Substance Abuse Substance Abuse TreatmentTreatment
Prevention and Policy Prevention and Policy in Correctional Servicesin Correctional Services
Dr. Myo Kyaw OoDr. Myo Kyaw OoConsultant PsychiatristConsultant Psychiatrist
Department of CorrectionsDepartment of CorrectionsJamaicaJamaica
Substance Abuse Substance Abuse Treatment & Treatment &
Rehabilitation must be Rehabilitation must be the Priority National the Priority National
AgendaAgenda
Treatment ModelsTreatment Models Many treatment modalities exist, based on Many treatment modalities exist, based on
wide range of factors within the context of wide range of factors within the context of a countrya country
Modalities are designed based on common Modalities are designed based on common problem of addiction and major economic, problem of addiction and major economic, cultural, religious and political dimensions.cultural, religious and political dimensions.
Resources available in countries vary Resources available in countries vary widelywidely
Important to remember hidden cost and Important to remember hidden cost and significant burden ( health care costs, significant burden ( health care costs, productivity loss, criminal justice costs..)productivity loss, criminal justice costs..)
Goal of TreatmentGoal of Treatment
Ultimate goal is ..to achieve “A Ultimate goal is ..to achieve “A Substance Free Quality life” Substance Free Quality life”
Programmatic GoalsProgrammatic Goals
Fiscal and political realitiesFiscal and political realities Appropriate use of resourcesAppropriate use of resources Philosophy of the program clearly Philosophy of the program clearly
defineddefined No single approach is effective for No single approach is effective for
everyoneeveryone Evaluation & ResearchEvaluation & Research
Objectives to provide a Objectives to provide a substance free quality lifesubstance free quality life
-harm reduction and motivation for -harm reduction and motivation for abstinenceabstinence
-bio-psycho-social level of functioning-bio-psycho-social level of functioning
-marital and family issues-marital and family issues
-job and financial management-job and financial management
-spiritual issues-spiritual issues
-relapse prevention-relapse prevention
Approach to Drug ProblemApproach to Drug Problem
Supply reductionSupply reduction Demand reductionDemand reduction
There should be a BALANCE between There should be a BALANCE between the two principlesthe two principles
Supply ReductionSupply Reduction
How to reduce supply reduction ?How to reduce supply reduction ? Cultivation, Manufacturing, Cultivation, Manufacturing,
EradicationEradication Trafficking & ExportTrafficking & Export EradicationEradication Precursors controlPrecursors control Money laundering and legislationMoney laundering and legislation
PreventionPrevention
No drugs …No abusersNo drugs …No abusers No precursors…No manufacturing No precursors…No manufacturing
processprocess How are you going to make prisons How are you going to make prisons
safe?safe? How do inmates receive their How do inmates receive their
supply?supply? Zero Tolerance Policy?Zero Tolerance Policy?
Demand ReductionDemand Reduction
Educational Approach, school Educational Approach, school education, public education, sport & education, public education, sport & cultureculture
Health & medical Measure, treatment Health & medical Measure, treatment and rehabilitation programsand rehabilitation programs
Community involvementCommunity involvement Economic empowermentEconomic empowerment Regional & International Cooperations Regional & International Cooperations
Caribbean & OAS Caribbean & OAS
Causes of Drug AddictionCauses of Drug Addiction
Moral/SpiritualMoral/Spiritual BiologicalBiological PsychodynamicPsychodynamic BehaviouralBehavioural Socio-culturalSocio-cultural Individual-drug-environmentIndividual-drug-environment INTEGRATIVEINTEGRATIVE
IntegrativeIntegrative
No single causeNo single cause Interaction of range of causesInteraction of range of causes Bio-Psycho-SocialBio-Psycho-Social Bio-Psycho-Socio-CulturalBio-Psycho-Socio-Cultural
Bio-Psycho-Socio-Bio-Psycho-Socio-CulturalCultural
No single causeNo single cause Interaction of the causesInteraction of the causes
General outline of demand General outline of demand reductionreduction
Treatment & RehabilitationTreatment & Rehabilitation Prevention & follow-upPrevention & follow-up
Models of Treatment Models of Treatment facilitiesfacilities
