Psychosis and Substance Use: Implications for Conditional Release Readiness Evaluations

Abstract

In Foucha v. Louisiana (1992), the United States Supreme Court ruled that individuals adjudicated not guilty by reason of insanity (NGRI) could not remain in a forensic hospital if they were no longer mentally ill and dangerous. Since this decision, a variety of important questions have arisen related to the insanity defense and what should happen to insanity acquittees post-adjudication. This article provides an analysis of clinical issues confronting forensic examiners when psychosis as a result of substance abuse is the underlying condition supporting an insanity defense. To accomplish this analysis, this article provides the reader with a review of literature showing the complex relationship between psychosis and substance abuse. Second, this article investigates how substance-induced psychosis may impact both insanity opinions and subsequent conditional release decisions. Third, the article aims to provide research-driven information to assist clinicians in conducting conditional release evaluations. Finally, this paper provides a model for evaluating dangerousness in the context of conditional release evaluations. Given the substantial comorbidity between substance abuse and psychosis, it is critical for researchers and clinicians to consider potential effects of substance abuse when evaluating insanity acquittees for conditional release, especially as substance use relates to future dangerousness. Copyright © 2016 John Wiley & Sons, Ltd.

Conditional release and cannabis use: Concerns and challenges for community reintegration

“…Given cannabis's popularity, addressing its use for those granted conditional release will continue to warrant resources and treatment. Although research has demonstrated the link between substance abuse and conditional release revocation (Manguno‐Mire et al., 2014; Tabernik & Vitacco, 2016), more research is needed to generate an accurate and up‐to‐date understanding of this complicated relationship.…”

“…Second, the use of prohibited substances can lead to mental health decompensation, which becomes the underlying reason for revocation (Vitacco et al., 2014). Either way, the use of substances, including cannabis, can lead to an insanity acquittee being revoked and returned to a secure setting (Tabernik & Vitacco, 2016). There is also middle ground that may present the best and most efficient strategy for dealing with substance use violations that do not lead to dangerous behavior.…”

“…The first recommendation is the need for individuals involved in the granting of CR to carefully consider potential links between violence risk related and cannabis use. Tabernik and Vitacco (2016) provided a detailed analysis of how to consider substance abuse when conducting conditional release readiness evaluations. They noted, “…the role of substances needs to be considered in terms of future dangerousness and the likelihood an individual will follow the conditional release plan” (p. 305).…”

Differences Between Readmitted and Non-readmitted Women in an Italian Forensic Unit: A Retrospective Study

“…Of studies that included substance abuse, this factor has consistently been associated with failure on conditional release ( Cohen et al, 1988 ; Callahan and Silver, 1998 ; Monson et al, 2001 ; Vitacco et al, 2008 , 2014 ; Green et al, 2014 ). Apart from conditional release of insanity acquittees, substance abuse is one of the strongest predictors of general criminal recidivism among mentally disordered offenders ( Bonta et al, 1998 ) and, together with a history of violence, of future violent behavior ( Swanson, 1994 ; Swanson et al, 2000 ; Douglas and Skeem, 2005 ; Conroy and Murrie, 2007 , Hanson, 2009 , see generally Tabernik and Vitacco, 2016 ).…”

“…Tabernik and Vitacco postulated several explanations for the association between substance use and failure at conditional release: The association of substance use with forms of criminal conduct, the potential for substance use to exacerbate a mental disorder, and substance use per se can be reason enough to revoke conditional release ( Tabernik and Vitacco, 2016 ). We should add a possible association with medication non-compliance and the potential for substance use alone inducing a mental state that predisposes the individual to criminal conduct or rule violation (e.g., intoxication or substance induced psychotic disorder).…”