House of Commons - Home Affairs

Select Committee on Home Affairs First Report

11 DRUG TREATMENT

268. Eighty per cent of people arriving in prison have serious drug or alcohol problems. In some inner city prisons as many as eight out of 10 men are found to have class A drugs in their system on reception.[211] However, many prisoners have never received help with their drug problems.[212] Drug misusers commit a high proportion of acquisitive crime: in nine areas where mandatory drug testing was carried out on people charged with offences such as shoplifting, burglary and drug offences, between 36 and 66% tested positive for the use of heroin, other opiates or cocaine.[213] These statistics underline the need for effective detoxification and drug treatment programmes, both in prison and continuing on release in the community, for all those prisoners identified as misusing or addicted to drugs.

The need for compulsory drug testing

269. At present, prisoners are not compulsorily drug tested on admission to prison. Prisoners are asked to disclose whether they have a drug habit or addiction. This is problematic on two counts. First, if a prisoner fails to disclose a drug habit, he will not automatically be referred to the detoxification unit or recommended for a drug treatment programme. Second, no comprehensive data of the true extent of the drug problem besetting the prison system is available to inform a pro-active drug treatment strategy.

270. The non-mandatory drug testing of prisoners on admission to prison is in direct contrast to the new powers of drug testing in police custody. Under the Criminal Justice and Court Services Act 2000, the police have the power to drug test detainees aged 18 or over who have been charged with a 'trigger offence' (these include theft, burglary, robbery, and possession and supply of Class A drugs).[214] Drug testing on charge was extended with effect from 1 August 2004 to include young persons from the ages of 14 to 17 inclusive in ten pilot sites. In addition, courts have power under the Act to order a pre-sentence drug test if a defendant over the age of 18 has been convicted of any offence and the court is considering passing a community sentence.[215]

271. We recommend that every prisoner should receive health care screening, including mandatory drug testing, on admission to prison, as part of their needs assessment. Whilst we are aware of the arguments against such a potentially invasive mandatory drug testing requirement,[216] we consider such a step justified in light of the current statistical evidence of the high levels of drug misuse by very many entering the prison system. It does not seem to us unreasonable that there should be a power to drug-test those who have been convicted and sentenced equivalent to the existing power to drug-test those who are arrested. We recommend that this provision should be introduced by way of Government amendment to the Drugs Bill expected to be introduced in the present Session of Parliament.

272. Mandatory drug testing on admission will benefit prisoners by facilitating more accurate assessments of the types of treatment required, thereby ensuring the most appropriate package of rehabilitative interventions for individual prisoners. In addition, mandatory testing will generate data which can be used to inform the development of a more targeted prison drug treatment strategy, and which will allow comparisons to be made with the results of compulsory drug testing on arrest.

273. Random mandatory drug testing of prisoners is conducted on a daily basis across the prison estate. Random drug testing indicates the availability of all classes of drugs within prisons. After five years of gradual reductions in the rate of recorded drug use, there was a very slight increase in 2002-03 to 11.7% from 11.6% in 2001-02. Research has suggested that the testing has not led to a significant overall reduction in drug use.[217] During the course of our prison visits, prisoners complained to us about the widespread availability of drugs and the consequent impact on morale for those trying to get off and stay off drugs. A Home Office Study found that 75% of prisoners interviewed had taken drugs whilst in prison, most commonly heroin (53%) and cannabis (55%).[218] We are aware that the Prison Service is attempting to address this ongoing problem. We encourage the Prison Service to continue to focus on reducing the numbers of drugs available in prison through strict security measures and continued use of random drug testing.

Drug treatment in prison

274. From our visits of various prison establishments, we discovered a wide variation in availability and approach to drug treatment for prisoners. The foundational drug treatment programme is the Counselling, Assessment, Referral, Advice and Throughcare (CARAT) Services. CARAT is a non-clinical, low-intensity drug misuse intervention service. Intensive Treatment Programmes are designed for prisoners with moderate to severe drug misuse problems but are less widely available. There are drug treatment and rehabilitation programmes in 60 of the 139 prisons across the prison estate, aimed at prisoners with moderate to severe drug misuse problems.

275. There are examples of particular good practice. For instance, during our visit to HMP Swaleside we learned about a RAPt (Rehabilitation for Addicted Prisoners Trust) Drug Treatment Programme, and met a group of adult male prisoners attending this. It is a 12-step programme based on total abstinence. Each course has around 10 places and runs approximately 16 weeks. The RAPt programme was the first drug treatment programme to gain national accreditation. There is evidence that the reconviction rates 2 years after release of those prisoners who successfully completed the RAPt course were significantly lower (40%) than rates for a similar group who did not participate in the programme.[219]

276. In 2003-04, 4,703 prisoners entered drug treatment programmes. The limited number of places on such programmes is a serious cause for concern. Access to the programmes is limited to those sentenced to two years or more because of the length of the treatment courses, which are a minimum of 12 weeks. The Prison Service does not keep records of prisoners with drug problems who actually receive treatment; however, according to a Home Office study, only 10% who had used drugs in the previous 12 months were receiving drug treatment. More than 40% of prisoners who had used drugs over that period wanted drug treatment but were not receiving any.[220] It is also a matter for concern that nearly half of the prisoners who enter drug treatment programmes do not complete them.[221]

277. The Home Office has acknowledged that it is currently resourced only to meet approximately 30% of the rehabilitation needs of drug misusing prisoners.[222] In its Updated Drugs Strategy 2002, the Government only committed itself to creating an additional 2,000 intensive treatment programme places in prisons, with low-intensity interventions being made available to short-term prisoners. We do not consider this an adequate response to the problem. In our view, the management of the delivery of drug treatment programmes constitutes a key element in the prison rehabilitation regime. We are critical of the limited number of places on prison drug treatment programmes and the restrictions on accessing those programmes. The provision of drug treatment services to only 10% of prisoners misusing drugs is inadequate when an estimated 80% of prisoners arriving in prison have serious drug or alcohol problems.

