How can research and evidence based practice inform effective interventions with substance misusing offenders?
Student ID No: 481211
How can research and evidence based practice inform effective interventions with substance misusing offenders?
This essay will evaluate the application of research findings to the relationship between substance misuse and offending and effective interventions. Following a detailed consideration of government policy and legislation the application of evidence-based interventions in a number of areas will be considered finishing with concluding observations.
Government policy, initiatives and legislation
The Government launched the Updated Drug Strategy 2002 builing upon, Tackling drugs to build a better Britain, launched in 1998 which briefly involves:
prevention measures targeted at young people and suppliers;
reducing drug-related crime and its impact on communities;
reducing drug use and drug-related offending through treatment and support; reducing drug-related death through harm minimisation.
Recognition is given to the input required from many different agencies including criminal justice, health, education and the development of social and economic policy. At present, however there still appears to be over-reliance upon Misuse of Drugs Act 1971 in an unfortunate waste of recources to criminalise and imprison many low level cannabis users and dealers. However, there are positive signs with the proposed declassification of cannabis and moves generally to deal with offenders who would have been subject to short prison sentences effectively in the community instead (Justice for All, 2002; A consultation document on the government's strategy on restorative justice 22.7.03).
The need for effective partnership working both at National and local level to address what is demonstrated by research to be a complex problem is recognised and that no single agency has the ability or resources to cope in isolation.
Drug Action Teams co-ordinate the local response to drugs assisted by the Drugs Prevention Advisory Service who disseminate best practice from emerging evidence. The National Probation Service is a key player in delivering the National Drugs Strategy in partnership primarily, with Criminal Justice Drugs Teams to offenders who misuse substances at local level. To this end it is essential to form and maintain effective working relationships in the provision of services.
The government aims to increase the participation of problem drug users in treatment programmes by 66% by 2005 (Tackling Drugs to build a better Britain, 1998). However this seems to be at the expense of providing better facilities for alcohol misuse which has more serious ramifications in terms of health and also has a major impact on crime - (Rosie Brocklebank, Addaction, in The Times, Hawkes and Brown, August 2003):
"The Government says it will finally implement its alcohol strategy in 2004. That is six years after it was announced. Our research shows that 240,000 people will have died from alcohol misuse within that time."
This may be compared with just 382 drug related deaths in Scotland in 2002, the highest ever recorded figure (Macleod, The Times August 2003). Nevertheless the scale of the crime problem presented by substance misusing offenders cannot be underestimated. Bennett (1998); (Updated drugs strategy, Home Office, 2002) found that one third of all arrestees admitted being dependant upon at least one drug (excluding alcohol) and a hard core of 9% were carrying out approximately 20 property crimes per month to fund expensive habits representing 52% of crime committed by the study group as a whole.
In any initiative to divert such offenders from the criminal justice system and into effective programmes the contribution of the Probation Service is vital. Current thinking in terms of harm-reduction is toward a move away from custodial sentencing, instead providing treatment by means of DTTO's and this together with current proposals to use restorative justices principals as a 'core element of the work of the Prison and Probation Services' (Blunkett, 2003) may help to explain the sustained high levels of recruitment to the Probation Service.
The British Crime Survey (Ramsey & Partridge 1999) reported that 32% of the adult population have used illegal drugs, However, few people develop a pattern of drug misuse, approximately 3% (Edmunds, 1999). Of those that do they invariably present with a whole range of social problems and may in fact be using substances to mask mental disorder or blot out traumatic experiences such as childhood abuse or the death of a principle carer such as parent or grandparent. In 1999 30,000 sought treatment (DOH, 2000).
A profile of users who have not voluntarily sought treatment is provided by Edmunds (1999) - white male, opiate/poly drug user in their late twenties to early thirties. This may help to dispel the racist myth that serious drugs misuse can primarily be associated with black people. Kaluntar-Crumpton (2003) in fact finds that white people are invariably higher up the chain of supply and low level black street users are unfairly targeted as a result of discriminatory 'street crime initiatives' (Blunkett, 2002) and legislation such as stop and search powers (e.g. CJPO 1994). It is submitted that better ...
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A profile of users who have not voluntarily sought treatment is provided by Edmunds (1999) - white male, opiate/poly drug user in their late twenties to early thirties. This may help to dispel the racist myth that serious drugs misuse can primarily be associated with black people. Kaluntar-Crumpton (2003) in fact finds that white people are invariably higher up the chain of supply and low level black street users are unfairly targeted as a result of discriminatory 'street crime initiatives' (Blunkett, 2002) and legislation such as stop and search powers (e.g. CJPO 1994). It is submitted that better allocation of police resources could have a greater and fairer impact in reducing the supply of opiates and cocaine and properly targeting those meriting imprisonment.
