Drug and Alcohol Findings home page in a new window EFFECTIVENESS BANK BULLETIN 5 September 2011

The entries below are our accounts of documents collected by Drug and Alcohol Findings as relevant to improving outcomes from drug or alcohol interventions in the UK. The original documents were not published by Findings; click on the Titles to obtain copies. Free reprints may also be available from the authors. If displayed, click prepared e-mail to adapt the pre-prepared e-mail message or compose your own message. The Summary is intended to convey the findings and views expressed in the document. Below may be a commentary from Drug and Alcohol Findings.


Contents

The workings and impacts of alcohol treatment requirements

This bulletin highlights four studies of the workings and impacts of alcohol treatment requirements imposed by British courts on problem-drinking offenders. Without a control group of offenders similar in every other way but not offered access to this sentence option, none of the studies can securely pin down its effects, but what they have been able to show is modestly promising. For convenience the first entry reminds readers of a relevant earlier analysis. The remaining three are new analyses.

Probation resources too stretched to adequately tackle huge drink problem ...

Probation and NHS alcohol team working well in West Yorkshire ...

Better lives for problem-drinking offenders in Lancashire ...

Crime cut and drinking less but still too much in the Midlands ...


Evidence-based practice? The National Probation Service's work with alcohol-misusing offenders.

McSweeney T., Webster R., Turnbull P.J. et al.
[UK] Ministry of Justice, 2009.
Unable to obtain a copy by clicking title? Try this alternative source.

This report on work in England and Wales describes a system creatively grappling with a huge drink problem among offenders, but one undermined by lack of evidence about what works and by under-resourcing linked to a dispute over whether health or probation should bear the core funding burden.

Summary Conducted by the Institute for Criminal Policy Research, this study examined how the probation service in England and Wales works with alcohol-misusing offenders. In particular:
• procedures for identifying and intervening with problem-drinking offenders;
• how far these complied with the principles set out in national guidance; and
• arrangements for the commissioning and delivery of sentences which involve alcohol treatment requirements.

Main sources were a telephone survey completed with the substance misuse policy or delivery lead in 41 of the 42 probation areas, and alcohol treatment requirement records for 2007/08. Additionally, Offender Assessment System (OASys) data The study analysed 17,183 assessments completed on 15,082 offenders during a three-month period in 2007. was obtained from six 'case study' drug action team areas selected to represent the range of such areas. Completed by criminal justice services at key stages in an offender's OASys is only mandatory for tiers 2, 3 and 4 community sentence offenders. In some cases up to half of all inmates are discharged from prison without being sentenced or after serving sentences of under 12 months so are never assessed using OASys. Also, though OASys is mandatory for prisoners serving more than 12 months, the assessment is often only undertaken about three months in to their sentence. prosecution and sentence, these assessments include whether drinking influenced offending, how much and how often the offender drinks, whether this has been linked to violence, and their motivation to tackle any drink problems. Each case study area was also asked to select 30 case files In the event 185 files were made available. for analysis. About two thirds documented offenders consecutively sentenced to an alcohol treatment requirement, the remainder offenders assessed as problem drinkers but not sentenced to a requirement. Also 64 in-depth interviews were conducted with stakeholders and with professionals involved in alcohol-related sentences and services in the six areas. The results of this work are summarised below under similar headings to those used in the report.

Probation work nationally with alcohol-misusing offenders

Based on responses to the national survey and stakeholder interviews, it seemed that the commissioning and delivery of alcohol services had been hampered by lack of: resources and dedicated funding; guidance on the targeting of interventions; appropriate and accessible treatment; probation staff's relevant confidence, skills and knowledge; and the prioritising of alcohol-related work by local commissioners. Relevant data below.

Half Compared to a quarter for drugs. of the OASys offender assessments identified alcohol as an influence on offending. In around a third the offender admitted to having drunk too much and just under one in four linked this to their offending. Despite the frequency of such problems, OASys data from sentence plan reviews revealed that 43% of alcohol interventions had yet to begin four to six months after probation supervision had started. In just 4% of cases had sentence planning objectives relating to alcohol been fully met by the first review. These findings are consistent with observations that in many areas offenders are increasingly 'stacked' awaiting the availability of programmes or elements of sentence requirements, and with records on OASys-identified dependent drinkers during 2007/08. These showed that by the end of a community sentence just 44% of alcohol-related interventions were continuing or had been completed. Despite the widespread drink problems revealed by the study, one in three of the surveyed probation areas had not completed an assessment of the level of need for alcohol-related services among their caseloads.

