Prison Based Services: The RAPt 12 Step Programme
This is provided in nine British prisons - HMP Littlehey (Cambridgeshire); HMP The Mount (Herts); HMP Norwich (Norfolk); HMP Send (Surrey); HMP Swaleside (Kent); HMP Wandsworth (London).
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Two recovering addicts speak about their experience of the RAPt drug treatment programme
RAPt set up the first specialised programme exclusively for drug and alcohol misusers. The programme is based on the '12-step Minnesota Model' that requires total abstinence from drugs and alcohol. The programme was the first to be the subject of an independent review and was the first to be accredited by the independent Correctional Services Accreditation panel. We have just been awarded our new accreditation for our latest manuals which backs up our leader in drug service reputation.
The intensity and focus of the RAPt programme is ideally suited to a prison environment. Participants receive concentrated treatment in a dedicated wing surrounded by the support of their peers and counsellors.
RAPt treatment programmes operate according to a fundamental 12-step philosophy, with clients being guided through the first five steps in the 12 week primary phase.
During this time, they are helped to come to terms with the fact that they cannot control their substance use, to explore the effect that their using has had on them and those around them, and to begin to learn the skills that they will need if they are to avoid a return to using. They are also given experience of living a clean and well-ordered life as part of a supportive community observing high standards of behaviour - this is guaranteed by regular and rigorous drug testing and the enforcement of widely known rules and expectations.
The core content of the programme has not changed and neither has the style of treatment offered. The basis of 12-step treatment is of mutual help - one addict helps another.
The style of treatment and the principles underlying the programme have not changed over the years but there have been some refinements to the programme form and content. These enhancements have led to the creation of a carefully standardised programme. This is embodied in a comprehensive treatment manual, which formed the basis of RAPt's successful bid for Home Office accreditation in 2000.
Everthorpe Client
The standardised RAPt programme is a three-stage intervention - assessment, primary treatment and aftercare
The first, MET (Motivational Enhancement Therapy) is an assessment stage giving basic information about drugs and their effects. It also motivates participants to start examining the effect of their using on their lives, and introduces them to 12 Step concepts
The 12-week primary phase. This programme is mainly group work based, employing a range of cognitive behavioural treatment processes, and focusing on creating awareness of the following issues: drug use and its impacts; how past behaviour affects others; positive goal setting; relapse prevention strategies; and personal responsibility.
Participants work through the first five of the 12 steps outlined in the RAPt manual.
Completion of Step 1 - "We admitted we were powerless over our addiction (which may include alcohol, drugs, gambling, anti-social behaviour) - that our lives had become unmanageable"
This requires participants to complete three assignments, examining the concepts of powerlessness, unmanageability and their use of substances other than their drug of choice. Examination of powerlessness, for example, requires a participant to write down five specific examples (including dates, times etc) of various drug-related experiences.
The other two assignments for Step One follow a similar pattern. Once assignments are completed they are presented to their peer group, who with counselling staff decide whether or not to accept the assignment as complete. All such assignments are undertaken in participants' free time, during the evenings and at weekends, and not during the working hours of the programme when group interaction is maximised. Literacy, while clearly an advantage, is not a requirement as we encourage other group members to provide help with completing written tasks
The content of the first five steps provides a structure for treatment and a link with the fellowships of NA and AA. In addition, the progression of the steps is intended to form a natural therapeutic path:
Step One aims to break down clients' denial about their addiction.
Steps Two and Three aim to motivate them towards identifying support to build a new life.
Steps Four and Five encourage them to examine the obstacles to recovery and the behaviours which have led to their failures in the past, to identify their strengths and assets on which they can build, and to create a realistic plan for the future. In all of these Steps, participants are reminded through contact with recovering addicts, counsellors and fellowship meetings, that recovery is possible.
The formal elements of the assignments and step work are supplemented by other processes such as therapy groups, lectures, meditation, complementary therapies and sports activities.
In some instances, individuals may also be given specific pieces of work to complete, such as anger or grief assignments, if their personal circumstances warrant it.
On completion of the primary programme, clients are invited to have an ending ceremony where they invite the counselling team, family members, their prison officer and their peers to give their honest feedback to their process .
The third phase of treatment is aftercare.
Aftercare focuses on a package of compulsory workshops covering a number of elements including: specific elements of relapse prevention and skills training.
These are delivered from within the primary treatment teams at each location and no prisoner can be said to have formally graduated from RAPt until he or she has completed these workshops.
Following completion of the three-stage programme graduates are expected to move onto other wings, where their new found strength and enthusiasm will make a major contribution to creating the anti-drug culture we are all looking for.
It is also expected that graduates will seek and find work within the prison workshops or participate in other structured or therapeutic activities. Some graduates, however, return to the programme to work as peer supporters, helping other prisoners through the programme and acting as role models to their peers.
Resettlement needs of prisoners must also be addressed and should consist of a support and resettlement service. The aim is to ensure that graduates of the programme maintained their recovery and are linked into proper support services in the community after their release. In particular, we seek to ensure that no graduate of the programme is discharged from prison without a stable address to go to. Whilst RAPt originally delivered the resettlement element itself, more recently the task has been taken on by the CARAT service.