Using the Alcohol, Smoking and Substance Involvement Screening Test to predict substance-related hospitalisation after release from prison: A cohort study

IF 5.2 1区医学 Q1 PSYCHIATRY Addiction Pub Date : 2023-10-19 DOI:10.1111/add.16365

Craig Cumming, Stuart A. Kinner, Rebecca McKetin, Jesse T. Young, Ian Li, David B. Preen

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Abstract

Background and Aims

Poor substance use-related health outcomes after release from prison are common. Identifying people at greatest risk of substance use and related harms post-release would help to target support at those most in need. The Alcohol Smoking and Substance Involvement Screening Test (ASSIST) is a validated substance use screener, but its utility in predicting substance-related hospitalisation post-release is unestablished. We measured whether screening for moderate/high-risk substance use on the ASSIST was associated with increased risk of substance-related hospitalisation.

Design

A prospective cohort study.

Setting

Prisons in Queensland and Western Australia.

Participants

Participants were incarcerated and within 6 weeks of expected release when recruited. A total of 2585 participants were followed up for a median of 873 days.

Measurements

Baseline survey data were combined with linked unit record administrative hospital data. We used the ASSIST to assess participants for moderate/high-risk cannabis, methamphetamine and heroin use in the 3 months prior to incarceration. We used International Classification of Diseases (ICD) codes to identify substance-related hospitalisations during follow-up. We compared rates of substance-related hospitalisation between those classified as low/no-risk and moderate/high-risk on the ASSIST for each substance. We estimated adjusted hazard ratios (aHR) by ASSIST risk group for each substance using Weibull regression survival analysis allowing for multiple failures.

Findings

During follow-up, 158 (6%) participants had cannabis-related, 178 (7%) had opioid-related and 266 (10%) had methamphetamine-related hospitalisation. The hazard rates of substance-related hospitalisation after prison were significantly higher among those who screened moderate/high-risk compared with those screening low risk on the ASSIST for cannabis (aHR 2.38, 95% confidence interval [CI] 1.74, 3.24), methamphetamine (aHR 2.23, 95%CI 1.75, 2.84) and heroin (aHR 5.79, 95%CI 4.41, 7.60).

Conclusions

Incarcerated people with an Alcohol Smoking and Substance Involvement Screening Test (ASSIST) screening of moderate/high-risk substance use appear to have a significantly higher risk of post-release substance-related hospitalisation than those with low risk. Administering the ASSIST during incarceration may inform who has the greatest need for substance use treatment and harm reduction services in prison and after release from prison.

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使用酒精、吸烟和物质参与筛查测试预测出狱后与物质相关的住院情况：一项队列研究。

背景和目的：出狱后与不良药物使用相关的健康结果很常见。确定释放后药物使用和相关危害风险最大的人将有助于将支持目标对准最需要的人。酒精吸烟和物质参与筛查测试（ASSIST）是一种经过验证的物质使用筛查仪，但其在预测释放后与物质相关的住院情况方面的实用性尚不明确。我们测量了ASSIST中中度/高风险药物使用筛查是否与药物相关住院风险增加有关。设计：一项前瞻性队列研究。背景：昆士兰和西澳大利亚的监狱。参与者：参与者被监禁，招募时在预期释放的6周内。共有2585名参与者接受了随访，中位数为873 天。测量：基线调查数据与相关单位记录管理医院数据相结合。我们使用ASSIST对参与者在监禁前3个月内的中度/高风险大麻、甲基苯丙胺和海洛因使用情况进行了评估。我们使用国际疾病分类（ICD）代码来确定随访期间与物质相关的住院情况。我们比较了ASSIST中每种物质的低/无风险和中/高风险患者的物质相关住院率。我们使用威布尔回归生存分析，通过ASSIST风险组估计了每种物质的调整后风险比（aHR），考虑到多次失败。调查结果：在随访期间，158名（6%）参与者与大麻有关，178名（7%）参与者与阿片类药物有关，266名（10%）参与者与甲基苯丙胺有关住院。与在ASSIST上筛查大麻低风险人群相比，筛选中度/高危人群的监狱后药物相关住院的危险率显著更高（aHR 2.38，95%置信区间[CI]1.74,3.24），甲基苯丙胺（aHR 2.23，95%CI 1.75，2.84）和海洛因（aHR 5.79，95%CI 4.41，7.60）。在监禁期间管理ASSIST可以告知谁在监狱中和出狱后最需要药物使用治疗和减少伤害服务。

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来源期刊

Addiction 医学-精神病学

CiteScore

10.80

自引率

6.70%

发文量

319

审稿时长

3 months

期刊介绍： Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines. Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries. Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.