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The purpose of this paper is to determine reconviction outcomes for 2,882 male and female offenders with significant alcohol and other drug (AOD) criminogenic needs, serving custodial sentences in New South Wales, between 2007 and 2011, who participated in the Getting SMART and/or the SMART Recovery® programs.

A quasi-experimental research design utilized data from 2,343 offenders attending Getting SMART; 233 attending SMART Recovery© and 306 attending both programs, compared to a propensity score-matched control group of 2,882 offenders. Cox and Poisson regression techniques determined survival times to first reconviction and rates of reconvictions, adjusting for time at risk.

Getting SMART participation was significantly associated with improved odds of time to first reconviction by 8 percent and to first violent reconviction by 13 percent, compared to controls. Participants attending both programs (Getting SMART and SMART Recovery©), had significantly lower reconviction rate ratios for both general (21 percent) and violent (42 percent) crime, relative to controls. Getting SMART attendance was associated with significant reductions in reconviction rates of 19 percent, and the reduction for SMART Recovery© attendance (alone) was 15 percent, the latter figure being non-significant. In all, 20 hours in either SMART program (ten sessions) was required to detect a significant therapeutic effect.

Criminal justice jurisdictions could implement this two SMART program intervention model, knowing a therapeutic effect is more likely if Getting SMART (12 sessions of cognitive-restructuring and motivation) is followed by SMART Recovery© for ongoing AOD therapeutic maintenance and behavioral change consolidation. SMART Recovery©, a not-for-profit proprietary program, is widely available internationally.

Getting SMART and SMART Recovery© have not previously been rigorously evaluated. This innovative two-program model contributes to best practice for treating higher risk offenders with AOD needs, suggesting achievable reductions in both violent and general reoffending.

This paper aims to describe: the need for substance misuse treatment with high risk, personality disordered prisoners, and the implementation of two evidence-based psychological interventions aimed at addressing substance misuse within a high secure, personality disorder treatment unit and potential future evaluation options.

In addition to the literature base evidencing the need for substance misuse treatment with this population, the Iceberg and ‘InsideOut’ interventions are presented. These interventions adopt a risk reduction and health intervention approach respectively. This includes explanations of how they came to be implemented within a prison based personality disorder treatment service and potential ways to evaluate these services.

Evidence-based psychological interventions can be implemented for this population whilst being responsive to changing government priorities for substance misuse treatment. The organisation’s research strategy includes an intention to evaluate these interventions in order to inform future delivery.

The high levels of co-morbidity between personality disorder and substance misuse disorders in the high security prison estate highlights the need for substance related treatment for this population. Given the responsivity issues relevant to personality disordered offenders, the format of delivery of evidence-based psychological interventions has to be considered.

This paper discusses the application of evidence-based psychological interventions for substance use within a high secure, personality disordered population which has developed as a result of ministerial changes within the treatment of both substance misuse and personality disorder.

The purpose of this paper is to inform the development of an evidence-based and effective rehabilitation programme to address substance use disorders in a population of patients with severe mental illness and mental disorders detained in a secure forensic psychiatric facility. A clinical review identified a high prevalence of substance use disorders in the patient population at a secure forensic facility in Sydney, Australia with only a limited number of patients being assessed and offered interventions for substance use problems.

A literature review was undertaken specifically looking at articles between 2009 and 2017 that considered models of care or approaches to substance use rehabilitation in patients with co-morbid psychiatric disorders. Articles were considered based on their relevance to the purpose and the environment of a secure forensic facility.

The literature review emphasised the need for a cohesive model of care integrating substance use rehabilitation with mental health care. Comprehensive assessment and individualised approaches that incorporated patient choice and stages of change were considered essential components to any dual diagnosis rehabilitation programme.

The literature regarding rehabilitation approaches for those with severe mental illness and co-morbid substance use disorders was reasonably consistent with the models of care used in relation to criminal offenders and mental illness generally. Integrated and individualised rehabilitation approaches for dual diagnosis patients could play a significant role in forensic settings.

Limited robust evidence for substance use rehabilitation has been published. The authors consider the existing evidence base and the underlying theory behind substance use rehabilitation to propose a model for rehabilitation in secure forensic settings. This is the first known review of substance use rehabilitation involving mentally ill offenders with dual diagnoses in secure forensic settings. This paper is the original work of the authors.