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Working with Alcohol Misusing Offenders –

a strategy for delivery


Contents

Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1. Why have a strategy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.2 Alcohol and crime . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.3 Aims and objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2. Key elements of the strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
2.1 Targeting, screening, referral and assessment . . . . . . . . . . . . . . . . . . . . . . 6
2.2 Brief interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2.3 Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2.3.1 Probation and the ‘Models of Care’ approach . . . . . . . . . . . . . . . . . 8
2.3.2 Offending Behaviour Programmes . . . . . . . . . . . . . . . . . . . . . . . . . . 10
2.3.3 A new focus on resettlement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
2.4 Addressing diversity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
2.5 Inter-agency working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
2.6 Training and development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2.7 Performance monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Glossary of terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Contact for enquiries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Working with Alcohol Misusing Offenders – a strategy for delivery 3

Foreword The Strategy will give the Probation Service a


coherent approach to tackling alcohol misuse which
is evidence-based. It contains a number of actions
The National Probation
for the centre and recommendations for areas to
Service (NPS) has a long
improve provision. In developing the strategy, we
history of working with
have worked closely with colleagues in the
problem alcohol misusers,
Community Integration Unit (CIU) and Drug
although in recent years the
Strategy Unit (DSU) 2 of the National Offender
Service has concentrated on
Management Service (NOMS) and the National
drug misuse in line with
Treatment Agency for Substance Misuse (NTA),
Government priorities.
as well as other key stakeholders e.g. Alcohol
Concern.
More recently, the
Government has focused
The emphasis will be on consolidating the work
more closely on alcohol misuse as a factor in
already being done across the service and building
offending behaviour and as a community health
on best practice within available resources. The
issue. It has made it a priority to tackle two major
strategy aims to improve our ability to get best
problems associated with alcohol misuse: crime and
value from what we presently deliver, essential if
anti-social behaviour in town and city centres; and
further resources are to be secured.
harm to health as a result of binge and chronic
drinking 1.

NPS has an important part to play in tackling


alcohol misuse within its wider role of protecting
the public and preventing further offending by
rehabilitating offenders. A great deal of good work Roger Hill
is already being done. This strategy aims to develop Director of Probation
more consistent and co-ordinated delivery. May 2006

1 Prime Minister’s Strategy Unit (2004) Alcohol Harm Reduction Strategy for England, London, PMSU.
2 Formerly HM Prison Service Drug Strategy Unit.
4 Working with Alcohol Misusing Offenders – a strategy for delivery

Why have a strategy? • Complement the Five Year Strategy for


Protecting the Public and Reducing Re-
offending 5, the NOMS drugs strategy and the
1.1 Introduction
programme of resettlement activity set out in
The National Reducing Re-offending Delivery
Alcohol is enjoyed by many without causing
Plan 6.
problems and has significant economic benefits. Yet
alcohol can also affect people’s behaviour so that
• Complement Models of Care for Alcohol
they act in a criminal or anti-social way. They may
Misusers (MoCAM) 7 and related work under
under-perform at work or have difficulties gaining
the Department of Health’s (DH) Programme of
employment; they can run into debt; their social
Improvement for Alcohol Misuse 8.
and family relationships can deteriorate; and they
may suffer health problems 3.
• Be consistent with the developing role of the
Regional Offender Managers (ROMs) in
This Strategy aims to:
commissioning on a regional basis.
• Establish a consistent approach to tackling
Wales does not have either a drug or an alcohol
alcohol-related offending across the Probation
strategy and has for the last ten years been working
Service based upon evidence of best practice.
to a combined substance misuse agenda. The
National Assembly for Wales produces its own
• Complement the Alcohol Harm Reduction
specific documents in respect of guidance for the
Strategy for England and the Prison Service
commissioning, managing and performance
Alcohol Strategy 4 to make a coherent NOMS
monitoring of substance misuse. Parts of this
strategy.
strategy will not be transferable to Wales, although
the underlying principles will apply.

