Understanding the treatment needs of drug users in prison
| Author | Joanne Neale,Esther Saville,Michele Robertson |
| Published date | 01 September 2005 |
| DOI | 10.1177/0264550505055433 |
| Date | 01 September 2005 |
| Subject Matter | Articles |
03_055433_Neale (JB-D) 27/7/05 3:25 pm Page 243
Probation Journal
Article
The Journal of Community and Criminal Justice
Copyright © 2005 NAPO Vol 52(3): 243–257
DOI: 10.1177/0264550505055433
www.napo.org.uk
www.sagepublications.com
Understanding the treatment needs of drug
users in prison
Joanne Neale, Oxford Brookes University
Michele Robertson, University of Glasgow
Esther Saville, Scottish Executive
Abstract The authors use data collected in Scotland to investigate differences
between individuals entering drug treatment in prison and those entering drug
treatment outside the prison setting. They also explore variations between male
and female drug-using prisoners. Their findings suggest that prison drug services
should be more tailored to the specific needs of both their male and female clients.
Keywords community, criminal justice, drug users, gender, heroin, prison,
Scotland, treatment
Tackling drug use within prisons is a major concern both nationally and inter-
nationally. Research suggests that up to half of all incarcerated individuals in
the UK are dependent on drugs, mainly opiates and cannabis, and at least a
quarter have injected (Marshall et al., 2000). In Scotland, information from
medical check-ups and urine testing reveals that more than three quarters of all
people entering prison are taking illicit substances, with the majority using opiates
such as heroin (Scottish Prison Service, 2000). Although women comprise a much
smaller proportion of the prison population than men, female imprisonment has
risen at a much faster rate than male imprisonment over the last two decades
(Pelissier et al., 2003) and the level of drug use amongst female prisoners is higher
than amongst males (Maden et al., 1994; Brochu et al., 1999; Borrill et al.,
2003a, b). In October 2000, a study of Scotland’s only all-female prison showed
that 94 per cent of women were testing positive for illegal substances on admis-
sion (HMIPS, 2001).
A key objective of the UK Government’s current 10-year drug misuse strategy
243
03_055433_Neale (JB-D) 27/7/05 3:25 pm Page 244
244 Probation Journal 52(3)
(‘Tackling Drugs to Build a Better Britain’) is to increase ‘the participation of
problem drug misusers, including prisoners, in drug treatment programmes’
(Cabinet Office, 1998: Aim iii). Aside from reducing the incidence of drug taking,
investment in drug services can produce benefits for society in terms of reduced
crime, safer communities and fewer demands on public resources, particularly
health services and policing (Redondo et al., 1999; Kothari et al., 2002). Target-
ing support at imprisoned drug users is important for two additional reasons. First,
rates of drug overdose amongst recently released prisoners are particularly high
(Seaman et al., 1998; Shewan et al., 2000). Second, prisoners with drug problems
tend to report greater childhood adversity, psychiatric ill-health, housing diffi-
culties, and employment problems than other inmates. They are therefore particu-
larly vulnerable and tend to require intensive support (Brooke et al., 2000; Kothari
et al., 2002).
The research evidence
To date, there has been almost no research examining how, if at all, the needs of
drug-using prisoners differ from those of drug users presenting for treatment
outside of the prison setting. One notable exception to this is a Canadian study by
Brochu et al. (1999), which compared the characteristics of three groups of men
addicted to alcohol or other drugs (553 offenders in community treatment, 499
non-offenders in community treatment, and 103 addicted prisoners). This research
found that, relative to non-prisoners, incarcerated drinkers and drug users:
● were younger;
● experienced more problems with the law;
● attained lower levels of education;
● had less stable employment;
● had lower income (including a higher rate of dependency on benefits);
● experienced more social maladjustment;
● were less integrated into the social world; and
● displayed more antisocial behaviours.
