title: Return to drug use and overdose after release from prison: a qualitative study of risk and protective factors.
abstract: BACKGROUND
  Former inmates are at high risk for death from drug overdose, especially in the immediate post-release period. The purpose of the study is to understand the drug use experiences, perceptions of overdose risk, and experiences with overdose among former prisoners.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of General Internal Medicine, University of Colorado School of Medicine, Mail Stop B180, 12631 East 17th Avenue, Aurora, CO 80045, USA. Ingrid.Binswanger@uc.denver.edu
authors.forename: Ingrid A
authors.initials: IA
authors.lastname: Binswanger
authors.forename: Carolyn
authors.initials: C
authors.lastname: Nowels
authors.forename: Karen F
authors.initials: KF
authors.lastname: Corsi
authors.forename: Jason
authors.initials: J
authors.lastname: Glanz
authors.forename: Jeremy
authors.initials: J
authors.lastname: Long
authors.forename: Robert E
authors.initials: RE
authors.lastname: Booth
authors.forename: John F
authors.initials: JF
authors.lastname: Steiner
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000453:epidemiology; D003151:Community Health Centers / Q000458:organization & administration*; D062787:Drug Overdose / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology; D005190:Family; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011330:Prisons; D036301:Qualitative Research; D012307:Risk Factors; D012944:Social Support; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology; D013405:Suicide; D013997:Time Factors