Original articles (peer reviewed)

A retrospective comparison study of Aboriginal and Torres Strait Islander injecting drug users and their contact with youth detention and/or prison

Posted on: 10 August, 2015
Issue: Vol 15 No 3, July 2015 – September 2015
Related to Adolescents Offender health Illicit drug use Research Queensland

Doolan I1, Prof Najman J2, Henderson S3,Dr Cherney A4,Dr Plotnikova M5Dr Ward J6,Kemp R5, Dev A5, Smirnov A5.(2015) A retrospective comparison study of Aboriginal and Torres Strait Islander injecting drug users and their contact with youth detention and/or prison. Australian Indigenous HealthBulletin 15(4). Retrieved [access date] from http://healthbulletin.org.au/articles/a-retrospective-comparison-study-of-aboriginal-and-torres-strait-islander-injecting-drug-users-and-their-contact-with-youth-detention-andor-prison

Abstract

Objective

To examine the extent to which the use of licit and illicit drugs is associated with the admission of Aboriginal and Torres Strait Islander and non-Indigenous injecting drug users to youth detention and adult imprisonment.

Methods

Using two recruitment methods (Peer Recruitment and Respondent Driven Sampling), the study recruited two approximately equal size samples of Aboriginal and Torres Strait Islander and non- Indigenous injecting drug users in Queensland, Australia. Survey data were analysed to assess differences between those with no history of incarceration, prison only history and those with a youth detention history and/or prison history.

Results

Respondents with a youth detention history reported the earlier age of onset for illicit drug use and multiple admissions to youth detention. Those with a prison only history also had an earlier age of onset of illicit drug use compared to those with no history of incarceration.

Conclusions

Early age of onset for drug use is a common precursor to a pattern of youth detention and adult incarceration.

Implications

Given the high rate of licit and illicit drug use by Aboriginal and Torres Strait Islander Australians, there is a unique opportunity for youth detention centre and prison based services to provide specific drug treatment and education to both Aboriginal and Torres Strait Islander and non-Indigenous Australian young people, with the intent of reducing recidivism and hence, rates of incarceration.

Key Words: Aboriginal and Torres Strait Islander, Over-Representation, Youth Justice, Youth Detention, Prison, Drug Use.

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Introduction

There are few studies which compare those ever having been to prison and those who report a youth detention and/or prison history. Aboriginal and Torres Strait Islander Australians are 12 times more likely to be imprisoned and 24 times more likely to be detained in a youth detention centre [1]. In Queensland, Australia, in the period July 2011 until June 2012, there were over 37,000 convictions of persons aged 10 years to 16 years. Of those convictions, over 15,000 convictions involved Aboriginal and Torres Strait Islander youth [2]. Aboriginal and Torres Strait Islander young people are at a much higher risk of progressing to adult correctional facilities [3].

Numerous studies have noted the over-representation of Aboriginal and Torres Strait Islander young people within the adult and youth justice systems. A number of explanations have been presented to account for this over-representation, ranging from untreated mental health and drug use problems, the over-policing of Aboriginal and Torres Strait Islander communities, cultural practices relating to the rearing of Aboriginal and Torres Strait Islander young people, criminal justice labelling of Aboriginal and Torres Strait Islander young people as deviant, the public nature of Aboriginal and Torres Strait Islander offending [4-6] and connection to country and culture [7]. There is some evidence that the rate of drug use, in particular injecting drug use, is higher among Aboriginal and Torres Strait Islander people [8]. Some studies have described injecting drug use practices in Aboriginal and Torres Strait Islander samples [9-11] but these studies have had limited sampling frames and have not provided comparisons with injecting practices in non-Aboriginal and Torres Strait Islander samples. There is a need to understand more about the age illicit drug use begins and what type of drugs have been used by Aboriginal and Torres Strait Islander Australians compared to their peers, and the potential this provides for delivering services at an earlier stage to Aboriginal and Torres Strait Islanders’ who use drugs, particularly within the youth detention centre context.

This paper uses data from the Queensland Indigenous Injecting Drug Survey (QuIIDS) to investigate the association between age of initiation of drug use, type of drugs ever used and having experienced incarceration in youth detention and/or prison. It examines the drug use patterns of those who have a history of youth detention and/or prison.

