The impact of mental health risks and needs on substance use among adults in community supervision: a multilevel model examining moderation by age and variation across statewide judicial circuits

Abstract Adults in community supervision (i.e., probation or parole) face disproportionately higher rates of substance use disorders (SUDs) compared to the general population, with older adults facing heightened risks. Further, SUDs often co-occur with mental illness, yet few studies have examined co-occurring SUDs and mental illness (CODs) among adults in community supervision and how these experiences vary across the life course. This study utilized a statewide sample of all adults in community supervision between 2018 and 2019 (N = 33,079) to assess the effects of mental health on substance use risks and needs, and whether age moderates this relationship. Multilevel modeling was used to examine associations while controlling for variation across judicial circuits. Findings revealed that substance use risk and need varies across circuits, effects of mental health on substance use vary regionally, and older persons in community supervision exhibit the highest rates of COD treatment needs. Social workers may benefit from these findings, which suggest a need for increased awareness of potential co-occurring needs among older adults in supervision, and available community-based interventions to meet these needs. Research evaluating training and available resources in the delivery of care for those with CODs in supervision remains a serious need.