Commissioner's Speeches

Making a Sustainable Difference in Corrections

Remarks by:

Lucie McClung
Commissioner of the Correctional Service of Canada
November 8, 2003

To the 29th Canadian Congress on Criminal Justice
Hope Beyond Hurt: Drugs, Crime and Canadian Society"
November 5-8th 2003
Vancouver, British Columbia


Check against delivery

1. Introduction

Hello, ladies and gentlemen. Thank you for giving me the opportunity to speak to you today. The Correctional Service of Canada is pleased to support this conference.

Among the obstacles that today's criminal justice system is facing is integration. We must show the Canadian public that the system's various stakeholders are working closely together to attain common goals even if their day-to-day concerns or activities are somewhat different.

It is essential that we go beyond sensationalism to avoid simplifying a very complex issue. It is only by employing concerted efforts that we will succeed in reflecting the Canadian values of hope and compassion to people who live in situations where suffering is pervasive.

The theme of this conference represents these Canadian values in the face of adversity.

Hope beyond hurt speaks to active intervention. And active intervention speaks to transfer of energy as well as hope - believing that someone can do better if he/she does not believe it or cannot even see a better future for himself or herself beyond today. That is the essence of intervention.

It demands attention to what else is out there and to what else is just waiting to be discovered.

I read an interesting opinion piece in the Montreal Gazette two weeks ago, which effectively underscores the debate around the supervised injection site program that has been going on here in Vancouver and the ones proposed for Montreal and Toronto.

You will be hearing more about this project and others like it later today. According to the article, the goal of these programs is to first stabilize patients by providing heroin and then work towards weaning them off and supporting them through this process.

In his opinion piece, journalist Peter Hadekel states, and I quote: "From an ethical perspective, it's hard to argue with harm reduction. An addict shooting up in a back alley does great harm to herself and others. She risks contracting HIV or hepatitis C through the use of shared needles. She may engage in prostitution or crime to feed her habit. The costs to her and society are considerable. It would seem wise to get these people off the street, and out of harm's way."

But the part that got my attention was where Mr. Hadekel went on to speculate, he says: "…implicit in such thinking is that there's nothing much else that can be done for these people…"

Is this true? Does it mean that we give up?

The fact that we are all here is testament, I think, to our determination to make sure that we do not. At the same time, we know that being realistic and practical is just as important as being hopeful and focused on the long-term.

As Dr. Patrick Smith of the Centre for Addictions and Mental Health said in his keynote address to open this conference, "there is harm reduction and there is harm acceptance". I do not buy into harm acceptance. Therefore, we must we must continually seek better ways.

We need to work on identifying who needs help with their substance problems, and identifying the specific problems that need addressing -- with offender populations, these problems can be wide-ranging and serious. We also need to be able to reach out in individual terms to those who need treatment. Truly engage at the individual level.

And of course, we need to be able to point to a variety of treatments available both inside institutions and upon release to our communities to respond to the spectrum of substance abuse problems and the range of their severity. It is only in so doing that we will minimize the harm associated with substance use.

It is clear that there is a correlation between substance use and crime. About 80% of federal offenders have substance abuse problems. And surveys of Canadian offenders have found that at least 1 in 2 used alcohol and/or drugs on the day of their offence.

So it is clear that there is a link between substance use and crime. But what is the specific nature of that link? Does substance use cause crime, or is it just one part of the lifestyle of criminally oriented individuals? Where, when and with whom should we intervene -- and with what purpose or goal? These are just some of the questions that drive us to better understand and respond to substance abuse.

My plan with you here this morning is to spend a little bit of time talking about how far we have come in addressing substance abuse in corrections. I then hope to challenge you, as I have been challenged, to think about where we need to go. I plan to leave quite a bit of time at the end for questions.

2. Where are We?

We have come a long way in the past 20 years in understanding and addressing substance abuse among the correctional population. And when I say "we," I mean the Correctional Service of Canada, in conjunction with many of you, members of the public, health organizations, community agencies, law enforcement, academia, and our fellow government departments, federal, provincial, territorial and municipal. As Canada's Drug Strategy emphasizes, no one government department can do it alone, and no one approach is sufficient in and of itself.

