Who receives substance abuse treatment in the ‘real world’ of the prison? A register-based study of Finnish inmates

Assessing and targeting substance abuse-related treatment needs according to evidence-based practice has become the norm in most prison administrations. Not everyone with a need will, however, receive support in practical settings. Drawing on Finnish prison registers, we show that of all prisoners released in 2011, 60% were assessed as having a need for substance abuse-related support. Of these, 22% received an intervention in prison. Two multivariate models were used to examine the factors related to selection into interventions. The main factors associated with receiving an intervention with evidence-based programmes were a longer sentence, Finnish nationality, younger age and treatment motivation. The predictors for any substance abuse interventions (including non-evidence-based) were the same, with the exception that motivation was no longer a significant predictor, and female gender remained significant. The selective use of motivation as an entrance criterion for interventions can be a means of systemic adaptation to a combination of a high prevalence of substance abuse problems and a lower prevalence of treatment motivation in the prison population. We discuss how our results might reflect a Scandinavian way of doing evidence-based, prison-based drug treatment—one that stresses rehabilitation as a goal in itself in addition to reducing recidivism. Most prisoners, however, do not receive any intervention at all.     

Not All Substance Dependence Problems are Recognized as Risks—Comparing a Medical Health Study with Prison Assessments

Substance abuse is viewed as one of the main factors (criminogenic needs) to be assessed and targeted in prison. Prison assessments of risk and needs are known to validly predict reoffending. However, there seems to be lacking research in how reliably the individual prisoner’s problems, such as substance abuse, are represented in the assessments. In this study, we compare an independent medical health study (N?=?510) with in-prison assessments for the same persons to see whether some of the inmates’ substance abuse disorders were overlooked in prison. We found that sentence plans (257) were in poor agreement with the health study (Kappa 0.315); they recognized only 65 % of all diagnoses. The risk and needs assessments (178) were in closer agreement with the health study, however, alcoholism diagnoses were recognized less accurately (Kappa 0.519) and less frequently (78 %) than drug diagnoses (Kappa 0.627, 87 %). The main factors predicting an assessment of substance abuse risks in prison, analysed through logistic regression were: longer stay in prison and one or more dependence diagnoses. We conclude that, a number of potentially criminogenic dependence problems remain unrecognized since some groups of prisoners are either completely left out from the more thorough instrument, the risk-and-needs assessment, or are not assessed thoroughly enough. This puts prisoners in unequal positions, since all interventions in prison are based on assessments. The study alerts us of the selectiveness of prisoner assessments in practical settings; the unrecognition of problems of shorter sentenced prisoners and prisoners with alcohol dependence.