Substance Use Disorders Associated with Restorability of Competence to Proceed
Competence to stand trial evaluations are conducted to determine whether an accused has the ability to understand the legal proceedings against them and effectively work with counsel in their defense. Court orders for competence to stand trial evaluations have rapidly increased prompting admission waitlists across the United States in what has been called a "competency crisis." Researchers have sought to identify demographic, clinical, and legal characteristics associated with restorability to inform forensic evaluators' opinions. It is understood that substance use impacts cognitive functioning even after periods of abstinence. However, few studies have examined the impact of specific substance use disorders on restorability. A retrospective chart review examined records for 287 adult males in a secure medical facility in Alabama. Regression analyses determined the association between specific substance use disorders and restorability and length of stay (LOS; as a proxy of time to be restored). In addition, regression analyses examined the relationship between dual diagnosis and restorability. After controlling for significant covariates (age, violent crime, and previous hospitalization LOS), accused with alcohol use disorder were more likely to be restored to competence whereas those with dual diagnoses and lengthier previous hospitalizations predicted incompetent and unrestorable adjudication. Age significantly predicted LOS in that older patients had slightly longer LOS (as a proxy of time to be restored) than younger patients. Forensic evaluators and the courts can weigh these factors when opining CTP outcomes, potentially reducing unnecessary periods of confinement for pre-trial accused unlikely to be restored, as well as indirectly reducing forensic waitlists by moving individuals through the CTP/ITP adjudication more swiftly.
competence to stand trial, forensic psychology, restorability, substance use disorder
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