What proportion of the prison population has a substance abuse problem? iii

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1 Substance Abuse in Crrectins FAQs This Substance Abuse in Crrectins FAQ was prepared by Dr. Jhn Weekes, Senir Research Analyst and Dr. Gerald Thmas, Senir Plicy Analyst, Research and Plicy Divisin, and Greg Graves, Crdinatr, Best Practices and Training, Canadian Centre n Substance Abuse (CCSA). It is intended t prvide current, bjective, and empirically-based infrmatin t guide the discussin n substance abuse in crrectins in Canada,i Hw des the crrectinal system in Canada perate? While many cuntries have a single prisn system (e.g., England and Wales, Nrway, Sweden, etc.), crrectins in Canada is tw-tiered: 1. individual prvincial/territrial crrectinal systems respnsible fr yung ffenders (under age 18), persns serving prbatin, and custdial sentences up t tw years, and 2. a federal prisn system perated by the Crrectinal Service f Canada (CSC) fr terms f incarceratin f tw years t life. ii Accrding t the Crrectins and Cnditinal Release Act (CCRA), 1 a majr purpse f crrectins in Canada is t prepare ffenders fr successful re-integratin back int sciety. This includes the delivery f treatment prgrams that are designed t address factrs related t ffending (e.g., vilence, sexual deviancy, substance abuse, etc.) Each federal/prvincial/territrial system has individual respnsibility fr all aspects f prisn peratins, including the develpment and delivery f all treatment services fr incarcerated ffenders, as well as thse n cnditinal release in the cmmunity. This includes the prvisin f substance abuse assessment and treatment. The relatively shrt duratin f imprisnment in prvincial/territrial crrectins, cupled with the large gegraphical area f mst prvinces and territries, creates unique challenges fr the prvisin f treatment services and maintenance/aftercare services t ffenders in need. CSC perates an Addictins Research Centre (ARC) in Mntague, PEI. The ARC is respnsible fr substance abuse prgram develpment and related research fr federal crrectins. The de-centralized nature f crrectins and crrectinal prgramming in Canada suggests that natinal crdinatin is needed t ensure the delivery f efficacius and best practice assessment, treatment, and maintenance/aftercare services t ffenders thrughut the cuntry. What prprtin f the prisn ppulatin has a substance abuse prblem? iii The majrity f ffenders shw evidence sme kind f substance abuse prblem. Canadian natinal prevalence data indicate that at least 7 f 10 ffenders in the federal crrectinal system have engaged in prblematic use f alchl and ther drugs during the ne-year perid prir t their incarceratin. 2 i Our review indicated that relatively little data n ffenders substance abuse prblems was readily available frm the prvincial/territrial departments f crrectins. Accrdingly, mst f the Canadian statistics cited herein are based n Crrectinal Service f Canada published data, except where therwise nted. ii Canada des nt have a death penalty. iii Variatins in the prevalence f substance abuse prblems acrss crrectinal jurisdictins is likely t be due, in part, t the different screening and measurement devices used t identify ffenders wh engage in prblematic use f alchl and ther drugs. Prepared by the Canadian Centre n Substance Abuse

2 In Canada, abut 51% f prisners hused in federal crrectinal institutins have an alchl prblem. 3 Abut 48% f Canadian federal prisners experience prblems with drugs (ther than alchl). 4 In Saskatchewan, up t 93% f prvincial ffenders are identified as having a substance abuse prblem. 5 Apprximately 80% f prisners in prisns in England and Wales have a substance abuse prblem. 6 An assessment f the entire prisn ppulatin in Maine fund that almst 90% f prisners had a substance abuse prblem. 7 In New Zealand, 80% f ffenders used alchl r ther drugs immediately prir t cmmitting their mst recent ffence(s). 8 Hw serius are ffenders substance abuse prblems? There is cnsiderable variatin in the severity f ffender substance abuse prblems. iv The severity f prblems has imprtant implicatins fr the length and intensity f treatment, number f sessins a week, and variety f treatment techniques and mdalities, as well as fr the cst f treatment and psttreatment maintenance and aftercare. While virtually all federal ffenders cnsume alchl r ther drugs, abut a third d nt shw signs f prblematic use. Anther third have a lw severity prblem; the final third shw evidence f mre serius prblems, including abut 20% wh have severe prblems (i.e., dependence ). By cntrast, nly abut 3% f the Canadian ppulatin (aged 15 and lder) shw signs f severe prblems r dependence. 9 Research has fund that the likelihd f ffenders engaging in ply-drug abuse (i.e., cnsumptin f mre than ne type f substance at the same time) increases with the severity f their prblem. 10 In recent years, Fetal Alchl Spectrum Disrder (FASD) has emerged as a ptentially serius prblem within crrectinal systems. 11 Althugh accurate prevalence statistics are nt yet available in Canada, research suggests that individuals with this disrder are at increased risk fr substance abuse and fr becming invlved with the criminal justice system. 12,13 In general, wmen in prisn have mre severe substance abuse prblems than men and are mre likely t be invlved in hard drugs (e.g., ccaine, herin, barbiturates, amphetamines, etc.). 