Antisocial Personality Disorder, Substance Use Disorder
Conditions
Keywords
crime, mental health, substance abuse, homelessness, Veterans
Brief summary
The purpose of this study is to determine whether Moral Reconation Therapy (MRT) is effective for reducing risk of criminal recidivism and improving other health-related outcomes (substance use, mental health, housing, and employment problems) among justice-involved Veterans entering residential mental health treatment programs in the Department of Veterans Affairs (VA).
Detailed description
Approximately 146,000 Veterans are released each year from correctional settings; however, two thirds will likely reoffend and return to the justice system. Antisocial cognitions and behaviors are the strongest predictors of reoffending and are highly prevalent among justice-involved Veterans (JIVs). However, in the absence of treatments with demonstrated effectiveness with JIVs, no systematic approach to address antisocial cognitions and behaviors has been implemented in VA. Moral Reconation Therapy (MRT) is a cognitive-behavioral intervention that aims to reduce antisocial cognitions and behaviors. MRT has the best empirical support for reducing risk for criminal recidivism among civilian offenders, and its associated mechanisms (improvements in interpersonal functioning and impulse control) have been linked to improvements in health-related outcomes that are also risk factors for recidivism (substance use, mental health, housing, and employment problems). However, no trials have been conducted with JIVs. Differences between JIVs and justice-involved civilians (e.g., prevalence of traumatic brain injuries; interpersonal problems) suggests prior research on MRT with civilians may not be generalizable, and prompted the VA's Veterans Justice Programs (VJP) and the developers of MRT to develop a Veteran-specific curriculum of this intervention. Using the new Veteran-specific manual, the overarching objective of the current proposal is to implement and evaluate MRT as an intervention to reduce risk for criminal recidivism and improve health-related outcomes among JIVs in VA Mental Health Residential Rehabilitation Treatment Programs (MH RRTPs). Using a Hybrid Type 1 design, this project will test the effectiveness of MRT in a multisite Randomized Controlled Trial (RCT) (Palo Alto, Little Rock, and Bedford VAs) and conduct a formative evaluation to facilitate future implementation of MRT in VA.
Interventions
BEHAVIORALMoral Reconation Therapy (MRT)
MRT is a group-based cognitive-behavioral intervention to restructure antisocial thinking. Patients will receive two groups per week of this intervention for approximately 12 weeks, in addition to the usual care they receive in the mental health residential rehabilitation treatment program.
Sponsors
VA Office of Research and Development
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Research Assistants conducting the 6- and 12- month outcome assessments are blinded to condition assignment.
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Veterans who * (a) are entering a mental health residential rehabilitation treatment program (MH RRTP) at one of three study sites (Palo Alto, Little Rock, or Bedford VA), and * (b) had been arrested and charged and/or released from incarceration in the past 5 years prior to MH RRTP admission will be eligible for participation
Exclusion criteria
* The only exclusion criterion is being too cognitively impaired to understand the informed consent process and other study procedures.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Risk for Criminal Recidivism (Criminal Thinking) | 6 months (post-baseline) | The Psychological Inventory of Criminal Thinking Styles (56 items) was administered to assess criminal thinking. The measure includes scales of Mollification, Cutoff, Entitlement, Power Orientation, Super-optimism, Cognitive Indolence, and Discontinuity . Scores on these scales were summed to create a General Criminal Thinking score, which has been validated as an overall index of recidivism risk. Higher scores equate to more criminal thinking. Scores were converted to a T-score metric (M=50, SD=10), calculated in reference to norms from samples of incarcerated offenders. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Drug Use | 6 months (post-baseline) | The quantity and frequency of patients' self-reported drug use in the past 6 months, measured with the Timeline Follow-Back interview. It was administered at each time point to calculate for the past 6 months total number of days using any drugs (marijuana, cocaine, amphetamines, heroin, other opiates, benzodiazepines, barbiturates, inhalants, or hallucinogens). |
