Using the “recovery” and “rehabilitation” paradigms to support desistance of substance-involved offenders: exploration of dual and multi-focus interventions
| Published date | 05 December 2016 |
| Date | 05 December 2016 |
| Pages | 274-290 |
| DOI | https://doi.org/10.1108/JCRPP-09-2016-0021 |
| Author | Sarah Elison,Glyn Davies,Jonathan Ward,Samantha Weston,Stephanie Dugdale,John Weekes |
| Subject Matter | Health & social care,Criminology & forensic psychology |
Invited paper
Using the “recovery”and
“rehabilitation”paradigms to support
desistance of substance-involved
offenders: exploration of dual and
multi-focus interventions
Sarah Elison, Glyn Davies, Jonathan Ward, Samantha Weston, Stephanie Dugdale and
John Weekes
Sarah Elison is a Research
Director, Glyn Davies is a
Director and Jonathan Ward is
a Director all at Breaking Free
Group, Manchester, UK.
Samantha Weston is a Lecturer
in Criminology at the School of
Sociology and Criminology,
Keele University, Keele, UK.
Stephanie Dugdale is a
Research Associate at
Breaking Free Group,
Manchester, UK.
John Weekes is an Adjunct
Research Professor at the
Department of Psychology,
Carleton University, Ottawa,
Canada and Senior Research
Manager at Correctional
Service Canada Research
Branch, Ottawa, Canada.
Abstract
Purpose –The links between substance use and offending are well evidenced in the literature, and
increasingly, substance misuse recovery is being seen as a central component of the process of rehabilitation
from offending, with substance use identified as a key criminogenic risk factor. In recent years, research has
demonstrated the commonalities between recovery and rehabilitation, and the possible merits of providing
interventions to substance-involved offenders that address both problematic sets of behaviours. The
purpose of this paper is to provide an overview of the links between substance use and offending, and the
burgeoning literature around the parallel processes of recovery and rehabilitation.
Design/methodology/approach –This is provided as a rationale for a new treatment approach for
substance-involved offenders, Breaking Free Online (BFO), which has recently been provided as part of the
“Gateways”throughcare pathfinder in a number of prisons in North-West England. The BFO programme
contains specific behaviour change techniques that are generic enough to be applied to change a wide range
of behaviours, and so is able to support substance-involved offenders to address their substance use and
offending simultaneously.
Findings –This dual and multi-target intervention approach has the potential to address multiple, associated
areas of need simultaneously, streamlining services and providing more holistic support for individuals, such
as substance-involved offenders, who may have multiple and complex needs.
Practical implications –Given the links between substance use and offending, it may be beneficial to
provide multi-focussed interventions that address both these behaviours simultaneously, in addition to other
areas of multiple and complex needs. Specifically, digital technologies may provide an opportunity to widen
access to such multi-focussed interventions, through computer-assisted therapy delivery modalities.
Additionally, using digital technologies to deliver such interventions can provide opportunities for joined-up
care by making interventions available across both prison and community settings, following offenders on
their journey through the criminal justice system.
Originality/value –Recommendations are provided to other intervention developers who may wish to
further contribute to widening access to such dual- and multi-focus programmes for substance-involved
offenders, based on the experiences developing and evidencing the BFO programme.
Keywords Treatment, Management, Evidence-based practice, Assessment, Mental health/disorders,
Through-care
Paper type Conceptual paper
Received 27 September 2016
Revised 27 September 2016
Accepted 10 October 2016
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VOL. 2 NO. 4 2016, pp.274-290, © Emerald Group Publishing Limited, ISSN 2056-3841 DOI 10.1108/JCRPP-09-2016-0021
Introduction
The recent Department of Health report by the UK Chief Medical Officer has revealed problematic
drug and/or alcohol use to be a major public health concern (Davies, 2012), with alcohol misuse
alone estimating to cost society £17-22 billion annually in health and broader social harms
(McManus et al., 2009). In terms of illicit drugs, the most recent Crime Survey for England and
Wales estimates that between April 2014 and March 2015, 8.6 per cent of 16-59 year olds living
in the UK had used an illicit drug within the last 12 months, which translates to approximately
2.8 million people (Home Office, 2015). Figures from the Manchester University National Drug
Evidence Centre estimate that in the period 2013-2014, 193,198 individuals aged 18 and over
were in contact with structured drug treatment services, and that 27 per cent of these individuals
accessed treatment within criminal justice settings (Public Health England, 2014).
