Dual diagnosis in a forensic patient sample: A preliminary tripartite investigation to inform group treatment delivery for substance use

Abstract

The aetiology of forensic dual diagnosis or co-occurring substance misuse problems in individuals with severe mental illnesses and forensic offending histories and the efficacy of psychosocial substance use interventions remain poorly understood. Using a tripartite investigative paradigm in conjunction with a grounded qualitative approach, this multi-study: (1) Systematically examined the literature base to determine what is empirically known about the acceptability, feasibility, and effectiveness of forensic psychosocial substance use interventions; (2) Empirically quantified from forensic inpatient’s perspectives (n=12) psychosocial risk factors relevant to the initiation and maintenance of substance using behaviours (Study 1); and (3) Evaluated from a service users (n=12) and service providers (n=9) standpoint the acceptability and feasibility of a novel psychosocial substance use intervention administered for use with forensic inpatients detained within conditions of a high secure hospital (Study 2). Findings showed that: (1) Existing psychosocial substance use interventions are mostly acceptable, nominally feasible, but of limited effectiveness in the treatment of forensic dual diagnosis; and (2) Eleven aetiological psychosocial risk factors and two bifurcative pathways within a broader proposed Forensic Aetiological Dual Diagnosis Framework are arguably implicated in the development and maintenance of substance using behaviours. Implications for treatment and directions for future research are outlined.