By Dave Taylor, Policy Officer, and Sam Biondo, Chief Executive Officer at the Victorian Alcohol & Drug Association (VAADA)
Alcohol and other drug (AOD) use contributes to a large portion of criminal convictions. These convictions drive many people with AOD dependency issues into the prison system, often exacerbating existing harms and generally offering little towards long-term positive health and wellbeing outcomes. This article illustrates the inimical nature of the prison system and the range of policy failures evident in this rapidly growing industry.
In Victoria, state elections and most state budgets are focused on significant boosts in funding in policing and corrections service sectors, resulting in a continually expanding police force and prison beds. The current Victorian Government has pledged 1,700 additional police members as well as 940 protective service officers by November 2014. Increasing police numbers inevitably leads to increasing convictions, driving the expansion of prison beds and prisons. At a national level, resource allocation for dealing with AOD related crime is skewed strongly toward supply reduction (law and order) with smaller allocations to treatment and prevention and very little toward harm reduction (this includes initiatives such as needle and syringe exchange programs).
An increase in punitive sentencing, including the recent reforms to the parole system and the abolition of suspended sentences, puts further pressure on the prison system in Victoria.
Not surprisingly, the momentum from the law and order behemoth corrals an increasing number of people into the forensic AOD treatment system (involuntary AOD treatment undertaken with individuals engaged in the criminal justice system), with an increase in forensic treatment referrals from just over 2,000 in 1997-1998 to approximately 15,000 in 2009-2010. The increasing demand is juxtaposed against that driven by the imperative for prisoners with pending parole or sentence management demands to be shortlisted into limited treatment places ahead of those who may have greater need but do not get priority into the system.
The increased demand on the forensic treatment system is problematic not only for the Victorian prison system but the voluntary treatment system as well. Such pressure for treatment is expected to get worse, with the Victorian Auditor-General asserting that capacity in the treatment and rehabilitation services has not kept pace with the increasing prisoner population. Additional resources allocated to the forensic treatment system are necessary to address this issue.
The disadvantage spiral
Prisoners in Victoria experience significant disadvantage. Recent research indicates:
- 46 per cent of people discharged from prison reported that they had been diagnosed with a mental health issue (this includes AOD), with one quarter of prisoners taking medication prescribed for mental health issues
- 34 per cent of prison entrants have completed below Year 10 of schooling
- 48 per cent of prisoners were unemployed in the 30 days leading to their incarceration
- 35 per cent of prison entrants were homeless in the 30 days leading to their incarceration and 43 per cent will be homeless on release
- 16 per cent of prison entrants have reported engaging in self harm and 7 per cent are at risk of self-harm or suicide
- 70 per cent of prison entrants (compared to 12 per cent of Australians aged over 14 years generally) reported that they had used illicit drugs –- and 44 per cent indicated that they had injected illicit drugs – in the past 12 months
- 13 per cent of those discharged from prison indicated that they had used illicit drugs in prison, with 7 per cent indicating that they had engaged in injecting drug use whilst in prison and using unsterile injecting equipment
- 41 per cent of prisoners are infected with Hepatitis C virus, yet only three of Victoria’s 14 prisons offer Hepatitis C treatment
- 84 per cent of prisoner entrants currently smoke compared with 14 per cent in the general community
- 46 per of prison entrants reported risky alcohol consumption in the past 12 months
- the crude mortality rate for prisoners four weeks following release is 15.3 per 1000 person years and 9.1 per 1000 person years over a 365 day period (the crude mortality rate for Australia in 2011 was approximately 5.7 – this figure accounts for all age groupings); 45 per cent of post release prisoner mortality between 2000 and 2007 involved AOD issues.
- mortality rates for Queensland prisoners released under the age of 25 years were 6 times greater than their cohorts in the general community; for young women, the mortality rate was 20 times greater
- drugs were the underlying or contributing cause in 43 per cent of young recently released prisoner mortality and half of all recently released young females
- 44 per cent of prisoners have a history of injecting drug use with 7 per cent using intravenous drugs whilst incarcerated.
Poor prison health
The current absence of evidence-informed harm reduction measures such as needle and syringe exchange programs is telling, with the Victorian Ombudsman noting that 41 per cent of Victorian prisoners are infected with Hepatitis C and 20 per cent infected with Hepatitis B. Exchange programs would facilitate the use of sterile injecting paraphernalia and reduce the likelihood of blood-borne virus contagion. Opposition to such programs stems from perceived risks to prison staff based on a single assault with a syringe in the 1990s. This assault, which occurred over 20 years ago, has not been replicated even though unsterile syringes are ubiquitous in Victoria’s prison system.
