A brief alcohol intervention for hazardously drinking incarcerated women

Study protocol: Exploring the use of Family Health Histories in the African American community to reduce health disparities in Flint, Michigan

Background Health disparities are costly and preventable differences in disease progression that disproportionately affect minority communities such as African Americans. Practices to reduce health disparities can be rooted in prevention, particularly through screening tools. Family Health History tools are preventative screening mechanisms meant to explore family history to better understand how an individual's health can potentially be predicted or impacted. These tools are underutilized in the African American community. Contributions to this underutilization include a lack of cultural tailoring in the tools, a lack of health literacy in community members, and a lack of effective health communication. The Family Health History Study will create a culturally appropriate Family Health History toolkit to increase family health history utilization and ultimately decrease health disparities. Methods The proposed sample will be composed of 195 African American adults ages 18 + who live in Genesee County, Michigan. The study consists of two phases: the development phase and the randomized pilot study phase. The goal of the development phase (n = 95) is to explore how Family Health History toolkits can be modified to better serve the African American community using a community based participatory research approach and to create a culturally tailored family health history toolkit. In the pilot study phase, 100 participants will be randomized to the culturally tailored toolkit or the current standard Family Health History toolkit. Outcomes will include feasibility and acceptability of the intervention. Discussion This study will result in a culturally appropriate Family Health History tool that is co-developed with community members that can be utilized by African American adults to better understand their family health histories. Trial Registration Clinicaltrials.gov: NCT05358964 Date: May 5, 2022.

Reimbursing incarcerated individuals for participation in research: A scoping review

BACKGROUND

Little is known about global practices regarding the provision of reimbursement for the participation of people who are incarcerated in research. To determine current practices related to the reimbursement of incarcerated populations for research, we aimed to describe international variations in practice across countries and carceral environments to help inform the development of more consistent and equitable practices.

METHODS

We conducted a scoping review by searching PubMed, Cochrane library, Medline, and Embase, and conducted a grey literature search for English- and French-language articles published until September 30, 2022. All studies evaluating any carceral-based research were included if recruitment of incarcerated participants occurred inside any non-juvenile carceral setting; we excluded studies if recruitment occurred exclusively following release. Where studies failed to indicate the presence or absence of reimbursement, we assumed none was provided.

RESULTS

A total of 4,328 unique articles were identified, 2,765 were eligible for full text review, and 426 were included. Of these, 295 (69%) did not offer reimbursement to incarcerated individuals. A minority (n = 13; 4%) included reasons explaining the absence of reimbursement, primarily government-level policies (n = 7). Among the 131 (31%) studies that provided reimbursement, the most common form was monetary compensation (n = 122; 93%); five studies (4%) offered possible reduced sentencing. Reimbursement ranged between $3-610 USD in total and 14 studies (11%) explained the reason behind the reimbursements, primarily researchers' discretion (n = 9).

CONCLUSIONS

The majority of research conducted to date in carceral settings globally has not reimbursed incarcerated participants. Increased transparency regarding reimbursement (or lack thereof) is needed as part of all carceral research and advocacy efforts are required to change policies prohibiting reimbursement of incarcerated individuals. Future work is needed to co-create international standards for the equitable reimbursement of incarcerated populations in research, incorporating the voices of people with lived and living experience of incarceration.

Motivational interviewing for substance use reduction

BACKGROUND

Substance use is a global issue, with around 30 to 35 million individuals estimated to have a substance-use disorder. Motivational interviewing (MI) is a client-centred method that aims to strengthen a person's motivation and commitment to a specific goal by exploring their reasons for change and resolving ambivalence, in an atmosphere of acceptance and compassion. This review updates the 2011 version by Smedslund and colleagues.

OBJECTIVES

To assess the effectiveness of motivational interviewing for substance use on the extent of substance use, readiness to change, and retention in treatment.

SEARCH METHODS

We searched 18 electronic databases, six websites, four mailing lists, and the reference lists of included studies and reviews. The last search dates were in February 2021 and November 2022.

SELECTION CRITERIA

We included randomised controlled trials with individuals using drugs, alcohol, or both. Interventions were MI or motivational enhancement therapy (MET), delivered individually and face to face. Eligible control interventions were no intervention, treatment as usual, assessment and feedback, or other active intervention.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane, and assessed the certainty of evidence with GRADE. We conducted meta-analyses for the three outcomes (extent of substance use, readiness to change, retention in treatment) at four time points (post-intervention, short-, medium-, and long-term follow-up).