3 Prime Minister’s Strategy Unit (2003) Interim Analytical Report.


4 HM Prison Service (2004) Addressing Alcohol Misuse – A Prison Service Alcohol Strategy for Prisoners, London, HMPS. See also the accompanying
Alcohol Treatment/Interventions Good Practice Guide and Alcohol Testing for Prisoners Manual of Policy and Procedures.
5 The Five Year Strategy, published in February 2006, set out the direction for NOMS and its partners, including the National Probation Service.
It includes a commitment to “give offenders better access to alcohol interventions, especially where their offending is linked to alcohol”.
6 NOMS published the National Reducing Re-offending Delivery Plan (NRRDP) on 22 November 2005. It reviewed the achievements made on the
reducing re-offending pathways contained in the Reducing Re-offending National Action Plan, including drugs and alcohol, and mapped the way
forward, setting out targets and commitments for the next eighteen months. The National Probation Service committed to producing an Alcohol
Delivery Strategy.
7 MoCAM will provide “an optimum local framework for the commissioning and provision of interventions and treatment for adult alcohol misusers
in England”.
8 The Programme of Improvement is a commitment from the Alcohol Harm Reduction Strategy and the Choosing Health White Paper, both published in
2004. Along with MoCAM, supportive publications included in the Programme of Improvement are the Alcohol Needs Assessment Research Project
(ANARP), Review of the Effectiveness of Treatment for Alcohol Problems and Alcohol Misuse Interventions – Guidance on developing a local
programme of improvement.
Working with Alcohol Misusing Offenders – a strategy for delivery 5

1.2 Alcohol and crime a ‘feature’ in almost two-thirds (62%). Furthermore,


almost half (48%) of these convicted domestic
Alcohol misuse contributes significantly to crime 9. violence offenders were alcohol dependent.
Alcohol features specifically in some offences, such
as drink-driving. Alcohol can also act as a 1.3 Aims and objectives
disinhibitor or be used as an excuse, or result in
crime because the individual has a drinking The overarching aim of the Strategy is to reduce
problem. It features prominently in violent offences, re-offending and alcohol-related harm and protect
including domestic violence 10, and is often the public by meeting the following objectives:
associated with anti-social behaviour. Research also
shows that those who frequently drink to excess are • To identify alcohol misuse and offending needs
more likely to offend than those who don’t 11. at an early stage of contact with the NPS and
refer offenders to appropriate interventions.
It is no surprise that many offenders under
probation supervision have alcohol problems linked • To ensure that staff are fully competent to
to their offending behaviour. The OASys Data deliver brief advice and support to alcohol
Evaluation & Analysis Team (O-DEAT) carried out an misusing offenders under their supervision.
analysis of data drawn from over 120,000 Offender
Assessment System (OASys) assessments 12 in 41 • To improve the advice and information
probation areas between 1 April 2004 and 31 provided to offenders about the risks of
March 2005. This found that over one-third (37%) alcohol misuse and about help that is
of offenders had a current problem with alcohol use available locally.
and a similar proportion (37%) with binge drinking.
Nearly half (47%) had misused alcohol in the past. • To develop and promote the delivery of
32% had violent behaviour related to their alcohol evidence-based interventions to meet the
use. 38% were found to have a criminogenic need needs of the full range of alcohol-misusing
relating to alcohol misuse, potentially linked to their offenders.
risk of reconviction 13.
• To increase the consistency of what is
Research 14 has found that alcohol had been delivered across the NPS based upon
consumed prior to the offence in nearly three- evidence of best practice.
quarters (73%) of domestic violence cases and was

9 The overall annual cost of crime and anti-social behaviour linked to alcohol misuse is calculated to be £7.3bn – Prime Minister’s Strategy Unit (2003)
Interim Analytical Report.
10 1.2m violent incidents (around a half of all violent crimes) and 360, 000 incidents of domestic violence (around a third) are linked to alcohol misuse –
Prime Minister’s Strategy Unit (2003) Interim Analytical Report.
11 Matthews, S. & Richardson, A. (2005) Findings from the 2003 Offending, Crime and Justice Survey: alcohol-related crime and disorder. Findings 261.
London: Home Office.
12 OASys is the offender assessment tool used by NOMS. Alcohol misuse is one factor used in the assessment.
13 Section 9 of OASys asks 5 questions related to alcohol misuse. Each question is scored between 0 (no problems), 1 (some problems) and 2 (significant
problems) and the scores added together to produce an overall section score ranging from 0 to 10. Scores of 4 or more indicate a criminogenic need
relating to alcohol misuse.
14 Gilchrist, E., Johnson, R., Takriti, R., Weston, S., Beech, A. & Kebbell, M. (2003) Domestic violence offenders: characteristics and offending related
needs. Findings 217. London: Home Office.
6 Working with Alcohol Misusing Offenders – a strategy for delivery

