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Schriftenreihe „Gesundheitsförderung im Justizvollzug“ Herausgegeben von H. Stöver, J. Jacob „Gesundheitsförderung zielt auf einen Prozess, allen Menschen ein höheres Maß an Selbstbestimmung über ihre Gesundheit zu ermögli- chen und sie damit zur Stärkung ihrer Gesundheit zu befähigen. Um ein angemessenes körperliches und seelisches Wohlbefinden zu erlan- gen, ihre Wünsche und Hoffnungen wahrnehmen und verwirklichen, sowie ihre Umwelt meistern bzw. sie verändern zu können“. Diese Gedanken leiten die Ottawa-Charta zur Gesundheitsförderung ein, die 1986 von einer internationalen Konferenz verabschiedet wurde. Ver- sucht man den Leitgedanken der Ottawa-Charta, die Stärkung der Selbstbestimmung über die Gesundheit, auf den Strafvollzug zu be- ziehen, stößt man schnell an Grenzen der Übertragbarkeit: Äußere Beschränkungen, Fremdbestimmungen, eingeschränkte Rechte prägen das Leben und die gesundheitliche Lage der Gefangenen. Mit der Schriftenreihe „Gesundheitsförderung im Justizvollzug“ wol- len wir Beiträge veröffentlichen, die innovative gesundheitspolitische Anregungen für den Justizvollzug geben und gesundheitsfördernde Praxisformen des Vollzugsalltags vorstellen. Außerhalb des Vollzugs bewährte Präventionsangebote und Versor- gungsstrukturen werden auf ihre Relevanz zur Verbesserung der ge- sundheitlichen Situation Inhaftierter hin überprüft und auf die Bedin- gungen des Justizvollzugs bezogen. Letztendlich kann nur eine größere Transparenz und Durchlässigkeit des Systems „Justizvollzug“ dazu beitragen, individuelle gesundheits- orientierte Potentiale Gefangener anzuregen und zu fördern. Die HerausgeberInnen Heike Zurhold, Christian Haasen, Heino Stöver Female Drug Users in European Prisons A European study of prison policies, prison drug services and the women’s perspectives volume 12 Bibliotheks- und Informationssystem der Universität Oldenburg 2005 Copyright © 2005 All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying and recording, or by any information storage or retrieval system, without permission in writing from the publisher. Quotation is authorised providing the source is acknowl- edged. Printed in Germany. Publisher Bibliotheks- und Informationssystem der Carl von Ossietzky Universität Oldenburg (BIS) – Verlag – Postfach 25 41, 26015 Oldenburg Tel.: 0441/798 2261, Telefax: 0441/798 4040 E-Mail: [email protected] http://www.bis.uni-oldenburg.de/bisverlag/bisverl.html ISBN 3-8142-0990-7 University of Hamburg With financial support from the European Commission Directorate General Justice and Home Affairs This publication is based upon a condensed version of the final report of a European research project on female drug users in European prisons. The project has been conducted with five European partners between September 2003 and August 2004 and was funded by the AGIS 2003 programme of the European Commission (project number: JAI/2003/AGIS/191). The authors are responsible for all contents and findings presented in this publication. Acknowledgements This study made considerable demands on different groups of participants who provided us with the requested data described in this report. The respon- sible partners of the European research project are grateful to all European Ministries of Justice for participating in the prison service survey. We are also grateful to the numerous members of prison staff and authorities and to the drug services, which established contacts to female drug users in prison and provided necessary information. Last not least, we are particularly grateful to the female drug users who agreed to be interviewed about their history of drug use and imprisonments and their experiences with drug services. Heike Zurhold, Hamburg Jacek Moskalewicz & Justyna Zulewska-Sak, Warsaw Xavier Majo Roca & Cristina Sanclemente, Barcelona Gabriele Schmied, Vienna David Shewan & Gabriele Vojt, Glasgow Heino Stöver, Bremen Table of Contents 1 Introduction 15 1.1 Objectives 16 1.2 Definition of the target group 17 1.3 Methods 18 1.3.1 Questionnaire among the 25 member states of the European Union 19 1.3.2 Questionnaire among female drug users in prison 21 2 Literature review on “drugs & prison” 25 2.1 Problem definition 25 2.2 Characteristics of female drug using prisoners 27 2.3 Health and social problems of female drug users entering prison 27 2.3.1 Drug use and health risks in prison 29 2.4 Drug and treatment services for drug using women in prison 33 2.5 Evaluation results of intervention programmes 37 2.5.1 Impact of intervention programmes on relapse prevention 38 2.5.2 Gender specific needs and barriers for relapse prevention 40 2.5.3 Assessment of best practice based on evaluation results 41 3 Results of the European