Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA.
Department of Criminology, Law and Society, George Mason University, Fairfax, VA, USA.
J Subst Use Addict Treat. 2024 Jan;156:209192. doi: 10.1016/j.josat.2023.209192. Epub 2023 Oct 20.
Individuals with opioid use disorder (OUD) in the criminal-legal system commonly present co-occurring mental health disorders. However, evidence-based treatment for high-risk populations such as those with co-occurring disorders is often unavailable within jails and prisons. Coordination of timely and affordable access to behavioral health treatment following incarceration is critical to address the multidimensional needs of people with co-occurring needs. However, the role of co-occurring disorders among adults with OUD and criminal-legal involvement who are accessing community-based treatment is understudied.
This retrospective cohort study investigated community and recovery outcomes among 2039 adults with OUD and criminal-legal involvement enrolled in a statewide forensic treatment initiative between October 2015 to March 2018. Using court records and clinical data, we assessed the impact of co-occurring OUD and mental health disorders on criminal recidivism and psychiatric recovery and the moderating role of co-occurring disorders on the relationship between community-based treatment and these outcomes.
We found that 47 % of those with OUD also had an underlying mental health disorder. Co-occurring OUD and mental health disorders predicted higher rates of recidivism during the early stages of treatment. Furthermore, group and individual therapy services were associated with lower odds of recidivism. A co-occurring disorder was an important predictor of more severe behavioral health needs when exiting community-based services and did moderate the relationship between service utilization-specifically group therapy and substance use outpatient services-and psychiatric recovery (i.e., behavioral health needs at exit).
Co-occurring mental health disorders are highly prevalent among adults with OUD who have criminal-legal involvement, but it appears that they can benefit from social support services in the community. Given the multidimensional needs of this high-risk population, criminal-legal stakeholders and community-based clinicians must work in tandem to develop tailored treatment plans that give individuals with co-occurring OUD and mental health disorders the best chance for success post-incarceration rather than a siloed approach to overlapping disorders.
在刑事法律系统中，患有阿片类药物使用障碍（OUD）的个体通常同时存在精神健康障碍。然而，对于那些同时存在障碍的高风险人群，如监狱和监狱内通常无法获得基于证据的治疗。在监禁后及时协调获得负担得起的行为健康治疗对于满足同时存在多种需求的人群至关重要。然而，在接受基于社区的治疗的同时患有 OUD 和刑事法律问题的成年人中，同时存在障碍的作用仍研究不足。
本回顾性队列研究调查了 2039 名患有 OUD 和刑事法律问题的成年人在 2015 年 10 月至 2018 年 3 月期间参加全州法医治疗计划的社区和康复结果。使用法庭记录和临床数据，我们评估了 OUD 和精神健康障碍共病对刑事累犯和精神病康复的影响，以及共病障碍对基于社区的治疗与这些结果之间关系的调节作用。
我们发现，47%的 OUD 患者也存在潜在的精神健康障碍。在治疗早期，共病 OUD 和精神健康障碍预测累犯率更高。此外，团体和个体治疗服务与较低的累犯率相关。共病障碍是退出社区服务时更严重的行为健康需求的重要预测因素，并调节了服务利用——具体来说是团体治疗和物质使用门诊服务——与精神病康复之间的关系（即，出院时的行为健康需求）。
在有刑事法律问题的 OUD 成年人中，共病精神健康障碍非常普遍，但他们似乎可以从社区中的社会支持服务中受益。鉴于这一高风险人群的多维度需求，刑事法律利益相关者和基于社区的临床医生必须协同工作，制定针对共病 OUD 和精神健康障碍患者的个性化治疗计划，使他们在监禁后获得最大成功的机会，而不是对重叠障碍采取孤立的方法。