Contributing to the system driven contagion of the prison population is the lack of treatment for Hepatitis C within the prison system. Hepatitis C is now a treatable condition and therefore government is beholden to provide treatment to prisoners with this infection. It could be argued that prison provides an ideal time to treat such an illness, as the course of treatment can take up to one year and could be closely overseen by medical staff who could monitor the progress of the treatment and respond to any adverse side effects.
The infection rates will increase as the prison population increases; the Victorian Auditor-General has forecast that the prison system will breach capacity by 2016, notwithstanding the construction of new jails and additional cells and beds tacked onto existing prisons. One means proposed by the Victorian Government of curbing the capacity crisis is to provide a private prison operating additional financial incentives ($40,000 per prisoner) if recidivism rates associated with their prisoners are reduced. This money could be much more effectively spent by providing additional treatment, early intervention and harm reduction programs within the prison system.
Paradox of punishment
The longstanding approach to AOD use within prisons has been highly punitive with a view to deterrence. Penalties for a positive urine test include transfer to another prison, loss of privileges (including visits), loss of prison employment and program engagement (in part by virtue of transfer) as well as fines. The difficulty with this approach is that it is based on the principles of specific and general deterrence, as is the concept of prison. The disjuncture in logic is that the prison drug policy is utilising a principle which has already spectacularly failed. Furthermore, penalties for AOD use impinge upon the efficacy of treatment and rehabilitation programs.
Many prisoners face tough challenges upon release. Those with AOD dependency may find it hard to seamlessly shift from a prison-based pharmacotherapy program to the community program. This issue requires in-depth consideration, due to a number of factors, including the disproportionately high mortality rate within one month of release. Community Pharmacotherapy is currently being reformed into an area-based model and specialist pharmacotherapy services are also being reformed; it is too early to tell whether these reforms will result in greater access, especially for at-risk populations such as recently released prisoners.
Other challenges facing recently released prisoners echo that facing many individuals with AOD dependency issues, including accessing housing and steady employment. Ex-prisoners, by virtue of their criminal history, often face additional challenges in obtaining employment, exacerbating existing weaknesses such as limited skills and education.
 Victorian Premier, ‘PSOs deployed to Mitcham, Pakenham and Altona’, Media Release, 20 May 2013, viewed 1 August 2013, http://www.premier.vic.gov.au/media-centre/media-releases/6850-psos-deployed-to-mitcham-pakenham-and-altona.html?highlight=YTo2OntpOjA7czoxMDoicHJvdGVjdGl2ZSI7aToxO3M6Nzoic2VydmljZSI7aToyO3M6ODoib2ZmaWNlcnMiO2k6MztzOjE4OiJwcm90ZWN0aXZlIHNlcnZpY2UiO2k6NDtzOjI3OiJwcm90ZWN0aXZlIHNlcnZpY2Ugb2ZmaWNlcnMiO2k6NTtzOjE2OiJzZXJ2aWNlIG9mZmljZXJzIjt9
 J Pollard, M Berry, S Ross, and M Kiehne, Forensic AOD treatment in Victoria, Department of Health, Melbourne, 2011.
 Victorian Auditor-General, Prison capacity planning, Melbourne, Victoria, 2012.
 Unless otherwise indicated, statistics are drawn from AIHW, The health of Australia’s prisoners 2012, Australian Institute of Health and Welfare, Cat. no. PHE 170, Canberra, 2013; AIHW, Recent patterns of alcohol, tobacco and other drug use, Australian Institute of Health and Welfare, 2013 viewed 31 July 2013, http://www.aihw.gov.au/recent-patterns-of-alcohol-tobacco-and-other-drug-use/
 Victorian Ombudsman, Investigation into prison access to health care, Victorian Ombuedsman, Melbourne, 2011.
 Quit Victoria, Smoking rates, 2013, accessed 31 July 2013, http://www.quit.org.au/resource-centre/fact-sheets/smoking-rates
 JY Andrews, SA Kinner, ‘Understanding drug-related mortality in released prisoners: a review of national coronial records’, BMC Public Health, vol 12, 2012.
 K Van Dooren, SA Kinner, S Forsyth, ‘Risk of death for young ex-prisoners in the year following release from adult prison’, Australian and New Zealand Journal of Public Health, vol 37, no 4, pp 377 – 382, 2013.
 P Mickelburough, ‘Cash bonus plan for Vic jail operators’, Herald Sun, 18 March.