Pathways of Substance Use Among Female and Male Inmates in Canadian Federal Settings

Abstract

This article presents a comparative study of 317 male and 176 female Canadian penitentiary inmates and considers the impact of incarceration on their substance use pathways. Ten men’s and 5 women’s penitentiaries were visited across Canada as part of two successive studies. The 493 respondents completed a questionnaire on their substance use habits before and during incarceration. Substance use before incarceration is important for female and male inmates. The consumption of alcohol and drugs during incarceration is significantly higher among men than women. The results also show that length of incarceration, security level, preincarceration drug use, and prior regular drug use are risk factors associated with substance use during incarceration.

Keywords

alcohol other drugs female and male inmates incarceration pathways

Male and Female Inmate Substance Use Before Incarceration

Numerous studies have shown that offenders have a higher rate of substance use (SU) compared to the general population, and a significant proportion of offenders has an addiction at the time of their incarceration (Brochu & Plourde, 2012; Kairouz, Boyer, Nadeau, Perreault, & Fiset-Laniel, 2008). An Australian study conducted in 27 detention facilities shows that almost two thirds (64%) of respondents reported having used illicit drugs in their lifetime (Butler, Levy, Dolan, & Kaldor, 2003). Another United States study reported that 50% of federal inmates used an illicit substance in the month prior to their incarceration, and more than 4 detainees out of 10 had a drug dependency or had abused drugs in the year prior to their detention (Mumola & Karberg, 2006). These figures exceed what is observed in adults in the general population. According to Patton and Adlaf (2005), 45.1% of Canadians who were interviewed as part of the Canadian Addiction Survey reported having used illicit substances at least once during their lifetime. Regarding federal inmates in Canada, a study reveals that during their lifetime, 95.1% of men had consumed alcohol and 80.5% had used at least one drug; the three most frequently used substances, on a daily or weekly basis, are alcohol, cannabis and cocaine (Brochu et al., 2001).

The situation seems worrisome for women who are subject to judicial control. Previous studies have noted that female inmates use drugs more than their male counterparts (Brochu, Desjardins, Douyon, & Forget, 1992; Fazel, Bains, & Doll, 2006), and women exhibit dependence problems in large proportions (Denton, 1994). In particular, the study by Butler and his colleagues (2003) reveals that more women than men reported occasional or regular use of heroin, cocaine and methadone in the 12 months prior to incarceration (Butler et al., 2003). Johnson (2006) also reports that 62% of incarcerated women in Australia were regular users in the 6 months prior to incarceration, and 40% of incarcerated women regularly used more than one type of illicit drug. According to an epidemiological study on SU by female inmates in provincial institutions in Canada (sentences of less than 2 years), 94.7% of the respondents had tried at least one drug in their lifetime (Brochu, Biron, & Desjardins, 1996). Concerning the rates of alcohol and drug dependence among female inmates, 14% of women are moderately, highly or severely dependent on alcohol, and nearly 59% of women are moderately, highly or severely dependent on illicit drugs (Brochu et al., 1996). This result is higher than what was found among men in federal custody (Brochu et al., 2001) and raises issues about health care during incarceration. An estimated 80% of addicted female inmates have a serious addiction, and there is a concomitant diagnosis of psychiatric disorders in 70% of these cases (McDonagh, Noël, & Wichmann, 2002). Finally, women who had a SU problem prior to incarceration were more likely to require psychiatric services during imprisonment (Faust & Magaletta, 2010).

Substance use during incarceration

Some authors have shown consistent patterns of SU at the time of incarceration (Butler et al., 2003; Keene, 1997; Strang et al., 2006). Many prisoners continue taking drugs once incarcerated (Andía et al., 2005; Boys et al., 2002; Butler et al., 2003). According to Butler and his colleagues (2003), between one third and one half of the individuals who used drugs before their detention continue to do so after being incarcerated. A study conducted in England and Wales on the prevalence of heroin, cocaine and amphetamine use concluded that drug use prior to incarceration predicted drug use in prison (Strang et al., 2006). Indeed, intraprison SU is present for some detainees. According to a two-prison study among 796 inmates in New York and Puerto Rico, 41% (New York) and 38% (Puerto Rico) of the inmates admitted using drugs during their detention (Andía et al., 2005). In Canada, one study reveals that almost 11% of inmates admitted to having injected drugs after being incarcerated (CSC, 2004).

