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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).
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Moral Reconation Therapy (MRT) | Experimental | 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. |
|
| Usual Care (UC) | No Intervention | Usual care provided by the mental health residential rehabilitation treatment programs, which patients in both groups are in. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Moral Reconation Therapy (MRT) | Behavioral | 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. |
| Measure | Description | Time Frame |
|---|---|---|
| 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. | 6 months (post-baseline) |
| 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. | 12 months (post-baseline) |
| Measure | Description | Time Frame |
|---|---|---|
| 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. | 6 months (post-baseline) |
| Drug Use |
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Inclusion Criteria:
Veterans who
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Daniel M. Blonigen, PhD MA | VA Palo Alto Health Care System, Palo Alto, CA | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Central Arkansas Veterans Healthcare System Eugene J. Towbin Healthcare Center, Little Rock, AR | North Little Rock | Arkansas | 72114-1706 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 29051795 | Result | Timko C, Booth BM, Han X, Schultz NR, Blonigen DM, Wong JJ, Cucciare MA. Criminogenic Needs, Substance Use, and Offending among Rural Stimulant Users. Rural Ment Health. 2017 Apr;41(2):110-122. doi: 10.1037/rmh0000065. | |
| 29514649 | Result | Blonigen DM, Cucciare MA, Timko C, Smith JS, Harnish A, Kemp L, Rosenthal J, Smelson D. Study protocol: a hybrid effectiveness-implementation trial of Moral Reconation Therapy in the US Veterans Health Administration. BMC Health Serv Res. 2018 Mar 7;18(1):164. doi: 10.1186/s12913-018-2967-3. |
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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.
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.
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| ID | Title | Description |
|---|---|---|
| FG000 | 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. |
| FG001 | Usual Care (UC) | Usual care provided by the mental health residential rehabilitation treatment programs, which patients in both groups are in. |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 6-month Follow-up |
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| ||||||||||||||||||
| 12-month Follow-up Interview |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | 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. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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. | 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). | Posted | Mean | 95% Confidence Interval | score on a scale | 6 months (post-baseline) |
|
Adverse event data was collected in the 12 months post-baseline for each participant.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | 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. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Death | Social circumstances | Non-systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Daniel M. Blonigen, PhD | Center for Innovation to Implementation, VA Palo Alto | 650-493-5000 | 27828 | daniel.blonigen@va.gov |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Jan 2, 2019 | Sep 13, 2021 | Prot_SAP_000.pdf |
| ICF | No | No | Yes | Informed Consent Form | Sep 16, 2016 | Sep 13, 2021 | ICF_001.pdf |
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| ID | Term |
|---|---|
| D000987 | Antisocial Personality Disorder |
| D019966 | Substance-Related Disorders |
| D000092862 | Psychological Well-Being |
| ID | Term |
|---|---|
| D010554 | Personality Disorders |
| D001523 | Mental Disorders |
| D064419 | Chemically-Induced Disorders |
| D010549 | Personal Satisfaction |
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Research Assistants conducting the 6- and 12- month outcome assessments are blinded to condition assignment.
|
|
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).
| 6 months (post-baseline) |
| 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) | 6 months (post-baseline) |
| 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. | 6 months (post-baseline) |
| 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). | 6 months (post-baseline) |
| 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. | 6 months (post-baseline) |
| 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. | 6 months (post-baseline) |
| 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. | 12 months (post-baseline) |
| 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). | 12 months (post-baseline) |
| 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) | 12 months (post-baseline) |
| 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. | 12 months (post-baseline) |
| 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). | 12 months (post-baseline) |
| 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. | 12 months (post-baseline) |
| 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. | 12 months (post-baseline) |
| VA Palo Alto Health Care System, Palo Alto, CA | Palo Alto | California | 94304-1207 | United States |
| VA Bedford HealthCare System, Bedford, MA | Bedford | Massachusetts | 01730-1114 | United States |
| 35080418 | Result | Blonigen DM, Smith JS, Javier S, Cucciare MA, Timko C, Nevedal AL, Filice N, Rosenthal J, Smelson D. Implementation Potential of Moral Reconation Therapy for Criminal Recidivism in Mental Health Residential Programs. Psychiatr Serv. 2022 Aug 1;73(8):856-863. doi: 10.1176/appi.ps.202100089. Epub 2022 Jan 26. |
