Potential Risk Factors for Methamphetamine Use Among Inmates in a Japanese Prison

Potential Risk Factors for Methamphetamine Use Among Inmates in a Japanese Prison | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Potential Risk Factors for Methamphetamine Use Among Inmates in a Japanese Prison Masahiko Takaya, Kiyoto Takigawa, Tetsuji Kawata This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5504895/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 22 May, 2025 Read the published version in BMC Psychiatry → Version 1 posted 11 You are reading this latest preprint version Abstract Background: In Japan, drug addiction recovery guidance and social reintegration programs are implemented for eligible inmates in many prisons. However, methamphetamine addiction, especially among those with a history of thinner inhalation, often seems not to be adequately addressed in addiction treatment programs. The comorbidities of substance use disorders may be generally overlooked. This study aimed to provide valuable data for guiding the development of programs to combat drug addiction and support social reintegration for inmates. The first step of this study sought to determine the association between history of daily/regular methamphetamine use and use of other substances as well as the relationship between methamphetamine use and sociodemographic background. Methods: This retrospective study included 470 consecutive inmates whose data were obtained andwho consulted a certified psychiatrist. Chi-square tests and paired t-tests were used for the analysis. Furthermore, a multinominal regression analysis was performed. Results: Our findings revealed that the history of daily/regular methamphetamine use was significantly associated with the history of psychiatric consultation, sexually transmitted infections, daily/regular thinner inhalation, and daily/regularly tobacco smoking. Moreover, daily/regular thinner inhalation was initiated at a significantly younger age than methamphetamine use. In addition, tobacco smoking was initiated at a significantly younger age than methamphetamine use. Conclusion: The present study suggested that a history of daily/regular thinner inhalation and daily/regular tobacco smoking may serve as potential risk factors for the development of daily/regular methamphetamine use. These results may provide valuable insights for supporting and protecting inmates with methamphetamine addiction as well as individuals at risk. Trial registration: Not applicable. Methamphetamine pathway causality strength temporality inmates prison Japan Background Methamphetamine abuse has been widely reported to cause neurological damage, leading to mental disorders, physical diseases, and cognitive dysfunction ( 1 ). While some pharmacological treatments for methamphetamine-induced disorders have been explored, further clinical studies are needed ( 2 ). Alternatively, psychological treatments for psychiatric symptoms associated with methamphetamine use have shown overall effectiveness ( 3 ). However, due to the wide range of psychiatric disorders associated with methamphetamine-induced neurological damage, treatment strategies remain insufficiently explored. Moreover, distinguishing between persistent methamphetamine-associated psychosis and schizophrenia based on behaviors and symptoms is particularly challenging ( 4 ). Furthermore, comorbid psychiatric diseases complicate the treatment of illicit methamphetamine users ( 5 ). Akindipe et al. showed that methamphetamine dependence is associated with mood, psychotic, and anxiety disorders, which can be classified into primary and substance-induced patterns, except for substance-induced anxiety disorder ( 5 ). Earlier initiation and prolonged methamphetamine use have also been associated with a higher risk of psychosis ( 6 ). Another study reported that the severity of psychotic and depressive symptoms in methamphetamine users, including the number of suicide attempts, correlated with the amount of methamphetamine used ( 7 ). While numerous studies have reported the adverse events and comorbidities of methamphetamine addiction, fewer have examined the reasons for its use. Some individuals turn to methamphetamine for self-medication to alleviate emotional distress ( 8 , 9 ). Brecht et al. analyzed drug initiation sequences in individuals seeking treatment for methamphetamine use and found that alcohol, marijuana, and tobacco use often preceded methamphetamine use ( 10 ). The authors also reported that approximately one-third of methamphetamine users did not complete high school ( 10 ). Another study also reported that methamphetamine-using felons exhibited psychosocial and behavioral characteristics ( 11 ). The subjects included in the aforementioned study, which aimed to help reduce HIV/AIDS transmission by investigating methamphetamine user patterns, motivations, social networks, and risk behaviors, were recruited using posters and media campaigns, agencies, etc. ( 11 ). Some reasons for initiating methamphetamine use include performance enhancement, coping with personal challenges, and increasing sexual performance and impulse control. Given these factors, prevention programs, withdrawal support, and education on methamphetamine’s harmful effects are of paramount significance ( 8 ). However, achieving these goals is particularly challenging due to the high recidivism rates among methamphetamine users, highlighting the need for appropriate interventions that address the root causes of addiction and repeated offenses ( 12 ). Hence, analyzing data from incarcerated individuals may provide valuable insights into these factors. To the best of our knowledge, no study has examined the pathways to methamphetamine use, including sociodemographic factors, specifically among inmates. In line with this, the present study aimed to determine the association between the history of the daily or regular use of methamphetamine and use of other substances as well as the association between methamphetamine abuse and sociographic background. In Japan, many prisons seem to offer drug addiction recovery guidance and social reintegration programs for eligible inmates. However, comorbid substance addictions, such as history of thinner inhalation alongside methamphetamine use, seem to be often overlooked in addiction treatment programs. Therefore, this study aimed to focus on this particular issue and offer insights that may improve the prevention and treatment of methamphetamine addiction, ultimately supporting inmates and individuals at risk. Methods Subjects Our study included 470 consecutive inmates whose data were obtained and who consulted a certified psychiatrist between March 2022 and January 2024 at the medical office of a prison in Japan (name withheld). Sampling was rational and not arbitrary, and only data obtained during this period were analyzed. This retrospective study used data from medical records based on routine intake questionnaires completed at prison admission and in the first psychiatric examination. These data might be valuable for planning drug addiction recovery programs for inmates struggling with stimulants or other substance addictions. In addition, these data could play a crucial role in developing social reintegration programs aimed at preventing recidivism. Both addiction recovery and social reintegration programs aim to reduce repeat offenses. Variables This study analyzed the following variables: age, educational background, history of psychiatric consultation, history of psychiatric hospital admission, history of sexually transmitted infections, history of daily/regular methamphetamine use (average initiation age), history of daily/regular thinner inhalation (average initiation age), history of daily/regular alcohol consumption (average initiation age), and history of daily/regular tobacco smoking (average initiation age). Analyzing these factors may provide key insights for the recidivism prevention plan among inmates in Japan. Statistical analysis All analyses were conducted using JMP 8 (SAS Institute Inc., Cary, NC, USA). Chi-square test was used to assess the association between the history of daily/regular methamphetamine use and other variables. A paired t-test was used to determine whether a significant difference existed between initiation ages of methamphetamine and other substances, in addition to identifying any significant associations. A multinomial regression analysis (n = 459) was performed, adjusting for potential confounding factors, to more accurately evaluate the independent relationships between methamphetamine use and other variables. A p -value of < 0.05 was considered statistically significant. Results Demographic data are summarized in Table 1 , with the right-most column displaying the number of subjects for each variable. The results of the association between the history of daily/regular methamphetamine use and other