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.

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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. "

    Full-text · Article · Dec 2015
    • "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.
    No preview · Article · Jun 2015 · Epidemiology and Psychiatric Sciences
    • "People who have a history of injecting drug use (PWID) are at particular risk of drug-related death, and are over-represented in the criminal justice system (Fazel et al., 2006); around 70% of people entering Australian prisons report illicit drug use in the past 12 months and around half report a history of injecting (Australian Institute of Health and Welfare, 2013). "
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    ABSTRACT: Release from prison is a period of elevated risk for drug-related harms, particularly among people who inject drugs (PWID). Non-fatal overdose can cause serious morbidity and predicts future fatal overdose, however neither the incidence nor the risk factors for non-fatal overdose following release from prison are well understood. Structured health-related interviews were conducted with 1051 adult prisoners in Queensland, Australia prior to release and approximately 1, 3 and 6 months post-release. Incidence of self-reported overdose in the community was calculated for PWID and all prisoners for three discrete time periods. Negative binomial regression with robust error variance was used to identify pre-release predictors of overdose among PWID. The incidence of reported overdose was highest between 1 and 3 months post-release (37.8 per 100 person-years (PY) among PWID; 24.5/100 PY among all ex-prisoners). In adjusted analyses, the risk of post-release non-fatal overdose was higher for PWID who reported: being unemployed for >6 months before prison, having been removed from family as a child, at least weekly use of benzodiazepines and/or pharmaceutical opiates in the 3 months prior to prison, and ever receiving opioid substitution therapy (OST). Pre-release psychological distress and a lifetime history of mental disorder also predicted overdose, whereas risky alcohol use in the year before prison was protective. PWID have a high risk of overdose following release from prison. Imprisonment is an opportunity to initiate targeted preventive interventions such as OST, overdose prevention training and peer-delivered naloxone for those with a high risk profile. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    No preview · Article · Jun 2015 · Drug and alcohol dependence
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