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Seid AK, Thylstrup B, Henriksen SH, Hesse M. Met and unmet prison-based treatment needs for people who are incarcerated with a history of substance use disorder: A nationwide cohort study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 159:209264. [PMID: 38103836 DOI: 10.1016/j.josat.2023.209264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 10/04/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Substance use disorders (SUD) are highly prevalent among incarcerated people. However, in some prisons, only a small percentage of those who need treatment receive it. The aims of this study were to examine coverage of treatment for SUD in Danish prisons and assess whether treatment differed by substance class. Further, we examined factors associated with receiving treatment for SUD, and types of services received. DATA AND METHODS We linked multiple Danish register data using unique personal identification numbers. This study retrospectively analysed data for 49,330 individuals (aged 18-90) incarcerated in Danish prisons between 2008 and 2018. We used a multivariable logistic regression model to predict enrolment in treatment for SUD in prison. RESULTS Of incarcerated people with a history of SUD, 34.6 % received treatment care during incarceration. We observed only minor variations in terms of substance classes concerning the type of treatment. Those who were women, immigrants, had higher education, or were married were less likely to receive treatment. CONCLUSIONS Improving access and increasing treatment coverage in the Danish Prison and Probation Services is crucial to reduce the burden of SUD in incarcerated populations.
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Affiliation(s)
- Abdu K Seid
- Center for Alcohol and Drug Research, Aarhus University, Denmark; University of Bergen, Norway.
| | | | | | - Morten Hesse
- Center for Alcohol and Drug Research, Aarhus University, Denmark
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Ghosh A, Pillai RR, Vij J, Nain R, Shetty D, Maulik PK, Basu D. Substance use in the correctional settings: A qualitative exploration of individual and contextual characteristics and intervention strategies using the behavior change wheel framework. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 158:209257. [PMID: 38072380 DOI: 10.1016/j.josat.2023.209257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/02/2023] [Accepted: 12/04/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND AND OBJECTIVES Planning and implementing prison-based substance use disorder (SUD) interventions are challenging. We wanted to understand why and how people in correctional settings (CS) use drugs and to explore what policies, environmental, and interpersonal factors influence substance use among incarcerated people. Using the Behavior Change Wheel (BCW) framework, we proposed a thematic map with intervention functions to reduce substance use in CS. METHODS We used the Framework Method of qualitative analysis. We did snowball sampling for the incarcerated people with drug use (PWD) and convenience sampling for the staff. The in-depth interview sample comprised 17 adult PWD, three prison administrative, and two healthcare staff. We determined the sample size by thematic data saturation. We followed a mixed coding approach for generating categories, i.e., deductive (based on the BCW framework) and inductive. The study constructed the final theoretical framework by determining the properties of the categories and relationships among the categories. RESULTS We identified eleven categories aligned with the BCW framework. The themes were prison routine, interpersonal dynamics of the incarcerated population, exposure to substance use, attitude of staff towards PWD, experience with prison healthcare, willingness (to reduce drug use) and coping, compassion, drug use harms, conflict between staff and residents, stigma, and family/peer support. The BCW framework aided the identification of potential intervention functions and their interactions with the organizational policies that could influence PWD's capability-opportunity-motivation (COM) and drug use behavior (B). CONCLUSION There is a need to raise awareness of SUD prevention and intervention among decision-makers and revisit the prison policies.
