Estimating a treatment effect on recidivism for correctional multiple component treatment for people in prison with an alcohol use disorder in England

Abstract

Background There is an emerging literature on the impact of correctional substance abuse treatment (SAT) on reoffending for people in prison with substance misuse issues. This study estimates a pathway effect for people in prison receiving multiple component treatments for an alcohol use disorder (AUD) to reduce reoffending by applying treatment effect estimation techniques for observational studies. Treatment groups comprised pharmacological treatments, psychosocial interventions (PSIs) and interventions that incorporate Risk Need Responsivity (RNR) programming. RNR compliant treatment matches treatment dose to the risk of reoffending, targets criminogenic need and is tailored to a person’s learning style. Methods Multiple treatment effect estimators are provided for people in prison diagnosed with an AUD in England when compared to a derived control group for: Pharmacological treatment only; RNR compliant treatment and PSIs. Results The outcomes for RNR compliant treatment suggest a lower recidivism rate compared to the control group. Pharmacological only treatment results in a statistically significant higher level of reoffending relative to the control group. Conclusions The creation of a universal system of ‘equivalence of care’ framed within a public health context in English correctional SAT may have had an unintended consequence of diluting approaches that reduce recidivism. There is an opportunity to develop an integrated, cross-disciplinary model for correctional SAT that unites public health and RNR compliant approaches.