the effect of the prison environment upon inmate drug taking behaviour

The Effect of the Prison Environment upon Inmate Drug

Taking Behaviour

RACHEL SWANN and PAM JAMESRachel Swann is Therapeutic Care Worker, Department of Psychological

Medicine, Great Ormond Street Hospital, LondonPam James is Director, School of Human Sciences, Liverpool

John Moores University

Abstract: The aim of the present study was to examine, from an inmate perspective, their use ofdrugs and the perceived effect of the prison environment upon their drug using behaviour.Design of the study was an analytic survey, presented to the respondents as an anonymous, self-administered questionnaire. The results suggest that the prison environment is not a supportiveenvironment for those individuals that wish to abstain from drug use and indeed for mostrespondents, actually encouraged drug use.

Illicit drug use within the prison system continues to remain an area ofconcern. It is now generally accepted that illicit drug use in prison is consid-erably more prevalent than official figures have in the past suggested andthat the number of inmates with a drug problem is significant and increas-ing. Accompanying this is a wide recognition that the Prison Service carriesa responsibility for making the most of the opportunity that imprisonmentpresents. The importance of meeting this responsibility has been sharpenedby the advent of HIV and AIDS.

A review of the studies (Maden, Swinton and Gunn 1991, 1992; Carvelland Hart 1990; Kennedy, Nair, Elliot and Ditton 1990, 1991; Turnball,Dolan and Stimson 1991; Dye and Isaacs 1991; McKee and Power 1992;Shewan, Gemmell and Davies 1993; Inner London Probation Service 1990)suggests that a large number of the prison population are using drugsbefore imprisonment. Most of these continue to do so during theirsentences in a range of establishments – long-term, short-term and remand.A wide range of drugs are being used, although the quantity of drugs andfrequency of use is not ascertained. The popularity of the drugs used alsovaries between establishments.

Drug use undoubtedly has an impact on the prison system. Equally, theprison system has an enormous potential for impact upon drug use. It iscrucial, therefore, that some understanding is gained of the relationshipbetween the prison environment and drug using behaviour.

The design and operation of the prison environment often entails a loss

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The Howard Journal Vol 37 No 3. Aug 98ISSN 0265–5527, pp. 252–265

Blackwell Publishers Ltd. 1998, 108 Cowley Road, Oxford OX4 1JF, UKand 350 Main Street, Malden, MA 02148, USA

of privacy, high spatial and social density, isolation from more normal every-day environments, overcontrol of individual behaviour through institutionalroutines, confinement to an environment that serves as a work, a residentialand recreational setting all in one, and low levels of stimulation that lead toboredom (Bell, Fisher and Loomis 1978).

Confining environments such as these have been shown to lead tomaladaptive behaviours (Bell, Fisher and Loomis 1978). This is not to saythat people cannot adapt successfully to such places, but that a high numberof people will have difficulties and will display symptoms of maladaption inthese settings. If drug use is perceived as a maladaptive behaviour when usedas a response to the impact of imprisonment; as a means of escaping thereality of the situation in which the offender finds him/herself, it is quitepossible that the prison environment, although indirectly, encourages drugmisuse.

Drug users in prison are, in the main, forced to conceal their habit and,at the time of the study, any formal treatment that did exist was likely toserve only a minority of the drug using prison population. A considerablebody of data exists however, on the ability to change one’s behaviour with-out the assistance of formal treatment. This is often described as ‘sponta-neous’ remission. Self-change does not appear however to be spontaneous,for a number of factors have been found to be related to the initiation ofchange (Saunders and Kershaw 1979; Tuckfeld 1981; Wille 1983). Thesefactors include: a personal illness or accident, hitting a personal ‘bottom’,some meaningful religious experience, employment, direct support fromfamily and friends, the drugs/alcohol related death or illness of anotherperson, the establishment of an important relationship or marriage andfinancial and/or legal problems related to substance use. Many of thesefactors will only be relevant to the drug misuser in the community, but it islikely that hitting a personal ‘bottom’ and financial and/or legal problemsas initiating factors will, or could, have an effect upon an individual’s abilityto initiate self-change during imprisonment. To this respect, the prison envi-ronment may well discourage continued drug misuse. However, successfulself-change is accompanied by other factors such as social support, alter-ations in one’s social and leisure activities, strategies for coping with stressand the generation of negative expectations of continued use and positiveexpectations concerning continued abstinence (Tuckfeld 1981). The abovefactors help maintain self-change. The degree to which these are present inthe prison environment is likely to vary between establishments.

