population, with an evaluation of an incarcerated problem drinking population, but not necessarily alcohol dependent, indicating that 80% of offenders were intoxicated during their assaultive crimes (Mayfield, 1976). Studies showing the average consumption of ethanol prior to violent criminal acts show shockingly high levels, with an average alcohol intake equivalent to 18 beers (Beck et al., 1993).
The correctional components of the criminal justice system, namely correctional and forensic-psychiatric institutions, have the ethical and legal responsibility to provide valid assessments of incoming prisoners in order to identify potential disorders (Hart and Hemphill, 1989). Substance abuse assessments help to identify an offenderís treatment needs, so that they can be appropriately matched with an applicable treatment and release risk management strategy. Over the past twenty years several clinicians and researchers have criticized the assessment procedures currently being used with correctional populations, stating that they are failing to adequately uphold these responsibilities (Shah, 1978; Monahan, 1981; Morris & Miller, 1985; Serin & Barbaree, 1993).
The increasingly large amount of drug abusing inmates in today's criminal justice system clearly requires an expansion of drug treatment programs. The combination of these increasing numbers of substance abusers with then trend towards institutional cutbacks force decisions to be made in regards to which inmates will receive treatment (Peters, 1992). In order to make such valid treatment decisions appropriate assessments must be carried out.
Boland, Henderson, and Baker (1999) classified substance abuse measures along five dimensions. First is the simple screen, a short and concise test that looks for simply the presence or absence of a substance problem. The second dimension measured by many substance abuse tools is an elaboration on the extent and nature of the identified abuse. Thirdly, some assessment tools, those meant to be used once treatment has been initiated as a repeated measure, go beyond the initial diagnostic measures and assess changes associated with the current treatment. The fourth type of substance abuse assessment instrument includes the more comprehensive test batteries, which unlike the aforementioned tools serve multiple purposes. Comprehensive batteries can identify the presence and severity of abuse, identify related needs, and aid in treatment planning. The final measures used within substance abuse evaluations are the laboratory assessments, which are of primary use as biological checks of current and chronic substance abuse and have very little psychological usefulness.
While the clinician directed interview may be the preferred assessment technique by many practitioners, due to its ability to establish client rapport and prevent idiosyncratic interpretation of test items, it does not provide the practical methodology required for a correctional type setting.
The clinician who is relying on traditional methods of estimating future behavior, namely the clinical interview, are clearly disadvantaged and less likely to make an accurate assessment. The actuarial methods of assessment have been clearly shown as superior to clinical methods (Poythress, 1992).
Clinicians appear to confuse actual risk variables with those they believe, often inappropriately, are predictive (Cunningham & Reidy, 1999). One possible reason for this is the fact that clinicians rarely, if ever, get feedback regarding the accuracy of their predictions. As a result, confidence, unrelated to any increase in accuracy, grows over time (Cunningham & Reidy, 1999). Morris and Miller (1985) have stated that the non-actuarial clinical interviewing methods do not significantly add to the accuracy of psychometric measures.
Expedience alone favors the use of self-administered assessment instruments (Svanborg & Asberg, 1994). With the large number of incoming assessments to be completed, a shortage of qualified staff, and the need for reliable longitudinal evaluations, self-administered assessments are of particular importance (Mieczkowski, 1990).
Reviews of substance abuse treatment programs have demonstrated the importance of longitudinal assessment procedures. The increased reliability with psychometric measures, because of unmodified presentation of items at each administration, make administered assessment tools more statistically valid when used in a multiple assessment context (Carroll, Fielding, & Blashki, 1973). As a result, such instruments are also preferred in a legal domain, and thus are preferred in the correctional context (Broome, Knight, Joe, & Simpson, 1996).
Additionally, the use of test-retest psychometric evaluations provides an important measure of change. Such a measure would allow a continual retooling of treatment strategies, when necessary, and would also provide a valuable descriptor of therapeutic progress, which could be used for parole and recidivism-risk evaluations.
Despite the consistently suggestive findings regarding the importance of utilizing psychometric substance abuse assessments, an in depth review of substance abuse programs in Canadian correctional facilities found that 50% of survey respondents could not adequately define a structured substance abuse assessment process (Gendreau, Goggin, & Annie, 1990). In fact 10% of facilities clearly stated that no such program existed whatsoever.
