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

A Systematic Review of the Efficacy of Alcohol Interventions for Incarcerated People Abstract 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. INTRODUCTION Alcohol substantially contributes to the global burden of disease and is responsible for 2.3 million premature deaths worldwide, many of which are preventable (Rehm et al., 2009). A recent survey showed that 70% of prisoners in the UK admitted drinking when committing the offence for which they were imprisoned (Alcohol and Crime Commission, 2014). Hazardous drinking is a repeated pattern of drinking that increases the risk of physical or psychological problems (Saunders and Lee, 2000), whereas harmful drinking is defined by the presence of these problems (World Health Organisation, 1992). Drinking at hazardous or harmful levels are often categorised as risky drinking. There are ~10.35 million people imprisoned worldwide. The USA has 2.28 million and the UK 85,843 (Walmsley, 2015). Worldwide, the prison population is 144 per 100,000 people; in the USA, this is 698 per 100,000 people compared witrh 148 per 100,000 in the UK (Walmsley, 2015). It has been shown that drinking norms in the criminal justice system differ widely from those in the general population (Newbury-Birch et al., 2016b). Risky drinking is higher in the criminal justice system than in the general population (Newbury-Birch et al., 2016b). However, it has been shown that risky drinking amongst incarcerated people differs across the world. A systematic review carried out by Newbury-Birch et al. (2016b) found that between 51% and 83% of incarcerated people are classified as risky drinkers; in the USA, risky drinking levels have been shown to be around 50% (Binswanger et al., 2009) and in Africa, the rates are shown to be just over 50% (Muigai, 2014). Furthermore, rates of dependence among those who are incarcerated have been shown to be up to ten times higher than the general population (Newbury-Birch et al., 2016b). Although the relationship is complex, there is well-documented evidence of an association between alcohol use and crime (Boden et al., 2012), with a complex interplay between the amount drank, the pattern of drinking and the individual and contextual factors (Graham et al., 2012). Evidence tells us that intensive interventions that target high-risk offenders work best for reducing recidivism (Andrews and Bonta, 2010) and this is where resources are being placed. However, services are currently advocating the use of brief interventions in the criminal justice system (Newbury-Birch et al., 2016b). Brief interventions have been shown to be effective in primary healthcare (O’Donnell et al., 2014). They are typically applied to opportunistic, non-treatment seeking populations, delivered by practitioners other than addiction specialists (Miller and Rollnick, 2002). Brief intervention largely consists of two different approaches (National Institute for Clinical and Health Excellence, 2010): simple structured advice which, following screening, seeks to raise awareness through the provision of personalised feedback and advice on practical steps to reduce drinking behaviour and its adverse consequences; and extended brief intervention, which generally involves behaviour change counselling. Extended brief intervention introduces and evokes change by giving the patient the opportunity to explore their alcohol use as well as their motivations and strategies for change. Both forms share the common aim of helping people to change drinking behaviour to promote health, but they vary in the precise means by which this is achieved. There is a wide variation in the duration and frequency of brief alcohol interventions, but typically they are delivered in a single session or a series of related sessions lasting between 5 min and 60 min and can be implemented by a range of practitioners in a wide variety of settings (Kaner et al., 2007). To date, there is a lack of evidence relating to the use of brief interventions in the criminal justice system in general, and in the prison system in particular (Newbury-Birch et al., 2016b). Intervening to reduce alcohol use has been shown to be cost-effective, generating both long- and short-term savings (UKATT Research Team, 2005). Therefore, given the high levels of risky drinking, the links between alcohol and crime, and the costs to society, it is important to find effective interventions that not only reduce alcohol consumption, but also potentially recidivism. Interventions carried out within the criminal justice system could potentially capitalise upon the ‘teachable moment’ considered to be conducive of behaviour change, wherein individuals can be encouraged to consider their alcohol use within the context of their offending behaviour and its punitive consequences (Babor and Grant, 1989). 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. METHODS Search strategy and selection criteria We carried out a systematic review of the international literature, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines on reporting of systematic reviews (Moher et al., 2009). The systematic review protocol was registered on the PROSPERO Register at the University of York (CRD42016039895). We included Randomised Controlled Trials (RCTs) or matched group trials. As well as examining the efficacy/effectiveness of alcohol interventions, the current review adds to other reviews in the criminal justice setting (Graham et al., 2012; Newbury-Birch et al., 2016b) by including evidence around the timing of screening and interventions within the offender journey and information about the type and nature of the interventions themselves. We included studies with control groups comprising: treatment as usual; information-only; assessment only; no assessment or another intervention. Studies eligible for this review were peer-reviewed trials of any alcohol interventions carried out in the jail/prison setting (including remand). We included interventions that were categorised as brief interventions as well as extended longer alcohol psychosocial interventions (extended brief interventions). We included individuals aged 16 years or over and any outcome measure. We excluded studies that included a drug and alcohol intervention where alcohol information could not be isolated. We searched: MEDLINE; PsychINFO; Web of Science; Cochrane Library; EBSCO; CINAHL and the Campbell Collaboration Library. We included all dates in the search. The search was conducted in August 2017. Citations were scanned and we contacted experts in the field to minimise selection bias. The search terms used were: ‘alcohol OR alcoholism OR alcohol abuse OR alcohol misuse OR binge drinking’ AND ‘crim* OR prison* OR offend* OR correctional OR penitentiary OR incarc* OR remand’ AND ‘randomised controlled trials OR randomise OR control OR trial OR random* OR quazi* OR quasi* OR matched’ with Boolean/phrase searches. Searches were tailored to the search functionality of each database. We also searched grey literature including google scholar and did a 360°-citation check of included papers. All authors were involved in the data sifting. Two reviewers on the team conducted eligibility assessments of titles and abstracts independently. Disagreements between reviewers were resolved by consensus or by discussing with a third person. Data were extracted into a Microsoft Excel spreadsheet independently by J.F., E.L.G., G.M., S.L. and A.H. These researchers jointly reviewed the extracted data and all studies were double extracted by D.N.-B. Data were extracted on characteristics of trial participants, type and nature of interventions (including content, duration, frequency, provider, setting), type of outcome measure as well as information relating to the interventions itself. We used the Template for Intervention Description and Replication (TIDieR) checklist to ascertain how interventions are reported in the included studies (Hoffman et al., 2014). One researcher completed the checklist (D.N.-B.) and it was checked by another (J.F.). Quality assessment The relevant screening tools from Critical Appraisal Skills Programme were used by one researcher (C.G.) and checked by another (D.N.-B.) (MKPC Trust, 2002). High risk of bias was recorded if ‘no’ or ‘unsure’ was recorded for 6 or more of the 11 questions on the tool. Medium risk of bias was assigned if ‘no’ or ‘unsure’ was recorded for 4–5 questions and low risk for 1–3 questions (Table 3). Data synthesis We grouped intervention content into two categories. The first was short interventions that were categorised as brief interventions and included up to three sessions. The second was extended brief interventions delivered over more than three sessions (Table 1). Table 1. Details of included papers from 11 Articles (9 studies) Author (country); study type Setting (% male/female) Age (ethnicity) Follow-up period (follow-up rates) Alcohol screening used and cut-off used (who screened) Intervention [number randomised] Control [number randomised] Brief interventions Davis et al. (2003) (USA); RCT Prison (97% male) Mean 45.7 SD 7.7 (49% Caucasian; 38% African-American) 2 Months (41%) Form-90 alcohol tool (researcher) 1 Session of MI (60 min) [n = 36] TAU and information on local services [n = 37] Stein et al. (2010) (USA); RCT Prison/jail (100% female) Mean 34.1 SD 8.9 (71% Caucasian; 19% African-American; 7% Hispanic) 1, 3 and 6 Months (76%, 79%, 79%) AUDIT 8+ (researcher) 2 Sessions of MI (45–60 min): Second session after the first follow-up [n = 125] TAU [n = 120] Begun et al. (2011) (USA); RCT Local Jails (100% female) Mean 35.7 SD 8.7 (57% African-American; 31% White; 6% Hispanic) 2 Months post-release (20%) AUDIT-12 8+ (researcher) 1 Session of MI (60–90 min) [n = 468] TAU [n = 261] Stein et al. (2011b) (USA); RCT Juvenile Correctional Facility (86% male) Mean 17.1 SD 1.1 (33% White; 29% Hispanic; 28% African-American) 3 Months (86%) Risk and Consequences Questionnaire- Alcohol (Researcher) 2 Sessions of MI (session 1 = 90 min; session 2 = 60 min) [n = 189 randomised, no breakdown given] 2 Sessions of relaxation training (session 1 = 90 min; session 2 = 60 min) Stein et al. (2011a) (USA); RCT Juvenile Correctional Facility (84% male) Mean 17.1 SD 1.1 (32% Hispanic; 30% African-American; 30% White) Owens and McCrady (2016) (USA); RCT Jails (100% male) Mean age 34.4 SD 9.8 (27.5% Hispanic; 20% Native American/Alaskan Native; 17.5% African-American; 7.5% Biracial/multiracial/other) Between 1 and 3 months (63%) ASSIST (Researcher) 1 Session of MI (50–60 min) [n = 23] 1 Session of educational videos (50–60 min) [n = 17] Longer interventions Chance et al. (1990) (USA); Matched group Prison (100% male) Not given 30 Weeks (68%) Unsure (unsure) 6–18 Months lifeline counselling (reality therapy and control theory) plus AA/NA attendance and aftercare including AA/NA and family counselling [n = 20] TAU [n = 40] Baldwin et al. (1991) (UK); RCT Juvenile Correctional Facility (100% male) Mean 19.4; range 16.9-20.8 (no ethnicity given) 12 Months (78%) More than half of their total offences drink-related (Social worker) 6 Sessions of MI (each session 120 min) [n = 14] TAU [n = 13] Peters et al. (1993) (USA) matched group Jail (74% male) Mean 29 SD 7.5 (53% African-American; 44% Caucasian) 12 Months (44%) Addiction Severity Index (Programme counsellors) Cognitive-behavioural, skills based intervention over 6 weeks (three groups) 1. Special topics group re motivation and commitment; 2. Relapse prevention (1); 3. Relapse prevention (2) 27+ sessions [n = 535] TAU [n = 422] Bowes et al. (2012), (UK); RCT Prison (100% male) Mean 24.5 SD 5.7 (93% White) Unclear (77%) Alcohol-related Aggression Questionnaire (unsure) 10 Sessions covering selection of topics; 20 h of group treatment, and 4 h of individual support over 4 weeks (COVAID) [n = 56] TAU [n = 59] Bowes et al. (2014), (UK) RCT Author (country); study type Setting (% male/female) Age (ethnicity) Follow-up period (follow-up rates) Alcohol screening used and cut-off used (who screened) Intervention [number randomised] Control [number randomised] Brief interventions Davis et al. (2003) (USA); RCT Prison (97% male) Mean 45.7 SD 7.7 (49% Caucasian; 38% African-American) 2 Months (41%) Form-90 alcohol tool (researcher) 1 Session of MI (60 min) [n = 36] TAU and information on local services [n = 37] Stein et al. (2010) (USA); RCT Prison/jail (100% female) Mean 34.1 SD 8.9 (71% Caucasian; 19% African-American; 7% Hispanic) 1, 3 and 6 Months (76%, 79%, 79%) AUDIT 8+ (researcher) 2 Sessions of MI (45–60 min): Second session after the first follow-up [n = 125] TAU [n = 120] Begun et al. (2011) (USA); RCT Local Jails (100% female) Mean 35.7 SD 8.7 (57% African-American; 31% White; 6% Hispanic) 2 Months post-release (20%) AUDIT-12 8+ (researcher) 1 Session of MI (60–90 min) [n = 468] TAU [n = 261] Stein et al. (2011b) (USA); RCT Juvenile Correctional Facility (86% male) Mean 17.1 SD 1.1 (33% White; 29% Hispanic; 28% African-American) 3 Months (86%) Risk and Consequences Questionnaire- Alcohol (Researcher) 2 Sessions of MI (session 1 = 90 min; session 2 = 60 min) [n = 189 randomised, no breakdown given] 2 Sessions of relaxation training (session 1 = 90 min; session 2 = 60 min) Stein et al. (2011a) (USA); RCT Juvenile Correctional Facility (84% male) Mean 17.1 SD 1.1 (32% Hispanic; 30% African-American; 30% White) Owens and McCrady (2016) (USA); RCT Jails (100% male) Mean age 34.4 SD 9.8 (27.5% Hispanic; 20% Native American/Alaskan Native; 17.5% African-American; 7.5% Biracial/multiracial/other) Between 1 and 3 months (63%) ASSIST (Researcher) 1 Session of MI (50–60 min) [n = 23] 1 Session of educational videos (50–60 min) [n = 17] Longer interventions Chance et al. (1990) (USA); Matched group Prison (100% male) Not given 30 Weeks (68%) Unsure (unsure) 6–18 Months lifeline counselling (reality therapy and control theory) plus AA/NA attendance and aftercare including AA/NA and family counselling [n = 20] TAU [n = 40] Baldwin et al. (1991) (UK); RCT Juvenile Correctional Facility (100% male) Mean 19.4; range 16.9-20.8 (no ethnicity given) 12 Months (78%) More than half of their total offences drink-related (Social worker) 6 Sessions of MI (each session 120 min) [n = 14] TAU [n = 13] Peters et al. (1993) (USA) matched group Jail (74% male) Mean 29 SD 7.5 (53% African-American; 44% Caucasian) 12 Months (44%) Addiction Severity Index (Programme counsellors) Cognitive-behavioural, skills based intervention over 6 weeks (three groups) 1. Special topics group re motivation and commitment; 2. Relapse prevention (1); 3. Relapse prevention (2) 27+ sessions [n = 535] TAU [n = 422] Bowes et al. (2012), (UK); RCT Prison (100% male) Mean 24.5 SD 5.7 (93% White) Unclear (77%) Alcohol-related Aggression Questionnaire (unsure) 10 Sessions covering selection of topics; 20 h of group treatment, and 4 h of individual support over 4 weeks (COVAID) [n = 56] TAU [n = 59] Bowes et al. (2014), (UK) RCT AA, alcoholics anonymous; MI, motivational interviewing; min, minutes; NA, narcotics anonymous; TAU, treatment as usual. Table 1. Details of included papers from 11 Articles (9 studies) Author (country); study type Setting (% male/female) Age (ethnicity) Follow-up period (follow-up rates) Alcohol screening used and cut-off used (who screened) Intervention [number randomised] Control [number randomised] Brief interventions Davis et al. (2003) (USA); RCT Prison (97% male) Mean 45.7 SD 7.7 (49% Caucasian; 38% African-American) 2 Months (41%) Form-90 alcohol tool (researcher) 1 Session of MI (60 min) [n = 36] TAU and information on local services [n = 37] Stein et al. (2010) (USA); RCT Prison/jail (100% female) Mean 34.1 SD 8.9 (71% Caucasian; 19% African-American; 7% Hispanic) 1, 3 and 6 Months (76%, 79%, 79%) AUDIT 8+ (researcher) 2 Sessions of MI (45–60 min): Second session after the first follow-up [n = 125] TAU [n = 120] Begun et al. (2011) (USA); RCT Local Jails (100% female) Mean 35.7 SD 8.7 (57% African-American; 31% White; 6% Hispanic) 2 Months post-release (20%) AUDIT-12 8+ (researcher) 1 Session of MI (60–90 min) [n = 468] TAU [n = 261] Stein et al. (2011b) (USA); RCT Juvenile Correctional Facility (86% male) Mean 17.1 SD 1.1 (33% White; 29% Hispanic; 28% African-American) 3 Months (86%) Risk and Consequences Questionnaire- Alcohol (Researcher) 2 Sessions of MI (session 1 = 90 min; session 2 = 60 min) [n = 189 randomised, no breakdown given] 2 Sessions of relaxation training (session 1 = 90 min; session 2 = 60 min) Stein et al. (2011a) (USA); RCT Juvenile Correctional Facility (84% male) Mean 17.1 SD 1.1 (32% Hispanic; 30% African-American; 30% White) Owens and McCrady (2016) (USA); RCT Jails (100% male) Mean age 34.4 SD 9.8 (27.5% Hispanic; 20% Native American/Alaskan Native; 17.5% African-American; 7.5% Biracial/multiracial/other) Between 1 and 3 months (63%) ASSIST (Researcher) 1 Session of MI (50–60 min) [n = 23] 1 Session of educational videos (50–60 min) [n = 17] Longer interventions Chance et al. (1990) (USA); Matched group Prison (100% male) Not given 30 Weeks (68%) Unsure (unsure) 6–18 Months lifeline counselling (reality therapy and control theory) plus AA/NA attendance and aftercare including AA/NA and family counselling [n = 20] TAU [n = 40] Baldwin et al. (1991) (UK); RCT Juvenile Correctional Facility (100% male) Mean 19.4; range 16.9-20.8 (no ethnicity given) 12 Months (78%) More than half of their total offences drink-related (Social worker) 6 Sessions of MI (each session 120 min) [n = 14] TAU [n = 13] Peters et al. (1993) (USA) matched group Jail (74% male) Mean 29 SD 7.5 (53% African-American; 44% Caucasian) 12 Months (44%) Addiction Severity Index (Programme counsellors) Cognitive-behavioural, skills based intervention over 6 weeks (three groups) 1. Special topics group re motivation and commitment; 2. Relapse prevention (1); 3. Relapse prevention (2) 27+ sessions [n = 535] TAU [n = 422] Bowes et al. (2012), (UK); RCT Prison (100% male) Mean 24.5 SD 5.7 (93% White) Unclear (77%) Alcohol-related Aggression Questionnaire (unsure) 10 Sessions covering selection of topics; 20 h of group treatment, and 4 h of individual support over 4 weeks (COVAID) [n = 56] TAU [n = 59] Bowes et al. (2014), (UK) RCT Author (country); study type Setting (% male/female) Age (ethnicity) Follow-up period (follow-up rates) Alcohol screening used and cut-off used (who screened) Intervention [number randomised] Control [number randomised] Brief interventions Davis et al. (2003) (USA); RCT Prison (97% male) Mean 45.7 SD 7.7 (49% Caucasian; 38% African-American) 2 Months (41%) Form-90 alcohol tool (researcher) 1 Session of MI (60 min) [n = 36] TAU and information on local services [n = 37] Stein et al. (2010) (USA); RCT Prison/jail (100% female) Mean 34.1 SD 8.9 (71% Caucasian; 19% African-American; 7% Hispanic) 1, 3 and 6 Months (76%, 79%, 79%) AUDIT 8+ (researcher) 2 Sessions of MI (45–60 min): Second session after the first follow-up [n = 125] TAU [n = 120] Begun et al. (2011) (USA); RCT Local Jails (100% female) Mean 35.7 SD 8.7 (57% African-American; 31% White; 6% Hispanic) 2 Months post-release (20%) AUDIT-12 8+ (researcher) 1 Session of MI (60–90 min) [n = 468] TAU [n = 261] Stein et al. (2011b) (USA); RCT Juvenile Correctional Facility (86% male) Mean 17.1 SD 1.1 (33% White; 29% Hispanic; 28% African-American) 3 Months (86%) Risk and Consequences Questionnaire- Alcohol (Researcher) 2 Sessions of MI (session 1 = 90 min; session 2 = 60 min) [n = 189 randomised, no breakdown given] 2 Sessions of relaxation training (session 1 = 90 min; session 2 = 60 min) Stein et al. (2011a) (USA); RCT Juvenile Correctional Facility (84% male) Mean 17.1 SD 1.1 (32% Hispanic; 30% African-American; 30% White) Owens and McCrady (2016) (USA); RCT Jails (100% male) Mean age 34.4 SD 9.8 (27.5% Hispanic; 20% Native American/Alaskan Native; 17.5% African-American; 7.5% Biracial/multiracial/other) Between 1 and 3 months (63%) ASSIST (Researcher) 1 Session of MI (50–60 min) [n = 23] 1 Session of educational videos (50–60 min) [n = 17] Longer interventions Chance et al. (1990) (USA); Matched group Prison (100% male) Not given 30 Weeks (68%) Unsure (unsure) 6–18 Months lifeline counselling (reality therapy and control theory) plus AA/NA attendance and aftercare including AA/NA and family counselling [n = 20] TAU [n = 40] Baldwin et al. (1991) (UK); RCT Juvenile Correctional Facility (100% male) Mean 19.4; range 16.9-20.8 (no ethnicity given) 12 Months (78%) More than half of their total offences drink-related (Social worker) 6 Sessions of MI (each session 120 min) [n = 14] TAU [n = 13] Peters et al. (1993) (USA) matched group Jail (74% male) Mean 29 SD 7.5 (53% African-American; 44% Caucasian) 12 Months (44%) Addiction Severity Index (Programme counsellors) Cognitive-behavioural, skills based intervention over 6 weeks (three groups) 1. Special topics group re motivation and commitment; 2. Relapse prevention (1); 3. Relapse prevention (2) 27+ sessions [n = 535] TAU [n = 422] Bowes et al. (2012), (UK); RCT Prison (100% male) Mean 24.5 SD 5.7 (93% White) Unclear (77%) Alcohol-related Aggression Questionnaire (unsure) 10 Sessions covering selection of topics; 20 h of group treatment, and 4 h of individual support over 4 weeks (COVAID) [n = 56] TAU [n = 59] Bowes et al. (2014), (UK) RCT AA, alcoholics anonymous; MI, motivational interviewing; min, minutes; NA, narcotics anonymous; TAU, treatment as usual. RESULTS The search yielded 10,298 papers, of which 28 papers were fully assessed for eligibility (Fig. 1). Eleven papers from nine studies were included in the final analysis (Chance et al., 1990; Baldwin et al., 1991; Peters et al., 1993; Davis et al., 2003; Stein et al., 2010, 2011a, 2011b; Begun et al., 2011; Bowes et al., 2012, 2014; Owens and McCrady, 2016) (Tables 1 and 2). Seven of the included studies were from the USA (Chance et al., 1990; Peters et al., 1993; Davis et al., 2003; Stein et al., 2010, 2011a, 2011b; Begun et al., 2011; Owens and McCrady, 2016) and two from the UK (Baldwin et al., 1991; Bowes et al., 2012, 2014). The included studies consisted of 2435 participants (range 27–729). Most of the studies included either all male participants (Chance et al., 1990; Baldwin et al., 1991; Bowes et al., 2012, 2014; Owens and McCrady, 2016) or majority male (Peters et al., 1993; Davis et al., 2003; Stein et al., 2011a, 2011b). Only two of the included studies examined women only (Stein et al., 2010; Begun et al., 2011). Because of the heterogeneity of the studies meta-analysis was not possible. Fig. 1. View largeDownload slide Flowchart of data. High risk of bias was recorded if ‘no’ or ‘unsure’ was recorded for 6 or more of the 11 questions on the tool. Medium risk of bias was assigned if ‘no’ or ‘unsure’ was recorded for 4–5 questions and low risk for 1–3 questions. Fig. 1. View largeDownload slide Flowchart of data. High risk of bias was recorded if ‘no’ or ‘unsure’ was recorded for 6 or more of the 11 questions on the tool. Medium risk of bias was assigned if ‘no’ or ‘unsure’ was recorded for 4–5 questions and low risk for 1–3 questions. Table 2. Outcome measures and significant results of included studies Author Outcomes (measures) Significant results Brief interventions Davis et al. (2003) P: Engagement with services with VA substance abuse services (TSR) Those in the IG were statistically more likely to schedule appointments at both VA services with 60 days (66.7 vs. 40.5%; X/5.01, P = 0.025). S: Contact with other substance abuse services (TSR) S: substance use (Form-90) S: Consequences (SIP) S: Addiction severity (ASI) S: Readiness to change (Readiness to Change Questionnaire) Stein et al. (2010) Drinking diary Intervention effects on abstinent days were statistically significant at 3 months (odds ratio = 1.96, 95% CI 1.17, 3.30). Alcohol use disorders (AUDIT) Begun et al. (2011) P: Engagement with substance abuse treatment services Mean reduction in AUDIT score from baseline to follow-up were greater in the intervention group (F(1,148) = 6.336, P< 0.001). P: Level of reported alcohol use (AUDIT-12) Stein et al. (2011b) Risk and consequences of drinking (RCQ-A) No significant results related to alcohol. Depression (CES-D) Stein et al. (2011a) Alcohol and drug use (structured clinical interview for DSM-IV) No significant results related to alcohol. Depression (CES-D) Alcohol use (TLFB) Owens and McCrady (2016) Feasibility No significant results related to alcohol. Pre-intervention motivation and confidence ratings IDPA to assess social networks ASI criminal and treatment history Alcohol and substance use Form-90 Extended interventions Chance et al. (1990) P: Sobriety (weekly urine sample) No significant results related to alcohol. S: Changes in attitude towards self and others (self-perception profiles) S: Control over life (staff self-perception profiles) Baldwin et al. (1991) P: Drinking behaviour (MAST; SADQ) The IG reported less drinking in units per session than CG (P < 0.05). The IG had significantly less ‘rules and regulations’ offences than the CG (P < 0.05). The IG averaged fewer offences against the person compared with the CG (P < 0.05). P: Offending behaviour (self-report) S: Wellbeing (General Health Questionnaire) The CG increased average number of alcohol units per week compared to the IG F(1,19) = 4.546 (P < 0.05); The CG increased average alcohol units per drinking session compared to the IG F(1,19) = 6.753 (P < 0.05). The IG reduced the average number of offences against property compared with the CG F(1,13) = 6.489 (P < 0.05). Peters et al. (1993) P: Recidivism (arrest data) The IG had significantly more days free before arrest compared to the CG t(418) = 3.0 (P = 0.01). Significantly less arrests t(418) = 2.7 (P = 0.01). Significantly less jailed time served t(418) = 2.4 (P = 0.05). Bowes et al. (2012) P: Alcohol-related aggression (ARAQ-AA) There were significant main effects of time, with lower scores at Time 2 for the following measures: ARAQ-AA, F(1, 87) = 4.81, P = 0.03, η2 = 0.05, CDSES OC, F(1, 87) = 15.78, P < 0.001, η2 = 0.15, CDSES CCFC, F(1, 86) = 20.88, P < 0.001, η2 = 0.20, CDSES NA, F(1, 87) = 20.16, P < 0.001, η2 = 0.19, CDSES PM, F(1, 87) = 5.92, P = 0.01, η2 = 0.06, CDSES quantity, F(1, 86) = 4.81, P < 0.001, η2 = 0.15, CDSES frequency, F(1, 87) = 11.37, P = 0.001, η2 = 0.12, total CDSES, F(1, 86) = 25.14, P < 0.001, η2 = 0.23, STAXI-2 Anger Expression Out, F(1, 86) = 10.69, P = 0.002, η2 = 0.11, STAXI-2 Anger Expression In, F(1, 86) = 4.04, P = 0.05, η2 = 