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Article
Publication date: 11 December 2009

Steffen Jöhncke

This article discusses drug use treatment as a particular, indispensable institution in the political and cultural imagination of contemporary welfare societies. It is…

Abstract

This article discusses drug use treatment as a particular, indispensable institution in the political and cultural imagination of contemporary welfare societies. It is argued that the existence and funding of treatment is legitimate less on grounds of what it produces in terms of improvements to drug users' lives, and more as a politically and culturally suitable form of organizing the relationship between drug using and non‐using sections of the population. In this regard the analytical concept of treamentality ‐ a term formed as a combination of ‘treatment’ and the Foucauldian notion of ‘governmentality’ ‐ is suggested to help focus on how treatment has become the ‘obvious’ way to address certain problems of certain people.

Details

Drugs and Alcohol Today, vol. 9 no. 4
Type: Research Article
ISSN: 1745-9265

Keywords

Book part
Publication date: 5 February 2010

Stacy Lee Burns and Mark Peyrot

Purpose – This study tracks the legal control of the problem of substance abuse.Methodology/Approach – The chapter explores the “natural history” of the evolution of the…

Abstract

Purpose – This study tracks the legal control of the problem of substance abuse.

Methodology/Approach – The chapter explores the “natural history” of the evolution of the social construction of drug use and our collective response to it. Over the past 100 years, our understanding of drug use/abuse and the system for handling drug problems have gone through a series of changes. In the past 20 years or so, provision of treatment for drug offenders within the criminal justice system has rapidly expanded. California's recently enacted Proposition 36 (Prop 36) initiates for the first time on a mass basis the court-supervised drug treatment that began a decade earlier on a much smaller scale with the original drug courts. This chapter compares the Prop 36 program for diverting nonviolent drug offenders into court-supervised treatment with the original drug courts.

Findings – The research shows how court-supervised drug treatment has evolved from a personalized care program in the original drug courts to a mass processing operation under Prop 36. The research finds that the social problem solution of offering treatment to more drug defendants created its own unanticipated consequences and problems, including significant standardization in the operations of the court and a dilution of many useful features that defined the early drug courts.

Practical implications – “Farming out” drug defendants to probation and treatment makes case-processing and treatment potentially less effective therapeutically. The chapter raises questions about how social control can extend its domain without “breaking the bank” and what the consequences are for how social problems are handled.

Details

New Approaches to Social Problems Treatment
Type: Book
ISBN: 978-1-84950-737-0

Article
Publication date: 1 March 2006

Ralf Jürgens

Since the early 1990s, various countries have introduced HIV prevention programmes in prisons. Such programmes include education on HIV/AIDS, HCV and on drug use for…

Abstract

Since the early 1990s, various countries have introduced HIV prevention programmes in prisons. Such programmes include education on HIV/AIDS, HCV and on drug use for prisoners and for staff, voluntary testing and counselling, the distribution of condoms, bleach, and needles and syringes, and substitution therapy for injecting drug users. Other forms of drug‐dependence treatment, as well as drug demand reduction and drug supply reduction measures may also be relevant to managing HIV/AIDS and HCV in prisons, and may facilitate HIV prevention measures ‐ or have unintended negative consequences for such measures. Prison systems in a growing number of countries are implementing such programmes. However, many of them are small in scale and restricted to a few prisons. Provision of care and treatment for people living with HIV or AIDS has become a priority worldwide, and it is considered to be a basic human right. This includes the provision of antiretroviral therapy (ARV) in the context of comprehensive HIV/AIDS care. Providing access to ARV for those in need in the context of correctional facilities is a challenge, but it is necessary and feasible. Studies have documented that, when provided with care and access to medications, prisoners respond well to ARV. Part 3 of the select annotated bibliography on HIV/AIDS and HCV in prisons contains selected “essential” articles and reports that provide information about (1) substitution treatment and other forms of drug‐dependence treatment; (2) other drug demand and drug supply reduction measures; and (3) care, treatment, and support for prisoners living with HIVor AIDS and/or HCV. Each section also contains a brief review of the evidence, based on recent work undertaken by the World Health Organization (WHO).

