National Offender Management Service NOMS Reducing Re-offending: Drug and Alcohol Treatment Strategy Danny Clark, Head of Substance Misuse interventions Reducing Re-offending Policy Group Directorate of Commissioning and Operational Policy
Context NOMS bringing together prisons and probation Regionalisation and commissioning Financial Restraint Population growth in Prisons and probation: But the big issue is throughput: the number of new (or returning) offenders received into prison each year is more than 130,000 The National Treatment Agency estimates that treating drug dependency successfully can take 5-7 years: Average prison sentence 9 months and community 18 months.
The NOMS Substance Misuse strategy 2008-2011 Reducing supply, through security measures and drug testing programmes; Reducing demand, through targeted interventions for low, moderate and severe substance mis-users; Establishing effective through-care links to ensure continuity of treatment post-release or continuation in treatment after supervision.
The NOMS Strategy 2008-2011 NOMS has in place a comprehensive Substance misuse treatment framework, based on the National Treatment Agency s revised Models of Care, to address the different needs of misuse. The interventions available are designed to meet the needs of low, moderate and severe misuse irrespective of age, gender or ethnicity.
The NOMS Drug Treatment - Prisons Detoxification and/or maintenance prescribing CARATs (Counselling, Assessment, Referral, Advice and Throughcare service) Integrated Drug Treatment System (IDTS) Drug Rehabilitation Programmes Young People s Substance Misuse Service
Prison Accredited programmes 4 Accredited CBT drug programmes Short Duration Programme Prison Adressing Substance misuse Related Offending STOP Focus 2 Drug 12 step programmes 4 Therapeutic communities Alcohol related violence programme COVAID Alcohol dependency programme
Continuity on release There are systems in place to ensure that the care of drug misusing offenders continues during their journey between the community and prison, back to the community or between prisons. For those sentenced to 12 months and over, their offender manager has the responsibility for ensuring there are appropriate licence conditions which require the offender to continue to address their problems on release. These conditions can require the offender to, for example, attend a substance misuse offending behaviour programme. Those sentenced to fewer than 12 months imprisonment -, a referral will be made to local Criminal Justice Integrated Teams (CJITs) to broker drug treatment provision in the community if required. Approved Premises residents are subject to drug testing as part of the rules of residence..
The history of court mandated drug treatment in the community Drug Treatment and Testing Orders (DTTO) introduced 2000 All existing orders replaced under CJA 2003 by single Community Order CJA 2003 made supervision and interventions available with Suspended Sentence Drugs Act 2005 introduced drug testing on arrest and Tough Choices
The Community Order Menu of 12 requirements: Activity Alcohol Treatment Attendance Centre (under 25) Curfew Drug Rehabilitation Exclusion Mental Health Treatment Prohibited activity Programme (accredited) Residence Supervision Unpaid Work Types: restrictive, support, personal change, treatment, control.
Drug Rehabilitation Requirement (DRR) Three levels of intensity Low: one contact per week, one drug test per week (DRR + supervision) Medium: 8 hours per week, two tests per week (DRR + supervision + programme) High 16 hours per week, two drug tests (DRR + supervision + programme + other requirement if necessary)can be residential treatment (i.e. rehab)
Treatment Modalities Must be structured treatment, in line with Models of Care (NTA) Care planning and key-working Structured Day Care Prescribing Residential rehabilitation (often 12 step) All but low intensity DRRs likely to be accompanied by a programme requirement Opportunity for substantial post programme follow up Intensity matches seriousness of offence NOT treatment need Contact hours include all aspects of the order, not just DRR All orders of 12 months or more reviewed by court every 4 weeks
Accredited Community Interventions Cognitive Behavioural Programmes: ASRO addressing substance misuse related offending OSAP - Offenders substance abuse programme PRISM - one to one programme Drink impaired drivers LIAP - Low intensity alcohol programme COVAID - Alcohol and violence
Review of Drug and Alcohol treatment programmes New guidance from NICE and NTA IDTS increased amount of methadone substitution Prescribing Ensure the right mix of programmes for the population Alignment of prison and probation Increase efficiency of delivery
Immediate priorities Reduce the number of CBT drug programmes Modularization of programmes where possible Develop a maintenance/ booster programme Abstinence programme for the community Update Carats practice manual
Future Priorities Better assessment and alignment of provision more closely with need Improve the continuity of treatment between the prison and community. Sequencing and links with other interventions Develop a comprehensive and viable research and evaluation programme for Substance misuse treatment. Quality assurance of non accredited interventions Establish value for money