Prison Based Motivational Intervention Therapy for Problem Drinkers; Impact of feasibility study in...
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Transcript of Prison Based Motivational Intervention Therapy for Problem Drinkers; Impact of feasibility study in...
Prison Based Motivational Intervention Therapy for Problem
Drinkers;Impact of feasibility study in HMP Altcourse
Emma PenningtonResearch Associate
CAIS Ltd, in association with IMSCaR, Bangor University
Need for alcohol treatment in Criminal Justice?
• Alcohol related harm costs the UK up to £20.1 billion per year, with crime and antisocial behaviour harm estimated at £7.3 billion (Alcohol Harm Reduction Strategy, 2004)
• During our feasibility study at HMP Altcourse we found that 87% (n=46) of prisoners screened over a 2 month period were drinking at hazardous to harmful levels before arrest
• “For every £1 spent on treatment, £5 saved (CJS)” (UKATT, 2005)
• “Motivational Enhancement Therapy is the leading treatment for alcohol in the UK” (UKATT, 2005)
• No published trials of psychosocial intervention in prison for alcohol treatment
Aims of feasibility trial
• Establish if prisoners engage in motivational intervention for alcohol misuse
• Investigate practicalities of running prison based trial, i.e. recruitment, randomisation and follow up
Location & eligibility criteria • HMP Altcourse, Liverpool
Category B Male prison Offenders returning to North Wales Sentenced 1 -3 months
Design & Methods
• Pragmatic randomised trial, design & methodology adapted from UKATT where possible
• All eligible newly incepted prisoners screened (AUDIT) • N=30 recruited to study • Baseline measures – 28 day retrospective drinking
history (taken from UKATT)• Randomised to either control (n=10) or experimental
conditions (n=20)• 3 sessions of intervention or treatment as usual• Post release follow up one month later, measures
repeated.
Computerised Motivational Intervention Therapy (ComMIT)
• 3 brief sessions, based on motivational interviewing (Miller & Rollnick, 1991; 2001) & drinker’s check-up (Miller et al, 1988)
• Sessions led by therapeutic worker • Gives participants objective feedback on their
drinking & feedback presented in relation to population norms
• Invites participants to weigh up the good things and not so good things about drinking
• Begins to address goals and potential triggers – thinking ahead to release
• Printed feedback at end of each session
Demographics• Average sentence length:
4.3 weeks
• Previous time in jail? 15 yes, 15 no
• Average age (and age range) 30.2 years (range 19-66)
• Offence related to alcohol? 24 Yes, 6 No
• Accommodation on release? 22 Housed, 8 NFA
• How many completed the study? 29 (1 transferred to different prison)
• How many attended for follow up? 19 in total. (16 intervention condition & 3 control condition)
Results
Baseline 1 month post release
OutcomeMeasures
Experimental
Control Total Experimental
Control Total
DaysAbstinent(%)
59.6 (n=16)
29.9 (n=3) 89.5 79 (n=16) 33.3 (n=3) 112.3
No ofdrinks
per drinkingday
499.8 (n=16)
967.5 (n=3)
1467.3 227.4 (n=16)
240.2 (n=3)
467.6
Table: Mean scores for baseline and secondary outcomes by allocated condition at one month follow up.
What did we find?
• Everybody engaged!
• Only 4/30 had ever sought any previous help for alcohol related problems
• Feedback indicated that prisoners would not do this “on the out” but almost all who took part reported that they found it useful
• Trial process worked well
Challenges of implementing & evaluating ComMIT in prison
• Room availability
• Release dates
• Access to inmates
• Participants often do not attend at post release follow up
Interviews with participants
“Do you have a problem with alcohol?” No“Was your offence related to alcohol?” Yes
“Everything [convictions] I’ve ever done is drink related” ‘Paul’, 28.
“If I drink again I’ll be back in prison”. ‘Frank’, 33
Almost every piece of feedback from participants has stated “I did not realise how much I was drinking”
In summary…
• Prison based randomised trials of psychosocial intervention for alcohol misuse is feasible – although difficulties present
• May be possible to engage offenders who would not otherwise be willing / interested
• Emphasis on post release interview essential to encourage attendance at follow up – particularly with controls
• Further research needed!