Literature Review: Understanding Aboriginal and Torres Strait Islander Over-Representation

Socio-economic status and a history of childhood maltreatment have some impact but do not fully explain the over-representation of Aboriginal and Torres Strait Islander young people in the youth justice system [12]. Others have suggested that many factors – racism and discrimination, mental health and drug use problems, sex, age, being Aboriginal rather than Torres Strait Islander, adequacy and availability of police resources, alcohol consumption, health conditions, housing and peer group influence – are likely to explain the high Aboriginal and Torres Strait Islander arrest rate [4-7].

A seminal report undertaken for the Australian National Council on Drugs reported there were few population-based studies that explicitly examined drug use by Aboriginal and Torres Strait Islander people [8]. The report found only a few studies reporting on injecting drug use by Aboriginal and Torres Strait Islander people.

A further report commissioned by the Commonwealth Department of Health in 2008 stated:

“There are no comprehensive data on the numbers of Indigenous Australians who inject drugs or on the numbers of Indigenous IDUs who currently access NSP services. However the available evidence suggests that, if anything, injecting drug use may be more common in the Indigenous than in the non-Indigenous population, and that there are substantial numbers of Indigenous IDUs who do have some contact with NSP services [13].

There is clearly a need for more population-based data to assess the factors associated with injecting drug use by Aboriginal and Torres Strait Islander people. Kratzmann et al. [8] raise the possibility that it is difficult to gain an accurate picture of injecting drug use by Aboriginal and Torres Strait Islander people for several reasons; the reliance of self-report, distrust of government and research institutions [14], the shame associated with injecting drug use as well as the practice of hiding injecting drug use from family or community and isolation from the broader community.

One of the major harms identified, along with health related harms, is involvement with the criminal justice system [8]. Studies have shown that people who inject drugs (PWID) are likely to be involved in and charged with offences against property and that Aboriginal and Torres Strait Islander Australian prisoners are over-represented in these categories of offences [15]. In Queensland, Aboriginal and Torres Strait Islander young people were almost 22 times more likely to have been charged with a property related offence than their non- Indigenous peers [2]. It has also been shown that a history of injecting drug use is associated with admission to youth detention [16].

Methods

Data sources

The Queensland Indigenous Injecting Drug Survey was initiated in response to concerns about rates of injecting drug use and associated risks among Aboriginal and Torres Strait Islander people. The importance of research into Aboriginal and Torres Strait Islander Australian injecting drug use is reflected in a resolution from the inaugural National Indigenous Drug and Alcohol Committee (NIDAC) 2010 conference stating:

  “That as injecting drug use is increasing at a concerning rate in Aboriginal and Torres Strait Islander populations, there is a need for increased attention to address the risk of HIV/AIDS and Hepatitis C transmission amongst Aboriginal and Torres Strait Islander people.”

Current PWID, defined as having injected more than once in the previous twelve months, were recruited from fourteen metropolitan and regional centers throughout Queensland. Recruitment was managed locally by health staff with structured interviews conducted by trained peer interviewers.

A total of 570 PWID were recruited into the study; of those, 295 participants identified as being of Aboriginal and/or Torres Strait Islander descent. The research design was intended to enable comparisons to be made between participating groups. Participants were recruited by either Peer Recruitment [PR] (N = 305) or via Respondent-Driven Sampling [RDS] (N = 265). For the peer interviewing component of the study, interviewers were recruited and interviewed a set number of respondents from their own networks. With respondent driven sampling there was a process of chain referral and incentives. Recruiters labelled seeds were given coupons to pass onto potential participants within their network. The intent of RDS is to exhaustively sample user networks.

While both strategies were successful in recruiting participants, their strengths lie in different areas. Overall, the PR method was more successful in recruiting from the target population of Aboriginal and Torres Strait Islander Australian injectors (61% vs. 39%), and was more appropriate in regional centres where PWID populations were likely to be too small to support RDS method.

Outcome measures

The respondents were administered a detailed questionnaire covering many areas of their lives. Respondents were asked questions regarding their experiences of crime and imprisonment including questions about having ever been in prison and having spent time in youth detention. The questionnaire asked respondents to outline the amount and frequency of their history of drug use. Predictor variables were the type of drug used along with the mean age of first use of each particular drug. Other predictor variables included a range of socio-demographic characteristics.

