A BCCDC study found that people who have experienced incarceration are four times more likely to die from drug toxicity than people who have not been incarcerated. In addition, the number of people in British Columbia prisons suffering from co-occurring mental health needs and substance use disorder has increased drastically over the past a few years. As the province invests in mental health and substance use support for people in contact with the law, evaluating the efficacy of programs in correctional settings is critical for determining how successes can be expanded to reach more people and how programs can be shaped on what worked, and what did not.

Dr. Amanda Butler, PhD in Criminology and Epidemiological Systems, has been awarded a 2022 Research Trainee Award from Michael Smith Health Research BC for her study, “Transforming prisons and improving health outcomes for people who use drugs: An evaluation of BC’s prison-based therapeutic community.” Dr. Butler is a postdoctoral trainee with the Department of Psychiatry, UBC and BC Mental Health and Substance Use Services, working under the supervision of Dr. Tonia Nicholls and co-supervisor, Dr. Jason Sutherland.

“Prisons are generally not the ideal environments to treat complex health issues including substance use disorders,” said Dr. Butler. “However, therapeutic communities (TCs) within corrections offer an alternative to traditional prison settings by creating environments focusing on skill-building and accountability through activities like group-based therapy, education, work, and community participation that prepare people for community re-entry.”

Dr. Butler’s study will evaluate an existing therapeutic community, Guthrie House program at Nanaimo Correctional Centre. Run by the John Howard Society/Connective, Guthrie is a voluntary program for people who want to address their substance use and offending needs. According to the BC government, the program “combines work, treatment, counselling and around-the-clock behavioural modelling to address the root causes of addiction and give residents a chance at a new beginning.” It is based on a philosophy that recovery is achieved by changing one’s life, identity, and addressing self-defeating behaviours through community. Every member has a role, senior residents act as mentors for junior residents, and each participant works towards building relationships and embracing responsibility.

The three-year study aims to identify promising approaches to supporting people with substance use disorders, to add to the policy initiatives focused on reducing overdose and increasing access to substance use care, and to uncover what can be scaled up, so corrections as a whole can be more therapeutic and supportive.

Research will focus on three components:

“To date, research in this area has been limited. One of the shortfalls has been the overt focus on recidivism as a marker of success for correctional programming. That is important but only tells you one thing, whether or not someone reoffends—but a person may not reoffend for a variety of reasons, including because they have died of an overdose. That’s not success. We want to paint a more complete picture by looking at a broader set of indicators, like access to health care, continuity of medication, reduced injuries, etc.”

These markers are being developed in collaboration with clients and alumni from the therapeutic community, who form part of a research advisory group. In the past, including correctional clients in studies was sometimes a challenge, as access to people in secure facilities was limited. For this study, BC Corrections and the John Howard Society/Connective are critical team members and are facilitating correctional clients’ participation by giving them virtual access to meetings via video conference. The team has received enthusiastic support from their project partners. The advisory group is also involved in creating the surveys, which may include questions around access to green space, how physical environment contributes to wellness, how client and staff relationships foster or hinder personal development, what has been particularly central to success, and the perceived impacts of program.

“People with substance use disorders face disproportionate barriers that make it more likely that they will encounter the justice system—things like homelessness, poverty, or reduced access to health care,” said Dr. Tonia Nicholls. “If you are living on the street, you are more likely to come into regular contact with police. There are so many complex, inter-related factors to consider. Of course what we want overall is to prevent people with mental health and substance use disorders from criminal offending, but if they end up in corrections, we should capitalize on that opportunity by providing treatment and resources to achieve the dual objectives of reducing the risk of criminal offending and helping people to get well. We want to use evidence-best recommendations to move away from punitive measures that are proven to be ineffective, towards more therapeutic, health-focused correctional programs. That is what we are aiming to achieve with this study.”