Facilitating Treatment Access and Engagement for Justice-Involved Veterans With Substance Use Disorders
| Published date | 01 March 2016 |
| Author | Matthew S. Kendra,Amanda M. Midboe,Christine Timko,James F. McGuire,Natalya C. Maisel,Daniel M. Blonigen,Lisa H. Glynn,Andrea K. Finlay,Janet C. Blodgett |
| Date | 01 March 2016 |
| DOI | 10.1177/0887403414560884 |
| Subject Matter | Articles |
research-article2014
Article
Criminal Justice Policy Review
2016, Vol. 27(2) 138 –163
Facilitating Treatment Access
© 2014 SAGE Publications
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DOI: 10.1177/0887403414560884
cjp.sagepub.com
Involved Veterans With
Substance Use Disorders
Lisa H. Glynn1,2,3, Matthew S. Kendra1,4,5,
Christine Timko1,5, Andrea K. Finlay1,
Janet C. Blodgett1, Natalya C. Maisel1,
Amanda M. Midboe1, James F. McGuire6,
and Daniel M. Blonigen1
Abstract
More than one half of U.S. military Veterans with criminal-justice involvement
report problematic substance use, but less than one third ever receive or engage in
treatment for substance use disorders (SUDs), despite access to the Veterans Health
Administration (VA). This underutilization of services places an already vulnerable
population at risk of negative outcomes, such as poor physical and mental health,
intimate partner violence, homelessness, suicide, and criminal recidivism. These
risks and harms can be reduced through connection with SUD treatment services,
and many Veterans already qualify for care through the VA and other agencies. In
this review, we outline the known and likely barriers to SUD treatment access and
engagement for justice-involved Veterans, suggest policy responses to these barriers,
and describe current efforts within the VA and community organizations to address
access and engagement in this population. A summary of current knowledge is
provided, and directions for future research are suggested.
1Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
2Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
3University of New Mexico, Albuquerque, NM, USA
4George Mason University, Fairfax, VA, USA
5Stanford University, CA, USA
6Veterans Health Administration, Washington, DC, USA
Corresponding Author:
Lisa H. Glynn, VA Puget Sound Health Care System, 1660 South Columbian Way (S-116-DDTP), Seattle,
WA 98108, USA.
Email: lisa.glynn@va.gov
Glynn et al.
139
Keywords
treatment access, engagement, substance use disorder, Veteran, criminal justice
Justice-involved Veterans (i.e., former U.S. military personnel who have been detained
by, or are under the supervision of, the criminal-justice system) make up approxi-
mately 10% of the population of incarcerated U.S. adults (Greenberg & Rosenheck,
2008; Mumola, 2000; Noonan & Mumola, 2007), which amounts to approximately
140,000 Veterans incarcerated in state or federal prisons (Noonan & Mumola, 2007)
and 69,300 in local jails (Mumola, 2000). However, these estimates likely represent
only a small portion of the total number of justice-involved Veterans, given that
approximately 75% of the total U.S. correctional population are on probation or parole
in the community rather than incarcerated in prisons or jails (Glaze, 2011).
Substance use disorders (SUDs) are highly prevalent among justice-involved
Veterans (Noonan & Mumola, 2007; Tsai, Kasprow, & Rosenheck, 2013). For exam-
ple, among incarcerated Veterans, 57% in federal prison and 61% in state prison meet
criteria for an SUD (Noonan & Mumola, 2007). For Iraq and Afghanistan Veterans
who are justice-involved, 56% of their interactions with the criminal-justice system
are related to either alcohol or drugs (Rieckhoff, Schleifer, & McCarthy, 2012).
Furthermore, as many as two thirds of justice-involved Veterans who are seen by out-
reach specialists from the Veterans Health Administration (VA) are assessed as having
an alcohol or drug use disorder and determined to be in need of SUD treatment
(Department of Veterans Affairs, 2012a, 2012b).
Despite the extensive need for SUD treatment among justice-involved Veterans,
most never access or engage in these services (Elbogen et al., 2013; Hoge et al., 2004;
Milliken, Auchterlonie, & Hoge, 2007). For example, fewer than half of Veterans in
jail receive any VA mental-health care the year after being contacted by a VA Outreach
Specialist (McGuire, Rosenheck, & Kasprow, 2003), with utilization rates of only
30% for outpatient mental-health services and only 3% for inpatient services. Thus,
SUDs are both highly prevalent and undertreated among justice-involved Veterans.
