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Substance Abuse Treatment Prevention and Policy in Correctional Services Dr. Myo Kyaw Oo Consultant Psychiatrist Department of Corrections Jamaica.

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Presentation on theme: "Substance Abuse Treatment Prevention and Policy in Correctional Services Dr. Myo Kyaw Oo Consultant Psychiatrist Department of Corrections Jamaica."— Presentation transcript:

1 Substance Abuse Treatment Prevention and Policy in Correctional Services Dr. Myo Kyaw Oo Consultant Psychiatrist Department of Corrections Jamaica

2 Substance Abuse Treatment & Rehabilitation must be the Priority National Agenda

3 Treatment Models Many treatment modalities exist, based on wide range of factors within the context of a country Many treatment modalities exist, based on wide range of factors within the context of a country Modalities are designed based on common problem of addiction and major economic, cultural, religious and political dimensions. Modalities are designed based on common problem of addiction and major economic, cultural, religious and political dimensions. Resources available in countries vary widely Resources available in countries vary widely Important to remember hidden cost and significant burden ( health care costs, productivity loss, criminal justice costs..) Important to remember hidden cost and significant burden ( health care costs, productivity loss, criminal justice costs..)

4 Goal of Treatment Ultimate goal is..to achieve “A Substance Free Quality life” Ultimate goal is..to achieve “A Substance Free Quality life”

5 Programmatic Goals Fiscal and political realities Fiscal and political realities Appropriate use of resources Appropriate use of resources Philosophy of the program clearly defined Philosophy of the program clearly defined No single approach is effective for everyone No single approach is effective for everyone Evaluation & Research Evaluation & Research

6 Objectives to provide a substance free quality life -harm reduction and motivation for abstinence -bio-psycho-social level of functioning -marital and family issues -job and financial management -spiritual issues -relapse prevention

7 Approach to Drug Problem Supply reduction Supply reduction Demand reduction Demand reduction There should be a BALANCE between the two principles

8 Supply Reduction How to reduce supply reduction ? How to reduce supply reduction ? Cultivation, Manufacturing, Eradication Cultivation, Manufacturing, Eradication Trafficking & Export Trafficking & Export Eradication Eradication Precursors control Precursors control Money laundering and legislation Money laundering and legislation

9 Prevention No drugs …No abusers No drugs …No abusers No precursors…No manufacturing process No precursors…No manufacturing process How are you going to make prisons safe? How are you going to make prisons safe? How do inmates receive their supply? How do inmates receive their supply? Zero Tolerance Policy? Zero Tolerance Policy?

10 Demand Reduction Educational Approach, school education, public education, sport & culture Educational Approach, school education, public education, sport & culture Health & medical Measure, treatment and rehabilitation programs Health & medical Measure, treatment and rehabilitation programs Community involvement Community involvement Economic empowerment Economic empowerment Regional & International Cooperations Caribbean & OAS Regional & International Cooperations Caribbean & OAS

11 Causes of Drug Addiction Moral/Spiritual Moral/Spiritual Biological Biological Psychodynamic Psychodynamic Behavioural Behavioural Socio-cultural Socio-cultural Individual-drug-environment Individual-drug-environment INTEGRATIVE INTEGRATIVE

12 Integrative No single cause No single cause Interaction of range of causes Interaction of range of causes Bio-Psycho-Social Bio-Psycho-Social Bio-Psycho-Socio-Cultural Bio-Psycho-Socio-Cultural

13 Bio-Psycho-Socio-Cultural No single cause No single cause Interaction of the causes Interaction of the causes

14 General outline of demand reduction Treatment & Rehabilitation Treatment & Rehabilitation Prevention & follow-up Prevention & follow-up

15 Models of Treatment facilities Residential based Residential based Hospital or centres Hospital or centres Short, medium, long term Short, medium, long term Outpatient based Drug Court Treatment Prison based

16 Treatment Approaches Individual therapy Individual therapy Group therapy Group therapy Family therapy Family therapy Special program ( juvenile, Drug court, prison based, combined HIV,STI, TB, therapeutic communities, cultural) Special program ( juvenile, Drug court, prison based, combined HIV,STI, TB, therapeutic communities, cultural)

17 Treatment Process Crisis Management (overdose, withdrawal, medical & psychiatric emergencies) Crisis Management (overdose, withdrawal, medical & psychiatric emergencies) Assessment & Detoxification Assessment & Detoxification Rehabilitation with or without Skilled training Rehabilitation with or without Skilled training Relapse prevention & follow-up Relapse prevention & follow-up Special services Special services

18 Networking & Supportive Services AA, NA AA, NA FBO, NGO, PSO FBO, NGO, PSO EAP EAP Government Ministries Government Ministries Family support groups Family support groups