Risk factors Associated With Substance Use in Prison

There are numerous risk factors associated with substance use in prison. The factors that are strongly associated with SU in prison include drug use before incarceration and drug dependence (Butler et al., 2003; Strang et al., 2006). Other factors, such as the number of times an inmate has been incarcerated and the inmate’s mental health problems, also emerge as important determinants of SU in prison (Boys et al., 2002). A qualitative study found that prisoners identified four components that explain SU in prison settings: (a) the need to escape from reality; (b) celebrations; (c) dependence; and (d) opportunity. The study reported that opportunity was the most frequently mentioned component (Wyatt et al., 2004). Other authors have identified predictive factors of SU in prison, such as the lack of opportunities for education and employment, early initiation into the drug market and deficient family dynamics (Lazaro de Carvalho, Gonçalves Valente, Gonçalves de Assis, & Godoi Vasconceslos, 2005). Affiliation with a gang and incarceration length (incarceration time is positively related to the likelihood of SU) have also been associated with SU in prison (Andía et al., 2005). Moreover, the analyses conducted by Butler and his colleagues (2003) show that the factors associated with a high risk of drug injection in prison are being a woman, being between 24 and 40 years old, having been placed in a foster home during childhood, having been imprisoned several times and being incarcerated for a violent crime.

Most studies of prison populations have been descriptive. Only few studies have considered gender differences of SU trajectories, and little information is available on SU trajectories among female inmates. Additionally, few studies have considered factors associated with intraprison SU among men and women. Therefore, our goal is to compare a sample of male and female inmates to provide a gender-differentiated portrait of SU before and during imprisonment. With an exploratory perspective, we will consider factors associated with intraprison SU among both male and female inmate respondents.

Method

Data from two successive studies were combined to achieve the stated objectives. The first study, which focused on SU before and during incarceration (Plourde & Brochu, 2002a, 2002b), involved 317 male inmates recruited in ten federal penitentiaries in Quebec, Canada. These data were collected from 1998 to 2001. The second study, in which 176 women were interviewed, considered the SU profile of female inmates before and during incarceration in five federal penitentiaries in five Canadian provinces. These data were collected from 2003 to 2006. Necessary ethics-related approvals were obtained from the Correctional Service of Canada and from the ethics committee of the Université du Québec à Trois-Rivières.

The recruitment strategies were similar in both studies. Posters were displayed in the targeted institutions to advertise the study, its objectives, the expected implications and the recruitment times. Participants were invited to meet voluntarily with a specially trained interviewer. The interviewers systematically solicited the entire female prison population¹ and because of their large numbers, the men were targeted randomly (10% per institution and at least 30 respondents per penitentiary). The male participation rate was 74.0% and the female participation rate was 52.1%. Several factors may explain this difference, including the interviewer’s gender (women interviewers for the men detainees and women interviewers for the women detainees), feeling unconcerned with the problem (e.g., I’m not using now so I won’t be useful to this study), the less restrictive layout of the women’s facilities (making the potential loss of privileges more costly for women than for men) and distrust of the researchers. The women appeared distinctly more distrustful.

The measurement instrument in the two studies borrowed questions from validated instruments, including the Alcohol Dependence Scale (ADS; α = .95) (Horn, Skinner, Wanberg, & Foster, 1984), the Computerized Lifestyle Assessment Instrument (CLAI; Weekes, Vanderburg, & Millson, 1995), Santé Québec’s Quebec Population Health Survey (1990-1991), the Mandatory Drug Testing in Prisons (MDT; α = .90; Edgar & O’Donnel, 1998), and the integral psychological scale of the French version of the Addiction Severity Index (ASI) (α = .72; Bergeron, Landry, Ishak, Vaugeois, & Trépanier, 1992). All of the instruments showed satisfactory validity and reliability coefficients. Filling out the questionnaire took an average of 30 min.

The total sample includes 493 participants (64.3% men and 35.7% women). The men’s average age is 37.41 (SD = 9.41) and the women’s average age is 35.34 (SD = 9.57). Table 1 presents the primary characteristics of the two respondent groups. Compared to the men, the women have significantly shorter sentences, are mostly in federal detention for the first time and have spent a longer time at the institution where they were interviewed. The majority of the respondents are of Caucasian Canadian origin. The largest proportion of respondents is incarcerated for a crime against persons, which is consistent with the federal system.

