Abstract

Background: There are no universal treatment standards for patients within opioid maintenance treatment programs in forensic psychiatric hospitals. Currently, the maintenance treatment in forensic psychiatries is composed of various different cri-teria. Additionally, the offered therapeutic interventions, such as sanctions for drug relapses and rule violations, are individualized for each patient. However, the goal should be to implement a standardized treatment approach in order to treat opioid addicts more efficiently. For this reason, this paper will investigate the effects of maintenance therapy on the therapeutic process of patients placed in forensic psy-chiatric hospitals according to bavarian Criminal Code § 64 StGB. The aim is to aid the advancement of addiction medicine, accompanied by an improvement of the therapeutic approaches within a forensic psychiatric setting. Methods: A total of 144 participants from 11 psychiatric prisons in Bavaria were in-cluded in this study. For this purpose, existing data of the clinic documentation sys-tems were used. The non-substituted participants at the time of data collection were compared as a control group with the substituted participants of the experimental group with regard to baseline characteristics, duration of placement, dropout rate, number of lock-up levels reached, downgrades, as well as willingness to participate in therapy and number of rule violations. Results: The samples differed clinically only in the frequency of failed detoxification attempts, which was significantly higher in the substitution group (median 1 vs. 3, p = 0.008). No significant differences were found with regard to the duration of ac-commodation, the dropout rate, the number of detoxification levels reached, the number of downgradings, the number of extensions of individual detoxification lev-els, and general therapy participation (occupational therapy, sports therapy, occupa-tional therapy, etc.). In the group of relapsed participants, significantly more relapses were recorded among the non-substituted participants (median 3 [1; 4–5] vs. 1 [1; 2–3] relapses, p = 0.008). In addition, nonsubstituted participants had more rule viola-tions than substituted participants (median 1 [1; 2]) vs. 2 [1; 3], p = 0.026, r = 0.298). Discussion: Although substituted participants in this study did not differ from the control group with regard to clinical parameters, such as length of stay, positive ef-fects of substitution therapy on the course of therapy in the correctional facility can still be derived. The subgroup studies of participants with rule violations and recidi-vism indicate that substitution therapy could have a positive effect on the course of therapy, especially with regard to the number of recidivism and rule violations. How-ever, further investigations are necessary here.