0.05, STAXI-2 Anger Control Out, F(1, 86) = 4.42, P = 0.04, η2 = 0.05, STAXI-2 Anger Expression Index, F(1, 86) = 12.57, P = 0.001, η2 = 0.13, and IVE I, F(1, 87) = 16.77, P < 0.001, η2 = 0.16. S: Anger (STAXI-2) S: Impulsivity (IVE) S: Self-efficacy (CDSES) There were significant Group × Time interactions, with the COVAID group reporting significantly greater change scores in the desired directions on ARAQ-AA (η2 = 0.05), ARAQ Total (η2 = 0.05), CDSES OC (η2 = 0.09), CDSES CCFC (η2 = 0.11), CDSES NA (η2 = 0.12), CDSES PM (η2 = 0.04), CDES Frequency (η2 = 0.07), CDSES Quantity (η2 = 0.07), CDSES Total (η2 = 0.14) and the IVE empathy subscale (η2 = 0.04). Bowes et al. (2014) Reconviction No significant results found. Author Outcomes (measures) Significant results Brief interventions Davis et al. (2003) P: Engagement with services with VA substance abuse services (TSR) Those in the IG were statistically more likely to schedule appointments at both VA services with 60 days (66.7 vs. 40.5%; X/5.01, P = 0.025). S: Contact with other substance abuse services (TSR) S: substance use (Form-90) S: Consequences (SIP) S: Addiction severity (ASI) S: Readiness to change (Readiness to Change Questionnaire) Stein et al. (2010) Drinking diary Intervention effects on abstinent days were statistically significant at 3 months (odds ratio = 1.96, 95% CI 1.17, 3.30). Alcohol use disorders (AUDIT) Begun et al. (2011) P: Engagement with substance abuse treatment services Mean reduction in AUDIT score from baseline to follow-up were greater in the intervention group (F(1,148) = 6.336, P< 0.001). P: Level of reported alcohol use (AUDIT-12) Stein et al. (2011b) Risk and consequences of drinking (RCQ-A) No significant results related to alcohol. Depression (CES-D) Stein et al. (2011a) Alcohol and drug use (structured clinical interview for DSM-IV) No significant results related to alcohol. Depression (CES-D) Alcohol use (TLFB) Owens and McCrady (2016) Feasibility No significant results related to alcohol. Pre-intervention motivation and confidence ratings IDPA to assess social networks ASI criminal and treatment history Alcohol and substance use Form-90 Extended interventions Chance et al. (1990) P: Sobriety (weekly urine sample) No significant results related to alcohol. S: Changes in attitude towards self and others (self-perception profiles) S: Control over life (staff self-perception profiles) Baldwin et al. (1991) P: Drinking behaviour (MAST; SADQ) The IG reported less drinking in units per session than CG (P < 0.05). The IG had significantly less ‘rules and regulations’ offences than the CG (P < 0.05). The IG averaged fewer offences against the person compared with the CG (P < 0.05). P: Offending behaviour (self-report) S: Wellbeing (General Health Questionnaire) The CG increased average number of alcohol units per week compared to the IG F(1,19) = 4.546 (P < 0.05); The CG increased average alcohol units per drinking session compared to the IG F(1,19) = 6.753 (P < 0.05). The IG reduced the average number of offences against property compared with the CG F(1,13) = 6.489 (P < 0.05). Peters et al. (1993) P: Recidivism (arrest data) The IG had significantly more days free before arrest compared to the CG t(418) = 3.0 (P = 0.01). Significantly less arrests t(418) = 2.7 (P = 0.01). Significantly less jailed time served t(418) = 2.4 (P = 0.05). Bowes et al. (2012) P: Alcohol-related aggression (ARAQ-AA) There were significant main effects of time, with lower scores at Time 2 for the following measures: ARAQ-AA, F(1, 87) = 4.81, P = 0.03, η2 = 0.05, CDSES OC, F(1, 87) = 15.78, P < 0.001, η2 = 0.15, CDSES CCFC, F(1, 86) = 20.88, P < 0.001, η2 = 0.20, CDSES NA, F(1, 87) = 20.16, P < 0.001, η2 = 0.19, CDSES PM, F(1, 87) = 5.92, P = 0.01, η2 = 0.06, CDSES quantity, F(1, 86) = 4.81, P < 0.001, η2 = 0.15, CDSES frequency, F(1, 87) = 11.37, P = 0.001, η2 = 0.12, total CDSES, F(1, 86) = 25.14, P < 0.001, η2 = 0.23, STAXI-2 Anger Expression Out, F(1, 86) = 10.69, P = 0.002, η2 = 0.11, STAXI-2 Anger Expression In, F(1, 86) = 4.04, P = 0.05, η2 = 0.05, STAXI-2 Anger Control Out, F(1, 86) = 4.42, P = 0.04, η2 = 0.05, STAXI-2 Anger Expression Index, F(1, 86) = 12.57, P = 0.001, η2 = 0.13, and IVE I, F(1, 87) = 16.77, P < 0.001, η2 = 0.16. S: Anger (STAXI-2) S: Impulsivity (IVE) S: Self-efficacy (CDSES) There were significant Group × Time interactions, with the COVAID group reporting significantly greater change scores in the desired directions on ARAQ-AA (η2 = 0.05), ARAQ Total (η2 = 0.05), CDSES OC (η2 = 0.09), CDSES CCFC (η2 = 0.11), CDSES NA (η2 = 0.12), CDSES PM (η2 = 0.04), CDES Frequency (η2 = 0.07), CDSES Quantity (η2 = 0.07), CDSES Total (η2 = 0.14) and the IVE empathy subscale (η2 = 0.04). Bowes et al. (2014) Reconviction No significant results found. P, primary outcome; S, secondary outcome; STAXI-2, state-trait anger expression inventory; IVE, impulsivity, venturesome and empathy scale; CDSES, controlled drinking self-efficacy scale; ASI, addiction severity index; IG, intervention group; CG, control group; RSQ-A, risks and consequence questionnaire—alcohol; TSR, treatment services review; SIP, short inventory of problems; P, primary outcome; S, secondary outcome; DSM-IV, diagnostic and statistical manual of mental disorders, 4th Edition; CES-D, Center for Epidemiological Studies—Depression; TLFB, time line follow back; AUDIT, alcohol use disorders identification test; VA, veterans association; MAST, Michigan Alcohol Screening Test; SADQ, severity of alcohol dependence questionnaire; ARAQ-AA, alcohol-related aggression questionnaire—alcohol aggression scale; CDSES PM, controlled drinking self-efficacy scale positive mood; CDSES CCFC, confidence controlling frequency and consumption; CDSES NA, controlled drinking self-efficacy negative affect; CDSES OC, controlled drinking self-efficacy overall confidence; IDPA, important people drug and alcohol interview. View Large Table 2. Outcome measures and significant results of included studies Author Outcomes (measures) Significant results Brief interventions Davis et al. (2003) P: Engagement with services with VA substance abuse services (TSR) Those in the IG were statistically more likely to schedule appointments at both VA services with 60 days (66.7 vs. 40.5%; X/5.01, P = 0.025). S: Contact with other substance abuse services (TSR) S: substance use (Form-90) S: Consequences (SIP) S: Addiction severity (ASI) S: Readiness to change (Readiness to Change Questionnaire) Stein et al. (2010) Drinking diary Intervention effects on abstinent days were statistically significant at 3 months (odds ratio = 1.96, 95% CI 1.17, 3.30). Alcohol use disorders (AUDIT) Begun et al. (2011) P: Engagement with substance abuse treatment services Mean reduction in AUDIT score from baseline to follow-up were greater in the intervention group (F(1,148) = 6.336, P< 0.001). P: Level of reported alcohol use (AUDIT-12) Stein et al. (2011b) Risk and consequences of drinking (RCQ-A) No significant results related to alcohol. Depression (CES-D) Stein et al. (2011a) Alcohol and drug use (structured clinical interview for DSM-IV) No significant results related to alcohol. Depression (CES-D) Alcohol use (TLFB) Owens and McCrady (2016) Feasibility No significant results related to alcohol. Pre-intervention motivation and confidence ratings IDPA to assess social networks ASI criminal and treatment history Alcohol and substance use Form-90 Extended interventions Chance et al. (1990) P: Sobriety (weekly urine sample) No significant results related to alcohol. S: Changes in attitude towards self and others (self-perception profiles) S: Control over life (staff self-perception profiles) Baldwin et al. (1991) P: Drinking behaviour (MAST; SADQ) The IG reported less drinking in units per session than CG (P < 0.05). The IG had significantly less ‘rules and regulations’ offences than the CG (P < 0.05). The IG averaged fewer offences against the person compared with the CG (P < 0.05). P: Offending behaviour (self-report) S: Wellbeing (General Health Questionnaire) The CG increased average number of alcohol units per week compared to the IG F(1,19) = 4.546 (P < 0.05); The CG increased average alcohol units per drinking session compared to the IG F(1,19) = 6.753 (P < 0.05). The IG reduced the average number of offences against property compared with the CG F(1,13) = 6.489 (P < 0.05). Peters et al. (1993) P: Recidivism (arrest data) The IG had significantly more days free before arrest compared to the CG t(418) = 3.0 (P = 0.01). Significantly less arrests t(418) = 2.7 (P = 0.01). Significantly less jailed time served t(418) = 2.4 (P = 0.05). Bowes et al. (2012) P: Alcohol-related aggression (ARAQ-AA) There were significant main effects of time, with lower scores at Time 2 for the following measures: ARAQ-AA, F(1, 87) = 4.81, P = 0.03, η2 = 0.05, CDSES OC, F(1, 87) = 15.78, P < 0.001, η2 = 0.15, CDSES CCFC, F(1, 86) = 20.88, P < 0.001, η2 = 0.20, CDSES NA, F(1, 87) = 20.16, P < 0.001, η2 = 0.19, CDSES PM, F(1, 87) = 5.92, P = 0.01, η2 = 0.06, CDSES quantity, F(1, 86) = 4.81, P < 0.001, η2 = 0.15, CDSES frequency, F(1, 87) = 11.37, P = 0.001, η2 = 0.12, total CDSES, F(1, 86) = 25.14, P < 0.001, η2 = 0.23, STAXI-2 Anger Expression Out, F(1, 86) = 10.69, P = 0.002, η2 = 0.11, STAXI-2 Anger Expression In, F(1, 86) = 4.04, P = 0.05, η2 = 0.05, STAXI-2 Anger Control Out, F(1, 86) = 4.42, P = 0.04, η2 = 0.05, STAXI-2 Anger Expression Index, F(1, 86) = 12.57, P = 0.001, η2 = 0.13, and IVE I, F(1, 87) = 16.77, P < 0.001, η2 = 0.16. S: Anger (STAXI-2) S: Impulsivity (IVE) S: Self-efficacy (CDSES) There were significant Group × Time interactions, with the COVAID group reporting significantly greater change scores in the desired directions on ARAQ-AA (η2 = 0.05), ARAQ Total (η2 = 0.05), CDSES OC (η2 = 0.09), CDSES CCFC (η2 = 0.11), CDSES NA (η2 = 0.12), CDSES PM (η2 = 0.04), CDES Frequency (η2 = 0.07), CDSES Quantity (η2 = 0.07), CDSES Total (η2 = 0.14) and the IVE empathy subscale (η2 = 0.04). Bowes et al. (2014) Reconviction No significant results found. Author Outcomes (measures) Significant results Brief interventions Davis et al. (2003) P: Engagement with services with VA substance abuse services (TSR) Those in the IG were statistically more likely to schedule appointments at both VA services with 60 days (66.7 vs. 40.5%; X/5.01, P = 0.025). S: Contact with other substance abuse services (TSR) S: substance use (Form-90) S: Consequences (SIP) S: Addiction severity (ASI) S: Readiness to change (Readiness to Change Questionnaire) Stein et al. (2010) Drinking diary Intervention effects on abstinent days were statistically significant at 3 months (odds ratio = 1.96, 95% CI 1.17, 3.30). Alcohol use disorders (AUDIT) Begun et al. (2011) P: Engagement with substance abuse treatment services Mean reduction in AUDIT score from baseline to follow-up were greater in the intervention group (F(1,148) = 6.336, P< 0.001). P: Level of reported alcohol use (AUDIT-12) Stein et al. (2011b) Risk and consequences of drinking (RCQ-A) No significant results related to alcohol. Depression (CES-D) Stein et al. (2011a) Alcohol and drug use (structured clinical interview for DSM-IV) No significant results related to alcohol. Depression (CES-D) Alcohol use (TLFB) Owens and McCrady (2016) Feasibility No significant results related to alcohol. Pre-intervention motivation and confidence ratings IDPA to assess social networks ASI criminal and treatment history Alcohol and substance use Form-90 Extended interventions Chance et al. (1990) P: Sobriety (weekly urine sample) No significant results related to alcohol. S: Changes in attitude towards self and others (self-perception profiles) S: Control over life (staff self-perception profiles) Baldwin et al. (1991) P: Drinking behaviour (MAST; SADQ) The IG reported less drinking in units per session than CG (P < 0.05). The IG had significantly less ‘rules and regulations’ offences than the CG (P < 0.05). The IG averaged fewer offences against the person compared with the CG (P < 0.05). P: Offending behaviour (self-report) S: Wellbeing (General Health Questionnaire) The CG increased average number of alcohol units per week compared to the IG F(1,19) = 4.546 (P < 0.05); The CG increased average alcohol units per drinking session compared to the IG F(1,19) = 6.753 (P < 0.05). The IG reduced the average number of offences against property compared with the CG F(1,13) = 6.489 (P < 0.05). Peters et al. (1993) P: Recidivism (arrest data) The IG had significantly more days free before arrest compared to the CG t(418) = 3.0 (P = 0.01). Significantly less arrests t(418) = 2.7 (P = 0.01). Significantly less jailed time served t(418) = 2.4 (P = 0.05). Bowes et al. (2012) P: Alcohol-related aggression (ARAQ-AA) There were significant main effects of time, with lower scores at Time 2 for the following measures: ARAQ-AA, F(1, 87) = 4.81, P = 0.03, η2 = 0.05, CDSES OC, F(1, 87) = 15.78, P < 0.001, η2 = 0.15, CDSES CCFC, F(1, 86) = 20.88, P < 0.001, η2 = 0.20, CDSES NA, F(1, 87) = 20.16, P < 0.001, η2 = 0.19, CDSES PM, F(1, 87) = 5.92, P = 0.01, η2 = 0.06, CDSES quantity, F(1, 86) = 4.81, P < 0.001, η2 = 0.15, CDSES frequency, F(1, 87) = 11.37, P = 0.001, η2 = 0.12, total CDSES, F(1, 86) = 25.14, P < 0.001, η2 = 0.23, STAXI-2 Anger Expression Out, F(1, 86) = 10.69, P = 0.002, η2 = 0.11, STAXI-2 Anger Expression In, F(1, 86) = 4.04, P = 0.05, η2 = 0.05, STAXI-2 Anger Control Out, F(1, 86) = 4.42, P = 0.04, η2 = 0.05, STAXI-2 Anger Expression Index, F(1, 86) = 12.57, P = 0.001, η2 = 0.13, and IVE I, F(1, 87) = 16.77, P < 0.001, η2 = 0.16. S: Anger (STAXI-2) S: Impulsivity (IVE) S: Self-efficacy (CDSES) There were significant Group × Time interactions, with the COVAID group reporting significantly greater change scores in the desired directions on ARAQ-AA (η2 = 0.05), ARAQ Total (η2 = 0.05), CDSES OC (η2 = 0.09), CDSES CCFC (η2 = 0.11), CDSES NA (η2 = 0.12), CDSES PM (η2 = 0.04), CDES Frequency (η2 = 0.07), CDSES Quantity (η2 = 0.07), CDSES Total (η2 = 0.14) and the IVE empathy subscale (η2 = 0.04). Bowes et al. (2014) Reconviction No significant results found. P, primary outcome; S, secondary outcome; STAXI-2, state-trait anger expression inventory; IVE, impulsivity, venturesome and empathy scale; CDSES, controlled drinking self-efficacy scale; ASI, addiction severity index; IG, intervention group; CG, control group; RSQ-A, risks and consequence questionnaire—alcohol; TSR, treatment services review; SIP, short inventory of problems; P, primary outcome; S, secondary outcome; DSM-IV, diagnostic and statistical manual of mental disorders, 4th Edition; CES-D, Center for Epidemiological Studies—Depression; TLFB, time line follow back; AUDIT, alcohol use disorders identification test; VA, veterans association; MAST, Michigan Alcohol Screening Test; SADQ, severity of alcohol dependence questionnaire; ARAQ-AA, alcohol-related aggression questionnaire—alcohol aggression scale; CDSES PM, controlled drinking self-efficacy scale positive mood; CDSES CCFC, confidence controlling frequency and consumption; CDSES NA, controlled drinking self-efficacy negative affect; CDSES OC, controlled drinking self-efficacy overall confidence; IDPA, important people drug and alcohol interview. View Large Screening for inclusion for five of the included studies was carried out by researchers (Davis et al., 2003; Stein et al., 2010, 2011a, 2011b; Begun et al., 2011; Owens and McCrady, 2016); one by social workers (Baldwin et al., 1991) and one by programme counsellors (Peters et al., 1993). Two studies did not include this information (Chance et al., 1990; Bowes et al., 2012, 2014). A range of tools was used to screen participants into studies. Two studies used the Alcohol Use Disorders Identification Test (AUDIT; Babor et al., 2001) screening tool to screen for risky drinking (Stein et al., 2010; Begun et al., 2011); one used the ASSIST (Owens and McCrady, 2016); one used the Alcohol-Related Aggression Questionnaire (McMurran and Baldwin, 2006; Bowes et al., 2012, 2014); one the Form-90 alcohol tool (Davis et al., 2003); one the Addiction Severity Index (Peters et al., 1993); one the risks and consequences of drinking questionnaire (Stein et al., 2010, 2011a, 2011b); one used the question ‘more than half of their total offences being drink related’ (Baldwin et al., 1991) and one did not give this information (Chance et al., 1990). Brief interventions Five studies (six papers) from the USA examined the efficacy of brief interventions for incarcerated participants (Davis et al., 2003; Stein et al., 2010, 2011a, 2011b; Begun et al., 2011; Owens and McCrady, 2016). The length of the brief interventions ranged from 45 to 150 min (Davis et al., 2003; Stein et al., 2010, 2011a, 2011b; Begun et al., 2011; Owens and McCrady, 2016). One study (two papers) was from the same authors and included relaxation training as the control condition (Stein et al., 2010, 2011a, 2011b). One study included educational videos as the control condition (Owens and McCrady, 2016). The other studies all included treatment as usual as the control condition (Davis et al., 2003; Stein et al., 2010; Begun et al., 2011). Studies did not give information on what treatment as usual was. Four of the studies were conducted with adults (Davis et al., 2003; Stein et al., 2010; Begun et al., 2011; Owens and McCrady, 2016) and one study with juveniles (Stein et al., 2011a, 2011b) (Table 1). In terms of quality assessment, one of the studies was classified as having a low risk of bias (Stein et al., 2010), three as medium risk of bias (Begun et al., 2011; Stein et al., 2011a, 2011b; Owens and McCrady, 2016) and one as having a high risk of bias (Davis et al., 2003) (Table 3). Table 3. Quality assessment of included studies Author Did the trial address a clearly focused issue? Was the assignment of patients to treatments randomised? Were participants blinded? Were the groups similar at the start of the trial? Were the groups treated equally? Were all participants accounted for at conclusion? How large was the treatment effect? How precise was the estimate of the treatment effect? Can the results be applied in the local population context? Were all important outcomes considered? Are the benefits worth the harms and the costs? Level of risk (quality assessment) Brief interventions Davis et al. (2003) YES YES NO NO YES NO YES YES UNSURE NO UNSURE HR Stein et al. (2010) YES YES R: YES YES YES UNSURE YES YES YES NO NO LR P: NO Begun et al. (2011) YES YES NO NO YES NO YES YES UNSURE NO YES MR Stein et al. (2011b) and Stein et al. (2011a) YES YES R: YES UNSURE UNSURE NO YES YES NO NO YES MR P: UNSURE Owens and McCrady (2016) YES YES NO NO YES NO NO NO NO YES NO MR Extended interventions Chance et al. (1990) YES NO NO UNSURE NO NO NO NO NO UNSURE UNSURE HR Baldwin et al. (1991) YES YES UNSURE NO NO NO YES YES NO YES YES MR Peters et al. (1993) YES NO UNSURE NO NO NO YES YES NO YES UNSURE HR Bowes et al. (2012, 2014) YES YES UNSURE NO YES NO YES YES NO NO YES MR Author Did the trial address a clearly focused issue? Was the assignment of patients to treatments randomised? Were participants blinded? Were the groups similar at the start of the trial? Were the groups treated equally? Were all participants accounted for at conclusion? How large was the treatment effect? How precise was the estimate of the treatment effect? Can the results be applied in the local population context? Were all important outcomes considered? Are the benefits worth the harms and the costs? Level of risk (quality assessment) Brief interventions Davis et al. (2003) YES YES NO NO YES NO YES YES UNSURE NO UNSURE HR Stein et al. (2010) YES YES R: YES YES YES UNSURE YES YES YES NO NO LR P: NO Begun et al. (2011) YES YES NO NO YES NO YES YES UNSURE NO YES MR Stein et al. (2011b) and Stein et al. (2011a) YES YES R: YES UNSURE UNSURE NO YES YES NO NO YES MR P: UNSURE Owens and McCrady (2016) YES YES NO NO YES NO NO NO NO YES NO MR Extended interventions Chance et al. (1990) YES NO NO UNSURE NO NO NO NO NO UNSURE UNSURE HR Baldwin et al. (1991) YES YES UNSURE NO NO NO YES YES NO YES YES MR Peters et al. (1993) YES NO UNSURE NO NO NO YES YES NO YES UNSURE HR Bowes et al. (2012, 2014) YES YES UNSURE NO YES NO YES YES NO NO YES MR R, researchers; P, participants; HR, high risk of bias; MR, medium risk of bias; LR, low risk of bias. Table 3. Quality assessment of included studies Author Did the trial address a clearly focused issue? Was the assignment of patients to treatments randomised? Were participants blinded? Were the groups similar at the start of the trial? Were the groups treated equally? Were all participants accounted for at conclusion? How large was the treatment effect? How precise was the estimate of the treatment effect? Can the results be applied in the local population context? Were all important outcomes considered? Are the benefits worth the harms and the costs? Level of risk (quality assessment) Brief interventions Davis et al. (2003) YES YES NO NO YES NO YES YES UNSURE NO UNSURE HR Stein et al. (2010) YES YES R: YES YES YES UNSURE YES YES YES NO NO LR P: NO Begun et al. (2011) YES YES NO NO YES NO YES YES UNSURE NO YES MR Stein et al. (2011b) and Stein et al. (2011a) YES YES R: YES UNSURE UNSURE NO YES YES NO NO YES MR P: UNSURE Owens and McCrady (2016) YES YES NO NO YES NO NO NO NO YES NO MR Extended interventions Chance et al. (1990) YES NO NO UNSURE NO NO NO NO NO UNSURE UNSURE HR Baldwin et al. (1991) YES YES UNSURE NO NO NO YES YES NO YES YES MR Peters et al. (1993) YES NO UNSURE NO NO NO YES YES NO YES UNSURE HR Bowes et al. (2012, 2014) YES YES UNSURE NO YES NO YES YES NO NO YES MR Author Did the trial address a clearly focused issue? Was the assignment of patients to treatments randomised? Were participants blinded? Were the groups similar at the start of the trial? Were the groups treated equally? Were all participants accounted for at conclusion? How large was the treatment effect? How precise was the estimate of the treatment effect? Can the results be applied in the local population context? Were all important outcomes considered? Are the benefits worth the harms and the costs? Level of risk (quality assessment) Brief interventions Davis et al. (2003) YES YES NO NO YES NO YES YES UNSURE NO UNSURE HR Stein et al. (2010) YES YES R: YES YES YES UNSURE YES YES YES NO NO LR P: NO Begun et al. (2011) YES YES NO NO YES NO YES YES UNSURE NO YES MR Stein et al. (2011b) and Stein et al. (2011a) YES YES R: YES UNSURE UNSURE NO YES YES NO NO YES MR P: UNSURE Owens and McCrady (2016) YES YES NO NO YES NO NO NO NO YES NO MR Extended interventions Chance et al. (1990) YES NO NO UNSURE NO NO NO NO NO UNSURE UNSURE HR Baldwin et al. (1991) YES YES UNSURE NO NO NO YES YES NO YES YES MR Peters et al. (1993) YES NO UNSURE NO NO NO YES YES NO YES UNSURE HR Bowes et al. (2012, 2014) YES YES UNSURE NO YES NO YES YES NO NO YES MR R, researchers; P, participants; HR, high risk of bias; MR, medium risk of bias; LR, low risk of bias. The five studies all used different outcome measures (Table 2), meaning results were unable to be synthesised by meta-analysis, yet despite this, some significant results were found. Davis et al. (2003) found that those that were given a brief intervention were significantly more likely to schedule follow-up appointments for treatment (66.7 vs. 40.5%; X2 5.01, P = 0.025) (Davis et al., 2003). Stein et al. (2010) found that those in the intervention group had reported significantly more days abstinent at follow-up (OR = 1.96) (Stein et al., 2010). Begun et al. (2011) found that for the intervention group the mean reduction in AUDIT score from baseline to follow-up were greater in the intervention group (F(1,148) = 6.336, P< 0.001; Begun et al., 2011). The Stein et al. (2011a, 2011b) study found no significant results related to alcohol. Owens and McCrady (2016) was a small feasibility study and although they found the study to be feasible they did not find any significant differences between groups. Extended brief interventions Four studies (five papers) examined the efficacy of alcohol interventions with adults in the prison system using extended brief interventions (Chance et al., 1990; Baldwin et al., 1991; Peters et al., 1993; Bowes et al., 2012, 2014). Two of the studies were from the USA (Chance et al., 1990; Peters et al., 1993) and two from the UK (Baldwin et al., 1991; Bowes et al., 2012, 2014). The interventions lasted from six sessions to 18 months in duration (no actual times given). Three of the studies were conducted with adults (Chance et al., 1990; Peters et al., 1993; Bowes et al., 2012, 2014) and one study with juveniles (Baldwin et al., 1991) (Table 1). In terms of quality assessment, one of the studies was classified as having a medium risk of bias (Bowes et al., 2012, 2014) whilst three had a high risk of bias (Chance et al., 1990; Baldwin et al., 1991; Peters et al., 1993) (Table 3). The four studies all used different outcome measures (Table 2) meaning results were unable to be synthesised. Chance et al. (1990) found no significant results related to alcohol (Chance et al., 1990). Baldwin et al. (1991) found that the control group increased the average number of alcohol units per week compared with the intervention group F(1,19) = 4.546 (P < 0.05); The control group also increased average alcohol units per drinking session compared to the intervention group F(1,19) = 6.753 (P < 0.05). In comparison, the intervention group reduced the average number of offences against property compared to the control group F(1,13) = 6.489 (P < 0.05) (Baldwin et al., 1991). Peters et al. (1993) found that those that were randomised to the intervention group had a significantly longer time period before being arrested again t(418) = 3.0 P < 0.01, significantly fewer arrests t(418) = 2.7 P < 0.01, and served significantly less jail time t(418) = 2.4 P < 0.05 compared with the control group. Bowes et al. (2012) found significantly lower scores for individuals in the intervention group compared to the control in relation to alcohol-related aggression (P < 0.05) as well as the different components of the Controlled Drinking Self-Efficacy Tool and the State-Trait Anger Expression Inventory (Bowes et al., 2012; Table 2). However, a follow-up study by the same authors found no statistically significant differences in relation to recidivism (Bowes et al., 2014). TIDieR results Results relating to how interventions were described are shown in Tables 3 and 4 using the TIDieR checklist (Hoffman et al., 2014). We found that for some categories detailed information was not given in the included papers. Table 4. TIDieR results of included brief intervention studies Davis et al. (2003) Stein et al. (2010) Begun et al. (2011) Stein et al. (2011b) and Stein et al. (2011a) Owens and McCrady (2016) Provide the name or a phrase that describes the intervention. Brief MI MI MI MI MI Describe any rationale, theory or goal of the elements essential to the intervention. MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). Materials: describe any physical or informational materials used in the intervention. Provide information on where the materials can be accessed. None given. Manual was used. Resource folder (including information about treatment, support services, housing, clothing, healthcare) and a 3-month calendar. Handouts were given (e.g. goals chosen). Manual that targeted alcohol and other drug use. Procedures: describe each of the procedures, activities, and/or processes used in the intervention, including any enabling or support activities. Personalised feedback provided (pre-incarceration drinking rates relative to national averages, performance on neuropsychological tests compared with national averages and ratings of physical and emotional health). Participants were also given graphical information re: types of situations in which they reported commonly using substances, self-reported problems and dependence criteria endorsed, and their reported readiness for change. Interviewers were non-confrontational in tone, asked open-ended questions and used reflective listening skills. Interviewers allowed participants to come to their own conclusions, if any, about the feedback and need for treatment. VA referral information was reviewed at the end of the interview. Initial session (during incarceration)—Interventionist used MI techniques re: goal setting and strategies to deal with obstacles/barriers that might affect these goals. Due to RIDOC regulations, participants were not allowed to keep any materials from the session. Upon release, the feedback report and change plan handouts, payment for the baseline interview, community resources, condoms and the next appointment date were mailed to participant. Feedback intervention to engage the women in an exploration of their own motivation and commitment to behaviour change. The objectives were to explore and resolve ambivalence, address decisional balance (the pros and cons of changing and not changing their substance-related behaviours), explore options (including self-change attempts, informal systems, and formal services), and resolve perceived barriers specific to engaging with substance abuse services. MI focusing on empathy, not arguing, developing discrepancy, self-efficacy and personal choice. Sections of the MI included developing rapport, exploration of motivation (pros and cons), personalised assessment feedback, imagining the future with and without change, and establishing goals. Focus of the intervention was on reduction of alcohol and/or marijuana use and associated risky behaviours and consequences of use (e.g. injuries while drunk or high). MI session following a manual that targeted alcohol and other drug use, and if relevant, participants social networks and engagement in treatment. Open-ended questions elicited participants’ reasons to change. Normative feedback was not included. Follow-Up Session—Based on participant’s goal(s) and change plan from initial MI session. Sessions focused on progress, assessment of barriers and developing concrete strategies for meeting new goals. For each category of intervention provider, describe their expertise, background and any specific training given. Clinical Research Staff who had completed/were completing Masters Degrees. 