James A. Swartz

Serious Mental Illness and Arrest The Generalized Mediating Effect of Substance Use

Past studies of the mediating effects of substance use on the criminal justice involvement of the mentally ill have tended to focus on a single disorder, schizophrenia, and on violent crimes. This study examined the generality of the relationships among psychiatric disorders, substance use, and arrests for violent, nonviolent, and drug-related offenses using data collected for the 2001 and 2002 National Survey on Drug Use and Health. Logistic regression models showed that for violent offenses, the statistical association between serious mental illness (SMI) and arrest across psychiatric diagnoses was substantially but only partially mediated by substance use. For nonviolent offenses and for drug-related offenses, the relationship between SMI and arrest was almost completely mediated by substance use and reduced to statistical nonsignificance. These findings suggest that co-occurring substance use increases the chances a person with any SMI, not just schizophrenia, will be arrested for any offense, not just violent offenses, but that the magnitude of this relationship varies by offense type and, to a lesser extent, by disorder.

Standardized Assessment of Substance-Related, Other Psychiatric, and Comorbid Disorders among Probationers

This study examined the prevalence of alcohol-and substance-related disorders in a random sample of 627 adult probationers in Illinois. The investigation also explored the prevalence of major psychiatric disorders and their co-occurrences with alcohol and substance use disorders. To detect the presence of psychiatric disorders, researchers employed standardized assessment tools based on Diagnostic and Statistical Manual of Mental Disorders criteria. Overall, results showed that probationers had significantly higher rates of psychiatric disorders, substance use disorders, and co-occurring disorders compared with persons in the general population. In light of these findings, probation administrators are urged to invest more resources in treating drug use, mental illness, and codisorders, the latter of which is associated with a higher risk of violent behaviors.

The Impact of IMPACT: An Assessment of the Effectiveness of a Jail-Based Treatment Program

This study examined the effects of a drug treatment program in Chicagos Cook County Jail (CCJ). The program, known as the Integrated Multiphase Program of Assessment and Comprehensive Treatment (IMPACT), involves three agencies and is based on the general model of a modified therapeutic community. IMPACT significantly reduced rearrest rates and delayed time-to-rearrest for program participants. Outcomes improved as length of stay in the program increased up to 150 days, after which there were no further reductions in recidivism. In addition, community treatment significantly reduced rearrest rates even for inmates who stayed an optimal length of time in the program.

CORRELATES OF HIV-RISK BEHAVIORS AMONG PRISON INMATES: IMPLICATIONS FOR TAILORED AIDS PREVENTION PROGRAMMING

AIDS was first identified among prison inmates in 1983. In 2001, the rate of confirmed cases of HIV infection was four times greater among federal and state prison inmates than in the general population. This study used extensive interviews to assess Illinois prison inmates’ sexual and drug-use practices, their knowledge about HIV riskreduction techniques, and their beliefs regarding their own HIV-risk status and their ability to avoid HIV infection. Respondents were classified into risk groups based on their sexual and drug-use behaviors prior to incarceration. Compared to those in the low-risk group, respondents in the high-risk group were more likely to have used or sold drugs and to have lower self-efficacy and perceived-risk scores. Respondents in the moderate-risk group were more likely than those in the low-risk group to be young, to have sold drugs, and to have lower self-efficacy scores. The implications of these differences for HIV-prevention programs tailored by risk profile are discussed.

Treatment at the front end of the criminal justice continuum: the association between arrest and admission into specialty substance abuse treatment

BackgroundTo reduce criminal recidivism and drug use, it has been proposed that the substance abuse treatment delivery system cut across different components of the criminal justice continuum. Arrest, at the front end of this continuum, may represent a critical moment to motivate people with substance use disorders (SUD) to seek treatment but is often over looked as an intervention point. We used data from the 2002 National Survey on Drug Use and Health (NSDUH) to compare treatment need and recent treatment admission for participants with no criminal justice (CJ) involvement in the past year, past-year arrest, and CJ supervision (i.e., probation or parole status).ResultsOf those arrested, 44.8% met criteria for an SUD. However, only 14% of those arrested with an SUD received treatment in the year of their arrest. In multivariate modelling, arrest was an independent predictor of treatment admission (odds ratio (OR) = 8.74) similar in magnitude to meeting criteria for an SUD (OR = 8.22). Those further along the continuum – under supervision – were most likely to receive treatment (OR = 22.62).ConclusionArrest involves the largest number of individuals entering the criminal justice system. The NSDUH suggests that nearly 6 million individuals in the US experience an arrest annually and that nearly half meet criteria for an SUD. Although arrest involves the largest number of individuals entering the criminal justice system, it is also the most fleeting point as individuals can move in and out rather quickly. Minimally, arrest imposes contact between the individual and a law enforcement person and can be an opportunity for early intervention strategies such as pre-arraignment diversion into treatment or brief intervention strategies. Using brief intervention at this early point in the continuum may motivate a greater number of individuals to seek treatment or decrease drug and alcohol use. Training and procedural shifts at this point of contact could have important policy implications in reducing the number of subsequent arrests or preventing individuals moving further along the criminal justice continuum, as well as decreasing the fiscal and resource burdens associated with criminal justice processing and confinement.

