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Co-Occurring Disorders in Criminal Justice Settings

Evidence-based and Promising Practices for Individuals with Co-Occurring Disorders in Criminal Justice Settings

Several evidence-based practices for co-occurring disorders have been adapted for use with justice-involved people. Here are a few examples:

  • Integrated Treatmentfor Co-occurring Disorders addresses both mental and substance use disorders in the same setting with cross-trained staff. One model that has been used with justice-involved people with co-occurring disorders is the modified therapeutic community. Integrated treatment approaches have been associated with positive outcomes, such as lower substance use and reduced criminal behavior.
  • Assertive Community Treatment is known as Forensic Assertive Community Treatment (FACT) when modified for justice-involved people in contact with the justice system. FACT is an adaptation of ACT that focuses on helping people prevent arrest and incarceration.
  • Cognitive Behavioral Therapy is an intervention that addresses current, destructive patterns of thinking and behaving. Cognitive behavioral approaches adapted for justice-involved people include treatment plans that are specific to each person. Treatments target individuals' risk, cognitive and criminogenic needs. These approaches also emphasize interpersonal skills.
  • Illness Management and Recovery is a set of practices that provides people with skills to manage their mental illness in order to achieve recovery goals. Illness Management and Recovery has been modified for people with co-occurring disorders in prison and under court-ordered community-based treatment.
  • Supported Employment is competitive employment designed to help an individual with mental illness select, find, and keep work. Continuous support services are offered during employment.
  • Supportive Housing is permanent housing that links individuals with mental illness and co-occurring substance use disorders to supportive services. Supportive housing programs have been implemented for justice-involved people with co-occurring disorders who are high users of jail, mental health, and shelter services.

These modified practices focus on achieving public safety outcomes (e.g., reducing criminal behavior) by attending to motivation, criminal thinking, cognition, and traumatic experiences. When choosing training for staff working with individuals with co-occurring disorders in criminal justice settings, consider:

  • Addressing trauma: Many people in the justice system with co-occurring disorders experience trauma. Addressing trauma is paramount for effective interventions. Trauma-informed systems reduce an individual's experience of retraumatization and improve responsiveness to treatment.
  • Incorporating the risk principle: Positive outcomes can be achieved when the risk principle is incorporated into interventions such as Illness Management and Recovery. For instance, a modified form of Illness Management and Recovery contains modules that address processing jail and prison experiences, thinking styles, and managing negative emotions.

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