MAIN RESULTS

We included 93 studies with 22,776 participants. MI was delivered in one to nine sessions. Session durations varied, from as little as 10 minutes to as long as 148 minutes per session, across included studies. Study settings included inpatient and outpatient clinics, universities, army recruitment centres, veterans' health centres, and prisons. We judged 69 studies to be at high risk of bias in at least one domain and 24 studies to be at low or unclear risk. Comparing MI to no intervention revealed a small to moderate effect of MI in substance use post-intervention (standardised mean difference (SMD) 0.48, 95% confidence interval (CI) 0.07 to 0.89; I2 = 75%; 6 studies, 471 participants; low-certainty evidence). The effect was weaker at short-term follow-up (SMD 0.20, 95% CI 0.12 to 0.28; 19 studies, 3351 participants; very low-certainty evidence). This comparison revealed a difference in favour of MI at medium-term follow-up (SMD 0.12, 95% CI 0.05 to 0.20; 16 studies, 3137 participants; low-certainty evidence) and no difference at long-term follow-up (SMD 0.12, 95% CI -0.00 to 0.25; 9 studies, 1525 participants; very low-certainty evidence). There was no difference in readiness to change (SMD 0.05, 95% CI -0.11 to 0.22; 5 studies, 1495 participants; very low-certainty evidence). Retention in treatment was slightly higher with MI (SMD 0.26, 95% CI -0.00 to 0.52; 2 studies, 427 participants; very low-certainty evidence). Comparing MI to treatment as usual revealed a very small negative effect in substance use post-intervention (SMD -0.14, 95% CI -0.27 to -0.02; 5 studies, 976 participants; very low-certainty evidence). There was no difference at short-term follow-up (SMD 0.07, 95% CI -0.03 to 0.17; 14 studies, 3066 participants), a very small benefit of MI at medium-term follow-up (SMD 0.12, 95% CI 0.02 to 0.22; 9 studies, 1624 participants), and no difference at long-term follow-up (SMD 0.06, 95% CI -0.05 to 0.17; 8 studies, 1449 participants), all with low-certainty evidence. There was no difference in readiness to change (SMD 0.06, 95% CI -0.27 to 0.39; 2 studies, 150 participants) and retention in treatment (SMD -0.09, 95% CI -0.34 to 0.16; 5 studies, 1295 participants), both with very low-certainty evidence. Comparing MI to assessment and feedback revealed no difference in substance use at short-term follow-up (SMD 0.09, 95% CI -0.05 to 0.23; 7 studies, 854 participants; low-certainty evidence). A small benefit for MI was shown at medium-term (SMD 0.24, 95% CI 0.08 to 0.40; 6 studies, 688 participants) and long-term follow-up (SMD 0.24, 95% CI 0.07 to 0.41; 3 studies, 448 participants), both with moderate-certainty evidence. None of the studies in this comparison measured substance use at the post-intervention time point, readiness to change, and retention in treatment. Comparing MI to another active intervention revealed no difference in substance use at any follow-up time point, all with low-certainty evidence: post-intervention (SMD 0.07, 95% CI -0.15 to 0.29; 3 studies, 338 participants); short-term (SMD 0.05, 95% CI -0.03 to 0.13; 18 studies, 2795 participants); medium-term (SMD 0.08, 95% CI -0.01 to 0.17; 15 studies, 2352 participants); and long-term follow-up (SMD 0.03, 95% CI -0.07 to 0.13; 10 studies, 1908 participants). There was no difference in readiness to change (SMD 0.15, 95% CI -0.00 to 0.30; 5 studies, 988 participants; low-certainty evidence) and retention in treatment (SMD -0.04, 95% CI -0.23 to 0.14; 12 studies, 1945 participants; moderate-certainty evidence). We downgraded the certainty of evidence due to inconsistency, study limitations, publication bias, and imprecision.

AUTHORS' CONCLUSIONS

Motivational interviewing may reduce substance use compared with no intervention up to a short follow-up period. MI probably reduces substance use slightly compared with assessment and feedback over medium- and long-term periods. MI may make little to no difference to substance use compared to treatment as usual and another active intervention. It is unclear if MI has an effect on readiness to change and retention in treatment. The studies included in this review were heterogeneous in many respects, including the characteristics of participants, substance(s) used, and interventions. Given the widespread use of MI and the many studies examining MI, it is very important that counsellors adhere to and report quality conditions so that only studies in which the intervention implemented was actually MI are included in evidence syntheses and systematic reviews. Overall, we have moderate to no confidence in the evidence, which forces us to be careful about our conclusions. Consequently, future studies are likely to change the findings and conclusions of this review.

Alcohol relapse prevention health care after alcohol withdrawal in New South Wales prisons, Australia: A patient file review

INTRODUCTION

People who enter custody have complex health issues and comorbidities may include alcohol use disorders. We investigated clinical service provision and comorbidities recorded among individuals with a likely alcohol withdrawal syndrome within prison in New South Wales, Australia.

METHODS

For this clinical case series review, electronic medical data were used to identify 50 people entering custody between August and November 2018 who likely had a treated alcohol withdrawal syndrome. We aimed for a 3:2 ratio of men and women, and a 1:1 ratio of Aboriginal and non-Aboriginal individuals. Data were extracted using a purposefully designed tool which included current alcohol withdrawal management, comorbidities and alcohol relapse prevention approaches used or recommended.

RESULTS

Thirty-eight men and 12 women, of whom 22 were Aboriginal, were included. Twenty-nine individuals (58%) reported a history of medical comorbidities. Thirty-five (70%) reported using other substances and over half (60%) had a diagnosis of mental health disorders. Fourteen (28%) individuals had a record of receiving brief intervention and five (10%) of motivational interviewing. Twenty-three individuals (46%) were referred to and seen by drug and alcohol clinicians. Only seven (14%) of the sample had pre-release community care plans.

DISCUSSION AND CONCLUSIONS

Individuals treated for an alcohol withdrawal syndrome in New South Wales prisons have a high prevalence of medical comorbidities and other substance use. Clinical interventions focused on alcohol withdrawal management, and relapse prevention interventions were not recorded for most individuals. Service innovation and expansion are needed to increase the provision of post-withdrawal management.

A Rapid Systematic Review of Worldwide Alcohol Use Disorders and Brief Alcohol Interventions in the Criminal Justice System

Although the relationship is complex, there is an association between alcohol use and offending behavior with an interplay between the amount drank, the pattern of drinking and individual and contextual factors. Alcohol brief interventions have been shown to be effective in primary healthcare, however there is currently a lack of compelling evidence in the criminal justice system. We carried out a rapid systematic review of the literature, which updated our review conducted in 2016. Following systematic searches, we included 36 papers on prevalence and 13 papers on effectiveness. Between 26 and 88% of individuals in the policy custody setting scored positive for an alcohol use disorder. In the magistrates court this was 95%; 31-86% in the probation setting and between 19 and 86% in the prison system. In relation to probable dependence, between 21 and 38% of individuals were shown to have probable alcohol dependence in the police custody suite setting; 39 per cent in the magistrate court system; 17-36% in the probation setting and between 18 and 48% in the prison system. This compares to 6% in the general population. We included 13 studies of effectiveness with differing outcome measures and outcomes. We conclude more studies are needed in the field to develop the current evidence base.

Scoping review of interventions to link individuals to substance use services at discharge from jail

INTRODUCTION

Individuals with substance use disorders (SUD) must be linked to community-based SUD treatment and other services upon their release from jail, given their high service needs and risks for relapse, recidivism, and opioid-related overdose following release.

METHOD

This scoping review identified 14 studies (28 affiliated publications) that used experimental or quasi-experimental designs to evaluate jail re-entry interventions for individuals with SUD. The team coded intervention components, study characteristics, and study outcomes based on a service continuum for treatment linkage and retention and for post-release substance use and criminal justice outcomes.

