A rethink on prison drug treatment is desperately overdue, says Mike Trace.
When I launched the first prison drug treatment strategy more than 25 years ago we knew there was a big problem to address – but we weren’t particularly clear on what we were ultimately trying to achieve.
Over the years it has become clearer. From a health perspective, the objectives are to provide a humane healthcare and prescribing service to prisoners who use drugs, and to take public health measures to minimise the risk of infections and overdoses – both in prisons and in the high-risk period shortly after release.
Meanwhile, from a criminal justice perspective, the objectives are to reduce demand for drugs on the wings, and to cut reoffending rates by rehabilitating those whose crimes are driven by drug use or addiction.
From 1999 to 2012, this balance between public health and rehabilitation activity was broadly maintained. True, substitute prescribing and general healthcare services were too often of low quality, and many of the 100 or so rehabilitation programmes consisted of little more than a few weeks of prison officers reading out classroom-style manuals to bored prisoners. But the ambition was there, and quality was gradually improving.
When the NHS took control of the budget for commissioning prison-based drug treatment in 2012, their priority was understandably to improve health service delivery and substitution treatment.
But unfortunately this was accompanied by a lack of interest in the criminal justice system objectives – funding for the activities that actually affected the prison drug market was cut, and the opportunities for prisoners to use their time inside to choose rehabilitation and recovery diminished.
Patterns of drug use in prison were changing before 2012, and have changed massively since – less than half of the people on treatment caseloads are now primary heroin users, and the dominant drug of choice inside is spice. This has meant that opiate substitution treatment in prison – though much improved in the last 15 years – has only a marginal impact on reducing demand.
Peer pressure on prisoners to be involved in a drug market now largely controlled by prison gangs and organised crime is greater than ever – 11 per cent of male prisoners and 18 per cent of females report developing a drug problem while inside (a remarkable figure considering that almost half of prisoners have a pre-existing problem on arrival).
Disastrously through this period, the range of structured and intensive drug and alcohol rehabilitation programmes in prisons was decimated. In 2012, there were more than 100 programmes – most managed internally by the prison service and of poor quality, although there were plenty of examples of great delivery.
Meanwhile, charities such as RAPt and Phoenix Futures delivered well designed and properly resourced intensive rehabilitation programmes – independently reviewed and researched, and demonstrating positive impacts on wing culture and post-release reoffending. Thousands of prisoners used these programmes as a springboard to a crime-free life and many now work in the sector.
The absence of meaningful rehabilitation and recovery options in most prisons over the last ten years means that the dominant culture on the landings is one of drug dealing, drug seeking, drug consumption, and the associated cycle of debt, violence and health crises. This also undermines efforts to reduce crime.
Most prisoners going in with a drug or alcohol problem come out with nothing changed – the main driver of the cycle of reoffending and rearrest that is making prisons overcrowded and unmanageable.
It doesn’t have to be like this. Most readers will know I’ve been banging on about this failure of strategy for at least ten years and more recently the chief inspector of prisons, the Justice Select Committee, the National Audit Office and numerous local independent monitoring boards have been saying the same thing. Even the prisons minister, James Timpson, acknowledges that prisons cannot function effectively with an uncontrolled drug market.
The substance misuse services in prisons have to do more than simply manage the chaos – we need to be supported to deliver services that actually change the culture on the wings. This means much greater attention to creating safe places for those prisoners who want to get away from the cycle of drugs, debt and crime – dedicated locations where the mutual aid groups, therapeutic communities and structured recovery programmes can do their work to help prisoners turn their lives around.
Both the prison service and the NHS are now realising that current provision is not having enough impact on the drug market or related harms. But despite plenty of warm words, 18 months into a new administration I still see no concerted action to change the reality on the wings. And as the RAPt t-shirts used to say, ‘If nothing changes, nothing changes’.
Mike Trace is chief executive of Forward Trust
Every year, the 16 Days of Activism Against Gender-Based Violence calls on people around the world to stand together to end violence against women and girls. 
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At Release, we’ve spoken to numerous individuals who’ve been penalised for missing appointments, despite notifying their services of their work schedules. In recent years, some services have changed their operating hours to better accommodate service users who are in work, but this isn’t always enough as clients can find it difficult to get an appointment during late opening hours due to the demand. 
