Prison-based Drug Treatment Research Articles

Learnings from a prison-based drug treatment program on planning for release: A qualitative study.

Prison-based drug and alcohol group treatment programs operate in all Australian jurisdictions. With more than two-thirds of people in prison having a history of substance use prior to incarceration, such programs are needed. There have been few published papers on the impact of attending group treatment programs in Australian prisons, and the research published to date has been predominately quantitative. We aim to report the experiences of males in prison who completed and those who did not complete a group-based drug and alcohol program, to gain insight into their strategies for reducing harm from drug and alcohol post-release. Qualitative thematic analysis of in-depth interviews with 12 males who completed or were about to complete and 10 males who discontinued a prison-based group drug and alcohol treatment program. Program completers were more likely to have well-developed plans to reduce drug and alcohol harms and maintain abstinence upon return to the community, which included creating healthier social networks. They also showed stronger insights into the factors that led to offending. Those who did not complete the drug and alcohol program appeared to rely on self-will as the main way to reduce drug and alcohol harms, with less awareness of options for support services to reduce or stop drug and alcohol use. Prison-based drug and alcohol program engagement imparted useful information for program completers. Controlled trials are needed to examine whether such differences equate to improved outcomes after release.

Drug Use Disorders before, during, and after Imprisonment

Drug-involved offenders have been long overrepresented in prisons. Intensified drug law enforcement in many countries increased both incarceration rates, especially for drug offenses, and numbers of drug-involved prisoners. This is attributable to four features of drugs and drug markets. Drug use disorders typically are not the only problems facing drug-involved prisoners. A high proportion exhibit severe mental health problems such as major depression, personality disorders, and psychotic disorders. Before incarceration, many drug-involved prisoners have unstable housing and are at high risk of homelessness; incarceration increases that risk. The high concentration of drug-involved offenders in prisons presents numerous challenges. After release, the most obvious are high rates of drug relapse and recidivism. Former prisoners have extraordinarily high risks of drug overdoses shortly after release; in the long term, diseases acquired during imprisonment are transmitted in the community. Effective prison-based drug treatment holds promise to break this cycle and mitigate physical and mental health problems of drug-involved prisoners. Unfortunately, access to treatment modalities proven to be effective in reducing drug use and recidivism is limited. A paradigm shift in drug enforcement and treatment is needed to meet the challenges presented by individuals with drug use disorders more effectively.

The role of physical and psychological health problems in the drug use treatment process

The role of physical and psychological health is examined as a predictor of client engagement in prison-based drug treatment. A treatment process model was expanded to include physical and mental health issues. The sample included 6009 offenders in prison-based drug treatment, comprised of 67% male, 26% African American, 51% white, and 22% Hispanic; average age was 34.6. Half reported “some physical health concerns” and mentioned a variety of ailments. A fifth reported moderate stress on the Kessler Psychological Distress Scale (K10) and 15% reported PTSD based on the PTSD Check List (PCL). Structural equation modeling was used to model treatment engagement in terms of demographics, physical health concerns, psychological distress, HIV risky behaviors, self-esteem, decision making, and treatment motivation. Two random samples were created, with one used for estimation and the other for cross-validation. The findings suggested physical health and HIV risky behaviors have effects on client engagement through psychological functioning, and that psychological functioning has direct effects on treatment engagement.

‘The right way to be a woman’: Negotiating femininity in a prison-based drug treatment programme

Drawing from an ethnographic study in a drug treatment wing for women in a Danish prison, the authors explore how femininity is negotiated between prisoners and staff. It is shown how the staff view the prisoners as both passive and disruptive and how the treatment aims to teach them what staff consider to be an ‘appropriate’ femininity characterised by the women being cooperative, feeling a sense of community, and being less masculine in their appearance. While the prisoners accept the identity constructions imposed upon them by the therapy regime, they also attempt to create alternative femininities. The article discusses whether gender-sensitive treatment approaches can work towards better integration of the women’s past experiences with the new dispositions learned in the treatment programme.