RESULTS

This review included 4 randomized controlled trials (RCT) for linkage to treatment with medications for opioid use disorder (MOUD); 4 RCTs and 4 quasi-experimental studies for linkage to non-specific SUD treatment; and 2 RCTs for linkage to HIV + SUD services. Most studies (9/14) used case management and/or peer or patient navigation as the core intervention; 2 studies provided medical management for MOUD induction and/or facilitated referral to MOUD in the community; and 3 studies used motivational-based linkage interventions. A qualitative analysis of study outcomes found evidence to support the effectiveness of a diverse range of interventions to link individuals to community-based SUD treatment, MOUD, and other services at re-entry, but limited support for intervention effects on longer-term outcomes, including treatment retention, medication adherence, recidivism, and substance use.

CONCLUSION

Future controlled trials and implementation studies should help to unpack and examine core components of jail re-entry interventions and their successful implementation to enhance treatment retention and improve post-release outcomes.

Psychosocial Interventions for Prisoners with Mental and Substance Use Disorders: A Systematic Review

PURPOSE OF THE REVIEW

The prevalence of mental and substance use disorders is three to five times higher than that of the general population. Psychosocial interventions are effective in identifying and managing mental health and substance use disorders. This article aims to review the randomized control studies which have used nonpharmacological interventions alone or in combination with pharmacological interventions for managing mental and substance use disorders in prison/correctional settings.

COLLECTION AND ANALYSIS OF DATA

Studies included were randomized control trials and pilot randomized studies that assessed the impact of psychosocial interventions for prisoners with mental disorders and substance use disorders. A comprehensive search for articles was done by the primary author (Sreekanth Nair Thekkumkara) in the following databases: PubMed, ProQuest, PsychArticles, and Google Scholar (search engine), for the period June 1, 2000, to December 31, 2020.

RESULTS AND CONCLUSIONS

The 21 studies included in the review had a sample size of 34 to 759. The settings of all the interventions were the prison and different types of psychosocial interventions were provided across the studies. The average duration of intervention ranged between 10 min and 120 min with the frequency of one to six sessions per week for 1 to 36 months. All the 21 Randomized Control Trials (RCTs) were nonIndian studies. Overall, the results of the included studies showed significant improvement postintervention (motivational intervention, interpersonal therapy, cognitive behavior therapy, positive psychology intervention, music therapy, and acceptance and commitment therapy) on primary outcome measures such as symptom severity of depression, anxiety, and substance abuse prisoners. Positive effects were observed on secondary outcome measures such as motivation, aggression, follow up rates, and recidivism. A limited number of studies have focused on evaluating psychosocial interventions in prison settings. Most of the interventions were tested in prisoners with substance use disorder alone or in those with dual diagnoses and in high-income countries.

Randomized controlled trial of twelve-step volunteer linkage for women with alcohol use disorder leaving jail

BACKGROUND

Alcohol use disorder predicts poor health outcomes among women returning to the community from jail. Twelve-step self-help groups are free and accessible to women leaving jail, but reaching out to strangers can pose a barrier. Pilot work suggested that a volunteer-led "warm handoff" may increase post-release twelve-step self-help group attendance.

METHODS

This randomized trial evaluated the effectiveness of a warm handoff intervention on post-release twelve-step attendance and alcohol use. Participants (189 women with alcohol use disorder) were recruited in jail and followed for 6 months after release. Participants were randomized to: (1) a warm handoff, in which a female twelve-step volunteer met with each woman individually in jail and the same volunteer attended the woman's first twelve-step meeting with her after release; or (2) enhanced standard care (a list of meetings and community resources). Outcomes included days abstinent from alcohol, drinks per drinking day, alcohol-related problems, twelve-step attendance, twelve-step affiliation, network support for abstinence, number of unprotected sexual occasions, and drug using days.

RESULTS

Among intervention participants, only 66 % were aware that the volunteer tried to contact them after jail, only 38 % reported post-jail contact with their volunteers (typically phone), and only four went to meetings with their volunteers post-release. Of 8 post-release outcomes, intervention effects differed on only one (alcohol-related problems).

CONCLUSION

Although twelve-step self-help group attendance predicted alcohol abstinence, the volunteer-led warm handoff intervention did not increase twelve-step attendance. The twelve-step tradition of Attraction may inhibit the active outreach required to connect women to services after jail release.

At the heart of the matter: Cardiovascular health challenges among incarcerated women

Many factors appear to contribute to an increased risk for cardiovascular disease (CVD) among incarcerated women. Imprisonment is associated with a bodyweight gain and an increased prevalence of overweight and obesity. Inadequate physical activity and unhealthy nutrition further contribute to this positive energy balance. Classical CVD risk factors are common, including hypertension, diabetes mellitus, metabolic syndrome, and smoking. Moreover, imprisonment is associated with an increased incidence of mental health issues, such as depression and anxiety, with coping mechanisms, including substance abuse, being frequently adopted. Specific attitudes in the correctional environment, including hunger strikes, bullying, abuse and solitary confinement, are effectors of cardiovascular and mental ill-health. Furthermore, the plethora of psychological stressors induces an accelerated aging process, paired with CVD risk. Communicable diseases, mainly human immunodeficiency virus, opportunistic infections and inadequate sunlight exposure increase cardiovascular dysregulation. Health care needs associated with the female sex are not always met, adding to the frustration and compromised well-being. All these factors act independently and cumulatively, increasing CVD risk among incarcerated women.

Perceived Substance Use Norms Among Jailed Women with Alcohol Use Disorders

BACKGROUND

Social norms regarding substance use predict substance use behaviors. In a sample of jailed women with alcohol use disorders (AUDs), we compared (i) jailed women's perceptions of the US women population's rates of substance use, with US women's actual rates of substance use; (ii) jailed women's perceived rates of substance use by US women, with their perceptions of use by their own friends; and (iii) US women's actual rates of substance use, with observed sample substance use rates.

METHODS

Participants were 205 jailed women who met criteria for an AUD. We used the 1-sample or dependent-samples t-test to make the comparisons.

RESULTS

Participants overestimated US women's rates of substance use and incarceration rates. They perceived their friends' substance use as less common than US women's. The jailed women reported higher rates of their own substance use than actual rates by US women. In addition, jailed women self-reported less cannabis use, but more alcohol and cocaine use and cigarette smoking, than they perceived their friends to have used. The more women perceived their friends as drinking, the less they had a goal to drink less or abstain from drinking postincarceration; in contrast, perceptions of US women's drinking were not related to personal goals for drinking.