12 h of training in MI. Training: didactics and observed practices and experiences and supervision provided. Graduate social workers trained in research protocol engaged women in initial demographic and brief screening interview. Research counsellors delivered both type of intervention. Treatments were manualized and 20 h training was given as well as weekly supervision. Delivered by advanced clinical psychology graduate tutors who were trained in MI and had experience of delivering MI. Describe the mode of delivery of the intervention and whether it was provided individually or in a group. One-on-one sessions. One-on-one sessions. One-on-one sessions. One-on-one sessions. One-on-one sessions. Describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features. Private room in the jail. First session in prison (no details). Second session in hospital based community research site (no details). Private room in the jail. Juvenile correctional facility. Private room at the jail that had windows to ensure the safety of study staff and participants but offered auditory confidentiality. Describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose. One session of 60 min per person. Two sessions of between 30-45 min per person. One session of 60–90 min per person. One 90 min session and one 60 min booster session. One session of 50–60 min per person. If the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how. Personalised MI intervention based on results of screening. Personalised MI intervention based on results of screening. Personalised MI intervention based on results of screening. MI: personalised intervention. RT: personalised as individual described relaxing place—individual to them. Personalised MI intervention based on results of screening. If the intervention was modified during the course of the study, describe the changes (what, why, when and how). N/A N/A N/A N/A N/A Planned: if intervention adherence of fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them. and Actual: describe the extent to which the intervention was delivered as planned. N/A MITI was used to train and to monitor the MI skills of the interventionists during biweekly supervision. The MITI allows for assessment of threshold competence for therapists and a measure of integrity of MI interventions using two global scores (‘empathy’ and ‘spirit;’ score range 1–7) and seven behaviour counts (e.g. ‘giving information’, ‘MI adherent’). N/A Adolescents and research counsellors completed evaluation forms assessing whether core components of the interventions occurred. Sessions were recorded for supervision with a certified MI trainer and to assess treatment fidelity. Davis et al. (2003) Stein et al. (2010) Begun et al. (2011) Stein et al. (2011b) and Stein et al. (2011a) Owens and McCrady (2016) Provide the name or a phrase that describes the intervention. Brief MI MI MI MI MI Describe any rationale, theory or goal of the elements essential to the intervention. MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). Materials: describe any physical or informational materials used in the intervention. Provide information on where the materials can be accessed. None given. Manual was used. Resource folder (including information about treatment, support services, housing, clothing, healthcare) and a 3-month calendar. Handouts were given (e.g. goals chosen). Manual that targeted alcohol and other drug use. Procedures: describe each of the procedures, activities, and/or processes used in the intervention, including any enabling or support activities. Personalised feedback provided (pre-incarceration drinking rates relative to national averages, performance on neuropsychological tests compared with national averages and ratings of physical and emotional health). Participants were also given graphical information re: types of situations in which they reported commonly using substances, self-reported problems and dependence criteria endorsed, and their reported readiness for change. Interviewers were non-confrontational in tone, asked open-ended questions and used reflective listening skills. Interviewers allowed participants to come to their own conclusions, if any, about the feedback and need for treatment. VA referral information was reviewed at the end of the interview. Initial session (during incarceration)—Interventionist used MI techniques re: goal setting and strategies to deal with obstacles/barriers that might affect these goals. Due to RIDOC regulations, participants were not allowed to keep any materials from the session. Upon release, the feedback report and change plan handouts, payment for the baseline interview, community resources, condoms and the next appointment date were mailed to participant. Feedback intervention to engage the women in an exploration of their own motivation and commitment to behaviour change. The objectives were to explore and resolve ambivalence, address decisional balance (the pros and cons of changing and not changing their substance-related behaviours), explore options (including self-change attempts, informal systems, and formal services), and resolve perceived barriers specific to engaging with substance abuse services. MI focusing on empathy, not arguing, developing discrepancy, self-efficacy and personal choice. Sections of the MI included developing rapport, exploration of motivation (pros and cons), personalised assessment feedback, imagining the future with and without change, and establishing goals. Focus of the intervention was on reduction of alcohol and/or marijuana use and associated risky behaviours and consequences of use (e.g. injuries while drunk or high). MI session following a manual that targeted alcohol and other drug use, and if relevant, participants social networks and engagement in treatment. Open-ended questions elicited participants’ reasons to change. Normative feedback was not included. Follow-Up Session—Based on participant’s goal(s) and change plan from initial MI session. Sessions focused on progress, assessment of barriers and developing concrete strategies for meeting new goals. For each category of intervention provider, describe their expertise, background and any specific training given. Clinical Research Staff who had completed/were completing Masters Degrees. 12 h of training in MI. Training: didactics and observed practices and experiences and supervision provided. Graduate social workers trained in research protocol engaged women in initial demographic and brief screening interview. Research counsellors delivered both type of intervention. Treatments were manualized and 20 h training was given as well as weekly supervision. Delivered by advanced clinical psychology graduate tutors who were trained in MI and had experience of delivering MI. Describe the mode of delivery of the intervention and whether it was provided individually or in a group. One-on-one sessions. One-on-one sessions. One-on-one sessions. One-on-one sessions. One-on-one sessions. Describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features. Private room in the jail. First session in prison (no details). Second session in hospital based community research site (no details). Private room in the jail. Juvenile correctional facility. Private room at the jail that had windows to ensure the safety of study staff and participants but offered auditory confidentiality. Describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose. One session of 60 min per person. Two sessions of between 30-45 min per person. One session of 60–90 min per person. One 90 min session and one 60 min booster session. One session of 50–60 min per person. If the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how. Personalised MI intervention based on results of screening. Personalised MI intervention based on results of screening. Personalised MI intervention based on results of screening. MI: personalised intervention. RT: personalised as individual described relaxing place—individual to them. Personalised MI intervention based on results of screening. If the intervention was modified during the course of the study, describe the changes (what, why, when and how). N/A N/A N/A N/A N/A Planned: if intervention adherence of fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them. and Actual: describe the extent to which the intervention was delivered as planned. N/A MITI was used to train and to monitor the MI skills of the interventionists during biweekly supervision. The MITI allows for assessment of threshold competence for therapists and a measure of integrity of MI interventions using two global scores (‘empathy’ and ‘spirit;’ score range 1–7) and seven behaviour counts (e.g. ‘giving information’, ‘MI adherent’). N/A Adolescents and research counsellors completed evaluation forms assessing whether core components of the interventions occurred. Sessions were recorded for supervision with a certified MI trainer and to assess treatment fidelity. MITI, MI Treatment Integrity Code Version 2.0. Table 4. TIDieR results of included brief intervention studies Davis et al. (2003) Stein et al. (2010) Begun et al. (2011) Stein et al. (2011b) and Stein et al. (2011a) Owens and McCrady (2016) Provide the name or a phrase that describes the intervention. Brief MI MI MI MI MI Describe any rationale, theory or goal of the elements essential to the intervention. MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). Materials: describe any physical or informational materials used in the intervention. Provide information on where the materials can be accessed. None given. Manual was used. Resource folder (including information about treatment, support services, housing, clothing, healthcare) and a 3-month calendar. Handouts were given (e.g. goals chosen). Manual that targeted alcohol and other drug use. Procedures: describe each of the procedures, activities, and/or processes used in the intervention, including any enabling or support activities. Personalised feedback provided (pre-incarceration drinking rates relative to national averages, performance on neuropsychological tests compared with national averages and ratings of physical and emotional health). Participants were also given graphical information re: types of situations in which they reported commonly using substances, self-reported problems and dependence criteria endorsed, and their reported readiness for change. Interviewers were non-confrontational in tone, asked open-ended questions and used reflective listening skills. Interviewers allowed participants to come to their own conclusions, if any, about the feedback and need for treatment. VA referral information was reviewed at the end of the interview. Initial session (during incarceration)—Interventionist used MI techniques re: goal setting and strategies to deal with obstacles/barriers that might affect these goals. Due to RIDOC regulations, participants were not allowed to keep any materials from the session. Upon release, the feedback report and change plan handouts, payment for the baseline interview, community resources, condoms and the next appointment date were mailed to participant. Feedback intervention to engage the women in an exploration of their own motivation and commitment to behaviour change. The objectives were to explore and resolve ambivalence, address decisional balance (the pros and cons of changing and not changing their substance-related behaviours), explore options (including self-change attempts, informal systems, and formal services), and resolve perceived barriers specific to engaging with substance abuse services. MI focusing on empathy, not arguing, developing discrepancy, self-efficacy and personal choice. Sections of the MI included developing rapport, exploration of motivation (pros and cons), personalised assessment feedback, imagining the future with and without change, and establishing goals. Focus of the intervention was on reduction of alcohol and/or marijuana use and associated risky behaviours and consequences of use (e.g. injuries while drunk or high). MI session following a manual that targeted alcohol and other drug use, and if relevant, participants social networks and engagement in treatment. Open-ended questions elicited participants’ reasons to change. Normative feedback was not included. Follow-Up Session—Based on participant’s goal(s) and change plan from initial MI session. Sessions focused on progress, assessment of barriers and developing concrete strategies for meeting new goals. For each category of intervention provider, describe their expertise, background and any specific training given. Clinical Research Staff who had completed/were completing Masters Degrees. 12 h of training in MI. Training: didactics and observed practices and experiences and supervision provided. Graduate social workers trained in research protocol engaged women in initial demographic and brief screening interview. Research counsellors delivered both type of intervention. Treatments were manualized and 20 h training was given as well as weekly supervision. Delivered by advanced clinical psychology graduate tutors who were trained in MI and had experience of delivering MI. Describe the mode of delivery of the intervention and whether it was provided individually or in a group. One-on-one sessions. One-on-one sessions. One-on-one sessions. One-on-one sessions. One-on-one sessions. Describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features. Private room in the jail. First session in prison (no details). Second session in hospital based community research site (no details). Private room in the jail. Juvenile correctional facility. Private room at the jail that had windows to ensure the safety of study staff and participants but offered auditory confidentiality. Describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose. One session of 60 min per person. Two sessions of between 30-45 min per person. One session of 60–90 min per person. One 90 min session and one 60 min booster session. One session of 50–60 min per person. If the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how. Personalised MI intervention based on results of screening. Personalised MI intervention based on results of screening. Personalised MI intervention based on results of screening. MI: personalised intervention. RT: personalised as individual described relaxing place—individual to them. Personalised MI intervention based on results of screening. If the intervention was modified during the course of the study, describe the changes (what, why, when and how). N/A N/A N/A N/A N/A Planned: if intervention adherence of fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them. and Actual: describe the extent to which the intervention was delivered as planned. N/A MITI was used to train and to monitor the MI skills of the interventionists during biweekly supervision. The MITI allows for assessment of threshold competence for therapists and a measure of integrity of MI interventions using two global scores (‘empathy’ and ‘spirit;’ score range 1–7) and seven behaviour counts (e.g. ‘giving information’, ‘MI adherent’). N/A Adolescents and research counsellors completed evaluation forms assessing whether core components of the interventions occurred. Sessions were recorded for supervision with a certified MI trainer and to assess treatment fidelity. Davis et al. (2003) Stein et al. (2010) Begun et al. (2011) Stein et al. (2011b) and Stein et al. (2011a) Owens and McCrady (2016) Provide the name or a phrase that describes the intervention. Brief MI MI MI MI MI Describe any rationale, theory or goal of the elements essential to the intervention. MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). Materials: describe any physical or informational materials used in the intervention. Provide information on where the materials can be accessed. None given. Manual was used. Resource folder (including information about treatment, support services, housing, clothing, healthcare) and a 3-month calendar. Handouts were given (e.g. goals chosen). Manual that targeted alcohol and other drug use. Procedures: describe each of the procedures, activities, and/or processes used in the intervention, including any enabling or support activities. Personalised feedback provided (pre-incarceration drinking rates relative to national averages, performance on neuropsychological tests compared with national averages and ratings of physical and emotional health). Participants were also given graphical information re: types of situations in which they reported commonly using substances, self-reported problems and dependence criteria endorsed, and their reported readiness for change. Interviewers were non-confrontational in tone, asked open-ended questions and used reflective listening skills. Interviewers allowed participants to come to their own conclusions, if any, about the feedback and need for treatment. VA referral information was reviewed at the end of the interview. Initial session (during incarceration)—Interventionist used MI techniques re: goal setting and strategies to deal with obstacles/barriers that might affect these goals. Due to RIDOC regulations, participants were not allowed to keep any materials from the session. Upon release, the feedback report and change plan handouts, payment for the baseline interview, community resources, condoms and the next appointment date were mailed to participant. Feedback intervention to engage the women in an exploration of their own motivation and commitment to behaviour change. The objectives were to explore and resolve ambivalence, address decisional balance (the pros and cons of changing and not changing their substance-related behaviours), explore options (including self-change attempts, informal systems, and formal services), and resolve perceived barriers specific to engaging with substance abuse services. MI focusing on empathy, not arguing, developing discrepancy, self-efficacy and personal choice. Sections of the MI included developing rapport, exploration of motivation (pros and cons), personalised assessment feedback, imagining the future with and without change, and establishing goals. Focus of the intervention was on reduction of alcohol and/or marijuana use and associated risky behaviours and consequences of use (e.g. injuries while drunk or high). MI session following a manual that targeted alcohol and other drug use, and if relevant, participants social networks and engagement in treatment. Open-ended questions elicited participants’ reasons to change. Normative feedback was not included. Follow-Up Session—Based on participant’s goal(s) and change plan from initial MI session. Sessions focused on progress, assessment of barriers and developing concrete strategies for meeting new goals. For each category of intervention provider, describe their expertise, background and any specific training given. Clinical Research Staff who had completed/were completing Masters Degrees. 12 h of training in MI. Training: didactics and observed practices and experiences and supervision provided. Graduate social workers trained in research protocol engaged women in initial demographic and brief screening interview. Research counsellors delivered both type of intervention. Treatments were manualized and 20 h training was given as well as weekly supervision. Delivered by advanced clinical psychology graduate tutors who were trained in MI and had experience of delivering MI. Describe the mode of delivery of the intervention and whether it was provided individually or in a group. One-on-one sessions. One-on-one sessions. One-on-one sessions. One-on-one sessions. One-on-one sessions. Describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features. Private room in the jail. First session in prison (no details). Second session in hospital based community research site (no details). Private room in the jail. Juvenile correctional facility. Private room at the jail that had windows to ensure the safety of study staff and participants but offered auditory confidentiality. Describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose. One session of 60 min per person. Two sessions of between 30-45 min per person. One session of 60–90 min per person. One 90 min session and one 60 min booster session. One session of 50–60 min per person. If the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how. Personalised MI intervention based on results of screening. Personalised MI intervention based on results of screening. Personalised MI intervention based on results of screening. MI: personalised intervention. RT: personalised as individual described relaxing place—individual to them. Personalised MI intervention based on results of screening. If the intervention was modified during the course of the study, describe the changes (what, why, when and how). N/A N/A N/A N/A N/A Planned: if intervention adherence of fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them. and Actual: describe the extent to which the intervention was delivered as planned. N/A MITI was used to train and to monitor the MI skills of the interventionists during biweekly supervision. The MITI allows for assessment of threshold competence for therapists and a measure of integrity of MI interventions using two global scores (‘empathy’ and ‘spirit;’ score range 1–7) and seven behaviour counts (e.g. ‘giving information’, ‘MI adherent’). N/A Adolescents and research counsellors completed evaluation forms assessing whether core components of the interventions occurred. Sessions were recorded for supervision with a certified MI trainer and to assess treatment fidelity. MITI, MI Treatment Integrity Code Version 2.0. Table 5. TIDieR results of included extended intervention studies Chance et al. (1990) Baldwin et al. (1991) Peters et al. (1993) Bowes et al. (2012, 2014) Provide the name or a phrase that describes the intervention Lifeline Drug and Alcohol Treatment Programme. Alcohol Education Course (AEC). In-Jail Treatment Programme. COVAID. Describe any rationale, theory, or goal of the elements essential to the intervention Reality therapy counselling AEC similar to other behavioural AECs with the omission of context inappropriate material. Cognitive-behavioural, skills based approach that includes a focus on relapse prevention. Goals are to encourage long-term abstinence through prevention of lapse and relapse to substance abuse. Cognitive-behavioural treatment aimed at reducing alcohol-related aggression. Materials: describe any physical or informational materials used in the intervention. Provide information on where the materials can be accessed Inmates completed a weekly self-perception profile that addressed attitudes to oneself and others within programme. Each participant kept a diary. AEC materials. None mentioned. Manualized COVAID intervention. Procedures: describe each of the procedures, activities, and/or processes used in the intervention, including any enabling or support activities. Weekly self-perception profile, individual counselling sessions and diary keeping. Materials were presented so offender clients could acquire info/skills in reduced drinking/offending. Control group received nothing. MSI interview, follow-up and collateral interview. Three types of groups offered: 1. Special Topics Group—Focus on issues related to orientation to treatment (inc. motivation and commitment, ambivalence about adopting a drug-free lifestyle, family issues, shame and guilt associated with substance abuse and health-related consequences of substance abuse). 