NHS Health Scotland



F. Evidence for throughcare and community reintegration (Enforcement model)


 There is highly processed and review-level evidence for throughcare planning on release from prison, with the role of family and housing highlighted as critical elements of aftercare support requirements to foster reintegration into the community. The limited evidence of effectiveness regarding case management suggests it may support facilitation of these ends.


NICE Clinical Guideline 51 [1] on drug misuse psychosocial interventions’ general considerations state:

  • For people in prison who have drug misuse problems, access to and choice of treatment should not depend on whether the person is participating in treatment voluntarily or is legally required to do so. And treatment options should be comparable to those available in the community, with additional consideration specific to the prison setting. For example, for those who choose to remain abstinent after release from prison, residential treatment should be considered as part of an overall care plan (given known high risk of overdose post-release).
  • Best practice for the treatment and care of people who misuse drugs should have the opportunity to make informed decisions about their care and treatment, in partnership with healthcare professionals. Good communication between staff and service users is essential. Treatment and care, and the information service users are given about it, should be culturally appropriate. It should also be accessible to people with additional needs, such as physical, sensory or learning disabilities, and to people who do not speak or read English.
  • Assessment should have a holistic approach to care planning with the service user with consideration given to specific needs, history of drug use and previous experience of treatment, goals and preferences.
  • Staff should support service users in fulfilling their care plan with a supportive relationship, developing coping strategies, access to wider range of services and maintaining engagement as well as ensuring successful collaboration with other care providers.

In the literature and policy review conducted for the Better Health, Better Lives for Prisoners framework the authors cite evidence that prisoners who are able to keep meaningful contact with their families are less likely to reoffend due to improved resettlement on release. Evidence of the protective quality of ‘social bonds’, including where an offender values and is valued as, being part of a family unit, is also cited from literature on desistance from reoffending. [2]

A Cochrane systematic review [3] identified limited evidence of unclear quality from US- based studies that therapeutic communities with aftercare for drug-using offenders with co-occurring mental illness reduces criminal activity and re-incarceration (but not rearrest or self-reported drug use) following treatment. However, the review authors highlight the paucity of evidence and the variability in the study measurement process for the desired outcomes.

There is little information from current evidence as to how to address the complex issues of individuals with mental illness and co-occurring substance abuse, and it is not known how treatment facilitates the specific rehabilitation needs of offenders with drug use and mental health problems. From the limited studies [3] the review authors discuss several successful treatment elements reported throughout the five US-based trials:

  1. treatment engagement, with informal support from family and friends
  2. encouraging specifically adapted programmes to needs of mental health clients
  3. (longer) retention improved outcomes.


In a Cochrane systematic review, limited US-based evidence suggests that offering treatment to female drug-using offenders is effective in reducing drug use and reducing re-incarceration (but not rearrest). There is insufficient evidence to determine if treatment type and setting affect outcomes. [Although three case management and cognitive skills-based intervention studies did significantly reduce re-incarceration.] However, the review authors highlight the paucity of evidence available. [4]

One study (Johnson 2011) did show a reduction in monthly primary drug use. The review authors note that this is consistent with other studies that indicate a gender effect in prison substance misuse treatment outcomes, with women having lower drug use rates than men in the months after release from prison when they have engaged in a treatment programme during their sentence. A gender-specific pathway for community reintegration has been suggested by researchers based on this gender effect also observed in relation to aftercare treatment completion and re-offending behaviour.

