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How Do Substance Use and Incarceration Predict Risks for Mortality?

In the U.S. and many other countries, people who get released from incarceration in a prison die at a significantly higher rate than people who never go to prison. In many cases, substance use plays an important role in bringing about the deaths of these individuals. In a study published in October 2013 in the journal Drug and Alcohol Dependence, researchers from Sweden’s Lund University sought to determine which specific substance use-related factors either act as a cause of death or increase a previously incarcerated person’s chances of dying prematurely.

Prison Incarceration Basics

Prisons are federal- or state-run facilities designed for the long-term housing of individuals convicted of relatively serious crimes called felonies. They differ from jails, which are city- or county-run facilities designed to hold people accused but not convicted of crimes, as well as people convicted of relatively minor crimes called misdemeanors. According to figures compiled by the federal Bureau of Justice Statistics, 1,571,013 men and women were incarcerated in a prison somewhere in the U.S. at the conclusion of 2012. Compared to previous totals from recent years, the overall trend of prison incarceration is down. However, the number of people housed in federal prison increased slightly in 2012.

Mortality Rates Following Prison

The high mortality rate among former prisoners is well established. In one study, published in 2007 in the New England Journal of Medicine, a team of researchers conducted a comprehensive analysis of the death rate among all people released from prison in Washington State between July of 1999 and December of 2003. Out of slightly more than 30,000 former inmates, 443 died within an average period of roughly two years. This mortality rate was approximately 3.5 times higher than the rate among Washington residents not sent to prison. In addition, in the first two weeks of their release from prison, the risk of death was 12.7 times greater for former inmates than for fellow state residents who had not gone to prison.

Substance use is well established as a primary factor in the deaths of former prison inmates. Other well-established factors include participation in violence that results in homicide and self-inflicted violence that culminates in suicide and heart disease.

The Role of Substance Use

In the study, the Lund University researchers sought to uncover the specific patterns of substance use that contribute to the drastically increased mortality rates among former prisoners. They also wanted to know how factors not directly related to substance use help predict which former inmates will die prematurely. To achieve these goals, the researchers analyzed data gained from 4,081 individuals affected by significant problems with drugs or alcohol before they began serving time in prison. While incarcerated, all of these individuals submitted to testing procedures designed to establish the severity of their substance-related issues. When the participants were released from prison, the researchers tracked them until they either died or otherwise became unavailable for further study. On average, this tracking period lasted for 3.6 years.

During the tracking phase of the study, 166 participants died. Fully 84 percent of these deaths were linked either directly to a substance-related health issue or to some other source of unnatural or premature mortality. Both men and women died with unusual frequency, but male former prisoners died somewhat more often than female former prisoners.

In descending order, the most common mortality causes among the study participants were unintentional poisoning from drugs or alcohol, involvement in motor vehicle accidents, incidents of poisoning or injury that may or may not have been accidental, and readily apparent acts of suicide. Specific factors that acted as predictors for one or more of these causes of death included the onset of a drug or alcohol overdose and use of the powerful opioid drug heroin. Interestingly, former prisoners with a history of depression died less often than their other substance-using peers.


As a result of their findings, the study authors believe that public health and prison officials need to improve their efforts to address drug and alcohol problems in both men and women who get convicted of felonies and sent to prison. They specifically state these efforts should take place at the start of incarceration, not at a later date. In addition, the authors believe that the information gathered during their research could potentially have a positive influence on efforts to provide newly released prison inmates with adequate treatment referrals and access to appropriate treatment programs.

Posted on March 20th, 2014

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