An historical review of racial bias in prison-based substance abuse treatment design

ABSTRACTThis study leverages critical race and legal epidemiological frameworks to illustrate the race-based historical evolution of U.S. rehabilitation paradigms directed at imprisoned heroin and opioid users. What began as a racist early-20th-century federal antinarcotic trafficking effort has since assumed a state-based treatment agenda whose programmatic operations are largely based in correctional settings disproportionately reserved for poor substance abusers of color. Even in contemporary carceral facilities, where incarcerated populations are teeming with White addicts, in the aggregate, White drug abusers have been protected from the depraved, incorrigible, and inherently pathological drug-using caricature assigned to their non-White counterparts. This historical examination demonstrates how links between broader drug policy and prison-based drug treatment support a legally codified White supremacist narrative that erodes health and wellbeing for program participants of color, and the communities to which they inevitably return.

Facing drug problems and advancing sentence plan. Prisoners’ perspectives on drug treatment programmes in Finland

ABSTRACTIn Nordic countries, the rapid development of various prison-based drug treatment (PDT) programmes emerged in the mid-1990s, and this development can be viewed as a criminological shift towards a “new form” of penal welfarism combining control and rehabilitation in a revised form in a new era. This article examines PDT programmes from the prisoners’ perspective to analyse their motives to participate, experiences, and relationships with counsellors, guards, and prisoners. Data were collected from interviews of the prisoners and observations in three Finnish prisons. Both the motives connected to handling drug problems and those connected to gaining an advantage for the duration of time spent in prison were experienced simultaneously by participants. Prisoners made a clear distinction between guards and drug counsellors and were somewhat confused by staff roles that combined both rehabilitative and control features. These findings suggest that new hybrid roles already found among correctional staff seem to exist also for prisoners.

Ceza İnfaz Kurumlarında Gerçekleştirilen Madde Bağımlılığı Programlarının Etkinliği: Meta-Analiz Çalışmaların Sistematik Olarak İncelenmesi

Ceza İnfaz Kurumlarında Gerçekleştirilen Madde Bağımlılığı Programlarının Etkinliği: Meta-Analiz Çalışmaların Sistematik Olarak İncelenmesi

Offender and/or client? Fuzzy institutional identities in prison-based drug treatment in Denmark

The last 20 years has witnessed a rise in prison-based drug treatment in Nordic countries. This increase has challenged the prominence of the punitive prison, and created changes in the roles of both clients and staff. This article explores the development of two institutional inmate identities: the offender and the client, which have occurred as a consequence of this shift in prison policy. However, in their institutional narratives and daily practice both prison officers and counsellors often fluctuate when addressing inmates as offenders and/or clients. This fluctuation creates a “fuzzy” dynamic. These institutional identities are characterized, on the one hand, by inmates being dealt with by counsellors as ‘real people' and ‘equals’, but simultaneously counsellors are resorting to the control opportunities allowed by the prison authorities such as urine tests and the use of isolation cells. On the other hand, prison officers handle inmates within a disciplinary logic, while concurrently dealing with them as inmates deserving a fair chance – a view resonant with the drug treatment ideology applied in prisons.

Who receives substance abuse treatment in the ‘real world’ of the prison? A register-based study of Finnish inmates

Assessing and targeting substance abuse-related treatment needs according to evidence-based practice has become the norm in most prison administrations. Not everyone with a need will, however, receive support in practical settings. Drawing on Finnish prison registers, we show that of all prisoners released in 2011, 60% were assessed as having a need for substance abuse-related support. Of these, 22% received an intervention in prison. Two multivariate models were used to examine the factors related to selection into interventions. The main factors associated with receiving an intervention with evidence-based programmes were a longer sentence, Finnish nationality, younger age and treatment motivation. The predictors for any substance abuse interventions (including non-evidence-based) were the same, with the exception that motivation was no longer a significant predictor, and female gender remained significant. The selective use of motivation as an entrance criterion for interventions can be a means of systemic adaptation to a combination of a high prevalence of substance abuse problems and a lower prevalence of treatment motivation in the prison population. We discuss how our results might reflect a Scandinavian way of doing evidence-based, prison-based drug treatment—one that stresses rehabilitation as a goal in itself in addition to reducing recidivism. Most prisoners, however, do not receive any intervention at all.

