INTRODUCTION TO THE STUDY
CHAPTER 2 LITERATURE STUDY
2.9 Canadian Correctional Service Substance Abuse programme proposal
The Addiction Research Centre in Correctional Services in Canada presented a discussion paper entitled Substance Abuse Programming – A proposed structure in 2001. The paper concentrated on female offenders, although the statistics showed that 70% of both male and female offenders are identified as having substance abuse problems. It was believed that there was a need for gender
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responsive programmes to understand the realities of women‟s lives and distinctive from men.
Substance abuse creates more problems in that persons abusing substances have more problems with associates, attitudes, employment and marital or family situations. They have few skills to manage stress and are more likely to have been hospitalised for mental health reasons. There is a higher recidivism which is reduced significantly with participation in substance abuse treatment.
Programme Review:
Identify relationships between substance abuse and pathways to crime.
Importance of levels of intervention including pre and post treatment components.
Train and maintain qualified staff
Evaluate effectiveness of combining behavioural and personal variables (self-esteem, depression, improved health, productive use of leisure time)
Recommendations for programming:
Harm reduction framework – Abstinence is a requirement in the correctional setting.
Programmes must be gender specific. There should not be an adaptation for male and females.
Need to ensure that both cognitive and therapeutic needs of the offenders are addressed.- Education, pre-treatment and on-going maintenance are considered essential.
Isolation was identified as a contributing factor in the growing concern regarding prison culture. Substance abuse should encourage the return to holistic healthy community model.
Supporting information:
The use of community agencies in program delivery. This impacts on effective reintegration.
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Program resources to be protected. Competing priorities should not impact on delivery.
Orientation and training
Research and evaluation are essential.
Programme Design
The design model proposed is multidimensional including formal and informal support and it is ongoing, integrated and holistic. It uses the environment to foster healthy and responsible living. There will be an interaction with all the core programmes of which there are four in the Canadian Correctional Services. (In Pollsmoor there are similar programmes of which the Crossroads programme is compulsory for all offenders).
Theoretical Influences:
Harm reduction promotes the reduction of adverse consequences of alcohol and drug use. For some life long abstinence is not a reasonable goal and the learning of strategies to reduce use and or the harm associated with use is empowering and relevant. An example would be the elimination of crack use from one‟s life but still continue with social drinking.
Cognitive and Emotive Interface – an integrated design is essential. The programme must strengthen cognitive based learning and provide a therapeutic forum. Offenders acquire critical skills in problem solving, decision making, rational thinking etc.
The model of change has enormous influences in the design of substance abuse treatment. This model offers a framework for working with those who are ready for change and those who are not. It uses six stages – pre-contemplation, contemplation, preparation, action, maintenance and termination with facilitators matching their intervention at appropriate stages. Motivational interviewing is important. People often say “they need to be ready” or “need to be motivated”
which illustrates the relevance of this approach.
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“To empower women to make healthy lifestyle choices through experience of a comprehensive, integrated and gender responsive programme fro recovery.”
Operating principles:
Positive community milieu
Content must be gender responsive.
Responsive to changing needs – some form of treatment needs to be available all the time
Immediate access to support
Education for the whole prison population
Peer support.
Link to criminal behaviour must be evident
Delivery;
Reaffirm the community role in recovery
Gender matching of facilities
Expertise in facilitation.
Management and Support:
Dedicated programme resources
Training needs to be ongoing for the staff
Programme integration is essential for holistic response.
Leadership, coordination, evaluation and feedback is essential for credibility.
Structure
The programme must start at admission and follow through to post release into the community. With peer support groups need to be involved at all stages.
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Initial Engagement - To occur in the first 48 to 72 hours after admission.
Sets the tone.
Use positive peer support.
Detoxification starts of the admission of the offender.
Education and Pre Treatment – Offered to all offenders as the majority experience problems relating to substance abuse.
Motivational interviewing.
Positively influence peer support culture.
Can also link with health services to deal with STD‟s etc.
Assessment and Evaluation – Used to determine eligibility.
Assess effectiveness/satisfaction
Motivation, readiness to change, severity, using patterns, problems and consequences of use and responsivity.
Use made of self-administered and structured interviews.
Therapeutic Intensive - Core treatment component follows education and assessment. It uses two groups – one orientated in relational theory and the second psychoeducational using a cognitive behavioural approach.
Emotive group deals with self-awareness, relationships, communication, parenting and trauma. Individual counselling, weekly, on request.
Cognitive Behavioural Group focuses on motivation and change. Focus group set on skills such as goal setting, problem solving, decision making and relapse prevention.
Exercises are used to reinforce these.
Continuing Support (Maintenance) – This is essential to the relapse prevention.
The programmes would follow throughout the sentence and continue in the community. This would be achieved
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through and open group with structured content drawing on the peer support groups
Establishing community groups is problematic due to the distribution and small number of offenders.
Transition – Pre-release sessions are recommended for the four week period prior to release.
Peer Support – This promotes leadership, mutual respect, support and self- management strategies. This needs to be available on an ongoing basis with a “drop in” venue with a defined cycle of materials and resources.
Community Meetings - this falls outside the programme but will generate a positive environment, a focus on healthy community. These meetings are an extension of the broader interest in integrated programming and community building.
Next steps
Using this framework the detailed content in each of the modules will be contracted out. A regional pilot programme will be instituted with a national roll out to follow. Discussion and collaboration with both mental health and health services will be important.