ALCOHOL SERVICESIN

PRISONTHE POLICY

BYCaroline Bonds

NOMS DRUG STRATEGY UNIT

BACKGROUND

• Alcohol plays an integral part in British Society;

• Many of us enjoy drinking alcohol with no problems, and moderate drinking may actually bring some health benefits;

• Alcohol misuse causes two major problems:

–Crime and anti-social behaviour; and–Health problems from binge and chronic drinking

ALCOHOL AND CRIME

• 40% of Binge Drinkers admitted committing a crime in past 12 months Budd 2003

• Binge drinkers 5 times more likely to be involved in a fight in previous 12 months Richardson and Budd 2003

• Victim, offender or both had been drinking in previous 4 hours in 90% of assaults Finney 2004

• Alcohol a feature in 62% of Domestic Violence

SIGNFICANT POLICIES

• Alcohol Harm Reduction Strategy for England, (AHRSE) 2004

• Choosing Health Agenda

• Prison Service Alcohol Strategy for Prisoners

• NPS Alcohol Strategy

• Devolved Responsibilities to PCTs

ALCOHOL HARM REDUCTION PROGRAMME (AHRP)• VIOLENT CRIME REDUCTION BILL (ALCOHOL

DISORDER ZONES, DRINKING BANNING ORDERS, DIRECTIONS TO LEVE ETC.)

• PROMOTIN OF A SAFER NIGHT-TIME ECONOMY

• VOLUNTARY CODE FOR PRODUCERS AND RETAILERS

• DRINKAWARE TRUST• TACKLING VIOLENT CRIME PROGRAMME• “SENSIBLE DRINKING CAMPAIGN• ALCOHOL CONDITIONAL CAUTION

TREATMENT WORKS!

• UNITED KINGDOM ALCOHOL TREATMENT TRIAL (UKATT) Heather, N., Raistrick, D., & Godfrey, C. (2005)

• FOUND THAT:

–FOR EVERY £1 SPENT ON TREATING PROBLEM DRINKERS, £5 IS SAVED ON COSTS TO HEALTH, SOCIAL AND CRIMINAL JUSTICE SERVICES

PROGRAMME OF IMPROVEMENT FOR ALCOHOL MISUSE• ALCOHOL NEEDS ASSESSMENT RESEARCH

PROJECT (ANARP)• ALCOHOL MISUSE INTERVENTIONS:

GUIDANCE ON DEVELOPING A LOCAL PROGRAMME OF IMPROVEMENT

• MODELS OF CARE FOR ALCOHOL MISUSERS (MOCAM)

• REVIEW OF THE EFFECTIVENESS OF TREATMENT FOR ALCOHOL PROBLEMS

• IDENTIFICATION AND BRIEF ADVICE TRAILBLAZERS

WHAT IS THE EXTENT OF THE ALCOHOL PROBLEM OF PRISONERS?

• 63% OF SENTENCED MALES AND 39% OF SENTENCED FEMALES CLASSED AS HAZARDOUS DRINKERS ONS, 1997 – Substance Misuse among prisoners in England and Wales

• THOSE PRISONERS IDENTIFIED AS HAVING A HAZARDOUS DRINKING PROBLEM ARE ALSO MORE LIKELY TO EXPERIENCE A WHOLE RANGE OF OTHER PROBLEMS SUCH AS:

–MENTAL ILLNESS–DRUG USE AND–HOMELESSNESS

FACTS AND FIGURES• 53% OF THOSE WITH A MAIN OFFENCE OF

VIOLENCE HAD TAKEN ALCOHOL;

• 9% OF THOSE ASSESSED BY CARATS SAID ALCOHOL WAS THEIR MAIN PROBLEM DRUG;

• 28% OF THOSE WITH A MAIN OFFENCE OF VIOLENCE SAID ALCOHOL WAS THEIR MAIN PROBLEM DRUG;

• HOME OFFICE STATISTICS SHOW THAT ONE FIFTH OF THE PRISON POPULATION ARE VIOLENT OFFENDERS

CONTINUED

• YOUNGER OFFENDERS

– In 2003/04 CARAT research data found 23.9% of those under 20 said that alcohol was their main problem drug. In the 20-24 age group this dropped to 5.7%.

