Transcript Document

ALCOHOL SERVICES
IN
PRISON
THE POLICY
BY
Caroline Bonds
NOMS DRUG STRATEGY UNIT
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
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
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
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
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
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
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
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
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
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
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
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
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
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.
‘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
CORE COMPONENTS
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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
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
POLY-DRUG MISUSER/ALCOHOL
WORKER AVAILABLE
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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
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
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
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
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
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
THANK YOU
• [email protected]
• Tel: 020 7035 6194