Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers

1. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Rome Consensus Meeting Rome, 14-15 December, 2009 Magdalena Sánchez Granados, Central Office Pablo Villarino Torrado, Ourense Provincial Office

2. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers

3. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Contents Some penitentiary data from Spain and Spanish Red Cross intervention in Penitentiary Centers Frame of Drug Dependency Program Ideology of intervention Program´s structure Conclusions

4. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Some penitentiary data from Spain and Spanish Red Cross intervention in Penitentiary Centers

5. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Some penitentiary data1,2,3,4 • 81 Penitentiary Centers (52 provinces)1 • 166 convicts per 100.000 persons criminality rate, highest in UE2 • More than 76.000 persons in prison (92% men; 8% women)1 • +7,5% in relation to 20083 • More than 16.000 preventive detention (21%) 1 • Convicts: ≈70% crimes against patrimony or public health3 • ≈70% of persons had consumed drugs the month previous to the entry in prison4

6. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Some penitentiary data5 • 8,6% persons in prison have HIV (0,3% in general population) • 63,2% of them taking medication • 92,3% of persons with HIV are coinfected with HCV • 30,7% of persons with HCV are coinfected with HIV • More than 20.000 syringes distributed each year thruough Syringe exchange programs • Methadone maintenance treatment programs in all prisons

7. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Penitentiary Centers location in Spain

8. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Spanish Red Cross intervention5 • 21 Penitentiary Centers (21 provinces) • More than 5.6000 persons attended (91% men; 9% women) • 99 volunteers taking part • Objectives: • To continue the treatment that persons were realizing in the exterior in the moment of the entry in prison • To favour the beginning of the treatment for persons who were not doing it • To reduce the risks and damages associated with the consumption • To improve the quality of life of convicts with drug dependency problems

9. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Spanish Red Cross drug dependency program location

10. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Funding • Drug dependency program has different funding resources: • Spanish Government • Autonomic Government • Local Administration

11. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Context for intervention

12. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Contents • Drug dependency • Person with drug dependency problems • Prison as a context for the subject • Prison as a context for intervention

13. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Drug dependency • It defines the identity for the subject • It expresses an internal discomfort • It marks a way of thinking, feeling and being into relation, with consequences in personal, familiar and social life • It constitutes a strategy of self-preservation

14. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Person with drug dependency problems • He/she consumes substances but also social and treatment resources • is externalizer (does not bear the responsibility) • proves to be ambivalent in his/her definition and in the positioning before the other one: • Victimized • Dominant in the relation • is ritualistic in relation to himself and to others • is impulsive and compulsive

15. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Prison as a context for the subject • It reinforces aspects of the subject´s identity as drug dependent • It contains and at the same time intensifies discomfort • It marks a way of thinking, feeling and being into relation stating an “us” –”prisoners”- different from a “them” –”prison workers”- with whom they are in conflict • It stimulates personal dependence and impedes their taking responsibility for their own lives

16. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Prison as a context for intervention

17. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Prison as a context for our Institution

18. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Ideology of intervention

19. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Contents • With whom do we intervene? • With drug dependent prisoners • With prison workers • With families • With volunteers

20. We intervene with persons with drug dependency problems • Drug dependency is a voluntary exposition to behaviours and experiences that suppose a risk for life in the short, medium or long term • Drug dependency is a symptom of a discomfort that goes beyond the consumption • Crisis and relapses are necessary during the treatment • Person as an entity integrated by the emotional and the corporal thing • Intervention leads to promote the aptitude to manage one´s own life • We work from coherence not from judgments or opinions • Every individual process of change is unique Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Premises when intervening with drug dependent prisoners

21. Prison workers have a work to do and rules to observe • They can facilitate or impede our work • Insofar as they are persons they represent the social exterior diversity • They have a tendency to treat prisoners as an object in order to control their own discomfort • They are often poorly informed and formed and maintain several prejudices • They have a great responsibility: their first duty is to preserve the life of the prisoners • If we involve them they usually cooperate positively Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Premises when intervening with prison workers

