The role of the Prison Service in rehabilitation of drug dependents
Author: T. G. J.P. GARNER
Pages: 19 to 23
Creation Date: 1970/01/01
Much has been said and written about the problem of drug dependence by many people, from many professions and from all walks of life, and now as a penologist, I would like to present my view.
I know that to some people it is inexcusable to even remotely consider that the two, penology, and drug dependence, could or should in any way be connected; however in so much as the problem of drug dependence is widely misunderstood, so too is the position of the role of the Prison Service in the field of social defence, and to some, its role is practically unknown.
The object of this paper is to clarify the position, and to clearly define the role that the Prison Service can, and must play in the field of drug dependence, if it is to fulfil its proper role in the field of social defence.
In this context I have decided to divide the paper into three parts under the headings " Why "," Where ", and " How ". The " When " needs no explanation, being self explanatory. Reference to drug dependence relates mainly to dependency on opium and heroin.
REASONS FOR INVOLVEMENT OF THE PRISON SERVICE
No one in the Prison Service if asked could honestly say that the service should voluntarily enter into the field of treatment of drug dependence; indeed, the Prison Service would not wish to add this to the already complex problem of rehabilitation of offenders.
The plain truth is the Prison Service in any country where the problem of drug dependence is present will have any one of three alternatives:
Ignore the problem saying it is none of their business;
Superficially treat drug dependents mainly in the first stage of physical withdrawal;
Plan a proper programme of treatment and rehabilitation and promote research into the problem in order to improve methods of treatment, gain further knowledge and adjust to the changing pattern of drug dependence.
It is not true to say that if drug dependence was not an offence, or if (and this would be a very big IF indeed) possession of drugs was not an offence, then the question of treatment in prisons would not arise.
Hong Kong has had the opportunity within the past 30 years to see both sides of the picture, and I can therefore quote with authority the following extract from a prison medical officer's report dated 26th February, 1940 covering the year 1939:
Suffering from chronic opium poisoning
Suffering from heroin
In those days licensed opium shops existed, yet, despite the ease by which opium could be obtained, a total of 31.26% of persons admitted to prison were found to be drug dependent.
The answer of course lies in the fact that they were not admitted for offences related to drugs at all, yet their problem of drug dependence was, and still is as acute as the problem of the person who is admitted because of a drug offence and who is drug dependent.
Turning to those who are found in possession of drugs, charged, found guilty and committed for treatment, it is often overlooked that many of these persons did willingly and with intent procure the drug for their own consumption, and as the law stands, knowingly broke the law in the first instance in order to obtain the drug. It is often said that ignorance of the law is no excuse. Should this be an exception?
I hold that it should not, because apart from the unwillingness of many to come forward voluntarily for treatment, they are still prepared to ensnare others, men, women, or young persons, particularly for financial gain or as a means of obtaining their supply.
Probation, fines, binding over, etc. is not the answer; the answer lies in treatment and rehabilitation and this applies to the first offender. However, everyone deserves an opportunity to make good, and in some cases subsequent consideration might be of benefit. Legislation should therefore exist by which no conviction need be recorded if this is considered desirable and in the interest of justice.
So we now determine the reason why; the Prison Service must become involved with the problem and play its full part in assisting those who come within its sphere of influence.
It is clearly undesirable to ignore the problems of drug dependents; indeed it would be folly to do so, and completely out of keeping with the task of the Service.
No one really knows just how many drug dependents there are in a given community, it therefore follows that it is difficult to estimate the percentage that come forward for voluntary treatment. Treatment therefore through the Prison Service can, and should be, classified as enforced treatment. I know from personal experience that this has saved many a life, the person having been in a very weak and exhausted condition on admission.
TYPE OF INSTITUTION AND ENVIRONMENT
If one agrees with the premise that the problem of narcotic drug dependence is a psychiatric one, then the question of where is solved immediately.
However, from the outset I want to make it quite clear that I do not subscribe to the belief that this problem is one for the psychiatrist and the psychiatrist only. That there is ample scope for the psychiatrist of this, there can be no doubt, and perhaps in a more affluent society it might be greater, but to put the problem completely in this sphere has contributed towards the poor results which have been produced over the years in the countries where this has been done.
This has not been due to a lack of effort by psychiatrists, indeed I admire the strenuous efforts made by men and women in this profession to seek a solution to the problem, but the plain fact is that in some cases the wrong tool has been used for the job.
Many and varied are the causes for taking drugs in the first instance; among them are relief of pain, curiosity, and the adventurous spirit of youth. These are not symptoms of mental illness and the latter two expressed in different ways can be very healthy signs.
The use of psychology is very important and essential to the programme; it is here that I draw the line between psychiatry and psychology which are not the same but are so often confused.
Any attempt to secure a success in this field will always fail unless the co-operation of the person involved is freely given and endorsed with his will to succeed, and even then success will only be his so long as he resolves to remain abstinent.
