Faculty Bibliography

This study examined the impact of three program-level factors (coercion level, type of antipsychotic prescribed, and guardian supervision) on antipsychotic medication adherence among parolees mandated to an outpatient psychiatric clinic. Overall, 70.7% of the participants tested positive for their prescribed antipsychotic. Older patients were more likely to test positive for their prescribed antipsychotic than younger patients, and African American patients (relative to all other race/ethnic groups) were less likely. With regard to program-level factors, perceived coercion was not significantly associated with medication adherence. However, being prescribed an atypical antipsychotic and having a guardian were independently associated with increased adherence, and combined, these two factors were associated with nearly a tenfold increase in the likelihood of patients testing positive for their prescribed antipsychotic agent, relative to patients who were prescribed conventional antipsychotics and were not under guardian supervision.

This study examined the independent and interactive associations between cocaine use and antipsychotic medication adherence in predicting 12 month criminal recidivism among a sample of mentally ill parolees (N = 200). Consistent with prior research, cocaine use (based on hair assays) was associated with more than a threefold increase (relative to non-cocaine users) in the likelihood of a parolee being returned to custody during the follow-up period. Although medication adherence (based on urine specimens) was not independently associated with a significant reduction in recidivism risk, the interaction between cocaine use and medication adherence was significant, revealing a disproportionate impact of medication adherence specific to cocaine users. Prediction models of recidivism based on self-reported measures of medication adherence and cocaine use revealed only marginally significant trends for cocaine use, no effect for adherence, and no significant interaction between these two predictors.

Five counties (Kern, Riverside, Sacramento, San Diego, San Francisco) that demonstrate both variations and similarities in their implementation of Proposition 36 (e.g., treatment approaches, urine testing) and patient mix have been selected to participate in a study assessing how California's Proposition 36 is affecting the drug treatment system and patient outcomes. Except for San Francisco, treatment admissions increased during the first year of Proposition 36 implementation over the prior year (27% in Kern, 21% in Riverside, 17% in Sacramento, and 16% in San Diego), mostly in outpatient drug-free programs. Compared to non-Proposition 36 patients, Proposition 36 patients were more likely to be men, first-time admissions, treated in outpatient drug-free programs, employed full-time, and users of methamphetamine or marijuana. They were less likely to be treated in residential programs or methadone maintenance programs and fewer reported heroin use or injection drug use. Guided by the multilevel open systems framework, the study examines key issues of Proposition 36 that influence treatment systems and outcomes and empirically identifies "best practice" approaches in treating drug-abusing offenders.