Posted: November 9th, 2023
Clinical Management and Psychosocial Treatment of Drug Addiction in Prison Settings
Clinical Management and Psychosocial Treatment of Drug Addiction in Prison Settings
Drug addiction is a complex and chronic condition that affects millions of people worldwide. According to the World Health Organization, drug use disorders are responsible for 11.2 million years of life lost due to premature mortality and disability in 2019 . Among the populations most affected by drug addiction are those in contact with the criminal justice system, who often face multiple challenges such as stigma, discrimination, violence, mental health problems, infectious diseases, and lack of access to adequate health care and social support .
In this blog post, we will discuss the current state of evidence and best practices for providing clinical management and psychosocial treatment of drug addiction in prison settings. We will also highlight some of the barriers and opportunities for implementing effective interventions in this context.
What is clinical management and psychosocial treatment of drug addiction?
Clinical management and psychosocial treatment of drug addiction are two complementary approaches that aim to reduce the harms associated with drug use, improve the quality of life and well-being of people with drug use disorders, and facilitate their recovery and social reintegration .
Clinical management refers to the provision of pharmacological interventions, such as medications for opioid use disorder (MOUD), which include methadone, buprenorphine, and naltrexone. These medications have been shown to reduce the risk of overdose, relapse, infectious diseases, and criminal recidivism among people with opioid use disorder . Clinical management also involves the assessment and treatment of co-occurring physical and mental health conditions, such as chronic pain, depression, anxiety, post-traumatic stress disorder, and hepatitis C .
Psychosocial treatment refers to the provision of behavioral interventions, such as cognitive-behavioral therapy (CBT), motivational interviewing (MI), contingency management (CM), and peer support. These interventions aim to enhance the motivation, skills, coping strategies, and social networks of people with drug use disorders, and to address the underlying psychological and environmental factors that contribute to their substance use . Psychosocial treatment can be delivered individually or in groups, in person or via telehealth, by trained professionals or peers .
Why is clinical management and psychosocial treatment of drug addiction important in prison settings?
Prison settings are characterized by high rates of drug use and drug-related problems among inmates. According to a global review, the prevalence of drug use in prison is estimated to be at 20%, around four times higher than in the general population. Moreover, 22% of people in prisons are sentenced for offences related to drug possession for personal use . Drug use in prison is associated with increased risks of overdose, infectious diseases (such as HIV, hepatitis B and C, and tuberculosis), self-harm, violence, disciplinary sanctions, and re-offending after release .
Providing clinical management and psychosocial treatment of drug addiction in prison settings can have multiple benefits for individuals, communities, and society. For individuals, these interventions can improve their health outcomes, reduce their substance use and criminal behavior, enhance their self-esteem and resilience, and prepare them for successful re-entry into society . For communities, these interventions can prevent the transmission of infectious diseases, reduce the burden on health care and criminal justice systems, and promote social cohesion and human rights . For society, these interventions can save lives, reduce costs, and contribute to the achievement of the Sustainable Development Goals .
What are the challenges and opportunities for providing clinical management and psychosocial treatment of drug addiction in prison settings?
