Treatment of Offenders - gov.wales · e.g. services that promote reintegration (such as housing,...

Treatment of Offenders

Treatment of O

ffenders

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Contents

Page

KeyPoints 3

1 Purpose 5

1.1 Overview 5

1.2 Structureofreport 5

2 Communitybasedtreatment 7

2.1 Overview 7

2.2 Keyfeaturesofsuccessfulcommunityprogrammes/interventions 7

2.3 Keyphaseofcommunityprogrammes 8

2.3.1 Arrestandtheperiodfollowingarrest 8

2.3.2 Courtappearance 9

2.3.3 Communitysentence 9

3 Prisonbasedsubstancemisuseprogrammes 11

3.1 Featuresofsuccessfulsubstancemisusesprogrammesinprisons: 11

3.2 Assessment 11

3.3 Careplanning 13

3.4 Interventions-psychosocial 13

3.5 Interventions-pharmacological 14

3.5.1 Appropriateprescribing 14

3.5.2 Opioids 15

3.5.3 Alcohol 16

3.5.4 Benzodiazepines 17

3.5.5 Stimulants 17

3.5.6 Supervisedconsumption 18

3.5.7 Preparingforrelease 18

3.6 Preventingsubstance-releaseddeaths 19

3.6.1 Overdose/toxicity 19

3.6.2 Naloxone 19

3.6.3 Blood-borneviruses 19

3.7 Co-occuringsubstancemisuseandmentalhealthproblems 20

3.8 Tobacco 20

3.9 Offenderswithalearningdisability 21

3.10 Naloxone 21

4 Releaseandresettlementprogrammes 23

4.1 Goodpracticeinrelease/resettlementprogrammes 23

TREATMENTOFOFFENDERS

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Appendix1 25

Appendix2 28

Bibliography 31

Glossary 34

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KeyPoints

Aimedatadultoffenders(aged18andabove)Communitytreatmentsarelikelytobemoreeffectiveformostproblem•substancemisusingoffenders.Imprisonmentcanhaveunintendednegativeconsequencesforproblemsubstancemisusingoffenders,andtherearemanypracticalissuesthatfrustratethedeliveryofsuccessfuldrugtreatmentprogrammesinprisons,particularlyforshorttermprisoners.

Successfulcommunityprogrammesarebaseduponhavingawiderange•ofservicestomeetthedifferingneedsofindividualdrugusingoffenderse.g.servicesthatpromotereintegration(suchashousing,educationandemployment)inordertoimprovelong-termoutcomes.

AneffectiveArrestReferralservice,managedwithintheCriminalJustice•IntegratedTeams(CJIT)iscentraltothemanagementofoffenderswithsubstancemisuseproblemsinCriminalJusticesettings.

TheDrugInterventionsProgramme(DIP)providesapackageofsupport•fordrugmisusingoffendersreachingtheendofaprisonbasedtreatmentprogramme,completingacommunitysentenceorleavingtreatment.

Goodpracticeinprisonsbasedprogrammesfortreatingsubstancemisuse•arebaseduponhavingarangeoftreatmentoptionsandaccesssimilartothoseinthecommunity,includingmaintenanceandsubstitutionoptions.Highqualityharmpreventionprogrammes,toreducedrug-relateddeathsbothfromoverdose/toxicityandblood-bornevirusesneedtobeincluded.

Acomprehensiveassessmentoftheoffender’sneedsandlevelofrisk•shouldbeginassoonaspossibleafterenteringprisonsothatappropriatecareandsupportcanbeprovided.

Effectivelinksbetweenprisonandcommunityservicesarevitalandthe•useofacommonclientrecord,careplanandcollaborativecareplanningwillfacilitatethis.

Protocolsshouldbedevelopedbetweenprisonsandaftercareservices•todealwithearly,unanticipated,andFridayreleases.

Drug-relatedmortalityamongstnewlyreleasedmaleandspecifically•femaleprisonersissignificantlyhigherthantherateamongsttheirpeersinthecommunityandshouldbeamajorconsiderationindischargeplanning.

Aftercareindividualsappearmorewillingtoengagewithserviceswhen•apersistentandnonjudgementalapproachisadopted.Regularcontactwithpotentialclientsininstitutionsislikelytoresultinhigherlevelsofengagement.

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1 Purpose

1.1 OverviewThisdocumentprovidesasummaryfromtheevidenceandprofessionalopiniononwhatisbestpracticeinrelationtothetreatmentofoffenderswithsubstancemisuseproblems.

Itistargetedatplanners,commissionersandprovidersofsubstancemisusetreatmentservicesinboththecommunityandprisons.Itisintendedtoassistthemintheplanninganddeliveryofappropriateservicesanddevelopmentofstandardsfortheprovisionoftheseservices.

IthastobesetinthecontextofthenewWelshAssemblyGovernmentsubstancemisusestrategyforWales“Workingtogethertoreduceharm”.

ThedocumentalsohastobereadinconjunctionwithpreviousevidencebasedgoodpracticeguidanceforWelshAssemblyGovernmentparticularlythosefor:

CommunityPrescribing•

Psychosocialinterventions•

CoexistingSubstanceMisuse/MentalHealthProblems•

AlcoholMisuseinWales.•

Themodulealsohastobereadinconjunctionwiththepublications-Drugmisuseanddependence:UKguidelinesonclinicalmanagement(2007),andtheWelshAssemblyGovernmentPrisonMentalHealthPathway(2006).

Thedocumentdoesnotaddresstheparticularproblemsofyoungoffenderswhichwillbethesubjectofseparateguidance.

WhilstitisacceptedthattheprisonestatewithinWalesdoesnotaccommodatewomenprisoners,theguidancecontainedwithinthisdocumentbydefinitionapplies.OperationalprotocolsareinplacewithlinkedcustodialestablishmentsthroughouttheUK,designedtoensurethatanywomenbeingdischargedintoWalesaredealtwithinaccordancewithpresentingneed.

ThemoduleisbasedupontechnicalreportsprovidedbytheNationalPublicHealthServiceforWales(NPHS)VulnerableGroupsTeamwhichareaccessibleontheNPHSwebsite.AsummaryoftheevidenceforcommunitybaseddrugprovisionisincludedinAppendix1thisdocument.

1.2StructureofreportThereportisessentiallyinthreepartssectionanddetailsgoodpracticein:

CommunitySettings(includingearlyinterventions) Prisons Resettlement

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2 Communitybasedtreatment

2.1 OverviewCommunitytreatmentsarelikelytobemoreeffectivethanimprisonment•formostproblemsubstancemisusingoffenders.

Imprisonmentcanhaveunintendednegativeconsequencesforproblem•substancemisusingoffenders,andtherearemanypracticalissuesthatfrustratethedeliveryofsuccessfuldrugtreatmentprogrammesinprisons,particularlyforshorttermprisoners.