| Criminal Associates | 6 months (post-baseline) | Scale A of the Measures of Criminal Attitudes and Associates (MCAA; Mills, Kroner, & Forth, 2002) was administered at each interview to quantify participants' associations with criminal peers, a strong predictor of criminal recidivism (Mills, Kroner, & Hemmati, 2004). Participants were asked to consider the four adults (excluding family, co-workers, or other residents in treatment) with whom they spend the most free-time. A count variable was created by summing the number of friends for which the participant answered yes to any of the questions of criminal involvement (possible range=0-4, where a higher score indicates a worse outcome) |
| Employment Problem Severity | 6 months (post-baseline) | The Employment module of the ASI was administered at each timepoint to assess problem severity in this domain, using composite score indices (range 0 to 1); higher scores indicate greater problem severity. |
| Alcohol Use | 6 months (post-baseline) | The quantity and frequency of patients' self-reported alcohol use in the past 6 months, measured with the Timeline Follow-Back interview that was administered at the 6-month follow-up interview. |
| Legal Problem Severity | 6 months (post-baseline) | The Legal Status module of the Addiction Severity Index (ASI; McLellan et al., 2006) was administered at each interview to assess legal problem severity. The latter is based on a composite index derived from five items: Are you presently awaiting charges, trial, or sentence? How many days in the past 30 have you engaged in illegal activities for profit? How serious do you feel your present legal problems are? (0=Not at all, 4=Extremely) How important to you now is counseling or referral for these legal problems? (0=Not at all, 4=Extremely) How much money did you receive from illegal sources in the past 30 days? These items were standardized and aggregated and yield scores ranging from 0 to 1; higher scores indicate greater problem severity of legal problems. |
| Family/Social Problems | 6 months (post-baseline) | The Family/Social module of the ASI was administered at each timepoint to assess problem severity in this domain, using composite score indices (range 0 to 1); higher scores indicate greater problem severity. |
| Alcohol Use Problem Severity. | 6 months (post-baseline) | The Alcohol module of the ASI was administered at each time point to assess problem severity in this domain, using composite score indices (ranging from 0 to 1); higher scores indicate greater problem severity. ASI composite scores such as this have long been used to provide internally-consistent evaluations of a patient in a particular problem area (Grahn & Padyab, 2020). |
Countries
United States
Participant flow
Recruitment details
Recruitment began on April 4, 2016 from 3 VA Mental Health Residential Rehabilitation Treatment Program (MH RRTP) at Bedford, MA, Little Rock, AR, and Palo Alto, CA. Recruitment officially closed on July 31, 2018.
Pre-assignment details
A total of 344 participants were enrolled across the 3 sites but only 341 were randomized to either the intervention group or control group. Three participants decided to withdraw from the study for various reasons such as declining to finish the baseline interview or deciding that he/she did not want to participate.
Participants by arm
| Arm | Count |
|---|---|
| Moral Reconation Therapy (MRT) MRT is a group-based cognitive-behavioral intervention to restructure antisocial thinking. Patients will receive two groups per week of this intervention for approximately 12 weeks, in addition to the usual care they receive in the mental health residential rehabilitation treatment program.
