Return to drug use and overdose after release from prison: a qualitative study of risk and protective factors

doi:10.1186/1940-0640-7-3

Addict Sci Clin Pract. 2012; 7(1): 3.

Published online 2012 March 15. doi: 10.1186/1940-0640-7-3

PMCID: PMC3414824

Return to drug use and overdose after release from prison: a qualitative study of risk and protective factors

Ingrid A Binswanger,^1,² Carolyn Nowels,³ Karen F Corsi,⁴ Jason Glanz,^5,⁶ Jeremy Long,^7,⁸ Robert E Booth,⁹ and John F Steiner¹⁰

¹Division of General Internal Medicine and Division of Substance Dependence, University of Colorado School of Medicine, Mail Stop B180, 12631 East 17th Avenue, Aurora, CO 80045, USA

²Denver Health Medical Center, 501 East 28th Street, Denver, CO 80045, USA

³Division of General Internal Medicine, University of Colorado School of Medicine, Mail Stop B180, 12631 East 17th Avenue, Aurora, CO 80045, USA

⁴Division of Substance Dependence, University of Colorado School of Medicine, 1741 Vine Street, Denver, CO 80206, USA

⁵Institute for Health Research, Kaiser Permanente Colorado, 10065 East Harvard Avenue, #300, Denver, CO 80231, USA

⁶Department of Epidemiology, Colorado School of Public Health, 13001 East 17th Place, Mail Stop B119, Aurora, CO 80045, USA

⁷Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204, USA

⁸Division of General Internal Medicine, University of Colorado School of Medicine, Mail Stop B180, 12631 East 17th Avenue, Aurora CO 80045, USA

⁹Division of Substance Dependence, University of Colorado School of Medicine, 1741 Vine Street, Denver, CO 80206, USA

¹⁰Institute for Health Research, Kaiser Permanente Colorado, 10065 East Harvard Avenue, #300, Denver, CO 80231, USA

Corresponding author.

Ingrid A Binswanger: Ingrid.Binswanger/at/ucdenver.edu; Carolyn Nowels: Carolyn.Nowels/at/ucdenver.edu; Karen F Corsi: Karen.Corsi/at/ucdenver.edu; Jason Glanz: Jason.M.Glanz/at/kp.org; Jeremy Long: Jeremy.Long/at/dhha.org; Robert E Booth: Robert.Booth/at/ucdenver.edu; John F Steiner: John.F.Steiner/at/kp.org

Received October 18, 2011; Accepted March 15, 2012.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Former inmates are at high risk for death from drug overdose, especially in the immediate post-release period. The purpose of the study is to understand the drug use experiences, perceptions of overdose risk, and experiences with overdose among former prisoners.

Methods

This qualitative study included former prison inmates (N = 29) who were recruited within two months after their release. Interviewers conducted in-person, semi-structured interviews which explored participants' experiences and perceptions. Transcripts were analyzed utilizing a team-based method of inductive analysis.

Results

The following themes emerged: 1) Relapse to drugs and alcohol occurred in a context of poor social support, medical co-morbidity and inadequate economic resources; 2) former inmates experienced ubiquitous exposure to drugs in their living environments; 3) intentional overdose was considered "a way out" given situational stressors, and accidental overdose was perceived as related to decreased tolerance; and 4) protective factors included structured drug treatment programs, spirituality/religion, community-based resources (including self-help groups), and family.

Conclusions

Former inmates return to environments that strongly trigger relapse to drug use and put them at risk for overdose. Interventions to prevent overdose after release from prison may benefit from including structured treatment with gradual transition to the community, enhanced protective factors, and reductions of environmental triggers to use drugs.

Keywords: Drug use, Overdose, Prisoners, Relapse, Prison re-entry

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