Compliance with national guidance on alcohol screening, advice and treatment

The national survey and in-depth interviews in the case study areas were used to assess the degree to which alcohol interventions were carried out and conformed to Models of Care for Alcohol Misusers (often abbreviated to 'MoCAM'), best practice guidance produced in 2006 by Britain's Department of Health and National Treatment Agency for Substance Misuse.

Survey responses indicated that OASys assessments were the main way of identifying offenders whose crime was linked to drinking. Three fifths of probation areas also said they routinely screened for risky drinking, primarily using the AUDIT questionnaire developed for primary care settings, one of several recommended in the guidance. Once screened the aim was usually then to intervene, signpost or refer on as appropriate. To aid this many probation areas had developed criteria for different intensities of intervention based on OASys and AUDIT scores. Casting doubt on how widely AUDIT actually was used, Or at least, its use was recorded. in the six case study areas just under half the alcohol-problem offenders on alcohol treatment requirements had been assessed using AUDIT and none who were not on requirements, resulting in an AUDIT screening rate of under one in three, even among this group with known drinking issues.

Commonly voiced concerns included the quality and accuracy of screening and assessments (such as whether AUDIT cut-off scores were sufficiently diagnostic), whether screening was consistently and routinely implemented, and delays in completing assessments and meeting court deadlines because of limited community-based provision, especially alcohol treatment services, a problem exacerbated by the limited purchasing power of probation areas. There were concerns too about the extent to which probation staff involved in delivering, managing or directing alcohol interventions were trained and competent to the relevant (ie, DANOS) benchmarks. Probation alcohol leads nationally seemed largely unaware of the level of accredited competence of staff involved in alcohol interventions, and in at least two of the six case study areas staff stressed their lack of alcohol-related training. The quality and continuity of provision offered to recently released prisoners was considered variable and inconsistent.

In terms of the specific programmes on offer, the Drink Impaired Drivers intervention was practically universal, and most areas ran named substance abuse courses and also courses on domestic violence. Most also offered brief interventions in a way consistent with the MoCAM guidelines, though rarely at every opportunity; three quarters of probation leads surveyed nationally said their areas delivered brief interventions during at least one of the five stages of the supervision process, but only six claimed to do so at all five stages. Some interventions Aggression Replacement Training (ART); Controlling Anger and Learning to Manage it (CALM); Addressing Substance Related Offending (ASRO); Lower Intensity Alcohol Programme (LIAP); Community Domestic Violence Programme (CDVP); Programme for Reducing Individual Substance Misuse (PRISM). however were usually not on offer at all, constricting the options available to match the profile of the offender.

The commissioning and delivery of alcohol treatment requirements

Available from 2005, alcohol treatment requirements can be imposed for up to three years as part of a community-based sentence or two within a suspended sentence. The offender has to have a drinking problem considered susceptible to treatment, which should reflect the severity of their drinking and offending, be acceptable to the offender, and locally available. The study found these requirements massively under-used but also that those which are imposed facilitate engagement with alcohol treatment services and may help resolve drinking problems more than sentences without a requirement. Under-use was linked to under-resourcing, itself partly due to a dispute over whether health or probation should bear the core funding burden. Details below.

Routinely collected data for England and Wales in 2007/08 suggests that demand for these sentences considerably outstripped supply. In that financial year 5145 requirements started, up nearly 50% on the previous year, but this still represented just 8% of offenders starting community sentences who had been assessed via OASys as 'dependent' Officially defined as achieving a section 9 (alcohol) score of six or more. Scores can range from zero to 10 and are based on five alcohol specific questions with possible responses ranging from zero (no problems) to two (significant problems). In the six case study areas AUDIT scores were found in just under half the files for offenders on alcohol treatment requirements. Scores ranged from six to 40 and averaged 27. The WHO AUDIT manual says "scores of 20 or above clearly warrant further diagnostic evaluation for alcohol dependence". drinkers. Amounting to a third of all offenders starting community sentences, had these roughly 24,000 Of the 71,373 offenders assessed at the start of community sentence between April 2007 and March 2008 across England and Wales, a third were assessed as dependent drinkers. dependent drinkers been treated, it would have more than doubled the national alcohol treatment caseload. Most areas reported targeting requirements at offenders posing the highest levels of risk and/or with high levels of alcohol dependence, a pattern confirmed in the six case study areas.