I have a brief outline here of some of the major initiatives the Correctional Service of Canada has undertaken to respond to the substance abuse needs of our offenders. I have framed our initiatives in line with the Four Pillars Approach adopted by the City of Vancouver in their strategy against drug abuse. The four pillars are prevention, treatment, enforcement and harm reduction. I find this to be a useful framework for discussing our work too.

I. Prevention

The first pillar is prevention.

About four of every five offenders arrive at our institutions with problems related to their use of alcohol, drugs or some combination of both. Our prevention efforts are therefore largely focused on providing information about the substance-abuse programs and other sources of support available. We also provide information to all offenders on such topics as infectious diseases and high-risk behaviours in prison.

In addition, our treatment program for women offenders discusses the effects of substance use during pregnancy and ways of dealing with these effects once a child is born.

II. Treatment

The second pillar in the fight against substance abuse is treatment. How do we know who needs treatment for substance abuse?

Well, we have a computerized assessment tool which research has shown does a pretty good job of identifying which offenders are likely to have substance abuse problems and require treatment. We are now making improvements to this tool and adding an audio component.

As you may have heard earlier during the conference, we are also doing research on Fetal Alcohol Spectrum Disorder (FASD). FASD affects a person's cognitive abilities, among other things, and affected offenders may therefore require specialized intervention. Knowing this, we need to find ways to estimate the incidence of FASD among our offenders and to identify those at risk.

Once we have identified who needs intervention, we have a variety of treatments available both inside our institutions and in the community.

We have developed cognitive-behavioural substance-abuse treatment programs of varying levels of intensity and duration, including one that is high-intensity. An international panel of experts accredited four of these programs, and they will be going for re-accreditation this December.

We are currently piloting a substance abuse program designed specifically for women offenders. It delivers education and awareness training to all women offenders admitted to an institution. Intensive treatment is also available with a strong holistic focus, along with relapse prevention and maintenance programs. It is estimated that at least 70% of women offenders have substance abuse problems.

Importantly, this program was designed specifically for women from the ground up, as opposed to being a male-oriented program that was later adapted for use with women. It reflects the collaborative efforts by many, including our Addictions Research Centre and numerous partners across the country and around the world, such as the Centre for Addiction and Mental Health, and women offenders themselves. A treatment program for Aboriginal offenders, who account for 17% of the incarcerated offender population, is being developed by members of the Aboriginal community with guidance from the Addictions Research Centre and our programming and Aboriginal initiatives specialists.

About 80% of federal Aboriginal offenders report early drug and/or alcohol use, and about 90% have particularly high needs relating to substance abuse. Clearly, this is an area where much work remains to be done and where we need to draw on the expertise of the Aboriginal community.

III. Enforcement

Enforcement is the third pillar, if you will, of our approach to substance abuse.

A 1995 survey of inmates found that more than one-third (38%) reported having used at least one illegal drug since coming to their current institution. With prison populations so highly engaged in the drug culture, keeping drugs out of prisons is a significant challenge. This comes as a surprise to almost everyone not connected to corrections. And yet, it is the number one problem of every correctional jurisdiction in the world.

People who have serious substance abuse problems upon admission continue to have serious substance problems while incarcerated - a reality that many forget.

We have used some tried and true tactics, as well as taking advantage of developing technology, to reduce the supply of drugs in our institutions. For example, we use the gamut of searching techniques along with drug dogs, ion scanners, urinalysis, and a network of intelligence.

It is important to mention here that our policy of zero tolerance for drugs is focused on preventing the entry of drugs into our institutions, not on preventing the entry of citizens, volunteers and visitors into our institutions. Volunteers and visitors are essential to affect change in lifestyle.

We must ensure proper protocols in using these tools and recently, Mr. Graham Stewart, of the John Howard Society, has pointed to issues such as inconsistency in application, records management and the need to carefully assess impact upon our capacity to fulfil the obligations under our Act.

Let me explain what our Zero tolerance policy means. It does not mean that we are shutting our eyes to the reality that we face. It is the opposite. It is all about having our eyes wide open to see and take action when we see.

IV Harm reduction

The fourth pillar is harm reduction.

