Evidence-based treatment and supervision practices for co-occurring mental and substance use disorders in the criminal justice system

Am J Drug Alcohol Abuse. 2017 Jul;43(4):475-488. doi: 10.1080/00952990.2017.1303838. Epub 2017 Apr 4.


Background: Over seven million persons in the United States are supervised by the criminal justice system, including many who have co-occurring mental and substance use disorders (CODs). This population is at high risk for recidivism and presents numerous challenges to those working in the justice system.

Objectives: To provide a contemporary review of the existing research and examine key issues and evidence-based treatment and supervision practices related to CODs in the justice system.

Methods: We reviewed COD research involving offenders that has been conducted over the past 20 years and provide an analysis of key findings.

Results: Several empirically supported frameworks are available to guide services for offenders who have CODs, including Integrated Dual Disorders Treatment (IDDT), the Risk-Need-Responsivity (RNR) model, and Cognitive-Behavioral Therapy (CBT). Evidence-based services include integrated assessment that addresses both sets of disorders and the risk for criminal recidivism. Although several evidence-based COD interventions have been implemented at different points in the justice system, there remains a significant gap in services for offenders who have CODs. Existing program models include Crisis Intervention Teams (CIT), day reporting centers, specialized community supervision teams, pre- and post-booking diversion programs, and treatment-based courts (e.g., drug courts, mental health courts, COD dockets). Jail-based COD treatment programs provide stabilization of acute symptoms, medication consultation, and triage to community services, while longer-term prison COD programs feature Modified Therapeutic Communities (MTCs).

Conclusion: Despite the availability of multiple evidence-based interventions that have been implemented across diverse justice system settings, these services are not sufficiently used to address the scope of treatment and supervision needs among offenders with CODs.

Keywords: Offenders; co-occurring disorders; criminal justice system; mental disorders; substance abuse.

Publication types

  • Review

MeSH terms

  • Criminal Law / methods
  • Criminals*
  • Diagnosis, Dual (Psychiatry)
  • Evidence-Based Practice / methods
  • Humans
  • Mental Disorders / complications
  • Mental Disorders / therapy*
  • Prisons
  • Substance-Related Disorders / complications
  • Substance-Related Disorders / therapy*
  • Therapeutic Community
  • United States