Prison population: substance use and wider support needs

Executive Summary

The last prison health needs assessment in Scotland was conducted in 2007 and a great deal has changed in the policy and service delivery landscape since then. This needs assessment is one of four prison population-focused commissioned studies. It explores the needs relating to alcohol, drugs, and tobacco use.

Substance use has long been a concern for the health and wellbeing of people living in Scotland's prisons, and the wider criminal justice system and remains a prominent challenge. Research indicates that individuals in prisons are more likely to have a substance use problem than to not have one. Treatment and support services for those who experience problems with substances whilst living in prison should be provided consistently across all prisons and on an equivalent basis to community-based services. Further there should be continuity of care both from the community into prison, following liberation, as well as between transfer from one prison to another.

Policy and political landscape

Substance use in prisons cannot and should not be divorced from the wider political and community landscapes. The complexity of these wider landscapes has often led Scottish prisons to become an isolated or peripheral partner in the development and delivery of substance use responses. Involvement in partnerships (such as Alcohol and Drug Partnerships, Community Planning Partnerships and Community Justice Partnerships) needs to be more consistent and purposeful rather than piecemeal, as it often is currently.

Existing evidence and data

There is a lack of existing, up-to-date literature on the extent and nature of substance use in Scottish prisons. There are also significant deficiencies and variations in existing substance use and related health data collection, analysis, sharing, and storage leading to significant difficulties in mapping across Scotland's prisons. Consequently, there is no universal or meaningful body of data to give an accurate quantitative overview. Only with a more accurate and consistent gathering of substance use and associated health data will the quantitative data produced by prisons and other partners be valid and of potential use.

Qualitative perspectives

In relation to the use of substances and support provided for those who experience problems with substance use, we heard a number of key messages that resonated across all those interviewed (whether from those with lived experience of from professionals).

Substance use

Our report takes cognisance of tobacco use and support within Scottish prisons. However, we have deferred to the extensive and recent evidence contained in the Tobacco in Prisons Study (2022), that maps out the successful management of tobacco-free prisons across the country.

Whilst it is clear that there are instances of alcohol use within prison, along with specific support needs for withdrawal (detoxification) upon entry into prison, the unaddressed primary alcohol need is for psychological support in preparation for returning to the community, where alcohol is readily available.

Since the last needs assessment it is evident that the nature of drug use within Scottish prisons has changed dramatically. Where previously this would have been heroin orientated, it is currently dominated by a combination of Novel Psychoactive Substances, Cannabinoids and 'Street Benzos' (most commonly Etizolam). For most individuals, illegal and illicit drugs continue to be readily available. Consumption choices are directed by what drugs are available rather than by what people might use outside of prison. Drug use and supply remain intrinsic to living in prison, both in terms of how some people choose to cope with living in prison and their role status within the prisoner community. Substance use in prisons is connected to psychological dependency and emotional regulation that some people use to cope with pre-existing trauma(s) and the additional trauma of entering and adjusting to living in prison.

Support for substance use

There are a number of consequences of this situation. This often begins with a lack of treatment and support continuity leading up to prison entry (both in terms of community support and support whilst in police custody) and is often immediately followed by the need for improving comprehensive substance use related health assessments for all at prison reception. It also includes complex issues of prescribing (availability, choice, continuity, equitability, and timeous) throughout an individual's time living in prison, and particularly during preparation for release and reintegration back into community services. We heard a clear message that focussing someone's treatment or support solely on their substance use was the wrong starting place, meaning that critical support needs (such as housing, mental and physical health, harm reduction, and recovery) are all too often insufficiently addressed.

Conclusions and recommendations

Given the systemic complexities and challenges of partnership working that our review has highlighted, we have chosen to present our recommendations in two distinct groupings: (1) a small set of four high-level key recommendations (which are explicit in terms of the action required by the named organisations within the recommendations), and followed by (2) a larger set of twenty-two outcome-based recommendations, grouped around a series of themes reflecting the findings of the needs assessment. These recommendations describe a 'preferred future' which will only be achieved by all relevant stakeholders and partners working together in close collaboration. Our recommendation is that there should be coherent, national oversight and governance of progress towards achieving all of the outcome-based recommendations contained within our report.