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Results show that interventions in the prison setting have the potential to positively impact on alcohol use; however, because of small numbers and the use of different outcome measures we could not conduct a meta-analysis or generalise findings. Future studies are needed to standardise approaches to ensure greater rigour and efficacy.
IntroductionIn the UK, a significant proportion of male remand prisoners have alcohol problems. Alcohol Brief Interventions (ABIs) are an effective component of a population-level approach to harmful and hazardous drinking. ABIs have been shown to reduce the aggregate level of alcohol consumed and therefore reduce harm to the individual and to others. However, in relation to remand prisoners, there is no evidence as to how effective ABIs could be. The aims of this study are therefore to explore the feasibility and acceptability of an ABI for adult male remand prisoners and to develop an ABI for this group to be piloted in a future trial.Methods and analysisThe study will comprise three stages. Stage 1: a cross-sectional survey of adult male remand and convicted prisoners (n=500) at one Scottish prison and one English prison will be undertaken to assess acceptability and feasibility of delivering an ABI, as well as prevalence rates of harmful, hazardous and dependent drinking. Stage 2: in-depth interviews will be conducted with a sample of remand prisoners (n=24) who undertook the survey (n=12 in Scotland; n=12 in England). Two focus groups (one in Scotland and one in England) with six to eight key stakeholders associated with alcohol-related healthcare provision in prisons will be conducted to explore views on barriers, facilitators and levers to ABI delivery. Stage 3: through formal intervention mapping, the analysed data will inform the refinement of an acceptable ABI that is feasible to deliver to male remand prisoners.Ethics and disseminationThe project has been approved by the National Research Ethics Committee (NRES), National Offender Management System, Health Board Research and Development, Scottish Prison Service and ethics committee at The University of Edinburgh. Results will be published in peer-reviewed journals and presented at local, national and international conferences.
Background: Addressing alcohol harm in prisons can potentially reduce the risk of re-offending, and costs to society, whilst tackling health inequalities. Health savings of £4.3 m and crime savings of £100 m per year can be a result of appropriate alcohol interventions. Prison therefore offers an opportunity for the identification, response and/or referral to treatment for those male remand prisoners who are consuming alcohol above recommended levels. There is however, limited evidence for the effectiveness, optimum timing of delivery, recommended length, content, implementation and economic benefit of Alcohol Brief Interventions (ABI) in the prison setting for male remand prisoners. As part of the PRISM-A study, we aimed to explore the 'elements' of an acceptable ABI for delivery, experiences of engagement with services/health professionals about alcohol use, alongside barriers and facilitators to implementation within the prison setting for male remand prisoners. Materials and methods: Twenty-four in-depth interviews were conducted with adult male remand prisoners at one Scottish prison (n = 12) and one English prison (n = 12). A focus group at each of the prison sites was held with key stakeholders (e.g. prison nurses, prison officers, voluntary alcohol/addiction services, health service managers and commissioners). Thematic analysis techniques utilizing NViVo 10 were employed. Results: A thematic content analysis of the interviews consistently highlighted that the majority of prisoners reflected about the connection between alcohol consumption and criminal offending, particularly in relation to offenses involving physical assaults. They also expressed motivation to change their alcohol consumption. Both prisoner interviews and focus groups with stakeholders (N = 2), indicated the value of continuous follow-up support outside of the prison system and also the need to address the lack of stable social environments, which is often associated with alcohol and drug consumption. Stakeholders further identified organizational barriers to the delivery of ABI, such as limited funding and manageable workloads. Conclusions: The importance of interpersonal trust indicated that intervention delivery by external organizations and nurses were favored in comparison to intervention delivery by prison staff and peer-prisoners. A2 Does perceived risk of harm mediate the effects of a primary care alcohol screening and brief advice intervention for adolescents?
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