Patterns of Substance Use in a Forensic Psychiatric Hospital in Germany ^†

Abstract

Background: This presentation is based on a paper that was published last year in the peer-reviewed journal Recht & Psychiatrie [1]. The study investigates consumption patterns in patients who have been diagnosed with a substance use disorder and are being treated in a forensic psychiatric hospital under section 64 of the German penal code. High cost of treatment and a higher risk of reoffending when terminated prematurely underlines the importance of determining who has a high chance of completing treatment and why. It is important to note, that the investigation of dynamic predictors of recidivism in patients who undergo mandatory forensic addiction treatment has been insufficiently examined. One dynamic factor could be the consumption pattern during treatment. Relapses during addiction treatment is not uncommon and relapse rates range from 16.7 to 81.6%. However, evidence shows that moderate consumption does not necessarily have a negative effect on legal prognosis. So far, there are no clear findings as to how substance use during therapy affects recidivism or early treatment termination. Furthermore, consumption patterns have not yet been conclusively conceptualized. Studies don’t go beyond quantifying relapses and only investigate factors that promote or protect patients from relapsing. So far, there has been no investigation of actual consumption patterns during forensic mandatory treatment. Therefore, the goal of this study was to provide a description and classification of consumption patterns, identify factors that promote substance use or encourage abstinence and describe the relationship between consumption patterns and treatment termination. Methods: This qualitative study examined the components of consumption patterns via 17 interviews with patients, who underwent mandatory treatment in a forensic psychiatric hospital in Germany and two focus groups with employees of the same hospital. Results: Findings show different patterns: temporal, observed and internal. A temporal pattern can be divided into five overarching types (progressive, regressive, constant, intermittent, chaotic). Internal patterns of factors within and outside the patient constitute the observed consumption patterns. Conclusions: The reflection of the observed behavior allows therapeutic intervention points. Future studies should validate the components and further investigate the relationship between certain patterns of consumption behavior and recidivism.