Table 1.

Characteristics of the Respondents

	Men (n = 317)		Women (n = 176)
	M	SD	M	SD
Age* (years)	37.41 [19, 70]	9.41	35.34 [19, 63]	9.57
Sentence length (months)* (excluding life sentences = 300 months)*	140.24 (87.21)	106.16 (60.78)	89.20 (44.55)	101.11 (32.15)
Number of months since entering*	16.31	14.39	19.61	25.27
Number of times in federal detention***	1.48	0.68	1.25	0.55
Origin • Canadian	89.0%		64.8%
• Aboriginal	3.0%		21.6%
• Other	8.0%		13.7%
Offense • Crime against persons	78.0%		58.0%
• Property crime	15.0%		22.7%
• Narcotics	7.0%		16.5%
• Other	—		2.8%

p < .05. ***p < .01.

Results

Substance Use

Almost all of the respondents (99.1% of men and 97.7% of women) reported having used substances (alcohol or illicit drugs) in their lifetime. The proportions remain high for the 3 months prior to incarceration, with significantly more men (86.3%) than women (69.8%) having consumed alcohol ( $χ_{(1, n = 493)}^{2}$ = 19.327, p < .001). Concerning the regular use of alcohol according to the ADS criteria (at least once a week for 1 month), 62.7% of the men and 58% of the women were regular users in their lifetime. The average age at which regular alcohol use began is significantly lower for women (M = 15.78 years old, SD = 5.45) than for men (M = 17.31 years old, SD = 5.73; t test = 2.210, df = 295, p < .05).

The proportion of men (90.9%) and women (86.9%) who have used illicit drugs in their lifetime is high. Most of them (83.3% of men and 82.9% of women) admitted to regular illicit drug use in the past that began at a similar age (M = 16.45 years old, SD = 5.80). Among those who had used substances in the 3 months prior to incarceration, Figure 1 shows group similarities in the proportions of respondents who had used heroin and hallucinogenic drugs and significant differences in the use of benzodiazepines, cocaine and cannabis. More women had taken benzodiazepines ( $χ_{(1, n = 323)}^{2}$ = 4.60, p < .05) and cocaine ( $χ_{(1, n = 324)}^{2}$ = 3.95, p < .05), while more men had used cannabis ( $χ_{(1, n = 314)}^{2}$ = 17.19, p < .001) during this period. Men indicated that their main reason for using drugs prior to incarceration was recreational, and women indicated that their main reason for using drugs was to forget their problems.

Figure 1.

Substances used in the 3 months prior to incarceration

When questioned about their SU during the last 3 months of their incarceration, significantly more men (33.1%) than women (11.6%) reported using drugs ( $χ_{(1, n = 490)}^{2}$ = 27.38, p < .001), regardless of the substance used. The consumption of alcohol ( $χ_{(1, n = 492)}^{2}$ = 20.99, p < .001) and drugs ( $χ_{(1, n = 491)}^{2}$ = 21.93 p < .001) during incarceration is significantly higher in men than in women (see Figure 2). For men and women, the substance of choice is cannabis, and few respondents admitted using adulterated alcohol.

Figure 2

Types of substances used during the 3 months of detention

Nearly two thirds of the men (62.1%) and women (65.3%) described themselves as not being problem drinkers prior to incarceration. Their perceptions of problematic illicit drug use are more divided. A slightly larger proportion of female (58.0%) than male (55.8%) inmates perceived their use of illicit drugs as being problematic prior to incarceration ( $χ_{(4, n = 493)}^{2}$ = 41.79, p < .001). More specifically, 41.5% of women and 39.4% of men believe they have a “severe” problem with illicit drugs.

Regarding perceptions of their current incarceration, 43.6% of all respondents consider themselves to be former users of illicit drugs, but this is true for significantly more females (59.4%) than males (35.0%; $χ_{(5, n = 492)}^{2}$ = 44.95, p < .001). Among those who used drugs during incarceration (n = 109), 41.3% of the respondents indicate that they are occasional users, while 21.1% consider themselves to be former users despite having used substances in the previous 3 months of confinement.

