www.phrn.nhs.uk systematic review of the effectiveness of alcohol treatments in offender populations...
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Systematic Review of the Effectiveness of Alcohol Treatments in Offender
Populations
Amanda Roberts
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Background
The PHRN commissioned reviews of existing literature for four work streams: Dentistry, Mental Health, Primary Care and Substance Misuse.
Part of a larger PHRN review commissioned and funded by Offender Health.
Entitled: ‘Drug and Alcohol Treatments in Prison and Community Settings’ (Roberts A, Hayes A, Carlisle J and Shaw J, 2007)
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Rationale
Substance misuse is a major problem in the general population as well as in prisons and the wider CJS.
Large body of evidence for community based drug treatments.
Far less research in CJS.Also, alcohol not often considered
separately but assimilated into the larger category of substance misuse.
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Policy
NOMS strategy for problematic drug users in
correctional services (NOMS, 2005). HM Prison Service
drug and alcohol strategies (HMPS, 2002; 2003; 2006)
good practice guide for alcohol treatment and interventions (HMPS, 2004)
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Policy
National Probation Service strategy for working with alcohol
misusing offenders (National Probation Service, 2006).
‘Safe. Sensible. Social’ (2007)National alcohol strategy including
offender populations
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Aims of the SR
To summarise the research evidence on the effectiveness of treatment and prevention interventions which aim to reduce;
(i) Alcohol use/abuse AND/OR (ii) criminal behaviours
in offender populations.
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Search Sources
Nine databases (April 10th-14th 2007)
Comprehensive range of Criminological, Psychological and Social Science journals.
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Search Terms
Combination of search terms relating to both alcohol and offending;
(i) alcohol* or drink* or drunk* AND(ii) jail* or inmate* or criminal* or offender*
or incarcerat* or penitentiar* Terms adapted for each search engine to
exploit the database most effectively.
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Search Results
7003 journals retrieved.
Duplicates removed.
Book reviews (19), discussion and opinion pieces removed (54).
Studies with dual reporting of drugs and alcohol (13), and for not evaluating an intervention (8).
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Search Results
28 journals met the final stage criteria.
4 further excluded after further inspection.
Final total 24 studies.
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Methodological Quality
In order to evaluate the effectiveness of interventions, a degree of scientific certainty was required.
Review employed a ‘methodological rigour rating scale’ (Scientific Methods Scale, (SMS) Sherman et al, 1997)
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Methodological Quality
Sliding scale from 1 to 5 (from 1= correlation to 5=RCT ‘gold standard’). The higher the SMS level the more able the study is to infer a ‘cause and effect’ relationship.
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Analysis
Heterogeneity of studies prevented any quantitative statistical analysis.
Quantitative Narrative Review was conducted.
Studies presented in tables of treatment type detailing: country, SMS level, total n, age, offence type, follow-up lengths, baseline differences present, outcomes on alcohol use and recidivism.
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Analysis
Studies classified also by type of study i.e T0,T1,T2,T3. T0=treatment group compared with control, T1= treatment group compared with another intervention.
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Demographics
Country of Origin: 19 USA; 2 UK; 1 Germany; 1 New Zealand; 1 Canada.
SMS Levels: 7 level 5; 6 level 4; 10 level 3; 1 level 2.
Sample sizes: ranged from 18 to 148,632Ages: 4 studies YOs; 10 adults; 8 mixed; 2
not reported.Offence Type: 17 DWI; 5 mixed; 1
Violence; 1 unreported
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Evaluated Interventions
Type of Intervention Number of Studies
Psycho-Social-Behavioural 12
VIPs 6
Legal Sanctions (II) 3
TCs 2
Psycho-Social-Behaviouralwith Legal Sanctions (II)
1
Psycho-Social-Behaviouralwith Legal Sanctions and Victim Impact Panels (VIPs)
1
Psycho-Social-Behaviouralwith Therapeutic Communities (TCs)
1
Psycho-Social-Behavioural with VIP 1
Other (Vipassana Meditation) 1
Total Studies 28
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Examples of Interventions
PSBAlcohol education courses (AECs)Self help manualsAACBTPsychological Interventions (individual or
family)Group dynamic interventions
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Examples of Interventions
PSB+Legal SanctionsJail term and PSB
Ignition Interlock and/or Licence suspensions and PSB
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Research Question
‘Which interventions help to decrease alcohol use/abuse and/or recidivism?’
Reported by treatment typeReported by study quality
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Results by Treatment Type
PSB4:16 effective in reducing alcohol use and
recidivism.* One study showed increased alcohol use and 2 studies reported increased rates recidivism post intervention
PSB and Legal Sanctions2:16, one effective in reducing alcohol not
recidivism; one effective in reducing recidivism but did not report alcohol outcomes.
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Results by treatment type
PSB, Legal Sanctions and VIP1:16, reduction in criminal activity not
alcohol
PSB and TC1:16, reduction in criminal activity and
alcohol use
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Results by Treatment Type
TCs2 studies evaluated the effectiveness of
TCs only one reduced later alcohol use
Legal Sanctions and Licence Suspension (II)
2 studies both reduced later alcohol-related driving offences
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Results by treatment type
VIPsOn the whole ineffective. One study
showing positive effect on recidivism. Only one reported alcohol outcomes and found no differences.
Other (VP)One study, effective in reducing alcohol
use but not recidivism.
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Results by study quality
6 RCTs (SMS level 5) For recidivism:
- only 2 effective (PSB and Legal Sanctions/II) - other 4 reported no differences
For alcohol:- 2 effective (PSB and TC)- 3 showed no differences (PSB/VIP (2), VIP)- 1 didn’t evaluate alcohol outcomes (LS)* one PSB intervention found increased alcohol use post intervention
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SR Conclusions
Limited conclusions can be drawnNo consistently conclusive evidence
for the effectiveness of a single intervention.
SR difficult when methodological quality of studies are poor.
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Caveats
Impact of CJS structural obstacles (i.e: random allocation not possible and/or control groups not possible) on research quality.
Non-equivalence limits ability to make causal inferences. Consequently, tried to implement comparison groups but this introduces baseline differences. (13 24 studies had such differences)
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Caveats
Mandatory/voluntary problem. (Coerced by virtue of a reduction in sentence) Introducing research ethical dilemmas.
Differential affect of being mandated to an intervention in a prison environment as oppose to in the community; what works in a prison setting may not work in the community and vice versa.
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Discussion
Cultural factors, design of interventions that can be implemented in multi-cultural settings.
Do different interventions work for different types of offenders?
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Discussion
Research needed that evaluates the effectiveness of interventions by individual characteristics and by offence type.
Some interventions are effective at differing follow up periods i.e long term not short term and vice versa. Therefore, research needed that evaluates interventions that have a long term sustainable effect