variables, including history of psychiatric consultation, history of psychiatric hospital admission, history of sexually transmitted infections, history of daily/regular thinner inhalation, history of daily/regular alcohol consumption, and history of daily/regular tobacco smoking, are detailed in Table 2 . The association between the history of daily/regular methamphetamine use and educational background is presented in Table 3 . Notably, Table 2 indicates that the history of daily/regular methamphetamine use was significantly associated with the history of psychiatric consultation, history of sexually transmitted infections, history of daily/regular thinner inhalation, and history of daily/regular tobacco smoking. Moreover, Table 3 shows that a lower educational background was significantly associated with the history of daily/regular methamphetamine use. Table 1 Social background and history of substance addiction, including initiation age Sample size Age (years), average ± s.d. 45.3 ± 12.0 470 Sex Male 470 Female 0 Educational background JH: 315 (68.2%) 462 SH: 122 (26.4%) UNI: 25 (5.4%) History of psychiatric consultation No: 58 (12.4%) 469 Yes: 411 (87.7%) History of psychiatric hospital admission No: 276 (59.5%) 464 Yes: 188 (40.5%) History of sexually transmitted infections No: 380 (80.1%) 470 Yes: 90 (19.1%) History of daily/regular methamphetamine use No: 216 (46.0%) 470 Yes: 254 (54.0%) Average initiation age (years) 22.2 ± 7.1 251 History of daily/regular thinner inhalation No: 277 (59.0%) 470 Yes: 193 (41.0%) Average initiation age (years) 14.6 ± 2.0 192 History of daily/regular alcohol consumption No: 104 (22.1%) 470 Yes: 366 (77.9%) Average initiation age (years) 18.4 ± 5.3 360 History of daily/regular tobacco smoking No: 59 (12.6%) 469 Yes: 410 (87.4%) Average initiation age (years) 15.6 ± 3.9 410 Abbreviations: JH, junior high school; SH, senior high school; UNI, university or higher Table 2 Chi-square test results MH χ 2 ( 1 ) = P -value Likelihood ratio test Pearson test Sample size No Yes PC No 37 (7.9%) 21 (4.5%) 0.0037* 0.0038* 469 (100%) Yes 179 (38.2%) 232 (49.5%) PA No 126 (27.2%) 150 (32.3%) 0.9843 0.9843 464 (100%) Yes 86 (18.5%) 102 (22.0%) STI No 187 (40.0%) 193 (41.1%) 0.0033* 0.0036* 470 (100%) Yes 29 (6.2%) 61 (13.0%) TI No 191 (40.6%) 86 (18.3%) < 0.0001** < 0.0001** 470 (100%) Yes 25 (5.3%) 168 (35.7%) AC No 46 (9.8%) 58 (12.3%) 0.6886 0.6889 470 (100%) Yes 170 (36.2%) 196 (41.7%) TBS No 47 (10.0%) 12 (2.6%) < 0.0001** < 0.0001** 469 (100%) Yes 168 (35.8%) 242 (51.6%) p -value: * <0.01, ** <0.001 Abbreviations: MH, history of daily/regular methamphetamine use; PC, history of psychiatric consultation; PA, history of psychiatric hospital admission; STI, history of sexually transmitted infections; TI, history of daily/regular thinner inhalation; AC, history of daily/regular alcohol consumption; TBS, history of daily/regular tobacco smoking. Table 3 Chi-square test results for the association between educational background and history of daily/regular methamphetamine use Educational background Sample size Junior high school Senior high school At least university MH No 110 (23.8%) 79 (17.1%) 21 (4.6%) 462 (100%) Yes 205 (44.4%) 43 (9.3%) 4 (0.9%) χ 2 ( 1 ) = P-value Likelihood ratio test: <0.0001, Pearson test: <0.0001 MH, history of daily/regular methamphetamine use. Table 1 presents the “initiation age” for daily/regular methamphetamine use, daily/regular thinner inhalation, daily/regular alcohol consumption, and daily/regular tobacco smoking. To explore the temporality of these associations, we compared the initiation ages of daily/regular methamphetamine use, daily/regular thinner inhalation, and daily/regular tobacco smoking using the paired t-test, with results shown in Table 4 . The temporality is important for investigating risk factors ( 13 ). Notably, the initiation age for methamphetamine use was significantly higher than that for thinner inhalation and tobacco smoking. Table 4 Paired t-test results for the initiation age of various substances Paired t-test for initiation age Between Sample size Average age of initiation (years) Average difference ± Standard error P-value (Prob > | t |) Thinner and Methamphetamine 167 Thinner: 14.6 Methamphetamine: 21.1 −6.5 ± 0.5 < 0.0001** Smoking and Methamphetamine 239 Smoking: 14.7 Methamphetamine: 22.1 −7.4 ± 0.5 < 0.0001** Smoking and Thinner 185 Smoking: 14.3 Thinner: 14.6 −0.3 ± 0.2 0.1391 p -value: ** < 0.001 The results of the multinomial regression analysis were as follows: when the history of daily/regular methamphetamine use was used as an independent variable, the p -values (from the likelihood radio test for each dependent variable) were 0.162 for educational background, 0.037 for history of psychiatric consultation, 0.438 for history of psychiatric hospital admission, 0.013 for history of sexually transmitted infections, < 0.0001 for history of daily/regular thinner inhalation, 0.038 for history of daily/regular alcohol consumption, and 0.0005 for history of daily/regular tobacco smoking. Discussion To the best of our knowledge, this study is the first to examine the association between daily/regular methamphetamine use and various social, medical, and addictive factors among inmates who consulted psychiatrists in prison. The results of the chi-square and paired t-tests were largely consistent with those of the multinomial regression analysis. However, in the multinomial regression analysis, educational background was not significantly associated with the history of daily/regular methamphetamine use. These results have important implications for preventing the initiation of methamphetamine use. However, it is essential to note that while this study establishes a chronological order using temporality, it does not confirm causality. A significant association was observed between the history of daily/regular methamphetamine use and the history of psychiatric consultation (Table 2 ). Conversely, no significant association was found between the history of daily/regular methamphetamine use and the history of psychiatric hospital admission (Table 2 ). This suggests that individuals who regularly use methamphetamine exhibit psychiatric disorders that are not severe enough to require hospitalization. Previous studies have primarily focused on methamphetamine addiction in psychiatric inpatients ( 5 , 6 , 10 , 14 ) and outpatients ( 5 , 7 , 15 ). The present findings raise questions about the necessity of hospital treatment for methamphetamine addiction. Instead, our results suggest that inmates with a history of methamphetamine may develop mild-to-moderate psychiatric disorders, leading them to seek psychiatric consultation. Although specific psychiatric disorders were not investigated in the present study, methamphetamine use has been linked to benzodiazepine abuse. In Japan, psychiatric disorders induced by methamphetamine are among the most common reasons for psychiatrist consultations by illicit drug users ( 16 ). In turn, this suggests that some patients with a history of methamphetamine use may seek psychiatric care to obtain benzodiazepine prescriptions. Moreover, amphetamines, which share pharmacological properties with methamphetamines, are considered among the most harmful substances to both users and society ( 17 ). This could be linked to criminal behavior. A significant association was also found between the history of daily/regular methamphetamine use and the history of sexually transmitted infections (Table 2 ). However, while the average initiation age (years) for methamphetamine use was 22.2 ± 7.1 years, data on the initiation age for sexually transmitted infections were unavailable (Table 1 ). Therefore, a direct association between the two could not be inferred. Previous research has linked the use of chemsex drugs to behaviors that increase the risk of sexually transmitted infections, particularly among men who have sex with men ( 18 ). However, due to the lack of data on sexual orientation in this study, further investigation is needed. Another significant association was observed between the history of daily/regular methamphetamine use and the history of daily/regular thinner inhalation (Table 2 ). In addition, daily/regular thinner inhalation was initiated at a significantly younger age than daily/regular methamphetamine use (Table 4 ). While this finding does not establish a causal relationship between thinner abuse and subsequent methamphetamine abuse, Tables 2 and 4 highlight the strength and temporality of the association, respectively ( 13 ). Thinners, primarily composed of mixed organic solvents like toluene, can be classified into various types. The inhalation of toluene, which is commonly used by children and adolescents for its intoxicating effects, is an important public health concern ( 19 ). Adolescent toluene abuse has been shown to affect specific neural pathways in the medial prefrontal cortex of