The natural reluctance on the part of the drug dependent voluntarily to come forward for treatment is understandable. Despite this, many do so and Hong Kong has a growing programme for such persons. For those who do not voluntarily seek treatment, it must be accepted that no amount of persuasion is likely to be effective in motivating them to do so. If such persons are to receive any treatment at all, it follows that compulsion is necessary, at least in the early stages of the programme. This can be so arranged as to offer an alternative to a penal environment, and in this direction lies the where.
Penologists are well aware of the problems involved in the treatment of their charges, age groupings, offences, social background, alcoholism, homosexuality, etc., (we are fortunate indeed to be fairly free of the latter two in Hong Kong), and the necessity to classify and treat according to individual needs; drug dependence therefore constitutes a problem of its own and calls for a specialized treatment environment, or as we call it in Hong Kong, a " Treatment Centre ".
All convicted male prisoners in Hong Kong must pass through a Classification Centre, and it is here the selection of persons for the Treatment Centre is made. At the present time the man [ 1] must be under the direction of the Prisons Department for a specified period decided by the court; it is therefore important that he should be encouraged to make the best possible use of the time he is to be detained.
Critics often seize this point to illustrate their belief that under such circumstances treatment is not possible; I disagree. If this were so, the rehabilitation of persons would surely fail in many fields and, in any case, this approach is geared to those who do not take advantage of voluntary treatment.
I consider it essential that this specified period of time should not be applied to drug dependents who are sent to a treatment centre but should be replaced by an indeterminate sentence of minimum and maximum length from 6 to 18 months.
Apart from providing further incentive for the individual this would also enable drug dependents to complete the treatment programme (the length of which varies with the individual) which is very often not the case as the law stands at the present time.
The penal system today is a far cry from that of 100, 50 or even 20 years ago. Immense changes have been made in this field, resulting in the outdating of the word " prison " which usually signifies a place where a person is kept in captivity.1
Reference to male used for convenience here and in subsequent passages (also applicable to female).
Many of the present-day so-called " prisons " are open institutions which testify to the successful spirit of co-operation which exists between prisoners and staff.
It is therefore against this background that the " where " must be planned: an " open " not " closed " institution which will afford the drug dependent a better environment in which to respond. I accept that if an " open " institution is not considered feasible, then such security as might be necessary should be imposed without making it appear too obvious, but this key question should be assessed taking into account the particular circumstances in each case.
The question that will be posed here is whether or not an open institution will present an easy way for drugs to be taken into the institution. Before this question can be answered, it must be remembered that the final decision in the whole of the treatment process will be taken by the man himself, and that any effort in any direction will be nullified if he decides in the negative.
Despite the many statements made to the contrary, most drug dependents want to be rid of their dependency - the fact that they often experience a complete sense of hopelessness sets up a defence mechanism which triggers off a " leave me alone " attitude.
Placed in the environment best suited to their needs, coupled with the right approach on the part of the staff, a spark can be kindled in most; it is then up to those dealing with them to fan it into a flame.
The spark once kindled goes a long way towards the prevention of trafficking and sets up a resentment against those who do.
It is my experience that treatment in an open institution does not facilitate the trafficking of drugs in the institution, and this has never been a problem at Tai Lam Treatment Centre.
I am well aware of the term " maximum security " and all the factors that go with it. Basically it is to restrict and control in the physical sense, a factor which is not essential in the problem of drug dependence, and in point of fact could adversely affect and even nullify efforts made to succeed.
Human nature often triumphs where the cunning of man fails, and I contend that with the right approach more can be achieved without, rather than with, bars and stone walls.
TREATMENT AND REHABILITATION PROGRAMME
It is my contention that the " how " does not begin on admission to prison, or as in the case of Hong Kong, the Reception Centre; it must go much further back to the time when the drug dependent becomes known to the law.
From here on anything which happens to him including anything said or the manner in which he is handled will condition him for the part that he must play at a later stage in the treatment programme.
I mention this because failure to understand the drug dependent's problems at this stage can create needless barriers, which must be overcome but which arise mainly out of ignorance on the part of the persons with whom he comes into contact.
I therefore consider it essential for law enforcement officers to have an appreciation of the problems which confront the drug dependent, and have some knowledge of the difficulties involved in treatment and rehabilitation. It is also necessary for the drug dependent to receive treatment when undergoing withdrawal symptoms while in police custody.
Once the drug dependent has been admitted to the Reception Centre of the Prisons Department, relief of human suffering must take priority, consequently immediate treatment for withdrawal symptoms must be provided as the first step on what has proved to be a long and difficult road for any drug dependent.
The treatment and rehabilitation programme must consist of 4 basic phases.
Medical treatment for withdrawal and for any other illness or disease from which the drug dependent may be suffering.
Physical build-up. Calculated to restore him to full physical fitness.
Mental build-up. Calculated to assist him in building up resistance against psychological dependence (the main factor in relapse).