That National Institute of Corrections (1991) has identified that there continues to be a pressing need to assess an offenderís needs in regards to substance abuse treatment. They have specifically recommended the creation and implementation of a standardized method of assessing abuse in the offender population. Secondly they have postulated that there is a need to carry out such assessments at the earliest possible opportunity, and continually throughout the offenders involvement with the correctional facility.
Literally, there are hundreds of different published instruments for usage in the assessment of substance abuse (Miller, Westerberg, & Waldron, 1995). The type of assessment tools used range greatly from simple self-report screens that take only minutes to complete, and minimal experience to assess to the extremely intricate structured psychometric interviews or test batteries. Unfortunately, even with so many instruments available for the assessment of substance abuse, no single instrument has been devised that adequately suits the needs of all clients, contexts, and evaluators (Babor, 1993).
Currently, correctional substance abuse assessment techniques are surrounded by a bevy of problems. Contextual concerns, issues with valid populations, and instrument design problems are common place, greatly effecting the ability for the correctional practitioner to complete a valid evaluation.
Brochu and Levesque (1990) recommend that an ideal substance abuse assessment instrument for a correctional context consists of evaluations of: (1) evaluation of the sequence between alcohol/drug use and first criminal activity; (2) family history of alcohol/drug abuse; (3) reasons for alcohol/drug use; (4) reasons for criminal behavior; (5) previous treatments for abuse; and (6) the willingness and ability towards change.
In a community context the goals of the assessment are to an extent different from those in the correctional setting. In the community the client, in regards to evaluation and treatment goals, is typically the abuser. The individual is being assessed so that the presence or level of substance abuse, and any other relevant psychological dysfunction, can be determined. Subsequently, treatment recommendations are formulated based upon this assessment. The ultimate goal of the entire process is the elimination of substance abuse within the individual and the return of appropriate functioning in any areas it had been significantly affecting.
In a correctional setting, however, there are significantly unique goals in substance abuse assessment and treatment. The correctional client is legally entitled to both medical and psychological/psychiatric treatment for any mental illness that has been deemed serious and curable. However, this constitutional/charter right for rehabilitation does not include alcohol or drug addiction. Subsequently, the failure to provide an individual with appropriate assessment or treatments for substance abuse is not a violation of their rights. The legal precedence appears to have changed the goals of the substance abuse programs in correctional facilities due to a shift in client responsibilities. With no responsibility towards the offender, the decision to provide substance abuse assessment and treatment can be given to the discretion of the institution. With the shift in goals the substance abuse program in prisons seems to be concerned entirely with recidivism. While an aspect of treatment is clearly involved in the goal of preventing recidivism, it is this decreased recidivism goal that drives the correctional approaches, not the means to that goal. These goals are expressed by the finding that virtually every evaluation of correctional assessment and treatment programs has focused on re-arrest (Swartz, Lurigio, & Slomka, 1996; Wexler, Falkin, Lipton, & Rosenblum, 1992). Prison substance abuse treatment evaluations rarely, if ever, investigate offender functioning, happiness with treatment, or any other variables related to client centered psychological functioning.
Surprisingly, however, none of the tools used in correctional settings have a measure of potential and predictive recidivism. One would suspect that such a measure would be critically important to the correctional assessment, especially since prediction of recidivism is often of the primary concern (Swartz, 1998). In fact, a good recidivism measure is important irregardless of the correctional rehabilitation goals. In a prison environment lowering a personís drug use may only be a result of an environment where it is both difficult to obtain substances and the absence of community factors that promoted the abuse prior to incarceration. A valid recidivism measure would aid in the identification of those individuals who would be at higher risk of reverting back to their old habits once their environment changes.
In order to be admitted into a correctional substance abuse treatment program an offenders assessment will typically describe an individual with a steady history of drug or alcohol abuse, combined with, as a result of that abuse, either a significant impairment in their psychosocial functioning or the presence of criminal behavior related to their abuse (Peters, 1992). Evidence of abuse or dependence includes withdrawal symptomology, lack of control over substance usage, and continual usage despite knowledge that it is effecting social functioning (American Psychiatric Association, 1994).
Additionally, Peters (1992) states that an offender who is unable or unwilling to recognize their current substance abuse habits will not typically be admitted to a primary substance abuse program. The difficulty in breaking down resistance with these individuals, who will not acknowledge the consequences of their substance related habits, is often incompatible with the common group treatment process. Unfortunately, individual therapy is impractical or impossible in most correctional settings due to the size of the client population and the shortage of qualified staff.