2. Key elements of • Appropriate targeting criteria linked to local


service provision and programme availability.
the strategy
• Clear and consistent brief interventions for
2.1 Targeting, screening, referral misusers at an early stage in their contact
and assessment with probation and referral for further
assessment, where applicable.
Problem drinking can broadly be broken down
into three categories: hazardous, harmful and • Those assessed as requiring some form of
dependent (including moderately and severely intensive treatment to be referred without
dependent) drinkers 15, which evidence suggests are delay into the most appropriate available
likely to require very different types of intervention. treatment.
Hazardous and harmful drinkers, whose criminal
activity is often directly alcohol-related (drink drivers, OASys covers alcohol problems in relation to risk
violent offences whilst intoxicated), are more likely of re-conviction, risk of harm and as a possible
to respond to low-level advice, information and criminogenic factor that may need to be addressed
support, often delivered by non-specialists e.g. if offending behaviour is to be reduced. Once
probation staff. Those with a habitual alcohol alcohol misuse has been identified as an issue by
dependency are likely to need specialised and OASys, however, the offender should be screened
intensive care-planned alcohol treatment. using a specific alcohol screening tool 16 to assess
the health aspects of alcohol misuse.
Accurate and early identification of those with
established alcohol problems and their referral into Brief interventions should be provided immediately
appropriate treatment is one of the main aims of following the screening and those with moderate
the Harm Reduction Strategy. In addition to OASys, to severe alcohol problems referred for a more
there is a need for: comprehensive alcohol assessment undertaken by
specialist staff, in line with the three levels of
• Specific alcohol screening and/or assessment screening and assessment set out in MoCAM.
which accurately identifies the nature and MoCAM also recommends the development of local
extent of alcohol misuse by offenders, systems of screening and assessment involving the
whether or not it is directly related to use of standardised procedures and tools,
their offending. development of clear referral criteria and adequate

15 The World Health Organisation’s tenth revision of the International classification of diseases (ICD-10) defines:
Hazardous use of a psychoactive substance, such as alcohol, as an “occasional, repeated or persistent pattern of use…which carries with it a high risk
of causing future damage to the medical or mental health of the user but which has not yet resulted in significant medical or psychological ill effects”;
and
harmful use of a psychoactive substance, such as alcohol, as “a pattern of use which is already causing damage to health. The damage may be
physical or mental”.
MoCAM states that dependence is characterised by “psychological dependence” with an increased drive to use alcohol, difficulty controlling its use,
despite the consequences, and in more severe cases physical withdrawals upon cessation of use.
16 Examples include the Alcohol Use Disorders Identification Test (AUDIT), Fast Alcohol Screening Test (FAST), Paddington Alcohol Test (PAT), Michigan
Alcoholism Screening Test (MAST), Five-shot questionnaire, Alcohol Related Aggression Questionnaire (ARAQ), Short Alcohol Dependence Data
(SADD), The Rapid Alcohol Problems Screen (RAPS), CAGE, TWEAK and T-ACE.
Working with Alcohol Misusing Offenders – a strategy for delivery 7

sharing of information between agencies, e.g. of its effectiveness in the probation context. There
prisons, probation and the voluntary sector. is no reason, though, to presume that the effective
use of brief interventions 18 successfully deployed
NPD will: in other settings cannot be replicated across the
probation service, when delivered by fully trained
• Support areas in implementing the and competent probation or other staff (see
recommendations in MoCAM relating section 2.6).
to screening and assessment.
Information should address the physical, social and
Areas should: psychological harms of alcohol; cover health
promotion and harm minimisation and ‘triggers’
• Ensure that when alcohol misuse has been for drinking; and should be realistic and believable.
identified as an issue through OASys the It should be targeted primarily at those offenders
offender should always undergo screening identified through OASys and/or alcohol screening
and, where relevant, further assessment using as hazardous or harmful drinkers, rather than
any locally agreed tools. delivered to every offender or only made available
in offices through displays or leaflets. The need for
• Ensure that anybody undertaking an initial greater consistency of delivery needs to be
screening is able to determine if alcohol is an balanced, however, against differences in local
issue, provide an immediate and appropriate service provision and the flexibility required to
response and identify those individuals who meet individual needs.
need onward referral.
NPD will:
• Work with their drug (and alcohol) action
teams (D(A)ATs) to develop local systems of • Identify and inform areas of the material
screening and assessment. that is currently being used and determine
what needs to be developed to fill any
2.2 Brief interventions gaps in provision.

