Feasibility of Prison-Based Motivational Intervention Therapy for Problem Drinkers: Impact of a Study in HMP Altcourse

1. Prison Based Motivational Intervention Therapy for Problem Drinkers;Impact of feasibility study in HMP Altcourse Emma Pennington Research Associate CAIS Ltd, in association with IMSCaR, Bangor University e.pennington@bangor.ac.uk

2. 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

3. 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

4. Location & eligibility criteria • HMP Altcourse, Liverpool • Category B Male prison • Offenders returning to North Wales • Sentenced • 1 -3 months

5. 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.

6. 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 topopulation 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

7. 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)

8. Results Table: Mean scores for baseline and secondary outcomes by allocated condition at one month follow up.

9. 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

10. Challenges of implementing & evaluating ComMIT in prison • Room availability • Release dates • Access to inmates • Participants often do not attend at post release follow up

11. 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”

12. 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!