A logistic regression analysis was performed to determine whether some conditions can promote the risk of SU during confinement. The participants were divided into two groups: intraprison illicit consumers (n = 125) and nonconsumers during incarceration (n = 368). To establish a predictive model, variables were selected on the basis of their causal relation to illegal drug use (Tables 2 and 3). Referring to Hosmer and Lemeshow’s (2000) criteria, we retained variables whose P values from the bivariate tests were less than 0.25. A correlation matrix (Table 4) was developed to assess the risks of colinearity among the variables that would be entered into the logistic regression model. A “stepwise forward” anterograde method was used, which consists of finding the most discriminating variable between the two groups, and then the next most discriminating variable, and so forth. This procedure was chosen to respond to our exploratory objective. When the correlation between two variables was greater than 0.6 or less than −0.6, one of those variables was systematically removed from the model depending on the strength of its association with the dependent variable. For this reason, the perception of having a drug problem in the 3 months before incarceration was removed from the logistic regression analysis. Given the significant gender difference in the intraprison prevalence of SU, this variable was controlled in the model. Finally, the continuous variables were categorized before they were entered in the model.

Table 2.

Correlation Between Risk Factors and Intraprison Substance Use

Pearson’s chi-square
	Value	df	Asymptotic signification (bilateral)
Gender	27.384	1	0.000
Security code	29.391	2	0.000
Number of times in federal detention	16.807	1	0.000
Alcohol (3 months before incarceration)	4.329	1	0.037
Regular alcohol use	7.738	1	0.005
Drugs (3 months before incarceration)	35.263	1	0.000
Regular drug use	25.701	1	0.000
Perception of guards’ attitudes toward illegal drug use	8.095	1	0.004
Offense	4.026	2	0.134
Perception of an alcohol problem before detention	6.745	1	0.009
Perception of a drug problem before detention	32.057	1	0.000

Table 3.

Differences Between the Risk Factors and Intraprison Substance Use

	Levene		t test
	F	Sig	T	df	Bilateral Sig.
Age	7.414	0.007	5.027	271	0.000
Sentence length	14.996	0.000	1.381	249	0.168
Time since entry	3.830	0.051	1.049	371	0.295

Table 4.

Correlation Matrix of Risk Factors (Variables Under Study)

Var.	1	2	3	4	5	6	7	8	9	10	11	12
1. Sex	—
2. Age	.105*	—
3. Code	.205***	−.180	—
4. Stays	.210***	.173***	.163***	—
5. Length	.229***	.295***	.125***	.001	—
6. A3av	−.199***	.022	−.104*	−.032	−.141***	—
7. Areg	−.045	−.012	−.070	−.076	−.021	.086	—
8. D3av	−.091	.192***	−.166***	−.105*	−.038	.111*	.101*	—
9. Dreg	−.006	.240***	−.135***	−.088	.024	.036	.188*	.462***	—
10. Guard	.101*	−.070	−.015	−.100	.061	−.030	.016	−.034	−.018	—
11. Off	−.209***	−.045	−.264***	.013	−.402***	.088	.122***	.041	−.019	−.082	—
12. Pal	.032	.049	.084	.072	.113*	−.337***	−.484***	−.196***	−.116*	.047	−.209***	—
13. Pdru	−.016	−.226***	.169***	.068	−.011	−.082	−.252***	−.655***	−.503***	.095*	−.069	.294***

Note: Stays = number of times in a federal institution. Length = sentence length. A3av = alcohol use 3 months before incarceration. Areg = regular use of alcohol. D3av = drug use 3 months before incarceration. Dreg = regular drug use. Guard = Perception of guards’ attitudes toward illegal drug use. Off = offense. Pal = perception of having an alcohol problem before incarceration. Pdru = perception of having a problem with other drugs before incarceration.

p < .05. ***p < .001.