22. It is difficult to get in touch with them, but we should try it • Some families are worried, some others are not. But they all are suffering • We must avoid judging families, blame it is not useful • We need to understand the family dynamics. Drug dependency is a family pathology • if we cannot involve family prognosis gets worse • Families can sabotage treatment Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Premises when intervening with families

23. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Premises when intervening with volunteers • Volunteers is compose of people, with fears, prejudices, motivations… • Academic training is a basis but is not sufficient for some types of interventions • Intervention requires the handling of the specific activity that is being carried out and also of the relationship with the user • Not all volunteers have the capacity (experiential) for all activities • Experiences from intervention should be worked out in order to incorporate them to the repertoire of skills and capabilities of the person • We have to take into account the emotional consequences that intervention may cause to volunteers

24. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Program´s structure

25. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Contents • Types of intervention • Organization of the treatment program • Patient profiles

26. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Types of intervention • Information • Reception and admittance • Bio-psycho-social evaluation • Therapeutic intervention • Harm reduction and risk-reduced drug consumption strategies • Health education • Relapse prevention

27. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Types of intervention • Social intervention • Family counselling • Drug prevention activities • Formation activities • Juridical advice • Derivation on the outside • Preparation for release • Treatment coordination and evaluation with agents inside and outside prison

28. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Organization of the treatment program

29. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Activities

30. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Patient profile Profile 1 • Age: 35-40 years • Polydrug addicts, long term heroin addicts, injectors. Principal drug: heroin • Diseases associated to risky behaviours: HIV, HCV, HBV • Low academic level. Drop out of school at early years • Socialization and development problems • Psychiatric problems (with or without diagnosis): either by the prolonged abuse of substances or prior to consumption

31. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Patient profile Profile 2 • Age: 20-30 years • Principal drug: cocaína, associated to synthetic drugs, amphetamine and alcohol • Recreative drug use • Seemingly normalized family, with problems of control on the son. • Development problems: lack of impulse control… • They have no conscience of the problem or risk (in a general way) • Maybe we could talk about a profile 3 in Spain formed by immigrant prisoners due to drugs traffic

32. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Conclussions

33. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers • Penitentiary Centers are spaces that offer important positive factors for the treatment of the drug dependency, though they also present difficulties • The whole prison is our field of work in one way or another • Drug dependency is a symptom of a discomfort that goes beyond the consumption, so treatment must go beyond merely abstinence • If drug dependency determines the identity for the subject, individual –subjective interpretation of reality-, familiar –family relationship patterns- and social factors –rules and values- are implied • Treatment goal is to return to people their ability to manage their own life. This is a paradoxal issue when working with people incarcerated

34. Spanish Red Cross attention and treatment for persons with drug dependency problems in penitentiary centers Data references 1 Official data from Dirección General de Instituciones Penitenciarias- Ministerio del Interior (Prison Service Headquarters -Home Office) http://www.mir.es/INSTPEN/ with access 06-12-2009 2 El País formato electrónico (2009): Muchos presos para tan pocos delitos. http://www.elpais.com/articulo/sociedad/Muchos/presos/pocos/delitos/elpepusoc/20090805elpepisoc_1/Tes with access 08-12-2009 3 Data organized by author from reference data collected in reference 1 4 Study “Drogodependientes que ingresan en prisión: consumo y prácticas de riesgo”. Cited in Dirección General de Instituciones Penitenciarias- Ministerio del Interior (Prison Service Headquarters -Home Office) (2004): Memoria 2003 5 Dirección General de Instituciones Penitenciarias- Ministerio del Interior (Prison Service Headquarters -Home Office) (2009): Boletín epidemiológico de Instituciones Penitenciarias vol. 14, nº 3 (del 1/03/09 al 28/03/09). http://www.mir.es/INSTPEN/INSTPENI/Sanidad/PDF/BOLETIN_03-2009.pdf with access 08-12-2009

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36. Titular de portada Con la colaboración de: Subtítulo www.cruzroja.es 902 22 22 92 Humanidad Imparcialidad Neutralidad Independencia Voluntariado Unidad Universalidad