Phoenix Futures are a not for profit organisation currently contracted to ... correctly identified on admission as requiring input from substance misuse services.
Substance Misuse Identification & Treatment in HMP Aberdeen Stephen Davidson (University of Aberdeen)
Background
Results
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Scotland has one of the highest rates of substance misuse in Europe: • 37,000+ hospital admissions per year from alcohol misuse • 55,000+ hospital admissions per year from opiate and benzodiazepine misuse 1
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Scotland also has one of the highest prison rates in Europe, where: • ¾ of prisoners have an alcohol use disorder • 73% test positive for illicit drugs on admission 1
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HMP Aberdeen is the local prison for North East Scotland and the Northern Isles and accommodates: • All remand prisoners from this geographical location • A proportion of short sentenced male prisoners from Grampian, Moray, Orkney and Shetland 2
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Phoenix Futures are a not for profit organisation currently contracted to provide specialist drug and alcohol treatment on behalf of the Scottish Prison Service (SPS) to sentenced prisoners only 3
‘Zone 4’ and ‘High Risk’ are the recommended thresholds for referring an individual to SMS 24 (65%; CI = 49.5 – 80.2) prisoners fell into the above categories for at least one substance 6 (16.2%) and 1 (2.7%) prisoner(s) fell into the above categories for two and three substances respectively
Aims •
To investigate whether individuals who are incarcerated at HMP Aberdeen are being correctly identified on admission as requiring input from substance misuse services (SMS)
Methods
69 new admissions arrived in HMP Aberdeen during the study period 37 (53.6%) of those individuals were interviewed
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2 of the 74 urine drug analysis results showed discrepancies to the information given during interview
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The total population of HMP Aberdeen during the study period was on average 165 (CI = 162.4 – 166.9) with 100 sentenced prisoners (CI = 98.8 – 102.0) On average 49 prisoners were involved with Phoenix Futures during the study period – 48.3% (CI = 45.6 – 51.0) of the sentenced prison population at HMP Aberdeen
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The study was reviewed and given a favourable opinion from the National Research Ethics Service Committee in East of England – Essex, the local NHS Research & Development office and the SPS Research Access & Ethics Committee
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This research involved a cross sectional, structured and interview based study carried out for 4 weeks in February 2013 All new English speaking, male admissions either remanded or sentenced were eligible participants First contact was made through an invitation letter given on admission to all new prisoners by the duty nurse Those interested in taking part in the research were given an information sheet when they returned their invitation letter to the duty nurse the next day The following day participants still willing to take part in the study then gave their written consent to be interviewed by the researcher, as well as permission for the researcher to access their urine drug analysis results
Discussion/Conclusions
Participants were screened for substance misuse using the Alcohol Use Disorders Identification Test (AUDIT) and the Alcohol, Smoking and Substance Involvement Screening Tool (ASSIST) tools AUDIT was developed by the World Health Organisation (WHO) as a simple tool to help identify harmful alcohol consumption 4 ASSIST was also developed by the WHO as an easy to follow manual in identifying harmful substance misuse, and in the case of this study was used for opiate and benzodiazepine misuse 5 The scoring systems in these tools divide individuals into different tiers of risk: • Zone I, II, III &IV in AUDIT • Lower, Moderate & High Risk in ASSIST 4, 5
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The prevalence of harmful substance misuse amongst new admissions was then compared against the average proportion of prisoners who were on the caseload of the SMS in HMP Aberdeen during the study period Results of urine screens for prisoners interviewed were obtained and compared to the screening tool results
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From the findings we can infer that there are improvements to be made in the identification and treatment of substance misusers at HMP Aberdeen The prevalence of alcohol and benzodiazepine misuse is higher than the misuse of opiates in the prison population of HMP Aberdeen Polysubstance misuse is an additional and relatively common problem within this population group The answers given during interview can be considered valid in regards to the congruent urine drug analysis results A direct comparison between the interview results and the Phoenix Futures caseload may not be made since both remanded and sentenced prisoners were interviewed Future research should address the limitations from this study and measure the effectiveness of SMS in other UK prisons as well as the community facilities for prisoners on liberation
Acknowledgements • This study could not have been possible without the contributions of Dr Margaret Bremner, Dr Bruce Davidson, the healthcare staff at HMP Aberdeen and of course the prisoners who participated in the research References 1) The Scottish Public Health Observatory. Available at: http://www.scotpho.org.uk/. Accessed February, 2013. 2) Scottish Prison Service. Available at: http://www.sps.gov.uk/home/home.aspx. Accessed February, 2013. 3) Phoenix Futures - Our Prison Services. Available at: http://scotland.phoenix-futures.org.uk/ourservices/our-prison-services/. Accessed February, 2013. 4) The Alcohol Use Disorders Identification Test. Available at: http://whqlibdoc.who.int/hq/2001/who_msd_msb_01.6a.pdf. Accessed February, 2013. 5) The Alcohol, Smoking and Substance Involvement Screening Tool. Available at: http://whqlibdoc.who.int/publications/2010/9789241599382_eng.pdf. Accessed Feb, 2013
