Inmates’ perspectives on prison drug treatment
| Author | Helle Vibeke Dahl,Karina Ellegaard Holm,Torsten Kolind,Vibeke Asmussen Frank |
| DOI | 10.1177/0264550515571394 |
| Published date | 01 June 2015 |
| Date | 01 June 2015 |
| Subject Matter | Articles |
Article
The Journal of Community and Criminal Justice
Probation Journal
Inmates’ perspectives
2015, Vol. 62(2) 156–171
ª The Author(s) 2015
on prison drug
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DOI: 10.1177/0264550515571394
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A qualitative study
from three prisons
in Denmark
Vibeke Asmussen Frank, Helle Vibeke Dahl,
Karina Ellegaard Holm and Torsten Kolind
Aarhus University, Denmark
Abstract
The purpose of this article is to employ a user-perspective on prison drug treatment.
Based on data from 32 in-depth qualitative interviews with inmates and three months
of observational studies in three Danish prisons, the article examines how drug
treatment in prison is experienced and strategically approached by enrolled inmates.
The analysis shows the broad range of reasons for entering as well as staying in
treatment during imprisonment, including how the prison setting influences and con-
strains inmates’ experiences in different ways. By employing a user-perspective the
article follows the research tradition, beginning in the 1990s, of including drug users’
perspectives on treatment. It adds important information to the drug treatment liter-
ature on issues such as organization, social relations and output of drug treatment.
Including a user-perspective, we were able to uncover aspects and experiences of
treatment services that differ from other actors in the field, e.g. counsellors, medical
doctors, nurses, politicians, and officers. A user-perspective also challenges our
understanding of what is at play in drug treatment as well as treatment in prisons.
Corresponding Author:
Vibeke Asmussen Frank, Centre for Alcohol and Drug Research, Aarhus University, Bartholins Alle 10, 3,
8000 Aarhus C, Denmark.
Email: vaf.crf@psy.au.dk
Frank et al.
157
Keywords
Danish prisons, inmates’ perspectives, prison drug treatment
Introduction
While the employment of a user perspective in community treatment is developing,
studies including a user perspective on prison drug treatment are still relatively few
(e.g. Frank et al., 2011; Haller, 2014; Melnick et al., 2004; Neale and Saville,
2004). Based on qualitative research in three Danish prisons, this article will thus
analyse the experiences of inmates enrolled in prison drug treatment programmes.
Generally, our data shows that these experiences cannot be separated from the
institutional environment of the prison that limits inmates’ freedom of movement,
action and interaction, and regulates their daily life by a comprehensive set of rules
(Cohen and Taylor, 1972; Ugelvik, 2011). Hereby, we follow research on com-
munity drug treatment, the aim of which is not only to include the drug users’ per-
spective on treatment services, but also the wider social context of both treatment
and drug users’ everyday lives.
Examining the experiences of drug users enrolled in treatment was almost non
existent before the late-1990s (see, however, Gold et al., 1988; Mavis et al.,
1991). As Hunt and Barker noted in 1999: ‘An analysis of the client’s experience
of treatment, the micro level of institutionalization and practice, is probably the
area of drug treatment research about which least is known’ (Hunt and Barker,
1999: 129). The work of Koester et al. (1999) especially inspired research on
drug users’ perspectives on treatment looking at the wider social context of both
treatment and drug users’ everyday life (see also studies by Hunt and Rosenbaum,
1998; Neale, 1998a, 1998b). Based on ethnographic research among heroin
users in methadone treatment, Koester et al. showed that while clients enrolled in
methadone treatment adapt to the institutional setting, they also approach the
treatment rather pragmatically based on their street-based drug-using lifestyle. For
instance, drug users applied for treatment in order to stabilize their life situation,
preserve jobs or withdraw from a violent drug environment. Koester et al. called
such approaches ‘self-prescribed attempts at harm reduction’ (Koester et al.,
1999: 1237). Since Koester et al.’s work, similar studies have been conducted
(e.g. Al-Tayyib and Koester, 2011; Dahl, 2007; Deering et al., 2011; Kolind,
2007; Laudet et al., 2009; McKegany et al., 2004; Patterson et al., 2008; Pat-
terson et al., 2010). For instance, researchers have argued that the way treatment
services are delivered, including the professional approach of the counsellors
towards the clients, is as important as the actual content (Kolind 2007). Similarly,
users when evaluating treatment services value, first and foremost, a high level of
accessibility and a non-patronizing attitude (Neale, 1998b; Notley et al., 2012).
