Faculty of Medicine, Uppsala University, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden.
Drug Alcohol Depend. 2024 Jun 1;259:111314. doi: 10.1016/j.drugalcdep.2024.111314. Epub 2024 Apr 26.
Substance use disorders are highly prevalent in people within the criminal justice system. Psychological programs are the most common type of treatment available and have been shown to decrease recidivism, but dropping out of treatment is common. Risk factors associated with treatment dropout remain unclear in this setting, and whether the risk factors differ by treatment form (group-based vs. individual).
Outcome (treatment dropout) was defined as not finishing the program due to client's own wish, misbehavior, no-shows, or because program leader found client to be unsuitable. Predictors of treatment dropout included a comprehensive set of individual-level clinical, socioeconomic, and crime-related pre-treatment characteristics. Multivariable regression models were used to estimate the associations between predictors and dropout.
The study cohort included 5239 criminal justice clients who participated in a psychological treatment program (group-based or individual). Multivariable logistic regression models showed that female sex (OR=1.64, 95% CI 1.20-2.25), age (0.99, [0.97-1.00]), sentence length (0.98, [0.97-0.98]), higher education (0.54, [0.28-1.00]), number of violent offenses (1.03, [1.01-1.05]), and anxiety disorders (1.32, [1.01-1.72]) were associated with dropout from the individual treatment program. For the group-based program, age (OR=0.98, 95% CI 0.96-1.00), sentence length (OR=0.96, 95% CI 0.94-0.98), stimulant use disorder (OR=1.48, 95%, 1.00-2.19), and self-harm (OR 1.52, 95% CI 1.00-2.34) were associated with dropout.
We identified certain sociodemographic, crime-related, and clinical characteristics that were particularly important in predicting dropout from psychological treatment. Further, we find that there are similarities and differences in predictors of dropout from group-based and individual treatment forms.
在刑事司法系统中的人群中，物质使用障碍的患病率很高。心理治疗是最常见的治疗类型，已被证明可以降低累犯率，但治疗脱落很常见。在这种情况下，与治疗脱落相关的风险因素仍不清楚，并且这些风险因素是否因治疗形式（团体与个体）而异。
结局（治疗脱落）定义为因客户自身意愿、行为不当、失约或因项目负责人认为客户不合适而未完成项目。治疗脱落的预测因素包括一套全面的个体临床、社会经济和犯罪相关的治疗前特征。使用多变量回归模型来估计预测因素与脱落之间的关联。
该研究队列包括 5239 名参与心理治疗计划（团体或个体）的刑事司法客户。多变量逻辑回归模型显示，女性（OR=1.64，95%CI 1.20-2.25）、年龄（0.99，[0.97-1.00]）、刑期（0.98，[0.97-0.98]）、较高的教育程度（0.54，[0.28-1.00]）、暴力犯罪次数（1.03，[1.01-1.05]）和焦虑障碍（1.32，[1.01-1.72]）与个体治疗计划的脱落有关。对于团体治疗计划，年龄（OR=0.98，95%CI 0.96-1.00）、刑期（OR=0.96，95%CI 0.94-0.98）、兴奋剂使用障碍（OR=1.48，95%CI 1.00-2.19）和自伤（OR 1.52，95%CI 1.00-2.34）与脱落有关。
我们确定了某些社会人口统计学、犯罪相关和临床特征，这些特征在预测心理治疗脱落方面尤为重要。此外，我们发现团体和个体治疗形式的脱落预测因素既有相似之处，也有不同之处。