Drug use is primarily a public health care issue. The primary function ofprisons cannot, however, be seen in terms of public health. Rather themain objectives of the prison system are secure custody, punishment andthe protection of society. The prison environment has the potential todiscourage continued drug use. However, the very nature of the environ-ment means that it may equally, although indirectly, encourage drugmisuse.

The purpose of the present study was to survey, from an inmate perspec-tive, their use of drugs and the perceived effect of the prison environmentupon their drug using behaviour.

253 Blackwell Publishers Ltd. 1998

Method

DesignThe illicit nature of the material meant that to ensure a good response, allthe information given would have to be guaranteed as anonymous andconfidential. A self-administered questionnaire was designed in an attemptto ensure a high response rate and a minimum of interviewer bias.

The data gathered would all be self-reported. No external sources, forexample, prison records, could be used to check the respondents’ answersbecause of the anonymity and confidentiality required. As self-report meth-ods have become more and more prominent in research on addictive behav-iours, there has been an increasing attention devoted to questions abouttheir usefulness and validity (Sobell and Sobell 1990; Baker and Brandon1990; Babor, Brown and Del Boca 1990; Maisto, McKay and Connors 1990).The findings would seem to indicate that self-report data pertaining toaddictive behaviour is inherently neither valid or invalid, but varies with themethodological sophistication of the data gatherer and the personal char-acteristics of the respondent. A variety of procedures to enhance the relia-bility and validity of the data, as suggested by the above authors, were usedin the present study.

In its final form, the design of the research remains at a level of func-tioning where it is necessary to assume that an event took place if someonesays that it did, and did not take place if they say that it did not.

The final questionnaire was constructed of both open and closed ques-tions and aimed to cover the following areas: drug use before and duringimprisonment (this included the drugs used, the method of drug adminis-tration and the frequency of drug use), the response of the prison to druguse and the effect and potential of the prison environment upon drug use.

Subjects

The aim of the study was to obtain a random sample of the general prisonpopulation at a prison in England. The sample did not intend to be repre-sentative of the general prison population in the United Kingdom. Inmatesat the sampled prison were all Category B prisoners and it is not apparentthat the drug use of such a population would be generally representative ofthe prison population as a whole.1

One-hundred-and-forty questionnaires were randomly distributedamong the general prison population, of which 85 (61%) were returned.Respondents were serving relatively long-term sentences, including elevenlifers, 26 sentenced to over ten years but not life and 41 sentenced to underten years. In comparison with the overall population at the sampled prison,at the time of research, the study was over-representative of those sentencedto over ten years but not life, under-representative of those sentenced tounder ten years, but representative of those serving life.

Of the respondents, 28.4% had been charged and sentenced under theMisuse of Drugs Act. A further 32.4% reported that their offence was drugrelated, for example, a robbery committed to support their drug habit, an


offence committed while under the influence of drugs. Only 39.2% said thattheir offence was not drug related.

All of the prisoners who participated in the study did so voluntarilyfollowing a full explanation of the aims and intent of the study.

ProcedureIn response to the work by Magura et al. (1987) who found more under-report-ing when interviews were done by a degreed professional compared to a para-professional who was a current or former drug treatment client, nine inmaterepresentatives were chosen to distribute and collect the questionnaire. It wasassumed that they would be less threatening than the researcher/author.Already identified by a Drug Awareness Group – a weekly event at the prison,these nine men had been selected and trained as drug counsellors. Their rolein the present study was to distribute the questionnaires, to qualify the intentand purpose of these and to encourage and collect the responses.

Results

The results were analysed statistically using SPSS (Statistical Package for theSocial Sciences). The use of chi-square analysis was limited as many of thecell counts were too small and it was impossible to combine many of the cellswithout losing the impact of the data and meaning of the table.

Table 1 illustrates the number of individuals that: were using/not usingdrugs both before and during imprisonment, that only started using drugsduring imprisonment or that stopped their drug use during imprisonment.

