Alcohol use disorder as a risk factor for violent offending and reoffending in delinquent women with substance use disorders

Unmet need for alcohol use disorder treatment in reproductive-age females, with emphasis on pregnant and parenting populations in the United States: Findings from NSDUH 2015-2021

The negative effects of alcohol use can transmit intergenerational harm if alcohol use disorder (AUD) occurs during pregnancy and/or while parenting a child. Prenatal alcohol exposure is the leading preventable cause of congenital anomalies in the USA, and heavy drinking in women has been on the rise, further accelerated by the COVID-19 pandemic. This study describes the most recent patterns in the past year AUD prevalence and treatment among reproductive-aged women, with a specific focus on pregnant and parenting women, and barriers to treatment among those affected. We analyzed data on reproductive-age women from the National Survey on Drug Use and Health (2015-2021). We used generalized linear models to estimate prevalence ratios (PR) for past 12-month AUD and its treatment based on DSM-V criteria. We considered sociodemographic characteristics, including age, race/ethnicity, income, health insurance type, and arrest history. Pregnant and parenting women displayed lower risk for AUD (PR = 0.48, 95% CI:0.41-0.57; PR = 0.5 95% CI:0.48-0.54, respectively) relative to non-pregnant/non-parenting women. Excess risk for AUD was associated with education (some college vs. college graduates, PR = 1.07, 95% CI:1.01-1.13) and history of arrests (PR = 2.93, 95% CI:2.67-3.21). There were no clear differences in AUD treatment use based on parenting or pregnancy status. Among those with AUD, the prevalence of treatment was higher among individuals aged 35-49 years compared to those 18-25 years (PR = 1.6, 95% CI: 1.19-2.14) and in those enrolled in Medicaid vs. private insurance (PR = 2.62, 95%CI:1.97-3.47). Financial barriers and treatment not being a priority were the most frequently reported barriers to treatment. To promote well-being among parents and their children, healthcare providers should prioritize reproductive-age women at higher AUD risk. Decreasing the stigma attached to AUD and intensifying efforts to educate women about the dangers of AUD may improve treatment use among pregnant and parenting women.

Predicting violence in female forensic inpatients with substance use disorders - the utility of a gender-responsive assessment

Introduction

Given that risk assessment tools are commonly based on male samples, the applicability to justice-involved women remains to be clarified. This study aimed at assessing (1) the predictive validity of the HCR-20 V3, the prevailing, yet primarily male-based violence risk assessment instrument, and (2) the incremental validity of the FAM, a gender-responsive supplement, for both inpatient violence and violent recidivism in justice-involved women.

Methods

The sample included 452 female forensic inpatients with substance use disorder discharged from German forensic psychiatric care between 2001 and 2018.

Results

ROC analyses revealed good predictive accuracy for the HCR-20 V3 while the FAM failed to provide incremental validity. Further, binary logistic regression determined several predictors of violence including personality disorder, covert/manipulative behavior, suicidal behavior/self-harm, and problematic intimate relationship.

Discussion

These findings support the applicability of the HCR-20 V3 in justice-involved women with substance use disorder, while highlighting the clinical relevance of the FAM in supporting a gender-informed risk management.

The curse of experiencing and committing violence as a criminal recidivism predictor: A comparison between female forensic psychiatric patients with severe mental disorders and substance use disorder

BACKGROUND

Violence occurs frequently in the life of forensic psychiatric patients, both as active aggression and in the form of victimization. Undoubtedly, these incidents shape personality, behavior, and affect the ability to interact adequately socially. Thus, such experiences may influence criminal recidivism and serve as forensic psychiatric/psychological predictors upon hospital discharge.

METHODS

Hence, this study aimed at characterizing two distinct female forensic psychiatric patient populations (nonsubstance use mental disorders [n = 110] versus substance use disorder [n = 415]) regarding their active and passive violent experiences as well as contextualizing these with their individual crime recidivism rates. The analysis followed a record-based, retrospective approach.

RESULTS

While both groups experienced aggression throughout childhood and youth equally often, substance use disorder patients were significantly more often exposed to violence during adulthood. On the other hand, severely mentally ill patients tended to react more often with violence during their hospital confinement. However, regarding their violent recidivism rate, no intergroup effects were observed. Finally, within the addicted group, a violent index crime as well as physical aggression during hospital confinement increased the odds for violent reoffending by approximately 2.4-fold (95% confidence interval 1.3-4.5) and 2.5-fold (95% confidence interval 1.1-5.9), respectively.

CONCLUSION

In summary, these findings underline the importance of active aggression rather than victimization as an influencing factor on resocialization especially in a substance use disorder patient population.