Maximisingtheuseandeffectivenessofcommunitysentencesislikely•tobemorebeneficialthanimprisonmentofproblemsubstancemisusingoffendersforcomparativelylessseriousacquisitivecrimesanddrugpossessionoffences.

Communitysentenceshavethepotentialtoofferbettervalueformoney•anddeliversimilarreductionsinoffending.

Awideandcomplexrangeofsubstancemisuseinterventionprovision•existsinWales.Theseincludeprocessestoidentifysubstancemisusers,interventionstopromoteengagementwithtreatment;andotherservicesandinterventionsthataddresssubstanceuseand/oroffending.(ThisprovisionissummarisedinAppendix2).

ManyoftheseinterventionsaredeliveredwithintheDrugInterventions•Programme(DIP).TheDIPpurposeisto‘breakthecycle’ofdrugrelatedoffendingandprisonbyencouragingoffenderstoengageandremainengagedwithtreatmentservices. (Figure 3 illustrates how the Programme intervenes in the cycle to move offenders out of crime and into treatment.)

TheDIPwillalsoprovideapackageofsupportfordrugmisusingoffenders•reachingtheendofaprisonbasedtreatmentprogramme,completingacommunitysentenceorleavingtreatment.

2.2 Goodpracticeforcommunityprogrammes/interventionsSuccessfulcommunityprogrammesarebasedupon:

Havingawiderrangeofservicestomeetthedifferingneedsofindividual•drugusingoffenders,forexampleservicesthataddressthespecificneedsofstimulantusers.

Effectiveassessmentofproblemdrug-usingoffenders,inordertomatch•themtoappropriateinterventions,withregularreviewsandreassessment.

Havingservicesthatpromotereintegration(suchashousing,educationand•employment)inordertoimprovelong-termoutcomes.

Afocusontheimpactonoutcomesofdeliveryissues,suchasstaff•skillsandpersonaldevelopment,moraleandmanagement,thatimproveconsistencyofservicequality.

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Adequateattentiontosupervisionandmonitoringofpractice,including,•consideringthepotentialforgreateruseofpositiveincentivebasedstrategiestoensurecompliance(contingencymanagement)ratherthanthecurrentpunishmentorientatedfocus.

Interventionsthatadoptholistic,problemsolvingapproachestoaddressing•druguse.

ExtendingtheuseofdrugtestingonArrestinspecificpolicecustody•suites,byexpandingtherangeoftriggeroffencesortestingforawiderrangeofdrugs,isaHomeOfficeinitiative,tobeimplementedasfromthe1April2009.Testingonarrestratherthattestingonchargehasbeenshowntobeeffectiveinincreasingthenumbersengagingintreatment.

Usingschemes,(e.g.DrugInterventionProgramme(DIP)Conditional•Cautioning),thatdivertdrugusingoffendersintheearlystagesoftheiroffendingandproblemdrugusingcareersfromprosecution,onconditionthattheyaddresstheirsubstanceuseandotherproblemsmayhavemerit.

2.3 Keyphasesofcommunityprogrammes2.3.1 Arrestandtheperiodfollowingarrest

AneffectiveArrestReferral(CriminalJusticeInterventionsTeam-(CJIT))Serviceiscentraltothemanagementofoffenderswithsubstancemisuseproblems.ThisservicecanbeprovidedbyArrestReferralWorkers,custodysuitenurses,forensicmedicalexaminersorcustodysuitestaff,applyingtheirspecialistskills.GoodpracticeguidelinesfortheclinicalmanagementofsubstancemisusedetaineesinpolicecustodyhavebeenpublishedbytheFacultyofForensicandLegalMedicineRoyalCollegeofPsychiatrists(2007).TheRoyalPharmaceuticalSocietyofGreatBritainhaspublishedguidanceonthepharmaceuticalcareofdetaineesinpolicecustody(2007).

CJITteamsworkinginthecustodysuitesshould:

Identifythosewithsubstancemisuseproblems.•

Undertakedrugtestingonarrest.•

Assess,advice,supportandprovideinformation.•

Referfortreatment.•

Identifyhazardous,harmfulanddependentdrinkers.•

Provideascreeningassessment.•

Giveadviceonalcoholanditsimpactandproviderelevantinformation.•

Providesimplebriefinterventionsforhazardousandharmfuldrinkers•whichcouldbedeliveredbyarangeofappropriatelytrainednon-specialistpractitioners.

Refermoderatetoheavydrinkersincludingthosewithdependenceformore•intensiveinterventions.

Beawareofthekeyissueofsafetyforoffendersatalltimes.•

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Incommunity settingstheprovisionofspecificprogrammesbyCriminalJusticeInterventionTeams(CJIT)caseworkersshouldprovide:

Furtherassessment,careplanningandcasemanagement,foraminimum•periodof13weeks.

Counselling,(whichinsomecircumstancescanincludealcoholmisuse)•groupwork,education,diversionaryactivities,psychosocialinterventions.

Familysupport,includinghousing,financialmanagement,supportwith•familyrelationships.

Prescribing/rapidprescribingservices.•

Asingleassessment/clientrecord.•

AnassurancethatwhereBailrestrictionsareimposed,theyareadhered•toinamannerconsistentwithclearoperationalguidelines.

2.3.2 Courtappearance

ThekeyworkersatthecourtphaseareCJITworkers,providingthe‘ArrestReferral’service.Theirmajorresponsibilitiesaretoprovide:

Assessment,advice,supportandinformation(drugsandalcohol).•

Referralfortreatmenttodrugandalcoholserviceproviders.•

EffectiveLiaisonwithCounsellingAssessmentReferralAdviceand•Throughcare(CARAT)servicesandforthosegivencustodialsentencesviajointCARAT/CJITprotocols.

2.3.3 Communitysentence

WithregardstothecommunitysentencestagetheserviceismanagedbytheProbationservice/NationalOffendersManagementService(NOMS).

TheirmajorresponsibilityisthedeliveryofDrugRehabilitationRequirementsandthecommunitymanagementofPersistentandProlificOffenders(PPO’s).NOMShasclearresponsibilitiesinmanagingthetransitionbetweenCustody,DIPandTier3services.Inthisareaofworkitisimportanttoemphasisethatabstinencebasedapproachestotreatmentmayhavelimitedsuccess,ifthereisanexpectationthatoffenderswillbecompletelydrugfreewithinweeks.TheProbationServicealsooffersalcoholtreatmentprogrammesdeliveredinacommunitysetting.