Tables 2 and 3 show the types of drug being used and the number ofrespondents using them both before and during imprisonment.

Of those using, the most frequently used drug before imprisonment wascannabis, followed by cocaine, alcohol, acid, amphetamines, ecstasy, heroin,tranquillisers, crack, barbiturates, methadone and solvents. The mostfrequently used drug during imprisonment was still cannabis, followed by,in contrast, ‘hooch’ – a home made alcoholic brew, heroin, tranquillisers,


TABLE 1The Connection Between Those Using Drugs Before and During Imprisonment

Used drugs before imprisonmentYes No

Used/using drugs duringimprisonmentYes 67.9% (57) 14.3% (12)No 2.4% (2) 15.5% (13)

X2 = 25.1, df1, p = 0.00025

Note: One respondent is excluded here because he was using drugs before imprisonment butdid not admit or deny drug use during imprisonment

barbiturates, ecstasy, acid and crack, cocaine, amphetamines, and solventsand methadone.

The proportion of respondents using a drug increased during impris-onment for heroin, cannabis, barbiturates and alcohol. With reference tothe latter, respondents’ comments indicate that unless an individual isknown to abstain from all drug use, his lack of participation in theconsumption of ‘hooch’ when available, may result in him being labelled asunreliable, or a threat to the wing. Those who did not drink before impris-onment, but who were using other drugs, may often drink instead of, or aswell as, their preferred drug of choice during imprisonment because it issocially acceptable to do so. The increase in the number of individualsusing heroin during imprisonment is reflected in the prison’s nickname(withheld for the purpose of anonymity). One respondent commentedupon how: ‘I take heroin now which I did not do before I came to prison.THIS PRISON’.

Asked how their drug taking behaviour differed during imprisonment, ofthose using before imprisonment, 23 respondents (39%) were doing lessbecause of the cost and limited availability of the drugs. Six respondents(10%) were doing less because they had reached their ‘time’ – a hypotheti-


TABLE 2Type of Drug Being Used and Number of Respondents Using it, Before and

During Imprisonment

Drug used Before imprisonment During imprisonment(n = 60) (n = 69)

Acid 45.0% (27) 15.9% (11)Amphetamines 45.0% (27) 13.0% (9)Barbiturates 21.7% (13) 20.3% (14)Cannabis 90.0% (54) 88.4% (61)Cocaine 56.7% (34) 14.5% (10)Crack 26.7% (16) 15.9% (11)Ecstacy 43.3% (26) 17.4% (12)Heroin 30.0% (18) 34.8% (24)Alcohol/Hooch 51.7% (31) 59.4% (41)Methadone 15.0% (9) 2.9% (2)Solvents 11.7% (7) 4.3% (3)Tranquillisers 28.3% (17) 23.2% (16)

TABLE 3Summary of Drug Use Before and During Imprisonment

Number of drugs usedMean Mode Max Min

Before imprisonment 4.644 3 12 1During imprisonment 3.101 1 12 1

cal point at which the drug user decides that they have had enough and thatit is time to stop. However, while some were doing less because of availabil-ity, lack of availability also encouraged individuals to use other drugs, someof which they may not have been using before, for example: ‘If I can’t getsome rocks I’ll take what’s going’. Three respondents stated that they hadstopped using ‘hard’ drugs but did not clarify whether they were using moreor less ’recreational’ drugs. Fourteen respondents (24% of those usingdrugs before imprisonment) continued to consume the same amount ofdrugs but claimed that the effects were better ‘inside’ and hence felt encour-aged to use them. Ten respondents (17%) claimed to be using more.

In an attempt to distinguish how ‘harmful’ the drug taking behaviourduring imprisonment was for the individual, a comparison was madebetween the methods of drug administration before and during imprison-ment. The results are shown in Table 4.

No difference was found in method of drug administration before andduring imprisonment for acid, crack, alcohol/hooch, solvents and tranquil-lisers. Cannabis was no longer eaten during imprisonment and ecstasy andmethadone were no longer smoked. Only one individual claimed to beinjecting during imprisonment – the drug he referred to was heroin. No oneclaimed to be using injection, during imprisonment, as a method of drugadministration for amphetamines, barbiturates and cocaine.

Of those respondents using drugs during imprisonment, 23.9% claimedthat their drug use had caused concern amongst their peers, that is, drugrelated debt and consequent bodily threat.