Moral Reconation Therapy (MRT): MRT is a group-based cognitive-behavioral intervention to restructure antisocial thinking. Patients will receive two groups per week of this intervention for approximately 12 weeks, in addition to the usual care they receive in the mental health residential rehabilitation treatment program. | 172 |
| Usual Care (UC) Usual care provided by the mental health residential rehabilitation treatment programs, which patients in both groups are in. | 169 |
| Total | 341 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| 12-month Follow-up Interview | Lost to Follow-up | 45 | 41 |
| 6-month Follow-up | Lost to Follow-up | 53 | 45 |
Baseline characteristics
| Characteristic | Total | Moral Reconation Therapy (MRT) | Usual Care (UC) |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 12 Participants | 6 Participants | 6 Participants |
| Age, Categorical Between 18 and 65 years | 329 Participants | 166 Participants | 163 Participants |
| Age, Continuous | 46.21 years STANDARD_DEVIATION 12.168 | 45.83 years STANDARD_DEVIATION 12.191 | 46.60 years STANDARD_DEVIATION 12.169 |
| Controlled environment Alcohol or drug treatment | 265 Participants | 130 Participants | 135 Participants |
| Controlled environment Jail | 27 Participants | 17 Participants | 10 Participants |
| Controlled environment Medical treatment | 8 Participants | 2 Participants | 6 Participants |
| Controlled environment No | 24 Participants | 14 Participants | 10 Participants |
| Controlled environment Other | 5 Participants | 3 Participants | 2 Participants |
| Controlled environment Psychiatric treatment | 12 Participants | 6 Participants | 6 Participants |
| Days in the residential program | 91.868 Days STANDARD_DEVIATION 98.183 | 91.20 Days STANDARD_DEVIATION 96.035 | 92.55 Days STANDARD_DEVIATION 100.326 |
| Race/Ethnicity, Customized American Indian/Alaska Native | 6 Participants | 4 Participants | 2 Participants |
| Race/Ethnicity, Customized Asian/Pacific Islander | 6 Participants | 4 Participants | 2 Participants |
| Race/Ethnicity, Customized Black or African American | 97 Participants | 45 Participants | 52 Participants |
| Race/Ethnicity, Customized Hispanic or Latino/a, White | 16 Participants | 10 Participants | 6 Participants |
| Race/Ethnicity, Customized Other | 19 Participants | 12 Participants | 7 Participants |
| Race/Ethnicity, Customized White | 197 Participants | 97 Participants | 100 Participants |
| Sex: Female, Male Female | 16 Participants | 8 Participants | 8 Participants |
| Sex: Female, Male Male | 325 Participants | 164 Participants | 161 Participants |
| Sites (U.S.) Continental | 110 Participants | 55 Participants | 55 Participants |
| Sites (U.S.) Northeast | 120 Participants | 61 Participants | 59 Participants |
| Sites (U.S.) Pacific | 111 Participants | 56 Participants | 55 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 7 / 172 | 12 / 169 |
| other Total, other adverse events | 0 / 172 | 0 / 169 |
| serious Total, serious adverse events | 2 / 172 | 4 / 169 |
Outcome results
Primary
Risk for Criminal Recidivism (Criminal Thinking)
The Psychological Inventory of Criminal Thinking Styles (56 items) was administered to assess criminal thinking. The measure includes scales of Mollification, Cutoff, Entitlement, Power Orientation, Super-optimism, Cognitive Indolence, and Discontinuity . Scores on these scales were summed to create a General Criminal Thinking score, which has been validated as an overall index of recidivism risk. Higher scores equate to more criminal thinking. Scores were converted to a T-score metric (M=50, SD=10), calculated in reference to norms from samples of incarcerated offenders.
Time frame: 6 months (post-baseline)
Population: Intent to treat population (all participants assigned to MRT or UC) analyzed using mixed-effects models. Effectiveness was measured by the time x condition interaction term (UC as the reference group).
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Moral Reconation Therapy (MRT) | Risk for Criminal Recidivism (Criminal Thinking) | 53.66 score on a scale |
| Usual Care (UC) | Risk for Criminal Recidivism (Criminal Thinking) | 53.30 score on a scale |
p-value: >0.05Mixed Models Analysis
Comparison: Per protocol analysis, which included all UC participants (n=169) and only those in the MRT condition who had received the minimum recommended dose of the intervention - i.e., Step 3 or higher of MRT (n=63)p-value: >0.05Mixed Models Analysis
Primary
Risk for Criminal Recidivism (Criminal Thinking)
The Psychological Inventory of Criminal Thinking Styles (56 items) was administered to assess criminal thinking. The measure includes scales of Mollification, Cutoff, Entitlement, Power Orientation, Super-optimism, Cognitive Indolence, and Discontinuity . Scores on these scales were summed to create a General Criminal Thinking score, which has been validated as an overall index of recidivism risk. Higher scores equate to more criminal thinking. Scores were converted to a T-score metric (M=50, SD=10), calculated in reference to norms from samples of incarcerated offenders.
