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The Alcohol and Offenders Criminal Justice Research Programme

The Alcohol and Offenders Criminal Justice Research Programme. Dr Lesley Graham Associate Specialist, Public Health ISD, NHS National Services Scotland Andrew McAuley Public Health Advisor (Substance Misuse/Alcohol) NHS Health Scotland. Acknowledgements. Advisory Group Members

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The Alcohol and Offenders Criminal Justice Research Programme

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  1. The Alcohol and Offenders Criminal Justice Research Programme Dr Lesley Graham Associate Specialist, Public Health ISD, NHS National Services Scotland Andrew McAuley Public Health Advisor (Substance Misuse/Alcohol) NHS Health Scotland

  2. Acknowledgements Advisory Group Members Iain MacAllister, Scottish Government Sharon Grant, Scottish Government George Howie, NHS Health Scotland Ruth Parker, Scottish Prison Service (SPS) Jim Carnie, SPS Stephen Heller-Murphy, Health Improvement Scotland (formerly SPS) Research Teams Tessa Parkes, Susan MacAskill and team, Stirling University Kate Skellington Orr, Shirley McCoard and team, MVA Consultancy

  3. The Alcohol and Offenders Criminal Justice Research Programme • Describes nature and scale of alcohol problems in offenders • Examines and contributes to the evidence base of what works • Maps current activity highlighting best practice

  4. Alcohol in Scotland • Enough alcohol is sold in Scotland for every adult to exceed male weekly limits[Health Scotland 2011] • Excess consumption is across all age and socio-economic groups[Scottish Health Survey 2010] • 1 in 20 deaths attributable to alcohol[Grant, Springbett and Graham 2009] • Those from the most deprived areas in Scotland are 6 times more likely to die an alcohol related death[Alcohol Statistics Scotland 2011]

  5. Alcohol-related mortality by deprivation, Scotland Alcohol-related deaths (underlying cause, deprivation category, 2001/02, 2005/06, 2009/10) Source: ISD Scotland (NRS)

  6. Alcohol and Crime in Scotland • Half (50%) of prisoners in Scotland reported being drunk at the time of their offence, rising to three quarters (77%) of young offenders[Scottish Prison Survey 2009] The problem is getting worse • There has been a rise in proportion of young Scottish offenders who consider alcohol has contributed to their offending (from 48% in 1979 to 80% in 2007)[McKinlay et al 2009] • Alcohol related crime is estimated to cost Scotland over £700 million per year[Societal Cost for Alcohol Misuse in Scotland in 2007 Scottish Government 2010]

  7. Alcohol and Violent Crime in Scotland • Where known, alcohol is a factor in more than two thirds (69%) of those accused of homicide[Homicide in Scotland 2008/9] • 70% of assaults in A&E may be alcohol related [QIS 2006] • In 62% of violent crime, victims said the offenders were under the influence of alcohol [Scottish Crime and Justice Survey 2010]

  8. Alcohol Problems in Offenders The prevalence of alcohol problems in offenders is high • 46% of Scottish prisoners may have harmful use/dependency (as defined by CAGE) compared to 14% of the adult male general population[Alcohol Statistics Scotland 2011][Scottish Health Survey 2010] Important to note that not all alcohol problems in offenders are directly linked to their offence

  9. The offender pathway: an opportunity for intervention • Population with a high prevalence of alcohol problems • Easier to reach the ‘hard to reach’ -over a third of prisoners said if they were offered help for their alcohol problems they would take it [Scottish Prison Survey 2009] • Potential to reduce re-offending • Positive effect on others (many young offenders have family members who have served a custodial sentence) • Reduce health inequalities

  10. A Prison Health Needs Assessment for Alcohol Problems

  11. Methods • Epidemiology of alcohol problems in prisoners in Scotland • Rapid review of international literature on screening tools and effective interventions • Mapping of alcohol services across all Scottish prisons • Case study of one prison -screening of prisoners using AUDIT -interviews with key informants (including prisoners) • Gap analysis • A model of care

