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Book Forum: Substance Abuse and Comorbidity   |    
Substance Abuse Treatment for Criminal Offenders: An Evidence-Based Guide for Practitioners
GREGORY B. LEONG, M.D.
Am J Psychiatry 2004;161:588-589. doi:10.1176/appi.ajp.161.3.588
View Author and Article Information
Tacoma, Wash.

By David W. Springer, Ph.D., C. Aaron McNeece, Ph.D., and Elizabeth Mayfield Arnold, Ph.D., L.C.S.W. Washington, D.C., American Psychological Association, 2003, 249 pp., $39.95.

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This book is part of the Forensic Practice Guidebooks series published by the American Psychological Association. One may question the need to even consider a book written about substance abuse treatment, since many already exist. Moreover, for more than a decade organized medicine has officially recognized the subspecialties of addiction psychiatry and forensic psychiatry, and an important work at the intersection of these two psychiatric subspecialties would have been anticipated. Curiously, however, the professional literature lacks a current comprehensive critical review on the topic of treatment of criminal offenders with substance use disorders.

A key premise of the book is the utilization of an "evidence-based" approach. The evidence-based approach, the catchy new phrase in the medical literature these days, is really nothing more than solid scientific inquiry. By taking this approach the authors provide a fresh look at the treatment of substance users in the criminal population. Because a substantial proportion of the criminal offender population suffers from substance use disorders, this review is not merely an academic exercise but has significant societal implications. The authors directly posit that the "War on Drugs," initiated by then President Nixon, is not winnable; they emphasize that treatment of substance-using criminal offenders and not incarceration has been the only effective way to decrease substance abuse and drug-related crimes.

From this starting point, the authors examine individual, family, and group treatment. Traditional and innovative treatment settings and approaches are also explored. What sets this book apart from others is that the authors have undertaken a concerted effort to explore the available research in three important offender subpopulations—juveniles, women, and minorities. Their review highlights the gaps in our knowledge of these subpopulations in the context of substance abuse treatment.

Of interest to psychiatrists is the chapter on offenders with dual diagnoses. In addition to the traditional individual with an axis I mental disorder and a substance use disorder, there is discussion of those with an axis II mental disorder and a substance use disorder. The authors point out that individuals with certain diagnoses have better outcomes with a particular treatment approach. This finding is also highlighted in the other chapters covering the different treatment modalities. This theme has important programmatic implications because the trend has been to implement substance abuse treatment with modalities that are locally available and not necessarily tailored for many who receive treatment. In our current climate of limited resources, identifying and using the most effective treatment approaches for substance abuse among criminal offenders become especially important.

This book is best considered as a guidebook to the best practices in the treatment of criminal offenders with substance use disorders. Psychiatrists who work with or have interest in patients with substance use disorders and/or correctional patients will find this book required reading to stay abreast of the psychosociocultural component in treating these often challenging patients. The psychiatrist or physician reader should be forewarned that there is only a very brief mention of psychopharmacological approaches, although it is up-to-date. The book is relatively short and can be quickly digested. Fifty-three pages of references point the reader toward further exploration. Equally as important as the mental health clinician readership for this book would be those with programmatic or fiduciary responsibilities, so they may be able to support the treatment approaches that work and discard the approaches that have been found to be of little or very limited utility.

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