title: Conspicuous by their abstinence: The limited engagement of heroin users in English and Welsh Drug Recovery Wings.
abstract: BACKGROUND
  In recent years, an abstinence-focused, 'recovery' agenda has emerged in UK drug policy, largely in response to the perception that many opioid users had been 'parked indefinitely' on opioid substitution therapy (OST). The introduction of ten pilot 'Drug Recovery Wings' (DRWs) in 2011 represents the application of this recovery agenda to prisons. This paper describes the DRWs' operational models, the place of opiate dependent prisoners within them, and the challenges of delivering 'recovery' in prison.
  
  
  METHODS
  In 2013, the implementation and operational models of all ten pilot DRWs were rapidly assessed. Up to three days were spent in each DRW, undertaking semi-structured interviews with a sample of 94 DRW staff and 102 DRW residents. Interviews were fully transcribed, and coded using grounded theory. Findings from the nine adult prisons are presented here.
  
  
  RESULTS
  Four types of DRW were identified, distinguished by their size and selection criteria. Strikingly, no mid- or large-sized units regularly supported OST recipients through detoxification. Type A were large units whose residents were mostly on OST with long criminal records and few social or personal resources. Detoxification was rare, and medication reduction slow. Type B's mid-sized DRW was developed as a psychosocial support service for OST clients seeking detoxification. However, staff struggled to find such prisoners, and detoxification again proved rare. Type C DRWs focused on abstinence from all drugs, including OST. Though OST clients were not intentionally excluded, very few applied to these wings. Only Type D DRWs, offering intensive treatment on very small wings, regularly recruited OST recipients into abstinence-focused interventions.
  
  
  CONCLUSIONS
  Prison units wishing to support OST recipients in making greater progress towards abstinence may need to be small, intensive and take a stepped approach based on preparatory motivational work and extensive preparation for release. However, concerns about post-release deaths will remain.
authors.affiliation: Mental Health and Addictions Research Group, Department of Health Sciences, University of York, YO10 5DD, United Kingdom. Electronic address: geoff.page@york.ac.uk.
authors.forename: Geoff
authors.initials: G
authors.lastname: Page
authors.affiliation: Independent Consultant, United Kingdom.
authors.forename: Lorna
authors.initials: L
authors.lastname: Templeton
authors.affiliation: Social Policy and Social Work, University of York, YO10 5DD, United Kingdom.
authors.forename: Sharon
authors.initials: S
authors.lastname: Grace
authors.affiliation: Independent Researcher, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Roberts
authors.affiliation: Centre for Drug Misuse Research, 19 Keith Street, Glasgow G11 6QQ, United Kingdom.
authors.forename: Neil
authors.initials: N
authors.lastname: McKeganey
authors.affiliation: Centre for Drug Misuse Research, 19 Keith Street, Glasgow G11 6QQ, United Kingdom.
authors.forename: Chris
authors.initials: C
authors.lastname: Russell
authors.affiliation: Institute of Criminology, University of Cambridge, Sidgwick Avenue, Cambridge CB3 9DA, United Kingdom.
authors.forename: Alison
authors.initials: A
authors.lastname: Liebling
authors.affiliation: School of Psychology, University of East London, Stratford Campus, Water Lane, London E15 4LZ, United Kingdom.
authors.forename: Zetta
authors.initials: Z
authors.lastname: Kougiali
authors.affiliation: Mental Health and Addictions Research Group, Department of Health Sciences, University of York, YO10 5DD, United Kingdom.
authors.forename: Charlie
authors.initials: C
authors.lastname: Lloyd
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D055030:Drug Users / Q000523:psychology*; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006556:Heroin Dependence / Q000188:drug therapy / Q000628:therapy; D006801:Humans; D008297:Male; D058850:Opiate Substitution Treatment / Q000379:methods; D011329:Prisoners / Q000523:psychology*; D011330:Prisons / Q000458:organization & administration; D006113:United Kingdom
keywords: Abstinence; Drug treatment; Heroin users; Prison; Recovery; Recovery capital