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

The entries below summarise documents collected by Drug and Alcohol Findings. Citation here does not imply that these documents are particularly relevant to Britain and of particular merit, though they may well be both. 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 Request reprint to send or adapt the pre-prepared e-mail message. The Summary is intended to convey the findings and views expressed in the study. Below may be comments from Drug and Alcohol Findings. Links to source documents are in blue. Hover mouse over orange text for explanatory notes.

Alcohol interventions in the British criminal justice system

Unmet need for alcohol services in English prisons ...

Scottish Prisons leave many problem drinkers without help ...

Not enough money for problem drinking offenders in the community ...

Other research

Review of what works best in treating adolescent cannabis use ...

How to prevent disorder and violence marring a night at the pub ...


Alcohol services in prisons: an unmet need.

HM Inspectorate of Prisons.
HM Inspectorate of Prisons, 2010.
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Prison inspections and surveys of prisoners and staff in England reveal a "depressing picture" of "very limited" services for problem drinking inmates, which leave them with poor prospects on release.

Summary

Introduction from HM Chief Inspector of Prisons

For some time, prison inspections have been describing the gap between the needs of prisoners with alcohol problems and the services that exist to support them. This short thematic report reveals the dimensions and the consequences of that gap.

The report draws on inspection surveys of 13,000 prisoners between 2004 and 2009, 72 inspection reports between 2006 and 2009, and surveys of drug coordinators in 68 prisons in 2009. The data cover all kinds of prisons holding those aged over 18.

The survey results, particularly for the most recent year, are startling. Within the whole sample, 13% of prisoners surveyed reported having an alcohol problem when they entered their prison. In the most recent year, 2008–09, this rose to 19%, nearly one in five. It was even higher among young adults (30%) and women (29%). These figures almost certainly underestimate the scale of the problem, as many of those with alcohol problems will fail to recognise or acknowledge them.

While most alcohol users, particularly women, reported concurrent use of illegal drugs, there was a significant proportion of male substance misusers for whom alcohol was the only problematic substance. This was true for half of the men in local prisons who reported having an alcohol problem. Among young adults, only a minority reported having drug problems [without also having] an alcohol problem.

Prisoners with alcohol problems are likely to be more problematic in general and to need greater support. More are high risk offenders and more had been in prison before. They were more likely than other prisoners to come into prison with pre-existing difficulties, such as housing needs and health – particularly mental health – issues. Alcohol use is accepted as a key risk factor in predicting violent reoffending.

Yet this report shows that at every stage in prison, their needs are less likely to be assessed or met than those with illicit drug problems. On entry to prison, alcohol problems are not consistently or reliably identified, nor is the severity of alcohol withdrawal symptoms. Some establishment drug coordinators' estimates of the extent of the problem in their prison appeared to be considerably at odds with our survey findings. Few prisons had an alcohol strategy based on a current needs analysis, and even where analyses had been carried out, some were likely to underestimate need.

Services for alcohol users were very limited, particularly for those who did not also use illicit drugs. There was a shortage of healthcare staff with training in alcohol misuse, or dual diagnosis (mental health and substance use). Interventions so far have largely consisted of Alcoholics Anonymous, an abstinence-based self-help approach which is not suitable for all those with alcohol problems. CARATs (counselling, assessment, referral, advice and throughcare service) teams are not resourced to work with those who have only an alcohol problem. Most drug coordinators identified the lack of specific funding as a major barrier to providing adequate services, even when new interventions became available – whereas there has been ring-fenced funding for illicit drug users.

It is therefore scarcely surprising that alcohol users expected to have more problems on release than other prisoners – for example, with accommodation, employment, and relationships. Worryingly, over a quarter of those who came into prison with only an alcohol problem said that they were likely to leave with a drug problem, suggesting that in the absence of either alcohol or treatment, a new dependency had been created. Since community alcohol provision suffers from the same deficits as provision in prisons, it was hard to put alcohol users in contact with supportive community services on release; there is no equivalent of the drug intervention projects that support those using illicit drugs.

This is a depressing picture. It is clear that alcohol misuse is a growing problem, fuelling violent crime, particularly among young people. Yet, as this report shows, prisons have not grappled effectively with this problem and are not resourced to do so. Such provision as there is has depended on local initiatives and locally sourced funding – a fragile and patchy basis for an essential service. What is needed is a national strategy, based on need and backed by sufficient resources, training and support. The consequences of inaction are much more costly.

Prison Service strategy for alcohol treatment and intervention

In response to the publication of the Alcohol Harm Reduction Strategy for England, the Prison Service produced a strategy in 2004 to support the new emphasis on tackling alcohol misuse, particularly in relation to its connection with offending behaviour. Addressing Alcohol Misuse: A Prison Service Alcohol Strategy for Prisoners laid down the following aims for service development:
• to improve education and communication;
• to improve the identification of prisoners who may have a drinking problem;
• to improve both the capacity and quality of alcohol treatment interventions available to prisoners;
• to spread good practice and ensure greater consistency across the prison estate;
• to reduce the supply and use of alcohol by prisoners, both into and within establishments.

The strategy stated an intention to adopt the National Treatment Agency's (NTA) model of care framework for alcohol treatment – a pathway model determined by individual need. A comprehensive strategic approach as defined by the NTA incorporates:
• targeted screening with brief intervention for hazardous and harmful drinkers;
• comprehensive assessment for those with identified alcohol problems;
• individualised care planning with "treatment goals, the treatment interventions and services to be provided, and the responsibilities of professionals, the individuals, their carers and others in the coordination and delivery and treatment";
• provision of a range of alcohol treatment interventions to meet local need;
• post-treatment support with information, advice and help to maintain "improvements in health and social wellbeing and reductions in alcohol consumption";
• managing alcohol treatment by means of, for example, ensuring staff competence or reviewing performance by utilising service user monitoring data.

The Prison Service alcohol strategy was supplemented by the Alcohol treatment/interventions good practice guide. In the absence of dedicated resources for the implementation of improvements in alcohol services, this document offers guidelines for service development where this is possible through locally sourced funding. The guide describes treatment for alcohol misuse that starts on arrival to prison and continues through to release, and that is flexible enough to meet individual needs. In sequential order the interventions outlined are:
• dependency assessment;
• alcohol detoxification;
• screening assessment;
• substance misuse triage assessment;
• substance misuse comprehensive assessment and care planning;
• general awareness raising;
• one-to-one motivation sessions;
• group work;
• Alcoholics Anonymous;
• structured treatment programmes;
• pre-release intervention;
• post-release access to community services.