2. Relapse Prevention—Level 1. 27 sessions: 2 h per day, 5 days per week. 3. Relapse Prevention—Level 2. For inmates who have completed Level 1, Level 2 groups focus on relapse prevention skills in greater depth. The 10 sessions covered: explaining alcohol-related aggression, crime harm reduction, managing anger and stress, modifying drinking, altering triggers, weakening the expectancies that contribute to alcohol-related violence, identifying and coping with high-risk situations, and enhancing problem solving skills. For each category of intervention provider, describe their expertise, background and any specific training given. Director of programme selected due to commitment to Lifeline and understanding of prisons. Other personnel given reality therapy training. Lead author was therapy certified and given ongoing training, as were inmates when they became peer counsellors. Each worker (social worker, prison psychologist, teacher) had achieved criterion performance with the Motivational Screening Instrument. Trained facilitators employed by the probation service or prison group work facilitators. Trained by Delight Training (www.delight.co.uk) Describe the mode of delivery of the intervention and whether it was provided individually or in a group. Individual and group counselling sessions as well as participation in self-help programmes including AA. Interviews (additional collateral interviews held with spouses/relatives/friend/drinking partners). In groups of 8–12 people. In groups of 8–10 people and individual sessions. Describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features. N/A N/A N/A N/A Describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule and their duration, intensity or dose. No pre-established length of time: ranged from 6–18 months. 6 Weekly sessions of 2 h. 27 Sessions, 2 h per day, 5 days per week. Level 2 then provides opportunity to focus on more. Average length of stay in programme was 45 days. 20 h of group treatment and 4 h of individual support. Altogether 10 sessions. If the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how. Individual counselling with sessions personalised. N/A Inmates work to design a long-term recovery plan and to develop a balanced lifestyle through participating in drug-free pleasurable activities. 4 h of individual support – including looking at personal coping strategies If the intervention was modified during the course of the study, describe the changes (what, why, when and how). N/A N/A N/A N/A Planned: if intervention adherence of fidelity was assessed, how and by whom, and if any strategies were used to maintain or improve fidelity, describe them and Actual: the extent to which the intervention was delivered as planned N/A N/A N/A N/A Chance et al. (1990) Baldwin et al. (1991) Peters et al. (1993) Bowes et al. (2012, 2014) Provide the name or a phrase that describes the intervention Lifeline Drug and Alcohol Treatment Programme. Alcohol Education Course (AEC). In-Jail Treatment Programme. COVAID. Describe any rationale, theory, or goal of the elements essential to the intervention Reality therapy counselling AEC similar to other behavioural AECs with the omission of context inappropriate material. Cognitive-behavioural, skills based approach that includes a focus on relapse prevention. Goals are to encourage long-term abstinence through prevention of lapse and relapse to substance abuse. Cognitive-behavioural treatment aimed at reducing alcohol-related aggression. Materials: describe any physical or informational materials used in the intervention. Provide information on where the materials can be accessed Inmates completed a weekly self-perception profile that addressed attitudes to oneself and others within programme. Each participant kept a diary. AEC materials. None mentioned. Manualized COVAID intervention. Procedures: describe each of the procedures, activities, and/or processes used in the intervention, including any enabling or support activities. Weekly self-perception profile, individual counselling sessions and diary keeping. Materials were presented so offender clients could acquire info/skills in reduced drinking/offending. Control group received nothing. MSI interview, follow-up and collateral interview. Three types of groups offered: 1. Special Topics Group—Focus on issues related to orientation to treatment (inc. motivation and commitment, ambivalence about adopting a drug-free lifestyle, family issues, shame and guilt associated with substance abuse and health-related consequences of substance abuse). 2. Relapse Prevention—Level 1. 27 sessions: 2 h per day, 5 days per week. 3. Relapse Prevention—Level 2. For inmates who have completed Level 1, Level 2 groups focus on relapse prevention skills in greater depth. The 10 sessions covered: explaining alcohol-related aggression, crime harm reduction, managing anger and stress, modifying drinking, altering triggers, weakening the expectancies that contribute to alcohol-related violence, identifying and coping with high-risk situations, and enhancing problem solving skills. For each category of intervention provider, describe their expertise, background and any specific training given. Director of programme selected due to commitment to Lifeline and understanding of prisons. Other personnel given reality therapy training. Lead author was therapy certified and given ongoing training, as were inmates when they became peer counsellors. Each worker (social worker, prison psychologist, teacher) had achieved criterion performance with the Motivational Screening Instrument. Trained facilitators employed by the probation service or prison group work facilitators. Trained by Delight Training (www.delight.co.uk) Describe the mode of delivery of the intervention and whether it was provided individually or in a group. Individual and group counselling sessions as well as participation in self-help programmes including AA. Interviews (additional collateral interviews held with spouses/relatives/friend/drinking partners). In groups of 8–12 people. In groups of 8–10 people and individual sessions. Describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features. N/A N/A N/A N/A Describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule and their duration, intensity or dose. No pre-established length of time: ranged from 6–18 months. 6 Weekly sessions of 2 h. 27 Sessions, 2 h per day, 5 days per week. Level 2 then provides opportunity to focus on more. Average length of stay in programme was 45 days. 20 h of group treatment and 4 h of individual support. Altogether 10 sessions. If the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how. Individual counselling with sessions personalised. N/A Inmates work to design a long-term recovery plan and to develop a balanced lifestyle through participating in drug-free pleasurable activities. 4 h of individual support – including looking at personal coping strategies If the intervention was modified during the course of the study, describe the changes (what, why, when and how). N/A N/A N/A N/A Planned: if intervention adherence of fidelity was assessed, how and by whom, and if any strategies were used to maintain or improve fidelity, describe them and Actual: the extent to which the intervention was delivered as planned N/A N/A N/A N/A COVAID, control of violence for angry impulsive drinkers. Table 5. TIDieR results of included extended intervention studies Chance et al. (1990) Baldwin et al. (1991) Peters et al. (1993) Bowes et al. (2012, 2014) Provide the name or a phrase that describes the intervention Lifeline Drug and Alcohol Treatment Programme. Alcohol Education Course (AEC). In-Jail Treatment Programme. COVAID. Describe any rationale, theory, or goal of the elements essential to the intervention Reality therapy counselling AEC similar to other behavioural AECs with the omission of context inappropriate material. Cognitive-behavioural, skills based approach that includes a focus on relapse prevention. Goals are to encourage long-term abstinence through prevention of lapse and relapse to substance abuse. Cognitive-behavioural treatment aimed at reducing alcohol-related aggression. Materials: describe any physical or informational materials used in the intervention. Provide information on where the materials can be accessed Inmates completed a weekly self-perception profile that addressed attitudes to oneself and others within programme. Each participant kept a diary. AEC materials. None mentioned. Manualized COVAID intervention. Procedures: describe each of the procedures, activities, and/or processes used in the intervention, including any enabling or support activities. Weekly self-perception profile, individual counselling sessions and diary keeping. Materials were presented so offender clients could acquire info/skills in reduced drinking/offending. Control group received nothing. MSI interview, follow-up and collateral interview. Three types of groups offered: 1. Special Topics Group—Focus on issues related to orientation to treatment (inc. motivation and commitment, ambivalence about adopting a drug-free lifestyle, family issues, shame and guilt associated with substance abuse and health-related consequences of substance abuse). 2. Relapse Prevention—Level 1. 27 sessions: 2 h per day, 5 days per week. 3. Relapse Prevention—Level 2. For inmates who have completed Level 1, Level 2 groups focus on relapse prevention skills in greater depth. The 10 sessions covered: explaining alcohol-related aggression, crime harm reduction, managing anger and stress, modifying drinking, altering triggers, weakening the expectancies that contribute to alcohol-related violence, identifying and coping with high-risk situations, and enhancing problem solving skills. For each category of intervention provider, describe their expertise, background and any specific training given. Director of programme selected due to commitment to Lifeline and understanding of prisons. Other personnel given reality therapy training. Lead author was therapy certified and given ongoing training, as were inmates when they became peer counsellors. Each worker (social worker, prison psychologist, teacher) had achieved criterion performance with the Motivational Screening Instrument. Trained facilitators employed by the probation service or prison group work facilitators. Trained by Delight Training (www.delight.co.uk) Describe the mode of delivery of the intervention and whether it was provided individually or in a group. Individual and group counselling sessions as well as participation in self-help programmes including AA. Interviews (additional collateral interviews held with spouses/relatives/friend/drinking partners). In groups of 8–12 people. In groups of 8–10 people and individual sessions. Describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features. N/A N/A N/A N/A Describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule and their duration, intensity or dose. No pre-established length of time: ranged from 6–18 months. 6 Weekly sessions of 2 h. 27 Sessions, 2 h per day, 5 days per week. Level 2 then provides opportunity to focus on more. Average length of stay in programme was 45 days. 20 h of group treatment and 4 h of individual support. Altogether 10 sessions. If the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how. Individual counselling with sessions personalised. N/A Inmates work to design a long-term recovery plan and to develop a balanced lifestyle through participating in drug-free pleasurable activities. 4 h of individual support – including looking at personal coping strategies If the intervention was modified during the course of the study, describe the changes (what, why, when and how). N/A N/A N/A N/A Planned: if intervention adherence of fidelity was assessed, how and by whom, and if any strategies were used to maintain or improve fidelity, describe them and Actual: the extent to which the intervention was delivered as planned N/A N/A N/A N/A Chance et al. (1990) Baldwin et al. (1991) Peters et al. (1993) Bowes et al. (2012, 2014) Provide the name or a phrase that describes the intervention Lifeline Drug and Alcohol Treatment Programme. Alcohol Education Course (AEC). In-Jail Treatment Programme. COVAID. Describe any rationale, theory, or goal of the elements essential to the intervention Reality therapy counselling AEC similar to other behavioural AECs with the omission of context inappropriate material. Cognitive-behavioural, skills based approach that includes a focus on relapse prevention. Goals are to encourage long-term abstinence through prevention of lapse and relapse to substance abuse. Cognitive-behavioural treatment aimed at reducing alcohol-related aggression. Materials: describe any physical or informational materials used in the intervention. Provide information on where the materials can be accessed Inmates completed a weekly self-perception profile that addressed attitudes to oneself and others within programme. Each participant kept a diary. AEC materials. None mentioned. Manualized COVAID intervention. Procedures: describe each of the procedures, activities, and/or processes used in the intervention, including any enabling or support activities. Weekly self-perception profile, individual counselling sessions and diary keeping. Materials were presented so offender clients could acquire info/skills in reduced drinking/offending. Control group received nothing. MSI interview, follow-up and collateral interview. Three types of groups offered: 1. Special Topics Group—Focus on issues related to orientation to treatment (inc. motivation and commitment, ambivalence about adopting a drug-free lifestyle, family issues, shame and guilt associated with substance abuse and health-related consequences of substance abuse). 2. Relapse Prevention—Level 1. 27 sessions: 2 h per day, 5 days per week. 3. Relapse Prevention—Level 2. For inmates who have completed Level 1, Level 2 groups focus on relapse prevention skills in greater depth. The 10 sessions covered: explaining alcohol-related aggression, crime harm reduction, managing anger and stress, modifying drinking, altering triggers, weakening the expectancies that contribute to alcohol-related violence, identifying and coping with high-risk situations, and enhancing problem solving skills. For each category of intervention provider, describe their expertise, background and any specific training given. Director of programme selected due to commitment to Lifeline and understanding of prisons. Other personnel given reality therapy training. Lead author was therapy certified and given ongoing training, as were inmates when they became peer counsellors. Each worker (social worker, prison psychologist, teacher) had achieved criterion performance with the Motivational Screening Instrument. Trained facilitators employed by the probation service or prison group work facilitators. Trained by Delight Training (www.delight.co.uk) Describe the mode of delivery of the intervention and whether it was provided individually or in a group. Individual and group counselling sessions as well as participation in self-help programmes including AA. Interviews (additional collateral interviews held with spouses/relatives/friend/drinking partners). In groups of 8–12 people. In groups of 8–10 people and individual sessions. Describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features. N/A N/A N/A N/A Describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule and their duration, intensity or dose. No pre-established length of time: ranged from 6–18 months. 6 Weekly sessions of 2 h. 27 Sessions, 2 h per day, 5 days per week. Level 2 then provides opportunity to focus on more. Average length of stay in programme was 45 days. 20 h of group treatment and 4 h of individual support. Altogether 10 sessions. If the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how. Individual counselling with sessions personalised. N/A Inmates work to design a long-term recovery plan and to develop a balanced lifestyle through participating in drug-free pleasurable activities. 4 h of individual support – including looking at personal coping strategies If the intervention was modified during the course of the study, describe the changes (what, why, when and how). N/A N/A N/A N/A Planned: if intervention adherence of fidelity was assessed, how and by whom, and if any strategies were used to maintain or improve fidelity, describe them and Actual: the extent to which the intervention was delivered as planned N/A N/A N/A N/A COVAID, control of violence for angry impulsive drinkers. TIDieR results—brief interventions All included studies described the brief intervention as being based on the motivational interviewing work of Miller and Rollnick (2002) with all papers giving some indication of what the components in the interventions were (Davis et al., 2003; Stein et al., 2010). All studies reported that interventions were given one-to-one and were based on the results of clients’ individual screening (Begun et al., 2011; Davis et al., 2003; Stein et al., 2010, 2011a, 2011b; Owens and McCrady, 2016). All studies were delivered by trained research staff, which calls into question how pragmatic the studies are and whether they could be implemented with fidelity in real life situations by existing programme staff. None of the included studies gave information about modifications during the study and only two gave information related to fidelity (Stein et al., 2011a, 2011b), with one giving in-depth information in relation to the intervention development (Stein et al., 2010). TIDieR results—extended brief interventions The four studies involving extended brief interventions were very different in content from the brief intervention studies (Chance et al., 1990; Baldwin et al., 1991; Peters et al., 1993; Bowes et al., 2012, 2014). Intervention details in these studies were sparse, meaning that they would be unable to be replicated. The total amount of time spent in intervention varied in length from a total of 12 h (Baldwin et al., 1991) to 20 h (Bowes et al., 2012, 2014) to 54 h (Peters et al., 1993). The remaining study stated that the time frame was 6–18 months but did not say how many sessions (Chance et al., 1990). Very little detail was provided about the information given during or as part of the intervention. According to the TIDIeR checklist authors, this is the question that is least likely to be answered (Hoffman et al., 2014). None of the included studies gave any information relating to where in the prison the interventions took place or of any fidelity checks. However, unlike the brief intervention studies, all of the extended brief interventions were delivered by trained individuals employed within the services (Table 5). DISCUSSION This systematic review examined the efficacy and/or effectiveness of alcohol interventions for incarcerated individuals. Results show that it is possible to carry out RCTs in this setting and that there is some promise in terms of effects. However, this study has shown that, to date, not enough studies have been carried out to ascertain efficacy or effectiveness and adequate methodological rigour in the available literature is questionable. Moreover, there is a distinct lack of information relating to female prisoners. Yet, this should not discourage researchers: the signs are that there is a place for interventions in this setting and they do hold promise, but more robust studies are needed with standardised approaches. This study, like others, has shown that interventions for offenders that tackle risky drinking issues are under-developed and under-researched (Bowes et al., 2014; Newbury-Birch et al., 2016b). It has also been shown that it is very difficult to conduct research studies in this setting, primarily due to the difficulties in collecting self-report follow-up data (Newbury-Birch et al., 2016b). One of the fundamental issues is that studies include different measurement tools and outcomes, with outcomes decided upon based on the research funding. A piece of work is currently taking place that aims to develop a Core Outcome Set for Alcohol Brief Interventions (ABI) to improve the measurement of alcohol-related change: Outcome Reporting in Brief Intervention Trials: Alcohol (ORBITAL) (Shorter et al., 2018). Furthermore, our results showed that interventions are not being described as methodically as they could be and that is an area to further improve in future research. The introduction of the TIDiER checklist (Hoffman et al., 2014) and the expectation that it will be used when describing studies is a step forward; however, this study shows that, to date, there is limited information relating to intervention content and delivery in this body of research. It is often thought that prisoners feel coerced into taking part in research projects; however, evidence tells us that participants do not feel coerced if the project is explained properly (Sherman et al., 2015). Although, research tells us that obtaining follow-up data with this population is fraught with difficulties because of the sometimes chaotic lifestyles of the participants (Newbury-Birch et al., 2016b). More work is needed into how we can use routinely collected data in criminal justice studies. For instance, a recent study carried out by researchers in the UK in the probation setting used reconviction data to follow up individuals using Police National Computer identifiers and followed-up 97% of participants (Newbury-Birch et al., 2014). In order for research to be applicable to the prison setting it is imperative that the experiences of inmates are integrated in co-designing the research question and study processes (Newbury-Birch et al., 2016a). By working together and drawing on the expertise of staff, inmates and researchers, it is possible to translate the results of research into real world practice (Sherman et al., 2015). For example, researchers in the UK have recently undertaken an ABI development study for male remand prisoners. As part of this, they have conducted in-depth interviews and focus groups with prisoners and prison staff/key stakeholders to develop not only the research process but also the type and nature of the ABI intervention (Holloway et al., 2017). There are several additional limitations to this study. The majority of the studies were undertaken in the USA and there was a lack of data relating to women. In addition, we were unable to complete a meta-analysis to quantitatively assess programme outcomes because of the variability in outcome measures used in the studies. This review has shown that although there are limited studies, it is feasible to carry out alcohol interventions with incarcerated individuals. More work is needed however, to clarify what exactly the outcomes of interest are to the criminal justice agencies we work with. Despite these recent developments the question remains: are we carrying out research projects for incarcerated individuals who are risky drinkers in the most effective way? Research studies in the criminal justice system are by their very nature complex and context-specific. Public health and criminal justice agencies have long been perceived as having entirely different approaches to dealing with alcohol issues (Shepherd and Sumner, 2017). In order to advance policy development, research and programme co-design, research highlights the need for more collaborative research partnerships developed at the start of a project to ensure programme suitability and efficacy (Newbury-Birch et al., 2016a, 2016b). Community-based participatory research has been shown to be a useful model for co-designing research with hard to reach groups (Leung et al., 2004). It has been argued that, in terms of informing policy, there tends to be an over-reliance on evidence from tightly controlled intervention trials which often lead to questions around the applicability of research in the real world (Pettman et al., 2012). The evidence to date, although limited does seem to be showing an effect. However, we are still at the stage where we need robust efficacy/effectiveness studies to prove whether the interventions are effective. FUNDING The research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors. CONTRIBUTORS Professor D.N.-B. and Professor A.H. conceptualised the study, interpreted the results and critically reviewed the article. Dr E.L.G., Ms J.F. and Dr G.J.M. carried out the initial searches and with Professor D.N.-B., Dr S.L., Dr K.J.S. and Dr C.G. screened articles, extracted data. Professor D.N.-B. and Ms J.F. carried out quality assessment. 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Google Scholar CrossRef Search ADS PubMed UKATT Research Team . ( 2005 ) Cost effectiveness of treatment for alcohol problems: findings of the randomised UK alcohol treatment trial (UKATT) . Br Med J 331 : 1 – 5 . CrossRef Search ADS Walmsley R . ( 2015 ) World prison population list , 11th edn . London : Institute for Criminal Policy Research . World Health Organisation . ( 1992 ) The role of general practice settings in the prevention and management of the harm done by alcohol . Copenhagen : World Health Organisation Regional Office for Europe . © The Author(s) 2018. Medical Council on Alcohol and Oxford University Press. All rights reserved. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Alcohol and Alcoholism Oxford University Press

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

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Oxford University Press
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© The Author(s) 2018. Medical Council on Alcohol and Oxford University Press. All rights reserved.
