Outcomes of a drug and alcohol relapse prevention programme in a population of mentally disordered offenders (original) (raw)
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Previous research demonstrated that alcohol and drug misuse prior to admission to special (high and medium) security psychiatric care in Scotland was high. Evidence from clinical practice subsequently suggested that the situation was worsening. In response, a three-pronged strategy was implemented: staff were trained in alcohol and drug issues in mentally disordered offenders, an admission screening programme was introduced to detect those at risk, and specific interventions were developed. This paper presents data on the admission screening programme and on a specific intervention.
Purpose-The purpose of this paper is to assess whether mental health symptoms affect one-year reoffending rates upon release from prison for participants engaging in substance dependence treatment in the UK. Design/methodology/approach-A retrospective cohort study was used to assess reconviction outcomes upon release. The Comprehensive Addiction and Psychological Evaluation (CAAPE) was administered to 667 inmates admitted to the programme. The effect of mental health, drug use, and static risk factors on reoffending was assessed at one-year post release. Findings-Logistic regression analysis showed that symptoms of Major Depressive Disorder at the start of substance dependence treatment increased the likelihood to reoffend, whilst Obsessive Compulsive Disorder symptoms and length of sentence decreased the likelihood to reoffend. Antisocial Personality Disorder symptoms show a trend towards increasing the likelihood to reoffend. In addition, previously established risk factors for reoffending, including dependence on heroin, crack/cocaine, and poly drug use significantly increased the likelihood of reconviction. Practical implications-Depressive symptomatology pre-treatment could affect reoffending outcomes for participants in substance dependence treatment in prison. An integrative approach addressing both substance misuse and mental health factors is pivotal. Future efforts to address both simultaneously can be made to improve assessment, training, treatment, and through care for prisoners in substance dependence treatment. Originality/value-Few studies have assessed the effect of mental health factors on reoffending outcomes for offenders in substance dependence treatment. A large sample was studied in an understudied population of UK prisoners in substance dependence treatment. The results have implications for clinical settings where mental health symptoms are not addressed concurrently with substance dependence. This finding can inform policy makers and practitioners who provide substance dependence treatment in prison.
Substance Use & Misuse, 2009
This review assesses the issues involved in the selection and treatment of patients comorbid for mental illness and substance misuse being treated in secure psychiatric facilities. It includes those individuals who have a history of offending and whose placement is the result of severe behavioral disturbance. The relevant issues in the assessment and treatment of these patients are reviewed and a battery of tests is suggested on the basis of their usefulness with this population in terms of their brevity, ease of administration, and for their value in planning treatment, providing motivational feedback, and monitoring change. The paucity of assessment tools developed specifically for this patient population is highlighted.
Drug-Related Arrests in a Cohort of Public Mental Health Service Recipients
Psychiatric Services, 2007
Objectives-The excessive prevalence of comorbid substance abuse among persons with severe mental illness has been well established and identified as the source of numerous negative outcomes. An overlooked aspect of illicit drug use in this population is its illegality and the potentially dire criminal sanctions. This study examined the prevalence of drug arrests in a cohort of persons receiving services from a state mental health agency who were followed for roughly ten years. Methods-Data on arrest spanning from 1991 to 2000 were obtained for all individuals receiving inpatient, case management, or residential services from July 1991 to June 1992 (N=13,816). Reports of prevalence were based on the number with at least one drug-related arrest in the observation period. Results-Five percent of individuals in the cohort experienced at least one drug-related arrest (N=720). These included simple possession as well as manufacturing and distribution. The prevalence was much higher (15%) among persons aged 18 to 25 years than in other age groups. Roughly 95% of persons with a drug arrest also had an arrest for another type of offense. This pattern is similar to that observed among persons with a drug-related arrest in the general population. Conclusions-Convictions on drug charges can void access to Section Eight housing and other benefits and are associated with other patterns of offending that also carry significant criminal sanctions. State mental health agencies may wish to target interventions toward youthful clientele by focusing specifically on the risks associated with involvement with illicit drugs. The many problems associated with substance abuse among persons with severe mental illness have been a prominent focus of the psychiatric and mental health services research communities for at least three decades. Data from both the Epidemiologic Catchment Area Study (1) and the National Comorbidity Study (2) reveal an extremely high prevalence of co-occurring substance abuse among persons with serious psychiatric disorders. Comorbid substance abuse has been linked to numerous negative clinical and behavioral outcomes in this population (3-5). It has been implicated in exacerbating persons' risk of engaging in violence toward others (6,7) as well as being victims of crime themselves (8). Failure to comply with substance abuse treatment protocols can result in expulsion from various programs, and inability to maintain abstinence can lead to ejection from some residential programs and increase risk of homelessness (9).
International Journal of Forensic Mental Health, 2010
Objective: To explore the relationship between regular substance abuse treatment and criminal recidivism in 403 male offenders with suspected mental disorder and substance abuse. Method: The study is observational, following a cohort of individuals during an observation period of up to 52 months. Individuals participating in planned substance abuse treatment were compared with nonparticipants with regard to crime relapse. Results: Individuals who had completed >6 weeks of substance abuse treatment had a significantly reduced risk (even considering possible and obtainable other criminogenic risk factors) of committing any new crime (HR = 0.346) as well as any new violent crime specifically (HR = 0.325) in comparison to a reference category of those who did not visit substance abuse clinics at all. Conclusion: Among forensic populations, adherence to interventions targeting substance abuse seems to be related to a reduced risk of criminal recidivism.
Interventions for drug-using offenders with co-occurring mental health problems
Cochrane Database of Systematic Reviews
Analysis 2.1. Comparison 2 Mental health court, Outcome 1 Self report dichotomous criminal activity.. .. .. Analysis 3.1. Comparison 3 Motivational interviewing and cognitive skills, Outcome 1 Self report drug use continuous. Analysis 3.2. Comparison 3 Motivational interviewing and cognitive skills, Outcome 2 Self report drug use dichotomous. Analysis 4.1. Comparison 4 Interpersonal psychotherapy, Outcome 1 Self report drug use dichotomous.. .. . .