Dual diagnosis

Substance abuse and mental illness are concentrated in correctional populations. Further, nearly half of female inmates and one-third of male inmates with substance use disorders have a diagnosable mental illness. Even with the higher rates of comorbid disorders of substance use and mental health, studies find that justice-involved individuals with mental illness tend to subscribe to a criminal lifestyle, criminal identity, and criminal values. Treatment for this population needs to address the syndemic of criminal lifestyle, mental illness, and substance abuse in order to effectively reduce recidivism and symptoms. The substance abuse population in most correctional settings is not homogeneous in terms of the type of drug abuse, the age and gender of the population, the criminal justice history, criminal lifestyle and value system, and mental health needs. In the justice system, there is a temptation to provide generic types of drug treatment. Treatment services need to be tailored to the individual in order to reduce symptoms and improve overall justice outcomes. For dually diagnosed patients, the need to provide treatment for both substance abuse and mental illness along with criminal lifestyle and thinking is widely recognized. This chapter reviews current knowledge about treatments for dually diagnosed patients. Included is a discussion of the factors that are unknown or unclear in the literature. Best practices and implementation issues regarding treatment for dual diagnosis patients are then discussed. An important part of these implementation issues are the systems factors required to support treatment in correctional settings. The chapter concludes with a research agenda for the future of dual diagnosis treatment in corrections.