Why a training on substance use disorders?
There is clear evidence that prison authorities are facing increasing problems with drug use and other risk behaviours that can be detrimental to the health of people in prison. Persons with substance use disorders (SUD) are over-represented in the prison population and in many countries they are stigmatised and discriminated members of society. Related health problems are caused by the continued and excessive use of substances, and the risk of contracting communicable diseases increases through injecting the substance used. Further, the widespread availability of illicit drugs within a prison is bound to have very negative repercussions on all aspects of prison life as its use contributes to a cycle of disruption and violence, leading to a reduced or unstable regime. Due to the high prevalence of people with SUD in prison, these institutions have an opportunity, but also an obligation, to identify these individuals early and to provide appropriate services before their release. This reinforces the need for a well-trained workforce that is able to meet the complex needs of persons in prison with SUD.

Purpose of the manual
The purpose of this manual is to provide sufficient methodological support and content to support future trainers to conduct cascade trainings of multidisciplinary prison staff (i.e. medical, custodial and psychosocial staff ). The trainings will increase understanding of the problems faced by persons with SUD, aimed at improving their care and treatment within the closed institutions, and connecting them to services upon their release, but also at reducing stigma and discrimination surrounding drug use and related disorders.

Structure of the manual
The training package is divided into 12 different topics (i.e. training sessions). Each topic provides an overview of the most important aspects. Some aspects of the training sessions are similar. Repeating certain closely linked aspects of the training will allow the trainers to become more acquainted with the information presented and reinforce the understanding of participants.

Each session begins with a statement of the time required for its delivery in a multidisciplinary setting. The trainer should decide what the core content for a multidisciplinary audience is – the depth of information required from the manual should be decided on by the trainer with careful consideration of the composition of the group of trainees. Trainers are free to modify or amend the sessions, for example by leaving certain parts out or adding new elements. Additional content may be used when presenting issues to be explored in-depth by a specific profession and requiring a longer session (e.g. topics presented exclusively to medical staff).

The main objectives of the training sessions (i.e. what a trainer can hope to achieve) are clearly outlined as well as the range of activities that can be used to achieve them (Annex 1). The proposed activities (e.g. discussion topics, role plays, case studies) are incorporated into each training session. Further, references to additional resources on respective topics are proposed.

For each of the training sessions, a PowerPoint presentation summarising the most important aspects is provided (Annex 2). These presentations may be used by the trainers. The national context is included in the presentations when applicable. These can be further personalised to fit target groups, for example by adding the context of a specific prison or a medical staff-only training.

A pre- and post-training questionnaire is included in Annex 3. After administering the pre-training questionnaire, analysis should be undertaken on the same day so that trainers can emphasise certain sessions or aspects depending on the current knowledge level of participants. The post-training questionnaire helps trainers evaluate if the learning objectives have been met. In order to determine the degree of satisfaction of participants, the work of the trainer(s), as well as the compliance of the material with expectations, a survey should be conducted at the end of the training.