  12. Rapid review: findings • Screening • AUDIT most promising but no single screening tool superior • Timing of screening may be important • Interventions • Evidence limited for most interventions (though therapeutic communities may be effective) • Alcohol Brief Interventions have highest evidence base in general population • Throughcare - little research available

  13. Screening: findings in one prison

  14. Mapping: findings across prisons • Recognition that prison provides an opportunity to detect and intervene with alcohol problems • No use of validated screening tool • Timing of asking can be important • Range of interventions to address alcohol problems • Not all interventions available to those on short sentences/remand • Low numbersof prisoners accessing interventions • Variation in capacity of staff due to other demands • Problems establishing continuity of care • Limited in-reachthough this is developing

  15. Case study: findings from interviews with prisoners & staff • Broadly convergent understanding of many alcohol aspects among prisoners and staff • Perception that alcohol issues are not as well resourced or as prominent as drug interventions • Prisoners view alcohol problem assessment on admission as an ‘yes or no’ question, asked at a time of competing concerns • Recognition that not all prisoners will acknowledge alcohol problems or want to deal with them • Recognition that differing patterns of alcohol misuse exist across age groups • Prisoners want more involvement of ‘outsiders’ and those with experience of alcohol problems

  16. Four tiers of intervention (MoCAM)

  17. Model of Care

  18. Scoping of Interventions for Offenders with Alcohol Problems in Community Justice Settings

  19. Methods Literature review and desk top analysis Primary data collection -interviews with Community Justice Authority Chief Officers -interviews with CJA local partners

  20. Rapid review: findings Limited data on prevalence of alcohol problems in offenders Limited routine data on alcohol-related offending 11% of probation orders had alcohol treatment as a requirement Screening again, AUDIT most promising Interventions Evidence limited for most interventions Alcohol Brief Interventions have highest evidence base in general population Arrest Referral effective in identifying those with alcohol problems

  21. Local Practice: findings • Alcohol rising up the agenda • Mainstream services being accessed but no formal care/offender pathways • Limited interventions specifically for offenders (e.g. alcohol and violence) • Most interventions post sentence • Some local examples of good practice

  22. Good practice examples • Alcohol Diversion Scheme (Fife) - early intervention addressing binge drinking and associated anti-social behaviour - opportunity to participate in an alcohol education session instead of FPN - especially popular with the 18 to 30 age group • Opportunity to Reduce Criminal Activity (ORCA) service (Grampian) - builds on multi agency working practices in its service delivery - observed reduction in crime locally • Tayside Short Term Prisoner Protocol - pre-release ‘surgeries’ facilitate integration back into community - short term prisoners referred to alcohol services on release

  23. Alcohol Brief Interventions is the Community Justice Setting: a feasibility pilot

  24. Methods Three pilot sites Offenders on probation orders or community service orders Single blind randomisation to either: -Screening (using AUDIT) and leaflet -Screening and ABI Follow up at three/six months Online staff survey Analysis of training (pre and post) In depth interviews with key staff Cost analysis

  25. ABI pilot: findings • 419 assessed; of whom 295 (70%) eligible; of whom 207 consented (70%) • 85% male; mean age 31 years • 59% (n=116) had an Alcohol Use Disorder of whom 42% (n=82) eligible for an ABI • 32 (39%) lost to follow up; 34 other outcome known, 16 individuals followed-up

  26. ABI pilot: findings • Training generally thought useful, relevant and improved confidence • AUDIT easy to use and ABI easy to deliver • Timing thought to be more beneficial earlier in process • Mixed views as to appropriateness and client engagement • Some lack of understanding by frontline staff about study design, purpose and effectiveness • £67 per person (majority overheads)

  27. Next Steps • £0.75 million funding for ADPs in 2011/12 for alcohol in prisons • Dissemination of research including event in February 2011 • Briefing of ADP chairs • ADP/CJA event in December • Guidance statement • Report for WHO HIPP on alcohol

  28. Contact/Further Information Dr Lesley Graham lesley.graham@nhs.net Alcohol and Offender Criminal Justice Programme http://www.healthscotland.com/topics/health/alcohol/offenders.aspx

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