19 Important thing to remember Drug abuse recovery is a process, not an event Drug abuse recovery is a process, not an event Treatment modalities must be designed based on multidimensional approach to meet the individual needs Treatment modalities must be designed based on multidimensional approach to meet the individual needs Success is measured not on absolute figures of statistical value but quality of life change of individual Success is measured not on absolute figures of statistical value but quality of life change of individual Constitutional rights of individual must be protected at all times Constitutional rights of individual must be protected at all times

20 Changing Model of Care Recovery is not an event but the process Recovery is not an event but the process Incarceration by itself does little to break the cycle of illegal drug use and crime Incarceration by itself does little to break the cycle of illegal drug use and crime Offenders sentenced to Incarceration exhibit high rate of RECIDIVISM once they are released Offenders sentenced to Incarceration exhibit high rate of RECIDIVISM once they are released

21 HARM REDUCTION Widely accepted Model of Care

22 What is Harm Reduction? Physical – death, illness, addiction, HIV, Hepatitis, Injuries related to accidents and violence Physical – death, illness, addiction, HIV, Hepatitis, Injuries related to accidents and violence Psychological – fear of crime/violence and effect on family Psychological – fear of crime/violence and effect on family Social – breakdown of social system Social – breakdown of social system Economic – drug trade, productivity loss, workplace accidents Economic – drug trade, productivity loss, workplace accidents

23 Drug Abuse Prevalence in prisons Drug Abuse in prison is very common Drug Abuse in prison is very common Estimated 22% - 86% Estimated 22% - 86% Most frequently used illicit drug “ Cannabis” 8% - 60% Most frequently used illicit drug “ Cannabis” 8% - 60% British Study 60% heroin user reported use in prison, more than 25% initiated use in prison British Study 60% heroin user reported use in prison, more than 25% initiated use in prison

24 Factors associated with substance abuse in prison Age, Ethnicity, Conduct disorder, abuses, school difficulties Age, Ethnicity, Conduct disorder, abuses, school difficulties Psychiatric disorders Psychiatric disorders Antisocial personality Antisocial personality Support system Support system Length of sentence Length of sentence

25 Drug Abuse Survey in Jamaican Prisons 2005

26 Methodology 4 maximum security prisons 4 maximum security prisons Sampling Frame of 3434 inmates Sampling Frame of 3434 inmates Stratified sampling method used Stratified sampling method used Estimated prevalence rate 45% ± 5% Estimated prevalence rate 45% ± 5% A total of 440 inmates A total of 440 inmates 42 items, 4 sections Questionnaire used 42 items, 4 sections Questionnaire used

27 Results - Age A Total of 440 inmates A Total of 440 inmates Male 82% (360), Female 18% (80) Male 82% (360), Female 18% (80) Age range – 18 to 73 years Age range – 18 to 73 years Majority 53% (Age range 23-34) Majority 53% (Age range 23-34)

28 Results – Age group by Gender Age group MaleFemaleTotal 17-22258 33 (8%) 23-289921 120 (27%) 29-349815 113 (26%) 35-407112 83 (19%) 83 (19%) 41-463512 47 (11%) 47 (11%) 47-52209 29 (6%) 53 & over 123 15 (3%)

29 Results – Education by gender LevelMaleFemaleTotal Primary22425 249 (57%) Secondary12837 165 (38%) Tertiary818 26 (5%) 26 (5%)

30 Results – Literacy level LevelMaleFemaleTotal Excellent5740 97 (22%) Good8924 113 (25%) Can help self 1209 129 (29%) Just a little 666 72 (16%) Can not read/write 281 29 (8%)

31 Knowledge Ganja is a drug72% Ganja is a drug72% Ganja smoking is harmful61% Ganja smoking is harmful61% Alcohol, tobacco & beady are drugs78% Alcohol, tobacco & beady are drugs78% Ganja improves sexual performance33% Ganja improves sexual performance33% Alcohol improves sexual performance38% Alcohol improves sexual performance38% Addiction is drug dependency85% Addiction is drug dependency85% A link between drug abuse & STI73% A link between drug abuse & STI73%

32 Prevalence PrevalenceNoYes Drug abuse before incarceration 163 273 ( 62% ) Drug abuse during incarceration 233 201 ( 46% )

33 Prevalence Drug abuse before incarcerated62% Drug abuse before incarcerated62% Drug abuse during incarceration 46% Drug abuse during incarceration 46%

34 Type of Substances abused (N=305) TypeNumber Ganja 172 (39%) Tobacco 98 (22%) Alcohol 21 (5%) Crack 6 (1%) Valium 5 (1%) Inhalant 3 (0.7%) 3 (0.7%)

35 Pattern of Abuse TypeDailyWeeklyOccasionally Ganja 98 (22%) 13 62 (14%) Tobacco 75 (17%) 7 42 (10%) Alcohol 9 (2%) 1 32 (7%) Valium 6 (1%) 0 6 (1%) 6 (1%) Crack 4 (0.9%) 4 (0.9%)0 3 (0.7%) 3 (0.7%) Inhalants 1 (0.2%) 1 (0.2%)0 2 (0.5%) 2 (0.5%)