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Affiliation(s)
- Abhishek Ghosh
- Drug Deaddiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Renjith R Pillai
- Drug Deaddiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jatina Vij
- Drug Deaddiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reina Nain
- Drug Deaddiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepa Shetty
- Drug Deaddiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pallab K Maulik
- George Institute India, India; Faculty of Medicine, University of New South Wales, Sydney, Australia; Mental Health, Imperial College London, United Kingdom; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Debasish Basu
- Drug Deaddiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Lloyd C, Page G, McKeganey N, Russell C. Capital depreciation: The lack of recovery capital and post-release support for prisoners leaving the Drug Recovery Wings in England and Wales. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 70:107-116. [PMID: 31238269 DOI: 10.1016/j.drugpo.2019.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND This article draws on the evaluation of the pilot Drug Recovery Wings (DRWs), which were introduced ten prisons in England and Wales, with the intention of delivering abstinence-focused drug recovery services. The DRW pilots can be seen as representing the extension of the recovery paradigm - so prevalent elsewhere in UK drug policy - to the prison system. This study aimed to provide a detailed account of DRW prisoners' expectations and experiences in the transition from prison to the community and explore the potential for 'doing recovery' in prison and on release. METHODS In-depth, qualitative interviews were conducted in prison with 61 prisoners across six of the DRWs. Follow-up interviews six months after release were conducted with 21 prisoners and 26 'recovery supports' (people identified as being close to the prisoners). Data from one, other or both sources was available for 36 prisoners. All interviews were fully transcribed and coded. RESULTS The majority of the 61 had long histories of alcohol and/or opiate dependence, childhood adversity, undiagnosed mental health problems and few educational qualifications. Nonetheless, many had long histories of employment - mostly in manual trades. The majority described themselves as being 'in recovery' at the time of the first interview in prison. While one of the main aims of the DRWs was to support prisoners' recovery journeys into the community, this aspect of their work did not materialize. Professional support at release was largely absent or, where present, ineffectual. Many were released street-homeless or to disordered and threatening hostels and night-shelters. Only three of the 36 were fully abstinent from drink and drugs at time of re-interview, although some had moderated their use. A substantial number had returned to pre-imprisonment levels of use, often with deeply damaging impacts on those around them. DISCUSSION AND CONCLUSIONS This research suggests a fundamental contradiction between recovery and imprisonment. In large part, imprisonment serves to erode recovery capital while, at the same time, making psychoactive substances readily available. Looking to the future, every effort should be made to divert substance users from imprisonment in the first place. Where that fails, the primary aim should be to reduce the erosion of recovery capital during imprisonment: through family support work, providing proper housing, training and education opportunities and ensuring a graduated reintroduction of prisoners into the community.
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Affiliation(s)
- Charlie Lloyd
- Social Policy and Social Work, University of York, Alcuin C, York, YO10 5DD, United Kingdom.
| | - Geoff Page
- Social Policy and Social Work, University of York, Alcuin C, York, YO10 5DD, United Kingdom
| | - Neil McKeganey
- Centre for Substance Use Research, Block 4/04, West of Scotland Science Park, 2317 Maryhill Road, Glasgow G20 0SP, United Kingdom
| | - Christopher Russell
- Centre for Substance Use Research, Block 4/04, West of Scotland Science Park, 2317 Maryhill Road, Glasgow G20 0SP, United Kingdom
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Abstract
Utilizing Bacchi’s poststructuralist approach, “What’s the problem represented to be?,” we critically examine how the “problem” of drug use in prison is represented within a key initiative—the Identified Drug User program (IDUP)—of prison drug policy in one Australian jurisdiction. We use two data sources for our analysis: interview transcripts of recently incarcerated young men (aged 19–24) with histories of injecting drug use and selected prison drug policy and program documents. We examine how the “problem” of drug use in prison is problematized within the IDUP and question commonly accepted ways of thinking that underpin the program. We explore the discursive and subjectification effects of problem representations which produce young men as “rational” and “choosing” and, at the same time, as “untrustworthy” and “deserving of punishment.” We highlight how these effects have consequences for young men’s connections to family while incarcerated which can work against the very issues the IDUP is trying to address. We make two claims in particular: that the IDUP produces harmful effects for young men and their families and that the harmful effects produced are, paradoxically, those the IDUP aims to avoid. Our analysis offers insights into how drug use in prison could be thought about differently, including suggestions that might reduce at least some of its adverse effects.
