title: Predictors of incarceration among urban adults with co-occurring severe mental illness and a substance use disorder.
abstract: OBJECTIVE
  People with severe mental illness and a co-occurring substance use disorder (co-occurring disorders) who live in urban areas experience high rates of incarceration. This study examined sociodemographic, clinical, economic, and community integration factors as predictors of incarceration among people with co-occurring disorders.
  
  
  METHODS
  This secondary analysis used data from a randomized controlled trial of assertive community treatment versus standard case management. In the parent study, researchers interviewed 198 people with co-occurring disorders from two urban mental health centers in Connecticut at baseline and every six months for three years. Researchers tracked incarceration, clinical engagement and status, employment, living situation, social relationships, and substance use. The study reported here used bivariate analyses and logistic regression analyses to compare individuals who were incarcerated during the study period with those who were not.
  
  
  RESULTS
  The overall incarceration rate was 38% during the study period. In multivariate analyses, prior incarceration predicted incarceration during the study period (odds ratio [OR]=3.26). Two factors were associated with a reduced likelihood of incarceration: friendships with individuals who did not use substances (OR=.19) and substance use treatment engagement (OR=.60).
  
  
  CONCLUSIONS
  Positive social relationships and engagement in substance use treatment are promising service and policy targets to prevent incarceration in this high-risk population.
authors.affiliation: Dr. Luciano, Dr. McHugo, Dr. Drake, and Dr. Xie are with the Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (e-mail: alison.luciano@dartmouth.edu ). Mr. Belstock and Mr. Malmberg are medical students, Faculty of Health Sciences, University of Linköping, Linköping, Sweden. Dr. Essock and Dr. Covell are with the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and with the Department of Mental Health Services and Policy Research, New York State Psychiatric Institute, New York City.
authors.forename: Alison
authors.initials: A
authors.lastname: Luciano
authors.forename: Johannes
authors.initials: J
authors.lastname: Belstock
authors.forename: Per
authors.initials: P
authors.lastname: Malmberg
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: McHugo
authors.forename: Robert E
authors.initials: RE
authors.lastname: Drake
authors.forename: Haiyi
authors.initials: H
authors.lastname: Xie
authors.forename: Susan M
authors.initials: SM
authors.lastname: Essock
authors.forename: Nancy H
authors.initials: NH
authors.lastname: Covell
mesh_terms: D000328:Adult; D003237:Connecticut; D003710:Demography; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D005544:Forecasting; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D001523:Mental Disorders; D015999:Multivariate Analysis; D011329:Prisoners / Q000706:statistics & numerical data; D036301:Qualitative Research; D012720:Severity of Illness Index; D012931:Social Environment; D019966:Substance-Related Disorders; D014505:Urban Population