Transforming Lives, Creating New Futures, November 2025 Edition
The data forms part of the Taking Action on Addiction campaign, launched in 2021 by HRH The Princess of Wales, which aims to encourage more open conversations about addiction and challenge stigma as a barrier to seeking help. The figures have been published during Addiction Awareness Week, alongside a call for a national conversation about addiction and recovery. The need is underscored by recent statistics showing 18,000 deaths in the UK last year linked directly to drugs, alcohol or gambling.
Join more than 600 delegates and over 40 exhibitors at the DDN Conference on 9 July in Birmingham.
The newsletter also shares updates from the therapeutic programme, where a recent development has been the arrival of three guinea pigs who are now part of daily sessions. Clients have been spending time with them during quiet reflective periods and many report feeling calmer and more grounded.
Read the full newsletter on the 
to improve ease of access to treatment and prevent clients from falling off their prescription or missing appointments. 
Having both units together is incredibly important. It means someone can come to us at crisis point for detox, but we can also offer the structured rehab and therapeutic programme that gives them the best chance of sustaining recovery. People don’t have to move to another service just as they’re beginning to stabilise, and that continuity of care makes a real difference.
Ongoing challenges
Kate has been part of Kaleidoscope for more than 15 years and brings extensive experience and a strong commitment to supporting the people who use the organisation’s services. During her time with Kaleidoscope, she has led a number of initiatives to improve service delivery and strengthen clinical governance.
Change Grow Live supported more than 200,000 people across England and Scotland during 2024/25. The organisation’s annual report opens with a reminder that those on the margins are often the most affected in difficult times, and that health should be a right, not a privilege.
DDN magazine is a free publication self-funded through advertising.
Limited to just eight clients at any one time, the setting fosters personalised care, privacy and community within a warm and discreet environment. Set in more than forty acres of beautiful natural surroundings, the centre combines mountain and sea views with the calming influence of the Mediterranean climate to create a peaceful space where clients can step away from the pressures of everyday life and focus fully on 
healing.
Results speak for themselves, with a success rate of over 65 per cent based on client history, placing InnerLife Recovery among the highest performing treatment centres worldwide. This is supported by an international team with more than one hundred years of combined experience across addiction, mental health and eating disorders. The team’s professional expertise, compassion and commitment ensure that each programme is both clinically effective and deeply supportive.
Choosing this recovery centre means working with a team fully committed to your long term recovery. They provide the tools, guidance and personalised treatment you need to overcome challenges and build a healthier future.
Long-term impact
‘Certainly, for a significant number of veterans, withdrawal, isolation and loneliness can be a consequence of attempts to cope with PTSD or complex PTSD,’ says Robinson – the latter defined as PTSD with additional symptoms such as difficulties in controlling emotions or problems with relationships. Loneliness of course can also be a ‘consequence of the secrecy that’s often around substance misuse’, he adds, as well as being ‘an important factor in risk to self-harm, suicide and accidental death’. 
Many professionals fear that the full psychological impact has yet to be seen, however, and is likely to escalate in both severity and complexity. Concerns already raised include disrupted education and its impact on life prospects, difficulties in forming intimate relationships, challenges around family planning, and the psychological burden of emerging research – such as whether ketamine misuse may eventually be linked to diseases such as bladder or kidney cancer. This raises troubling questions – do such harms contribute to further ketamine use, or even extend to polysubstance misuse in those already struggling with its consequences?
But much has changed in the abstinence-based treatment sector in the last four years, prompting a need to revisit the costs and priorities of treatment versus the costs associated with doing nothing. Costs have heavily impacted the residential sector in the same way they have everywhere else – our economics are those of running a hotel whilst adding a full daily treatment programme and some medical and detoxification services on top. Food, energy, trade service and maintenance costs have all rocketed, along with wages, inflation and taxation. 
Mount Ararat pushed us all to our limits – physically and emotionally. But we made it. Together. We returned with battered knees and full hearts, and an even deeper belief in what’s possible.
The danger is that the narrative becomes split into two extremes: either it’s ‘totally safe’ or it’s ‘catastrophic’. That leaves very little middle ground for factual, pragmatic conversation – and even less space for early intervention.
