Alcohol and drug addiction among prisoners Włodzimierz Wróbel Professor of Criminal Law Jagiellonian University Krakow, Poland Introduction The assertion that alcohol and drug addiction is one of the most frequent reasons for committing crimes (so called individual risk factors) is not very revealing. Those addictions are not left behind before passing the prison gates. On the contrary, they are recognized among the most serious problems the penitentiary system is facing. It is behind bars, that the percentage of addicted individuals is significantly higher than in free society. Drug and alcohol addictions present a problem when it comes to conviction and sentencing, as well as when the sentence is implemented and after release when after care is provided and the main purpose is to prevent relapse into crime. As it is emphasized in the professional literature, drug and alcohol addicts are rejected by society, cannot find employment and irrespective of their punishment are additionally sentenced by the society to being criminals. It leads to a vicious circle: prison release after serving the sentence lack of chances to rejoin the society another offence. In the seventies, it was estimated that in Poland approximately 25% of convicts serving a prison sentence were addicted to alcohol or drugs. No subsequent research in his area had been carried out until 2001. At that time, the research showed that almost 19% of the prison population were alcohol addicts, 2,5% drug addicts and approximately 5% individuals suffering of personality disorders. At the same time, it was estimated that approximately 60 to 80% of the inmates had intense (in various degrees) problems with using or abusing chemical substances. The only chance for effective readaptation of those prisoners is a withdrawal therapy, because prison isolation itself will not cure a convict from his addiction. On the contrary, seeking to satisfy his needs, such a convict can easily fall a prey to the prison subculture. One must also bear in mind, that one of the distinctive features of alcohol or drug addiction is the lack of consciousness of the addiction and denying that fact. A stay in prison itself will 111
not change the personality of the addicted convicts if they are not under specialistic therapeutic care. Therefore, the answer to the phenomenon of addiction among individuals serving a prison sentence is the development of therapeutic methods while the prison sentence is implemented. The Code on the Implementation of Sentences distinguishes (besides various kinds and types of penal institutions) three systems of enforcing custodial sentences: the programmed system, the therapeutic system and the normal system. The therapeutic system The therapeutic system can be applied in three cases, by virtue of: a sentence, when the court can indicate this system for the implementation of the sentence; a classifying decision. However, the convicts addicted to alcohol or drugs can be referred to treatment only with their consent (or in the case of lack of that consent, by virtue of the ruling of the penitentiary court); the ruling of the court ordering the application of forensic detention as a preventive measure imposed on the offender, who committed a crime in relation to his alcohol or drug addiction. Convicts with psychological disturbances, intellectually handicapped convicts and convicts addicted to alcohol or drugs or other intoxicating or psychotropic substances as well as physically handicapped convicts who require specialist treatment, especially psychological, medical or rehabilitative care serve their sentences in the therapeutic system. In this system the emphasis is placed on prevention of the development of pathological personality features, redress of psychic balance and creation of the ability to coexist in the society. Every convict with a recognized addiction should be referred to the adequate therapeutic system. The task to diagnose and refer lies upon the penitentiary psychologist and the prison doctor. Referral can take place, if: the convict himself reports specific problems to his tutor or psychologist. After acquiring his consent he is subject to a special addiction assessment test, and then on the basis of his written consent, he can be referred to the treatment; the court in its sentence orders the offender to submit to the treatment. In that case no written consent is required. The convict is obliged to give information about his health condition, to participate in individual or group 112
activities organized in the therapeutic unit and to accomplish other given tasks indispensable for his treatment and rehabilitation. In the therapeutic units there is a possibility to allow special favors and apply modifications to the generally binding prison rules, like the possibility to leave the cells open, to receive outside volunteers in the unit, or to permit the patient s family to participate in the therapy. In 2005 the addictions therapy was applied to 4,300 convicts and 25,000 convicts took part in rehabilitation programs outside the therapeutic system. Approximately only 20% of those, who require help, are involved in various kinds of therapeutic and preventive programs. There was no relationship between the severity of the penalty and the application of the therapeutic system. The largest group involved in the therapeutic system was first time convicts, then recidivists and juvenile convicts. The results of the research leave no doubts the biggest percentage of addicts is among recidivists. The results of the research concerning the percentage of addicted convicts accommodated by the withdrawal treatment are also interesting: in case of alcohol addicts it was 50,3 % and in case of drug addicts 54,8%. Thus, a visible progress is noticeable over the years. The advanced thesis, that the concentration of therapeutic activities in separated prison units is necessary, has also been confirmed, because those activities in other penal institutions are practically impossible and virtually illusory. At present there are 34 programs available for addicted convicts, with a total number of 1,170 places (data from 2006). Among them are 21 programs concerning alcohol addiction (689 places) and 13 connected with narcotic drugs (481 places). Furthermore, there are some programs outside the therapeutic system (especially preventive ones). Over 90% of the convicts who start a therapy, complete the therapeutic program; this rate being unbelievably high compared with the programs outside the penitentiary system. Still, there are a lot of convicts waiting for the therapy. Currently the average waiting time is ten months. The Polish penitentiary system is developing under very difficult conditions coping with overpopulation and lack of personnel. Therapeutic programs based on solid theoretical and empirical grounds are still a rarity. Very often they are simply authorial rehabilitation projects prepared by psychologists and tutors employed in prisons. The assessment of the effectiveness of those programs is still a challenge for criminal law science. 113
