Assessing Comorbid Substance Use in Detained Psychiatric Patients: Issues and Instruments for Evaluating Treatment Outcome

Abstract

This review assesses the issues involved in the selection and treatment of patients comorbid for mental illness and substance misuse being treated in secure psychiatric facilities. It includes those individuals who have a history of offending and whose placement is the result of severe behavioral disturbance. The relevant issues in the assessment and treatment of these patients are reviewed and a battery of tests is suggested on the basis of their usefulness with this population in terms of their brevity, ease of administration, and for their value in planning treatment, providing motivational feedback, and monitoring change. The paucity of assessment tools developed specifically for this patient population is highlighted.

Group substance abuse treatment for women in secure services

“…Assessments were undertaken using case history data and a battery of assessments deemed applicable to secure settings (Long & Hollin, 2009) …”

“…This problem is exacerbated in secure settings where issues regarding treatment motivation and assessment are compounded (Long & Hollin, 2009) and where histories of sexual and physical abuse pose greater risks for problematic treatment outcomes (Rosen, Ouimette, Sheikh, Gregg & Moos, 2002). While greater effectiveness has been demonstrated for women-only programmes that address problems common to substance abusing women (Greenfield et al, 2007) there is a paucity of literature on treatment outcomes for dual diagnosis women treated in secure settings.…”

“…Given data supporting efficacy for both group and individual cognitive behaviour therapy approaches to substance abuse (Rotgers & Nguyen, 2006), the former was favoured on pragmatic grounds. This evaluation acknowledges the necessity of using outcome measures that are an indirect or proxy assessment of progress in treatment or which have been shown to relate to outcome in other settings (Long & Hollin, 2009;Swain, Boulter & Piek, 2010).…”

Substance-abusing women in a medium secure psychiatric setting: characteristics and psychometric test performance

“…The increased rates of substance misuse and dependence disorders in crisis settings such as hospitals, forensic and prison settings (D'Silva & Ferriter, 2003;Scott et al, 2004) and the context in which evaluation occurs (Long & Hollin, 2009) make use of 'feasible' and appropriate assessment measures (Slade et al, 1999) crucial in guiding treatment selection and evaluation. Women admitted to secure psychiatric settings often have a dual diagnosis of personality disorder (mostly emotionally unstable or borderline type) with or without mental illness, a forensic history, a history of past trauma and complex needs and are detained under the Mental Health Act 1983 (Long et al, 2008).…”

“…Tests were chosen on the basis of their psychometric properties and utility with detained populations (Long & Hollin, 2009). Where applicable, patients were asked to rate the 6-month period before entering the mental health or prison system (when there was no restriction on their use of substances).…”