Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
J Subst Abuse Treat. 2022 Dec;143:108893. doi: 10.1016/j.jsat.2022.108893. Epub 2022 Oct 1.
The objective of this study was to inform clinical practice by identifying distinct subgroups of US veterans with criminal histories in residential mental health treatment. The study characterized veteran patients on their alcohol and drug use and criminogenic thinking. We also examined predictors and outcomes of subgroup membership.
Participants were 341 veterans with a criminal history in residential mental health care. A parallel latent growth trajectory model characterized participants' alcohol and drug use and criminogenic thinking at treatment entry and at 6- and 12-month follow-ups.
The study identified four distinct classes: 53 % Normative Improvement, 27 % High Criminogenic Thinking, 11 % High Recurrence (of substance use), and 9 % High Drug Use. Compared to the Normative Improvement class, prior to treatment entry, patients in the High Recurrence class were less likely to be on parole or probation, and patients in the High Criminogenic Thinking class were more likely to be chronically homeless. Compared to the Normative Improvement class, at follow-ups, patients in the High Drug Use and High Criminogenic Thinking classes were more likely to recidivate, and patients in the High Drug Use class were more likely to report unstable housing. Depression scores were higher (nearly double) in the High Drug Use, High Recurrence, and High Criminogenic Thinking classes at follow-ups compared to the Normative Improvement class.
That the Normative Improvement class entered mental health residential treatment with relatively low alcohol and drug use and criminogenic thinking, and sustained these low levels, suggests that treatment does not need to be broadened or intensified to improve these domains for these patients with criminal histories. In contrast, findings for the High Drug Use, High Recurrence, and High Criminogenic Thinking classes, which composed 47 % of the sample, suggest that more integrated and sustained treatment may be needed to reduce recidivism, depression, and homelessness among these patients.
本研究的目的是通过识别有犯罪记录的美国退伍军人在住院精神健康治疗中的不同亚组，为临床实践提供信息。该研究描述了退伍军人的酒精和药物使用情况以及犯罪倾向思维。我们还研究了亚组归属的预测因素和结果。
参与者是 341 名有犯罪记录的住院精神健康治疗的退伍军人。一个平行的潜在增长轨迹模型描述了参与者在治疗开始时以及 6 个月和 12 个月随访时的酒精和药物使用情况以及犯罪倾向思维。
该研究确定了四个不同的类别：53%为正常改善，27%为高犯罪倾向思维，11%为高复发（药物使用），9%为高药物使用。与正常改善类相比，在治疗开始前，高复发类的患者更不可能处于假释或缓刑状态，而高犯罪倾向思维类的患者更可能长期无家可归。与正常改善类相比，在随访时，高药物使用和高犯罪倾向思维类的患者更有可能再次犯罪，而高药物使用类的患者更有可能报告不稳定的住房状况。与正常改善类相比，在随访时，高药物使用、高复发和高犯罪倾向思维类的患者的抑郁评分更高（几乎翻倍）。
正常改善类在进入心理健康住院治疗时，酒精和药物使用以及犯罪倾向思维相对较低，并且在整个治疗过程中保持了这些较低水平，这表明对于这些有犯罪记录的患者，治疗不需要扩大或加强，以改善这些领域。相比之下，高药物使用、高复发和高犯罪倾向思维类的发现，占样本的 47%，这表明需要更综合和持续的治疗，以减少这些患者的复发、抑郁和无家可归现象。
