Criminal Typology of Veterans Entering Substance Abuse Treatment

Abstract

Criminal justice involvement among veterans is a critical and timely concern, yet little is known about criminal histories and clinical characteristics among veterans seeking treatment for substance use disorders (SUDs). The present study examined criminal typology, clinical characteristics, treatment utilization, and 12-step mutual-help group (MHG) participation among veterans (N = 332) at intake to SUD treatment at the Department of Veterans Affairs (VA), and 6 months and 1 year post-intake. Cluster analysis yielded three types of criminal histories mild—(78.9%), moderate (13.6%), and severe (7.5%)—distinguished by type of offense, number of convictions, and number of months incarcerated. At intake, participants with mild criminal histories reported more alcohol problems and fewer legal and employment problems than participants with moderate and severe criminal histories. Participants with severe criminal histories were most likely to attend a 12-step MHG meeting in the year post-intake, but all groups had high attendance. When only participants who had attended at least one meeting in the year post-intake were compared, participants with mild criminal histories worked more steps and were more involved in 12-step practices. All groups improved between baseline and follow-up and did not differ at follow-ups on substance use or other clinical outcomes. Multiple regressions identified treatment utilization and MHG attendance, but not baseline criminal history, as significant predictors of improved substance use problem severity at follow-up. Outpatient treatment and 12-step MHG attendance appear to be important components of recovery for veterans with varying criminal histories. Clinicians in SUD treatment programs should screen for criminal histories at treatment intake to ensure appropriate treatment planning.

Systematic Review of Criminal and Legal Involvement After Substance Use and Mental Health Treatment Among Veterans: Building Toward Needed Research

“…Effect sizes indicating the strength of associations of substance use or mental health treatment with reduced legal or violence severity scores were generally in the medium to large range and were larger for patients with scores that were more severe at baseline. 44,49,[55][56][57] Improvement occurred despite the high rates of criminal involvement prior to entering opioid use, other substance use, or mental health treatment. For example, Timko et al's study found that 91% of veterans entering mental health treatment had a history of violent or non-violent offenses.…”

“…46 Of eight studies that examined other substance use treatment, seven reported that legal and criminal problem severity declined among veterans with alcohol or drug use disorders and among veterans with co-occurring mental health problems. [41][42][43]50,52,55 In addition, longer treatment was associated with better outcomes among alcohol and drug patients, 42,49 and treatment completion (which cannot be achieved if patients are detained or reincarcerated during treatment) was related to a lower likelihood of incarceration than was noncompletion. 51 All of these studies examined veterans entering a new episode of substance use treatment.…”

“…Using another approach, Schultz et al found that veterans (98% male) admitted to VA outpatient substance use treatment clustered into three profiles based on their criminal history: mild (low numbers of criminal offenses, convictions, and months incarcerated; 79% of patients); moderate (high number of public order offenses, repeated convictions, and >3 years incarcerated; 14% of patients); and severe (violent criminal offenses, repeated convictions, and >10 years incarcerated; 7% of patients). 55 In one of only two randomized controlled trials (RCTs) in this review, Siegal et al randomly assigned 453 veterans (98.7% men) who received VA substance use treatment (residential and outpatient treatment followed by continuing outpatient care) to case management or no case management. 49 In the whole sample, ASI legal severity scores declined from baseline to 1-year follow-up (Ms = .17 [SD = .21] and M = .08 [SD = .16], respectively; Cohen's d = .48), but a significance test was not reported; 31.1% had a new arrest during the 1-year follow-up.…”

“…To summarize studies that examined substance use treatment other than for opioid use, most reported that legal and criminal problem severity declined among veteran patients, including those with co-occurring mental health problems, [41][42][43]50,52,55 or that longer treatment was associated with better legal and criminal outcomes. 42,49…”

The Integration Program of Prevention and Treatments of Substance Use and HIV/AIDS in the Rural Primary Health Care (PHC) System of Iran

“…According to reports of Addiction and mental health office of the ministry of health of Iran (2007), from 3277 cases, 64% of HIV positive cases were infected from substance injection. Due to comorbidity of HIV/AIDS with drug consumption, injective drug abuse is a considerable health issue, because it is correlated with social problems such as violence, crime and high risk driving (20). There is drug abuse in prisons of Iran.…”