Treatment requirements do seem to facilitate engagement with alcohol treatment services and perhaps also to contribute to reducing alcohol-related needs. Of the 3129 requirements which ended during 2007/08, 56% had been completed and 35% revoked (meaning the offender may be resentenced for the original offence). Completion rates varied considerably (from 31% to 60%) between probation areas. A more fine-grained indication of progress was gained by analysing the 119 offenders serving alcohol treatment requirements among the 185 problem drinker case files made available in the six case study areas. Over the first six months of their supervision orders, offenders on requirements attended alcohol treatment services on average six times compared to less than once for the other offenders. One in seven offenders on requirements did not attend services at all, but this was the norm among their non-requirement counterparts.

OASys drinking severity scores for these offenders recorded later in their sentence had on average declined slightly (by 1 out of a possible score of 10), reflecting the progress made by the half of the offenders whose scores had fallen. More (59% v. 38%) offenders on than not on requirements had reduced severity scores, but even among requirement offenders, for a third their scores had remained unmoved.

Low usage of alcohol treatment requirements (and their unavailability in a third of probation areas at the time of the study) was related to funding and commissioning The locally funded system for alcohol treatment of offenders was commonly contrasted with central funding of equivalent sentences for offenders with drug problems. structures. Probation argue that (as for any local resident) health authorities should pick up the bill, but health argues that the criminal justice system is responsible for funding services to meet the demand it creates. As a result, three in five probation areas nationally which delivered requirements paid for these mainly or exclusively with their own money. In some case study sites, limited alcohol treatment capacity impeded the monitoring of attendance, making courts less willing to impose new requirements and rendering many existing sentences for a time unenforceable. Differing degrees of constricted access to treatment also seem to have contributed to wide regional variations (from 1% to 26%) in the proportions of OASys-assessed dependent drinkers sentenced to alcohol treatment requirements.

Funding issues may also have affected the quality and intensity of the treatment provided in pursuance of the requirements, which usually amounted to six hourly sessions over a six-month period. Among the 28 probation areas offering requirements, only eight described interventions consistent with the specialist treatment recommended in national guidance. Another four offered only low intensity brief interventions. The remainder varied intensity depending not just on the needs of the offender, but also on treatment availability – a pattern replicated in the six case study sites, where the distinction between brief interventions and treatment was often blurred. It was generally agreed that there was scope for better targeting of requirements, more accurately assessing motivation, and offering more timely interventions.

The evidence base and emerging best practice

Little British research is available to guide the provision of alcohol interventions in a criminal justice context. However, the National Offender Management Service which includes probation services is funding projects to help identify, develop and disseminate best practice.

The featured study itself found four examples of good practice in the six case study sites which warranted further exploration and possibly replication:
• the integration of dedicated alcohol workers in probation offices was universally seen as particularly positive. With routine use of feedback forms, it helped ensure direct and regular communication between offender managers and partnership staff, without obscuring the delineation of roles and responsibilities;
• in one area integration had reached the point where alcohol treatment staff routinely had direct access to probation case management systems, reportedly common in Wales;
• at one site, three-way meetings between the offender, their offender manager, and their alcohol treatment worker at the start, middle and end of an alcohol treatment requirement, were reportedly working well as a way of establishing the aims of the requirement and monitoring progress;
• new arrangements in one area aimed to ensure that treatment services measured the impact of interventions by routinely asking questions from the alcohol section of the probation service's OASys assessment system. It meant that both services were measuring and recording impact in a consistent way.

Apart from these highlighted practices, the focus on dedicated provision for alcohol-misusing offenders was universally welcomed. In line with national guidance, four sites had arrangements in place to ensure that offenders whose problems were severe enough to warrant an alcohol treatment requirement were referred for specialist assessment. Staff found that provider inputs into pre-sentence assessments helped them make more appropriate referrals. In all the case study areas staff were routinely applying motivational interviewing and 'cycle of change' skills with alcohol-misusing offenders. Probation staff at one site also reported having access to an alcohol intervention practitioner who offered a brief intervention and outreach service for risky but not dependent drinkers. On the whole, alcohol treatment services and probation managers had good working relationships, often built on historical links between services.

