Assessment of alcohol problems using AUDIT in a prison setting: more than an 'aye or no' question

<br>Background: Alcohol problems are a major UK and international public health issue. The prevalence of alcohol problems is markedly higher among prisoners than the general population. However, studies suggest alcohol problems among prisoners are under-detected, under-recorded and under-treated. Identifying offenders with alcohol problems is fundamental to providing high quality healthcare. This paper reports use of the AUDIT screening tool to assess alcohol problems among prisoners.</br> <br>Methods: Universal screening was undertaken over ten weeks with all entrants to one male Scottish prison using the AUDIT standardised screening tool and supplementary contextual questions. The questionnaire was administered by trained prison officers during routine admission procedures. Overall 259 anonymised completed questionnaires were analysed.</br> <br>Results: AUDIT scores showed a high prevalence of alcohol problems with 73% of prisoner scores indicating an alcohol use disorder (8+), including 36% having scores indicating ‘possible dependence’ (20-40). AUDIT scores indicating ‘possible dependence’ were most apparent among 18-24 and 40-64 year-olds (40% and 56% respectively). However, individual questions showed important differences, with younger drinkers less likely to demonstrate habitual and addictive behaviours than the older age group. Disparity between high levels of harmful/hazardous/dependent drinking and low levels of ‘treatment’ emerged (only 27% of prisoners with scores indicating ‘possible dependence’ reported being ‘in treatment’). Self-reported associations between drinking alcohol and the index crime were identified among two-fifths of respondents, rising to half of those reporting violent crimes.</br> <br>Conclusions: To our knowledge, this is the first study to identify differing behaviours and needs among prisoners with high AUDIT score ranges, through additional analysis of individual questions. The study has identified high prevalence of alcohol use, varied problem behaviours, and links across drinking, crime and recidivism, supporting the argument for more extensive provision of alcohol-focused interventions in prisons. These should be carefully targeted based on initial screening and assessment, responsive, and include care pathways linking prisoners to community services. Finally, findings confirm the value and feasibility of routine use of the AUDIT screening tool in prison settings, to considerably enhance practice in the detection and understanding of alcohol problems, improving on current more limited questioning (e.g. ‘yes or no’ questions).</br&gt

Women and community sentences

Despite the increasing numbers of women given community sentences in the UK and in other jurisdictions in recent years, there has been relatively little research into women’s experiences of these disposals. This is particularly surprising given what is known about the distinctive characteristics of women in conflict with the law and the gendered nature of pathways to crime. This article draws upon the experiences of women made subject to a range of community sentences to identify recurring themes including the complexity of women’s problems, the significance of stigma, trauma and abuse, the importance to women of their supervisory relationships, the relevance of self-efficacy and the nature of barriers to compliance. The article considers the consequences of the discourses of ‘penality’ when underpinned by ideological assumptions and expectations based on gender relations. The implications for the supervision of women in the community are considered, while acknowledging that community sanctions are unlikely in themselves to be capable of addressing broader issues that bring women into and retain them in the criminal justice system

Probation, credibility and justice

This paper explores the difficulties that arise for probation agencies or those that deliver community sanctions in developing and maintaining their credibility in prevailing ‘late-modern’ social conditions. It begins by questioning the limits of the pursuit and promise of ‘public protection’ as a source of credibility, and then proceeds to examine the emergence of an alternative strategy – based principally on reparation and ‘payback’ – in Scotland, arguing that these Scottish developments have much to say to the emerging debates in England and Wales (and elsewhere) about the ‘rehabilitation revolution’ and the proper use of imprisonment. The paper provides a critical account of the development and meaning of the Scottish version of ‘payback’, linking it to some important philosophical and empirical studies that may help to steer the development of payback away from a ‘merely punitive’ drift. In the conclusion, I argue that probation agencies and services need to engage much more deeply and urgently with their roles as justice services, rather than as ‘mere’ crime reduction agencies

'Holistic' Community Punishment and Criminal Justice Interventions for Women

Calls for ‘holistic' responses to halt the increasing imprisonment of women are continually reiterated. Solutions are sought which aim to be both ‘gender-responsive' and ‘community-based'; however, the absence of meaningful definitions of ‘community' and ‘holistic' means that superficial responses are often put in place in response to failures of the system. Taking as an example one attempt to introduce a community-based service for women in Scotland, this article examines the challenges of implementing services that are located within ‘the community' and considers the consequences for feasible attempts to reduce the number of women in prison in Scotland and internationally

Four forms of 'offender' rehabilitation: Towards an interdisciplinary perspective

This paper aims to advance the case for a more fully interdisciplinary understanding of offender rehabilitation, partly as a means of shedding light upon and moving beyond contemporary ‘paradigm conflicts’. It begins with a review of current arguments about what a credible ‘offender’ rehabilitation theory requires and by exploring some aspects of current debates about different theories. It goes on to locate this specific kind of contemporary theory building in the context of historical arguments about and critiques of rehabilitation as a concept and in practice. In the third part of the paper, I explore the nature of the relationship between desistance theories and rehabilitation theories, so as to develop my concluding argument; that is, that debates about psychological rehabilitation have been hampered by a failure to engage fully with debates about at least three other forms of rehabilitation (legal, moral, and social) that emerge as being equally important in the process of desistance fr

HIV and incarceration: prisons and detention

The high prevalence of HIV infection among prisoners and pre-trial detainees, combined with overcrowding and sub-standard living conditions sometimes amounting to inhuman or degrading treatment in violation of international law, make prisons and other detention centres a high risk environment for the transmission of HIV. Ultimately, this contributes to HIV epidemics in the communities to which prisoners return upon their release

Routes out of prison using life coaches to assist resettlement

Scotland is undertaking one of its biggest penal reforms in a generation and is seeking a fundamental change to its approach to punishment, which is characterised by the use of very short prison sentences. This article discusses some findings from phase one of an ongoing evaluation study of Routes out of Prison (RooP) which uses Life Coaches, many of whom are themselves former prisoners, to support the transition and resettlement of large numbers of short-term prisoners back to the community. The article examines the way in which these Life Coaches were recruited and managed, how they were viewed by their clients, and the added value that peer or mentor support can offer