Treatment of substance use disorder in forensic psychiatric patients:the role of impulsivity

Substance use appears to have a negative influence on rates of criminal recidivism.The foremost important goal of treatment of forensic psychiatric patients is toprotect society from criminal recidivism. Therefore, forensic psychiatric patientsneed to change maladaptive behaviour, such as substance use. However, lack ofproblem insight and high levels of impulsivity may impede forensic psychiatricpatients from behavioural change.The aim of this study was to investigate whether impulsivity had a moderating effecton the relationship between problem insight into substance use and actual substanceuse. In order to compare levels of problem insight and impulsivity, 43 forensicpsychiatric patients with a substance use disorder (SUD) and a comorbid Axis Iand/or II disorder were divided in two groups based on whether or not they usedsubstances in the past six months. Levels of impulsivity were determined by scoreson the Barratt Impulsiveness Scale (BIS-11) and the amount of commission errorson the Cued Go/ No Go task. Levels of problem insight into substance use weremeasured by observations of patients’ behaviour by staff members and were scoredindependently by the researcher based on examination of daily reports.Participants who did use substances in the past six months appeared to havesignificantly lower levels of problem insight into their substance use thanparticipants who did not use substances in the past six months. Both groups ofparticipants did not differ in levels of impulsivity, demonstrated by equal totalscores of the BIS-11 and the amount of commission errors on the Cued Go/ No Gotask. Lower levels of problem insight predicted substance use, but higher levels ofimpulsivity did not. Hence, no moderating effect of impulsivity on the relationshipbetween problem insight into substance use and actual substance use was found.Possible explanations, such as low to moderate levels of impulsivity within thesample, together with limitations of this study and recommendation for futureresearch are being discussed