14,15,16 An Australian study fund that wmen ffenders incarcerated in the State f Queensland had a higher rate f injectin drug use (51%) than male ffenders hused in varius institutins arund the state (range = 12 42%) as well as higher rates f hepatitis C infectin. 17 In England, a 2001 Hme Office reprt indicated that 41% f wmen n remand were dependent n piates during the year befre cming t prisn, cmpared with 26% f men. 18 A study f wmen ffenders in Prince Albert, Saskatchewan revealed that 75% had been r were still injectin drug users (IDUs v ). 19 In general, Abriginal ffenders in Canada reprt mre serius substance abuse prblems than nn- Abriginal ffenders. 20,21 38% f male Abriginal ffenders have serius prblems with alchl versus 16% f nn-abriginal males. On the ther hand, 71% f female Abriginal ffenders have a serius drug use prblem cmpared with 66% f female nn-abriginal ffenders. 22 Substance use is a majr factr in cntributing t the re-admissin f ffenders back int custdy fllwing release. Canadian studies have demnstrated that as many as 70% f ffender release suspensins invlve alchl and ther drugs. 23 What kinds f drugs d ffenders cnsume? There is cnsiderable reginal variatin in terms f drug preference within Canada as there is acrss varius internatinal crrectinal jurisdictins. Fr example, while verall prevalence rates are similar acrss the cuntry, herin is abused at high rates in regins with large urban centres (e.g., iv In cmbinatin with the quantity, type, and frequency f alchl and ther drugs used, severity is defined as the extent t which an individual s pattern f substance use affects a range f health, scial, interpersnal, emplyment, criminal behaviur, and lifestyle factrs. v Injectin drug use is a prcess whereby ne r mre psychactive substances is injected directly int the bdy using a hypdermic needle and syringe. Althugh many drug users dn t like this way f taking drugs because f discmfrt r fear f needles, it is ften the preferred methd f cnsumptin because the drug enters the bld stream mre quickly and directly than with ther methds (e.g., smking, swallwing, r snrting). It is ften cnsidered by injectin drug users (IDUs) t be mre efficient and less wasteful than ther means f cnsumptin. Prepared by the Canadian Centre n Substance Abuse

3 Vancuver, Trnt, and Mntreal, whereas abuse f alchl and ccaine are mre prminent in Atlantic Canada. Analysis f natinal drug cnsumptin patterns amng ffenders hused in CSC facilities revealed the fllwing pattern f cnsumptin during the six mnths prir t ffenders (mst recent) arrest: Marijuana 85% Alchl and drugs 80% Ccaine 60% Tranquillizers 35% Opiates 30% Hallucingens 25% Stimulants 25% Sedatives 20% Herin 15% Inhalants 5% Data vi frm the State f Maine Office f Substance Abuse 24 shwed the fllwing patterns f ffender drug use 12 mnths prir t arrest: Marijuana 59% Ccaine 22% Herin 10% Prescriptin drugs 5% Other 4% T what extent is substance abuse related t ffending? Abut half f all prisners in the United States have disclsed that they were under the influence f alchl r ther drugs at the time f their ffence (Federal = 34%; State = 51%). 25 In Canada, the use and abuse f alchl and ther drugs is strngly assciated with a brad range f criminal activities and cnduct (e.g., vilence, prperty ffences, etc.). Data n federal ffenders indicated the fllwing: 26 Driving under influence 94% Assault 69% Theft 66% Murder 58% Break and Enter 56% Rbbery 56% Sexual Assault 45% Drug-related ffences 28% Fraud 22% Overall, just ver half f all Canadian federal ffenders reprt that substance use and abuse was either directly r indirectly related t ne r mre f the ffences n their present cnvictin. 27,28 The link between substance use and crime can ccur in several different ways: 1) as a result f the psychpharmaclgical effects f the drug (e.g., vilence that results frm the disinhibiting effects f alchl), 2) acquisitive crime t pay fr drugs (e.g., armed rbberies t supprt a ccaine addictin), and 3) criminal activity as a way f transacting business in relatin t drugs (e.g., cnducting murders in relatin t the drug trade). 29 The extent t which substance abuse and criminal behaviur are linked increases dramatically with the severity f ffenders prblems. Of thse ffenders with severe prblems, 97% reprted that they used n the day f the ffence; 87% reprted that substance abuse was assciated with their crimes ver the curse f their criminal histry. 30 Offenders with mre serius substance abuse prblems are mre likely t be readmitted t custdy fllwing release. 31 vi Unlike the Canadian statistics, the data frm Maine d nt include alchl. Prepared by the Canadian Centre n Substance Abuse