Even with our best efforts to reduce the supply of drugs in our institutions and the demand among offenders for them, drugs are still getting in.

It therefore obligates us, in keeping with community health standards, to focus on reducing the harm associated with drug use.

Under the Peer Education Program, inmate volunteers are provided with information on high-risk behaviours and infectious diseases. These volunteers then help educate other inmates, and tell them where to get more information.

We encourage offenders to be tested for infectious diseases on admission or at any time during their incarceration. This testing is accompanied by counselling to underline harm reduction messages and ensure inmates understand the test results.

To help prevent the spread of infectious diseases, we distribute condoms, lubricant and dental dams. We also promote immunization for Hepatitis A and B. Recognizing that many infectious diseases are spread through the use of man-made paraphernalia, we provide bleach. We are also weighing the benefits and drawbacks of providing safe equipment for tattooing.

Methadone maintenance treatment is available to all who need it. As most of you know, this treatment is used to stabilize the behaviour of people addicted to opiates by providing methadone, a legally available drug, as a substitute for opiates. While it does not produce a high, it does reduce the withdrawal effect. This is a new program and is already showing positive impact. Many staff members report seeing some dramatic behaviour changes among inmates on methadone, including better communication and increased motivation for programming and fewer disciplinary problems.

All offenders receiving complex medical treatments such as methadone maintenance, HIV or Hepatitis C treatment are linked with community support systems when they are released from their institution.

V. Sharing Lessons Learned: A fifth pillar

A fifth pillar supports the previous four.

It is actually more like a guiding principle for everything we do. And that is to be committed to learning new things from others about a given subject and sharing what we know as well. To this end, we have the Addictions Research Centre, whose mandate is to enhance corrections policy, programming and management practices on substance abuse through the creation and dissemination of knowledge and expertise. I know staff from the Centre have been quite involved in the agenda for this conference.

Last Spring, the Addictions Research Centre hosted the International Forum on Addictions and Criminal Justice with 160 delegates from 11 countries attending, including representatives from most of the provinces and territories and from many provincial addiction service agencies.

3. How far have we come?

I am proud of the way we have built most of our initiatives from a strong foundation based on research, knowledge and experience.

I am proud of how we have balanced our supply reduction efforts with demand reduction.

I am also proud of the results that have come out of our program evaluation studies, showing an impact on reoffending. A 1999 evaluation, for example, found that offenders who had completed the Offender Substance Abuse Pre-Release Program (a program targeting offenders with moderate to severe substance abuse problems), demonstrated a 13% reduction in re-admissions; a 29% reduction in new convictions; and a 53% reduction in violent offences in the year following release.

Similarly, our community-based substance-abuse program called Choices, showed a 29% reduction in re-admissions; a 56% reduction in re-convictions; and a 50% reduction in readmission for severe substance abusers.

4. Where do we go from here?

Clearly, we have come a long way.

But I came here to talk about making a real difference and the only way we can do that, I believe, is by continually questioning what we do, why we do it and how we do it. So where do we need to go now?

In preparing my thoughts for this presentation, I took the opportunity to ask some individuals from around the country for their point of view on what corrections should be doing to seriously address substance abuse. I'd like to spend the rest of my time here discussing the challenges they have posed for us.

Recognizing the complexity of our population

One of the individuals we spoke to was Dr. Patrick Smith of the Centre for Addictions and Mental Health. You had the pleasure of hearing him deliver the keynote address for this conference. Dr. Smith believes we need to recognize that the addictions population we are working with in corrections is much more complex and has more complicated issues and problems than the addictions population in the general public. What are the implications of this?

Dr. Smith explains that the addiction population in corrections presents a range of concurrent mental health disorders and other needs in addition to their addiction. Given the range of problems, we need a range of options for treatment. The more complex the problems of a population, the more complex the treatment needs to be.

We will need to understand that some of the research studies that have evaluated treatment in non-correctional populations may not completely solve the problems of our populations. We therefore cannot expect to be able to simply "pop" a treatment program that had great results in the community into settings that involve our correctional clientele.

