Use this URL to cite or link to this record in EThOS:
Title: Influences on engagement with drug treatment in prisons : environmental, personal and procedural factors
Author: Asher, Hugh Robert MacIver
ISNI:       0000 0004 6421 9124
Awarding Body: Lancaster University
Current Institution: Lancaster University
Date of Award: 2016
Availability of Full Text:
Access from EThOS:
Reducing drug-related crime through increasing participation in drug treatment is a key feature of the current National Drug Strategy. Prison has been identified as a point of entry to drug treatment; an important setting in which to deliver drug treatment and support; and an opportunistic location to engage drug users in treatment. However, if the system fails to maximise the potential of this situation and actively or substantively engage the drug user with treatment, then a valuable opportunity may be missed. Additionally, if the experience is viewed negatively, it may impact on drug users' attitudes toward engaging with drug treatment in the future. This research primarily seeks to look at factors that influence engagement with prison-based drug treatment, with a focus on providing insight into the influence of the relationship or 'therapeutic working alliance' between prison drug workers and drug-using prisoners. Semi-structured interview data was collected from 63 drug ­using prisoners and 11 prison drug workers from two 'local' prisons. Observational data were also gathered during the year in which the fieldwork and data collection was conducted. Thematic Analysis was used to analyse the data, and three key themes in terms of barriers to treatment engagement and the formation of therapeutic working alliances in prisons were identified. These were environmental barriers; procedural barriers; and personal barriers relating to the drug-using prisoners and to the prison drug workers. Several features of the prison environment and regime were identified as making and maintaining confidentiality difficult and were identified as factors potentially affecting treatment engagement and the strength of the therapeutic relationship between drug-using prisoners and their drug workers. The high ratio of clients to practitioners was identified as detrimental to the intensity of treatment and support that was available. It was also found that appointment systems were uncommon, which meant that prisoners could not prepare adequately for sessions with their drug workers. For some participants, poor support post-release affected their confidence and self-efficacy in achieving changes, and this influenced their engagement with prison-based drug treatment. Whilst there were certain consistent features relating to the drug workers that were identified as important in strengthening therapeutic relationships, sometimes relating to specific characteristics of the client, there was little attempt to match the practitioner to the client to exploit those features that were identified. For example, some prisoners preferred civilian drug workers whilst others preferred uniformed drug workers, but these pairings were rarely deliberately made. The reasons behind these preferences were sometimes founded on the legitimacy with which the client perceived the worker. Uniformed drug workers were seen as less legitimate by some drug-using prisoners, and consequently this posed a barrier to treatment engagement for them. Conversely, longer experience of working in prisons and the perception that uniformed drug workers had a better understanding of what life was like for prisoners than civilian staff did, gave uniformed staff a greater degree of perceived psychological legitimacy for other drug-using prisoners. Likewise lack of life experience in some civilian drug workers was seen as detrimental to perceptions of legitimacy, but having actually 'lived the experience' was seen as increasing psychological legitimacy. Methadone prescribing was also identified as a potential influence, both positive and negative, on treatment engagement and the formation of therapeutic working relationships. Finally, the research also draws on theories of legitimacy, procedural justice and compliance within wider criminal justice interventions, and compares these to the more therapeutic concept of the working alliance. Crewe's typologies of prisoner compliance are used to explore and explain how the therapeutic working alliance could vary in quality and strength between different drug workers and prisoners. Importantly, it has previously been reported by the author of the most widely used concept of the therapeutic working alliance (Bordin, 1979) that a different kind of alliance is evident in prisons. This more collusive type of relationship is discussed and evidence that it may only apply to certain relationships in certain situations is described.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available