4 T what extent are alchl vii and ther drugs available in prisn? Prisns huse the highest per-capita prprtin f persns with substance abuse prblems in sciety. Drugs are available in prisn. Studies examining rates f substance use indicate that the per capita use f drugs in Canada s prisns is substantially higher than n the street. In additin, drug trade is als much mre vilent in prisn than it is n the street. Indeed, alchl and ther drugs are available t sme extent in virtually every crrectinal jurisdictin in the wrld. An interview study f 317 federal prisners in Quebec revealed that 33% had used alchl r ther drugs at least nce during the preceding three mnths. 32 The 2003 Eurpean Mnitring Centre fr Drugs and Drug Addictin (EMCDDA) Annual Reprt cited estimates that 12 60% f inmates hused in Eurpean prisns have used drugs during incarceratin. 33 Despite extensive effrts t limit r eliminate drugs in prisns, alchl and ther drugs cntinue t be seized, and ffenders are discvered t be intxicated ( cnditin ther than nrmal ), test psitive fr varius drugs n urinalysis screening, and reprt n surveys and questinnaires that they use drugs while in prisn. In England, Her Majesty s Prisn Service (HMPS) Drug Strategy Unit reprted that between April, 2002 and March, 2003, a brad range f drugs were seized by prisn service authrities, including: diamrphine (mst frequent), cannabis, sterids, ccaine/crack ccaine, amphetamines/ecstasy, herin, and a large number f lesser knwn drugs. 34 In Canada, CSC s Security Divisin annual reprt fr 2003 indicated that just ver 11% f ffenders test psitive fr drugs thrugh the Service s randm urinalysis prgram. 35 Labratry analysis f these samples cmbined with cntraband drug seizure reprts reveal that cannabis and ther THC-based viii prducts are being used mst frequently, fllwed by a variety f piates, benzdiazepines, and ccaine. Seizure amunts were as fllws: THC-based prducts 9,358 grams Benzdiazepines 1,489 pills Opiates 226 grams Ccaine 159 grams During 2003, a ttal f 8,732 litres f alchl/brew were seized in Canadian federal prisns. In additin, 328 syringes were seized as well as 357 smking devices (fr cannabis and ther drugs). Hw effective are effrts t limit the availability f alchl and ther drugs in prisn? A brad range f search and seizure techniques and prcedures have been used in an attempt t minimize r eliminate the availability f alchl and ther drugs in prisns. These supply reductin measures include: Randm cell and facility searches by security persnnel Staff and visitr entry/exit screening and searches Intrusive searches with just cause (i.e., bdy cavity searches) Use f dry cells with just cause Drug detectin dgs Clsed-circuit mnitring (CCTV) Perimeter security measures (netting ver exercise yards, higher internal fences t prevent prjectiles, rapid respnse vehicles patrlling the prisn perimeter) Purchasing f gds frm apprved suppliers nly Intelligence analysts at every institutin Drug detectin technlgies (e.g., in scanners, x-ray machines, etc.) Mdificatins t the design and layut f visiting areas (use f fixed and lw-level furniture) vii The alchl that is available in prisns is typically nt cmmercially prduced, but manufactured inside using basic ingredients such as sugar, yeast (frm bread), and fruit r vegetable juices. Cntraband alchl is variusly referred t in prisn terminlgy as brew in Canada and hch in the US and in England and Wales. Alchl is typically prduced when there is a shrtage f drugs within prisn and is f particular cncern t prisn authrities because f its disinhibiting effects and ptential fr facilitating vilent behaviur. viii Tetra-hydr-cannabinl, the psychactive ingredient in cannabis. Prepared by the Canadian Centre n Substance Abuse

5 Mandatry randm urinalysis testing Drug-free units ix Vluntary urinalysis testing prgrams There is little slid and cnsistent empirical evidence available t cnfirm the efficacy f these cmprehensive and cstly drug interdictin measures. In additin, it is unlikely that even the best effrts f prisn staff and fficials can cmpletely eliminate alchl and ther drugs frm prisn. Indeed, the ntin f a drug-free prisn has been acknwledged by sme prisn systems as unrealistic. 36 In large measure, it appears that this cnclusin has been reached based n attempts t balance security cncerns with human rights. Hw effective are prisn-based urinalysis prgrams in reducing ffender drug use? Mst crrectinal jurisdictins make use f sme frm f randm r mandatry drug testing prgram. This typically invlves the labratry analysis f urine. Hwever, examinatin f urine testing frm England and Wales and Canada paints an incnclusive picture with respect t effectiveness f mandatry drug testing in genuinely reducing the rate f drug use amng incarcerated ffenders and thse n release. 37,38 Recent urinalysis statistics frm HMPS demnstrated that between 1997 and 2003 the psitive rate fell frm 24.4% t 11.7%. 39 On the ther hand, a 2001 study by the CSC fund that between 1996 and 2000 the psitive rate remained largely unchanged (11 12%). 40 Despite ptential inter-jurisdictinal differences in urinalysis prgram plicy and practice, the Canadian results are further bscured by the fact that there has been an increase in the rate at which ffenders refuse testing (even when refusal results in disciplinary actin). This finding has been mst evident at the maximum security level where the refusal rate increased frm 16 t 29% ver the fur-year perid. Sme investigatrs have suggested that the existence f randm testing prgrams may prmpt ffenders t turn t mre serius drugs with shrter metablite half lives (e.g., herin, ccaine, etc.) than THC-based substances t avid detectin. 41,42 Hwever, patterns f urinalysis results in Canadian research d nt supprt this cnclusin unambiguusly. 