A new Ministry of Justice (MoJ) analysis raises further questions over alcohol treatment options for prisoners. The MoJ 'Data Lab report [pdf] assesses the outcomes of 435 offenders engaged with the Forward Trust Alcohol Dependence Treatment Programme (ADTP) but found no improvement in outcomes compared with a comparison group.
Previous reports have raised questions over the availability and research of alcohol interventions in the criminal justice system and likely impacts on re-offending. The Forward Trust (formerly RAPt and Blue Sky) who deliver the ADTP programme in a number of prisons however claim it is still effective in reducing re-offending and that the original ‘Rapt’ 12 step treatment programme showed a 65% reduction in crime.
The latest analysis indicates 37% of those participating in the ADTP programme re-offended, not statistically different from the 36% rate of re-offending in the comparison group. The Forward Trust states 'technical challenges in adequately matching the characteristics of our programme clients with a control group of offenders', namely that the level of alcohol dependence in the comparison group could not be established. It also states other work has shown re-offending rates of 58% for those with drug or alcohol problems and that offenders in the comparison group were highly likely to have received 'some form of alcohol intervention' in custody.
Alcohol treatment in prisons: a missed opportunity?
The latest national figures for those receiving treatment in secure settings show 7,663 people had alcohol only treatment in 2016-17, a decrease from 8,551 the previous year. Nearly half (28,958) of all prisoners engaging in substance treatment cited problematic alcohol with the majority primarily receiving opiate treatment.
In 2014 a report released by Addaction called for more to be done in prisons to address alcohol problems, including amongst non-dependent drinkers. It recommended that alcohol treatment services should form a key part of any prison rehabilitation, which must include continuing support for prisoners as they reintegrate into the community, and for further reserach into effective interventions. The HM Chief Inspector of Prisons for England and Wales Annual Report 2017–18 reports 42% men and 45% women said they had not been helped with their alcohol problem while in prison.
Indeed various work has identified the limited availability of research on alcohol treatment during and following prison sentences despite the prevalence of alcohol problems within the criminal justice setting. In 2011 the Centre for Mental Health published a report calling for policy change to support alcohol misusing offenders. In the same year a NHS Scotland review identified 'little in the published literature about what works in addressing alcohol problems among offenders' with no studies on the effectiveness of brief interventions. However it noted support for Arrest Referral schemes through targeting offenders with alcohol or drug problems 'early in their criminal justice journey'.
Some may question the focus of many prison based alcohol programmes on 12 step approaches which may not be seen as suitable as a single option for all those experiencing alcohol problems, particularly those with lower severity alcohol misuse, but follow a focus on abstinence based recovery promoted through the 2010 drug strategy. In 2014 a large US randomised control trial examined higher intensity therapeutic community interventions for higher risk offenders in the prison setting, but yielded no gains over less intense outpatient treatment. The Forward Trust also indicate a range of interventions are offered through its services, including motivational enhancement, case management and support around building recovery capital.
Many will note that the criminal justice settings is one part of a wider system seeking to engage with those with alcohol problems that has faced significant financial constraints. Notably community level treatment services have been described as in crisis as budgets shrink and numbers in treatment decline. A new national alcohol strategy is expected early next year. Whilst there has been little firm indication as to what line it may take, many may consider improving alcohol interventions across the criminal justice system as a missed opportunity to better engage those with a range of alcohol problems.
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