Illicit Substance Use As Indicators of Service Utilization Patterns Behaviors Among Individuals on Probation and Parole

Background and Purpose: Approximately 4.3 million people are on probation or parole annually in the United States. Individuals under probation and parole record higher rates of substance misuse by about 26% compared to the general population. For illicit substances in particular, previous literature suggests that those on probation and parole misuse 2-5 times more than individuals without justice-involvement. The intersection of illicit substance use, mental health and service utilization is critically important for this group, as it impacts their health and well-being. Community correction settings have the potential to be frontline providers of mental health and substance misuse treatment. This paper explores the heterogeneity of illicit substance misusers among those who are justice-involved and explores differences in mental health and service use rates over the last year.

Methods: A latent class analysis was conducted using the National Survey of Drug Use and Health data from 2015-2019. A narrowed sample (N = 5,226) of adults on probation and parole with illicit substance misuse histories was used. Classes were built based on patterns of six dichotomous illicit substance indicators: marijuana, hallucinogens, methamphetamines, tranquilizers, opioids, and crack/cocaine misuse within the past year. Differences between classes were explored on auxiliary variables- predictors (i.e., demographic and mental health variables) and distal outcomes of service utilization. Demographic predictors of class included sex, marital status, age, race, poverty, and education level. Mental health predictors included serious psychological distress, mental illness, major depressive episodes, number of health conditions, and overall health within the last year. Distal outcomes of service utilization (general care, mental health treatment, and substance misuse treatment) in the past year were explored.

Results: This analysis found three classes of substance misuse within the sample: high risk polysubstance users, exclusive marijuana users, and low-risk polysubstance users. Demographics found that both groups of polysubstance users were more likely to be women between 18 and 34 years old, married, white, and living above poverty with some high school education than marijuana users. Low-risk users were over 3-times more likely to have serious psychological distress and a major depressive episode in the last year when compared to high-risk misusers. Low-risk users also reported having fewer health conditions and self-reported better health than high-risk users. Based on classes, there were no significant differences between receiving healthcare (i.e., hospital stays). However, low-risk misusers were twice as likely to receive both mental health and substance misuse treatment than the high-risk and marijuana misusers, which was significant. The least likely class to use healthcare and substance misuse treatment were high-risk misusers while marijuana users used mental health treatment least.

Conclusions and Implications: Those on probation or parole within the last year and are high-risk polysubstance users are not utilizing services at the same rate as those who are either exclusively marijuana users or low-risk polysubstance users. We suggest next steps such as targeted service outreach prior to release for high-risk polysubstance users, further assessment of treatment for low-risk users, and aimed approaches for 18–34-year-old women with substance histories and justice-involvement.