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

Arun Sondhi,Alessandro Leidi,David Best

doi:10.1186/s13011-020-00310-5

Abstract

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

Highlights

There is an emerging literature on the impact of correctional substance abuse treatment (SAT) on reoffending for people in prison with substance misuse issues
There is a sizeable literature on SAT in correctional settings whereby treatment for alcohol use disorder (AUD) has been integrated within interventions addressing illicit drug misuse, there is relatively little known on the effectiveness of correctional treatment for people in prison who present with alcohol issues only
Data on prison leavers were linked to the National Drug Treatment Monitoring System (NDTMS) a public health surveillance system used in the community and in prison settings

Summary

Introduction

There is an emerging literature on the impact of correctional substance abuse treatment (SAT) on reoffending for people in prison with substance misuse issues. There is a sizeable literature on SAT in correctional settings whereby treatment for AUDs has been integrated within interventions addressing illicit drug misuse, there is relatively little known on the effectiveness of correctional treatment for people in prison who present with alcohol issues only. The National Health Service (NHS) supports English community and correctional SAT Implicit in this framework is the concept of ‘equivalence of care’ across correctional and community SAT based on the principle of universality, where any person in prison is entitled to access the same treatment in correctional settings as in the community. Inconsistencies in achieving equivalence of care have been noted due to the increased size and complexity of the prison population, alongside the effects of austerity on resourcing [28]

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