Military service and crime: new evidence

New Research on Veterans Treatment Courts: An Overview of the Community Participatory Research on Veterans in Specialized Programming Project

Justice-involved veterans return to civilian life with a variety of mental and physical health challenges that often go untreated and increase their risk for self-harm and involvement in the criminal-legal system. Veterans Treatment Courts (VTC) were created to respond to the unique problems of justice-involved veterans by attempting to coordinate services and support with the U.S. Department of Veterans Affairs (VA), local treatment providers, and the VTC. Our research has two distinct phases. In Phase 1, we conducted qualitative interviews with VTC team members in twenty (20) VTCs from each USA region; in each VTC, we gained the perspectives of team members-judges, prosecutors, defense attorneys, VJOs, VTC program coordinators, mentors, probation officers, and treatment providers--- on the operation of VTCs, with a focus on how to improve service provision for justice-involved veterans. A total of 145 interviews were conducted. We begin by describing the unique problems and treatment needs of justice-involved veterans, and briefly summarize the findings from previous research on the implementation and impact of VTCs. We then present our research study protocol and highlight findings from our phase 1 qualitative interviews with VTC team members. In addition, we describe phase 2 of our project, which will include focus groups with VTC graduates, and quantitative analyses of the service provision networks of three VTCs.

Prison Adjustment Among Military Veterans: The Impact of Traumatic Events, Service History, and PTSD

Military veterans have been shown to differ demographically from non-veterans in the criminal justice system. However, relatively little is known about their psychological adjustment, institutional misbehavior, and the efficacy of programing received while incarcerated. Using data taken from a national sample of prison inmates, this study investigates how traumatic events experienced during military service can impact the intensity of negative affect among veterans. Additionally, we examine whether prison misconduct is influenced by military service history and the receipt of substance abuse treatment. Controlling for a host of relevant variables, our results indicate that traumatic events show a significant effect on psychological adjustment only indirectly through veterans who developed post-traumatic stress disorder and that misconduct is lower among those who received an honorable discharge. Overall, these findings suggest that the ability of veterans to resist adverse outcomes may depend on a variety of factors both within and outside the prison environment.

Military-to-civilian transition strains and risky behavior among post-9/11 veterans

Many military veterans face significant challenges in civilian reintegration that can lead to troublesome behavior. Drawing on military transition theory (MTT) and using data from a survey of post-9/11 veterans in two metropolitan areas (n = 783), we investigate previously unexamined relationships between post-discharge strains, resentment, depression, and risky behavior, taking into account a set of control variables, including combat exposure. Results indicated that unmet needs at time of discharge and perceived loss of military identity are associated with increased risky behavior. Much of the effects of unmet discharge needs and loss of military identity are mediated by depression and resentment toward civilians. The results of the study are consistent with insights from MTT, providing evidence of specific ways in which transitions can affect behavioral outcomes. Moreover, the findings highlight the importance of helping veterans meet their post-discharge needs and adapt to changing identity, in order to reduce the risk of emotional and behavioral problems.

Military Service and Offending Behaviors of Emerging Adults: A Conceptual Review

Focusing on the United States, this paper examines the impact of military service for the cohort of individuals that have experienced the social factors that characterize emerging adulthood as a unique stage in the life course. We argue that military service, as a turning point, may act differently in contemporary times compared to findings from past research. This difference is driven by changes in military service, the draft versus volunteer military service, and the prevalence of emerging adulthood. As a background, we describe emerging adulthood, examine how emerging adulthood relates to crime and deviance, explore the impact of military life on young adults, provide an overview of the demographics of military service, discuss the influence and outcomes of military life on young adults, and explore existing research linking military service and deviant and criminal behavior. We develop a theoretical model of the relationship between military service and emerging adulthood and explore the impact on criminological theory and policy.

Veterans Justice Programs: Assessing Population Risks for Suicide Deaths and Attempts

OBJECTIVES

Understanding suicide risks among Veteran subpopulations is a national priority. This study assessed risks of suicide, suicide attempts, and other-cause mortality among recipients of Veterans Health Administration (VHA) Veterans Justice Program services as compared to other Veteran VHA users.

METHODS

Per VHA records, the cohort included 5,401,192 Veterans alive as of January 1, 2013 and with VHA utilization in 2012. Receipt of Veterans Justice Outreach (VJO) or Health Care for Reentry Veterans (HCRV) services in 2012 was assessed using encounter codes. Multivariable proportional hazards regression assessed risks of suicide (per National Death Index search results from the VA/DoD Mortality Data Repository) and attempts (per diagnoses and site reports) in 2013-2016, adjusting for demographic and clinical indicators.

RESULTS

Compared to other patients, Veterans with VJO encounters had greater risk of suicide (unadjusted HR = 2.80, 95% confidence interval [CI] = 2.30-3.40; adjusted HR = 1.25, 95% CI = 1.02-1.53) and attempts (unadjusted HR = 8.88, 95% CI = 8.45-9.35; adjusted HR = 1.06, 95% CI = 1.00-1.11). Veterans with HCRV encounters had elevated risk of suicide attempts (unadjusted HR = 4.56, 95% CI = 4.00-5.20; adjusted HR = 1.42, 95% CI = 1.24-1.62). Risks were also elevated for other external causes of mortality.

CONCLUSIONS

Findings document increased risk of suicidal behavior among Veterans Justice Program recipients. These results have informed VHA suicide prevention activities.