278. We recommend that the number of places available on intensive drug treatment programmes be substantially increased, and that resources invested in community drug treatment services should be made available to the prison population, with prisons being directly linked with local community drug treatment providers.

279. In addition, we recommend that short, intensive, drug treatment programmes be made available to short-term prisoners, who are currently excluded from any form of intensive drug treatment programmes. We welcome the Government's commitment to developing a short duration drug treatment programme for short-term prisoners as an action point in its National Action Plan.[223]

280. We recommend that the Government should make a public commitment to ensuring that the guaranteed quality of access to drug treatment for prisoners will never be less than that offered to offenders in the community.

Drug treatment in the community

281. The National Treatment Agency for Substance Misuse and the National Institute for Mental Health in England have developed a national programme to improve access to drug treatment for drug misusers in the community. In 2004, the pooled drug treatment budget allocated by the Government for the treatment of drug misusers was increased to £253 million. Nevertheless, whilst the total number of treatments has increased from 128,000 in 2001-02 to 140,900 in 2002-03, a significant gap between demand for and supply of drug treatment programmes remains, with an average waiting time of between 1.5 to 4 weeks for all types of drug treatment.[224]

282. The Criminal Justice Interventions Programme ("CJIP"), which was introduced in 2003 in 25 high crime areas with Drug Action Teams, aims to "develop and integrate measures for directing drug misusing offenders out of crime and into treatment"[225] and to co-ordinate the treatment of drug misusing offenders more effectively by increasing co-operation between criminal justice agencies and drug treatment agencies. The interventions available under the CJIP include Enhanced Arrest Referral of drug mis-using offenders into treatment by drug workers in custody suites, drug testing for cocaine and opiates for offenders with 'trigger' offences and community sentences with treatment conditions attached, such as Drug Treatment and Testing Orders (DTTOs).[226] It is still too early to assess the results of the CJIP initiative.

283. There remains a discernible disparity in provision of drug treatment programmes for ex-prisoners in the community. We have been informed of waiting lists for drug treatment for ex-prisoners of between 6 weeks and 6 months. In comparison, 70% of those offenders put on a Drug Treatment and Testing Order, a community sentence for offenders who misuse drugs, see a treatment provider within two days of the Order.[227] The National Treatment Agency for Substance Misuse acknowledges that "bridging the gap between prison and community has been challenging in a number of areas".[228]

284. The CJIP Enhanced Arrest Referral provides direct and immediate access to drug treatment services in direct contrast to the long waiting period imposed on the majority of ex-prisoners. One of most vulnerable times for a discharged prisoner who has had a drug problem is the first few days after he or she has been released. It is vital that there is a seamless transition in drug treatment provision.

285. We recognise the significant investment that the Government is making in drug treatment services. However, care must be taken not to focus on the availability of treatment to those entering the Criminal Justice System at the expense of those with drug problems already in the prison system. As a first step, targets for access to services for new offenders and for existing prisoners should be aligned. The longer-term objective should be to move towards continuity of care for released prisoners, which is critical to avoid wasted investment.

286. We recommend that the Government work in partnership with community providers to put in place a tracking system to monitor prisoners' access to community drug treatment and report to Parliament on the progress made in levelling out access to and provision of drug treatment as part of its Reducing Re-offending National Action Plan.

Alcohol misuse

287. Alcohol misuse and addition is widespread amongst prisoners. HM Chief Inspector of Prisons, Anne Owers, stated that there is "no specific funding, and no overall strategy, for programmes to manage alcohol consumption". She commented that in one young offender institution she visited, 42% of the young people expected to have an alcohol problem on release.[229] The Committee is critical of the failure to date to develop any overall strategy for dealing with prisoner alcohol misuse or addiction as an important element in its prison rehabilitation strategy, particularly in light of the alarming upward trend in alcohol-related crime. We welcome the Government's commitment in its National Action Plan to introduce alcohol strategies for approval by March 2005.[230] These strategies will comprise the twin elements of treatment interventions and alcohol testing. We urge the Government not to let the timetable on the introduction of these strategies slip. There needs to be rapid progress in setting up mechanisms to implement the national strategies at the regional and local level.

211 Interview with the Director General of the Prison Service, Mr Phil Wheatley, Independent, 1 December 2003 Back

212 According to the Social Exclusion Unit Report (2002), prison officers at HMP Manchester have estimated that 70% of prisoners come into the jail with a drugs misuse problem but that 80% of these have never had any contact with drug treatment services. Back

213 Evaluation of drug testing in the criminal justice system in nine pilot areas, Home Office Research findings 180 (2003) Back

214 Criminal Justice and Court Services Act 2000, section 57. An officer of the rank of Inspector or above can authorise a test of an individual charged with a non-trigger offences if there are reasonable grounds for suspecting that the misuse of heroin and/or cocaine contributed to the offence. Back

215 Criminal Justice and Court Services Act 2000, s 48 Back

216 Such as prisoners' rights to privacy under ECHR Article 8. Back

217 Prison Service, Annual Report and Accounts 2002-03 (2003) Back

218 Mandatory drug testing in prisons, RDS Study 189, Home Office (1998) Back

219 Ev 137 (para 3.1.14) Back

220 Prisoners' drug use and treatment: seven studies, Home Office Research Finding 186 (2003) Back

221 HC Deb, 15 November 2004, col 1126W. Out of the 4.703 prisoners who entered programmes in 2003-04, there were 2,418 completions. Back

222 HC Deb, 12 February 2003 Back