INTERVENTION ALTERNATIVES FOR DRUG-ABUSING INMATES OF ISRAELI PRISONS
Israel Prison Service
Prisons are junctions through which most drug-abusers pass sooner or later, for offenses such as the trafficking, distribution and use of illegal drugs and property offenses committed to pay for their drug consumption. The Prison Service is convinced that advantage should be taken of their stay in prison to make preventive, orientational, therapeutic and rehabilitational interventions.
The Deployment of Multidisciplinary Teams
The basic premise, accepted by most professionals, is that, although the reasons for drug addiction are still neither adequately known nor straightforward, addiction is caused by a combination of factors, among them psychological, biological and social factors (the bio-psycho-social combination).
On this basis, the treatment of the addict has to be the work of a multidisciplinary team who, by applying a comprehensive but individually oriented approach, can deal with the addict’s problems during his rehabilitation with an optimal repertoire of professional skills.
Success in the treatment of the addict depends on the collaboration and team work of medical staff (unit doctor and paramedics), social workers, specialists in employment and rehabilitation and education, a rabbi and therapy officers of the Drugs Section of the Prison Service.
Successful treatment also requires bringing in specialists in community care from outside the Prison Service (e.g. community care workers, representatives of the Prisoners Rehabilitation Authority and of Narcotics Anonymous (NA), and others) at different stages of the treatment process, especially during preparation for release.
The complications of the drug problem and the high concentration of drug- abusers in prisons require a special effort from all Service staff to cope with and reduce the size of the problem. No Service staffer can include himself out of this effort.
In its determination to recruit every prisoner willing to abandon drugs and return to a normal, drug-free life, the Service has developed a range of interventions. The first stage in the treatment process is diagnosis and classification of the inmate into one of three categories:
2. Occasional or heavy user
3. Drug traffickers (not always users).
This last group are identified by intelligence work and the receipt of intelligence from the Israel National Police (INP).
The three categories are each housed in separate locations:
* Category one in drug-free wings to eliminate contact with addicts, users or traffickers.
* Category two prisoners will be referred to one of the rehabilitation programs according to the depth of their addiction and chances of rehabilitation.
* Category three, the traffickers, are housed separately within the regular wings.
The Range of Interventions
There follows a brief description of the various rehabilitation programs:
Ambulatory Treatment in Facility Clinics
Medication is given (decreasing dosages of a drug substitute such as methadone) to stabilize the prisoner, accompanied by psychosocial interventions designed to improve the inmate’s functioning and prepare him for other forms of intervention. This therapy is performed in the correctional facility clinic (all facilities have one) by general practitioners and psychiatrists from the Unit for the Treatment of Addictions.
The MAGASH Negev Program
("Magash" is the Hebrew acronym for Treatment and Rehabilitation Facility) This is a rehabilitation program located in the south (Negev) of the country to which prisoners are transferred to achieve medical stabilization, resocialization and normal reintegration into society upon their release. Physical withdrawal is achieved either by medication or by total isolation from drugs under psychiatric supervision. After physical withdrawal relapse prevention measures are taken. This program takes in the majority of the target population. Psychosocial therapies aim at improving the ‘normal’ personal, social and occupational functioning of the prisoner to prevent recidivism.
MAGASH Prison Service Medical Center
This facility is designed for total withdrawal and relapse prevention at the psychosocial level. It employs no medication (drug-free) but uses intensive psychotherapy to try and modify the personality of the addict to enable him to change his way of life, behavior and habits. The facility is designed as a therapeutic community and admits only highly motivated and gifted prisoners.
Narcotics Anonymous Groups
The Service has authorized NA to organize self-help and mutual support groups in its prisons. Addicts on the way to recovery and those already recovered receive assistance from ex-addicts who have long been drug-free. The groups meet weekly with NA representatives who convey the message and hope of success by means of the ’12 Steps Program’. This program aims to develop positive leadership by encouraging participants through the twelve steps.
The 18 Steps Program
The program is aimed at prisoners who want to refind their religious vocation. Similar to the 12 Steps Program, it adds elements of the religious life in order to fill the emptiness often felt by those who have renounced drugs and a delinquent life style.
Project Lev (Heart)
This program, initiated by the Prison Service, places addicted prisoners in the same cell with those who have successfully withdrawn from drugs and who assist them also to withdraw physically and mentally. The basis of the project is mutual assistance under professional direction and control.
Health Improvement Workshop
The principal objective of this workshop is to convey the message that it is worth being drug-free and that anybody can do it, whether on his own or with help. The emphasis is on the improvement of physical and mental health.
HALAS (Hebrew acronym for "Life Without Drugs")
This project was designed by the Ministry of Education to enable prisoners to understand their deficiencies and how to surmount them. Participants commit themselves not to use drugs, to separate from those who do, to adopt attitudes that will enable them to find values unconnected with drug abuse, and to accept their personalities and deficiencies without having to resort to drugs.
Here the emphasis is on explanation of the physical and mental damage to the individual and his social life caused by drugs and a delinquent life style. It intends to bring the prisoner to self-knowledge, to know his personality and weaknesses and how to stand up to them and to the causes of his addiction. Through this self-awareness, he is helped to reach a decision to withdraw from drugs and to hold to that decision.
These groups are conducted by social workers for newly arrived prisoners who show an interest in quitting drugs to inform them of the range of programs available.
For that section of the prisoner population that does not use drugs and is not involved in any way with the drug trade and to protect them from negative pressures from other prisoners to start the habit, the Service provides specially controlled, drug-free areas within a facility. To reinforce their resolve not to use drugs they are supplied with special social and educational activities and amenities. More than 500 drug-free prisoners are housed in such wings.
All rehabilitation programs are assisted by urinalysis testing in Prison Service laboratories.
General Directions for Community Involvement and Research
The Service has organized contact with experts in the field to exchange with them knowledge and experience. Efforts are being made to expand research in the following fields:
* The incidence of drug-abuse in prisons
* General information about drug-abuse in prisons
* Medical, epidemiological, social and criminological aspects of drug addiction.
* Therapy outcomes
The Service has also set up contacts with universities and treatment and prevention agencies. In recent years it has sponsored a Drug Forum, a monthly meeting of professionals to discuss aspects of the drug problem. The contact with treatment agencies in the community ensures the continued treatment of discharged prisoners who have received treatment during their prison stay.