Substance use disorders in prisoners: an updated systematic review and meta‐regression analysis in recently incarcerated men and women

Abstract

AimsThe aims were to (1) estimate the prevalence of alcohol and drug use disorders in prisoners on reception to prison and (2) estimate and test sources of between study heterogeneity.MethodsStudies reporting the 12‐month prevalence of alcohol and drug use disorders in prisoners on reception to prison from 1 January 1966 to 11 August 2015 were identified from seven bibliographic indexes. Primary studies involving clinical interviews or validated instruments leading to DSM or ICD diagnoses were included; self‐report surveys and investigations that assessed individuals more than 3 months after arrival to prison were not. Random‐effects meta‐analysis and subgroup and meta‐regression analyses were conducted. Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed.ResultsIn total, 24 studies with a total of 18 388 prisoners across 10 countries were identified. The random‐effects pooled prevalence estimate of alcohol use disorder was 24% [95% confidence interval (CI) = 21–27], with very high heterogeneity (I 2 = 94%). These ranged from 16 to 51% in male and 10–30% in female prisoners. For drug use disorders, there was evidence of heterogeneity by sex, and the pooled prevalence estimate in male prisoners was 30% (95% CI = 22–38; I 2 = 98%; 13 studies; range 10–61%) and, in female prisoners, was 51% (95% CI = 43–58; I 2 = 95%; 10 studies; range 30–69%). On meta‐regression, sources of heterogeneity included higher prevalence of drug use disorders in women, increasing rates of drug use disorders in recent decades, and participation rate.ConclusionsSubstance use disorders are highly prevalent in prisoners. Approximately a quarter of newly incarcerated prisoners of both sexes had an alcohol use disorder, and the prevalence of a drug use disorder was at least as high in men, and higher in women.

Commentary on Fazel et al. (2017): High levels of substance use disorders among correctional inmates—some implications for interventions of the review data from Fazel et al.

“…Fazel et al, in their systematic review, confirm results of their previous work regarding substantially elevated substance use disorders among correctional populations [1]. Before offering thoughts on the implications for interventions, we make a point on key-and 'social justice'-focused-forces behind these data.…”

“…Commentary on Fazel et al (2017): High levels of substance use disorders among correctional inmatessome implications for interventions of the review data from Fazel et al…”

Technological advances in the assessment of impulse control in offenders: A systematic review

“…The corrections‐related keywords were selected based on search terms used in previous systematic reviews in this population (e.g. Fazel, Yoon, & Hayes, ). For inclusion, studies had to meet the following criteria: (i) published in a peer‐reviewed journal between 1 January 1997 and 31 December 2017; (ii) written in English; (iii) inclusion of a sample of offenders; and (iv) inclusion of a technology‐based assessment of impulse control.…”

Review article: Common emergency department presenting complaints of prisoners: A systematic review

“…The acute, severe stress associated with criminal charge, incarceration and loss of individual freedom, coupled with a predisposition to mental illness and substance abuse that many inmates already possess, [13][14][15][16] often manifest as harmful behaviour to self and others, with significant morbidity and mortality. The acute, severe stress associated with criminal charge, incarceration and loss of individual freedom, coupled with a predisposition to mental illness and substance abuse that many inmates already possess, [13][14][15][16] often manifest as harmful behaviour to self and others, with significant morbidity and mortality.…”

“…5,6 Mortality among inmate populations is high compared to national averages of several countries. [13][14][15][16] However, little is known regarding common reasons that prisoners present to EDs. [13][14][15][16] However, little is known regarding common reasons that prisoners present to EDs.…”