In their Scottish-Government-commissioned evidence review, Best et al (2010) cite recovery research focusing on relapse (Litt and Mallon 2003) and recidivism (Lemieux 2002) demonstrating the role of sober/support or social networks incorporated into the treatment and aftercare of offenders in maintaining positive outcomes. [5]


Case management
Cochrane review-level evidence suggests case management is effective as a strategy for linking community and treatment services for persons with substance-use disorders in need of a variety of support. However, effects differ depending on availability, access and model of case management (with the most promising effect found for strengths-based approaches and the use of a manual to guide and standardise delivery). Findings related to drug-use outcomes varied but overall did not provide convincing support that case management is effective to reduce illicit drug use, although a small effect was found when compared with other specific treatment such as motivational interviewing or drug counselling. A small number of studies found evidence of a moderate significant effect for improvements in housing and small (yet non-significant) but consistent effect on legal outcomes (e.g. number of days incarcerated, charges for drug-related offences). This evidence is drawn from studies that concerned patients who were out of treatment when assigned to case management or control. [6]


Scottish policy and practice note

The Road to Recovery (2008) [7] Scotland’s drug strategy states a need to ensure continuity of care on admission, on transfer to other prisons during a sentence and on release into the community. Information-sharing will underpin this between prisons and community service providers.

All prisoners with addiction difficulties have their needs assessed and appropriate treatment arranged through the Scottish Prison Service’s Integrated Case Management (ICM) process, with those subject to statutory supervision on release linked to community-based services as part of their multi-agency ICM case conference risk management plan to ensure necessary supports are in place post-release. The policy states: ‘Assisting prisoners with their drug problems helps prevent further reoffending on release and promotes integration.’

The Commission on Women Offenders [8] was established by the Scottish Government in June 2011 to look at ways to improve outcomes for women in the criminal justice system. Recommendations encompass service redesign, alternatives to prosecution, alternatives to remand, sentencing, prisons, community reintegration and leadership structures and delivery.

Community reintegration recommendations include introduction of inter-agency protocols on prison discharge and homelessness, arrangements for access to benefit entitlement immediately upon release from prison and community reintegration support for all women offenders during and after their custodial sentence.

In accepting these recommendations, the Scottish Government recognise the vital role of housing in the sequence of interventions to help women desist from crime and will therefore work with local authorities to achieve a consistent approach across Scotland. The Scottish Government has developed a pilot scheme in HMP Cornton Vale in collaboration with the UK Department for Work and Pensions to enable pre-release applications for relevant benefit entitlements for prompt access on release.

Reintegration and throughcare support will be part of the establishment of Community Justice Centres recommended by the Commission and a key aim of the group on services and through-care as part of Phase 2 of the Reducing Reoffending Programme.





  1. National Institute for Health Care Excellence (NICE, 2011) Clinical Guidelines 51: Drugs Misuse: Psychosocial Interventions. London: NICE.

  2. Brutus, L. Mackie, P. Millard, A. Fraser, A. Conacher, A. Hardie, S. McDowall, L. Meechan, H. (2012) Better Health, Better Lives for Prisoners: A framework for improving the health of Scotland’s prisoners. Volume 2: Supporting material for the framework.

  3. Perry, A. E. Neilson, M. Martin-St James, M. Glanville, J. M. McCool, R. Duffy, S. Godfrey, C. Hewitt, C. (2014) Interventions for drug-using offenders with co-occurring mental illness. Cochrane Database of Systematic Reviews.

  4. Perry, A. E. Neilson, M. Martin-St James, M. Glanville, J. M. McCool, R. Duffy, S. Godfrey, C. Hewitt, C. (2014) Interventions for female drug-using offenders. Cochrane Database of Systematic Reviews.

  5. Best, D. Rome, A. Hanning, K.A. White, W. Gossop, M. Taylor, A. Perkins, A. (2010) Research for Recovery: A Review of the Drugs Evidence Base. Edinburgh: Scottish Government.

  6. Hesse, M. Vanderplasschen, W. Rapp, R. Broekaert, E. Fridell, M. (2007) Case Management for persons with substance use disorders. Cochrane Database of Systematic Reviews.

  7. Scottish Government (2008) The Road to Recovery: A New Approach to Tackling Scotland's Drug Problem. Edinburgh: Scottish Government. Available from (external link, 5.4MB) : http://www.gov.scot/Publications/2008/05/22161610/0

  8. The Commission on Women Offenders (2011-12) Available from (external link): : www.scotland.gov.uk/About/Review/commissiononwomenoffenders