Substance use in remand prisoners: a consecutive case study

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Abstract
Objectives: To determine the prevalence of drug and alcohol use among newly remanded prisoners, assess the effectiveness of prison reception screening, and examine the clinical management of substance misusers among remand prisoners. Design: A consecutive case study of remand prisoners screened at reception for substance misuse and treatment needs and comparison of findings with those of prison reception screening and treatment provision. Setting: A large adult male remand prison (Durham). Subjects: 548 men aged 21 and over awaiting trial. Main outcome measures: Prevalence of substance misuse; treatment needs of substance misusers; effectiveness of prison reception screening for substance misuse; provision of detoxification programmes. Results: Before remand 312 (57%) men were using illicit drugs and 181 (33%) met DSM-IV drug misuse or dependence criteria; 177 (32%) men met misuse or dependence criteria for alcohol. 391 (71%) men were judged to require help directed at their drug or alcohol use and 197 (36%) were judged to require a detoxification programme. The prison reception screen identified recent illicit drug use in 131 (24%) of 536 men and problem drinking in 103 (19%). Drug use was more likely to be identified by prison screening if an inmate was using multiple substances, using opiates, or had a diagnosis of abuse or dependence. 47 (9%) of 536 inmates were prescribed treatment to ease the symptoms of substance withdrawal. Conclusions: The prevalence of substance misuse in newly remanded prisoners is high. Prison reception health screening consistently underestimates drug and alcohol use. In many cases in which substance use is identified the quantities and numbers of different substances being used are underestimated. Initial management of inmates identified by prison screening as having problems with dependence producing substances is poor. Few receive a detoxification programme, so that many are left with the option of continuing to use drugs in prison or facing untreated withdrawal. In screening for substance use in remand prisoners a positive finding must be considered the norm rather than the exception Present prison reception procedures fail to identify the extent to which substances are used and misused by people newly remanded to prison Provision of detoxification programmes for prisoners identified by reception screening as having serious drug and alcohol related problems is inadequate Prisoners who need help but think that asking for this is more likely to result in punishment than treatment are not likely be truthful about their substance use More consideration needs to be given to reducing substance misuse in prisons by improving assessment at reception and providing better treatment for misusers rather than using random urine screening to detect and punish offenders