CONCLUSIONS

Interventions that correct misperceptions about substance use norms may have utility for jailed women with AUDs.

Peer navigation for individuals with serious mental illness leaving jail: a pilot randomized trial study protocol

Background

Serious mental illness (SMI) is a prevalent public health problem affecting 25% of individuals in jail. Re-entry to the community following incarceration is a vulnerable time for justice-involved individuals with SMI. SMI requires prompt and ongoing access to mental health and other healthcare services.

Methods

The study will (1) develop a Mentoring And Peer Support (MAPS) intervention for post-release mental health and other service connection among jailed individuals with SMI and (2) pilot test the MAPS intervention to determine its feasibility and acceptability. The primary outcomes will be to evaluate the feasibility and acceptability of the proposed recruitment methods and research design, of the intervention training methods, and of delivering the enhanced peer-navigator and control interventions. Study samples include focus groups (n=36), open trial (n=15), and a randomized pilot trial in a sample of 40 individuals with SMI re-entering the community after jail release. Secondary outcomes will include post-release enrollment in mental health, medical care, and substance use services. We will also evaluate reduction in psychiatric symptoms, improvements in functioning, adherence to psychiatric medications, fewer substance using days, fewer hospitalizations and suicide attempts, nights unstably housed, and time until rearrest.

Discussion

This pilot study will evaluate the feasibility and acceptability of a peer navigation intervention for individuals with serious mental illness leaving jails. The study will serve as a formative work for a larger randomized controlled trial assessing the effectiveness of peer navigator intervention for (include the primary outcome) in this population.

Psychosocial treatment for incarcerated methamphetamine users: the Philippines experience

PURPOSE

The purpose of this study is to evaluate a psychosocial treatment program for prisoners incarcerated because of methamphetamine use. It compared the outcomes of prisoners who received the program while incarcerated, those who were released and received the treatment as part of community-based drug recovery program and a waitlist-control group (WC) with no treatment.

DESIGN/METHODOLOGY/APPROACH

A quasi-experimental design was use with pre- and post-test surveys administered to three groups: a WC group, a pre-release treatment-while-incarcerated (TWI) group, and a post-release outpatient treatment group (OP). Surveys measured recovery skills, life skills and substance use disorder (SUD) symptoms were administered before and after the intervention.

FINDINGS

Results revealed that at baseline OP and TWI had significant higher recovery skills compared to WC group. However, in terms of life skills, there was no significant difference observed among the WC, OP and TWI group at baseline. TWI had a significantly lower number of SUD symptoms compared to the WC group at baseline. As hypothesized, findings revealed significant changes in recovery and life skills among the OP and TWI group compared to the WC group. No significant change in SUD scores were observed for all groups.

RESEARCH LIMITATIONS/IMPLICATIONS

A major limitation of the study was the use of a quasi-experimental design because legal issues did not allow a randomized control trial. Future research using randomized controlled trial designs would provide more robust conclusions on the impact of the intervention. The study design was also limited to pre- and post-evaluation. Further studies are encouraged to look at longitudinal outcomes of appears on SUD symptoms and possibility of relapse.

PRACTICAL IMPLICATIONS

Given that there were no significant differences in outcomes between OP and TWI groups, results suggest that the program may serve either as a pre- or post-release program for incarcerated drug users. However, results also suggest that completion is higher when the program is used as a pre-release program. Delivering the program prior to release also reduces challenges related to attrition including conflict in schedules and the lack of resources for transportation.

SOCIAL IMPLICATIONS

The study suggests the value of psychosocial treatment as opposed to punitive approaches in dealing with drug use. In particular, delivering interventions prior to release can prepare participants for problems they may encounter during reintegration and prevent recidivism. In a country where drug-related killings are on the rise, the study presents an alternate and restorative justice approach.

ORIGINALITY/VALUE

The study addresses a dearth in the literature on psychosocial intervention for methamphetamine users. It also fills a vacuum in studies from developing countries such as the Philippines.

Reentry interventions that address substance use: A systematic review

Justice-involved individuals with substance use problems have heightened risk of relapse and recidivism after release from incarceration, making reentry a critical time to provide evidence-based treatments (EBTs) for substance use; however, the extent to which reentry interventions incorporate EBTs for substance use is unclear. This systematic review identified studies of reentry interventions in the past 10 years that address substance use, assessed whether EBTs were used, and explored which interventions were effective in reducing substance use and recidivism postrelease. Eligible studies included interventions that began during incarceration and continued postrelease or began within 3 months of release and addressed substance use in some capacity. One hundred twelve full text articles were reviewed and 38 met inclusion criteria, representing 34 unique interventions. Of the 34 interventions, 21 provided substance use treatment whereas 13 facilitated connections to treatment. Of the 21 interventions providing treatment, the primary modalities were cognitive-behavioral therapy (n = 6), motivational interviewing (n = 2), medication assisted treatment (n = 2), therapeutic community (n = 2), psychoeducation or 12-step (n = 5), and four did not specify the modality. Of the 31 studies that assessed recidivism outcomes, 18 found reduced recidivism for the treatment group on at least one indicator (e.g., rearrest, reincarceration). Of the 13 studies that assessed substance use outcomes, 7 found reduced substance use for the treatment group on at least one indicator. Results were not consistent for any particular treatment approach or modality and highlight the need for consistent integration of EBTs for substance use into reentry interventions. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

The Church Challenge: A community-based multilevel cluster randomized controlled trial to improve blood pressure and wellness in African American churches in Flint, Michigan

Chronic disease carries high morbidity and mortality in the United States, with large racial and ethnic disparities observed in chronic disease. Physical activity and healthy food are vital for chronic disease prevention yet challenging to access in economically distressed areas. Public health prevention efforts have become particularly prominent within faith-based organizations over the last three decades. This manuscript describes the protocol of the Church Challenge, a multilevel cluster-randomized controlled nutrition and physical activity trial across 24 churches to reduce blood pressure by 6 mmHg among 576 residents in Flint, MI. The Church Challenge was developed using community-based participatory approaches and is rooted in a church-based program developed by and for primarily African-American Flint church congregations. This three-level intervention addresses health at the community (level 3), church (level 2), and individual (level 1) to reduce blood pressure, reduce chronic disease risk, and promote health equity and wellbeing in Flint. Churches are randomized in a 1:1 ratio to a 16-week physical activity and nutrition program or a 4-session health and wellness workshop. Flint is not a unique community but has a history of traumatic community wide events; even now, the public health infrastructure continues to be a challenge and distract residents from focusing on their health. This trial is highly significant and innovative because it uses a combination of evidence-based practices simultaneously supporting health behavior change for individuals and their faith organizations, and evaluates multilevel efforts to sustain long-term health promotion activities in vulnerable communities like Flint.

