Pre and post release programmes

The time before and after release from prison has very important impact on future criminal activity, re-incarceration, and relapse (WHO et al. 2007b). The time just after release from prison is especially difficult and needs to be considered separately. The risk of opiate overdose is especially high in the two weeks after release. There is a twenty to fifty fold increase of drug related deaths in the first week after release, this drops by 50% per week and plateaus at 4 weeks (Farrell 2005). Pre- and post-release treatments as well as throughcare programmes constitute important features of treatment.

Main results

Aftercare (and throughcare) is essential

Continuity of treatment provision is an important factor, particularly as aftercare following release and this is linked to re-offending rates (Porporino et al. 2002).

The prevention of relapses after release and the reduction of recidivism among inmates is one of the major concerns of a penal system bound to rehabilitation. Nevertheless in Europe, there is not much evidence for efforts to provide relapse prevention programmes or to evaluate the effects of those treatments provided. If one wants to know what works, you have to look for findings from Northern-America. Here, a number of specific treatment programmes combined with aftercare had been established in several state prisons. Most of these programmes base upon in-prison therapeutic communities (TC) - often for drug dependents - which are followed by gradually release programmes and participation in aftercare treatment. The most famous programmes are the Californian “Forever Free” in-prison, residential, substance abuse treatment program designed for women (Hall et al. 2004), the “Amity” TC program (Prendergast et al. 2004b), and the corrections-based drug treatment “Key-Crest” in Delaware (Butzin et al. 2005). In addition there are evaluations of prison-based TC’s from New York (Metraux and Culhane 2004; Turley et al. 2004). These studies have been done by tracking the same cohort of inmates over time to assess the impact of treatment on recidivism.

One of the Californian studies was conducted among 4.155 participants of in prison- based TC treatment (Burdon et al. 2004). The results highlight the importance of duration of time spent in treatment. Increased time spent in prison-based treatment

predicted increased participation in aftercare and decreased the 12-month recidivism. The “Forever Free” assessment based upon a 1-year follow up of a treatment (N=101) and a comparison group (N=79) (Hall et al. 2004). According to the findings did those women with more lifetime arrests show a significantly increased risk of re- incarceration. Treated women had significantly fewer arrests, less drug use, and greater employment. Similar results are to be found in the “Amity” 5-year post release follow- up (Prendergast et al. 2004b). Again the treatment group had significantly lower rates of re-incarceration than the control group. Those who attended also aftercare had even lower levels of re-incarceration and higher levels of employment. Another 5-year follow-up study examined the effects of post-release transitional therapeutic community treatment in Delaware corrections system (Butzin et al. 2005). The comparison between the treatment and control group showed substantial and persistent benefits for the treatment group even for those with extensive criminal history, low rates of marital bonds, and substantial unemployment. About 32 % of the treatment participants were drug-free compared to 10 % of non-treated. The time to relapse was a mean of 28.8 months in the treatment group versus 13.2 months in the no-treatment group. The impact of prison-based treatment and aftercare programmes in reducing the rates of re- incarceration significantly are as well underlined by two studies from New York (Metraux and Culhane 2004; Turley et al. 2004).

In English prisons the drug treatment programme provided by RAPt (Rehabilitation of Addicted Prisoners Trust) has been assessed (Ramsay 2003b). This programme for male prisoners aims at a total abstinence from drugs and alcohol. After a 2-year follow up period the reconviction rate was significantly lower for the treatment group than for untreated prisoners (40 % vs. 50 %. The main finding was that good-quality treatment can be effective in reducing drug use and re-offending. To be effective treatment needs to be

y tailored to individual needs, y of sufficient duration,

y followed up by high-quality aftercare, both in prison and on release.

Another study from UK evaluated the effectiveness of different types of treatment for drug dependent prisoners (Harrison et al. 2003). According to the results the strongest evidence for effectiveness have first behavioural skills training and second cognitive- behavioural therapies and Motivational Interviewing. Relapse prevention as a cognitive behavioural approach is proofed to be generally effective to prolong the intervals between relapses and to reduce the severity of relapses. Methadone maintenance has been found to reduce injecting risk behaviour in prison and to decrease crime rates. However, the authors concluded that the success of prison-based treatment is closely connected with the provision of throughcare and aftercare arrangements.

Apart from treatment needs prisoners often have several inter-related resettlement requirements (accommodation, employment, training, health issues) when leaving

prison. For this reason Crow (2006) underlined the “importance of multi-modal action addressing the full range of offenders’ needs”. Agencies can play a part in encouraging and reinforcing ex-prisoners’ own efforts and to support these efforts good linkage between agencies is essential. Psychological impairment (Messina et al. 2006) and the situation that there is nothing in place at the time of release increase the likelihood to return to drug uses and related offending.

Because of the high risk of overdose after release, a linkage to immediate substitution treatment is recommended (Rich et al. 2005).

The importance of continued and integrated interventions in the different stages (incarceration until aftercare) are highlightened by Inciardi (1996).

One release programme operating since 1992 is Antenne Toxicomanie, an intensive pre- release course, which decreases the reincarceration rate: 39% of participants returned to prison within one year, compared to 63% in a control group (Turnbull and Webster 1998).

“Especially good-quality aftercare that covers the vulnerable period from release until the first months of re-entry into the community has been proofed to be vital to the success of treatment programmes in prison.” (Zurhold et al. 2005).