Recent Violence Among Persons Entering Short-Term Residential Mental Health and Substance Abuse Treatment

Abstract

Objective: Large-scale epidemiologic studies have consistently found that co-occurring mental health and substance use disorders are associated with increased risk of involvement in violence. Individuals with co-occurring mental and substance use disorders can present either in mental health or substance abuse treatment systems, and both systems must be able to respond to their needs. This study examined the prevalence and correlates of recent violence (both perpetration and victimization) among adults (N = 419) entering short-term residential mental health and substance abuse treatment. Methods: Approximately 41% (n = 171) of participants reported having any involvement in violence, and for the majority of them (n = 144; 84%) that included victimization. For analytic purposes, we classified participants with involvement in violence as any perpetration (n = 87) or only victimization (n = 84) and conducted bivariate and multivariate logistic regression analyses examining potential correlates of these different types of violence. Results: Homelessness (adjusted odds ratio [AOR] = 1.6, 95% confidence interval [CI] [1.0–2.4], p < .04), alcohol use disorder (AOR = 1.8, 95% CI [1.1–2.9], p < .03), and the interaction of comorbidity and substance abuse treatment system (AOR = 2.8, 95% CI [1.0–7.6], p < .05) were associated with an increased likelihood of any violence. Alcohol use disorder (AOR = 1.8, 95% CI [1.0–3.3], p < .05) increased the likelihood of perpetration. Homelessness (AOR = 1.9, 95% CI [1.1–3.2], p < .02) and the interaction of comorbidity and being recruited from substance abuse treatment (AOR = 5.1, 95% CI [1.8–14.2], p < .003) increased the likelihood of involvement in only victimization. Conclusions: Victimization was far more prevalent than perpetration. Comorbidity was not a significant predictor of violence, but individuals with comorbidity recruited from the substance abuse treatment system were more likely to be involved in violence.

Keywords:

• mental disorders
• substance use disorders
• co-occurring disorders
• violence
• victimization

ACKNOWLEDGMENTS

This work was supported by the National Institute of Drug Abuse grants R01 DA010836, P50 DA09253, and T32 DA07250. It was completed by Dr. Havassy while she was a professor of psychiatry in the School of Medicine at the University of California, San Francisco (UCSF) and published posthumously. During her more than 40-year career at UCSF, Dr. Havassy conducted a number of critical studies examining the service needs and service use of individuals with co-occurring mental and substance use disorders and mentored numerous investigators who continue work in this area. The authors would like to thank Jennifer Alvidrez, PhD, and Kevin Delucchi, PhD, for comments on earlier versions of this manuscript.

This article is published posthumously for lead author Barbara E. Havassy, PhD.