The criminal justice system, due to its substantially high proportion of substance abusers, provides the unique opportunity to offer services to abusers who would not have likely sought treatment by their own means (Tims & Leukefeld, 1992).
However, criminal offenders are often placed in treatment programs that have in the past been developed to serve voluntary clients (Farbee, Nelson, & Spence, 1993). Individuals who typically enter at treatment program tend to do so as the result of social or financial pressures that they are experiencing (Maddux, 1988). One should not jump to the conclusion that the needs of a voluntary client versus those of a legally referred client are the same.
None the less, most current assessment and treatment procedures assume a similarity between these two populations that has not been empirically established. Farbee, Nelson, and Spence (1993) postulated that while these two populations do clearly display similarities in some aspects, there is significant and highly relevant differences between the two groups.
Clients who have been placed into treatment in a correctional setting are less likely to have spent time evaluating themselves and their problems. Thereby, the criminal justice client is often less receptive to the therapeutic process that is devoted towards the adjustment of their behavior (Farbee, Nelson, & Spence, 1993). Hubbard, Collins, Rachal, and Cavanaugh (1988) found that clients who were entering a treatment program under legal regulation showed less satisfaction with the treatment then those who were entering such programs voluntarily. A significant number of criminal justice clients will only join treatment via this legal coercion, making them critically different from the populations that the assessment screens and treatment programs were both created for and validated with (Brown & Needle, 1994; Peters & May, 1992).
Kosten et al. (1998) suggested that the criminal justice client perceives, perhaps accurately, a threat of increased punishment or sanctions for their previous or current behavior. Subsequently, they significantly reduce their likeliness of self disclosure of alcohol and drug abuse. This perceived threat likely accounts for the extremely significant under-reporting of substance abuse tendencies and information in both the adult and juvenile populations (Mieczkowski et al., 1991; Feucht et al., 1994).
Even when they are informed that their information would remain confidential and that it would not effect their penalties, criminals populations appeared to remain prone to misrepresent, minimize, or deny substance use (Farabee & Fredlund, 1996). It is possible that an additional motivation towards the minimization of substance abuse habits is that offenders realize that drug treatment is not a simple and passive experience, and that a minimization of their abuse or dependence will lead to a less difficult incarceration or parole.
Farabee and Fredlund (1996) carried out an exploration of individual differences and deception within the criminal justice population, providing useful findings regarding which populations are more likely to misrepresent themselves. Ethnicity was significantly related to the misrepresentation of self reported drug abuse information. With minorities significantly under-reporting their substance abuse habits.
On a positive note, offenders who have previously undergone substance abuse treatment were twice as likely to report habits consistent with their actual abuse histories. This is an important finding, since those who have previously taken part in a substance abuse treatment program would clearly have a significantly relevant abuse history.
Clinical interviewers asked to rate the truthfulness of a clientís response style during a structured interview were able to significantly identify those individuals who were not confabulating, and thereby had some internal capability to detect deception (Farabee & Fredlund, 1996). Therefor, the addition of a clinical interview to any self-report screening instruments would seem warranted.
Beyond the minimization and denial of correctional clients substance abuse is the possibility that some correctional clients simply are naive to the extent and nature of their habits. Often offenders do not know the potency of the drugs they are using, or for that matter what the drugs even are (Rogers, Cashel, Johansen, Sewell, & Gonzalez, 1997). The offenders minimization of the nature of their abuse may occasionally be error and quite unintentional.
The possibility also exists that a criminal justice client may exaggerate the level of their substance abuse and dependency. While this situation may not occur as frequently as minimization, certain individuals may believe they will receive leniency if they attribute their crimes to the affects of substance abuse. A short treatment program can often appear more appealing than a long term of incarceration.
The Juvenile Delinquent Abuser.
Winters and Stinchfield (1995) state that the self-report questionnaires developed to assess adult usage and abuse of alcohol do not adequately make considerations for adolescent developmental factors in drinking and drug patterns.
