Sex Offender Treatment
Does It Work? Is It Worth It?
by Ron Kokish
This can be a controversial subject. What constitutes success? Do
we look only at sexual reoffenses, or also at related (compulsive)
behaviors like alcoholism, drugs, gambling, etc.? What about other
crimes - burglary, assaults, etc.? Do we look at the probationary
period only, or is post treatment considered? If post, how long?
How do we get data? Self report? Crime reports? Family follow-up?
How hard do we look for failure? Do we rely only on crime reports
or do we do a confidential study where we annually polygraph people
for ten years following treatment? How do we count treatment drop
outs in such a study - as treated offenders, untreated offenders,
or as a separate group?
Its unreasonable to expect zero recidivism, so how much does
a program have to reduce reoffenses to call itself successful?
Given all the difficulties, here are some things we do know.
Barry Maletzky, MD and Kevin McGovern, Ph.D. of The Sexual Abuse
Clinic of Portland Oregon followed about 5000 offenders treated
in their clinic and similar clinics between 1973 and 1990 using
behavior oriented methods. About 3700 of these were pedophiles -770
were exhibitionists. The remainder were referred for a variety of
other paraphilias. Criteria for "success" included:
Using these stringent measures to follow some men for as long as 17
years post treatment, success was achieved with 94.7% of heterosexual
and 86.4% of homosexual pedophiles. Rapists showed 73.5% success,
exhibitionists and public masturbators about 92% , with men referred
for various other paraphilias ranging from 100% for zoophiliacs to
80% for frotteurs. These data do not represent a controlled study,
but the sample is large and with success criteria as stringent as
they were, the data gives strong indication that treatment is effective
for a great many offenders.
- No re-arrest
- Self report of no maladaptive sexual behaviors
- Reduced deviant arousal maintained post - treatment as verified
on penile plethysmograph
- "Significant other" ratings of patient behavior
A June 1991 report to the State of Washington legislature also supports
community treatment as a viable alternative for sex offenders. The
report covers 613 probation eligible offenders sentences between January
1985 and July 1986. Three hundred thirteen of these actually received
probation sentences while 300 were sent to prison. Both groups were
followed. The probationers had significantly lower re-arrest rates
and conviction rates in all crime categories. The study concluded
that, generally speaking, probationary sentences did not place the
community at undue risk and offered a cost - effective alternative
An Oregon study of sex offender monitoring using polygraphy indicated
dramatic success having offenders complete their probationary periods
In 1999 Margaret Alexander, Ph.D. (Oshkosh, Wis. Correctional Facility)
examined no less than 424 studies. After eliminating most of them
because they were poorly done she presented an analysis of the remaining
79studies covering 10, 988 offenders with some being followed as long
as ten years post treatment. (Sexual Abuse; A Journal of Research
and Treatment, 11(2) Here are some of her findings.
Also in 1999, Grossman, Martis and Fichtner presented an analysis
of Medline literature and concluded that offenders treated with anti-androgen
and / or cognitive-behavioral therapy showed a robust treatment effect
in the neighborhood of 30%. (Psychiatric Services, 50(3) ) Recently
released Data from ATSAs collaborative database project also
show a robust over-all treatment effect.
- Over all, treated offenders reoffended at a rate of 11%, untreated
- True incest offenders have lower reoffense rates than other
child molesters. (5.3% with 5-year follow-up without treatment,
no recidivism with treatment, compares to 17.8% treated and 25%
untreated for non-incestuous child molesters.)
- When subjects were followed for as long as ten years, the "treatment
effect" weakened over time, but even in the tenth year, treated
offenders reoffended less untreated men.
- Men treated before 1980 (more traditional methods) reoffended
at a rate of 12.8%. while men treated after 1980 (present day
methods) reoffended at 7.4% (1993 data not included in
Data from a variety of sources show that some treatment is not
better than none is an unwarranted attitude. Treatment dropouts
reoffend at the same or higher rates than do untreated offenders.
None of this represents true controlled studies. Such experiments
are under way in California and Vermont using inpatient populations
and preliminary data are interesting, but samples are so small that
statistically significant data will not be available until 2005. Even
then, we will not necessarily be able to generalize to outpatient
programs. Controlled outpatient studies may never be done because
of reluctance to have matched controls at large in the community without
any treatment. (Studies comparing various forms of treatment are however,
feasible and should be done.)
Robert Prentky, Ph.D. (Bridgewater. Mass. Correctional Facility) developed
a cost effectiveness model for "success." He suggested comparing
the cost of prosecuting a single reoffense, incarcerating the offender,
and treating one additional victim to the cost of meaningfully treating
an offender during his initial incarceration. According to his figures,
the Bridgewater program is cost effective if it reduces reoffenses
by 11%, it. When Janice Marques applied his model to California she
arrived at a 14% cutoff.
Given available data, it appears that out patient programs do much
better than 11 - 14% offense reduction. In fact, it does not seem
unreasonable to assume we reduce reoffenses by a third or more, that
we teach offenders empathy, encouraging them to treat others better
in non-sexual ways as well, and that we make a significant contribution
to their social functioning. (reduce non-sexual crimes, improve employment
The United States already locks up a greater percentage of its people
than any western nation while California, with about 10% of the country's
population accounts for about 14% of the U.S. prison population. Under
theses circumstances, strict conditions of probation, close monitoring
and quality treatment paid for by the offenders themselves is clearly
the most promising alternative.