Fitting a quart into a black box: Keyworking in quasi-coercive drug treatment in England

Aims: The aim of this article is to assess what goes on in treatment sessions in court-mandated drug treatment in the UK. Methods: The study used a case note audit involving interviews with drug workers about each of their active cases, assessing client characteristics and their reports on what activities had taken place in treatment sessions. Findings: The average session lasts just under 30 minutes and typically at least three different types of worker-led activity are engaged in per session, often including time spent on compliance with treatment, with prescriptions and with the testing requirements of the court mandate. The amount of time dedicated to evidenced psychosocial interventions is typically less than 10 minutes. Conclusions: The tensions reported elsewhere for drug workers engaged in criminal justice services are evidenced in the study given the range of tasks (potentially conflicting) that drug workers are required to engage in and the limited opportunity for them to engage in effective psychosocial drug treatment.