Alcohol Treatment Matrix cell E5: Treatment systems; Safeguarding the community

2020/21 update funded by

Alcohol Change UK web site. Opens new Window

Alcohol Change UK

Previously also funded by

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

Developed with

Skills Consortium web site. Opens new window

Alcohol Treatment Matrix

Effectiveness Bank Alcohol Treatment Matrix

Includes brief interventions

Drug Treatment Matrix

Effectiveness Bank Drug Treatment Matrix

Includes harm reduction

About the matrices

Effectiveness Bank matrices

Articles, slides, and video


Effectiveness bank home page. Opens new window Matrix cell

Alcohol Treatment Matrix cell E5 Matrix cell logo

Treatment systems; Safeguarding the community

Key studies on local, regional and national systems for treatment in criminal justice settings and/or to benefit the community. A review argues that despite radically different starting points, criminal justice and treatment must collaborate to deliver treatment. Question its key ingredients for collaboration, ask yourself how far collaboration should go, and ponder why problem drinking is so prominent among prisoners, yet not among prison services.

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 G Watershed moment for the place of child protection in substance use treatment systems ([UK] Advisory Council on the Misuse of Drugs, 2003). Results of an inquiry into children in the UK seriously affected by parental drug use. Though published in 2003, this report from the UK government’s drug policy advisers warrants the accolade “seminal” because after its publication, no commissioner or system planner could justifiably claim ignorance of the need to prioritise the child while treating their parents’ substance use problems. Says that though “Our main focus is … on problem drug use … many of the recommendations … will also be applicable to the children of problem drinkers”. Includes (starting p. 71) guidance on how drug and alcohol treatment and other services can act together in the best interests of children. Update published in 2006 documents (from p. 44) the degree to which such systems had been established. Scottish guidance below. For related discussion click and scroll down to highlighted heading.

K Probation struggling to cope with alcohol-misusing offenders ([UK] Ministry of Justice, 2009). National study in England and Wales describes a system creatively grappling with a huge drink problem among offenders, but undermined by lack of evidence and under-resourcing linked to a dispute over whether health or probation should be the core funders. See also similar report for Scotland (NHS Health Scotland, 2011). For discussions click here and here scroll down to highlighted headings.

K “Unmet need” for alcohol services in Britain’s prisons (HM Inspectorate of Prisons, 2010). Inspections and surveys of prisoners and staff in England reveal “very limited” services for problem-drinking inmates, leaving them with poor prospects on release. See also similar report for Scotland (NHS Health Scotland, 2011). For discussion click and scroll down to highlighted heading.

K Challenges to collaboration between health and criminal justice (2010). Based on exhaustive consultations in south west England, investigates the blockages to providing alcohol-related services to offenders and recommends improvements in commissioning, coordination and practice. See also associated policy report (2011). For related discussion click and scroll down to highlighted heading.

K Lessons of coordinating prison-to-community support in Scotland (2017). In Scotland continuity of care on leaving prison (the key to avoiding relapse to dependent substance use) was devolved to prison officers trained as ‘throughcare’ support officers. Featured evaluation suggested they improved linkage of prisoners to services and remission in problem substance use. Working mostly outside prison, the officers developed and imported into prison an awareness of the obstacles to reintegration. Another throughcare structure in Scotland was a ‘public social partnership’ between the prison, community justice and the third-sector, which was associated with fewer prisoners being re-imprisoned than would be expected (1 2). For discussion click and scroll down to highlighted heading.

K Inter-agency working helps tackle systemic barriers to employing problem drinkers ([UK] Department for Work and Pensions, 2010). Clearest lesson from interviews with UK alcohol service clients and staff working in or with treatment agencies was that when treatment, employment and other services work together, the result is better support for problem drinkers and better access to training and employment opportunities.

K Lessons from Welsh pilot of integrated support for children affected by substance use in the family (Welsh Government, 2014). Evaluates the first three schemes in a nationwide rollout of services based on the Option 2 (2012) crisis intervention service for the children of problem substance using parents. Documents how the schemes changed in response to experience and strategic and operational contexts, and the need to invest in raising and regularly re-raising awareness of the schemes and building relationships with social work teams and wider partners to improve the flow of referrals and embed integrated family support tools and practices. For related discussion click and scroll down to highlighted heading.

K G Uncovering and responding to children’s needs in relation to problem-drinking parents ([English] Office of the Children’s Commissioner, 2014; alternative source). Investigation of case-study areas in England aimed to identify and promote good practice. Key questions were how local areas can discover the extent of need and how services can best respond. For discussion click and scroll down to highlighted heading.