Evidence-based effective interventions
(1) DTTO's
DTTO's were a key component of the government's drug strategy introduced in 1998 "Tackling Drugs to Build a Better Britain". The initiative builds on experience and research from the UK (Bennett, 1998; Edmunds et al 1999) and across the world which suggests:
· Accessing treatment produces a significant reduction in the levels of criminality exhibited by drug misusing offenders.
· Treatment enforced through court orders is no less effective than treatment entered into entirely voluntarily.
· Courts can be persuaded to make use of non-custodial penalties if they have faith in their effectiveness.
This strategy was given legislative force in sections 61-64 Crime and Disorder Act 1998 now-sections 52-58 PCC(S) Act 2000 as a response to the ever-growing research evidence of the link between persistent acquisitive offending and drug misuse (Turnbull et al, 2000:3). Turnbull et al carried out an 18 months evaluation producing recommendations about the most effective ways for multi-agency teams to deliver DTTO's.
The Orders are targeted at serious drug misusing offenders aged 16 or over with the dual aim of treating drug dependency and reducing the level of crime required to fund the habit. Realistic expectations of offenders ability to deal with their substance misuse can be drawn from the evaluation by Turnbull et al. For example the Gloucestershire pilot's expectation that offenders would be completely drug free within a matter of weeks was seen to be 'pushing them too far, too fast'. Frequency of drug testing at the rate of more than twice a week was unlikely to be cost effective and even counter-productive in that offenders may be reducing the amount consumed, which demonstrates measurable and realistic progress.
It is during these difficult months that Probation Officers can continually seek to motivate offenders to change using motivational interviewing skills. (Miller, 2002). Eliciting from offenders perceived benefits of giving up substance misuse such as relationship improvements, the likelihood of being able to find and sustain work and attendant financial benefits, mental and physical health improvements and decreasing contact with the criminal justice process thus moving themselves one step further away from the threat of imprisonment. To this end even small improvements need to be praised and encouraged coupled with a realistic acceptance by probation officers that change in such offenders cannot happen overnight. It is not easy for such offenders with necessarily chaotic lifestyles to regularly turn up for the Think First programme which is an essential part of a DTTO. For this reason local Warwickshire policy provides that a DTTO must be of at least 12 months duration, to give them sufficient time to achieve this, nothwithstanding PCC(S)Act 2000 which provides that an order may be as short as 6 months.
Research indicates that court directed treatment afforded by DTTO's can be a useful way of coercing individuals who would not voluntarily do so, to address their drug dependencies (Turnbull et al, 2000). However, Barton (2002) discusses the potential consequences of 'coerced treatment' for those charged with implementing the new scheme and the tensions between health and the criminal justice system such orders may bring.
However, in the writer's albeit limited practical experience to date which involved a referral for a DTTO, coincidentally a 28 year old male fitting the profile provide by Edmunds (1999) above, there is a reasonable degree of co-operation received from Criminal Justice Drugs Workers charged with dealing with substance misusing offenders subject to DTTO's. However, there seems rather less co-operation from the Drug Advisory Service, to whom offenders refer on a voluntary basis, whose prime concern is clearly protecting health and maintaining client confidentiality, rather than co-operating with the detection and enforcement of crime. The Probation Service having been forced to cast off its image as a social work service through successive legislation appear to be viewed with a degree of mistrust. But, by referring suitable probation service users to treatment probation officers may provide the most effective interventions currently available for offenders whilst also contributing to meeting the performance indicators for the Updated Strategy.
Due to the relative success of DTTO's compared with other programmes based solely on cognitive behaviouralism there are now proposals for a scaled-down version of the DTTO to deal with substance misusers with lower criminogenic need.
There is a continuing and important role for probation officers in providing support and supervision of offenders whilst subject to the programme. To this end maintaining a close working relationship with the Criminal Justice Worker with overall responsibility for providing treatment under the Order is an essential networking skill for a probation officer.
