Smelling the ethanol

The links between alcohol consumption and offending are well-documented, at least at a topline level. Over a fifth of prisoners surveyed in 2012 reported an alcohol problem when they began their sentence (a survey which was likely to underestimate the prevalence of alcohol problems among offenders due to under-reporting and recognition of problems), and an earlier survey in 2010 found that three fifths of those entering prison with an alcohol problem would also leave with one.

This week the RSA asked how we might break the cycle of alcohol-related criminal behaviour. Informing the debate was a new survey from Addaction’s Alcohol and Crime Commission, which found that almost two fifths of respondents believed they had a ‘big drinking problem’, with almost three-quarters of them (some 25% of all respondents) reporting that they had been drinking at the time of committing the offence for which they were sentenced.

Other surveys have shown similar findings. The Scottish Prison Service found that 50% of prisoners reported being drunk at the time of their offence, up from 40% in 2005. Our own Transitions project has found that within the HMP Everthorpe* prisoner population, where our project is based, 40% of prisoners reported having a past or present problem with alcohol. (Similarly, 53% of prisoners reported having a past or present problem with drugs.)

However, the extent to which a prisoner reports a problem with alcohol does not seem to represent their concern over the relationship between drinking and offending after their release. Despite only seven percent of prisoners worrying that they will (re-)develop a problem with alcohol after finishing their sentence, 46% say that not drinking too much alcohol will be an important factor in preventing reoffending in the future. (Similarly seven percent of prisoners worry about future drug use becoming a problem, but 49% report that not using drugs will be an important factor in preventing reoffending in the future.)

It may be the case that framing alcohol among prisoners – and the prison system – more as a factor that fuels the likelihood of reoffending in a significant proportion of cases, rather than framing alcohol solely as an ‘addiction’ problem, would result in more offenders recognising and receiving help with alcohol consumption. Various forms of treatment and support should be offered more consistently not only to those offenders who self-discloses a problem with alcohol, but also to people whose crimes were characterised by alcohol being a factor when the offence was committed.

This need was surfaced in the debate. John Podmore, Professor of Applied Social Sciences at the University of Durham and former governor of Belmarsh, Swaleside and Brixton prisons, recounted a conversation with a prisoner who explained: ‘I don’t have an alcohol problem, but I’m usually drunk when I’m arrested’. Prison is currently set up to see alcohol dependency as the problem – but offending behaviour can result when there is no dependency.

While the Addaction report was careful not to call for additional resources for alcohol treatment and support, calling instead for better targeting of existing resources, the report also makes clear that alcohol provision is a ‘Cinderella service’. My own view is that more resources are required, and should include better training of the prison workforce (which our Transitions work has shown, are characterised by a strong desire to engage and support prisoners on the issue). As Simon Antrobus, Chief Executive of Addaction, suggested in the debate, the forthcoming Transforming Rehabilitation programme needs a strong plan on alcohol. But any plan must be properly resourced.

Back to the data. The fact that almost half of the people responding to our Transitions survey were concerned about their future drinking prompts the question of how people seek to control their alcohol intake, particular given that, generally, the links between prisons and community-based services and support are poor and need to be significantly improved for it to be effective in reducing alcohol-related harm, supporting recovery, and supporting desistance from crime.

Some recently published research has shown interesting differences between the ways people seek to protect themselves against alcohol-related harm, the effectiveness of those strategies employed, and their primary motivations for drinking alcohol. Broadly, people may seek to employ one of two approaches: either they can attempt to limit their alcohol consumption (for example by setting self-imposed limits), or they can seek to employ their time in different ways (engage in different activities other than drinking). Again broadly, people may have two different motivations for drinking (which may not be fixed): either they may wish to drink through ‘positive motives’ (such as social or personal enhancement), or they might be ‘negatively motivated’ (seeking to cope or conform, for example). Those that seek to ‘avoid’ through drinking are generally shown to be poor at guarding themselves against over-consumption (as to some extent they are drinking to relieve distress of some kind), but also that they are more likely to employ such strategies. They are more successful in reducing alcohol-related consumption and harm when employing ‘alternatives to drinking’ methods.

Understanding motivations for drinking alcohol is therefore important, particularly as people exiting prison may be more negatively motivated (given recent experiences of prison, and prior life experiences). The debate called for more research around drinking behaviour, understanding root causes and motivations. Simon Antrobus felt that prisoners with alcohol problems develop them through underlying causes and are often self-medicating with alcohol.

