This study examined the relationship between risk of future crime/violence and mental health status/co-occurring disorders in 2,077 probationers in Tarrant County, Texas. Screening tools assessed substance use, mental health disorders, and risk levels. Probationers with co-occurring substance use and mental health disorders had significantly higher risk of future crime than those with only one disorder or no disorders. Treating both substance use and mental health issues is important for reducing recidivism in this population.
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Assessment of substance use disorders 010915Tom Wilson
A presentation on screening and assessment of substance use disorders made to the Leadership in Rehabilitation Counseling Graduate Program at the Boise Campus of the University of Idaho, Boise campus.
1. Roberto Cardarelli, DO, MPH
Director, Primary Care Research
Center of the Texas Prevention
Institute
Mental Health
Screening and
Treatment
Initiative (MHSTI)
2. Acknowledgements
• This research is supported by the Meadows Foundation (Grant
#2009040047) and is approved by the UNT Health Science Center
IRB
• Roberto Cardarelli, DO, MPH
• Christopher Mann, DO, Eagle Medical Centers, PA
• Michael Ellison, PhD, Texas Wesleyan University
• Ron Sivernell, MA, LCDC-AAC, Tarrant County Community
Supervision and Corrections Department
• Elizabeth Balyakina, MS, MPH, Research Coordinator
• Kimberly G. Fulda, DrPH, Associate Director, PCRC/NorTex
• Simrat Kaur Sarai, MBBS, Research Assistant
3. Background
• The criminal justice system is the primary service delivery
system for many adults with drug and alcohol dependence,
mental health and other health service needs
• Texas has largest correctional population in the US
• In 2003, Texas Department of Criminal Justice spent $383
million on health care
• 11% of total correctional expenditures
• As a result, increased focus on reducing recidivism,
community supervision and treatment programs
4. Substance abuse and mental
health among offenders
• In 2002, 61% of probationers screened by the Texas
Treatment Alternative to Incarceration Program had
a substance use disorder which required intervention
• 70% to 80% of people entering substance abuse
treatment programs had at least one co-morbid
psychiatric disorder
• Offender populations at increased risk of untreated
mental illness and co-occurring disorders
5. Purpose
• Examine the relationship between the risk of future
crime and violence, mental health status and co-
occurring disorders in a large substance abuse
diversion probationer population
6. Methods
• Purposive sample of 2,077 Tarrant County probationers
completed self-reported electronic questionnaire screening
for mental health disorders, substance use, risk of future
offense, and demographic characteristics
• Administered on 5 DigiveyTM touch screen survey stations
with bilingual audio
• “Report card” printed at a 6th station and was discussed with
assigned Licensed Chemical Dependency Counselor
8. Methods
• Multiple logistic regression assessing the association
between risk of future offense and co-occurring
disorders
• Adjusted for age, gender, race/ethnicity, number of
people in household, total yearly household income,
education, and employment status
• Another model composed by adding medication use
• Unadjusted and adjusted odds ratios and 95%
confidence intervals calculated (α=0.05)
9. Participant Characteristics
• Average age: 31.7 (sd=11.4)
• 71.7% male
• 56.3% White, 22.0% African American, and 18.3%
Hispanic/Latino
• Most common offense: drug related or driving while
intoxicated (64.9%)
• Over 70% graduated from college or received GED;
42.9% had completed some college
10. Mental Health Screening Scores, Positive
Screeners, Tarrant County, TX 2009-2010 (n=2077)
Variable n (%)
GAIN-SS
Internalizing Disorders 597 28.7
Externalizing Disorders 174 8.4
Suicide Risk 120 5.8
Substance Disorders 484 23.3
Risk for Violence/Crime
Low Risk 1889 90.9
Moderate Risk 175 8.4
High Risk 13 0.6
12. Results
• Probationers who screened + for any co-occurring
substance use and mental health disorder
significantly more likely to have a moderate to high
risk of future crime and violence than…
• those who screened + for only a substance use disorder
• those who screened + for only a mental health disorder
• those who had no substance use or mental health
disorder
13. Simple and multiple logistic regression for moderate
to high risk of future crime and violence
Simple logistic
