Department of Sociology, University of Central Florida, Orlando, FL, USA; Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, MI, USA.
Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, MI, USA; Department of Sociology & Criminology, University of New Mexico, Albuquerque, NM, USA.
Drug Alcohol Depend. 2022 Aug 1;237:109511. doi: 10.1016/j.drugalcdep.2022.109511. Epub 2022 May 28.
Criminal legal system (CLS) exposed adults experience higher rates of substance use, substance use disorder (SUD), and overdose. As most CLS exposed adults are not incarcerated, it is important to focus on CLS exposure across the carceral continuum.
This research used pooled data from adult respondents (N = 206,314) in the National Survey on Drug Use and Health (2015-2019). Survey weighted descriptive statistics and Poisson regression were used to estimate prevalence of polysubstance use (i.e., concurrent use) across CLS exposure types (i.e., arrest, probation, parole), identifying relevant correlates.
The prevalence of polysubstance use was higher among CLS exposed adults, and nearly two-thirds of CLS exposed adults who used multiple types of substances indicated having an SUD. Comparing CLS exposure types, polysubstance use was less likely among adults on probation (IRR=0.89, 95%CI=0.84,0.94) or parole (IRR=0.82, 95%CI=0.76,0.87) compared to those arrested. Polysubstance use was also more likely among adults on probation (IRR=1.09, 95%CI =1.01,1.17) compared to those on parole. While some characteristics (i.e., age, ethnicity, SUD) were consistently associated with polysubstance use across types of CLS exposure, other characteristics (i.e., sexual identity, marital status, suicidal ideation) were not.
There is heterogeneity in health risks as a function of CLS exposure type. Further research is needed to identify causal mechanisms and differences based on demographic characteristics. Given high levels of polysubstance use across CLS exposure types, a shift towards a more comprehensive approach in substance use epidemiology may facilitate building an evidence-base to maximize treatment related interventions to reduce polysubstance-involved overdoses.
刑事法律体系（CLS）暴露的成年人中，物质使用、物质使用障碍（SUD）和过量用药的发生率更高。由于大多数 CLS 暴露的成年人没有被监禁，因此关注整个监禁连续体中的 CLS 暴露非常重要。
本研究使用了 2015-2019 年全国毒品使用和健康调查中成年受访者（N=206314）的汇总数据。使用调查加权描述性统计和泊松回归来估计 CLS 暴露类型（即逮捕、缓刑、假释）下的多种物质使用（即同时使用）的流行率，并确定相关的相关性。
CLS 暴露的成年人中，多种物质使用的流行率更高，近三分之二的 CLS 暴露成年人同时使用多种物质，表明他们有 SUD。与 CLS 暴露类型相比，缓刑（IRR=0.89，95%CI=0.84，0.94）或假释（IRR=0.82，95%CI=0.76，0.87）的成年人比被捕者更不可能使用多种物质。与假释者相比，缓刑者更有可能使用多种物质（IRR=1.09，95%CI=1.01，1.17）。虽然一些特征（即年龄、种族、SUD）在 CLS 暴露类型之间与多种物质使用始终相关，但其他特征（即性取向、婚姻状况、自杀意念）则不然。
CLS 暴露类型的健康风险存在异质性。需要进一步研究以确定因果机制和基于人口特征的差异。鉴于 CLS 暴露类型下多种物质使用的水平较高，在物质使用流行病学中转向更全面的方法可能有助于建立一个证据基础，以最大限度地提高与治疗相关的干预措施，减少涉及多种物质的过量用药。
