Parole revocation among prison inmates with psychiatric and substance use disorders

Objective: This retrospective cohort study examined the association between co-occurring serious mental illness and substance use disorders and parole revocation among inmates from the Texas Department of Criminal Justice, the nation's largest state prison system. Methods: The study population included all 8,149 inmates who were released under parole supervision between September 1, 2006, and November 31, 2006. An electronic database was used to identify inmates whose parole was revoked within 12 months of their release. The independent risk of parole revocation attributable to psychiatric disorders, substance use disorders, and other covariates was assessed with logistic regression analysis. Results: Parolees with a dual diagnosis of a major psychiatric disorder (major depressive disorder, bipolar disorder, schizophrenia, or other psychotic disorder) and a substance use disorder had a substantially increased risk of having their parole revoked because of either a technical violation (adjusted odds ratio [OR]=1.7, 95% confidence interval [CI]=1.4-2.4) or commission of a new criminal offense (OR=2.8, 95% CI=1.7-4.5) in the 12 months after their release. However, parolees with a diagnosis of either a major psychiatric disorder alone or a substance use disorder alone demonstrated no such increased risk. Conclusions: These findings highlight the need for future investigations of specific social, behavioral, and other factors that underlie higher rates of parole revocation among individuals with co-occurring serious mental illness and substance use disorders.