the brain, which may contribute to future substance abuse ( 20 ). Similarly, a significant association was observed between the history of daily/regular methamphetamine use and the history of daily/regular tobacco smoking (Table 2 ). Moreover, daily/regular tobacco use was initiated at a significantly younger age than daily/regular methamphetamine use. Again, while this finding does not establish a causal relationship between tobacco smoking and subsequent methamphetamine use, Tables 2 and 4 demonstrate the strength and temporality of the relationship, respectively ( 13 ). Also, prior research suggests that tobacco use may precede methamphetamine use, either directly or through the use of other substances ( 10 ). Interestingly, no significant association was observed between daily/regular methamphetamine use and daily/regular alcohol consumption (Table 2 ). While substances like marijuana and alcohol influence different neurotransmitter systems, they both reinforce the dopaminergic pathway via the mesolimbic system ( 21 ). Nicotine exposure during adolescence has been linked to increased susceptibility to drug abuse, with nicotine and methamphetamine often being used together ( 22 ). The present study also found that a low educational background was significantly associated with daily/regular methamphetamine use (Table 3 ), aligning with the results of a previous study ( 10 ). However, in the multinomial regression analysis, this association was not significant, highlighting a key nuance in the findings. Notably, the initiation age (years) for daily/regular methamphetamine use was 22.1 ± 7.1 years, which was much older than the typical junior high school graduation age (15 years). This suggests that educational background influences methamphetamine use temporally rather than causally ( 13 ). The findings of the present study provide novel and valuable insights for developing strategies to prevent methamphetamine abuse and addiction. This research was inspired by real-world observations, followed by a review of existing literature, which revealed a lack of sufficient data. As a result, we conducted this study using available information. A key finding of the present study is that habitual tobacco smoking and/or thinner inhalation during childhood is associated with habitual methamphetamine use in young adulthood. Addressing this issue may require improvements in education and stronger regulations against thinner inhalation and tobacco smoking. However, such interventions may be challenging to implement, as they would require broader social and structural changes. On the other hand, addiction treatment in correctional facilities must integrate conventional programs into a newly developed hybrid system, considering the findings of this study. Regarding drug addiction treatment in correctional facilities, the current system in Japan seems to rely on two main approaches: First, incarceration prevents inmates from using methamphetamine during their sentence. Second, rehabilitation programs used in general society are also applied within correctional facilities. However, these methods alone have proven insufficient, as recidivism rates for methamphetamine abuse remain high. The findings of the present study suggest the need for a third approach: considering inmates’ history of daily/regular thinner inhalation and daily/regular tobacco smoking. Therefore, social reintegration is needed while developing rehabilitation strategies. A more comprehensive reintegration plan should incorporate these factors, ensuring that post-release support for individuals with methamphetamine addiction addresses comorbid substance abuse. The present study had several limitations. First, most data used in this study were collected through self-reported interviews, which may have affected reliability and limited the ability to establish causality. Second, this study could not precisely determine the duration or patterns of substance abuse. Third, only a limited range of sociodemographic data was collected; for example, information on family background, criminal records, previous occupations, and types of crime committed was unavailable due to confidentiality concerns. Fourth, the present study focused exclusively on male inmates in a single prison, potentially introducing selection bias. Fifth, this study might have methodological flaws, for example retrospective design and simple statistical method. Finally, potential confounding factors were not fully considered. Future research should aim to address these limitations by collecting more detailed data. Despite these limitations, the present study had some strengths. It highlighted the potential for integrating methamphetamine addiction treatment with interventions for thinner inhalation and nicotine dependence. However, methodological improvements are necessary for future research to strengthen these findings. Conclusion The history of daily/regular thinner inhalation and the history of daily/regular tobacco smoking may be potential risk factors for daily/regular methamphetamine use. The findings of this study can aid in the development of strategies for supporting and protecting both inmates struggling with methamphetamine addiction and individuals at risk of developing such dependencies. Abbreviations AC: history of daily/regular alcohol consumption JH: junior high school MH: history of daily/regular methamphetamine use PA: history of psychiatric hospital admission PC: history of psychiatric consultation SH: senior high school STI: history of sexually transmitted infections TI: history of daily/regular thinner inhalation TBS: history of daily/regular tobacco smoking UNI: university or more Declarations Ethical approval and consent to participate The current study adhered to the Declaration of Helsinki and was approved by the Ethics Review Committee of Correctional Medicine Academic Research Council, established by the Correction Bureau, Ministry of Justice of Japan. Consent for publication Not applicable. Availability of data and materials The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests The authors declare no competing interests. Funding The authors declare that this research was carried out without any financial support. Authors’ contributions MT: conceptualization, methodology, formal analysis, validation, writing - original draft preparation, writing ‐ review and editing. KT: validation, writing ‐ review and editing. TK: validation, writing ‐ review and editing. Acknowledgements We thank the staffs in the prison (who remain anonymous) for their dedicated and routine work, which contributed to the success of this study. References Potvin S, Pelletier J, Grot S, Hebert C, Barr AM, Lecomte T. Cognitive deficits in individuals with methamphetamine use disorder: A meta-analysis. Addict Behav. 2018;80:154-60. Yates JR. Pharmacological treatments for methamphetamine use disorder: Current status and future targets. Subst Abuse Rehabil. 2024;15:125-61. Stuart AM, Baker AL, Denham AMJ, Lee NK, Hall A, Oldmeadow C, et al. Psychological treatment for methamphetamine use and associated psychiatric symptom outcomes: A systematic review. J Subst Abuse Treat. 2020;109:61-79. Sekiguchi Y, Okada T, Okumura Y. Treatment response distinguishes persistent type of methamphetamine psychosis from schizophrenia spectrum disorder among inmates at Japanese medical prison. Front Psychiatry. 2021;12:629315. Akindipe T, Wilson D, Stein DJ. Psychiatric disorders in individuals with methamphetamine dependence: prevalence and risk factors. Metab Brain Dis. 2014;29:351-7. Chen CK, Lin SK, Sham PC, Ball D, Loh EW, Hsiao CC, et al. Pre-morbid characteristics and co-morbidity of methamphetamine users with and without psychosis. Psychol Med. 2003;33:1407-14. Karabulut S. Factors associated with psychotic and depressive symptoms in methamphetamine users. Iran J Psychiatry. 2024;19:1-10. Hancer Tok H, Tokur Kesgin M. Reasons for using methamphetamine: Systematic review. Arch Psychiatr Nurs. 2024;52:147-54. 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A study of longitudinal patterns of substance abuse with special reference to multiple use problems. Arukoru Kenkyuto Yakubutsu Ison. 1992;27:284-96. Basedow LA, Kuitunen-Paul S, Wiedmann MF, Ehrlich S, Roessner V, Golub Y. Verbal learning impairment in adolescents with methamphetamine use disorder: a cross-sectional study. BMC Psychiatry. 2021;21:166. Yamamoto T, Kimura T, Tamakoshi A, Matsumoto T. Variables associated with methamphetamine use within the past year and sex differences among patients with methamphetamine use disorder: A cross-sectional study in Japan. Am J Addict. 2022;31:134-41. Bonnet U, Specka M, Kanti AK, Scherbaum N. Differences between users' and addiction medicine experts' harm and benefit assessments of licit and illicit psychoactive drugs: Input for psychoeducation and legalization/restriction debates. Front Psychiatry. 