Substance use treatment completion and criminal justice system contact in Chile: A retrospective, linked data cohort study

BACKGROUND AND AIMS

Substance use treatment (SUT) has shown to be effective in reducing self-reported offending; however, the association between SUT completion and criminal justice system (CJS) contact has been underexplored, especially in Latin America. This study aimed to estimate the association between SUT completion status and (1) any subsequent CJS contact and (2) CJS contact leading to imprisonment, at 1, 3 and 5 years post-discharge, in Chile.

DESIGN

Retrospective cohort study using multivariable survival analysis based on linked administrative data from 2010 to 2019.

SETTING

This study took place in Chile, where SUT is available at no cost through Chile's publicly funded health-care, and is provided in outpatient and inpatient modalities in public and private centres.

PARTICIPANTS

A total of 70 854 individuals received their first SUT from 2010 to 2019. They were mainly males (76.3%), and their main substance used at admission was cocaine paste (39.2%).

MEASUREMENTS

SUT completion status included completion, late dropout (≥ 3 months) and early dropout (< 3 months). Outcomes were (1) any CJS contact and (2) CJS contact leading to imprisonment after baseline treatment. We estimated the association between treatment completion and CJS contact through flexible parametric Royston-Parmar models while adjusting for several covariates.

FINDINGS

Those who completed SUT (27.2%) were less likely to have any CJS contact at 5 years post-SUT compared with those who dropped out late [with a gap of -9.5%, 95% confidence interval (CI) = -8.7, -10.3] and early (-11.2%, 95% CI = -10.1, -12.3). Also, those who completed SUT were less likely to have CJS contact leading to imprisonment at 5 years post-SUT compared with those who dropped out late (-2.6%, 95% CI = -2.2, -3.1) and early (-4.0%, 95% CI = -3.3, -4.6). These differences were also observed at 1 and 3 years post-SUT for each outcome.

CONCLUSIONS

In Chile, completion of substance use treatment appears to be associated with lower probabilities of both any criminal justice system contact and contact leading to imprisonment.

Navigating pregnancy and early motherhood in prison: a thematic analysis of mothers' experiences

BACKGROUND

Maternal imprisonment negatively impacts mothers and their children and is likely to have lifelong and intergenerational sequelae. In many jurisdictions nationally and internationally, young children (usually those less than 5 years) can reside with their mothers in prison. However, there is considerable debate regarding the impact of prison environments on incarcerated mothers and their children who are born, and/or raised in prison. Research to date on the pregnancy and mothering experiences of imprisoned mothers and their preferences for care arrangements for their babies and young children is limited.

METHODS

This study was part of the Transforming Corrections to Transform Lives project, in which workshops were conducted with imprisoned mothers to understand their needs while in custody and post-release, and the kind of supports and system changes that are required to meet those needs. Incarcerated mothers (n = 75) participated in seven workshops conducted across four Queensland prisons. Themes were generated through reflexive thematic analysis.

RESULTS

Three themes characterised mothers' experiences of being pregnant and undertaking a mothering role of a young child while in prison. First, for most mothers, imprisonment adds vulnerability and isolation during pregnancy and childbirth. Second, although mothers felt that residing together with their children in prison motivated them to change for a better future, they were concerned about the potential negative impact of the prison environment on the child's development. Lastly, most mothers voiced losing autonomy and agency to practice motherhood independently within custodial settings. Mothers expressed a need for the correctional system to be adapted, so it is better equipped to address the unique and additional needs of mothers with young children.

CONCLUSION

Mothers' experiences indicated that the correctional system and policies, which were predominantly designed for men, do not adequately address the varied and complex needs of pregnant women, mothers, and their young children. Imprisonment of pregnant women and mothers with young children should be the last resort, and they should be provided with holistic, individually tailored support, most preferably in community settings, to address their multiple intersecting needs.

Do antisocial females exhibit poor outcomes in adulthood? An Australian cohort study

OBJECTIVE

Antisocial behaviour in young people is common and associated with adverse effects in adulthood. The question whether these effects are observed in both genders remains controversial. A typology of antisocial behaviour that captures childhood limited (CL), adolescent onset (AO) and life course persistent behaviour (LCP) through both developmental stages is utilized to examine young adult outcomes in both sexes.

METHODS

The Mater-University of Queensland Study of Pregnancy (MUSP) data set is a longitudinal study following up a cohort of 7223 infants and mothers from antenatal care to the child's 21st year. Data on child antisocial behaviour was collected at ages 5 and 14 years. At the 21-year follow up, self-reported outcomes were collected on antisocial behaviour, use of alcohol, tobacco and cannabis, physical and mental health functioning. The relationship between the three antisocial sub-types and negative young adult outcomes was examined for both males and females using a series of logistic regressions.

RESULTS

Complete data across 21 years was available for 3173 participants. Males experienced higher levels of antisocial behaviour. In both males and females, AO and LCP groups exhibited elevated risk of negative outcomes including continuing antisocial behaviour, cannabis use, general health problems and depression/anxiety symptoms. The CL group exhibited poorer outcomes in physical and mental health but not in other domains.

CONCLUSION

Both males and females exhibiting AO and LCP antisocial behaviour are at increased risk of serious adverse outcomes in young adulthood. The significant loss to follow up of high-risk groups suggests the important relationship between early antisocial behaviour and problems in adulthood have been underestimated. Further research is required to understand antisocial behaviour in adolescence, identify factors that reinforce its continuity into adulthood, and identify interventions which are able to modify adult outcomes.

Early risk factors for adolescent antisocial behaviour: an Australian longitudinal study

OBJECTIVE

This investigation utilizes data from an Australian longitudinal study to identify early risk factors for adolescent antisocial behaviour.

METHOD

Analyses are based on data from the Mater University Study of Pregnancy, an on-going longitudinal investigation of women's and children's health and development involving over 8000 participants. Five types of risk factors (child characteristics, perinatal factors, maternal/familial characteristics, maternal pre- and post-natal substance use and parenting practices) were included in analyses and were based on maternal reports, child assessments and medical records. Adolescent antisocial behaviour was measured when children were 14 years old, using the delinquency subscale of the Child Behaviour Checklist.

RESULTS

Based on a series of logistic regression models, significant risk factors for adolescent antisocial behaviour included children's prior problem behaviour (i.e. aggression and attention/restlessness problems at age 5 years) and marital instability, which doubled or tripled the odds of antisocial behaviour. Perinatal factors, maternal substance use, and parenting practices were relatively poor predictors of antisocial behaviour.

CONCLUSIONS

Few studies have assessed early predictors of antisocial behaviour in Australia and the current results can be used to inform prevention programs that target risk factors likely to lead to problem outcomes for Australian youth.