The logistic regression analysis (final model) results indicate that only four of the variables are significant contributors: level of security, length of sentence, use of illicit drugs in the 3 months prior to incarceration and regular lifetime use of illicit drugs (Table 5). The test comparing the complete model with the model that only includes the constant is significant ( $χ_{(6, n = 434)}^{2}$ = 68.84, p < .001) and allows for good classification in 71.9% of the cases. The Hosmer-Lemeshow goodness-of-fit test is nonsignificant ( $χ_{(8, n = 434)}^{2}$ = 5.70, p = .681), so there is no significant difference between the model probabilities (theoretical) and the observed probabilities. According to this test, our model has a good fit. Finally, a ROC curve test was conducted to measure the quality of the model. The area obtained under the curve is 0.780, which indicates that the discrimination is acceptable (Hosmer & Lemeshow, 2000). Therefore, we conclude the equation containing the variables (Table 5) explains 21.8% (Cox & Snell’s R² = .218; Nagelkerke’s adjusted R² = .310) of the variation of intraprison SU.

Table 5.

Logistic Regression: Risk Factors Associated With Illegal Substance Use in the Institutions

Risk factors	B	SE	Wald	Odds ratio	CI (95%)
Step 1
sex	1.452	0.310	21.969***	4.271	[2.327, 7.839]
dro3msav	−1.949	0.392	24.675***	0.142
Step 2
sex	1.498	0.312	23.041***	4.474	[2.427, 8.249]
dreg	−1.946	0.627	9.633*	0.143	[0.042, 0.488]
dro3msav	−1.446	0.410	12.413***	0.236	[0.105, 0.526]
Step 3
sex	1.342	0.321	17.521***	3.826	[2.041, 7.173]
Maximum security	—	—	10.111*	—	—
Minimum security	−1.214	0.394	9.513*	0.297	[0.137, 0.642]
Medium security	−0.505	0.335	2.272	0.604	[0.313, 1.164]
dreg	−1.855	0.631	8.644*	0.157	[0.045, 0.539]
dro3msav	−1.387	0.415	11.168***	0.250	[0.111, 0.563]
Final model
Sex	1.537	0.357	18.569***	4.652	[2.312, 9.361]
Maximum security	—	—	10.523*	—	—
Minimum security	−1.280	0.402	10.150***	0.278	[0.126, 0.611]
Medium security	−0.567	0.341	2.764	0.567	[0.291, 1.107]
dromsav	−1.471	0.423	12.096***	0.230	[0.100, 0.526]
dreg	−1.845	0.633	8.488*	0.158	[0.046, 0.547]
Length (>123 months)	—	—	7.776*	—	—
Length (<48 months)	0.741	0.340	6.663*	2.099	[1.209, 4.083]
Length (49-122 months)	0.789	0.306	12.096***	2.202	[0.100, 4.010]

Note: CI = Confidence interval. dro3msav = drug use 3 months before incarceration. dreg = regular lifetime drug use.

p < .05. ***p < .001.

More specifically, the male inmates are approximately four times more at risk of using substances than their female counterparts during confinement (OR = 4.652, p < .001). The risk of SU is lower for detainees in minimum security prisons (OR = .604, p < .001) than for detainees in medium or maximum security prisons. Therefore, the maximum security level represents the highest risk of SU in prison. The length of incarceration also appears to significantly affect the risk of SU in prison. The Wald statistic also indicates that inmates who receive shorter sentences are at higher risk. The odds ratio for sentences of 48 months or less is 2.099 times (p < .05) higher than the odds ratio for sentences of 123 months or more and the odds ratio for sentences of 49 to 122 months is 2.202 times (p < .001) higher. Finally, according to the model, never having used drugs on a regular basis (OR = 0.158, p < .05) and not having used drugs in the 3 months prior to incarceration (OR = 0.230, p < .001) reduces the risk of SU during imprisonment.

Discussion

Substance use (SU) before incarceration is important for female and male inmates. For the three months prior to incarceration, the proportion of inmates who used substances is high. There is a major gap in the lifetime use of illicit drugs between inmates and other Canadians. Indeed, while the prevalence rate is 45.1% for the general population (Canadians over the age of 15; Adlaf, Begin, & Sawka, 2005), the rate is 89.5% for our sample. In addition to a high rate of drug consumption (70.1%), nearly three quarters of the detainees (71.6%) who had previously used drugs also reported using cocaine in the three months prior to incarceration. This rate is also much higher than the rate in Canadian population. These results are consistent with the findings in previous studies (Butler et al., 2003; Harlow, 1991) and show that people who are subjected to judicial control use substances at an alarming rate.

