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Paola R, Pavel S, Tatiana D, Hagit BN, Joseph M, Ronny B, Barak S. Impact of opioid maintenance therapy in the community on re-incarceration in individuals with opioid use disorder-A linked cohort study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 163:209393. [PMID: 38754555 DOI: 10.1016/j.josat.2024.209393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 04/05/2024] [Accepted: 05/09/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Studies have found associations between Opioid Agonist Maintenance Treatment during incarceration and reduced recidivism among recently released formerly incarcerated persons. However, the role of community-based Opioid Agonist Maintenance Treatment in reducing recidivism post-release remains less explored. This study examines whether pre-release arranged, prison-to-rehabilitation Opioid Agonist Maintenance Treatment in the community following release is associated with reduced rates and lengths of re-incarceration among justice-involved individuals with Opioid Use Disorder. METHODS A retrospective matched cohort study was conducted using linked records of 208 individuals with a history of Opioid Use Disorder and treatment during their incarceration. The primary predictor variable was the duration of Opioid Agonist Maintenance Treatment, with re-incarceration rates and lengths of stay after re-incarceration being the primary outcomes examined. RESULTS Analysis showed a significant decrease in re-incarcerations and or lengths of stay in prison among those who have been re-incarcerated and have undergone Opioid Agonist Maintenance Treatment in the community for >24 months. CONCLUSIONS Maintaining Opioid Agonist Maintenance Treatment over 24 months may reduce re-incarcerations, and may be significantly associated with a reduction in the length of prison stay for re-incarcerated individuals. The effects were consistent across the overall population and the individuals receiving the treatment. Various other unmeasured factors, including judicial discretion, individual motivation, type of offense, and employment status, could influence this association.
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Affiliation(s)
- Rosca Paola
- Department for the Treatment of Substance Abuse, Israel Ministry of Health, Jerusalem, Israel; Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel
| | - Spivak Pavel
- Department for the Treatment of Substance Abuse, Israel Ministry of Health, Jerusalem, Israel
| | - Dudkinski Tatiana
- Department for the Treatment of Substance Abuse, Israel Ministry of Health, Jerusalem, Israel
| | | | - Mendlovic Joseph
- Israel Ministry of Health, Jerusalem, Israel; Department of Pediatrics, Shaare Zedek Medical Center, affiliated with Haddasah-Hebrew University School of Medicine, Jerusalem, Israel
| | - Berkovitz Ronny
- Division of Enforcement and Inspection, Israel Ministry of Health, Jerusalem, Israel
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Curtis M, Winter RJ, Dietze P, Wilkinson AL, Cossar RD, Stewart AC, Agius PA, Butler T, Aitken C, Kirwan A, Walker S, Stoové M. High rates of resumption of injecting drug use following release from prison among men who injected drugs before imprisonment. Addiction 2022; 117:2887-2898. [PMID: 35665554 PMCID: PMC9796148 DOI: 10.1111/add.15971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 05/17/2022] [Indexed: 01/01/2023]
Abstract
AIMS To estimate incidence of post-release injecting drug use (IDU) among men who injected drugs before imprisonment and determine factors associated with post-release IDU frequency. DESIGN, SETTING, PARTICIPANTS Prospective cohort study of men reporting monthly IDU before a period of sentenced imprisonment in Victoria, Australia, recruited between September 2014 and May 2016 (n = 195). MEASUREMENTS Any post-release IDU and IDU frequency was measured via self-report at 3-month follow-up interview. IDU frequency, measured over the preceding month, was categorised as no IDU, irregular IDU (1-4 days IDU) and regular IDU (≥5 days IDU). Incidence of any IDU was calculated at 3 months post-release. Factors associated with IDU frequency were estimated using ordinal logistic regression. FINDINGS Most (83%) participants reported post-release IDU (265 per 100 person-years, 95% CI, 227-309); with half (48%) reporting regular IDU, 23% irregular IDU and 29% no IDU in the month preceding follow-up. Poorer psychological well-being at follow-up (General Health Questionnaire [GHQ-12] score; adjusted odds ratio [AOR], 1.18; 95% CI, 1.07-1.29) and post-release unemployment (AOR, 4.57; 95% CI, 1.67-12.49) were associated with increased IDU frequency. Retention in opioid agonist treatment (AOR, 0.49; 95% CI, 0.24-0.98) was associated with reduced IDU frequency. Non-linear (inverted-u) associations between IDU frequency and age (age: AOR, 1.51; 95% CI, 1.17-1.96; age-squared: AOR, 0.99; 95% CI, 0.99-0.99) and pre-imprisonment IDU frequency (pre-imprisonment IDU frequency: AOR, 1.36; 95% CI, 1.15-1.61; pre-imprisonment IDU frequency-squared: AOR, 0.99; 95% CI, 0.99-0.99) were found, with odds peaking at age 39 and 19 days IDU, respectively. Longer baseline sentence length was associated with reduced odds of irregular and regular IDU (AOR, 0.99; 95% CI, 0.99-0.99). CONCLUSION Among Australian men who inject drugs before imprisonment, resumption of injecting drug use after release from prison appears to be common, with imprisonment seeming to have little impact on reducing injecting drug use behaviour.