Alcohol Screening and Brief Intervention in Police Custody Suites: Pilot Cluster Randomised Controlled Trial (AcCePT)

Aims

There is a clear association between alcohol use and offending behaviour and significant police time is spent on alcohol-related incidents. This study aimed to test the feasibility of a trial of screening and brief intervention in police custody suites to reduce heavy drinking and re-offending behaviour.

Short summary

We achieved target recruitment and high brief intervention delivery if this occurred immediately after screening. Low rates of return for counselling and retention at follow-up were challenges for a definitive trial. Conversely, high consent rates for access to police data suggested at least some outcomes could be measured remotely.

Methods

A three-armed pilot Cluster Randomised Controlled Trial with an embedded qualitative interview-based process evaluation to explore acceptability issues in six police custody suites (north east and south west of the UK). Interventions included: 1. Screening only (Controls), 2. 10 min Brief Advice 3. Brief Advice plus 20 min of brief Counselling.

Results

Of 3330 arrestees approached: 2228 were eligible for screening (67%) and 720 consented (32%); 386 (54%) scored 8+ on AUDIT; and 205 (53%) were enroled (79 controls, 65 brief advice and 61 brief counselling). Follow-up rates at 6 and 12 months were 29% and 26%, respectively. However, routinely collected re-offending data were obtained for 193 (94%) participants. Indices of deprivation data were calculated for 184 (90%) participants; 37.6% of these resided in the 20% most deprived areas of UK. Qualitative data showed that all arrestees reported awareness that participation was voluntary, that the trial was separate from police work, and the majority said trial procedures were acceptable.

Conclusion

Despite hitting target recruitment and same-day brief intervention delivery, a future trial of alcohol screening and brief intervention in a police custody setting would only be feasible if routinely collected re-offending and health data were used for outcome measurement.

Trial registration

ISRCTN number: 89291046.

A Systematic Review of the Efficacy of Alcohol Interventions for Incarcerated People

Aim

The aim of this current study was to systematically review the literature on brief alcohol interventions for incarcerated individuals to ascertain the efficacy or effectiveness in making changes to either consumption of alcohol or other social outcomes.

Short summary

Levels of risky drinking and dependency are high amongst incarcerated individuals. Eleven studies from nine articles were included in the systematic review. Six of the studies included brief intervention and three extended interventions. Interventions have the potential to positively impact on risky drinking. More studies are needed in this setting.

Introduction

It has been shown that around three times as many incarcerated individuals are risky drinkers and alcohol dependency is ten times higher than in the general population.

Methods

Systematic review of randomised controlled trials or matched group trials of the efficacy of psychosocial alcohol interventions for incarcerated individuals: we searched seven databases, with no restrictions on language, year or location from inception through to August 2017. The Critical Appraisal Skills Programme tool was used to assess the quality of included studies. The Template for Intervention Description and Replication checklist was used to ascertain intervention descriptions.

Results

Nine studies from 11 papers were included in the analysis. Six of the studies included brief interventions and three extended interventions. Every study used a different measure of alcohol consumption. Three of the studies that looked at brief interventions and all of the three extended intervention studies found significant reductions in relation to alcohol outcomes.

Conclusions

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.

Reasons for Testing Mediation in the Absence of an Intervention Effect: A Research Imperative in Prevention and Intervention Research

OBJECTIVE

Mediation models are used in prevention and intervention research to assess the mechanisms by which interventions influence outcomes. However, researchers may not investigate mediators in the absence of intervention effects on the primary outcome variable. There is emerging evidence that in some situations, tests of mediated effects can be statistically significant when the total intervention effect is not statistically significant. In addition, there are important conceptual and practical reasons for investigating mediation when the intervention effect is nonsignificant.

METHOD

This article discusses the conditions under which mediation may be present when an intervention effect does not have a statistically significant effect and why mediation should always be considered important.

RESULTS

Mediation may be present in the following conditions: when the total and mediated effects are equal in value, when the mediated and direct effects have opposing signs, when mediated effects are equal across single and multiple-mediator models, and when specific mediated effects have opposing signs. Mediation should be conducted in every study because it provides the opportunity to test known and replicable mediators, to use mediators as an intervention manipulation check, and to address action and conceptual theory in intervention models.

CONCLUSIONS

Mediators are central to intervention programs, and mediators should be investigated for the valuable information they provide about the success or failure of interventions.

Hazardously Drinking Jailed Women: Post-Release Perceived Needs and Risk of Reincarceration

Women who drink hazardously face a high risk for re-arrest and reincarceration when they return to their communities after a jail stay. This study is the first to examine the associations between women's own reports of basic needs 1 month after jail release, and reincarceration (defined as spending at least one night in jail) during the next 5 months among unsentenced, female pretrial jail detainees who drink hazardously. Perceived needs for housing (adjusted odds ratio [AOR] = 3.63; p < .01), substance treatment services (AOR = 2.65; p < .01), assistance/benefits (AOR = 2.37; p < .05), and mental health counseling (AOR = 2.07; p < .05) at 1 month after jail release were associated with reincarceration during the next 5 months for the 165 hazardously drinking jailed women in this study. These findings demonstrate that self-reported needs during the high-risk period immediately following jail release are associated with heightened odds of reincarceration among hazardously drinking jailed women.

Study protocol: Community Links to Establish Alcohol Recovery (CLEAR) for women leaving jail

PURPOSE

This article describes the protocol for a randomized effectiveness trial of a method to link alcohol use disordered women who are in pretrial jail detention with post-release 12-step mutual help groups.