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3 Prisonbasedsubstancemisuseprogrammes

3.1 GoodpracticeforsubstancemisuseprogrammesinprisonsGoodpracticeinprisonsbasedprogrammesfortreatingsubstancemisusearebasedupon:

Highqualitysystemsofclinicalgovernance.•

Assessmentofneedsacrossthefourdomainsofdrugandalcoholmisuse;•health;socialfunctioning;andcriminalinvolvement.

Arangeoftreatmentoptionssimilartothoseinthecommunity,including•maintenanceandsubstitutionoptions,withthesamelevelofaccessasinthecommunity.

Arangeofinterventionsforsubstancemisusetreatment,including•psychosocialandpharmacologicalinterventionsasappropriate.

Highqualitypreventionprogrammestoreducedrug-relateddeathsboth•fromoverdose/toxicityandblood-borneviruses.

Acareortreatmentplanbasedontheneedsoftheindividual,•whichisregularlyreviewed.

Managementofthecareortreatmentplanbyanamedindividual.•

Supporttomaximisecontinuityofcare,especiallyonrelease.•

Assessmentofriskstodependantchildrenforallsubstancemisusingparents•inrelationtohomevisitsandrelease.

3.2 AssessmentTheassessmentprocessbeginsatreceptionintoprisoncustody,withreceptionscreeningforsubstancemisuse,thepurposeofwhichisto:

Enquireaboutdrugandalcoholmisuse,andtoscreenforevidence•ofdependenceinthosewhoreportcurrentorrecentuse.

Determineimmediatehealthcareneeds,includingwithdrawal,•forwhichthereshouldbeaccesstoadequateandeffectiveprescribingformanagementuponreceptionintolocalprisoncustody.

Afteraninitialassessmentincludingariskassessment,cliniciansshoulddevelopplansofcarewithoffenderstoaddressimmediateconcerns.

Assessingriskisanintegralelementinscreening,triageassessmentandcomprehensiveassessment.Itprovidesinformationthatwillinformthecareplanningprocess.Riskassessmentsshouldinclude:

risksassociatedwithsubstancemisuse(suchasphysical/mentalhealth•damage,acutetoxicity/overdose);

riskofself-harmorsuicide;•

riskofharmtoothers(includingchildprotectionandotherdomestic•violence,abusiveand/orexploitativerelationships,andharmtotreatmentstaff);

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riskofharmfromothers(includingdomesticabuse);and•

riskofself-neglect.•

Whenrisksareidentified,managementplanswillneedtobedevelopedandimplementedtohelpmitigateimmediateconcerns.

Ifclinicianshaveconcernsabouttheneedsandsafetyofchildrenofsubstancemisusersorofvulnerableadults,localprotocolsmustbefollowed.

Acomprehensiveassessmentoftheoffender’sneedsandlevelofriskshouldbeginduringthefirstnightandinductionperiodsothatappropriatecareandsupportcanbeprovided.

Rapidwithdrawalfromdrugscanupsetanindividual’smentalequilibrium,heighteningtheirriskofimpulsiveself-destructivebehaviour.Anoffendercomingintocustodywithcomplexneedsshould,therefore,beprovidedwithclinicaltreatmenttostabilisetheirwithdrawalfromopioidorbenzodiazepinedependence.Considerationshouldbegivenatthisearlystagetotheindicationformaintenanceopioidsubstitutiontreatment.

Acomprehensiveassessmentshouldincludethefollowing:

treatinganyemergencyoracuteproblem;•

confirmingthattheoffenderismisusingsubstances(history,examination•anddrugtesting);

assessingdegreeofdependence;•

identifyingphysicalandmentalhealthproblems;•

identifyingsocialproblems,includinghousing,employmentand•domesticviolence;

assessingriskbehaviour;•

determiningtheoffender’sexpectationsoftreatmentanddesire•tochange;and

determiningtheneedforsubstitutemedication.•

Theassessmentprocessalsoprovidesanexcellentopportunityforclinicianstoprovidebriefinterventionstoreduceimmediateharmfromsubstancemisuse.Itisalsoimportanttoassessthemostappropriatelevelofexpertiserequiredtomanagetheindividual’streatment(thismayalterovertime),andreferorliaiseappropriately.

Theassessmentprocessshouldresultinawrittendocumentthatcanbereferredtoandusedasabasisfordiscussingcareplanning,goalsandobjectiveswiththeoffender.

Agreementoncommon‘standards’ofscreening,assessmentandrecording,isimportantindevelopinganintegratedsystemofcareintheprisonsetting.

Basicawarenesstrainingofassessmentstocustodialsuitestaffandescortstaffcanonlyaddvaluetothecareandattentionofprisoners.

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3.3 CareplanningAssessmentprovidesinformationthatwillcontributetothedevelopmentofacareplan,whichmeetsagreedstandardsandshouldbeagreedwiththeoffender.Itshouldnormallycovertheirneeds(andhowthesewillbemet)inoneormoreofthefollowingdomains;substancemisuse,physicalandpsychologicalhealth,andoffending.IdeallythecareplanshouldbeintegratedwiththeCareProgrammeApproach(CPA),theDrugInterventionRecord(DIR),andTheWalesIn-DepthIntegratedSubstanceMisuseAssessmentToolkit(WIISMAT)specialistsubstancemisuseassessmentprocessforpeopleusingspecialist,substancemisusetreatmentservices.

Thecareplanshouldincludethefollowing:

Settingthegoalsfortreatmentandmilestonesforachievement.•

Indicatinginterventionsplannedandbywhom.•

Makingexplicitreferencetoriskmanagement.•

Identifyinginformationgiventootherprofessionals/agencies.•

Indicatingthenameofthekeyworker.•

Identifyareviewdate.•

Aswithsubstancemisusemanagementinothersettings,thereisaneedtointegrateprescribingpracticewithpsychological,medicalandsocialinterventions.Thiswillrequireclinicianstohaveinputfrom,orfacilitatereferralto,arangeofotherprofessionals.Integrationwithmentalhealthandprimaryhealthcareservicesisalsoveryimportanttoaddressthehighlevelsofcomplexneedswithintheprisonpopulation.

3.4 Interventions-psychosocialTreatmentforsubstancemisuseneedstoincludeapsychologicalcomponent.Psychosocialinterventionsarethemainstayoftreatmentforthemisuseofcocaineandotherstimulants,andforcannabisandhallucinogens.

Psychosocialinterventionscanbedeliveredalongsidepharmacologicalinterventionsoralone,dependingonassessedneedandthegoalsoftreatment.Discreteformalpsychosocialinterventionsmaybeprovidedeitherforsubstancemisuseproblems,suchascocainemisuse,ortoaddresscommon,associatedorco-occurringmentalhealthdisorderssuchasdepressionoranxiety.