43 Nnetheless, the ptential health risks assciated with ffenders turning t mre prblematic drugs (since sme ffenders d begin injecting drugs in prisn) may utweigh the value fr prisn systems f cntinuing t test fr THC. Hw serius a prblem is injectin drug use and needle-sharing in prisn? Given the large prprtin f prisners with substance abuse prblems (many f whm engage in injectin drug use), there is serius cncern regarding the spread f infectius diseases such as hepatitis C and HIV/AIDS. The HIV/AIDS infectin rate f prisners in the Canadian federal crrectinal system (1.7%) is mre than 10 times higher than in the general ppulatin (0.13%). Rates f HIV/AIDS infectin are particularly high amng female federal prisners (8% in the Prairie regin). 44 Rates f hepatitis C infectin amng Canadian federal prisners are even higher than thse fr HIV/AIDS with the verall prevalence rate (23.6%) mre than 20 times higher than in the general ppulatin f Canada. Once again, verall rates f hepatitis C infectin are much higher fr female prisners (41.2%) than fr male prisners (23.2%). 45 The EMCDDA reprted in 2003 that 3 34% f Eurpean prisners have injected drugs while in prisn. 46 In Canada, apprximately 18.3% f ffenders reprted injecting drugs befre cming t prisn. Of these, 54.6% injected during the six mnths befre incarceratin. 47 A 1995 survey f inmates in federal custdy fund that 11% disclsed that they had injected drugs since cming t prisn % f these individuals indicated that the injectin equipment was nt clean r that they did nt knw whether it was clean. 49 A survey cnducted in 1998 at Jyceville Institutin x fund that 24% f respndents reprted using intravenus drugs in prisn (25% f whm reprted that they started injecting drugs after cming t prisn). 50 ix Drug-free units are living units within a prisn that are ppulated with prisner vlunteers wh have signed a cntract prmising t remain drug free. They may r may nt have a substance abuse prblem. Typically, prisners als agree t submit t additinal drug testing and search prcedures. In sme instances, drug-free units incrprate treatment services. In sme crrectinal systems these units are referred t as cntract units and intensive supprt units. Prepared by the Canadian Centre n Substance Abuse

6 Hw mtivated are ffenders t change their substance abuse behaviur? Althugh it is ften thught that ffenders are prne t engaging in denial when asked abut the existence f alchl and ther drug prblems, existing data paint a smewhat different picture. A Canadian study fund that virtually every ffender in the study with intermediate t severe substance abuse prblems acknwledged that they felt that they had a prblem. 51 Similarly, abut 75% f ffenders with lw severity prblems reprted that their use f substance was prblematic. Rather than cncluding that the remaining 25% were in a state f denial, it is pssible, given the lw severity f their prblem, that they simply did nt recgnize their behaviur as being prblematic. 52 Taken tgether, the evidence is that the majrity f ffenders with a substance abuse prblem are aware that they have a prblem. Hwever, prblem recgnitin des nt necessarily translate directly int mtivatin t address the issue. In general, it has been fund that ffender mtivatin fr treatment is inversely related t the severity f their prblems (e.g., prneness t vilence, sexual deviancy, etc.). This phenmenn als appears t hld true fr ffenders with substance abuse prblems. While ffenders with severe prblems may recgnize that their behaviur is prblematic and high risk (bth t themselves and thers), they are the least mtivated t address their prblem. In recent years, a prmising interventin apprach called mtivatinal interviewing has been applied t ffenders with substance abuse prblems in the hpes f helping them t engage in and fllw thrugh with substance abuse treatment bth during and fllwing release frm prisn. 53 In fact, all new interventin prgrams ffered by CSC incrprate mtivatinal interviewing techniques. A number f US state departments f crrectin als emply mtivatinal interviewing in their substance abuse prgrams (e.g., Maine, Ohi, Pennsylvania, and New Jersey). What kind f substance abuse treatment prgramming is available t ffenders in prisn and n release in the cmmunity? Over the years a wide range f preventin, treatment, and cunselling services have been implemented with ffenders, including: Detxificatin prgrams Residential treatment Therapeutic cmmunity prgrams Nn-residential prgrams Brief interventins Pharmactherapy (e.g., methadne maintenance treatment) Drug curts Self-help grups (e.g., Alchlics Annymus, Narctics Annymus, etc.) Relapse preventin prgrams Transitinal treatment Maintenance and aftercare Preventin prgrams fr ffenders withut a substance abuse prblem. These interventins and services have varied widely in terms f their theretical fundatin (r they lack thery altgether) and the extent t which the prgram design is based n slid empirical evidence. Indeed, the majrity f prgrams currently being ffered t ffenders thrughut the wrld have been develped withut a clear theretical base, empirical evidence, r strng adherence t accepted best practice guidelines. xi x Jyceville Institutin is a medium-security federal crrectinal facility with an ffender ppulatin f apprximately 500, lcated near Kingstn, Ontari. xi Part f the prblem may stem frm the fact that there is n clear cnsensus within the clinical cmmunity as t the ingredients f best practices and very little well designed research (discussed belw) t guide prgram develpment and peratin. Prepared by the Canadian Centre n Substance Abuse