Stringency of the order is maintained by regular court reviews to monitor progress. In an enlightened article in The Times (2002) Judge Barrington Black acknowledges the need to consider more constructive solutions to the problems of criminals with a habit underlining the government's finding in the Strategy. Probation Officers clearly need the co-operation of the judiciary and magistrates in accepting their recommendations for a DTTO on an offender's behalf. The Judge cites the case of an offender aged 40 who had been given the full range of disposals for burglary including 5 prison terms which 'held no fear for him' and had been a hard drugs user for 15 years. The Judge was persuaded to impose an 18 month DTTO due to the offender indicating in prison he wished to 'chuck the habit'. Only 13 months later it was revoked for good progress and a few days later he received his first job offer in 20 years. The judge goes on to describe the changing role of the judiciary in ensuring the success of these orders by monitoring and encouraging progress in a less formalistic manner than the usual court room atmosphere. Forging links with such enlightened members of the judiciary may be a positive role for the future probation officer in an attempt to make real progress on reforming substance misusing offenders,.
(2) Further alternatives to custody
Further moves toward treatment of substance misusing offenders as opposed to punitivism where the emphasis is on punishment and imprisonment may be the only way to address the serious social implications of their offending.
Punitiveness may still have a place for those who are not motivated to change as offenders themselves acknowledge but the coercion involved in getting those offenders to effectively choose between treatment or prison may be a necessary one to increase motivation given the seriousness of the problem. As McGuire (2001) argues punitive methods to reduce crime such as imprisonment have little effect in fact they can make matters worse, due to factors such as peer group influence and social exclusion caused by imprisonment.
National Standards, 2000 require that offenders consider the impact of their offending upon victims and research has demonstrated that such restorative justice techniques have proven efficacy in reducing offending.
Hammersley et al (2003) point out that individual counselling or small scale interventions may be more appropriate than generic services to deal with the diversity of substance use in young offenders with 39% indicating they use drugs to block out their problems. However, such interventions may not be as readily available once young offenders leave the care of Youth Offending Teams. For example in the Warwickshire area there are insufficient resources to cover the requirement for 'One to One' programmes.
Substance misusing offenders need the right level of intervention based upon an assessment of their criminogenic needs. The risk principle (McIvor, 2000) needs to be considered in relation to lower-risk substance misusers who may be adversely affected by too interventionist an approach. Middle-range programmes may address substance misuse and increase victim empathy with cognitive behavioural programmes being reserved for the most persistent offenders (Chapman and Hough, 1998).
Determining success of treatment by offender self-assessment may be impractical as the majority of offenders proclaim themselves "cured" after the minimum number of sessions, (Barnard et al:l989). Fuller et al (1998) found that Probation areas tended to favour this approach and few were actually analysing re-conviction data to demonstrate efficacy of programmes. HM Inspectorate of Probation has now set targets for the introduction of effective practice which involves 60,000 offenders being placed on programmes informed by 'what works' principles. As a result a 5% reduction in offending is predicted. DTTO's and interventions by ETE advisors have proven efficacy and do not suffer from the limitations recognised in programmes based purely upon cognitive behavioural principles (Nacro, 2002).
Al-Attar (2002) finds offender's motivation to change may be influenced by appraisal of his own needs and perceived usefulness of the programme and this can only be addressed by greater use of motivational interviewing by officers to identify barriers to motivation (Miller and Rollnick:l992). Such techniques also have proven efficacy in preparing people to change addictive behaviour (Miller & Rollnick, 1991).
(3) Alcohol Misuse
The use of illegal drugs and the problematical use of legal substances is a major component of the work of the Criminal Justice System. Alcohol clearly cannot be left out of account given its prove links to public disorder and violence, domestic violence and road safety (O'Shea, 2003:23).
Drug and alcohol abuse is often dismissed as a young person's right of passage rather than a real problem. But 'we have a lot of evidence of problematic use of drugs among young people' (Brocklehurst of Addaction, in the Guardian 22.8.03, Hawkes and Brown)
There is a very strong correlation between the use of illegal drugs and the use of volatile substances, tobacco and alcohol amongst young people [Drug Misuse Declared in 1996: Key Results from the British Crime Survey" - Ramsey H an Spiller J, Home Office Research Findings 56 (1997)].
Alcohol also plays a major role in middle-aged deaths due to liver failure and this age group appear to feature far more frequently with alcohol, rather than drugs problems when referred to the probation service. In spite of this there is no programme specifically targeted at them, unless they are also drivers (DIDS) which many of them are not due to their low social standing and often unemployed status. Although arrest referral schemes dealt with more fully below were not developed for problem alcohol users O'shea (2003) found that in fact they are now accessing services via this facility. Workers are emphasising they are not just drug workers so that they do not exclude this group of problem substance misusers who may also be misusing drugs.