BACKGROUND

Jails serve 15 times more people per year than do prisons and have very short stays, posing few opportunities for treatment or treatment planning. Alcohol use is associated with poor post-jail psychosocial and health outcomes including sexually transmitted diseases and HIV, especially for women. At least weekly 12-step self-help group attendance in the months after release from jail has been associated with improvements in alcohol use and alcohol-related consequences. Linkage strategies improve 12-step attendance and alcohol outcomes among outpatients, but have not previously been tested in criminal justice populations.

DESIGN

In the intervention condition, a 12-step volunteer meets once individually with an incarcerated woman while she is in jail and arranges to be in contact after release to accompany her to 12-step meetings. The control condition provides schedules for local 12-step meetings. Outcomes include percent days abstinent from alcohol (primary), 12-step meeting involvement, and fewer unprotected sexual occasions (secondary) after release from jail. We hypothesize that (Minton, 2015) 12-step involvement will mediate the intervention's effect on alcohol use, and (O'Brien, 2001) percent days abstinent will mediate the intervention's effect on STI/HIV risk-taking outcomes. Research methods accommodate logistical and philosophical hurdles including rapid turnover of commitments and unpredictable release times at the jail, possible post-randomization ineligibility due to sentencing, 12-step principles such as Nonaffiliation, and use of volunteers as interventionists.

A randomized study of the use of screening, brief intervention, and referral to treatment (SBIRT) for drug and alcohol use with jail inmates

BACKGROUND

Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based practice that has been shown to reduce alcohol and drug use in healthcare, educational, and other settings, but research on the effectiveness of SBIRT with populations involved in the criminal justice system is limited. These populations have high rates of substance use but have limited access to interventions.

METHODS

The study randomized 732 jail inmates from a large urban jail to the SBIRT intervention or to the control group. Using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), the intervention assessed the risk level for drug and alcohol misuse by inmates and provided those who were at low or medium risk with a brief intervention in jail and referred those at high risk to community treatment following release, including the opportunity to participate in a brief treatment (eight sessions) protocol. Using interview and records data from a 12-month follow-up, analyses compared the two groups with respect to the primary study outcomes of reductions in drug and alcohol use and the secondary outcomes of participation in treatment, rearrest, reduction in HIV risk behaviors, and quality of life. In addition, the costs of delivering the SBIRT intervention were calculated.

RESULTS

When baseline differences were controlled, the groups did not differ at follow-up on any of the primary or secondary outcomes.

CONCLUSIONS

Future research should develop and evaluate SBIRT models that are specifically adapted to the characteristics and needs of the jail population. Until more favorable results emerge, attempts to use SBIRT with jail inmates should be implemented with caution, if at all.

TRIAL REGISTRATION NUMBER

NCT01683643.

Climbing down the steps from the ivory tower: how UK academics and criminal justice practitioners need to work together on alcohol studies

Purpose

Evidence in the UK tells us that risky drinking is high amongst those in contact with the criminal justice system. The purpose of this paper is to explore the reasons why carrying out research around risky drinking in this setting is so difficult.

Design/methodology/approach

A commentary on the issues of carrying out research in the criminal justice setting.

Findings

There are issues of carrying out research in the criminal justice setting. The authors argue, that as academics we can be more proactive in working with practitioners in the design and carrying out of studies. By examining what the primary outcome of interest is to those that work in the field rather than what funding agencies tell us academics must use, academics may engage in a more co-productive way that enables everyone to achieve what they need. Moreover more work is needed to show how this approach can be achieved both in the UK and internationally.

Originality/value

This editorial explores some of the difficulties of carrying out alcohol research in the criminal justice system and postulates ways that this could be made easier.

A rapid systematic review of what we know about alcohol use disorders and brief interventions in the criminal justice system

Purpose

– The purpose of this paper is to review the evidence of alcohol use disorders within the different stages of the criminal justice system in the UK. Furthermore it reviewed the worldwide evidence of alcohol brief interventions in the various stages of the criminal justice system.

Design/methodology/approach

– A rapid systematic review of publications was conducted from the year 2000 to 2014 regarding the prevalence of alcohol use disorders in the various stages of the criminal justice system. The second part of the work was a rapid review of effectiveness studies of interventions for alcohol brief interventions. Studies were included if they had a comparison group. Worldwide evidence was included that consisted of up to three hours of face-to-face brief intervention either in one session or numerous sessions.

Findings

– This review found that 64-88 per cent of adults in the police custody setting; 95 per cent in the magistrate court setting; 53-69 per cent in the probation setting and 5,913-863 per cent in the prison system and 64 per cent of young people in the criminal justice system in the UK scored positive for an alcohol use disorder. There is very little evidence of effectiveness of brief interventions in the various stages of the criminal justice system mainly due to the lack of follow-up data.

Social implications

– Brief alcohol interventions have a large and robust evidence base for reducing alcohol use in risky drinkers, particularly in primary care settings. However, there is little evidence of effect upon drinking levels in criminal justice settings. Whilst the approach shows promise with some effects being shown on alcohol-related harm as well as with young people in the USA, more robust research is needed to ascertain effectiveness of alcohol brief interventions in this setting.

Originality/value

– This paper provides evidence of alcohol use disorders in the different stages of the criminal justice system in the UK using a validated tool as well as reviewing the worldwide evidence for short ( < three hours) alcohol brief intervention in this setting.

Sex Trading Among Hazardously Drinking Jailed Women

For women involved in sex trading, both alcohol problems and passage through the criminal justice system are highly prevalent. This study is the first to conduct a focused examination of factors associated with sex trading among hazardously drinking, pretrial, jailed women. Cocaine use, social support for alcohol abstinence, and more days incarcerated in the 90 days leading up to the index incarceration were significantly associated with sex trading involvement among alcoholic women. Helping incarcerated alcoholic women reduce cocaine use and improve sober support networks during and following an incarceration may minimize sex trading after release.

A systematic review of randomized controlled trials of interventions to improve the health of persons during imprisonment and in the year after release

We systematically reviewed randomized controlled trials of interventions to improve the health of people during imprisonment or in the year after release. We searched 14 biomedical and social science databases in 2014, and identified 95 studies. Most studies involved only men or a majority of men (70/83 studies in which gender was specified); only 16 studies focused on adolescents. Most studies were conducted in the United States (n = 57). The risk of bias for outcomes in almost all studies was unclear or high (n = 91). In 59 studies, interventions led to improved mental health, substance use, infectious diseases, or health service utilization outcomes; in 42 of these studies, outcomes were measured in the community after release. Improving the health of people who experience imprisonment requires knowledge generation and knowledge translation, including implementation of effective interventions.