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Affiliation(s)
- Michael Curtis
- Behaviours and Health Risks Program, Public Health DisciplineBurnet InstituteMelbourneAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia,Monash Addition Research CentreMonash UniversityMelbourneAustralia
| | - Rebecca J. Winter
- Behaviours and Health Risks Program, Public Health DisciplineBurnet InstituteMelbourneAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia,Department of GastroenterologySt Vincent's HospitalMelbourneAustralia
| | - Paul Dietze
- Behaviours and Health Risks Program, Public Health DisciplineBurnet InstituteMelbourneAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia,National Drug Research InstituteCurtin UniversityPerthAustralia
| | - Anna L. Wilkinson
- Behaviours and Health Risks Program, Public Health DisciplineBurnet InstituteMelbourneAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Reece D. Cossar
- Behaviours and Health Risks Program, Public Health DisciplineBurnet InstituteMelbourneAustralia
| | - Ashleigh C. Stewart
- Behaviours and Health Risks Program, Public Health DisciplineBurnet InstituteMelbourneAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Paul A. Agius
- Behaviours and Health Risks Program, Public Health DisciplineBurnet InstituteMelbourneAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia,School of Population and Global HealthUniversity of MelbourneMelbourneAustralia
| | - Tony Butler
- Justice Health Research Program, School of Population HealthUniversity of New South WalesSydneyAustralia
| | - Campbell Aitken
- Behaviours and Health Risks Program, Public Health DisciplineBurnet InstituteMelbourneAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Amy Kirwan
- Behaviours and Health Risks Program, Public Health DisciplineBurnet InstituteMelbourneAustralia
| | - Shelley Walker
- Behaviours and Health Risks Program, Public Health DisciplineBurnet InstituteMelbourneAustralia,National Drug Research InstituteCurtin UniversityPerthAustralia
| | - Mark Stoové
- Behaviours and Health Risks Program, Public Health DisciplineBurnet InstituteMelbourneAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
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Karlsson A, Håkansson A. Crime-Specific Recidivism in Criminal Justice Clients with Substance Use—A Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137623. [PMID: 35805282 PMCID: PMC9265645 DOI: 10.3390/ijerph19137623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 12/04/2022]
Abstract
Criminal recidivism is a major global concern. There is a well-known association between substance use disorders and offending. Yet, little is known about crime-specific recidivism. The aim of this study was to investigate the relationship between specific substance use and crime-specific recidivism. The study is based on 4207 Swedish prison clients with substance use assessed with Addiction Severity Index interviews between 2001 and 2006. Clients were followed for an average of 2.7 years. Risk factors for criminal recidivism were assessed with the Cox regression analysis. Sixty-eight percent of the clients returned to the criminal justice system. Apart from well-known risk factors such as male gender and young age, amphetamine, injection drug use, prior prosecution for violent and property crime, as well as homelessness and psychiatric problems, were risk factors for criminal recidivism. Sedatives and cannabis were, in this setting, negative risk factors for general recidivism. Age, heroin and injection drug use elevated the risks of recidivism to property and drug crime. Alcohol was associated with violent recidivism. When analysing different categories of crime separately, risk factors differed substantially. This further highlights the need for crime-specific research. Identifying crime-specific risk factors should be an important part of improving rehabilitation into society after imprisonment and hopefully decrease recidivism.
