Empowering through change: The treatment of substance use disorders among forensic patients

A significant proportion of forensic mental health patients have co-occurring substance use disorders, which complicates inpatient rehabilitation and eventual community reintegration. Forensic services to date have typically relied on psychoeducation approaches to target substance use, however, these lack empirical support. More information is needed on treating this population. Chapter Two provides an up-to-date review of the literature on mental disorders, co-occurring substance use disorders, and offending as well as treatment approaches for co-occurring substance use disorders among forensic patients. This chapter highlights the need for evidence-based, tailored treatment approaches. Cognitive Behavioural Therapy (CBT) skills-based programmes combined with motivational interviewing techniques have shown some promise in the United Kingdom, particularly the Substance Use Treatment Programme (SUTP). To date, no study has examined a substance use treatment programme adapted specifically for Australian forensic patients. Chapter Three describes the first study to evaluate the feasibility, acceptability, and preliminary efficacy of an adapted 12-week SUTP for forensic patients in Australia (n=39). Results indicated that participant adherence was high, with 61.5% of the sample (n=24) attending all 12 sessions (Mdn=12.0), as were post-intervention follow-up rates (84.6%; n=33). Participants reported high levels of satisfaction and positive levels of therapeutic alliance. Participants also demonstrated a significant shift from an external to an internal drug-related locus of control upon completion, suggesting that participants had a stronger belief in their ability to have control over their drug use. SUTP is a first of its kind intervention to be evaluated in Australia. It could significantly improve the transitional pace of forensic patients with substance use disorders through forensic services, improve participant wellbeing and reduce recidivism