Prison Based Motivational Intervention Therapy for Problem

Drinkers;Impact of feasibility study in HMP Altcourse

Emma PenningtonResearch Associate

CAIS Ltd, in association with IMSCaR, Bangor University

e.pennington@bangor.ac.uk

Need for alcohol treatment in Criminal Justice?

• Alcohol related harm costs the UK up to £20.1 billion per year, with crime and antisocial behaviour harm estimated at £7.3 billion (Alcohol Harm Reduction Strategy, 2004)

• During our feasibility study at HMP Altcourse we found that 87% (n=46) of prisoners screened over a 2 month period were drinking at hazardous to harmful levels before arrest

• “For every £1 spent on treatment, £5 saved (CJS)” (UKATT, 2005)

• “Motivational Enhancement Therapy is the leading treatment for alcohol in the UK” (UKATT, 2005)

• No published trials of psychosocial intervention in prison for alcohol treatment

Aims of feasibility trial

• Establish if prisoners engage in motivational intervention for alcohol misuse

• Investigate practicalities of running prison based trial, i.e. recruitment, randomisation and follow up

Location & eligibility criteria • HMP Altcourse, Liverpool

Category B Male prison Offenders returning to North Wales Sentenced 1 -3 months

Design & Methods

• Pragmatic randomised trial, design & methodology adapted from UKATT where possible

• All eligible newly incepted prisoners screened (AUDIT) • N=30 recruited to study • Baseline measures – 28 day retrospective drinking

history (taken from UKATT)• Randomised to either control (n=10) or experimental

conditions (n=20)• 3 sessions of intervention or treatment as usual• Post release follow up one month later, measures

repeated.

Computerised Motivational Intervention Therapy (ComMIT)

• 3 brief sessions, based on motivational interviewing (Miller & Rollnick, 1991; 2001) & drinker’s check-up (Miller et al, 1988)

• Sessions led by therapeutic worker • Gives participants objective feedback on their

drinking & feedback presented in relation to population norms

• Invites participants to weigh up the good things and not so good things about drinking

• Begins to address goals and potential triggers – thinking ahead to release

• Printed feedback at end of each session

Demographics• Average sentence length:

4.3 weeks

• Previous time in jail? 15 yes, 15 no

• Average age (and age range) 30.2 years (range 19-66)

• Offence related to alcohol? 24 Yes, 6 No

• Accommodation on release? 22 Housed, 8 NFA

• How many completed the study? 29 (1 transferred to different prison)

• How many attended for follow up? 19 in total. (16 intervention condition & 3 control condition)

Results

Baseline 1 month post release

OutcomeMeasures

Experimental

Control Total Experimental

Control Total

DaysAbstinent(%)

59.6 (n=16)

29.9 (n=3) 89.5 79 (n=16) 33.3 (n=3) 112.3

No ofdrinks

per drinkingday

499.8 (n=16)

967.5 (n=3)

1467.3 227.4 (n=16)

240.2 (n=3)

467.6

Table: Mean scores for baseline and secondary outcomes by allocated condition at one month follow up.

What did we find?

• Everybody engaged!

• Only 4/30 had ever sought any previous help for alcohol related problems

• Feedback indicated that prisoners would not do this “on the out” but almost all who took part reported that they found it useful

• Trial process worked well

Challenges of implementing & evaluating ComMIT in prison

• Room availability

• Release dates

• Access to inmates

• Participants often do not attend at post release follow up

Interviews with participants

“Do you have a problem with alcohol?” No“Was your offence related to alcohol?” Yes

“Everything [convictions] I’ve ever done is drink related” ‘Paul’, 28.

“If I drink again I’ll be back in prison”. ‘Frank’, 33

Almost every piece of feedback from participants has stated “I did not realise how much I was drinking”

In summary…

• Prison based randomised trials of psychosocial intervention for alcohol misuse is feasible – although difficulties present

• May be possible to engage offenders who would not otherwise be willing / interested

• Emphasis on post release interview essential to encourage attendance at follow up – particularly with controls

• Further research needed!