Statistical analysis

Logistic regression analysis, chi square and t-tests were used to assess the association between Aboriginal and Torres Strait Islander status and a history of licit and illicit drug use. For all tables we compare Aboriginal and Torres Strait Islander and non-Indigenous respondents, all of whom were recruited because they were PWID. All data analysis was undertaken using STATA 10 for Windows (Stata Corp, College Station, TX).

The study was approved by The University of Queensland Behavioural and Social Sciences Ethical Review Committee and Darling Downs – West Moreton Human Research Ethics Committee (HREC/10/QTDD/48).

Results

Questions regarding criminal history and history of having ever served time in youth detention were compared with questions relating to licit and illicit drug use particularly the age of first initiation to drug use and the type of drugs used. Aboriginal and Torres Strait Islander respondents were more likely to report having served time in youth detention three or more times (χ²= 14.5 p=0.001). Aboriginal and Torres Strait Islander respondents were as likely as non-Indigenous respondents to report a prison history, although the Aboriginal and Torres Strait Islander respondents appeared to be more likely to report three or more times being in an adult prison.

Table 1. Youth Detention and Prison History by Aboriginal and Torres Strait Islander Status

Youth Detention History Prison History
χ²=14.5, p=0.001 χ²=8.7, p=0.033
Aboriginal and Torres Strait Islander Non- Indigenous Aboriginal and Torres Strait Islander Non- Indigenous
n = 270% n = 258% n = 266% n = 256%
Never 73.0 82.6 54.5 53.4
1 – 2 Times 13.3 13.2 14.7 23.8
3+ Times 13.7 4.3 30.8 23.1

Analysis of socio-demographic characteristics of the respondents showed PWID who had been in prison and/or youth detention were more likely to be of Aboriginal and Torres Strait Islander descent (OR=1.66) and male (prison only OR=2.74;or have spent time in youth detention and/or prison OR=2.71).

The data showed that PWID who had been in prison only, or youth detention and/or prison were more often 35 years of age and older, while those who have been admitted to youth detention and/or prison were substantially less likely to have completed high school. PWID who have been admitted to youth detention were also more likely to have a family background involving parental marital breakdown before the respondent was 16 years of age. Admission to prison and youth detention is also associated with a history of sleeping rough, having nowhere to stay, having lived in multiple places in the previous 12 months and having a low income. The history of PWID who spend time in prison and youth detention is associated with multiple indicators of prior educational, familial and economic adversity and disadvantage.

Table 2. Socio-Demographic Characteristics by Youth Detention and/or Prison History

Nevern=247 Prison onlyn=153 Youth Detention*n=119
Aboriginal and Torres Strait Islander Status
non- Indigenous 1 1 1
Aboriginal and Torres Strait Islander 1 0.79 (0.52,1.18) 1.66 (1.06, 2.59)
Gender
Female 1 1 1
Male 1 2.74 (1.75, 4.30) 2.71 (1.66, 4.44)
Age of respondent
35+ years 1 1 1
21-34 years 1 0.39 (0.25, 0.59) 0.52 (0.33, 0.88)
17-20 years 1 0.13 (0.04, 0.44) 0.73 (0.33, 1.66)
Education of respondent
Post high school 1 1 1
Completed high school 1 0.64 (0.32, 1.29) 0.99 (0.29, 3.45)
Not completed high school 1 1.31 (0.71, 2.41) 6.67 (2.30, 19.40)
Biological parent together until at least age of 16 years
Yes 1 1 1
No 1 1.43 (0.71, 2.41) 2.34 (1.36, 4.05)
Ever had to sleep rough or in a squat
No 1 1 1
Yes 1 5.20 (3.15, 8.60) 5.81 (3.28, 10.28)
Ever had nowhere to stay
No 1 1 1
Yes 1 4.02 (2.38, 6.81) 2.96 (1.73, 5.06)
How many different places lived in the last 12  months
1 place 1 1 1
2 places 1 1.63 (1.02, 2.62) 4.46 (2.59, 7.69)
3+ places 1 1.13 (0.68, 1.89) 1.47 (0.77, 2.81)
Take home pay last week
$400+ 1 1 1
$399- 1 4.85 (2.91,8.06) 3.58 (2.13, 6.01)
* Youth detention includes those who were subsequently imprisoned

PWID who had been incarcerated had a history of more frequent use of illicit drugs (cannabis, inhalants, hallucinogens, heroin, prescription opiates, cocaine, benzodiazepines and antidepressants).