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0735-0414
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1464-3502
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10.1093/alcalc/agy032
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Abstract

Abstract 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. INTRODUCTION Alcohol substantially contributes to the global burden of disease and is responsible for 2.3 million premature deaths worldwide, many of which are preventable (Rehm et al., 2009). A recent survey showed that 70% of prisoners in the UK admitted drinking when committing the offence for which they were imprisoned (Alcohol and Crime Commission, 2014). Hazardous drinking is a repeated pattern of drinking that increases the risk of physical or psychological problems (Saunders and Lee, 2000), whereas harmful drinking is defined by the presence of these problems (World Health Organisation, 1992). Drinking at hazardous or harmful levels are often categorised as risky drinking. There are ~10.35 million people imprisoned worldwide. The USA has 2.28 million and the UK 85,843 (Walmsley, 2015). Worldwide, the prison population is 144 per 100,000 people; in the USA, this is 698 per 100,000 people compared witrh 148 per 100,000 in the UK (Walmsley, 2015). It has been shown that drinking norms in the criminal justice system differ widely from those in the general population (Newbury-Birch et al., 2016b). Risky drinking is higher in the criminal justice system than in the general population (Newbury-Birch et al., 2016b). However, it has been shown that risky drinking amongst incarcerated people differs across the world. A systematic review carried out by Newbury-Birch et al. (2016b) found that between 51% and 83% of incarcerated people are classified as risky drinkers; in the USA, risky drinking levels have been shown to be around 50% (Binswanger et al., 2009) and in Africa, the rates are shown to be just over 50% (Muigai, 2014). Furthermore, rates of dependence among those who are incarcerated have been shown to be up to ten times higher than the general population (Newbury-Birch et al., 2016b). Although the relationship is complex, there is well-documented evidence of an association between alcohol use and crime (Boden et al., 2012), with a complex interplay between the amount drank, the pattern of drinking and the individual and contextual factors (Graham et al., 2012). Evidence tells us that intensive interventions that target high-risk offenders work best for reducing recidivism (Andrews and Bonta, 2010) and this is where resources are being placed. However, services are currently advocating the use of brief interventions in the criminal justice system (Newbury-Birch et al., 2016b). Brief interventions have been shown to be effective in primary healthcare (O’Donnell et al., 2014). They are typically applied to opportunistic, non-treatment seeking populations, delivered by practitioners other than addiction specialists (Miller and Rollnick, 2002). Brief intervention largely consists of two different approaches (National Institute for Clinical and Health Excellence, 2010): simple structured advice which, following screening, seeks to raise awareness through the provision of personalised feedback and advice on practical steps to reduce drinking behaviour and its adverse consequences; and extended brief intervention, which generally involves behaviour change counselling. Extended brief intervention introduces and evokes change by giving the patient the opportunity to explore their alcohol use as well as their motivations and strategies for change. Both forms share the common aim of helping people to change drinking behaviour to promote health, but they vary in the precise means by which this is achieved. There is a wide variation in the duration and frequency of brief alcohol interventions, but typically they are delivered in a single session or a series of related sessions lasting between 5 min and 60 min and can be implemented by a range of practitioners in a wide variety of settings (Kaner et al., 2007). To date, there is a lack of evidence relating to the use of brief interventions in the criminal justice system in general, and in the prison system in particular (Newbury-Birch et al., 2016b). Intervening to reduce alcohol use has been shown to be cost-effective, generating both long- and short-term savings (UKATT Research Team, 2005). Therefore, given the high levels of risky drinking, the links between alcohol and crime, and the costs to society, it is important to find effective interventions that not only reduce alcohol consumption, but also potentially recidivism. Interventions carried out within the criminal justice system could potentially capitalise upon the ‘teachable moment’ considered to be conducive of behaviour change, wherein individuals can be encouraged to consider their alcohol use within the context of their offending behaviour and its punitive consequences (Babor and Grant, 1989). 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. METHODS Search strategy and selection criteria We carried out a systematic review of the international literature, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines on reporting of systematic reviews (Moher et al., 2009). The systematic review protocol was registered on the PROSPERO Register at the University of York (CRD42016039895). We included Randomised Controlled Trials (RCTs) or matched group trials. As well as examining the efficacy/effectiveness of alcohol interventions, the current review adds to other reviews in the criminal justice setting (Graham et al., 2012; Newbury-Birch et al., 2016b) by including evidence around the timing of screening and interventions within the offender journey and information about the type and nature of the interventions themselves. We included studies with control groups comprising: treatment as usual; information-only; assessment only; no assessment or another intervention. Studies eligible for this review were peer-reviewed trials of any alcohol interventions carried out in the jail/prison setting (including remand). We included interventions that were categorised as brief interventions as well as extended longer alcohol psychosocial interventions (extended brief interventions). We included individuals aged 16 years or over and any outcome measure. We excluded studies that included a drug and alcohol intervention where alcohol information could not be isolated. We searched: MEDLINE; PsychINFO; Web of Science; Cochrane Library; EBSCO; CINAHL and the Campbell Collaboration Library. We included all dates in the search. The search was conducted in August 2017. Citations were scanned and we contacted experts in the field to minimise selection bias. The search terms used were: ‘alcohol OR alcoholism OR alcohol abuse OR alcohol misuse OR binge drinking’ AND ‘crim* OR prison* OR offend* OR correctional OR penitentiary OR incarc* OR remand’ AND ‘randomised controlled trials OR randomise OR control OR trial OR random* OR quazi* OR quasi* OR matched’ with Boolean/phrase searches. Searches were tailored to the search functionality of each database. We also searched grey literature including google scholar and did a 360°-citation check of included papers. All authors were involved in the data sifting. Two reviewers on the team conducted eligibility assessments of titles and abstracts independently. Disagreements between reviewers were resolved by consensus or by discussing with a third person. Data were extracted into a Microsoft Excel spreadsheet independently by J.F., E.L.G., G.M., S.L. and A.H. These researchers jointly reviewed the extracted data and all studies were double extracted by D.N.-B. Data were extracted on characteristics of trial participants, type and nature of interventions (including content, duration, frequency, provider, setting), type of outcome measure as well as information relating to the interventions itself. We used the Template for Intervention Description and Replication (TIDieR) checklist to ascertain how interventions are reported in the included studies (Hoffman et al., 2014). One researcher completed the checklist (D.N.-B.) and it was checked by another (J.F.). Quality assessment The relevant screening tools from Critical Appraisal Skills Programme were used by one researcher (C.G.) and checked by another (D.N.-B.) (MKPC Trust, 2002). High risk of bias was recorded if ‘no’ or ‘unsure’ was recorded for 6 or more of the 11 questions on the tool. Medium risk of bias was assigned if ‘no’ or ‘unsure’ was recorded for 4–5 questions and low risk for 1–3 questions (Table 3). Data synthesis We grouped intervention content into two categories. The first was short interventions that were categorised as brief interventions and included up to three sessions. The second was extended brief interventions delivered over more than three sessions (Table 1). Table 1. Details of included papers from 11 Articles (9 studies) Author (country); study type Setting (% male/female) Age (ethnicity) Follow-up period (follow-up rates) Alcohol screening used and cut-off used (who screened) Intervention [number randomised] Control [number randomised] Brief interventions Davis et al. (2003) (USA); RCT Prison (97% male) Mean 45.7 SD 7.7 (49% Caucasian; 38% African-American) 2 Months (41%) Form-90 alcohol tool (researcher) 1 Session of MI (60 min) [n = 36] TAU and information on local services [n = 37] Stein et al. (2010) (USA); RCT Prison/jail (100% female) Mean 34.1 SD 8.9 (71% Caucasian; 19% African-American; 7% Hispanic) 1, 3 and 6 Months (76%, 79%, 79%) AUDIT 8+ (researcher) 2 Sessions of MI (45–60 min): Second session after the first follow-up [n = 125] TAU [n = 120] Begun et al. (2011) (USA); RCT Local Jails (100% female) Mean 35.7 SD 8.7 (57% African-American; 31% White; 6% Hispanic) 2 Months post-release (20%) AUDIT-12 8+ (researcher) 1 Session of MI (60–90 min) [n = 468] TAU [n = 261] Stein et al. (2011b) (USA); RCT Juvenile Correctional Facility (86% male) Mean 17.1 SD 1.1 (33% White; 29% Hispanic; 28% African-American) 3 Months (86%) Risk and Consequences Questionnaire- Alcohol (Researcher) 2 Sessions of MI (session 1 = 90 min; session 2 = 60 min) [n = 189 randomised, no breakdown given] 2 Sessions of relaxation training (session 1 = 90 min; session 2 = 60 min) Stein et al. (2011a) (USA); RCT Juvenile Correctional Facility (84% male) Mean 17.1 SD 1.1 (32% Hispanic; 30% African-American; 30% White) Owens and McCrady (2016) (USA); RCT Jails (100% male) Mean age 34.4 SD 9.8 (27.5% Hispanic; 20% Native American/Alaskan Native; 17.5% African-American; 7.5% Biracial/multiracial/other) Between 1 and 3 months (63%) ASSIST (Researcher) 1 Session of MI (50–60 min) [n = 23] 1 Session of educational videos (50–60 min) [n = 17] Longer interventions Chance et al. (1990) (USA); Matched group Prison (100% male) Not given 30 Weeks (68%) Unsure (unsure) 6–18 Months lifeline counselling (reality therapy and control theory) plus AA/NA attendance and aftercare including AA/NA and family counselling [n = 20] TAU [n = 40] Baldwin et al. (1991) (UK); RCT Juvenile Correctional Facility (100% male) Mean 19.4; range 16.9-20.8 (no ethnicity given) 12 Months (78%) More than half of their total offences drink-related (Social worker) 6 Sessions of MI (each session 120 min) [n = 14] TAU [n = 13] Peters et al. (1993) (USA) matched group Jail (74% male) Mean 29 SD 7.5 (53% African-American; 44% Caucasian) 12 Months (44%) Addiction Severity Index (Programme counsellors) Cognitive-behavioural, skills based intervention over 6 weeks (three groups) 1. Special topics group re motivation and commitment; 2. Relapse prevention (1); 3. Relapse prevention (2) 27+ sessions [n = 535] TAU [n = 422] Bowes et al. (2012), (UK); RCT Prison (100% male) Mean 24.5 SD 5.7 (93% White) Unclear (77%) Alcohol-related Aggression Questionnaire (unsure) 10 Sessions covering selection of topics; 20 h of group treatment, and 4 h of individual support over 4 weeks (COVAID) [n = 56] TAU [n = 59] Bowes et al. (2014), (UK) RCT Author (country); study type Setting (% male/female) Age (ethnicity) Follow-up period (follow-up rates) Alcohol screening used and cut-off used (who screened) Intervention [number randomised] Control [number randomised] Brief interventions Davis et al. (2003) (USA); RCT Prison (97% male) Mean 45.7 SD 7.7 (49% Caucasian; 38% African-American) 2 Months (41%) Form-90 alcohol tool (researcher) 1 Session of MI (60 min) [n = 36] TAU and information on local services [n = 37] Stein et al. (2010) (USA); RCT Prison/jail (100% female) Mean 34.1 SD 8.9 (71% Caucasian; 19% African-American; 7% Hispanic) 1, 3 and 6 Months (76%, 79%, 79%) AUDIT 8+ (researcher) 2 Sessions of MI (45–60 min): Second session after the first follow-up [n = 125] TAU [n = 120] Begun et al. (2011) (USA); RCT Local Jails (100% female) Mean 35.7 SD 8.7 (57% African-American; 31% White; 6% Hispanic) 2 Months post-release (20%) AUDIT-12 8+ (researcher) 1 Session of MI (60–90 min) [n = 468] TAU [n = 261] Stein et al. (2011b) (USA); RCT Juvenile Correctional Facility (86% male) Mean 17.1 SD 1.1 (33% White; 29% Hispanic; 28% African-American) 3 Months (86%) Risk and Consequences Questionnaire- Alcohol (Researcher) 2 Sessions of MI (session 1 = 90 min; session 2 = 60 min) [n = 189 randomised, no breakdown given] 2 Sessions of relaxation training (session 1 = 90 min; session 2 = 60 min) Stein et al. (2011a) (USA); RCT Juvenile Correctional Facility (84% male) Mean 17.1 SD 1.1 (32% Hispanic; 30% African-American; 30% White) Owens and McCrady (2016) (USA); RCT Jails (100% male) Mean age 34.4 SD 9.8 (27.5% Hispanic; 20% Native American/Alaskan Native; 17.5% African-American; 7.5% Biracial/multiracial/other) Between 1 and 3 months (63%) ASSIST (Researcher) 1 Session of MI (50–60 min) [n = 23] 1 Session of educational videos (50–60 min) [n = 17] Longer interventions Chance et al. (1990) (USA); Matched group Prison (100% male) Not given 30 Weeks (68%) Unsure (unsure) 6–18 Months lifeline counselling (reality therapy and control theory) plus AA/NA attendance and aftercare including AA/NA and family counselling [n = 20] TAU [n = 40] Baldwin et al. (1991) (UK); RCT Juvenile Correctional Facility (100% male) Mean 19.4; range 16.9-20.8 (no ethnicity given) 12 Months (78%) More than half of their total offences drink-related (Social worker) 6 Sessions of MI (each session 120 min) [n = 14] TAU [n = 13] Peters et al. (1993) (USA) matched group Jail (74% male) Mean 29 SD 7.5 (53% African-American; 44% Caucasian) 12 Months (44%) Addiction Severity Index (Programme counsellors) Cognitive-behavioural, skills based intervention over 6 weeks (three groups) 1. Special topics group re motivation and commitment; 2. Relapse prevention (1); 3. Relapse prevention (2) 27+ sessions [n = 535] TAU [n = 422] Bowes et al. (2012), (UK); RCT Prison (100% male) Mean 24.5 SD 5.7 (93% White) Unclear (77%) Alcohol-related Aggression Questionnaire (unsure) 10 Sessions covering selection of topics; 20 h of group treatment, and 4 h of individual support over 4 weeks (COVAID) [n = 56] TAU [n = 59] Bowes et al. (2014), (UK) RCT AA, alcoholics anonymous; MI, motivational interviewing; min, minutes; NA, narcotics anonymous; TAU, treatment as usual. Table 1. Details of included papers from 11 Articles (9 studies) Author (country); study type Setting (% male/female) Age (ethnicity) Follow-up period (follow-up rates) Alcohol screening used and cut-off used (who screened) Intervention [number randomised] Control [number randomised] Brief interventions Davis et al. (2003) (USA); RCT Prison (97% male) Mean 45.7 SD 7.7 (49% Caucasian; 38% African-American) 2 Months (41%) Form-90 alcohol tool (researcher) 1 Session of MI (60 min) [n = 36] TAU and information on local services [n = 37] Stein et al. (2010) (USA); RCT Prison/jail (100% female) Mean 34.1 SD 8.9 (71% Caucasian; 19% African-American; 7% Hispanic) 1, 3 and 6 Months (76%, 79%, 79%) AUDIT 8+ (researcher) 2 Sessions of MI (45–60 min): Second session after the first follow-up [n = 125] TAU [n = 120] Begun et al. (2011) (USA); RCT Local Jails (100% female) Mean 35.7 SD 8.7 (57% African-American; 31% White; 6% Hispanic) 2 Months post-release (20%) AUDIT-12 8+ (researcher) 1 Session of MI (60–90 min) [n = 468] TAU [n = 261] Stein et al. (2011b) (USA); RCT Juvenile Correctional Facility (86% male) Mean 17.1 SD 1.1 (33% White; 29% Hispanic; 28% African-American) 3 Months (86%) Risk and Consequences Questionnaire- Alcohol (Researcher) 2 Sessions of MI (session 1 = 90 min; session 2 = 60 min) [n = 189 randomised, no breakdown given] 2 Sessions of relaxation training (session 1 = 90 min; session 2 = 60 min) Stein et al. (2011a) (USA); RCT Juvenile Correctional Facility (84% male) Mean 17.1 SD 1.1 (32% Hispanic; 30% African-American; 30% White) Owens and McCrady (2016) (USA); RCT Jails (100% male) Mean age 34.4 SD 9.8 (27.5% Hispanic; 20% Native American/Alaskan Native; 17.5% African-American; 7.5% Biracial/multiracial/other) Between 1 and 3 months (63%) ASSIST (Researcher) 1 Session of MI (50–60 min) [n = 23] 1 Session of educational videos (50–60 min) [n = 17] Longer interventions Chance et al. (1990) (USA); Matched group Prison (100% male) Not given 30 Weeks (68%) Unsure (unsure) 6–18 Months lifeline counselling (reality therapy and control theory) plus AA/NA attendance and aftercare including AA/NA and family counselling [n = 20] TAU [n = 40] Baldwin et al. (1991) (UK); RCT Juvenile Correctional Facility (100% male) Mean 19.4; range 16.9-20.8 (no ethnicity given) 12 Months (78%) More than half of their total offences drink-related (Social worker) 6 Sessions of MI (each session 120 min) [n = 14] TAU [n = 13] Peters et al. (1993) (USA) matched group Jail (74% male) Mean 29 SD 7.5 (53% African-American; 44% Caucasian) 12 Months (44%) Addiction Severity Index (Programme counsellors) Cognitive-behavioural, skills based intervention over 6 weeks (three groups) 1. Special topics group re motivation and commitment; 2. Relapse prevention (1); 3. Relapse prevention (2) 27+ sessions [n = 535] TAU [n = 422] Bowes et al. (2012), (UK); RCT Prison (100% male) Mean 24.5 SD 5.7 (93% White) Unclear (77%) Alcohol-related Aggression Questionnaire (unsure) 10 Sessions covering selection of topics; 20 h of group treatment, and 4 h of individual support over 4 weeks (COVAID) [n = 56] TAU [n = 59] Bowes et al. (2014), (UK) RCT Author (country); study type Setting (% male/female) Age (ethnicity) Follow-up period (follow-up rates) Alcohol screening used and cut-off used (who screened) Intervention [number randomised] Control [number randomised] Brief interventions Davis et al. (2003) (USA); RCT Prison (97% male) Mean 45.7 SD 7.7 (49% Caucasian; 38% African-American) 2 Months (41%) Form-90 alcohol tool (researcher) 1 Session of MI (60 min) [n = 36] TAU and information on local services [n = 37] Stein et al. (2010) (USA); RCT Prison/jail (100% female) Mean 34.1 SD 8.9 (71% Caucasian; 19% African-American; 7% Hispanic) 1, 3 and 6 Months (76%, 79%, 79%) AUDIT 8+ (researcher) 2 Sessions of MI (45–60 min): Second session after the first follow-up [n = 125] TAU [n = 120] Begun et al. (2011) (USA); RCT Local Jails (100% female) Mean 35.7 SD 8.7 (57% African-American; 31% White; 6% Hispanic) 2 Months post-release (20%) AUDIT-12 8+ (researcher) 1 Session of MI (60–90 min) [n = 468] TAU [n = 261] Stein et al. (2011b) (USA); RCT Juvenile Correctional Facility (86% male) Mean 17.1 SD 1.1 (33% White; 29% Hispanic; 28% African-American) 3 Months (86%) Risk and Consequences Questionnaire- Alcohol (Researcher) 2 Sessions of MI (session 1 = 90 min; session 2 = 60 min) [n = 189 randomised, no breakdown given] 2 Sessions of relaxation training (session 1 = 90 min; session 2 = 60 min) Stein et al. (2011a) (USA); RCT Juvenile Correctional Facility (84% male) Mean 17.1 SD 1.1 (32% Hispanic; 30% African-American; 30% White) Owens and McCrady (2016) (USA); RCT Jails (100% male) Mean age 34.4 SD 9.8 (27.5% Hispanic; 20% Native American/Alaskan Native; 17.5% African-American; 7.5% Biracial/multiracial/other) Between 1 and 3 months (63%) ASSIST (Researcher) 1 Session of MI (50–60 min) [n = 23] 1 Session of educational videos (50–60 min) [n = 17] Longer interventions Chance et al. (1990) (USA); Matched group Prison (100% male) Not given 30 Weeks (68%) Unsure (unsure) 6–18 Months lifeline counselling (reality therapy and control theory) plus AA/NA attendance and aftercare including AA/NA and family counselling [n = 20] TAU [n = 40] Baldwin et al. (1991) (UK); RCT Juvenile Correctional Facility (100% male) Mean 19.4; range 16.9-20.8 (no ethnicity given) 12 Months (78%) More than half of their total offences drink-related (Social worker) 6 Sessions of MI (each session 120 min) [n = 14] TAU [n = 13] Peters et al. (1993) (USA) matched group Jail (74% male) Mean 29 SD 7.5 (53% African-American; 44% Caucasian) 12 Months (44%) Addiction Severity Index (Programme counsellors) Cognitive-behavioural, skills based intervention over 6 weeks (three groups) 1. Special topics group re motivation and commitment; 2. Relapse prevention (1); 3. Relapse prevention (2) 27+ sessions [n = 535] TAU [n = 422] Bowes et al. (2012), (UK); RCT Prison (100% male) Mean 24.5 SD 5.7 (93% White) Unclear (77%) Alcohol-related Aggression Questionnaire (unsure) 10 Sessions covering selection of topics; 20 h of group treatment, and 4 h of individual support over 4 weeks (COVAID) [n = 56] TAU [n = 59] Bowes et al. (2014), (UK) RCT AA, alcoholics anonymous; MI, motivational interviewing; min, minutes; NA, narcotics anonymous; TAU, treatment as usual. RESULTS The search yielded 10,298 papers, of which 28 papers were fully assessed for eligibility (Fig. 1). Eleven papers from nine studies were included in the final analysis (Chance et al., 1990; Baldwin et al., 1991; Peters et al., 1993; Davis et al., 2003; Stein et al., 2010, 2011a, 2011b; Begun et al., 2011; Bowes et al., 2012, 2014; Owens and McCrady, 2016) (Tables 1 and 2). Seven of the included studies were from the USA (Chance et al., 1990; Peters et al., 1993; Davis et al., 2003; Stein et al., 2010, 2011a, 2011b; Begun et al., 2011; Owens and McCrady, 2016) and two from the UK (Baldwin et al., 1991; Bowes et al., 2012, 2014). The included studies consisted of 2435 participants (range 27–729). Most of the studies included either all male participants (Chance et al., 1990; Baldwin et al., 1991; Bowes et al., 2012, 2014; Owens and McCrady, 2016) or majority male (Peters et al., 1993; Davis et al., 2003; Stein et al., 2011a, 2011b). Only two of the included studies examined women only (Stein et al., 2010; Begun et al., 2011). Because of the heterogeneity of the studies meta-analysis was not possible. Fig. 1. View largeDownload slide Flowchart of data. High risk of bias was recorded if ‘no’ or ‘unsure’ was recorded for 6 or more of the 11 questions on the tool. Medium risk of bias was assigned if ‘no’ or ‘unsure’ was recorded for 4–5 questions and low risk for 1–3 questions. Fig. 1. View largeDownload slide Flowchart of data. High risk of bias was recorded if ‘no’ or ‘unsure’ was recorded for 6 or more of the 11 questions on the tool. Medium risk of bias was assigned if ‘no’ or ‘unsure’ was recorded for 4–5 questions and low risk for 1–3 questions. Table 2. Outcome measures and significant results of included studies Author Outcomes (measures) Significant results Brief interventions Davis et al. (2003) P: Engagement with services with VA substance abuse services (TSR) Those in the IG were statistically more likely to schedule appointments at both VA services with 60 days (66.7 vs. 40.5%; X/5.01, P = 0.025). S: Contact with other substance abuse services (TSR) S: substance use (Form-90) S: Consequences (SIP) S: Addiction severity (ASI) S: Readiness to change (Readiness to Change Questionnaire) Stein et al. (2010) Drinking diary Intervention effects on abstinent days were statistically significant at 3 months (odds ratio = 1.96, 95% CI 1.17, 3.30). Alcohol use disorders (AUDIT) Begun et al. (2011) P: Engagement with substance abuse treatment services Mean reduction in AUDIT score from baseline to follow-up were greater in the intervention group (F(1,148) = 6.336, P< 0.001). P: Level of reported alcohol use (AUDIT-12) Stein et al. (2011b) Risk and consequences of drinking (RCQ-A) No significant results related to alcohol. Depression (CES-D) Stein et al. (2011a) Alcohol and drug use (structured clinical interview for DSM-IV) No significant results related to alcohol. Depression (CES-D) Alcohol use (TLFB) Owens and McCrady (2016) Feasibility No significant results related to alcohol. Pre-intervention motivation and confidence ratings IDPA to assess social networks ASI criminal and treatment history Alcohol and substance use Form-90 Extended interventions Chance et al. (1990) P: Sobriety (weekly urine sample) No significant results related to alcohol. S: Changes in attitude towards self and others (self-perception profiles) S: Control over life (staff self-perception profiles) Baldwin et al. (1991) P: Drinking behaviour (MAST; SADQ) The IG reported less drinking in units per session than CG (P < 0.05). The IG had significantly less ‘rules and regulations’ offences than the CG (P < 0.05). The IG averaged fewer offences against the person compared with the CG (P < 0.05). P: Offending behaviour (self-report) S: Wellbeing (General Health Questionnaire) The CG increased average number of alcohol units per week compared to the IG F(1,19) = 4.546 (P < 0.05); The CG increased average alcohol units per drinking session compared to the IG F(1,19) = 6.753 (P < 0.05). The IG reduced the average number of offences against property compared with the CG F(1,13) = 6.489 (P < 0.05). Peters et al. (1993) P: Recidivism (arrest data) The IG had significantly more days free before arrest compared to the CG t(418) = 3.0 (P = 0.01). Significantly less arrests t(418) = 2.7 (P = 0.01). Significantly less jailed time served t(418) = 2.4 (P = 0.05). Bowes et al. (2012) P: Alcohol-related aggression (ARAQ-AA) There were significant main effects of time, with lower scores at Time 2 for the following measures: ARAQ-AA, F(1, 87) = 4.81, P = 0.03, η2 = 0.05, CDSES OC, F(1, 87) = 15.78, P < 0.001, η2 = 0.15, CDSES CCFC, F(1, 86) = 20.88, P < 0.001, η2 = 0.20, CDSES NA, F(1, 87) = 20.16, P < 0.001, η2 = 0.19, CDSES PM, F(1, 87) = 5.92, P = 0.01, η2 = 0.06, CDSES quantity, F(1, 86) = 4.81, P < 0.001, η2 = 0.15, CDSES frequency, F(1, 87) = 11.37, P = 0.001, η2 = 0.12, total CDSES, F(1, 86) = 25.14, P < 0.001, η2 = 0.23, STAXI-2 Anger Expression Out, F(1, 86) = 10.69, P = 0.002, η2 = 0.11, STAXI-2 Anger Expression In, F(1, 86) = 4.04, P = 0.05, η2 = 0.05, STAXI-2 Anger Control Out, F(1, 86) = 4.42, P = 0.04, η2 = 0.05, STAXI-2 Anger Expression Index, F(1, 86) = 12.57, P = 0.001, η2 = 0.13, and IVE I, F(1, 87) = 16.77, P < 0.001, η2 = 0.16. S: Anger (STAXI-2) S: Impulsivity (IVE) S: Self-efficacy (CDSES) There were significant Group × Time interactions, with the COVAID group reporting significantly greater change scores in the desired directions on ARAQ-AA (η2 = 0.05), ARAQ Total (η2 = 0.05), CDSES OC (η2 = 0.09), CDSES CCFC (η2 = 0.11), CDSES NA (η2 = 0.12), CDSES PM (η2 = 0.04), CDES Frequency (η2 = 0.07), CDSES Quantity (η2 = 0.07), CDSES Total (η2 = 0.14) and the IVE empathy subscale (η2 = 0.04). Bowes et al. (2014) Reconviction No significant results found. Author Outcomes (measures) Significant results Brief interventions Davis et al. (2003) P: Engagement with services with VA substance abuse services (TSR) Those in the IG were statistically more likely to schedule appointments at both VA services with 60 days (66.7 vs. 40.5%; X/5.01, P = 0.025). S: Contact with other substance abuse services (TSR) S: substance use (Form-90) S: Consequences (SIP) S: Addiction severity (ASI) S: Readiness to change (Readiness to Change Questionnaire) Stein et al. (2010) Drinking diary Intervention effects on abstinent days were statistically significant at 3 months (odds ratio = 1.96, 95% CI 1.17, 3.30). Alcohol use disorders (AUDIT) Begun et al. (2011) P: Engagement with substance abuse treatment services Mean reduction in AUDIT score from baseline to follow-up were greater in the intervention group (F(1,148) = 6.336, P< 0.001). P: Level of reported alcohol use (AUDIT-12) Stein et al. (2011b) Risk and consequences of drinking (RCQ-A) No significant results related to alcohol. Depression (CES-D) Stein et al. (2011a) Alcohol and drug use (structured clinical interview for DSM-IV) No significant results related to alcohol. Depression (CES-D) Alcohol use (TLFB) Owens and McCrady (2016) Feasibility No significant results related to alcohol. Pre-intervention motivation and confidence ratings IDPA to assess social networks ASI criminal and treatment history Alcohol and substance use Form-90 Extended interventions Chance et al. (1990) P: Sobriety (weekly urine sample) No significant results related to alcohol. S: Changes in attitude towards self and others (self-perception profiles) S: Control over life (staff self-perception profiles) Baldwin et al. (1991) P: Drinking behaviour (MAST; SADQ) The IG reported less drinking in units per session than CG (P < 0.05). The IG had significantly less ‘rules and regulations’ offences than the CG (P < 0.05). The IG averaged fewer offences against the person compared with the CG (P < 0.05). P: Offending behaviour (self-report) S: Wellbeing (General Health Questionnaire) The CG increased average number of alcohol units per week compared to the IG F(1,19) = 4.546 (P < 0.05); The CG increased average alcohol units per drinking session compared to the IG F(1,19) = 6.753 (P < 0.05). The IG reduced the average number of offences against property compared with the CG F(1,13) = 6.489 (P < 0.05). Peters et al. (1993) P: Recidivism (arrest data) The IG had significantly more days free before arrest compared to the CG t(418) = 3.0 (P = 0.01). Significantly less arrests t(418) = 2.7 (P = 0.01). Significantly less jailed time served t(418) = 2.4 (P = 0.05). Bowes et al. (2012) P: Alcohol-related aggression (ARAQ-AA) There were significant main effects of time, with lower scores at Time 2 for the following measures: ARAQ-AA, F(1, 87) = 4.81, P = 0.03, η2 = 0.05, CDSES OC, F(1, 87) = 15.78, P < 0.001, η2 = 0.15, CDSES CCFC, F(1, 86) = 20.88, P < 0.001, η2 = 0.20, CDSES NA, F(1, 87) = 20.16, P < 0.001, η2 = 0.19, CDSES PM, F(1, 87) = 5.92, P = 0.01, η2 = 0.06, CDSES quantity, F(1, 86) = 4.81, P < 0.001, η2 = 0.15, CDSES frequency, F(1, 87) = 11.37, P = 0.001, η2 = 0.12, total CDSES, F(1, 86) = 25.14, P < 0.001, η2 = 0.23, STAXI-2 Anger Expression Out, F(1, 86) = 10.69, P = 0.002, η2 = 0.11, STAXI-2 Anger Expression In, F(1, 86) = 4.04, P = 0.05, η2 = 0.05, STAXI-2 Anger Control Out, F(1, 86) = 4.42, P = 0.04, η2 = 0.05, STAXI-2 Anger Expression Index, F(1, 86) = 12.57, P = 0.001, η2 = 0.13, and IVE I, F(1, 87) = 16.77, P < 0.001, η2 = 0.16. S: Anger (STAXI-2) S: Impulsivity (IVE) S: Self-efficacy (CDSES) There were significant Group × Time interactions, with the COVAID group reporting significantly greater change scores in the desired directions on ARAQ-AA (η2 = 0.05), ARAQ Total (η2 = 0.05), CDSES OC (η2 = 0.09), CDSES CCFC (η2 = 0.11), CDSES NA (η2 = 0.12), CDSES PM (η2 = 0.04), CDES Frequency (η2 = 0.07), CDSES Quantity (η2 = 0.07), CDSES Total (η2 = 0.14) and the IVE empathy subscale (η2 = 0.04). Bowes et al. (2014) Reconviction No significant results found. P, primary outcome; S, secondary outcome; STAXI-2, state-trait anger expression inventory; IVE, impulsivity, venturesome and empathy scale; CDSES, controlled drinking self-efficacy scale; ASI, addiction severity index; IG, intervention group; CG, control group; RSQ-A, risks and consequence questionnaire—alcohol; TSR, treatment services review; SIP, short inventory of problems; P, primary outcome; S, secondary outcome; DSM-IV, diagnostic and statistical manual of mental disorders, 4th Edition; CES-D, Center for Epidemiological Studies—Depression; TLFB, time line follow back; AUDIT, alcohol use disorders identification test; VA, veterans association; MAST, Michigan Alcohol Screening Test; SADQ, severity of alcohol dependence questionnaire; ARAQ-AA, alcohol-related aggression questionnaire—alcohol aggression scale; CDSES PM, controlled drinking self-efficacy scale positive mood; CDSES CCFC, confidence controlling frequency and consumption; CDSES NA, controlled drinking self-efficacy negative affect; CDSES OC, controlled drinking self-efficacy overall confidence; IDPA, important people drug and alcohol interview. View Large Table 2. Outcome measures and significant results of included studies Author Outcomes (measures) Significant results Brief interventions Davis et al. (2003) P: Engagement with services with VA substance abuse services (TSR) Those in the IG were statistically more likely to schedule appointments at both VA services with 60 days (66.7 vs. 40.5%; X/5.01, P = 0.025). S: Contact with other substance abuse services (TSR) S: substance use (Form-90) S: Consequences (SIP) S: Addiction severity (ASI) S: Readiness to change (Readiness to Change Questionnaire) Stein et al. (2010) Drinking diary Intervention effects on abstinent days were statistically significant at 3 months (odds ratio = 1.96, 95% CI 1.17, 3.30). Alcohol use disorders (AUDIT) Begun et al. (2011) P: Engagement with substance abuse treatment services Mean reduction in AUDIT score from baseline to follow-up were greater in the intervention group (F(1,148) = 6.336, P< 0.001). P: Level of reported alcohol use (AUDIT-12) Stein et al. (2011b) Risk and consequences of drinking (RCQ-A) No significant results related to alcohol. Depression (CES-D) Stein et al. (2011a) Alcohol and drug use (structured clinical interview for DSM-IV) No significant results related to alcohol. Depression (CES-D) Alcohol use (TLFB) Owens and McCrady (2016) Feasibility No significant results related to alcohol. Pre-intervention motivation and confidence ratings IDPA to assess social networks ASI criminal and treatment history Alcohol and substance use Form-90 Extended interventions Chance et al. (1990) P: Sobriety (weekly urine sample) No significant results related to alcohol. S: Changes in attitude towards self and others (self-perception profiles) S: Control over life (staff self-perception profiles) Baldwin et al. (1991) P: Drinking behaviour (MAST; SADQ) The IG reported less drinking in units per session than CG (P < 0.05). The IG had significantly less ‘rules and regulations’ offences than the CG (P < 0.05). The IG averaged fewer offences against the person compared with the CG (P < 0.05). P: Offending behaviour (self-report) S: Wellbeing (General Health Questionnaire) The CG increased average number of alcohol units per week compared to the IG F(1,19) = 4.546 (P < 0.05); The CG increased average alcohol units per drinking session compared to the IG F(1,19) = 6.753 (P < 0.05). The IG reduced the average number of offences against property compared with the CG F(1,13) = 6.489 (P < 0.05). Peters et al. (1993) P: Recidivism (arrest data) The IG had significantly more days free before arrest compared to the CG t(418) = 3.0 (P = 0.01). Significantly less arrests t(418) = 2.7 (P = 0.01). Significantly less jailed time served t(418) = 2.4 (P = 0.05). Bowes et al. (2012) P: Alcohol-related aggression (ARAQ-AA) There were significant main effects of time, with lower scores at Time 2 for the following measures: ARAQ-AA, F(1, 87) = 4.81, P = 0.03, η2 = 0.05, CDSES OC, F(1, 87) = 15.78, P < 0.001, η2 = 0.15, CDSES CCFC, F(1, 86) = 20.88, P < 0.001, η2 = 0.20, CDSES NA, F(1, 87) = 20.16, P < 0.001, η2 = 0.19, CDSES PM, F(1, 87) = 5.92, P = 0.01, η2 = 0.06, CDSES quantity, F(1, 86) = 4.81, P < 0.001, η2 = 0.15, CDSES frequency, F(1, 87) = 11.37, P = 0.001, η2 = 0.12, total CDSES, F(1, 86) = 25.14, P < 0.001, η2 = 0.23, STAXI-2 Anger Expression Out, F(1, 86) = 10.69, P = 0.002, η2 = 0.11, STAXI-2 Anger Expression In, F(1, 86) = 4.04, P = 0.05, η2 = 0.05, STAXI-2 Anger Control Out, F(1, 86) = 4.42, P = 0.04, η2 = 0.05, STAXI-2 Anger Expression Index, F(1, 86) = 12.57, P = 0.001, η2 = 0.13, and IVE I, F(1, 87) = 16.77, P < 0.001, η2 = 0.16. S: Anger (STAXI-2) S: Impulsivity (IVE) S: Self-efficacy (CDSES) There were significant Group × Time interactions, with the COVAID group reporting significantly greater change scores in the desired directions on ARAQ-AA (η2 = 0.05), ARAQ Total (η2 = 0.05), CDSES OC (η2 = 0.09), CDSES CCFC (η2 = 0.11), CDSES NA (η2 = 0.12), CDSES PM (η2 = 0.04), CDES Frequency (η2 = 0.07), CDSES Quantity (η2 = 0.07), CDSES Total (η2 = 0.14) and the IVE empathy subscale (η2 = 0.04). Bowes et al. (2014) Reconviction No significant results found. Author Outcomes (measures) Significant results Brief interventions Davis et al. (2003) P: Engagement with services with VA substance abuse services (TSR) Those in the IG were statistically more likely to schedule appointments at both VA services with 60 days (66.7 vs. 40.5%; X/5.01, P = 0.025). S: Contact with other substance abuse services (TSR) S: substance use (Form-90) S: Consequences (SIP) S: Addiction severity (ASI) S: Readiness to change (Readiness to Change Questionnaire) Stein et al. (2010) Drinking diary Intervention effects on abstinent days were statistically significant at 3 months (odds ratio = 1.96, 95% CI 1.17, 3.30). Alcohol use disorders (AUDIT) Begun et al. (2011) P: Engagement with substance abuse treatment services Mean reduction in AUDIT score from baseline to follow-up were greater in the intervention group (F(1,148) = 6.336, P< 0.001). P: Level of reported alcohol use (AUDIT-12) Stein et al. (2011b) Risk and consequences of drinking (RCQ-A) No significant results related to alcohol. Depression (CES-D) Stein et al. (2011a) Alcohol and drug use (structured clinical interview for DSM-IV) No significant results related to alcohol. Depression (CES-D) Alcohol use (TLFB) Owens and McCrady (2016) Feasibility No significant results related to alcohol. Pre-intervention motivation and confidence ratings IDPA to assess social networks ASI criminal and treatment history Alcohol and substance use Form-90 Extended interventions Chance et al. (1990) P: Sobriety (weekly urine sample) No significant results related to alcohol. S: Changes in attitude towards self and others (self-perception profiles) S: Control over life (staff self-perception profiles) Baldwin et al. (1991) P: Drinking behaviour (MAST; SADQ) The IG reported less drinking in units per session than CG (P < 0.05). The IG had significantly less ‘rules and regulations’ offences than the CG (P < 0.05). The IG averaged fewer offences against the person compared with the CG (P < 0.05). P: Offending behaviour (self-report) S: Wellbeing (General Health Questionnaire) The CG increased average number of alcohol units per week compared to the IG F(1,19) = 4.546 (P < 0.05); The CG increased average alcohol units per drinking session compared to the IG F(1,19) = 6.753 (P < 0.05). The IG reduced the average number of offences against property compared with the CG F(1,13) = 6.489 (P < 0.05). Peters et al. (1993) P: Recidivism (arrest data) The IG had significantly more days free before arrest compared to the CG t(418) = 3.0 (P = 0.01). Significantly less arrests t(418) = 2.7 (P = 0.01). Significantly less jailed time served t(418) = 2.4 (P = 0.05). Bowes et al. (2012) P: Alcohol-related aggression (ARAQ-AA) There were significant main effects of time, with lower scores at Time 2 for the following measures: ARAQ-AA, F(1, 87) = 4.81, P = 0.03, η2 = 0.05, CDSES OC, F(1, 87) = 15.78, P < 0.001, η2 = 0.15, CDSES CCFC, F(1, 86) = 20.88, P < 0.001, η2 = 0.20, CDSES NA, F(1, 87) = 20.16, P < 0.001, η2 = 0.19, CDSES PM, F(1, 87) = 5.92, P = 0.01, η2 = 0.06, CDSES quantity, F(1, 86) = 4.81, P < 0.001, η2 = 0.15, CDSES frequency, F(1, 87) = 11.37, P = 0.001, η2 = 0.12, total CDSES, F(1, 86) = 25.14, P < 0.001, η2 = 0.23, STAXI-2 Anger Expression Out, F(1, 86) = 10.69, P = 0.002, η2 = 0.11, STAXI-2 Anger Expression In, F(1, 86) = 4.04, P = 0.05, η2 = 0.05, STAXI-2 Anger Control Out, F(1, 86) = 4.42, P = 0.04, η2 = 0.05, STAXI-2 Anger Expression Index, F(1, 86) = 12.57, P = 0.001, η2 = 0.13, and IVE I, F(1, 87) = 16.77, P < 0.001, η2 = 0.16. S: Anger (STAXI-2) S: Impulsivity (IVE) S: Self-efficacy (CDSES) There were significant Group × Time interactions, with the COVAID group reporting significantly greater change scores in the desired directions on ARAQ-AA (η2 = 0.05), ARAQ Total (η2 = 0.05), CDSES OC (η2 = 0.09), CDSES CCFC (η2 = 0.11), CDSES NA (η2 = 0.12), CDSES PM (η2 = 0.04), CDES Frequency (η2 = 0.07), CDSES Quantity (η2 = 0.07), CDSES Total (η2 = 0.14) and the IVE empathy subscale (η2 = 0.04). Bowes et al. (2014) Reconviction No significant results found. P, primary outcome; S, secondary outcome; STAXI-2, state-trait anger expression inventory; IVE, impulsivity, venturesome and empathy scale; CDSES, controlled drinking self-efficacy scale; ASI, addiction severity index; IG, intervention group; CG, control group; RSQ-A, risks and consequence questionnaire—alcohol; TSR, treatment services review; SIP, short inventory of problems; P, primary outcome; S, secondary outcome; DSM-IV, diagnostic and statistical manual of mental disorders, 4th Edition; CES-D, Center for Epidemiological Studies—Depression; TLFB, time line follow back; AUDIT, alcohol use disorders identification test; VA, veterans association; MAST, Michigan Alcohol Screening Test; SADQ, severity of alcohol dependence questionnaire; ARAQ-AA, alcohol-related aggression questionnaire—alcohol aggression scale; CDSES PM, controlled drinking self-efficacy scale positive mood; CDSES CCFC, confidence controlling frequency and consumption; CDSES NA, controlled drinking self-efficacy negative affect; CDSES OC, controlled drinking self-efficacy overall confidence; IDPA, important people drug and alcohol interview. View Large Screening for inclusion for five of the included studies was carried out by researchers (Davis et al., 2003; Stein et al., 2010, 2011a, 2011b; Begun et al., 2011; Owens and McCrady, 2016); one by social workers (Baldwin et al., 1991) and one by programme counsellors (Peters et al., 1993). Two studies did not include this information (Chance et al., 1990; Bowes et al., 2012, 2014). A range of tools was used to screen participants into studies. Two studies used the Alcohol Use Disorders Identification Test (AUDIT; Babor et al., 2001) screening tool to screen for risky drinking (Stein et al., 2010; Begun et al., 2011); one used the ASSIST (Owens and McCrady, 2016); one used the Alcohol-Related Aggression Questionnaire (McMurran and Baldwin, 2006; Bowes et al., 2012, 2014); one the Form-90 alcohol tool (Davis et al., 2003); one the Addiction Severity Index (Peters et al., 1993); one the risks and consequences of drinking questionnaire (Stein et al., 2010, 2011a, 2011b); one used the question ‘more than half of their total offences being drink related’ (Baldwin et al., 1991) and one did not give this information (Chance et al., 1990). Brief interventions Five studies (six papers) from the USA examined the efficacy of brief interventions for incarcerated participants (Davis et al., 2003; Stein et al., 2010, 2011a, 2011b; Begun et al., 2011; Owens and McCrady, 2016). The length of the brief interventions ranged from 45 to 150 min (Davis et al., 2003; Stein et al., 2010, 2011a, 2011b; Begun et al., 2011; Owens and McCrady, 2016). One study (two papers) was from the same authors and included relaxation training as the control condition (Stein et al., 2010, 2011a, 2011b). One study included educational videos as the control condition (Owens and McCrady, 2016). The other studies all included treatment as usual as the control condition (Davis et al., 2003; Stein et al., 2010; Begun et al., 2011). Studies did not give information on what treatment as usual was. Four of the studies were conducted with adults (Davis et al., 2003; Stein et al., 2010; Begun et al., 2011; Owens and McCrady, 2016) and one study with juveniles (Stein et al., 2011a, 2011b) (Table 1). In terms of quality assessment, one of the studies was classified as having a low risk of bias (Stein et al., 2010), three as medium risk of bias (Begun et al., 2011; Stein et al., 2011a, 2011b; Owens and McCrady, 2016) and one as having a high risk of bias (Davis et al., 2003) (Table 3). Table 3. Quality assessment of included studies Author Did the trial address a clearly focused issue? Was the assignment of patients to treatments randomised? Were participants blinded? Were the groups similar at the start of the trial? Were the groups treated equally? Were all participants accounted for at conclusion? How large was the treatment effect? How precise was the estimate of the treatment effect? Can the results be applied in the local population context? Were all important outcomes considered? Are the benefits worth the harms and the costs? Level of risk (quality assessment) Brief interventions Davis et al. (2003) YES YES NO NO YES NO YES YES UNSURE NO UNSURE HR Stein et al. (2010) YES YES R: YES YES YES UNSURE YES YES YES NO NO LR P: NO Begun et al. (2011) YES YES NO NO YES NO YES YES UNSURE NO YES MR Stein et al. (2011b) and Stein et al. (2011a) YES YES R: YES UNSURE UNSURE NO YES YES NO NO YES MR P: UNSURE Owens and McCrady (2016) YES YES NO NO YES NO NO NO NO YES NO MR Extended interventions Chance et al. (1990) YES NO NO UNSURE NO NO NO NO NO UNSURE UNSURE HR Baldwin et al. (1991) YES YES UNSURE NO NO NO YES YES NO YES YES MR Peters et al. (1993) YES NO UNSURE NO NO NO YES YES NO YES UNSURE HR Bowes et al. (2012, 2014) YES YES UNSURE NO YES NO YES YES NO NO YES MR Author Did the trial address a clearly focused issue? Was the assignment of patients to treatments randomised? Were participants blinded? Were the groups similar at the start of the trial? Were the groups treated equally? Were all participants accounted for at conclusion? How large was the treatment effect? How precise was the estimate of the treatment effect? Can the results be applied in the local population context? Were all important outcomes considered? Are the benefits worth the harms and the costs? Level of risk (quality assessment) Brief interventions Davis et al. (2003) YES YES NO NO YES NO YES YES UNSURE NO UNSURE HR Stein et al. (2010) YES YES R: YES YES YES UNSURE YES YES YES NO NO LR P: NO Begun et al. (2011) YES YES NO NO YES NO YES YES UNSURE NO YES MR Stein et al. (2011b) and Stein et al. (2011a) YES YES R: YES UNSURE UNSURE NO YES YES NO NO YES MR P: UNSURE Owens and McCrady (2016) YES YES NO NO YES NO NO NO NO YES NO MR Extended interventions Chance et al. (1990) YES NO NO UNSURE NO NO NO NO NO UNSURE UNSURE HR Baldwin et al. (1991) YES YES UNSURE NO NO NO YES YES NO YES YES MR Peters et al. (1993) YES NO UNSURE NO NO NO YES YES NO YES UNSURE HR Bowes et al. (2012, 2014) YES YES UNSURE NO YES NO YES YES NO NO YES MR R, researchers; P, participants; HR, high risk of bias; MR, medium risk of bias; LR, low risk of bias. Table 3. Quality assessment of included studies Author Did the trial address a clearly focused issue? Was the assignment of patients to treatments randomised? Were participants blinded? Were the groups similar at the start of the trial? Were the groups treated equally? Were all participants accounted for at conclusion? How large was the treatment effect? How precise was the estimate of the treatment effect? Can the results be applied in the local population context? Were all important outcomes considered? Are the benefits worth the harms and the costs? Level of risk (quality assessment) Brief interventions Davis et al. (2003) YES YES NO NO YES NO YES YES UNSURE NO UNSURE HR Stein et al. (2010) YES YES R: YES YES YES UNSURE YES YES YES NO NO LR P: NO Begun et al. (2011) YES YES NO NO YES NO YES YES UNSURE NO YES MR Stein et al. (2011b) and Stein et al. (2011a) YES YES R: YES UNSURE UNSURE NO YES YES NO NO YES MR P: UNSURE Owens and McCrady (2016) YES YES NO NO YES NO NO NO NO YES NO MR Extended interventions Chance et al. (1990) YES NO NO UNSURE NO NO NO NO NO UNSURE UNSURE HR Baldwin et al. (1991) YES YES UNSURE NO NO NO YES YES NO YES YES MR Peters et al. (1993) YES NO UNSURE NO NO NO YES YES NO YES UNSURE HR Bowes et al. (2012, 2014) YES YES UNSURE NO YES NO YES YES NO NO YES MR Author Did the trial address a clearly focused issue? Was the assignment of patients to treatments randomised? Were participants blinded? Were the groups similar at the start of the trial? Were the groups treated equally? Were all participants accounted for at conclusion? How large was the treatment effect? How precise was the estimate of the treatment effect? Can the results be applied in the local population context? Were all important outcomes considered? Are the benefits worth the harms and the costs? Level of risk (quality assessment) Brief interventions Davis et al. (2003) YES YES NO NO YES NO YES YES UNSURE NO UNSURE HR Stein et al. (2010) YES YES R: YES YES YES UNSURE YES YES YES NO NO LR P: NO Begun et al. (2011) YES YES NO NO YES NO YES YES UNSURE NO YES MR Stein et al. (2011b) and Stein et al. (2011a) YES YES R: YES UNSURE UNSURE NO YES YES NO NO YES MR P: UNSURE Owens and McCrady (2016) YES YES NO NO YES NO NO NO NO YES NO MR Extended interventions Chance et al. (1990) YES NO NO UNSURE NO NO NO NO NO UNSURE UNSURE HR Baldwin et al. (1991) YES YES UNSURE NO NO NO YES YES NO YES YES MR Peters et al. (1993) YES NO UNSURE NO NO NO YES YES NO YES UNSURE HR Bowes et al. (2012, 2014) YES YES UNSURE NO YES NO YES YES NO NO YES MR R, researchers; P, participants; HR, high risk of bias; MR, medium risk of bias; LR, low risk of bias. The five studies all used different outcome measures (Table 2), meaning results were unable to be synthesised by meta-analysis, yet despite this, some significant results were found. Davis et al. (2003) found that those that were given a brief intervention were significantly more likely to schedule follow-up appointments for treatment (66.7 vs. 40.5%; X2 5.01, P = 0.025) (Davis et al., 2003). Stein et al. (2010) found that those in the intervention group had reported significantly more days abstinent at follow-up (OR = 1.96) (Stein et al., 2010). Begun et al. (2011) found that for the intervention group the mean reduction in AUDIT score from baseline to follow-up were greater in the intervention group (F(1,148) = 6.336, P< 0.001; Begun et al., 2011). The Stein et al. (2011a, 2011b) study found no significant results related to alcohol. Owens and McCrady (2016) was a small feasibility study and although they found the study to be feasible they did not find any significant differences between groups. Extended brief interventions Four studies (five papers) examined the efficacy of alcohol interventions with adults in the prison system using extended brief interventions (Chance et al., 1990; Baldwin et al., 1991; Peters et al., 1993; Bowes et al., 2012, 2014). Two of the studies were from the USA (Chance et al., 1990; Peters et al., 1993) and two from the UK (Baldwin et al., 1991; Bowes et al., 2012, 2014). The interventions lasted from six sessions to 18 months in duration (no actual times given). Three of the studies were conducted with adults (Chance et al., 1990; Peters et al., 1993; Bowes et al., 2012, 2014) and one study with juveniles (Baldwin et al., 1991) (Table 1). In terms of quality assessment, one of the studies was classified as having a medium risk of bias (Bowes et al., 2012, 2014) whilst three had a high risk of bias (Chance et al., 1990; Baldwin et al., 1991; Peters et al., 1993) (Table 3). The four studies all used different outcome measures (Table 2) meaning results were unable to be synthesised. Chance et al. (1990) found no significant results related to alcohol (Chance et al., 1990). Baldwin et al. (1991) found that the control group increased the average number of alcohol units per week compared with the intervention group F(1,19) = 4.546 (P < 0.05); The control group also increased average alcohol units per drinking session compared to the intervention group F(1,19) = 6.753 (P < 0.05). In comparison, the intervention group reduced the average number of offences against property compared to the control group F(1,13) = 6.489 (P < 0.05) (Baldwin et al., 1991). Peters et al. (1993) found that those that were randomised to the intervention group had a significantly longer time period before being arrested again t(418) = 3.0 P < 0.01, significantly fewer arrests t(418) = 2.7 P < 0.01, and served significantly less jail time t(418) = 2.4 P < 0.05 compared with the control group. Bowes et al. (2012) found significantly lower scores for individuals in the intervention group compared to the control in relation to