Substance Abuse and Dependence in Prisoners: A Systematic Review

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The relationship between offending and substance misuse has been demonstrated in a variety of criminal justice and medical settings. Recently, associations between individuals with a clinical diagnosis of substance abuse and subsequent violent offending have been shown in a large prospective study of patients leaving hospital and in a national study of all psychiatric patients discharged into the community. Estimates of the burden of substance abuse and dependence in the criminal population would therefore be useful to inform service developments and public health interventions. In particular, information on the prevalence of substance abuse and dependence in prisoners would be important, as there is scope for initiating treatment while in custody and encouraging contact with community services on release. Prison may provide the only opportunity that a marginalized population has to engage with treatment services.

Aims:  To review studies of the prevalence of substance abuse and dependence in prisoners on reception into custody.

Design and method:  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.

Findings:  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.

Conclusions:  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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References:

Fazel S, Bains P, Doll H. Addiction. 2006 Feb;101(2):181-91