There may be multiple reasons why many individuals access treatment for substance misuse
within criminal justice settings, although one of the most significant maybe the fact that in the UK,
possession of most psychoactive substances of use and misuse is a criminal offence. In this way,
UK law could be suggested to criminalise, and therefore stigmatise, substance users (Lloyd,
2010; Stevens, 2011), regardless of whether they might be dependent on these substances or
not, with some commentators suggesting that the drug criminalisation issue is used as a tool by
political parties to win public votes (MacGregor, 2013).
However, despite the political issues, the links between substance use and criminal behaviour are
supported by the research literature (Bennett et al., 2008; Hough, 2002; Schroeder et al., 2007).
High levels of crime committed by substance users during periods of use (Ball et al., 1983;
Bennett et al., 2008; Bennett and Holloway, 2009; Best et al., 2001; Goldstein, 1985; Gossop
et al., 2000; Inciardi, 1979; McGlothlin et al., 1978) indicate that the two behaviours often
co-occur. The association between substance use and offending is illustrated further by the high
prevalence of substance use among prisoners. Research suggests that approximately
50 per cent of offenders entering prison may be dependent on alcohol or drugs (Budd et al.,
2005; Fazel et al., 2006; Prison Reform Trust, 2011; Singleton et al., 1999) and substance use
has been identified as a key criminogenic factor that predicts offending and recidivism (Andrews
et al., 2006; National Treatment Agency for Substance Misuse, 2009).
Although the links between offending and substance use are well-documented, there are as yet
unanswered questions around the precise casual mechanisms betweenthe two sets of behaviours,
and subsequently, there is still a paucity of knowledge and application around the most effective
intervention approaches that might be employed to address substance-related offending. Given the
steadily increasing prison population in England and Wales and the extent to which prisons have
become overcrowded (Hardwick, 2015; Warmsley, 2005), it may be useful to understand how
substance-involved offenders may be most effectively rehabilitated to help them achieve recovery
from their substance misuse and desist fromengaging in drug- and alcohol-relatedoffending. With
recent data suggesting that substance-involved offenders make up around 64 per cent of the UK
prison population (Ministry of Justice,2013a), if even a proportion of these offenders are supported
to achieve substance misuse recovery and rehabilitation from offending, this could have a significant
impact on the size of the UK prison population and reduce public expenditure on drug- and alcohol-
related harms and criminal justice costs (Crane and Blud, 2012; Gossop et al., 2005; Hiller et al.,
1999; Lurigio, 2000). This could be likely even if the links between substance use and offending a re
not directly causative or are more tenuous than the literature would suggest.
Over the past 20 years the UK Government has introduced a range of drug treatment initiatives to
various segments of the criminal justice system to divert substance-involved offenders away from
crime and into treatment. These initiatives have been introduced from the first point of contact
with the criminal justice system through to sentence and beyond. Arrest referral schemes
(Edmunds et al., 1999) have evolved from a motivational focus on referral to treatment to a
fundamentally more coercive approach of drug-testing on charge (Home Office, 2004a) and even
drug testing on arrest in many areas (Home Office, 2011). The government focus on diversion
extends into court sentences with offenders receiving custodial sentences being offered a
number of treatment interventions. The introduction of counselling, assessment, referral, advice,
and throughcare services, or CARAT schemes (Harman and Paylor, 2005), saw for the first time
in UK prisons an intensified focus on breaking the links between drugs and crime.
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