Time frame: 12 months (post-baseline)
Population: Intent to treat population (all participants assigned to MRT or UC) analyzed using mixed-effects models. Effectiveness was measured by the time x condition interaction term (UC as the reference group).
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Moral Reconation Therapy (MRT) | Risk for Criminal Recidivism (Criminal Thinking) | 50.96 score on a scale |
| Usual Care (UC) | Risk for Criminal Recidivism (Criminal Thinking) | 49.80 score on a scale |
p-value: >0.05Mixed Models Analysis
Comparison: Per protocol analysis, which included all UC participants (n=169) and only those in the MRT condition who had received the minimum recommended dose of the intervention - i.e., Step 3 or higher of MRT (n=63)p-value: >0.05Mixed Models Analysis
Secondary
Alcohol Use
The quantity and frequency of patients' self-reported alcohol use in the past 6 months, measured with the Timeline Follow-Back interview that was administered at the 6-month follow-up interview.
Time frame: 6 months (post-baseline)
Population: Intent to treat population (all participants assigned to MRT or UC) analyzed using mixed-effects models. Effectiveness was measured by the time x condition interaction term (UC as the reference group).
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Moral Reconation Therapy (MRT) | Alcohol Use | 94 percentage of days abstinent (past 6 mo) |
| Usual Care (UC) | Alcohol Use | 95 percentage of days abstinent (past 6 mo) |
p-value: >0.05Mixed Models Analysis
Comparison: Per protocol analysis, which included all UC participants (n=169) and only those in the MRT condition who had received the minimum recommended dose of the intervention - i.e., Step 3 or higher of MRT (n=63)p-value: >0.05Mixed Models Analysis
Secondary
Alcohol Use
The quantity and frequency of patients' self-reported alcohol use in the past 6 months, measured with the Timeline Follow-Back interview that was administered at the 12-month follow-up interview.
Time frame: 12 months (post-baseline)
Population: Intent to treat population (all participants assigned to MRT or UC) analyzed using mixed-effects models. Effectiveness was measured by the time x condition interaction term (UC as the reference group).
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Moral Reconation Therapy (MRT) | Alcohol Use | 94 percentage of days abstinent (past 6 mo) |
| Usual Care (UC) | Alcohol Use | 94 percentage of days abstinent (past 6 mo) |
p-value: >0.05Mixed Models Analysis
Comparison: Per protocol analysis, which included all UC participants (n=169) and only those in the MRT condition who had received the minimum recommended dose of the intervention - i.e., Step 3 or higher of MRT (n=63)p-value: >0.05Mixed Models Analysis
Secondary
Alcohol Use Problem Severity.
The Alcohol module of the ASI was administered at each time point to assess problem severity in this domain, using composite score indices (ranging from 0 to 1); higher scores indicate greater problem severity. ASI composite scores such as this have long been used to provide internally-consistent evaluations of a patient in a particular problem area (Grahn & Padyab, 2020).
Time frame: 6 months (post-baseline)
Population: Intent to treat population (all participants assigned to MRT or UC) analyzed using mixed-effects models. Effectiveness was measured by the time x condition interaction term (UC as the reference group).
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Moral Reconation Therapy (MRT) | Alcohol Use Problem Severity. | 0.09 score on a scale |
| Usual Care (UC) | Alcohol Use Problem Severity. | 0.06 score on a scale |
p-value: >0.05Mixed Models Analysis
Comparison: Per protocol analysis, which included all UC participants (n=169) and only those in the MRT condition who had received the minimum recommended dose of the intervention - i.e., Step 3 or higher of MRT (n=63)p-value: >0.05Mixed Models Analysis
Secondary
Alcohol Use Problem Severity.
