This article describes the development of an instrument to screen male and female offenders for co-occurring substance use and mental disorders. This phase developed and pilot tested (N = 100) the Criminal Justice Drug Abuse Treatment Studies (CJDATS) Co-occurring Disorders Screening Instrument for Mental Disorders (CODSI-MD), a 6-item instrument derived from three standard mental health screeners. The overall accuracy of the CODSI-MD (81%) compared favorably with the three standard instruments. A second 3-item instrument, developed to screen for severe mental disorders (the CODSI-SMD), had an overall accuracy of 82%. The results of this pilot study must be viewed cautiously, pending validation of the findings with a larger sample. Keywords co-occurring disorders; screening instrument; criminal justice; mental health; substance abuse CJDATS Co-Occurring Disorders Screening Instrument for Mental Disorders (CODSI-MD)Offenders who have co-occurring substance use and mental disorders (hereafter referred to as co-occurring disorders, or COD) constitute a population of significant concern. In practical terms, the special needs of offenders with COD (e.g., segregated programming, multiagency discharge planning) place exceptional demands on the criminal justice system. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptAlthough rapidly growing throughout the criminal justice system, this population remains largely understudied, despite its attendant clinical and administrative challenges. Forensic programs and services must be established for these offenders.Prevalence-In community-based settings, substance abuse programs have typically reported that 50% to 75% of their clients had some type of COD (although not usually a severe mental disorder), whereas studies in mental health settings reported that between 20% and 50% of their clients had a co-occurring substance use disorder (for a summary of studies, see Sacks, Sacks, De Leon, Bernhardt, & Staines, 1997; for more recent studies, see Compton, Cottler, Phelps, Abdallah, & Spitznagel, 2000;Havassy, Alvidrez, & Owen, 2004).Studies have found the prevalence of mental disorders to be higher in the prison system than in the general population (Fazel & Danesh, 2002;O'Brien, Mortimer, Singleton, & Meltzer, 2003). For example, the rate of lifetime prevalence for schizophrenia and bipolar disorder in the general population was 0.8% and 1.5%, respectively, whereas the corresponding rates in state prison populations were between 2.3% and 3.9% for schizophrenia and between 2.1% and 4.3% for bipolar disorder (Veysey & Bichler-Robinson, 1999). In a large meta-analysis of 62 studies, Fazel and Danesh (2002) found that prisoners were 2 to 4 times as likely to suffer from psychotic illness or major depression compared to the general population. The U.S. Department of Justice reported that 16% of state prison inmates, jail inmates, and probationers reported either a mental condition or an overnight stay in a mental hospital during their lifetimes (Ditton...
Three standardized screening instruments-the Global Appraisal of Individual Needs Short Screener (GSS), the Mini-International Neuropsychiatric Interview-Modified (MINI-M), and the Mental Health Screening Form (MHSF)-were compared to two shorter instruments, the 6-item Co-Occurring Disorders Screening Instrument for Mental Disorders (CODSI-MD) and the 3-item CODSI for Severe Mental Disorders (CODSI-SMD) for use with offenders in prison substanceabuse treatment programs. Results showed that the CODSI screening instruments were comparable to the longer instruments in overall accuracy and that all of the instruments performed reasonably well. The CODSI instruments showed sufficient value to justify their use in prison substance-abuse treatment programs and to warrant validation testing in other criminal justice populations and settings.Keywords co-occurring disorders; criminal justice; mental disorders; substance abuse; screening; instrument Inmates with co-occurring substance use and mental disorders (COD) represent a significant problem in the criminal justice system, given the increasing numbers of prisoners diagnosed with co-occurring disorders and the difficulty of managing and treating offenders with © American Association for Correctional and Forensic PsychologyAddress all correspondence to Stanley Sacks, PhD, CIRP, NDRI, 71 West 23rd Street, 8th Floor, New York, NY 10010; stansacks@mac.com. Views and opinions are those of the authors and do not necessarily reflect those of Department of Health and Human Services, the NIH, NIDA, or other participants in CJDATS. This article has not been published elsewhere nor has it been submitted simultaneously for publication elsewhere. NIH Public Access Author ManuscriptCrim Justice Behav. Author manuscript; available in PMC 2011 October 3. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript concurrent disorders. It is estimated that, compared to the general population, prisoners are 2 to 4 times more likely to suffer from psychotic illness or major depression (Fazel & Danesh, 2002). Estimates from U.S. Department of Justice statistics indicate that 16% of those in state prisons, jails, and on probation suffer from some form of mental disorder (Ditton, 1999).Furthermore, the number of correctional clients with mental disorders appears to be increasing. As an example, reports from the Colorado Department of Corrections chronicle a steadily rising proportion of inmates with mental illness, from 4% in 1991, to 14% in 2001 (Kleinsasser & Michaud, 2002, to 20% more recently (J. Stommel, personal communication, March 16, 2005). Among the 20% of inmates with mental illness, three quarters were estimated to have a co-occurring substance-use disorder.The need to identify and treat these individuals is evinced in the risk to the community, problems of behavior management within the prison system, and poorer treatment outcomes. The increased risk of violence among individuals with COD has now been well-documented (Melnick, Sacks, & Banks, 2006;Mona...
The present study examines the relationship between substance use, mental health problems, and violence in a sample of offenders released from prison and referred to substance abuse treatment programs. Data from 34 sites (n = 1,349) in a federally funded cooperative, the Criminal Justice Drug Abuse Treatment Studies (CJDATS), were analyzed. Among parolees referred to substance abuse treatment, self-reports for the six-month period before the arrest resulting in their incarceration revealed frequent problems with both substance use and mental health. For most offenders with substance use problems, the quantity of alcohol consumed and the frequency of drug use were associated with a greater probability of self-reported violence. Mental health problems were not indicative of increases in violent behavior, with the exception of antisocial personality problems, which were associated with violence. The paper emphasizes the importance of providing substance abuse treatment in relation to violent behavior among offenders with mental health problems being discharged to the community.
Against a backdrop of increasing concern about the adequacy of treatment for co-occurring substance use and mental disorders (typically known as "co-occurring disorders," or COD) in the criminal justice system, this article attempts to provide empirical evidence for a typology of levels of COD treatment for offenders in both prison and community settings. The paper investigates two levels of treatment programs for COD; "intermediate" programs, in which treatment programming has been designed primarily for offenders with a single disorder, and "advanced" programs, in which programming has been designed to provide integrated substance abuse treatment and mental health services. Findings from a national survey of program directors indicated that both intermediate and advanced COD treatment programs were similar in their general approach to substance abuse treatment, but differed considerably in their treatment of mental disorders, where the advanced programs employed significantly more evidence- and consensus-based practices. Results provide support for the distinction between intermediate- and advanced-level services for offenders with COD and support a typology that defines advanced programs as integrating a range of evidence- and consensus-based practices so as to modify treatment sufficiently to address both diseases.
Previous research has shown the performance of the CJDATS Co-Occurring Disorders Screening Instruments (CODSI-MD and SMD)--six- and three-item instruments to screen for any mental disorder (CODSI-MD) and for severe mental disorders (CODSI-SMD), respectively--to be comparable or superior to other, longer instruments. This study tested the stability of the performance of the CODSI-MD and SMD across three racial/ethnic groups of offenders entering prison substance abuse treatment programs (n = 353), consisting of 96 African American, 120 Latino, and 137 White admissions. The Structured Clinical Interview (SCID) was used to obtain DSM-IV Axis I and II diagnoses; a lifetime SCID diagnosis of a mental disorder or a severe mental disorder was the criterion against which the CODSI-MD and SMD were validated. Results showed no statistical differences in sensitivity or specificity for either the CODSI-MD or SMD across the African American, Latino, and White prisoner groups. The value of the CODSI-MD and SMD as brief screens for mental disorders among offenders with diverse racial/ethnic backgrounds is discussed.
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