Further, we need to be investigating complex treatment programs in correctional populations and setting up programs structured more around the complexity of our populations. Indeed, one of the principles behind our Women Offender Substance Abuse Program was that it be designed specifically for women and for their complex needs. We believe that our programs must be based on what works -- that is, evidence-based -- but also that they must recognize the complex needs of sub-groups within our population, like women and Aboriginal offenders.

Framing the Questions

The substance abuse programs the Correctional Service of Canada currently has in place nationally were first tested on a pilot basis and then implemented based on the pilot's results, with a research and evaluation component built into the program design. This means that our programs are research-based and the subject of periodic evaluations and on-going research to determine their effect on recidivism, among other things.

I was reminded by Dr. Lynn Lightfoot, a clinical psychologist in Ontario who has spent many years working in this field, that many questions remain to be answered. In a chapter she wrote for our Compendium 2000 on Effective Correctional Programming, Dr. Lightfoot asks:

• Do some treatments work better for some "types" of offenders?
• How do we determine which "types" of offenders to intervene with?
• Are some substances more closely associated with criminal behaviour than others, or should our goal be to eliminate all substance use?
• Do offenders have to be willing participants in treatment for it to work, or is compulsory treatment worthwhile?
• How long do offenders have to remain in treatment for it to be effective?
• Is abstinence the only reasonable goal for offender treatment, or are moderation and harm reductions appropriate for some offenders?

M. Daniel Sansfaçon posed similar challenges to our definition of substance abuse. Dr. Sansfaçon is Deputy Director General of the International Centre for Crime Prevention in Montreal and was the Director General of Research for the Special Senate Committee on Illegal Drugs.

One of Dr. Sansfaçon's first questions when we spoke to him was: "How do you define substances? Are you including alcohol in your definition?" He believes that, even though it is legal, alcohol should be included in the definition of 'substance.'

Why? Because, according to him, "Alcohol is in fact as significant a contributor to crime, specifically personal violence, as other illegal drugs."

There is evidence to back this up. In an analysis of data on almost 8,600 federal offenders, it was found that violent crimes were the most common type of offence committed by offenders who had consumed alcohol on the day of their offence. There were proportionately more instances of alcohol consumption (without drugs) on the day of the crime among offenders incarcerated for committing violent crimes, including assault (38%), murder (31%) or sexual assault (30%), than for any other crime.

Drug use, either exclusively or combined with alcohol consumption, on the day of the crime was more strongly linked to crimes of acquisitiveness, such as theft, robbery and breaking and entering.

Dr. Sansfaçon also questions how we define 'abuse,' wondering whether abstinence is a realistic goal for the offender population.

Dr. Sansfaçon believes that abstinence may be a desirable and eventual goal but not an essential one, and that it can in fact be counter-productive to treatment at times. He suggests that relapse should not be associated with penalties because use of substances does not necessarily lead to recidivism. He suggests that we view treatment goals in a "harm reduction" light: that the goal of substance abuse treatment be for the individual to reduce or better control his or her consumption of substances.

Dr. Sansfaçon went on to suggest that we continue the good work of evaluating our treatment efforts, particularly in the long term, and that we ask pointed questions in our research to, in his words, "open up the box on how different factors come together to work in particular cases." He suggests we ask:

• What attitudes must parole officers have to successfully address the needs of released offenders with substance abuse problems?
• What resources are required for an offender to be supported in the community?
• What sort of intensive supervision is required?
• What are the opinions of treatment participants on why their treatment worked?
• How can the answers to these questions inform those delivering programs on what to do in specific situations?

Dr. Smith of the Centre for Addictions and Mental Health posed an equally interesting question and that is: What is not working? It may be equally important to ask why a particular treatment strategy did not work, at both the aggregate and individual level.

Clearly, there is still a lot to discover about what works, why it works and how it works.

Furthering harm reduction

A report published in 2001 by Health Canada entitled "Reducing the Harm Associated with Injection Drug Use in Canada", recommended that the health community "work with law enforcement, justice, all levels of government, community groups and others to enhance the implementation, accessibility and effectiveness of needle exchange programs and reduce the barriers in all settings in Canada, including the consideration of pilot projects in correctional facilities."

