Substance abuse and dependence in prisoners: a systematic review

AIMS

To review studies of the prevalence of substance abuse and dependence in prisoners on reception into custody.

DESIGN AND METHOD

A systematic review of studies measuring the prevalence of drug and alcohol abuse and dependence in male and female prisoners on reception into prison was conducted. Only studies using standardized diagnostic criteria were included. Relevant information, such as mean age, gender and type of prisoner, was recorded for eligible studies. The prevalence estimates were compared with those from large cross-sectional studies of prevalence in prison populations.

FINDINGS

Thirteen studies with a total of 7563 prisoners met the review criteria. There was substantial heterogeneity among the studies. The estimates of prevalence for alcohol abuse and dependence in male prisoners ranged from 18 to 30% and 10 to 24% in female prisoners. The prevalence estimates of drug abuse and dependence varied from 10 to 48% in male prisoners and 30 to 60% in female prisoners.

CONCLUSIONS

The prevalence of substance abuse and dependence, although highly variable, is typically many orders of magnitude higher in prisoners than the general population, particularly for women with drug problems. This highlights the need for screening for substance abuse and dependence at reception into prison, effective treatment while in custody, and follow-up on release. Specialist addiction services for prisoners have the potential to make a considerable impact.

Innovative alcohol- and drug-user treatment of inmates in New Zealand prisons

The Kowhai Alcohol and Drug Treatment Unit at Rolleston Prison offers an innovative treatment approach for New Zealand inmates. The development of the program has involved local staff from Public Prisons, Psychological Services, and the Community Probation Service (CPS). This presentation outlines the author's impression of this bold innovation. The primary aim of the program is to reduce recidivism. This is achieved by assisting inmates to recognize the thoughts, emotions, and behaviours that are present in the period preceding and/or during the commission of criminal activity--particularly those that are precipitated and/or maintained by alcohol and drug use. This insight, coupled with the learning of specific coping skills and intensive lifestyle and reintegration planning, leads naturally to the follow-up phase that is conducted in the community. The functional relationship between offending and substance use is far more explicitly addressed in this new program compared with past programs that focused more on substance use.

Public Drinking and Violence: Not Just an Alcohol Problem

Three hundred hours of unstructured observation by pairs of observers in twenty-three licensed premises in Sydney allowed the identification through qualitative analysis of situational factors and management practices that increase the risk of physical violence. Four high-risk and two low-risk premises were particularly contrasted, as were violent and non-violent occasions in the same venues. Violence was concentrated in' specific places at specific times. It was related to complex interactions between aspects of patron mix, levels of comfort, boredom, and intoxication, and the behaviour of bouncers. Violence is perpetuated by poor management, lax police surveillance, and inappropriate bureaucratic controls and legislation. The authors conclude that regularly violent venues should have their licenses cancelled, and police should enforce laws regulating bouncers. Promotions which cause mass intoxication should be banned, but responsible serving practices on their own may not greatly influence levels of violence.

Young offenders and alcohol-related crime: what interventions will address the issues?

Although most young offenders will grow out of both drinking and crime, interventions aimed at reducing crime through reducing drinking or reducing drinking so as to reduce health and social problems are important for some offenders. Where the aim is to reduce crime by reducing drinking, it is essential to assess carefully the relationship between the two in each person to ensure that this is logical. Since most adolescents drink and since controlled drinking is achievable by younger people with fewer alcohol-related problems, moderation rather than abstinence is a realistic goal for most young offenders. Behavioural self-control training is one type of intervention which can effectively encourage moderate drinking, but this has to be conducted in ways that will engage young offenders' interest, for example through self-help manuals, developing peer interventions and using simulated bar settings. In addressing the questions of which types of people commit which types of crime and what part alcohol plays in setting the conditions for crime to occur, studying the effects that young offenders expect alcohol to have under various conditions may contribute to the development of cognition modification components of interventions and enable better matching of clients with programmes.