The importance of drug treatment in prison is well recognised, given the prevalence of problem substance use among prisoners. Engagement and retention in drug treatment is a key factor in improving outcomes. An evaluation of a group-based motivational intervention, developed in order to identify and engage with substance users in a prison setting at an earlier stage with regard to their drug use, is described here.1
The motivational intervention was based on motivational interviewing and the Prochaska and DiClemente transtheoretical model of behaviour change. Motivational interviewing is defined as ‘a client-centred directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence’. After the intervention the authors expected that participants would show:
- increased recognition of their problem behaviour,
- decreased ambivalence towards their drug use, or
- positive behavioural change in relation to their drug use.
Prisoners in Mountjoy prison who were current substance users were invited to participate in the intervention programme. Those with active psychiatric illness or a release date before the end of the programme were not included. There were 76 potential participants: 44 were offered a place on the programme and 38 accepted. Each participant gave informed consent. Eleven potential participants were put on a wait list and formed the control group. The 12-session group-based motivational intervention took six weeks and each session lasted 1½ hours.
Demographic data, sentencing details, drug use history, risk behaviour and current engagement with treatment services were collected for each participant using a semi-structured interview. The primary outcome measure of treatment effectiveness was collected using the internationally validated questionnaire – Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES).2 This measures a participant’s readiness for change. It was filled out by the participant (self-reported) before and after the treatment. Retention rates in the programme were 88% at two weeks and 76% (n=31) at six weeks. Information on the seven who had dropped out by the sixth week was not included in the final analysis.
The mean age of the participants was 31 years and all were male. Most were incarcerated for non-violent drug crimes (39%), followed by violent crime (35%). Opiates were the main drug used (71%). Three quarters (74%) reported ever injecting while nearly half (48%) reported recent injecting drug use. No statistically significant difference was found between the characteristics of the participants and the control group.
Reported limitations of the study included small sample size, lack of randomised or treatment-as-usual control group, and use of self-reported outcome measures. Many of the participants and those in the control group were also engaged in other prison drug treatment services, e.g. methadone maintenance, which may indicate that they already had a higher degree of motivation than other prisoners who were not engaged with the services.
The authors considered the high level of retention and completion rates in the programme very positive. There was a statistically significant reduction in the ambivalence of the participants around their drug use after the intervention. The authors concluded that group-based motivational interventions could be useful in a prison setting but they require further investigation. (Suzi Lyons)
1. Harper S and O’Rourke A (2015) An evaluation of group-based motivational intervention for substance misusers in an Irish forensic setting. Irish Journal of Psychological Medicine, early on-line http://www.drugsandalcohol.ie/23573/
2. Miller W and Tonigan J (1996) Assessing drinkers motivation for change. The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). Psychology of Addictive Behaviours (10):81–89