The Alcohol module of the ASI was administered at each time point to assess problem severity in this domain, using composite score indices (ranging from 0 to 1); higher scores indicate greater problem severity. ASI composite scores such as this have long been used to provide internally-consistent evaluations of a patient in a particular problem area (Grahn & Padyab, 2020).
Time frame: 12 months (post-baseline)
Population: Intent to treat population (all participants assigned to MRT or UC) analyzed using mixed-effects models. Effectiveness was measured by the time x condition interaction term (UC as the reference group).
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Moral Reconation Therapy (MRT) | Alcohol Use Problem Severity. | 0.04 score on a scale |
| Usual Care (UC) | Alcohol Use Problem Severity. | 0.06 score on a scale |
p-value: >0.05Mixed Models Analysis
Comparison: Per protocol analysis, which included all UC participants (n=169) and only those in the MRT condition who had received the minimum recommended dose of the intervention - i.e., Step 3 or higher of MRT (n=63).p-value: <0.05Mixed Models Analysis
Secondary
Criminal Associates
Scale A of the Measures of Criminal Attitudes and Associates (MCAA; Mills, Kroner, & Forth, 2002) was administered at each interview to quantify participants' associations with criminal peers, a strong predictor of criminal recidivism (Mills, Kroner, & Hemmati, 2004). Participants were asked to consider the four adults (excluding family, co-workers, or other residents in treatment) with whom they spend the most free-time. A count variable was created by summing the number of friends for which the participant answered yes to any of the questions of criminal involvement (possible range=0-4, where a higher score indicates a worse outcome)
Time frame: 12 months (post-baseline)
Population: Intent to treat population (all participants assigned to MRT or UC) analyzed using mixed-effects models. Effectiveness was measured by the time x condition interaction term (UC as the reference group).
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Moral Reconation Therapy (MRT) | Criminal Associates | 0.37 friends with criminal involvement |
| Usual Care (UC) | Criminal Associates | 0.43 friends with criminal involvement |
p-value: >0.05Mixed Models Analysis
Comparison: Per protocol analysis, which included all UC participants (n=169) and only those in the MRT condition who had received the minimum recommended dose of the intervention - i.e., Step 3 or higher of MRT (n=63).p-value: <0.01Mixed Models Analysis
Secondary
Criminal Associates
Scale A of the Measures of Criminal Attitudes and Associates (MCAA; Mills, Kroner, & Forth, 2002) was administered at each interview to quantify participants' associations with criminal peers, a strong predictor of criminal recidivism (Mills, Kroner, & Hemmati, 2004). Participants were asked to consider the four adults (excluding family, co-workers, or other residents in treatment) with whom they spend the most free-time. A count variable was created by summing the number of friends for which the participant answered yes to any of the questions of criminal involvement (possible range=0-4, where a higher score indicates a worse outcome)
Time frame: 6 months (post-baseline)
Population: Intent to treat population (all participants assigned to MRT or UC) analyzed using mixed-effects models. Effectiveness was measured by the time x condition interaction term (UC as the reference group).
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Moral Reconation Therapy (MRT) | Criminal Associates | 0.43 friends with criminal involvement |
| Usual Care (UC) | Criminal Associates | 0.28 friends with criminal involvement |
p-value: >0.05Mixed Models Analysis
Comparison: Per protocol analysis, which included all UC participants (n=169) and only those in the MRT condition who had received the minimum recommended dose of the intervention - i.e., Step 3 or higher of MRT (n=63)p-value: >0.05Mixed Models Analysis
Secondary
Drug Use
The quantity and frequency of patients' self-reported drug use in the past 6 months, measured with the Timeline Follow-Back interview. It was administered at each time point to calculate for the past 6 months total number of days using any drugs (marijuana, cocaine, amphetamines, heroin, other opiates, benzodiazepines, barbiturates, inhalants, or hallucinogens).
