Persistence of drug use during imprisonment: relationship of drug type, recency of use and severity of dependence to use of heroin, cocaine and amphetamine in prison.

AIM: To investigate the persistence of use of heroin, cocaine and amphetamine drugs during imprisonment, and to identify factors associated with increased levels of persistence. DESIGN: The use of heroin, cocaine and amphetamine by current prison inmates has been examined and, in particular, the relationship between drug use within prison and the type of drug used prior to imprisonment, recency of use and severity of dependence. SETTING AND PARTICIPANTS: A randomly selected sample of 1009 adult male prisoners in 13 prisons in England and Wales during 1994/95; structured confidential interviews conducted by independent research staff. Enquiry about prior use of heroin, cocaine or amphetamine focused on three time-periods (ever, last year and last month pre-prison) and the use of these drugs during the first month of imprisonment. FINDINGS: A total of 557 (55%) of the 1009 prisoners had used previously one of the three drugs selected for study: 58% had used heroin, 69% cocaine and 75% amphetamine. More than half (59%; 327/557) had used these drugs in the month before the current imprisonment. Drug use in prisons was most likely to occur among those who had used in the month prior to imprisonment. The persistence of heroin use in prison occurred more frequently (70%) than use of cocaine (20%) or amphetamine (15%). Of those using heroin pre-imprisonment, 67% considered they were dependent, compared to 15% and 22%, respectively, for cocaine and amphetamine users. CONCLUSIONS: Changes in the drug-taking behaviour of drug users after imprisonment vary according to the type of drug being taken. Prisoners were much more likely to continue to use heroin than either cocaine or amphetamines while in prison. Heroin was most likely to be used by those who had been using heroin during the immediate pre-imprisonment period, and particularly by the two-thirds of heroin users who considered themselves dependent. In view of the high prevalence of prior use of these drugs by individuals currently imprisoned, continuing attention is required to study of their behaviour and of the impact of interventions that may be introduced during or following their incarceration.

Measuring therapeutic attitude among drug workers.

A reluctance of nonspecialists to work with drug and alcohol misusers have focused upon belief-based systems, including therapeutic commitment (TC) and situation-specific constraints. This paper describes the development and assessment of a theoretical model for nonspecialist drug workers, characterised as a synthesis of attitudinal and constraints explanations. A cohort of 189 nonspecialist drug workers completed self-report measures of overall TC and situational constraints scales. Predictive analysis of associations between TC, role security (RS), role requirements, and situational constraints was performed to explore direct and indirect effects. Such assessment allowed for the identification of a predictive process by which TC may be established, manipulated, and maintained. Levels of TC were found to be explained by the direct effects of self-esteem (SE), situational constraints, role support, and RS. Role support and situational constraints were also found to have indirect effects. Experience with working with drug users and education on drug-related issues were found to have predominantly indirect effects on TC via situational constraints and RS. Findings show the synthesised model to be partially supported. Implications for the development of a process-driven theoretical understanding of TC and situational constraints are discussed, and applied recommendations for training intervention are presented.