Brochu et al. (1999) identified few differences between the prisoners and non-
prisoners in levels of drug consumption or the amount of money spent on
psychoactive chemicals (cocaine was the illicit drug of choice for all participants
in the research). However, the prisoners were more likely to abuse a wide range
of substances and had a lower motivation to address their drug use. In addition,
they had worse physical health, but fewer symptoms of mental ill-health, than the
non-prisoners.
A small number of American studies (Anglin et al., 1989; Farabee et al., 1993;
Kline, 1997) have examined differences between voluntary drug treatment clients
and those referred by criminal justice agencies – although participants in these
studies were not actually imprisoned at the time of the research. Like Brochu et al.
03_055433_Neale (JB-D) 27/7/05 3:25 pm Page 245
Neale et al. ● Understanding the treatment needs of drug users in prison 245
(1999), Kline (1997) found that criminal justice-referred clients reported more
arrests and a greater likelihood of one or more convictions and were less moti-
vated to undergo treatment than voluntary clients. More unexpectedly though,
criminal justice-referred clients:
● experienced fewer social problems;
● had better social and psychological adjustment with respect to family and
social relationships;
● were less preoccupied with their drug use and its effects;
● had made fewer suicide attempts;
● had experienced less physical or sexual abuse; and
● reported fewer episodes of depression.
In respect of gender, various studies have investigated the specific needs of
incarcerated addicted women (Yang, 1990; Wellisch et al., 1993; Peugh and
Belenko, 1999) and sought to identify any differences that exist between imprisoned
drug-using males and females (Peters et al., 1997; Langan and Pelissier, 2001;
Pelissier et al., 2003). For example, Peters et al. (1997) conducted a survey of 1220
male and 435 female inmates admitted to a substance abuse treatment
programme in a Florida county prison whilst Langan and Pellisier (2001) examined
gender differences among 1326 male and 318 female federal prisoners enrolled
in the Drug and Alcohol Treatment Programme (DAP). Most recently, Pelissier et al.
(2003) investigated 1842 male and 473 female subjects as part of a multi-site
evaluation of prison-based Residential Drug Abuse Programmes (RDAP).
This literature indicates that female imprisoned drug users have a greater
number of life problems than their male counterparts but also distinct experiences
and needs. As Pelissier et al. (2003) note, criminal behaviour is the only area
where women have been found to have less serious problems than men. Thus,
imprisoned female drug users are less likely to have committed a violent crime
(Peters et al., 1997) or to have a prior criminal record than their male counter-
parts (Langan and Pelissier, 2001).
In contrast, women drug-using prisoners are significantly more impaired than
men in terms of education, employment, legal status, income, and health (Peters
et al., 1997; Langan and Pelissier, 2001; Pelissier et al., 2003). They report higher
levels of depression, anxiety, eating and personality disorders than men (Maden
et al., 1994), as well as more suicidal behaviour, more histories of physical or
sexual abuse, and lower self-esteem (Wallen, 1992; Peters et al., 1997; Langan
and Pelissier, 2001).
In terms of their drug use, women prisoners are less likely than men to have
participated in previous alcohol or drug treatment (Peters et al., 1997). Despite
this, there is consistent evidence (Peters et al., 1997; Langan and Pelissier, 2001;
Pelissier et al., 2003) that women prisoners:
● use drugs more frequently;
● inject more often;
● take harder substances;
03_055433_Neale (JB-D) 27/7/05 3:25 pm Page 246
246 Probation Journal 52(3)
● are more likely to use drugs as self-medication to alleviate physical or
emotional pain (such as depression, psychological stress and traumatic
events); and
● are more likely to report being ‘considerably’ or ‘extremely’ bothered by
their drug problems.
From this brief review of the literature, it is clear that knowledge about the specific
treatment needs of drug-using prisoners, as opposed to their non-imprisoned
counterparts, is limited. However, more information is available on how male and
female drug-using prisoners’ needs and circumstances differ. That said, the
existing published research has almost entirely been conducted in North America.