Residential basedResidential based Hospital or centresHospital or centres Short, medium, Short, medium,
long termlong term
Outpatient basedOutpatient based Drug Court Drug Court
TreatmentTreatment Prison basedPrison based
Treatment ApproachesTreatment Approaches
Individual therapyIndividual therapy Group therapyGroup therapy Family therapyFamily therapy Special program ( juvenile, Drug Special program ( juvenile, Drug
court, prison based, combined court, prison based, combined HIV,STI, TB, therapeutic HIV,STI, TB, therapeutic communities, cultural)communities, cultural)
Treatment ProcessTreatment Process
Crisis Management (overdose, Crisis Management (overdose, withdrawal, medical & psychiatric withdrawal, medical & psychiatric emergencies)emergencies)
Assessment & DetoxificationAssessment & Detoxification Rehabilitation with or without Rehabilitation with or without
Skilled trainingSkilled training Relapse prevention & follow-upRelapse prevention & follow-up Special servicesSpecial services
Networking & Supportive Networking & Supportive ServicesServices
AA, NAAA, NA FBO, NGO, PSOFBO, NGO, PSO EAPEAP Government MinistriesGovernment Ministries Family support groupsFamily support groups
Important thing to Important thing to rememberremember
Drug abuse recovery is a process, not Drug abuse recovery is a process, not an eventan event
Treatment modalities must be Treatment modalities must be designed based on multidimensional designed based on multidimensional approach to meet the individual needsapproach to meet the individual needs
Success is measured not on absolute Success is measured not on absolute figures of statistical value but quality figures of statistical value but quality of life change of individualof life change of individual
Constitutional rights of individual must Constitutional rights of individual must be protected at all timesbe protected at all times
Changing Model of CareChanging Model of Care
Recovery is not an event but the Recovery is not an event but the processprocess
Incarceration by itself does little to Incarceration by itself does little to break the cycle of illegal drug use break the cycle of illegal drug use and crimeand crime
Offenders sentenced to Offenders sentenced to Incarceration exhibit high rate of Incarceration exhibit high rate of RECIDIVISM once they are releasedRECIDIVISM once they are released
HARM HARM REDUCTIONREDUCTIONWidely accepted Model of Widely accepted Model of
CareCare
What is Harm What is Harm Reduction?Reduction?
Physical – death, illness, addiction, Physical – death, illness, addiction, HIV, Hepatitis, Injuries related to HIV, Hepatitis, Injuries related to accidents and violenceaccidents and violence
Psychological – fear of Psychological – fear of crime/violence and effect on familycrime/violence and effect on family
Social – breakdown of social systemSocial – breakdown of social system Economic – drug trade, productivity Economic – drug trade, productivity
loss, workplace accidentsloss, workplace accidents
Drug Abuse Prevalence Drug Abuse Prevalence in prisonsin prisons
Drug Abuse in prison is very Drug Abuse in prison is very commoncommon
Estimated 22% - 86%Estimated 22% - 86% Most frequently used illicit drug “ Most frequently used illicit drug “
Cannabis” 8% - 60%Cannabis” 8% - 60% British Study 60% heroin user British Study 60% heroin user
reported use in prison, more than reported use in prison, more than 25% initiated use in prison25% initiated use in prison
Factors associated with Factors associated with substance abuse in prisonsubstance abuse in prison
Age, Ethnicity, Conduct disorder, Age, Ethnicity, Conduct disorder, abuses, school difficultiesabuses, school difficulties
Psychiatric disordersPsychiatric disorders Antisocial personalityAntisocial personality Support systemSupport system Length of sentenceLength of sentence
Drug Abuse Drug Abuse Survey in Survey in
Jamaican PrisonsJamaican Prisons20052005
MethodologyMethodology
4 maximum security prisons 4 maximum security prisons Sampling Frame of 3434 inmatesSampling Frame of 3434 inmates Stratified sampling method usedStratified sampling method used Estimated prevalence rate 45% ± Estimated prevalence rate 45% ±
5%5% A total of 440 inmatesA total of 440 inmates 42 items, 4 sections Questionnaire 42 items, 4 sections Questionnaire
usedused
Results - AgeResults - Age
A Total of 440 inmatesA Total of 440 inmates Male 82% (360), Female 18% (80)Male 82% (360), Female 18% (80) Age range – 18 to 73 yearsAge range – 18 to 73 years Majority 53% (Age range 23-34)Majority 53% (Age range 23-34)
