engleski

Choice Architecture as a Complementing Strategy in Responding to the Psychoactive Substance Abuse among Forensic Patients

While traditional prevention interventions focus on conscious decision-making, motivation and intent, environmental prevention approach targets the automatic system of behaviour, and therefore requires lower individual personal resources. Forensic patients with substance-related problems often have weak impulse control, and focusing on their self-regulation solely doesn't seem sufficient in responding to substance abuse. In the past decades, from foundation of the forensic psychiatry department at the University Psychiatric Hospital Vrapče in Croatia, forensic patients were treated in physical environment with inadequate security, i.e. at ward where patients with various forensic risk, treatment goals and characteristics mutually interacted and shared the same space. In such an inpatient setting, problem of psychoactive substance abuse has been present continuously. From February 2019, forensic patients moved to a building with more complex security measures that directly change design of situations (e.g. video surveillance, electronic bracelets, separate wards based on the course of the treatment, forensic risk and other characteristics). The aim of this paper is to present some aspects of substance abuse among forensic patients at the University Psychiatric Hospital Vrapče before and after introducing choice architecture, and to discuss influence of physical environmental measures in responding to this problem. Research was based on the records review: medical information system, Registry of forensic patients, judicial and social data. Data were collected in the two timeframes: before (February 2018 – January 2019) and after (February 2019 – January 2020) introducing choice architecture. Besides the primary diagnosis (most commonly psychotic disorders), documented history of substance abuse and/or diagnosis of substance- related disorders are inclusion criteria. Results showed that choice architecture decreased opportunities for drug consumption among inpatients, and therefore should be combined with individual interventions in order to decrease substance use among forensic patients.

Choice architecture ; psychoactive substances ; forensic patients

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