Keyworkingisabasicdeliverymechanismforarangeofkeycomponents,includingthereviewofcareortreatmentplansandgoals,provisionofdrug-relatedadviceandinformation,harmreductioninterventions,andinterventionstoincreasemotivationandpreventrelapse.Helptoaddresssocialproblems,suchashousingandemployment,isalsoimportantaspartofthroughcareandaftercare.Discreteformalpsychosocialinterventionsmaybeprovidedinadditiontokeyworking.Theseshouldbetargetedtoaddressingneed.

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StandardsforpsychologicalinterventionsforsubstancemisusehavebeenissuedbytheWelshAssemblyGovernment.Astructuredcarepackageofpsychosocialsupportshouldbeprovidedforoffenderswithsubstancemisuseproblemsinorderto:

complementclinicalinterventions;•

takeintoaccountprevioustreatmentinthecommunityorcustody;and•

provideaplatformforlonger-termsubstancemisusetreatmentinprison•andonrelease.

Interventionsthatneedtobeavailableinthecontextofsubstancemisuseincludebriefmotivationalinterventionsandmutualaid(self-help)approaches.Arangeofmoreintensive,structuredpsychosocialinterventionsmayberequiredforoffenderswithhighlevelsofdependenceonsubstance(s),forthosewithrecurrentproblems,forthosewithcomplexneedsandforthosewhomaybemorevulnerable.Psychologicalinterventionsshouldalwaysbeconsideredforoffenderswhoaredependentonbenzodiazepine.Evaluationoftheapproach,togetherwiththetrainingandsupportneededtosupportit,willbeneededbeforeitcanbeimplemented

Offenderswithsignificantdrugmisuseproblemsmaybeconsideredforatherapeuticcommunitydevelopedforthespecificpurposeoftreatingdrugmisusewithintheprisonenvironment.Forthosewhohavemadeaninformeddecisiontoremainabstinentafterreleasefromprison,residentialtreatmentshouldbeconsideredaspartofanoverallcareplan.

ItisworthdenotingthatoffenderswithanIQlessthan80cannotbeconsideredforaCBTprogrammeandsupportservicesneedtobecognisantoftheneedforCBTorotherpsychosocialinterventions.Thisplacesademandoncommissionerstoensurethesearecateredfor.

3.5 Interventions-pharmacological3.5.1 Appropriateprescribing

Inviewofthepotentiallyrapidonsetofwithdrawaleffectsinprisonandaheightenedriskofself-harmandsuicideamongsubstancemisusersduringtheearlydaysofcustody,aclinicalresponsetophysicaldependenceisessential.Prescribingprotocolsmayprovideasolutiontotheclinicalchallengespresentedbytheprisonenvironment.

Aswithpracticeincommunityservices,non-medicalprescribingshouldbeencouragedanddeveloped.

Adecisiontoprescribe,whatandhowmuchtoprescribewilldependon:

theoveralltreatmentplanfortheindividual;•

clinicalguidelines;•

theclinician’sexperienceandcompetencies;•

discussionwithothermembersofamultidisciplinaryteam;and•

advice,wherenecessary,fromaspecialistinsubstancemisuse.•

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Inthecontextofprescribing,theBritish National Formulary(BNF),whichisupdatedtwiceayear,isakeyreference.ThedosagesstatedintheDrugMisuseandDependence:UKGuidelinesonClinicalManagementandintheBNFareintendedforgeneralguidanceandrepresent,unlessotherwisestated,therangeofdosesthataregenerallyregardedasbeingsuitableforprescribing,inthecontextoftreatingadultswhohavebecomedependant.

Offendersmustbemadefullyawareoftherisksoftheirmedication.Prescribingarrangementsshouldalsoaimtoreducerisks,includingaccidentalingestion,tochildrenandothersinthecontextofhomevisitsorrelease.

Cliniciansshouldaimtooptimisetreatmentinterventionsforoffenderswhoarenotbenefitingfromtreatment,usuallybyprovidingadditionalandmoreintensiveinterventions(pharmacologicalandpsychosocial)thatmayincreaseretentionandimproveoutcomes.Treatmentexitsshouldbenegotiableandrevisited.Intheeventofrelapseinprison,theclinicianshouldexplorethereasonsforthiswiththeserviceuser,anddiscusstreatmentoptions.

3.5.2 Opioids

Opioid substitution treatment

Whereopioidmisusersarereceivedintoprisonhavinghadtheircommunitydosecontinuedinpolicecustody,thistreatmentshouldbecontinuedinprison,subjecttoregularreview.Timespentinpoliceandcourtcustodyoftenresultsinabreakinoffendersreceivingsubstitutemedicationbetweenthedayoftheirarrestandtheirsubsequentreceptionintoprison.

Cliniciansshouldseektoverifyprescriptionsandconsumptionwithcommunityservices,thepoliceorboth,anduseappropriatedrugteststoverifythepresenceofopioidsinthebody.Asoffendersfrequentlyarriveinprisonintheevening,itmaynotbepossibletosecurethisinformationduringaninitialassessment.Prescribingwillthereforeneedtobecircumspectenoughtoaddresstherisksrelatedtothisabsenceofinformation.

Methadoneorbuprenorphine,usedattheoptimaldoserange,areeffectivemedicinesformaintenancetreatment.Buprenorphineandnaloxonecombination(Suboxone®)hasbeenapprovedforrestrictedusewithinNHSWalesforthetreatmentforopioiddependence,interimtoguidancefromtheNationalInstituteforHealthandClinicalExcellence(NICE)shoulditsubsequentlybepublished.

Inthecontextoflowavailabilityofillicitdrugs,offendersmaystabiliseonlowerdosesofopioidsubstitutiontreatmentsinprison,thantheywouldinthecommunity.However,cliniciansshouldbepreparedtouseequivalentdosestothoseusedinthecommunitywhereneeded,toalevelthatachievesappropriateclinicalstability.

Priortorelease,considerationshouldbegiventoreviewingthecurrentdoseofopioidsubstitutewiththeserviceuser,tooptimisetheirlikelyretentionintreatmentonreturntothecommunity.Thismayentailincreasingthedosepriortorelease,inconsultationwiththecommunityprescriber,andexplainingtotheserviceuserwhythisisappropriate.

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Wheredoseinductionisclinicallyappropriate,theindividualshouldbestartedonasuitabledoseofopioidsubstituteandthedoseoptimisedthroughtitration.Thisshouldaimtoachieveaneffectivedosewhilealsoexercisingcautionabouttheinherentrisksoftoorapidanincrease.

