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Key Risk Factors for Relapse and Rearrest Among Substance Use Treatment Patients Involved in the Criminal Justice System

Abstract

Substance use treatment programs for criminal justice populations have great potential for crime reduction, if they can effectively manage patients’ risk for relapse and rearrest. The current study used data drawn from the Comprehensive Assessment and Treatment Outcome Research (CATOR) system, a national registry of substance use treatment programs, which collected patient outcome data at 6- and 12-month intervals following discharge from treatment. The primary objective was to examine sets of factors that may compromise relapse and rearrest outcomes among patients who were court mandated to participate in treatment. Findings demonstrated that patients’ clinical severity of substance use was associated with relapse, which also significantly increased the probability of post-treatment arrest. Adolescent risk behaviors represented another set of risk factors, particularly among patients who experienced the most severe pattern of relapse and arrest outcomes. Additionally, demographic risk factors, including age, marital status (i.e., single or unmarried relative to married), employment (i.e., being unemployed compared to employed), and lower educational attainment were consistently linked to higher probabilities of relapse and rearrest. Treatment programs for criminal justice populations should consider incorporating appropriate clinical risk assessment measures, behavioral risk assessments, and appropriate employment interventions into standard treatment programming in an effort to improve outcomes.

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Correspondence to Albert M. Kopak.

Appendix

Appendix

Items included in the clinical severity index.

  1. 1.

    What was your most recent ingestion of alcohol, marijuana, cocaine, stimulants, barbiturates/sedative, opiates, tranquilizers, hallucinogens, narcotic painkillers, other: (0) Did not use substances in the past 24 h, (1) Used one substance in the past 24 h, (2) Used multiple substances in the past 24 h.

  2. 2.

    What was your typical use of alcohol, marijuana, cocaine, stimulants, barbiturates/sedative, opiates, tranquilizers, hallucinogens, narcotic painkillers, other in the past year? (0) Did not use any substance daily, (1) Used one substance daily, (2) Used multiple substances daily.

  3. 3.

    Have you ever used a needle to inject street drugs? (0) No (1) Yes.

  4. 4.

    Have you ever drank a fifth of liquor, 20 drinks, 3 six-packs of beer, or 3 bottles of wine in one day? (0) No (1) Yes.

  5. 5.

    Have you ever had delirium tremens, fits, seizures, or hallucinations after stopping drinking? (0) No (1) Yes.

  6. 6.

    Have you ever had withdrawal symptoms after stopping drug use? (0) No (1) Yes

  7. 7.

    Patients who met diagnostic criteria for dependence on one substance were coded (1), those who met criteria for dependence on two substances were coded (2), those who met criteria for three were coded (3), up to (6) for those who met criteria for dependence on six substances.

  8. 8.

    Patients who did not use alcohol or drugs during treatment were coded (0) and those who did use alcohol or drugs during treatment were coded (1).

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Kopak, A.M., Hoffmann, N.G. & Proctor, S.L. Key Risk Factors for Relapse and Rearrest Among Substance Use Treatment Patients Involved in the Criminal Justice System. Am J Crim Just 41, 14–30 (2016). https://doi.org/10.1007/s12103-015-9330-6

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Keywords

  • Treatment outcomes
  • Relapse
  • Recidivism
  • Drug dependence
  • Crime prevention