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Affiliation(s)
- Anna Karlsson
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, 221 00 Lund, Sweden;
| | - Anders Håkansson
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, 221 00 Lund, Sweden;
- Malmö Addiction Center, Region Skåne, 205 02 Malmö, Sweden
- Correspondence: ; Tel.: +46-46-175596
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"It's a revolving door": Ego-depletion among prisoners with injecting drug use histories as a barrier to post-release success. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 101:103571. [PMID: 35007877 DOI: 10.1016/j.drugpo.2021.103571] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/25/2021] [Accepted: 12/18/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND People who inject drugs (PWID) are overrepresented among prisoner populations worldwide. This qualitative study used the psychological concept of "ego-depletion" as an exploratory framework to better understand the disproportionate rates of reincarceration among people with injecting drug use histories. The aim was to illuminate mechanisms by which prospects for positive post-release outcomes for PWID are enhanced or constricted. METHODS Participants were recruited from a longitudinal cohort study, SuperMIX, in Victoria, Australia. Eligible participants were invited to participate in an in-depth interview. Inclusion criteria were: aged 18+; lifetime history of injecting drug use; incarcerated for >three months and released from custody <12 months previously. Analysis of 48 interviews examined how concepts relevant to the ego-depletion framework (self-regulation; standards; consequences and mitigators of ego-depletion) manifested in participants' narratives. RESULTS Predominantly, participants aimed to avoid a return to problematic drug use and recidivism, and engaged in effortful self-regulation to pursue their post-release goals. Post-release environments were found to diminish self-regulation resources, leading to states of ego-depletion and compromising the capacity to self-regulate according to their ideals. Fatalism, stress, and fatigue associated with the transition period exacerbated ego-depletion. Strategies that mitigated ego-depletion included avoidance of triggering environments; reducing stress through opioid agonist therapy; and fostering positive affect through supportive relationships. CONCLUSIONS Post-release environments are ego-depleting and inconducive to sustaining behavioural changes for PWID leaving prison. Corrections' behaviourist paradigms take insufficient account of the socio-structural factors impacting on an individual's self-regulation capacities in the context of drug dependence and desistance processes. Breaking the cycles of reincarceration among PWID requires new approaches that moderate ego-depletion and facilitate long-term goal-pursuit.
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Stewart AC, Cossar RD, Wilkinson AL, Quinn B, Dietze P, Walker S, Butler T, Curtis M, Aitken C, Kirwan A, Winter R, Ogloff J, Kinner S, Stoové M. The Prison and Transition Health (PATH) cohort study: Prevalence of health, social, and crime characteristics after release from prison for men reporting a history of injecting drug use in Victoria, Australia. Drug Alcohol Depend 2021; 227:108970. [PMID: 34488074 DOI: 10.1016/j.drugalcdep.2021.108970] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/22/2021] [Accepted: 07/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND People who inject drugs are overrepresented in prison and have diverse and complex health needs. However, outcomes after release from prison are poorly understood, limiting effective interventions supporting community reintegration. We describe the prevalence of socio-demographics, physical and mental health, alcohol and other drug use, and crime characteristics of men with histories of injecting drug use after their release from prison in Victoria, Australia. METHODS Data come from the Prison and Transition Health (PATH) prospective cohort study. Interviews were undertaken approximately three, 12, and 24 months after release from their index prison episode and were completed in the community, or in prison for those reimprisoned during the study. We present cross-sectional descriptive statistics for each follow-up wave of the PATH study. RESULTS Among 400 men recruited into PATH, 85 % (n = 336) completed at least one follow-up interview; 162 (42 %) completed all three interviews. Participants reported social disadvantage and health inequity, including high rates of unemployment, homelessness, and physical and mental health morbidities at each follow-up time point. Rapid return to illicit substance use was common, as was overdose (ranging 9 %-13 %), receptive syringe sharing (ranging 20 %-29 %), involvement in crime-related activities (ranging 49 %-58 %), and reimprisonment (ranging 22 %-50 %) over the duration of follow-up. CONCLUSION Men in this study experienced substantial health and social challenges across a 24-month prospective follow-up period. Improved understanding of characteristics and experiences of this group after release from prison can inform more coordinated and continued care between prison and the community.
