The Alcohol and Offenders
Criminal Justice
Research Programme
Dr Lesley Graham
Associate Specialist, Public Health
ISD, NHS National Services Scotland
Andrew McAuley
Public Health Advisor (Substance Misuse/Alcohol)
NHS Health Scotland
Acknowledgements
Advisory Group Members
Iain MacAllister, Scottish Government
Sharon Grant, Scottish Government
George Howie, NHS Health Scotland
Ruth Parker, Scottish Prison Service (SPS)
Jim Carnie, SPS
Stephen Heller-Murphy, Health Improvement Scotland (formerly
SPS)
Research Teams
Tessa Parkes, Susan MacAskill and team, Stirling University
Kate Skellington Orr, Shirley McCoard and team, MVA Consultancy
The Alcohol and Offenders Criminal Justice
Research Programme
Describes
nature and scale of alcohol problems in offenders
Examines and contributes to the evidence base of what
works
Maps current activity highlighting best practice
Alcohol in Scotland


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Enough alcohol is sold in Scotland for every adult to
exceed male weekly limits [Health Scotland 2011]
Excess consumption is across all age and socioeconomic groups [Scottish Health Survey 2010]
1 in 20 deaths attributable to alcohol
[Grant, Springbett
and Graham 2009]

Those from the most deprived areas in Scotland are
6 times more likely to die an alcohol related death
[Alcohol Statistics Scotland 2011]
Alcohol-related mortality by deprivation,
Scotland
Alcohol-related deaths (underlying cause, deprivation category, 2001/02,
2005/06, 2009/10)
EASR per 100,000 population
70
60
50
2001
40
2005
30
2009
20
10
0
5
4
3
SIMD quintile
Source: ISD Scotland (NRS)
2
1
Alcohol and Crime in Scotland

Half (50%) of prisoners in Scotland reported being
drunk at the time of their offence, rising to three
quarters (77%) of young offenders [Scottish Prison Survey
2009]
The problem is getting worse

There has been a rise in proportion of young Scottish
offenders who consider alcohol has contributed to
their offending (from 48% in 1979 to 80% in 2007)
[McKinlay et al 2009]

Alcohol related crime is estimated to cost Scotland
over £700 million per year [Societal Cost for Alcohol Misuse in
Scotland in 2007 Scottish Government 2010]
Alcohol and Violent Crime in Scotland

Where known, alcohol is a factor in more than two
thirds (69%) of those accused of homicide [Homicide in
Scotland 2008/9]

70% of assaults in A&E may be alcohol related
[QIS
2006]

In 62% of violent crime, victims said the offenders
were under the influence of alcohol [Scottish Crime and
Justice Survey 2010]
Alcohol Problems in Offenders
The prevalence of alcohol problems in offenders is
high

46% of Scottish prisoners may have harmful
use/dependency (as defined by CAGE) compared to
14% of the adult male general population [Alcohol
Statistics Scotland 2011][Scottish Health Survey 2010]
Important to note that not all alcohol problems in
offenders are directly linked to their offence
The offender pathway: an
opportunity for intervention


Population with a high prevalence of alcohol
problems
Easier to reach the ‘hard to reach’
-over a third of prisoners said if they were offered
help for their alcohol problems they would take it
[Scottish Prison Survey 2009]



Potential to reduce re-offending
Positive effect on others (many young offenders have
family members who have served a custodial
sentence)
Reduce health inequalities
A Prison Health Needs Assessment for
Alcohol Problems
Methods
Epidemiology of alcohol problems in prisoners in
Scotland
 Rapid review of international literature on screening
tools and effective interventions
 Mapping of alcohol services across all Scottish prisons
 Case study of one prison
-screening of prisoners using AUDIT
-interviews with key informants (including prisoners)
 Gap analysis
 A model of care

Rapid review: findings

Screening
-

Interventions
-

AUDIT most promising but no single screening
tool superior
Timing of screening may be important
Evidence limited for most interventions (though
therapeutic communities may be effective)
Alcohol Brief Interventions have highest evidence
base in general population
Throughcare
- little research available
Screening: findings in one prison
AUDIT Score by Age (n = 259)
100
0-7 Low risk
90
8-15 Hazardous
80
16-19 Harmful
70
20- 40 Possibly Dependent
60
50
40
30
20
10
0
18-24 Years
25-29
30-39
40-64
Mapping: findings across prisons