7 Ntewrthy exceptins include CSC prgrams, 54 and prgrams develped by the US Federal Bureau f Prisns, 55 State f Maine Department f Crrectins, 56 and HMPS High Security Prisns. 57 Each f these prgram mdels is grunded in integrated thery and emplys cmprehensive evaluatin framewrks. xii Many crrectinal substance abuse prgrams require prgram participants t be free frm all drugs and medicatins prir t cmmencing treatment, insist n ttal abstinence frm all alchl and ther drugs as the nly suitable utcme fr treatment, and dismiss participants frm treatment fr using. Hwever, sme crrectinal jurisdictins are beginning t realize that many ffenders wh are interested in receiving treatment are either unwilling r unable t discntinue their alchl and ther drug use and that these individuals can still be apprpriate candidates fr treatment and can make significant imprvements in their substance use behaviur, thereby reducing the likelihd f future substance abuse and criminality. It is well established in the brad field f relapse preventin (fr varius prblems including substance abuse) that slips, lapses, and relapses are mre the nrm than the exceptin alng the rad t behaviur change, even fr thse wh have prgressed well in treatment. As a result, prgrams that require abstinence r dismiss participants fr using are largely unrealistic and, as will be discussed belw, may result in increased likelihd f failure leading t substance abuse and criminality (fr ffenders). 58 What are the characteristics f best practice substance abuse prgrams in prisn? Recent develpments in the area f effective crrectinal treatment have identified three primary principles that are key t determining the develpment f an apprpriate treatment respnse. 59 Overall, this mdel extends frm the ntin that nt all ffenders need the same type f treatment, nr is every treatment apprpriate fr every individual. The three principles are: 1. Intensive interventin services shuld be reserved fr ffenders wh are assessed as being high risk fr further criminal behaviur. High risk cases respnd better t intensive services whereas lw risk cases respnd t less intensive services 2. Treatment shuld be designed t target crimingenic factrs r needs that are theretically and empirically predictive f criminal behaviur. These needs are dynamic in the sense that they may be changed thrugh treatment (e.g., substance abuse). 3. Treatment shuld be designed t respnd t thse persns wh participate in treatment taking int accunt their rientatin, cgnitive style, learning styles, etc. A number f specific treatment techniques and cmpnents have been assciated with significant reductins in pst-treatment substance use: Scial skills training Prblem-slving skills Cping skills training High risk identificatin skills Structured relapse preventin Gal-setting in treatment Mtivatinal Interviewing/Enhancement techniques Emplyment skills Behaviural marital training Stress management training Maintenance, mnitring, and aftercare Cmmunity reinfrcement techniques In recent years, HMPS and the CSC have develped a framewrk against which prisn-based substance abuse prgrams can be evaluated fr likely effectiveness. xiii xii CSC substance abuse prgrams have been implemented in a number f prvincial and internatinal crrectinal jurisdictins and agencies including the Saskatchewan Department f Crrectins and Public Safety; New Brunswick Department f Public Safety, Cmmunity and Crrectinal Services Divisin; Bermuda Department f Crrectins; Natinal Prbatin Service (England and Wales); Nrwegian Ministry f Justice and the Plice; Swedish Prisn and Prbatin Service; and the Vlunteers f America, Delaware Valley. xiii Recently, the Swedish Prisn and Prbatin Service (Kriminalvården) has intrduced a similar prgram review and accreditatin prcess. Prepared by the Canadian Centre n Substance Abuse

8 Funded n thery that is evidence-based Use effective methds, techniques, and mdalities Multi-faceted incrprate different treatment mdalities Apprpriate intensity t respnd t participants needs (lw t high severity) Prgram integrity delivered cnsistently and accrding t established principles Quality staff recruited accrding t selectin criteria Well trained staff certified, mnitred, and supprted Management supprt Supprtive crrectinal envirnment fr prgram delivery Prper assessment and selectin f participants Cmprehensive evaluatin and mnitring infrastructure Unique interventin and service mdels are needed fr wmen, ethnic minrities (including Abriginal peples), and yunger ffenders. While the basic treatment cncepts and techniques (e.g., relapse preventin, mtivatinal interviewing, etc.) are relatively universal and may be suitable fr use with these treatment ppulatins, the ways in which treatment prgrams are designed and structured may differ dramatically frm prgrams that are designed and delivered t adult male ffenders. Indeed, the pathways t substance abuse, the reasns why they cntinue t use at prblematic levels, the health cnsequence f using, and the ways in which they seek help and why are quite different frm their male cunterparts. 60,61,62 Hw effective are substance abuse treatment prgrams fr ffenders? As mentined previusly, ne f the legislated mandates f crrectins in Canada is t prepare ffenders fr release. Given the high prevalence rates fr substance abuse amng the ffender ppulatin, bth in Canada and elsewhere, effective treatment is critical t successful reintegratin and reductins in risk t re-ffend. Hwever, review f the substance abuse literature reveals that relatively few prisn- and cmmunitybased prgrams have been the subject f rigrus utcme evaluatins. Of thse prgrams that have been evaluated there is sme evidence that substance abuse treatment services fr ffenders are capable f reducing substance use and criminality. 