The Prison Service alcohol strategy states that it will expand existing treatment provision where resources are available. It acknowledges a requirement for tailoring treatments to individual need and motivation levels. However, the scope for doing so is inherently constrained by a scarcity of resources to expand on current provision, particularly in the current climate. Unlike the provision of drug-related treatment, there is a conspicuous absence of centrally allocated funding to enhance alcohol services, and the strategy has been criticised for being no more than "an illusion of action to tackle alcohol".

Many strategies produced locally by establishments for enhancing services for alcohol users have lacked conviction, and this is likely to be a consequence of insufficient resources. Despite the publication of the national and Prison Service alcohol strategies, funding for and access to substance use services in prisons has continued to be primarily ring-fenced for those with a problem with illegal drugs, with alcohol often only addressed as part of a poly-substance misuse issue.

The scope of the report

HM Inspectorate of Prisons has published criteria, called Expectations, for the treatment and conditions of prisoners, covering all aspects of prison life. Prisons are then assessed under four key tests: safety, respect, purposeful activity and resettlement.

The Expectations for substance use services, including alcohol service provision, at an establishment include:
• a multi-disciplinary strategy team implements and monitors a written substance use strategy which is informed by regular population needs assessments;
• the treatment programmes provided are appropriate to the requirements of the population served, taking account of patterns of substance use;
• all prisoners with substance use problems are identified at reception and given information about the services available;
• after clinical intervention for substance dependency, treatment is integrated with psychosocial interventions;
• there are specialist dual diagnosis services provided for those with both a mental health and substance-related problem;
• those with substance use problems have prompt access to a range of psychosocial treatment and support, which meet their identified needs. Prisoners are also actively involved in the care planning and reviewing process;
• work related to substance use is integrated and coordinated, and linked to custody and sentence planning. Resettlement needs are addressed by linking prisoners with community service providers so they can access appropriate support and continued treatment on release.

The findings in this report focus solely on provision in young adult and adult prisons, for both men and women aged 18 and over, and come from the three sources described below.

Prisoner surveys This is a dataset of a representative sample of prisoners surveyed, in the course of inspections, at 144 prisons between May 2004 and March 2009. It consists of responses from 13,093 prisoners, of whom 1682 (13%) stated that they had an alcohol problem (either alone or together with drugs) when they arrived at the prison where they were surveyed. Analyses have been completed for the overall sample and for each functional prison type, except for dispersal and open prisons, where numbers were too small for statistical comparison, but responses from these prisons were incorporated into the overall analysis.

Comparisons are made between those reporting that they had an alcohol problem (whether alcohol only or alcohol and drugs) on arrival and those who did not; for ease the former are referred to simply as those with an alcohol problem throughout the text. At some points, however, there is a comparison between those with alcohol-only (ie, no coincident drug use) problems and those with drug, or drug and alcohol, problems.

Inspection reports This is data from 72 reports of full inspections conducted between April 2006 and March 2009, of 24 training prisons, three dispersal prisons, 19 local prisons, seven women's prisons and 14 young offender (aged 18–21) institutions.

Establishment drug coordinators survey This derives from surveys of establishment drug coordinators about services available in their prisons. Sixty-eight surveys were returned out of 129 sent out in June 2009, a response rate of 53%.

Key findings

Overall, in the 2004–09 period, in surveys carried out by HM Inspectorate of Prisons, 13% of prisoners said that they had arrived at prison with an alcohol problem. The number reporting alcohol problems rose considerably, to 19%, for prisons in the 2008–09 inspection year, reaching 30% in young offender institutions and 29% in women's prisons. The high prevalence of problematic alcohol use in the prison population is supported by O-DEAT data.

Over half (54%) of prisoners with alcohol problems also reported a problem with drugs, and 44% said they had emotional or mental health issues in addition to their alcohol problems. The correlation with emotional or mental health issues was especially pronounced among the women surveyed.

The analysis of inspection reports and the surveys sent to establishment drug coordinators revealed that a considerable number of establishments had no alcohol strategy. Where strategies existed, inspections often found them inadequate. Few were based on accurate population needs analysis, and a number prioritised the detection of alcohol consumption in the prison, or lacked detail.

In local prisons, the onus for screening prisoners for alcohol problems rested primarily on reception processes, and training prisons relied heavily on this process being completed at local prisons. However, two establishment drug coordinators from local prisons said that they did not use a standardised screening tool for identifying alcohol problems, and in total nearly half of all prisons reported that no screening tool was used.

Arrival in custody

Establishment drug coordinators at all local prisons said that they offered alcohol detoxification for prisoners with physical withdrawal symptoms, and all except one were able to locate those undergoing clinical treatment on either a substance misuse or healthcare inpatient unit.

A large majority of those entering prison receptions with an alcohol problem reported problems in other areas of welfare, in areas such as housing, emotional wellbeing and physical health.

Life in prison

In all prison types, those reporting alcohol problems said that they felt less safe than the rest of the population: nearly half (45%) had felt unsafe at some time in the prison, and for those in local prisons, just under a quarter (24%) felt unsafe at the time they were surveyed. Adults with alcohol problems were less likely to report respectful treatment by staff, or that they had a member of staff to turn to if they had a problem.

Those with alcohol problems were twice as likely as other prisoners to report an emotional wellbeing or mental health issue. Some prisons still did not have mental health staff with dual diagnosis expertise, and the two services – alcohol and mental health – were usually separate.

Treatment and interventions for alcohol problems

There is considerable unmet need for ongoing treatment and support. Links with Alcoholics Anonymous (AA) appeared reasonably well established, but were the sole specific provision for those with alcohol problems at a number of prisons. Responses from establishment drug coordinators showed that those with alcohol-only problems were much less likely to have access to interventions than those who had both drug and alcohol problems. This was supported in prisoner surveys, especially for those in local prisons. Fewer prisoners with alcohol-only problems (60%) reported that they had received any help or intervention than prisoners with either a drug and alcohol problem (75%) or drug-only problem (84%). In 43% of cases where offenders had been assessed by criminal justice staff as disinhibited by alcohol or where alcohol was linked to offending, no intervention for alcohol use was prescribed. This compared with only 28% in cases involving drug use.