Information, brief advice and support for Areas should:


behavioural change may, if targeted appropriately,
help to encourage responsible drinking and reduce • Provide appropriate information, advice and
risks to health 17. It may also help to reduce support to all those offenders at risk of
offending related to alcohol misuse. However, only developing serious alcohol problems and
around half of areas currently offer any preventative identified by the screening process as
information and there is generally a lack of evidence hazardous or harmful drinkers.

17 Heather, N., Raistrick, D., & Godfrey, C. (2006) Review of the Effectiveness of Treatment for Alcohol Problems, to be published later in 2006.
18 Brief interventions are carried out in community settings and are delivered by non-specialist personnel. There are two main kinds of brief interventions.
Brief advice or simple brief intervention is usually provided by a competent practitioner in about five minutes, immediately following a screening
assessment or in another “teachable” moment. Brief support for behavioural change or extended brief interventions typically takes 20-30 minutes to
deliver and can involve a small number of repeat sessions.
8 Working with Alcohol Misusing Offenders – a strategy for delivery

• Link with local crime and disorder reduction pattern and context of a person’s drinking although
partnerships (CDRPs), primary care trusts some misusers may never be able to achieve control
(PCTs) and D(A)ATs to develop a community- over their drinking and will therefore need to
wide approach that fits within current abstain from alcohol completely.
partnerships e.g. parallel work with prolific
and other priority offenders (PPOs), and MoCAM sets out a four-tier treatment framework
Supporting People. from low level interventions, often provided by
generalists, to intensive specialist treatment. Local
• Ensure that all staff know how to make a commissioners should work towards ensuring that
referral directly to an alcohol service, alcohol misusers have access to a full range of
where appropriate. interventions and treatment to meet their needs
and can move between them. MoCAM advocates
2.3 Treatment a ’Stepped Care’ model of treatment, where the
intensity of intervention is increased only as needed.
2.3.1 Probation and the ‘Models of Care’
approach Current provision across NPS, frequently delivered in
partnership with a range of voluntary and statutory
Treatment should be allocated according to agencies, broadly consists of:
individual need, subject to availability, and linked
to an offender’s motivation. OASys data indicates • Delivery of services in Tiers One and Two of
that over a quarter (27%) of offenders had MoCAM e.g. interventions comprising alcohol
problems with motivation to tackle their alcohol screening, advice and information and referral
misuse 19. Probation staff have a key role in building into mainstream specialist interventions in
and sustaining motivation. Tiers Two to Four 20 where appropriate. This
can include the use of mutual aid groups such
Alcohol dependence and other problem drinking as Alcoholics Anonymous (AA) 21.
behaviours are susceptible to change once the
misuser has acknowledged and understands that • Offending behaviour programmes (see 2.3.2).
there is a problem, though this is often very
difficult. • Resettlement/lifestyle assistance e.g.
education, training and employment (ETE),
A successful intervention is one that leads to a learning and skills and help with
reduction in alcohol-related problems not necessarily accommodation, which link in with the
the number of units of alcohol consumed. The pathways of the Government’s National
desired outcome may be achieved by changing the Reducing Re-offending Delivery Plan.

19 Taken from the same O-DEAT analysis as the figures referred to in the second paragraph of Section 1.2.
20 These range from low threshold easy to access services to structured services which are aimed at individuals with a high level of presenting need
including e.g. weekly counselling, structured day programmes, alcohol detoxification or stabilisation services and residential rehabilitation units.
21 Where no arrangements presently exist, areas should make contact with their local AA inter-group in order to develop a process for referring
offenders. The AA Conference has recently approved the Thames Valley Probation/AA Liaison Model, which allows for referrals to be picked up 24/7,
as the model of best practice. This model is now being adopted by other probation areas e.g. Derbyshire, Wiltshire.
Working with Alcohol Misusing Offenders – a strategy for delivery 9

Probation areas will provide or broker the NPD will:


provision of:
• Review guidance on the implementation of
• Motivational work. the alcohol treatment requirement (ATR) of
the community order in light of MoCAM and
• Screening, brief advice and information and the Review of the Effectiveness of Treatment
referral for further assessment/to specialist for Alcohol Problems.
interventions.
• Use the relevant NOMS Sub-Boards on
• Accredited programmes, where appropriate. reducing re-offending to ensure that partners
are aware of any issues concerning the
• Relapse prevention. availability, quality and quantity of treatment
for offenders in the community.
Careful consideration, within the sentence planning
process, needs to be given to the sequencing of • Work with NOMS CIU and other key partners
interventions 22. This is particularly important for to support the commissioning process at PCT,
those leaving prison to ensure that there is the right D(A)AT/CDRP, regional and area level.
kind of follow up to interventions begun in custody
and that progress made is maintained upon release, Areas should:
(although in prisons, as in the community, alcohol
services have not developed as comprehensively as • Work with their D(A)ATs and PCTs to ensure a
for illicit drugs). This is likely to require close links comprehensive assessment of local need is
with CARAT teams and the Drug Interventions available and the D(A)ATs/PCTs commission
Programme (DIP) for those with polysubstance services to meet these needs.
misuse (including alcohol) problems. Also, offender
managers should ensure that all alcohol • Provide information on the extent of alcohol-
interventions, whether delivered directly or brokered related offending in their area and bring it to
from other providers, should routinely be followed the attention of CDRPs
up to determine whether or not they have been
effective and if further intervention will be needed. • Consider the use of additional licence
conditions 23 e.g. to address alcohol

22 A cohort study (ITTSI – Investigating the Targeting, Tailoring and Sequencing of Interventions) is currently underway with offenders on community orders
which will include data on the level and frequency of drinking, severity of dependence, perceptions of treatment needs, contact with alcohol services
and how these are sequenced in relation to other interventions. Another study (SPCR – Surveying Prisoner Crime Reduction) is examining similar issues
with offenders in prison.
23 PC 28/2004 – Criminal Justice and Court Services Act 2000: Drug testing as a licence condition and further guidance on licence procedures for short
term offenders refers.
10 Working with Alcohol Misusing Offenders – a strategy for delivery

problems, where appropriate, to support Regional Offender Managers (ROMs) are developing
post-custody interventions building upon regional strategies which respond to the profiled
what is delivered in prison. needs of their regions. ROMs will have service level
agreements (SLAs) in place with the prisons and
2.3.2 Offending Behaviour Programmes probation areas which make up their regions.
These SLAs will include performance management
The Probation Service has available a suite of and delivery of interventions and will set out the
accredited programmes aimed at addressing contribution to be made to regional reducing
offending behaviour. A gap in existing provision has re-offending strategies.
been identified in relation to those whose alcohol
misuse needs are not sufficient to lead to a referral Joined-up delivery is critical at regional and local
to the existing substance misuse programmes 24. level and requires effective partnership working.
This includes those on other programmes, such as To support this work, a strategic partnership board
violence and domestic violence, assessed as having will be commissioned in every region with
alcohol misuse needs and those whose Offender appropriate representation from NOMS and its
Group Reconviction Scale (OGRS) score is too low partners. Reducing re-offending is included within
for accredited programmes generally. A further guidance on local area agreements (LAAs), and local
programme 25, the Lower Intensity Alcohol Module strategic partnerships (LSPs) are encouraged
(LIAM), is about to be piloted to meet this gap. to consider this to ensure successful rehabilitation
of offenders is achieved within local communities.
NPD will: It is important, therefore, that we ensure that the
need for effective alcohol services is on the agenda
• Continue to develop and implement LIAM. at local, regional and national level.

2.3.3 A new focus on resettlement The development of the Offender Management


Model 27 provides for one offender manager to plan
Social factors such as accommodation, education and manage interventions for offenders throughout
and employment are significantly associated with their sentence whether or not they are in custody or
re-offending 26 and need to be addressed in the community. This should provide, among other
conjunction with alcohol misuse for effective things, for treatment/intervention needs to be
outcomes. This is reflected in the National identified while the offender is in custody and for
Reducing Re-offending Delivery Plan and regional treatment undertaken in prison to be built on upon
resettlement strategies. release into the community. All offenders should be

24 Addressing Substance Related Offending (ASRO), Offender Substance Abuse Programme (OSAP) and Programme for Reducing Individual Substance
Misuse (PRISM).
25 See PC 70/2005 – Substance Misuse Modules for more information.
26 Social Exclusion Unit (2002) Reducing re-offending by ex-prisoners, London, ODPM. Available online at:
http://www.socialexclusion.gov.uk/page.asp?id=263
27 The Offender Management Model is being piloted in the North West. It is the case management framework, which is evidence-based, and
designed to ensure better screening and assessment, co-ordination, targeting, brief interventions and brokering into treatment and offending
behaviour programmes.
Working with Alcohol Misusing Offenders – a strategy for delivery 11

allocated an offender manager who has overall • Where relevant, be involved in joint care plan
responsibility for developing and reviewing the reviews to have input into issues such as
sentence plan during the offender’s journey through whether or not the offender needs aftercare,
the correctional system. AA or any other treatment.