Like adult offenders, adolescent delinquents clearly under-report their drug use (Winters, Stinchfield, Henly, & Schwartz, 1992). However, adolescents and adults, irregardless of the context, clearly report different factors affecting their usage and abuse of drugs. Adolescents tend to attribute their drug usage to different circumstances and etiological factors than the typical adult substance abuser. Juvenile abusers tend to relate their use of drugs to positive rather than negative reasons, and secondly to interpersonal reasons over internal ones (McKay, Murphy, McGuire, Rivinus, & Maisto, 1992). With adolescents a likely scenario of drug use occurs when one is feeling good or is out with friends. Drug use was found to be rarely associated with unpleasant emotions, interpersonal conflict, physical discomfort, or urges to use, attributions that were commonly associated with the patterns of abuse in adult populations (Maisto et al., 1988; Marlatt & Gordon, 1985).
With clearly different motivations and psychological needs between non-criminal substance abusers, substance abusing offenders, and juvenile delinquents, restructuring of assessment and treatment strategies may be beneficial for the legally referred juvenile clients (Farabee, Nelson, & Spence, 1993).
Dembo (1995) advocates for the need of more integrated and interrelated assessment services in the criminal justice system. With addition to preliminary screening, which is used to identify potential alcohol and drug use and related problems, a more in-depth and broad assessment is required. This process serves to document both the nature and the seriousness of the previously identified abuse, and subsequently to develop an appropriate intervention. To this date, however, in-depth assessments in the juvenile and adult justice systems has been an exception to the norm.
Due to the inability to give comprehensive assessments to every incoming offender, a quick and simplistic substance abuse screening strategy is typically applied in order to identify potential clients that may require further evaluation. A typical substance abuse screen may involve a short series of questions administered by a front-end officers of the correctional institution. General questions regarding substance abuse history ("Do you have a drug or alcohol problem?") and motivation for treatment ("Would you participate in a drug treatment program?") are typical (Peters, 1992). Ideally, the purpose of the front-end substance abuse screen is to quickly identify individuals who are potentially substance abusers or substance dependent. Once identified these individuals would typically be referred for further assessment, where a more valid and meaningful test battery would aid in the verification of substance problems, identify problem areas, and provide possible treatment recommendations.
The problem with developing a brief screening instrument for self-administered use is that face validity becomes an issue. Any offender being assessed who does not acknowledge, or desire others to know, that there is a dysfunctional substance abuse pattern can easily realize what the questions are looking for and could easily go undetected (Otto & Hall, 1988).
Improper Normative Samples.
With the vast number of screening instruments presently being used to determine drug abuse and drug dependence in various populations as well as the highly correlated relationship between crime and substance abuse, one would expect that sufficient instruments would be available for criminal justice clients. However, those instruments widely used have not been sufficiently normed on this significantly distinct client population (Swartz, 1998).
The most popular substance abuse assessment instruments were designed for individuals seeking admission and treatment within a drug rehabilitation program. The primary goal of such assessment tools is to assess and classify addicted clients who are acknowledging that they have a substance abuse problem and who are seeking help for that problem based on their own motivations (Swartz, 1998).
One of the most commonly used substance abuse instruments is the Addiction Severity Index (ASI), a comprehensive instrument that examines the substance problem area, legal problems, and family/social problems (McLellan et al., 1992). Because of the instruments breadth it is popular in comparison to those assessment tools that only examine frequency of substance use. The diverse areas of the ASI allow for an assessment of functional impairment, wich is required for an appropriate DSM-IV diagnosis and treatment considerations.
McLellan and colleagues (1992) showed the ASI to be a reliable and valid assessment inventory among substance abusers applying for treatment. Related fields have used this information to support the usage of the ASI with other substance abusing populations. The ASI has an extensive history of use withing the substance abusing forensic population. However, the designers of the ASI state that while they did consult with a number of researchers within the forensic areas, there has been no published studies determining the nature of the instruments reliability or validity within the populations (McLellan, et al, 1992).
The ASI is used by a trained interviewer who typically administers it to a treatment-seeking population in an environment in which there is little reason for the abuser to misrepresent themselves. Even in this situation, however, some misrepresentation occurs (McLellan et al., 1992). The circumstance in which an individual is being evaluated for a probationary, parole, or possible sentencing there is clearly an increased motivation towards misrepresentation of which the ASI was not designed to assess.
In an attempt to identify misrepresentation a number of clinical instruments have consistency checks incorporated into the scales. Miller (1985) found that more then 80% of clients using his own Substance Abuse Subtle Inventory (SASSI), an instrument specifically designed to not to allow clients to easily minimize their abuse habits, were able to conceal their drug abuse and usage. He stated that there is indeed a need for lie and validity scales via more complicated instruments with not so obvious face validity. While these may be of some benefit in identifying misrepresentation, they are in no way substitutes for empirical evaluations of an instruments validity and reliability with abusers in the criminal justice system.