Detoxification from opioids

Peopleinprisonshouldhavethesametreatmentoptionsforopioiddetoxificationaspeopleinthecommunity.Cliniciansshouldtakeintoaccountadditionalconsiderationsspecifictotheprisonsetting,including:

practicaldifficultiesinassessingdependenceandtheassociatedrisk•ofopioidtoxicityearlyintreatment;

lengthofsentenceorremandperiod,andthepossibilityofunplanned•release;and

risksofself-harm,deathorpost-releaseoverdose/toxicity.•

Polydruguseiscommonamongoffendersenteringcustody.Incasesofco-dependencyonanycombinationofalcohol,opioidsandbenzodiazepines,morethanonereductionregimenmayberequired,withadditionalcautionnecessaryduetotheinteractionofthesesubstances.Detoxificationfrommorethanonesubstanceshouldnottakeplaceconcurrently.Whenthisisrequired,alcoholdetoxificationshouldusuallybetheinitialpriority.

Methadone,buprenorphineandlofexidinearealleffectiveindetoxificationregimens.Opioiddetoxification,usingthemedicationtheindividualhasbeenmaintainedon,shouldbeofferedinanappropriatesettingtothosereadyforandcommittedtoabstinence.

Whenanopioidsubstituteisprescribed,aperiodofstabilisationoverthefirstfivedaysisadvisableratherthananimmediatereductionofthedose,becauseoftheriskofself-harmandsuicideinthisperiod.Theremayalsobeanincreasedriskofsuicideclosetotheendof,orjustfollowing,completionofadetoxificationregimen.

Detoxificationshouldbeprovidedinassociationwithpsychosocialsupport,aspartofapackagewhichincludespreparationandpost-detoxificationsupporttopreventrelapse.

3.5.3 Alcohol

Offenderswithanalcoholproblemwillneedsupportparticularlywhentheriskofwithdrawalsymptomsishigh.Pharmacologicalinterventionsaremosteffectivewhenusedasenhancementstopsychosocialtherapiesaspartofanintegratedprogrammeofcare.Thisusuallyinvolvesdetoxificationfollowedbyarangeofpsychosocialandpharmacologicalinterventionsasappropriatetopreventrelapse.Thestandardtreatmentsforalcoholdependenceandmisuseapplytothosewhoalsomisuseotherdrugs.

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Threeclassesofpharmacologicaltreatmentshavebeenidentifiedthatareeffectiveinthetreatmentofalcoholmisusers:

medicinesfortreatingwithdrawalsymptomsduringassistedalcohol•withdrawal,

medicinestopromoteabstinenceorpreventrelapse,includinganti-craving•agentsandsensitisingagents,and

nutritionalsupplements,includingvitaminsupplements,asaharmreduction•measureforheavydrinkersandhighdoseparenteralthiamineforthepreventionandtreatmentofindividualswithWernicke’sencephalopathy.

3.5.4 Benzodiazepines

Suddencessationinbenzodiazepineuseinthosewhoaredependentcanleadtoarecognisedwithdrawalstate.However,thereislittleevidencetosuggestthatlong-termsubstituteprescribingofbenzodiazepinesreducestheharmassociatedwithbenzodiazepinemisuse.

Prescribingtoassistwithdrawalshouldonlybeinitiatedwherethereisclearevidenceofbenzodiazepinedependencyfromtheserviceuser’shistory,observedsymptomsanddrugtesting.

Iftheserviceuserisalsoreceivingalong-termprescriptionofmethadoneforconcomitantopioiddependency,themethadonedoseshouldbekeptstablethroughoutthebenzodiazepinereductionperiod.Concurrentdetoxificationfrombothmedicinesisnotrecommendedincommunitysettings.

3.5.5 Stimulants

Clinicianswillseestimulantuserswithawiderangeofseverityofproblems.Themainstayoftreatmentispsychosocialandnon-pharmacological.Therearenoeffectivepharmacologicaltreatmentstoalleviatetheeffectsofwithdrawalfromstimulantsatpresent,includingcocaine.Likewise,nonehaveconvincinglybeendemonstratedtobeusefulinpromotingabstinence.Stimulantwithdrawalshouldbetreatedaccordingtoclinicalindications.

Emergingsymptoms,suchasdepressedmoodandinsomnia,arelikelytobeshort-livedandanyprescribingforthisshouldgenerallybeshort-termandreviewedbeforerenewal.Offendersarrivinginprisonwitharecenthistoryofstimulantuseshouldbeobservedduringthefirstthreedaysofcustodyforanysignofemergingacutephysicalorpsychologicalproblems.Offendersdemonstratingsymptomsofpsychologicaldistressshouldcontinuetobemonitoredandreferredformentalhealthassessmentiftheyareshowingsignsofpsychosisorotherseriousmentalhealthproblems.

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3.5.6 Supervisedconsumption

Supervisedconsumptionshouldbeavailableforalloffendersforalengthoftimeappropriatetotheirneedsandrisks.Thisisusuallycontinuedthroughouttheperiodofremandorprisonsentenceforopioidsubstitutiontreatment.

Additionally,benzodiazepinesmaybeprescribedforsupervisedconsumptiontoenhancecontrolofdiversion.

3.5.7 Preparingforrelease

Researchondrug-relatedmortalityamongstnewlyreleasedmaleandfemaleprisonershighlightsthattheyare29and69timesmorelikely,respectively,todieduringthefirstweekofreleasefromprison,comparedtomalesandfemalesinthegeneralpopulation.Around90%ofthesedeathsweredrug-relatedwithopioidsinvolvedinalmost97%ofthem.

Theprincipalobjectiveinpreparingasubstance-misusingoffenderforreleaseshouldbetopreventoverdose/toxicity.Preventingrelapseandfacilitatingcontinuationintreatment(ifneeded)oraccesstosuitableaftercareprovisionorsupportareimportantinthemselvesandasameansofpreventingoverdose/toxicity.Thefollowinginterventionscanallhelpachievetheseobjectives.

Detoxified,formerlyopioid-dependantindividualswhoaremotivatedtoremaininasupportivecareabstinenceprogrammemaystarttreatmentwithnaltrexonepriortoreleasefromprison.However,naltrexoneshouldbeadministeredundersupervisionanditseffectivenessinpreventingopioidmisusereviewedregularly.

Priortoreleasesomeoffendersrequestre-inductionontoopioidsubstitutiontreatment.Re-inductionshouldbeconsideredforoffenderswhoareabouttoleaveprisonandforwhomthereisaclearlyidentifiableriskofoverdose/toxicity.Thosewiththemostsignificantriskofdeathhaveahistoryofinjectingopioidmisuseimmediatelypriortocustody,longstandingopioiddependenceandpolydrugdependence.Theymayalsohaveahistoryofnon-fataloverdose/toxicity.Re-inductionmaybeofferedaftertheindividualhasbeenofferedanddeclinedrelapsepreventioninterventions,andoncetheimplicationsofrestartingopioidmisusehavebeenexplained.

