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• Response to commentary
  Seena Fazel
  Published on: 6 November 2006

• Published on: 6 November 2006

  Response to commentary

  • Seena Fazel, Clinical Senior Lecturer
  • Other Contributors:
    • Parveen Bains, Helen Doll

  Dear Editor,

  Peters discusses some limitations in relation to our systematic review of the prevelance of substance abuse and dependence in prisoners. Peters states that we have not disaggregated findings obtained from sentenced and unsentenced prisoners. In fact, in Table 3, we do present the findings of sentenced and remand prisoners separately by gender, and by type of substance (alcohol and drug).

  Pet...

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  Dear Editor,

  Peters discusses some limitations in relation to our systematic review of the prevelance of substance abuse and dependence in prisoners. Peters states that we have not disaggregated findings obtained from sentenced and unsentenced prisoners. In fact, in Table 3, we do present the findings of sentenced and remand prisoners separately by gender, and by type of substance (alcohol and drug).

  Peters also states that we have reported the findings from his study inaccurately. This depends on how the data are extracted. The Peters study involved diagnostic interviews with 400 inmates consecutively admitted to a state prison. Peters states that the prevalence of "drug use" was 36.8% and "alcohol use" was 34.5% - and this uses denominators of 307 and 380 prisoners, respectively. However, we extracted the data for "dependence disorder" rather than "use" - again, this is in order to be consistent with the other included studies (where studies provided both data on prevalences for "dependence" and "abuse or dependence", we used the former). Further, we decided to use 400 inmates as the denominator. This is based on an assumption that those who did not complete the protocols were not substance dependent, which we believe is reasonable. Even if it is not, as we did not meta-analyse the data, this does not alter our main findings, and the alternative estimates from the Peters study fall within the range of prevalences already given in our review. The alternative prevalences for drug dependence would be 28.0% rather than 25.0%, and for alcohol 26.3% rather than 21.5%.

  Finally, Peters states that with changes in the types of drugs used in the community, it is unclear whether the range of prevelances for drug dependence would still be applicable. By eyeballing the figures in our review, there does not appear to be any time trend for the prevalence estimates in the included studies (1988-1998 in the men; 1996-2001 in the women), periods when it is also likely for there to have been changes in the types of drugs used in the community.

  The summary notes in EBMH rightly state that the inclusion criterion for sample size was not clearly reported in our review of reception studies. In fact, we chose not to have a sample size criterion and all studies - of any size - were included that met the other criteria.

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  Conflict of Interest:
  None declared.

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