– In 2004/05 CARAT research data showed 20.4% of those under 20 said alcohol was their main problem drug. In the 20-24 age group this dropped to 12.5%

In 2002/3 an estimated 6,400 prisoners undertook alcohol detoxification programmes, and an estimated 7,000 more prisoners undertook detoxification for combined alcohol and drug misuse

PRISON SERVICE ALCOHOL STRATEGY

• A COMPREHENSIVE ALCOHOL STRATEGY FOR PRISONERS WAS LAUNCHED IN DECEMBER 2004

• FOLLOWS CLOSELY THE GOVERNMENT’S NATIONAL ALCOHOL HARM REDUCTION STRATEGY, THE NPS ALCOHOL STRATEGY AND COMPLIMENTS BOTH THE EXISTING NOMS DRUG STRATEGY AND WIDER PROGRAMME OF RESETTLEMENT ACTIVITY

AIMS & OBJECTIVES• THE STRATEGY HAS TWO OBJECTIVES

–TO REDUCE THE HARM ASSOCIATED WITH THE MISUSE OF ALCOHOL, INCLUDING THAT RELATED TO OFFENDING, BY OFFERING TREATMENT AND SUPPORT TO PRISONERS; AND

–TO DETER THE USE OF ALCOHOL IN PRISONS

• WITH THE AIM OF:–IMPROVING CONSISTENCY–BUILDING ON GOOD PRACTICE

KEY ELEMENTS OF THE STRATEGY

• BETTER EDUCATION AND COMMUNICTION

• BETTER IDENTIFICATION, REFERRAL AND TREATMENT

• BETTER THROUGHCARE/WIDER LINKS;

• RECOGNISING DIVERSE NEEDS; AND

• REDUCING THE SUPPLY AND USE OF ALCOHOL BY PRISONERS, BOTH INTO AND WITHIN ESTABLISHMENTS

WHAT ALCOHOL SERVICES ARE AVAILABLE IN PRISON?

• MANAGEMENT OF THE SYMPTOMS OF WITHDRAWAL FROM ALCOHOL FORMS AN IMPORTANT ELEMENT OF THE REVISED STANDARD FOR CLINICAL SERVICES FOR SUBSTANCE MISUSERS

• DETOXIFICATION IS AVAILABLE IN ALL LOCAL AND REMAND PRISONS

• ALCOHOL AWARENESS COURSES

CONTINUED

• GENERAL OFFENDING BEHAVIOUR PROGRAMMES ADDRESS THE UNDERLYING CRIMINOGENIC FACTORS WHICH OCCUR IN ALCOHOL-RELATED CRIME; AND

• FOR THOSE PRISONERS WHOSE ALCOHOL MISUSE IS PART OF POLY-DRUG MISUSE OR WHERE LOCAL FUNDING IS AVAILABLE CARATS (Counselling, Assessment, Referral, Advice and Throughcare) SERVICES ARE AVAILABLE.

‘MODEL TREATMENT FRAMEWORK’

• A STRUCTURED MODEL OF HOW TO ORGANISE A RANGE OF INTERVENTIONS APPROPRIATE TO TAKING ALCOHOL PROBLEMS

• BASED ON MODELS OF CARE FOR ALCOHOL MISUSERS

• LACK OF RESOURCES MEANS THE FULL RANGE OF INTERVENTIONS CANNOT BE IMPLEMENTED

CORE COMPONENTS

• THE DEPENDENCEY ASSESSMENT• ALCOHOL DETOXIFICATION• SCREENING ASSESSMENT• SMTA• CSMA AND CARE PLANNING• GENERAL AWARENESS RAISING• 1-1 MOTIVATION SESSIONS• STRUCTURED GROUP WORK• AA AND OTHER SELF HELP GROUPS• ACCREDITED ALCOHOL TREATMENT PROGRAMMES• PRE-RELEASE INTERVENTIONS• POST RELEASE ACCESS TO COMMUNITY SERVICES