While the non correctional instruments provide a more in depth assessment of functioning, it is difficult to use these instruments validly because the base rates of the normative sample are not formulated on a correctional population. The base rate is a statistical measure of the prevalence of an assessed behavior over a set period of time and in a specific population. Base rates are the fundamental statistic in assessment and is seen as the most important type of information in assessments (Webster, Harris, Rice, Cormier, & Quinsey, 1994). If a clinician undertaking an assessment uses an instrument validated on a population unique from the normative sample and does not modify the estimates for the unique context of prediction significant errors could result (Monahan, 1981; Shah, 1978).
A few screening and assessment instruments, such as the Offender Profile Index, have been developed with the criminal justice populations in mind (Inciardi, McBride, & Weinman, 1983). However, for the most part these instruments are neither being used regularly or have they had their reliability or validity empirically demonstrated. This is partially because a number of these tools are created within assessment facilities and have not been pressured to do empirical analysis (Hepburn, 1994).
While a discussion of commorbidity is somewhat beyond the scope of this article, multiple diagnosis is key in the effective evaluation of the alcohol abusing incarcerated offender. Alcoholics with antisocial personality disorder have been shown to be significantly different from their non antisocial counterparts in background and prognosis (Schuckit & Russel, 1984; Coid, 1982). Additionally, the sociopathic alcoholics are significantly more likely to be intoxicated during violent acts (Virkkunen, 1979).
Treatment outcomes can also be affected by commorbidity. Individuals who have been assessed as having a number of psychopathological characteristics or dual diagnosis display especially poor prognosis and treatment outcomes (Rounsaville, Dolinsky, & Babor, 1987). The treatment of these commorbid mental illnesses may be essential in the successful treatment and resolution of substance abuse issues.
Certain social characteristics are also helpful in identifying which offenders are appropriate candidates for substance abuse treatment. For example, offenders who have a history of drug dealing are typically inappropriate individuals for the typical group therapy context that occurs within correctional institutions (Peters, 1992). Such offenders will frequently undermine the treatment process by leading other inmates to questions newly developed attitudes and beliefs, encouraging a return to maladaptive behaviors. It is important that a comprehensive assessment tool includes evaluations of criminal history, so those offenders with drug dealing histories are identified and directed towards alternative treatment strategies.
Contextual variation is a unique concern that goes beyond the aforementioned instrumental issues. One must also consider that the environment in which the behavior of concern (in this case substance abuse), including all of its situational, interpersonal, and influential factors, is quite different between prison and the community where the abuse or dependence was initially an issue (Monahan, 1996). With the convergence of such factors not being adequately replicated in prison, an individuals behavioral patterns might be assessed quite differently then they would be within a less controlled context. While alcohol and drugs are available in prison to some extent, it is not nearly as readily available as it is in the community. Subsequently, the degree of abuse tends to be significantly lower.
Substance abuse assessment tools, generally developed on a community based abuser sample, tend to be very concise on their query of specific substances of abuse. Currently instruments may not adequately identify abuse of the non-typical substances encountered in a prison environment. While abuse of alcohol, cocaine, and other hard drugs may be lowered or cease entirely in a prison environment, an individual may not be as substance free as the psychometric evaluations indicate. While the abuse of the more common substances may have decreased, or been eliminated, usage may have been replaced by new substances of abuse that the community based substance abuse screens were not designed to identify. A valid correctional substance abuse instrument should evaluate this wide range of potential substances of abuse. While recognizing that drug and alcohol trafficking in prisons is minimized, a measure is required that is not naive to home made substances that do exist in the prison environment. For the most part, abuse of these substances is not queried by any of the current assessment tools.
An additional, and epidemic, problem with the assessment of substance abuse populations in a correctional context is the extremely large amount of clients that must be assessed in a very limited amount of time (Belenko, 1990; Heaps & Swartz, 1995). With the very large population that must be assessed upon entry into the correctional system there is clearly not enough time for extensive interviews and assessments. A structured screening assessment interview like the popular Alcoholism Screening Inventory (ASI), which can take upwards to forty-five minutes to complete, is far to long a process to undertake in combination with other required assessments.