| 35404638 | Result | Blonigen DM, Cucciare MA, Byrne T, Shaffer PM, Giordano B, Smith JS, Timko C, Rosenthal J, Smelson D. A randomized controlled trial of moral reconation therapy to reduce risk for criminal recidivism among justice-involved adults in mental health residential treatment. J Consult Clin Psychol. 2022 May;90(5):413-426. doi: 10.1037/ccp0000721. Epub 2022 Apr 11. |
| 40455528 | Derived | Ward M, Baldwin N, Blonigen DM. Assessing the impact of combat trauma on the severity, expression, and course of posttraumatic stress disorder in justice-involved veterans. Psychol Trauma. 2025 Jun 2:10.1037/tra0001950. doi: 10.1037/tra0001950. Online ahead of print. |
| 38140960 | Derived | Bowdring MA, Macia KS, Shaffer PM, Smelson D, Blonigen DM. Criminogenic Needs and Legal Problem Severity Among Legal System Involved Veterans. Mil Med. 2024 Jul 3;189(7-8):e1544-e1551. doi: 10.1093/milmed/usad472. |
| 36215912 | Derived | Timko C, Vest N, Cucciare MA, Smelson D, Blonigen D. Substance use and criminogenic thinking: Longitudinal latent class analysis of veterans with criminal histories. J Subst Abuse Treat. 2022 Dec;143:108893. doi: 10.1016/j.jsat.2022.108893. Epub 2022 Oct 1. |
| 32880104 | Derived | Gibbon S, Khalifa NR, Cheung NH, Vollm BA, McCarthy L. Psychological interventions for antisocial personality disorder. Cochrane Database Syst Rev. 2020 Sep 3;9(9):CD007668. doi: 10.1002/14651858.CD007668.pub3. |
| NOT COMPLETED |
|
|
| BG001 | Usual Care (UC) | Usual care provided by the mental health residential rehabilitation treatment programs, which patients in both groups are in. |
| BG002 | Total | Total of all reporting groups |
| Participants |
|
| Age, Continuous | Mean | Standard Deviation | years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race/Ethnicity, Customized | Count of Participants | Participants |
|
| Controlled environment | Count of Participants | Participants |
|
| Sites (U.S.) | Count of Participants | Participants |
|
| Days in the residential program | Median | Standard Deviation | Days |
|
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. |
| OG001 | Usual Care (UC) | Usual care provided by the mental health residential rehabilitation treatment programs, which patients in both groups are in. |
|
|
|
| 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. | 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). | Posted | Mean | 95% Confidence Interval | percentage of days abstinent (past 6 mo) | 6 months (post-baseline) |
|
|
|
|
| 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). | 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). | Posted | Mean | 95% Confidence Interval | Days (in past 6 months) | 6 months (post-baseline) |
|
|
|
|
| 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) | 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). | Posted | Mean | 95% Confidence Interval | friends with criminal involvement | 6 months (post-baseline) |
|
|
|
|
| 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. | 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). | Posted | Mean | 95% Confidence Interval | score on a scale | 6 months (post-baseline) |
|
|
|
|
| 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). | 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). | Posted | Mean | 95% Confidence Interval | score on a scale | 6 months (post-baseline) |
|
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|
|
| 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. | 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). | Posted | Mean | 95% Confidence Interval | score on a scale | 6 months (post-baseline) |
|
|
|
|
| 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. | 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). | Posted | Mean | 95% Confidence Interval | score on a scale | 6 months (post-baseline) |
|
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|
| 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. | 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). | Posted | Mean | 95% Confidence Interval | score on a scale | 12 months (post-baseline) |
|
|
|
|
| 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. | 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). | Posted | Mean | 95% Confidence Interval | percentage of days abstinent (past 6 mo) | 12 months (post-baseline) |
|
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|
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| 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). | 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). | Posted | Mean | 95% Confidence Interval | Days (in past 6 months) | 12 months (post-baseline) |
|
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|
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| 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) | 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). | Posted | Mean | 95% Confidence Interval | friends with criminal involvement | 12 months (post-baseline) |
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|
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| 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. | 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). | Posted | Mean | 95% Confidence Interval | score on a scale | 12 months (post-baseline) |
|
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|
|
| 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). | 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). | Posted | Mean | 95% Confidence Interval | score on a scale | 12 months (post-baseline) |
|
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|
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| 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. | 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). | Posted | Mean | 95% Confidence Interval | score on a scale | 12 months (post-baseline) |
|
|
|
|
| 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. | 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). | Posted | Mean | 95% Confidence Interval | score on a scale | 12 months (post-baseline) |
|
|
|
|
| 7 |
| 172 |
| 2 |
| 172 |
| 0 |