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Affiliation(s)
- Shelley Walker
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Melbourne, Victoria, Australia
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Kari Lancaster
- Centre for Social Research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Kensington, New South Wales, Australia
| | - Mark Stoové
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Peter Higgs
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia
- Department of Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Mandy Wilson
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Melbourne, Victoria, Australia
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Giertsen H, Nylander PÅ, Frank VA, Kolind T, Tourunen J. Prisoners' experiences of drug treatment and punishment in four Nordic countries. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017. [DOI: 10.1515/nsad-2015-0017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aims This article describes and analyses prisoners' experiences of drug treatment in prison in four Nordic countries: Denmark, Finland, Norway and Sweden. The article examines how prisoners experience drug treatment, control and sanctions as related to three main topics, namely motivation; the content of the measure and relations to staff; and control and sanctions. Methods & DATA – The article is based on data from twelve prisons, three in each of the four countries; 91 interviews with prisoners; and around six months of observation. The two main kinds of drug treatment measures are drug treatment units and day programmes. Results – Prisoners described several motives to participate in drug treatment measures: to leave drugs and crime; to renew relations with family and friends; to solve health problems; and to improve their prison conditions. Prisoners found that drug treatment measures offered possibilities to acquire new ways of being. Staff behaviour seemed to be more important to prisoners than the methods used, and some prisoners seemed more positive to staff involved with the drug treatment than to other staff. A surprising finding was the prisoners' limited critique of controls and sanctions. We see this as embedded in the situation of being a prisoner, and also in relation to contexts outside prison. Conclusion In discussing their experiences in the treatment units, prisoners are not so concerned about the rehabilitative features or the controls and sanctions. They evaluate their present situation in light of a future, which is their real concern. This is in line with a main task for staff, which is to prepare prisoners for release.
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Mjåland K. Exploring prison drug use in the context of prison-based drug rehabilitation. DRUGS-EDUCATION PREVENTION AND POLICY 2016. [DOI: 10.3109/09687637.2015.1136265] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
BACKGROUND Although there is a need for well-designed evaluations, international evidence shows that drugs frequently enter prisons and enforcement efforts are said to be linked to adverse events. OBJECTIVES This study sought to examine drug enforcement within a federal prison system, overseen by the Correctional Service of Canada (CSC), and to detail competing perspectives. METHODS Three main sources of data were used in this qualitative study: 16 interviews conducted between 2010 and 2012 with former CSC senior officials, former frontline staff, and external stakeholders; CSC research publications and other documents; and transcripts from a relevant House of Commons Standing Committee public study. All texts were coded and compared to examine emergent themes of interest. RESULTS Six key themes are described as contested effects of enhanced in-prison drug enforcement: (1) continued and creative efforts to bring in drugs; (2) climate of tensions and violence; (3) prisoners switching their drug use; (4) health-related harms; (5) deterrence of visitors; and (6) staff involvement in the in-prison drug trade. CONCLUSIONS/IMPORTANCE Urgently needed are rigorous evaluations of in-prison drug enforcement, along with closer scrutiny of policy recommendations that uphold the goal of drug-free prisons. Studying similar prison systems as complex risk-managing organizations may offer new information about drug enforcement policy and practice resistance despite detrimental effects.
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Affiliation(s)
- Tara Marie Watson
- a Centre for Addiction and Mental Health, Social and Epidemiological Research , Toronto , Ontario , Canada
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Kolind T. Drugs and discretionary power in prisons: The officer's perspective. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:799-807. [DOI: 10.1016/j.drugpo.2015.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 03/25/2015] [Accepted: 04/16/2015] [Indexed: 10/23/2022]
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Watson TM. The politics of harm reduction in federal prisons. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 25:916-23. [DOI: 10.1016/j.drugpo.2014.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 05/29/2014] [Accepted: 06/10/2014] [Indexed: 11/16/2022]
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Ritter C, Broers B, Elger BS. Cannabis use in a Swiss male prison: qualitative study exploring detainees' and staffs' perspectives. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 24:573-8. [PMID: 23773686 DOI: 10.1016/j.drugpo.2013.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 04/27/2013] [Accepted: 05/06/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Several studies suggest a high prevalence of cannabis use before and during imprisonment, but subjective perspectives of detainees and staff towards its use in prison are lacking. This issue was explored in the framework of an observational study addressing tobacco use in three Swiss prisons in 2009 and 2010 that involved multiple strands (quantitative and qualitative components). This article presents qualitative data on cannabis use collected in one of the settings. METHODS We used in-depth semi-structured interviews with both detainees and staff to explore their attitudes towards cannabis in one post-trial male Swiss prison. We performed specific coding and thematic analysis for cannabis with the support of ATLAS.ti, compared detainees' and staff's opinions, and considered the results with regard to drug policy in prison in general. RESULTS 58 participants (31 male offenders, mean age 35 years, and 27 prison staff, mean age 46 years, 33% female) were interviewed. Detainees estimated the current use of cannabis use to be as high as 80%, and staff 50%. Participants showed similar opinions on effects of cannabis use that were described both at individual and institutional levels: analgesic, calming, self-help to go through the prison experience, relieve stress, facilitate sleep, prevent violence, and social pacifier. They also mentioned negative consequences of cannabis use (sleepiness, decreased perception of danger and social isolation), and dissatisfaction regarding the ongoing ambiguous situation where cannabis is forbidden but detection in the urine was not sanctioned. However, the introduction of a more restrictive regulation induced fear of violence, increased trafficking and a shift to other drug use. CONCLUSION Although illegal, cannabis use is clearly involved in daily life in prison. A clearer and comprehensive policy addressing cannabis is needed, including appropriate measures tailored to individual users. To sustain a calm and safe environment in prison, means other than substance or medication use are required.
