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Little research has been done on treatment for opioids dependence in prisons in the UK. Treatment programmes are coercive and are abstinence‐orientated, and maintenance substitution treatment is rarely offered. This research aimed to investigate prisoners' perceptions of existing treatment and treatment choices offered by the service.A qualitative methodology was used with eight semi‐structured interviews with prisoners who were currently or had recently completed an opioid detoxification regime. The study took place in Wandsworth prison in south London, and interviews were recorded and analysed using theme analysis.Prisoners felt that substance misuse assessment failed to identify their needs. They had little if any input into the decision regarding substitute prescribing and they felt that their current treatment regime did not meet their needs. Not all prisoners felt coerced into treatment, however, they all described coercive measures. Homelessness compounded prisoners' substance use and treatment progress.There is significant dissonance between the services offered and the prisoners' own perceptions of service need. Many prisoners are not yet ready to achieve abstinence, the predominant treatment opportunity available. If coercion into substance misuse treatment is to be integral to the criminal justice system, treatment services should be tailored to clients' needs.

This paper aims to understand the current scale of substance misuse in psychiatric intensive care units (PICUs), identify how substance misuse affects members of staff, patients and the running of wards and explore with staff what resources would be most useful to more effectively manage substance misuse and dual diagnosis on PICUs.

The paper used a mixed-methods approach, using a quantitative survey to determine the extent of substance use in PICUs and a co-design workshop to understand the impact of substance misuse on PICU wards, staff and patients.

The estimated rate of substance misuse in PICUs over a 12-month period is 67%, with cannabis the most frequently used substance. Despite the range of problems experienced on PICUs because of substance misuse, the availability of training and resources for staff was mixed.

The findings may not be fully generalisable as research participants were members of a national quality improvement programme, and therefore, may not be representative of all PICUs. Data was collected from clinicians only; if patients were included, they might have provided another perspective on substance misuse on PICUs.

This paper emphasises the importance of substance misuse training for PICU staff to adequately respond to patients who misuse substances, improve the ward environment, staff well-being and patient outcomes.

This paper provides an updated estimation of rates of substance misuse in PICUs over a 12-month period and make suggestions for a training programme that can better support staff to address substance misuse on PICUs.

The purpose of this paper is to understand prisoner perceptions on being trained and having received take-home naloxone (THN) kits once released from prison back into the community, in order to prevent an opiate-related overdose.

A survey was run of all prisoners receiving THN training across ten prisons in one English region. In total, 142 prisoners were surveyed out of 206 (69 per cent) being trained in THN across the ten prisons. Five focus groups (n=26) with prisoners were conducted across four remand and one open prison that included discussions on THN within a range of topics. Discussions were recorded using short-hand and the data were subsequently thematically interpreted using visual mapping techniques.

The survey highlighted a high degree of exposure amongst prisoners to overdose either directly (54 per cent) or having witnessed another person’s overdose (73 per cent). For prisoners who had overdosed, only a minority (38 per cent) were taken to hospital by an ambulance. In total, 81 per cent of prisoners surveyed also expressed little or no knowledge about THN prior to training. Prisoners were resistant to THN as an intervention resulting from this lack of prior knowledge. Focus group interviews suggested that there was a confused and mixed message in providing a harm reduction initiative within the context of recovery-orientated treatment. Prisoners also exhibited name confusion with other drugs (naltrexone) and there was some degree of resistance to being trained based on perceived side-effects brought on by its administration. Prisoners were also acutely aware of official agency perceptions (e.g. police) if seen to be in possession of THN kits.

The distribution of THN within a custodial setting requires consideration of wider marketing approaches to address levels of confusion and misapprehension amongst prisoners.

The study is one of the few focused on THN based on a UK prison environment.

Opioid substitution treatment (OST), such as Buprenorphine, has become a well-established evidence-based approach for the treatment of inmates with opioid use disorder (OUD) in most of the developed world. However, its application in Lebanon remains mainly as a community-based intervention. The purpose of this paper is to highlight the need of its implementation within the Lebanese correctional system.

The work is a pilot cross-sectional study that compares two groups: 30 male adult prisoners with OUD convictions receiving symptomatic treatment and 30 male adult community patients with OUD receiving Buprenorphine. The objective was to measure the difference in the patients’ general perception and satisfaction of the treatments available. OUD was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders 5th Edition criteria and the level of satisfaction was measured by “Treatment Perceptions Questionnaire (TPQ).”

The prison group reported significantly lower satisfaction when compared to the community group (total TPQ mean scores: M=34.73, SD =4.12 and M=16.67, SD =4.78, respectively, with t (56.76) =15.68, p=0.000). Furthermore, age, marital status, education level and elapsed time in treatment had no significant interactions with the total TPQ score.

The major principles of the ethics of care and evidence-based safe practices will be proposed for the introduction of Buprenorphine to Lebanese prisons. This work provides an opportunity for the expansion of the Lebanese OST program and consequently other countries in the region could benefit from this experience.