Additionally, the unavailability of adequately trained clinicians to conduct such assessments is of particular concern (Swartz, 1995). With the presence of very few qualified clinicians to carry out initial screenings there is a growing need for an instrument that does not require considerable clinical ability for appropriate administration and scoring (Swartz, 1998). A desirable assessment instrument would provide a set of objective, invariant criteria, that does not require a high degree of clinical skill for administration or scoring. Once screening is completed a funneling process can occur, in which clients who need further evaluation can be referred for further in depth assessments.
Commonly used community based substance abuse assessment tools also do not consider the complexity of the prison population. In the correctional setting we have multiple goals with the substance abuse assessment. The correctional subject is like its community counterpart in that he/she is being assessed for a potential alcohol or drug problem. However, this population is unique in that they are a criminal population. With the correctional alcohol and drug assessment one must not only look at the issue of substance abuse, but also the nature of its relationship with violence and criminal activities. Popular assessment methods that evaluate the abusers personality via self reported behaviors and consumption are inadequately conceptualized and do not provide the information required for proper evaluation and treatment recommendations (Brochu & Levesque, 1990).
Biological Assessment Strategies
From a clinical perspective, a complete drug history remains an essential component for diagnosis and treatment planning, and should not be excluded from other means of psychiatric and physical examinations (authors, 1998). However, with the reliability of self-report methods of illegal activities coming increasingly under doubt alternative methods have been adopted into a number of correctional facilities (Mieczkowski, 1990). Feucht, Stephens, and Walker (1994) state that two alternatives to self-report information are urinalysis and hair assay. Combined these techniques have the ability to detect the amount and frequency of drug use from a period ranging from most recent use to abuse over the past several months. While there are some methodological concerns with these techniques these issues are irrelevant to the issue at hand and are thereby beyond the scope of this article (Kidwell, 1990; Holden, 1990).
Methodological issues aside, the functional use of biochemical assessment techniques is greatly limited, and if used as the only screen for substance abuse or dependence it is also an area of great concern. Biological assessment techniques should only be employed as a tool complementary to standardized psychological assessments. Their use in determining the severity of substance abuse problems is virtually non existent. However, they have some utility as a biological validity check for offenders who may be purposefully providing inaccurate information regarding their current substance related habits.
The Correctional Services of Canada Approach
Based on the results of substance abuse program evaluations, many of the existing Canadian substance abuse assessment and treatment strategies were highlighted as needing revisions (Gendreau, Goggin, & Annis, 1990). Relatively unsophisticated assessment techniques and insufficient evaluations were commonplace, even though recognition of these procedures as being insufficient in their current form had been an area of concern for some time.
As a result of this evaluation the Correctional Service of Canada (CSC) devised and adopted a computerized approach to inmate assessments (Correctional Service of Canada, 1990). The Correctional Services of Canada Lifestyle Assessment Instrument (LIS) includes a wide range of assessment areas related to substance abuse, areas that have been identified as key dimensions in a comprehensive assessment. Areas include such diverse dimensions as nutrition, physical and mental health, social relationships, familial patterns and relationships, criminal behavior, and readiness for substance abuse treatment.
The LIS is subdivided into three primary domains: alcohol abuse, drug abuse, and interventions. The two substance abuse domains have a variety of items devised psychometrically to identify abuse patterns, situations and contexts where the abuse occurs, and finally environmental and biological variables that may interfere with treatment and recovery. The intervention domain examines past treatment histories.
The Lifestyle Assessment Instruments first role is to allow initial comprehensive screenings that assess an offender for substance abuse risk factors, and subsequently match the client to an appropriate intervention if needed. Secondly, the LIS is used as an instrument for continual assessment. Through out the treatment process the offender is continually reassessed and treatment recommendations are modified when needed. The reassessment process continues from the initial evaluation at first admission up to the full release of the offender into the community
The Correctional Services of Canada (1990) believes that a primary advantage of the LIS is its self administered computer approach. The computerized administration of this instrument allows every incoming offender to complete a large assessment instrument that is not limited by staffing issues or face validity concerns of the short screening instruments.
Additionally, it was expected that offenders would respond more honestly to a computer than an interviewer, though this assumption may be naive since it has yet to be empirically validated.
The LIS has limitations similar to other self-administered comprehensive test batteries. The non-interview format always creates the potential of a subject misinterpreting the question as well as particular difficulty with offenders with very low levels of literacy. Additionally, the computer based administration format adds a possible difficulty of administering the LIS to offenders who have great difficulty with computers. However, the presence of an individual who can clarify questions that may arise due to these limitations could possibly eliminate many administration problems.
