Critique of Articles on Substance Use and Misuse

The assignment requires a critique of two articles on substance use and misuse in ex-prisoners. The first article uses national coronial records to identify drug-related deaths among released prisoners, finding that 45% of deaths were due to accidental drug-associated issues. The second article presents a nationwide longitudinal cohort study examining the relationship between substance use disorders, psychiatric disorders, and mortality after release from prison. The critique should include a detailed analysis of the methods, results, and implications of each article, as well as an evaluation of their strengths and limitations.

Running head: INTRODUCTION TO SUBSTANCE USE & MISUSE
INTRODUCTION TO SUBSTANCE USE & MISUSE
Name of the Student
Name of the university
Author’s note

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INTRODUCTION TO SUBSTANCE USE & MISUSE
CRITIQUE OF ARTICLES
Articles
1. Andrews, J. Y., & Kinner, S. A. (2012). Understanding drug-related mortality in released
prisoners: a review of national coronial records. BMC Public Health, 12(1), 270.
2. Chang, Z., Lichtenstein, P., Larsson, H., & Fazel, S. (2015). Substance use disorders,
psychiatric disorders, and mortality after release from prison: a nationwide longitudinal
cohort study. The Lancet Psychiatry, 2(5), 422-430.
Hypothesis:
To understand the health outcomes or mortality among the ex-prisoners in the post release period
due to substance abuse.
Search strategy
As per the studies, almost half of the jail inmates were found to be under the influence of
drugs and their deterioration of the mental and the physical health have also been noticed. Post
release mortality due to drug abuse has also been noticed among the prisoners and there were
many reports that suggested the linkage between the types of crime conducted and drug abuse.
The articles for the critical analysis have been done by brainstorming through two data bases

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PubMed and CINAHL. In the CINAHL data base the search parameters were (Predictors OR
precipitating) AND (Drugs OR substance) AND (incarceration OR imprisonment).The advanced
search criteria was “incarceration and substance abuse”. Articles were also searched through
PubMed by using the MESH term “Incarceration” AND MESH term “drugs". The search was
further narrowed by using the limiters AND '' health burden". From 8 articles 2 peer reviewed
articles were selected for the critical analysis. Both the articles contained the different
precipitating factors for the drug abuse among the prisoners. Their contribution to the physical
and the mental health of the prisoners as well as the prevalence of the increased crime was
analyzed.
Critique
High mortality rates have been found in people, who have been released from the prison
in comparison to the general population. This paper discus about the potential risk factors of the
substance use in the mortality of the exprisoners and the association between the psychotic
disorders due to substance abuse among the prisoners released from a prison in Sweden (Chang
et al., 2015).
The study population is all the prisoners who have been behind the bars since Jan 2000
and released before Dec 2009 in a prison of Sweden. All the risk factors and the external; causes
such as suicide, accidents and homicides are taken into consideration for assessing the mortality
after their release form the prison. As per the results there were about 47326 individuals that
have been released from the prison during that time. 42% of 43480 men and 64% of 3486
women had psychotic disorders related to substance abuse. The longitudinal cohort study could
actually prove that substance use is associated to an increased rate of mortality among the ex-

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prisoners. Very few evidences were found that reported other types of disorders responsible for
the mortality. According to the results the linkage of drug abuse and mortality may be due to the
criminological or the socio-demographical or the familial factors. It has been found that
discontinuation of treatment, hospital discharge have been linked to the increased amount of
mortality among the ex-prisoners.
The strength of the study is that it is the first study for investigating the consequence of
the substance use disorder and other psychotic disorders on the death of the exprisoners. Both the
familial, sociodemograpic and the criminological confounding factors were taken into
considerations. This paper also collected the individual causes of death similar to the paper by
Andrews and Kinner, (2012). It has been found that non traffic accidents and self harm added to
a large number of the external causes of the death.
The study contains three main limitations. Firstly, the certainty of the psychiatric disorder
entirely depended on the informations accumulated from the patient registers. In spite of having
good diagnostic validity, the absence of proper respondent follow up, reporting and the
occurrence of some of the psychotic disorders may be underestimated. Secondly the analysis did
not provide information regarding the ameliorative effects of the treatment. Thirdly the results
were based on population of Sweden and things might vary with other criminal justice system in
different countries. The study focused on several implications (Chang et al., 2015).
Future research is required to discover about how the therapies can be associated to
community care and programs that are cost effective.
Andrews and Kinner, (2012) on the other hand focuses upon the burden of the diseases or
mortality among the ex-prisoners. A nationwide search was conducted by considering the

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Australian National coroner's Information system (NCIS). Coronial records of 388 deceased ex
prisoners were detected and almost 45% of the deaths were found to be because of Accidental
drug associated issues. Most of the drug related deaths were found to be caused in the home
environment. The ex-prisoners who died due to drug related damage were less likely to be
indigenous, which is again contradictory to the predetermined notion that the indigenous people
are more like to be the victims of addiction. The NCIS data were collected covering the
demographic characteristics, social circumstances, mental and the physical strength. 36% of the
deaths were found to be due to drug overdose. 40 % was found to be due to psychotic problems,
20 % was found to be due to chronic or the infectious diseases and 4% due to unknown causes.
The study consists of three limitations. Firstly the data were gathered from free text documents
of the coronial records thus there was a reduction in the number of valid observations. Secondly
it was not possible to follow from the coronial study when the deceased was released from the
jail. Thirdly the search method was done considering a small population and the strength of the
study was that it was the first study for examining the drug related deaths among the ex prisoners
form the coronial records.
The prisoner population is characterized by an elevated burden of diseases. Substance
abuse and lack of nutritious food not only add up to their physical burden but also affects their
mental health (Binswanger et al., 2012). This can contribute to recurrence of the crimes and
violence. Substance abuse and addiction have noteworthy implications among the public health
including those staying behind the bars (Jalilian et al., 2013). There is also a close relationship
between the drug abuse and crime. Drug abusers also commit crime to pay for their drugs. Many
antisocial activities take place even inside the jails and there are chains of antisocial people who

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supply the drugs to the prisoners. Thus drug trafficking is another outcome of the drug abuse
(Rafaiee et al., 2012).

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References
Andrews, J. Y., & Kinner, S. A. (2012). Understanding drug-related mortality in released
prisoners: a review of national coronial records. BMC Public Health, 12(1), 270.
Binswanger, I. A., Nowels, C., Corsi, K. F., Glanz, J., Long, J., Booth, R. E., & Steiner, J. F.
(2012). Return to drug use and overdose after release from prison: a qualitative study of
risk and protective factors. Addiction science & clinical practice, 7(1), 3.
Chang, Z., Lichtenstein, P., Larsson, H., & Fazel, S. (2015). Substance use disorders, psychiatric
disorders, and mortality after release from prison: a nationwide longitudinal cohort
study. The Lancet Psychiatry, 2(5), 422-430.
Jalilian, F., MIRZAEI, A. M., Amoei, M. R., ZINAT, M. F., Hatamzadeh, N., & Allahverdipour,
H. (2013). Prevalence and pattern of drug abuse among prisoners in Kermanshah city.
Rafaiee, R., Olyaee, S., & Sargolzaiee, A. (2013). The Relationship Between the Type of Crime
and Drugs in Addicted Prisoners in Zahedan Central Prison. International Journal of
High Risk Behaviors & Addiction, 2(3), 139–140. http://doi.org/10.5812/ijhrba.13977