Prescribingtopromoteabstinenceorpreventrelapseinalcoholdependence,includinganti-cravingagentsandsensitisingagents,maybestartedpriortoreleasewhereappropriate.

Preparationsforsubstancemisusetreatmentpost-release,ifrequired,shouldbeplannedwhereverpossible.Wherereleaseisunanticipated(whenanoffenderisreleasedfollowinganorderfromthecourt,forinstance,orwhereanindividualleavesprisonoutsideofstandardworkinghours),cliniciansshouldoperateacontingencyarrangement,whichmayinvolvemakingadirectreferraltoacommunity-basedsubstancemisusetreatmentservice.

Inadditiontoasubstancemisusetreatmentservicereferral,cliniciansshouldattempttosecureGPsforoffendersbeforetheyleaveprison,adviseboththesubstancemisusetreatmentproviderandGPofdischargemedicinesand,ifappropriate,theneedtoquicklytakeoverprescribing.

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3.6 Preventingsubstance-relateddeaths3.6.1 Overdose/toxicityprevention

Allprisonsshouldhaveanemergencyprotocolinplacethatcoversthemanagementofsubstance-relatedoverdose/toxicity.

Substance-relateddeathsarehighinthefirstweeksfollowingreleasefromprison.Reduced/lossoftoleranceisconsideredtobeasignificantriskfactor.

Fataloverdose/toxicityofteninvolvestheuseofopioidsaloneorincombinationwithotherrespiratorydepressantssuchasalcoholand/orbenzodiazepines.Likewise,alcoholaloneorincombinationalsohasasignificantroleinsubstance-relatedoverdose/toxicity.

Retainingserviceusersinhighqualitytreatmentprotectsagainstoverdose/toxicity.Thisprotectionmaybeenhancedbyotherinterventionsincludingtrainingsubstancemisusersintherisksofoverdose/toxicity,itspreventionandhowtorespondinanemergency.

3.6.2 Naloxone

Naloxoneisanopioidantagonistwhichtemporarilyreversestheeffectsofopioidssuchasheroinandmethadone.Itsuseaspartofapackageofoverdose/toxicitypreventionmeasuresisestablishedpracticeinsomepartsoftheUK.AnumberofdemonstrationsitesarebeingestablishedincommunityandprisonsettingsinWalestoprovidetrainingonoverdose/toxicitymanagementandnaloxoneprovisiontoopioidusersandtheirfamily/carersifappropriate.

Theprisonsiteswillissuenaloxonetooffenderswhoareassessedasbeingatriskofoverdoseonreleasefromprison.Whereoffendersarereleasedfromprisonwithoutanassessmentoriftheyneedtohavetheirinitialsupplyreplaced,theycanvisitademonstrationsiteinthecommunity.Wewilllearnthelessonsfromthedemonstrationsitesandconsiderationwillbegiventorollingouttheprovisionasappropriate.

3.6.3 Blood-borneviruses

Thegeneralprinciplesinrelationtoblood-bornevirusesandotherinfectionsapplyequallytoprisons.Manyoffendersinprisonareatparticularriskofblood-borneviralinfectionsnotonlyduetoinjectingdrugusepriortoprison,butalsoduetotherisksofongoingtransmissionwhilstinprison,suchassharinginjectingequipmentandparaphernalia,unprotectedsexandtattooing.

Prisonsneedtohavehighqualityprogrammesofharmreductionpreventioninterventionsinplace.Reducingpotentialharmduetooverdose,blood-bornevirusesandotherinfectionsshouldbeapartofcareforalloffendersinprison.

Atpresent,policyforprisonsinEnglandandWalesisnottointroduceneedleexchangewheresecurityremainsofparamountimportance.Althoughprovisionofdisinfectanttabletshasbeenintroduced,thereissomeconditionalinternationalevidencetosuggestthatitmaynotbeparticularlyeffective.Thereisgoodinternationalevidencethatisitpossibletoprovidearangeofharmreductionmeasures,includingneedleexchange,withinacustodialsetting.Theemergingevidencebaseneedstobetakenintoaccountindeterminingbestpractice.

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Prisonpresentsanopportunityandachallengetoaddressawiderangeofclinicalneedsofsubstancemisusers,especiallyharmreductioninterventionssuchashepatitisBvaccinationandhepatitisCtreatment.

AsstatedintheImmunisationagainstInfectiousDiseaseguidelinesTheGreenBook,allhighriskdrugmisusersshouldbeofferedvaccinationagainsthepatitisB,andagainsthepatitisA,whereindicated.HepatitisBvaccinationsshouldbecompleted(onasuper-acceleratedschedule).Thisshouldincludeinformationonhowindividualscancompletevaccinationandreceiveaboosterinthecommunity,ifreleasedbeforecompletion.

Alldrugmisusersshouldbeofferedtesting,andifrequired,treatmentforhepatitisC,andhumanimmunodeficiencyvirusinfections.

3.7 Co-occurringsubstancemisuseandmentalhealthproblemsItiscommonforthosewithsubstancemisuseproblemstoalsohaveothermentalhealthdifficulties.Interventionsforthementalhealthproblemsmayalsoneedtobeprovidedintheprisonsetting.Anintegratedapproachisrecognisedasbeingthebestwayofmanagingpeoplewithcomplexneeds.ThisinvolvesconsultationbetweentheCARAT,clinicalsubstancemisuse,primaryhealthcareandmentalhealthteams.

Thosewithseverementalhealthproblemsshouldhavehighqualitycareintegratedwithmentalhealthservices.Detailsofanyplannedcareprovidedbythepatient’scommunitymentalhealthteamandsubstancemisuseservicespriortocustodyshouldbeestablished.Theoffender’sinformedwishesandtheadviceofcommunityprovidersshouldbetakenintoaccountwhenclinicalsubstancemisusecareisplannedintheprisonsetting.Ifdetoxificationisthepreferredaction,thenagradualreductionprogrammeshouldbeprovided.

Whilstinprison,wherethereislessreadyaccesstoillicitdrugs,anoffender’smentalstatemayappeartoberelativelystable.Thereleasecareplanneedstotakeintoaccounttheprevioushistoryofsubstancemisuse,astheoffendermayreturntosubstancemisuseuponrelease.Similarly,aprevioushistoryofsubstancemisusemustalsobeconsideredwhenanoffenderistransferredtoanotherprison.

