Addiction and offending behavior: clinical characteristics and treatment outcomes in forensic addiction care

Introduction

The relationship between offending behavior and substance-use disorder (SUD) is well-known and complex. Forensic patients with SUD vary in clinical characteristics like psychiatric comorbidity, patterns of substance use and type of offense. We examined whether different patient classes in forensic addiction care could be identified based on type of psychiatric diagnosis and historic risk  factors (for example past substance use and offense history) and whether these classes differed on risk behavior during treatment and treatment outcomes. 

Method

Data were retrieved from health records in a forensic addiction treatment centre in the Netherlands (n=252). In the treatment centre, SUD, offending behavior and related problems are treated simultaneously. Information included DSM-5 diagnoses, historical risk factors for recidivism, urine toxicology, number of aggression incidents and drop-out. To identify patient classes, a Latent Class Analysis (LCA) was performed. 

Results

We identified four patient-classes, including one with a high prevalence of psychopathology and high historic risks, one with severe past substance use and long treatment history and two classes with low historic risks. These classes did not differ in risk behavior or treatment outcomes. Mild intellectual disability (MID) was higly prevalent in all classes and associated with risk behavior during treatment, but not with treatment outcomes. 

Conclusions

The results indicate that patients in forensic addiction care do not form a homogenous patient group as different subpopulations exist, each with unique profiles on clinical characteristics and risk factors. Although subpopulations of forensic addiction patients are identifiable, historic risks do not predict variations in treatment outcomes. MID is highly prevalent across all classes and associated with higher risky behavior during treatment, which should be taken into account when adjusting treatment to these subpopulations.