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

BibliographyAssociationofForensicPhysicians,RoyalCollegeofPsychiatrists.SubstanceMisuseDetaineesinPoliceCustody:GuidelinesforClinicalManagement.London,RoyalCollegeofPsychiatrists.2006

AllWalesMedicinesStrategyGroup.FinalAppraisalReport:Buprenorphine/naloxone(Suboxone®).Cardiff.WelshAssemblyGovernment.2008

BellinE,WessonJ,TomasinoV,NolanJ,GlickAJ.Highdosemethadonereducescriminalrecidivisminopiateaddicts.AddictionResearch1999;7(1):19-29

BennettTDrugsandCrime;TheresultsoftheseconddevelopmentalstageoftheNEW-ADAMprogramme.HomeOfficeResearchStudy204.London:HomeOfficeResearchandStatisticsDirectorate(2000)

BorehamR,CronbergA,DollinLandPudneySTheArresteeSurvey2003-2006.HomeOfficeStatisticalBulletin12/07.London:HomeOffice(2007)

CentersforDiseaseControlandPrevention.HIVTransmissionAmongMaleInmatesinaStatePrisonSystem-Georgia,1992-2005.MMWRWeekly,421-426.

DawsonP,CuppleditchL.AnimpactassessmentoftheProlificandotherPriorityOffenderprogramme.HomeOfficeOnlineReport08/07

DepartmentofHealth(England)andthedevolvedadministrations.DrugMisuseandDependence:UKGuidelinesonClinicalManagement.London,DepartmentfHealth(England),theScottishGovernment,WelshAssemblyGovernmentandNorthernIrelandExecutive.2007

DepartmentofHealth.Afirstclassservice:QualityinthenewNHS.1-7-1998.London,DepartmentofHealth.12-3-2008.RefType:Report

DepartmentofHealth.ClinicalManagementofDrugDependenceintheAdultPrisonSetting:IncludingPsychosocialTreatmentasaCorePart.London,DepartmentofHealth.2006

DepartmentofHealth.PsychiatricmorbidityamongprisonersinEnglandandWales.London,TheStationeryOffice.1998

DolanK,HallW,WodakA.Methadonemaintenancereducesinjectinginprison.BMJ1996;312(7039):1162

DolanKA,ShearerJ,MacDonaldM,MattickRP,HallW,WodakAD.ArandomisedcontrolledtrialofmethadonemaintenancetreatmentversuswaitlistcontrolinanAustralianprisonsystem.Drug&AlcoholDependence2003;72(1):59-65

FarrellM,MarsdenJ.Drug-relatedmortalityamongnewlyreleasedoffenders1998to2000.HomeOfficeOnlineReport40/05.2005

FoxA,KhanL,BriggsD,Rees-JonesN,ThompsonZ,OwensJ.Throughcareandaftercare:approachesandpromisingpracticeinservicedeliveryforclientsreleasedfromprisonorleavingresidentialrehabilitation.HomeOfficeOnlineReport01/05

GossopM,BrowneN,StewartD,MarsdenJ.Alcoholuseoutcomesandheavydrinkingat4-5yearsamongatreatmentsampleofdrugmisusers.JournalofSubstanceAbuseTreatment25;135-143(2003)

HarmanK,PaylorI.AnevaluationoftheCARATinitiative.TheHowardJournal44(4);357-373(2005)

32

HealthProtectionAgency,SCIEH,NationalPublicHealthServiceforWales,CDSCNorthernIreland,CRDHB,UASSG.ShootingUp;InfectionsamonginjectingdrugusersintheUnitedKingdom2002.London,HealthProtectionAgency.2003

HollowayK,BennettT&FarringtonD.Theeffectivenessofcriminaljusticeandtreatmentprogrammesinreducingdrugrelatedcrime:asystematicreview,HomeOfficeOnlinereport26/05London:HomeOffice(2005)

HomeOfficeAnintroductiontothedruginterventionsprogrammeprisonsandprobationservices.London:HomeOffice2007

HomeOffice.Drug-relatedmortalityamongnewly-releasedoffenders.HomeOffice,2003

HoughM,ClancyA,McSweenyTim,TurnbullPJ.TheimpactofDrugTreatmentandTestingOrdersonoffending:twoyearreconvictionresults.Findings184,London:HomeOffice,2003

HucklesbyA,EastwoodC,SeddonT,SpriggsATheEvaluationoftheRestrictiononBailPilotFinalReport.HomeOfficeOnlineReport06/07.London:HomeOffice(2007)

JointFormularyCommittee.BritishNationalFormulary.Number57.2009.London,BritishMedicalAssociationandRoyalPharmaceuticalSocietyofGreatBritain2009

JürgensR.InterventionstoaddressHIVinprisons:needleandsyringeprogrammesanddecontaminationstrategies.GenevaWorldHealthOrganisation,2007

King’sCollege,London;UniversityofBristol;ImperialCollege,London;andtheLondonSchoolofEconomicsandPoliticalScienceNationalEvaluationofCriminalJusticeIntegratedTeams:Summary.London:TheInstituteforCriminalPolicyResearchSchoolofLaw,King’sCollege,London(2007)