Despite the evidence and benefits of clinical management and psychosocial treatment of drug addiction in prison settings, there are many challenges and barriers that hinder their implementation and effectiveness. Some of these challenges include:
– Lack of political will and funding to prioritize health care for people with drug use disorders in prison settings
– Lack of legal and regulatory frameworks to support the provision of evidence-based interventions in prison settings
– Lack of trained staff and resources to deliver quality care for people with drug use disorders in prison settings
– Lack of coordination and continuity of care between prison health services and community health services
– Lack of data collection and monitoring systems to evaluate the impact and outcomes of interventions in prison settings
– Stigma and discrimination against people with drug use disorders by prison staff, inmates, families, and society
– Resistance and reluctance by some prison staff and inmates to accept or participate in interventions for drug use disorders
However, there are also many opportunities and initiatives that can facilitate the provision of clinical management and psychosocial treatment of drug addiction in prison settings. Some of these opportunities include:
– Increasing awareness and advocacy among policy makers, prison authorities, health professionals, civil society organizations, media outlets, and the general public about the importance and benefits of providing health care for people with drug use disorders in prison settings
– Developing and implementing national and international guidelines, standards, and protocols for the provision of evidence-based interventions in prison settings, such as the WHO/UNODC/UNAIDS Technical Guide for Countries to Set Targets for Universal Access to HIV Prevention, Treatment and Care for Injecting Drug Users and the UNODC/WHO International Standards for the Treatment of Drug Use Disorders
– Building the capacity and skills of prison health staff and community health staff to deliver quality care for people with drug use disorders in prison settings, through training, supervision, mentoring, and peer support
– Establishing and strengthening partnerships and networks among prison health services, community health services, civil society organizations, academic institutions, and international agencies to share best practices, resources, and experiences in providing interventions for drug use disorders in prison settings
– Implementing and evaluating innovative and scalable models of service delivery, such as telehealth, mobile clinics, peer-led interventions, and transitional care programs, to improve the access, coverage, and quality of interventions for drug use disorders in prison settings
– Conducting and disseminating research and evidence on the effectiveness, cost-effectiveness, and impact of interventions for drug use disorders in prison settings, to inform policy and practice decisions and to generate knowledge and learning
Clinical management and psychosocial treatment of drug addiction in prison settings are essential components of a comprehensive and humane response to the global drug problem. These interventions can improve the health and well-being of people with drug use disorders in prison settings, prevent the spread of infectious diseases, reduce crime and recidivism, and promote social justice and human rights. However, there are many challenges and barriers that limit the availability and quality of these interventions in prison settings. Therefore, there is a need for increased political commitment, funding, capacity building, coordination, innovation, research, and advocacy to ensure that people with drug use disorders in prison settings have access to effective and evidence-based interventions that meet their needs and respect their dignity.
: World Health Organization. (2020). Global Health Estimates 2019: Deaths by Cause, Age, Sex, by Country and by Region. Retrieved from https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates
: United Nations Office on Drugs and Crime. (2019). World Drug Report 2019: Booklet 5: The Drug Problem and Organized Crime, Illicit Financial Flows,
Corruption And Terrorism. Retrieved from https://wdr.unodc.org/wdr2019/prelaunch/WDR19_Booklet_5_DRUG_PROBLEM_AND_ORGANIZED_CRIME.pdf
: United Nations Office on Drugs and Crime & World Health Organization. (2016). International Standards for the Treatment of Drug Use Disorders. Retrieved from https://www.unodc.org/documents/commissions/CND/CND_Sessions/CND_59Reconvened/December_2016/ECN72016_CRP12_V1610192.pdf
: Mattick RP et al. (2014). Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev 2:CD002207.
: Larney S et al. (2017). A systematic review of injecting-related injury
and disease among people who inject drugs. Drug Alcohol Depend 171:39–49.
: Dutra L et al. (2008). A meta-analytic review of psychosocial interventions for substance use disorders. Am J Psychiatry 165(2):179–187.
: Marsch LA et al. (2016). Technology-based interventions for the treatment
and recovery management of substance use disorders: a JSAT special issue.
J Subst Abuse Treat 60:1–5.
: United Nations Office on Drugs and Crime. (2022). Rethinking incarceration: UNODC hosts Consultation on Treatment of Drug Use Disorders
and Associated Mental Health Disorders in Prison Settings. Retrieved from https://www.unodc.org/unodc/frontpage/2022/January/rethinking-incarceration_-unodc-hosts-consultation-on-treatment-of-drug-use-disorders-and-associated-mental-health-disorders-in-prison-settings.html
: Fazel S et al. (2006). Substance abuse and dependence in prisoners: a systematic review. Addiction 101(2):181–191.
: Mitchell SG et al. (2012). The effectiveness of incarceration-based drug treatment on criminal behavior: a systematic review. Campbell Systematic Reviews 8(18).
: World Health Organization Regional Office for Europe & Pompidou Group Council of Europe. (2013). Prisons And Health. Retrieved from https://