Drug Treatment Matrix cell E5: Treatment systems; Safeguarding the community

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Treatment systems; Safeguarding the community

Seminal and key studies on how local treatment systems can protect the community. The task is to meld enforcement pressure and surveillance focused on crime with the patient-centred ethos of treatment. Asks whether coercion and/or collaboration with enforcement undermine treatment’s community protection impacts, and whether to maximally reduce crime, treatment systems should focus on coercion or on voluntary engagement.

S Seminal studiesK Key studiesR ReviewsG Guidancemore Search for more studies

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S Proactive arrest referral works best ([UK] Home Office, 1999). Treatment entry and consequent crime reduction promoted by proactively engaging arrestees or offenders in cells and courts.

S G Watershed moment for the place of child protection in substance use treatment systems ([UK] Advisory Council on the Misuse of Drugs, 2003). Results of an inquiry in to children in the UK seriously affected by the drug use of parents or guardians. Though published in 2003, this report from the UK government’s drug policy advisers deserves the accolade of “seminal”. After its publication, no commissioner or system planner could justifiably claim ignorance of the need to prioritise the child while treating their parents’ substance use problems. Includes (starting p. 71) guidance on how drug and alcohol treatment and other services can act together in the best interests of the children. Update published in 2006 documents (from p. 44) the degree to which such systems had been established.

S California’s experience with compulsory treatment (1977). Lessons of contemporary relevance from the California Civil Addict Program on how to integrate criminal justice procedures with voluntary and coerced treatment.

K Retention maximises treatment’s crime-reduction impact ([UK] National Treatment Agency for Substance Misuse, 2012). Treatment systems which retain patients maximally protect society from crime as assessed by reconvictions.

K Characteristics of successful systems to divert from prison to treatments (2011; free source). Interviews with stakeholders in Californian localities with the most successful systems identified four clusters of success factors: fostering offender engagement, monitoring their progress, and sustaining their cooperation; cultivating buy-in among key stakeholders; capitalising on the prestige, influence and power of the court and the judge; and creating a setting which promotes high-quality treatment, use of existing resources, and broad financial and political support.

K Lessons of coordinating prison-to-community support in Scotland (2017). Continuity of care (‘throughcare’) on leaving prison is the key to avoiding relapse to dependent substance use. In Scotland orchestrating this was devolved to prison officers trained as throughcare support officers. They improved linkage of prisoners to services and there was some evidence that the process led to remission in problem substance use. The officers’ experience of working mostly outside prison meant that an appreciation of the obstacles to reintegration was imported into prison. Another throughcare structure in Scotland was the public social partnership at Low Moss prison, a collaboration between the prison, community justice and the third-sector, which was associated with fewer prisoners being re-imprisoned than would be expected (1 2).

K System changes double post-release aftercare completion (2009). Promoting aftercare following release from a prison therapeutic community entailed improvements in offender involvement in pre-release planning, the aftercare funding system, staffing, cross-system training, and community support structures. See related guidance (Public Health England, 2018) for England.

K Promoting continuity of opioid use treatment after prison (2018). From the USA, a rare randomised trial found in favour of continuing methadone maintenance when patients entered prison rather than compulsory withdrawal. The potential benefits were most apparent in the near-100% continuation of protective treatment during the highly overdose-prone weeks after leaving prison, likely to have helped (2018) prevent overdose deaths. See related guidance (Public Health England, 2018) for England and related review below.

K Systemic barriers to employing problem drug users ([UK] Department for Work and Pensions, 2010). Interviews with drug service clients in Britain and with staff working in or with treatment agencies highlighted the need for greater integration between treatment services, the social security system, employment services and employers.

K Lessons from Welsh pilot of integrated support for children affected by substance use in the family (Welsh Government, 2014). Evaluation of the first three local schemes in a nationwide rollout of services based on the Option 2 (2012) crisis intervention service for families of parents with drug or alcohol problems. Documents how the schemes changed in response to experience and strategic and operational contexts.

R The more voluntary the treatment the greater the crime reductions (2008). Synthesis of 129 studies of offender treatment for problems including substance use finds treatment’s crime-reducing impact increased to the degree to which the offender was free to choose treatment. Implication is that treatment systems should make it easy and attractive for problem drug users to enter treatment without legal coercion. For discussion click and scroll down to highlighted heading.

R Expert guidance on treatment and criminal justice integration (2003). Evidence-based thoughts of eminent researcher on therapeutic criminal justice interventions for problem drug use. Argues for blending treatment and criminal justice sanctions/supervision in the offender’s own community (“enabling clients to maintain family and social contacts and seek or continue in gainful education or employment”), offers guidance on matching interventions to the offender, and identifies characteristics of successful programmes. See also this academic (2002) and fully referenced version. For discussion click and scroll down to highlighted heading.

R Melding disparate objectives and cultures is key to criminal justice treatment (Australian Government, 2005). Realistically acknowledges (section headed “Providing AOD treatment within the context of the criminal justice system”) that criminal justice and treatment have different objectives and philosophies and don’t naturally see eye to eye, but argues that education and training can underpin collaboration to achieve shared goals. For discussion click and scroll down to highlighted heading.

R Plan for continuity of care to make most of opioid maintenance in prison (2012). Continuity of treatment from before to during and after prison is the key to gaining benefits similar to those in seen in community settings. See related guidance (Public Health England, 2018) for England and related study above.

G Commission for recovery in the community and in prisons ([UK] National Treatment Agency for Substance Misuse, 2010). Calls for commissioners to replicate “as appropriate” within prisons a balanced, recovery-focused treatment system with access to community-based and residential treatment, and ongoing mutual aid support.

G Reducing drug-related crime and rehabilitating offenders (2010). In the absence of more resources, government-supported expert group recommends commissioning and coordination measures to improve outcomes from drug treatment and interventions for prisoners in England.

G Clinical governance in drug treatment ([UK] National Treatment Agency for Substance Misuse, 2009). Guidance for providers and commissioners on systems to deliver and demonstrate that the quality and safety of services are of a high standard and continually improving; includes prison- and community-based criminal justice interventions.

G Protocol for joint working between drug/alcohol services and children/family services ([UK] National Treatment Agency for Substance Misuse, 2011). Intended to help local areas develop agreements to strengthen the relationship between these services to safeguard the children of substance using parents. Includes identification of at-risk children, assessment and referral, sharing information, and staff competencies and training. For discussion click and scroll down to highlighted heading.

G ‘Whole-family’ recovery advocated in Scotland (Scottish Government, 2013). Guidance specific to substance use intended for all child and adult services, including drug and alcohol services. What new patients should be asked about children and the role these services should play in a system which (“Getting our Priorities Right” is the document’s title) prioritises child welfare. For discussion click and scroll down to highlighted heading.

G Working together to prevent domestic violence and abuse ([UK] National Institute for Health and Care Excellence, 2016). Planning and delivering multi-agency services for domestic violence and abuse. Includes but not specific to substance use.

G Implementing support systems to prevent domestic violence and abuse related to substance use (2017). From Adfam, the national UK charity specialising in drugs and the family, good-practice guidance on how commissioners and service managers can meet the needs of adults in families affected by substance use. Brings together Adfam’s 30+ years of experience in family support.

more Retrieve all relevant Effectiveness Bank analyses or search more specifically at the subject search page. See also hot topics on protecting children and on whether testing for and sanctioning substance use can displace treatment.

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