Out of the 410 participants 80.2% were males (Table 1), with 205 (50%) of the participants in the age group 25 -40 years. 53% were from an urban background. As shown in table 1, 91% had an educational level below GCE O/L and 82% of the participants were either unemployed or were temporarily employed.
The prevalence of substance use disorder during the last 12 months for any substance was 24.4% (95% CI 20.2– 28.6). Prevalence of current alcohol and tobacco use disorder were 8.1% (95% CI 5.6-11.1) and 31.3% (95% CI 26.7-35.9), respectively. The figures for cannabis and opioids were 11.3% (95% CI 8.3-14.8) and 9.5% (95% CI 6.8-12.7), respectively.
The life time substance use for any substance was 75.6%. Of the life time substance users, 78.8% were 40 years or younger and 77. 8% of them had a history of unemployment (Table 2).
Males and those who were less than 40 years old had higher odds of having harmful use or dependence of any substance (OR= 10.3 and 2.0 respectively). Having a lower education level, residing in an urban area, being unemployed or only having a temporary employment also had higher odds of being dependent or having harmful use of any substance. (OR 3.2, 1.2, 0.49 respectively). Furthermore, a past history of mental illness, having being imprisoned earlier had higher odds (OR =0.25. and 0.41 respectively). History of parental separation or loss as a child, family history of substance use or mental illness did not have a higher odds.
The highest prevalence for any life time substance use disorder was in those less than 20 years of age (table 3). In that age group the most commonly used substance was tobacco, mostly in the form of smoking. At least 50% or more inmates in this age group met criteria for alcohol and cannabis use disorders and 47.6% fulfilled criteria for an opioid use disorder (Table 3).
Alcohol was the most prevalent substance use disorder among males while opioids were more commonly used than other substances by female prison inmates (Table 4)
Further analysis of the data was carried out to determine the strength of association between various variables and substance use. Table 5 shows results of binary multiple logistic regression.
Of those who were serving a sentence 19% were imprisoned due to illicit drug intake/drug smuggling or trafficking, and out of them 63.8% were male Out of those who were imprisoned due to a conviction of illicit drug intake/drug smuggling or trafficking 53.4% had served at least one previous sentence for the same reason, 80.0% were dependent or meeting criteria for a harmful use of any substance. Out those dependent or meeting criteria for harmful use of a substance, 56.2% and 68.8% met criteria for alcohol and tobacco dependence/harmful use respectively, and 58.8% and 68.8% met criteria for a cannabis and opioid use disorder, respectively.
Illicit substances used among the participants were cannabis (either locally grown or Kerala ganja), heroin, ICE, GHB, and illicitly brewed alcohol. Cannabis was used among 36.8% of the prison inmates who were male. Heroin was the most prevalent illicit substance used by female prison inmates.
When those who were serving a sentence for murder or attempted murder were considered 82.7% met criteria for dependence/ harmful use of any substance. 71.3% and 74.7% fulfilled diagnostic criteria for alcohol and tobacco use disorder respectively while 74.7% and 5.3% met criteria for cannabis and opioid use disorder respectively.
Among those who were found to have a lifetime substance use, 61% had been introduced to substance use by friends, and 28% by spouse or partner. The common reasons attributed to substance use included use to relieve stress (24.5%), acceptance by peers (14.9%), experimentation (13.4%), availability (8.0%), to feel “normal” (5.2%) and to boost their confidence.
22.8% of users of opioids were intra -venous users. Fear of infection and fear of pain were the commonest reason for not considering intravenous drug use by the others. Among those who used intravenous drugs the reason for choosing this route was the users’ belief that this route gives maximum pleasure.