ALCOHOL SERVICES IN PRISON THE POLICY BY Caroline Bonds NOMS DRUG STRATEGY UNIT.
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Transcript of ALCOHOL SERVICES IN PRISON THE POLICY BY Caroline Bonds NOMS DRUG STRATEGY UNIT.
ALCOHOL SERVICESIN
PRISONTHE POLICY
BYCaroline 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 20-24 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 20-24 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
THANK YOU
• [email protected]• Tel: 020 7035 6194