Build On Belief is a LERO offering out-of-hours social connection support across London, Sussex and Buckinghamshire. Of course, when COVID hit in March 2020 we were forced to offer distance support and, within weeks of lockdown, launched an online programme of groups imitating what we offered face-to-face.
This is vital to showing us they understand, accept and own the boundaries, and it also allows the boundaries to be explored for clarification. One of them is our intoxication boundary – you’re allowed to attend, but a behaviour-based decision will be made to ensure other people aren’t triggered. Intoxicated people may be asked to turn their camera off and just listen, for example.
That has resulted in a wonderfully diverse range of activities. For example, on a Monday you could go to recovery coaching followed by Tai Chi (or a quiz, which is serious business here!) followed by ‘topic of the week’ and finish up with mindfulness meditation. On a Thursday you could have fun with the ‘wheel of mystery’, then the women’s group, then ‘daily dilemmas’ and end with recovery support. There’s something for everyone, but it’s not for everyone.
Philip describes the horses as ‘mirror, metaphor and medicine’, adding that they ‘mirror our emotional state. We talk about how the horse feels. How can we help the horse calm down? How can we look at regulating emotions? Usually the young people will say, “oh, the horse did that” and this leads to discussions on things like how they feel when someone approaches them too quickly. Does it make them feel a bit scared? How do they deal with it? Let’s practise these calming techniques with the horses. And medicine, because neuroscience shows very clearly that being around horses can make us feel good. It affects the emotional centre of our brain. It helps us process unprocessed emotion.’
We need to stop asking people to fit into our complicated systems and start providing genuine person-centred support. If we’re serious about building a world-class treatment system and reducing drug related deaths, then all evidence-based treatment options should be funded and consistently available across the country. We must create clear pathways from court or prison into residential care, and we must invest in treatment provision for those with multiple needs.
CEO of Kenward Trust Penny Williams has been featured in a new BBC article examining addiction, recovery, and the challenges facing treatment services in the UK. This visibility helps raise awareness of the vital work being done by organisations like ours – and reinforces Kenward Trust’s commitment to delivering high-quality care across Kent.
With a broken boot on the way, foggy weather and the wind and rain against them, they did a smashing job of reaching the peak and raising over £700 in the process! Here’s what the team had to say:
Mark brings over 25 years of experience in the social care sector, having worked extensively with adults with learning disabilities, mental health needs, and complex social care issues. A qualified social worker with a master’s in applied social studies, Mark is also an IOD chartered director. His previous roles as CEO of several social care organisations have been marked by transformative change and strategic growth.
The Leading Forward series has released a new audio episode with The Forward Trust’s CEO Mike Trace providing a deep-dive into the world of drug consumption rooms.
The line got a big round of applause from a crowd that included representatives of Anglian Water, NHS Lincolnshire, Bowmer + Kirkland, the Recovery Coach Academy, teachers’ union NASUWT and several local firms, and for us at LRP it summed up the aim of the day. We want employers to see potential, not problems. People in recovery bring resilience, loyalty and a hunger to prove themselves. This was about showing that, with the right support, they can be a huge asset.
The fact that the census is carried out by so many different bodies across the country – ‘homelessness organisations and local authorities of course, but also the substance use sector, the health sector, the violence against women and girls (VAWG) sector, the migrant support sector’ – means that the data is much more accurate than the government’s, she stresses. ‘The census gets the right people to look for women in the right places. It’s a model that could, and should, be adopted nationally.’
DEVASTATING EFFECTS
COPING MECHANISM
The Border Force confiscated almost 15 tonnes of cocaine worth more than £1bn between 1 June and 31 August, the Home Office has announced – ‘equivalent to the weight of a London double decker bus’.
John Elford is known for his work helping people recover from drug and alcohol addictions, and has published a series of popular self-help books. Six years ago he opened Somerton Lodge on the Isle of Wight, one of the UK’s first alcohol-free ‘sober hotels’, which he continues to run as a successful business. But the earlier part of his life was dominated by alcoholism, with his chaotic lifestyle leaving him jobless, homeless, and regularly in hospital for treatment.