ALCOHOL SERVICES IN PRISON THE POLICY BY Caroline Bonds NOMS DRUG STRATEGY UNIT

1. ALCOHOL SERVICESINPRISONTHE POLICYBYCaroline BondsNOMS DRUG STRATEGY UNIT

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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.

16. ‘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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. THANK YOU • Caroline.bonds@homeoffice.gsi.gov.uk • Tel: 020 7035 6194