There are several basic obstacles for the proper development of the therapeutic system, such as: overpopulation (non compliance with the program rules due to shortage of personnel or too many participants); bureaucracy; overlegislation (there is a large number of state programs accompanied by deficiency of measures for their realization); lack of rehabilitation priority (the sanction itself does not reduce, but rather increases the number of social problems). Irrespective of those external obstacles, therapeutic programs provided in a prison setting meet other restrictions that can be described as internal. Addiction treatment in a penitentiary setting is not an easy task. One has to remember that it concerns individuals, who are subject to a prison discipline that might interfere with a therapy program. It is also not easy to ensure therapy participants a sense of security and trust. Residing in overcrowded cells is also not a very favorable circumstance. Alcohol addicted prisoners are characterized by serious deficits in basic social skills, such as: communication skills, building and sustaining constructive relations, making decisions, systematic work and above all ability to perform basic social roles. Frequently, the abstinence coerced by incapacitation makes convicts believe they can control the consumption of alcohol or narcotic drugs. The illusion of trouble free drinking is hereby strengthened. Under circumstances it is also hard to foster the inmates need and ability to plan their future life. Very often the therapy is seen by the patients not as a chance to change their life, but rather as an opportunity to gain some relief from serving their punishment. The other difficulty is lack of trust in the therapists, who are part of the penitentiary system. Another problem is that patients often belong to prison subcultures. This limits their possibility to join the therapy and to inform others about their weak sides. For alcohol addicted prisoners, the program ATLANTIS, based on Twelve Steps of Alcoholics Anonymous, has been introduced. The withdrawal therapy does not include the use of pharmacological means. The main idea of the program is psycho correction. The therapy period varies from three to four months. In individual cases this period can be shortened or prolonged. The patient can be signed out earlier, if he resigns himself from further treatment, if he does not comply with the withdrawal unit regulations, if he infringes provisions of the contract or does not fulfill his duties. 114
The problem of drug addiction on more large scale appeared in Poland in the seventies. Earlier, the basic stimulants were tobacco, alcohol and strong tea (according to research in 1987, this kind of tea was consumed by approximately 85% of prisoners). Currently a custom of consuming such tea is on the wane (presently it lingers only among old recidivists and is very sporadic among young prisoners). The first polls on drug addiction among prisoners were carried out in 1981 and 1984. The number of addicts was rather small (for 83,455 prisoners in 1981 the addiction was confirmed in 180 cases and three years later in 454 reported cases). At that time, the first therapeutic prison unit had been opened. The next research took place in 1987, when 13% of the prisoners admitted the use of drugs or other intoxicants (except alcohol). Only a very small part of this group participated in therapy. Subsequent research was carried out in 2001. This time it showed that almost 20% of the prisoners were using drugs. The most popular drugs were marihuana, hashish and amphetamine. Approximately 22% used drugs during imprisonment (mainly medicines, marihuana, hashish and amphetamine). Use of drugs was related to young age and practically did not involve convicts over 40 years of age. The Duet Program Since 2002 a very interesting therapy program for young offenders addicted to alcohol and for the first time sentenced to imprisonment, has been implemented in pre trial prison in Cracow. A part of this program consists in engaging the addicts, after completing the therapy, in socially useful work. The basis idea is that a group of convicts is working with handicapped people in Social Welfare Houses. The Duet Program is based on a few rules: the main goal is social readaptation of individuals with alcohol problem through work with handicapped youth; owing to the program, the chances of the handicapped grow. Convicts work is not a fiction, but it meets real social needs; the work with handicapped should enhance the convicts will to cooperate in the process of forming the desired attitudes, especially his sense of responsibility; the work with handicapped should serve convicts to restore positive values and to find positive aims in their lives; 115
the work with handicapped helps to overcome the feeling of isolation, both in the group of convicts and in the group of the Social Welfare House residents. It is the essential element of social readaptation; the work with handicapped enables the convicts to develop communication skills and the experience gained during work with people requiring professional care, increases their chances for future employment; the program promotes the chance for therapy and social readaptation. To qualify for the Duet Program a convict has to fulfill the following criteria: completion of a full therapy course in the therapeutic unit; no medical contraindications; a positive opinion from the prison tutor; no psychic or personality disorders; the length of the sentence already served allows the convict to file a petition for conditional release. Six convicts, who collaborate with the Social Welfare House personnel, are directly engaged in realizing the program. They participate in a training concerning basic pedagogical and psychological knowledge and practical methods of dealing with handicapped persons. Social Welfare House personnel also participate in the training, familiarizing them with the specific character of penitentiary institutions and problems connected with addictions (especially alcohol addiction). In the initial phase of the program, the main difficulty was to overcome the fear by the Social Welfare House personnel and the families of the handicapped persons. On the other hand, there was an apprehension that convicts will resign from the program, when they realize how hard the work is. The convicts were also uncertain whether the Social Welfare House personnel would accept them. After a few days, all these fears were gone and the convicts underlined the experienced shock, not only caused by the first contact with the handicapped, but also by the friendliness and openness of the Social Welfare employees. The convicts participating in the program work 40 hours a week. They help full time employees in their everyday duties, closely related to the resident s daily routine. The convicts take their share in everyday activities (supervision and control during everyday toilet and meals, help in dressing and undressing, seeing them off to school and bringing them back, help in performing their basic duties, like making their beds, emptying dustbins et cetera, 116
participation in therapeutic art/music/sport activities) and participate in therapeutic meetings. Conclusion In current discussions the rehabilitative function of criminal law sounds almost like an invective. Looking at the therapeutic programs, we see that the idea of rehabilitation must be essential for all state activities during enforcement of the sentence, since their task is to prepare the return of the convict in free society without ending in a vicious circle of subsequent crimes. The programs described above are the best example. And even when their effectiveness is limited, it is still worth to make an effort, because this is the best way to limit criminality and the growth of prison population. 117