Counselling, assessment, referral, advice and throughcare services (CARATs) were not funded to provide ongoing support for those with alcohol-only problems. Fewer than half (42%) of inspection reports described a CARAT team able to provide even a minimal level of support for alcohol-only users.

Very few treatment or offending behaviour programmes have been developed or accredited specifically for alcohol misusers, and none were yet available in any prison inspected except for a non-specific programme in dispersal prisons and a pilot alcohol dependency programme at one prison. This had not yet been rolled out to other prisons. During 2009, a recently accredited alcohol and violence programme was being piloted in four prisons. Enhanced services for alcohol were dependent on staff initiatives and locally sourced funding, which could be difficult to obtain or sustain. It is apparent that those support services which require supplemented funding are less widely available, and AA, which comes at a minimal cost, is most prevalent.

Resettlement

When prisoners were asked if staff had helped them to prepare for release, there was no significant difference in response between those reporting an alcohol problem and those who did not. However, only around a fifth of both groups felt that staff had helped them.

In every area of resettlement, and in all prison types, prisoners reporting alcohol problems were more likely to feel that they would have problems on release from prison. Their knowledge of the services available in custody to help them prepare for release was also considerably worse than those without alcohol problems. They were over twice as likely as other prisoners to say that they thought they would leave prison with a drug problem, and 60% said that they would leave with an ongoing alcohol problem.

Those with an alcohol problem who said that they would still have this problem on release reported considerable deficits in substance use treatment received in prison, access to purposeful activity, and resettlement.

Last revised 03 April 2011. First uploaded

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Prison health needs assessment for alcohol problems.

Parkes T., MacAskill S., Brooks O. et al.
NHS Health Scotland, 2011.
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What does the Scottish Prison Service need to do to adequately address alcohol problems among inmates? This needs assessment funded by the Scottish Government assesses the size of the problem, identifies the gaps, and recommends ways to plug them based on a review of relevant research.

Summary

Background and rationale

Alcohol problems are a major and growing public health problem in Scotland with the relationship between alcohol and crime, in particular violent crime, increasingly being recognised. The consequences affect individuals, their families, the health and emergency services, and wider society. The current policy context includes a strategic approach to enhancing the detection, early intervention, treatment and support for alcohol problems across Scotland, as well as efforts to reduce re-offending. This study is part of a wider alcohol research programme funded by the Scottish Government in criminal justice settings, which also includes a pilot of the delivery of brief alcohol interventions and a scoping study of alcohol interventions in community justice settings. It is anticipated that the study findings will inform broader health service development such as the integration of prison health care into the National Health Service (NHS) and the update of core alcohol treatment and support services. These developments are set within a policy and practice context which acknowledges alcohol problems in the population, and increasingly so, the alcohol problem in offenders, along with the importance of applying a person-centred, recovery-orientated approach underpinned by the NHS's commitment to quality of service.

Aims and objectives

The aims of this study were to undertake a needs assessment of alcohol problems experienced by prisoners and recommend service improvement including a model of care. The central objectives were to:
• Conduct a rapid review of the relevant literature on effective interventions for identifying and treating offenders with alcohol problems in prison;
• Report on the epidemiology of alcohol problems experienced by prisoners in Scotland compared to the general population and other offenders;
• Undertake an assessment of alcohol problems among offenders within an individual prison;
• Map current models of care in the Scottish Prison Service and how they interface with community care models, including assessing aspects of treatment continuity and finding examples of best practice;
• In a case study setting, explore and report on attitudes towards the delivery and effectiveness of current alcohol interventions;
• Conduct a gap analysis between current service provision, best practice, effective interventions and national care standards for substance misuse.

Methodology

The study involved both quantitative and qualitative information being gathered through document retrieval and analysis as well as primary data collection. It was conducted according to ethical principles essential in research with vulnerable groups. The study benefited from internal research team advisers and an external project advisory group representing the Scottish Government, Scottish Prison Service, Information & Statistics Division and NHS Health Scotland. To ensure representation of other interests, such as prisoners and their families, two further organisations reviewed and commented on the draft report.

Findings

A number of general trends in alcohol consumption and harm in the Scottish population can be noted from current evidence. There has been a rise in alcohol consumption over the past decades with a consequent rise in alcohol-related harms. A high proportion of the population drink excessively across all ages and socioeconomic groups, although drinking patterns and levels between groups and ages vary. Young men are the highest alcohol consumers and more likely to 'binge' drink. Scotland has the highest prevalence of alcohol-related health problems in the UK and among the highest in Western Europe. There is, however, emerging evidence that some specific alcohol-related harms may be stabilising in Scotland.

The prisoner population in Scotland is younger than the general population and predominantly male. Data indicate a high prevalence of alcohol problems in this population among both men and women, and a higher prevalence of alcohol problems among remand than sentenced prisoners.

A rapid review was undertaken to inform the primary research components of the study. Three screening tools were identified as having good reliability with offending populations, although no single screening tool was identified as superior. AUDIT was found to be most promising and is being used in several UK interventions related to offenders currently being evaluated. Several screening tools may be required for this diverse population. There is also some indication that timing of screening may be an issue, with very early screening post-imprisonment being relatively ineffective.

The review also indicated that evidence is limited for most interventions in prison settings. In addition, many studies conflate alcohol and drugs making it difficult to identify specific alcohol-related outcomes. There is also a particular lack of published research from the UK, although several relevant studies are in progress. While there is evidence of the effectiveness of therapeutic communities, this is confined to people whose alcohol use supplements drug misuse, and studies report that they are costly and time-intensive. Brief alcohol interventions have the highest quality evidence base but effectiveness in this setting is still to be established. There is some evidence that addiction interventions have an economic benefit through the reduction of reoffending. Overall, there is a need for more research in the area of effectiveness of alcohol interventions in prison populations, in particular in identifying screening tools that work with this population, more information on what is effective, on the optimum timing for both screening and interventions, and the potential economic benefits of screening and interventions.

As part of the study, for 12 weeks universal screening for alcohol problems was undertaken in a male prison, based on the AUDIT screening tool. 73% of prisoners had scores indicating a degree of alcohol problems (8+ AUDIT score), including 36% possibly dependent (20+ AUDIT score). The highest proportion of 20+ AUDIT scores were in the 18–24 and 40–64 age groups, but drinking patterns differed, with those in middle age more likely to show features of dependence than younger prisoners. Higher AUDIT scores were notable among those with shorter sentences (less than six months). This was a predominantly young population with a high prevalence of social exclusion factors, in particular unemployment and low education achievement, many of whom were on remand or short sentences. Over 1 in 4 reported their current offence to be a violent crime and four fifths had been in prison before. Alcohol was self-reported to be a factor in the offence in 40% of cases (50% for violent crime) and, of these, nearly half giving further information said drugs were also involved.

