Psychotropic Medication Could Seriously Reduce Recidivism

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Photo: Jonathan Nackstrand/AFP/Getty Images

One of the most tricky, societally important challenges behavioral scientists face is trying to figure out how to get criminals who are released from prison to not end up right back there. Recidivism has a devastating effect on individuals, as well as their families and communities, so there’s a pretty big cohort of researchers trying to figure out how to reduce it. One major area of attention has to do with mental illness: People with serious mental illnesses are overrepresented in incarcerated populations, and researchers think that untreated mental illness can be a significant driver of recidivism.

Earlier this month, the Journal of the American Medical Association published a big new study out of Sweden that brings some interesting new evidence to the table — evidence suggesting that the prescription of so-called psychotropic medication, or medication designed to help people manage psychological symptoms and/or mental illness, could make a nice dent in various countries’ recidivism rates.

For the study, led by Zheng Chang of the University of Oxford, the research team capitalized on Sweden’s rather comprehensive record-keeping. They were able to examine the trajectories of every Swedish prisoner who was released between July 1, 2005, and December 31, 2010, or 22,275 in all (more than 90 percent of them male). With some number crunching, the researchers were able to correlate the prescription of various types of psychotropic drugs, as well as a handful of non-pharmaceutical psychological treatments, with the risk that a given ex-offender would commit a violent crime and end up back in jail.

In the paper’s conclusion, the authors write that they were able to establish two main findings: “First, 3 classes of psychotropic medications (antipsychotics, psychostimulants, and drugs used in addictive disorders) were associated with substantial reductions in violent reoffending. Second, the magnitudes of these associations were as strong as and possibly stronger than those for widely disseminated psychological programs in prison.”

Here’s some additional context from the paper about how this fits into the ongoing scientific conversation about recidivism:

There has been uncertainty about whether treatment for released prisoners with mental disorders should focus on criminogenic rather than mental health–related factors. The current observational study supports the potential role of treating psychiatric disorders, including by antipsychotic medication. The latter is consistent with recent findings that certain psychotic symptoms and untreated schizophrenia are associated with higher reoffending risk. Further, the findings provide evidence for potential benefits of psychostimulants for prisoners at high risk for reoffending. Although the stability of ADHD from childhood to adulthood is increasingly recognized, ADHD remains commonly underdiagnosed and undertreated in adults, including prisoners. In relation to substance use disorders, most intervention research in prisoners has focused on psychological treatments. Randomized clinical trials of pharmacological treatments (eg, methadone for opioid dependence) have mostly demonstrated relapse reduction and symptomatic improvement. The current study suggests that such benefits may extend to lower rates of violent reoffending if validated in trials. Owing to the high prevalence of substance use disorders among prisoners and strong links with premature mortality, pharmacological treatments for substance use disorders could have a substantial public health benefit. [Endnotes removed.]

There’s no magic-bullet approach to reducing recidivism, of course, and this study can’t speak to non-psychological risk factors like a lack of housing or unemployment (nor to differences between the U.S. and Sweden that might mean studies don’t translate effortlessly between the two countries).

But what studies like this can do is incrementally increase the knowledge at policy-makers’ and clinicians’ fingertips. In the long run, that could allow for much more tailored approaches to recidivism — we see you have risk factors A, B, and C, so we’re going to hook you up with treatment options X, Y, and Z — that could significantly benefit society.