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Conspicuous by their abstinence: the limited engagement of heroin users in English and Welsh Drug Recovery Wings

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Publication details

JournalInternational Journal of Drug Policy
DateE-pub ahead of print - 23 Dec 2015
DatePublished (current) - Mar 2016
Volume29
Number of pages8
Pages (from-to)49-56
Early online date23/12/15
Original languageEnglish

Abstract

Background
In recent years, an abstinence-focused, ‘recovery’ agenda has emerged in UK drug policy, largely in response to the perception that many opioid users had been ‘parked indefinitely’ on Opioid Substitution Therapy (OST). The introduction of ten pilot ‘Drug Recovery Wings’ (DRWs) in 2011 represents the application of this recovery agenda to prisons. This paper describes the DRWs’ operational models, the place of opiate dependent prisoners within them, and the challenges of delivering ‘recovery’ in prison.

Methods
In 2013, the implementation and operational models of all ten pilot DRWs were rapidly assessed. Up to three days were spent in each DRW, undertaking semi-structured interviews with a sample of 94 DRW staff and 102 DRW residents. Interviews were fully transcribed, and coded using grounded theory. Findings from the nine adult prisons are presented here.

Results
Four types of DRW were identified, distinguished by their size and selection criteria. Strikingly, no mid- or large-sized units regularly supported OST recipients through detoxification. Type A were large units whose residents were mostly on OST with long criminal records and few social or personal resources. Detoxification was rare, and medication reduction slow. Type B's mid-sized DRW was developed as a psychosocial support service for OST clients seeking detoxification. However, staff struggled to find such prisoners, and detoxification again proved rare. Type C DRWs focused on abstinence from all drugs, including OST. Though OST clients were not intentionally excluded, very few applied to these wings. Only Type D DRWs, offering intensive treatment on very small wings, regularly recruited OST recipients into abstinence-focused interventions.

Conclusion
Prison units wishing to support OST recipients in making greater progress towards abstinence may need to be small, intensive and take a stepped approach based on preparatory motivational work and extensive preparation for release. However, concerns about post-release deaths will remain.

Bibliographical note

© 2016 Elsevier B.V.This is an author produced version of a paper accepted for publication in International Journal of Drug Policy. Uploaded in accordance with the publisher's self-archiving policy.

    Research areas

  • Heroin Dependence, PRISONERS, drug recovery, Engagement

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