A mapping exercise was undertaken of alcohol interventions across the Scottish prison estate, including the community interface. This was based on interviews undertaken with key informant stakeholders and staff members involved in alcohol service delivery across all prisons. Currently there is no formal alcohol screening using a validated instrument. A range of interventions are available to address alcohol problems in the context of offending but there is no alcohol-specific model of care. There was variation in capacity for addiction nurses to deliver interventions. Not all alcohol interventions are available to those on short sentences or remand (a large proportion of those with alcohol problems). Overall, the research found there to be limited accessibility to alcohol specific interventions, with far greater numbers accessing general substance misuse interventions.

In-reach Editorial explanation: Helping agencies based in the community coming in to prisons to make contact with prisoners both to help while they are in prison and to try to engineer continuity of care on release. into prisons was also limited, although this was viewed as developing. Continuity of care is more difficult if a prisoner is released to a different geographic area. Alcohol interventions are being delivered by different providers in prison, so there can be limited awareness of overall service provision and care pathways among relevant staff. There is also a lack of outcome evidence and information to inform planning and service improvement.

To give more depth to the study, a case study incorporating qualitative focus groups with prisoners and interviews with internal and external staff was undertaken in one prison. This found broadly convergent understandings of alcohol issues among prisoners and staff, both recognising links between alcohol and offending, including violent offending, and drug use. There was a general perception that alcohol interventions are not as well resourced or as prominent as drug interventions. Initial support is often limited and related to alcohol dependence and physical health needs, with few interventions addressing wider behaviour change and interrelated social problems. Staff also highlighted the challenge of delivering effective interventions for remand and short-term prisoners.

Prisoners spoke about assessment of alcohol problems on admission as being a 'Yes or no' question, asked at a time of competing concerns and when taking in new information can be difficult. Key aspects identified were an empathetic approach and some separateness from the discipline regime. Prisoners also wanted more involvement of 'outsiders' and peers/ex-prisoners/those with experience of alcohol problems in the delivery of interventions.

Implications of findings for a model of care and care pathway

There are many implications from the research undertaken in this study for a model of care for alcohol for Scottish prisoners. Some of the most significant are:
• That limited evidence on the effectiveness of alcohol interventions in prison settings makes it important to use wider literature from community settings to inform a gap analysis and model of care for the Scottish Prison Service;
• The importance of tailored interventions including those to address violence and alcohol, and co-occurring drug and alcohol problems;
• The need for interventions that address alcohol in the wider context of social problems, such as social exclusion and unemployment;
• That good assessment, including use of a validated screening tool, is necessary in order to ensure prisoners that need them are offered relevant needs-led opportunities to address alcohol.

A model of care, or treatment framework, outlines the provision necessary to have a meaningful impact on prisoners with a range of alcohol-related needs. The findings of this study contributed to an enhanced understanding of the importance of implementing a full model of care in the Scottish Prison Service representing treatment pathways that address all four tiers in the Models of Care for Alcohol Misusers (MoCAM) guidance, with the Scottish Prison Service being viewed as a "treatment system". The planning and development of tiered interventions is an important mechanism in being able to better target and tailor interventions to prisoner need. The approach taken in creating the model of care was also informed by the principle of equivalence, whereby standards of health care for people in custody are the same as for the wider community. Outlined below are what is currently delivered in the Scottish Prison Service, where the gaps are and what is needed to fill gaps, drawing on the MoCAM model.


TIER 1 In MoCAM, tier 1 consists of a range of interventions that can be provided by generic providers, depending on their competence and partnership arrangements with specialised alcohol services.

Currently delivered
• Limited screening (yes or no question);
• Alcohol advice and information – the Enhanced Addiction Casework Service (EACS);
• Overdose Awareness Session (has alcohol component);
• Referral of those requiring more than above for specialised alcohol treatment (to EACS).

What is needed in addition to above
• Universal screening with validated tool for increased detection of alcohol problems;
• Verbal self-referrals due to literacy issues;
• Piloting and evaluation of simple brief interventions for hazardous and harmful drinkers accessible to all who need them including short-term (under 31 days) and remand prisoners;
• Interventions offered that are meaningful to prisoners, are person-centred, meet their needs and are credible.


TIER 2 In MoCAM, tier 2 interventions include provision of open access facilities and outreach that provide: alcohol-specific advice, information and support; extended brief interventions to help alcohol misusers reduce alcohol-related harm; and assessment and referral of those with more serious alcohol-related problems for care-planned treatment.

Currently delivered
• Alcohol-specific information, advice and support (EACS Alcohol Awareness session, Scottish Prison Service approved activity Alcohol Awareness);
• Alcohol-specific assessment (health assessments) and referral of those requiring structured or more intensive support and interventions (EACS) or treatment (prison health care);
• Triage assessment (addictions nurse);
• Mutual aid groups (Alcoholics Anonymous).

What is needed in addition to above
• Universal screening with validated tool for increased detection of alcohol problems;
• Extended brief interventions and brief treatment to reduce alcohol-related harm among hazardous/harmful drinkers and possibly mildly dependent drinkers;
• The provision of personalised feedback, often part of brief interventions, could be used to enhance motivation for action;
• Provide a range of interventions that will meet the high level of need and/or demand, eg, one-to-one and group interventions, and some level of choice;
• Increased interventions drawing on peer support or provided by peer approaches;
• Interventions offered that are meaningful to prisoners, are person-centred, meet their needs and are credible.


TIERS 3 and 4 In MoCAM, tier 3 interventions include provision of community-based specialised alcohol misuse assessment, and alcohol treatment that is care co-ordinated and care-planned; tier 4 interventions include provision of residential, specialised alcohol treatments which are care-planned and co-ordinated to ensure continuity of care and aftercare.

Currently delivered
• Comprehensive substance misuse assessment (but effective detection is missing);
• Care planning and review for those in structured treatment;
• Case management;
• Evidence-based prescribing interventions (alcohol withdrawal/detox) and prescribing interventions to reduce risk of relapse;
• Structured evidence-based psychological therapies (eg, Scottish Prison Service prisoner programmes) that address alcohol and co-existing conditions (ie, alcohol and offending behaviour – SROBP, alcohol and other substance use);
• Liaison services for acute medical and psychiatric health services;
• Pre- and post-release work including community integration.