Book part
Publication date: 23 September 2005

Christine Godfrey, Steve Parrott, Gail Eaton, Anthony Culyer and Cynthia McDougall

This chapter introduces a simulation model to estimate the social costs of problem drug misusers in England and Wales, and how policies to increase the number of drug

Abstract

This chapter introduces a simulation model to estimate the social costs of problem drug misusers in England and Wales, and how policies to increase the number of drug users in treatment may impact on both social costs and government expenditure. Consequences are divided into five domains – health, crime, social care, work, and driving. Social costs are estimated to be between £12 and £12.3 billion, and the total cost of government expenditure is around £3.5 billion. Increases in the numbers in treatment, are estimated to reduce social costs across a 5-year period by between £3.0 and £4.4 billion.

Details

Substance Use: Individual Behaviour, Social Interactions, Markets and Politics
Type: Book
ISBN: 978-1-84950-361-7

Article
Publication date: 14 March 2016

Anya Sarang, Lucy Platt, Inna Vyshemirskaya and Tim Rhodes

The purpose of this paper is to analyze poor management of tuberculosis (TB) prevention and treatment and explore parameters and causes of this problem drawing on…

Abstract

Purpose

The purpose of this paper is to analyze poor management of tuberculosis (TB) prevention and treatment and explore parameters and causes of this problem drawing on qualitative interviews with former prisoners and medical specialists in Kaliningrad Oblast in Russia.

Design/methodology/approach

The authors undertook a qualitative study, to explore access to HIV and TB treatment for people who inject drugs in Kaliningrad. The authors interviewed (outside of prisons) 15 patients and eight health specialists using a semi-structured guide. The authors analyzed the accounts thematically and health consequences of imprisonment emerged as a major theme.

Findings

Prisons are overcrowded and lack basic hygiene and infection control. Demand for medical services outstrip supply, HIV and TB prevention lacking, HIV and TB treatment is patchy, with no second-line drugs available for resistant forms. The prison conditions are generally degrading and unhealthy and many respondents perceived surviving prisons as a miracle. Cooperation with medical services in the community is poor.

Research limitations/implications

The authors used qualitative research methods, which do not rely on a representative sample. However, many of the structural barriers preventing effective TB treatment and prevention highlighted in this paper have been noted elsewhere, suggesting that findings are likely to reflect conditions elsewhere in Russia. The authors tried to include all possible points of view, as of the medical staff and the patients. However, due to resistance of the officials the authors were unable to conduct interviews with employees of the FCS. Since all the interviews are recalling past experience, the situation may have changed. This does not undermine importance of the findings, as they shed light on particular treatment experiences, and development of prison health system.

Originality/value

The paper contributes to the literature on prisons as a contributor to TB epidemic, including drug resistant forms. An urgent penitentiary reform in Russia should focus on HIV and TB prevention, case detection, availability of medications and effective treatments. Key to decreasing prison population and improving health is political reform aimed at introduction of effective drug treatment, de-penalization and de-criminalization of drug users and application of alternatives to incarceration.

Details

International Journal of Prisoner Health, vol. 12 no. 1
Type: Research Article
ISSN: 1744-9200

Keywords

Article
Publication date: 1 May 1996

Robert S. Gossweiler and Steven S. Martin

This study examines the relationship of personality characteristics to drug treatment effectiveness for prison releasees. Prison releasees from two drug treatment programs…

Abstract

This study examines the relationship of personality characteristics to drug treatment effectiveness for prison releasees. Prison releasees from two drug treatment programs (an out‐patient setting and a therapeutic community setting) are compared with each other and to releasees from a comparison group. Treatment success is measured 6 months after release from prison in terms of 1) abstinence of illicit drug use and 2) lack of recidivism. The data are analyzed using logistic regression with demographic, criminal history, past drug use, psychological, and treatment measures included in the equations. Findings suggest that several personality dimensions are related to treatment effectiveness, sometimes in unexpected ways. The findings also reveal that different personality characteristics are associated with each of the two measures of treatment success. The results are discussed in terms of policy implications for treatment programs.

