Craving management workshops and peer-led support are helping French prisons reframe addiction as a healthcare issue.

The most recent congress of the French association of healthcare professionals working in the prison service (ASPEP), held in Paris, revisited the issue of substance use disorders among incarcerated individuals.

For many years, drug use in prisons was met with ambiguity — or even outright denial — by authorities. The prison administration maintained the somewhat simplistic belief that because drug use is illegal, it could not exist in a system where the law is meant to prevail.

This perspective began to shift in the early 1980s, when concern over the transmission of HIV and hepatitis from injectable drug use prompted a more serious response. However, the focus at the time remained on controlling infectious disease risk rather than addressing addiction as a medical condition.

That era has since passed. Today, prison authorities — working alongside healthcare professionals — acknowledge the reality of both drug use and addiction within correctional settings.

A major step forward came in May 2024 with the publication of the first national statistical survey on substance use in French prisons: The ESSPRI study (Survey on Health and Substance Use in Prisons), led by the French Monitoring Centre for Drugs and Drug Addiction (OFDT). The study reflects a growing commitment among the medical community to objectively assess and address substance use behind bars.

The survey was conducted between April and June 2023 and included approximately 1000 inmates aged 18 years or older. It assessed their use of psychoactive substances. The results — revisited at the March ASPEP congress — revealed significant levels of substance use:

• 63% of inmates reported daily tobacco use (compared with 25% of adult men in the general population)
• 26% reported using cannabis (vs 3% outside prison)
• 14% had used other illicit substances (including cocaine, crack, MDMA, and heroin) since being incarcerated 

Targeted Policy Recommendations

By contrast, alcohol use within French prisons appears relatively low: Only 16% of inmates reported drinking alcohol while incarcerated. However, this is likely due to limited availability rather than a voluntary choice to abstain.

Based on its findings, the OFDT identified three broad patterns of substance use among inmates:

• One third — primarily younger inmates — regularly use both tobacco and cannabis.
• One third use only tobacco.
• One third — often older inmates — do not use any psychoactive substances.

The OFDT called for health policies that reflect these actual patterns of use. In particular, they recommended that prevention and treatment strategies within prisons focus more specifically on tobacco and cannabis, which are the most widely used substances.

Transition After Release

Across France, various initiatives have emerged to improve addiction care in correctional settings. However, program implementation remains fragmented, as most addiction services are organized independently by individual prison-based addiction treatment centers (known as CSAPAs). Despite this lack of coordination, some initiatives are particularly noteworthy.

At the Bois-d’Arcy remand center in Yvelines, for example, CSAPA staff have introduced “release kits” to support continuity of care for inmates with substance use disorders as they transition back into the community. This post-release period is a time of heightened vulnerability, marked by unstable living conditions and an increased risk of high-risk behaviors. In fact, post-release mortality — primarily due to suicide or overdose — is 3.6 times higher than during incarceration.

The release kits, developed collaboratively with inmates and grounded in harm-reduction principles, are available in three versions tailored to individual needs:

• Basic kit: Includes key information, such as emergency contact numbers and referral options for addiction specialists.
• Kit for crack and cocaine users: Offers harm-reduction materials and substance-specific guidance to promote safer consumption practices.
• Kit for individuals who inject drugs: Contains sterile injection equipment and a dose of naloxone for emergency overdose reversal.

Workshops to Address Craving

At Baumettes Prison in Marseille, France, the local CSAPA has developed a program focused on managing craving — the intense urge to use substances experienced by individuals with addiction.

Care is delivered through therapeutic workshops codesigned with inmates. These consist of four weekly group sessions facilitated by two healthcare professionals. Each group includes up to six participants and encourages open discussion of cravings and coping strategies, with a strong focus on shared experience and peer support.

“We explore how patients perceive their cravings and work to activate their psychosocial skills so they can draw on their own internal resources,” explained Camille Normandin, Elisa Carta, and Damien Mauillon during a presentation at the recent ASPEP congress.

The workshops provide education on the physiological mechanisms underlying craving, while also helping participants develop personalized relapse prevention strategies. Inmates are encouraged to identify their own high-risk situations and develop tailored solutions to avoid giving in to urges.

While pharmacologic substitution therapies are addressed, “the real focus is on empowering inmates to draw on their own experiences and insights,” emphasized the CSAPA team from Baumettes.

The ASPEP congress also served as a platform for healthcare professionals working in the prison system to call for better coordination of addiction services and, importantly, for more transparent and stable funding — which they described as inconsistent and difficult to track across facilities.

This story was translated from JIM.