There are significant gaps in current provision such 2.4 Addressing diversity
as the availability of services during evenings and
weekends when offenders are most vulnerable and Many of the same groups that are under-
at risk, and how best to continue motivational work represented in drug treatment also have difficulty
with individuals completing programmes. Mutual in accessing alcohol services. For example, the social
aid and self help groups such as AA can provide stigma attached to women’s alcohol misuse may act
a useful resource here 28. as a barrier to the referral of women to treatment 29
and many people from ethnic minorities feel
NPD will: disinclined to approach alcohol services, which are
perceived to be unreceptive to their needs 30. There
• Work with the relevant NOMS Sub-Board are often additional problems such as language,
to maximise the accessibility and availability of childcare, and strong ties to lifestyle and social
alcohol services for offenders. networks revolving around drinking. While
overcoming such barriers can be resource intensive,
• Support the ROMs in their role of Probation Areas have experience which can be
implementing the regional reducing brought to bear widening access to services 31.
re-offending strategies.
Many alcohol misusers have multiple needs.
Areas should: Alcohol misuse and mental ill-health are frequently
interlinked; around a quarter of drug misusers also
• Ensure sentence plans take into account misuse alcohol 32; and alcohol misuse is associated
alcohol interventions undertaken in custody as with problems such as homelessness. Alcohol can
part of end-to-end offender management. also have multiple impacts e.g. a woman offender
who is a mother, where there might be child
• Assess alcohol as a potential risk factor when protection concerns and who is a victim of domestic
preparing the risk of harm assessment and violence. Perpetrators of alcohol related domestic
risk management plan (where applicable). violence may also require co-ordinated interventions

28 AA is available nationally 24 hours a day, 7 days a week and offers a highly integrated model of ongoing support and care using the 12 step
approach. However, AA promotes abstinence which will not be appropriate for everyone.
29 Alcohol Concern (2001) Women and Alcohol Summary.
30 Purser, B. et al, (2001) Drinking in second and subsequent generation black and asian communities in the English midlands, Alcohol Concern.
31 For example, in the provision of child care for women offenders to be able to carry out community punishment (now called unpaid work).
32 Prime Minister’s Strategy Unit (2004) Alcohol Harm Reduction Strategy for England, London, PMSU.
12 Working with Alcohol Misusing Offenders – a strategy for delivery

addressing a range of problems. It is important, treating them separately. More effective partnership
therefore, that interventions tackle the full range of arrangements need to be established between
assessed needs. agencies, particularly the alcohol treatment sector
and mental health services 33. In addition, better
Many Areas monitor referrals and run specific training needs to be provided for those non-
schemes for hard-to-reach groups but there is specialists who might have to deal with offenders
limited evidence that such provision is working with other problems. It is the responsibility of local
successfully. Evidence that is available and helpful commissioners to develop integrated care pathways
includes monitoring and feedback from the (ICPs) for those with complex needs but protocols
providers and users, increased engagement of the could usefully be identified for how probation refers
targeted groups, and higher rates of completion into and liaises with health and treatment services.
of interventions.
NPD will:
Services must be appropriate and relevant to the
needs of diverse populations. For ethnic minorities, • Use information from OASys and secondary
these needs include providing services in the screening tools, such as AUDIT, to examine the
person’s first language, being sensitive to religious pattern of alcohol misuse and offending
responsibilities/traditions and cultures, and recruiting within specific groups and, where appropriate,
more ethnic minority workers into the treatment develop links with other agencies that share
sector. It does not follow that this means separate responsibility for these groups to improve
interventions. For women one solution might be the access to treatment for everyone.
greater use of female staff at key stages of
assessment and treatment delivery. NPD has • Work with ROMs to ensure that service
developed a Working with Women Offenders specifications for providers include positive
Policy and Strategy, which includes a section on actions to promote diversity e.g. services for
substance misuse, and has a number of practice women, ethnic minority offenders; that good
aims to improve equality of outcome of services practice expectations are reflected in SLAs
for women offenders. with providers of treatment; and that
information is available to evidence whether
More could be done to provide a holistic response treatment services’ outcomes are equitable.
to offenders with multiple needs, rather than

33 The Department of Health’s Dual diagnosis good practice guide (2002) identifies ideal approaches to the commissioning and provision of treatment
for those with substance misuse and severe mental illness. Mental health services should take the lead in instances where there is a diagnosis of
serious mental ill-health.
Working with Alcohol Misusing Offenders – a strategy for delivery 13

• Make those accredited offending behaviour • regular case conferences and inter-agency
programmes used in Wales available through meetings,
the medium of Welsh language.
• joint training.
Areas should:
Some areas have reported that basing specialist
• Ensure that staff have the knowledge and treatment staff in probation offices has proved very
skills to deal with cultural and educational effective in terms of the number of offenders seen
differences. and in fostering effective working relationships 34.