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Affiliation(s)
- Ashleigh C Stewart
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Reece D Cossar
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia; Centre for Forensic Behavioural Science, Swinburne University of Technology and Forensicare, Australia.
| | - Anna L Wilkinson
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Brendan Quinn
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Paul Dietze
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; National Drug Research Institute, Curtin University, Perth, Australia
| | - Shelley Walker
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia
| | - Tony Butler
- School of Public Health and Community Medicine, University of Sydney, Sydney, Australia
| | - Michael Curtis
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Campbell Aitken
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Amy Kirwan
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia
| | - Rebecca Winter
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia; Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia
| | - James Ogloff
- Centre for Forensic Behavioural Science, Swinburne University of Technology and Forensicare, Australia
| | - Stuart Kinner
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Justice Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia; Griffith Criminology Institute, Griffith University, Brisbane, Australia; Mater Research Institute-UQ, University of Queensland, Brisbane, Australia
| | - Mark Stoové
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Marotta PL, Stringer KL, Mandavia AD, Davis A, Beletsky L, Hunt T, Goddard-Eckrich D, Wu E, Gilbert L, El-Bassel N. Assessing factors associated with discharge from opioid agonist therapy due to incarceration in the United States. J Addict Dis 2020; 38:1-18. [PMID: 31821129 PMCID: PMC7224404 DOI: 10.1080/10550887.2019.1690365] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The following study investigates factors associated with discharge from OAT due to incarceration in a sample of 64,331 discharges in the United States. Multinomial regression investigated the association between demographic factors, prior arrest, referral source (i.e criminal justice agency) intravenous drug use, types of drug used, length of prior treatment and discharge due to incarceration compared to completing treatment or discharge due to other reasons. African Americans, Latinx, and Native Americans were at greater risk of discharge due to incarceration compared to whites. Referral to OAT from criminal justice agencies and self-referral was associated with increased risk of discharge from OAT due to incarceration compared to referral from a health care provider. Substance use of heroin, benzodiazepines, synthetic opioids, cocaine and non-prescription use of methadone were associated with discharge due to incarceration. Risk of discharge due to incarceration was higher for patients who reported intravenous drug use and who reported a co-morbid psychiatric problem. These findings enrich a nascent body of literature on mechanisms associated with attrition from OAT due to incarceration and emphasize the need for programs to divert people with OUD from incarceration to increase engagement and retention in OAT.
