Predictors of Accessing Substance Abuse Services Among Individuals With Mental Disorders Released From Correctional Custody

Abstract

Objective: In the context of an increasing correctional population and corresponding rates of mental illness and substance abuse among this population, this study focuses on describing the predictors of substance abuse service utilization for ex-inmates with dual disorders. Our aim is to assess the likelihood and characteristics of ex-inmates with mental disorders who access substance abuse treatment services within 2 years of correctional release. Methods: Using merged administrative data on all ex-inmates with open mental health cases released from the Massachusetts Department of Corrections and two county houses of corrections from 2007 to 2009 (N = 2,280) and substance abuse treatment outcome data through 2011, we analyze the influence of demographics, behavioral and mental disorders, and criminal justice variables on entry into substance abuse treatment within 24 months post-release. We also describe primary drug use and services utilized for all the ex-inmates who accessed substance abuse services (n = 1,383). Regression techniques were used to analyze the probability of utilizing substance abuse treatment services by various demographic, behavioral, and criminal involvement characteristics. Results: The prevalence of a history of substance use disorders is high in this population (69%, n = 1,285). Subsequently, at 24 months post release, 61% (n = 1,383) of ex-inmates with open mental health cases utilized substance abuse treatment services. This group was disproportionately female and White, with a preincarceration history of substance abuse and an increased number of previous incarcerations, and was more likely released under correctional supervision. Conclusions: Substance abuse is a chronic relapsing disorder and dual diagnosis is common among individuals with mental disorders involved with the criminal justice system. Their service needs and contacts across substance abuse, mental health, and criminal justice systems highlight individuals caught up in the institutional circuit. Study results point to the need for expanded and targeted dual diagnosis treatment approaches and relapse prevention for ex-inmates with mental disorders post correctional release.

Keywords:

• mental illness
• mental disorder
• substance abuse
• criminal justice
• dual diagnosis
• history of substance abuse services
• substance abuse treatment services
• ex-inmates

ACKNOWLEDGMENTS

This work was funded by the National Institute of Health NIMH1RC1MH088716-01. Thank you to Alison Moll our grant manager at UMass Boston. The investigators would also like to thank Dr. Martha Lyman, Michael Lupo, and Julie White, LICSW, for their contributions and commitment to this project. Gratitude goes to our excellent research assistants from UMass Boston: Paul Anskat, Phoebe Lehman, Brianna Roach, Jenn Walker, Taylor Hall, and James Wall. Thanks to Debra Pinals, MD, and Paul Benedict for their expertise and technical assistance from the Department of Mental Health; Lisa Sampson, Natalya Pushkina, William Saltzman, and Ken Nelson for their support from the DOC; and Andrew Hanchett, Hermik Babakhanlou-Chase, Adam Pojani, and Michael Botticcelli for their support from the Department of Public Health Bureau of Substance Abuse Services.

Notes

1. Massachusetts’ Department of Correction facilities hold offenders who receive sentences of more than 2.5 years. These inmates serve 4 years on average. County Houses of Corrections usually supervise and control inmates who commit less serious crimes. These facilities usually hold offenders whose sentences are 2.5 years or less, and who serve an average of 9 months.

2. An article describing this process was recently published (Hartwell et al., 2012).

3. Essentially, almost 30% of individuals accessing treatment are estimated to be new substance abuse treatment need cases without a prior substance abuse history (n = 1,126).