Substance use disorder and rural detention center readmission: Results from a 3-year prospective cohort study.

Abstract

Despite the steady increase in drug-related overdoses and deaths in custody recorded in jails, limited research has focused on substance use disorder (SUD) in rural county detention facilities. The first goal of this study was to provide an accurate assessment of the prevalence of SUDs in a rural jail and the second was to determine how these specific conditions were associated with readmission over a 3-year period. Comprehensive interviews consistent with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition SUD diagnoses were conducted with a cohort of 283 participants admitted to a rural detention center in a southern Appalachian County. Official records were obtained from the facility's database to determine the number of admissions and the length of detention. After identifying bivariate associations between specific SUDs and readmission, multivariate models were estimated to further assess these relationships while accounting for demographic background factors. Alcohol use disorder (71.0%) was the most prevalent condition, followed by methamphetamine (48.8%), and cannabis (36.4%). Those who endorsed criteria consistent with more severe designations of methamphetamine use disorder (MUD) had higher rates of readmission (incidence rate ratio [IRR] = 1.11, p = .031) compared with those who did not endorse similar criteria. A MUD was also associated with a significantly higher rate of days detained (IRR = 1.17, p = .004), demonstrating a longer period of detention for those who endorsed these criteria. Identifying specific SUDs in rural jail populations is an important first step toward a long-term strategy to reduce lengths of confinement and the likelihood of repeat admissions. Public Health Significance StatementThe majority of people admitted to rural jails present indications of substance use disorder, but comprehensive assessments are not available in many facilities. Alcohol and methamphetamine are among the most prevalent in some areas, and the most severe cases are associated with an increased likelihood of readmission. Rural jails must facilitate connections to care in order to reduce lengths of detention and the risk of repeated admissions.