The Methodology of the Multi-site Study of the Termination of Supplemental Security Income Benefits for Drug Addicts and Alcoholics

This paper describes the quantitative and qualitative methodologies used in a nine-site, two-year study of the effects of terminating Supplemental Security Income (SSI) for drug addiction and alcoholism (DA&A). The quantitative component of the study involved a longitudinal survey that collected data on 1,744 former DA&A recipients, representing about one-fourth of the national population, and achieved an aggregate follow-up rate of 82%. Despite limitations in questionnaire design and implementation, the survey provided reasonably valid data in the following areas: demographics, employment/income, medical/psychiatric status, drug and alcohol use, legal involvement, family/social functioning, food and hunger, housing, and victimization. The qualitative component examined the lives of a subsample to help clarify important issues that could not be addressed within the more structured protocol and format of the longitudinal survey. The paper also presents details on the survey instrument design, the results of validation studies of selected survey items, and data collection protocols across study sites.

An Analysis of the Criminogenic Effects of Terminating the Supplemental Security Income Impairment Category for Drug Addiction and Alcoholism

This study examined the criminogenic effects of terminating the Supplemental Security Income program for drug addiction and alcoholism. Hierarchical linear modeling was used to analyze self-reported crime, economic, and drug-use data collected as part of a two-year multisite study with five interview waves from 1,640 former DA&As. The primary independent variables examined included subjects’ replacement of lost SSI benefits legally or through re qualification under another disability category and their weekly use of heroin and/or cocaine. The study found that failure to replace lost cash benefits resulted in a moderate increase in crime, particularly drug and property crime, that peaked two years after loss of benefits. Heroin and cocaine use were also related to criminality, though the magnitude of this effect was greatest at six months after loss of benefits. The study also found a relationship between drug use and loss of benefits, suggesting that the federal legislation has created a crime-prone residual population of drug users with limited treatment access.

Substance Abuse and Welfare Policy at the New Century

Drawing on findings from the SSI Study and other research, this paper takes up various policy questions fundamental to any welfare program for substance abusers. The paper considers the place of disability benefits in the U.S. system of categorical aid and the problems raised by substance abuse for the disability category. It discusses the desirable objectives of a welfare program for substance abusers and the various mechanisms by which they might be achieved. And finally, it considers how any new program might be positioned in the context of categorical aid and American federalism.

The Relative Odds of Lifetime Health Conditions and Infectious Diseases Among Men Who Have Sex With Men Compared With a Matched General Population Sample

To address the understudy of health conditions and infectious diseases that are not strictly related to sexual transmission among men who have sex with men (MSM), this study examined the relative odds of 10 health conditions and two infectious diseases in a sample of MSM compared with a matched general population sample. MSM (N = 653) living mainly in Chicago were sampled through successive administrations of an Internet-based survey (2008-2010) that assessed physical and mental health, substance use, and HIV status. Propensity score matching was used to obtain a demographically comparable sample of men (N = 653) from aggregated administrations (2008-2012) of the National Survey on Drug Use and Health. Multivariate Firth logistic regressions compared the odds of ever having been diagnosed with each condition or disease, controlling for demographics, substance use, psychological distress, and HIV/AIDS status. MSM were more likely (p < .01) to have experienced: ulcers (odds ratio [OR] = 2.3), hypertension (OR = 2.1), liver disease (OR = 5.7), and sexually transmitted infections other than HIV/AIDS (OR = 8.9). Two other conditions, pneumonia and pancreatitis, as well as tuberculosis, were significant at p < .05 but below the statistical threshold used to reduce alpha error. The findings suggest that relative to non-sexual-minority men, MSM are more likely to experience a range of health conditions not specifically attributable to HIV/AIDS, sexual behavior, psychological distress, or substance use. The implications for research on the health status and provision of health care to MSM in light of the study findings are considered.

Chronic Medical Conditions among Jail Detainees in Residential Psychiatric Treatment: A Latent Class Analysis

Studies of incarcerates with serious mental illnesses have found elevated rates of chronic medical conditions such as asthma and diabetes, and of infectious diseases such as tuberculosis compared with general population rates. This study explored the pattern of chronic medical conditions in a sample of adult detainees in psychiatric treatment in a large urban jail to develop a clinical profile encompassing the full range of medical conditions. A total of 431 male and female detainees were sampled with certainty from admissions to a residential psychiatric treatment program (overall recruitment rate = 67%). Interviews used the World Mental Health version of the Composite International Diagnostic Interview to assess psychiatric and substance use disorders per DSM-IV criteria and chronic medical conditions. Latent class analysis was conducted using 17 medical conditions as class indicators, yielding a 3-class model composed of: a latent class with a high to intermediate probability of multiple medical conditions (HMC; 12.5% of the sample); an intermediate class with a lower probability of having a smaller number of medical conditions (MMC; 43.2%); and a class with a low probability of any medical condition (44.3%). Those in the HMC class were more likely to report respiratory problems, severe headaches, musculoskeletal pain, hypertension, and arthritis, have greater functional impairment, and have a higher number of co-occurring psychiatric disorders. Being older (50+ years) and female were associated with higher odds of being in the HMC or MMC classes. The policy implications for providing medical care to incarcerates with complex mixtures of medical conditions and psychiatric disorders are considered.