What is needed in addition to above
• Enhanced detection using a standardised tool, prior to comprehensive assessment;
• Enhanced capacity for additional structured evidence-based psychological therapies including counselling approaches – provide access to meet need;
• Better access to all interventions for short term prisoners whether in community or prison;
• Interventions offered that are meaningful to prisoners, are person-centred, meet their needs and are credible;
• Increased interventions drawing on peer support or provided by peer approaches;
• Interventions/therapies/treatment targeting specific groups (ie, levels of dependence) and diversity issues, ie, women, co-existing mental health problems/dual diagnosis, learning disabilities, and social problems such as homelessness and literacy;
• Enhanced work on community and external provider linkages for communication and service access including in-reach;
• Emphasis on throughcare for all prisoners with identified alcohol problems.


Alcohol care pathways are locally agreed templates for best practice that map out the local help available at various stages of a treatment journey for alcohol. A flow diagram is outlined below showing the key decision points in a high level pathway of care that has been designed to be a subject for dialogue in local areas when planning and commissioning appropriate alcohol services for the prison population.

Integrated alcohol care pathway for Scottish Prisoners

Conclusion

Prison presents an opportunity to address alcohol issues among a particularly marginalised group of people. The prevalence of alcohol problems amongst prisoners in Scotland is far higher than in the general population. This study identifies a considerable proportion of individuals in the Scottish Prison Service who could benefit from interventions that address alcohol consumption and alcohol-related harm and while a range of alcohol-related interventions exist, many prisoners who could potentially benefit from such interventions are being missed. The planning and development of tiered interventions, based on detection with a validated screening tool and subsequent comprehensive specialist assessment when appropriate, is an important mechanism in being able to better target and tailor interventions to prisoner need.

Integrated alcohol care pathways in the Scottish Prison Service are an important part of this process and likely to be best developed as a result of multi-level discussions amongst a range of stakeholders. Integration of the Scottish Prison Service and NHS health care services, due to take place in Autumn 2011, will be of particular relevance to the further development of this work. It is hoped that this report will add to current awareness of alcohol-related problems amongst individuals in prison in Scotland and contribute to building on the achievements made thus far.


Findings logo commentary This report complements a similar investigation of problem drinking offenders in Scotland and responses to them by community criminal justice services.

Last revised 04 April 2011

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

STUDY 2010 Alcohol services in prisons: an unmet need

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Scoping study of interventions for offenders with alcohol problems in community justice settings.

McCoard S., Skellington Orr K., McKellar J. et al.
NHS Health Scotland, 2011.
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Investigates what outside prison is being done in Scotland to meet the needs of problem drinking offenders by criminal justice and other services, and assesses whether local arrangements measure up to the size and nature of the task. Non-evidence based funding and the need to develop integrated care pathways emerged as key issues.

Summary This report presents the findings of a scoping study of alcohol problems among offenders in the community justice setting. It is one of three studies that make up the portfolio of the Alcohol and Offenders Criminal Justice Research Programme which is led by NHS Health Scotland and funded by the Scottish Government.

The overarching aim of the portfolio is to understand better the extent and nature of alcohol problems in offenders, and which effective interventions can address them, recognising that the criminal justice setting is an opportunity to detect and intervene in an often 'hard to reach' population.

This research sought specifically to inform policy and practice by mapping plans, arrangements and procedures in local areas throughout Scotland to identify and intervene with offenders with alcohol problems, as part of the criminal justice process or otherwise, in community settings, including identifying emerging good practice. It also sought to establish what is known about the effectiveness of interventions for this group.

Methods

The research adopted a two-stage, mixed method approach, including a brief review of the evidence from both published literature and routine data and primary research interviews with community justice authority Community justice authorities were set up across Scotland in April 2006 to make communities safer by reducing re-offending and improving the management of offenders. Their role is to coordinate the delivery of offender services by councils, voluntary organisations and other partners and to ensure close cooperation between community and prison services to aid the rehabilitation of offenders. They also decide how the criminal justice social work budget allocated to their area should be spent. In consultation with partners and Scottish government ministers, the authorities prepare an area plan for reducing re-offending, and monitor compliance with the plan. They also coordinate the sharing of information between partner bodies as relevant, and promote good practice for all involved. The authorities are made up of elected councillors from local authorities. chief officers and local partners.

The review of evidence focused on both published articles and grey literature covering prevalence, trends, screening and interventions for alcohol problems in offenders in the community justice setting. The review concentrated on the community justice setting and, although research was uncovered from the prison, primary care, and other settings which may have relevant messages, coverage of this material was not in scope of the current study.

For the primary research, community justice authority Community justice authorities were set up across Scotland in April 2006 to make communities safer by reducing re-offending and improving the management of offenders. Their role is to coordinate the delivery of offender services by councils, voluntary organisations and other partners and to ensure close cooperation between community and prison services to aid the rehabilitation of offenders. They also decide how the criminal justice social work budget allocated to their area should be spent. In consultation with partners and Scottish government ministers, the authorities prepare an area plan for reducing re-offending, and monitor compliance with the plan. They also coordinate the sharing of information between partner bodies as relevant, and promote good practice for all involved. The authorities are made up of elected councillors from local authorities. chief officers were interviewed in the first instance, and they provided contact details for relevant partner organisations able to provide more in-depth information and local knowledge. Follow-up depth interviews (by phone and face-to-face) and electronic evidence-gathering with core authority partners was then undertaken to explore some of the information of greatest relevance to the scope of the research.

Review of evidence

The review of evidence revealed that there is a limited amount of routine data relating to the prevalence of alcohol problems in offenders and associated offending.

Information on the contribution of an offender's alcohol consumption to the offence is not routinely collected as part of police reporting or recording procedures. Alcohol-related offending can only be estimated through alcohol-related offences which are 100% attributable to alcohol (eg, drunkenness/drink-driving), or through official criminal justice statistics where alcohol has been identified as a significant contributory factor in the offence, as determined by the court, eg, homicide. Further, such statistics are often influenced by local police initiatives, so it is difficult to interpret if a change in statistics reflects changes in the prevalence of alcohol-related offending, or in the enforcement and identification of perpetrators.

