ALCOHOL SERVICES IN PRISON THE POLICY BY Caroline 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 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 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

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