Tobacco, alcohol, and illicit substance use continue to result in substantial morbidity and mortality and significant societal economic costs despite considerable efforts to minimize use of licit substances and prevent use of illicit substances. Each year, more than 400,000 Americans die from cigarette smoking, and one in every five deaths in the United States is believed to be smoking related (1). Consequences of alcohol and illicit substance abuse include, among others, cirrhosis, job loss, and criminal behavior related to the acquisition and sale of illicit drugs. The economic costs of addiction were estimated as $400 billion yearly in the United States in 1999 (2). Substance use is associated with a wide range of risk behaviors. For the more commonly used substances, risk behavior includes symptoms of both dependence (e.g., reducing important activities because of use of the substance) and abuse (e.g., driving a car more than once while intoxicated, getting into trouble with superiors or co-workers because of intoxication). For example, in 2002, 4.7 percent of the population reported driving under the influence of an illicit drug and 14.2 percent reported driving under the influence of alcohol at least once during the past year (3).

/pdf/the-social-epidemiology-of-substance-use-35kvyllrv2.pdf

The social epidemiology of substance use.

The relationship between personal unsecured debt and mental and physical health: a systematic review and meta-analysis.

Aims To investigate drug-related deaths among newly released prisoners in England and Wales. Design Database linkage study. Participants National sample of 48 771 male and female sentenced prisoners released during 1998– 2000 with all recorded deaths included to November 2003. Findings There were 442 recorded deaths, of which 261 (59%) were drug-related. In the year following index release, the drug-related mortality rate was 5.2 per 1000 among men and 5.9 per 1000 among women. All-cause mortality in the first and second weeks following release for men was 37 and 26 deaths per 1000 per annum, respectively (95% of which were drug-related). There were 47 and 38 deaths per 1000 per annum, respectively, among women, all of which were drug-related. In the first year after prison release, there were 342 male deaths (45.8 were expected in the general population) and there were 100 female deaths (8.3 expected in the general population). Drug-related deaths were attributed mainly to substance use disorders and drug overdose. Coronial records cited the involvement of opioids in 95% of deaths, benzodiazepines in 20%, cocaine in 14% and tricyclic antidepressants in 10%. Drug-related deaths among men were more likely to involve heroin and deaths among women were more likely to involve benzodiazepines, cocaine and tricyclic antidepressants. Conclusions Newly released male and female prisoners are at acute risk of drug-related death. Appropriate prevention measures include overdose awareness education, opioid maintenance pharmacotherapy, planned referral to community-based treatment services and a community overdose-response using opioid antagonists.

http://www.antoniocasella.eu/archila/Farrell_Marsden_2007.pdf

Acute risk of drug-related death among newly released prisoners in England and Wales

Background. Personal debt is one of many factors associated with anxiety, depression and suicidality. The aim of this study was to examine the relationship between personal debt and suicidal ideation in the context of sociodemographic factors, employment and income, lifestyle behaviours, and recently experienced traumatic events.Method. Interviews were conducted with a random probability sample comprising 7461 respondents for the third national survey of psychiatric morbidity of adults in England. Fieldwork was carried out throughout 2007. The prevalence of suicidal thoughts in the past week, past year and lifetime was assessed and current sources of debt were recorded.Results. In 2007, 4.3% of adults in England had thought about taking their own life in the past 12 months, ranging from 1.8% of men aged >= 55 years to 7.0% of women aged 35-54 years. Those in debt were twice as likely to think about suicide after controlling for sociodemographic, economic, social and lifestyle factors. Difficulty in making hire purchase or mail order repayments and paying off credit card debt, in addition to housing-related debt (rent and mortgage arrears), was strongly associated with suicidal thoughts. Feelings of hopelessness partially mediated the relationship between debt and suicidal ideation.Conclusions. The number of debts, source of the debt and reasons for debt are key correlates of suicidal ideation. Individuals experiencing difficulties in repaying their debts because they are unemployed or have had a relationship breakdown or have heavy caring responsibilities may require psychiatric evaluation in addition to debt counselling.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0033291710001261

Personal debt and suicidal ideation.

Prevention of transmission of HIV, hepatitis B virus, hepatitis C virus, and tuberculosis in prisoners.

Aims To investigate heroin and cocaine use in a sample of British prisoners, and to explore the characteristics of inmates who use these drugs for the first time while in prison. Design, participants A cross-sectional survey of all prisons in England and Wales conducted as part of a major national study of psychiatric morbidity. A total of 3142 prisoners (88.2% of those selected) completed a structured interviewer-administered questionnaire. Measurements Interview measures of personal demographics, social history, psychiatric morbidity and drug use. Personality disorders were diagnosed via the Structured Clinical Interview for DSM-IV (SCID-II) and neurotic symptoms were assessed using the revised Clinical Interview Schedule (CIS-R). Findings More than 60% of the heroin users and cannabis users reported that they had used these drugs in prison compared with less than a quarter of the life-time cocaine users. More than a quarter of the heroin users reported that they had initiated use of this drug in prison. The extent of an individual’s experience of prison was related more consistently to heroin and/or cocaine use in and out of prison than other personal background, social history or psychiatric variables assessed. Conclusions The findings indicate that prisons are a high-risk environment for heroin and other drug initiation and use. Although related to drug use, psychiatric variables were not generally associated with initiation in prison, which was dominated by prison exposure. There is a need to explore ways of reducing heroin initiation in prison as part of a broader risk-prevention strategy.

Drug use and initiation in prison: results from a national prison survey in England and Wales.

The main objective of this study is to test the hypothesis that mental disorder is more common in people with debt in the general population than in people with no debts, and to examine whether this relationship varies with type of disorder and type of debt. The study design is a cross sectional nationally representative survey among private households in England, Scotland and Wales. There were 8545 adults participants aged 16-74. The main outcome measures are Neurosis, psychosis, alcohol abuse and drug abuse, identified through structured assessments including SCAN, AUDIT and other measures. Detailed questions were asked about finances and debts. The results have shown that around half of people with debts in the general population have a mental disorder, compared with 14% of the general population with no debts, and 15% of the general population. People in debt have two to three times the rate of neurosis, three times the rate of psychosis, over twice the rate of alcohol dependence and four times the rate of drug dependence as people with no debt. Having had a disconnected utility, cutting down on utility use and borrowing money from informal sources are respectively associated with three to four times, twice, and two to three times increased rates of disorder compared to those who have not. In conclusion debt, disconnected utilities, trying to reduce consumption of utilities and borrowing from informal sources are all predictors of markedly raised rates of all kinds of mental disorder. Whether the association is causal, an outcome of mental illness or reciprocal, these findings demonstrate the mental health aspects of the significant public health impact of debt in the general population; and have implications for debt policy, debt counselling agencies and for companies managing loans, repayments and pursuing debt recovery.

Mental Disorder in People with Debt in the General Population

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Drug use and initiation in prison: results from a national prison survey in England and Wales.

Mental Disorder in People with Debt in the General Population