TABLE 4Methods of Drug Administration and Number of Respondents Before and

During Imprisonment

Method of Drug AdministrationDrug used Inhalation I.V. Oral Nasal Various

B D B D B D B D B D

Acid – – – – 27 8 – – – –Amphetamine – – 4 0 10 3 11 4 0 1Barbiturates – – 1 0 12 13 – – – –Cannabis 50 57 – – 1 0 – – – –Cocaine 2 1 4 0 0 0 21 6 1 1Crack 13 9 – – – – – – 1 1Ecstacy 1 0 – – 23 10 – – 2 1Heroin 9 21 7 1 – – 1 0 – –Alc./Hooch – – 1 0 27 34 – – – –Methadone 1 0 – – 8 2 – – – –Solvents – – – – 1 1 6 2 – –Tranquillisers – – – – 17 15 – – – –

Note: B = Before imprisonment, D = During imprisonment

Forty-five respondents (52.9%) claimed that the pressure to use drugswas greater during imprisonment than in the community outside. Thisperceived pressure was greater for a wide range of individuals, includingthose that claimed never to have used drugs, those that wished to abstainfrom all or some drugs use and those that wished to continue their drug use.Thirty-eight (44.7%) said that the pressure was not greater and two respon-dents did not answer this question.

Of those using drugs before imprisonment, only 22 respondents (37%)claimed that, on reception to the sampled prison, they had been questionedabout their drug use. Only two of these respondents admitted their druguse. They claim that the Prison Service did nothing in response, indeed inreply to the question: ‘If you admitted your drug use what was theresponse?’, one respondent wrote: ‘Nothing at all, no response, he thoughtit was funny!’. Twenty respondents denied their drug use. Their reasons fordenial are illustrated in Table 5. Thirty-eight (63%) claimed that they hadnot been questioned.

For those on methadone prescription before imprisonment (n = 3), noprescription was available during imprisonment. Barbiturates and tranquil-lisers were available, though only one of five individuals prescribed tranquil-lisers before imprisonment continued his prescription during imprisonment.

Twenty-two respondents (26%) claimed to have seriously tried to stopusing drugs. Of these 31.8% had tried to stop using drugs before imprison-ment, 18.2% had tried during imprisonment and 50% had tried both beforeand during imprisonment. The reasons for their attempt/s to abstain, asperceived by the respondent, are illustrated in Table 6. The reference to‘Time’ within the table refers to a theoretical turning point described byrespondents as: ‘I thought its about time to stop wasting my life’ and ‘I willno longer allow drugs to rule my life or dictate my actions or behaviours’.

The current attitude towards drug use of those using drugs at the time ofthe study was assessed by asking respondents to choose one of sevensentences provided, that they felt applied most to themselves. Theirresponse is illustrated in Table 7. The reference to ‘hard’ and ‘recreational’drugs was made by respondents throughout the study. ‘Hard’ drug userefers to the use of, for example, heroin and crack while ‘recreational’/‘soft’drug use is used to refer to, for example, the use of cannabis. However, theseparation is not exclusively distinct.


TABLE 5Reasons for Denial of Respondents’ Drug Use

Reason for denial of drug use Number of respondents

Punitive/negative staff response 6Personal/private business 6No problems with drug use 3Only using cannabis 3Embarrassed 2

Tables 8 and 9 illustrate the appeal of a drug free unit (which was, at thetime of the study, in the process of being established at the sampledprison) and the services requested for drug users, by the general inmatepopulation at the sampled prison, regardless of whether they were drugusers or not.

Table 10 illustrates the services that were requested by only those thatwere earnest about trying to abstain from drug use. In contrast to Table 9, noreference is made to: methadone prescription, full detox/rehab., needleexchange and outside agency involvement.

