As part of a broader approach to treatment, the use of pharmacological agents on a voluntary basis may be helpful adjuncts to treatment for some sexually abusive individuals. For example, adults or juveniles who experience cooccurring psychiatric conditions such as anxiety, depression, thought disorders, or attention–deficit hyperactivity disorder may not respond as effectively to interventions because of interfering symptoms. These types of mental health issues tend not to be underlying factors that lead to sex offending and they are generally not related to sexual recidivism (Hanson & Morton–Bourgon, 2005). Rather, these symptoms are potential responsivity factors, and medication intervention is designed to reduce symptoms and increase functional status so that individuals are better able to participate in and benefit from the treatment process.
For other individuals, however, pharmacological interventions may be necessary to manage psychiatric disorders that are more closely linked to offending. Specifically, some adults and juveniles experience recurring and intense sexual drives and urges (e.g., paraphilias) that exacerbate or even fuel sex offending behaviors. In these instances, medications such as antiandrogens or other hormonal agents can reduce the intensity and/or frequency of sexual drives, urges, preoccupations, or compulsions that have not responded sufficiently to behavioral or cognitive–behavioral interventions (Berlin, 2000; Bradford & Fedoroff, 2006; Glaser, 2003; Grubin, 2000; Kafka, 2001; Kafka & Hennen, 2002). Recent research indicates that the use of hormonal agents is associated with recidivism reductions among sex offenders (Lösel & Schmucker, 2005; MacKenzie, 2006), although other research has raised questions about their use (Hanson & Harris, 2000).
The use of selective serotonin reuptake inhibitors (SSRIs) can be beneficial when treating some sex offenders, particularly those with co–occurring mood, anxiety, or impulse–control disorders. This is because SSRIs not only lessen symptoms of those disorders, but also have common side effects such as reduced sexual drives and urges (AACAP, 1999; Berlin, 2000; Bradford & Fedoroff, 2006; Bradford & Greenberg, 1998; Greenberg & Bradford, 1997; Grubin, 2000; Sheerin, 2004).
The primary goal of pharmacological interventions is to assist offenders with gaining control over problematic sexual drives, urges, and behaviors—not to eliminate sexual behaviors altogether (Bradford & Greenberg, 1998; Laws & O’Donohue, 1997). The use of pharmacological interventions is not without controversy; questions exist regarding the potential range of side effects, the provision of informed consent with often involuntary clients, and the failure to use these agents as part of a more comprehensive and integrated treatment strategy (Glaser, 2003). Some experts argue that neither the positive benefits nor negative side effects of hormonal agents are understood fully (Glaser, 2003; Sheerin, 2004). Moreover, none of the classes of pharmacological agents has been sanctioned for use in the treatment of sexual deviance by the respective regulatory bodies in the United States, Canada, United Kingdom, or most other Western countries (Bradford & Fedoroff, 2006).
Pharmacological interventions with juvenile sex offenders should be utilized judiciously (Hunter & Lexier, 1998; Morenz & Becker, 1995). While the use of psychotropic medications to ameliorate symptoms of common disorders of justice–involved youth (e.g., attention–deficit hyperactivity disorder, anxiety and depressive disorders) is less controversial, the appropriateness of antiandrogens and hormonal agents continues to be very questionable with juvenile sex offenders except in extreme cases (AACAP, 1999; Bradford & Fedoroff, 2006; Hunter & Lexier, 1998). Because of the potential additive value under limited circumstances, some pharmacological interventions may be appropriate when included as part of a broader treatment regimen for certain juveniles who have committed sex offenses—namely older, more impulsive youth, and those who clearly evidence symptoms of paraphilic disorders (Bradford & Fedoroff, 2006; Hunter & Lexier, 1998; Sheerin, 2004). And despite the promise of SSRIs, the
U.S. Food and Drug Administration, the federal oversight agency in the United States that is responsible for regulating medications, recently warned about their overall use with adolescents because of the increased potential for increased self–harm and aggression toward others (U.S. Food and Drug Administration, 2004). Further research is clearly needed. In the meantime, careful risks–benefits analyses must be conducted before using pharmacological agents with juveniles, and close monitoring by qualified and experienced medical professionals is required in the event that such medications are deemed necessary (Bradford & Fedoroff, 2006; CSOM, 1999; Hunter & Lexier, 1998).
When pharmacological interventions are warranted, it is important that the medical or psychiatric professionals providing care to sex offenders work collaboratively with the other professionals involved in the sex offender management process. In so doing, supervision and offense–specific treatment providers can become better educated about potential benefits and limitations of these interventions and can also assist medical professionals with monitoring critical issues such as potential side effects and medication non–compliance. Furthermore, collaboration ensures that pharmacological agents are not used as the exclusive mode of treatment; rather, such interventions should be used to complement and enhance offense–specific treatment and treatment (Berlin, 2000; Bradford & Greenberg, 1998; Grubin, 2000; Laws & O’Donohue, 1997).
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