HIV prevention for adults with criminal justice involvement: a systematic review of HIV risk-reduction interventions in incarceration and community settings

We summarized and appraised evidence regarding HIV prevention interventions for adults with criminal justice involvement. We included randomized and quasi-randomized controlled trials that evaluated an HIV prevention intervention, enrolled participants with histories of criminal justice involvement, and reported biological or behavioral outcomes. We used Cochrane methods to screen 32,271 citations from 16 databases and gray literature. We included 37 trials enrolling n = 12,629 participants. Interventions were 27 psychosocial, 7 opioid substitution therapy, and 3 HIV-testing programs. Eleven programs significantly reduced sexual risk taking, 4 reduced injection drug risks, and 4 increased testing. Numerous interventions may reduce HIV-related risks among adults with criminal justice involvement. Future research should consider process evaluations, programs involving partners or families, and interventions integrating biomedical, psychosocial, and structural approaches.

Pilot test of 12-step linkage for alcohol-abusing women in leaving jail

BACKGROUND

More than a million US women are detained in jails each year; many have alcohol use disorders (AUDs). AUD intervention with pretrial jail detainees presents a logistical challenge due to limited jail stays and lack of resources for postrelease treatment. The availability, no-cost entry, and promise of anonymity of Alcoholics Anonymous (AA) make it a highly accessible resource for underserved populations. However, the outreach of AA volunteers into jails (as opposed to prisons) has been limited, and incarcerated women are unlikely to seek out strangers for help after release. This study pilot tested an enhanced referral approach introducing a 12-step volunteer to a woman in jail who would attend a meeting with her after release.

METHODS

Participants were 14 unsentenced female pretrial jail detainees with AUD. Intervention consisted of introducing participants detained in jail to female AA volunteers who could accompany them to an AA meeting after release. Assessments took place at baseline and 1 month after release. This uncontrolled pilot study evaluated the feasibility and acceptability of this enhanced referral approach. Pre-post alcohol use, drug use, alcohol problems, and AA attendance are also reported.

RESULTS

Enhanced referral was feasible and acceptable. Many (57%) of the 14 participants who met with AA volunteers in jail were in contact with those volunteers after release from jail. Participants had significantly fewer drinking days, heavy drinking days, alcohol problems, and drug-using days during the postrelease follow-up than they did before jail detention.

CONCLUSIONS

Providing linkage between women in jail and female AA volunteers who can accompany them to a postrelease meeting is achievable, and may be a disseminable and low-cost method to improve alcohol outcomes in this vulnerable population.

Examining a curvilinear model of readiness to change and alcohol consumption

Research examining the relationship between readiness to change and alcohol consumption among college students is inconsistent. The purpose of the present study was to extend these findings, using two different measures of readiness to change. We hypothesized a curvilinear effect would occur such that the relationship between readiness to change and alcohol use would be relatively low for students low and high on readiness to change, whereas the relationship would be relatively high for those with moderate levels of readiness to change. Data were collected from two studies: Study 1 consisted of 263 undergraduate students and Study 2 consisted of 245 undergraduates participating in either intercollegiate or recreational athletics at three US universities. In Study 1, we examined the association between both linear and quadratic scores on a readiness to change measure and alcohol use. In Study 2, we examined the relationship between scores on a stage of change measure that included subscales indicative of different levels of readiness to change and alcohol use. The pattern of relationships supported the existence of an effect where the highest levels of alcohol use occurred among those with scores representing moderate levels of readiness to change.

Sexual risk-taking mediates the association between impulsivity and acquisition of sexually transmitted infections among hazardously drinking incarcerated women

BACKGROUND

A growing literature has identified associations between impulsivity and negative behaviors such as sexual risk-taking among high-risk and/or vulnerable populations, but few studies have linked impulsivity to biological outcomes of sexual risk-taking. The main purpose of this study was to document associations among impulsivity, sexual risk-taking, and biological measures of sexually transmitted infection (STI+) in a sample of hazardously drinking incarcerated women.

METHODS

Two hundred forty-five hazardously drinking incarcerated women self-reported alcohol consumption and consequences, impulsivity, and sexual behavior.

RESULTS

Biological testing revealed a 22.9% prevalence rate for STI+. In this sample, sexual risk-taking fully mediated the association between impulsivity and likelihood of STI+. In addition, individuals reporting sexual activity with multiple partners were significantly more likely to test STI+ than those reporting sexual activity with a primary partner.

CONCLUSION

These results support previous research on impulsivity by demonstrating that impulsivity leads to STI+ through risky behavioral choices. These findings also extend prior work by documenting this association using biologically confirmed measures in a vulnerable female population that carries multiple risk factors and thus warrants increased research attention.

Prevalence and predictors of sexually transmitted infections in hazardously-drinking incarcerated women

Incarcerated women are at high risk for sexually transmitted infections. Left untreated, these infections can have severe adverse health effects. In this study the authors present prevalence rates of trichomonas, chlamydia, and gonorrhea, and factors related to having a sexually transmitted infection in a sample of 245 hazardously-drinking incarcerated women who reported heterosexual intercourse in the previous 3 months. Vaginal swabs were collected following the self-report baseline assessment. Participants averaged 34.0 (±8.8) years of age; 174 (71.3%) were non-Hispanic Caucasian, 47 (19.3%) were African-American, 17 (7.0%) were Hispanic, and 6 (2.5%) were of other racial or ethnic origins. Twenty-three percent of participants tested positive for chlamydia, trichomonas, or gonorrhea. Being African-American, more frequent sex with a casual partner, and reporting more than one male partner were significantly positively related to sexually transmitted infection, while more frequent sex with a main partner was inversely related. Due to the high rates of infection in this population, jail admission provides a public health opportunity to access a concentrated group of sexually transmitted infectious women. Sexually transmitted infection testing targeted at specific demographic factors, for instance younger age, will miss infected women. Risky sexual partnerships, as well as the benefit of maintaining stable main partnerships may be important topics during sexually transmitted infection prevention interventions.

