Understanding the active ingredients, barriers, and facilitators to implement brief psychological interventions for substance misuse in Indian prisons: A qualitative study.

BACKGROUND

Substance misuse is prevalent in criminal justice populations. Addressing it in the criminal justice system (CJS) is vital for improving public health and reducing crime.

AIM

This study explores the mechanisms, barriers, and facilitators of a brief psychosocial intervention for reducing substance misuse among inmates in a North Indian prison.

METHODS

A multidisciplinary team evaluated qualitatively using the Framework Method, guided by the Behavior Change Wheel (BCW) framework. Participants were purposively selected from those enrolled in a clinical trial and included inmates aged 18-60 who completed three sessions of the intervention. Data were collected through in-depth interviews (IDIs) and focus group discussions (FGDs) between November and December 2023. Thematic analysis identified key themes related to behavior change, implementation barriers, and facilitators.

RESULTS

The study identified ten main themes encompassing facilitators and barriers to behavior change. Key facilitators included peer influence, supportive relationships, intervention strategies, and self-reflection. Major barriers were access to drugs, prison dynamics, psychological stressors, stigmatization, and withdrawal symptoms. The BCW framework highlighted the importance of addressing both individual and contextual factors, such as capability, opportunity, and motivation, to support behavior change. The intervention's emphasis on stress management, acceptance, and building supportive peer networks was critical for its success.

CONCLUSION

Individual interventions must be supplemented by systemic and structural changes to address prison-specific challenges. Comprehensive staff training, integrated treatment models, peer support systems, and policy advocacy are recommended to enhance the effectiveness and scalability of psychosocial interventions in the CJS.