Recommendations

Probation settings offer important opportunities to identify actual or potential drinking problems and to address these through brief interventions and referral to specialist provision, opportunities only partially grasped. English and Welsh probation areas do offer a broad range of alcohol-related interventions to some of the offenders they supervise. However, convergent data from several sources show there remains a high level of unmet need. A key policy priority should be to increase the use of evidence-based alcohol interventions with offenders whose criminality is related to drinking, in the short term, by sharing and disseminating best practice and identifying strategies for ensuring more offenders start and complete current programmes; in the longer term, by developing the evidence base and using it to formulate new guidance. Whatever the interventions adopted, it is important to increase the range, capacity and funding of the probation service's alcohol-related work.

In more detail, improvements are required in: alcohol screening and specialist assessment; the accessibility of specialist treatment; and training for offender managers in alcohol issues generally and delivering brief interventions in particular. In many areas, upgraded training could be built in to existing arrangements. For example, one case study site was negotiating with its treatment providers to ensure they were involved in training probation staff in brief interventions. Such training plus dissemination of emerging best practice from elsewhere could help ease bottlenecks.

The prevalence of serious drinking problems gives considerable scope for increasing the number of alcohol treatment requirements, but uncertainty and inconsistency around funding, targeting, and the form treatment should take, urgently need to be resolved. Resolving the impasse between probation and health authorities over which should fund which elements of alcohol interventions for offenders will however be difficult because health resources are stretched and substantial cuts are expected in probation budgets. Expanding the remit of centrally set drug treatment allocations to include alcohol is one possibility. The new Alcohol Interventions Guidance will need to further clarify these important issues. It should help that having been provisionally accredited, probation services can now refer many less problematic drinkers to the Lower Intensity Alcohol Programme, enabling the scarce resources required to implement requirements to be yet more sharply targeted at the greatest level of alcohol-related need.


Findings logo commentary The featured report describes a system creatively grappling with a huge drink problem among offenders, but one substantially undermined by the lack of evidence about what works to reduce those problems and curb re-offending, and by under-resourcing linked to a dispute over whether health or probation should bear the core burden of addressing these problems through brief interventions and treatment. The new Alcohol Interventions Guidance for criminal justice services which the featured report hoped might help resolve this issue describes the problem without offering definitive solutions. It is however usefully specific about which interventions should be targeted at which offenders depending on the severity of their problems and the nature of their offending, another issue the featured report thought in need of resolution.

Much of the recent policy impetus has focused on increasing the number of offenders who complete accredited crime-reduction programmes, including those which address substance use. A key weakness with this reliance on set programmes is that these have rarely been scientifically evaluated. They may meet accreditation criteria, but this is no guarantee that they reduce crime or improve health any more effectively than routine non-accredited work. Also the programmes themselves are accredited, yet much depends on how well they are implemented and the overall offender management process within which they are located. A short-lived move to accredit these systems as a whole was abandoned in the mid-2000s as too complex.

Alcohol Concern's news bulletins and the updating service provided by the Alcohol Policy UK web site will help readers remain up to date on developments in alcohol interventions for offenders. See for example the latter's entry on the featured report.

Thanks for their comments on this entry in draft to Tim McSweeney of the Institute for Criminal Policy Research at King's College London and Libby Ranzetta of Ranzetta Consulting and the AERC Alcohol Academy. Commentators bear no responsibility for the text including the interpretations and any remaining errors.

Last revised 22 July 2010. First uploaded

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Delivering the Alcohol Treatment Requirement: assessing the outcomes and impact of coercive treatment for alcohol misuse.

Ashby J., Horrocks C., Kelly N.
Probation Journal: 2011, 58(1), p. 52–67.
Unable to obtain a copy by clicking title? Try asking the author for a reprint by adapting this prepared e-mail or by writing to Dr Ashby at j.l.ashby@bradford.ac.uk.

In one English district, most of the problem-drinking offenders who agreed to be ordered in to alcohol treatment by the courts stopped drinking or successfully cut back.

Summary Available in Britain from 2005, alcohol treatment requirements can be imposed for up to three years as part of a community-based sentence or two years within a suspended sentence. The offender has to have a drinking problem considered susceptible to treatment, which should reflect the severity of their drinking and offending, be acceptable to the offender, and locally available. The featured study reports on research that aims to understand and evaluate the implementation and impacts of these requirements in a district in West Yorkshire in northern England.