Details

International Journal of Sociology and Social Policy, vol. 16 no. 5/6
Type: Research Article
ISSN: 0144-333X

Article
Publication date: 21 December 2015

Kate Dolan, Heather Worth and David Wilson

Injecting drug use is a global concern, with an estimated 16 million people who inject drugs (PWIDs) in over 148 countries. A number of Asian countries detain PWIDs for…

Abstract

Purpose

Injecting drug use is a global concern, with an estimated 16 million people who inject drugs (PWIDs) in over 148 countries. A number of Asian countries detain PWIDs for compulsory treatment. The paper aims to discuss this issue.

Design/methodology/approach

The authors reviewed the literature on compulsory drug treatment in seven Asian countries.

Findings

The authors identified 1,269 closed settings which held over 600,000 drug users in eight countries. The average detainee was aged from 20 to 30 years and was predominantly male. HIV risk behaviour continued in detention in some countries. In most countries treatment comprised physical labour, military drills. Methadone maintenance treatment and antiretroviral therapy were rarely available. No data were located to show detention in a closed setting treated drug dependency. Issues of concern were; no due legal process for the detention of drug users, lack of evidence-based drug treatment, lack of HIV prevention and treatment, abusive conditions, forced labour and exercise, arbitrary exit procedures and very high relapse rates.

Research limitations/implications

The review of compulsory treatment of drug users failed to find any evaluation of effective drug treatment for detainees. Instead serious breaches in human rights conditions were evident. Prominent international organisations have called for the compulsory treatment of drug users to cease.

Practical implications

Many countries are spending vast amounts of funding on ineffective treatments for drug users.

Social implications

Funding should be directed to community-based drug treatments that have been shown to work.

Originality/value

This is the largest review of compulsory treatment of drug users to date.

Details

International Journal of Prisoner Health, vol. 11 no. 4
Type: Research Article
ISSN: 1744-9200

Keywords

Article
Publication date: 1 March 2007

Charlotte N. E. Tompkins, Joanne Neale, Laura Sheard and Nat M. J. Wright

Imprisonment is common among drug users. However, historically healthcare for injecting drug users in prison in England and Wales has not been equivalent to that offered…

Abstract

Imprisonment is common among drug users. However, historically healthcare for injecting drug users in prison in England and Wales has not been equivalent to that offered in community settings. Fiftyone injecting drug users who had a history of imprisonment were interviewed. Interviews focused on the experiences of drug‐related care and treatment in prison. The interviews were analysed using the Framework method. Accounts of prison drug treatment experiences provided valuable insights into drug treatment in the English prison. The participants’ accounts provided a historical perspective, many of which reflected the different practices of different prisons and prison staff and the changes in policy and practice that have occurred in prison healthcare over recent decades. Positive and negative experiences of healthcare and drug treatment in prison were discussed. Issues that affected levels of drug use inside prisons and their receipt of care, support and treatment in prison included prescribing policies, illicit drug availability and prison staff and doctor attitudes. Whilst negative experiences of prison and drug treatment prevailed, users identified that recent policy and practice changes had positively influenced healthcare provision for drug users in prison, particularly the provision of opiate maintenance therapy. Drug users often saw prison as an opportunity to detoxify and contemplate their drug use. Further work needs to build on the positive experiences identified to ensure that prison drug treatment in England and Wales is consistent, effective and efficient in the future.

Details

International Journal of Prisoner Health, vol. 3 no. 3
Type: Research Article
ISSN: 1744-9200

Keywords

Article
Publication date: 8 March 2013

Johan Edman

This article seeks to investigate the ideological visions embedded in the political formulation of the Swedish drug problem and in the bureaucratic management of the…

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Abstract

Purpose

This article seeks to investigate the ideological visions embedded in the political formulation of the Swedish drug problem and in the bureaucratic management of the Swedish drug treatment services during the years 1960‐2000.

