Racial Differences in the Association between Recent Arrest History and Co-Occurring Mental Health and Substance Use Disorders Among Women in the United States: An Analysis of Administrative Data

Background and Purpose: Co-occurring mental health and substance use disorders are highly prevalent among women involved in the criminal justice system. Most existing research on the influence of criminal justice involvement has been on incarceration. However, incarceration is only one kind of criminal justice experience. Focusing on incarceration may mask the extent to which the criminal justice system impacts co-occurring mental health and substance use disorders. The largest number of people entering the criminal justice system experience an arrest, including approximately three million women in the United States each year. Focusing on co-occurring mental health and substance use disorders among women with a recent arrest offers a broader understanding of the experiences and needs of women involved with the criminal justice system. The FBI Uniform Crime Report indicates that the level of arrest risk varies among women from different racial and ethnic backgrounds. Therefore, this study examines the association between recent arrest history and co-occurring mental health and substance use disorders among women while assessing racial differences.

Methods: Data were from the 1,431,180 drug-related treatment admissions reported in the 2015-2017 Treatment Episode Data Set (TEDS) public use files. TEDS, reported annually by the Substance Abuse and Mental Health Services Administration, provides data on substance use treatment admissions among individuals 12 years or older to state-licensed or certified substance use treatment centers receiving federal funding. Participants self-reported their sociodemographic characteristics (e.g., race, age, employment status), drug use (e.g., frequency, route of administration), mental health problems, treatment referral sources, and arrest histories. Bivariate analyses were conducted to determine the disparities in co-occurring mental health and substance use disorders among women with and without arrest histories. Multi-level analysis was then conducted to examine the association between arrest histories and co-occurring disorders and whether this association is different for women from disparate racial and ethnic backgrounds.

Results: Findings suggest that women with arrest histories have had significantly higher rates of co-occurring mental health and substance use disorders compared to women without arrest histories. Multi-level logistic regression revealed that women who have been arrested once had 1.13 the odds to have co-occurring mental health and substance use disorders as women without arrest histories (95% CI = 1.05 – 1.22, p = .002). Moreover, women from different racial and ethnic backgrounds tend to be differentially impacted by having arrest histories. Specifically, Latino women who have been arrested twice or more had 1.51 the odds to have co-occurring mental health and substance use disorders as their White counterparts (95% CI = .99 – 2.29, p = .054).

Conclusions and Implications: This study suggests the necessity for future research to expand beyond an incarceration focus when examining the health consequences of criminal justice contacts. Findings indicate that social work interventions, specifically mental health and substance use services, should consider the high comorbidity of mental health and substance use needs among women with arrest histories. Moreover, these interventions should consider the potentially elevated health impacts associated with arrest histories among Latino women.