Time frame: 12 months (post-baseline)
Population: Intent to treat population (all participants assigned to MRT or UC) analyzed using mixed-effects models. Effectiveness was measured by the time x condition interaction term (UC as the reference group).
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Moral Reconation Therapy (MRT) | Drug Use | 18.63 Days (in past 6 months) |
| Usual Care (UC) | Drug Use | 15.03 Days (in past 6 months) |
p-value: >0.05Mixed Models Analysis
Comparison: Per protocol analysis, which included all UC participants (n=169) and only those in the MRT condition who had received the minimum recommended dose of the intervention - i.e., Step 3 or higher of MRT (n=63p-value: >0.05Mixed Models Analysis
Secondary
Drug Use
The quantity and frequency of patients' self-reported drug use in the past 6 months, measured with the Timeline Follow-Back interview. It was administered at each time point to calculate for the past 6 months total number of days using any drugs (marijuana, cocaine, amphetamines, heroin, other opiates, benzodiazepines, barbiturates, inhalants, or hallucinogens).
Time frame: 6 months (post-baseline)
Population: Intent to treat population (all participants assigned to MRT or UC) analyzed using mixed-effects models. Effectiveness was measured by the time x condition interaction term (UC as the reference group).
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Moral Reconation Therapy (MRT) | Drug Use | 23.07 Days (in past 6 months) |
| Usual Care (UC) | Drug Use | 15.01 Days (in past 6 months) |
p-value: >0.05Mixed Models Analysis
Comparison: Per protocol analysis, which included all UC participants (n=169) and only those in the MRT condition who had received the minimum recommended dose of the intervention - i.e., Step 3 or higher of MRT (n=63)p-value: >0.05Mixed Models Analysis
Secondary
Employment Problem Severity
The Employment module of the ASI was administered at each timepoint to assess problem severity in this domain, using composite score indices (range 0 to 1); higher scores indicate greater problem severity.
Time frame: 6 months (post-baseline)
Population: Intent to treat population (all participants assigned to MRT or UC) analyzed using mixed-effects models. Effectiveness was measured by the time x condition interaction term (UC as the reference group).
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Moral Reconation Therapy (MRT) | Employment Problem Severity | 0.58 score on a scale |
| Usual Care (UC) | Employment Problem Severity | 0.61 score on a scale |
p-value: >0.05Mixed Models Analysis
Comparison: Per protocol analysis, which included all UC participants (n=169) and only those in the MRT condition who had received the minimum recommended dose of the intervention - i.e., Step 3 or higher of MRT (n=63).p-value: >0.05Mixed Models Analysis
Secondary
Employment Problem Severity
The Employment module of the ASI was administered at each timepoint to assess problem severity in this domain, using composite score indices (range 0 to 1); higher scores indicate greater problem severity.
Time frame: 12 months (post-baseline)
Population: Intent to treat population (all participants assigned to MRT or UC) analyzed using mixed-effects models. Effectiveness was measured by the time x condition interaction term (UC as the reference group).
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Moral Reconation Therapy (MRT) | Employment Problem Severity | 0.48 score on a scale |
| Usual Care (UC) | Employment Problem Severity | 0.53 score on a scale |
p-value: >0.05Mixed Models Analysis
Comparison: Per protocol analysis, which included all UC participants (n=169) and only those in the MRT condition who had received the minimum recommended dose of the intervention - i.e., Step 3 or higher of MRT (n=63).p-value: >0.05Mixed Models Analysis
Secondary
Family/Social Problems
The Family/Social module of the ASI was administered at each timepoint to assess problem severity in this domain, using composite score indices (range 0 to 1); higher scores indicate greater problem severity.
Time frame: 12 months (post-baseline)
Population: Intent to treat population (all participants assigned to MRT or UC) analyzed using mixed-effects models. Effectiveness was measured by the time x condition interaction term (UC as the reference group).