This sentiment was echoed by Dr. Serge Brochu, Director of the International Centre for Comparative Criminology at the University of Montreal. Dr. Brochu told us that he believes the next step for corrections is to go further in our harm reduction efforts, specifically by introducing a needle exchange program in our institutions.

The Correctional Investigator suggested the same thing in his 2002-2003 report.

We know that needle exchange programs are available in many communities in Canada. We've seen it here in Vancouver.

We also know that there are 19 prisons in Europe with needle exchange programs (in Switzerland, Germany and Spain). Evaluations of these programs have shown: no increase in drug use; a decrease in needle sharing between inmates; a reduction in overdoses and institutional violence; and an increased number of drug users entering substance abuse programs. These are some of the other things we know:

• One of every three federal offenders injected drugs before being incarcerated.
• One in ten has injected drugs during incarceration.
• Almost 5% of women offenders and almost 2% of male offenders reportedly have HIV.
• About 40% of women offenders and 23% of male offenders are living with Hepatitis C.
• A history of injection drug use is the most common risk factor for infection with HIV and Hepatitis C among federal inmates.
• Almost all inmates eventually get released back into the community at some point.
• Virtually all incarcerated heroin addicts will, if not treated, return to using heroin upon release.

It is estimated that the direct and indirect costs of HIV/AIDS attributed to injection drug use will be $8.7 billion over a six-year period if trends continue. And the medical costs to treat people with Hepatitis C are expected to exceed those for HIV/AIDS.

We have a responsibility to take care of the health of our offenders. We have a responsibility to ensure we are doing all we can to reduce the risk posed by offenders returning to the community. We also have a responsibility to carefully consider anything we do that will have an impact on our offenders, our staff, and the public.

In my work as Commissioner of the Correctional Service of Canada, I often have the opportunity to meet people who are not familiar with the context within which Canadian corrections operates. In trying to describe to them some of the great challenges and rewards of my job, I often speak of the tension between the voices that call for more control in how we manage offenders and those who call for more assistance in what we provide to offenders.

And so I find myself in the same position here in regard to needle exchange. Many people, including our staff and members of the public, have serious concerns about any harm-reduction measures that appear to accept inmate drug use. There are front-line staff who feel that some harm-reduction measures will put their own safety at risk. Some members of the public don't understand why we cannot keep drugs out of our institutions. These are legitimate concerns and legitimate questions.

At the same time, as I have described up to this point, there are many voices calling on us to take our harm-reduction measures even further to prevent the spread of serious infectious diseases. These voices, too, share legitimate concerns and ask legitimate questions.

I cannot ignore either of these viewpoints. In fact, I am grateful to have them both as they will encourage us to do our absolute best to carefully consider what we do before we do it.

Thankfully, we in corrections do not have an audience that is completely accepting of everything we do. And because of this, we will do our utmost to ensure that we have consulted with all affected partners, that we have considered all viewpoints and that we have reviewed all available evidence before we take any course of action.

Staff emphasized to us, during our evaluation of the Methadone Maintenance Treatment Program, that methadone in and of itself, was not useful. Rather, it needed to be combined with appropriate programming and social support measures. I agree.

In fact, I see any prevention, treatment, enforcement or harm-reduction initiative as but one ingredient in a complex recipe of initiatives aimed at better understanding and responding to the problems arising from drug and alcohol abuse.

5. Conclusion

In closing, let me say that I believe we've come a long way in addressing substance abuse as it relates to our correctional mandate, but I think we can go further.

I am encouraged by the way in which the different domains of health services and law enforcement are working together. It is at times like this that I am particularly proud of the values we, as Canadians, hold dear.

I am also encouraged by the progress the Correctional Service of Canada has made to address this complex issue in a practical and evidence-based way, and by the way in which research is now part of the infrastructure of most everything we do.

And I am encouraged by the thoughtful prodding offered by the presenters at this conference and others who have a learned opinion to share on the challenges that remain for us.

I hope we can continue the momentum of this conference and find even more ways to work together and learn together. As Dr. Smith put it, "Let's continue supporting initiatives that bring health services and corrections together shoulder-to-shoulder."

Thank you so much for your attention and for the opportunity to speak before you today.

I would be happy to take any questions you may have.