Background: As many as 70% of remand prisoners have admitted to being under the influence of alcohol when committing the crime leading to their imprisonment. Providing support and advice regarding alcohol consumption can be effective in some groups of people. There is little evidence regarding this for men on remand in prison.
Objective: To pilot the study measures and evaluation methods to assess the feasibility of conducting a future definitive multicentre, pragmatic, parallel group, randomised controlled trial.
Design: A two-arm, parallel group, individually randomised pilot study of a self-efficacy-enhancing psychosocial alcohol intervention to reduce levels of alcohol consumption for males on remand in prison and on liberation.
Setting: Two purposively selected prisons in Scotland and England.
Participants: Adult men on remand in prison with an Alcohol Use Disorders Identification Test score of ≥ 8.
Intervention: The APPRAISE intervention delivery comprised four steps: Step 1: 1 × 40-minute face-to-face session, delivered by a trained practitioner from Change Grow Live in prison. Steps 2, 3 and 4: 20-minute sessions conducted by phone, on or as close as possible to days 3, 7 and 21 post liberation. Control: assessment, screening and referral onto further alcohol support options.
Main outcome measures: Recruitment and retention rates, completion of follow-ups, outcome measures at 12 months and interventions delivered. The primary outcome for the pilot study was alcohol consumed in the 28 days prior to Time Point 2, assessed using the extended Alcohol Use Disorders Identification Test-C.
Results: Of 182 men on remand approached across two study sites, 132 were randomised (90 in England; 42 in Scotland) with 46 randomised to intervention and 44 to care as usual in England and 22 randomised to intervention and 20 to care as usual in Scotland. A total of 53 in-prison interventions were delivered. One day-3 post-liberation intervention was delivered, no day-7 and one day-21. At 12 months, of 132 randomised, 18 (13%) were followed up, 53 (40%) were not liberated; 47 (36%) were uncontactable and 14 (11%) had been released but could not be located. Data completeness was 96% at baseline and 8% at 12 months. The process evaluation reported good acceptability of the intervention with investment in time, capacity and space to support implementation identified. The economic study produced guidance on how to assess costs associated with implementing the APPRAISE intervention which could be applied more broadly.
Harms: No adverse events or side effects were noted.
Conclusions: A future definitive trial would be possible, but only if follow-up mechanisms can be addressed as well as full access to recidivism and health data. Collaboration with the probation service in future could offer the opportunity to develop a robust process and system to optimise follow-up post liberation. Dedicated resources to support the intervention delivery both in and out of the prison setting are recommended.
Limitations: Coronavirus disease discovered in 2019 impacted recruitment and follow-up, with access to prisons restricted. We were unable to deliver the post-liberation element of the intervention. We did not include probation services or other agencies in the trial.
Trial registration: This trial is registered as Current Controlled Trials ISRCTN36066.
Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 17/44/11) and is published in full in Public Health Research; Vol. 12, No. 11. See the NIHR Funding and Awards website for further award information.
Keywords: EXTENDED ALCOHOL BRIEF INTERVENTION; FEASIBILITY; MEN; PILOT RANDOMISED CONTROLLED TRIAL; PRISON; PROCESS EVALUATION; REMAND; SELF-EFFICACY ENHANCING.
We know many men on remand report being under the influence of alcohol at the time of their arrest. Having a short conversation providing alcohol support and advice (known as an ‘intervention’) can be effective. However, we do not know if an alcohol intervention for men on remand in prison is possible to deliver or if we can ‘test’ the benefit of it. The aim of the study was to ‘test’ an intervention named APPRAISE using a small study, for men on remand in one Scottish and one English prison. We aimed to get 180 men in this study. Men taking part were asked to tell us about their alcohol drinking. Men reporting ‘risky’ drinking were split into two groups by chance. One group were to be given the APPRAISE intervention while in prison and once released. The other group did not receive the intervention. We then set out to measure their drinking levels after 12 months. We interviewed different people involved in the study to find out what they thought. We successfully recruited 132 men but had to stop due to coronavirus disease discovered in 2019, as we were unable to go into the prisons. We delivered 53 out of 68 interventions in prison but not once men were released; we were only able to contact 18 out of 132 men at 12 months. People we interviewed stated that having an intervention to reduce risky drinking would be acceptable; however, this would require investment, time, space, capacity and trust. Before we can plan a larger study we need to identify the best way to locate men once released from prison, to deliver the whole intervention and measure its effect on drinking levels.