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Recognition that prison provides an opportunity to detect and
intervene with alcohol problems
No use of validated screening tool
Timing of asking can be important
Range of interventions to address alcohol problems
Not all interventions available to those on short
sentences/remand
Low numbers of prisoners accessing interventions
Variation in capacity of staff due to other demands
Problems establishing continuity of care
Limited in-reach though this is developing
Case study:
findings from interviews with prisoners & staff

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Broadly convergent understanding of many alcohol aspects
among prisoners and staff
Perception that alcohol issues are not as well resourced or as
prominent as drug interventions
Prisoners view alcohol problem assessment on admission as an
‘yes or no’ question, asked at a time of competing concerns
Recognition that not all prisoners will acknowledge alcohol
problems or want to deal with them
Recognition that differing patterns of alcohol misuse exist across
age groups
Prisoners want more involvement of ‘outsiders’ and those with
experience of alcohol problems
Four tiers of intervention (MoCAM)
Tier 1 Interventions
alcohol-related information and advice; screening; simple brief
interventions; and referral
Tier 2 Interventions
open access, non-care-planned, alcohol-specific interventions
Tier 3 Interventions
community-based, structured, care-planned alcohol treatment
Tier 4 Interventions
alcohol specialist inpatient treatment and residential
rehabilitation
Model of Care
Scoping of Interventions for Offenders
with Alcohol Problems in Community
Justice Settings
Methods

Literature review and desk top analysis

Primary data collection
-interviews with Community Justice Authority Chief
Officers
-interviews with CJA local partners
Rapid review: findings


Limited data on prevalence of alcohol problems in
offenders
Limited routine data on alcohol-related offending
-

Screening
-

11% of probation orders had alcohol treatment as a
requirement
again, AUDIT most promising
Interventions
-
Evidence limited for most interventions
Alcohol Brief Interventions have highest evidence base in
general population
Arrest Referral effective in identifying those with alcohol
problems
Local Practice: findings

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Alcohol rising up the agenda
Mainstream services being accessed but no formal
care/offender pathways
Limited interventions specifically for offenders (e.g.
alcohol and violence)
Most interventions post sentence
Some local examples of good practice
Good practice examples



Alcohol Diversion Scheme (Fife)
- early intervention addressing binge drinking and associated
anti-social behaviour
- opportunity to participate in an alcohol education session
instead of FPN
- especially popular with the 18 to 30 age group
Opportunity to Reduce Criminal Activity (ORCA) service
(Grampian)
- builds on multi agency working practices in its service delivery
- observed reduction in crime locally
Tayside Short Term Prisoner Protocol
- pre-release ‘surgeries’ facilitate integration back into
community
- short term prisoners referred to alcohol services on release
Alcohol Brief Interventions is the
Community Justice Setting: a feasibility
pilot
Methods

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Three pilot sites
Offenders on probation orders or community service
orders
Single blind randomisation to either:
-Screening (using AUDIT) and leaflet
-Screening and ABI
Follow up at three/six months
Online staff survey
Analysis of training (pre and post)
In depth interviews with key staff
Cost analysis
ABI pilot: findings
419 assessed; of whom 295 (70%) eligible;
of whom 207 consented (70%)
 85% male; mean age 31 years
 59% (n=116) had an Alcohol Use Disorder of
whom 42% (n=82) eligible for an ABI
 32 (39%) lost to follow up; 34 other outcome
known, 16 individuals followed-up

ABI pilot: findings

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Training generally thought useful, relevant and
improved confidence
AUDIT easy to use and ABI easy to deliver
Timing thought to be more beneficial earlier in
process
Mixed views as to appropriateness and client
engagement
Some lack of understanding by frontline staff about
study design, purpose and effectiveness
£67 per person (majority overheads)
Next Steps
£0.75 million funding for ADPs in
2011/12 for alcohol in prisons
 Dissemination of research including
event in February 2011
 Briefing of ADP chairs
 ADP/CJA event in December
 Guidance statement
 Report for WHO HIPP on alcohol

Contact/Further Information
Dr Lesley Graham
lesley.graham@nhs.net
Alcohol and Offender Criminal Justice
Programme
http://www.healthscotland.com/topics/he
alth/alcohol/offenders.aspx