alcohol-related aggression (P < 0.05) as well as the different components of the Controlled Drinking Self-Efficacy Tool and the State-Trait Anger Expression Inventory (Bowes et al., 2012; Table 2). However, a follow-up study by the same authors found no statistically significant differences in relation to recidivism (Bowes et al., 2014). TIDieR results Results relating to how interventions were described are shown in Tables 3 and 4 using the TIDieR checklist (Hoffman et al., 2014). We found that for some categories detailed information was not given in the included papers. Table 4. TIDieR results of included brief intervention studies Davis et al. (2003) Stein et al. (2010) Begun et al. (2011) Stein et al. (2011b) and Stein et al. (2011a) Owens and McCrady (2016) Provide the name or a phrase that describes the intervention. Brief MI MI MI MI MI Describe any rationale, theory or goal of the elements essential to the intervention. MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). Materials: describe any physical or informational materials used in the intervention. Provide information on where the materials can be accessed. None given. Manual was used. Resource folder (including information about treatment, support services, housing, clothing, healthcare) and a 3-month calendar. Handouts were given (e.g. goals chosen). Manual that targeted alcohol and other drug use. Procedures: describe each of the procedures, activities, and/or processes used in the intervention, including any enabling or support activities. Personalised feedback provided (pre-incarceration drinking rates relative to national averages, performance on neuropsychological tests compared with national averages and ratings of physical and emotional health). Participants were also given graphical information re: types of situations in which they reported commonly using substances, self-reported problems and dependence criteria endorsed, and their reported readiness for change. Interviewers were non-confrontational in tone, asked open-ended questions and used reflective listening skills. Interviewers allowed participants to come to their own conclusions, if any, about the feedback and need for treatment. VA referral information was reviewed at the end of the interview. Initial session (during incarceration)—Interventionist used MI techniques re: goal setting and strategies to deal with obstacles/barriers that might affect these goals. Due to RIDOC regulations, participants were not allowed to keep any materials from the session. Upon release, the feedback report and change plan handouts, payment for the baseline interview, community resources, condoms and the next appointment date were mailed to participant. Feedback intervention to engage the women in an exploration of their own motivation and commitment to behaviour change. The objectives were to explore and resolve ambivalence, address decisional balance (the pros and cons of changing and not changing their substance-related behaviours), explore options (including self-change attempts, informal systems, and formal services), and resolve perceived barriers specific to engaging with substance abuse services. MI focusing on empathy, not arguing, developing discrepancy, self-efficacy and personal choice. Sections of the MI included developing rapport, exploration of motivation (pros and cons), personalised assessment feedback, imagining the future with and without change, and establishing goals. Focus of the intervention was on reduction of alcohol and/or marijuana use and associated risky behaviours and consequences of use (e.g. injuries while drunk or high). MI session following a manual that targeted alcohol and other drug use, and if relevant, participants social networks and engagement in treatment. Open-ended questions elicited participants’ reasons to change. Normative feedback was not included. Follow-Up Session—Based on participant’s goal(s) and change plan from initial MI session. Sessions focused on progress, assessment of barriers and developing concrete strategies for meeting new goals. For each category of intervention provider, describe their expertise, background and any specific training given. Clinical Research Staff who had completed/were completing Masters Degrees. 12 h of training in MI. Training: didactics and observed practices and experiences and supervision provided. Graduate social workers trained in research protocol engaged women in initial demographic and brief screening interview. Research counsellors delivered both type of intervention. Treatments were manualized and 20 h training was given as well as weekly supervision. Delivered by advanced clinical psychology graduate tutors who were trained in MI and had experience of delivering MI. Describe the mode of delivery of the intervention and whether it was provided individually or in a group. One-on-one sessions. One-on-one sessions. One-on-one sessions. One-on-one sessions. One-on-one sessions. Describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features. Private room in the jail. First session in prison (no details). Second session in hospital based community research site (no details). Private room in the jail. Juvenile correctional facility. Private room at the jail that had windows to ensure the safety of study staff and participants but offered auditory confidentiality. Describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose. One session of 60 min per person. Two sessions of between 30-45 min per person. One session of 60–90 min per person. One 90 min session and one 60 min booster session. One session of 50–60 min per person. If the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how. Personalised MI intervention based on results of screening. Personalised MI intervention based on results of screening. Personalised MI intervention based on results of screening. MI: personalised intervention. RT: personalised as individual described relaxing place—individual to them. Personalised MI intervention based on results of screening. If the intervention was modified during the course of the study, describe the changes (what, why, when and how). N/A N/A N/A N/A N/A Planned: if intervention adherence of fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them. and Actual: describe the extent to which the intervention was delivered as planned. N/A MITI was used to train and to monitor the MI skills of the interventionists during biweekly supervision. The MITI allows for assessment of threshold competence for therapists and a measure of integrity of MI interventions using two global scores (‘empathy’ and ‘spirit;’ score range 1–7) and seven behaviour counts (e.g. ‘giving information’, ‘MI adherent’). N/A Adolescents and research counsellors completed evaluation forms assessing whether core components of the interventions occurred. Sessions were recorded for supervision with a certified MI trainer and to assess treatment fidelity. Davis et al. (2003) Stein et al. (2010) Begun et al. (2011) Stein et al. (2011b) and Stein et al. (2011a) Owens and McCrady (2016) Provide the name or a phrase that describes the intervention. Brief MI MI MI MI MI Describe any rationale, theory or goal of the elements essential to the intervention. MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). Materials: describe any physical or informational materials used in the intervention. Provide information on where the materials can be accessed. None given. Manual was used. Resource folder (including information about treatment, support services, housing, clothing, healthcare) and a 3-month calendar. Handouts were given (e.g. goals chosen). Manual that targeted alcohol and other drug use. Procedures: describe each of the procedures, activities, and/or processes used in the intervention, including any enabling or support activities. Personalised feedback provided (pre-incarceration drinking rates relative to national averages, performance on neuropsychological tests compared with national averages and ratings of physical and emotional health). Participants were also given graphical information re: types of situations in which they reported commonly using substances, self-reported problems and dependence criteria endorsed, and their reported readiness for change. Interviewers were non-confrontational in tone, asked open-ended questions and used reflective listening skills. Interviewers allowed participants to come to their own conclusions, if any, about the feedback and need for treatment. VA referral information was reviewed at the end of the interview. Initial session (during incarceration)—Interventionist used MI techniques re: goal setting and strategies to deal with obstacles/barriers that might affect these goals. Due to RIDOC regulations, participants were not allowed to keep any materials from the session. Upon release, the feedback report and change plan handouts, payment for the baseline interview, community resources, condoms and the next appointment date were mailed to participant. Feedback intervention to engage the women in an exploration of their own motivation and commitment to behaviour change. The objectives were to explore and resolve ambivalence, address decisional balance (the pros and cons of changing and not changing their substance-related behaviours), explore options (including self-change attempts, informal systems, and formal services), and resolve perceived barriers specific to engaging with substance abuse services. MI focusing on empathy, not arguing, developing discrepancy, self-efficacy and personal choice. Sections of the MI included developing rapport, exploration of motivation (pros and cons), personalised assessment feedback, imagining the future with and without change, and establishing goals. Focus of the intervention was on reduction of alcohol and/or marijuana use and associated risky behaviours and consequences of use (e.g. injuries while drunk or high). MI session following a manual that targeted alcohol and other drug use, and if relevant, participants social networks and engagement in treatment. Open-ended questions elicited participants’ reasons to change. Normative feedback was not included. Follow-Up Session—Based on participant’s goal(s) and change plan from initial MI session. Sessions focused on progress, assessment of barriers and developing concrete strategies for meeting new goals. For each category of intervention provider, describe their expertise, background and any specific training given. Clinical Research Staff who had completed/were completing Masters Degrees. 12 h of training in MI. Training: didactics and observed practices and experiences and supervision provided. Graduate social workers trained in research protocol engaged women in initial demographic and brief screening interview. Research counsellors delivered both type of intervention. Treatments were manualized and 20 h training was given as well as weekly supervision. Delivered by advanced clinical psychology graduate tutors who were trained in MI and had experience of delivering MI. Describe the mode of delivery of the intervention and whether it was provided individually or in a group. One-on-one sessions. One-on-one sessions. One-on-one sessions. One-on-one sessions. One-on-one sessions. Describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features. Private room in the jail. First session in prison (no details). Second session in hospital based community research site (no details). Private room in the jail. Juvenile correctional facility. Private room at the jail that had windows to ensure the safety of study staff and participants but offered auditory confidentiality. Describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose. One session of 60 min per person. Two sessions of between 30-45 min per person. One session of 60–90 min per person. One 90 min session and one 60 min booster session. One session of 50–60 min per person. If the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how. Personalised MI intervention based on results of screening. Personalised MI intervention based on results of screening. Personalised MI intervention based on results of screening. MI: personalised intervention. RT: personalised as individual described relaxing place—individual to them. Personalised MI intervention based on results of screening. If the intervention was modified during the course of the study, describe the changes (what, why, when and how). N/A N/A N/A N/A N/A Planned: if intervention adherence of fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them. and Actual: describe the extent to which the intervention was delivered as planned. N/A MITI was used to train and to monitor the MI skills of the interventionists during biweekly supervision. The MITI allows for assessment of threshold competence for therapists and a measure of integrity of MI interventions using two global scores (‘empathy’ and ‘spirit;’ score range 1–7) and seven behaviour counts (e.g. ‘giving information’, ‘MI adherent’). N/A Adolescents and research counsellors completed evaluation forms assessing whether core components of the interventions occurred. Sessions were recorded for supervision with a certified MI trainer and to assess treatment fidelity. MITI, MI Treatment Integrity Code Version 2.0. Table 4. TIDieR results of included brief intervention studies Davis et al. (2003) Stein et al. (2010) Begun et al. (2011) Stein et al. (2011b) and Stein et al. (2011a) Owens and McCrady (2016) Provide the name or a phrase that describes the intervention. Brief MI MI MI MI MI Describe any rationale, theory or goal of the elements essential to the intervention. MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). Materials: describe any physical or informational materials used in the intervention. Provide information on where the materials can be accessed. None given. Manual was used. Resource folder (including information about treatment, support services, housing, clothing, healthcare) and a 3-month calendar. Handouts were given (e.g. goals chosen). Manual that targeted alcohol and other drug use. Procedures: describe each of the procedures, activities, and/or processes used in the intervention, including any enabling or support activities. Personalised feedback provided (pre-incarceration drinking rates relative to national averages, performance on neuropsychological tests compared with national averages and ratings of physical and emotional health). Participants were also given graphical information re: types of situations in which they reported commonly using substances, self-reported problems and dependence criteria endorsed, and their reported readiness for change. Interviewers were non-confrontational in tone, asked open-ended questions and used reflective listening skills. Interviewers allowed participants to come to their own conclusions, if any, about the feedback and need for treatment. VA referral information was reviewed at the end of the interview. Initial session (during incarceration)—Interventionist used MI techniques re: goal setting and strategies to deal with obstacles/barriers that might affect these goals. Due to RIDOC regulations, participants were not allowed to keep any materials from the session. Upon release, the feedback report and change plan handouts, payment for the baseline interview, community resources, condoms and the next appointment date were mailed to participant. Feedback intervention to engage the women in an exploration of their own motivation and commitment to behaviour change. The objectives were to explore and resolve ambivalence, address decisional balance (the pros and cons of changing and not changing their substance-related behaviours), explore options (including self-change attempts, informal systems, and formal services), and resolve perceived barriers specific to engaging with substance abuse services. MI focusing on empathy, not arguing, developing discrepancy, self-efficacy and personal choice. Sections of the MI included developing rapport, exploration of motivation (pros and cons), personalised assessment feedback, imagining the future with and without change, and establishing goals. Focus of the intervention was on reduction of alcohol and/or marijuana use and associated risky behaviours and consequences of use (e.g. injuries while drunk or high). MI session following a manual that targeted alcohol and other drug use, and if relevant, participants social networks and engagement in treatment. Open-ended questions elicited participants’ reasons to change. Normative feedback was not included. Follow-Up Session—Based on participant’s goal(s) and change plan from initial MI session. Sessions focused on progress, assessment of barriers and developing concrete strategies for meeting new goals. For each category of intervention provider, describe their expertise, background and any specific training given. Clinical Research Staff who had completed/were completing Masters Degrees. 12 h of training in MI. Training: didactics and observed practices and experiences and supervision provided. Graduate social workers trained in research protocol engaged women in initial demographic and brief screening interview. Research counsellors delivered both type of intervention. Treatments were manualized and 20 h training was given as well as weekly supervision. Delivered by advanced clinical psychology graduate tutors who were trained in MI and had experience of delivering MI. Describe the mode of delivery of the intervention and whether it was provided individually or in a group. One-on-one sessions. One-on-one sessions. One-on-one sessions. One-on-one sessions. One-on-one sessions. Describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features. Private room in the jail. First session in prison (no details). Second session in hospital based community research site (no details). Private room in the jail. Juvenile correctional facility. Private room at the jail that had windows to ensure the safety of study staff and participants but offered auditory confidentiality. Describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose. One session of 60 min per person. Two sessions of between 30-45 min per person. One session of 60–90 min per person. One 90 min session and one 60 min booster session. One session of 50–60 min per person. If the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how. Personalised MI intervention based on results of screening. Personalised MI intervention based on results of screening. Personalised MI intervention based on results of screening. MI: personalised intervention. RT: personalised as individual described relaxing place—individual to them. Personalised MI intervention based on results of screening. If the intervention was modified during the course of the study, describe the changes (what, why, when and how). N/A N/A N/A N/A N/A Planned: if intervention adherence of fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them. and Actual: describe the extent to which the intervention was delivered as planned. N/A MITI was used to train and to monitor the MI skills of the interventionists during biweekly supervision. The MITI allows for assessment of threshold competence for therapists and a measure of integrity of MI interventions using two global scores (‘empathy’ and ‘spirit;’ score range 1–7) and seven behaviour counts (e.g. ‘giving information’, ‘MI adherent’). N/A Adolescents and research counsellors completed evaluation forms assessing whether core components of the interventions occurred. Sessions were recorded for supervision with a certified MI trainer and to assess treatment fidelity. Davis et al. (2003) Stein et al. (2010) Begun et al. (2011) Stein et al. (2011b) and Stein et al. (2011a) Owens and McCrady (2016) Provide the name or a phrase that describes the intervention. Brief MI MI MI MI MI Describe any rationale, theory or goal of the elements essential to the intervention. MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). MI based on work of Miller and Rollnick (2002). Materials: describe any physical or informational materials used in the intervention. Provide information on where the materials can be accessed. None given. Manual was used. Resource folder (including information about treatment, support services, housing, clothing, healthcare) and a 3-month calendar. Handouts were given (e.g. goals chosen). Manual that targeted alcohol and other drug use. Procedures: describe each of the procedures, activities, and/or processes used in the intervention, including any enabling or support activities. Personalised feedback provided (pre-incarceration drinking rates relative to national averages, performance on neuropsychological tests compared with national averages and ratings of physical and emotional health). Participants were also given graphical information re: types of situations in which they reported commonly using substances, self-reported problems and dependence criteria endorsed, and their reported readiness for change. Interviewers were non-confrontational in tone, asked open-ended questions and used reflective listening skills. Interviewers allowed participants to come to their own conclusions, if any, about the feedback and need for treatment. VA referral information was reviewed at the end of the interview. Initial session (during incarceration)—Interventionist used MI techniques re: goal setting and strategies to deal with obstacles/barriers that might affect these goals. Due to RIDOC regulations, participants were not allowed to keep any materials from the session. Upon release, the feedback report and change plan handouts, payment for the baseline interview, community resources, condoms and the next appointment date were mailed to participant. Feedback intervention to engage the women in an exploration of their own motivation and commitment to behaviour change. The objectives were to explore and resolve ambivalence, address decisional balance (the pros and cons of changing and not changing their substance-related behaviours), explore options (including self-change attempts, informal systems, and formal services), and resolve perceived barriers specific to engaging with substance abuse services. MI focusing on empathy, not arguing, developing discrepancy, self-efficacy and personal choice. Sections of the MI included developing rapport, exploration of motivation (pros and cons), personalised assessment feedback, imagining the future with and without change, and establishing goals. Focus of the intervention was on reduction of alcohol and/or marijuana use and associated risky behaviours and consequences of use (e.g. injuries while drunk or high). MI session following a manual that targeted alcohol and other drug use, and if relevant, participants social networks and engagement in treatment. Open-ended questions elicited participants’ reasons to change. Normative feedback was not included. Follow-Up Session—Based on participant’s goal(s) and change plan from initial MI session. Sessions focused on progress, assessment of barriers and developing concrete strategies for meeting new goals. For each category of intervention provider, describe their expertise, background and any specific training given. Clinical Research Staff who had completed/were completing Masters Degrees. 12 h of training in MI. Training: didactics and observed practices and experiences and supervision provided. Graduate social workers trained in research protocol engaged women in initial demographic and brief screening interview. Research counsellors delivered both type of intervention. Treatments were manualized and 20 h training was given as well as weekly supervision. Delivered by advanced clinical psychology graduate tutors who were trained in MI and had experience of delivering MI. Describe the mode of delivery of the intervention and whether it was provided individually or in a group. One-on-one sessions. One-on-one sessions. One-on-one sessions. One-on-one sessions. One-on-one sessions. Describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features. Private room in the jail. First session in prison (no details). Second session in hospital based community research site (no details). Private room in the jail. Juvenile correctional facility. Private room at the jail that had windows to ensure the safety of study staff and participants but offered auditory confidentiality. Describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose. One session of 60 min per person. Two sessions of between 30-45 min per person. One session of 60–90 min per person. One 90 min session and one 60 min booster session. One session of 50–60 min per person. If the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how. Personalised MI intervention based on results of screening. Personalised MI intervention based on results of screening. Personalised MI intervention based on results of screening. MI: personalised intervention. RT: personalised as individual described relaxing place—individual to them. Personalised MI intervention based on results of screening. If the intervention was modified during the course of the study, describe the changes (what, why, when and how). N/A N/A N/A N/A N/A Planned: if intervention adherence of fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them. and Actual: describe the extent to which the intervention was delivered as planned. N/A MITI was used to train and to monitor the MI skills of the interventionists during biweekly supervision. The MITI allows for assessment of threshold competence for therapists and a measure of integrity of MI interventions using two global scores (‘empathy’ and ‘spirit;’ score range 1–7) and seven behaviour counts (e.g. ‘giving information’, ‘MI adherent’). N/A Adolescents and research counsellors completed evaluation forms assessing whether core components of the interventions occurred. Sessions were recorded for supervision with a certified MI trainer and to assess treatment fidelity. MITI, MI Treatment Integrity Code Version 2.0. Table 5. TIDieR results of included extended intervention studies Chance et al. (1990) Baldwin et al. (1991) Peters et al. (1993) Bowes et al. (2012, 2014) Provide the name or a phrase that describes the intervention Lifeline Drug and Alcohol Treatment Programme. Alcohol Education Course (AEC). In-Jail Treatment Programme. COVAID. Describe any rationale, theory, or goal of the elements essential to the intervention Reality therapy counselling AEC similar to other behavioural AECs with the omission of context inappropriate material. Cognitive-behavioural, skills based approach that includes a focus on relapse prevention. Goals are to encourage long-term abstinence through prevention of lapse and relapse to substance abuse. Cognitive-behavioural treatment aimed at reducing alcohol-related aggression. Materials: describe any physical or informational materials used in the intervention. Provide information on where the materials can be accessed Inmates completed a weekly self-perception profile that addressed attitudes to oneself and others within programme. Each participant kept a diary. AEC materials. None mentioned. Manualized COVAID intervention. Procedures: describe each of the procedures, activities, and/or processes used in the intervention, including any enabling or support activities. Weekly self-perception profile, individual counselling sessions and diary keeping. Materials were presented so offender clients could acquire info/skills in reduced drinking/offending. Control group received nothing. MSI interview, follow-up and collateral interview. Three types of groups offered: 1. Special Topics Group—Focus on issues related to orientation to treatment (inc. motivation and commitment, ambivalence about adopting a drug-free lifestyle, family issues, shame and guilt associated with substance abuse and health-related consequences of substance abuse). 