63 Hwever, this research is prblematic. 64 Prblems fund in this bdy f research include misinterpretatin f statistical analyses, unclear r incnsistent participant selectin criteria, remval f ffenders frm the analyses wh failed t cmplete the prgrams, remval f ffenders wh were dismissed frm the prgram fr using alchl r ther drugs, etc. The net effect f these methdlgical prblems is t ptentially skew the results in the directin f finding a psitive utcme. The results f several mre carefully designed studies xiv have shwn reasn fr ptimism when cnsidering the effectiveness f prisn-based substance abuse prgrams: A 19-site evaluatin f prisn-based residential substance abuse prgrams perated by the US Federal Bureau f Prisns fund that after six mnths, 20% f prgram participants versus 36% f untreated ffenders had at least ne psitive urinalysis. Mrever, 3.1% treated cmpared with 15% f untreated ffenders were re-arrested n a new charge. 65 A study f CSC substance abuse prgrams fund that 16% f prgram participants (including drp-uts and ther nn-cmpleters) were recnvicted fllwing ne full year n release cmpared with 23% f a matched cmparisn grup xv. This difference represents a 30% reductin in the rate f recnvictin between the treatment and cmparisn grups. 66 Overall, research suggests that successful prgrams fcus n skill-develpment (as ppsed t insight-riented, nn-directive appraches), emphasize cgnitive-behaviural factrs, include structured relapse preventin, and invlve gradual transitin t extended maintenance and aftercare (t master relapse preventin skills). The pst-release phase f the treatment prcess has been fund t be f critical imprtance in reducing the risk f relapse and further criminal activity amng ffenders with substance abuse prblems. Research has demnstrated this finding repeatedly. 67 xiv Neither f these studies is cmpletely free f ptential biases. The use f quasi -experimental designs limits the extent t which firm cnclusins can be drawn frm each. xv The cmparisn grup was nt a n treatment cntrl; sme f these individuals received substance abuse cunselling and treatment services, but they did nt participate in the prgrams under study. Prepared by the Canadian Centre n Substance Abuse

9 Research als suggests that fr mst ffenders with substance abuse prblems, the ptimal treatment plan invlves prisn-based treatment, cmplimentary cmmunity-based fllw up treatment, and nging maintenance, supprt and after-care services. 68 In Canada, cmmunity-based treatment is prvided by a wide range f rganizatins, bth gvernmental and nn-gvernmental (e.g., half-way huse rganizatins, substance abuse treatment rganizatins, etc.). Althugh, in the past, the efficacy f the treatment services ffered by many f these rganizatins was largely unknwn r was determined t be incnsistent with evidence-based practice, 69 mre recently, a grwing number f these rganizatins ffer best practice treatment services t criminal justice clients. Hwever, much wrk still needs t be dne t ensure that highneed criminal justice clients receive effective care and supprt. In what ways can harm reductin appraches be used successfully in prisn settings? A variety f harm reductin xvi techniques have been intrduced int crrectinal settings in recent years in an attempt t incrprate innvative and pragmatic alternatives t traditinal crrectinal appraches t dealing with ffender substance use and abuse. These include: Disseminatin f infrmatin n HIV/AIDS and ther diseases assciated with risky injectin practices Prvisin f bleach dispensers t clean needles Instructin n safe injectin practices Prisn-based needle exchange prgrams Remving abstinence as a pre-requisite fr ffenders t begin treatment Mderated/reduced use as psitive treatment gals A study cnducted by CSC fund that fllwing treatment, ffenders wh had chsen mderated use as their gal fr treatment were recnvicted at a lwer rate than thse wh were attempting t cmpletely abstain frm all intxicants. A similar pattern was fund fr thse ffenders with severe prblems. 70 These imprtant findings suggest that treating substance abuse as a public health prblem (where the gal is nt necessarily t achieve abstinence, but t facilitate imprvements in health and a crrespnding reductin in criminal behaviur), may be a mre effective way f reducing future criminal invlvement. Are there needle exchange prgrams in crrectinal institutins? Over the past 15 years, needle exchange prgrams have been intrduced in 46 prisns in six cuntries: Switzerland, Germany, Spain, Mldva, Kyrgyzstan, and Estnia. 71 The main impetus behind the intrductin f needle exchange prgrams in these crrectinal jurisdictins has been cncern ver the risk f infectius disease transmissin thrugh the sharing f dirty needles in the cntext f drug use in prisn. Prisn-based needle exchange prgrams can be seen as an integral part f a cmprehensive drug strategy, alng with ther harm reductin, treatment, and maintenance ptins t reduce prisner engagement in high-risk behaviurs. T date, there are n dcumented cases in which needles have been used as weapns against either crrectinal staff r prisners. 