Drug and alcohol addiction is one of the most frequent motivators for offending. Addiction does not disappear when a person enters the prison system, and it is in prison where the percentage of addicted individuals is significantly higher than in free society. Addiction presents a problem when convicting and sentencing, during the sentence and especially after release, when after-care is provided and the primary goal is to prevent recidivism. Drug and alcohol addicts are rejected by society, often struggle to find employment and are treated by society as criminals. Addiction can lead to a brutal cycle of prison, release, lack of opportunity to reintegrate in to society, reoffending and reconviction.
Drug Treatment Units (DTU) are credited as the Department of Correction’s most successful therapeutic programme. The residential 3 – 6 month long programme aims to rehabilitate prisoners with substance abuse problems through group-based programmes, teaching inmates about addiction, change, relapse and the effect their action has on others. Run collaboratively by Care NZ (the delivery arm of the New Zealand Society on Alcohol and Drug Dependence) and Corrections, there are nine Drug Treatment Units nationwide able to provide treatment for up to 940 inmates who meet the criteria to receive treatment. Of these, six are dedicated to prisoners serving short-term sentences and have 450 spaces available each year. In New Zealand, a 2006 evaluation of the 24-week programme revealed that DTUs reduced the reconviction rate by 15% for male offenders and by 30% for female offenders. Drug Treatment Units in prisons are necessary to assist the 80% of prisoners with substance abuse problems to successfully rehabilitate, reintegrate into the community and pursue employment opportunities.
Drug and Alcohol intervention as part of a rehabilitation process, accompanied by post-prison care and support, can reduce recidivism rates significantly. A 1999 study in a California State Prison involving 478 prisoners, found that after three years only 27% of the prisoners involved in the drug treatment programme and after-care programme reoffended and returned to prison, compared to a 75% recidivism rate for those who did not receive the treatment. Eighty per cent of all offending in New Zealand is related to drugs and/or alcohol in some way, therefore to combat our high recidivism rate (over 50% of those released from prison will return within 5 years) it seems a logical solution to make these programmes widely available to all prisoners. Unfortunately this is not so, as under 1000 of the 20,000 people who spend time in prison each year will receive this treatment. Corrections must seriously consider the success of Drug Treatment Units, expand the availability of the therapy and invest more on Drug Treatment in Prison and the after-care in communities.
The DTU 3 – 6 month long residential programme aims to support the participant and provide sufficient harm-minimisation education and resources. In order to limit the harm caused by the misuse and addiction to drugs, the DTU involves:
- Providing methadone maintenance treatment (MMT) for opioid dependent inmates;
- Managing detoxification in line with clinical needs;
- Maintaining strict control of the dispensing of prescription medications in prisons;
- Implementing measures to support risk reduction and humane treatment for prisoners with blood-borne viruses such as HIV/AIDS and Hepatitis C;
- Implementing health promotion activities. (Department of Corrections Drug and Alcohol Strategy 2009-2014)
Some of the operations of DTUs are successful in helping prisoners overcome their addiction and supporting them in reintegrating in society and ultimately reducing recidivism. However, policies such as the management of prescription medication can have serious effects on prisoners’ physical and mental health. A prison sentence is already the loss of freedom, not a sentence of ill health and suffering.
A 2004 study by Ian Sheerin, Terri Green, Douglas Sellman, Simon Adamson, and Daryle Deering demonstrated the reduction of crime and reoffending by drug addicts on a methadone maintenance treatment (MMT) programme. The study indicated that:
- 71% of those receiving MMT ceased their participation in criminal offences.
- 80 % of non-Māori and 88% of Māori participants reported that their involvement in crime had reduced considerably since they had been on MMT.
- Only 14% of non-Māori and 9% of Māori said their involvement was unchanged or increased.
- Over 90% said their involvement with drug dealers or people committing crimes had reduced.
However, community waiting lists for MMT are long (the average waiting time for MMT in Christchurch is 12.7 months) and resources and funding are short. Sheerin et al., determined that Corrections save an average of $994 per MMT participant per year. Corrections and the media often cite the $91,000 cost of each prisoner per year, but by making DTUs available to more prisoners, recidivism will lower, reducing the average cost of imprisonment. Moreover, a 2012 Ombudsman’s report found that training courses for nurses administering methadone treatment had been cancelled. Comprehensive training in Health Services policy is important if the health needs of prisoners are to be adequately met. Proper methadone administration is a matter of direct relevance to life and death for injectable drug addicts.
Corrections maintain strict control of the dispensing of prescription medications in prisons, primarily with those participating in DTUs. The 2012 Ombudsman’s report stated the only pain relief provided in prison is paracetamol, and often prisoners felt paracetamol did not provide sufficient relief for the pain they were experiencing. This means, no matter what pain you are experiencing, be it toothache or severe wounds, morphine-based pain relief is off-limits, and paracetamol is all you are going to get. The strict control of prescription drugs can have damaging effects on prisoner health, evident in the treatment of Rimutaka prison inmate Stephen McMurtie this year.