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Affiliation(s)
- Catherine Ritter
- University Centre of Legal Medicine of Geneva and Lausanne, 9, av. de Champel, 1211 Geneva 4, Switzerland.
| | - Barbara Broers
- Unit for Dependency in Primary Care at the Department of Community Health and Primary Care, University Hospitals of Geneva, Faculty of Medicine, 1211 Geneva 4, Switzerland
| | - Bernice S Elger
- Head of the Institute of Biomedical Ethics at the University of Basel, Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
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Prison drug treatment in Denmark: A historical outline and an analysis of the political debate. NORDIC STUDIES ON ALCOHOL AND DRUGS 2012. [DOI: 10.2478/v10199-012-0046-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Aims The article outlines the historical development of prison drug treatment (PDT) in Denmark in order to understand the present situation where PDT is viewed as a natural benign practice. We also identify the different rationales within the political debate on PDT since its rapid expansion in 2000. Data Historical and policy documents, grey literature, interviews with key informants in the field. Results Four historical periods are identified, from a period when drug treatment was unwelcome in prisons to a re-emergence of the rehabilitation ideal over the last 15 years, when PDT appears unquestioned and its popularity has exploded. Five dissimilar and at times conflicting rationales have been present in the political debate legitimising this policy shift. Conclusion Part of the popularity of PDT stems from the fact that it has been used in political debates in order to justify a range of different and even conflicting objectives. With changing penal discourse, PDT may again become unwanted in prison settings.
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Pedersen MU, Elmeland K, Frank VA. Addiction research centres and the nurturing of creativity. The Centre for Alcohol and Drug Research: social science alcohol and drug research in Denmark. Addiction 2011; 106:2072-8. [PMID: 20955214 DOI: 10.1111/j.1360-0443.2010.03152.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS The purpose of this paper is to introduce the social science alcohol and drug research undertaken by the Centre for Alcohol and Drug Research (CRF) and at the same time offer an insight into the development in Danish alcohol and drug research throughout the past 15-20 years. METHOD A review of articles, books and reports published by researcher from CRF from the mid-1990s until today and an analysis of the policy-making in the Danish substance use and misuse area. RESULTS CRF is a result of the discussions surrounding social, health and allocation policy questions since the mid-1980s. Among other things, these discussions led to the formal establishment of the Centre in 1991 under the Aarhus University, the Faculty of Social Science. Since 2001 the Centre has received a permanent basic allocation, which has made it possible to appoint tenured senior researchers; to work under a more long-term research strategy; to function as a milieu for educating PhD students; and to diversify from commissioned research tasks to initiating projects involving more fundamental research. Research at the Centre is today pivoted around four core areas: consumption, policy, prevention and treatment. CONCLUSION The emergence, continuation, financing and character of the research taking place at CRF can be linked closely to the specific Danish drug and alcohol discourse and to the division of the responsibility for alcohol and drug research into separate Ministries.
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Affiliation(s)
- Mads U Pedersen
- Centre for Alcohol and Drug Research, Nobelparken bygn. 1453, Jens Chr. Skousvej 3, Aarhus University, Arhus, Denmark.
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