2022;13:1041762. Ivey K, Bernstein KT, Kirkcaldy RD, Kissinger P, Edwards OW, Sanchez T, et al. Chemsex drug use among a national sample of sexually active men who have sex with men, - American men's internet survey, 2017-2020. Subst Use Misuse. 2023;58:728-34. Braunscheidel K, Okas M, Woodward JJ. Toluene alters the intrinsic excitability and excitatory synaptic transmission of basolateral amygdala neurons. Front Neurosci. 2024;18:1366216. Wayman WN, Woodward JJ. Exposure to the abused inhalant toluene alters medial prefrontal cortex physiology. Neuropsychopharmacology. 2018;43:912-24. Ren M, Lotfipour S. Nicotine gateway effects on adolescent substance use. West J Emerg Med. 2019;20:696-709. Carreno D, Facundo A, Cardenas A, Lotfipour S. Sub-chronic nicotine exposure influences methamphetamine self-administration and dopamine overflow in a sex-and genotype-dependent manner in humanized CHRNA6 3'-UTR SNP (rs2304297) adolescent rats. Front Pharmacol. 2024;15:1445303. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5504895","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":436971941,"identity":"c2b283b8-5628-4ddd-ba93-aa44594471d9","order_by":0,"name":"Masahiko Takaya","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA30lEQVRIiWNgGAWjYFACNijN3gAkDCwIa+CBa+E5ANIiQYoWiQQwSViLPfuxxM88NYflzSWfX93wo0CCgb+9OwG/LTxph6V5jh023Dk7p+xmD9BhEmfObiDgsPQGaR62w4wbbuek3eABajGQyCWghf9582+ef4ftN9w8k3bzD1FaJNKOSfO2HU7ccIP92G3ibLnxLM1ybl968oYzOWy3ZQwkeAj6hb0/zfjGm2/WthuOH392880fGzn+9l78WkCAiYehGWShAdhagspBgPEHQx3IwgdEqR4Fo2AUjIKRBwCcL0jzUQwfgAAAAABJRU5ErkJggg==","orcid":"","institution":"Osaka Prison","correspondingAuthor":true,"prefix":"","firstName":"Masahiko","middleName":"","lastName":"Takaya","suffix":""},{"id":436971942,"identity":"040d300a-4747-4b39-93d3-2f41bec24672","order_by":1,"name":"Kiyoto Takigawa","email":"","orcid":"","institution":"Kindai University","correspondingAuthor":false,"prefix":"","firstName":"Kiyoto","middleName":"","lastName":"Takigawa","suffix":""},{"id":436971943,"identity":"ac4cb8fb-2cc6-42bc-b1e7-d3c65229ad86","order_by":2,"name":"Tetsuji Kawata","email":"","orcid":"","institution":"Kyoto Prison","correspondingAuthor":false,"prefix":"","firstName":"Tetsuji","middleName":"","lastName":"Kawata","suffix":""}],"badges":[],"createdAt":"2024-11-22 13:23:38","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5504895/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5504895/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12888-025-06966-2","type":"published","date":"2025-05-22T15:58:20+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":83460242,"identity":"44608ad1-f724-425f-b0b8-28b3dae845ef","added_by":"auto","created_at":"2025-05-26 16:12:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":638018,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5504895/v1/e8d124c1-a006-471e-9bb9-ced00b5dfb47.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Potential Risk Factors for Methamphetamine Use Among Inmates in a Japanese Prison","fulltext":[{"header":"Background","content":"\u003cp\u003eMethamphetamine abuse has been widely reported to cause neurological damage, leading to mental disorders, physical diseases, and cognitive dysfunction (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). While some pharmacological treatments for methamphetamine-induced disorders have been explored, further clinical studies are needed (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Alternatively, psychological treatments for psychiatric symptoms associated with methamphetamine use have shown overall effectiveness (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, due to the wide range of psychiatric disorders associated with methamphetamine-induced neurological damage, treatment strategies remain insufficiently explored. Moreover, distinguishing between persistent methamphetamine-associated psychosis and schizophrenia based on behaviors and symptoms is particularly challenging (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Furthermore, comorbid psychiatric diseases complicate the treatment of illicit methamphetamine users (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Akindipe et al. showed that methamphetamine dependence is associated with mood, psychotic, and anxiety disorders, which can be classified into primary and substance-induced patterns, except for substance-induced anxiety disorder (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Earlier initiation and prolonged methamphetamine use have also been associated with a higher risk of psychosis (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Another study reported that the severity of psychotic and depressive symptoms in methamphetamine users, including the number of suicide attempts, correlated with the amount of methamphetamine used (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile numerous studies have reported the adverse events and comorbidities of methamphetamine addiction, fewer have examined the reasons for its use. Some individuals turn to methamphetamine for self-medication to alleviate emotional distress (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Brecht et al. analyzed drug initiation sequences in individuals seeking treatment for methamphetamine use and found that alcohol, marijuana, and tobacco use often preceded methamphetamine use (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The authors also reported that approximately one-third of methamphetamine users did not complete high school (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Another study also reported that methamphetamine-using felons exhibited psychosocial and behavioral characteristics (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The subjects included in the aforementioned study, which aimed to help reduce HIV/AIDS transmission by investigating methamphetamine user patterns, motivations, social networks, and risk behaviors, were recruited using posters and media campaigns, agencies, etc. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSome reasons for initiating methamphetamine use include performance enhancement, coping with personal challenges, and increasing sexual performance and impulse control. Given these factors, prevention programs, withdrawal support, and education on methamphetamine\u0026rsquo;s harmful effects are of paramount significance (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). However, achieving these goals is particularly challenging due to the high recidivism rates among methamphetamine users, highlighting the need for appropriate interventions that address the root causes of addiction and repeated offenses (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Hence, analyzing data from incarcerated individuals may provide valuable insights into these factors. To the best of our knowledge, no study has examined the pathways to methamphetamine use, including sociodemographic factors, specifically among inmates. In line with this, the present study aimed to determine the association between the history of the daily or regular use of methamphetamine and use of other substances as well as the association between methamphetamine abuse and sociographic background. In Japan, many prisons seem to offer drug addiction recovery guidance and social reintegration programs for eligible inmates. However, comorbid substance addictions, such as history of thinner inhalation alongside methamphetamine use, seem to be often overlooked in addiction treatment programs. Therefore, this study aimed to focus on this particular issue and offer insights that may improve the prevention and treatment of methamphetamine addiction, ultimately supporting inmates and individuals at risk.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSubjects\u003c/h2\u003e \u003cp\u003eOur study included 470 consecutive inmates whose data were obtained and who consulted a certified psychiatrist between March 2022 and January 2024 at the medical office of a prison in Japan (name withheld). Sampling was rational and not arbitrary, and only data obtained during this period were analyzed.\u003c/p\u003e \u003cp\u003eThis retrospective study used data from medical records based on routine intake questionnaires completed at prison admission and in the first psychiatric examination. These data might be valuable for planning drug addiction recovery programs for inmates struggling with stimulants or other substance addictions. In addition, these data could play a crucial role in developing social reintegration programs aimed at preventing recidivism. Both addiction recovery and social reintegration programs aim to reduce repeat offenses.