Abstinence-oriented programmes

This kind of programmes refers to different approaches of psychosocial interventions aiming at abstinence by providing rehabilitation and social reintegration. Another term used is “demand reduction”, which describes

“policies or programmes directed towards reducing the consumer demand for narcotic drugs and psychotropic substances covered by the international drug convention control conventions” (United Nations 1998).

The goal of these programmes is to support prisoners in leading a drug-free life in response to an awareness of risks associated with the use of drugs especially in the prison setting. The most common approaches include therapeutic communities, drug free wings, and cognitive-behavioural programmes. Access to these programmes is voluntary under certain conditions, sometimes even with contracts for behavioural change. The central objective is abstinence. Therefore urine testing plays a major role to ensure the drug-free status. These programmes are mostly run in separate sections of the prison with no direct contact with other prisoners and a high control standard.

Therapeutic communities offer support for prisoners suffering from ‘emotional disturbance’ in a group setting and are based on principles of a ‘collaborative, democratic and de-institutionalised approach to staff-patient interaction’ (see Association of Therapeutic Communities 2007). As prisoners are effectively a captive audience, this offers some advantages to prison based therapeutic communities,

however, the regime can also impede such programmes effectiveness, due to strict regulations impact on group and individuals’ decisions regarding treatment.

Drug free units are formed on separate sections within prisons, offering support to those prisoners who wish to cease all types of drug use (often including smoking). Prisoners are routinely tested, attend regular and often intensive counselling programmes and group activities, which might include cognitive behavioural programmes. They focus on ceasing drug use during the sentence and also may provide after care services once prisoners are released (Hough 1996).

Cognitive-Behavioural programmes are structured psychosocial interventions aiming at modifying cognition and behaviour. It usually includes some kind of skills training and practice to deal with craving as well as relapse prevention. Different modifications and The provision of abstinence-based treatment programmes in prison varies considerably throughout the EU. According to Turnbull, by 1997 80% of all Council of Europe countries had abstinence-based programmes, but the extent varies greatly (Turnbull and Webster 1998). Some countries show an increase of drug-free areas since the mid-nineties of 300-400% (Turnbull and McSweeney 2000, p. 48). Therapeutic communities and other rehabilitative programmes are available in most European countries, but not sufficient data for the new member states are available. Drug-free units are available in Austria, Denmark, England/Wales, Finland, Germany, Ireland, Luxembourg, Netherlands, Norway, Portugal, Scotland, Spain, and Sweden, mostly in only parts of the prison system, and no drug-free wings exist in Belgium and France, whereas there were no data for the new EU-member states (Merino 2005).

Main results

Prison-based TC reduces criminal activity, recidivism and relapse. Drug-free wings and other abstinence-oriented treatment seem to be helpful as well.

Not many studies have been conducted on the effectiveness of psychosocial interventions in the prison setting (Strang et al. 2007), and a need for more studies on effectiveness of treatment programmes was identified (Costall et al. 2006). Studies indicate that it is important for prison systems to develop particular strategies for prison drug treatment rather than simply just reflecting those strategies that exist in the community (Turnbull and Sweeney 1999). Generally there is a growing consensus that drug treatment programmes in prison can be effective if they are based on the needs and resources of prisoners and are of sufficient length and quality (Ramsay 2003b).

The effectiveness of TC on recidivism for incarcerated drug users was shown (Pearson and Lipton 1999), other treatment approaches including cognitive-behavioural interventions and 12-step programmes were declared as promising but there was not enough studies to evaluate (Pearson and Lipton 1999). Two RCTs (Wexler et al. 1999;

Sacks et al. 2004) were identified on TC in prison, both from the USA. TC in prison was associated with reductions in criminal activity, recidivism, and relapse, compared to a prison control group. For the reincarceration rate no significant difference was

found at 12 months but at five years (Smith et al. 2006; Strang et al. 2007). No effectiveness of boot-camps (a military-style scheme) for young offenders was demonstrated in two US studies, as the treatment group did not differ from the control group (Strang et al. 2007). For incarcerated women case management, skills training, and TCs are especially recommended (Lewis and Lewis 2006).

On drug-free units a German study found significant lower criminal recidivism in regular programme completers than in drop-outs (Heinemann et al. 2002). There are some indicators that drug-free units reduce drug use, and some conflicting evidence on recidivism (WHO et al. 2007b). Counselling programmes in prison seem to be effective in reducing re-offending but not drug use, and voluntary programmes seem to be more effective than other programmes, but the study quality on these issues is not good (WHO et al. 2007b).

Abstinence-based treatment programmes provide a good opportunity for those prisoners who are motivated and capable to cease using drugs.

Table 7: Example studies on abstinence-based treatment in prison

Study Quality Results

Costall et al.

2006 survey Interventions in nine European countries are presented. The effectiveness needs to be studied, and models of interventions should be evaluated.

Heinemann et

al. 2002 survey 408 prisoners in two drug-free units in Hamburg/Germany were followed. Those who finished the programme regularly had significant lower criminal recidivism than drop-outs. Drop-out during first 100 days predicted worst outcome.

Persaon and

Lipton 1999 E TC is effective on reducing recidivism; boot camps and drug-focused counselling are not. ST, 12-step, cognitive-behavioural approaches, and substance abuse education are all promising but too few studies to evaluate.

Rosen et al.

2004 D 220 inmates in substance abuse treatment compared to 441 not in treatment. Treatment motivation was evaluated; increased focus on internal motivation may lead to more effective treatment.

Smith et al.

2006 F This Cochrane review found two RCTs on TC in prison;

participants had significantly fewer re-incarcerations criminal activity, alcohol and drug offences after 12 months, compared to Mental Health treatment group.

Strang et al.

2007 F Two RCTs on TC, same as Smith et al. Two studies on bootcamps did find no difference between treatment and control group in a traditional juvenile camp.

Turnbull and

Webster 1998 survey Extend of drug demand programmes varies widely between countries. Most common interventions are to provide information and to encourage treatment contact.