prison survey 43 3.1 Introduction 43 3.2 Prison population of the 25 member states of the European Union 44 3.3 Adult female prisoners in Europe 46 3.3.1 Prevalence of adult female drug users in European prisons 49 3.3.2 Assessment of drug-related problems in prison 57 8 3.4 Provision of drug and treatment services in European prisons 62 3.4.1 Country specific comparison of available drug services in prison 67 3.4.2 Pre- and post-release services for female drug users 84 3.5 Quality assurance of drug care in prison 87 3.6 Future requirements for drug services in prison 91 4 Description of the prison settings 97 4.1 Hamburg – the prison Hahnöfersand 97 4.2 Barcelona – the prisons Brians and Wad-Ras 101 4.3 Glasgow – the prison Cornton Vale 103 4.4 Vienna – the prisons Favoriten and Schwarzau 106 4.5 Warsaw – the prison Lubliniec 110 5 Female drug using prisoners in five European cities: Results of the questionnaires 113 5.1 Social profile of female drug using prisoners 114 5.1.1 Summary 120 5.2 Delinquency and previous imprisonment 121 5.2.1 Illegal activities and reasons for current imprisonment 121 5.2.2 Lifetime prevalence of prison sentences 129 5.2.3 Summary 139 5.3 Patterns of drug use outside and inside prison 142 5.3.1 Drug use in the month before entering prison 146 5.3.2 Drug use since being in prison 157 5.3.3 Methadone maintenance treatment in prison 163 5.3.4 Summary 165 5.4 Health and social functioning in prison 168 5.4.1 Psychosocial distress of the women 170 5.4.2 Social contacts before and since entering prison 175 5.4.3 Summary 182 5.5 Utilisation of drug services outside and inside prison 184 9 5.5.1 Previous utilisation of community drug services 185 5.5.2 Utilisation of drug services while in prison 190 5.5.3 Access to drug and treatment services while in prison 201 5.5.4 Satisfaction with drug and treatment services while in prison 203 5.5.5 Further drug and treatment services needed in prison 212 5.5.6 Summary 217 5.6 Utilisation of release services and plans for the time after prison release 219 5.6.1 Utilisation and assessment of pre-release services 219 5.6.2 Future plans and support needs for rehabilitation 226 5.6.3 The women’s confidence to realise future plans 233 5.6.4 Summary 235 6 Recommendations 237 References 245 Prison websites in Europe 257 10 Tables Table 1-1: Responses to the Prison Service Survey Questionnaire 20 Table 1-2: Recruited sample 24 Table 3-3: Prison population in the 25 member states of the European Union – an update of 2005 45 Table 3-4: Number of penal institutions for adult female prisoners and number of female prisoners – (n=27) 47 Table 3-5: Country-by-country availability of harm-reduction services – (n=27) 69 Table 3-6: Country-by-country availability of drug treatment services – (n=27) 76 Table 3-7: Country-by-country availability of pre-and post-release services – (n=27) 86 Table 3-8: Implementation of additional drug services in the near future – (n=11) 96 Table 5-9: Social profile of female drug using prisoners – (n=185) 115 Table 5-10: Age at first imprisonment and overall duration of previous imprisonments 135 Table 5-11: Age at the beginning of regular drug use and years of drug use – (n=179) 144 Table 5-12: Drug use in the past 30 days before entering prison – (n=183) 148 Table 5-13: Main routes of administration in the past 30 days before entering prison – (n=164) 155 Table 5-14: Any use of illicit substances while in prison – (n=185) 160 Table 5-15: Available drug services in the ten European prisons involved 191 Table 5-16: Reasons for not utilising services while in prison – (n=42) multiple nominations 192 Table 5-17: Number of women who ever and currently utilised any service 193 11 Table 5-18: Access to drug services in prison – (n=175) – multiple nominations 202 Table 5-19: Benefits of participating in drug or treatment programmes – (n=137) multiple nominations 207 Table 5-20: Satisfaction with drug and treatment services: means (standard deviation) of the Treatment Perception Questionnaire 210 Table 5-21: Additional items on the impact of drug and treatment services 211 Table 5-22: Structural conditions of the discharge planning – (n=184) 220 Table 5-23: Available release services in the ten European prisons 221 Table 5-24: Satisfaction of the women with their preparation for release 226 Table 5-25: Existence of concrete plans for the time after prison release – (n=184) 228 Table 5-26: Self-reported confidence to realise future plans 234 Figures Figure 3-1: Proportion of female prisoners among the national prison populations – (n=27) 46 Figure 3-2: Percentage of adult female drug users on a specific date in 2002 – (n=17) 50 Figure 3-3: Trend in the proportion of imprisoned female drug users from 2001 to 2002 – (n=26)