While not yet having its own empirical studies of validity, the Lifestyle Assessment Instrument is the combined product of two well validated psychometric instruments, the Drug Abuse Screening Test (DAST) and the Alcohol Dependence Scale (ADS), and therefore expectations of validity are promising (Correctional Service of Canada, 1990). However, the nature of the normative population and its relevance to a correctional population remains a valid concern.
Reviewers of the LIS believe it sufficiently covers all the essential areas needed to ensure an existing substance abuse problem is spotted and its severity determined (Boland, Henderson, & Baker, 1999). With over two-hundred items allocated for the three substance abuse domains alone the LIS is as comprehensive as any popular community based assessment tools. Additionally, its format of administration allows the instrument to be applied to every incoming offender, something no other test has been able to accomplish to date.
Substance abuse has become an exceedingly important issue within the correctional component of the criminal justice system. Recent investigations have shown extremely significant relationships between substance abuse and violent crime (Lindqvist, 1991). Program evaluations have indicated that post-treatment outcomes of substance abuse recidivism, criminal activity, and employment are all predicted by pre-treatment evaluations of these areas (Anglin & Hser, 1990). Which such high risks being associated with this disorder, and the potential recidivism of criminal behavior influenced by it, accurate assessments and appropriate treatments have become paramount to the safe reintegration of these offenders into the community.
There are several different approaches to substance abuse assessment. Self report questionnaires, structured or unstructured clinical interviews, comprehensive test batteries, biological markers, or a combination of the aforementioned strategies. While a great deal of clinicians prefer to use the unstructured clinical interview, its validity is clearly questionable. The limited effectiveness of this approach, combined with an ever growing offender population and staffing cut-backs make this technique, valid or not, very impractical.
The preferred technique, at least in a validity sense, is the comprehensive psychometric assessment instrument. Hundreds of substance abuse assessment tools are currently available. The effectiveness of these tools with a correctional substance abusing clientele is questionable. Sufficient validity studies have not been performed in the correctional environment. There is very clear distinctions between the correctional populations these tests are being administered to and those populations their normative data was based on. The distinct differences in client attributes, context, and assessment goals make the usage of community based substance abuse assessment instruments an area of concern.
Research has continually criticized the current assessment procedures being used with correctional populations (Serin & Barbaree, 1993). The commonly used technique of an initial screening instrument identifying potential individuals for further in depth assessment seems attractive and practical. However, the combination of blatantly high face validity with a population that tends to be purposefully deceptive suggests that a great deal of offenders who could benefit from a proper assessment and treatment may be remaining unidentified.
The development of a comprehensive assessment tool, that includes methods of deception detection, seems necessary. Brochu and Levesque (1990) recommend that an ideal substance abuse assessment instrument for a correctional context consists of evaluations of: (1) evaluation of the sequence between alcohol/drug use and first criminal activity; (2) family history of alcohol/drug abuse; (3) reasons for alcohol/drug use; (4) reasons for criminal behavior; (5) previous treatments for abuse; and (6) the willingness and ability towards change.
Alternative biological methods of assessment do exist. However, when compared to psychological measures, such methods lose a great deal of information that may be particularly relevant to therapeutic and recidivism evaluations. The application of such biological indicators should only be considered as complimentary to psychological assessment, and may possibly provide a good indicator of potential deception.
The introduction of the Correctional Services of Canada Lifestyle Assessment Instrument is encouraging. This standardized assessment procedure that is now being applied in correctional institutions across the entire country has been identified as having all the major components needed for an appropriate correctional substance abuse assessment (Boland, Henderson, & Baker, 1999). While the instrument remains to be empirically validated, its design is adapted from two well accepted substance abuse assessment instruments. The LISís self-administered computer format allows this intricate test battery to be applied to all incoming offenders, eliminating the need for a questionably valid screening instrument and possibly even limiting the minimization of substance abuse typical of the correctional population.
Hepburn (1994) concluded that the ideal instrument has yet to be developed. Validity concerns have been identified for virtually all assessment techniques to date, with the weaknesses of face validity and the usage of improperly applied base rates being just two of the more apparent problems. The creation of the computer based LIS appears to be a step in the right direction. However, this instrument cannot be accepted at face value alone and empirical validation of the instrument is most certainly required.
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Written By Michael W. Decaire - 01/04/01