Transcript by Dr Sanja Stojadinovic, Pyschologist

Treating drug
users in prison
Dr Sanja Stojadinovic
Special Prison Hospital
Belgrade
Page 1
Drug use and crime
 Individuals who use illicit drugs are
more likely to commit crimes.
 Drug use amongst offenders
entering prison is on the increase,
mirroring the rising levels of drug
use generally in the community.
Page 2
Breaking the cycle
 Treatment is the most effective
course for interrupting the drug
use/criminal justice cycle for
offenders with drug use problems.
 Forced abstinence is not treatment,
and it does not cure addiction.
Page 3
Learning new skills
 Abstinent individuals must still learn
how to avoid relapse, including
those who may have been abstinent
for a long period of time while
incarcerated.
Page 4
Therapeutic process change
 To alter attitudes, beliefs, and
behaviors that support drug use, the
drug user must engage in a
therapeutic change process, which
may include medications to help
prevent relapse.
Page 5
Why should drug use treatment be
provided to offenders?
 Effective treatment decreases future
drug use and drug-related criminal
behavior, can improve the
individual’s relationships with his or
her family, and may improve
prospects for employment.
 In addition, it can save lives.
Page 6
Why should drug use treatment be
provided to offenders? (2)
 Also, drug use treatment is cost
effective, it reduces costs associated
with low productivity, crime and
incarceration.
 The largest economic benefit of
treatment is seen in avoided costs of
crime (incarceration and victimization
costs).
Page 7
Voluntary or mandatory
treatment ?
 Most studies suggest that outcomes
for those who are legally pressured to
enter treatment are as good as or
better than outcomes for those who
entered treatment without legal
pressure.
Page 8
Voluntary or mandatory
treatment ? (2)
 Individuals under legal pressure also
tend to have higher attendance rates
and remain in treatment for longer
periods, which can also have a
positive impact on treatment
outcomes.
Page 9
Evidence based interventions in
drug use treatment
 Evidence-based interventions include:
cognitive-behavioral therapy to help
participants learn positive social and
coping skills,
contingency management approaches to
reinforce positive behavioral change, and
motivational enhancement to increase
treatment engagement and retention.
Page 10
Phases of treatment
 Early phases of treatment help the
participant stop using drugs and
begin a therapeutic process of
change.
 Later stages address other problems
related to drug use and, importantly,
help the individual learn how to selfmanage the drug problem.
Page 11
“What works?” principles
 Interventions should address:
Risk: the ‘intensity’ of the intervention
should be matched to the risk of reoffending. Therefore prisoners assessed
as having a higher risk of re-offending
should receive the most intensive
interventions and vice versa.
Page 12
“What works?” principles (2)
 Need: interventions should be targeted
at risk factors for re-offending (also
known as criminogenic needs). These
risk factors, when targeted effectively,
can be reduced thus reducing the risk of
recidivism.
Page 13
“What works?” principles (3)
 Responsivity: this requires that
interventions are matched to an
offender’s learning style and personality
characteristics and the characteristics of
the therapist/ counselor.
Page 14
SPECIAL PRISON
HOSPITAL
BELGRADE
Page 15
Special prison Hospital in
Belgrade
 Special Prison Hospital is specialized
for treatment of offenders with drug
and alcohol use problems and mental
disorders referred to mandatory
treatment by a court decision.
Page 16
Psychosocial treatment of drug
users
 Treatment involve different
psychosocial interventions:
structured group work,
counseling and psychotherapy
(cognitive-behavioral, gestalt, clientoriented),
Drug free unit.
Page 17
Structured groupwork
 Interventions include:
Motivational enhancement: delivered via
motivational interviewing;
Relapse prevention (training drug users to
develop a range of skills to identify,
anticipate, avoid and/or cope with high
risk situations and triggers for relapse);
Prerelease: planning and preparation for
release.
Page 18
Counseling and psychotherapy
 Based on cognitive-behavioral
strategies includes relapse prevention
strategies (identifying triggers, highrisk situations, strategies to cope with
craving) and identifying
dysfunctional patterns of thinking,
emotions and dealing with problems.
Page 19
Counseling and psychotherapy (2)
 Components include managing
cravings, preventing a “lapse”
becoming a “relapse”, rehearsing
skills and developing relapse
prevention/management plans,
identifying and beginning positive
fulfilling alternative activities, coping
with stress and instilling a belief in
the drug user’s own self efficacy.
Page 20
More on psychotherapy –
Creating bonds
 One of the major goals of
psychotherapy is connecting to
external world by developing
adequate relationships with therapists,
family and social network outside the
closed universe of addiction.
Page 21
Creating bonds
 In order to maintain abstinence and
accomplish better therapy outcome,
client and therapist need to establish
meaningful relationship or positive
therapeutic alliance.
Page 22
Relational approach
• Relational approach in psychotherapy
puts emphasis on creating deep,
independent attachment to new life
style and to people sharing that new
life style.
Page 23
The dark side of addiction
 “I came from the dark side, tied up by the barriers
that other posed and that I posed by myself,
bounded by fear. My life was just a simulation,
filled with substitutions of life.
 Now, I am the person striving to conquer my fears,
anger and guilt by positive thinking. I am learning
to deal with everyday problems and frustrations, I
am learning to communicate freely and to exchange
my emotions with others.
 I am learning to be free, in order to learn who I
am”. (Patient in Special Prison Hospital)
Page 24
Drug free unit
 In Special prison hospital since 2007,
as a result of cooperation with OSCE
mission to Serbia.
 Up to 17 prisoners from Drug
addiction department.
 Besides enhanced conditions, it offers
more intense psychosocial treatment.
Page 25
SERBIAN PRISON
REFORM
Page 26
Serbian prison reform
 Goals of Serbian prison reform are
 implementing evidence based approach
to offenders, introducing risk assessment
tools and
treating criminogenic needs of offenders
in order to decrease the rate of reoffending.
Page 27
Treatment in Serbian prisons
 Since 2010 OASys (Offenders
Assessment System) has been applied
in risk assessment for offenders with
prison sentences over 3 years.
Page 28
Drug using inmates in Serbian
prisons in 2012.
70%
30%
drug users
Page 29
Treatment in Serbian prisons
 Serbian prisons until now offered no
integrated, specialized treatment for
drug using inmates.
 Concerning the number of drug using
inmates and high rates of reoffending, the necessity for systematic
addressing the problem emerged.
Page 30
Treatment in Serbian prisons (2)
 Second phase of reform of the
Treatment service in Serbian prisons is
directed to introducing specialized
programs targeting criminogenic
needs (dynamic risk factors in which it
is possible to intervene) of offenders.
 One of them will offer psychosocial
treatment for drug users in all Serbian
prisons.
Page 31
Treatment in Serbian prisons (3)
 Program for drug users is based on
UNODC recommendations for
effective drug users treatment and will
include structured group work,
cognitive-behavioral strategies and
relapse prevention strategies
(modeled according to program in
Special prison hospital).
Page 32
Specialized program for drug
users
 Interventions include:
Motivational enhancement: delivered via
motivational interviewing in order to
build motivation for change, compliance
for treatment and provide remaining in
treatment for sufficient time;
Page 33
Specialized program for drug
users (2)
Relapse prevention (training drug users to
develop a range of skills to identify,
anticipate, avoid and/or cope with high
risk situations and triggers for relapse);
Prerelease: planning and preparation for
release.
Page 34
Thank you for your
attention!
Page 35