Criminal justice social work statistics provide an indicator of the proportion of community-based sentences by area, including those with alcohol treatment/education conditions attached. Data from 2009/10 show that, at the national level, the number of conditions of alcohol treatment/education attached to probation orders was 1208, representing 11% of all conditions awarded.

Data from the Scottish Prison Service Prisoner Survey 2009 show that around half those sentenced to custody or on remand in a Scottish prison reported being drunk at the time of their offence. Data relating specifically to young offenders showed that more than three quarters (77%) of young offenders reported being drunk at the time of their offence. The Scottish Crime and Justice Survey 2009/2010 reported that a large proportion of victims (62%) thought the offender was under the influence of alcohol at the time of violent crimes.

NHS Quality Improvement Scotland undertook the Scottish Emergency Department Alcohol Audit in 2006 which provided an indicator of alcohol-related assaults and violence, based on attendances at emergency departments. The national audit, covering 16 departments in Scotland, showed that at least 70% of all assaults may be alcohol-related. With an estimated 110 assaults presenting to departments each day, this means that there may be at least 77 alcohol-related assaults presenting each day.

Although survey and other data highlight positive associations between alcohol and offending, there is relatively little published research on interventions which engage with offender groups to identify, screen and intervene with those who have alcohol problems.

Among the research undertaken, there are some examples of the application of the Alcohol Use Disorders Identification Test (AUDIT) for screening in police custody and probation settings, which show varying levels of operational success in identifying offenders with alcohol problems.

Whilst there is a considerable body of evidence that supports the effectiveness of brief alcohol interventions delivered in the primary care setting, there is limited evidence which specifically explores the suitability or effectiveness of these interventions in criminal justice settings. Indeed, there is limited evidence that explores the suitability or effectiveness of alcohol interventions or treatment of any kind in this setting. Much of the evidence in this population relates to drugs or combined drug and alcohol interventions, rather than alcohol interventions per se.

One effective intervention that is evident from the published literature is arrest referral, Normally substance misuse counsellors make contact with suspects held in police cells after arrest but before prosecution and offer referral to drug/alcohol services in appropriate cases. Such referral does not mean the suspect avoids prosecution, but their willingness to seek help may be taken in to account by the courts. which has proven to be effective at targeting offenders with both alcohol and drug misuse problems early in their criminal justice journey, ie, at the point of initial police detention. Research in Scotland has shown that arrest referral can identify individuals with significant drug and alcohol problems and offending behaviour linked to substance misuse, and link them to appropriate services. There is, however, limited evidence to date which shows that arrest referral, Normally substance misuse counsellors make contact with suspects held in police cells after arrest but before prosecution and offer referral to drug/alcohol services in appropriate cases. Such referral does not mean the suspect avoids prosecution, but their willingness to seek help may be taken in to account by the courts. reduces alcohol consumption and/or harm.

Evidence of effective interventions for offenders post-sentence or post-release is also limited. The absence of research literature does not, of course, necessarily mean the absence of practice, rather that work may not be systematically recorded or documented, or if recorded, is not readily identifiable in the literature.

Local practice

Interviews and evidence gathering at the community justice authority Community justice authorities were set up across Scotland in April 2006 to make communities safer by reducing re-offending and improving the management of offenders. Their role is to coordinate the delivery of offender services by councils, voluntary organisations and other partners and to ensure close cooperation between community and prison services to aid the rehabilitation of offenders. They also decide how the criminal justice social work budget allocated to their area should be spent. In consultation with partners and Scottish government ministers, the authorities prepare an area plan for reducing re-offending, and monitor compliance with the plan. They also coordinate the sharing of information between partner bodies as relevant, and promote good practice for all involved. The authorities are made up of elected councillors from local authorities. level revealed a strong awareness among partners of the need to focus more on tackling alcohol problems in offenders in Scotland, as reflected in local area plans.

The research revealed a multitude of generic and specialist drug and alcohol services, many of which will engage with offenders as part of their role, but which do not actively target this client group or tailor their services to offenders' needs. The number of interventions, services and future plans to engage specifically with offenders with alcohol problems is far more restricted, especially when focussing specifically on community justice clients.

Research has shown considerable support across Scotland for arrest referral, Normally substance misuse counsellors make contact with suspects held in police cells after arrest but before prosecution and offer referral to drug/alcohol services in appropriate cases. Such referral does not mean the suspect avoids prosecution, but their willingness to seek help may be taken in to account by the courts. and it seems this might usefully be applied more widely to identify and refer those at risk. The research has also shown that there is already awareness among interviewees of how brief alcohol interventions can be incorporated into the criminal justice process. Several local authorities appear to have already trained staff to deliver these for community justice clients, though this is being applied differently in local jurisdictions.

There seems little proactive identification of offenders with alcohol problems beyond routine criminal justice social work risk assessments and SERs. Most interventions appear to occur post-sentence, although there are some interventions which occur earlier in the process, for example, at police arrest and detention stage.

Across all community justice authority Community justice authorities were set up across Scotland in April 2006 to make communities safer by reducing re-offending and improving the management of offenders. Their role is to coordinate the delivery of offender services by councils, voluntary organisations and other partners and to ensure close cooperation between community and prison services to aid the rehabilitation of offenders. They also decide how the criminal justice social work budget allocated to their area should be spent. In consultation with partners and Scottish government ministers, the authorities prepare an area plan for reducing re-offending, and monitor compliance with the plan. They also coordinate the sharing of information between partner bodies as relevant, and promote good practice for all involved. The authorities are made up of elected councillors from local authorities. areas, two groups emerge as priorities for action: young people, and women offenders. There are numerous examples of specifically tailored services into which women and young people can be referred (both mainstream and some specifically for offenders) but, again, there is little evidence of early intervention work for women or screening at early points in the criminal justice system for either group.

The scoping study has not identified many practical uses of care pathways for offenders with alcohol problems between statutory and other support and treatment organisations. There is also a limited availability of offender-specific services, as many of the interventions and treatments available to tackle the alcohol problems of offenders are delivered by generic substance misuse programmes or services. It has therefore been difficult to isolate specific referral routes or interventions for offenders with alcohol problems independently.

