Interventions for drug-using offenders with co-occurring mental health problems: a systematic review and economic appraisal.
BACKGROUND
Drug-using offenders with co-occurring mental health problems are common in the criminal justice system. A combination of drug use and mental health problems makes people more likely to be arrested for criminal involvement after release compared to offenders without a mental health problem. Previous research has evaluated interventions aimed broadly at those with a drug problem but rarely with drug use and mental health problems. This systematic review considers the effectiveness of interventions for drug-using offenders with co-occurring mental health problems.


METHODS
We searched 14 electronic bibliographic databases up to May 2014 and five Internet resources. The review included randomised controlled trials designed to reduce, eliminate, or prevent relapse of drug use and/or criminal activity. Data were reported on drug and crime outcomes, the identification of mental health problems, diagnoses and resource information using the Drummond checklist. The systematic review used standard methodological procedures as prescribed by the Cochrane collaboration.


RESULTS
Eight trials with 2058 participants met the inclusion criteria. These evaluated: case management (RR, 1.05, 95 % CI 0.90 to 1.22, 235 participants), motivational interviewing and cognitive skills, (MD-7.42, 95 % CI-0.20.12 to 5.28, 162 participants) and interpersonal psychotherapy (RR 0.67, 95 % CI 0.3 to 1.5, 38 participants). None of these trials reported significant reductions in self-report drug misuse or crime. Four trials evaluating differing therapeutic community models showed reductions in re-incarceration (RR 0.28, 95 % CI 0.13 to 0.63, 139 participants) but not re-arrest (RR 1.65, 95 % CI 0.83 to 3.28, 370 participants) or self-report drug use (RR 0.73, 95 % CI 0.53 to 1.01, 370 participants). Mental health problems were identified across the eight trials and 17 different diagnoses were described. Two trials reported some resource information suggesting a cost-beneficial saving when comparing therapeutic communities to a prison alternative.


CONCLUSIONS
Overall, the studies showed a high degree of variation, warranting a degree of caution in the interpretation of the magnitude of effect and direction of benefit for treatment outcomes. Specifically, tailored interventions are required to assess the effectiveness of interventions for drug-using offenders with co-occurring mental health problems.
Department of Health Sciences, University of York, ARRC Building Second Floor, Heslington York, YO10 5DD UK.
Rebecca
R
Woodhouse
University of Leeds, Leeds, UK.
Matthew
M
Neilson
University of Sheffield, Sheffield, UK.
Marrissa
M
Martyn-St James
YHEC, University of York, York, UK.
Julie
J
Glanville
Trials Unit, University of York, York, UK.
Catherine
C
Hewitt
Department of Health Sciences, University of York, ARRC Building Second Floor, Heslington York, YO10 5DD UK.
Amanda E
AE
Perry
Drug use; Mental health; Offenders; Systematic review
Psychiatr Serv. 1998 Apr;49(4):483-92
9550238
Lancet. 2002 Feb 16;359(9306):545-50
11867106
J Psychiatr Res. 2012 Sep;46(9):1174-83
22694906
Law Hum Behav. 2012 Feb;36(1):37-50
22471384
J Clin Psychol. 2014 Jul;70(7):644-57
24449031
Psychother Psychosom. 2015;84(1):30-6
25547522
Br J Psychiatry. 2013 Nov;203(5):341-9
24029536
Eur Arch Psychiatry Clin Neurosci. 2005 Apr;255(2):75-82
15812600
J Subst Abuse Treat. 2003 Oct;25(3):213-21
14670525
J Case Manag. 1997 Fall;6(3):119-26
9573971
Aust N Z J Psychiatry. 2012 May;46(5):407-21
22535291
Int J Environ Res Public Health. 2016 Sep 29;13(10):
27690077
J Exp Criminol. 2011 Sep;7(3):225-253
21949490
Cochrane Database Syst Rev. 2015 Jun 02;(6):CD010862
26035084
BMJ. 2008 Apr 26;336(7650):924-6
18436948
Cochrane Database Syst Rev. 2015 Jun 02;(6):CD010901
26034938
J Addict Dis. 2012;31(3):258-69
22873187
Behav Sci Law. 2004;22(4):477-501
15282836
J Stud Alcohol Drugs. 2011 May;72(3):497-506
21513687
Law Hum Behav. 2012 Feb;36(1):1-12
22471380
Psicothema. 2013;25(3):307-12
23910743
J Clin Epidemiol. 2012 Jul;65(7):748-55
22564503
Alcohol Alcohol. 2006 May-Jun;41(3):328-35
16547122
Behav Sci Law. 2003;21(4):415-27
12898500
Cochrane Database Syst Rev. 2005 Oct 19;(4):CD005331
16235402
Cochrane Database Syst Rev. 2010 Feb 17;(2):CD003499
20166067
Cochrane Database Syst Rev. 2015 Jun 02;(6):CD010910
26035085
Psychiatr Serv. 2002 Oct;53(10):1290-6
12364677
Syst Rev. 2013 Sep 23;2:81
24059250
Cochrane Database Syst Rev. 2011 May 11;(5):CD008063
21563163
J Subst Abuse Treat. 2012 Apr;42(3):247-59
21943810