Substance abuse and dependence in prisoners: a systematic review. [Research Support, Non-U.S. Gov't Review]

Department of Psychiatry, University of Oxford, Oxford, England, United Kingdom
Addiction (Impact Factor: 4.74). 03/2006; 101(2):181-91. DOI: 10.1111/j.1360-0443.2006.01316.x
Source: PubMed


To review studies of the prevalence of substance abuse and dependence in prisoners on reception into custody.
A systematic review of studies measuring the prevalence of drug and alcohol abuse and dependence in male and female prisoners on reception into prison was conducted. Only studies using standardized diagnostic criteria were included. Relevant information, such as mean age, gender and type of prisoner, was recorded for eligible studies. The prevalence estimates were compared with those from large cross-sectional studies of prevalence in prison populations.
Thirteen studies with a total of 7563 prisoners met the review criteria. There was substantial heterogeneity among the studies. The estimates of prevalence for alcohol abuse and dependence in male prisoners ranged from 18 to 30% and 10 to 24% in female prisoners. The prevalence estimates of drug abuse and dependence varied from 10 to 48% in male prisoners and 30 to 60% in female prisoners.
The prevalence of substance abuse and dependence, although highly variable, is typically many orders of magnitude higher in prisoners than the general population, particularly for women with drug problems. This highlights the need for screening for substance abuse and dependence at reception into prison, effective treatment while in custody, and follow-up on release. Specialist addiction services for prisoners have the potential to make a considerable impact.


Available from: Seena Fazel
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    • "One possible explanation is a version of the healthy worker effect: those who are physically healthy may be more able to commit certain crimes and might therefore be at higher risk of re-incarceration. This effect has previously been proposed as an explanation for lower rates of natural deaths during incarceration (Fazel and Benning 2006). Conversely, a history of STI was associated with a marginal increase in risk of return to custody. "

    12/2015; 3(1). DOI:10.1186/s40352-015-0022-6
    • "In contrast to reviews on addiction (Fazel et al. 2006), reviews on SMI in prison populations combined prevalence estimates from studies of all existing prisoners and admission studies (Fazel & Danesh, 2002; Fazel & Seewald, 2012). They may have systematically underestimated the rates of SMI present in people who are committed to penal justice systems, especially for emerging countries. "
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    ABSTRACT: Previous mental health surveys conducted in prisons within emerging countries recruited samples of all prisoners at any single point in time. However, this sampling strategy results in an overrepresentation of long-term prisoners as compared with those studies recruiting from all admissions over time. This study aimed to assess mental disorders in consecutively admitted prisoners soon after admission, in order to address service needs of people with short-term imprisonments and people at early stages of imprisonment. Disorders were assessed in a sample of 229 male and 198 female prisoners, consecutively committed to the penal justice system in Santiago de Chile, using the structured Mini-Neuropsychiatric interview. Prevalence rates were calculated as per cent values. Ninety-five per cent confidence intervals were calculated for the proportions. Illicit drug and/or alcohol use disorders in the year prior to admission were present in 173 (76%) male and 64 (32%) female prisoners. The substances most frequently causing addiction were cocaine-based products in 108 (47%) male and 42 (21%) female prisoners. Current major depression was present in 124 (54%) male and 86 (43%) female prisoners, and current non-affective psychotic disorders in 18 (8%) male and in 10 (5%) female prisoners. High suicidal risk was present in 64 (28%) male prisoners and in 29 (15%) female prisoners. When consecutive prisoners are assessed at admission, rates of mental health and substance use disorders were higher than in previous studies in emerging countries that had sampled from all existing prisoners at a time. Affective disorders and suicide risk appear more prevalent than in admission studies conducted in Western high-income countries. Previous research may have systematically underestimated the extent of mental health problems in prisoners, which poses a major public health challenge in emerging countries.
    Epidemiology and Psychiatric Sciences 06/2015; -1:1-9. DOI:10.1017/S2045796015000554 · 3.91 Impact Factor
    • "Injecting drug users are over represented in prison populations (European Monitoring Centre for Drugs and Drug Addiction, 2012; Fazel et al., 2006; Shewan et al., 2005; World Health Organisation, 2012). There are an estimated 40,000 drug users in English and Welsh prisons at any one time (Lee and George, 2005). "
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    ABSTRACT: Purpose - The purpose of this paper is to explore prison drug injecting prevalence, identify any changes in injecting prevalence and practice during imprisonment and explore views on prison needle exchange. Design/methodology/approach - An empirical prospective cohort survey conducted between 2006 and 2008. The study involved a random sample of 267 remand and sentenced prisoners from a large male category B prison in England where no prison needle exchange operates. Questionnaires were administered with prisoners on reception and, where possible, at one, three and six months during their sentence. Findings - In total, 64 per cent were injecting until admission into prison. The majority intended to stop injecting in prison (93 per cent), almost a quarter due to the lack of needle exchange (23 per cent). Yet when hypothetically asked if they would continue injecting in prison if needle exchange was freely available, a third of participants (33 per cent) believed that they would. Injecting cessation happened on prison entry and appeared to be maintained during the sentence. Research limitations/implications - Not providing sterile needles may increase risks associated with injecting for prisoners who continue to inject. However, providing such equipment may prolong injecting for other prisoners who currently cease injecting on account of needle exchange programmes (NEPs) not being provided in the UK prison setting. Practical implications - Not providing sterile needles may increase risks associated with injecting for prisoners who continue to inject. However, providing such equipment may prolong injecting for other prisoners who currently cease injecting on account of NEPs not being provided in the UK prison setting. Originality/value - This survey is the first to question specifically regarding the timing of injecting cessation amongst male prisoners and explore alongside intention to inject should needle exchange facilities be provided in prison.
    International Journal of Prisoner Health 03/2015; 11(1):17-29. DOI:10.1108/IJPH-09-2014-0032
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