Genesis of change: Substance use treatment for forensic patients with mental health concerns

Abstract

Substance use disorders are highly prevalent among forensic patients. They are associated with many challenges for patients with these problems, including their ability to rehabilitate and successfully move through secure forensic mental health services, as well as increasing risk for recidivism. Traditionally, forensic services have been more adept at focusing on and treating the primary mental health diagnosis alone and have been less likely to prioritise this co‐occurring patient need. Opportunities exist to foster effective treatment strategies for substance use disorders, and past research has produced positive outcomes among forensic patients in studies in both Australia and the UK to navigate a new course for patients with these problems. By providing empirically validated, co‐produced and culturally competent treatment responses, forensic patients living with substance use disorders will have the opportunity to significantly improve their wellbeing and progress through the system. They will also be more prepared and equipped to face challenges upon discharge into the community, including increased availability of alcohol and other drugs, social stigma and barriers to employment. Moreover, by prioritising effective substance use treatment programs during inpatient rehabilitation, services can reduce the levels of post‐discharge recidivism.

The Long-Term Changes in Dynamic Risk and Protective Factors Over Time in a Nationwide Sample of Dutch Forensic Psychiatric Patients

“…Furthermore, it is important to underline that the patients in high-security forensic psychiatric institutions differ in terms of dynamic risk and protective factors, which may be partly attributed to their diverse psychiatric diagnoses ( 16 , 17 ). Substance use disorders (SUD) and psychotic disorders are particularly common clinical disorders in these patients, as are cluster B personality disorders [PDs; ( 18 – 20 )]. These disorders have been shown to reinforce violent behavior and are important predictors of recidivism ( 6 , 21 , 22 ).…”

“…Substance use may lead to disinhibition making aggression more likely ( 6 ). In addition, patients with SUD are more likely to have difficulties in areas such as family relationships, employment, legal matters, housing, and health ( 20 ), which can also indirectly increase the risk of recurrence of criminal behavior. Furthermore, patients with SUD are considered difficult to treat because of their propensity for extreme emotional reactions and the difficulty of engaging them until abstinence is achieved.…”

Was ist wirksam in forensischer Suchtbehandlung? – Ein nicht-systematischer Einblick in die Evidenzbasierung von Behandlungsansätzen und Interventionen im Kontext des § 64 StGB

“…Dies mag erklären, weshalb sich Veröffentlichungen im internationalen Kontext eher auf forensisch-psychiatrische Patienten oder auf Straftäter jeweils mit (komorbiden) Suchtproblemen stützen. Zugleich wird der Mangel an klinischen und Evaluationsstudien zu forensischer Suchtbehandlung auch in anderen Ländern beklagt [52].…”