McMurtie was serving a 3-year sentence for the possession of class ‘A’ drugs, when he dislocated his shoulder during a work-out at the gym. He underwent an operation at Hutt Hospital, and then was prescribed prescription medication upon returning to prison. After his prescription ran out, McMurtrie – who has serious liver problems – waited three days for a replacement script and was given ibuprofen and the anti-inflammatory drug Voltaren as pain relief by prison medical staff in the meantime. McMurtrie claims he was given no instructions as to how to take the medication, nor was he told not to consume it on an empty stomach. He collapsed into a 5-day coma caused by liver failure.
Another example is seen in prisoners with Attention Hyperactivity Disorder (ADHD) (an estimated 43% of prisoners suffer from some form of ADHD). These prisoners are denied Ritalin in prison on the grounds it is a drug of abuse and can become a commodity in prison. When left untreated, prisoners with ADHD struggle to concentrate in rehabilitation programmes. Prisoners being denied Ritalin are being set up to fail. Appropriate medical treatment is a basic human right, and the Department of Corrections has a responsibility to provide it. Section 75 of the Corrections Act 2004 states:
“A prisoner is entitled to receive medical treatment that is reasonably necessary” and “the standard of healthcare that is available to prisoners in a prison must be reasonably equivalent to the standard of healthcare available to the public”.
Given that methadone is dispensed under full supervision, why can’t Ritalin be dispensed in the same way?
Drug Treatment Units are a positive initiative and they yield results, yet they aren’t receiving the necessary funding or resources to make a significant impact on reducing reoffending. Roger Brooking of Alcohol and Drug Assessment Counselling claims that, although Corrections spend over $130 million on rehabilitation and reintegration services, a mere $4.7 million is spent on drug treatment in prison. This can be compared with $6 million that was spend on new prison officer uniforms in 2010, or $11 million on cell phone blocking technology. Additionally, what happens to prisoners who seek therapy from DTUs but are denied as they do not meet the ‘criteria’? How dependent on drugs must you be before you qualify?
I asked Julie Miller, Manager of Ministerial Services for the Department of Corrections, what criteria an inmate must meet to receive treatment from the DTUs. To be eligible, prisoners must be over 18 and still have enough time remaining in their sentence to complete a 3 or 6 month course. They require a score of 8 or more on the Department of Corrections Alcohol Use Disorders Identification Test (AUDIT) and/or a score of 3 or more on the Drug Abuse Screening Test (DAST). The AUDIT asks the offender 10 questions, and offers 4 different answers with corresponding scores (never – 0, less than monthly – 1, 2 to 4 times a month – 2, 2 to 3 times a week – 3, and 4 or more times a week – 4). All questions refer to the 12 months prior to the AUDIT and include:
- In the last twelve months, did you have a drink containing alcohol?
- How often did you find you could not stop drinking once you had started?
- How often did you need a first drink in the morning to get you going after a heavy drinking session?
- Have you or someone else been injured as a result of your drinking?
- Has a relative, friend, doctor or other health professional expressed concern about your drinking or suggest you cut down?
A score or 8 or more for men or 7 or more for women suggests an inmate has a harmful pattern of drinking and meets the criteria for treatment. The DAST is similar, asking questions referring to the past 12 months, with answers scoring either a 0 or 1. Questions include:
- In the last twelve months, did you use drugs other than alcohol or those prescribed to you for medical reasons?
- Did you abuse more than one drug at a time?
- Have you neglected your family because of drug use?
- Have you engaged in illegal activities in order to obtain drugs?
- Have you had medical problems as a result of your drug use?
A score of 3 or more means the offender has a harmful pattern of drug use, and qualifies for treatment. However, in addition to AUDIT and DAST requirements, prisoners must be able to participate and learn in a group environment and may be rejected due to psychiatric disorders, insufficient intellectual capacity or limited English language skills. Sex offenders are considered on a case-by-case basis, and must have completed all other designated rehabilitative programmes before entering a DTU. Priority is given to those with a high-risk of reoffending. Prisoners must be motivated to receive treatment, give full consent to enter the programme and sign a contract agreeing to comply with the requirements, be free of identified drug use and returned two negative drug tests or one negative drugs test with one pending within the last two months.
What about those who score highly on the AUDIT or DAST, but are rejected due to insufficient intellectual capacity or limited English language skills?
One former inmate, Tony Maude, who was sentenced to prison for methamphetamine possession and supply, requested help but was told he did not qualify for the DTU. Maude turned to the faith-based rehabilitation unit where completed a full 18 month programme and kept clean upon release. Faith-based prison units have now been closed after failing to ‘prove their worth’.
Corrections need to make some serious adjustments in order to make the most of a programme already showing signs of success. Eighty per cent of prisoners have alcohol and drug issues they need to address upon entering a prison sentence. Not providing the necessary treatment or care is setting a prisoner up to fail, which maintains our high recidivism rates and negative societal costs of imprisonment.
Article by Holly Mortimore (JS Intern) on 31 August 2013