Use Incentives to Stop Inmates' Substance Abuse

Article excerpt

CORONADO, CALIF. -- Treatment and continuing care are two key components to a chronic care approach to effective recovery for patients with a substance abuse problem.

But in a correctional setting, that basic model faces several challenges and is sometimes impossible to employ, Dr. Jack Kuo said at the annual meeting of the American Academy of Addiction Psychiatry.

Frequent lockdowns, lack of communication between mental health and substance abuse staff, and access to drugs by inmates are just a few obstacles he faces as a staff psychiatrist for the California Department of Corrections and Rehabilitation.

"Many people think that prisoners with substance abuse problems are abstinent because they are in prison," he said. "Unfortunately, that's not always the case. They have access through various types of smugglings, sometimes through visitors to the inmates, sometimes through guards, sometimes through medical personnel. You do have a number of illegal drugs that make their way into the system."

Abuse of prescription medications is common, he said, and inmates "will manufacture complaints to get their hands on these products." A popular drug of abuse is Wellbutrin, "which a lot of them will crush and snort as a cheap stimulant. A lot of them will also use Seroquel or other types of sedating medications."

Interventions that have been demonstrated in research studies to be effective for drug-abusing offenders include residential substance abuse treatment, cognitive-behavioral therapy, contingency management, and medications. However, treatment must last an average of 90 days to produce stable behavior change, Dr. Kuo said. That's difficult to achieve in a state prison system like California's, where lockdowns because of infighting or gang violence shut down prison yards for months at a time and medications such as methadone, naltrexone, and buprenorphine cannot be used.

In addition, some correctional officers may frown upon efforts to rehabilitate inmates with a history of substance abuse. …