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Affiliation(s)
- Phillip L. Marotta
- Division of Prevention and Community Research, Department of Psychiatry, The Consultation Center, School of Medicine, Yale University, New Haven, CT, USA
| | - Kristi L. Stringer
- School of Social Work, Columbia University, New York, NY, USA
- Social Intervention Group, New York, NY, USA
| | - Amar D. Mandavia
- Department of Counseling and Clinical Psychology, Teachers College of Columbia University, New York, NY, USA
- Center for the Study of Social Difference, Columbia University, New York, NY, USA
| | - Alissa Davis
- School of Social Work, Columbia University, New York, NY, USA
- Social Intervention Group, New York, NY, USA
| | - Leo Beletsky
- Center for the Study of Social Difference, Columbia University, New York, NY, USA
- School of Law, Northeastern University, Boston, MA, USA
- Bouve College of Health Sciences Northeastern University, Boston, MA, USA
| | - Tim Hunt
- Division of Prevention and Community Research, Department of Psychiatry, The Consultation Center, School of Medicine, Yale University, New Haven, CT, USA
- School of Social Work, Columbia University, New York, NY, USA
| | - Dawn Goddard-Eckrich
- Division of Prevention and Community Research, Department of Psychiatry, The Consultation Center, School of Medicine, Yale University, New Haven, CT, USA
- School of Social Work, Columbia University, New York, NY, USA
| | - Elwin Wu
- Division of Prevention and Community Research, Department of Psychiatry, The Consultation Center, School of Medicine, Yale University, New Haven, CT, USA
- School of Social Work, Columbia University, New York, NY, USA
| | - Louisa Gilbert
- Division of Prevention and Community Research, Department of Psychiatry, The Consultation Center, School of Medicine, Yale University, New Haven, CT, USA
- School of Social Work, Columbia University, New York, NY, USA
| | - Nabila El-Bassel
- Division of Prevention and Community Research, Department of Psychiatry, The Consultation Center, School of Medicine, Yale University, New Haven, CT, USA
- School of Social Work, Columbia University, New York, NY, USA
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Kirwan A, Curtis M, Dietze P, Aitken C, Woods E, Walker S, Kinner S, Ogloff J, Butler T, Stoové M. The Prison and Transition Health (PATH) Cohort Study: Study Protocol and Baseline Characteristics of a Cohort of Men with a History of Injecting Drug Use Leaving Prison in Australia. J Urban Health 2019; 96:400-410. [PMID: 30989484 PMCID: PMC6565648 DOI: 10.1007/s11524-019-00353-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
People who inject drugs (PWID) are disproportionately represented among individuals who experience imprisonment and often have more complex physical and mental health needs than people in prison without injecting histories. The trajectories of PWID after prison release are poorly understood, hampering the development of effective strategies to address their distinct health needs. The Prison and Transition Health (PATH) Cohort Study is characterising the post-release trajectories of incarcerated male PWID in Victoria, Australia. We outline study methodology and baseline characteristics of participants prior to their release. Four hundred participants were recruited from three prisons and completed researcher-administered baseline interviews covering socio-demographics, social supports, physical health, mental health, alcohol and other drug use, and pre-release and transitional service utilisation. The median age among participants was 36 years (IQR 30-42), and they reported a median of five (IQR 3-9) previous adult incarcerations. Almost half (49%) were reliant on government payments prior to incarceration. One quarter (25%) of participants reported removal from their parents' care as children and 64% reported being a parent or primary caregiver to children. Most participants (81%) reported a previous mental health diagnosis and 44% reported three or more diagnoses. The most common drugs injected prior to incarceration were crystal methamphetamine (80%) and heroin (62%), and most (85%) reported being under the influence of drugs at the time of committing offences for which they were currently incarcerated. Injecting drug use during their current sentence was reported by 40% of participants, and 48% reported engaging with some form of drug treatment during their current sentence. Study participants are characterised by significant mental health and substance use morbidities, social disadvantage and criminogenic histories that present challenges for the provision of post-release support services. Data from the PATH Cohort Study will help inform strategies to improve the health and social outcomes of this population.
