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• W1977102912 abstract "In their cohort study of more than 42 000 individuals released from prisons in Queensland, Australia, Forsyth and colleagues 1 extend the existing literature on post-release health outcomes in two important ways. First, the study highlights alcohol as an important cause of death among indigenous people from prison. International studies have demonstrated an early elevated risk of drug-related death after release from prison 2, 3. However, compared to drugs, alcohol use as a contributor to poor post-release health outcomes has received relatively less attention by researchers and policymakers. As highlighted by the authors, interventions that focus exclusively on reducing the complications of drug use may not adequately address the needs of many at risk for complications of alcohol use. Secondly, time trends in mortality after release from prison vary by cause of death and population. For instance, Forsyth and colleagues show no clear early peak in alcohol-related deaths among non-indigenous people and only a small early elevation in alcohol-related deaths in indigenous people after release from prison. Differences in substance use patterns, economic circumstances, community and family support and access to community services vary by culture, ethnicity, gender and regional context. Interventions to address post-release morbidity and mortality may show the most benefit when tailored to the cultural backgrounds of people returning from prison and the specific contexts to which they return. Unfortunately, there is a notable paucity of evidence-based, effective interventions designed to prevent post-release morbidity and mortality. It is critical to develop and test novel interventions, particularly tailored interventions, to prevent poor outcomes among individuals coming out of prisons. It would be expected that the benefits of interventions may be heterogeneous across medical diagnoses, mental health conditions, substances involved, time relative to release and populations studied. Epidemiological findings on post-release mortality provide some guidance on the diversity of potential health outcomes to consider, when they should be assessed relative to release and in which populations of people leaving prisons. In the meantime, there are many evidence-based treatments for substance use disorders that are systematically denied to individuals in prison and to which those leaving prisons have limited access. While enforced abstinence may be relatively feasible in prison, this approach does not prepare people well for the post-release environment and life in the community. In the community, individuals are faced with numerous triggers to use alcohol and drugs 4. Pharmacologically supported treatments for alcohol, tobacco and other drugs should be made available to those who need and want them in prisons and during the transition back to the community. It is critical that people in prisons have access to a broad range of effective treatment options, given that they may have previously failed some, have experienced adverse effects of others and may have strong individual (or cultural) preferences for the types of treatment they want. Decisions about which treatments are available to people with criminal justice involvement cannot be made based on long-standing biases against medication-assisted treatment; nor should they be made based on simplistic cost estimates that fail to account for the high cost of incarceration and uncontrolled substance use disorders. People involved in the criminal justice system, often as a result of problems with alcohol and drugs, are the people who need the very best treatment options we have to offer—but are the least likely to get them 5-7. At the same time, community access to evidence-based treatment is one approach to preventing incarceration in the first place. Without universal access to evidence-based addiction treatment in the community, having a truly ethical justice system is out of reach. None." @default.
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• W1977102912 date "2014-08-27" @default.
• W1977102912 modified "2023-09-23" @default.
• W1977102912 title "Commentary on Forsythet al. (2014): Subgroup differences in post-release mortality-implications for access to diverse and effective treatments" @default.
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• W1977102912 doi "https://doi.org/10.1111/add.12687" @default.
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