regression
Multiple logistic
regression
Multiple logistic
regression with
medication use
OR 95% CI OR 95% CI OR 95% CI
Substance and Depression
No Substance or Depression --- --- --- --- --- ---
Substance Only 11.9 (8.0-17.7) 11.9 (7.9-17.8) 11.5 (7.6-17.3)
Depression Only 2.9 (1.5-5.3) 2.8 (1.5-5.3) 2.5 (1.3-4.8)
Substance and Depression 12.9 (8.2-20.3) 11.9 (7.4-19.2) 10.3 (6.4-16.7)
14. Simple and multiple logistic regression for moderate
to high risk of future crime and violence
Simple logistic
regression
Multiple logistic
regression
Multiple logistic
regression with
medication use
OR 95% CI OR 95% CI OR 95% CI
Substance and ADHD
No Substance or ADHD --- --- --- --- --- ---
Substance Only 10.9 (7.5-15.8) 10.8 (7.4-15.7) 10.4 (7.1-15.3)
ADHD Only 7.6 (3.6-16.0) 7.1 (3.3-15.4) 6.2 (2.8-13.6)
Substance and ADHD 20.9 (12.1-36.3) 19.0 (10.7-33.9) 15.5 (8.5-28.2)
15. Simple and multiple logistic regression for moderate
to high risk of future crime and violence
Simple logistic
regression
Multiple logistic
regression
Multiple logistic
regression with
medication use
OR 95% CI OR 95% CI OR 95% CI
Substance and Anxiety
No Substance or Anxiety --- --- --- --- --- ---
Substance Only 11.1 (7.5-16.5) 11.0 (7.3-16.4) 10.7 (7.1-16.0)
Anxiety Only 4.0 (2.1-7.7) 4.0 (2.0-7.8) 3.4 (1.7-6.7)
Substance and Anxiety 15.8 (10.0-25.0) 15.1 (9.3-24.4) 12.9 (7.8-21.1)
16. Simple and multiple logistic regression for moderate
to high risk of future crime and violence
Simple logistic
regression
Multiple logistic
regression
Multiple logistic
regression with
medication use
OR 95% CI OR 95% CI OR 95% CI
Substance and Bipolar
No Substance or Bipolar --- --- --- --- --- ---
Substance Only 10.0 (5.4-18.5) 10.4 (5.6-19.5) 10.1 (5.4-19.0)
Bipolar Only 3.7 (2.1-6.5) 3.5 (2.0-6.1) 3.2 (1.8-5.7)
Substance and Bipolar 25.0 (15.2-41.2) 22.6 (13.5-37.7) 20.4 (12.2-34.2)
17. Simple and multiple logistic regression for moderate
to high risk of future crime and violence
Simple logistic
regression
Multiple
logistic
regression
Multiple logistic
regression with
medication use
OR 95% CI OR 95% CI OR 95% CI
Substance and Mental Health
Disorder*
No Substance/Mental Health
Disorder --- --- --- --- --- ---
Substance Only 12.6 (8.2-19.5) 12.8 (8.2-19.9) 12.6 (8.1-20.0)
Mental Health Disorder Only 3.3 (1.9-5.8) 3.2 (1.8-5.8) 2.9 (1.6-5.2)
Substance and Mental Health
Disorder 15.0 (9.7-23.3) 13.9 (8.8-22.1) 12.0 (7.5-19.2)
*Does not include scores for bipolar disorder from the MDQ
18. Conclusions
• Study results confirm the intensification of risk for crime and
violence among probationers with co-occurring disorders as
compared to those with substance use or mental health
disorders alone
• Addition of current medication use improved the overall fit of
the model
• Need for improved coordination between substance use
and mental health services
• Assessment of prior or current probationer status in primary
care may be used as a cue to screen for mental health
disorders
19. References
1Human Rights Watch. Ill-equipped: US prisons and offenders with mental illness. New York: Human Rights Watch;
2003.
2Taxman FS, Perdoni ML, Harrison LD. Drug treatment services for adult offenders: The state of the state. J Subst
Abuse Treat. 2007;32:239-254.
32002-2003 state health expenditure report. New York: Milbank Memorial Fund; 2005.
42003 state expenditure report. Washington, DC: National Association of State Budget Officers; 2004.
5The Pew Center on the States. One in 100: Behind bars in America. The Pew Charitable Trusts; 2008.
6Texas Department of Justice. Treatment alternatives to incarceration programs fact sheet. Austin, TX: Texas
Department of Justice – Community Justice Assistance Division; 2003.
7Dennis ML, Chan YF, Funk RR. Development and validation of the GAIN Short Screener (GSS) for internalizing,
externalizing and substance use disorders and crime/violence problems among adolescents and adults. Am J Addict.
2006;15 Suppl 1:80-91.
8Drug and Alcohol Services Information System. Admissions with co-occurring disorders:1995 and 2001. Rockville, MD:
Office of Applied Studies, Substance Abuse and Mental Health Services Administration; 2001.
9Ditton P. Bureau of justice statistics special report: Mental health and treatment of inmates and probationers. US
Department of Justice; 1999.
10Villagonzalo KA, Dodd S, Ng F, Mihaly S, Lanbein A, Berk M. The utility of the mood disorders questionnaire as a
screening tool in a methadone maintenance treatment program. Int J Psych Clin Pr. 2010;14:150-153.