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eVariables\u003c/h3\u003e\n\u003cp\u003eThis study analyzed the following variables: age, educational background, history of psychiatric consultation, history of psychiatric hospital admission, history of sexually transmitted infections, history of daily/regular methamphetamine use (average initiation age), history of daily/regular thinner inhalation (average initiation age), history of daily/regular alcohol consumption (average initiation age), and history of daily/regular tobacco smoking (average initiation age). Analyzing these factors may provide key insights for the recidivism prevention plan among inmates in Japan.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eAll analyses were conducted using JMP 8 (SAS Institute Inc., Cary, NC, USA). Chi-square test was used to assess the association between the history of daily/regular methamphetamine use and other variables. A paired t-test was used to determine whether a significant difference existed between initiation ages of methamphetamine and other substances, in addition to identifying any significant associations. A multinomial regression analysis (n\u0026thinsp;=\u0026thinsp;459) was performed, adjusting for potential confounding factors, to more accurately evaluate the independent relationships between methamphetamine use and other variables. A \u003cem\u003ep\u003c/em\u003e-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eDemographic data are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, with the right-most column displaying the number of subjects for each variable. The results of the association between the history of daily/regular methamphetamine use and other variables, including history of psychiatric consultation, history of psychiatric hospital admission, history of sexually transmitted infections, history of daily/regular thinner inhalation, history of daily/regular alcohol consumption, and history of daily/regular tobacco smoking, are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The association between the history of daily/regular methamphetamine use and educational background is presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Notably, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e indicates that the history of daily/regular methamphetamine use was significantly associated with the history of psychiatric consultation, history of sexually transmitted infections, history of daily/regular thinner inhalation, and history of daily/regular tobacco smoking. Moreover, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows that a lower educational background was significantly associated with the history of daily/regular methamphetamine use.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocial background and history of substance addiction, including initiation age\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSample size\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years), average\u0026thinsp;\u0026plusmn;\u0026thinsp;s.d.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45.3\u0026thinsp;\u0026plusmn;\u0026thinsp;12.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e470\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e470\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEducational background\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJH: 315 (68.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e462\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSH: 122 (26.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUNI: 25 (5.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of psychiatric consultation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo: 58 (12.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e469\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes: 411 (87.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of psychiatric hospital admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo: 276 (59.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e464\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes: 188 (40.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of sexually transmitted infections\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo: 380 (80.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e470\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes: 90 (19.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of daily/regular methamphetamine use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo: 216 (46.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e470\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes: 254 (54.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage initiation age (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.2\u0026thinsp;\u0026plusmn;\u0026thinsp;7.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e251\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of daily/regular thinner inhalation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo: 277 (59.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e470\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes: 193 (41.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage initiation age (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e192\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of daily/regular alcohol consumption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo: 104 (22.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e470\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes: 366 (77.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage initiation age (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e360\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of daily/regular tobacco smoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo: 59 (12.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e469\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes: 410 (87.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage initiation age (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e410\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eAbbreviations: JH, junior high school; SH, senior high school; UNI, university or higher\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eChi-square test results\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eMH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003cp\u003eLikelihood ratio test\u003c/p\u003e \u003cp\u003ePearson test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSample size\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003cp\u003e(7.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003cp\u003e(4.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.0037*\u003c/p\u003e \u003cp\u003e0.0038*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e469\u003c/p\u003e \u003cp\u003e(100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e179\u003c/p\u003e \u003cp\u003e(38.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e232\u003c/p\u003e \u003cp\u003e(49.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e126\u003c/p\u003e \u003cp\u003e(27.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e150\u003c/p\u003e \u003cp\u003e(32.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.9843\u003c/p\u003e \u003cp\u003e0.9843\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e464\u003c/p\u003e \u003cp\u003e(100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86\u003c/p\u003e \u003cp\u003e(18.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e102\u003c/p\u003e \u003cp\u003e(22.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSTI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e187\u003c/p\u003e \u003cp\u003e(40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e193\u003c/p\u003e \u003cp\u003e(41.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.0033*\u003c/p\u003e \u003cp\u003e0.0036*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e470\u003c/p\u003e \u003cp\u003e(100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003cp\u003e(6.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61\u003c/p\u003e \u003cp\u003e(13.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e191\u003c/p\u003e \u003cp\u003e(40.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86\u003c/p\u003e \u003cp\u003e(18.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001**\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e470\u003c/p\u003e \u003cp\u003e(100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003cp\u003e(5.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e168\u003c/p\u003e \u003cp\u003e(35.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003cp\u003e(9.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58\u003c/p\u003e \u003cp\u003e(12.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.6886\u003c/p\u003e \u003cp\u003e0.6889\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e470\u003c/p\u003e \u003cp\u003e(100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e170\u003c/p\u003e \u003cp\u003e(36.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e196\u003c/p\u003e \u003cp\u003e(41.