Drug problems and drug treatment programmes (both within prisons and in the
community) tend to differ in this part of the world from elsewhere. As such, the
findings are not necessarily applicable to other countries.
In order...
Probation Journal
Article
The Journal of Community and Criminal Justice
Copyright © 2005 NAPO Vol 52(3): 243–257
DOI: 10.1177/0264550505055433
www.napo.org.uk
www.sagepublications.com
Understanding the treatment needs of drug
users in prison
Joanne Neale, Oxford Brookes University
Michele Robertson, University of Glasgow
Esther Saville, Scottish Executive
Abstract The authors use data collected in Scotland to investigate differences
between individuals entering drug treatment in prison and those entering drug
treatment outside the prison setting. They also explore variations between male
and female drug-using prisoners. Their findings suggest that prison drug services
should be more tailored to the specific needs of both their male and female clients.
Keywords community, criminal justice, drug users, gender, heroin, prison,
Scotland, treatment
Tackling drug use within prisons is a major concern both nationally and inter-
nationally. Research suggests that up to half of all incarcerated individuals in
the UK are dependent on drugs, mainly opiates and cannabis, and at least a
quarter have injected (Marshall et al., 2000). In Scotland, information from
medical check-ups and urine testing reveals that more than three quarters of all
people entering prison are taking illicit substances, with the majority using opiates
such as heroin (Scottish Prison Service, 2000). Although women comprise a much
smaller proportion of the prison population than men, female imprisonment has
risen at a much faster rate than male imprisonment over the last two decades
(Pelissier et al., 2003) and the level of drug use amongst female prisoners is higher
than amongst males (Maden et al., 1994; Brochu et al., 1999; Borrill et al.,
2003a, b). In October 2000, a study of Scotland’s only all-female prison showed
that 94 per cent of women were testing positive for illegal substances on admis-
sion (HMIPS, 2001).
A key objective of the UK Government’s current 10-year drug misuse strategy
243
03_055433_Neale (JB-D) 27/7/05 3:25 pm Page 244
244 Probation Journal 52(3)
(‘Tackling Drugs to Build a Better Britain’) is to increase ‘the participation of
problem drug misusers, including prisoners, in drug treatment programmes’
(Cabinet Office, 1998: Aim iii). Aside from reducing the incidence of drug taking,
investment in drug services can produce benefits for society in terms of reduced
crime, safer communities and fewer demands on public resources, particularly
health services and policing (Redondo et al., 1999; Kothari et al., 2002). Target-
ing support at imprisoned drug users is important for two additional reasons. First,
rates of drug overdose amongst recently released prisoners are particularly high
(Seaman et al., 1998; Shewan et al., 2000). Second, prisoners with drug problems
tend to report greater childhood adversity, psychiatric ill-health, housing diffi-
culties, and employment problems than other inmates. They are therefore particu-
larly vulnerable and tend to require intensive support (Brooke et al., 2000; Kothari
et al., 2002).
The research evidence
To date, there has been almost no research examining how, if at all, the needs of
drug-using prisoners differ from those of drug users presenting for treatment
outside of the prison setting. One notable exception to this is a Canadian study by
Brochu et al. (1999), which compared the characteristics of three groups of men
addicted to alcohol or other drugs (553 offenders in community treatment, 499
non-offenders in community treatment, and 103 addicted prisoners). This research
found that, relative to non-prisoners, incarcerated drinkers and drug users:
● were younger;
● experienced more problems with the law;
● attained lower levels of education;
● had less stable employment;
● had lower income (including a higher rate of dependency on benefits);
● experienced more social maladjustment;
● were less integrated into the social world; and
● displayed more antisocial behaviours.
Brochu et al. (1999) identified few differences between the prisoners and non-
prisoners in levels of drug consumption or the amount of money spent on
psychoactive chemicals (cocaine was the illicit drug of choice for all participants
in the research). However, the prisoners were more likely to abuse a wide range
of substances and had a lower motivation to address their drug use. In addition,
they had worse physical health, but fewer symptoms of mental ill-health, than the
non-prisoners.