The RSA’s Whole Person Recovery work has shown that people with substance misuse problems are often entrenched in social networks (often solely) containing others who use drugs and/or alcohol problematically. This social influence reinforces the risks of adopting protective strategies that seek to limit consumption. For the significant group of individuals that drink alcohol alone, there is also an absence of positive social cues to support a consumption-limiting strategy.

Those who worry about developing a problem with alcohol after their release, and/or those who recognise that ‘not drinking too much’ will be in important factor in helping them desist from crime, are both much more likely to report that they have never felt part of something that they would call a community.

The RSA’s work employs a ‘recovery capital’ approach, seeking to understand the system of personal, social, community and cultural resources required to spark and sustain recovery. Within this, there is a need to pay attention to social recovery capital. In our work, cprodued with service users, we aim to foster new (in structure, resource and influence) social networks that support recovery, which are often based around common interests/activities that themselves can create new bridges to wider social and community based support and opportunities. Such a social model makes the more effective ‘alternatives to drinking’ strategies easier to employ for negatively motivated drinkers. In a prisons context, it is also important because those people responding to our survey who worry about developing a problem with alcohol after their release, and/or those who recognise that ‘not drinking too much’ will be in important factor in helping them desist from crime, are both much more likely to report that they have never felt part of something that they would call a community.

Kevin McGrath, High Sheriff of the County of Greater London, spoke strongly at the debate about the need to build networks of support around people. But as John Podmore acknowledged, although ‘the concept of community is vital, we have failed miserably to respond to it.’ Our Transitions project seeks to build a model that is deeply embedded in the local community and sub-region. Under Transforming Rehabilitation, resettlement prisons will aim to better support people transitioning back into their local community. In order to do so, resettlement prisons will require resettlement cultures – open to community links and engagement, and networked and embedded in local communities in order to help build protective and supportive social networks around prisoners while they are still serving their sentence and beyond through the gate. As John Podmore observed, prisons designated as resettlement facilities face a significant challenge in moving towards a culture that facilitates resettlement effectively.

A challenging factor in all of this is our wider society’s relationship with alcohol. John Podmore suggested that alcohol is ‘socially lauded’ in the UK, despite the fact it kills more people than illicit drugs such as cannabis, heroin and cocaine. Alcohol’s pervasiveness means that there is a relatively small cultural space for abstinence, which undermines attempts to maintain less problematic drinking. A few years ago, I heard some thoughts on the recovery movement in different historical and social contexts from Keith Humphreys, Professor of Psychiatry at Stanford University and former senior policy adviser at the White House Drug Policy Office, who suggested that in countries such as the US, the cultural space for recovery is much greater in part due to wider social attitudes and relationships with alcohol, meaning that recovery groups are not secreted away on the margins and that recovery capital is more widely accessible. New statistics from the World Health Organisation illustrate the point: the proportion of people aged 15+ in the US who are ‘former drinkers’ (those who used to drink alcohol but who have not done so in the last year) is 19%. In the UK is it one percent. Per capita consumption of alcohol is 26% higher in the UK compared to the US, and heavy episodic drinking is 66% higher.

Every ten seconds there is an alcohol-related death. A new report from the World Health Organisation, calculates that there were 3.3 million deaths linked to alcohol consumption worldwide in 2012. As John Podmore said in closing his remarks, perhaps it is time we woke up and smelt the ethanol. Inhaling from an RSA perspective prompts one final reflection from the lens of the RSA’s current change programme and its organising principle of the ‘power to create’. What does this notion of enabling people to turn their ideas into realty mean in this context? On first inspection, it is perhaps not promising: ideas and aspirations around not reoffending may in many cases be trying to be realised through strategies that are likely to fail. Recovery is, however, a process – a journey through which the understanding and capability necessary to sustain itself are (sometimes very slowly) acquired and implemented. A recovery (and rehabilitation) system that understands motivations and the set of social protective factors (and problematic social influences too) is more likely to be able to coproduce recovery plans that prosper. In doing so, people wishing to recover and/or become rehabilitated may adjust their ideas (for example in wishing to self-manage alcohol consumption in their existing networks) and strategies for realising them.

With the points above in mind, our Transitions project is now seeking to build on our recovery capital work by develop and testing a ‘rehabilitation capital and culture’ model and set of tools within the next phase of our work that will enable a networked prison capable of linking to and making use of community-based assets and opportunities.

* HMP Everthorpe is currently being merged with HMP Wolds and will form HMP Humber, a new Category C resettlement prison.

The next report from our Transitions project will be published in June 2014.

Steve Broome is Director of Research at the RSA and is on Twitter at @smbroome