Earlier this week the Scottish Government published the latest in a series of health needs assessments of people in prison in Scotland with this research paper focusing on substance use. Despite a lack of reliable data, the report concludes that the the nature of drug use within Scottish prisons has changed dramatically over the last decade. Where previously this would have been heroin orientated, it is currently dominated by a combination of Novel Psychoactive Substances, Cannabinoids and ‘Street Benzos’ (most commonly Etizolam). For most individuals, illegal and illicit drugs continue to be readily available.
Consumption choices are directed by what drugs are available rather than by what people might use outside of prison. Drug use and supply remain intrinsic to living in prison, both in terms of how some people choose to cope with living in prison and their role status within the prisoner community. Substance use in prisons is connected to psychological dependency and emotional regulation that some people use to cope with pre-existing trauma(s) and the additional trauma of entering and adjusting to living in prison.
The headline message from this study is that prison is the wrong place to try and address the wide range of intensely complex environmental, emotional, physical, psychological, and social needs experienced by people in prison who have problems with substance use.
The depressing headline finding is that individuals in Scotland’s prisons are more likely to have a substance use problem than to not have one.
The research found that existing prison drug treatment varies considerably across the country. There are also inadequacies and deficiencies for individuals in relation to the continuation of their treatments and support – both from the community into prison, and back to the community following release.
The reports’ authors say that there is a need to challenge underlying assumptions regarding substance use:
“In the main, substance use is viewed and treated within the prison system as a ‘problem’. This is not suggesting that substance use is not problematic, but rather that substance use should not be problematised. For most, substance use is considered to be a coping strategy, both outside prison and inside prison to medicate the traumas of past and present experiences. Further, it could be argued (and we often heard) that using substances whilst in prison is considered to be a logical response to the traumatic situation that individuals find themselves in (e.g. ‘getting yer heid down’, dealing with peer pressure, and/or dealing with emotional/physical/psychological pain).”
The report concludes that the primary needs of those individuals who use substances through their time in Scotland’s prisons are not particularly substance use related, but more to do with a range of other issues, particularly: housing, trauma, mental health, finance, and emotional intelligence. It argues that the priority should be on how individuals are best prepared for release and that these preparations should start from the first moment an individual steps inside a prison. From a substance use point of view the biggest challenge is one of continuity of care/treatment (or lack of) through and beyond prison.
The report makes four key high-level recommendations focusing on:
- Better consistency and continuity of care achieved through a detailed partnership agreement between all the key partners involved in the commissioning and delivery of substance use services and support across prisons (and wider criminal justice pathways).
- A multi agency group to drive through the learning from this needs assessment.
- A new independent national oversight and assurance group to ensure that progress is made towards all the detailed outcome based recommendations included in the report.
- The consistent and full implementation of the Medical Assisted Treatment standards across all of Scotland’s prisons.
Thanks to Andy Aitchison for kind permission to use the header image in this post. You can see Andy’s work here.