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

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 Baseline1 month post release Outcome Measures Experime ntal ControlTotalExperimen tal ControlTotal Days Abstinent (%) 59.6 (n=16) 29.9 (n=3) (n=16)33.3 (n=3)112.3 No of drinks per drinking day (n=16) (n=3) (n=16) (n=3) 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!