Table 3. Ever use of a drug by prison and/or youth detention history

Type of drug Never% Prison only% Youth detention*% Chi-square p value
Alcohol 97.6 96.1 99.2 2.64 ns
Tobacco 89.4 97.4 97.5 13.76 <0.001
Cannabis 91.1 96.7 97.5 8.60 0.01
Inhalants 26.4 28.9 41.2 8.49 0.01
Hallucinogens 39.6 59.2 56.3 17.55 <0.001
Ecstasy 52.8 59.9 59.7 2.52 ns
Amphetamines 97.2 96.1 97.5 0.53 ns
Heroin 50.0 77.6 76.5 41.32 <0.001
Prescription opiates 44.3 78.3 63.0 45.96 <0.001
Opiate replacement therapy 36.2 65.1 52.1 32.40 <0.001
Cocaine 31.7 52.6 47.1 19.00 <0.001
Benzodiazepines 54.7 80.9 67.2 28.73 <0.001
Anti-depressants 34.7 53.3 37.0 13.33 <0.001
Steroids 4.5 7.9 6.7 2.07 ns

* Youth detention includes those who were subsequently imprisoned

Not only are PWID who had been incarcerated found to have used a wider range of drugs, they also had a younger mean age of onset of the use of a number of drugs. For example, most PWID report they began using alcohol, tobacco and cannabis before the age of 15, and inhalant use at just over 15 years of age. While the statistically significant differences are limited to only five drugs (alcohol, tobacco, cannabis, inhalants and amphetamines), those who have a history of incarceration, particularly incarceration in youth detention, tend to begin their drug using careers at a younger age. Based upon these figures it is likely that multiple licit and illicit drug use at a young age is associated with youth detention.

Table 4: Mean age (years) when first used by any method

Type of drug Never Prison only Youth detention* F-Ratio Significance
Alcohol 14.13 13.05 12.74 10.468 <0.001
Tobacco 14.26 13.18 12.42 8.994 <0.001
Cannabis 14.26 14.53 13.50 7.451 0.001
Inhalants 16.25 15.57 14.00 3.481 0.033
Hallucinogens 18.66 17.48 17.55 1.543 ns
Ecstasy 21.14 21.37 21.10 0.037 ns
Amphetamines 20.13 19.12 17.15 8.611 <0.001
Heroin 20.57 20.63 19.47 0.913 ns
Prescription opiates 24.31 25.03 22.96 1.168 ns
Opiate replacement therapy 26.92 27.05 25.23 1.000 ns
Cocaine 22.82 21.80 22.70 0.523 ns
Benzodiazepines 21.41 21.79 20.41 0.863 ns
Anti-depressants 23.88 26.04 25.14 1.097 ns
Steroids 24.60 23.50 24.86 0.063 ns

* Youth detention includes those who were subsequently imprisoned

Discussion

A history of youth detention and/or imprisonment is associated with multiple indicators of disadvantage and drug use. Those with a history of youth detention are less likely to report completing high school, more likely to come from a broken home, more likely to report unstable accommodation and more likely to report a background of low socio-economic status. These results appear consistent with many previous studies [e.g 4-7].

The results also show those respondents with a youth detention and/or prison history report higher rates of drug use and having used a wider range of drugs. This along with a reported earlier age of initiation, suggest that young people entering youth detention are at a stage where specifically targeted interventions should be considered.

Piquero and Mazerolle [17] using a life course perspective argue that these factors act as “snares” that inhibit a person’s ability to break away from a life course of crime or “desist” from criminal offending. Farrington [18] argues that life course theories are concerned with accounting for the development of offending pathways and anti-social behaviour, the impact of different risk and protective factors at various stages of the life course, and their impact on changes in offending behaviour. Piquero and Moffitt [19] suggest that events which occur at particular points in the life course may disproportionately impact on behavioural outcomes. It appears likely that earlier initiation of illicit drug use reflects a family history of exposure to trauma, poverty and instability. Our findings raise the possibility that earlier initiation into injecting drug use may be a strong predictor of an offending trajectory that begins in the adolescent period.

