1. The relationship between substance abuse treatment and self-reported outcomes among offenders with mental health problems and substance use problems Natalie Durbeej Gumpert, C. H., Alm, C., Eriksson, Å., Berman, A. H., Kristiansson, M., & Palmstierna, T. Department of Clinical Neuroscience, Division of Forensic Psychiatry, Karolinska Institutet, Sweden

2. Mental disorder, Substance Abuse, and Crime (MSAC)  A Swedish follow up-study that explores the association between utilization of substance abuse treatment and - The risk of re-offending - Relapse into use of alcohol and/or drugs - Mental health problems among offenders with mental health problems and substance use problems,  Substance abuse treatment has been associated with reductions in re- offending, substance use and mental health problems (Gumpert et al., 2010; Grella et al., 2010; Holloway et al., 2006; Prendergast et al., 2002) 17 september 2015Natalie Durbeej2

3. 17 september 2015Natalie Durbeej3 Aim of the present study To examine the relationship between register-based planned outpatient treatment for substance use problems and self- reported a) Substance use b) Mental health problems c) Re-offending among offenders with mental health problems and substance use problems.

4. Study design 17 september 2015Natalie Durbeej4 Baseline n=207Second follow-up n=149 Utilization of planned outpatient treatment for substance use problems (Official registry on health care utilization in Stockholm County) 2009-12-31 First follow-up n=153 2006-01-01 “At least one visit to an outpatient clinic focusing on substance use problems” Self-reported number of days with *Substance use *Mental health problems *Offending (ASI-6) Treatment utilizers n= 48 Non-utilizers n= 61 VS Self-reported number of days with *Substance use *Mental health problems *Offending (ASI-6) n=109

5. Descriptives 2011-07-215 n = 109 mean age = 35 years (SD = 11.82) mean follow-up time = 17.8 months (SD = 8.45) 89% 11% 71% 29% 72% 28%

6. Outcome: planned outpatient treatment utilization in relation to substance use and mental health problems* 17 september 2015Natalie Durbeej6 Time: p<.001 Treatment: N.S Time x Treatment: N.S Time: N.S Treatment: N.S Time x Treatment: N.S Time: p<.05 Treatment: p<.1 Time x Treatment: N.S *During the past 30 days

7. Outcome: planned outpatient treatment utilization in relation to offending* 17 september 2015Natalie Durbeej7 Time: p<.1 Treatment: N.S Time x Treatment: N.S * During the past six months Time: p<.001 Treatment: N.S Time x Treatment: N.S Time: p<.1 Treatment: N.S Time x Treatment: N.S

8. Differences between improved and non- improved participants 17 september 2015Natalie Durbeej8 Improved over time Non-improved over time VS Participants who reduced their 1. Alcohol consumption 2. Mental health problems 3. Violent offending Participants who remained stable or increased their 1. Alcohol consumption 2. Mental health problems 3. Violent offending

9. Differences between improved and non- improved participants  Participants who improved w.r.t. alcohol consumption had -fewer ER-visits to substance abuse clinics -more days in inpatient treatment*(both planned and acute) -fewer years of regular and heavy alcohol consumption (during lifetime) compared to non-improved participants (p<0.05) 17 september 2015Natalie Durbeej9 *somatic-, psychiatric-, and substance abuse treatment

10. Differences between improved and non- improved participants  Participants who improved w.r.t. mental health problems -had fewer ER-visits to substance abuse clinics -had more weeks of employment (during the past six months) compared to non-improved participants (p<0.05)  Participants who improved w.r.t. violent offending -were younger -had fewer years of regular amphetamine use (during lifetime) compared to non-improved participants (p<0.05) 17 september 2015Natalie Durbeej10

11. Factors that may be positively or negatively correlated with recovery of offenders with mental health problems and substance use problems 17 september 2015Natalie Durbeej11 +Utilization of inpatient treatment +Employment -Life-time use of alcohol and/or drugs -Age -ER-visits to substance abuse clinics

12. 17 september 2015Natalie Durbeej12 Topics for discussion  Does natural recovery over time play a role?  Institutional correction/contact with correctional system might have been beneficial  A need to explore effects of treatment in sub-groups among offenders with mental health problems and substance use problems  A need to further identify the factors that contribute to the recovery of these individuals

13. Thank you! Natalie Durbeej Department of Clinical Neuroscience Division of Forensic Psychiatry Karolinska Institutet Sweden Natalie.Durbeej@ki.se