Transcript Dr Oliver Aldridge

Management of
Addiction
in the
Criminal Justice System
Dr Oliver Aldridge
MBBCh, DRCOG, MRCGP
Certificant of the International Society of
Addiction Medicine
Scots Parliament of 1617
...all persons lawfully convicted of drunkenness...
• First offence: £3 or 6 hours in prison
• Second offence: £5 or 12 hours in prison
• Third offence: £10 or 24 hours in prison
• Subsequent offences: "committed to jail until they
find security for their good behaviour."
Death Penalty for Drug Offences
High Commitment
Low Commitment
• China
• Indonesia
• Kuwait
• Thailand
• Pakistan
• Egypt
• Syria
• Yemen
• Bangladesh
• Iran
• Saudi-Arabia
• Vietnam
• Singapore
• Malaysia
http://www.ihra.net/files/2010/06/16/IHRA_DeathPenaltyReport_Web1.pdf
Symbolic Application States
• Oman
• Sri Lanka
• Qatar
• Bahrain
• India
• USA
• Bangladesh
• Gaza
• UAE
• South
Korea
• South
Korea
• Myanmar
• Lao
• BruneiDarussalam
• Cuba
Scotland's Prison Population
• Per 100,000 population
• www.prisonstudies.org/info/worldbrief/wpb_country.
php?country=171
Reconviction Rates - 1 year
http://www.scotland.gov.uk/Topics/Statistics/Browse/Crime-Justice/TrendData
The Road to Recovery: 2008
• "People who use drugs
undermine their potential to
lead rich and fulfilling lives"
• "...one third to over a half of all
acquisitive crime is related to
illegal drug use"
Drug use and offending
• High rates of drug problems in prison:20-50%
• DTTO: Reduction in drug use - the primary focus of
work to reduce offending behaviour
• Offending substantiates diagnosis of addiction (eg
TOPS)
Hierarchical Relationship
Drug Use
Criminal Justice System
Questions
• Coercion: not in Rx for the right reasons?
• Hobson's choice?
• Committing crime to gain access to a service?
• Why not access regular drug treatment?
Initiation of Drug Use
• Age 11/12: Nicotine and Alcohol
• Teenage Years: Benzodiazepines, Cannabis,
"PartyDrugs", Hallucinogens, Gas, Dissociatives
• Heroin: later onset drug, around 19 yrs.
• 25% first use Heroin in custody
Involvement with the
Criminal Justice System
• Adult convictions from age 16
• Children's Hearing System
Acquired Brain Injury
• Contact sports
• Domestic violence
• Adolescent males who
drink
• Falls
• Fights
Incidence of TBI
• 8.5% of General Population
• 71% of DTTO audit had experienced at least one
episode of traumatic loss of consciousness
• Majority as teenagers (age range 5 - 31).
• Mostly as a result of fighting or assault
• As a group had had very little, if any, follow up
Frankenstein
• Mary Shelley
• Adapted by Nick Warburton
2000
Frankenstein
• "I came across people, other beings which I could see
were almost like myself. Or so I thought at first when
I approached them, though, I found that they did not
consider me as one of their own kind. As soon as they
saw me, their faces became twisted with fear. They
shouted at me and threw things and ran away from
me, just as my own maker had done. So this is what I
learned about myself - that I was a disgusting
creature. Even though I had given them no cause, all
men hated me."
Childhood Trauma
•
Violence in the home
•
Stigmatisation: eg parental
imprisonment
•
Parental substance misuse (including
alcohol)
•
Learning disability
•
Care system
•
Traumatic brain injury
•
Bereavement
•
Poor nutrition
•
Poverty
•
Difficulty managing contrasting school vs
home vs street environment
•
Abuse: sexual/physical/emotional
Social Exclusion
• "... is about more than income poverty. It is a short
hand term....combination of linked
problems...unemployment, discrimination, poor
skills, low incomes, poor housing, high crime and
family breakdown. These problems are linked and
mutually reinforcing." Mooney et al 2010
Alienation
• Jimmy Reid (1932-2010)
• Rector of Glasgow University
1971
• New York Times: "the greatest
speech since President Lincoln's
Gettysburg Address"
"People feel alienated by society"
Jimmy Reid 1972
• "It is the cry of men who feel themselves the victims
of blind economic forces beyond their
control....excluded from decision making. The feeling
of despair and hopelessness that pervades people who
feel with justification that they have no real say in
shaping or determining their own destinies."
Addiction Factory
• Bruce Alexander
• Psychosocial dislocation
Alienation Syndrome
• "Alienation expresses itself in different ways in
different people....criminal antisocial
behaviour....drop outs.....so called maladjusted....who
seek to permanently escape from the reality of society
through intoxicants and narcotics."
• "It is a much greater factor in all of them than is
generally recognised"
Addiction becomes
pre-eminent
• Drug use cements people in the criminal justice
system
• Failure to address addiction fatally undermines other
rehabilitative attempts
• "A particular form of ill-treatment and possibly
torture of drug users is the denial of opiate
substitution treatment" UN Special Rapporteur 2013
Prison as gold standard??
• 400 years later,
instinct is still to
punish
• Good at keeping
people alive
• Poor at fostering
recovery
http://www.scccj.org.uk/wp-content/uploads/2012/08/SCCCJ-Report-onAddictions-Recovery-Prisons-210512-
Narcotics Farms
1935 - 1960's
• $4M institution on 1000 acres
of farmland
• Relapse rate on release "close to
100%" - NIH consensus
statement 1997
Problem Solving Justice
• Drug courts
• DTTO's
• Combine high quality drug treatment with
wraparound care and resolution of criminal justice
system issues
• Focused on empathic, rehabilitative response
California Civil Addict Program
• 1962 onwards
• Long term, heavily addicted, criminally active drug users
• Randomised by a "fluke"
• Treatment reduced drug use
• Legal pressure promoted treatment entry, retention and
compliance
• The legal system at the service of treatment
• http://www.findings.org.uk/docs/Ashton_M_25.pdf
Conclusions
•
Drug use and imprisonment are symptoms of alienation
•
High quality drug treatment essential and can be effective within the
criminal justice system
•
Denial of opiate substitution treatment is torture (UN Special
Rapporteur 2013)
•
Prison is not the gold standard criminal justice disposal for drug
problems
•
Rehabilitation and empathy, not punishment
•
Challenge is to move towards prevention: dismantling the addiction
factory