Women in an open prison: Can we make alcohol screening and brief interventions work for them?

By Dr Jennifer Ferguson, Lecturer in Criminology at Teesside University.

This blog post reports on a research study undertaken by Dr Jennifer Ferguson that examined what factors need to be considered when designing and implementing alcohol screening and brief interventions (ASBIs) within a female open prison in England.

 


What is the problem?

Researching alcohol use disorders (AUDs) in a criminal justice setting can be difficult for many researchers, particularly with women in prison. What is not difficult is establishing a need to do so. Women currently make up 5% of the prison population, with 3,100 women in prison in the UK compared to 74,981 men (Ministry of Justice and Her Majesty’s Prison and Probation Service, 2021). Significantly more females are found to be risky drinkers when they arrive in prison (24%) compared to their male counterparts (18%) (Ministry of Justice and Office for National Statistics, 2018). Moreover, those involved in the criminal justice system, particularly women, are much more likely to suffer from inequalities in society (Prison Reform Trust, 2019; opens PDF).


What did I research?

The psychological impact of imprisonment remains a concern and one key aspect is the impact of multiple transitions into, between, and out of prison. Each transition can be difficult for people in prison to negotiate. The ability of individuals to manage these transitions can be linked to the process of identity transformation that was first conceptualised by Strauss (1962). It is suggested that people experience ‘turning points’ or ‘critical incidents’, where they can move between their old status as an offender and their new pro-social identity. As part of this, many people serving custodial sentences attempt to address factors that might have contributed to their offending and this frequently includes the use of drugs and alcohol.


Alcohol and the pains of imprisonment

ASBIs are used to detect and prevent AUDs and have been shown to reduce alcohol intake and associated harm. Before implementing any intervention, it is essential to understand the psychological impact of custodial sentences that Sykes (1958) described as the ‘pains of imprisonment’. Crewe et al. (2017) expanded this and identified the gendered pains for women serving sentences that include losing contact, power, autonomy and control, mental and physical well-being, and trust, privacy and intimacy. Crewe argued that these ‘pains’ differed from their male counterparts and this is possibly due to the influence of pre-prison traumatic experiences, including inward facing violence due to guilt, regret, anger or grief; or being unable to trust, but longing for intimacy in the absence of outside relationships.

Women’s experience of imprisonment can also be made more difficult because they are often located a significant distance from their home (average of 64 miles from home), meaning receiving visits from family and friends can be more difficult, and for some, it can be impossible. The small number of prisons also means that women are held in either closed or open conditions, with no separation based on the seriousness of the offence.

Whilst alcohol education courses have steadily increased in prison since 1980, interventions tailored towards women are neglected and under-researched. Given what we know about the psychological impact of imprisonment it makes sense to tailor any interventions to the prison environment. This study built on work that has been carried out in a range of settings, including more recent work in men’s prisons (Holloway et al., 2017; Holloway et al., 2021), and it explored how ASBI could be tailored for delivery in a women’s open prison, focussing particularly on the acceptability from the women, and the feasibility from the staff.


Assessing acceptability and feasibility: What did I find?

The findings of the study identified that although the participants have difficulty trusting others, this did not necessarily impact the relationships that they had with prison officers and other residents. When asked who they would choose to deliver an ASBI, they suggested that this should be the prison officer. This was something that differed to our previous work with men in prison (Holloway et al., 2017; Holloway et al., 2021).

The research also explored at what point in their sentence there would be what is described as a ‘teachable moment’, a point in time when they would be more willing to consider positive behaviour change. It was expected that this would be when the women find themselves in prison, thus the incarceration acting as a teachable moment. However, this study found that the women often had two teachable moments. One when they first find themselves in prison serving a custodial sentence, and one in the open estate when they are preparing to return home. It makes sense that a woman who is drinking in a risky way will not consider an alcohol intervention a priority in the closed estate because it can be more difficult to access alcohol and they often have more immediate concerns such as being separated from their families and the aforementioned pains of imprisonment.

The second teachable moment appeared to happen when they reach the open estate and have the opportunity to leave the prison for Release on Temporary Licence (ROTL), usually for work or to spend short periods at home. ROTL is an important part of the move to open prison conditions because it provides an opportunity for the women to prepare for release, but it comes with some level of risk, including more access to alcohol. At this point in their sentence, the participants were anxious that they would do something wrong that would see them returned to closed conditions making them more likely to respond positively to an ASBI.


What can we do next?

Taking a multidisciplinary approach, the work focused on the behaviour change element of the ASBI as well as the pains of imprisonment. As ASBIs are well evidenced in other settings, the research did not set out to prove the robustness or effectiveness of the intervention itself. The findings of this study suggest that the use of ASBIs within a female open prison would be acceptable to both the women and the staff that support them. Underpinning the public health intervention (ASBI) with criminological theory (pains of imprisonment) has suggested a way forward in developing a more holistic intervention for this population of women. The time in open conditions represented a ‘teachable moment’ for the women and therefore an intervention at this stage in their sentence has the potential to bring about positive behaviour change. These interventions need to be informed by our understanding of the journey women experience during their sentence and need to be adapted to specifically meet their needs so that women can capitalise on the ‘teachable moment’ and potentially change behaviour. To enable this to happen we need to take both a public health and criminological theory approach to such interventions.


To learn more about Jennifer's research, watch the video below, recorded at a Scottish Alcohol Research Network (SARN) Member Meeting in January 2022:


INEBRIA Edinburgh Conference 2022

If you are interested in screening and brief interventions, consider attending the INEBRIA Edinburgh Conference 2022, from 21-23 September 2022 (pre-conference on 21 September): inebriaedinburgh2022.com

Abstract submission is open until 9am BST, 15 April 2022.


SHAAP Blogposts are published with the permission of the author. The views expressed are solely the author's own and do not necessarily represent the views of Scottish Health Action on Alcohol Problems (SHAAP).