Results – Age group by Results – Age group by GenderGender
Age groupAge group MaleMale FemaleFemale TotalTotal
17-2217-22 2525 88 33 (8%)33 (8%)
23-2823-28 9999 2121 120 (27%)120 (27%)
29-3429-34 9898 1515 113 (26%)113 (26%)
35-4035-40 7171 1212 83 (19%)83 (19%)
41-4641-46 3535 1212 47 (11%)47 (11%)
47-5247-52 2020 99 29 (6%)29 (6%)
53 & over53 & over 1212 33 15 (3%)15 (3%)
Results – Education by Results – Education by gendergender
LevelLevel MaleMale FemaleFemale TotalTotal
PrimaryPrimary 224224 2525 249 (57%)249 (57%)
SecondarySecondary 128128 3737 165 (38%)165 (38%)
TertiaryTertiary 88 1818 26 (5%)26 (5%)
Results – Literacy levelResults – Literacy level
LevelLevel MaleMale FemalFemalee
TotalTotal
ExcellentExcellent 5757 4040 97 (22%)97 (22%)
GoodGood 8989 2424 113 (25%)113 (25%)
Can help selfCan help self 120120 99 129 (29%)129 (29%)
Just a littleJust a little 6666 66 72 (16%)72 (16%)
Can not Can not read/writeread/write
2828 11 29 (8%)29 (8%)
KnowledgeKnowledge
Ganja is a drugGanja is a drug 72%72% Ganja smoking is harmfulGanja smoking is harmful 61%61% Alcohol, tobacco & beady are drugsAlcohol, tobacco & beady are drugs 78%78% Ganja improves sexual performanceGanja improves sexual performance 33%33% Alcohol improves sexual performanceAlcohol improves sexual performance 38%38% Addiction is drug dependencyAddiction is drug dependency 85%85% A link between drug abuse & STIA link between drug abuse & STI 73%73%
PrevalencePrevalence
PrevalencePrevalence NoNo YesYes
Drug abuse before Drug abuse before incarcerationincarceration
163163 273 ( 62% 273 ( 62% ))
Drug abuse during Drug abuse during incarcerationincarceration
233233 201 ( 201 ( 46%46% ))
PrevalencePrevalence
Drug abuse before incarceratedDrug abuse before incarcerated 62%62%
Drug abuse during incarcerationDrug abuse during incarceration 46%46%
Type of Substances abusedType of Substances abused(N=305)(N=305)
TypeType NumberNumber
GanjaGanja 172 (39%)172 (39%)
TobaccTobaccoo
98 (22%)98 (22%)
AlcoholAlcohol 21 (5%)21 (5%)
CrackCrack 6 (1%)6 (1%)
ValiumValium 5 (1%)5 (1%)
InhalanInhalantt
3 (0.7%)3 (0.7%)
Pattern of AbusePattern of Abuse
TypeType DailyDaily WeeklyWeekly OccasionallOccasionallyy
GanjaGanja 98 (22%)98 (22%) 1313 62 (14%)62 (14%)
TobaccoTobacco 75 (17%)75 (17%) 77 42 (10%)42 (10%)
AlcoholAlcohol 9 (2%)9 (2%) 11 32 (7%)32 (7%)
ValiumValium 6 (1%)6 (1%) 00 6 (1%)6 (1%)
CrackCrack 4 (0.9%)4 (0.9%) 00 3 (0.7%)3 (0.7%)
InhalantInhalantss
1 (0.2%)1 (0.2%) 00 2 (0.5%)2 (0.5%)
Factors affecting Factors affecting frequencyfrequency
FactorsFactors StatisticsStatistics
MoneyMoney 122 (28%)122 (28%)
AvailabilityAvailability 63 (14%)63 (14%)
Afraid of Disciplinary Afraid of Disciplinary actionaction
11 (3%)11 (3%)
Afraid of being seenAfraid of being seen 6 (1%)6 (1%)
Reason for Drug useReason for Drug use To feel more relaxedTo feel more relaxed 119119 27%27% To meditateTo meditate 9999 23%23% To cope with prisonTo cope with prison 8484 19%19% To sleepTo sleep 6565 15%15% CuriosityCuriosity 4646 11%11% LonelyLonely 3636 8%8% Peer pressurePeer pressure 2626 6%6% AddictionAddiction 2222 5%5% ReligionReligion 88 2%2%
Source of supply in Source of supply in prisonprison
Fellow inmatesFellow inmates 189189 43%43% Correctional officersCorrectional officers 13 13 3% 3% Over prison wall/fenceOver prison wall/fence 8 8 2% 2% Family/friendsFamily/friends 5 5 1% 1%
Motivation for changeMotivation for change
Want to stop drug abuseWant to stop drug abuse 150150 34%34%
Request assistance to stopRequest assistance to stop 113113 26%26%
Interest to participate in program 348Interest to participate in program 348 79%79%
Best group to sensitize Best group to sensitize drug abuse programdrug abuse program
GroupGroup StatisticsStatistics
Recovering addictsRecovering addicts 233 233 (53%)(53%)
ChurchChurch 108 108 (25%)(25%)
FamilyFamily 34 34 (8%)(8%)
Fellow inmateFellow inmate 29 29 (7%)(7%)
OthersOthers 22 22 (5%)(5%)
Correctional officersCorrectional officers 14 14 (2%)(2%)
SummarySummary
Prevalence of drug abusePrevalence of drug abuse 46%46% Ganja is most commonly abusedGanja is most commonly abused
39%39% 34%34% of inmates are motivated to of inmates are motivated to
quit and quit and 26%26% requested assistance. requested assistance. 79%79% showed interest to participate showed interest to participate
in the drug abuse program in prison.in the drug abuse program in prison.