McIvorG,BarnsdaleL,EleyS,MallochM,YatesR,BrownA.TheOperationandEffectivenessoftheScottishDrugCourtPilots.ResearchFindingsNo81/2006.EdinburghScottishExecutive.SocialResearch,CrimeandCriminalJustice

McSweeneyT,StevensA.HuntN,TurnbullPJ.Twistingarmsorhelpinghand?Assessingtheimpactof‘coerced’andcomparable‘voluntary’drugtreatmentoptions.BritishJournalofCriminology47,470-490(2007)

MinozziS,AmatoL,VecchiS,DavoliM,KirchmayerU,VersterA.Oralnaltrexonemaintenancetreatmentforopioiddependence.CochraneDatabaseofSystematicReviews2006onlinereview

NationalOffenderManagementService.IntegratedDrugTreatmentSystem:TheFirst28Days:PsychosocialSupport.London,MinistryofJustice,2006

NationalTreatmentAgencyforSubstanceMisuse.ClinicalGovernanceinDrugTreatment:Adraftgoodpracticeguideforprovidersandcommissioners.OnlinereportNationalTreatmentAgency.2008

NICE.Drugmisuse:opioiddetoxification.NICEclinicalguideline52.London,NationalInstituteforHealthandClinicalExcellence,2007

NICE.Drugmisuse:psychosocialinterventions.NICEclinicalguideline51.London,NationalInstituteforHealthandClinicalExcellence,2007

NICE.Methadoneandbuprenorphineforthemanagementofopioiddependence.NICEtechnologyappraisalguidance114.2007.London,NationalInstituteforHealthandClinicalExcellence

33

NICE.Naltrexoneforthemanagementofopioiddependence.NICEtechnologyappraisalguidance115.2007.London,NationalInstituteforHealthandClinicalExcellence

RichterKP,ArnstenJH.Arationaleandmodelforaddressingtobaccodependenceinsubstanceabusetreatment.SubstanceAbuseTreatment,Prevention,andPolicy2006;1(23)

RoyalCollegeofPsychiatrists.Co-existingproblemsofmentaldisorderandsubstancemisuse(dualdiagnosis):Aninformationmanual.BanerjeeS,ClancyC,CromeI,editors.2001.London,RoyalCollegeofPsychiatristsResearchUnit.18-10-2007.RefType:Report

RoyalCollegeofPsychiatrists.Prisonpsychiatry:adultprisonsinEnglandandWales.2007.London,RoyalCollegeofPsychiatrists.11-12-2007.RefType:Report

ShawJ,ApplebyL,BakerD.Saferprisons:Anationalstudyofprisonsuicides1999-2000bytheNationalConfidentialInquiryintoSuicidesandHomicidesbyPeoplewithMentalIllness.2003.London,DepartmentofHealth.14-11-2007.RefType:Report

SkodboS,BrownG,DeaconS,CooperA,HallA,MillarT,SmithJ&WhithamK(2007).TheDrugInterventionsProgramme(DIP):addressingdruguseandoffendingthrough‘ToughChoices’.HomeOfficeResearchReport2.London:HomeOffice

StrangJ,HeustonJ,WhiteleyC,BacchusL,MadenT,GossopMetal.IsprisontattooingariskbehaviourforHIVandotherviruses?ResultsfromanationalsurveyofprisonersinEnglandandWales.CriminalBehaviourandMentalHealth2000;10:60-66

WelshAssemblyGovernment.AlcoholMisuseinWales.Cardiff:WelshAssemblyGovernment,2008

WelshAssemblyGovernment,HMPrisonServiceCardiffPrisonMentalHealthPathway(2006)

WelshAssemblyGovernment.PsychologicalTherapyandPsychosocialinterventionsintheTreatmentofSubstanceMisuse.Cardiff,WelshAssemblyGovernment,2006

WorkingTogethertoReduceHarm.TheSubstanceMisuseStrategyforWales2008-2018.WelshAssemblyGovernment,2008

RoyalPharmaceuticalSocietyofGreatBritain.Pharmaceuticalcareofdetaineesinpolicecustody.Onlinereport:RoyalPharmaceuticalSocietyofGreatBritain:2007

SondhiA,O’SheaJandWilliamsT.Arrestreferral:Emergingfindingsfromthenationalmonitoringandevaluationprogramme.DPASpaper18.London:HomeOffice;2002

BirchA,DobbieF,ChalmersT,BarnsdaleL,McIvorGandYatesR.Evaluationofthearrestreferralpilotschemes.CrimeandCriminalJusticeResearchProgrammeResearchFindingsNo.87/2006.Edinburgh:ScottishExecutive;2006

StrangJ,HeustonJ,GossopM,GreenJ,MadenT.ResearchFindingsNo.82:HIV/AIDSRiskBehaviourAmongAdultMalePrisoners.London:HomeOffice;1998

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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.