Risk classes of patients diagnosed with substance use disorders in Dutch forensic psychiatric centers

Abstract

Purpose Given the complex association between substance use disorders (SUD), comorbid mental health problems and criminal recidivism in forensic patients, homogenous patient classes can contribute to a refined treatment. This paper aims to construct those classes in forensic patients (N = 286) diagnosed with SUD, unconditionally released between 2004 and 2013 of one of ten Dutch forensic psychiatric centers. Design/methodology/approach Retrospective data were derived from electronic patient files. Classes were based on the Dutch risk assessment tool, the Historisch Klinisch Toekomst-Revisie (Historical Clinical Future–Revised [HKT-R]) and identified by means of explorative Latent Class Analysis in Latent Gold version 5.1. In a three-step approach, posterior class memberships were related to external variables (i.e. diagnoses, type of drug and type of offence). Findings Four classes were identified that differ in the risk of recidivism, as well as Axis I and II diagnoses and type of drug consumption. Practical implications This study informed on the heterogeneity of forensic patients with SUD and identified four homogenous classes that differ in important variables for the treatment approach. Based on these classes, a more refined treatment approach can be developed. Possible treatment approaches are discussed, but future research is needed to provide evidence. Originality/value This study is the first to identify classes within forensic patients with SUD and, therefore, sets the first step to develop a tailored treatment approach based on characteristics informative for treatment.

A Latent Class Analysis of Forensic Psychiatric Patients in Relation to Risk and Protective Factors

“…Overall, the results largely support the previously established patient classes found by Van Der Veeken et al ( 2017 ), and show similarities with other studies (Bogaerts and Spreen, 2011 ; Van Nieuwenhuizen et al, 2011 ; Schmitter et al, 2021 ). However, notable differences were also evident.…”

“…Likewise, at the item level, this class displayed the highest levels of antisocial behavior, impulsivity and addiction. Many previous studies have consistently related substance use, antisocial behavior, and greater levels of impulsivity to cluster B PDs, which is the main characteristic of the antisocial class identified in this study (e.g., Perry and Körner, 2011 ; Goretti et al, 2017 ; Schmitter et al, 2021 ). It could be that poor impulse control and addiction problems put patients in the antisocial class at risk for more serious violent offenses than patients in the other classes.…”

“…As far as we know, there is only one study investigating patient classes based on the clinical factors of the risk assessment tool—the Historical Clinical Future Revised (HKT-R; Spreen et al, 2014 ), and how these classes differ in comorbidity on Axis I, comorbidity on Axis II, type of drug and type of offense (violent vs. non-violent). However, this study was conducted on a smaller sample of 286 forensic psychiatric patients presenting with SUD (Schmitter et al, 2021 ), while at least 500 participants are required to reliably perform the latent class analysis (LCA) (Vermunt, 2004 ). Another shortcoming of the study by Schmitter et al ( 2021 ) is that when examining comorbidity on Axis II, intellectual disability (ID) was not taken into account.…”

“…However, this study was conducted on a smaller sample of 286 forensic psychiatric patients presenting with SUD (Schmitter et al, 2021 ), while at least 500 participants are required to reliably perform the latent class analysis (LCA) (Vermunt, 2004 ). Another shortcoming of the study by Schmitter et al ( 2021 ) is that when examining comorbidity on Axis II, intellectual disability (ID) was not taken into account. Patients with this type of disability have rarely been studied in forensic settings and considering them in research would contribute significantly to the literature.…”

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

“…The latter represents one of the main factors associated with serious and persistent criminal offending ( 40 ), while poor self-regulation and higher impulsivity are considered crucial in explaining criminal behavior according to the general theory of crime ( 41 ). In addition, many previous studies have often linked cluster B PDs to SUD, and antisocial behavior [e.g., ( 42 – 44 )], i.e., factors that are also significant predictors of violent reoffending ( 1 ).…”