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTBS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003cp\u003e(10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003cp\u003e(2.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001**\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e469\u003c/p\u003e \u003cp\u003e(100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e168\u003c/p\u003e \u003cp\u003e(35.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e242\u003c/p\u003e \u003cp\u003e(51.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003ep\u003c/em\u003e-value: * \u0026lt;0.01, ** \u0026lt;0.001\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eAbbreviations: MH, history of daily/regular methamphetamine use; PC, history of psychiatric consultation; PA, history of psychiatric hospital admission; STI, history of sexually transmitted infections; TI, history of daily/regular thinner inhalation; AC, history of daily/regular alcohol consumption; TBS, history of daily/regular tobacco smoking.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eChi-square test results for the association between educational background and history of daily/regular methamphetamine use\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eEducational background\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSample\u003c/p\u003e \u003cp\u003esize\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJunior high school\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSenior high school\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAt least university\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e110\u003c/p\u003e \u003cp\u003e(23.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79\u003c/p\u003e \u003cp\u003e(17.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21\u003c/p\u003e \u003cp\u003e(4.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e462\u003c/p\u003e \u003cp\u003e(100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e205\u003c/p\u003e \u003cp\u003e(44.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43\u003c/p\u003e \u003cp\u003e(9.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e(0.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;P-value\u003c/p\u003e \u003cp\u003eLikelihood ratio test: \u0026lt;0.0001, Pearson test: \u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eMH, history of daily/regular methamphetamine use.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the \u0026ldquo;initiation age\u0026rdquo; for daily/regular methamphetamine use, daily/regular thinner inhalation, daily/regular alcohol consumption, and daily/regular tobacco smoking. To explore the temporality of these associations, we compared the initiation ages of daily/regular methamphetamine use, daily/regular thinner inhalation, and daily/regular tobacco smoking using the paired t-test, with results shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. The temporality is important for investigating risk factors (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Notably, the initiation age for methamphetamine use was significantly higher than that for thinner inhalation and tobacco smoking.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePaired t-test results for the initiation age of various substances\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePaired t-test for initiation age\u003c/p\u003e \u003cp\u003eBetween\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSample size\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAverage age of initiation (years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAverage difference\u003c/p\u003e \u003cp\u003e\u0026plusmn; Standard error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value (Prob \u0026gt; | t |)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThinner\u003c/p\u003e \u003cp\u003eand\u003c/p\u003e \u003cp\u003eMethamphetamine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThinner:\u003c/p\u003e \u003cp\u003e14.6\u003c/p\u003e \u003cp\u003eMethamphetamine:\u003c/p\u003e \u003cp\u003e21.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;6.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003cp\u003eand\u003c/p\u003e \u003cp\u003eMethamphetamine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e239\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSmoking:\u003c/p\u003e \u003cp\u003e14.7\u003c/p\u003e \u003cp\u003eMethamphetamine:\u003c/p\u003e \u003cp\u003e22.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;7.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003cp\u003eand\u003c/p\u003e \u003cp\u003eThinner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSmoking:\u003c/p\u003e \u003cp\u003e14.3\u003c/p\u003e \u003cp\u003eThinner:\u003c/p\u003e \u003cp\u003e14.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1391\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003ep\u003c/em\u003e-value: ** \u0026lt; 0.001\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe results of the multinomial regression analysis were as follows: when the history of daily/regular methamphetamine use was used as an independent variable, the \u003cem\u003ep\u003c/em\u003e-values (from the likelihood radio test for each dependent variable) were 0.162 for educational background, 0.037 for history of psychiatric consultation, 0.438 for history of psychiatric hospital admission, 0.013 for history of sexually transmitted infections, \u0026lt;\u0026thinsp;0.0001 for history of daily/regular thinner inhalation, 0.038 for history of daily/regular alcohol consumption, and 0.0005 for history of daily/regular tobacco smoking.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo the best of our knowledge, this study is the first to examine the association between daily/regular methamphetamine use and various social, medical, and addictive factors among inmates who consulted psychiatrists in prison. The results of the chi-square and paired t-tests were largely consistent with those of the multinomial regression analysis. However, in the multinomial regression analysis, educational background was not significantly associated with the history of daily/regular methamphetamine use. These results have important implications for preventing the initiation of methamphetamine use. However, it is essential to note that while this study establishes a chronological order using temporality, it does not confirm causality.\u003c/p\u003e \u003cp\u003eA significant association was observed between the history of daily/regular methamphetamine use and the history of psychiatric consultation (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Conversely, no significant association was found between the history of daily/regular methamphetamine use and the history of psychiatric hospital admission (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This suggests that individuals who regularly use methamphetamine exhibit psychiatric disorders that are not severe enough to require hospitalization. Previous studies have primarily focused on methamphetamine addiction in psychiatric inpatients (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) and outpatients (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The present findings raise questions about the necessity of hospital treatment for methamphetamine addiction. Instead, our results suggest that inmates with a history of methamphetamine may develop mild-to-moderate psychiatric disorders, leading them to seek psychiatric consultation. Although specific psychiatric disorders were not investigated in the present study, methamphetamine use has been linked to benzodiazepine abuse. In Japan, psychiatric disorders induced by methamphetamine are among the most common reasons for psychiatrist consultations by illicit drug users (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). In turn, this suggests that some patients with a history of methamphetamine use may seek psychiatric care to obtain benzodiazepine prescriptions. Moreover, amphetamines, which share pharmacological properties with methamphetamines, are considered among the most harmful substances to both users and society (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). This could be linked to criminal behavior.\u003c/p\u003e \u003cp\u003eA significant association was also found between the history of daily/regular methamphetamine use and the history of sexually transmitted infections (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). However, while the average initiation age (years) for methamphetamine use was 22.2\u0026thinsp;\u0026plusmn;\u0026thinsp;7.1 years, data on the initiation age for sexually transmitted infections were unavailable (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Therefore, a direct association between the two could not be inferred. Previous research has linked the use of chemsex drugs to behaviors that increase the risk of sexually transmitted infections, particularly among men who have sex with men (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). However, due to the lack of data on sexual orientation in this study, further investigation is needed.