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Systematic Review of the Effectiveness of Alcohol Treatments in Offender Populations

Systematic Review of the Effectiveness of Alcohol Treatments in Offender Populations. Amanda Roberts . Background. The PHRN commissioned reviews of existing literature for four work streams: Dentistry, Mental Health, Primary Care and Substance Misuse.

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Systematic Review of the Effectiveness of Alcohol Treatments in Offender Populations

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  1. Systematic Review of the Effectiveness of Alcohol Treatments in Offender Populations Amanda Roberts

  2. 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)

  3. 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.

  4. 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)

  5. 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

  6. 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.

  7. Search Sources • Nine databases (April 10th-14th 2007) • Comprehensive range of Criminological, Psychological and Social Science journals.

  8. Search Terms • Combination of search terms relating to both alcohol and offending; • alcohol* or drink* or drunk* AND • jail* or inmate* or criminal* or offender* or incarcerat* or penitentiar* • Terms adapted for each search engine to exploit the database most effectively.

  9. 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).

  10. Search Results • 28 journals met the final stage criteria. • 4 further excluded after further inspection. • Final total 24 studies.

  11. 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)

  12. 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.

  13. 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.

  14. 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.

  15. 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 148,632 • Ages: 4 studies YOs; 10 adults; 8 mixed; 2 not reported. • Offence Type: 17 DWI; 5 mixed; 1 Violence; 1 unreported

  16. Evaluated Interventions

  17. Examples of Interventions PSB • Alcohol education courses (AECs) • Self help manuals • AA • CBT • Psychological Interventions (individual or family) • Group dynamic interventions

  18. Examples of Interventions PSB+Legal Sanctions • Jail term and PSB • Ignition Interlock and/or Licence suspensions and PSB

  19. Research Question ‘Which interventions help to decrease alcohol use/abuse and/or recidivism?’ • Reported by treatment type • Reported by study quality

  20. Results by Treatment Type PSB • 4:16 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 Sanctions • 2:16, one effective in reducing alcohol not recidivism; one effective in reducing recidivism but did not report alcohol outcomes.

  21. Results by treatment type PSB, Legal Sanctions and VIP • 1:16, reduction in criminal activity not alcohol PSB and TC • 1:16, reduction in criminal activity and alcohol use

  22. Results by Treatment Type TCs • 2 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

  23. Results by treatment type VIPs • On 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.

  24. 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

  25. SR Conclusions • Limited conclusions can be drawn • No consistently conclusive evidence for the effectiveness of a single intervention. • SR difficult when methodological quality of studies are poor.

  26. 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)

  27. 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.

  28. Discussion • Cultural factors, design of interventions that can be implemented in multi-cultural settings. • Do different interventions work for different types of offenders?

  29. 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

  30. Drug and Alcohol Review • ‘Drug and Alcohol Treatments in Prison and Community Settings’ (Roberts A, Hayes A, Carlisle J and Shaw J, 2007) • Full review can be found at www.phrn.nhs.uk/prison/SMreview.pdf

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