AMA I work with prisoners who have substance and alcohol misuse issues

[liftingprincess]

I work in a cat b prison supporting men with substance and alcohol issues who are in custody either sentenced or on remand.

I will not say where I work or describe individual stories.

So they give the opiate ones methadone, subutex etc?

But what about the alcohol ones?

Also you must get people lying about how big their habit is to get more medication. How do you know how much they actually need?

Do you give enough to stop them being sick, but they just want more?

Thank you!

What training do you have? Are you a MH nurse or similar? Or is it a role anyone could get into? (asking because it sounds really interesting!)

Is the drugs coming into prisons as bad as the media says? Is rehab in prisons successful?

@BillieWiper I don’t personally prescribe opioid substance treatments or OSTs but yes many people in come into Prison are given these medications. Unless they have been on subutex or buvidal in the community, people begin on Methadone and once released if they show they are continuing to engage they can progress onto subutex or buvidal. Each case in terms of dose is on a case by case basis. Some people might come into prison having abused methadone. You can also have people inside diverting methadone to sell.
Alcohol detox- can be prescribed benzodiazepines to help when detoxing. When detoxed alcomprasate can be prescribed to maintain abstinence.

@ReflectiveGilet yes there is a lot of substances within prisons sadly. The main one being spice. It is frequently laced with nitazenes which is a synthetic opioid much stronger then heroin. The risk is people will have a lowered tolerance which increases the risk of overdose.

Do the prisoners have the option to attend 12 step meetings, such as AA, NA or CA?

Rehab in prison- depends. If you are in a remand local prison then people are in and out on recalls. The main issue is this means housing can not be arranged, people released homeless no money so they will use them reoffend because if it is snowing or cold prison is warm. In a longer term prison or a training prison as we call it, they are serving longer sentence so more meaningful work from a psycho social perspective can be done. Also longer term to work with resettlement for life after prison. A remand prison holds people for shorter term until release or move to training prison as a rule

What made you choose this job and do you enjoy it?

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@serene12yes…..either internal or external providers as well as group work. I work in a longer term prison so this is more possible. We also ensure support on the out is in place. We encourage people to take ownership of recovery, to work on understanding substance use, to understand triggers and develop strategies to deal with these. We understand recovery is not linear

I do enjoy it a great deal. I chose this job because I understand the many barriers prisoners face. I see the man in front of me not their sentence. People are not given opportunity to build upon recovery. Housing is the main issue. I find it very rewarding mostly. You do have to have boundaries and a thick skin: I have learnt that some people do not want to give up but we hope that eventually something will click. Hardest part is when we hear about deaths once released.

@AmberSpy I have background in forensic settings and mental health. I am not a nurse- the clinical are who prescribe. You do not need experience per se with substances but you need compassion, be non judgemental and have an ability to separate work from home as it’s intense. We do qualifications too.

Thank you. I'm presuming you can't answer about how they know how much they need etc. if you don't actually prescribe?

I am part of the multi disciplinary team who works together. Us from a psycho social perspective. Clinical support goes hand in hand with us..generally I would ask if their medication is holding them, are they having craving or withdrawals or symptoms of this. We then bring this to the clinical team. We discuss how they are presenting. If someone on a script is additionally using spice inside. It’s a collaborative thing.

What % do you suspect are neurodiverse?

I am also always baffled how many drugs enter prisons and how. Makes them very unsafe for staff

I really admire you for doing this.

impossible to say percentage. A lot I would say. A lot of people have experienced significant trauma in their life and had adverse childhood experiences which led them to using as a coping mechanism. A lot of people only have a support network of other who use so it’s hard to break free.

Do you feel there is a revolving door cycle - have lots of these people had poor upbringings, perhaps in/out of care and then struggling to be independent and becoming vulnerable adults, having their own kids also going into care and repeat.

Paper that has been soaked in spice. Throw overs, people deliberately coming in on recalls with it secreted- it’s big money. Clothes- thread soaked in substances

Sadly yes. Many see prison as the only stability they can have and feel safe in- they get a bed, food and structure.
how can we expect people to not use and reoffend if they are released homeless. On day of release they might need to report to probation, visit council to ask for housing support, visit the local community substance team to collect prescription. Walk past an off licence.

Thank you. I do it to help people that’s my motivation always

Thank you for your answer! Another one, if you don't mind - is there anything you wish the general public knew about prison or prisoners?

What are your thoughts on the Rat Park, experiments and the seemingly lack of joined up thinking we still seem to exhibit as a society regarding the connection between lack of basic needs being met, mental health and addiction?

Thanks again!

That we shouldn’t just lock them up and throw away the key. That there are significant social barriers prisoners face. Finally prison is not like a hotel- the conditions are poor and non conducive to rehabilitation.