SCENARIOS – PERSON ENTERING PRISON CUSTODY WITH AN ALCOHOL PROBLEM

SOLE ALCOHOL USERS

• RECEPTION SCREENING• CLINICAL ASSESSMENT• CARATS• SMTA• BRIEF INTERVENTION – ADVICE AND

INFORMATION• IF ESTABLISHMENT PART OF IDTS – ALCOHOL

AWARENESS SESSION

POLY-DRUG MISUSER/ALCOHOL WORKER AVAILABLE

• RECEPTION SCREENING• CLINICAL ASSESSMENT• CARATS• SMTA• BRIEF INTERVENTION – ADVICE AND INFORMATION• CSMA (SDS/AUDIT) AND CARE PLANNING (IF TIME

ALLOWS)• 1-1 WORK• STRUCTURED GROUPWORK• AA (IF APPROPRIATE)• OFFENDING BEHAVIOUR PROGRAMME• RELAPSE PREVENTION• POST-RELEASE ACCESS TO COMMUNITY SERVICES

CURRENT DEVELOPMENTS• ALCOHOL VIDEO

• ALCOHOL INFORMATION PACK

• PILOT ALCOHOL BEFRIENDING SCHEME

• DEVELOPMENT OF TWO PILOT ACCREDITED ALCOHOL TREATMENT PROGRAMMES

• IDTS (ALCOHOL AWARENESS SESSION)

• WORKFORCE STRATEGY

CHALLENGES• LACK OF FUNDING

• ESTABLISHMENTS NOT ABLE TO IMPLEMENT THE FULL RANGE OF INTERVENTIONS DESCRIBED IN THE ‘MODEL’ TREATMENT FRAMEWORK UNLESS FUNDING CAN BE MADE AVAILABLE LOCALLY

• LACK OF CONSISTENCY ACROSS THE ESTATE

• PRISON RULES PROHIT THE USE OF ALCOHOL BUT ALCOHOL CONSUMPTION IS LEGAL IN THE COMMUNITY

CONTINUED

• IMPORTANT TO TARGET HIGH-RISK GROUPS WITH A VERY LOW UNDERSTANDING OF THEIR VULNERABILITY TO ALCOHOL, ESPECIALLY YOUNG PEOPLE

• PRISONERS ARE A DIVERSE COMMUNITY

• ADDITIONAL NEEDS MUST ALSO BE TAKEN INTO ACCOUNT E.G. FAMILY NEEDS

WHAT ARE THE BENEFITS OF HAVING AN ALCOHOL STRATEGY WITHOUT FUNDING?

• ENABLES NOMS TO BE CONSISTENT WITH WIDER GOVERNMENT INITIATIVES AND REFLECTS A JOINED UP APPROACH

• PROVIDES A MORE CONSISTENT AND CORDINATED APPROACH FOR ADDRESSING THE HARM ASSOCIATED WITH ALCOHOL MISUSE AND THE PREVENTION AND USE OF ALCOHOL IN PRISONS;

• PROVIDES A FRAMEWORK FOR ADDRESSING PRISONERS’ ALCOHOL PROBLEMS BALANCING TREATMENT AND SUPPORT WITH SUPPLY REDUCTION MEASURES

CONTINUED

• PROVIDES A BENCHMARK FOR PRISONS TO FORMULATE THEIR OWN RESPONSE TO ALCOHOL AT A LOCAL LEVEL

• ESTABLISHMENTS WHO HAVE IDENTIFIED FUNDING AND WISH TO IMPROVE/DEVELOP ALCOHOL TREATMENT INTERVENTIONS HAVE A MODEL TREATMENT FRAMEWORK TO WORK FROM

THANK YOU

• Caroline.bonds@homeoffice.gsi.gov.uk• Tel: 020 7035 6194