A Systematic Review and Narrative Synthesis of Interventions to Address Substance Use Disorders and Other Mental Health Disorders in Prison Settings With a Focus on Low- and Middle-Income Countries

Published date01 June 2023
AuthorAshly E. Jordan,Wataru Kashino,Sanita Suhartono,Giovanna Campello,Anja Busse
Date01 June 2023
Subject MatterArticles
CRIMINAL JUSTICE AND BEHAVIOR, 2023, Vol. 50, No. 6, June 2023, 787 –805.
DOI: https://doi.org/10.1177/00938548231166155
Article reuse guidelines: sagepub.com/journals-permissions
© 2023 International Association for Correctional and Forensic Psychology
United Nations Office on Drugs and Crime
Center for Drug Use and HIV/HCV Research
United Nations Office on Drugs and Crime
Interventions to treat substance use disorders (SUDs) and other mental health disorders (MHDs) in prison settings
vary in both availability and effectiveness across contexts. Furthermore, incomplete characterization of intervention
efficacy and/or effectiveness impacts the ability to know whether an intervention with demonstrated effectiveness in
one setting will be effective in another setting. We systematically reviewed the literature for studies of interventions
for SUDs and other MHDs conducted in prison settings, and synthesized the identified interventions and identified
evidence gaps. Search strategies yielded 9,599 articles published between January 1, 2010, and December 31, 2020.
A total of 82 articles were identified as eligible with interventions presented for SUDs (n = 52), for MHDs (n = 23),
and for SUDs/MHDs (n = 7). Findings point to a narrow range of interventions of demonstrated effectiveness and to
important gaps in the evidence-base for which high-quality research, particularly in low- and middle-income settings,
is needed.
Keywords: effectiveness research; prison-based health care; substance use disorders; mental health disorders; systematic
review and narrative synthesis
AUTHORS’ NOTE: Anja Busse, Wataru Kashino Sanita Suhartono, and Giovanna Campello are staff mem-
bers of the United Nations. The views reflected in the articles are those of the authors and do not necessarily
reflect the views of the United Nations. The literature review was supported through regular budget funds
provided by Member States to the United Nations. We are grateful to Dr. David Farabee (Research Professor,
New York University, New York, New York, USA) for his early review of the manuscript and discussion of its
contents. Correspondence concerning this article should be addressed to Ashly E. Jordan, Center for Drug Use
and HIV/HCV Research, 708 Broadway, 4th Floor, New York, NY 10003; e-mail: ejordanashly@gmail.com.
1166155CJBXXX10.1177/00938548231166155Criminal Justice and BehaviorJordan et al. / Effectiveness of Interventions for SUDs and MHDs
The 2021 World Prison Report estimates that the number of people held in prisons may
be in excess of more than 11.5 million, with approximately 70% incarcerated in what the
World Bank designates as low- and middle-income countries (LMICs; Baranyi et al., 2019;
Fair & Walmsley, 2021; World Bank, 2021). People with mental health disorders (MHDs),
including substance use disorders (SUDs), are more likely to interact with police and to be
arrested than those without MHDs (Magee et al., 2021; Ramezani et al., 2022). People held
in prisons are 16 times more likely to have MHDs compared with the general population,
and 10% to 60% of people held in the criminal justice settings are estimated to have SUDs
(Baranyi et al., 2019). In many settings, including in LMICs, the prevalence of SUDs and
other MHDs is increasing, yet their treatment is not—SUDs and other MHDs constitute a
global public health, developmental, and security problem, particularly for LMICs (United
Nations Office on Drugs and Crime [UNODC], 2019; World Health Organization [WHO],
According to the United Nations (UN) Standard Minimum Rules for the Treatment of
Prisoners (the Nelson Mandela Rules), health services that are available in a community
should be available in criminal justice settings in that community—this standard has also
been reflected in the UNODC and the WHO International Standards for the Treatment of
Drug Use Disorders (United Nations General Assembly, 2016b; WHO and UNODC, 2020).
However, the degree of symmetry between health services available in a community and
that community’s prison settings varies widely (McLeod et al., 2020; Ramezani et al.,
2022). Inequities in prison-based health services persist globally, with people held in LMIC-
based prison settings less likely than people held in high-income country prison settings to
receive needed health care (Baranyi et al., 2019; McLeod et al., 2020). While it is estimated
that globally more than 80% of those with MHDs reside in LMICs, more than 90% of
global mental health resources are located in high-income countries (Jacob et al., 2007;
WHO, 2016). Disparate resources contribute to the undertreatment of SUDs and other
MHDs both in community and in prison settings (Baingana et al., 2015; Dean, 2017;
Degenhardt et al., 2017; Jaeschke et al., 2021). Strengthening prevention, screening and
diagnosis, and treatment for SUDs and other MHDs is an essential demand reduction strat-
egy of public health importance and is both a cornerstone of the 2016 UN General Assembly
Special Session World Drug Problem outcome document and has been specifically set as
Target 3.5 of Goal 3, in the 2030 Agenda for Sustainable Development Goals (Lee et al.,
2016; United Nations General Assembly, 2016a).
Many of the current recommendations for treating SUDs and other MHDs in prison set-
tings, including guidance documents put forth by the UNODC and the WHO, are based on
evidence which comes from studies conducted in high-income settings, with expert guid-
ance or extrapolation required in domains where there are gaps in the published evidence-
base (Baingana et al., 2015; WHO and UNODC, 2020). Identifying interventions which
are effective in prison settings in LMICs, and which are scalable given available resources,
is a global need (McLeod et al., 2020; Mundt et al., 2018). With increasing life expectancy
and population growth in LMICs, combined with increasing rates of incarceration, the
burden of SUDs and other MHDs is expected to increase in the coming decades posing
additional burdens for prison populations and prison systems (Dean, 2017). The provision
of evidence-based, accessible, and affordable health services, including for people in

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