36 Factors affecting frequency FactorsStatistics Money 122 (28%) Availability 63 (14%) 63 (14%) Afraid of Disciplinary action 11 (3%) Afraid of being seen 6 (1%) 6 (1%)

37 Reason for Drug use To feel more relaxed11927% To feel more relaxed11927% To meditate9923% To meditate9923% To cope with prison8419% To cope with prison8419% To sleep6515% To sleep6515% Curiosity4611% Curiosity4611% Lonely368% Lonely368% Peer pressure266% Peer pressure266% Addiction225% Addiction225% Religion82% Religion82%

38 Source of supply in prison Fellow inmates189 43% Fellow inmates189 43% Correctional officers 13 3% Correctional officers 13 3% Over prison wall/fence 8 2% Over prison wall/fence 8 2% Family/friends 5 1% Family/friends 5 1%

39 Motivation for change Want to stop drug abuse150 34% Want to stop drug abuse150 34% Request assistance to stop113 26% Request assistance to stop113 26% Interest to participate in program 348 79% Interest to participate in program 348 79%

40 Best group to sensitize drug abuse program GroupStatistics Recovering addicts 233 (53%) Church 108 (25%) Family 34 (8%) Fellow inmate 29 (7%) Others 22 (5%) Correctional officers 14 (2%)

41 Summary Prevalence of drug abuse46% Prevalence of drug abuse46% Ganja is most commonly abused39% Ganja is most commonly abused39% 34% of inmates are motivated to quit and 26% requested assistance. 34% of inmates are motivated to quit and 26% requested assistance. 79% showed interest to participate in the drug abuse program in prison. 79% showed interest to participate in the drug abuse program in prison.

42 Implementation of Substance Abuse Treatment & Prevention in Prisons is well justified

43 Models of Treatment facilities Residential based Residential based Hospital or centres Hospital or centres Short, medium, long term Short, medium, long term Outpatient based Drug Court Treatment Prison based

44 Principle of Therapeutic Jurisprudence Prof. Bruce Winnick Prof. David Wexler

45 Application of TJ Offenders with underlying drug abuse problems Offenders with underlying drug abuse problems Incarceration alone does not help or reduce recidivism Incarceration alone does not help or reduce recidivism Therapeutic principle is applied in Judicial process Therapeutic principle is applied in Judicial process Diversion Programme Diversion Programme Prison Based Programme Prison Based Programme Parallel Model Parallel Model

46 Diversion Programme Drug Court Treatment & Rehabilitation Drug Court Treatment & Rehabilitation May 2001 Kingston, July 2001 Montego Bay May 2001 Kingston, July 2001 Montego Bay Drug Court Act 1999 Drug Court Act 1999 Offenders with Minor Offences who meet eligible criteria Offenders with Minor Offences who meet eligible criteria Bail offered Bail offered Six months outpatient programme under court supervision and weekly urine testing Six months outpatient programme under court supervision and weekly urine testing

47 Jamaica Drug Court May 2001 – March 2009 Treatment Center Total referred by Court Admission Drop out Graduated Kingston2951499950 Montego Bay 284262153109 579411252159

48 Jamaica Drug Court May 2001 – March 2009 Eligibility71% Drop Out 61% Graduation39% Monthly saving on one graduate J$ 58,333.33 Total saving on graduates J$ 9,274,978.80

49 What about those ineligible Offenders?

50 Prison Based Programme Prison based Program Prison based Program ? Legislation ? Legislation Political will Political will Budget commitment Budget commitment Outpatient Drug Court Legislation Court supervision Probation period after graduation Criminal offence not recorded

51 Jamaica DCS Pilot Project Situational Analysis Situational Analysis Training Training Project Design and Implementation Project Design and Implementation Evaluation Evaluation

52 Things to remember Two pillars approach supply and demand reduction Two pillars approach supply and demand reduction Integrative model of causes Integrative model of causes Recovery is a process, not an event Recovery is a process, not an event Harm Reduction model Harm Reduction model Therapeutic Jurisprudence principles in judicial process Therapeutic Jurisprudence principles in judicial process Legislation to assist rehabilitation Legislation to assist rehabilitation

53 Things to remember Interagency Cooperation & Coordination Interagency Cooperation & Coordination Regional & International Cooperation Regional & International Cooperation Research and Publication Research and Publication

54 Insanity is doing the same thing over and over and expecting different results Punitive Model without Rehabilitation does not solve underlying issues Try innovative methods and programs

55 Thank You Dr. Myo Kyaw Oo MBBS,DPM, DM Psych. Acting Senior Medical Officer Bellevue Hospital June 10, 2009


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