COMORBIDITY CONUNDRUM: ASSESSING TREATMENT PARTICIPATION AND RECIDIVISM OUTCOMES AMONG INCARCERATED INDIVIDUALS WITH CO-OCCURRING OPIOID USE AND MENTAL HEALTH DISORDERS

Opioid use disorder (OUD) is a serious and prevalent issue, particularly among justice-involved individuals. Formerly incarcerated individuals with OUD are at an increased risk for overdose death and recidivism and often have co-occurring mental health disorders (COD). Further, there are serious gaps between the treatment and service needs of people with CODs and receipt of treatment. The purpose of this dissertation research is to examine connections between treatment participation and completion, and reincarceration, among formerly incarcerated individuals by behavioral health (BH) statuses of opioid use disorder (OUD-only), co-occurring opioid use and mental health disorders (Co-COD), other substance use disorders (other SUD), and other CODs. The following primary research questions are posed: 1) What percentage of individuals participate in each type of program by BH status? (e.g., therapeutic community (TC), outpatient (OP), co-occurring (CO), medications for opioid use disorder (MOUD), 2) What are the differences in treatment participation and completion by BH status? 3) How does BH status affect reincarceration? 4) How does treatment participation affect reincarceration? 5) From the perspective of treatment staff, how does the treatment process differ between individuals by BH status? This mixed-methods study was conducted using secondary, de-identified data for incarcerated individuals released between 2017-2021 (N = 51,914) obtained from the Pennsylvania Department of Corrections (PADOC) and through qualitative, semi-structured interviews with PADOC treatment staff (N = 20). Results revealed that those with any COD, including both Co-OUD and other CODs, were more likely to participate in treatment, but less likely to complete treatment. Among those with OUD, participation in MOUD increased the odds of treatment participation and completion by 65% and 95% (p < .001), respectively. Finally, those with Co-OUD, OUD-only, and other CODs had a higher risk for a recidivism event to occur within the study period compared to those with no substance use issues or other SUDs (p < .001). Treatment participation also reduced the risk of reincarceration (HR = 0.83, p < .001), but this relationship was moderated by BH status, indicating that the effect of treatment may depend on different BH conditions. This research has both scholarly and policy implications regarding the impact of treatment programs in the PADOC and is the first study to compare treatment outcomes and recidivism among individuals with COD and SUD in the same prison system. It also makes theoretical contributions that inform the risk-need-responsivity framework in the BH treatment of individuals in correctional settings.