title: Drug use and initiation in prison: results from a national prison survey in England and Wales.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
authors.affiliation: National Addiction Centre, Kings College London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Boys
authors.forename: M
authors.initials: M
authors.lastname: Farrell
authors.forename: P
authors.initials: P
authors.lastname: Bebbington
authors.forename: T
authors.initials: T
authors.lastname: Brugha
authors.forename: J
authors.initials: J
authors.lastname: Coid
authors.forename: R
authors.initials: R
authors.lastname: Jenkins
authors.forename: G
authors.initials: G
authors.lastname: Lewis
authors.forename: J
authors.initials: J
authors.lastname: Marsden
authors.forename: H
authors.initials: H
authors.lastname: Meltzer
authors.forename: N
authors.initials: N
authors.lastname: Singleton
authors.forename: C
authors.initials: C
authors.lastname: Taylor
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D044383:Black People; D019970:Cocaine-Related Disorders / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D003430:Cross-Sectional Studies; D004739:England / Q000453:epidemiology; D005260:Female; D006556:Heroin Dependence / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D008875:Middle Aged; D011329:Prisoners / Q000523:psychology*; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000209:etiology / Q000523:psychology*; D014852:Wales / Q000453:epidemiology; D044465:White People