Design/methodology/approach

The empirical basis for the analysis consists mainly of parliamentary material from the Swedish Parliament (403 parliamentary bills, 66 government bills, 198 parliamentary records, 14 government letters and 159 standing committee statements) as well as archival materials produced in the application process of 73 aspiring treatment homes from the years 1960‐2001. The empirical material is partly analyzed from a theoretical understanding of political consensus as a doxa and political debate as permeated by naturalizing ideologies.

Findings

The article examines drug consumption as a political problem and its ideological undertones. It shows how drugs and drug consumption often have been subordinate in problem descriptions that have fulfilled other political purposes. Worries about politically radical youth, foreign religions or incomprehensible music have been understood as a drug problem. In the Swedish parliament the drug problem has been described in terms of capitalist class oppression, Americanism or cultural superficiality. Modernity, urbanization and industrialization have also been criticized in the name of the drug problem. In the treatment centres and within the ruling bureaucracy it was also elucidated that the drug problem was an ideological problem. The effective treatment method has been elusive, but the effective method has also played second fiddle in the choice of treatment solutions. Other values have been awarded, such as rural romanticism, Swedishness, solidarity and diligence. Individualism, Americanism and profit making have also been opposed within the ideological treatment sector. At the end of the research period such assessments however became subordinate to an overarching ideological quest to make substance abuse treatment a market among others.

Social implications

A focus on the ideological content both in political discussions and bureaucratic management might enrich the understanding of both politics and bureaucracy as well as the formulation of the drug problem and the suggested solutions. Ideology is not the opposite of facts or evidence‐based solutions; ideology permeates every aspect of problem formulations and solutions. To recognize the drug issue's ideological disposition should therefore not be seen as way of avoiding discussions about the actual dilemma with drugs, it is rather an opportunity to seriously start a discussion on how to solve the problem.

Originality/value

The analyzing of naturalized and apparently self‐evident ideology as part of the rational argument rather than its very opposite would be useful both for further research on the topic as well as for deepening the democratic discussions on, for instance, evidence‐based methods within the drug treatment services.

Details

Drugs and Alcohol Today, vol. 13 no. 1
Type: Research Article
ISSN: 1745-9265

Keywords

Article
Publication date: 7 December 2015

Bagga Bjerge, Karen Duke and Vibeke Asmussen Frank

The purpose of this paper is to examine the shifting roles of medical professionals as stakeholders in opioid substitution treatment (OST) policies and practices in…

Abstract

Purpose

The purpose of this paper is to examine the shifting roles of medical professionals as stakeholders in opioid substitution treatment (OST) policies and practices in Denmark and the UK within the past 15 years.

Design/methodology/approach

The paper is based on literature reviews, documentary analyses and key informant interviews with a range of stakeholders involved in OST and policy in Denmark and UK. The study is part of the EU-funded project: Addictions and Lifestyles in Contemporary Europe: Reframing Addictions Project.

Findings

Denmark and the UK are amongst those few European countries that have long traditions and elaborate systems for providing OST to heroin users. The UK has a history of dominance of medical professionals in drugs treatment, although this has been recently challenged by the recovery movement. In Denmark, a social problem approach has historically dominated the field, but a recent trend towards medicalisation can be traced. As in all kinds of policy changes, multiple factors are at play when shifts occur. We examine how both countries’ developments around drugs treatment policy and practice relate to broader societal, economic and political changes, how such divergent developments emerge and how medical professionals as stakeholders enhanced their roles as experts in the field through a variety of tactics, including the production and use of “evidence”, which became a key tool to promote specific stakeholder’s perspectives in these processes.

Originality/value

The paper contributes to current policy and practice debates by providing comparative analyses of drug policies and examination of stakeholder influences on policy processes.

Details

Drugs and Alcohol Today, vol. 15 no. 4
Type: Research Article
ISSN: 1745-9265

Keywords

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