\u003c/p\u003e \u003cp\u003eAnother significant association was observed between the history of daily/regular methamphetamine use and the history of daily/regular thinner inhalation (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). In addition, daily/regular thinner inhalation was initiated at a significantly younger age than daily/regular methamphetamine use (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). While this finding does not establish a causal relationship between thinner abuse and subsequent methamphetamine abuse, Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e highlight the strength and temporality of the association, respectively (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Thinners, primarily composed of mixed organic solvents like toluene, can be classified into various types. The inhalation of toluene, which is commonly used by children and adolescents for its intoxicating effects, is an important public health concern (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Adolescent toluene abuse has been shown to affect specific neural pathways in the medial prefrontal cortex of the brain, which may contribute to future substance abuse (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSimilarly, a significant association was observed between the history of daily/regular methamphetamine use and the history of daily/regular tobacco smoking (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Moreover, daily/regular tobacco use was initiated at a significantly younger age than daily/regular methamphetamine use. Again, while this finding does not establish a causal relationship between tobacco smoking and subsequent methamphetamine use, Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e demonstrate the strength and temporality of the relationship, respectively (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Also, prior research suggests that tobacco use may precede methamphetamine use, either directly or through the use of other substances (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Interestingly, no significant association was observed between daily/regular methamphetamine use and daily/regular alcohol consumption (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). While substances like marijuana and alcohol influence different neurotransmitter systems, they both reinforce the dopaminergic pathway via the mesolimbic system (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Nicotine exposure during adolescence has been linked to increased susceptibility to drug abuse, with nicotine and methamphetamine often being used together (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe present study also found that a low educational background was significantly associated with daily/regular methamphetamine use (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), aligning with the results of a previous study (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). However, in the multinomial regression analysis, this association was not significant, highlighting a key nuance in the findings. Notably, the initiation age (years) for daily/regular methamphetamine use was 22.1\u0026thinsp;\u0026plusmn;\u0026thinsp;7.1 years, which was much older than the typical junior high school graduation age (15 years). This suggests that educational background influences methamphetamine use temporally rather than causally (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe findings of the present study provide novel and valuable insights for developing strategies to prevent methamphetamine abuse and addiction. This research was inspired by real-world observations, followed by a review of existing literature, which revealed a lack of sufficient data. As a result, we conducted this study using available information. A key finding of the present study is that habitual tobacco smoking and/or thinner inhalation during childhood is associated with habitual methamphetamine use in young adulthood. Addressing this issue may require improvements in education and stronger regulations against thinner inhalation and tobacco smoking. However, such interventions may be challenging to implement, as they would require broader social and structural changes. On the other hand, addiction treatment in correctional facilities must integrate conventional programs into a newly developed hybrid system, considering the findings of this study. Regarding drug addiction treatment in correctional facilities, the current system in Japan seems to rely on two main approaches: First, incarceration prevents inmates from using methamphetamine during their sentence. Second, rehabilitation programs used in general society are also applied within correctional facilities. However, these methods alone have proven insufficient, as recidivism rates for methamphetamine abuse remain high. The findings of the present study suggest the need for a third approach: considering inmates\u0026rsquo; history of daily/regular thinner inhalation and daily/regular tobacco smoking. Therefore, social reintegration is needed while developing rehabilitation strategies. A more comprehensive reintegration plan should incorporate these factors, ensuring that post-release support for individuals with methamphetamine addiction addresses comorbid substance abuse.\u003c/p\u003e \u003cp\u003eThe present study had several limitations. First, most data used in this study were collected through self-reported interviews, which may have affected reliability and limited the ability to establish causality. Second, this study could not precisely determine the duration or patterns of substance abuse. Third, only a limited range of sociodemographic data was collected; for example, information on family background, criminal records, previous occupations, and types of crime committed was unavailable due to confidentiality concerns. Fourth, the present study focused exclusively on male inmates in a single prison, potentially introducing selection bias. Fifth, this study might have methodological flaws, for example retrospective design and simple statistical method. Finally, potential confounding factors were not fully considered. Future research should aim to address these limitations by collecting more detailed data.\u003c/p\u003e \u003cp\u003eDespite these limitations, the present study had some strengths. It highlighted the potential for integrating methamphetamine addiction treatment with interventions for thinner inhalation and nicotine dependence. However, methodological improvements are necessary for future research to strengthen these findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe history of daily/regular thinner inhalation and the history of daily/regular tobacco smoking may be potential risk factors for daily/regular methamphetamine use. The findings of this study can aid in the development of strategies for supporting and protecting both inmates struggling with methamphetamine addiction and individuals at risk of developing such dependencies.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAC: history of daily/regular alcohol consumption\u003c/p\u003e\n\u003cp\u003eJH: junior high school\u003c/p\u003e\n\u003cp\u003eMH: history of daily/regular methamphetamine use\u003c/p\u003e\n\u003cp\u003ePA: history of psychiatric hospital admission\u003c/p\u003e\n\u003cp\u003ePC: history of psychiatric consultation\u003c/p\u003e\n\u003cp\u003eSH: senior high school\u003c/p\u003e\n\u003cp\u003eSTI: history of sexually transmitted infections\u003c/p\u003e\n\u003cp\u003eTI: history of daily/regular thinner inhalation\u003c/p\u003e\n\u003cp\u003eTBS: history of daily/regular tobacco smoking\u003c/p\u003e\n\u003cp\u003eUNI: university or more\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe current study adhered to the Declaration of Helsinki and was approved by the Ethics Review Committee of Correctional Medicine Academic Research Council, established by the Correction Bureau, Ministry of Justice of Japan.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that this research was carried out without any financial support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMT: conceptualization, methodology, formal analysis, validation, writing - original draft preparation, writing ‐ review and editing. KT: validation, writing ‐ review and editing. TK: validation, writing ‐ review and editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the staffs in the prison (who remain anonymous) for their dedicated and routine work, which contributed to the success of this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePotvin S, Pelletier J, Grot S, Hebert C, Barr AM, Lecomte T. Cognitive deficits in individuals with methamphetamine use disorder: A meta-analysis. Addict Behav. 