The Long-Term Effects of Prison-Based Drug Treatment and Aftercare Services on Recidivism

This article examines recidivism among a cohort of formerly incarcerated people released from the Sheridan Correctional Center (SCC), a dedicated drug treatment facility based on a Therapeutic Community (TC) model of prison-based drug treatment. After an average of 6.9 years post-release, the SCC releasees had a 15% lower likelihood of recidivism than the comparison group, and a 44% reduction in the likelihood of recidivism when both prison-based drug treatment and aftercare programming were accessed. The current analyses showed that the beneficial effects of prison-based drug treatment were bolstered by aftercare services and continued long after release from prison.

“Give them a chance!” The social representation of the counsellor’s institutional role in prison-based drug treatment programmes in Finland.

See abstract in article.

Effectiveness of the rehabilitation for addicted prisoners trust (RAPt) programme

The Rehabilitation for Addicted Prisoners Trust (RAPt) Programme, the largest provider of intensive prison-based drug treatment in the UK, addresses both substance dependence and criminal behaviour through a comprehensive model. This study examined recidivism in a group of male prisoners who completed the RAPt programme (n = 352), a group of male prisoners who did not complete (n = 355) the programme, and a third comparison group of male prisoners who completed another in-prison drug treatment programme (n = 232). 12-month post-release recidivism data for the three groups were assessed with multivariate logistic regression in relation to age, race/ethnicity, length of sentence, prisoners’ drugs of choice, and prisoners’ primary offence for imprisonment. Results indicated that RAPt completers were less likely to re-offend within one year of prison release compared to the Comparison completers and prisoners who started but did not complete RAPt. Prisoners’ drugs of choice were also associated with re-offence with those treated for heroin or cocaine (crack or powder) use being more likely to re-offend compared with those treated for use of any other drugs. Finally, the type of offence for which prisoners were convicted was also a prominent factor with those sentenced for a property offence more likely to reoffend within one year compared to those convicted of a non-property offence. These findings demonstrate the effectiveness of the RAPt programme and identify prisoners with heroin or cocaine dependence at highest risk for recidivism. Programme enhancements may address the additional risk among prisoners who identified heroin or cocaine use as their primary drug of choice.

Methadone prescribing in local prisons in England

Purpose – The purpose of this paper is to evaluate some of the wider aims and potential consequences of maintaining remand and short-term prisoners on methadone, rather than providing them with a rapid detoxification on first reception into prison. Consideration is given to the effects of methadone prescribing on treatment engagement; drug-related violence; treatment choice, including detoxification, maintenance and reduction doses; recidivism; and through care. Design/methodology/approach – The author draws on qualitative data gathered during a wider study involving drug-using prisoners and prison drug workers exploring the influence of the therapeutic working alliance on outcomes in prison-based drug treatment. Findings – Whilst participants reported advantages to the prescribing of methadone in prisons, such as reduced levels of bullying and drug-related violence in the prisons, they were also critical of many aspects of methadone prescribing which were intended to increase treatment choice, but in pra...

Prison-based drug treatment in Nordic political discourse: An elastic discursive construct

Prison-based drug treatment (PDT) has increased markedly in the Nordic countries over the last 15 years. Based on data from Denmark, Finland, Norway and Sweden, we outline the historical development of PDT and analyse the rationales employed in the political discourse in the Nordic countries legitimizing this development. These rationales relate to the reduction of criminality, zero tolerance, rights and the modern welfare state, and managerialism. Though these rationales may appear dissimilar, they have been combined with relative ease in the political discourse. Actually, this elasticity may partly explain the popularity of PDT. We discuss whether the increased use of PDT reflects a criminalization of social problems and signals a rebirth of the treatment ideology in Nordic prisons.

For whom does prison-based drug treatment work? Results from a randomized experiment

Objectives Prison-based therapeutic community (TC) drug treatment followed by community aftercare is widely recognized as the most effective treatment paradigm for drug-dependent offenders. However, few randomized experiments have addressed this question and fewer studies have examined how interactions between treatment modality and individual characteristics may explain variations in outcomes.