• Monitor the effectiveness of provision for LAAs can facilitate a more flexible response to
diverse groups and take the appropriate offender management at a local level. They also
corrective action, where needed. present an excellent opportunity for local partners
engaged in offender management to work closer
2.5 Inter-agency working together to achieve shared outcomes and reduce
costs. LAAs should therefore be used to consider
The majority of current alcohol provision is delivered ways in which different partners and partnerships
in partnership with voluntary and statutory involved in reducing offending and re-offending
agencies, which provide interventions ranging from can work better together.
specialist counselling to residential detoxification.
Alcohol is also often linked with a number of other Many solutions to crime, disorder and offending are
problems which may need to be treated by a rooted in issues like health, housing, education and
relevant specialist service. environmental design so there are huge benefits
from LSPs and those involved in reducing offending
In addition to local alcohol agencies, probation working closer together. Reducing re-offending has
areas engage with D(A)ATs, PCTs, CDRPs, police, now been accepted as a core indicator within LAAs.
prisons, agencies responsible for housing and Many of the second phase of LAAs have identified
employment and alcohol arrest referral schemes. alcohol issues which will be addressed at the
Establishing effective inter-agency arrangements local level.
is vital. This could involve;
NPD will:
• sharing information between agencies,
• Work closely with key partners such as
• an agreed referral process, Alcohol Concern, NTA, DH etc. to ensure
provision is consistently on the agenda.
• a clear lead agency on each case,

34 Typically, a treatment worker is attached to each probation office a different day of the week and time of day to undertake assessments, identify any
incidence of alcohol misuse, and assist the officer preparing the Pre-Sentence Report (PSR); work with probation after sentence on sentence planning
in relation to alcohol misuse; deliver alcohol programmes; and be available on a consultancy basis to probation staff to discuss particular cases.
Several quadrants in London Probation Area are employing Alcohol Liaison Workers (ALWs) based in probation teams. ALWs carry out full alcohol
assessments and refer offenders into treatment, where appropriate.
14 Working with Alcohol Misusing Offenders – a strategy for delivery

Areas should: the nature of addiction; and the knowledge to


assess and refer offenders. This could be achieved
• Have an alcohol policy lead responsible for through specific alcohol awareness training run
making links with local alcohol services and in-house; shadowing a provider or going on job
understanding the types of services available. secondment; specialist alcohol services providing the
This person should also act as the main training; or on a multi-agency basis as part of
contact point for services. workforce planning to develop local alcohol
treatment systems.
• Work with key partners (PCTs, D(A)ATs,
CDRPs) to ensure that there is sufficient Training should be linked to the Drugs and Alcohol
alcohol and supporting provision e.g. National Occupational Standards (DANOS) 35
accommodation, ETE locally. Adherence to DANOS will ensure:

2.6 Training and development • Recruitment of staff with the necessary


knowledge, skills and experience.
The Harm Reduction Strategy proposed “improved
training of staff to increase awareness of likely signs • Development of appropriate job descriptions
of alcohol misuse” as one of a number of measures and person specifications.
to improve the early identification and treatment of
alcohol problems. • Appropriate induction and training.

Across the Probation Service training is variable; NPD will:


for example, only in some areas is an alcohol
component included in staff induction. Many areas • Ensure that the standards and training for
have no specific alcohol training in place and a new probation officers are consistent with
significant proportion of staff do not feel DANOS.
adequately trained to work with alcohol-misusing
offenders under their supervision. Areas should ensure that:

Staff need to be able to identify a problem with • All probation staff involved in delivering and
alcohol misuse; offer basic advice on safe drinking managing (or directing) Tier One and/or Tier
levels; challenge offenders about the impact that Two interventions, including alcohol education
drinking has on all aspects of their lives; and know or information and brief advice and support,
how to refer an individual with a problem. Basic are trained and competent to the relevant
training for all staff working with alcohol misusing DANOS standards and more specific/specialist
offenders should allow them to develop training is provided for those who need it.
motivational skills; techniques for working with
offenders with different needs; an understanding of

35 DANOS specifies the functions carried out in tackling alcohol misuse, the standards of performance required of individual workers and the knowledge
and skills they require. Where non-alcohol specialist professionals work with drinkers, relevant DANOS competencies are drawn into the standards for
their own profession.
Working with Alcohol Misusing Offenders – a strategy for delivery 15

• Staff have sufficient knowledge of sentencing


options and appropriate treatment provisions
and who to target for what type of
sentence/intervention.

