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Advisory Committee Chair

Karen Cropsey

Advisory Committee Members

William Beidleman

Foster Cook

Peter Lane

Sylvie Mrug

Document Type

Dissertation

Date of Award

2011

Degree Name by School

Doctor of Philosophy (PhD) College of Arts and Sciences

Abstract

Current evidence suggests that persons with co-occurring disorders (COD) are at risk for poorer treatment outcomes in terms of substance use and recidivism. Studies have examined this trend in incarcerated individuals, but few have examined COD offenders under community supervision. The purpose of this study was to develop a predictive model to identify offenders under community corrections supervision with substance use diagnoses who were actively taking psychotropic medications (SUPM) as an index of COD and to compare demographics, social histories, and sexual risk behaviors for SUPM offenders to offenders with a substance use disorder (SUD) only and those who met neither criterion. Between 2002 and 2007, a total of 1,845 TASC offenders were identified as SUPM at the time of their intake interview. These offenders were compared to 1,876 SUD only offenders and 1874 controls. Demographics, social risk behaviors, diversion outcomes, and substance use outcomes were compared across groups using chi-square and ANOVA analyses. Logistic regressions were used to identify predictive risk factors for SUPM status. SUPM offenders were more likely to be White, divorced, females, to meet abuse/dependence criteria for cocaine and opiates, and more frequently reported a history of overdose, suicidal ideation/attempt, trading sex for drugs, injection drug use, and having sex with injection drug users than both SUD only offenders and controls. Unique predictors of SUPM versus SUD only and controls were identified. Controls were more likely to have positive TASC outcomes while SUD only offenders were most likely to have negative dispositions. Finally, SUPM offenders were more likely to fail a urine drug screen at the middle and end of their TASC supervision than those with SUD only. Treatment success, as measured by substance abstinence and program discharge status, among this special population was significantly reduced in comparison to controls. However, SUPM offenders fared better in comparison to SUD only offenders. This suggests that a number of implications regarding access to care and the importance of mental health screenings among this population--as undiagnosed psychiatric problems likely contributed to observed outcomes. Implications for management of COD in community corrections are discussed.

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