Delivering brief interventions for alcohol use in custody suites: Dr Ruth McGovern talks to the SSA
In the custody suite they would ask ‘has your alcohol use in some way impacted on your involvement with an offence?’. But they would also ask about some of the other risks that from increased risk or high-risk drinking
SSA: Your study focused on custody suite staff and brief interventions for alcohol, can you tell me a bit more about what you did?
Dr McGovern: “So, we were conducting a feasibility randomised controlled trial of alcohol screening and brief interventions in a custody suite setting. It was in the North-East and also the South West in Bristol. Going into the study we thought it would be the Detention Officers that would probably be part of the feasibility trial, but actually what we learned when we were recruiting was that some sites had Alcohol Intervention Referral (AIR) workers and arrest referral workers and they wanted them to be involved in the trials. The qualitative study that was published in Drugs: Education Prevention and Policy was linked to the feasibility randomised controlled trial to try and understand a little bit more about the different roles and who might be best placed to administer alcohol screening and brief interventions within custody suits.”
Can you say a bit more about the different roles of Detention Officers and Alcohol Intervention Referral Workers?
“The Detention Officers are civilian members of the police force. Their role was more closely affiliated with the containment function of the custody suites. They were involved in the routine processes for prisoners. But increasingly over recent years there’s been a greater focus placed on care within that role. So, as a result of things like deaths following custody there’s an appreciation that a lot of the arrestees in the custody suite could be vulnerable. It was about trying to manage some of the health and social care concerns that an arrestee might have whilst they are within custody. But that might continue to have some impact as they left.”
“Alcohol Intervention Referral workers, however, tended to be employed by voluntary sector organisations that supported people with alcohol or drug problems and were usually affiliated with a caring role. They often had a role where they would identify someone in the custody suite setting and try and support them to access services following their release within their local communities.”
What kind of brief interventions did people deliver?
“Broadly speaking there are two types of brief intervention. There’s one which is more about brief advice and there’s another one that’s based on a brief lifestyle counselling approach. We asked all custody staff who were randomised to an intervention to deliver brief advice. Following a screening and identification of someone who was drinking above what was recommended the custody staff would then provide 10 minutes of brief advice in order to help the person identify the risks associated with their drinking and connect it with some of the difficulties they might have been experiencing. So, obviously in the custody suite they would ask ‘has your alcohol use in some way impacted on your involvement with an offence?’. But they would also ask about some of the other risks that from increased risk or high-risk drinking. Then give some guidance about how that person might go about making changes.”
Some offences were thought to be too severe or were more likely to have longer sanctions put in place. So, it was really questioned about whether it was appropriate, necessary or would do any good in that situation.
In your paper you said that Detention Officers and Alcohol Intervention Referral workers motivation to intervene varied according to the characteristics of the person they were dealing with. What kinds of characteristics changed this?
“The custody staff seemed to think that some people were better suited to the alcohol intervention than others. A lot of this was based on the frequency of the event and the severity of the crime. So, if you’re person who gets arrested on a regular basis who’s in and out of custody it would feel really appropriate to deliver the intervention because it might deter that person from whatever the behaviour was that lead to them being repeatedly arrested. The custody staff could see a connection between intervening and changing the behaviour, and that seemed to bring about some motivation.”
“Some offences were thought to be too severe or were more likely to have longer sanctions put in place. So, it was really questioned about whether it was appropriate, necessary or would do any good in that situation. So, where somebody had been arrested for a sexual offence it was often considered that it wouldn’t help to deliver an alcohol intervention. Because the custody staff needed to be able to see the teachable moment too. There was also something about people that the custody staff felt deserving of care in that setting, so there were some values that were involved in that as well. On some occasions, not always. On some occasions there was some sense that it wouldn’t be appropriate necessary or helpful.”
You also mentioned about a busy working environment, were there times when the amount of work or the type of environment prevented people from delivering those interventions?
“Yeah, it was really interesting this one because if you take the Detention Officers, they were there the most, so 24/7 there was a Detention Officer as a member of custody staff. But they had other tasks, so, although they felt it was legitimate to do brief alcohol interventions, that legitimacy was lost if doing so in any way impacted upon any of the activities that were central to their role. So, brief interventions were the nice, but not necessary tasks if you like.”
“The Alcohol Intervention Referral workers on the other hand were there for that reason so I guess that the pressure of the environment was different for them insofar as delivering this kind of intervention was their central task. Equally, their central task, although important to them, could not interfere with the process and requirements that were core to the custody suite function. So it was always this balancing act whereby the people who were best placed were different from the people who were best suited to the intervention activity. And this all competed with the tasks that necessary for the containment setting.”
“We talked about the fingerprinting processes because at that point we could see an situation that could be a really positive interaction, but because there were tasks that were the priority at that point it was difficult to draw in the staff. They saw that fingerprinting was their priority and they needed to get on with that particular task. So, there were lots of missed of opportunities from our point of view, but not from the custody staff’s point of view of course because they had different priorities.”
Your paper focused on the feasibility of doing this and understanding the context in which interventions were delivered. Is there research on effectiveness of delivering brief interventions in custody suits?
“Not really. There’s a lot of evidence around alcohol brief interventions in primary health care settings and as a result of just how large and robust that evidence base is, NICE has made recommendations that brief alcohol interventions are implemented in a range of settings including the criminal justice system, but there’s really not a lot of evidence for that.”
“We tried to do the feasibility trial with a view to doing a large randomised controlled trial, but we found that it really wasn’t feasible to do a trial in this particular setting. Or if it was it was going to be really quite difficult, because we couldn’t follow up. We had really low follow-up rates in this population so we would need to use an outcome measure that was routinely collected such as arrest rates. But, where would you go for funding where it isn’t a health outcome? So it became really quite difficult to find a way to make this particular research feasible.”
Dr McGovern is a lecturer in Public Health at Newcastle University, in the Population Health Sciences Institute.
The original paper was published in Drugs: Education Prevention and Policy: Containment and care? A qualitative interview study exploring police custody staff views about delivering brief alcohol interventions to heavy drinking arrestees. This interview was recorded in February 2021.
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