Opening doors

Alan RushmoreDrug treatment within custody needs an overhaul, says Alan Rushmore 

Drug treatment in prison lacks consistency and is over-burdened and over-complicated by assessment. It need not be so.

Many clients will simply require an assessment of need and possibly a brief intervention. Others may benefit from coursework and/or individual support to confront their offending behaviour. Some will not perceive an issue with their recreational use but may benefit from some information or guidance.

Poly-substance using clients will require more intensive support and involvement with a wider stream of expertise. Others will be on Integrated Drug Treatment System (IDTS) and will need support to withdraw.

Even after 15 years of working ‘behind the wire’ I am often surprised and impressed by the level of commitment from both clients and colleagues to implement change. Yet I am also saddened by the obstacles and lack of communication thrown up by the prison system or organisations that employ us.

It would be easier if each service provider employed the same assessment tool, and if the client’s care plan was reviewed upon transfer. Presently the payment by results culture dictates repetition of assessment, with files rarely transferred with the client. If this were routinely done, clients could be seen promptly and we would have greater continuity of care.

IDTS should be about reduction from methadone and Subutex, not about maintenance. To do this we need to provide the relevant support and guidance and elicit the appropriate community support to encourage self-control and abstinence.

Ideally it would be good to have a national service that enabled prisoners to be met and accompanied to probation, housing providers or rehab. Meet and greet services should be national and not confined to specific service providers.

As drug and alcohol practitioners we need to work closely with our colleagues in healthcare, mental health and discipline. Again, I have been fortunate in that I have always believed that I have worked successfully with my colleagues from other disciplines, but sadly mental health services are often over burdened and under resourced. This has to be rectified as the majority of my clients (and possibly yours) have demonstrated either primary or secondary mental health concerns.

Those who work within addiction recovery possess an array of skills. The opportunity to share ‘best practice’ – a cross-pollination of skills to improve services to clients and to improve dialogue and understanding between custody and community – would be welcomed. DIP teams are actually quite remarkable and have demonstrated excellent practice, but we need to use them more.

Access to alternative therapies and fellowship groups (NA, CA, AA etc) is presently limited and enhanced access would be beneficial. Personally speaking, prison should be about rehabilitation and promoting positive lifestyle choices. Sadly it appears more to be about containment, punishment and retribution.

Our clients are often stigmatised and disenfranchised by their addictions. We should be empowering our clients to confront and take control of their drug use, to rebuild relationships, to access support, to develop trust and enable them to transfer to the community as ‘well’.

As practitioners we run the risk of working in isolation. We need to recognise and understand the difficulties and frustrations of working within different institutions and organisations. We need to widen our experience of different environments to make us better practitioners.

We read and hear about ‘the war on drugs’. It is not a battle, but it certainly is a struggle to cope with the global pandemic of drug use. Addiction does not discriminate but sadly it is only too easy to be criminalised and thereby marginalised by becoming infected by substance abuse.

‘Let’s work together, come on, come on, let’s work together’ to confront the disease of addiction and addictive behaviour. We need to replace use with positive lifestyle choices to enable our clients to make balanced decisions based upon informed choice. By communicating and demonstrating consistency we can encourage empowerment. We’re all on the same side.

Alan Rushmore is a drug and alcohol counsellor and therapist

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