Sarah Larney, Bradley Mathers and Kate Dolan Illicit drug treatment ...

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2.2.2 Psychiatric complicationsOngoing psychostimulant use can result in mood disturbances and/or psychosis. Patientsmust be carefully assessed for psychosis, depression and suicidal ideation and appropriatemedications prescribed. Patients with severe psychosis or suicidal ideation may requirehospitalisation.2.2.3 Experimental pharmacotherapiesStudies are underway to determine the efficacy of mirtazapine in treatingpsychostimulant withdrawal. A recent study in a criminal justice setting in Thailandfound that patients treated with mirtazapine had reduced withdrawal severity scorescompared to a placebo group (Kongsakon, Papadopoulos, & Saguansiritharn, 2005).Pending further studies, mirtazapine may be a useful pharmacotherapy for use inpsychostimulant detoxification in prisons.2.3 Psychological supportPsychological support in the form of accurate information regarding withdrawalsymptoms and strategies for coping with cravings can be useful in reducing patientanxiety and preparing the patient for the withdrawal experience. Psychological support isalso valuable in cases where withdrawal symptoms continue beyond the provision ofwithdrawal medications. Providing psychological support during withdrawal adds to theeffectiveness of pharmacological treatments (Amato et al., 2004).13
3. DRUG-FREE WINGSVoluntary drug-free units or drug-free wings are a form of residential correctionaltreatment program with the primary objective of rehabilitating offenders with histories ofillicit drug use. Inmates residing in drug-free wings are segregated from the generalprison population and pledge to abstain from drug use, usually in return for increasedprivileges such as recreational facilities or improved accommodation. Inmates areregularly urine tested and punishments for a positive urinalysis include loss of privilegesor expulsion from the program (Incorvaia & Kirby, 1997). Drug-free units are usedwidely across Europe (Zurhold, 2004) and Australia (Black, Dolan, & Wodak, 2004), yetvery little is known about their long-term effectiveness as few have been evaluated.Programs offered in drug-free wings also vary widely so the precise factors thatcontribute to a positive rehabilitative environment are uncertain.A study of a drug-free wing in a Dutch prison compared behavioural changes of inmatesin a drug-free wing to those in the general prison population and those in a specialistdrug-free detention centre. Schippers et al (1998) concluded that there were nodifferences between these groups at one-year follow-up on drug use, criminal recidivism,social functioning or physical functioning. However, compared to the comparison group,a greater proportion of inmates in the drug-free wing were referred to drug treatmentafter release (64% v. 26%). Inmates from the drug-free unit were also more likely thanthose in the comparison group to have actual contact with a treatment agency (42% v.8%). These results suggest that drug-free wings may assist inmates to access treatment onrelease (Schippers, Van den Hurk, Breteler, & Meerkerk, 1998).An analysis of predictors of behaviour change in this study concluded that changes inrecidivism among drug-free wing participants could not be predicted. Changes in druguse could be predicted to a limited extent by legal status of income; those who reportedthat their main source of income was legal showed a decrease in drug use at follow-up(Breteler, Van den Hurk, Schippers, & Meerkerk, 1996).14
Page 1: Sarah Larney, Bradley Mathers and K
Page 5: AcknowledgementsAn earlier draft of
Page 9 and 10: 1. INTRODUCTIONThe relationship bet
Page 11 and 12: 2. DETOXIFICATIONDetoxification is
Page 13: To date, there have been no publish
Page 17 and 18: 4. THERAPEUTIC COMMUNITIESThe thera
Page 19 and 20: completion, which in turn was assoc
Page 21 and 22: of similar cost-effectiveness to MM
Page 23 and 24: prison in New York revealed that th
Page 25 and 26: 5.2.4 Levo-alpha-acetylmethadol mai
Page 27 and 28: outcomes should be conducted. Other
Page 29 and 30: Dolan, K., Wodak, A., Hall, W., Gau
Page 31: Ward, J., Mattick, R., & Hall, W. (

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