Substance use is a significant issue in prisons across England and Wales and it affects the regime stability along with resident and staff health and well-being. This research used case study methodology to identify factors associated with substance use in five English prisons – all of them closed prisons for men. The aim was to explore the wider cultural features of the prisons which, according to the recovery literature, may have an impact on levels of drug use, and has not been investigated in prior research. Observations, interviews, documentation analysis and data gathering were carried out. A total of 78 staff members and 61 residents across the five prisons were interviewed. Using thematic analysis, themes to explore factors associated with substance use across the prisons were generated. There are some limitations with case study designs; whilst qualitative methodology enables the exploration of rich, in-depth information it is difficult to generalise the findings and to explore causal relationships. The learning made may not be relevant to all staff and residents or to other prison sites – particularly to prisons at lower or higher security level or those holding women or younger people. It is also unlikely that the five selected sites will have identified all of the possible factors associated with substance use. Another limitation was that the final site selection may have been biased to sites who were more willing to be involved in research. 

Nine themes emerged from the qualitative analyses, which were clustered into three domains. The first domain was entitled ‘descriptions of drug use’ comprising themes which described the extent and consequences of drug use. This included a theme around the ‘epidemic’ nature of drug use, which encapsulated the perceptions that the extent of substance use was widespread, had major impacts on the prison, staff and residents, and was akin to an epidemic in prisons. Psychoactive substances were the most problematic drug reported. Also identified was a theme around the reasons for drug use, entitled ‘escapism’, to reflect the most commonly cited reason for drug use across the five prisons, as well as a theme entitled ‘prison type and population’, which grouped together perceptions of different contextual factors which impact on drug use, including the specifics of the population held at the prison, the prison type, the regime and staffing levels. The second domain was ‘rehabilitative focus’, and contained three themes: relationships, hope and prison culture. Relationships between staff and residents, and within staffing groups were perceived as fundamental, and differed between prisons with higher levels of substance use and those with lower levels of substance use. In prisons with a more prominent drug problem and amongst those who reported using drugs, there was a real sense of hopelessness and helplessness amongst both staff and residents. The culture of the prisons also seemed to be related to substance use, with more punitive cultures existing in the prisons with greater levels of substance use. The third domain was called ‘enablers of a more effective response to drug use’ and included themes around resources (e.g. staff numbers and time), treatment provision, and prison regime/activity, all of which were factors which could help better address substance use. Resourcing was perceived to be key in dealing with the issue of drug use in prisons. Particularly in prisons with higher levels of drug use, many staff said that they did not have the time to devote to meaningful activity with residents, being instead overrun with paperwork, and managing processes and the consequences of drug use. There was limited treatment provision for substance use across all five prisons, and services were often observed to be quite separate from the rest of the prison rather than an integral part. The provision and availability of purposeful activity and a full regime were deemed important to support the reduction of substance use in prisons.

Recommendations arising from this predominantly qualitative analysis included recognising the extent of drug use, the need to focus on ‘recovery capital’, and adopting a prison wide approach. Improving and strengthening staff and residents’ relationships, a greater use of rehabilitation over a solely punitive stance, better training for staff, a focus on improving procedural justice, and improving communication between staffing groups regarding Substance Misuse Services (SMS) and healthcare services were also recommended.