3.8 TobaccoSmoking-relateddiseasesarehighlyprevalentinsubstancemisusers.Dependenttobaccosmokersarelikelytogainsignificanthealthbenefitsfromquitting.Evidencesuggeststhathelpwithsmokingcessationmaybeassociatedwithimproveddrugtreatmentoutcomes.ChangesinsocietalattitudesandthesmokingbanthatwasintroducedinWalesinApril2007mayincreasethedemandfortreatmentfortobaccodependencegenerally.Offenderswithsubstancemisuseproblemswhosmoketobaccoshouldbeofferedsmokingcessationinterventions.

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3.9 OffenderswithalearningdisabilityOffenderswithbothalearningdisabilityandasubstancemisuseproblemhaveparticularrequirements.Theseareessentiallyaroundissuesassociatedwithcommunication.Itisimportantthatprisonstaffareawareoftheirparticularneedsandthatprogrammesandinterventionsaredeliveredaroundacceptedgoodpractice.Contactwithspecialistlearningdisabilityservicesandprofessionalsareanimportantpartofthisapproach.

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4. Releaseandresettlementprogrammes4.1 Goodpracticeinrelease/resettlementprogrammes

Withregardstogoodpracticeinsubstancemisusetreatmentfollowingrelease,evidenceindicatesthat:

Onentryintocustodyorrehabilitationcentreanindividualshouldbe•assessedassoonaspossibleforthroughcareandaftercareneeds,althoughthesemaychangeastheprisoner/residentprogressesthroughtreatment.

Inprison,priorityforassessmentsshouldbegiventoremandandshort-•sentenceprisoners.

Effectivelinksbetweenprisonandcommunityservicesarevitalandthe•useofacommonclientrecord,careplanandcollaborativecareplanningwillfacilitatethis.

Protocolsshouldbedevelopedbetweenprisonsandaftercareservices•todealwithearly,unanticipated,andFridayreleases.

Aftercareclientsappearmorewillingtoengagewithserviceswhen•apersistentandnonjudgementalapproachisadoptedbystaff.Regularcontactwithpotentialclientsininstitutionsislikelytoresultinhigherlevelsofengagement.

Routinemeetingofclientsattheprisongatewillhelpensurethattheyare,•andremain,incontactwithservices.

Agenciesshouldbeflexible,bothintermsoftheirconditionsforaccepting•clients,andtheamountoftimeforwhichsupportisoffered

Whereverpossible,communitybasedtreatmentservicesshouldcarryout•apostreleasecareplanforthoseheldincustody,ideallypriortorelease.Thisprocessshouldincludethesecuringofcontinuedprescribingatanappropriateclinicallevel.

WorkingrelationshipsbetweenTransitionalSupportServices(TSS)•andprisonstaffneedtobegoodtofacilitatereferrals.

Peermentorsanda24-hourpointofcontactarehighlyvaluedbyclients,•evenifthelatterisrarelyused.

Aftercarestaffrequireclearguidance/trainingregardingthesignsorfeatures•ofhigh-risksituationsandcharacteristicsthatpredisposetheirclientstorelapse,tooverdose(deliberatelyorsemi-deliberately),andtoreturntocrime.

ItisworthacknowledgingthattheProbationServicealsooffersalcohol•treatmentprogrammesdeliveredinacommunitysetting.

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25

Appendix1

Maintypesofcommunity-baseddrugprovisioninEnglandandWales

TypeofProvision Evidence/Evaluation

Testingonarresttoidentifyheroin,crackandcocaineusersfollowingarrestforacquisitivecrimes.

Thereisnoevidenceontheeffectivenessoftestingeitherasastandaloneformofroutinemonitoringorinprovidedaddedvaluewhenusedincombinationwithtreatmentinterventions.

‘ToughChoices’whichintroducedtestingonarrestandmandatoryassessmenthasincreasedthenumbersbeingtestedandengagingintreatment(TypeIVevidence).

Thereissomeevidencethatsuggeststheeffectivenessofdrugtestingonarrestforidentifyingproblemdrugusingoffendersnotincontactwithservicesmaybeerodedovertime.(TypeVevidence).

Mandatoryassessmentsfollowingapositivetestwhichmayleadtoareferraltodrugtreatmentservices.Itisanoffencetorefusetheassessmentbutnotthetreatment.

Introductionofmandatoryassessmentsfollowingapositivedrugtestonarresthasimprovedtheratesofparticipationinassessment.(TypeIVevidence).

Arrestreferralinvolvesspecialistworkersseeingdetaineesinpolicecustodysuites,andincreasinglyincourttoprovideinformationand,whereappropriate,referraltotreatmentorothermeansofassistance.

Arrestreferral(inareaswherethereisnotesting)hasbeenshowedtobesuccessfulinidentifyingandengagingdrugusersintreatment.(TypeIVevidence)Currentlytherearenopublishedevaluationsthatcomparetheeffectivenessandvalueformoneyofapproachesforidentifyingproblemdrugusingoffendersincustodysuites.

CriminalJusticeIntegratedTeams(CJITs)arethecoreoftheDIP.Theycasemanageoffendersover18andcoordinateservicesandagencies.

Anationalevaluation(undertakenbeforetheintroductionofmandatorydrugtesting)reportedsignificantreductionsindruguseandoffendingamongstthosetakenontoCJITcaseloads(TypeIVevidence).

RestrictionsonBail(RoB)followingapositivetestallowsfordrugtreatmenttobeaconditionofcourtbail.

EvaluationofpilotsinthreeEnglishsitesconcludedthattheimpactonillicitdruguseandoffendingwasunclearbutthereweresomepositivefindingsintermsofcomplianceandtreatmentengagement(TypeIVevidence).

26

TypeofProvision Evidence/Evaluation

Prolificandotherpriorityoffenderprogrammeaimstotargetresourcesatoffendersinthecommunitywithsixormoreconvictionsintheprevious12months.

Evaluationoftheschemeshoweda43%reductioninoffendingcomparingthetotalnumberofconvictionsinthe17monthsbeforeandthe17monthsaftertheprogrammeimplementation(TypeIVevidence).

Conditionalcautioningallowsforaconditionconducivetorehabilitation,whichcanincludedrugtreatment,tobeaconditionofapolicecaution,withprosecutionfortheoriginaloffencepossibleiftheoffenderdoesnotcomply.

Anassessmentoftheearlystagesofimplementationshowedthattheuseofconditionalcautionsvariedwidelybetweenareas.Ofthosegivenaconditionalcautionaboutafifthhadsomesortofdrugreferralcondition.Aboutaquarterofthosegivenaconditionalcautionsfailedtocomplywithsomeaspectsofthisandwereprosecuted.