An earlier study by Doolan, Najman and Cherney [20] found Aboriginal and Torres Strait Islander young people in youth detention were more often referred to treatment for drug use than for other reasons. The study also showed Aboriginal and Torres Strait Islander young people were less likely to be released from youth detention prior to being assessed and were referred for treatment at a younger age.

These findings combined with the literature on treatment-seeking behaviour of Aboriginal and Torres Strait Islander Australians indicate an admission to youth detention may be one of the few opportunities to provide effective intervention.

Aboriginal and Torres Strait Islander Australians do not access mainstream drug treatment services preferring to access Aboriginal and Torres Strait Islander specific services when they do seek treatment. Even when accessing Aboriginal and Torres Strait Islander specific services, access tends to be for tobacco, cannabis and alcohol related issues [8, 21-25]. There is here an opportunity for the drug and alcohol services operating within youth detention centres to intervene with Aboriginal and Torres Strait Islander young people.

There were multiple factors associated with a higher risk of imprisonment among the Aboriginal and Torres Strait Islander respondents. We found high rates of accommodation difficulties along with poor educational outcomes and low income levels were associated with imprisonment. It is difficult to separate the impact of each of these factors individually. It is also difficult to know whether the poor accommodation, education and financial outcomes were a causal factor in higher rates of drug use or a consequence of drug use itself. Indeed, multiple causal pathways are consistent with the available evidence [8]. This study highlights the need for multi-faceted and holistic policy to address the associations we have observed. This study has also emphasised the need for Aboriginal and Torres Strait Islander appropriate services to be provided within youth detention facilities. It suggests a need to positively discriminate by providing illicit drug use services to Aboriginal and Torres Strait Islander as well as non- Indigenous young people within youth detention centres in Australia, so they may engage with services. This engagement needs to be facilitated by, and wherever possible, be provided by culturally aware and trained workers.

Limitations

This study is based on a sample of people who inject drugs. The sample selected appeared to be in an older age group for injecting behaviour and more recent initiates may have a different history. The results may be particular to this group and not generalisable to the greater youth detention population.

Also, this study may not have adequately controlled for other possible factors (eg. mental health problems, PTSD). It may also be the case that exposure at times other than those assessed in this study are important. A further limitation is the reliance on self-reported data. Even though Secades-Villa and Fernandez-Hermida [26] present a compelling case for the general accuracy of self-report measures, one possible limitation of this study could be the reliance on self-reports. Also, it is difficult to discern whether the other factors mentioned are causal factors in illicit drug use, or whether they are a consequence of illicit drug use, or both.  There remains some ambiguity in determining causal pathways.

Conclusion

This study has highlighted the multiplicity of factors associated with contact with the juvenile and adult detention system. We find that poor accommodation, education and finances play a role along with earlier and higher rates of drug use.

Respondents admitted to a youth detention facility are likely to commence their illicit drug use career at an earlier age, particularly with regard to the use of alcohol, tobacco, cannabis, inhalants and amphetamines. We have also found that respondents who have multiple admissions to a youth detention centre are more likely to be exposed to multiple levels of disadvantage and illicit drug use. This provides an opportunity for youth detention centre based services to engage young people by providing a no-barrier approach to service utilisation.

Doolan, Najman and Cherney [20] showed that Aboriginal and Torres Strait Islander Australian people are more likely to be referred to services within the youth detention setting for drug use, which further emphasises the need for appropriate interventions to be in place to minimise the risk of these young people progressing to injecting drug use and also into the prison system.

Policies which reduce economic, social and structural disadvantage experienced by Aboriginal and Torres Strait Islander Australians may reduce the demand for licit and illicit drugs. Such policies have long been advocated and some are being implemented; albeit at a modest pace. With this in mind, it is important that young people, particularly Aboriginal and Torres Strait Islander young people, are provided with as many opportunities as possible to engage with services within the youth detention centre environment. This would suggest that being in detention may be a pivotal factor in engaging young people in drug use intervention, and provides a unique opportunity to engage young people who may otherwise not engage with drug treatment services.

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