A small number of American studies (Anglin et al., 1989; Farabee et al., 1993;
Kline, 1997) have examined differences between voluntary drug treatment clients
and those referred by criminal justice agencies – although participants in these
studies were not actually imprisoned at the time of the research. Like Brochu et al.
03_055433_Neale (JB-D) 27/7/05 3:25 pm Page 245
Neale et al. ● Understanding the treatment needs of drug users in prison 245
(1999), Kline (1997) found that criminal justice-referred clients reported more
arrests and a greater likelihood of one or more convictions and were less moti-
vated to undergo treatment than voluntary clients. More unexpectedly though,
criminal justice-referred clients:
● experienced fewer social problems;
● had better social and psychological adjustment with respect to family and
social relationships;
● were less preoccupied with their drug use and its effects;
● had made fewer suicide attempts;
● had experienced less physical or sexual abuse; and
● reported fewer episodes of depression.
In respect of gender, various studies have investigated the specific needs of
incarcerated addicted women (Yang, 1990; Wellisch et al., 1993; Peugh and
Belenko, 1999) and sought to identify any differences that exist between imprisoned
drug-using males and females (Peters et al., 1997; Langan and Pelissier, 2001;
Pelissier et al., 2003). For example, Peters et al. (1997) conducted a survey of 1220
male and 435 female inmates admitted to a substance abuse treatment
programme in a Florida county prison whilst Langan and Pellisier (2001) examined
gender differences among 1326 male and 318 female federal prisoners enrolled
in the Drug and Alcohol Treatment Programme (DAP). Most recently, Pelissier et al.
(2003) investigated 1842 male and 473 female subjects as part of a multi-site
evaluation of prison-based Residential Drug Abuse Programmes (RDAP).
This literature indicates that female imprisoned drug users have a greater
number of life problems than their male counterparts but also distinct experiences
and needs. As Pelissier et al. (2003) note, criminal behaviour is the only area
where women have been found to have less serious problems than men. Thus,
imprisoned female drug users are less likely to have committed a violent crime
(Peters et al., 1997) or to have a prior criminal record than their male counter-
parts (Langan and Pelissier, 2001).
In contrast, women drug-using prisoners are significantly more impaired than
men in terms of education, employment, legal status, income, and health (Peters
et al., 1997; Langan and Pelissier, 2001; Pelissier et al., 2003). They report higher
levels of depression, anxiety, eating and personality disorders than men (Maden
et al., 1994), as well as more suicidal behaviour, more histories of physical or
sexual abuse, and lower self-esteem (Wallen, 1992; Peters et al., 1997; Langan
and Pelissier, 2001).
In terms of their drug use, women prisoners are less likely than men to have
participated in previous alcohol or drug treatment (Peters et al., 1997). Despite
this, there is consistent evidence (Peters et al., 1997; Langan and Pelissier, 2001;
Pelissier et al., 2003) that women prisoners:
● use drugs more frequently;
● inject more often;
● take harder substances;
03_055433_Neale (JB-D) 27/7/05 3:25 pm Page 246
246 Probation Journal 52(3)
● are more likely to use drugs as self-medication to alleviate physical or
emotional pain (such as depression, psychological stress and traumatic
events); and
● are more likely to report being ‘considerably’ or ‘extremely’ bothered by
their drug problems.
From this brief review of the literature, it is clear that knowledge about the specific
treatment needs of drug-using prisoners, as opposed to their non-imprisoned
counterparts, is limited. However, more information is available on how male and
female drug-using prisoners’ needs and circumstances differ. That said, the
existing published research has almost entirely been conducted in North America.
Drug problems and drug treatment programmes (both within prisons and in the
community) tend to differ in this part of the world from elsewhere. As such, the
findings are not necessarily applicable to other countries.
In order...
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