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

Discussion

This systematic review examined the efficacy and/or effectiveness of alcohol interventions for incarcerated individuals. Results show that it is possible to carry out RCTs in this setting and that there is some promise in terms of effects. However, this study has shown that, to date, not enough studies have been carried out to ascertain efficacy or effectiveness and adequate methodological rigour in the available literature is questionable. Moreover, there is a distinct lack of information relating to female prisoners. Yet, this should not discourage researchers: the signs are that there is a place for interventions in this setting and they do hold promise, but more robust studies are needed with standardised approaches.

This study, like others, has shown that interventions for offenders that tackle risky drinking issues are under-developed and under-researched (Bowes et al., 2014; Newbury-Birch et al., 2016b). It has also been shown that it is very difficult to conduct research studies in this setting, primarily due to the difficulties in collecting self-report follow-up data (Newbury-Birch et al., 2016b). One of the fundamental issues is that studies include different measurement tools and outcomes, with outcomes decided upon based on the research funding. A piece of work is currently taking place that aims to develop a Core Outcome Set for Alcohol Brief Interventions (ABI) to improve the measurement of alcohol-related change: Outcome Reporting in Brief Intervention Trials: Alcohol (ORBITAL) (Shorter et al., 2018).

Furthermore, our results showed that interventions are not being described as methodically as they could be and that is an area to further improve in future research. The introduction of the TIDiER checklist (Hoffman et al., 2014) and the expectation that it will be used when describing studies is a step forward; however, this study shows that, to date, there is limited information relating to intervention content and delivery in this body of research.

It is often thought that prisoners feel coerced into taking part in research projects; however, evidence tells us that participants do not feel coerced if the project is explained properly (Sherman et al., 2015). Although, research tells us that obtaining follow-up data with this population is fraught with difficulties because of the sometimes chaotic lifestyles of the participants (Newbury-Birch et al., 2016b). More work is needed into how we can use routinely collected data in criminal justice studies. For instance, a recent study carried out by researchers in the UK in the probation setting used reconviction data to follow up individuals using Police National Computer identifiers and followed-up 97% of participants (Newbury-Birch et al., 2014).

In order for research to be applicable to the prison setting it is imperative that the experiences of inmates are integrated in co-designing the research question and study processes (Newbury-Birch et al., 2016a). By working together and drawing on the expertise of staff, inmates and researchers, it is possible to translate the results of research into real world practice (Sherman et al., 2015). For example, researchers in the UK have recently undertaken an ABI development study for male remand prisoners. As part of this, they have conducted in-depth interviews and focus groups with prisoners and prison staff/key stakeholders to develop not only the research process but also the type and nature of the ABI intervention (Holloway et al., 2017).

There are several additional limitations to this study. The majority of the studies were undertaken in the USA and there was a lack of data relating to women. In addition, we were unable to complete a meta-analysis to quantitatively assess programme outcomes because of the variability in outcome measures used in the studies. This review has shown that although there are limited studies, it is feasible to carry out alcohol interventions with incarcerated individuals. More work is needed however, to clarify what exactly the outcomes of interest are to the criminal justice agencies we work with.

Despite these recent developments the question remains: are we carrying out research projects for incarcerated individuals who are risky drinkers in the most effective way? Research studies in the criminal justice system are by their very nature complex and context-specific. Public health and criminal justice agencies have long been perceived as having entirely different approaches to dealing with alcohol issues (Shepherd and Sumner, 2017). In order to advance policy development, research and programme co-design, research highlights the need for more collaborative research partnerships developed at the start of a project to ensure programme suitability and efficacy (Newbury-Birch et al., 2016a, 2016b). Community-based participatory research has been shown to be a useful model for co-designing research with hard to reach groups (Leung et al., 2004). It has been argued that, in terms of informing policy, there tends to be an over-reliance on evidence from tightly controlled intervention trials which often lead to questions around the applicability of research in the real world (Pettman et al., 2012). The evidence to date, although limited does seem to be showing an effect. However, we are still at the stage where we need robust efficacy/effectiveness studies to prove whether the interventions are effective.

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