In this district the requirements were jointly delivered by the local probation service and the NHS alcohol team. Where previously probation staff would have addressed offenders' alcohol misuse, two alcohol treatment workers were now also employed to work in partnership delivering alcohol treatment across the district to offenders on alcohol treatment requirements. Though national guidance sees the requirements as for dependent drinkers, the reported severity of 'binge drinking' across the district led to a decision to extend this option also to hazardous and harmful drinkers. Detoxification is available for dependent drinkers but most of the work focuses on support and counselling. Staff trained in motivational interviewing techniques ask offenders to monitor their drinking using a drink diary, offer education about safe levels of alcohol consumption, and aid in individual goal setting, lifestyle change and relapse prevention strategies.

The alcohol treatment workers were located in probation offices and worked in an integrated manner with probation. They assessed offenders for an alcohol treatment requirement after offender managers had identified evidence that drinking was a key factor in the offender's criminality. At the time of data collection there had been 181 such assessments leading to 120 offenders being assessed as suitable for treatment and being sentenced to an alcohol treatment requirement. Due to the severity of their offences, a small proportion of offenders assessed as suitable were not sentenced to the requirement but to a custodial sentence instead.

Main findings

The research was based on data in probation and treatment files relating to 81 offenders who had finished or were near the end of their alcohol treatment requirements. Nearly all were white men and had been previously convicted, most (59%) were aged 18–35 years, 78% were unemployed, and three quarters were considered dependent on alcohol, meaning they drank heavily on a daily basis and reported withdrawal symptoms upon waking or after not drinking for a time. Most of the rest were heavy episodic or 'binge' drinkers. For 40% the offence for which they were sentenced to an alcohol treatment requirement had involved violence, and in half these cases the victims were partners, relatives or other members of the household. Over 8 in 10 were assessed as posing at least a medium risk of reoffending.

Of the 81 offenders, 57 or 70% had completed their alcohol treatment requirement, mainly a matter of attending as required whether or not they were still drinking heavily. Despite completing, 12 of these offenders had not engaged successfully with treatment and 8 had relapsed towards the end of their treatment. Just 15% failed to complete due to non-attendance or reoffending and were re-sentenced to custody. At the time the data was collected, 59 of the 81 offenders had not been reconvicted, but many were still on or had recently completed their alcohol treatment requirement. Mainly young unskilled men, few of the unemployed gained employment.

As assessed by the treatment workers, on completion of the requirement 44 of the offenders – just over half – were either not drinking at all (26) or had successfully curbed their drinking.

The authors' conclusions

This analysis provides evidence of a high completion rate for the alcohol treatment requirement with most offenders positively engaging in treatment. Perhaps the flexibility and openness of the requirement is one of its main strengths in terms of maintaining alcohol-related offenders in treatment. The acceptance of self-report and the non-punitive approach to relapse could be seen as permitting continued heavy drinking, but in fact many offenders who had completed or almost completed their requirements reported having cut down or stopped drinking. It seems that by enforcing regular attendance, the coercive element of the requirement provides an opportunity for a flexible and supportive approach to facilitating behaviour change which worked for most but not all the offenders in this sample.

Last revised 02 September 2011

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Evaluation of the alcohol treatment requirement in five sites across the Lancashire probation area.

Baldwin H., Duffy P.
Centre for Public Health, Liverpool John Moores University, 2010.

In Lancashire in northern England, problem-drinking offenders who agreed to be ordered in to alcohol treatment by the courts dramatically cut their drinking and offending and experienced improved health and wellbeing.

Summary Available in Britain from 2005, alcohol treatment requirements can be imposed for up to three years as part of a community-based sentence or two years within a suspended sentence. The offender has to have a drinking problem considered susceptible to treatment, which should reflect the severity of their drinking and offending, be acceptable to the offender, and locally available. The featured study presents the findings of an evaluation of alcohol treatment requirement schemes at five sites across Lancashire in northern England.

In these areas the probation service commissioned treatment providers to deliver structured alcohol treatment to offenders sentenced to the requirements. Treatment staff recorded the offenders' alcohol use, alcohol-related behaviour, and health at the start of the order and if possible three and six months later. For the 32 offenders who agreed to join the study, this information was made available to the researchers, who also interviewed the offenders to gain their views and experiences. Staff in services involved with the schemes were also interviewed. For the 32 offenders in the study and a few others who consented to these elements, probation and arrest records were also obtained.

