A Systematic Review of the Efficacy of Alcohol Interventions for Incarcerated People

Dorothy Newbury-Birch; Jennifer Ferguson; Sarah Landale; Emma L. Giles; Grant J. McGeechan; Charlotte Gill; Kelly J. Stockdale; Aisha Holloway

Disclosures

Alcohol Alcohol. 2018;53(4):412-425. 

In This Article

Abstract and Introduction

Abstract

Aim: The aim of this current study was to systematically review the literature on brief alcohol interventions for incarcerated individuals to ascertain the efficacy or effectiveness in making changes to either consumption of alcohol or other social outcomes.

Short summary: Levels of risky drinking and dependency are high amongst incarcerated individuals. Eleven studies from nine articles were included in the systematic review. Six of the studies included brief intervention and three extended interventions. Interventions have the potential to positively impact on risky drinking. More studies are needed in this setting.

Introduction: It has been shown that around three times as many incarcerated individuals are risky drinkers and alcohol dependency is ten times higher than in the general population.

Methods: Systematic review of randomised controlled trials or matched group trials of the efficacy of psychosocial alcohol interventions for incarcerated individuals: we searched seven databases, with no restrictions on language, year or location from inception through to August 2017. The Critical Appraisal Skills Programme tool was used to assess the quality of included studies. The Template for Intervention Description and Replication checklist was used to ascertain intervention descriptions.

Results: Nine studies from 11 papers were included in the analysis. Six of the studies included brief interventions and three extended interventions. Every study used a different measure of alcohol consumption. Three of the studies that looked at brief interventions and all of the three extended intervention studies found significant reductions in relation to alcohol outcomes.

Conclusions: Results show that interventions in the prison setting have the potential to positively impact on alcohol use; however, because of small numbers and the use of different outcome measures we could not conduct a meta-analysis or generalise findings. Future studies are needed to standardise approaches to ensure greater rigour and efficacy.

Introduction

Alcohol substantially contributes to the global burden of disease and is responsible for 2.3 million premature deaths worldwide, many of which are preventable (Rehm et al., 2009). A recent survey showed that 70% of prisoners in the UK admitted drinking when committing the offence for which they were imprisoned (Alcohol and Crime Commission, 2014). Hazardous drinking is a repeated pattern of drinking that increases the risk of physical or psychological problems (Saunders and Lee, 2000), whereas harmful drinking is defined by the presence of these problems (World Health Organisation, 1992). Drinking at hazardous or harmful levels are often categorised as risky drinking.

There are ~10.35 million people imprisoned worldwide. The USA has 2.28 million and the UK 85,843 (Walmsley, 2015). Worldwide, the prison population is 144 per 100,000 people; in the USA, this is 698 per 100,000 people compared witrh 148 per 100,000 in the UK (Walmsley, 2015). It has been shown that drinking norms in the criminal justice system differ widely from those in the general population (Newbury-Birch et al., 2016b). Risky drinking is higher in the criminal justice system than in the general population (Newbury-Birch et al., 2016b). However, it has been shown that risky drinking amongst incarcerated people differs across the world. A systematic review carried out by Newbury-Birch et al. (2016b) found that between 51% and 83% of incarcerated people are classified as risky drinkers; in the USA, risky drinking levels have been shown to be around 50% (Binswanger et al., 2009) and in Africa, the rates are shown to be just over 50% (Muigai, 2014). Furthermore, rates of dependence among those who are incarcerated have been shown to be up to ten times higher than the general population (Newbury-Birch et al., 2016b). Although the relationship is complex, there is well-documented evidence of an association between alcohol use and crime (Boden et al., 2012), with a complex interplay between the amount drank, the pattern of drinking and the individual and contextual factors (Graham et al., 2012).

Evidence tells us that intensive interventions that target high-risk offenders work best for reducing recidivism (Andrews and Bonta, 2010) and this is where resources are being placed. However, services are currently advocating the use of brief interventions in the criminal justice system (Newbury-Birch et al., 2016b). Brief interventions have been shown to be effective in primary healthcare (O'Donnell et al., 2014). They are typically applied to opportunistic, non-treatment seeking populations, delivered by practitioners other than addiction specialists (Miller and Rollnick, 2002). Brief intervention largely consists of two different approaches (National Institute for Clinical and Health Excellence, 2010): simple structured advice which, following screening, seeks to raise awareness through the provision of personalised feedback and advice on practical steps to reduce drinking behaviour and its adverse consequences; and extended brief intervention, which generally involves behaviour change counselling. Extended brief intervention introduces and evokes change by giving the patient the opportunity to explore their alcohol use as well as their motivations and strategies for change. Both forms share the common aim of helping people to change drinking behaviour to promote health, but they vary in the precise means by which this is achieved. There is a wide variation in the duration and frequency of brief alcohol interventions, but typically they are delivered in a single session or a series of related sessions lasting between 5 min and 60 min and can be implemented by a range of practitioners in a wide variety of settings (Kaner et al., 2007). To date, there is a lack of evidence relating to the use of brief interventions in the criminal justice system in general, and in the prison system in particular (Newbury-Birch et al., 2016b).

Intervening to reduce alcohol use has been shown to be cost-effective, generating both long- and short-term savings (UKATT Research Team, 2005). Therefore, given the high levels of risky drinking, the links between alcohol and crime, and the costs to society, it is important to find effective interventions that not only reduce alcohol consumption, but also potentially recidivism. Interventions carried out within the criminal justice system could potentially capitalise upon the 'teachable moment' considered to be conducive of behaviour change, wherein individuals can be encouraged to consider their alcohol use within the context of their offending behaviour and its punitive consequences (Babor and Grant, 1989).

The aim of this current study was to systematically review the literature on brief alcohol interventions for incarcerated individuals to ascertain the efficacy or effectiveness in making changes to either consumption of alcohol or other social outcomes.

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