France: supervising, not banning, alcohol consumption

Matthieu Fieulaine. Individuals do not automatically receive treatment when they enter prison. To receive treatment, the person must admit to their addiction and be willing to talk about it when they arrive. In most cases, inmates do not share the fact that they are addicted to alcohol due to shame or fear of stigma. This results in brutal withdrawal symptoms that can be extremely dangerous if the person does not receive treatment.

Individuals who share their addiction can receive medical treatment for withdrawal symptoms. This only applies to a small proportion of the prison population, in particular because of a lack of human and material resources.

Psychotropic drugs are used systematically and on a massive scale. Their purpose is to prevent withdrawal symptoms, mental deterioration or any other symptoms resulting from the brutal conditions of incarceration.

However, the mental suffering that can result from this increases the risk of taking illegally obtained substances, and consequently of addiction.¹

Inmates who are identified as being dependent on alcohol can also be offered support when they leave prison. They may be offered parole if they agree to continue their commitment to sobriety. As a condition of their release, they must attend an addiction treatment center. In practice, they often begin drinking again, and may even drink more than before. In some cases, the individual overdoses or ends up in an alcohol-induced coma.

According to the prison administration, addictive substances are not consumed in prison, so there is no need to treat addiction. However, we observe that these claims are not borne out by reality. Treatment is not possible if the prison administration refuses to recognize addiction and patterns of consumption.

MF. Until the 1980s, wine and beer were served with meals in prison. Nowadays, due to purported riots involving one or more persons under the influence of alcohol, all types of alcohol are completely prohibited. This raises an important question: alcohol is a legal substance, so why is its consumption permitted in society but banned in prison? Why is alcohol banned but not tobacco?
The management of prisons in France is guided entirely by security concerns.

Other countries have adopted a more pragmatic and effective approach, where the prison administration does not attempt to control all aspects of inmates’ lives.

As long as the prison administration refuses to accept that alcohol is consumed in prison, it will be impossible to implement a harm reduction policy. This is the approach that I, along with most addiction and harm reduction specialists, would recommend: it aims to supervise consumption and ensure that it is safe. In prison, this approach is currently impossible because of the institutionalized denial surrounding alcohol consumption.

Does alcohol find its way into prison? If so, how is it consumed? How can we monitor consumption? The answers to these questions will enable us to develop best practices and put in place the necessary tools to monitor consumption. For example, in the case of drug use, making syringes available stops inmates from using pens to inject opiates or other injectable substances. In South America, the presence of large amounts of cocaine in prison has forced the prison establishment to provide appropriate materials to inmates to limit the risk of the spread of illnesses such as hepatitis C.

Furthermore, French policy is too repressive. Driving under the influence or a repeat offence can result in a 3- to 6-month prison sentence. Imprisoning these individuals means that their consumption cannot be supervised and can result in them losing their work, housing and family ties, thus increasing their propensity to addiction. A lot of people end up in prison or in halfway houses with no support. It is past time that the justice systems look at these cases from a practical point of view and without moral judgement. Some countries have established support systems due to widespread consumption or difficult conditions for usage (lack of material, dangerous sanitary conditions, etc.). Other countries already have a longstanding tradition of integrating harm reduction considerations in their public health policy.

MF. This specific ban is based on the ban on alcoholic drinks in prison. It’s ridiculous. Prisons are potential hotspots for the coronavirus, as detention conditions and shared spaces encourage the spread of the virus. There is a serious shortage of healthcare staff because they are in hospitals or subject to family constraints. Hand sanitizer is an effective product for prevention, and would help minimize the spread of the virus at the entrances and exits of shared spaces. Banning it in prison is unacceptable. We know of inmates who have been punished because their family tried to give them hand sanitizer during visiting hours at the start of the crisis.

If an inmate were to consume hand sanitizer, it would not be a voluntary choice, but rather a way to stave off withdrawal symptoms. In this case, consumption would be an indicator for us as healthcare providers about the effects of withdrawal and the lack of treatment.

This inappropriate usage would call for immediate treatment. For all these reasons, we want to see the ban lifted. The ban itself is specific to France and has not been imposed in other countries, such as Chile.

Some prisoners’ rights organizations have raised the issue of access to masks, gloves and hand sanitizer with the Council of State. The Council has ruled that it cannot force prison administrations to provide an adequate quantity of masks and gloves, and that soap and water can be used in place of hand sanitizer. We are aware of an increasing number of water supply cuts, for instance at the La Santé prison in Paris. This is not about debating whether or not there is a shortage; it is about speaking out against the absurdity of banning hand sanitizer, a product whose sole function is sanitary and which is particularly necessary during an epidemic.