72 A recent review fund n increase in drug use r injectin drug use in prisns ffering needle exchange prgrams. 73 Currently, needle exchange prgrams are nt available in crrectinal institutins in Canada, althugh in 1998 a CSC news release indicated that the agency was mnitring the use f prisn-based needle exchange prgrams in ther cuntries. 74 xvi Harm reductin is a health-centred apprach that seeks t reduce the individual and scial harms assciated with alchl and drug misuse withut necessarily requiring ttal abstinence frm alchl and ther dug use. Harm reductin includes a brad cntinuum f respnses frm thse that prmte safer substance use t thse that aim t assist individuals in achieving abstinence. Prepared by the Canadian Centre n Substance Abuse

10 Endntes The authrs wuld like t thank Neil Byd, Serge Brchu, Andrea Mser, Carmen Lng, and Michael Wheatley fr their cnstructive cmments and input t an earlier versin f this dcument. Any errrs r missins are slely the respnsibility f the CCSA. 1 Crrectins and Cnditinal Release Act, Statutes f Canada. (1992), c Weekes, J. R. (2002). Assessment and treatment f frensic clinical ppulatins. Invited paper presented at the 10 th British Prisn Drug Wrkers' Cnference, Manchester, England 3 Weekes, J. R., Mser, A. E., & Langevin, C. M. (1999). Assessing substance-abusing ffenders fr treatment. In E. J. Latessa (Ed.) Strategic slutins: The Internatinal Cmmunity Crrectins Assciatin examines substance abuse. Lanham, MD: American Crrectinal Assciatin Press. 4 Weekes, et al. (1999). 5 Head, D. (2001). Alchl and drugs: A perspective frm crrectins in the Prvince f Saskatchewan. Frum n Crrectins Research, 13, Her Majesty s Prisn Service. (Nvember 25, 2003). The Prisn Service Drug Strategy, Briefing Nte. Lndn: Her Majesty s Prisn Service, Drug Strategy Unit. 7 Graves, G., & Bell, R. (2004). Cmputerized Screening Assessment: Data analysis reprt. Augusta, MA: State f Maine, Office f Substance Abuse. 8 Mrris, Richard (2001). Alchl and drugs: A perspective frm New Zealand. Frum n Crrectins Research, 13, Statistics Canada (2003). Canadian Cmmunity Health Survey: Mental health and well-being. Ottawa: Statistics Canada. 10 Weekes, et al. (1999). 11 Bland, F. J., Burrill, R., Duwyn, M., & Karp, J. (1998). Fetal alchl syndrme: Implicatins fr crrectinal service. Ottawa: Crrectinal Service f Canada. 12 Burd, L., Selfridge, R. H., Klug, M. G., & Juelsn, T. (2003). Fetal alchl syndrme in the Canadian crrectins system. Jurnal f Fetal Alchl Syndrme,14, Fast, D. K., Cnry, J., & Lck, C. A. (1999). Identifying fetal alchl syndrme amng yuth in the criminal justice system. Develpmental and Behaviral Pediatrics, 20, Graves, G., & Bell, R. (2004). 15 Mrris, R. (2001). 16 Brrill, J., Maden, A., Martin, A., Weaver, T., Stimsn, G., Farrell, M., & Barnes, T. (2003). Differential substance misuse, treatment needs f wmen, ethnic minrities and yung ffenders in prisn: Prevalence f substance misuse and treatment needs. Lndn: Hme Office. 17 Fairbairn, M. (2001). Drugs and prisners in Queensland. Paper presented at the 2 nd Internatinal Cnference n Drugs and Yung Peple, Melburne, Australia. 18 Hme Office (2001). Statistics n wmen and the criminal justice system Lndn: Hme Office 19 Head, D. (2001). 20 Weekes, et al. (1999). 21 Canadian Public Health Assciatin (2004). A health care needs assessment f federal inmates in Canada. Canadian Jurnal f Public Health, Canadian Public Health Assciatin (2004). 23 Weekes, J. R., Millsn, W. A., Prprin, F. J., & Rbinsn, D. (1994). The Offender Substance Abuse Pre-Release Prgram: Intermediate and pst-release utcmes. Ottawa: Research and Statistics Branch, Crrectinal Service f Canada 24 Graves, G., & Bell, R. (2004). 25 Mumla, C. J. (1999). Substance abuse and treatment, State and Federal prisners, Washingtn, DC: Bureau f Justice Statistics, Special Reprt, US Department f Justice. 26 Brchu, S., Cusineau, M-M., Gillet, M., Curnyer, L-G., Pernanen, K., & Mtiuk, L. (2002). Drugs, alchl, and criminal behaviur: A prfile f inmates in Canadian federal institutins. Frum n Crrectins Research, 13, Brchu, et al. (2002). 28 Weekes, et al. (1999). 29 Gldstein, P. (1985). The drugs/vilence nexus: A tripartite cnceptual framewrk. Jurnal f Drug Issues, 14, Weekes, et al. (1999). 31 Weekes, et al. (1999). 32 Plurde, C., & Brchu, S. (2002). Drugs in prisn: A break in the pathway. Substance Use and Misuse, 37, Eurpean Mnitring Centre fr Drugs and Drug Addictin (2003). Annual reprt 2003: State f the drugs prblem in the Eurpean Unin and Nrway. Lisba, Prtugal: Eurpean Mnitring Centre fr Drugs and Drug Addictin. 34 LGC Frensic Drugs Team (2004). HM prisn drugs reprt: April 2002 t March Lndn: Drug Strategy Unit, Her Majesty s Prisn Service fr England and Wales. 35 Crrectinal Service f Canada (2004). Urinalysis statistics and drug seizures. Ottawa: Security Divisin, Crrectinal Service f Canada. 36 Her Majesty s Prisn Service (December 17, 2003). The Prisn Service Drug Strategy, Briefing Nte. Lndn: Her Majesty s Prisn Service, Drug Strategy Unit. 37 Her Majesty s Prisn Service (Nvember 25, 2003). Prepared by the Canadian Centre n Substance Abuse