K Treatment needs help from curbs on availability to reduce drink-drive deaths (2005). Multi-million dollar attempt to equip US communities to tackle substance misuse only succeeded in reducing alcohol-related traffic deaths when treatment initiatives were supplemented by limiting the availability of alcohol. Measures included ‘sting’ operations to expose illegal sales, responsible service training, closing or blocking the opening of alcohol outlets and regulating advertising, all coordinated by city-wide task forces.

R Managing drink-drivers (Health Canada, 2004). Canadian report based on reviewing evidence and expert opinion; includes recommended ways of coordinating treatment, rehabilitation and enforcement approaches to alcohol/drug impaired driving.

R Melding disparate objectives and cultures is key to criminal justice treatment (Australian Government, 2005). Realistically acknowledges (section headed “Providing AOD treatment within the context of the criminal justice system” starting page 9) that criminal justice and treatment have different objectives and philosophies and don’t naturally see eye to eye, but argues that education and training can underpin collaboration to achieve shared goals. For discussions click here, here and here, and scroll down to highlighted headings.

R The more voluntary the treatment, the greater the crime reduction (2008). Synthesis of 129 studies of offender treatment for problems including substance use finds treatment’s crime-reducing impact increased to the degree to which the offender was free to choose treatment. Implication is that treatment systems should make it easy and attractive for problem substance users to enter treatment without this requiring legal coercion.

G Management of problem-drinking offenders in England and Wales ([UK] National Offender Management Service, 2010). Official guidance on the commissioning, management and delivery of interventions which predates changes in targets and performance indicators and commissioning and service provision structures introduced since May 2010. See also general health commissioning guidance ([UK] NHS Commissioning Board, 2013) issued after NHS England took responsibility for commissioning prison healthcare and local authorities for commissioning public health services for offenders under community supervision, in both cases including treatment of substance use problems. For related discussion click and scroll down to highlighted heading.

G Scotland aims to divert problem-substance using offenders into treatment and treat those not diverted (Scottish Government, 2018). Government strategy for treating substance use problems, including in chapter 7 among offenders. Emphasis is on “Diverting those with problematic alcohol and drug use away from the justice system and into treatment, support, and other interventions that reduce harm and preserve life”, and delivering “Healthcare services in prison, including alcohol and drug services … of equal quality to those delivered in a community setting.”

G Scotland advocates “whole family” coordination of services to protect children of problem substance users (Scottish Government, 2013). Guidance specific to substance use intended for all child and adult services, including drug and alcohol services. Sees treatment of the parent’s substance use as one element of a “whole family” strategy responding to the wider family’s needs, with elements such as supporting the children and enhancing parenting and resilience. Challenges substance use services to play their part (Getting our Priorities Right is the title) in prioritising child welfare. English guidance above. For related discussion click and scroll down to highlighted heading.

G Protocol for joint working between English substance use and children/family services ([English] National Treatment Agency for Substance Misuse, 2011). Intended to help local areas develop agreements to strengthen the relationship between these services to safeguard the children of substance-using parents. Includes identification of at-risk children, assessment and referral, sharing information, and staff competencies and training. For discussion click and scroll down to highlighted heading.

G A model system for responding to problem-drinking prisoners (World Health Organization, 2012). Based on UK experience, offers an integrated model of best practice care for problem-drinking prisoners from screening to identify them through brief intervention and more intensive treatment, adjustable depending on need and feasibility.

G Working together to prevent domestic violence and abuse ([UK] National Institute for Health and Care Excellence, 2016). Planning, commissioning and delivering multi-agency services for domestic violence and abuse. Advocates an “integrated commissioning strategy”. Includes but not specific to substance use. 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 on how commissioners and service managers can meet the needs of adults in families affected by substance use. Brings together Adfam’s 30+ years of experience in family support. For related discussion click and scroll down to highlighted heading.

G Lessons from drink-related domestic homicides (2016). Messages for UK alcohol treatment services and their commissioners on preventing change-resistant drinkers from perpetrating domestic violence, abuse, and homicide, investigations of which informed the guidance. For discussion click and scroll down to highlighted heading.

more Retrieve all relevant Effectiveness Bank analyses or search more specifically at the subject search page. See also hot topics on protecting children, commissioning substance use services, and on whether testing for and sanctioning substance use can displace treatment.

Matrix Bite Open Matrix Bite guide to this cell Open Matrix Bite guide and commentary