Greater reduction in these harms has been demonstrated by research to be achieved by strengthening the police enforcement role with the provision of stronger links with partnership agencies (Britton and Pamneja, 2000:8). But as noted above with the Drugs Advisory Service there may be tensions between the Probation Service and the Alcohol Advisory Service given their widely differing remits, hampering effective interventions with such offenders.
(4) Arrest referral schemes
The majority of arrest referral schemes became operational from April 1st 2000 and by the end of April 2002, all Police Forces in England and Wales were operating arrest referral schemes, employing approximately 400 arrest referral workers.
CrimeReduction, gov.uk (2003):
The pro-active arrest referral initiative is one of a series of criminal justice interventions that seek to identify problem drug-using offenders in the (CJS) and refer them to treatment. The idea is that a dedicated drugs worker, working in police custody cells, makes contact and refers to appropriate treatment addressing drug use with the aim of reducing drug related offending. Involvement with the scheme is voluntary and it is not an alternative to prosecution or due process. Being focused on the point of entry to the CJS, this initiative aims to identify and help problem drug-using offenders as early as possible.
A three year evaluation programme has recently been completed collecting data on the characteristics of service users and outcomes for them with a view to maximising perceived benefits. The Scheme has been found to be successful in targeting 'prolific problem users' with a large percentage being opiate and crack users, injectors and prolific shoplifters with an average spend of £11,000 per annum. Over half had never received treatment before which indicates the success of workers targeting users in police cells and at court.
Evidence from the evaluations suggests that the level of police re-arrest rates significantly declined six months after contact with an arrest referral worker. In one study, shoplifting declined by 50%. Economic and social benefits of the scheme are around 4.4 billion over an eight year period. (Sondi et al, 2002;
O'Shea et al (2003) found a wide variety of working practices which means that at present service users are not receiving equality of service levels across the UK. Best practice was found in Leeds and Oxford where the emphasis was on establishing a good rapport prior to referral to gain confidence of arrestees and motivational approaches were also found effective in engaging with arrestees.
The lack of appropriate drug policies may lead to the right help not being available to those in need. (Britton and Pamneja, 2000:5) and clearly further efforts need to be made to streamline service provision.
The above provisions may divert many offenders from the usual criminal justice process which will reduce the strain on the provision of services by the Probation Service, but lessons from best practice may be identified for example the benefits of confidence gaining and motivational techniques.
It is unfortunate perhaps that probation officers do not appear to have the discretion to refer immediately when in contact with such offenders for example in the provision of specific sentence reports at court. Further training of probation officers could be a step forward in the provision of services to further the aim of the overall reduction of crime. Those found in possession for personal use should be targeted as opposed to drug traffickers for whom different protective and deterrent policy considerations apply.
(5) Drug misuse and social exclusion
The Advisory Council on the Misuse of Drugs (1998) acknowledges drug misuse as having a central role in homelessness. Homeless people are likely to use a wider range of illicit drugs than the general population (Craig et al, 1996; Smart and Adlaf, 1991). Research by Fitzpatrick et al (2000) indicates that homeless drug users are at greater risk in their drug taking patterns and behaviour. The above factors indicate the importance of the probation service tackling social factors such as housing in addressing what may clearly be criminogenic needs directly linked to offending, but struggle with resources and rely very much on the voluntary sector, e.g. Syrenians.
Drug misuse is also more prevalent among those experiencing disadvantaged circumstances and social exclusion (Smart and Obsorne, 1994). Homelessness may arguably be the greatest of such disadvantages. Figures produced by Home66% Carlen (1996) and 76% DrugScope (2000) found that 66% and 76% of young homeless people use drugs. Drug misuse may be a consequence of homelessness by young people or a means of coping with it and may perpetuate the situation (Britton et al, 2000:6). Other factors clearly linked to offending behaviour such as unemployment are clearly interrelated with homelessness in that the lack of an address in itself can making it impossible to gain employment.
Conclusions
From the writer's discussions with individual probation officers it is clear they recognise that in spite of government legislation it is essential not to entirely lose sight of the services' social work routes in order to genuinely help offenders. Those who misuse substances invariably have the greatest degree of problems and need for care, empathy and understanding.
Contact with criminal justice agencies can become a vigorous opportunity for change. Ensuring the system is structured to make rehabilitation back to a healthy and safe lifestyle a much more likely outcome is a major challenge to those involved in reducing the harm caused by substance misuse.