Trends in cannabis use among justice-involved youth in the United States, 2002-2017

BACKGROUND

Little is known regarding trends in cannabis use among justice-involved youth. We hypothesize that cannabis use will be higher over time among justice-involved youth who, on average, are more likely to be exposed to and seek out cannabis.

OBJECTIVES

The present study compares trends in cannabis use among justice-involved youth (past year) with youth in the general population age 12-17 who have not been arrested in the past year.

METHODS

Public-use data as part of the 2002-2017 National Survey on Drug Use and Health (NSDUH), which does not include state-level identifiers, was used. Males constitute 51% of the total sample. Among justice-involved youth, 66.4% were males. We employed logistic regression analyses with survey year as an independent variable and past-year cannabis use as the dependent variable. A series of logistic regressions examined the association between cannabis use and psychosocial and behavioral factors.

RESULTS

The prevalence of past-year cannabis use among justice-involved youth (3.09% of the sample) steadily increased from 54% in 2002 to 58% in 2017 (AOR = 1.018, 95% CI = 1.004-1.034), while the concurrent prevalence of cannabis use among youth with no past year arrests decreased from a high of 14% in 2002 to 12% in 2017 (AOR = 0.993, 95% CI = 0.990-0.997).

CONCLUSION

Study findings suggest that cannabis use is increasing among justice-involved youth.

Systematic Review of Criminal and Legal Involvement After Substance Use and Mental Health Treatment Among Veterans: Building Toward Needed Research

Evidence indicates that substance use and mental health treatment is often associated with reduced criminal activity. The present systematic review examined this association among military veterans, and aimed to provide a comprehensive summary of needed research to further contribute to reduced criminal activity among veterans. This systematic review was derived from a scoping review that mapped existing research on justice-involved veterans' health. For the current systematic review, a subset of 20 publications was selected that addressed the question of whether criminal activity declines among veterans treated for substance use and mental health disorders. Generally, veterans improved on criminal outcomes from pre- to post-treatment for opioid use, other substance use, or mental health conditions, and more sustained treatment was associated with better outcomes. This occurred despite high rates of criminal involvement among veterans prior to entering treatment. Needed are substance use and mental health treatment studies that include women justice-involved veterans, follow criminally-active veterans for longer periods of time, and use validated and reliable measures of criminal activity with fully transparent statistical procedures. Future randomized trials should evaluate new treatments against evidence-based treatments (versus no-treatment control conditions). Subsequent studies should examine how to link veterans to effective treatments, facilitate sustained treatment engagement, and ensure the availability of effective treatments, and examine mechanisms (mediators and moderators) that explain the association of treatment with reduced criminal activity among veterans. Best practices are needed for reducing criminal activity among the minority of justice-involved veterans who do not have diagnosed substance use and/or mental health disorders.

A scoping review of military veterans involved in the criminal justice system and their health and healthcare

BACKGROUND

In the criminal justice system, special populations, such as older adults or patients with infectious diseases, have been identified as particularly vulnerable to poor health outcomes. Military veterans involved in the criminal justice system are also a vulnerable population warranting attention because of their unique healthcare needs. This review aims to provide an overview of existing literature on justice-involved veterans' health and healthcare to identify research gaps and inform policy and practice.

METHODS

A systematic search was conducted to identify research articles related to justice-involved veterans' health and healthcare that were published prior to December 2017. Study characteristics including healthcare category, study design, sample size, and funding source were extracted and summarized with the aim of providing an overview of extant literature.

RESULTS

The search strategy initially identified 1830 unique abstracts with 1387 abstracts then excluded. Full-text review of 443 articles was conducted with 252 excluded. There were 191 articles included, most related to veterans' mental health (130/191, 68%) or homelessness (24/191, 13%). Most studies used an observational design (173/191, 91%).

CONCLUSIONS

Knowledge gaps identified from the review provide guidance on future areas of research. Studies on different sociodemographic groups, medical conditions, and the management of multiple conditions and psychosocial challenges are needed. Developing and testing interventions, especially randomized trials, to address justice-involved veterans care needs will help to improve their health and healthcare. Finally, an integrated conceptual framework that draws from diverse disciplines, such as criminology, health services, psychology, and implementation science is needed to inform research, policy and practice focused on justice-involved veterans.

Typologies of adverse childhood experiences and their relationship to incarceration in U.S. military veterans

Numerous studies have reported that adverse childhood experiences (ACEs) are associated with negative psychosocial outcomes in adulthood, but no study has examined the different typologies of ACEs and the relationship of these with adult incarceration in military veterans. The current study used latent class analysis to examine the existence of different childhood maltreatment and household dysfunction typologies in a sample of U.S. military veterans identified through the National Epidemiological Survey on Alcohol and Related Conditions-III ((NESARC-III)). A total of 60.73% of veterans reported one or more ACEs. Four latent classes were identified and were named Low adversities, Moderate maltreatment with high household substance use, Severe maltreatment with moderate household dysfunction and Severe multi-type adversities. Relative to the Low adversities class, the three maltreatment/dysfunction classes had significantly elevated odds ratios (1.72-2.29) for adult incarceration, when controlling for sociodemographic characteristics and alcohol and drug use. The results point to the importance of examining childhood risk factors for incarceration and suggest that a certain sub-group of military personnel who are about to transition into the civilian life may need additional support to adjust and live successful lives.