The challenge of effective prison drug treatment

Large-scale study of need

It is essential that the support provided to prisoners with a drug or alcohol problem extends well beyond the focus on drug treatment itself to address major long standing and deep rooted areas of difficulty in the prisoners’ lives.

That is the conclusion of a recent (10 May 2016) article by Professor Neil McKeganey, Charlie Lloyd and colleagues in Drugs: Education, Prevention and Policy. The article, entitled, “Meeting the needs of prisoners with a drug or alcohol problem: No mean feat” is based on structured interviews with 319 prisoners beginning enhanced treatment on drug recovery wings in prisons in England and Wales.

Wider research

This article is part of a wider Department of Health research study looking at six drug recovery wings (all in male prisons), combining both a process and outcome evaluation. Most of this blog posts summarises the key findings from the prisoner interviewees regarding their substance misuse, mental health and other needs.

Substance use

As you can see from the table reproduced below, 39% prisoners reported drinking higher strength beer almost every day over the last week (in the community) and 27% reported drinking spirits with the same frequency. With regard to illicit drug use 41% of our prisoners had used heroin, 46% had used cocaine, 39% crack cocaine, 68% cannabis and 31% amphetamines (all in the last six months). 37% prisoners were injecting drug users and 85% were regular smokers.

DRW McGeg 1

Mental health

One third of these prisoners had received a past diagnosis of a major depressive disorder, 30% had received a past prescription for medication
in response to a depressive disorder and 19% were currently receiving such a prescription. Generalised anxiety disorder had been diagnosed in 6% of prisoners, 3% of prisoners were currently receiving prescription medication for this condition.

Twelve percent of our sample had reported past emotional abuse and 17% reported past physical abuse by a parent or guardian before age 13. Twenty percentage reported having been in receipt of counselling or psychiatric care before age 13. Over three quarters (77%) had been either temporarily or permanently excluded from school.

Family and friends

Many of these prisoners reported that their family members and close friends were also involved in drug-taking and criminal behaviour. 21% of prisoners reported that their spouse had committed offences, 29% reported having parents that had committed offences and 78% having close friends who had committed offences. Nearly one third of prisoners had a sibling who had spent time in prison.

Similarly, 44% prisoners reported having a spouse or a parent that had used illegal drugs 35% had siblings who had used illegal drugs and fully 80% had friends who had used illegal drugs.

Motivation for being on the drug recovery wing

One of the most interesting sections of this short article looks at these drug using prisoners’ motivations for being on the drug recovery wing. The full table of responses to a series of 15 possible motivations is reproduced below.

DRW McGeg 2

There was strong support amongst the prisoners surveyed on the importance of receiving treatment with 81% agreeing or strongly agreeing that they needed help in dealing with drug use 82% agreeing or strongly agreeing that treatment programmes can help them 90% agreeing or strongly agreeing that they wanted to be in treatment and 98% agreeing or strongly agreeing that they wanted to get their life straightened out.

In terms of the prisoners’ own views as to what they felt would most help their efforts to cease offending on their release 80% cited having a job, 79% cited ceasing their drug use, and 78% cited having a place to live.

Conclusion

The authors draw two main conclusions from their research with which it is hard to argue.

Firstly, they point to the fact that treatment is likely to need to be holistic and extensive to be effective:

Meeting the needs of prisoners with a drug or alcohol problem will inevitably require moving well beyond the realm of substance use treatment to remedying long standing behavioural, attitudinal, contextual and familial problems in the prisoners’ lives – many of which will have been deep rooted and long standing.

Secondly, (and there is a substantial international evidence base to support this conclusion) that support in the community on release is critical:

These figures underline the importance of not only ensuring that prisoners receive appropriate treatment whilst in prison but also the importance of maintaining that support following release.

 

If  you’re interested in working with drug users in prison, there are a number of current vacancies on my jobs board.

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