After-care. Calculated to assist him after discharge.
In addition a planned programme of research, which not only helps to reveal the problem as it stands, but enables workers in the field to keep abreast of the changing pattern of drug dependence, is essential.
The value of research cannot be over-emphasized; if we are to be successful in dealing with this problem it is necessary to learn all we can about it. This can only be done through a careful and thorough investigation.
An authoritative approach in the treatment field allows for the introduction of a measure of discipline, an element which is essential to the programme particularly in the initial stages; this I contend is a definite asset and one which has been neglected in the past. The introduction of discipline need not be harsh or too evident. It can be maintained firmly, but fairly, with the aim of regulating the lives of those under treatment in much the same way as discipline within society exists.
Any programme of treatment and rehabilitation must be planned to suit the needs of persons subjected to it; cultural background, social background, the pattern of drug dependence, and the affluence of society are among factors which must influence it.
In Hong Kong much has occurred within the past twenty years which has changed the pattern of drug dependence, bringing to bear favourable or unfavourable influences on it. One of the greatest problems has been the degree of ignorance involved, a factor which is not uncommon in other areas of the world where the problem exists, but which fortunately is no longer the case in Hong Kong at least amongst some.
The planning of a programme in an open environment enables the planners to include plenty of outdoor activity of all kinds.
This includes work and manual skills which are important to the programme. They will enable the drug dependent to be employed on tasks away from the Centre, and within the community on projects which will benefit the community.
Inmates will carry out this work under the guidance of staff who act as leaders or supervisors. They must be encouraged to take pride in their work, to make suggestions, and learn to discuss the various problems with the staff and fellow workers as they arise.
This way they will regain self-confidence, re-discover their own working ability, develop a sense of responsibility, and because the work takes place within the community in the open, regain a sense of belonging.
Projects can be numerous: to mention but a few, path laying, road building and small buildings of many kinds; however it is essential that they be interesting and productive and of a type which visibly shows the results of their labour to the persons under treatment.
A drug dependent's progress throughout his stay at the Treatment Centre must be followed with the closest interest by the staff, for much depends on the relationship which is formed. By staff I mean all levels with deep personal involvement from the Superintendent down. It is particularly important for the Superintendent to be involved in order that he can keep his hand on the pulse of the treatment programme, and to make himself accessible to all those subject to it. Staff should not wear uniform.
Inmates at the Centre should be housed in open conditions, without the use of bolts, bars, or locks. Adult education classes, discussion groups, recreation of many kinds, entertainment, religious activities and library facilities are all important aspects of the programme.
The value of after-care cannot, and must not, be under-estimated. Everything possible must be done to foster a good relationship between both parties.
I emphasize the importance of the relationship because I fail to understand how a satisfactory one can exist unless the After-care Officer has been in frequent personal contact with the case from early in the treatment programme.
This allows for a solid foundation, on which a bond of confidence based on mutual trust and understanding can be built, for without this, after-care must surely fail.
Persons discharged who have a home to go to with either parents, wife, 2 children, relatives or even good friends are fortunate. Some will not have this advantage. Arrangements, therefore, must be made to assist them so that they can settle down again within the community.
It is at this stage that a " Half-way House " project will be very valuable - this will provide a link half-way between complete detention and complete freedom.
Persons residing in the house can be allowed to undertake outside employment, going to and from work unsupervised, and paying the cost at least in part of their board at the house.
This will help prevent them from returning to previous unhealthy environments, by presenting the opportunity to settle down in a new district.
Compulsory residence in the house can be arranged for those who require it by making it form part of the rules of after-care. This calls for compulsory after-care with which I am in favour.
We are fortunate to have a Half-way House in Hong Kong, and although only recently opened, I am sure it will eventually play a very important role in the treatment programme.
Some form of Narcotics Anonymous programme is also necessary. This will enable former drug dependents to assist each other, and provide facilities where they can spend their leisure hours. Families should also be encouraged to join in.
Here again we are fortunate to have succeeded in establishing such a club, which, although only established 4 months, has a membership of 75 former drug dependents which is most encouraging.
What I have outlined is a programme tried, proven and workable. It enables former drug dependents to develop self confidence, regain working ability, lose their anti-social behaviour and take on a new lease of life.
Of course some relapse, and we must accept disappointment as well as success (if only to try again) but of one thing I am sure, a person leaving the treatment Centre is in a much better position to face life than he was before he was admitted.
He leaves the Centre with a sense of accomplishment and a renewed interest in life, knowing that the time he has spent at the Centre has been of assistance to him.2
Husband in the case of a female drug dependent.
This then, is the role that the Prison Service can and should play in the treatment of drug dependents. The concept of authority in a therapeutic setting is not only possible, but practical, and is the only way that drug dependents who fail to make use of voluntary facilities can be placed in a therapeutic environment.
I am proud of the progress we have made in this field and view the future with optimism.