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A prevalence study of alcohol amongst offenders in the probation and prison services in A prevalence study of alcohol amongst offenders in the probation and prison services in North East England Dr. Dorothy Newbury-Birch Senior Research Associate dorothy. [email protected] ac. uk

From arrest to conviction: final outcome of cases 40% of all↑ 40% of all From arrest to conviction: final outcome of cases 40% of all↑ 40% of all cases convicted cases pled or found guilty ______________________________________ ↓ 49% ↓ Notcases do not of all charged get to court From: Entry into the criminal justice system: a survey of police arrests and their outcomes. (1998) Phillips C and Brown D. Home Office Research Study 185.

 • Research undertaken to inform the Alcohol Pathway of the prevalence of alcohol • Research undertaken to inform the Alcohol Pathway of the prevalence of alcohol misuse amongst offenders in the North East of England.

Subjects • Three probation areas: – Northumbria – Durham – Teesside (not all offices Subjects • Three probation areas: – Northumbria – Durham – Teesside (not all offices in each area) • Four prisons: – – Durham Deerbolt Holme House Low Newton

 • All offenders for the month of November 2006 were asked to complete • All offenders for the month of November 2006 were asked to complete a questionnaire • 715 completed from a possible 1131 cases (63%)

Results - Age • 94% of prison cases and 86% of probation cases were Results - Age • 94% of prison cases and 86% of probation cases were men • Half of those who answered were aged between 22 -34 [probation 49%, prison 51%] • 25% were aged between 18 -21 [27% probation, 24% prison] • 22% were aged between 35 -49 [21% probation, 23% prison] • 2% were aged 50 or more [3% probation, 2% prison]

Alcohol prevalence • 15% reported that they did not drink (8% women). Alcohol prevalence • 15% reported that they did not drink (8% women).

Alcohol prevalence • In the probation setting 69% of men and 53% of women Alcohol prevalence • In the probation setting 69% of men and 53% of women were classed as having an AUD • In the prison setting 59% of men and 63% of women were classed as having an AUD • This is compared to 38% of men and 16% of women in the general population (ANARP 2004)

Alcohol prevalence • In the probation setting 35% of men and 25% of women Alcohol prevalence • In the probation setting 35% of men and 25% of women were classed as ‘possibly dependant’ • In the prison setting 36% of men and 42% of women were classed as ‘possibly dependant’ • This is compared to 6% of men and 2% of women in the general population (ANARP 2004)

However… when comparing AUDIT scores to OASYs alcohol scores Audit Range Abstainers Low Risk However… when comparing AUDIT scores to OASYs alcohol scores Audit Range Abstainers Low Risk Hazardous Risk Harmful Risk Possibly Dependence % missed using OASys -5% -12% 73% 46% 14%

What’s happening? What’s happening?

 • Primary Aim - Address evidence gaps associated with SBIs for Alcohol Misuse • Primary Aim - Address evidence gaps associated with SBIs for Alcohol Misuse • Funded by DH; £ 3. 2 million as an action under the “Alcohol Harm Reduction Strategy for England” (2004) • Collaboration between: – Institute of Psychiatry, London – Newcastle University, Institute of Health and Society – University of York

Primary Aims of SIPS To identify: 1. The best screening methods 2. The most Primary Aims of SIPS To identify: 1. The best screening methods 2. The most effective intervention techniques 3. The most appropriate, acceptable and cost effective methods of implementation for detecting harmful & hazardous alcohol consumption across 3 health and social care settings: - Primary Health Care (PHC) - Accident & Emergency Departments (AED) - Probation (CJS)

Design Methodology • Pragmatic Cluster RCTs • • North East, London, South East 2 Design Methodology • Pragmatic Cluster RCTs • • North East, London, South East 2 year time span (6 & 12 month follow-up) • Intervention Approaches • Patient Information Leaflet (PIL) • Brief advice 5 minutes + PIL • Extended intervention 20 -30 minutes + PIL • Screening Tools • AUDIT: gold standard • FAST: 4 questions • M- SASQ: 1 question • M-PAT: AED related

Research Programme Design • For the whole trial participants will be recruited from: – Research Programme Design • For the whole trial participants will be recruited from: – 24 PHC practices – 31 patients from each – 9 AEDs – 131 patients from each – 96 Offender Managers in Probation – 5 clients from each • North East will work with 12 GP practices, 4 AEDs and 43 Offender Managers • The overall aim is to recruit over 2, 600 people across the three trials

Outcome Measures – Implementation: barriers and facilitators – Identify most effective screening tools – Outcome Measures – Implementation: barriers and facilitators – Identify most effective screening tools – Assess effects on drinking patterns – Explore most cost effective intervention approach – Common measures and design to allow comparisons – Best methods to roll-out nationally (e. g. need for AHWs)

What we do know…. . For every £ 1 spent on alcohol treatment £ What we do know…. . For every £ 1 spent on alcohol treatment £ 5 saved to CJS (UK alcohol treatment trial)