Main findings

During the study period (1 April 2009 to 31 March 2010), 121 offenders were assessed for an alcohol treatment requirement of whom 70 started treatment. 32 treatment-starters joined the study; nearly all the rest were excluded because their assessments were too delayed rather than because they refused the study. Three and six months later treatment reviews were available for 25 and 21 offenders respectively and 21 and 9 were interviewed by researchers. Only offenders reviewed/interviewed at the first follow-up were included in the final follow-up.

Up to the end of September 2010, 67 of the 70 offenders who had started treatment had been discharged. Of these discharges, 48 (71%) were planned and 19 (28%) unplanned. In the first six months of their orders, the 70 offenders attended on average 22 mandatory treatment appointments. Study participants attended mandatory treatment and probation appointments on a weekly or fortnightly basis. During these sessions participants' alcohol use, offending and related factors were monitored, discussed and addressed.

Nine of 79 offenders given an alcohol treatment order breached the requirements of the order; for another 18, breach proceedings were started but withdrawn. While offenders believed a breach would result in them being re-sentenced to custody, most who did breach either had their breach withdrawn, their community sentence modified, or were given a new community order.

Among study participants there were significant reductions in alcohol consumption and dependence and alcohol-related problem behaviour, particularly during the first three months of their orders. Among the 21 offenders for whom treatment review data was available at both follow-ups, the proportion drinking daily fell from 76% to 29% and 10% three and six months later, and their drinking diaries showed that typical weekly consumption had fallen from 60 UK units to 8 and 18. From all scoring as dependent on alcohol on the AUDIT questionnaire, six months later just 19% did so.

Study participants reported having good relationships with their treatment workers and in some cases, their offender managers. These two sets of staff communicated well and participants recalled attending three-way meetings in which their progress was reviewed by the partner services together. Participants were satisfied with the treatment they had received and their various needs were addressed, though many required ongoing assistance with issues including accommodation and employment. Overall, they felt confident about completing their court orders and continuing to tackle their problems. Several planned to remain in contact with their treatment worker and/or attend further alcohol treatment sessions.

Among the 32 offenders who gave permission for this data to be accessed, the number of arrests fell significantly from 40 during the six months before starting their orders to 14 during the first six months of the order. The most common offences were violence and criminal damage.

Findings also indicated significant improvements in study participants' health and wellbeing and in their relationships with friends, family and partners.

The authors' conclusions

In conclusion, there were positive outcomes for offenders who participated in the evaluation in terms of alcohol use, attitudes, offending, health and relationships. Participants also reported positive experiences of treatment. However, without a control group of similar offenders not sentenced to an alcohol treatment requirement, it is not possible to attribute the positive outcomes to the requirement schemes alone.

Last revised 02 September 2011

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The impact and delivery of alcohol treatment requirements in the Leicestershire and Rutland Probation Trust area.

McSweeney T., Bhardwa B.
London: Institute for Criminal Policy Research, Birkbeck College, 2011.

In the English Midlands, problem-drinking offenders who agreed to be ordered in to alcohol treatment by the courts had a worse prognosis than comparable previous offenders but slightly fewer reoffended; also their drinking was reduced but for many remained excessive.

Summary Available in Britain from 2005, alcohol treatment requirements can be imposed for up to three years as part of a community-based sentence or two years within a suspended sentence. The offender has to have a drinking problem considered susceptible to treatment, which should reflect the severity of their drinking and offending, be acceptable to the offender, and locally available. The featured study reports on research that aims to understand and evaluate the implementation and impacts of these requirements in counties in the English Midlands.

The featured report is a summary of key findings from an independent evaluation of the effectiveness of alcohol treatment requirement provision in the Leicestershire and Rutland Probation Trust area. Delivered by its criminal justice drugs team, the schemes aim to reduce probationers' dependence on alcohol and the frequency and seriousness of their related offending.

The research comprised three core elements:
• analysis of existing administrative records originating from the probation service, police, and treatment systems;
• in-depth interviews with staff, stakeholders and ex-service users/peer mentors involved with local alcohol treatment requirements; and
• questionnaire-based interviews with 15 alcohol misusing probationers sentenced to alcohol treatment requirements.

