Alcohol Treatment Matrix cell A5: Interventions; Safeguarding the community

2020/21 update funded by

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Previously also funded by

Society for the Study of Addiction web site Society for the Study of Addiction

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Alcohol Treatment Matrix

Effectiveness Bank Alcohol Treatment Matrix

Includes brief interventions

Drug Treatment Matrix

Effectiveness Bank Drug Treatment Matrix

Includes harm reduction

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Interventions; Safeguarding the community

Key studies on the impact of alcohol treatment on the community including families, children and crime. Explores the core contradiction between punishment and rehabilitation, asks whether this accounts for the poor record of criminal justice treatment, highlights the most robust test yet of brief alcohol counselling in probation, asks whether it can ever be safe to leave children with severely dependent drinkers, and recounts the alleged deception at the heart of a recommended treatment method.


S Seminal studiesK Key studiesR ReviewsG Guidancemore Search for more studies

Links to other documents. Hover over for notes. Click to highlight passage referred to. Unfold extra text Unfold supplementary text

S No use ordering ‘chronic drunks’ to AA (or to treatment) (1967). Identified by reviews (1; below) as one of just three randomised trials of self-help groups, among arrestees who already had a suspended sentence hanging over their heads it found that a court order to attend an “alcoholism clinic” or AA meetings did not further reduce arrests over the following year compared to no treatment; if anything, the reverse. Originally optimistic about the interventions, the authors ended by concluding that their findings “offer no support for a general policy of forced referrals to brief treatment”. Related study and review below. For discussion click and scroll down to highlighted heading.

S Disulfiram backed by sanctions helps reform repeat alcohol-related offenders (1966). In the early ’60s in Atlanta in the USA, a pioneering trial tested whether instead of another spell in jail, ‘skid-row’ repeat drunkenness offenders would take a drug which generates deterrent physical reactions to alcohol. Most did, belying their supposedly hopeless condition. The Effectiveness Bank commentary describes an early trial (1983) in London which tested a similar programme with similar results. For a related discussion click and scroll down to highlighted heading.

K No significant benefits from court-ordered treatment in England (2011). In the English Midlands court-ordered treatment for problem-drinking offenders on probation could not be shown to have reduced re-offending more (though the reductions were substantial) than previous probation arrangements. Similar evaluations in Lancashire (2010), West Yorkshire (2011) and nationally (original source, [UK] Ministry of Justice, 2009) also found considerable improvements but did not benchmark these against any, or any adequate, comparison groups. For discussion click and scroll down to highlighted heading.

K UK anti-offending programme did not cut crime (2011). The main cognitive-behavioural group therapy programme (ASRO) for problem substance users on probation in the UK could not be shown to have affected reconviction rates. See also similar UK findings (2012) from the same cognitive-behavioural family of interventions applied to drink-driving. For discussion click and scroll down to highlighted heading.

K No crime-reduction dividend from offering brief counselling to drunk arrestees in England ([UK] Home Office, 2012). Government-funded pilot schemes found no crime-reduction benefits from brief alcohol counselling for arrestees under the influence of drink, confounding hopes that these ‘arrest referral’ schemes would help quell late-night alcohol-related disorder. The schemes did, however, uncover many dependent drinkers. Related review below. For related discussion click and scroll down to highlighted heading.

K In Wales no crime-reduction return from brief intervention for young men convicted of violence while drunk (2008). Over the following year a randomised trial of a 15–20 minute counselling session based on motivational interviewing did not find it had significantly reduced offending or drinking, though emergency unit attendance for injuries was reduced. Related review below. For related discussion click and scroll down to highlighted heading.

K In UK probation services brief counselling no better than a basic warning at curbing drinking but crime may have been reduced (2014). The largest alcohol brief intervention evaluation yet conducted in Britain found risky drinking rates fell as much after a minimal warning about excessive drinking as after more sophisticated and longer alternatives, but these might (the researchers were unsure) have further reduced the reconviction rate. A similar Scottish study did not directly test effectiveness. Related review below. For discussions click here and here and scroll down to highlighted headings.

K No significant reduction in offending from alcohol treatment in English prisons (2020). Based on a comparison between prisoners recorded as having an alcohol use disorder and released during 2013–14 who while in prison were treated versus those who were not. Overall the proportion who reoffended in the year after release was virtually identical. The few high-risk prisoners who underwent relatively extensive treatment using recommended psychosocial methods may have been less likely to reoffend than the untreated comparison group, but this difference was not statistically significant, and the comparison was not of like with like. For discussion click and scroll down to highlighted heading.

K No offending dividend from UK AA-based prison programme (2018). On key measures the post-release offending records of prisoners who received an intensive programme based on the 12 steps of AA were virtually identical to those of a matched set of prisoners who did not receive the programme. For discussion click and scroll down to highlighted heading.

