The relationship between substance abuse treatment and self-reported outcomes among

offenders with mental health problems and substance use problems

Natalie Durbeej Gumpert, C. H., Alm, C., Eriksson, Å., Berman, A. H., Kristiansson, M., &

Palmstierna, T.

 

Department of Clinical Neuroscience, Division of Forensic Psychiatry,

Karolinska Institutet, Sweden

Mental disorder, Substance Abuse, and Crime (MSAC)

A Swedish follow up-study that explores the association between utilization of substance abuse treatment and

- The risk of re-offending - Relapse into use of alcohol and/or drugs- Mental health problems

among offenders with mental health problems and substance use problems

Substance abuse treatment has been associated with reductions in re-offending, substance use and mental health problems (Gumpert et al., 2010; Grella et al., 2010; Holloway et al., , 2006; Prendergast et al., 2002)

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Aim of the present study

To examine the relationship between register-based planned

outpatient treatment for substance use problems and self-

reported

a) Substance use

b) Mental health problems

c) Re-offending

among offenders with mental health problems and substance use problems.

Study design

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Baseline n=207 Second follow-up n=149

Utilizationof planned outpatient treatment

for substance use problems (Official registry on health care utilization

in Stockholm County)

2009-12-31

First follow-up n=153

2006-01-01

“At least one visit to an outpatient clinic focusing on substance use problems”

Self-reported number of days with

*Substance use *Mental health problems

*Offending

(ASI-6)

Treatment utilizers

n= 48

Non-utilizers

n= 61

VS

Self-reportednumber of days with

*Substance use*Mental health problems

*Offending

(ASI-6)

n=109

Descriptives

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n = 109 mean age = 35 years (SD = 11.82)mean follow-up time = 17.8 months (SD = 8.45)

89%

11%

71%

29%

72%

28%

Outcome: planned outpatient treatment utilization in relation to substance use and mental health problems*

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Time: p<.001Treatment: N.STime x Treatment: N.S

Time: N.STreatment: N.STime x Treatment: N.S

Time: p<.05Treatment: p<.1Time x Treatment: N.S

*During the past 30 days

Outcome: planned outpatient treatment utilization in relation to offending*

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Time: p<.1Treatment: N.STime x Treatment: N.S

*During the past six months

Time: p<.001Treatment: N.STime x Treatment: N.S

Time: p<.1Treatment: N.STime x Treatment: N.S

Differences between improved and non-improved participants

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Improved

over time

Non-improved

over time

VS

Participants who reduced their

1. Alcohol consumption

2. Mental health problems3. Violent offending

Participants who remained stable or increased their

1. Alcohol consumption

2. Mental health problems3. Violent offending

Differences between improved and non-improved participants

Participants who improved w.r.t. alcohol consumption had

- fewer ER-visits to substance abuse clinics- more days in inpatient treatment*(both planned and acute) - fewer years of regular and heavy alcohol consumption (during lifetime)

compared to non-improved participants (p<0.05)

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*somatic-, psychiatric-, and substance abuse treatment

Differences between improved and non-improved participants

Participants who improved w.r.t. mental health problems

- had fewer ER-visits to substance abuse clinics- had more weeks of employment (during the past six months)

compared to non-improved participants (p<0.05)

Participants who improved w.r.t. violent offending

- were younger - had fewer years of regular amphetamine use (during lifetime)

compared to non-improved participants (p<0.05) 19 april 2023Natalie Durbeej 10

Factors that may be positively or negatively correlated with recovery of offenders with mental

health problems and substance use problems

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+ Utilization of inpatient treatment

+ Employment

- Life-time use of alcohol and/or drugs

- Age

- ER-visits to substance abuse clinics

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Topics for discussion

Does natural recovery over time play a role?

Institutional correction/contact with correctional system might have been beneficial

A need to explore effects of treatment in sub-groups among offenders with mental health problems and substance use problems

A need to further identify the factors that contribute to the recovery of these individuals

Thank you!

Natalie DurbeejDepartment of Clinical Neuroscience

Division of Forensic PsychiatryKarolinska Institutet

SwedenNatalie.Durbeej@ki.se