NEW COCHRANE REVIEW! - 01 April 2014

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A number of policy directives are aimed at enabling people with drug problems to live healthy, crime-free lives. Drug-using offenders with co-occurring mental health problems represent a group of people who access treatment for a variety of different reasons. The complexity of the two problems makes the treatment and rehabilitation of this group of people particularly challenging.

Study characteristics
The review authors searched scientific databases and internet resources to identify randomised controlled trials (where participants are allocated at random to one of two or more treatment groups) of interventions to reduce, eliminate, or prevent relapse or criminal activity of drug-using offenders with co-occurring mental illness. We included people of any gender, age or ethnicity.

Key results
We identified eight trials (three of which are awaiting classification) evaluating treatments for drug-using offenders with co-occurring mental illness. The interventions included case management via a mental health court, a therapeutic community and an evaluation of motivational interviewing techniques and cognitive skills (a person's ability to process thoughts) in comparison to relaxation training. Overall, the combined interventions were not found to reduce self report drug use, but did have some impact on re-incarceration rates, but not re-arrest. A specific analysis of therapeutic community interventions did subsequently reduce re-incarceration but proved to be less effective for re-arrest and self report drug use. Two single studies evaluating case management via a mental health drug court and motivational interviewing and cognitive skills did not show significant reductions in criminal activity and self report drug use respectively. Little information is provided on the costs and cost effectiveness of such interventions and trial evaluations focusing specifically on the needs of drug misusing offenders with co-occurring mental health problems are required.

Quality of the evidence
This review was limited by the lack of information reported in this group of trials and the quality of the evidence is unclear. The evidence is current to March 2013.