• Any additional training is designed around the


DANOS competencies.

2.7 Performance monitoring

NPD presently monitors the use of the ATR and the


range of accredited programmes in dealing with
alcohol problems, compliance with orders and the
use of additional licence conditions.

Areas also need performance data to inform future


decisions about the commissioning and delivery of
services, although this needs to be balanced against
the operational burden of data collection.

In the longer term, performance monitoring is likely


to be included in the remit of the ROMs.

NPD will:

• Review the data on the use of the ATR to


identify any potential problems and agree
remedial action and continue to monitor
alcohol related interventions more generally
within existing performance monitoring
arrangements.

• Work with RDS-NOMS to develop and


implement arrangements for monitoring the
delivery of the strategy and assessing its
success against its aims and objectives.

The Strategy will be reviewed in light of wider


developments in the alcohol field, including the
implementation of the Alcohol Harm Reduction
Strategy.
16 Working with Alcohol Misusing Offenders – a strategy for delivery

Glossary of terms
AA Alcoholics Anonymous
ATR Alcohol Treatment Requirement
AUDIT Alcohol Use Disorders Identification Test
CARATs Counselling, Advice, Referral, Assessment and Throughcare services
CIU Community Integration Unit (NOMS)
CDRPs Crime and Disorder Reduction Partnerships
D(A)ATs Drug (and Alcohol) Action Teams
DANOS Drugs and Alcohol National Occupational Standards
DIP Drug Interventions Programme
DH Department of Health
DSU Drug Strategy Unit (NOMS)
ETE Education, training and employment
ICPs Integrated Care Pathways
LAAs Local Area Agreements
LIAM Lower Intensity Alcohol Module
LSPs Local Strategic Partnerships
MoCAM Models of Care for Alcohol Misusers
NOMS National Offender Management Service
NPD National Probation Directorate
NPS National Probation Service
NTA National Treatment Agency for Substance Misuse
OASys Offender Assessment System
O-DEAT OASys Data Evaluation & Analysis Team
OGRS Offender Group Reconviction Scale
PCTs Primary Care Trusts
PPOs Prolific and other Priority Offenders
RDS Research, Development and Statistics
ROMs Regional Offender Managers
SLAs Service Level Agreements
Working with Alcohol Misusing Offenders – a strategy for delivery 17

Acknowledgements
NPD Interventions Unit would like to thank all the individuals and organisations who contributed to the
development of this strategy. In particular, we would like to express our gratitude to the following for their
assistance and helpful input:

Alcohol Concern
Alcoholics Anonymous (AA)
Department of Health (DH)
National Offender Management Service (NOMS):
Community Integration Unit (CIU)
Drug Strategy Unit (DSU)
Research, Development and Statistics (RDS)
NPD OASys Data Evaluation & Analysis Team (O-DEAT)
National Treatment Agency for Substance Misuse (NTA)
Various Alcohol Treatment Agencies
Various Probation Areas

Particular thanks are due to:

Eric Appleby (former Chief Executive, Alcohol Concern)


Patricia Best (National Policy Development, NOMS CIU)
Caroline Bonds (Drug Treatment Team Leader, NOMS DSU)
Dr. Gemma Harper (Programme Director, RDS-NOMS Research & Evaluation Programme)
Philip Howard (Senior Research Officer, O-DEAT)
Trevor McCarthy (Senior Policy Officer: Alcohol, National Treatment Agency)
Don Shenker (Director of Policy and Services, Alcohol Concern)

and all current and former colleagues within NPD, the Home Office and across the Probation Service who
worked on or contributed to the strategy during its long gestation.

Contact for enquiries


For further information about the strategy contact:

Robert Stanbury
Drug/Alcohol Policy Developer
NPD Interventions Unit
Tel: 020 7217 0767
Email: Robert.Stanbury@homeoffice.gsi.gov.uk
18 Working with Alcohol Misusing Offenders – a strategy for delivery

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Treatment Requirement (ATR)
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Hard copies, where available, can be requested from:


NPSpublications@homeoffice.gsi.gov.uk
NPD/AS1/2006