DrugTreatmentandTestingOrders(DTTOs)andnowDrugRehabilitationRequirements(DRRs)arecommunitysentenceswhichresultinsanctionsiftherequirementsarenotmet.

TodatenoevaluationofDRRhasbeenpublishedbutareportontheimpactofDTTOsonoffendingwaspublishedbytheHomeOfficein2003.Thisreportwasbasedon210offendersfollowedupfor2yearsafterthestartoftheorder.

• Datawereonlyavailableon174offenders,ofthese80%hadbeenreconvictedwithin2years.

• CompletionratesforDTTOswerelow.Outcomeinformationwasavailablefor161offenders,30%finishedtheirorderssuccessfully,67%hadtheirordersrevoked.

• Therewasastatisticallysignificantdifferenceinoffendingbetweenthosewhocompletedtheirorders(53%)andthosewhoseorderswererevoked(91%).

• 44%ofoffendersinEnglandandWaleswhostartedDRR/DTTOin2006/2007completedcomparedwith28%ofthosewhostartedin2003(TypeIVevidence).

TheOffenderSubstanceAbuseProgramme(OASP)andAddressingSubstanceRelatedOffending(ASRO)areaccreditedbehaviour-changeprogrammes,sometimesattachedtocommunityorders.P-ASROisaprisonbasedversionofASRO.

ThereisnopublishedevidenceassessingOASP,ASROandP-ASRO,howevertheseprogrammesareaccreditedTheJointPrisonProbationAccreditationPanel.

27

TypeofProvision Evidence/Evaluation

Drugcourtsandsimilarcommunityjusticecourtshavebeenpiloted.TheybuildonDTTOsandDRRsbyprovidingcontinuityofsentenceforthereviewprocessanduseaproblem-solvingandinter-agencyapproachtohelpaddressthecausesofoffending.

Goodinternationalevidencebase.EvaluationofthedrugcourtpilotsinScotlandfoundthatasizableproportionofclientsmadesubjecttoDrugCourtOrderswereabletoachieveandsustainreductionsindruguseandassociatedoffendingbehaviour.(TypeIVevidence)

Type1evidence(strongestevidence):atleastonegoodsystematicreview(includingatleastonerandomisedcontrolledtrial).

TypeIIevidence:atleastonegoodrandomisedcontrolledtrial.

TypeIIIevidence:welldesignedinterventionalstudieswithoutrandomisation.

TypeIVevidence:welldesignedobservationalstudies.

TypeVevidence(weakestevidence):expertopinion;influentialreportsandstudies.

Source:BarkerJ,WeightmanAL,LancasterJ.ProjectfortheenhancementoftheWelshProtocolsforHealthGain:projectmethodology2.Cardiff:DuthieLibrary;1997.

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Appendix2

Figure1:Interventionsforproblemdrug-usingoffenderswithinthecriminaljusticesystem-community-basedprovision

Processestoidentify

drugusersforinterventions

Interventionstopromoteengagementwithtreatment

andotherservices(ormaintaindrug-freestatus)

Interventionsaddressing

substanceuseand/oroffending

Drugtestingandmandatoryassessment

ArrestReferral

Court-basedassessments

Criminaljusticeinterventionsteam(CJIT)case-management

Prolificandotherpriorityoffender(PPO)programme

RestrictionsonBail(RoB)

Conditionalcautioning

Diversionfromprosecution

Probationorderswithdrugtreatmentconditions

DrugRehabilitationRequirements(DRRs)

DrugCourtsandCommunityJusticeCourts

InterventionOrders

Drugtestingandotherdrug-relatedconditionsonreleaseonlicence

AddressingSubstanceRelatedOffending(ASRO)

OffenderSubstanceAbuseProgramme(OASP)

29

Figure3:HowtheDIPprogrammeworksatallstagesoftheCJS

Case management by CJIT

Case managem

ent by CJIT (by CJIT or NO

M)

Case

man

agem

ent

by C

JIT

Case management (by CARATs in prison or NOMS in community)

Adultdrug-misusing

offender

Access to theProgramme via CJIT

worker in police custody(Required Assessment

or voluntaryassessment)

Restrictionon Bail drives

access totreatment

Access totreatmenton remand

Community sentence

Access to treatment via

Drug RehabilitationRequirement

Access to treatmentand release planning

in custody

Access to aftercaresupport (housing,

training etc) in appropriate cases

Access totreatment

via conditionalcautioning

Access to theProgramme via CJIT worker

in police custody (Required Assessment

or voluntaryassessment)

Custodialsentence

No (or reduced)drug misuse

and offending No (or reduced)drug misuse

and offending

Courtprocess

Release andresettlement

Trigger offence,arrest, drug

testing (Class A)

Charge where applicable,drug testing (Class A)

if not carried out earlier

30

31

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GlossaryArrestreferralservice Arrestreferralworkersoperateinpolicestationsand

interviewarresteestoidentifythosewithadrugproblemforonwardreferraltootheragencies.

CARAT Counselling,Assessment,Referral,AdviceandThroughcareteamsoperatewithinprisons.Theyundertakeassessmentsoftheneedfordrugservicesandprovideone-to-onemotivationalsupportandgroupworkforproblemdrugusers.Theyalsoprovidecasemanagementfacilitatingaccesstoawiderrangeofservicesbothincustodyandoninitialrelease.

CJIT CriminalJusticeIntegratedTeamsarecommunitybasedandassessoffenderswhotestpositive.Theyprovidecasemanagement,referringoffenderstotreatmentandorganisingtheprovisionofothersupportsuchashousingandemploymentservices.

DIPDrugInterventions Programmeprovidesarangeofinterventionsaimedatgettingproblemdrug-usingoffendersintotreatmentandothersupport.

TSS TheTransitionalSupportServiceaimstoprovide‘throughthegate’mentoringandsupportforshortsentenceprisoners(usuallylessthan12monthssentence)forupto12weeksfollowingtheirrelease.Theserviceisdesignedtoaddressthepracticalresettlementneedsofthosewithon-goingsubstancemisuseproblems.Theprimaryfocusisonincreasingaccesstodrugtreatmentbuttheschemealsoaddressesproblemsthatmayleadtore-offending,suchashomelessness,relationshipdifficulties,finance,loweducationalattainmentandunemployment.

NOMS TheNationalOffenderManagementServiceisresponsibleforoverseeingthemanagementofoffendersinprisonandinthecommunity.NOMSusestheconceptofthe‘end-to-endmanagement’ofoffenders.AsingleoffendermanagerwillsuperviseeachoffenderthroughouttheircontactwiththeCriminalJusticeSystem(CJS),anddrawonanappropriaterangeofservicesprovidedbyagenciesfromallsectors.