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Moral Reconation Therapy (MRT) | Family/Social Problems | 0.19 score on a scale |
| Usual Care (UC) | Family/Social Problems | 0.11 score on a scale |
p-value: <0.05Mixed Models Analysis
Comparison: Per protocol analysis, which included all UC participants (n=169) and only those in the MRT condition who had received the minimum recommended dose of the intervention - i.e., Step 3 or higher of MRT (n=63).p-value: >0.05Mixed Models Analysis
Secondary
Family/Social Problems
The Family/Social module of the ASI was administered at each timepoint to assess problem severity in this domain, using composite score indices (range 0 to 1); higher scores indicate greater problem severity.
Time frame: 6 months (post-baseline)
Population: Intent to treat population (all participants assigned to MRT or UC) analyzed using mixed-effects models. Effectiveness was measured by the time x condition interaction term (UC as the reference group).
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Moral Reconation Therapy (MRT) | Family/Social Problems | 0.1 score on a scale |
| Usual Care (UC) | Family/Social Problems | 0.1 score on a scale |
p-value: <0.05Mixed Models Analysis
Comparison: Per protocol analysis, which included all UC participants (n=169) and only those in the MRT condition who had received the minimum recommended dose of the intervention - i.e., Step 3 or higher of MRT (n=63)p-value: >0.05Mixed Models Analysis
Secondary
Legal Problem Severity
The Legal Status module of the Addiction Severity Index (ASI; McLellan et al., 2006) was administered at each interview to assess legal problem severity. The latter is based on a composite index derived from five items: Are you presently awaiting charges, trial, or sentence? How many days in the past 30 have you engaged in illegal activities for profit? How serious do you feel your present legal problems are? (0=Not at all, 4=Extremely) How important to you now is counseling or referral for these legal problems? (0=Not at all, 4=Extremely) How much money did you receive from illegal sources in the past 30 days? These items were standardized and aggregated and yield scores ranging from 0 to 1; higher scores indicate greater problem severity of legal problems.
Time frame: 12 months (post-baseline)
Population: Intent to treat population (all participants assigned to MRT or UC) analyzed using mixed-effects models. Effectiveness was measured by the time x condition interaction term (UC as the reference group).
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Moral Reconation Therapy (MRT) | Legal Problem Severity | 0.09 score on a scale |
| Usual Care (UC) | Legal Problem Severity | 0.09 score on a scale |
p-value: >0.05Mixed Models Analysis
Comparison: Per protocol analysis, which included all UC participants (n=169) and only those in the MRT condition who had received the minimum recommended dose of the intervention - i.e., Step 3 or higher of MRT (n=63).p-value: <0.05Mixed Models Analysis
Secondary
Legal Problem Severity
The Legal Status module of the Addiction Severity Index (ASI; McLellan et al., 2006) was administered at each interview to assess legal problem severity. The latter is based on a composite index derived from five items: Are you presently awaiting charges, trial, or sentence? How many days in the past 30 have you engaged in illegal activities for profit? How serious do you feel your present legal problems are? (0=Not at all, 4=Extremely) How important to you now is counseling or referral for these legal problems? (0=Not at all, 4=Extremely) How much money did you receive from illegal sources in the past 30 days? These items were standardized and aggregated and yield scores ranging from 0 to 1; higher scores indicate greater problem severity of legal problems.
Time frame: 6 months (post-baseline)
Population: Intent to treat population (all participants assigned to MRT or UC) analyzed using mixed-effects models. Effectiveness was measured by the time x condition interaction term (UC as the reference group).
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Moral Reconation Therapy (MRT) | Legal Problem Severity | 0.14 score on a scale |
| Usual Care (UC) | Legal Problem Severity | 0.13 score on a scale |
p-value: >0.05Mixed Models Analysis
Comparison: Per protocol analysis, which included all UC participants (n=169) and only those in the MRT condition who had received the minimum recommended dose of the intervention - i.e., Step 3 or higher of MRT (n=63)p-value: <0.05Mixed Models Analysis