Addiction to psychoactive substances is closely linked to the commission of criminal offenses, resulting in a high percentage of inmates with this problem in prisons. According to the report of the Administration for the Execution of Criminal Sanctions,[1] there are 5,146 registered drug addicts in institutions for the execution of criminal sanctions, which constitutes about half of the total number of inmates. It is important to note the presence of a “dark figure” here, meaning that official data on the number of addicts is based on direct evidence or the statements of the inmates themselves, and is thus likely lower than the actual number.
Photography: Ana Batrićević, Artwork made by a convict, District Prison in Belgrade, 2023.
The specificity of addiction as a disease and its significant impact on society make this category of individuals particularly vulnerable in a prison environment. In this context, a key issue pertains to the position of psychoactive substance addicts and their rehabilitation, which is very specific when serving a prison sentence. This is because working with this prison population requires the existence of special departments, dedicated work programs, a sufficient number of trained staff, and the motivation of inmates to participate in programs, and so on. Additionally, it demands that those working with psychoactive substance addicts in prisons understand the complexities of addiction, the characteristics of this population, possess the necessary communication and other skills for working with addicts, and exhibit the required patience and so forth.
The treatment must be focused on the individual needs of each convicted person, their specific addiction and motivation, and the role they play in the system of psychoactive substance abuse in prison. The program implemented through individual work should aim to educate about addiction to psychoactive substances and the negative consequences of abuse; motivate for life changes and maintaining abstinence; develop a plan for overcoming addiction problems; provide support for adopting healthy lifestyles, developing personal capacities, and so on. Regarding group work, a specialized program for group work with drug addicts has been implemented in penal institutions in Serbia over the past two years. The general goal of this program is to reduce addiction relapse to reduce criminological recidivism, while the specific goals of the program are as follows: motivation for active participation in treatment; gaining insight into one’s own addiction and treatment needs; changing behavioral patterns, mastering habits and skills, etc. The implementation of this specialized program is significant because it contributes to achieving individual goals, such as adopting socially acceptable behavior models or establishing/maintaining abstinence. In addition, the implementation of the General Cognitive-Behavioral Program, which is applicable to all categories of inmates, including those addicted to psychoactive substances, is also important, as it focuses on changing dysfunctional thoughts and behaviors, enabling learning new ways of thinking, developing healthier coping strategies, and reducing the risk of relapse.
Comparative examples of best practices indicate that prisons establish drug-free units, where inmates agree to random drug tests to confirm they are not using drugs, and in return, they receive incentives such as expanded rights and privileges or better living conditions compared to regular prison units. This is suitable only for those highly motivated to avoid contact with drugs while serving their sentence. In Serbia, there are currently no drug-free units in any prison. Such units were established during 2020/2021 in the Belgrade District Prison and the Penal Correctional Institution in Pančevo but were subsequently closed due to a lack of spatial and staff capacities. Additionally, a drug-free unit program was introduced in the Penal Correctional Institution in Niš but was completely shut down in 2017. According to official statements, the implementation required a separate building, courtyard, and the involvement of more staff, which was not feasible given the overcrowded accommodation capacities and lack of spatial and staff resources.
When it comes to inmates addicted to psychoactive substances, their position and treatment in prisons are complicated by the fact that the majority of these individuals cannot begin treatment in prison. Substitution therapy is only available to those who started treatment in the community before arriving in prison. Substitution therapy is accessible in healthcare institutions from primary to tertiary levels of care. However, healthcare services in prisons fall under the Ministry of Justice rather than the Ministry of Health. The National Mechanism for the Prevention of Torture (NPM) observed during visits to penal institutions that the number of inmates on substitution therapy is significantly lower than the actual needs, precisely because only those who began treatment in the community before incarceration are included in substitution therapy. Therefore, the NPM indicated in its report that it is necessary to improve procedures by enhancing access to opioid substitution therapy in prisons. This would involve creating conditions whereby all individuals with substance abuse issues, whom a prison psychiatrist deems in need of substitution therapy, can be referred to competent healthcare institutions for evaluation and decision-making regarding the introduction of such therapy. The European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment also highlighted the need for improvement in this area in its report on the visit to the Republic of Serbia in 2015[2], and again in the 2021 visit report. Among other recommendations, the Committee called on Serbian authorities to develop a comprehensive strategy to assist inmates with drug-related problems as part of a broader national drug strategy.
To adequately address the healthcare needs of this category of inmates, it is essential for healthcare workers to identify them during intake examinations, pay due attention to their particular vulnerability in prison, provide appropriate therapy, and timely organize the continuation of care upon their release. In this regard, it is necessary to ensure that specialist psychiatric services are available in all prisons. There is also a need for an increased number of treatment officers, security personnel, and healthcare staff, as well as the creation of conditions for the rehabilitation of psychoactive substance addicts. This primarily involves the existence of special isolated units, specialized work programs, and trained staff to ensure that the primary issue of addiction does not remain unresolved and overshadowed by the secondary issue of committing a criminal offense. In short, a special and specialized approach tailored to the needs of this particularly sensitive category of the prison population is required.
Dr Nataša Tanjević
[1] Report on the work of the Administration for the Execution of Criminal Sanctions, 2015
[2] CPT/Inf, (2015) 60