Justice Involvement, Opioid Use, And Co-Occurring Mental Health Disorders: Implications For Transdiagnostic Treatment

Opioid use disorder (OUD) is disproportionately prevalent among justice involved groups, related to justice involvement above and beyond other substances, and associated with severe co-occurring mental health disorders that exacerbate behavioral and legal outcomes. Past studies examining mental health disorders, OUD, and justice involvement have been limited by an overly broad or strictly categorical approach to diagnostic operationalization. Further, extant treatment of co-occurring disorders among justice involved groups lacks specificity, such that interventions are lengthy and not targeted towards the most impairing mental health symptoms. An examination of transdiagnostic symptoms affecting justice involved individuals with OUD is warranted. Structured and semi-structured clinical diagnostic interviews were conducted among a 50-person sample of adults receiving medication for OUD (MOUD). Additionally, history of arrest was assessed in the style of a life events calendar. Regression and moderation analyses were employed to examine the associations among substance use disorder, opioid use disorder, mental health symptoms/diagnoses, and arrest history. We expected arrest history to moderate the relationship between domains of co-occurring disorders and substance use. Contrary to hypotheses, no significant effects were found in study models. Implications in the context of assessment, intervention, and justice involvement are discussed. Additional work among a larger, more representative sample is necessary to disentangle symptom-level associations among vulnerable, substance using groups in the justice system