Our comparative analysis between male and female inmates shows gender differences in SU. First, there is a difference in the substances used in the three months prior to incarceration. More men reported consuming alcohol or cannabis, while more women reported consuming cocaine or benzodiazepines. Butler and his colleagues (2003) and Johnson (2006) emphasize the importance of the severity of female inmates’ SU. A higher rate of concomitant mental health problems among women might explain why they use benzodiazepines more often than men. McDonagh and his colleagues (2002) reported a high prevalence of mental health problems among female inmates.

Nevertheless, although the women show signs that could indicate a trajectory of SU that is more severe than the men’s trajectory before incarceration, fewer women than men claimed to use substances while in prison. The observed gap between male and female inmates regarding illegal SU in prison is consistent with the findings by Andía and colleagues (2005) and may be partly attributable to the conditions of confinement. The federal institutions for women are very different than the men’s penitentiaries. Women who are rated to be in minimum or medium security are kept in detention units that are similar to community residences. Men, regardless of their security level, stay in cells that are sometimes shared with another inmate. Women have more privileges to lose if they were transferred to a cell in a maximum security unit as a result of illicit SU. Although their daily prison life may be difficult regardless of the conditions of confinement, the fact remains that the promiscuity and tension in men’s prisons may play a role in risk-taking behaviors, including illicit SU.

Another explanation for this gender difference in illegal SU is that female inmates may have easier access to prescription medication than their male counterparts. In the second component of the study on women, a detailed study of the prescription drug profile cards shows major drug management that may not exist for male inmates. As reported in our previous work (Plourde & Brochu, 2002c), a homeostasis effect may enter prison settings depending on whether the inmates have access to their medication. The more an environment is infiltrated by illicit drugs, the less the inmates report taking medication. The reverse is also true. Additionally, drug availability varies by prison, so permanent accessibility is not guaranteed. A second article that will be published (Plourde, Dufour, Brochu, & Gendron, submitted), which concerns medication among female inmates, will provide a detailed explanation of this hypothesis.

Although it is weak in terms of predictive capacity, the exploratory model that was tested in the present research also clarifies some possible explanations for the phenomenon of SU in prison. The model also provides therapeutic indications for clinicians and administrators of the correctional system. First, as reported by Andía and colleagues (2005), the length of incarceration is a predictive factor for the risk of illegal SU during incarceration. Shorter sentences are associated with a higher risk. Inmates who have received short sentences are likely to be less inclined to start reflecting on their SU and may be less engaged in a process of change. The transtheoretical model of intentional behavior change (DiClemente, 2003) considers how individuals become addicted and the process with which they can free themselves along a common path. In this model, addiction is viewed as a process of intentional behavior change through four stages: contemplation, preparation, action, and maintenance. Inmates serving longer sentences have more privileges to lose if they are caught, and they may be more likely to be engaged in a process of change. The results from Wyatt and colleagues (2004) support this finding.

Similarly, inmates’ security level is also a factor that can explain the opportunities to use drugs. Despite tighter security conditions making it more difficult to obtain substances than in less secure levels, our first work with male inmates showed that men in medium and maximum security institutions used more drugs than inmates in minimum security (Plourde & Brochu, 2002b). We raised the possibility that there is a greater risk of losing privileges in minimum security institutions compared with other security levels (medium and maximum), where there are fewer privileges anyway. We think that gender is also an important factor to consider even if, like men, women who use drugs in prison are not rated minimum security. Above all, we must remember that the realities of men and women taking drugs in prison are different, which implies a need for different responses. These aspects should be considered when establishing security classifications and choosing programs to offer individuals during their incarceration, which may have an impact on their SU patterns in prison.

