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"Treatment of High-Risk Sexual Offenders addresses concrete management strategies, from initial intake to community treatment programs, and describes a detailed program for high risk offenders which has been developed, tested and refined for over 15 years. Provides a thorough review of contemporary theory and research relating to complex, challenging populations, and translates it into a comprehensive system of assessment and treatment for high risk sexual offenders Offers detailed coverage of setting and staff requirements, the importance of the therapeutic alliance, and how to balance individual therapy with group components in order to develop social and self-management skills Builds on the principle of integrative care, drawing on the established Risk-Need-Responsivity (RNR) model for offender assessment and rehabilitation but adding new components of CBT and motivational interviewing Includes a complete assessment battery and strategies for managing serious mental illness and comorbidity "--

According to a literature review by Marshall (1996), presently available data have not clarified the proportion of sexual offenders who would meet diagnostic criteria for addictive problems. Our own literature review failed to find published studies comparing sexual offenders to nonsexual violent offenders on standardized measures of substance abuse. Our study is a preliminary investigation of the differences between sexual offenders (rapists: n = 72; child molesters: n = 34) and nonsexual violent offenders (n = 24) on measures of alcohol and drug abuse. The findings indicate that sexual offenders were more likely to abuse alcohol than were nonsexual violent offenders. Nonsexual offenders were significantly more likely to have had a history of other forms of substance abuse. The results are considered in terms of theories of alcohol's contribution to aggressive behavior and sexual aggression. Implications for assessment and treatment of sexual offenders are discussed.

Although psychopathy is a well-established risk factor for recidivism among those who have committed sexual offenses, there are nonetheless some individuals with sexual offense histories who are high in psychopathy but do not recidivate. This population—nonrecidivating psychopathic sex offenders (NRP-SOs)—was the focus of the current investigation. Data from 111 individuals with sexual offense histories who received a Hare Psychopathy Checklist–Revised (PCL-R) rating of at least 25 (suggesting the presence of psychopathy) were analyzed. With recidivism operationalized as the accrual of any new serious—that is, violent or sexual—charges, 39 recidivated (RP-SOs), whereas 72 did not (NRP-SOs). A logistic regression was conducted to assess whether NRP-SOs could be differentiated from RP-SOs. Being older at the time of release, a lesser criminal history, and being married predicted nonrecidivism. PCL-R factor scores and sexual deviance were not predictive. These findings highlight the heterogeneity that exists, even among those high in psychopathy.

Three groups of subjects (N = 95) consisting or rapists, child molesters, and a comparison group of violent offenders were examined with reference to history of alcohol abuse, history of drug abuse, intimacy deficits, and emotionally based coping strategies. No differences were found between the two groups of sex offenders on any of the measures examined. Sex offenders were found to be significantly older than the comparison group. When age was entered as a covariate sex offenders were found to have significantly more difficulties with alcohol use as measured by the Michigan Alcohol Screening Test (MAST) and were significantly more likely to use emotionally based coping strategies as measured by the Coping Inventory for Stressful Situations (CISS). No differences were found between any of the groups with reference to drug abuse as measured by the Drug Abuse Screening Test (DAST). Results are discussed in terms of Marshall's theory of intimacy deficits in sexual offenders.

Factors related to phallometric nonresponding in sexual offenders were investigated. Scores on the Hare Psychopathy Checklist—Revised, the Crowne—Marlowe Social Desirability Scale, the Balanced Inventory of Desirable Responding, and the Multi-Phasic Sex Inventory were used as measures of psychological factors which may influence the level of responding obtained during presentations of audio and visual sexual stimuli. Phallometric measures employed were age/gender and female violence assessments. Significant differences were obtained between responders and nonresponders on several measures. Specifically, low responders to the female violence assessment had significantly higher scores on the Crowne-Marlowe Social Desirability Scale and the Impression Management subscale of the Balanced Inventory of Desirable Responding scale. Of special interest was the finding that approximately 75% of the participants failed to respond above 20% of full erection to either of the assessment methods.

The present study investigates whether leuprolide acetate (Lupron) adds to the efficacy of traditional sex offender treatment. A group of sex offenders receiving both Lupron and cognitive behavioral therapy (CBT; n = 25) were compared with a group of sex offenders receiving only CBT ( n = 22). Treated subjects were compared with norms available with reference to the Static-99R, as well as compared with a sample of untreated, nonsexual violent offenders ( n = 81), to provide baseline data regarding risk of violent recidivism. Results indicated that subjects receiving Lupron were at significantly higher risk of recidivism and significantly more likely to be diagnosed with a paraphilia than subjects receiving only CBT, a priori. Both treated groups of sexual offenders recidivated at substantially lower rates than predicted by the Static-99R. Currently, this study represents the only, long-term outcome study on Lupron administration using officially recorded recidivism as the primary dependent measure.

One hundred thirty child sexual abusers were diagnosed using each of following four methods: (a) phallometric testing, (b) strict application of Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision [DSM-IV-TR]) criteria, (c) Rapid Risk Assessment of Sex Offender Recidivism (RRASOR) scores, and (d) "expert" diagnoses rendered by a seasoned clinician. Comparative utility and intermethod consistency of these methods are reported, along with recidivism data indicating predictive validity for risk management. Results suggest that inconsistency exists in diagnosing pedophilia, leading to diminished accuracy in risk assessment. Although the RRASOR and DSM-IV-TR methods were significantly correlated with expert ratings, RRASOR and DSM-IV-TR were unrelated to each other. Deviant arousal was not associated with any of the other methods. Only the expert ratings and RRASOR scores were predictive of sexual recidivism. Logistic regression analyses showed that expert diagnosis did not add to prediction of sexual offence recidivism over and above RRASOR alone. Findings are discussed within a context of encouragement of clinical consistency and evidence-based practice regarding treatment and risk management of those who sexually abuse children.