Evidence-based practices for co-occurring disorders in offenders

Abstract

Individuals with substance use and concurrent mental disorders or co-occurring disorders (CODs) present numerous risks and treatment challenges. CODs are particularly pronounced within criminal justice settings. Offenders with CODs have higher risk for recidivism and have unique problems including criminal thinking and antisocial behaviours, commonly referred to as “criminogenic needs”. Two important frameworks for treating CODs with offender populations are the Risk-Need-Responsivity Model (RNR) and the Social Learning Model (SLM). These help to guide the application of integrated evidence-based treatments (EBTs) including Cognitive Behavioural Therapy (CBT), Motivational Interviewing (MI), behavioural modification, behavioural social skills training and family therapy. Programmatic adaptions include comprehensive screening/assessment, specialised tracks for dual diagnoses, intensive and phased treatment, ancillary services (e.g. peer support, relapse prevention), cross-training of staff, interdisciplinary treatment teams, specialised caseloads, and linkage with community mental health and social services. EBTs and programmatic adaptations have been successfully applied in community, jail and prison settings, and research indicates that integrated and structured treatment approaches significantly reduce reoffending and recidivism. Aftercare or reentry services can improve successful transition back into the community and improve offender outcomes. Risk assessment and structured assessment can be used to match offenders to the appropriate level of care and intensity of services. Future research should include controlled trials that examine the effectiveness of integrated offender treatment programmes and their components on key outcomes that include recidivism, substance use, utilisation of behavioural health services and psychosocial functioning.

Keywords:

• Offenders
• co-occurring disorders
• evidence-based practices
• integrated treatment