Discussion

The results suggest that for the majority of individuals drug use will decreaseduring imprisonment. There was no decrease in the range of drugs used but


TABLE 6Attempts to Abstain From Drug Use and Accompanying Reasons

Number of individuals who attempted to abstain

Before During Both TotalReason imprisonment imprisonment times

Marriage/important 3 0 5 8relationship‘Time’ 4 1 3 8Financial 3 2 2 7Imprisonment 0 1 5 6Birth of a child 2 0 4 6Personal illness 2 0 2 4Illness/death of another 1 1 0 2Employment 1 0 0 1Family 0 0 1 1

TABLE 7Current Attitude Towards Drugs of Those Using Drugs During Imprisonment

Current attitude towards drugs Number of individuals( = 68)*

To abstain from all drug use 12To abstain from ‘hard’ drug use only 19To continue all drug use 10Is using only those drugs classified as ‘recreational’ 27

*Note: One individual did not state his current attitude towards drugs, and has beenexcluded

the availability and popularity of the range used by the respondent did differbetween the community and prison. However, nearly half of those respon-dents who claimed not to be using drugs before imprisonment only startedonce imprisoned. Their drug use did not decrease then but in fact quitedramatically increased during imprisonment. In contrast to the findings ofShewan, Gemmell and Davies (1993) they were not limited.

The results do not suggest that the methods of drug administration areany more ‘harmful’ to the individual during imprisonment than those in thecommunity outside. Indeed the results indicate that there is less use of injec-tion as a means of using heroin, amphetamines, barbiturates and cocaine.Only one individual claimed to be injecting during imprisonment – thedrug he referred to was heroin. No one admitted to injection as a means of


TABLE 8Overall Appeal of a Drug Free Unit

Drug free unit appeals? Number of individuals(n = 85)

Yes 44.7% (38)No 48.2% (41)Don’t know 4.7% (4)No answer 2.4% (2)

TABLE 9Overall Response to Question: ‘What, if any, Services Would you Like to See

Available for Drug Users in Prison?’

Response Number of individuals

As much as possible 28.2% (24)No answer/missing 16.5% (14)Don’t care 8.2% (7)HIV testing 7.1% (6)Health education 7.1% (6)‘Free drugs!’ 5.9% (5)Waste of money 4.7% (4)Drug free unit 4.7% (4)Methadone prescription 4.7% (4)Don’t know 3.5% (3)Staff education 3.5% (3)Full detox and rehabilitation 2.4% (2)Needle exchange 2.4% (2)Outside agency involvement 1.2% (1)No needles 1.2% (1)Help during remand 1.2% (1)

using any other drug. This result is probably unrealistic. Respondents’comments suggested that injecting does occur in prison and to a muchhigher degree than the results suggest. Lack of availability of needles hasmeant that smoking is becoming the more common method of administra-tion of heroin during imprisonment. Asked which services he would like tosee available for drug users in prison, one respondent replied: ‘No offer offree needles etc. since most i/v users at the sampled prison now smoke, whichmust be a step in the right direction’. Injecting does still go on however andthose that are may well be sharing. Why then, with the exception of onerespondent, did no one admit to intravenous use of drugs during imprison-ment? The decision to use the ‘counsellor’ inmates to distribute and collectthe questionnaires was made in response to findings that have suggestedthat under-reporting is more common when interviews are done by adegreed professional compared to a paraprofessional who is a current orformer drug treatment clinic. However, it is possible that some respondentswould have felt uneasy in admitting their intravenous use of drugs duringimprisonment, suspecting that the ‘counsellor’ inmates would look at theirresponses. There is a stigma attached to injection as a method of drug admin-istration during imprisonment. This most probably stems from the responseof staff to the injection of drugs and the increased attention drawn to thearea when injecting equipment is found. The injecting individual then is athreat to the undetected drug use of others in the area. Despite criticism byMaden et al. (1992), data provided by ex-prisoners currently at liberty maywell be a good indicator of the level of intravenous drug use in prison, even ifover-reported. The above method clearly under-reports.

Of those respondents using drugs during imprisonment, 23.9% claimedthat their drug use had caused concern amongst their peers. This percentage


TABLE 10Drug Services as Requested by Those who were Earnest about Tryng to Abstain

from Drug Use

Attempts to abstain from drug use

Drug service Before During Both Totalrequested imprisonment imprisonment times

As much as possible 1 2 3 6Drug free unit 0 0 2 2Health education 1 1 0 2HIV testing 0 1 1 2Staff education 0 0 1 1No needles 0 0 1 1Help during remand 0 0 1 1Don’t know 1 0 0 1‘Free drugs!’ 1 0 0 1Waste of money 0 0 1 1Don’t care 1 0 0 1

is more alarming than it seems however. Within the prison culture, a ‘debt’only occurs when an individual does not pay. There is a system of ‘credit’ or‘riding debt’ where a drug user can have his drugs on the Monday and pay,for example, on the following Thursday after a visit from his wife who hasbrought in the payment. Another respondent wrote how his drug use ‘hascaused debt but am able to clear up my debt by going without canteen’. Adeferred payment then is only considered a debt when it has not, and looksas if it will not, be paid. Such debts can lead to threat and actual bodily harmfrom the individual’s peers.