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Affiliation(s)
- Amy Kirwan
- Behaviours and Health Risks Program, Public Health Discipline, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Michael Curtis
- Behaviours and Health Risks Program, Public Health Discipline, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Paul Dietze
- Behaviours and Health Risks Program, Public Health Discipline, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Campbell Aitken
- Behaviours and Health Risks Program, Public Health Discipline, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Emma Woods
- Behaviours and Health Risks Program, Public Health Discipline, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Shelley Walker
- Behaviours and Health Risks Program, Public Health Discipline, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia
- National Drug Research Institute, Curtin University, Perth, Western Australia
| | - Stuart Kinner
- National Drug Research Institute, Curtin University, Perth, Western Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Griffith Criminology Institute, Griffith University, Brisbane, Australia
- Mater Research Institute-UQ, University of Queensland, Mount Gravatt, Australia
| | - James Ogloff
- Centre for Forensic Behavioural Science, Swinburne University of Technology and Forensicare, Melbourne, Australia
| | - Tony Butler
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Mark Stoové
- Behaviours and Health Risks Program, Public Health Discipline, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
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Predicting Inpatient Detoxification Outcome of Alcohol and Drug Dependent Patients: The Influence of Sociodemographic Environment, Motivation, Impulsivity, and Medical Comorbidities. JOURNAL OF ADDICTION 2017; 2017:6415831. [PMID: 28367351 PMCID: PMC5358444 DOI: 10.1155/2017/6415831] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/13/2017] [Indexed: 11/17/2022]
Abstract
Aims. This prospective study aims to identify patient characteristics as predictors for treatment outcome during inpatient detoxification treatment for drug and alcohol dependent patients. Methods. A mixed gender sample of 832 consecutively admitted drug and alcohol dependent patients were interviewed by an experienced physician. The impact of a variety of factors concerning social environment, therapy motivation, impulsivity related variables, medical history, and addiction severity on treatment outcome was examined. Results. 525 (63.1%) of the patients completed detoxification treatment whereas 307 (36.9%) dropped out prematurely. Being female, living in a partnership, having children, being employed, and having good education were predictive for a positive outcome. Family, health, the fear of losing the job, prosecution, and emergency admission were significant motivational predictors for treatment outcome. Being younger, history of imprisonment, and the number of previous drop-outs were predictive for a negative outcome. Conclusions. Variables concerning social environment and the number of previous drop-outs have been identified as best predictors for treatment outcome. Socially stable patients benefit from the current treatment setting and treatment shall be adapted for patients with negative predictors. Treatment may consequently be tailored with respect to intervention type, duration, and intensity to improve the outcome for those patients that fulfil criteria with negative impact on treatment retention.
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Resumption of injecting drug use following release from prison in Australia. Drug Alcohol Depend 2016; 168:104-111. [PMID: 27635997 DOI: 10.1016/j.drugalcdep.2016.08.640] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/12/2016] [Accepted: 08/25/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Ex-prisoners with a history of injecting drug use (IDU) experience disproportionate drug-related harm. Rapid resumption of substance use following prison release is common and evidenced in high rates of overdose mortality. However, few studies have documented the rate of IDU resumption following prison release or identified risk factors for relapse. METHODS Structured interviews were conducted with 533 adults with a history of IDU in Queensland, Australia prior to release from prison and approximately 1, 3 and 6 months post-release. Incidence of self-reported IDU resumption was calculated overall and for each follow-up interval. Risk factors associated with time to resumption of IDU were estimated using discrete-time survival analysis. RESULTS IDU resumption was reported by 41% of participants during a median of 98days of follow-up (IQR=94-121), an overall crude incidence of 1.06 per person-year. The highest rate was observed in the first month (23%; crude incidence 2.24 per person-year). In adjusted discrete-time survival analyses, being unemployed at the previous interview (AHR=1.59; 95%CI:1.10-2.30), shorter incarceration (≤90days vs. >365days; AHR=2.20; 95%CI:1.33-3.65), and IDU during the index incarceration (AHR=2.80; 95%CI:1.92-4.09) were significantly associated with time to IDU resumption; parole was protective (AHR=0.66; 95%CI:0.47-0.92). CONCLUSIONS Evidence-based efforts to prevent IDU in prison and IDU resumption after release are important for both prisoner and public health. Enhancing opportunities for employment and capitalising on the short-term benefits of parole for ex-prisoners may delay resumption of IDU after release from prison. These strategies should complement rather than replace harm reduction efforts for this high-risk population.
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Bruno R, van Dyken E, Prichard J. New applications of wastewater analyses for assessing substance use. Drug Alcohol Rev 2016; 35:125-7. [DOI: 10.1111/dar.12386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/23/2015] [Accepted: 12/25/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Raimondo Bruno
- School of Medicine; University of Tasmania; Hobart Australia
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