Classification of offenders with mental health problems and problematic substance use using the Addiction Severity Index version 6: analysis of three-year follow-up data and predictive validity

Abstract

Previous research is scarce on the problems and needs of the “triply troubled” – among offenders with mental health problems and problematic substance use. Classifying this population into clusters based on problem profiles may provide information about individual needs for treatment. In a previous study, we identified four clusters of triply troubled: less troubled, severely triply troubled, triply troubled with medical problems, and working triply troubled. The present study explored the stability and predictive validity of these clusters in a naturalistic design. In total, 125 triply troubled individuals included in any of the four clusters were followed for approximately three years with regard to their inpatient and outpatient treatment participation. They were also interviewed with the 6th version of the Addiction Severity Index, the Psychopathy Checklist–Revised, and the World Health Organization Quality of Life–Bref. The main finding of the study was that on average the participants of all four clusters exhibited substantial improvements over the course of time but that improvements were cluster-specific rather than sample-specific. Implications of the study are discussed.

Keywords:

• offenders
• substance use
• mental health
• Addiction Severity Index version 6
• problem severity
• quality of life

Acknowledgements

We thank Eva Bjerke and Mats Wikström for their aid in collecting and coding data There is no financial relationship that may pose a conflict of interest.

Funding

Preparation of this article was supported by the Swedish Council for Working Life and Social Research [grant number: 2005/5:11].

Notes

1. According to the Swedish penal system, all offenders are sentenced in court following a criminal offense, regardless of their psychiatric status. However, offenders with no known serious mental disorder at the time of the offense are sentenced to prison or probation (or an initial period of imprisonment followed by probation), while offenders with a serious mental disorder at the time of the offense are sentenced to inpatient forensic psychiatric treatment (sometimes followed by outpatient forensic psychiatric treatment).