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Predictors of Incarceration Among Urban Adults With Co-Occurring Severe Mental Illness and a Substance Use Disorder
Alison Luciano, M.P.H., Ph.D.; Johannes Belstock, B.A.; Per Malmberg, B.A.; Gregory J. McHugo, Ph.D.; Robert E. Drake, M.D., Ph.D.; Haiyi Xie, Ph.D.; Susan M. Essock, Ph.D.; Nancy H. Covell, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300408
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Dr. Luciano, Dr. McHugo, Dr. Drake, and Dr. Xie are with the Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (e-mail: alison.luciano@dartmouth.edu). Mr. Belstock and Mr. Malmberg are medical students, Faculty of Health Sciences, University of Linköping, Linköping, Sweden. Dr. Essock and Dr. Covell are with the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and with the Department of Mental Health Services and Policy Research, New York State Psychiatric Institute, New York City.

Copyright © 2014 by the American Psychiatric Association

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Abstract

Objective  People with severe mental illness and a co-occurring substance use disorder (co-occurring disorders) who live in urban areas experience high rates of incarceration. This study examined sociodemographic, clinical, economic, and community integration factors as predictors of incarceration among people with co-occurring disorders.

Methods  This secondary analysis used data from a randomized controlled trial of assertive community treatment versus standard case management. In the parent study, researchers interviewed 198 people with co-occurring disorders from two urban mental health centers in Connecticut at baseline and every six months for three years. Researchers tracked incarceration, clinical engagement and status, employment, living situation, social relationships, and substance use. The study reported here used bivariate analyses and logistic regression analyses to compare individuals who were incarcerated during the study period with those who were not.

Results  The overall incarceration rate was 38% during the study period. In multivariate analyses, prior incarceration predicted incarceration during the study period (odds ratio [OR]=3.26). Two factors were associated with a reduced likelihood of incarceration: friendships with individuals who did not use substances (OR=.19) and substance use treatment engagement (OR=.60).

Conclusions  Positive social relationships and engagement in substance use treatment are promising service and policy targets to prevent incarceration in this high-risk population.

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