Of those that were using drugs during imprisonment, 15% wished tocontinue their drug use but 18% wished to abstain from all drug use. Inaddition, 28% wished to abstain from ‘hard’ drug use. Throughout the studythere was a definite perceived difference between ‘hard’ and ‘recreational’drug use. This was clearly illustrated in a selection of responses to the ques-tion about which services the respondents wished to see available to drugusers in prison. Respondents’ comments included: ‘Anything that will helpthose that need it but leave the puff alone’ and ‘The idea of a drug free unitdoesn’t appeal because I intend to continue using cannabis’. For those thatwished to abstain from all drug use, a Drug Free Wing and RehabilitationUnit was due to commence at the sampled prison, but for those that wishedto abstain only from ‘hard’ drug use nothing was available. An alternativeproject to the drug free wing was needed to promote harm reduction tothose who will not abstain from drug use and to those who wished only toabstain from a specific number/kind of drugs.

Of those using drugs during imprisonment, 32% (n = 22) had seriouslytried to abstain from drug use before and/or during imprisonment. Theimpact of imprisonment was a distinctive factor in initiating change. Askedhow their drug taking behaviour differed during imprisonment, manyrespondents made reference to the positive impact of imprisonment uponthem. Comments included: ‘Being placed in prison woke me up from adream world’, ‘Now there is much more incentive for me to stop. Lookwhere it has got me’ and ‘It gives you time to think using drugs is not worthit, while in prison your thought and behaviour changes, you see thingsdifferent’. However, more respondents wrote about the negative impact ofimprisonment upon drug use. Comments here included: ‘Outside I usedrugs for fun but now I take drugs to relieve the boredom and help methrough my sentence’, ‘Drug use is better when you use in prison, you forgetyour problems and times go faster’, ‘The place is so lacking in things to do,gym is insufficient etc., that to get through a long sentence and handle thetime the odd joint helps’ and ‘In my personal opinion I feel dependent oncannabis whilst serving my time, where on the out I use it solely as a recre-ational pastime’. Most striking was the following comment: ‘I think now Ihave a problem’. Forty-five respondents (52.9%) claimed that the pressureto use drugs was greater than in the community outside. This perceivedpressure was greater for a range of individuals, including those who wishedto abstain, those that had never used drugs and those who wished tocontinue their drug use. Despite such pessimism, imprisonment did providemotivation for change in some, however few. What is important for those


who do wish to change while in prison, is that the tools for change andcontinued abstinence are there. Unfortunately these are often lacking.Furthermore, a great many of the respondents felt ambiguous about anyattempt to provide the appropriate services for drug misusers in prison. Theattitude of most respondents is summed up by one respondent who wrote:‘Until the attitude of staff changes, its pointless putting any of the above [heis referring here to a list of suggested services] in place’. Others claimed: ‘You willnever get the screws to help people with a drug problem’. What is neededthey claim, is ‘more understanding, thru’ education of staff, of drug prob-lems and related difficulties suffered by drug users’.

Thirty-eight of all the respondents (44.7%) said that the drug free unitappealed to them. Of these, about half were not using drugs before orduring imprisonment. Comments by those who were not using drugsincluded: ‘I think there should be an area set aside for people like myselfwho do not use drugs’, ‘I think too much emphasis is based on the peoplewho take drugs. 90% or more people are now taking drugs. It’s the minor-ity who should have the opportunity of entering a drug free zone becauseit’s the minority who are under pressure’ and ‘Put them [he refers to drugusers] in a field and drop a bomb on them’. The proposed drug free wing atthe sampled prison was designed to accommodate both the drug user whowants to abstain and the non-drug user, who wishes to stay in a drug freearea If the attitudes of this latter group are as strong as the comment madeby the last respondent, one wonders how harmonious such a unit would be?