Finally, the model does not show that using alcohol prior to incarceration or having ever used alcohol regularly increases the probability of illegal SU in prison. However, as suggested by numerous authors (Boys et al., 2002; Gillepsie, 2005; Strang et al., 2006), illicit drug use before incarceration and regular illicit drug use during the lifetime are associated with SU in prison. It is clear that the use of illicit drugs before incarceration, especially the regular use of highly addictive products, renders individuals vulnerable once they are incarcerated. The impact of imprisonment can also generate enough stress and anxiety on a person to increase his or her individual vulnerability. Despite improvements in the conditions of confinement, inmates face a series of deprivations and sufferings to which they must adapt; SU can act as a coping strategy for these problems (Plourde, Brochu, Couvrette, & Gendron, 2007). The effects of incarceration can be addressed from several angles, including the direct impacts on persons during their confinement (e.g., physical and mental health, posttraumatic stress) and the collateral damage that follows incarceration upon one’s return to the community (Liebling & Maruna, 2005). While some authors maintain that inmates adapt gradually and that their initial stress diminishes over time, other authors suggest that inmates’ adaptation is characterized by retreat and avoidance of social contacts or prison activities (Vacheret & Lemire, 2007). SU may play a major role in avoidance strategies that were intended to help inmates adapt to and reduce their psychological discomfort (Fillmore & Dell, 2005; Dumont, 2001; Saylors & Daliparthy, 2005). This is an interesting avenue that should be investigated in future work.

Limitations

This study has limitations, so readers should be cautious when interpreting the results. First, the study relies on self-declared questionnaires, which leaves room for a gap between the true conditions and those that were divulged by the inmates. The sensitive nature of the subject would have undoubtedly prevented some participants from telling the interviewers about their illicit SU. Therefore, the phenomenon of SU in prison is most likely underestimated. Additionally, it is important to remind our readers that female inmates’ participation rate was low in comparison to the male inmates. This difference could partially explain the weaker prevalence of prison SU among women. Finally, contrary to the Canada-wide study involving women, the study involving men was conducted only in Quebec (one province vs. five provinces for women). The reality of male inmates may be different in English Canada. Subsequent studies should consider federal inmates elsewhere in Canada.

Conclusion

A significant proportion of male and female inmates suffer from addiction problems. Women’s SU is troublesome. Health care provisions related to SU should be considered when individuals are introduced into the judiciary system. The effectiveness of addiction treatment programs is inconstant, and scientific data supporting treatment-related initiatives are lacking. Furthermore, some reliable studies describe interventions that are supported by scientific evidence, such as substitution treatments and behavioral and psychosocial interventions (Sellman, 2010; Strang et al., 2012).

We must prioritize the development of integrated and flexible health care systems that are equipped with resources to meet the needs of prisoners. This means that health care must consider both the upstream and downstream of SU trajectories. Finally, the use of drugs during confinement is most likely not a systematic part of the detention lifestyle, especially for illegally obtained substances. Prison settings involve environments that restrict individuals’ access to substances. The choice to take drugs illegally or not in prison depends on the availability of products in the institutions as well as on a person’s pathway of use before incarceration, commitment to a process of change and coping strategies they tend to use to face the difficulties.

Footnotes

Authors’ Note

The opinions and conclusions presented here do not necessarily reflect those of the Correctional Service of Canada.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: We wish to thank the Fonds québécois de la recherche sur la société et la culture (FQRSC) and the Université du Québec à Trois-Rivières for their financial contributions to this research project.

Notes

Bios

Chantal Plourde is criminology professor in psychoeducation at the Universite du Quebec a Trois-Rivieres. She is also a researcher at the International Center for Comparative Criminology (CICC) and at the Centre Dollard-Cormier University on dependencies. She specializes in alcohol and other drug use among prison populations and native peoples.

Serge Brochu is clinical psychology professor at the School of Criminology of the University of Montreal and the executive director of the International Forum of Public Universities. He is currently the codirector of Recherche et intervention sur les substances psychoactives—Quebec (RISQ) and a researcher at the Centre Collard-Cormier University Institute on dependencies. His research themes are drug/crime relationships, treatment of addict offenders, and program evaluation.

Annie Gendron is a researcher pursuing a PhD degree in psychology from the Universite du Quebec a Trois-Rivieres. Her research focuses on gambling, drug use, and psychological distress among youth. Since 2006, she has coordinated activities of the Canada Research Chair on Drug Use Patterns and Related Problems.

Natacha Brunelle is chairholder of the Canada Research chair on drug use patterns and related problems. She is professor of psychoeducation/special education at the Universite du Quebec a Torois-Rivieres and a researcher at the Centre Dollard-Cormier University Institute on dependencies addictions and the RISQ group. She specializes in studies of drug use trajectories and associated problems related to delinquency and gambling.

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