Evaluating effectiveness of substance misuse and addiction treatment in correctional services in Sweden

A large proportion of people who enter the criminal justice system have problems with alcohol or drug use.

Substance misuse and substance use disorders (SUDs) in this population have large impact on public health and the society at large, as they are associated with an increased risk of recidivism, overdoses, and mortality.

Thus, there is a critical need for effective SUD treatments on all sanction levels, from prison to probation and forensic psychiatric care.

However, previous international and Swedish studies have underscored substantial knowledge gaps in whether existing treatments are effective in this population.

Therefore, the aim of this proposal is to use high quality Swedish nationwide register data to evaluate the effectiveness of SUD treatments in Swedish correctional and forensic psychiatric services.

We will investigate whether psychological and pharmacological treatments reduce the risk of recidivism, overdoses, and mortality.

Randomized clinical trials are considered the best evidence in effectiveness research, but they are challenging, and sometimes impossible, to conduct in this context due to practical and ethical complications. However, non-randomized observational studies often have poor validity for investigating causal questions.

Therefore, we will utilize state-of-the-art epidemiological and quasi-experimental methods such as target trial emulation, instrumental variables, and regression discontinuity design, which can bring observational study results as close as possible to what might have resulted from a randomized clinical trial.

The knowledge gained from this research is likely to have direct implications for policy, clinical practice, and treatment guidelines.