Brief interventions for alcohol misuse in the Criminal Justice System
One response to the prevalence of alcohol related problems in the Criminal Justice System (CJS) is the use of ‘brief interventions’. These provide an opportunity for non-specialists working in the system to deliver advice or counselling, with potentially wide-reaching effects for individuals displaying, or vulnerable to, problematic alcohol use.
This summary describes the findings of a recent review of the efficacy of brief interventions in the CJS (Newbury-Birch et al., 2016).
What is it?
The governance of alcohol consumption presents numerous challenges for the Criminal Justice System (CJS). Some 40% of all violent crimes in the UK were estimated to have involved alcohol in 2017, and alcohol has been linked to increased incidences of street violence, domestic violence, violence against the police, and sexual violence (Flatley, 2015 and 2018). Given the link between alcohol consumption and crime, it is not surprising that between 64% and 84% of people in the CJS have patterns of problematic drinking (Newbury-Birch et al., 2016). This includes people at all stages of the CJS, including those in police custody, magistrate’s court, probation and the prison system (Newbury-Birch et al., 2016).
Brief interventions have two components: firstly there must be identification of a problem or potential problem, if identification has not already occurred. In addition the intervention aims to encourage or help an individual to address this problem. The widespread use of brief interventions in the UK began in primary health care settings for those requiring treatment who were presenting problems with alcohol, whether or not this was directly related to the required treatment.
A brief intervention generally follows formal identification of a problem. The intervention itself can include an array of activities, including the provision of advice, counselling, and referral to a specialist. The intervention might be a single session or a series of short sessions. There are different definitions of what constitutes a ‘brief’ intervention, but Newbury-Birch et al. (2016) considered all interventions that were five or fewer sessions lasting between 5 and 40 minutes, or, were under three hours in total.
Should it work?
The idea behind the approach is that a relatively informal, albeit professional, intervention early in an individual’s drinking career, can raise awareness of the longer-term risks associated with heavy alcohol consumption. This should, in theory, help to prevent escalation of drinking to harmful levels, or reduce levels of harmful drinking if it is already occurring. Two strengths of brief interventions are that delivery of the intervention does not have to be done by an ‘expert’, and that this allows interventions to be delivered in a more informal and spontaneous manner.
Does it work?
The review looked at the impact of brief interventions at the various stages of the CJS, including custody, courts, probation and prison. The review found ‘very little evidence of either efficacy or effectiveness studies of alcohol brief interventions in the criminal justice system in the UK’ (Newbury-Birch et al. 2016: 66). The authors did note some inconclusive studies in the US that suggested that brief interventions might work for some people in some prison contexts. The review does not rule out the possibility of effectiveness, and calls for more research and better evidence.
How strong is the evidence?
The review used well-designed and transparent methodologies. The review considered only studies that used comparison groups. Research design and replicability were assessed using the Cochrane risk of bias tool. Some of the studies had a high risk of bias. Overall, the review concluded that more robust evidence is needed in relation to all stages in the CJS.
Is it worth it?
The review did not address the financial costs or benefits of using brief interventions in the CJS.
Can it be implemented?
Brief interventions can be delivered informally and by a non-specialist. This suggests that implementation should be relatively straightforward. The review described here did not consider implementation or potential barriers to effective implementation.
What's missing from the evidence?
The review found that brief interventions were increasingly popular in prisons, despite the limited evidence of their effectiveness. The authors note that there is not yet sufficient evidence to prove that such interventions do not cause harm. There is also a lack of evidence on the implementation of brief interventions in the CJS.
The authors conclude their review by calling for more research that is methodologically robust and that investigates, not just how effective brief interventions are in the CJS, but for whom they are most effective, and in what contexts.