What do we know about the prevalence of risky drinking What do we know about the prevalence of risky drinking and alcohol brief interventions in the criminal justice and alcohol brief - PDF Document

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  1. What do we know about the prevalence of risky drinking What do we know about the prevalence of risky drinking and alcohol brief interventions in the criminal justice and alcohol brief interventions in the criminal justice system in the UK? system in the UK? Professor of Alcohol and Public Health Research, Director of the Centre for Crime, Harm Prevention and Security, Teesside University Twitter: @dotbirch @TUCCHPS Dorothy Newbury-Birch

  2. •Alcohol misuse is estimated to cost £21 billion annually in the UK; in healthcare (£3.5b), crime (£11b) and lost productivity (£7.3b) •For every £1 invested in specialist alcohol treatment, £5 is saved on health, welfare and crime costs (LGA, 2015) •If everyone in UK drank within recommended limits the alcohol industry would lose £10 billion annually

  3. Prevalence of alcohol use disorders in the general population in the UK •Primary health care (20-30% 8+ on AUDIT and ~4% 20+) (Funk et al, 2005) •In 2017/18, 76 thousand were treated for problematic drinking alone which was a 6% decrease on the previous year (Alcohol Statistics, 2019)

  4. How do we know if someone has an alcohol use disorder •We can use a validated screening tool: •One question – SASQ (Canagasaby & Vinson, 2005) •Three questions – AUDIT-C (Saunders, 1993) •Four questions – FAST (Hodgson et al, 2002) •Ten questions – AUDIT (Gold standard) (Saunders, 1993)

  5. Police custody suites in UK Police custody suites in UK •Alcohol use disorders (8+ on AUDIT) •64-84%(Brown et al, 2010; Hopkins & Sparrow, 2006; Barton, 2011; Kennedy et al, 2012; McCracken et al, 2012) •Probable dependency (20+ on AUDIT) •21-38%(Barton, 2011; Hopkins & Sparrow, 2006; Kennedy et al, 2012; McCracken et al, 2012) Newbury-Birch D, McGovern R, Birch J, O’Neill G, Kaner H, Sondhi A, Lynch K. (2016) A rapid systematic review of what we know about alcohol use disorders and brief interventions in the criminal justice system. International Journal of Prisoner Health. 12(1):57-70.

  6. Probation in the UK Probation in the UK •Alcohol use disorders (8+ on AUDIT) •59% and 67% (Orr et al, 2015; Newbury-Birch et al, 2009) •Probable dependency (20+ on AUDIT) •17% and 33% (Orr et al, 2015; Newbury-Birch et al, 2009) Newbury-Birch D, McGovern R, Birch J, O’Neill G, Kaner H, Sondhi A, Lynch K. (2016) A rapid systematic review of what we know about alcohol use disorders and brief interventions in the criminal justice system. International Journal of Prisoner Health. 12(1):57-70.

  7. Prisons in the UK Prisons in the UK • Alcohol use disorders (8+ on AUDIT) • 51 – 83% (Parkes et al, 2011; Newbury-Birch et al, 2009; Graham et al, 2012; MacAskill et al, 2011; Lader et al, 2000; McMurran and Cusens, 2005) • Probable dependency (20+ on AUDIT) • 25 - 43% (Parkes et al, 2011; Newbury-Birch et al, 2009; Graham et al, 2012; MacAskill et al, 2011; Lader et al, 2000) Newbury-Birch D, McGovern R, Birch J, O’Neill G, Kaner H, Sondhi A, Lynch K. (2016) A rapid systematic review of what we know about alcohol use disorders and brief interventions in the criminal justice system. International Journal of Prisoner Health. 12(1):57-70.

  8. Young people in the CJS in the UK Young people in the CJS in the UK (Newbury-Birch et al, 2014) •Adult cut- offs (8+ and 20+) •64% 8+ and 30% 20+ •Young people cut-offs (2+ and 3+) (Knight et al, 2003) •81% 2+ and 77% 3+ Newbury-Birch D, McGovern R, Birch J, O’Neill G, Kaner H, Sondhi A, Lynch K. (2016) A rapid systematic review of what we know about alcohol use disorders and brief interventions in the criminal justice system. International Journal of Prisoner Health. 12(1):57-70.

  9. What does the evidence tell us we can do?

  10. Police custody suites – interventions Two articles from two phases of the same trial (Kennedy et al., 2012; McCracken et al., 2012). UK based (matched control design) •No statistically significant differences were found for reoffending at either of the two phases

  11. Probation – interventions Two studies from the UK (Newbury-Birch et al., 2014; Orr et al., 2015. • In the Orr et al. (2015) study only 22% were followed up, therefore, no effectiveness data were available. • Follow-up rates were 68% at six months and 60 % at 12 months for Newbury-Birch et al. (2014). At both time points there was no significant advantage of more intensive interventions compared to the control group in terms of AUDIT status. Those in the brief advice and brief lifestyle counselling intervention groups were statistically significantly less likely to reoffend (36 and 38%, respectively) than those in the client information leaflet group (50%) in the year following intervention.

  12. • Prison- interventions • There have been no effectiveness studies in the UK. Three studies were found from the USA (Davis et al., 2003; Stein et al.,2010; Begun et al., 2011). • In the Davis et al. (2003) study no differences were found between groups for any alcohol measures. Those in the intervention group were more likely to schedule appointments at a veterans’ addiction clinic following their release (31 vs 14 per cent; p<0.08). • Stein et al. (2010) found that participants randomised to MI had significantly fewer drinking days (OR=1.96, 95% CI 1.17, 3.30) and reported fewer alcohol-related problems at three months (p<0.05). Although, this effect was not maintained at six month follow-up. Very low-response rate (20%). • Begun et al. (2011) could not test any effectiveness of the intervention.

  13. •It could be argued that the stages in the criminal justice system are analogous to the health care system. •POLICE CUSTODY SUITES are busy and chaotic very like accident and emergency departments. •PROBATION is similar to primary care, appointments made and an emphasis on dealing with the underlying issues. •PRISON is similar to hospital wards in as much as often the person is there for a period of time.

  14. Conclusions •Alcohol use levels are high in the criminal justice system •There is clear evidence of effectiveness of ABI’s in the health system •There is a lack of evidence, so far, on the effectiveness of ABI’s in the criminal justice system •More work is need to understand the complexities within the criminal justice system

  15. Thank you