Return to drug use and overdose after release from prison: a qualitative study of risk and protective factors

This qualitative study included former prison inmates (N = 29) who were recruited within two months after their release. Interviewers conducted in-person, semi-structured interviews which explored participants' experiences and perceptions. Transcripts were analyzed utilizing a team-based method of inductive analysis.The following themes emerged: 1) Relapse to drugs and alcohol occurred in a context of poor social support, medical co-morbidity and inadequate economic resources; 2) former inmates experienced ubiquitous exposure to drugs in their living environments; 3) intentional overdose was considered "a way out" given situational stressors, and accidental overdose was perceived as related to decreased tolerance; and 4) protective factors included structured drug treatment programs, spirituality/religion, community-based resources (including self-help groups), and family.Former inmates return to environments that strongly trigger relapse to drug use and put them at risk for overdose. Interventions to prevent overdose after release from prison may benefit from including structured treatment with gradual transition to the community, enhanced protective factors, and reductions of environmental triggers to use drugs.Over 7.2 million people were incarcerated or on probation/parole at year-end 2009 [1]. A history of drug use or misuse is pervasive among prison inmates by every measure, including prior use, use at the time the offense is committed, drug abuse, and drug dependence [2-4]. Despite the magnitude of the problem of substance use disorders among criminal justice populations, prisoners have limited access to evidence-based substance abuse treatment during incarceration, during the transition to the community, or while under community supervision [3,5-7]. Therefore, inmates are often released without the tools to avoid returning to drugs after release from prison.Studies in the United States and other countries have shown a high risk of drug-related death after re