Main findings

Offending Overall 40% of the 182 offenders sentenced to an alcohol treatment requirement between August 2005 and December 2008 were reconvicted for another new proven Consistent with Ministry of Justice usage, 'proven' reoffending was defined as any offence committed in this one-year period which was proven by a court conviction (either in the one-year period, or in a further six months), while 'new' offences referred to those not relating to breach of bail and/or statutory supervision. offence committed in the 12 months following the start of their requirements. This was lower (but not to a statistically significant degree) than the corresponding figure of 45% for a matched comparison group of 294 alcohol misusing probationers supervised by the same probation service before the introduction of the requirements. Both these figures were lower than the expected re-offending rate of 59% based on the offenders' profiles. There were no significant differences between the two groups in whether their new offence was more or less serious than the offence for which they were originally convicted.

However, the roughly equivalent offending rate and severity across requirement and comparison offenders must be seen in the light of the fact that the former seemed (based on their offending histories, needs and circumstances) a more intractable group than their predecessors.

Drinking Available data on 209 probationers commencing requirements during 2009/10 indicated that during their time on the orders they had cut (according to their own accounts) the number of days on which they drank by on average 37%. The proportion reporting daily drinking fell from 42% to 23% and, among those for whom this data was recorded, daily UK units of alcohol consumed had halved from on average 26 to 13 – still over more three times the daily recommended limit for men. Continuing severe if reduced drinking problems were also indicated by scores on the AUDIT questionnaire which fell from an average of 29 to 21; by the end of their orders, 46% of requirement offenders no longer scored as dependent. But even among requirement completers, 70% recorded scores indicative of high levels of on-going alcohol-related need.

Most effective programmes The factor associated with the largest reduction in proven new reoffending (a 55% reduction) was successfully completing the court order of which the alcohol treatment requirement formed a part, while offenders who completed structured alcohol treatment were four times more likely than other offenders to report a reduction in drinking days. No other programmes were positively correlated with or predictive of reduced drinking or related offending.

The role of mentors Interviews with various stakeholders indicated that mentoring from peers or ex-service users fulfilled a number of important functions as part of the service delivered to offenders on the requirements. Prominent among these was pro-social modelling. Mentors could, for example, introduce probationers on the orders to different techniques and approaches to begin addressing their drinking – strategies which the mentors themselves may have successfully employed. Our analyses also suggested that a key focus for ex-service user/peer mentors could be to support probationers experiencing more acute forms of social isolation, a strategy which may further improve drinking outcomes.

The authors' conclusions

The main implications of the findings for the area's alcohol treatment requirement provision are that efforts should be made to develop effective strategies to ensure that alcohol treatment requirements and overall orders are completed, that offending outcomes for a large minority of those on requirements are improved, and that adequate provision is made for ongoing throughcare and aftercare following completion of the requirements. Against the backdrop of considerable uncertainty and reform regarding the structure and commissioning of alcohol treatment at both local and national levels, the research provides some indicative evidence for potential funders and commissioners to support the contention that both public health and criminal justice objectives are achievable across the area via alcohol treatment requirements.

Thanks for their comments on this entry in draft to Tim McSweeney of the Institute for Criminal Policy Research, at Birkbeck College in London. Commentators bear no responsibility for the text including the interpretations and any remaining errors.

Last revised 05 September 2011

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Top 10 most closely related documents on this site. For more try a subject or free text search

STUDY 2012 The effect on reconviction of an intervention for drink-driving offenders in the community

STUDY 2010 Evaluation of the alcohol treatment requirement in five sites across the Lancashire probation area

STUDY 2011 Delivering the Alcohol Treatment Requirement: assessing the outcomes and impact of coercive treatment for alcohol misuse

STUDY 2015 Calling time on ‘alcohol-related’ crime? Examining the impact of court-mandated alcohol treatment on offending using propensity score matching

REVIEW 1999 Barriers to implementing effective correctional drug treatment programs

STUDY 2013 Criminal justice responses to drug related crime in Scotland

HOT TOPIC 2015 Will intensive testing and sanctions displace treatment?

REVIEW 2011 A new paradigm for long-term recovery

DOCUMENT 2012 Will intensive testing and sanctions displace treatment?

STUDY 2009 Evidence-based practice? The National Probation Service's work with alcohol-misusing offenders





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