Implementation of Implementation of Substance Abuse Substance Abuse
Treatment & Prevention Treatment & Prevention in Prisons is well in Prisons is well
justifiedjustified
Models of Treatment Models of Treatment facilitiesfacilities
Residential basedResidential based Hospital or centresHospital or centres Short, medium, Short, medium,
long termlong term
Outpatient basedOutpatient based Drug Court Drug Court
TreatmentTreatment Prison basedPrison based
Principle of Principle of Therapeutic Therapeutic
JurisprudenceJurisprudence
Prof. Bruce WinnickProf. Bruce Winnick
Prof. David WexlerProf. David Wexler
Application of TJApplication of TJ
Offenders with underlying drug abuse Offenders with underlying drug abuse problems problems
Incarceration alone does not help or Incarceration alone does not help or reduce recidivismreduce recidivism
Therapeutic principle is applied in Therapeutic principle is applied in Judicial processJudicial process
Diversion ProgrammeDiversion Programme Prison Based ProgrammePrison Based Programme Parallel ModelParallel Model
Diversion ProgrammeDiversion Programme
Drug Court Treatment & RehabilitationDrug Court Treatment & Rehabilitation May 2001 Kingston, July 2001 Montego May 2001 Kingston, July 2001 Montego
BayBay Drug Court Act 1999Drug Court Act 1999 Offenders with Minor Offences who meet Offenders with Minor Offences who meet
eligible criteriaeligible criteria Bail offeredBail offered Six months outpatient programme under Six months outpatient programme under
court supervision and weekly urine testingcourt supervision and weekly urine testing
Jamaica Drug CourtJamaica Drug CourtMay 2001 – March 2009May 2001 – March 2009
Treatment CenterTreatment Center Total referred by Total referred by CourtCourt
AdmissioAdmissionn
Drop outDrop out GraduateGraduatedd
KingstonKingston 295295 149149 9999 5050
Montego Montego BayBay
284284 262262 153153 109109
579579 411411 252252 159159
Jamaica Drug CourtJamaica Drug CourtMay 2001 – March 2009May 2001 – March 2009
EligibilityEligibility 71%71%
Drop OutDrop Out 61%61%
GraduationGraduation 39%39%
Monthly saving on one Monthly saving on one graduategraduate
J$ 58,333.33 J$ 58,333.33
Total saving on graduatesTotal saving on graduates J$ J$ 9,274,978.809,274,978.80
What about those What about those ineligible ineligible
Offenders?Offenders?
Prison Based ProgrammePrison Based Programme
Prison based Prison based ProgramProgram
? Legislation? Legislation Political willPolitical will Budget Budget
commitmentcommitment
Outpatient Drug Outpatient Drug CourtCourt
LegislationLegislation Court supervisionCourt supervision Probation period Probation period
after graduationafter graduation Criminal offence Criminal offence
not recordednot recorded
Jamaica DCS Pilot Jamaica DCS Pilot ProjectProject
Situational AnalysisSituational Analysis TrainingTraining Project Design and ImplementationProject Design and Implementation EvaluationEvaluation
Things to rememberThings to remember
Two pillars approach supply and Two pillars approach supply and demand reductiondemand reduction
Integrative model of causesIntegrative model of causes Recovery is a process, not an eventRecovery is a process, not an event Harm Reduction modelHarm Reduction model Therapeutic Jurisprudence Therapeutic Jurisprudence
principles in judicial processprinciples in judicial process Legislation to assist rehabilitationLegislation to assist rehabilitation
Things to rememberThings to remember
Interagency Cooperation & Interagency Cooperation & CoordinationCoordination
Regional & International Regional & International CooperationCooperation
Research and PublicationResearch and Publication
Insanity is doing the Insanity is doing the same thing over and same thing over and over and expecting over and expecting
different resultsdifferent results
Punitive Model without Punitive Model without Rehabilitation does not solve Rehabilitation does not solve
underlying issuesunderlying issues
Try innovative methods and Try innovative methods and programsprograms
Thank YouThank You
Dr. Myo Kyaw OoDr. Myo Kyaw OoMBBS,DPM, DM Psych.MBBS,DPM, DM Psych.
Acting Senior Medical OfficerActing Senior Medical OfficerBellevue HospitalBellevue Hospital
June 10, 2009June 10, 2009