Stöver, Heino

Background: The two main obstacles of the German penal system are reintegration of the prisoner and protection of the general population. Prevention and treatment of drug-related disorders are less important. In addition, there is a lack of financial resources for health-related services in prison and specialized prison staff in addiction medicine. The execution of criminal justice in Germany falls within the domain of the German Laender. Since 2006, the Laender have also been responsible for legislation in this area. There is no established national data collection procedure on the health of prison inmates in Germany. However, regional data surveys and individual studies focusing on sub-populations of individual facilities do exist. In order to create standardized treatment guidelines for drug users in prison, a comprehensive overview and a nationwide regulation are needed. Therefore, national data are being collected to assess quality and quantity of drug-related health care services in German prisons. The aim of this dissertation is to demonstrate structural strengths and weaknesses of drug-related health care in German prisons. Methods: A mixed-methods approach was chosen. Quantitative data was collected using a comprehensive questionnaire, which was sent to the Ministries of justice of all 16 Laender. The questionnaire collected data about the percentage of drug use, intravenous drug use and infectious diseases on reception into prison and during imprisonment, as well as type and extent of drug-related health care services in German prisons. Reference date was 31st March 2010. Qualitative data was collected via 15 qualitative semi-structured interviews, of which 11 were conducted in Bavaria and 4 in Berlin. Data was collected and compared in 2 Laender, which have two very different approaches concerning the drug problem: Bavaria, a territorial state, restrictive and emphasising sanctions and Berlin, a city state, with a focus on harm reduction. Interviewees were prison health care staff and consultants, prison guards, a former prisoner, prison nurses, and probation officers. In the interviews, respondents were asked to describe their everyday work, its challenges and how those challenges could be addressed. The interviews were analysed using GABEK WinRelanA and results were presented in network graphs. Results and Discussion: 14 out of 16 Laender answered the questionnaire. There was an average of 50 % missing items. Another half of the missing items was commented with a data is not recordeda . Concerning drug use the results show that around 30 % of the prisoners were tested upon admission. Upon admission the percentage of positive results was higher than during imprisonment (45 % vs. 16 %). Results show that during imprisonment, there is especially a decrease in the use of opioids (17 % vs. 10 %) and cocaine (10 % vs. 1 %). In contrast, the percentage of positive drug tests increased for some substances, especially for Cannabis (57 % vs. 75 %) and a othera substances (1 % vs. 15 %). Concerning intravenous drug use, results indicate a percentage of 47 % intravenous drug users among all drug users, which equates to 11 % of all prisoners. Concerning infectious diseases, around 50 % of the prisoners were tested upon admission, with 0,8 % tests positive for HIV, 1,8 % positive for Hepatitis B and 15 % positive for Hepatitis C. The results of the questionnaire in combination with the interviews, several topics turned out to be of relevance: the role of the justice system in strengthening the motivation to abstinence, therapy instead of punishment, working in a prison and (not) being part of the justice system, educating prisoners and prison guards, vaccinating, testing and treating of infectious diseases, harm reduction services, opioid substitution therapy and preparations for release. Taking together the results of this study, it can be summarized that at the time of the data collection there was no equivalent health care in German prisons compared to the general population. There is still a huge potential for improvement of the criminal justice system and especially of the prison health care system concerning drug use inmates. Change processes take a while and usually start on an individual level.

The central question of this thesis is how to integrate culture pedagogical approaches in the three areas medical rehabilitation, aftercare and addiction prevention. Basis of this thesis are the experiences of the 1990 established "Wilde Bühne" (Wild Stage), a socio-cultural forum of former drug addicts. The following results have arisen: - theatre work in the inpatient medical rehabilitation for former drug addict contributes to the success of the therapy. - development of a play on addiction prevention based on the experiences of former drug addicts in the aftercare phase represents an effective relapse prevention. - the pupils assess the cultural educational drug prevention of the "Wilde Bühne" (theatre performance and subsequent discussion with former drug addicts) almost entirely positive.

The dissertation begins with an overview on Ervings Goffmans concept of total institutions and shows that first modern prisons are still total institutions. Second it is shown that there are several negative consequences for the prisoners resulting from the total institution. Creativity and art are understood as an aid of living and surviving within the incriminating atmosphere of a total instution. The concluding part of the dissertation introduces the work of an art-group in the juvenile prison of Bremen.

Stöver, Heino

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