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J Addict Med. 2014 Jan-Feb;8(1):66-72. doi: 10.1097/ADM.0000000000000009.

Association of recent incarceration with traumatic injury, substance use-related health consequences, and health care utilization.

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From the Division of Preventive Medicine (NR), University of Alabama at Birmingham; Division of Hospital Medicine and Department of Quantitative Health Sciences (LSH), University of Massachusetts Medical School, Memorial Campus, Worcester, MA; Clinical Addiction Research and Education Unit (DMC, JHS, RS), Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA; Department of Biostatistics (DMC), Data Coordinating Center (MRW), Department of Community Health Sciences (JHS), and Department of Epidemiology (RS), Boston University School of Public Health, Crosstown Center, Boston, MA; and School of Health Sciences (DAD), Cleveland State University, Cleveland, OH.



The higher risk of death among recently released inmates relative to the general population may be because of the higher prevalence of substance dependence among inmates or an independent effect of incarceration. We explored the effects of recent incarceration on health outcomes that may be intermediate markers for mortality.


Longitudinal multivariable regression analyses were conducted on interview data (baseline, 3-, 6-, and 12-month follow-up) from alcohol- and/or drug-dependent individuals (n = 553) participating in a randomized clinical trial to test the effectiveness of chronic disease management for substance dependence in primary care. The main independent variable was recent incarceration (spending ≥1 night in jail or prison in the past 3 months). The 3 main outcomes of this study were any traumatic injury, substance use-related health consequences, and health care utilization--defined as hospitalization (excluding addiction treatment or detoxification) and/or emergency department visit.


Recent incarceration was not significantly associated with traumatic injury (adjusted odds ratio [AOR] = 0.98; 95% confidence interval [CI]: 0.65-1.49) or health care utilization (AOR = 0.88; 95% CI: 0.64-1.20). However, recent incarceration was associated with higher odds for substance use-related health consequences (AOR = 1.42; 95% CI: 1.02-1.98).


Among people with alcohol and/or drug dependence, recent incarceration was significantly associated with substance use-related health consequences but not injury or health care utilization after adjustment for covariates. These findings suggest that substance use-related health consequences may be part of the explanation for the increased risk of death faced by former inmates.

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