This paper examines the social and institutional context of barriers to drug service throughcare and aftercare for prisoners in England and Wales, including those that specifically affect Black and minority ethnic prisoners. A research project in 2004 reviewed relevant literature and statistical data, mapped prison drug services, and sought the perspectives of relevant stakeholders: in total, 334 individuals were recruited to the study. The methodology facilitates analysis of the structure of services and the agency prisoner in accessing them. Recommendations are made for changes to the structure and delivery of prison drug services.

There is a strong political imperative to regard the prison as a key social setting for health promotion, but evidence indicates that drug misuse continues to be a significant issue for many prisoners. This paper aims to examine the social and environmental factors within the setting that influence individuals' drug taking.

Focus groups and interviews were conducted with prisoners and staff in three male training prisons in England. The sampling approach endeavoured to gain “maximum variation” so that a broad based understanding of the prison setting could be gathered. The data were analysed in accordance with Attride‐Stirling's thematic network approach.

The findings suggest a myriad of social and environmental factors influencing drug use. While staff recognised the scale of the drugs problem, they struggled to cope with creative inmates who were not perturbed by taking risks to gain their supplies. Fellow prisoners played a major role in individuals' decision making, as did the boredom of institutional life and Mandatory Drug Testing (MDT) policies within the institutions.

Drug treatment is an essential component of prison healthcare, but it only forms a small part of creating a health‐promoting setting. If the health‐promoting prison is to be fully realised, a more radical, upstream and holistic outlook is required.

The settings approach is an important theoretical and practical approach in health promotion. In comparison to other settings (such as schools), however, there has been limited research on the prison as a health‐promoting environment.

Cognitive-behavioural interventions, such as the substance related offending behaviour programme (SROBP), are being implemented across forensic contexts in an attempt to address the detrimental economic, social and personal impacts of substance use and offending. Whilst support exists for the effectiveness of such treatment, there remains to be limited knowledge of offenders’ experiences of treatment and factors that promote treatment efficacy and support desistance. This study aims to develop an idiographical understanding of those processes.

Six prisoners who had completed the SROBP were interviewed via a semi-structured schedule to collate their individual experiences of engaging in treatment. Interviews transcripts were analysed by the lead researcher using interpretative phenomenological analysis, and external auditing analysis was conducted by the research supervisors.

Three superordinate themes resulted: “Therapeutic processes and relationships,” “Therapeutic outcomes” and “Threats to post treatment recovery.” Participants identified factors which facilitated the effectiveness of treatment and were effective in meeting their needs, although there were other factors that required improvement.

The important role of motivation at various stages of treatment as this engenders commitment to treatment aims and longer-term recovery. Treatment efficacy is linked with perceived relevance and value of treatment outcomes in supporting desistence from substance use. Pro-social peer relationships are important for effective application of learning and recovery. Attentiveness to participants specific needs is required. The lack of post-programme support has the potential to threaten therapeutic alliances and reinforce experiences of rejection and abandonment. The management of the exit phase from programmes is critical.

Results are discussed in light of their implications for future working practices in supporting therapeutic processes and rehabilitative culture.

Dual‐diagnosis strategies are developing in medium secure services in response to both government policies and clinical need and there has been a move towards integrated services for this patient group. Substance use that has been a feature of the index offence must be taken into account as much as psychosis or the offending behaviour. Treatment of dual diagnosis relies heavily on cognitive‐behavioural therapies. Relapse in either psychosis or substance use increases risk and re‐admission rates to medium security. This paper reviews the literature on family interventions in dual diagnosis and its applicability to forensic mental health inpatient services. As there appeared to be limited direct evidence, various domains were examined and extrapolated to a forensic setting as appropriate. The review indicates the potential for positive outcomes for families following family interventions in dual diagnosis, which may be beneficial in a forensic setting in lowering risk.

With permission, this paper is an edited and abridged version of an article written by Richards, Doyle and Cook for The British Journal of Forensic Practice (Richards et al, 2009), detailing their literature review on family interventions in dual diagnosis and with reference to forensic mental health care. There appeared to be limited direct evidence, therefore various domains were examined and extrapolated to a forensic setting as appropriate. The review indicates the potential for positive outcomes for families following family interventions in dual diagnosis, which may be beneficial in a forensic setting in lowering risk.

Insomnia is a problem commonly identified by remand prisoners who also have a concurrent dual diagnosis of substance misuse and mental health problems. Historically, sleep problems in prison have been treated with either hypnotics or benzodiazepines but these cause adverse side effects and are often misused. Valerian teabags were introduced in 2004 but their efficacy was untested within the prison setting. The aim of this study was to establish whether Valerian teabags improve subjective sleep quality for men with sleep disturbance and dual diagnosis in a remand prison setting within a 14‐day period. The findings show that herbal alternatives appear to improve sleep quality for prisoners with complex needs.