Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

362 IV. SPECIAL POPULATIONSdrawal from any substance, but especially alcohol, benzodiazepines, or othersedatives. It is common for those who are surrendering to have had a “last hit”before entering incarceration. For long-term users who are not actively intoxicatedor in withdrawal, the opportunity to be referred to rehabilitation programscan be missed. Medical screening at intake can likewise be of greatimportance, because it alone may produce evidence of an SUD. Conversely, ahistory of an SUD prompts further, specialized medical assessment. These individualsare at high risk for infectious diseases such as human immunodeficiencyvirus (HIV) and the viral hepatidities, especially hepatitis C (Baillargeon et al.,2003).Screening instruments and other manner of case finding need to be appropriatefor the setting. In general, searching for SUDs among the incarcerated isdifficult because of a high degree of antisocial personality style, which includesdenial and sometimes the wish not to attend to one’s addiction. For this reason,the authority must use instruments or simple assumptions to lead to the case.Instruments such as the Michigan Alcoholism Screening Test (MAST) and theCAGE Questionnaire are helpful in the assessment of alcohol use in the primarycare setting but have not been specifically assessed for use among prisoners.It is likely that the single best means of finding cases is through face-to-faceclinical evaluations with nonaggressive interviewing styles. Additionally, findingson physical examinations, such as spider angiomata, needle tracks, nasalseptum injuries, or autonomic arousal may trigger suspicion. Testing of bodyfluids or hair is seen as costly and inefficient, since it basically serves to confirmeither use in the past days or at some point in the past 3 months. Nonetheless,urine, blood, and hair testing, which all have high rates of sensitivity and specificityfor cannabis, opiates, benzodiazepines, and alcohol, can help (see Chapter4, this volume). Screening for SUDs must also be geared to detect comorbidpsychiatric conditions, which are common among the addicted incarceratedpopulation.Long-Term IncarcerationFor those who remain in custody for months or years, another approach isneeded. In this setting, there is the opportunity for treatment and possibly rehabilitation.On the other hand, drugs and alcohol also make their way to prisoners.Authorities and clinicians must be ready to address both issues.There is great variation in the available resources given to long-term treatmentof addictions among the incarcerated. Unfortunately, many prison systemsdo not address addiction in long-term inmates. Or in some systems, addictionis addressed only in the last months of incarceration. On the other hand,other systems have ongoing Alcoholics Anonymous (AA) meetings, education,and group, and even individual, psychotherapies.