The association between criminal justice referral type and substance use treatment outcomes among discharges of justice-involved pregnant women

<i>Background:</i> There is variation in the criminalization of substance use during pregnancy across U.S. states. How the context of criminal justice system involvement impacts outpatient substance use treatment outcomes among pregnant women is understudied.<i>Objectives:</i> This study tested associations of criminal justice referral status with 1) treatment completion and 2) reduced substance use among individuals at discharge who were pregnant and referred to outpatient treatment from the criminal justice system.<i>Methods:</i> Data were obtained from the 2015-2021 Treatment Episode Dataset-Discharges (TEDS-D). The sample consisted of 7881 justice-involved outpatient discharges who were pregnant. The independent variable was the type of criminal justice referral: court or diversionary program, probation or parole, or other. Outcome variables included treatment completion and reduced substance use. Multivariable logistic regression models were used to measure associations of referral type with treatment outcomes, adjusting for covariates.<i>Results:</i> Referrals from court or diversionary programs had higher odds of treatment completion than referrals from probation or parole (AOR = 1.40, 95% CI = 1.23-1.60). Among individuals at discharge who reported daily use prior to admission, those referred through court or diversionary programs had higher odds of reduced substance use at discharge compared to those referred through probation or parole (AOR = 1.85, 95% CI = 1.23-2.79).<i>Conclusions:</i> Overall, better outcomes were observed among those referred through courts or diversionary programs compared to those referred through probation or parole. These findings demonstrate the potential utility of drug courts and diversionary programs in facilitating positive treatment outcomes while also preventing exposure to more punitive forms of criminal justice system involvement.