11 38 Crrectinal Service f Canada (2003). 39 Her Majesty s Prisn Service (Nvember 25, 2003). 40 MacPhersn, P. (2001). Randm urinalysis prgram: Plicy, practice, and research results. Frum n Crrectins Research, 13, Crrectinal Service f Canada (June 5, 1998). News release: Crrectinal Service f Canada releases results f inmate survey at Jyceville Institutin near Kingstn, Ontari. Ottawa: Crrectinal Service f Canada. 42 Plurde, C., & Brchu, S. (2002). 43 MacPhersn, P. (2001). 44 Mlughney, B. (2004). A health care needs assessment f federal inmates. Canadian Jurnal f Public Health, 95 (Supplement 1), S1-S Mlughney, B. (2004). 46 Eurpean Mnitring Centre fr Drugs and Drug Addictin (2003). 47 Canadian Public Health Assciatin (2004). 48 Crrectinal Research and Develpment (1996). Natinal Inmate Survey: Final reprt. Ottawa: CSC. 49 Crrectinal Research and Develpment (1996). 50 Crrectinal Service f Canada (June 5, 1998). New Release: Crrectinal Service f Canada releases results f inmate survey at Jyceville Institutin near Kingstn, Ontari. Ottawa: Crrectinal Service f Canada. 51 Weekes, J. R., Ginsburg, J. I., & Vanderburg, S. A. (2000). Enhancing ffender mtivatin fr substance abuse treatment. Paper presented at the meeting f the Canadian Psychlgical Assciatin, Ottawa, Ontari. 52 Prchaska, J. O., & DiClemente, C. C. (1982). Transtheretical therapy: Tward a mre integrative mdel f change. Psychtherapy: Thery, Research, and Practice, 19, Ginsburg, J. I. D., Mann, R., Rtgers, F., & Weekes, J. R. (2002). Mtivatinal Interviewing with Criminal Justice Ppulatins. In W. R. Miller & S. Rllnick (Eds.) Mtivatinal Interviewing: Preparing peple fr change, (2 nd ed). New Yrk: Guilfrd. 54 Weekes, J. R., & Lng, C. (1998). Substance abuse treatment: Canada s apprach. In E. Rhine (Ed.) Best practices: Excellence in crrectins. Lanham, MD: American Crrectinal Assciatin Press. 55 US Federal Bureau f Prisns (1998). Drug abuse treatment prgrams in federal prisns. In E. Rhine (Ed.) Best practices: Excellence in crrectins. Lanham, MD: American Crrectinal Assciatin Press. 56 Rtgers, F., & Graves, G. (1999). Differential Substance Abuse Treatment (DSAT) mdel. Augusta, MA: Office f Substance Abuse: State f Maine Department f Mental Health, Mental Retardatin, and Substance Abuse Services. 57 Her Majesty s Prisn Service (2002). FOCUS Prgramme manual. Wakefield, West Yrkshire: Drugs Strategy Supprt Unit, Directrate f High Security Prisns, Her Majesty s Prisn Service. 58 Parks, G. A., & Marlatt, G. A. (1999). Keeping what wrks wrking: Cgnitive-behaviral relapse preventin therapy with substanceabusing ffenders. In E. Latessa (Ed.) Strategic slutins: The Internatinal Cmmunity Crrectins Assciatin examines substance abuse. Lanham, MD: American Crrectinal Assciatin Press. 59 Andrews, D. A., Zinger, R. D., Hge, P., Gendreau, P., & Cullen, F. T. (1990). Des crrectinal treatment wrk? A clinically-relevant and psychlgically-infrmed meta-analysis. Criminlgy, 28, Natinal Center n Addictin and Substance Abuse (2003). The frmative years: Pathways t substance abuse amng girls and wmen ages New Yrk: CASA. 61 Crmier, R. A., Dell, C. A., & Ple, N. (2003). Wmen and substance use prblems. Ottawa: Wmen s Health Surveillance Reprt, Canadian Institute fr Health Infrmatin. 62 Canadian Human Rights Cmmissin (2003). Prtecting their rights:a systemic review f human rights in crrectinal services fr federally sentenced wmen. Ottawa: Canadian Human Rights Cmmissin. 63 Dwden, C., & Blanchette, K. (2002). An evaluatin f the effectiveness f substance abuse prgramming fr female ffenders. Internatinal Jurnal f Offender Therapy and Cmparative Criminlgy, 46, Gaes, G. G., Flanagan, T. J., Mtiuk, L. L., & Stewart, L. (1999). Adult crrectinal treatment. In M. Tnry and J. Petersilia (Eds.) Prisns. Chicag: University f Chicag Press. 65 Pellisier, B., Wallace, S., O Neil, J., Gaes, G., Camp, S., Rhdes, W., & Saylr, W. (2001). Federal prisn residential drug treatment reduces substance use and arrests after release. American Jurnal f Alchl and Drug Abuse, 27, Prprin, F. J., Rbinsn, D., Millsn, W. A., & Weekes, J. R. (2002). An utcme evaluatin f prisn-based treatment prgramming fr substance abusers. Substance Use and Misuse, 37, Prprin, et al. (2002). 68 Prprin, et al. (2002). 69 Graves, G., & En, J. (1993). The classificatin study f substance abuse treatment prgrams fr ffenders in Canada. Ottawa: Crrectinal Service f Canada. 70 Weekes, J. R. (2002). 71 Stöver, H., & Nelles, J. (2003). Ten years f experience with needle and syringe exchange prgrammes in Eurpean prisns. Internatinal Jurnal f Drug Plicy, 14, Stöver, H., & Nelles, J. (2003). 73 Stöver, H., & Nelles, J. (2003). 74 Crrectinal Service f Canada (June 5, 1998). News release: CSC releases results f inmate survey at Jyceville Institutin near Kingstn, Ontari. Ottawa: Crrectinal Service f Canada. This dcument was first published in Octber 2004 Prepared by the Canadian Centre n Substance Abuse

12 The Canadian Centre n Substance Abuse (CCSA), Canada s natinal addictins agency, was established in 1988 by an Act f Parliament. CCSA prvides a natinal fcus fr effrts t reduce health, scial and ecnmic harm assciated with substance abuse and addictins. Fr further infrmatin, please write: Canadian Centre n Substance Abuse Suite 300, 75 Albert St., Ottawa, ON K1P 5E7 Tel.: (613) ; fax (613) Visit ur Web site at ISBN (nline) Cpyright 2004 Canadian Centre n Substance Abuse (CCSA). All rights reserved Prepared by the Canadian Centre n Substance Abuse

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