Pathways to Effective Treatment for Individuals Convicted of Sexual Offences Who Are Taking Medication to Manage Problematic Sexual Arousal.

The use of medication to manage problematic sexual arousal among individuals convicted of sexual offences is still an understudied treatment option in the U.K. Because of this, our knowledge of the medication service is limited to nomothetic analyses of pre- and post-treatment effectiveness, and qualitative analyses of the lived experiences of people taking the medication. This paper contributes a novel perspective on the service by using service-level data to chart the treatment pathways of all service users (N = 139) who have received this medication at the first evaluation site. Using a rigorous process of data triangulation and inter-rater reliability checking, we identified six distinct treatment pathways based on initial drug classes, changes in dosage or drug class, and the (dis)continuation of medication. Each pathway is associated with positive changes in indices of problematic sexual arousal, while highlighting the nuance within service user journeys. In conducting this exercise, we have also produced a framework for ethical client centered prescribing that considers both clinical effectiveness and service user experiences to help clinicians make decisions that are likely to yield both positive clinical outcomes and long-term medication adherence among service users.