Families with children initially at risk of being taken in to public care and actually taken in during follow-up period

K Intensive support for problem drinking parents enabled children to stay at home (Welsh Assembly Government, 2008). Evaluated a service which worked intensively over a few weeks with substance-using parents (mainly involved with alcohol) whose children faced imminent care proceedings. The initiative delayed and shortened their removal from the home; a later evaluation (2012) confirmed this was not at the expense of the children’s welfare chart. Listed below the initial evaluation of a national rollout of similar services and related reviews (1 2) and guidance. For discussion click and scroll down to highlighted heading.

K Lessons from Welsh pilot of integrated support for children affected by substance use in the family (Welsh Government, 2014). Evaluation of the first three local schemes in a nationwide rollout of services based on the evaluations listed above. Documents how the schemes changed in response to experience and strategic and operational contexts. Related reviews (1 2) and guidance listed below. For discussion click and scroll down to highlighted heading.

K No demonstrable benefits from intensive support for “troubled families” ([UK] Department for Education, 2011). Early evaluation of national scheme which financially incentivised providers to ‘turn round’ troubled families in England found substantial remission in substance use problems but could not attribute these to the interventions. Later evaluation (2016) of the programme as implemented from 2012 to 2015 found that relative to comparison families, there were no significant impacts on substance use, employment, job-seeking, school attendance and anti-social behaviour. From 2015 the programme was revised to target families with a much broader range of disadvantages and to help younger children benefit. A series of evaluation reports have been published, but the studies (2017) lacked an adequate comparison group. Related reviews (1 2) and guidance listed below. For related discussion click and scroll down to highlighted heading.

K Problem-solving and collaborative approach improves outcomes of child care proceedings in London (2016). Addressing parents’ entrenched substance use and other problems was at the heart of the first UK family drug and alcohol court in the UK. Compared to ordinary care proceedings, it achieved sustainably improved parental and child outcomes at lower cost ([UK] Home Office, 2012). The courts spread outside London. Observations and interviews with judges showed they had (2016) implemented the intended collaborative, problem-solving ethos and given parents a voice, while still prioritising the child’s welfare. The new courts made parents feel (2018) valued, supported, able to share their difficulties, and fairly dealt with. For discussion click and scroll down to highlighted heading.

K Support the relatives too (2011). Brief counselling by specially trained primary care staff seemed to help relatives in England cope with living with a problem drinker, but without a control group against whom to benchmark the outcomes, we cannot be sure that the benefits were actually due to the interventions. Related guidance below (1 2).

Improvements in violence in the family and child welfare after treatment for drinking problems

K Patient-focused treatment helps partners and children too (2003 and 2006). Study of 301 men living with female partners and seeking treatment at two US outpatient alcohol clinics showed that even when treatment is focused on the man with the drinking problem, families benefit in the form of reduced violence and improved child welfare chart. Related review below. For related discussion click and scroll down to highlighted heading.

K If feasible, families benefit most from couples therapy (2009). Compared to individual therapy, found that anti-violence benefits for partners of people with drinking problems were greatest when both were allocated to couples-based therapy which addressed relationships as well as drinking. See also similar couples-therapy reports focused on men (2004) or women (2009; free source at time of writing) with drinking problems, and UK-based advice (2007; free source at time of writing) on how to avoid the risk that couples therapies might provoke partner abuse. Listed below further couples-therapy report from same research stable and related review and guidance (1 2).

% of children of problem drinking fathers with clinically impaired psychosocial adjustment

K When dad has a drinking problem, couples and children benefit most from couples therapy (2002; free source at time of writing). Compared to individual therapy only or the passive attendance of the female partner, adding couples therapy to individual therapy for men seeking treatment for drinking problems significantly improved the functioning of their children ( chart) and the partners’ relationships. Child welfare may be further improved (2008; free source at the time of writing) by integrating joint mother/father parental skills training with couples therapy. See also UK-based advice (2007; free source at time of writing) on how to avoid the risk that couples therapies might provoke partner abuse. Couples-therapy report from same research stable listed above. Related reviews (1 2) and guidance (1 2 3 4) below.

R Routine alcohol treatment can reduce domestic violence (2009; free source at time of writing). When successful, alcohol treatment in general results in reduced violence between sexual partners; couples therapy has yet greater impacts, but is not always (2007; free source at time of writing) safe or feasible. Related studies above (1 2). For discussions click here and here and scroll down to highlighted headings.

R Family programmes can improve the prospects of children whose parents have substance use problems (2012) Of the reviewed programmes, most effective were those which involved both parents and children, particularly the Strengthening Families Programme (2004). Related review and guidance below. For discussion click and scroll down to highlighted heading.

