摘要：

In March 2016, the Probation Service and Irish Prison Service (IPS) published an independent review of alcohol and drug treatment services for adult offenders in the community and in prison.1 The review explores current provision and sets out a model of effective practice for the treatment of adult offenders that can facilitated through a continuum of care from prison to the community. The authors argue that the prison environment provides a unique opportunity to support individuals in addressing addiction, and it is appropriate that a range of treatment and intervention options is provided in the prison estate. Excluding direct staff and general practitioner costs, the IPS and the Probation Service have combined expenditure of €3.33m on the provision of addiction services for adult offenders. Spending has declined in recent years in line with the fall in the number of prisoners held in the prison estate as more initiatives, such as community return, have been introduced. During the course of the review, concern was expressed about the lack of investment in health in the prison system and the absence of a clinical director or health director at senior management level. Reduced expenditure on addiction counselling has resulted in a reduction in the number of addiction counsellors provided by Merchants Quay Ireland (MQI) and changes in the types of services they provide. Some prisons only have part-time access and waiting times for addiction counsellors have increased. Consultations with service providers, the Probation Service, the IPS and the Health Service Executive (HSE) all highlighted a number of recent changes that were affecting the capacity to treat offenders with addictions:<li style="color: #000000;">A decline in opiate-based addiction and an increase in the abuse of benzodiazepines, novel psychoactive substances, opiate-based analgesics, and other narcotics as well as increased polysubstance abuse;<li style="color: #000000; font-size: 11pt;">Increasing numbers of offenders presenting with comorbidities, most notably mental illness combined with drug and/or alcohol addiction;<li style="color: #000000; font-size: 11pt;">The ready availability of drugs within the prison system;<li style="color: #000000; font-size: 11pt;">Younger people with complex needs, such as drug addiction combined with chaotic personal lifestyles, homelessness, mental health issues, poor literacy, and communication skills deficits. A cohort of offenders moving in and out of the criminal system poses significant challenges to effective treatment. Female offenders are more likely to be chaotic substance users than their male counterparts. This results in particular challenges when treating their addictions. Model of effective practiceThe review sets out a model of effective practice aligned with the principles set out in the National Drugs Rehabilitation Implementation Committee (NDRIC) framework and refined following consultations with community-based organisations (CBOs), prison-based health teams and addiction counsellors, and a review of international literature. The model recognises that recovery takes time and often requires several episodes of treatment and that the person in recovery should have a broad range of options available to facilitate the process. Good communication both within the prison system and between the prison environment and the community are necessary to ensure clear treatment pathways and that the opportunity provided by time in prison to address addiction is taken. The core components of the model are pre-work and preparation, referral, assessment, care planning, case management, treatment and recovery management.<p style="margin: 0in 0in

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