2. Relapse Prevention—Level 1. 27 sessions: 2 h per day, 5 days per week. 3. Relapse Prevention—Level 2. For inmates who have completed Level 1, Level 2 groups focus on relapse prevention skills in greater depth. The 10 sessions covered: explaining alcohol-related aggression, crime harm reduction, managing anger and stress, modifying drinking, altering triggers, weakening the expectancies that contribute to alcohol-related violence, identifying and coping with high-risk situations, and enhancing problem solving skills. For each category of intervention provider, describe their expertise, background and any specific training given. Director of programme selected due to commitment to Lifeline and understanding of prisons. Other personnel given reality therapy training. Lead author was therapy certified and given ongoing training, as were inmates when they became peer counsellors. Each worker (social worker, prison psychologist, teacher) had achieved criterion performance with the Motivational Screening Instrument. Trained facilitators employed by the probation service or prison group work facilitators. Trained by Delight Training (www.delight.co.uk) Describe the mode of delivery of the intervention and whether it was provided individually or in a group. Individual and group counselling sessions as well as participation in self-help programmes including AA. Interviews (additional collateral interviews held with spouses/relatives/friend/drinking partners). In groups of 8–12 people. In groups of 8–10 people and individual sessions. Describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features. N/A N/A N/A N/A Describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule and their duration, intensity or dose. No pre-established length of time: ranged from 6–18 months. 6 Weekly sessions of 2 h. 27 Sessions, 2 h per day, 5 days per week. Level 2 then provides opportunity to focus on more. Average length of stay in programme was 45 days. 20 h of group treatment and 4 h of individual support. Altogether 10 sessions. If the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how. Individual counselling with sessions personalised. N/A Inmates work to design a long-term recovery plan and to develop a balanced lifestyle through participating in drug-free pleasurable activities. 4 h of individual support – including looking at personal coping strategies If the intervention was modified during the course of the study, describe the changes (what, why, when and how). N/A N/A N/A N/A Planned: if intervention adherence of fidelity was assessed, how and by whom, and if any strategies were used to maintain or improve fidelity, describe them and Actual: the extent to which the intervention was delivered as planned N/A N/A N/A N/A Chance et al. (1990) Baldwin et al. (1991) Peters et al. (1993) Bowes et al. (2012, 2014) Provide the name or a phrase that describes the intervention Lifeline Drug and Alcohol Treatment Programme. Alcohol Education Course (AEC). In-Jail Treatment Programme. COVAID. Describe any rationale, theory, or goal of the elements essential to the intervention Reality therapy counselling AEC similar to other behavioural AECs with the omission of context inappropriate material. Cognitive-behavioural, skills based approach that includes a focus on relapse prevention. Goals are to encourage long-term abstinence through prevention of lapse and relapse to substance abuse. Cognitive-behavioural treatment aimed at reducing alcohol-related aggression. Materials: describe any physical or informational materials used in the intervention. Provide information on where the materials can be accessed Inmates completed a weekly self-perception profile that addressed attitudes to oneself and others within programme. Each participant kept a diary. AEC materials. None mentioned. Manualized COVAID intervention. Procedures: describe each of the procedures, activities, and/or processes used in the intervention, including any enabling or support activities. Weekly self-perception profile, individual counselling sessions and diary keeping. Materials were presented so offender clients could acquire info/skills in reduced drinking/offending. Control group received nothing. MSI interview, follow-up and collateral interview. Three types of groups offered: 1. Special Topics Group—Focus on issues related to orientation to treatment (inc. motivation and commitment, ambivalence about adopting a drug-free lifestyle, family issues, shame and guilt associated with substance abuse and health-related consequences of substance abuse). 2. Relapse Prevention—Level 1. 27 sessions: 2 h per day, 5 days per week. 3. Relapse Prevention—Level 2. For inmates who have completed Level 1, Level 2 groups focus on relapse prevention skills in greater depth. The 10 sessions covered: explaining alcohol-related aggression, crime harm reduction, managing anger and stress, modifying drinking, altering triggers, weakening the expectancies that contribute to alcohol-related violence, identifying and coping with high-risk situations, and enhancing problem solving skills. For each category of intervention provider, describe their expertise, background and any specific training given. Director of programme selected due to commitment to Lifeline and understanding of prisons. Other personnel given reality therapy training. Lead author was therapy certified and given ongoing training, as were inmates when they became peer counsellors. Each worker (social worker, prison psychologist, teacher) had achieved criterion performance with the Motivational Screening Instrument. Trained facilitators employed by the probation service or prison group work facilitators. Trained by Delight Training (www.delight.co.uk) Describe the mode of delivery of the intervention and whether it was provided individually or in a group. Individual and group counselling sessions as well as participation in self-help programmes including AA. Interviews (additional collateral interviews held with spouses/relatives/friend/drinking partners). In groups of 8–12 people. In groups of 8–10 people and individual sessions. Describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features. N/A N/A N/A N/A Describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule and their duration, intensity or dose. No pre-established length of time: ranged from 6–18 months. 6 Weekly sessions of 2 h. 27 Sessions, 2 h per day, 5 days per week. Level 2 then provides opportunity to focus on more. Average length of stay in programme was 45 days. 20 h of group treatment and 4 h of individual support. Altogether 10 sessions. If the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how. Individual counselling with sessions personalised. N/A Inmates work to design a long-term recovery plan and to develop a balanced lifestyle through participating in drug-free pleasurable activities. 4 h of individual support – including looking at personal coping strategies If the intervention was modified during the course of the study, describe the changes (what, why, when and how). N/A N/A N/A N/A Planned: if intervention adherence of fidelity was assessed, how and by whom, and if any strategies were used to maintain or improve fidelity, describe them and Actual: the extent to which the intervention was delivered as planned N/A N/A N/A N/A COVAID, control of violence for angry impulsive drinkers. Table 5. TIDieR results of included extended intervention studies Chance et al. (1990) Baldwin et al. (1991) Peters et al. (1993) Bowes et al. (2012, 2014) Provide the name or a phrase that describes the intervention Lifeline Drug and Alcohol Treatment Programme. Alcohol Education Course (AEC). In-Jail Treatment Programme. COVAID. Describe any rationale, theory, or goal of the elements essential to the intervention Reality therapy counselling AEC similar to other behavioural AECs with the omission of context inappropriate material. Cognitive-behavioural, skills based approach that includes a focus on relapse prevention. Goals are to encourage long-term abstinence through prevention of lapse and relapse to substance abuse. Cognitive-behavioural treatment aimed at reducing alcohol-related aggression. Materials: describe any physical or informational materials used in the intervention. Provide information on where the materials can be accessed Inmates completed a weekly self-perception profile that addressed attitudes to oneself and others within programme. Each participant kept a diary. AEC materials. None mentioned. Manualized COVAID intervention. Procedures: describe each of the procedures, activities, and/or processes used in the intervention, including any enabling or support activities. Weekly self-perception profile, individual counselling sessions and diary keeping. Materials were presented so offender clients could acquire info/skills in reduced drinking/offending. Control group received nothing. MSI interview, follow-up and collateral interview. Three types of groups offered: 1. Special Topics Group—Focus on issues related to orientation to treatment (inc. motivation and commitment, ambivalence about adopting a drug-free lifestyle, family issues, shame and guilt associated with substance abuse and health-related consequences of substance abuse). 2. Relapse Prevention—Level 1. 27 sessions: 2 h per day, 5 days per week. 3. Relapse Prevention—Level 2. For inmates who have completed Level 1, Level 2 groups focus on relapse prevention skills in greater depth. The 10 sessions covered: explaining alcohol-related aggression, crime harm reduction, managing anger and stress, modifying drinking, altering triggers, weakening the expectancies that contribute to alcohol-related violence, identifying and coping with high-risk situations, and enhancing problem solving skills. For each category of intervention provider, describe their expertise, background and any specific training given. Director of programme selected due to commitment to Lifeline and understanding of prisons. Other personnel given reality therapy training. Lead author was therapy certified and given ongoing training, as were inmates when they became peer counsellors. Each worker (social worker, prison psychologist, teacher) had achieved criterion performance with the Motivational Screening Instrument. Trained facilitators employed by the probation service or prison group work facilitators. Trained by Delight Training (www.delight.co.uk) Describe the mode of delivery of the intervention and whether it was provided individually or in a group. Individual and group counselling sessions as well as participation in self-help programmes including AA. Interviews (additional collateral interviews held with spouses/relatives/friend/drinking partners). In groups of 8–12 people. In groups of 8–10 people and individual sessions. Describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features. N/A N/A N/A N/A Describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule and their duration, intensity or dose. No pre-established length of time: ranged from 6–18 months. 6 Weekly sessions of 2 h. 27 Sessions, 2 h per day, 5 days per week. Level 2 then provides opportunity to focus on more. Average length of stay in programme was 45 days. 20 h of group treatment and 4 h of individual support. Altogether 10 sessions. If the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how. Individual counselling with sessions personalised. N/A Inmates work to design a long-term recovery plan and to develop a balanced lifestyle through participating in drug-free pleasurable activities. 4 h of individual support – including looking at personal coping strategies If the intervention was modified during the course of the study, describe the changes (what, why, when and how). N/A N/A N/A N/A Planned: if intervention adherence of fidelity was assessed, how and by whom, and if any strategies were used to maintain or improve fidelity, describe them and Actual: the extent to which the intervention was delivered as planned N/A N/A N/A N/A Chance et al. (1990) Baldwin et al. (1991) Peters et al. (1993) Bowes et al. (2012, 2014) Provide the name or a phrase that describes the intervention Lifeline Drug and Alcohol Treatment Programme. Alcohol Education Course (AEC). In-Jail Treatment Programme. COVAID. Describe any rationale, theory, or goal of the elements essential to the intervention Reality therapy counselling AEC similar to other behavioural AECs with the omission of context inappropriate material. Cognitive-behavioural, skills based approach that includes a focus on relapse prevention. Goals are to encourage long-term abstinence through prevention of lapse and relapse to substance abuse. Cognitive-behavioural treatment aimed at reducing alcohol-related aggression. Materials: describe any physical or informational materials used in the intervention. Provide information on where the materials can be accessed Inmates completed a weekly self-perception profile that addressed attitudes to oneself and others within programme. Each participant kept a diary. AEC materials. None mentioned. Manualized COVAID intervention. Procedures: describe each of the procedures, activities, and/or processes used in the intervention, including any enabling or support activities. Weekly self-perception profile, individual counselling sessions and diary keeping. Materials were presented so offender clients could acquire info/skills in reduced drinking/offending. Control group received nothing. MSI interview, follow-up and collateral interview. Three types of groups offered: 1. Special Topics Group—Focus on issues related to orientation to treatment (inc. motivation and commitment, ambivalence about adopting a drug-free lifestyle, family issues, shame and guilt associated with substance abuse and health-related consequences of substance abuse). 2. Relapse Prevention—Level 1. 27 sessions: 2 h per day, 5 days per week. 3. Relapse Prevention—Level 2. For inmates who have completed Level 1, Level 2 groups focus on relapse prevention skills in greater depth. The 10 sessions covered: explaining alcohol-related aggression, crime harm reduction, managing anger and stress, modifying drinking, altering triggers, weakening the expectancies that contribute to alcohol-related violence, identifying and coping with high-risk situations, and enhancing problem solving skills. For each category of intervention provider, describe their expertise, background and any specific training given. Director of programme selected due to commitment to Lifeline and understanding of prisons. Other personnel given reality therapy training. Lead author was therapy certified and given ongoing training, as were inmates when they became peer counsellors. Each worker (social worker, prison psychologist, teacher) had achieved criterion performance with the Motivational Screening Instrument. Trained facilitators employed by the probation service or prison group work facilitators. Trained by Delight Training (www.delight.co.uk) Describe the mode of delivery of the intervention and whether it was provided individually or in a group. Individual and group counselling sessions as well as participation in self-help programmes including AA. Interviews (additional collateral interviews held with spouses/relatives/friend/drinking partners). In groups of 8–12 people. In groups of 8–10 people and individual sessions. Describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features. N/A N/A N/A N/A Describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule and their duration, intensity or dose. No pre-established length of time: ranged from 6–18 months. 6 Weekly sessions of 2 h. 27 Sessions, 2 h per day, 5 days per week. Level 2 then provides opportunity to focus on more. Average length of stay in programme was 45 days. 20 h of group treatment and 4 h of individual support. Altogether 10 sessions. If the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how. Individual counselling with sessions personalised. N/A Inmates work to design a long-term recovery plan and to develop a balanced lifestyle through participating in drug-free pleasurable activities. 4 h of individual support – including looking at personal coping strategies If the intervention was modified during the course of the study, describe the changes (what, why, when and how). N/A N/A N/A N/A Planned: if intervention adherence of fidelity was assessed, how and by whom, and if any strategies were used to maintain or improve fidelity, describe them and Actual: the extent to which the intervention was delivered as planned N/A N/A N/A N/A COVAID, control of violence for angry impulsive drinkers. TIDieR results—brief interventions All included studies described the brief intervention as being based on the motivational interviewing work of Miller and Rollnick (2002) with all papers giving some indication of what the components in the interventions were (Davis et al., 2003; Stein et al., 2010). All studies reported that interventions were given one-to-one and were based on the results of clients’ individual screening (Begun et al., 2011; Davis et al., 2003; Stein et al., 2010, 2011a, 2011b; Owens and McCrady, 2016). All studies were delivered by trained research staff, which calls into question how pragmatic the studies are and whether they could be implemented with fidelity in real life situations by existing programme staff. None of the included studies gave information about modifications during the study and only two gave information related to fidelity (Stein et al., 2011a, 2011b), with one giving in-depth information in relation to the intervention development (Stein et al., 2010). TIDieR results—extended brief interventions The four studies involving extended brief interventions were very different in content from the brief intervention studies (Chance et al., 1990; Baldwin et al., 1991; Peters et al., 1993; Bowes et al., 2012, 2014). Intervention details in these studies were sparse, meaning that they would be unable to be replicated. The total amount of time spent in intervention varied in length from a total of 12 h (Baldwin et al., 1991) to 20 h (Bowes et al., 2012, 2014) to 54 h (Peters et al., 1993). The remaining study stated that the time frame was 6–18 months but did not say how many sessions (Chance et al., 1990). Very little detail was provided about the information given during or as part of the intervention. According to the TIDIeR checklist authors, this is the question that is least likely to be answered (Hoffman et al., 2014). None of the included studies gave any information relating to where in the prison the interventions took place or of any fidelity checks. However, unlike the brief intervention studies, all of the extended brief interventions were delivered by trained individuals employed within the services (Table 5). DISCUSSION This systematic review examined the efficacy and/or effectiveness of alcohol interventions for incarcerated individuals. Results show that it is possible to carry out RCTs in this setting and that there is some promise in terms of effects. However, this study has shown that, to date, not enough studies have been carried out to ascertain efficacy or effectiveness and adequate methodological rigour in the available literature is questionable. Moreover, there is a distinct lack of information relating to female prisoners. Yet, this should not discourage researchers: the signs are that there is a place for interventions in this setting and they do hold promise, but more robust studies are needed with standardised approaches. This study, like others, has shown that interventions for offenders that tackle risky drinking issues are under-developed and under-researched (Bowes et al., 2014; Newbury-Birch et al., 2016b). It has also been shown that it is very difficult to conduct research studies in this setting, primarily due to the difficulties in collecting self-report follow-up data (Newbury-Birch et al., 2016b). One of the fundamental issues is that studies include different measurement tools and outcomes, with outcomes decided upon based on the research funding. A piece of work is currently taking place that aims to develop a Core Outcome Set for Alcohol Brief Interventions (ABI) to improve the measurement of alcohol-related change: Outcome Reporting in Brief Intervention Trials: Alcohol (ORBITAL) (Shorter et al., 2018). Furthermore, our results showed that interventions are not being described as methodically as they could be and that is an area to further improve in future research. The introduction of the TIDiER checklist (Hoffman et al., 2014) and the expectation that it will be used when describing studies is a step forward; however, this study shows that, to date, there is limited information relating to intervention content and delivery in this body of research. It is often thought that prisoners feel coerced into taking part in research projects; however, evidence tells us that participants do not feel coerced if the project is explained properly (Sherman et al., 2015). Although, research tells us that obtaining follow-up data with this population is fraught with difficulties because of the sometimes chaotic lifestyles of the participants (Newbury-Birch et al., 2016b). More work is needed into how we can use routinely collected data in criminal justice studies. For instance, a recent study carried out by researchers in the UK in the probation setting used reconviction data to follow up individuals using Police National Computer identifiers and followed-up 97% of participants (Newbury-Birch et al., 2014). In order for research to be applicable to the prison setting it is imperative that the experiences of inmates are integrated in co-designing the research question and study processes (Newbury-Birch et al., 2016a). By working together and drawing on the expertise of staff, inmates and researchers, it is possible to translate the results of research into real world practice (Sherman et al., 2015). For example, researchers in the UK have recently undertaken an ABI development study for male remand prisoners. As part of this, they have conducted in-depth interviews and focus groups with prisoners and prison staff/key stakeholders to develop not only the research process but also the type and nature of the ABI intervention (Holloway et al., 2017). There are several additional limitations to this study. The majority of the studies were undertaken in the USA and there was a lack of data relating to women. In addition, we were unable to complete a meta-analysis to quantitatively assess programme outcomes because of the variability in outcome measures used in the studies. This review has shown that although there are limited studies, it is feasible to carry out alcohol interventions with incarcerated individuals. More work is needed however, to clarify what exactly the outcomes of interest are to the criminal justice agencies we work with. Despite these recent developments the question remains: are we carrying out research projects for incarcerated individuals who are risky drinkers in the most effective way? Research studies in the criminal justice system are by their very nature complex and context-specific. Public health and criminal justice agencies have long been perceived as having entirely different approaches to dealing with alcohol issues (Shepherd and Sumner, 2017). In order to advance policy development, research and programme co-design, research highlights the need for more collaborative research partnerships developed at the start of a project to ensure programme suitability and efficacy (Newbury-Birch et al., 2016a, 2016b). Community-based participatory research has been shown to be a useful model for co-designing research with hard to reach groups (Leung et al., 2004). It has been argued that, in terms of informing policy, there tends to be an over-reliance on evidence from tightly controlled intervention trials which often lead to questions around the applicability of research in the real world (Pettman et al., 2012). The evidence to date, although limited does seem to be showing an effect. However, we are still at the stage where we need robust efficacy/effectiveness studies to prove whether the interventions are effective. FUNDING The research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors. CONTRIBUTORS Professor D.N.-B. and Professor A.H. conceptualised the study, interpreted the results and critically reviewed the article. Dr E.L.G., Ms J.F. and Dr G.J.M. carried out the initial searches and with Professor D.N.-B., Dr S.L., Dr K.J.S. and Dr C.G. screened articles, extracted data. Professor D.N.-B. and Ms J.F. carried out quality assessment. 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Alcohol and AlcoholismOxford University Press

Published: May 10, 2018

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