Alarmingly High Numbers of Ex-Prisoners Die From Substance Abuse

A new study of over 47,000 former prisoners has found that a third of all deaths of male ex-prisoners and half of those of female ex-prisoners are related to drugs or alcohol. The finding draws attention to the mental health problems of those in prison, and particularly to the fact that we should be doing more to treat addiction while prisoners are incarcerated. The study also showed that of the external-cause deaths (due to things like accidents or suicide), 42 percent of those involving men and 70 percent of those involving women could be attributed to substance abuse.

The study involved people in Sweden who had been imprisoned from the start of the year 2000 and released before 2010. The authors were primarily interested in looking at how substance abuse or other mental health conditions were associated with deaths following release. By looking at participants with siblings also in jail but without substance abuse disorders or other mental health issues, the researchers were able to separate the risk associated with those conditions from potential genetic influences or factors related to early life experiences.

Overall, the researchers identified 47,326 eligible prisoners, and 6 percent of them (almost 2,900 individuals) died after their release during a five-year follow-up period.

The researchers found that substance use disorders were associated with a greater likelihood of death following release from jail, with an increased risk of 62 percent for alcohol abusers and 67 percent for other drug users. They also controlled for factors that could have impacted this finding, including demographic factors, criminal history and family-related factors, and the result remained the same. For other psychiatric conditions, however, after these factors were controlled for, there was no association with death following release from jail.

Of the men who died from any cause, 34 percent of the deaths could be attributed to substance abuse, and for the women, half of all deaths were potentially attributable to substance abuse. For the deaths related to external causes such as suicide, accidents or homicides, 42 percent of those in men were potentially related to substance abuse, and a massive 70 percent of those in women were potentially drug- or alcohol-related.

Reducing Deaths in Ex-Prisoners

The authors point out that the study used a five-year follow-up period and still found a significant association between substance abuse disorders and death further down the line. Existing evidence in other settings (such as hospitals) has found that the transition from one setting to another (like being let out of the hospital or finishing treatment) is associated with increased risk of death in those struggling with addiction, but the evidence suggests that the effect is fairly short-lived. According to the authors, this study is the first time mental health issues and odds of death following release from prison have been assessed while accounting for potential influencing factors such as demographics, criminal history and family history, and it shows a strong association persisting years after release.

The authors suggest that the short-term care currently offered to such individuals—supporting them through the transitional period identified as a risky time by previous studies—is inadequate, and that switching to a “chronic disease-management model” could be beneficial. The researchers also suggest that alcohol abusers should be offered help just as much as other drug abusers (since their odds of death on release were similar), but point out that in many cases, services are less likely to be offered to them. In England and Wales in 2010 to 2011, for example, half of prisons had no alcohol services to turn to, and in some countries, alcohol services were available only if the individual had also taken drugs.

In addition, the authors point out that the benefits of such approaches would be enhanced in countries with higher incarceration rates than Sweden, such as the U.S. The authors calculate that if their results—in terms of the impact of substance abuse on preventable, external-cause mortality—were obtained in the U.S., about 9 percent of external-cause mortality in the adult population might be preventable if addiction were fully treated in jail.

Sarah Wakeman of Harvard Medical School and Josiah Rich of Brown University commented on the study, saying that, “The withholding of evidence-based treatment for prisoners is arguably unethical and certainly unwise. In the USA, correctional facilities are mandated by the Supreme Court to provide medical care that meets the community standard. And yet, within state prisons people with drug use disorders largely go without care: of these people, only 0.8 percent receives detoxification services, 0.3 percent receives maintenance pharmacotherapy, 6.5 percent receive counseling by a professional, and 9.5 percent receive treatment in a residential facility. The absence of care in this deeply affected population translates into high costs to society and the communities that these individuals return to.”

Helping Prisoners Helps Society

The core takeaway from the study is that substance abuse strongly predicts the odds of death after release from prison, and given that many potentially important factors were controlled for, the study presents a strong case that there is a definite, causal explanation for the finding. This would suggest that not offering support and ongoing treatment to those in jail struggling with addiction is a huge missed opportunity, and one that ultimately does damage to society as a whole. Addiction locks prisoners in a spiral of abuse, risk-taking and re-offending, and if we want to reduce crime and drug abuse in our society, prisoners in need should be offered long-term support to help them overcome their addictions and break the cycle.