The prevalence and manifestation of substance use paralleling behaviours in a secure forensic psychiatric hospital

Abstract

Co-morbid substance dependence is common in patients of secure psychiatric services. Identifying opportunities for intervention, monitoring progress in treatment and assessing risk of relapse are compromised by this group's limited access to illicit substances. This research investigated the validity of the substance use paralleling behaviour (SUPB) framework, which was developed to assist staff in identifying behaviours indicative of substance dependence in controlled environments. Thirty-one patients admitted to the acute units of a secure forensic psychiatric hospital were interviewed and assessed with the Brief Psychiatric Rating Scales, the structured clinical interview for DSM disorders substance use disorders module, and an original questionnaire measuring motivations for drug use and behaviours indicative of substance dependence in a controlled setting (SUPBs). Results showed that patients with a history of substance dependence preceding admission engaged in more SUPBs during hospitalisation than patients without a history of substance dependence. Severity of psychiatric illness was unrelated to the frequency of requests for Pro re nata (PRN) medication and SUPBs. These results provide preliminary support for the SUPB framework and suggest that these behaviours might usefully be considered by staff of secure psychiatric hospitals when planning treatment, measuring progress and ascertaining risk of relapse. Opportunities for clinical application and future research are discussed.

Exploring substance use as rule‐violating behaviour during inpatient treatment of offender patients with schizophrenia

“…They may be trying to relieve boredom. It is not easy to be a resident in a secure hospital, so rule‐violating drugs may be for anxiety reduction or to increase social confidence (Schaefer et al., 2011). All possibilities should also be taken into account in treatment.…”

“…The association of substance misuse (alcohol or illicit drugs) and offending in persons suffering from severe mental illness (Elbogen & Johnson, 2009;Pickard & Fazel, 2013) and especially in those along the schizophrenia spectrum (Fazel et al, 2009;Swanson et al, 2006;) is well established. Considering this, a higher prevalence of history of substance misuse and comorbid substance use disorder has been found in forensic psychiatric populations (Elbogen & Johnson, 2009;Schaefer, Daffern & Ferguson, 2011;.…”

“…The association of substance misuse (alcohol or illicit drugs) and offending in persons suffering from severe mental illness (Elbogen & Johnson, 2009; Pickard & Fazel, 2013) and especially in those along the schizophrenia spectrum (Fazel et al., 2009; Swanson et al., 2006; Volavka & Citrome, 2011) is well established. Considering this, a higher prevalence of history of substance misuse and comorbid substance use disorder has been found in forensic psychiatric populations (Elbogen & Johnson, 2009; Schaefer, Daffern & Ferguson, 2011; Whyte, Scott & Maden, 2004). Further, patients with an existing diagnosis of substance misuse or substance use disorder were reported to be younger at initial admission to a psychiatric facility, to have longer psychiatric hospitalisations, to have more severe and complex criminal histories, and to be more likely to have a history of self‐injurious and suicidal behaviour (Mueser et al., 2000; Ogloff, Lemphers & Dwyer, 2004).…”

“…While illicit substances are known to enter secure forensic psychiatric hospitals, research indicates that the quantity is small and below that entering jails (D'silva & Ferriter, 2003; Schaefer et al., 2011). When patients are not (or scarcely) using during hospitalisation, this may mislead to an assumption that they no longer have a substance use disorder or at least a substance misuse problem when it is only access that has changed (Schaefer et al., 2011).…”

“…While illicit substances are known to enter secure forensic psychiatric hospitals, research indicates that the quantity is small and below that entering jails (D'silva & Ferriter, 2003; Schaefer et al., 2011). When patients are not (or scarcely) using during hospitalisation, this may mislead to an assumption that they no longer have a substance use disorder or at least a substance misuse problem when it is only access that has changed (Schaefer et al., 2011). Because of the high prevalence of substance use disorder in the forensic context, the question arises as to whether patients who misuse substances during hospitalisation share any other characteristics that differentiate them from those who do not misuse in these circumstances.…”