An exciting new report from the Ex-Prisoners Recovering From Addiction (EPRA) Working Group sets out blueprints for the treatment and throughcare of prisoners with histories of drug dependence.
Previous research has shown a ‘cliff-edge’ of support for released prisoners recovering from substance abuse. Whilst prison interventions can effectively initiate recovery journeys, prisoners’ hopes for transformation become unrealistic when they are released homeless and unsupported. The Ex-prisoners Recovering from Addiction (EPRA) Expert Working Group, chaired by Lord Patel of Bradord, was thus set up to produce evidence-based blueprints for the effective treatment and throughcare of prisoners recovering from addiction to drugs and/or alcohol.
In the course of its work, EPRA has considered reviews of the research evidence, received reports on promising approaches around the country and had feedback from focus groups of male and female prisoners with histories of substance misuse. Reflecting different needs and opportunities, four blueprints have been developed separated by gender (men and women) and sentence length (short and longer sentences).
The EPRA Report details the four blueprints, provides a synthesis of the evidence base underpinning them, and presents a cost-benefit analysis for each model. The EPRA Working Group believes that evaluated trials of these blueprints will demonstrate clear benefits and cost savings, by transforming post-release support for prisoners who seek to make fundamental changes to their lives.
A number of common features underpin the EPRA blueprints:
- A ‘life-changing’ phase of treatment, which is essential for transformative change.
- Dedicated, segregated units within prisons providing secure environments for initiating prisoners’ recovery journeys, free from novel psychoactive substances and other drugs.
- Maximised use of the Home Detention Curfew (HDC) which allows prisoners to be released early, reducing the costs of imprisonment and overcrowding. While HDC rates have increased, prisoners with no secure address are not eligible.
- OST detoxification taking place prior to entry into abstinence-focused prison units.
- Psychosocial support as the cornerstone of treatment, delivered by diploma-level counsellors and supported by recovery workers with relevant lived experience.
- Treatment completion is timed to coincide with HDC eligibility, creating a seamless supported transition whilst reducing both the costs of imprisonment and overcrowding.
- Prisoners move from abstinence-focused prison treatment into abstinence-focused, substance misuse specialist community accommodation.
- Ex-prisoners are motivated to engage with the full treatment pathway by benefits including early release and a gold standard package of enhanced post-release support.
- HDC requires individuals to continue engaging with residential treatment. Disengagement results in their return to prison through a fixed-term recall.
- Throughout both prison and community provision, a strong emphasis is placed on progressing to secure independent tenancies, maintaining or re-establishing family ties and providing education, training and employment opportunities.
For prisoners with only a few months left to serve intensive prison treatment is an essential starting point,
providing prisoners with introductions to tools for abstinence initiation and maintenance, support networks, and an
understanding of the pathway into the community. The EPRA model consequently pairs a short prison intervention
with a longer, intensive, life-changing phase of residential treatment following their release.
Longer term prisoners can access substantive abstinence-focused programmes (such as 6-18 month Therapeutic
Communities), which mirror community-based residential treatment. Following this life-changing phase of treatment,
ex-prisoners would enter less intensive drug-free supported housing with a focus on meeting other resettlement needs.
- Reflecting their greater levels of more complex needs, programmes must take account of historic trauma, women’s concerns around childcare and custody, and abusive partners.
- Women released from long-term prison programmes should ideally move on to women-only residential treatment services. However, there are few of these.
- All staff working in prison units should be trauma aware. All units should be women-only.
- Treatment should be evidence-based, theory-informed and trauma aware, although no such prison programmes have been identified.
- The lack of women-only community services argues for doing as much as possible inside prison – delivering longer, lifechanging prison interventions wherever this is possible.
- However, all prison programmes have to be followed by packages of support that can enable women to sustain life changes after release. Piecing these together requires serious consideration of local conditions, and the context to which women will return.
EPRA analysis shows that even the most intensive community-based residential programmes cost about the same as
imprisonment for men and are cheaper than imprisonment for women. Specialist drug-free supported housing is much
cheaper than imprisonment. Models estimating the costs of the elements described in the blueprints show that:
- the blueprints for men and women serving longer sentences would be cheaper than current provision, even without reductions in re-offending and re-imprisonment; and
- in the short-term blueprints, investment would be needed in order to fund residential treatment in the community. However, small reductions in offending would outweigh these costs. Prisoners eligible for these interventions currently receive little support, but are attended by much higher rates of reoffending.
Nearly 20% of prisoners serving short sentences are released homeless, with 10% released to unsettled accommodation. Even higher proportions of the EPRA target group fall within these categories. As they are unlikely to be released on HDC and re-offend at a very high rate, the investment required to deliver the short-term blueprint brings with it much greater transformative (and cost-saving) potential.
EPRA argues convincingly that these blueprints offer an outstanding potential for spending better to save, by conceiving of abstinence-focused interventions as a start-to-end process and not a process that begins in prisons, and ends at the prison gates.