Associations between posttraumatic stress and legal charges among substance using veterans.

Abstract

Substance misuse is prevalent among veterans entering the criminal justice system, and is related to recidivism. Research demonstrates that trauma exposure and posttraumatic stress (PTS) symptoms, which commonly co-occur with substance misuse, also increase the risk of legal involvement and recidivism. However, it is unclear whether the associations between trauma, PTS symptoms and violent and nonviolent crime may be conflated by substance use. The aim of the present study was to understand the association between PTS symptoms and criminal justice involvement (both violent and nonviolent crime) among substance-using veterans seeking Veterans Affairs (VA) specialty mental health care after accounting for substance use frequency and demographics including age, gender, and ethnicity. Further, this study examined whether specific clusters of PTS were associated with violent and nonviolent veteran offending. Participants included 697 veterans (52 women) aged 21 to 75 (M = 47.49, SD = 13.51) with a history of trauma exposure. Veterans self-reported past-month PTS symptoms, substance use, and lifetime legal charges. Logistic regression results indicated total PTS symptoms were associated with violent, but not nonviolent charges, above and beyond age, sex, race, cocaine use, and heavy alcohol use. Intrusion symptoms, in particular, were associated with violent charges. Results highlight the utility of examining PTS as a multifaceted construct and have implications for the assessment and treatment needs of justice-involved veterans. For example, the findings suggest that treatment needs appear to differ for those reporting violent or nonviolent offending, with a greater need for assessing and treating PTS for those involved with violent crime. (PsycINFO Database Record

A scoping review of military veterans involved in the criminal justice system and their health and healthcare

“…Several articles focused on conditions and experiences related to military service such as PTSD and trauma (Backhaus et al, 2016; Bennett, Morris, Sexton, Bonar, & Chermack, 2018; Elbogen et al, 2012; Saxon et al, 2001; Sigafoos, 1994). A number of observational studies addressed violence (Elbogen et al, 2012; Hoyt et al, 2014; MacManus et al, 2013) and Veterans Treatment Courts (Clark, Blue-Howells, & McGuire, 2014; Knudsen & Wingenfeld, 2016; Tsai, Flatley, Kasprow, Clark, & Finlay, 2017).…”

“…Court mandates for treatment were not recorded in these databases. Single VHA site studies used criminal justice data gathered through randomized controlled trials (Anderson et al, 2017; Bennett et al, 2018), longitudinal treatment surveys (Atkinson, Tolson, & Turner, 1993; Timko et al, 2017), and one-time questionnaires (Backhaus et al, 2016; Briggs et al, 2001). Multiple VHA site studies included qualitative interviews (Blonigen et al, 2018), longitudinal assessments (Tsai, Middleton, et al, 2017), and administrative evaluation data (Coker & Rosenheck, 2014).…”

“…Combat exposure – and related PTSD from such experiences – was examined to explain the link between military experience and criminal justice involvement, though results were mixed. Combat experience has been associated with lower odds of non-violent offending (Bennett et al, 2018), and serving in wartime has been linked with lower odds of incarceration (Culp et al, 2013). However, greater combat exposure has also been associated with higher odds of unlawful behavior, including “having been arrested”, “being on probation or parole”, or “driving a car or other vehicle after having too much to drink” (Larson & Norman, 2014).…”

Does a history of violent offending impact treatment response for comorbid PTSD and substance use disorders? A secondary analysis of a randomized controlled trial

“…Clark et al (2014) reported that regular substance users with a history of trauma were more likely to report histories of violent offending than individuals with either substance use problems or trauma histories alone. Bennett et al (2018) found that within a large sample (n = 697) of trauma-exposed veterans in SUD clinics, violent legal charges were associated with greater posttraumatic stress symptom severity. In an Australian sample of 102 men and women seeking outpatient services for comorbid PTSD and SUD, higher levels of aggression and PTSD hyperarousal symptoms were found to predict past-month violent criminality (Barrett et al, 2011).…”

“…The PTSD symptom cluster of hyperarousal, in particular, has been linked to aggression in veterans (Taft et al, 2007), a nationallyrepresentative sample of non-institutionalized adults (Smith, Smith, Violanti, Bartone, & Homish, 2015), as well as civilians with comorbid PTSD+SUD (Barrett, Mills, & Teesson, 2011;Barrett, Teesson, & Mills, 2014). However, recent work with substance-using veterans identified the intrusion symptom cluster as uniquely predictive of violent criminality (Bennett, Morris, Sexton, Bonar, & Chermack, 2018).…”