Year: 2010
Type: report
Abstract: Background and rationaleAlcohol problems are a major and growing public health problem in Scotland with the relationship between alcohol and crime, in particular violent crime, increasingly being recognised.The consequences affect individuals, their families, the health and emergency services, and wider society.The current policy context includes a strategic approach to enhancing the detection, early intervention, treatment and support for alcohol problems across Scotland, as well as efforts to reduce reoffending.This study is part of a wider Scottish Government funded alcohol research programme in criminal justice settings which also includes a pilot of the delivery of alcohol brief interventions and a scoping study of alcohol interventions in community justice settings.It is anticipated that the study findings will inform broader health service development such as the integration of prison health care into the NHS and the update of core alcohol treatment and support services.These developments are set within a policy and practice context which acknowledges alcohol problems in the population and increasingly so the alcohol problem in offenders, along with the importance of applying a person-centred, recovery orientated approach underpinned by the NHS commitment to quality of services. Aims and objectivesThe aim of this study was to undertake a needs assessment of alcohol problems experienced by prisoners and provide recommendations for service improvement including a model of care.The central objectives were to:1. Conduct a rapid review of the relevant literature on effective interventions for identifying and treating offenders with alcohol problems in prison.2. Report on the epidemiology of alcohol problems experienced by prisoners in Scotland compared to the general population and other offenders.3. Undertake an assessment of alcohol problems among offenders within an individual prison.4. Map current models of care in the Scottish Prison Service (SPS) and how they interface with community care models, including assessing aspects of treatment continuity and finding examples of best practice.5.In a case study setting, explore and report on attitudes towards the delivery and effectiveness of current alcohol interventions.6. Conduct a gap analysis between current service provision, best practice, effective interventions and national care standards for substance misuse. MethodologyThe study involved both quantitative and qualitative information being gathered through document retrieval and analysis as well as primary data collection.It was conducted according to ethical principles essential in research with vulnerable groups.The study benefited from internal research team advisers and an external Project Advisory Group representing the Scottish Government, SPS, Information & ii Statistics Division and NHS Health Scotland.To ensure representation of other interests, such as prisoners and their families, two further organisations reviewed and commented on the draft report. 1 Based on emerging evidence on the effectiveness of such interventions, see Section 4. v structured or more intensive support and interventions (EACS) or treatment (prison health care) Triage assessment (Addictions Nurse) Mutual aid groups (Alcoholics Anonymous) What is needed in addition to above Universal screening with validated tool for increased detection of alcohol problems Extended brief interventions and brief treatment to reduce alcohol-related harm among hazardous/harmful drinkers and possibly mildly dependent drinkers The provision of personalised feedback, often part of brief interventions, could be used to enhance motivation for action Provide a range of interventions that will meet the high level of need and/or demand e.g.one-to-one and group interventions, and some level of choice Increased interventions drawing on peer support or provided by peer approaches Interventions offered that are meaningful to prisoners, are person-centred, meet their needs and are credible.Tiers 3 and 4 2 Currently delivered Comprehensive substance misuse assessment (but effective detection is missing) Care planning and review for those in structured treatment Case management Evidence-based prescribing interventions (alcohol withdrawal/detox) and prescribing interventions to reduce risk of relapse Structured evidence-based psychological therapies (e.g.SPS prisoner programmes) that address alcohol and co-existing conditions (i.e.alcohol and offending behaviour -SROBP, alcohol and other substance use) Liaison services for acute medical and psychiatric health services Pre-and post-release work including community integration What is needed in addition to above Enhanced detection using a standardised tool, prior to comprehensive assessment Enhanced capacity for additional structured evidence-based psychological therapies including counselling approaches -provide access to meet need Better access to all interventions for short term prisoners whether in community or prison Interventions offered that are meaningful to prisoners, are person-centred, meet their needs and are credible. Increased interventions drawing on peer support or provided by peer approaches Interventions/therapies/treatment targeting specific groups (i.e.levels of dependency) and diversity issues -i.e.women, co-existing mental health problems/dual diagnosis, learning disabilities, and social problems such as homelessness and literacy Enhanced work on community and external provider linkages for communication and service access including in-reach Emphasis on throughcare for all prisoners with identified alcohol problems.Alcohol Care Pathways (ACPs) are locally agreed templates for best practice that map out the local help available at various stages of a treatment journey for alcohol.A flow diagram is outlined below showing the key decision points in a high level vi * At any point in a prisoner's stay if they/others think they have an alcohol problem they can enter the start of the process.** Triage is a critical part of the decision making process and includes determining the presence of other co-occurring social and health problems and the prioritisation of those that most need interventions in the context of high demand. Not in withdrawalUniversal screening using AUDIT AUDIT 8+ (hazardous/harmful/dependent) Triage** / initial assessment and prioritising need AUDIT Score of 0-7 AUDIT 20+ mainly but not exclusively: Comprehensive assessment and careplanning Consider community assessment for short stay/remand (move to arrow to the right) General awareness-raising of risks including harm minimisation AUDIT 8-19 mainly but not exclusively: Offer a range of Tier 1 and 2 interventions depending on prisoner need and preference e.g.Information and brief advice on sensible drinking Simple Brief Interventions Extended Brief Interventions Evidence based group interventions Motivational interviewing Self help/mutual aid/peer approaches AUDIT 20+ mainly but not exclusively: Offer a range of Tier 3 and 4 evidence-based psycho-social interventions depending on prisoner need and preference e.g.Motivational enhancement Range of other psychosocial therapies Self help/mutual aim/peer approaches Accredited prisoner programmes Therapeutic community settings Consider clinical input e.g.prescribing antabuse Community Integration Planning /addiction throughcare as needed Prisoner refusal viii ConclusionPrison presents an opportunity to address alcohol issues among a particularly marginalised group of people.The prevalence of alcohol problems amongst prisoners in Scotland is far higher than in the general population.This study identifies a considerable proportion of individuals in the SPS who could benefit from interventions that address alcohol consumption and alcohol-related harm and while a range of alcohol-related interventions exist, many prisoners who could potentially benefit from such interventions are being missed.The planning and development of tiered interventions, based on detection with a validated screening tool and subsequent comprehensive specialist assessment when appropriate, is an important mechanism in being able to better target and tailor interventions to prisoner need.Integrated Alcohol Care Pathways in the SPS are an important part of this process and likely to be best developed as a result of multilevel discussions amongst a range of stakeholders.The integration between SPS and NHS Health Care services, due to take place in Autumn 2011, will be of particular relevance to the further development of this work.It is hoped that this report will add to current awareness of alcoholrelated problems amongst individuals in prison in Scotland and contribute to building on the achievements made thus far. How we aim to tackle offenders' drug and alcohol problems: Address the needs of problematic drug users (PDUs) when they first come into contact with NOMS, to reduce the chances of them re-offending and help prevent the harm they cause themselves and others: provide end-to-end drug treatment for PDUs before, during and after sentence, co-ordinated with the http://www.drugs.gov.uk/drug-interventions-programme/(DIP) reduce drug misusing re-reduce drug misusing offenders' re-offending reduce illicit use of drugs by offenders reduce the physical harm caused to drug misusing offenders and others ensure robust links with other agencies, including DIP build on the National Alcohol Harm Reduction Strategy to improve treatment and support for offenders with alcohol misuse problems.
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2141370141