Of the 22 respondents questioned about their drug use on reception tothe sampled prison, 20 denied their drug use. The reasons for the respon-dents’ denial of their drug use included: embarrassment, that the individualwas only using cannabis (note: the perceived difference between ‘hard’ and‘recreational’ drug use again), that they had no problems with their druguse, that their drug use was their private business and not a concern of theprison and the consequent negative and punitive response of the prison offi-cers. Respondents commented on how: ‘I’ve known many people in prisonwho have been picked on by the screws because of their drug use and so Iwasn’t going to trust them’ and ‘To stop hassles all round, unnecessaryharassment of one’s family and myself etc. also certain members of staff arequite apt to play mind games’. There is a lot of work to be done in encour-aging trust and confidentiality between inmates and staff. The crucial pointof contact and one of the greatest obstacles to the implementation of anyservice is the identification of drug misusers in prison. Extreme manage-ment and the negative attitude towards drug users by many staff preventdrug misusers from identifying themselves and serve only to drive the drugculture further underground.

For those respondents on methadone prescription before imprisonment(n = 3), no prescription was made available during imprisonment.Barbiturates and tranquillisers were available, although only one of five indi-viduals prescribed tranquillisers before imprisonment continued his prescrip-tion during imprisonment. It is, of course, possible that those on prescriptionbefore imprisonment did not seek to continue during imprisonment. Thegeneral policy however would appear to be not to give medication to a known


drug addict. Detoxification, within the hospital wing, was available onrequest of the prisoner. However, as we have seen, most respondents wouldbe wary about requesting such a service through fear of being picked on bythe prison staff. If no help is provided for the withdrawing addict, or thecontinuation of a community prescription at least considered, the individualis likely to return to the craved substance or, if not available, a substitute andthese are readily available. Yet despite the doctors’ apparent hesitancy toprescribe to known drug addicts, the prescription of drugs for depression,back pain and epileptic seizures among others, appear to be easily obtainedby both drug and non-drug users. Often these are then traded for othersubstances, for example, tobacco and other illegal drugs.

The potential of the Prison Service appears to be enormous. When asked:‘What, if any, services would you like to see made available for drug users inprison?’, of the general population, drug using or not, only 13% respondednegatively, for example: ‘I wouldn’t like to see any services for drug misusersin prison. If people wished to do drugs it is their look out, the money wastedyearly trying to rehabilitate those who don’t want to be would be betterspent on projects to benefit the majority in prison’. According to the presentstudy however, the majority of prisoners at the sampled prison were usingdrugs and indeed the majority of individuals (71%) responded positively tothis question (note: 16% did not answer). The most popular response wasfor as much help as possible. As one respondent replied: ‘Anything to helpthose with a drug problem is alright by me’. Other services requestedincluded (in order of popularity):

• methadone prescription, drug free unit, health education, HIV testing• staff education• needle exchange, full detox/rehabilitation• no needles, outside agency involvement, help during remand

From an inmate perspective, the prison environment was not perceived tobe a supportive environment for those that wished to abstain from druguse. While the results do suggest that for the majority of people drug usewill decrease during imprisonment, most probably as a result of reducedavailability, the environment does not support those individuals that wishto stop their drug use. Any positive impact of the environment upon theindividual, and it was for some, is notably outweighed by the negativeimpact it presented for the majority of respondents. For most respondents,the prison environment (reduced availability apart) only encouraged druguse.2,3

Notes

1 The sampled prison asked to exercise their right of anonymity stating that public-ity over the ‘historical’ view presented in this paper would detract from their exist-ing work in 1997: ‘a completely new Drug Strategy, included within which is oneof the largest Drug Treatment Communities in the country’.

2 Conducted in 1994, the study was the first independent evaluation of the sampledprison’s attempt to establish a drug free environment. The results of the research


sufficiently concerned the prison to commission two further pieces of work andconsequently revise their Drug Strategy.

3 Acknowledgements: We thank the inmates who volunteered for this study andacknowledge the help of the nine inmates who helped to design, distribute andcollect the questionnaire.

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Date submitted: May 96Date accepted: November 96


the effect of the prison environment upon inmate drug taking behaviour

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