2018;80:154-60.\u003c/li\u003e\n\u003cli\u003eYates JR. Pharmacological treatments for methamphetamine use disorder: Current status and future targets. Subst Abuse Rehabil. 2024;15:125-61.\u003c/li\u003e\n\u003cli\u003eStuart AM, Baker AL, Denham AMJ, Lee NK, Hall A, Oldmeadow C, et al. Psychological treatment for methamphetamine use and associated psychiatric symptom outcomes: A systematic review. J Subst Abuse Treat. 2020;109:61-79.\u003c/li\u003e\n\u003cli\u003eSekiguchi Y, Okada T, Okumura Y. Treatment response distinguishes persistent type of methamphetamine psychosis from schizophrenia spectrum disorder among inmates at Japanese medical prison. Front Psychiatry. 2021;12:629315.\u003c/li\u003e\n\u003cli\u003eAkindipe T, Wilson D, Stein DJ. Psychiatric disorders in individuals with methamphetamine dependence: prevalence and risk factors. Metab Brain Dis. 2014;29:351-7.\u003c/li\u003e\n\u003cli\u003eChen CK, Lin SK, Sham PC, Ball D, Loh EW, Hsiao CC, et al. Pre-morbid characteristics and co-morbidity of methamphetamine users with and without psychosis. Psychol Med. 2003;33:1407-14.\u003c/li\u003e\n\u003cli\u003eKarabulut S. Factors associated with psychotic and depressive symptoms in methamphetamine users. Iran J Psychiatry. 2024;19:1-10.\u003c/li\u003e\n\u003cli\u003eHancer Tok H, Tokur Kesgin M. Reasons for using methamphetamine: Systematic review. Arch Psychiatr Nurs. 2024;52:147-54.\u003c/li\u003e\n\u003cli\u003eHansen ER, Carvalho S, McDonald M, Havens JR. A qualitative examination of recent increases in methamphetamine use in a cohort of rural people who use drugs. Drug Alcohol Depend. 2021;229:109145.\u003c/li\u003e\n\u003cli\u003eBrecht ML, Greenwell L, Anglin MD. Substance use pathways to methamphetamine use among treated users. Addict Behav. 2007;32:24-38.\u003c/li\u003e\n\u003cli\u003eSemple SJ, Zians J, Strathdee SA, Patterson TL. Methamphetamine-using felons: psychosocial and behavioral characteristics. Am J Addict. 2008;17:28-35.\u003c/li\u003e\n\u003cli\u003eSherman SG, Sutcliffe CG, Srirojn B, German D, Thomson N, Aramrattana A, Celentano DD. Predictors and consequences of incarceration among a sample of young Thai methamphetamine users. Drug Alcohol Rev. 2010;29:399-405.\u003c/li\u003e\n\u003cli\u003eOliver D, Chesney E, Cullen AE, Davies C, Englund A, Gifford G, et al. Exploring causal mechanisms of psychosis risk. Neurosci Biobehav Rev. 2024;162:105699.\u003c/li\u003e\n\u003cli\u003eSuwaki H, Yamasaki M, Horii S, Watanabe T, Kazunaga H, Fujimoto A. A study of longitudinal patterns of substance abuse with special reference to multiple use problems. Arukoru Kenkyuto Yakubutsu Ison. 1992;27:284-96.\u003c/li\u003e\n\u003cli\u003eBasedow LA, Kuitunen-Paul S, Wiedmann MF, Ehrlich S, Roessner V, Golub Y. Verbal learning impairment in adolescents with methamphetamine use disorder: a cross-sectional study. BMC Psychiatry. 2021;21:166.\u003c/li\u003e\n\u003cli\u003eYamamoto T, Kimura T, Tamakoshi A, Matsumoto T. Variables associated with methamphetamine use within the past year and sex differences among patients with methamphetamine use disorder: A cross-sectional study in Japan. Am J Addict. 2022;31:134-41.\u003c/li\u003e\n\u003cli\u003eBonnet U, Specka M, Kanti AK, Scherbaum N. Differences between users\u0026apos; and addiction medicine experts\u0026apos; harm and benefit assessments of licit and illicit psychoactive drugs: Input for psychoeducation and legalization/restriction debates. Front Psychiatry. 2022;13:1041762.\u003c/li\u003e\n\u003cli\u003eIvey K, Bernstein KT, Kirkcaldy RD, Kissinger P, Edwards OW, Sanchez T, et al. Chemsex drug use among a national sample of sexually active men who have sex with men, - American men\u0026apos;s internet survey, 2017-2020. Subst Use Misuse. 2023;58:728-34.\u003c/li\u003e\n\u003cli\u003eBraunscheidel K, Okas M, Woodward JJ. Toluene alters the intrinsic excitability and excitatory synaptic transmission of basolateral amygdala neurons. Front Neurosci. 2024;18:1366216.\u003c/li\u003e\n\u003cli\u003eWayman WN, Woodward JJ. Exposure to the abused inhalant toluene alters medial prefrontal cortex physiology. Neuropsychopharmacology. 2018;43:912-24.\u003c/li\u003e\n\u003cli\u003eRen M, Lotfipour S. Nicotine gateway effects on adolescent substance use. West J Emerg Med. 2019;20:696-709.\u003c/li\u003e\n\u003cli\u003eCarreno D, Facundo A, Cardenas A, Lotfipour S. Sub-chronic nicotine exposure influences methamphetamine self-administration and dopamine overflow in a sex-and genotype-dependent manner in humanized CHRNA6 3\u0026apos;-UTR SNP (rs2304297) adolescent rats. Front Pharmacol. 2024;15:1445303.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Methamphetamine, pathway, causality, strength, temporality, inmates, prison, Japan","lastPublishedDoi":"10.21203/rs.3.rs-5504895/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5504895/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003eIn Japan, drug addiction recovery guidance and social reintegration programs are implemented for eligible inmates in many prisons. However, methamphetamine addiction, especially among those with a history of thinner inhalation, often seems not to be adequately addressed in addiction treatment programs. The comorbidities of substance use disorders may be generally overlooked. This study aimed to provide valuable data for guiding the development of programs to combat drug addiction and support social reintegration for inmates. The first step of this study sought to determine the association between history of daily/regular methamphetamine use and use of other substances as well as the relationship between methamphetamine use and sociodemographic background.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis retrospective study included 470 consecutive inmates whose data were obtained andwho consulted a certified psychiatrist. Chi-square tests and paired t-tests were used for the analysis. Furthermore, a multinominal regression analysis was performed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eOur findings revealed that\u003cstrong\u003e \u003c/strong\u003ethe history of daily/regular methamphetamine use was significantly associated with the history of psychiatric consultation, sexually transmitted infections, daily/regular thinner inhalation, and daily/regularly tobacco smoking. Moreover, daily/regular thinner inhalation was initiated at a significantly younger age than methamphetamine use. In addition, tobacco smoking was initiated at a significantly younger age than methamphetamine use.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe present study suggested that a history of daily/regular thinner inhalation and daily/regular tobacco smoking may serve as potential risk factors for the development of daily/regular methamphetamine use. These results may provide valuable insights for supporting and protecting inmates with methamphetamine addiction as well as individuals at risk.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration:\u003c/strong\u003e Not applicable.\u003c/p\u003e","manuscriptTitle":"Potential Risk Factors for Methamphetamine Use Among Inmates in a Japanese Prison","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-02 14:22:30","doi":"10.21203/rs.3.rs-5504895/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-06T06:51:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-06T06:45:59+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-14T11:14:23+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-14T06:32:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"144073765223778768695165166606414287197","date":"2025-04-06T00:58:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-04T13:35:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"161151008601706487544638820672692291687","date":"2025-04-04T13:19:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"154856320222225885664628694632746597372","date":"2025-04-04T10:48:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-01T14:24:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-24T09:23:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychiatry","date":"2025-03-20T10:25:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"107dcb98-ef81-44ba-aaea-df6560f18115","owner":[],"postedDate":"April 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-05-26T16:07:44+00:00","versionOfRecord":{"articleIdentity":"rs-5504895","link":"https://doi.org/10.1186/s12888-025-06966-2","journal":{"identity":"bmc-psychiatry","isVorOnly":false,"title":"BMC Psychiatry"},"publishedOn":"2025-05-22 15:58:20","publishedOnDateReadable":"May 22nd, 2025"},"versionCreatedAt":"2025-04-02 14:22:30","video":"","vorDoi":"10.1186/s12888-025-06966-2","vorDoiUrl":"https://doi.org/10.1186/s12888-025-06966-2","workflowStages":[]},"version":"v1","identity":"rs-5504895","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5504895","identity":"rs-5504895","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}