Substance use disorder in forensic hospitals: A scoping review of practices and interventions

Substance use disorders (SUDs) are prevalent in individuals with mental illness who interact with criminal justice systems, and inpatient forensic hospital care presents a treatment opportunity. Despite recognition that addressing SUD should be a central feature in forensic hospital care, knowledge is limited regarding existing practices. This scoping review addressed the research question: "What is known about the screening, assessment, treatment, and management of SUD in inpatient forensic hospital settings?".

We conducted this review in accordance with the Joanna Briggs Institute Manual for Evidence Synthesis and the PRISMA extension for scoping reviews, searching MEDLINE, PsycINFO, PubMed, and Embase databases. Inclusion criteria comprised original, English language, peer-reviewed studies focusing on inpatient substance use practices and interventions in forensic hospitals internationally, and published from database inception to May 13, 2025.

Forty-nine articles were included. Most of this research has been conducted in Europe using observational study designs. SUDburden was high, with prevalence estimates varying depending on detection approach. Treatment evidence came mostly from uncontrolled evaluations with small sample sizes of group-based psychosocial interventions. These data show acceptability and improvements in intermediate outcomes, but mixed results on substance use-specific outcomes. Studies highlighted service fragmentation, workforce training gaps, and security-related issues that strained the therapeutic alliance.

This review can inform the development of effective SUD treatment pathways and standardized models of care, improving health outcomes and quality of life, and reducing recidivism in this vulnerable population. This work establishes a foundational knowledge base essential for improving forensic hospital services.