DRUG USE AND PRISONS: AN INTERNATIONAL PERSPECTIVE

Drug Use and Prisons: An International Perspective Eds David Shewan, John B
Davies Harwood Academic, 19 [pounds sterling], pp 256 ISBN 90 5823 004X

Rating: *

Illicit psychoactive drugs agitate minds and arouse passions even among
non-users. The public debate is dominated by high emotions, strong
simplifications, and immutable views. It is therefore refreshing to read
Drugs: Dilemmas and Choices, a lucidly written book summarising major
research findings which discusses various policy options, ranging from
trying to keep the status quo to different degrees of legalisation, and
which keeps an open mind.

The content of the book mirrors the multifaceted nature of the drug
problem. After a brief presentation of the most important drugs, there is a
historical overview of the recreational use of drugs and efforts to control
their use, spanning from Sumerian beer drinking to the current epidemics of
heroin, ecstasy, and crack cocaine. There is a balanced discussion of the
complex causes of drug use, and good reviews of the consequences and
treatment of drug use. The latest references are from 1999. Unfortunately,
not all factual statements have been backed up by evidence. Captivating and
thought provoking topics include the international drug trade, the
international and national efforts to prevent and control drug use, and the
dynamics of major epidemics, from gin drinking in 17th century England to
today's "war on drugs" in the United States.

One of the book's recommendations is that, within Britain's current
expenditure on tackling drug problems, funding for treatment should be
increased and activities of customs and the police decreased. This
recommendation is based on there being evidence that methadone maintenance
treatment decreases illicit drug use and crime but there being no such
evidence for law enforcement.

Lack of evidence is, however, a weak argument for relaxing control efforts.
Would it not be better first to try to acquire evidence for the
effectiveness of various law enforcement methods? Historical evidence
suggests that law enforcement has been useful in the control of alcohol,
tobacco, amphetamine, and opioids. When British Customs and Excise says
that it can intercept only 5-10% of the drugs entering the country, there
is room for applying more intensive control efforts and evaluating their
effects.

One puzzling contradiction is that the RAND Corporation in the United
States found that treatment was more effective in reducing cocaine use than
any type of law enforcement, whereas this book concludes that no treatment
for cocaine dependence has been conclusively shown to be effective in
producing sustained abstinence.

Another recommendation is that efforts with proved effectiveness should be
favoured and that those that have been shown to be ineffective should be
stopped. The ineffectiveness of school based drug education could have been
stated more emphatically. There is clear evidence that such programmes,
except those against cigarette smoking, do not work and may sometimes cause
harm.

How should we deal with the drug problem? Unfortunately, as the authors
conclude, there are no easy answers. We need more research, social
experiments of various policy options, and a well informed public debate.

An excellent start to this debate would be to read this book. I'd love to
see an enlarged, updated, and thoroughly referenced second edition. The
drug problem is likely to be with us for some time, and this book could
continue to be a cornerstone of all policy discussions.

Illicit use of psychoactive drugs, HIV infection, hepatitis B, and
hepatitis C have been observed among prisoners for decades. Drug Use and
Prisons: An International Perspective gives an idea of how large these
problems have become and how little has been done to prevent and treat them.

Case reports from several countries show that prisons are not doing all
they could and should. This multiauthor book has chapters describing the
situation in Australia, Brazil, Germany, the Netherlands, Switzerland,
sub-Saharan Africa, Britain, and the United States. However, there is no
justification given for choosing only these countries.

The responses to drug problems vary greatly. The hard core Swiss addict may
legitimately have his or her dose of heroin. The United States, with its
thriving prison industry with over a million clients, has many kinds of
behavioural treatment projects, but not a word is said about methadone
maintenance or needle exchange programmes. Are such interventions
incompatible with US "zero tolerance" ideology?

Most of the chapters are clearly written, although some are heavy to read
because of data overload. Several chapters lack summaries and conclusions.
Lack of vigorous editing makes the reader's task burdensome, although the
content is informative. This is definitely only for those who need
specialist level information on health problems in prisons.

Ratings are on a 4 star scale, 4=excellent

Kari Poikolainen research director, Finnish Foundation for Alcohol Studies,
Helsinki, Finland