A Multisite Evaluation of Prison-Based Drug Treatment

This study examined three postrelease outcomes (reincarceration, rearrest, drug relapse) for inmates who participated in therapeutic community (TC) drug treatment programs ( n = 555) or comparison groups ( n = 998) at five prisons. The comparison group consisted of TC-eligible inmates participating in less intensive programming at the same institutions. Control variables included drug dependency, age, and criminal history. TC had a moderate, significant impact on reducing the probability of reincarceration and did so in the absence of community aftercare. Effects of TC on rearrest and drug relapse, however, were not significant. Implications for research, theory, and practice are discussed.

Psychosocial functioning among inmates in prison-based drug treatment: results from Project BRITE

To assess the impact of a positive behavioral reinforcement intervention on psychosocial functioning of inmates over the course of treatment and on post-treatment self-reported measures of treatment participation, progress, and satisfaction. Male (n = 187) and female (n = 143) inmates participating in 12-week prison-based Intensive Outpatient (IOP) drug treatment were randomly assigned to receive standard treatment (ST) or standard treatment plus positive behavioral reinforcement (BR) for engaging in targeted activities and behaviors. Participants were assessed for psychosocial functioning at baseline and at the conclusion of treatment (post-treatment). Self-reported measures of treatment participation, treatment progress, and treatment satisfaction were also captured at post-treatment. The intervention affected female and male subjects differently and not always in a way that favored BR subjects, as compared to the ST subjects, most notably on measures of depression and criminal thinking. Possible explanations for the results include differences in the male and female custody environments combined with the procedures that study participants had to follow to earn and/or receive positive reinforcement at the two study sites, as well as baseline differences between the genders and a possible floor effect among females on measures of criminality. Limitations of the study included the inability to make study participants blind to the study conditions and the possible over-branding of the study, which may have influenced the results.

Drug treatment in Swedish prisons – moving towards evidence-based interventions?

Aim This article reviews the development in Sweden of prison-based drug treatment (PBDT) from the 1970s to the present situation. Data The data consists of committee reports, white papers, research reports and interviews with two senior managers from the Swedish Prison and Probation Services (SPPS). Results The 1970s and 1980s trials with milieu therapy in prisons were followed by the introduction of cognitive programmes in the 1990s. Due to the growing number of prisoners with drug problems, the Prison Anti-Drug Effort increased the number of places and programmes for drug treatment in prisons. As of 2000, the scientific evaluation of all prison-based drug treatment has been strongly emphasised. Drug control has increased since 2004, and the very concept of PBDT is now approached rather more rigorously and scientifically. Conclusion The SPPS programme evaluations are scientifically formed, but changes in practice are slow to emerge. The SPPS runs a more restricted policy compared to treatment outside, which leads to some evidence-based treatment methods being rejected. Also, PBDT is somewhat under threat by changes in the prisons’ internal organisation with growing specialisation in different wings, as well as by the poor financial situation of the SPPS.

Prison-based drug treatment and rehabilitation in the Nordic countries

Prison-based drug treatment and rehabilitation in the Nordic countries

Prison-based drug treatment in Finland: History, shifts in policy making and current status

Aim The article outlines, at the level of political discourse, changes in drug and criminal policy that may have influenced the penal system as a backdrop to the rise of prison-based drug treatment programmes (PBDT) in Finland. Methods and Data Our perspective is historical. The article is based on historical and political documents, scholarly research and white papers. Results The history of PBDT in Finland is characterised by an absence of drug treatment programmes until the 1980s, first initiatives at the end of the 1980s, enthusiastic programme development from the mid-1990s, and decreasing interest during recent years. Unlike the National Drug Strategy, the Prison Drug Strategy aimed at a drug-free environment (zero tolerance) and implemented harm-reduction measures only to a limited extent. Conclusion The development of PBDT represents the new way of performing treatment in prisons, with features of managerialism. PBDT is also affected by an organisational segregation of rehabilitation and medical treatment, which prevents integration of harm-reduction measures with rehabilitative treatment, and is in conflict with general aims of integrating substance abuse treatment to mental and healthcare services in Finland. In the spirit of a new kind of Penal Welfarism, the role of documented individual risk and needs assessment in defining an offender's sentence has increased.