Although a user perspective may not reveal the ‘truth’ about drug treatment
(Asmussen and Jo¨hncke, 2004), we are nevertheless able to learn more about
158
Probation Journal 62(2)
what it takes to enter, stay and terminate a treatment programme; knowledge
which is important when planning and implementing relevant drug treatment,
including prison drug treatment.
In the following, we first introduce our data, the methods used for data collection,
the prison setting and the treatment forms offered. Secondly, we present our anal-
ysis, which explore: a) inmates’ reasons for entering and staying in treatment; and
b) how inmates experience both prison and treatment settings as unstable worlds.
These sections are inextricably connected because the reasons for entering and
staying in treatment are influenced by the experiences of uncertainties produced by
the prison setting. The analysis shows more generally how the institutional setting
(both prison and treatment settings), the everyday life outside prison, and the inmate
culture in a complex mix influence the inmates’ balancing of pros and cons for
entering and staying in treatment. In the conclusion, we discuss this issue further and
offer ideas for action and further research.
Data and setting
Our study was conducted in three different prisons in Denmark between June
2011 and June 2012.1 It is based on three months of observations and 32 qua-
litative semi-structured interviews with inmates, between the ages of 19 and 54
enrolled in a prison drug treatment programme. Twenty of them were men. Five of
the interviewees, all still imprisoned, were re-interviewed around half a year after
the first interview. Altogether, the interviewees represent a heterogeneous sample
of inmates in relation to drug use (preference of substances, patterns and extent of
use), criminal record (type of criminality, length of sentence, former incarcera-
tions) and experiences with drug treatment in other institutional settings. The
interviews lasted 1 – 11=2 hours each. All interviews were recorded and tran-
scribed. Transcripts of interviews and observational notes were coded themati-
cally. The thematic coding helped to develop relevant analytical concepts as well
as isolate and categorize specific and contextual related themes (cf. Lewis, 1995;
Strauss and Corbin, 1997).
Since 2007, all of Denmark’s 13 prisons (5 closed, 8 open) housing approxi-
mately 4000 inmates at a time, are legally obliged to provide non-medical drug
treatment to inmates within two weeks of request (Frank and Kolind, 2008; Kolind
et al., 2012; Kriminalforsorgen, 2011). Two types of differently organized
treatment programmes are available: a day treatment model and a residential
model. Inmates enrolled in day treatment spend their daily life in ordinary prison
wings and participate in individual counselling and/or group therapy sessions for
usually about 12 hours a week. Enrolment can be as long as the inmate wishes or
as the counsellors consider it appropriate. Inmates enrolled in a treatment wing
(the residential model) spend both their treatment and their sentence time in the
same wing, closed off from the rest of the prison. Both types of treatment are
‘imported’ from municipal drug treatment centres or independent institutions.
Consequently, the counsellors are employed by these treatment organisations in
Frank et al.
159
question, but work within the prison setting (for further details see Kolind et al.,
2014).
According to the Prison Service, inmates have both the right and the duty to
be employed for 37 hours a week (Lovtidende, 2009). Employment covers work
and school as well as participation in treatment. Inmates receiving day treat-
ment thus combine it with work and/or school making their daily schedule
similar to that of other inmates. Residential treatment, on the other hand, con-
sists of a structured and intense daily programme in which daily duties (clean-
ing, cooking and dishwashing) and social interactions are regarded as equally
important for counselling and therapy. The day treatment programme we stud-
ied is located in an open prison for both men and women. One of the resi-
dential treatment programmes was in a closed male prison. The other
programme is for women only and functions as a semi-closed prison inside an
otherwise open prison (Dahl and Pedersen, 2006). All three programmes con-
tained an average of 1215 enrolled inmates.
The study has been reported to the Danish Data Protection Agency. All inmates
were informed about the purpose of the study and the methods. All information was
handled confidentially and all participants have been anonymized.
Results
Reasons to start – and stay – in treatment
The easy access to drug treatment within Danish prisons may give rise to the belief
that inmates with drug problems flock to programmes while serving their sentences.
However, research on community drug...
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