Treatment and Reentry Approaches for Offenders with Co-occurring Disorders

Abstract

An increasing number of offenders in jail, prison, and community corrections settings have mental health and substance abuse problems. In a recent survey conducted within state prisons, 24% of inmates reported a recent history of mental health problems (Bureau of Justice Statistics, 2006), and prevalence estimates of mental disorders in jails and prisons range from 10 to 15% (Lamb, Weinberger, & Gross, 2004; National GAINS Center, 2004; Teplin, Abram, & McClelland, 1996, 1997). Approximately three-quarters of prisoners have had a diagnosable substance abuse or dependence disorder in their lifetime (Peters, Greenbaum, Edens, Carter, & Ortiz, 1998). Rates of both mental health and substance use disorders among offenders far surpass those found in the general population (Robins & Regier, 1991). A significant proportion of offenders have co-occurring mental health and substance use disorders (National GAINS Center, 2004), including 80% of probationers sentenced to participate in substance abuse treatment (Hiller, Knight, & Simpson, 1996) and as many as half of female offenders and juvenile detainees (Jordan, Schlenger, Fairbank, & Caddell, 1996; Teplin, Abram, McClelland, Dulcan, & Mericle, 2002). Research indicates that from 72 to 87% of offenders with severe mental disorders have co-occurring substance use disorders (Abram & Teplin, 1991; Abram, Teplin, & McClelland, 2003; Chiles, Cleve, Jemelka, & Trupin, 1990; Bureau of Justice Statistics, 2006). A number of factors explain the influx of inmates with co-occurring disorders to jails and prisons. These include the closing and “downsizing” of state mental hospitals, adoption of restrictive civil commitment criteria, inadequate access to community support services, widespread availability of relatively cheap and rapidly addicting street drugs, and law enforcement efforts to eliminate drug use and drug-related street crime. Studies examining persons with mental disorders in community settings indicate that having co-occurring disorders increases the risk for community violence and for arrest (Monahan et al., 2001, 2005). Once arrested, persons with co-occurring disorders are more likely to be incarcerated, and once incarcerated, these persons remain in jail significantly longer than other inmates, and are more likely to receive a sentence Chapter 22