Facilitating justice-involved Veterans’ access to and engagement in SUD treatment
is critical for their long-term health and well-being. SUDs are linked to and can exac-
erbate a host of negative outcomes among justice-involved Veterans, including poor
physical and mental health (McGuire et al., 2003; Noonan & Mumola, 2007; Osher,
2005; Saxon et al., 2001; Tsai, Kasprow, & Rosenheck, 2013), intimate partner vio-
lence (Fairweather, Gambill, & Tinney, 2010; Weaver, Joseph, Dongon, Fairweather,
& Ruzek, 2013), homelessness (Tsai, Rosenheck, Kasprow, & McGuire, 2013), and
suicide (Frisman & Griffin-Fennell, 2009; Swords to Plowshares, 2011; Wortzel,
Blatchford, Conner, Adler, & Binswanger, 2012), and are one of the strongest predic-
tors of criminal offending among Veterans (Erickson, Rosenheck, Trestman, Ford, &
Desai, 2008). Accordingly, increasing justice-involved Veterans’ access to and engage-
ment in SUD treatment can improve these health outcomes and reduce the likelihood
of criminal recidivism in this population (Center for Substance Abuse Treatment
[CSAT], 2005; Cradock-O’Leary, Young, Yano, Wang, & Lee, 2002; Pandiani, Ochs,
140
Criminal Justice Policy Review 27(2)
& Pomerantz, 2010). Furthermore, SUD treatment services have been shown to be
highly cost-effective (Ettner et al., 2006) and may therefore reduce the significant
financial burden that justice-involved Veterans pose to the VA and other health care
systems (McGuire et al., 2003). Importantly, the endogeneity of other risk factors (e.g.,
homelessness, poor physical health, mental disorders) within this population suggests
that holistic care might promote better management of both SUDs and those other
factors.
Using a prevailing model of health care utilization (Andersen & Newman, 2005),
the goals of this article are to (a) review known and likely barriers to SUD treatment
access and engagement among justice-involved Veterans, (b) suggest possible policy
responses to these barriers, and (c) describe current efforts within the VA and com-
munity organizations that can improve access and engagement. We hope this docu-
ment can serve as a guide to clinicians and systems seeking to provide the most
effective care for justice-involved Veterans with SUDs, stimulate research, and facili-
tate treatment engagement among this vulnerable population.
Review Strategy
The current qualitative review was derived from a collaborative project between the
Center for Innovation to Implementation at the Veterans Affairs Palo Alto Health Care
System and the Veterans Health Administration Justice Programs, which generated an
internal structured evidence review regarding the treatment needs of justice-involved
Veterans and associated psychological interventions (Blodgett, Fuh, Maisel, &
Midboe, 2013). The initial review included a sample of more than 200 articles, derived
from multiple search engines (i.e., Google Scholar, PsycInfo, PubMed, and Web of
Science) and targeted searches of relevant agencies (e.g., U.S. Bureau of Justice
Statistics, U.S. National Institute of Justice, Substance Abuse and Mental Health
Services Administration [SAMHSA]’s National GAINS Center, and the U.S. Bureau
of Prisons).
The literature about access and engagement for justice-involved Veterans with
SUD was sparse, and thus, our review expanded the search to related research areas to
identify likely barriers and possible policy responses. These areas included (a)
Veterans, (b) SUDs (e.g., “alcohol” / “drug” / “substance”), (c) treatment, and
(d) criminal-justice involvement (“justice involve*” / “incarcerat*” / “legal” / “prison”
/ “jail”). From this list, we further selected articles based on their relevance to access
and engagement.
Why Are Justice-Involved Veterans Not Accessing and
Engaging in Treatment for SUD?
This section reviews known and likely barriers to SUD treatment access and engage-
ment among justice-involved Veterans. Treatment access refers to appropriate and
well-timed care that is affordable to clients and integrated across systems (e.g.,
Petzel, 2012) and includes outpatient, inpatient, residential, and pharmacotherapy
Glynn et al.
141
services (Harris, Gifford, Hagedorn, & Ekstrom, 2011). Treatment engagement
includes actions that clients take to maximize treatment benefits, including atten-
dance, assessment, group or individual psychotherapy, pharmacotherapy, mutual-
help group attendance, or biomarker drug testing (Center for Advancing Health,
2010; Department of Veterans Affairs & Department of Defense [VA/DoD], 2009;
Institute of Medicine, 2013). Access and engagement represent two aspects of
health-service utilization, which is shaped by both individual and societal influences
(Andersen & Newman, 2005).
As an organizing structure, throughout this review, we draw on Andersen and
Newman’s (2005) model of determinants of health-service utilization to summarize
barriers to and facilitators of SUD treatment among justice-involved Veterans.
Specifically, we highlight predisposing factors (i.e., stigma; co-occurring disorders),
need (i.e., lack of awareness or ambivalence about the need for SUD treatment), and
lack of enabling resources...
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