R Programmes for substance using parents or their children validated in randomised trials (2015). Covers the same territory as review above, but narrowed down to trials where families were allocated at random to the evaluated intervention versus a comparator and where children were shown to have benefited on at least one measure. Just four studies met these criteria; the two most relevant (1, free source at the time of writing; 2) are listed above (1; 2). Related guidance below. For related discussion click and scroll down to highlighted heading.

R Alcohol treatment prevents injuries (Cochrane review, 2004) … and also causes of injury such as violence and accidents; same lead author was responsible for an earlier review (1999) analysed for the Effectiveness Bank. Similar message tentatively emerged from another review analysed (2000) for the Effectiveness Bank. For discussion click and scroll down to highlighted heading.

R No “robust” support for any type of alcohol intervention in the criminal justice system (2019) “No specific model of treatment at any stage of the criminal justice system was supported by a substantial, robust and consistent body of literature,” concluded a UK review of the international literature. Studies were either too few or where there were an appreciable number the results were less promising. Related reviews below (1 2). For discussion click and scroll down to highlighted heading.

R “Very little evidence” for brief interventions in UK criminal justice system (2016). Found “very little evidence of effectiveness of brief interventions … mainly due to the lack of follow-up data”. Similarly a review of the international literature on brief interventions in prisons (2016) concluded, “there is some promise in terms of effects [but] not enough studies have been carried out to ascertain efficacy or effectiveness and adequate methodological rigour in the available literature is questionable”. Related studies (1 2) and review above. For discussions click here and here and scroll down to highlighted headings.

R How to stop drink-drivers reoffending (2006). Broader review of drink-driving and responses to it includes the “encouraging” results from rehabilitation programmes. Related guidance below.

R Attending AA: encourage but don’t coerce (1999). Synthesis of studies concludes that people forced by courts or other means to attend AA do worse than when coerced instead into professionally run treatments or left to their own devices. When participants choose AA or allied treatments overall they do significantly better in terms of drinking reductions than when they choose no treatment and sometimes better than in less intensive alternative treatments, but these non-randomised studies are unable to eliminate bias due to more motivated or otherwise more promising participants opting for AA-based approaches. Related seminal study above.

R Is therapy undermined by a punishment context? (2005). Asks whether in criminal justice settings, the contradictions of helping and punishing at the same time (“motivational arm-twisting”) undermine interventions which might work elsewhere – in particular, the client-centred motivational interviewing style of counselling. For discussion click and scroll down to highlighted heading.

G Offender management guidance for England and Wales ([UK] National Offender Management Service, 2010); Treating prisoners in Scotland (Scottish Prison Service, 2011). Official guidance on the commissioning, management and delivery of interventions for alcohol misusing offenders, dating from before the transfer of responsibility for treatment in prison to the NHS. For discussion click and scroll down to highlighted heading.

G Managing alcohol problems among prisoners (World Health Organization, 2012). Based on UK experience, offers an integrated model of best practice in care for problem-drinking prisoners, including a consideration of specific types of treatments. For discussion click and scroll down to highlighted heading.

G Scottish guidance on working with children, young people and families affected by problematic alcohol and/or drug use (Scottish Government, 2013). Intended for all child and adult services, including drug and alcohol services. Includes what new patients should be asked about children and the role these services should play in a system which (Getting our Priorities Right is the document’s title) prioritises child welfare. Related local toolkit for practitioners listed below. For related discussion click and scroll down to highlighted heading.

G Toolkit to help practitioners safeguard children and families affected by problem substance use (NHS Lothian and partner agencies, 2014). Co-produced by health, social and enforcement authorities in the Edinburgh region. Designed to assist the day-to-day practice of health and social care practitioners working with children and families affected by alcohol and drug problems in the family. Getting it right in the toolkit’s title echoes the Scottish national guidance listed above. For related discussion click and scroll down to highlighted heading.

G Implementing support systems to prevent domestic violence and abuse related to substance use (2017). From Adfam, the national UK charity specialising in drugs and the family, good-practice guidance including intervention principles and specific programmes/approaches. Brings together Adfam’s 30+ years of experience in family support. Related studies (1 2 3) and review listed above and guidance below.

G How to broach and manage domestic violence with clients in substance use services (2012). Australian guidance on identifying and dealing with clients who may be perpetrators as well as victims. Related studies (1 2 3), review and guidance listed above.

G Treating the drink-driver (Health Canada, 2004). Authors reviewed evidence and consulted experts to arrive at recommended education and treatment and rehabilitation approaches to alcohol/drug impaired driving. Related review above.

G US expert consensus on treatment in the criminal justice system ([US] Substance Abuse and Mental Health Services Administration, 2005). Guidance on interventions, matching to the offender, and planning programmes.

more Retrieve all relevant Effectiveness Bank analyses or search more specifically at the subject search page. See also hot topics on supporting families, testing and sanctions and protecting children.

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