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Intoxication and drugs in facilities 

Intoxication and drugs in facilities
Chapter:
Intoxication and drugs in facilities
Author(s):

Jason D. Ourada

and Kenneth L. Appelbaum

DOI:
10.1093/med/9780199360574.003.0024
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date: 21 May 2019

Active abuse of substances by inmates poses a challenge for correctional psychiatrists. Substance use disorders (SUD) are common among inmates, with higher prevalence usually found in those with general psychiatric conditions. Knowledge about substance use in correctional facilities fosters competent clinical intervention and enhances management at all levels. Psychiatrists working in jails and prisons have the challenging task of maintaining therapeutic alliances with patients who have co-occurring SUDs and also may be actively using substances. Patients might not spontaneously report use during incarceration because they fear retribution by correctional staff or not receiving needed treatment for medical and mental health problems. Psychiatrists need to remain aware of this and to screen for SUD and active substance use as part of comprehensive treatment planning. The clinical challenges in jails and prisons differ, and the substances found in facilities vary geographically. Active substance abuse by inmates presents clinical and systemic challenges for correctional psychiatrists. The interplay among mental health, medical, and custody staff regarding screening, detection, triage, management, and treatment lies at the heart of these challenges. Correctional psychiatrists make important contributions by providing direct assessment and treatment to inmates, and by offering educational, clinical, and policy consultations to other staff. These contributions help prevent potentially life-threatening complications of intoxication and withdrawal, ensure integrated and evidence-based care, and avoid misguided or ill-informed disciplinary or other institutional practices. This chapter highlights these differences, outlines clinical management, and describes an interdisciplinary approach to intervention.

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