There appears to be considerable variation both between and within community justice authorities, Community justice authorities were set up across Scotland in April 2006 to make communities safer by reducing re-offending and improving the management of offenders. Their role is to coordinate the delivery of offender services by councils, voluntary organisations and other partners and to ensure close cooperation between community and prison services to aid the rehabilitation of offenders. They also decide how the criminal justice social work budget allocated to their area should be spent. In consultation with partners and Scottish government ministers, the authorities prepare an area plan for reducing re-offending, and monitor compliance with the plan. They also coordinate the sharing of information between partner bodies as relevant, and promote good practice for all involved. The authorities are made up of elected councillors from local authorities. with regards to the level and nature of engagement with alcohol and drug partnerships, health boards and community health and care partnerships. The research interviews suggested that there is some scope for ensuring that local strategic plans and priorities are better aligned between criminal justice and health partners. In areas where there is closer joint working between community justice authorities, Community justice authorities were set up across Scotland in April 2006 to make communities safer by reducing re-offending and improving the management of offenders. Their role is to coordinate the delivery of offender services by councils, voluntary organisations and other partners and to ensure close cooperation between community and prison services to aid the rehabilitation of offenders. They also decide how the criminal justice social work budget allocated to their area should be spent. In consultation with partners and Scottish government ministers, the authorities prepare an area plan for reducing re-offending, and monitor compliance with the plan. They also coordinate the sharing of information between partner bodies as relevant, and promote good practice for all involved. The authorities are made up of elected councillors from local authorities. and alcohol and drug partnerships, these partnerships appear to be working well.

Several examples of good practice were identified which may provide reference for the development of initiatives elsewhere. Despite this, there seems to be little evidence-based development of services (especially evidence to inform the continuation of existing services) or routine monitoring or evaluation of new services and interventions.

Conclusions

The scoping study has shown there is significant evidence pointing to the extent and nature of alcohol problems in offenders. It has also shown that there is little in the published literature about what works in addressing alcohol problems among offenders, although the body of evidence is growing. At present, there appears to be no clear pattern of referral activity or standard practice locally across Scotland with regard to plans, arrangements and procedures in place to identify and intervene with offenders with alcohol problems.

One of the concerns that is apparent from the consultation is that there may be a need for funding to be based more on evidenced success, rather than historically based and automatically continued. However, the measurement criteria for success are difficult to define. There appears to be a paradox in that services are required to be evidence-based, with a need for robust monitoring and evaluation of performance, yet local partners reported that funding is limited to undertake formal evaluation work. As a consequence, many forgo formal evaluation in favour of anecdotal 'verbal' evaluation from service users and staff running the schemes, as this can be undertaken at no cost. Whilst the value of service users' and staff voices is acknowledged, the limitations of this approach are clear.

Having said this, there are numerous examples of good practice locally, both with regard to partnership working, and effective screening and interventions, although the absence of formal monitoring and evaluation data makes it difficult to substantiate their impact. Most interventions available for offenders with alcohol problems were developed locally, with several being cited as examples of good practice by local partners. The positive comments made regarding these services provides a good opportunity to share examples of best practice beyond the local area, something already undertaken among a number of community justice authorities, Community justice authorities were set up across Scotland in April 2006 to make communities safer by reducing re-offending and improving the management of offenders. Their role is to coordinate the delivery of offender services by councils, voluntary organisations and other partners and to ensure close cooperation between community and prison services to aid the rehabilitation of offenders. They also decide how the criminal justice social work budget allocated to their area should be spent. In consultation with partners and Scottish government ministers, the authorities prepare an area plan for reducing re-offending, and monitor compliance with the plan. They also coordinate the sharing of information between partner bodies as relevant, and promote good practice for all involved. The authorities are made up of elected councillors from local authorities. and which could be extended.

Encouragingly, what the research has shown is that the need to focus on alcohol and offending is well recognised by health and criminal justice partners alike, and there is a willingness to move forward to meet future needs in line with national priorities.


Findings logo commentary This report complements a similar investigation of problem drinkers and responses to them in Scottish prisons.

Last revised 04 April 2011. First uploaded

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STUDY 2013 Criminal justice responses to drug related crime in Scotland

STUDY 2010 Alcohol services in prisons: an unmet need

STUDY 2011 Prison health needs assessment for alcohol problems

STUDY 2010 Offender alcohol interventions: minding the policy gap

DOCUMENT 2012 The government's alcohol strategy

STUDY 2012 Summary of findings from two evaluations of Home Office alcohol arrest referral pilot schemes

DOCUMENT 2010 Drug Strategy 2010. Reducing Demand, Restricting Supply, Building Recovery: Supporting People to Live a Drug Free Life

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

STUDY 2011 Delivering alcohol brief interventions in the community justice setting: evaluation of a pilot project

STUDY 2012 Alcohol screening and brief intervention in probation





A meta-analysis of interventions to reduce adolescent cannabis use.

Bender K., Tripodi S.J. , Sarteschi C. et al.
Research on Social Work Practice: 2011, 21(2), p. 153–164.
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 Bender at kimberly.bender@du.edu.

The first synthesis of research on therapeutic interventions for adolescent cannabis users highlighted the relative success of family and multi-component approaches, but the evidence base was too narrow to securely determine what works best.

Summary Objective This meta-analytic A study which uses recognised procedures to combine quantitative results from several studies of the same or similar interventions to arrive at composite outcome scores. Usually undertaken to allow the intervention's effectiveness to be assessed with greater confidence than on the basis of the studies taken individually. review assesses the effectiveness of substance abuse interventions to reduce adolescent cannabis use.

Method A systematic search identified 15 randomised controlled evaluations of interventions to reduce adolescent cannabis use published between 1960 and 2008. The entire sample of youth participants was aged 12–19 and all the studies were carried out within the United States. The primary outcome variables – frequency and quantity of cannabis use – were measured between one month and a year after completion of treatment.

Results The studies and their results were varied, so outcomes were combined using an approach (a 'random effects model') which does not assume there is one 'true' impact size which simply varied by chance across the studies. Instead it assumes that impact really does differ for the different interventions and the different situations in which they were tested. These analyses resulted in roughly equivalent moderate effect sizes A standard way of expressing the magnitude of a difference (eg, between outcomes in control and intervention groups) applicable to most quantitative data. Enables different measures taken in different studies to be compared or (in meta-analyses) combined. Based on expressing the difference in the average outcomes between control and experimental groups as a proportion of how much the outcome varies across both groups. The most common statistic used to quantify this difference is called Cohen's d. Conventionally this is considered to indicate a small effect when no greater than 0.2, a medium effect when around 0.5, and a large effect when at least 0.8. The featured study instead used a variant called 'Hedges's g' which corrects for the bias that would otherwise result when few studies are available to be combined. for individual and family-based treatments, which across all the studies meant that 69% (50% is the break-even point) of young people offered the tested treatments reduced their cannabis use more than those in comparison treatments or (rarely) whose treatment was delayed. Impacts tended to wane as follow-up periods lengthened, suggesting that clinicians should when possible offer follow-up or booster sessions. The minority of studies with follow-up periods of a year or more revealed that behavioural treatment and especially Multidimensional Family Therapy had large and enduring effects.

