Substance Use, Substance Use Disorders, and Co-Occurring Psychiatric Disorders in Recently Incarcerated Men: A Comparison with the General Population

Abstract

<b><i>Introduction:</i></b> The rates of alcohol and illegal drug use and the prevalence of alcohol and illegal drug use disorders (AUDs and DUDs) are high in prison populations, particularly in men entering jail. However, these rates have never been exhaustively assessed and compared to those of the general population in France. <b><i>Methods:</i></b> We based our research on two surveys, conducted in the same French region, which included a total of 630 men entering jail and 5,793 men recruited from the general population. We used the Mini-International Neuropsychiatric Interview to assess alcohol and drug use, AUD, DUD, as well as co-occurring psychiatric disorders, and we examined differences in prevalence rates between the two populations. Logistic regression models were performed to (i) identify the factors associated with AUD and DUD and (ii) test whether the interaction between admission to jail and the presence of AUD, DUD, or both is linked to the presence of at least one co-occurring psychiatric disorder. <b><i>Results:</i></b> Compared to the general population sample, the prevalence of AUD (33.8% vs. 8.7%, <i>p</i> < 0.001) and DUD (at least one type of drug: 28.7% vs. 5.0%, <i>p</i> < 0.001; cannabis: 24.0% vs. 4.7%, <i>p</i> < 0.001; opioids: 6.8% vs. 0.4%, <i>p</i> < 0.001; stimulants: 5.2% vs. 0.8%, <i>p</i> < 0.001) was significantly higher in the jail population sample, as well as the rates of past-year use of various substances (alcohol: 62.1% vs. 56.4%, <i>p</i> = 0.007; at least one type of illegal drug: 50.0% vs. 14.4%, <i>p</i> < 0.001; cannabis: 45.6% vs. 13.9%, opioids: 9.4% vs. 0.7%; stimulants: 8.6% vs. 1.9%). Admission to jail was associated with a higher risk of AUD (aOR = 3.80, 95% CI: 2.89–5.01, <i>p</i> < 0.001) or DUD (aOR = 4.25, 95% CI: 3.10–5.84, <i>p</i> < 0.001). History of trauma was also associated with both AUD (aOR = 1.81, 95% CI: 1.53–2.14, <i>p</i> < 0.001) and DUD (aOR = 2.15, 95% CI: 1.74–2.65, <i>p</i> < 0.001), whereas history of migration was only associated with DUD (aOR = 1.38, 95% CI: 1.12–1.71, <i>p</i> = 0.003). AUDs and DUDs were more strongly associated with co-occurring psychiatric disorders in incarcerated men than in the general population. Among individuals with AUD, DUD, or both, co-occurring anxiety and mood disorders were particularly more frequent in jail than in the general population. <b><i>Discussion/Conclusion:</i></b> As in most countries, AUD and DUD are highly prevalent among men entering jail in France. Our results also suggest that incarceration constitutes an independent vulnerability factor for a dual disorder, which supports a systematic assessment and treatment of psychiatric disorders in men entering jail and diagnosed with an AUD or DUD.

The prevalence of substance use disorders among people in Norwegian, Danish and Swedish prisons: A multi‐national cohort study, 2010–19

“…Even though direct comparisons with other studies are difficult, due to different methods used, our results are in line with studies reporting a high prevalence of SUDs among people in prison [2, 3, 29]. Compared to the general population, the prevalence of SUDs was markedly higher in the prison populations, a finding that also has been reported in other studies [30].…”

“…Studies reporting prevalence estimates among people in prison often vary regarding the use of methods. Most studies on prevalence use screening interviews [30] or surveys [29] when assessing SUD diagnoses, which may lead to an overestimation of prevalence [37]. As our study relied solely upon national registry data, dependent upon seeking and receiving treatment, there is reason to believe that the estimates of SUDs are somewhat underestimated and that the true prevalence is likely to be higher.…”

Unmet need for alcohol use disorder treatment in reproductive-age females, with emphasis on pregnant and parenting populations in the United States: Findings from NSDUH 2015–2021

“…Among those who reported past-year AUD, pregnant and parenting women had a higher prevalence of treatment relative to the not pregnant, not parenting women (see Table 2). Treatment was modestly patterned by age, with the oldest group age (35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49) most likely to receive treatment (5.3%, 95%CI: 4.3-6.4), followed by the middle age group (ages 26-34 years; 4.9%, 95%CI: 3.8-6.1) and then the youngest (ages 18-25; 3.3.%, 95%CI: 2.6-4). Women with less than high school education and those in the lowest annual household income category had a higher treatment prevalence (8.0%, 95%CI: 5.8-10.2 and 7.1%, 95% CI: 5.4-8.8 respectively) relative to their counterparts with higher education or household incomes.…”

“…History of arrests displayed the strongest association with both AUD and AUD treatment. The link between alcohol misuse and criminal behavior may be bidirectional, with AUD increasing the likelihood of engaging in criminal activities [37] and involvement with the criminal justice system increasing the risk of substance use disorders [38]. Women with a history of arrests may have encountered legal consequences related to their substance use, such as courtmandated treatment or probation requirements [39][40][41].…”

De quels troubles psychiatriques souffrent les personnes détenues en France ?

“…Les troubles psychiatriques et de l'usage de substances sont donc particulie `rement fre ´quents en milieu carce ´ral, mais c'est surtout leur co-occurrence qui caracte ´rise la population carce ´rale [1,67]. L'e ´tude Sante´en population carce´rale mene ´e dans les Hautsde-France a pu montrer que les troubles de l'usage de substances (alcool et drogues illicites) sont plus e ´troitement associe ´s a `des troubles psychiatriques concomitants chez les hommes re ´cemment incarce ´re ´s qu'en population ge ´ne ´rale masculine [56]. Le double diagnostic concerne environ 40 % des personnes de ´tenues dans plusieurs e ´tudes [48,77] et la triade trouble psychiatrique se ´ve `re (e ´pisode de ´pressif caracte ´rise ´, trouble bipolaire, trouble psychotique), trouble de l'usage de substances et trouble de la personnalite ´est e ´galement fre ´quemment identifie ´e [77].…”