| 172 |
| EG001 | Usual Care (UC) | Usual care provided by the mental health residential rehabilitation treatment programs, which patients in both groups are in. | 12 | 169 | 4 | 169 | 0 | 169 |
Not provided
Not provided
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| D001519 | Behavior |
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) |
| Mixed Models Analysis |
Models adjusted for covariates (yielded estimated mean values of the outcome) and non-response weights based on completion of follow-up interviews. |
| >0.05 |
The threshold for statistical significance was p = 0.05 |
| Time x Condition at 6 mo.(Beta value) |
| 0.02 |
| 2-Sided |
| Superiority |
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) |
| Mixed Models Analysis |
Models adjusted for covariates (yielded estimated mean values of the outcome) and non-response weights based on completion of follow-up interviews. |
| >0.05 |
The threshold for statistical significance was p = 0.05 |
| Time x Condition at 6 mo.(Beta value) |
| 14.64 |
| 2-Sided |
| Superiority |
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) |
| Mixed Models Analysis |
Models adjusted for covariates (yielded estimated mean values of the outcome) and non-response weights based on completion of follow-up interviews. |
| >0.05 |
The threshold for statistical significance was p = 0.05 |
| Time x Condition at 6 mo.(Beta value) |
| 1.22 |
| 2-Sided |
| Superiority |
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). |
| Mixed Models Analysis |
Models adjusted for covariates (yielded estimated mean values of the outcome) and non-response weights based on completion of follow-up interviews. |
| >0.05 |
The threshold for statistical significance was p = 0.05 |
| Time x Condition at 6 mo.(Beta value) |
| 0.02 |
| 2-Sided |
| Superiority |
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) |
| Mixed Models Analysis |
Models adjusted for covariates (yielded estimated mean values of the outcome) and non-response weights based on completion of follow-up interviews. |
| >0.05 |
The threshold for statistical significance was p = 0.05 |
| Time x Condition at 6 mo.(Beta value) |
| 0.02 |
| 2-Sided |
| Superiority |
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) |
| Mixed Models Analysis |
Models adjusted for covariates (yielded estimated mean values of the outcome) and non-response weights based on completion of follow-up interviews. |
| <0.05 |
The threshold for statistical significance was p = 0.05. |
| Time x Condition at 6 mo.(Beta value) |
| -0.08 |
| 2-Sided |
| Superiority |
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) |
| Mixed Models Analysis |
Models adjusted for covariates (yielded estimated mean values of the outcome) and non-response weights based on completion of follow-up interviews. |
| >0.05 |
The threshold for statistical significance was p = 0.05. |
| Time x Condition at 6 mo.(Beta value) |
| 0.06 |
| 2-Sided |
| Superiority |
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) |
| Mixed Models Analysis |
Models adjusted for covariates (yielded estimated mean values of the outcome) and non-response weights based on completion of follow-up interviews. |
| >0.05 |
The threshold for statistical significance was p = 0.05 |
| Other[Time x Condition at 12 mo.(Beta v |
| -0.89 |
| 2-Sided |
| Superiority |
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) |
| Mixed Models Analysis |
Models adjusted for covariates (yielded estimated mean values of the outcome) and non-response weights based on completion of follow-up interviews. |
| >0.05 |
The threshold for statistical significance was p = 0.05 |
| Other[Time x Condition at 12 mo.(Beta v |
| 0.01 |
| 2-Sided |
| Superiority |
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 |
| Mixed Models Analysis |
Models adjusted for covariates (yielded estimated mean values of the outcome) and non-response weights based on completion of follow-up interviews. |
| >0.05 |
The threshold for statistical significance was p = 0.05 |
| Other[Time x Condition at 12 mo.(Beta v |
| 5.68 |
| 2-Sided |
| Superiority |
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). |
| Mixed Models Analysis |
Models adjusted for covariates (yielded estimated mean values of the outcome) and non-response weights based on completion of follow-up interviews. |
| <0.01 |
The threshold for statistical significance was p = 0.05 |
| Other[Time x Condition at 12 mo.(Beta v |
| 0.46 |
| 2-Sided |
| Superiority |
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). |
| Mixed Models Analysis |
Models adjusted for covariates (yielded estimated mean values of the outcome) and non-response weights based on completion of follow-up interviews. |
| >0.05 |
The threshold for statistical significance was p = 0.05 |
| Other[Time x Condition at 12 mo.(Beta) |
| -0.08 |
| 2-Sided |
| Superiority |
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). |
| Mixed Models Analysis |
Models adjusted for covariates (yielded estimated mean values of the outcome) and non-response weights based on completion of follow-up interviews. |
| <0.05 |
The threshold for statistical significance was p = 0.05. |
| Other[Time x Condition at 12 mo.(Beta)] |
| -0.07 |
| 2-Sided |
| Superiority |
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). |
| Mixed Models Analysis |
Models adjusted for covariates (yielded estimated mean values of the outcome) and non-response weights based on completion of follow-up interviews. |
| <0.05 |
The threshold for statistical significance was p = 0.05 |
| Other[Time x Condition at 12 mo.(Beta)] |
| -0.08 |
| 2-Sided |
| Superiority |
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). |
| Mixed Models Analysis |
Models adjusted for covariates (yielded estimated mean values of the outcome) and non-response weights based on completion of follow-up interviews. |
| >0.05 |
The threshold for statistical significance was p = 0.05. |
| Other[Time x Condition at 12 mo.(Beta)] |
| 0.08 |
| 2-Sided |
| Superiority |