Who’s Prone to Breaking the Rules?—Predictors of Challenging Patient Behavior in Forensic Addiction Treatment

Abstract

Many patients in substance use disorder treatment exhibit behavior that is challenging for therapy. In Germany, offenders with addiction problems may be sentenced to treatment in forensic psychiatric institutions (Sect. 64 of the German Criminal Code). In general, therapy-challenging behavior (TCB) increases the risk that forensic addiction treatment (FAT) will fail. This article identifies a set of indicators allowing therapists to assess the risk of TCB during FAT. We define TCB as any substance use, escapes/abscondence and disciplinary incidents by patients. As potential predictors, anamnestic sociodemographic data, disorder-related variables, and delinquency-related data (set A) in addition to the therapists’ assessments of the therapy process (set B) were analyzed. N = 548 records of patients, who had been in treatment for at least 12 and at most 24 months, were included in this study. Patients were treated in several forensic institutions throughout Germany. N = 187 patients showed at least one type of TCB (34.1%). In a first univariate step (applying Chi²-tests or t-test) various possible predictors were identified. Their predictive values were then analyzed in three binary stepwise logistic regression models. The first comprises set A predictors, the second set B and a third inclusive model combined both sets of variables (set AB). The combination of anamnestic and treatment-related variables (AB) proved to be superior to the other models and resulted in a significant model for prediction of TCB (p < .001). It includes seven variables and explains more than one third of TCB variance. The findings allow TCB in FAT to be more quickly identified in a population at risk and offer the possibility to provide these patients with appropriate treatment.