Incidence of sexually transmitted infections among hazardously drinking women after incarceration

INTRODUCTION AND BACKGROUND

At the time of incarceration, women have a high prevalence of sexually transmitted infections (STI). In the months after community release, women remain at high risk for new infections. This study assessed the rates and predictors of incident chlamydia, gonorrhea, and trichomoniasis in a sample of hazardously drinking women after incarceration.

METHODS

Self-reported behavioral data were collected from 245 incarcerated women. Vaginal swabs were collected at baseline, and 3- and 6-month time points and tested for chlamydia, gonorrhea, and trichomoniasis. Treatment was provided for all positive tests.

RESULTS

Participants' mean age was 34.1 years of age; 175 (71.4%) were Caucasian, 47 (19.2%) were African American, 17 (6.9%) were Hispanic, and 6 (2.4%) were of other ethnic origins. The STI incidence rate was estimated to be 30.5 (95% confidence interval, 21.3-43.5) new infections per 100 person-years. Number of male sex partners reported during follow-up was a significant (z = 2.16; p = .03) predictor of STI; each additional male sex partner increased the estimated hazard of STI by 1.26.

CONCLUSION

Incarcerated women who are hazardous drinkers are at high risk for STI in the months after their return to the community. In addition to testing and treatment during incarceration, post-release rescreening, education, partner treatment, and follow-up are recommended.

Hazardously drinking women leaving jail: time to first drink

This study evaluated time to first drink in women being released from jail to determine predictors of early relapse among women with hazardous drinking and HIV risk behaviors. Between February 2004 and June 2007, 245 participants were recruited from the Rhode Island Department of Corrections. Following the baseline assessment, participants were randomized to a motivational intervention group or to a control condition. Follow-up assessments at 1, 3, and 6 months were completed for 210 participants. Alcohol use during follow-up occurred in 86.7% of participants, 42.4% initiated alcohol use on Day 1. The rate of initiation was associated with norms favorable to using alcohol (p < .01) and having a partner with an alcohol problem (hazard ratio [HR] = 1.62, p < .01). The rate of drink initiation decreased significantly (HR = 0.82, p < .05) as length of incarceration increased. The intervention was not associated with decreased drinking. Interventions to maintain abstinence need to reach women within their first days postrelease.

Motivational interviewing for substance abuse

BACKGROUND

There are 76.3 million people with alcohol use disorders worldwide and 15.3 million with drug use disorders. Motivational interviewing (MI) is a client-centred, semi-directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. The intervention is used widely, and therefore it is important to find out whether it helps, harms or is ineffective.

OBJECTIVES

To assess the effectiveness of motivational interviewing for substance abuse on drug use, retention in treatment, readiness to change, and number of repeat convictions.

SEARCH STRATEGY

We searched 18 electronic databases, 5 web sites, 4 mailing lists, and reference lists from included studies and reviews. Search dates were November 30, 2010 for Cochrane Library, Medline, Embase and PsychINFO.

SELECTION CRITERIA

Randomized controlled trials with persons dependent or abusing substance. Interventions were MI or motivational enhancement therapy. The outcomes were extent of substance abuse, retention in treatment, motivation for change, repeat conviction.

DATA COLLECTION AND ANALYSIS

Three authors independently assessed studies for inclusion, and two authors extracted data. Results were categorized into (1) MI versus no-treatment control, (2) MI versus treatment as usual, (3) MI versus assessment and feedback, and (4) MI versus other active treatment. Within each category, we computed meta-analyses separately for post-intervention, short, medium and long follow-ups.

MAIN RESULTS

We included 59 studies with a total of 13,342 participants. Compared to no treatment control MI showed a significant effect on substance use which was strongest at post-intervention SMD 0.79, (95% CI 0.48 to 1.09) and weaker at short SMD 0.17 (95% CI 0.09 to 0.26], and medium follow-up SMD 0.15 (95% CI 0.04 to 0.25]). For long follow-up, the effect was not significant SMD 0.06 (95% CI-0.16 to 0.28). There were no significant differences between MI and treatment as usual for either follow-up post-intervention, short and medium follow up. MI did better than assessment and feedback for medium follow-up SMD 0.38 (95% CI 0.10 to 0.66). For short follow-up, there was no significant effect . For other active intervention there were no significant effects for either follow-up.There was not enough data to conclude about effects of MI on the secondary outcomes.

AUTHORS' CONCLUSIONS

MI can reduce the extent of substance abuse compared to no intervention. The evidence is mostly of low quality, so further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.

Alcoholics Anonymous and hazardously drinking women returning to the community after incarceration: predictors of attendance and outcome

BACKGROUND

The number of women incarcerated within the United States has risen dramatically in recent decades, and high rates of alcohol problems are evident among this population. Although little is known about the patterns of help utilization and efficacy for alcohol problems, preliminary evidence suggests that Alcoholics Anonymous (AA) is a widely available resource for this population.

METHODS

Data were collected as part of a study evaluating the effect of a brief intervention to reduce alcohol use among hazardously drinking (i.e., score of 8 or above on the Alcohol Use Disorders Identification Test or 4 or more drinks at a time on at least 3 days in prior 3 months) incarcerated women. The current study characterized demographic, clinical, and previous AA attendance variables associated with AA attendance in the 6 months following incarceration. Associations between frequency of AA attendance and drinking outcomes following incarceration were also evaluated.

RESULTS

Among the 224 participants who provided data about AA attendance, 54% reported some AA attendance during the follow-up assessment period. AA attendance in the year prior to study entry (OR = 4.02; 95% CI: 3.32 to 4.71) and greater baseline consequences of alcohol use (OR = 2.09; 95% CI: 1.73 to 2.44) were associated with increased odds of higher frequency of AA attendance following incarceration. Weekly or greater AA attendance was associated with reductions in negative drinking consequences (B = -0.45; p < 0.01) and frequency of drinking days (B = -0.28; p < 0.01) following incarceration.

CONCLUSIONS

Findings from this study suggest that AA is frequently utilized by hazardously drinking women following incarceration. Alcohol outcomes may be enhanced by AA attendance at a weekly or greater frequency is associated with better alcohol outcomes relative to lower levels of AA attendance. Evaluation of clinical guidelines for prescribing AA attendance for incarcerated women remains a task for future research.