Substance Abuse Treatment Prevention and Policy in Correctional Services

1. Substance Abuse TreatmentPrevention and Policy in Correctional Services Dr. Myo Kyaw Oo Consultant Psychiatrist Department of Corrections Jamaica

2. Substance Abuse Treatment & Rehabilitation must be the Priority National Agenda

3. Treatment Models • Many treatment modalities exist, based on wide range of factors within the context of a country • Modalities are designed based on common problem of addiction and major economic, cultural, religious and political dimensions. • Resources available in countries vary widely • Important to remember hidden cost and significant burden ( health care costs, productivity loss, criminal justice costs..)

4. Goal of Treatment • Ultimate goal is ..to achieve “A Substance Free Quality life”

5. Programmatic Goals • Fiscal and political realities • Appropriate use of resources • Philosophy of the program clearly defined • No single approach is effective for everyone • Evaluation & Research

6. Objectives to provide a substance free quality life -harm reduction and motivation for abstinence -bio-psycho-social level of functioning -marital and family issues -job and financial management -spiritual issues -relapse prevention

7. Approach to Drug Problem • Supply reduction • Demand reduction There should be a BALANCE between the two principles

8. Supply Reduction • How to reduce supply reduction ? • Cultivation, Manufacturing, Eradication • Trafficking & Export • Eradication • Precursors control • Money laundering and legislation

9. Prevention • No drugs …No abusers • No precursors…No manufacturing process • How are you going to make prisons safe? • How do inmates receive their supply? • Zero Tolerance Policy?

10. Demand Reduction • Educational Approach, school education, public education, sport & culture • Health & medical Measure, treatment and rehabilitation programs • Community involvement • Economic empowerment • Regional & International Cooperations Caribbean & OAS

11. Causes of Drug Addiction • Moral/Spiritual • Biological • Psychodynamic • Behavioural • Socio-cultural • Individual-drug-environment • INTEGRATIVE

12. Integrative • No single cause • Interaction of range of causes • Bio-Psycho-Social • Bio-Psycho-Socio-Cultural

13. Bio-Psycho-Socio-Cultural • No single cause • Interaction of the causes

14. General outline of demand reduction • Treatment & Rehabilitation • Prevention & follow-up

15. Residential based Hospital or centres Short, medium, long term Outpatient based Drug Court Treatment Prison based Models of Treatment facilities

16. Treatment Approaches • Individual therapy • Group therapy • Family therapy • Special program ( juvenile, Drug court, prison based, combined HIV,STI, TB, therapeutic communities, cultural)

17. Treatment Process • Crisis Management (overdose, withdrawal, medical & psychiatric emergencies) • Assessment & Detoxification • Rehabilitation with or without Skilled training • Relapse prevention & follow-up • Special services

18. Networking & Supportive Services • AA, NA • FBO, NGO, PSO • EAP • Government Ministries • Family support groups

19. Important thing to remember • Drug abuse recovery is a process, not an event • Treatment modalities must be designed based on multidimensional approach to meet the individual needs • Success is measured not on absolute figures of statistical value but quality of life change of individual • Constitutional rights of individual must be protected at all times

20. Changing Model of Care • Recovery is not an event but the process • Incarceration by itself does little to break the cycle of illegal drug use and crime • Offenders sentenced to Incarceration exhibit high rate of RECIDIVISM once they are released

21. HARM REDUCTION Widely accepted Model of Care

22. What is Harm Reduction? • Physical – death, illness, addiction, HIV, Hepatitis, Injuries related to accidents and violence • Psychological – fear of crime/violence and effect on family • Social – breakdown of social system • Economic – drug trade, productivity loss, workplace accidents

23. Drug Abuse Prevalence in prisons • Drug Abuse in prison is very common • Estimated 22% - 86% • Most frequently used illicit drug “ Cannabis” 8% - 60% • British Study 60% heroin user reported use in prison, more than 25% initiated use in prison

24. Factors associated with substance abuse in prison • Age, Ethnicity, Conduct disorder, abuses, school difficulties • Psychiatric disorders • Antisocial personality • Support system • Length of sentence

25. Drug Abuse Survey in Jamaican Prisons 2005

26. Methodology • 4 maximum security prisons • Sampling Frame of 3434 inmates • Stratified sampling method used • Estimated prevalence rate 45% ± 5% • A total of 440 inmates • 42 items, 4 sections Questionnaire used

27. Results - Age • A Total of 440 inmates • Male 82% (360), Female 18% (80) • Age range – 18 to 73 years • Majority 53% (Age range 23-34)

28. Results – Age group by Gender

29. Results – Education by gender

30. Results – Literacy level

31. Knowledge • Ganja is a drug 72% • Ganja smoking is harmful 61% • Alcohol, tobacco & beady are drugs 78% • Ganja improves sexual performance 33% • Alcohol improves sexual performance 38% • Addiction is drug dependency 85% • A link between drug abuse & STI 73%

32. Prevalence

33. Prevalence • Drug abuse before incarcerated 62% • Drug abuse during incarceration 46%

34. Type of Substances abused(N=305)

35. Pattern of Abuse

36. Factors affecting frequency

37. Reason for Drug use • To feel more relaxed 119 27% • To meditate 99 23% • To cope with prison 84 19% • To sleep 65 15% • Curiosity 46 11% • Lonely 36 8% • Peer pressure 26 6% • Addiction 22 5% • Religion 8 2%

38. Source of supply in prison • Fellow inmates 189 43% • Correctional officers 13 3% • Over prison wall/fence 8 2% • Family/friends 5 1%

39. Motivation for change • Want to stop drug abuse 150 34% • Request assistance to stop 113 26% • Interest to participate in program 348 79%

40. Best group to sensitize drug abuse program

41. Summary • Prevalence of drug abuse 46% • Ganja is most commonly abused 39% • 34% of inmates are motivated to quit and 26% requested assistance. • 79% showed interest to participate in the drug abuse program in prison.

42. Implementation of Substance Abuse Treatment & Prevention in Prisons is well justified

43. Residential based Hospital or centres Short, medium, long term Outpatient based Drug Court Treatment Prison based Models of Treatment facilities

44. Principle of Therapeutic Jurisprudence Prof. Bruce Winnick Prof. David Wexler

45. Application of TJ • Offenders with underlying drug abuse problems • Incarceration alone does not help or reduce recidivism • Therapeutic principle is applied in Judicial process • Diversion Programme • Prison Based Programme • Parallel Model

46. Diversion Programme • Drug Court Treatment & Rehabilitation • May 2001 Kingston, July 2001 Montego Bay • Drug Court Act 1999 • Offenders with Minor Offences who meet eligible criteria • Bail offered • Six months outpatient programme under court supervision and weekly urine testing

47. Jamaica Drug CourtMay 2001 – March 2009

48. Jamaica Drug CourtMay 2001 – March 2009

49. What about those ineligible Offenders?

50. Prison based Program ? Legislation Political will Budget commitment Outpatient Drug Court Legislation Court supervision Probation period after graduation Criminal offence not recorded Prison Based Programme