Discussion Substance abuse treatment programmes should consider implementing evidence-based interventions highlighted in this meta-analysis which fit the needs and characteristics of their client base and agency setting. There is not yet enough published data to determine which if any of the reviewed treatments is the most effective, but evidence is strongest for family-based or multisystem approaches including Integrated Family and Cognitive Behaviour Therapy, Multidimensional Family Therapy, and Teaching Family. Given their roughly equivalent impact, the higher cost of family versus client-focused individual therapies may be a decisive consideration.


Findings logo commentary Multidimensional Family Therapy emerged as the most supported therapy in this analysis but mainly when compared to weak alternatives; advantages with respect to cognitive-behavioural therapy were minor and in the single study to test this, not statistically significant. See this Findings analysis for more on this approach and the strengths and limitations of the evidence for it being preferable to alternatives.

Last revised 01 April 2011

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STUDY 2011 Treatment of adolescents with a cannabis use disorder: Main findings of a randomized controlled trial comparing multidimensional family therapy and cognitive behavioral therapy in The Netherlands

STUDY 2013 Multidimensional family therapy lowers the rate of cannabis dependence in adolescents: A randomised controlled trial in Western European outpatient settings

STUDY 2011 Using a cross-study design to assess the efficacy of motivational enhancement therapy-cognitive behavioral therapy 5 (MET/CBT5) in treating adolescents with cannabis-related disorders

REVIEW 2014 Interventions to reduce substance misuse among vulnerable young people

STUDY 2009 Multidimensional Family Therapy for young adolescent substance abuse: twelve-month outcomes of a randomized controlled trial

STUDY 2009 Therapist behavior as a predictor of black and white caregiver responsiveness in multisystemic therapy

REVIEW 2011 Evidence-based psychotherapy relationships: The alliance in child and adolescent psychotherapy

STUDY 2012 Using pay for performance to improve treatment implementation for adolescent substance use disorders

REVIEW 2011 Evidence-based therapy relationships: research conclusions and clinical practices

REVIEW 2011 Effectiveness of motivational interviewing interventions for adolescent substance use behavior change: a meta-analytic review





Interventions for disorder and severe intoxication in and around licensed premises, 1989–2009.

Brennan I., Moore S.C., Byrne E. et al.
Addiction: 2011, 106, p. 706–713.
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 Moore at mooresc2@cardiff.ac.uk. You could also try this alternative source.

Surprisingly, the big problem of disorder and violence associated with bars, clubs and pubs has not attracted a correspondingly large evidence base on how to prevent it. This review concludes that training bar staff to identify and respond to warning signs has some potential.

Summary Aims To systematically review rigorous evaluation studies into the effectiveness of interventions in and around licensed premises that aimed to reduce severe intoxication and disorder.

Methods A systematic search was conducted. Papers that rigorously evaluated interventions based in and around licensed premises to reduce disorder or intoxication were included.

Results Fifteen studies were identified. Three Editorial note: Though the body of the article says: "Five studies adopted a randomized controlled trial methodology, the remaining nine used quasi-experimental controlled methods." were randomised controlled trials which randomly allocated premises or areas to the intervention or to a control A group of people, households, organisations, communities or other units who do not participate in the intervention(s) being evaluated. Instead, they receive no intervention or none relevant to the outcomes being assessed, carry on as usual, or receive an alternative intervention (for the latter the term comparison group may be preferable). Outcome measures taken from the controls form the benchmark against which changes in the intervention group(s) are compared to determine whether the intervention had an impact and whether this is statistically significant. Comparability between control and intervention groups is essential. Normally this is best achieved by randomly allocating research participants to the different groups. Alternatives include sequentially selecting participants for one then the other group(s), or deliberately selecting similar set of participants for each group. group. Another 12 were non-randomised trials which did not allocate at random, but still had a set of comparison premises or areas against which to benchmark the effect of the intervention. Outcome measures included test purchasing using research staff who pretended to be drunk, breath alcohol concentration of customers, server behaviour, police-recorded assaults, hospital injury data, arrests for disorderly conduct and the total number of other arrests. The most common intervention tested was responsible beverage server training which aims to develop the capacity of bar staff to identify risks (such as rapid drinking) and to equip them with the skills to address them proactively. Also tested were server violence prevention training, enhanced enforcement of licensing regulations, licensee accords which usually entail a voluntary agreement between licensees, police and local government, and a risk-focused consultation. Several studies tested multi-component interventions which typically implement a range of interventions including those already listed as well as seeking to mobilise the community to influence norms, legislation and licensed premises policies, and to exert pressure on police to enforce legislation and on premises to address risk factors. Among randomised trials of violence prevention interventions, server training appeared the most successful, though training content varied considerably. No other intervention reduced violence. Of the 10 non-randomised trials, three reported a significant reduction in disorder and three significant reductions in intoxication. Interventions were usually targeted at individual licensed premises and these were most likely to reduce disorder, but not intoxication. Two community-level interventions were evaluated in randomised trials but neither reported a significant reduction in disorder. Of the other five community-level evaluations, three reported significant reductions in disorder, but the interventions varied considerably.

Conclusions Server training courses that are designed to reduce disorder have some potential, although there is a lack of evidence to support their use to reduce intoxication and the evidence base is weak.

Last revised 01 April 2011

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REVIEW 2011 Alcohol and drug prevention in nightlife settings: a review of experimental studies

STUDY 2009 Protecting young people from alcohol related harm

STUDY 1999 Alcohol-related violence cut when licensees adopt and implement codes of conduct

STUDY 2008 Internationally proven community alcohol crime and harm reduction programmes feasible in Britain

STUDY 2004 Police and licensees working together curb violent incidents in Cardiff

REVIEW 2003 Just say, 'No sir'

STUDY 2005 Communities can reduce drink-driving deaths

STUDY 2011 Achieving positive change in the drinking culture of Wales

STUDY 2000 Community action cuts drink-driving deaths

STUDY 2001 Persistent and credible enforcement needed to prevent widespread alcohol sales to under-18s





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