Psychopharmaco-psychosocial treatment for substance misuse among individuals in a Canadian forensic psychiatric program

BACKGROUND: Substance misuse is disproportionately prevalent among individuals in the criminal justice system and can complicate their recovery and community reintegration. While psychosocial therapy is integral for managing substance use, its efficacy may be limited if not well-designed to effectively integrate with psychopharmacological treatment to target patients risk factors and resources. OBJECTIVE: This study presents findings from a semi-structured manualized treatment program (SSMTP) for substance misuse based on motivational enhancement and cognitive behavioural models among individuals in a Canadian forensic psychiatry program. METHODS: This retrospective study was completed by reviewing pre- and post-treatment data of patients with concurrent disorders who underwent the SSMTP in addition to psychopharmacological treatment. The review explored data collected on readiness for change using the Stage of Change Readiness and Treatment Eagerness Scale (SOCRATES) across domains of recognition, ambivalence, and taking steps. RESULTS: The patients (n = 96) were predominantly males (90.6 %). Mean age was 40.25 (SD = 10.04) years. For patients using alcohol, ambivalence increased significantly between pre- and post-SSMTP treatment (p = .025). For patients using cannabis, cocaine, and tobacco, there were significant increases in recognition and taking steps between pre- and post-SSMTP treatment, without any significant change in ambivalence. CONCLUSION: This study suggests SSMTP may increase the level of recognition and degree of steps taken toward substance use cessation and abstinence in forensic populations with concurrent disorders, albeit its effects may amplify within a psychopharmaco-psychosocial treatment model. Future trials with robust methodology are needed to establish the long-term efficacy of SSMTP and generalization to a broader population.