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4/28/2014
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Legal Pathways, Assessment and Treatment of Offenders with ID – Offence Related Thinking, Alcohol Related Violence, Violence, Sexual Offences.
Prof Bill LindsayCastlebeck, DarlingtonUniv. Abertay, Dundee,Univ. Bangor, Gwyneth
Lindsay, O’Brien et al 2010, Criminal Justice and B ehaviour
Data set 1. All referrals in 2003 to:
477 cases of offenders or Offending behaviour – Case Note Study
Community Generic LD
Services n=239
Community forensic LD
ServicesN=97
Low/Medium Secure LD
ServicesN=91
Maximum Secure LD
ServicesN=50
Decreasing level of service/ security
Index Behaviour/Offences.
0
10
20
30
40
50
60
70
PhysAgg ConSexOff Arson PropDam
High
Med/low
CommForen
Community
*
**
Referral Source.
0
5
10
15
20
25
30
35
40
45
Community Court Social service tertiaryHealth
High
Med/Low
CommForen
Community
70%
*
*
**
Other characteristics.
0
5
10
15
20
25
30
Age1stOff SexAbuse NAI SevDep
HighMed/lowCommForenCommunity
**
*
*
Psychiatric assessment information.
0
5
10
15
20
25
30
schz Bipol DpAx PD ASD ADHD
High
Med/low
CommForen
Community
* *
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• ASD
• Personality Disorder
• Childhood Adversity and abuse
Foren ID (74) V non foren ID (282) V Non ID foren (506)
(Lunsky et al 2011, Psychol. Crime and Law)
0
5
10
15
20
25
30
Sex abuse NAI Neglect suicide Global
Severity
forensic ID
Non forensic ID
Forensic
PD (n=77) V no PD (n=61) (Alexander et al 2010 JIDR)
Not significant Significant differences
Conclusion – “there were more similarities than differences between PD group and the rest” p650
Progress and engagement –
Treatment and supervision.
Anger, aggression and violence.Fire raising.Theft and driving offences.Social problem solvingSexual offences and inappropriate sexual behaviour
High
Medium
Low
Local Inpatient
Com. Forensic
Com. Generic
Independent
Prison
Lost
Referred to 12 Months 24Months
16 14 14
1
1
(13)
1
(1)
(1)
1
(1)
High
Medium
Low
Local Inpatient
Com. Forensic
Com. Generic
Independent
Prison
Lost
Referred to 12 Months 24 Months
17 16 10(9)
1(1)
(4)
(3)3
4
4/28/2014
3
High
Medium
Low
Local Inpatient
Com. Forensic
Com. Generic
Independent
Prison
Lost
Referred to 12 Months 24 Months
18 15 13(13)
3
3
(3)
2
(2)
High
Medium
Low
Local Inpatient
Com. Forensic
Com. Generic
Independent
Prison
Lost
Referred to 12 Months 24 Months
16
3
4
2
4
2
1
3(3)
2(2)
(2)2
5(3)
4
(1)(1)
(2)
(2)
High
Medium
Low
Local Inpatient
Com. Forensic
Com. Generic
Independent
Prison
Lost
Referred to 12 Months 24 Months
53 25
3
2
12
5
5
1
16(15)
(1)
(4)
(8)
(2)
2
2
9
4
1
19
(1)
(1)(1)
(1)
(1)(8)
(3)
(1)
(5)
(1)
High
Medium
Low
Local Inpatient
Com. Forensic
Com. Generic
Independent
Prison
Lost
Referred to 12 Months 24 Months
77 58
2
1
3
4
5
1
3 11
2
5
47
2
3
2
5
(3)
(1)
(2)
(47)
(2)
(1)
(1)
(4)
(2)
(1)
(3)
(7)(1)
(1)(1)
Relationship between Risk for Violence and Security.
Lindsay et al (2010) J For.Psych.Psychol.Levels of Security
• High
• Medium
• Low
• Local Inpatient
• Com. Forensic
• Com. Generic
Risk Assessments
• Violence Risk
Appraisal Guide
• Static 99
Relationship between Risk for Violence and Security.
Lindsay et al (2010) J For.Psych.Psychol.
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Relationship between Risk for Sexual Violence and Security.
Lindsay et al (2010) J For.Psych.Psychol.Motivation
• Statutory penalties (probation/deferred sentence etc.), own, others’,general offence
• Community reactions(personal experience,pos./neg.,centre experiences; news, other stories
• Imagine consequences of reoffending
• Peer criticism (group processes)
• Praise for success (group process)
• Review problem events – resolve problems
• Use relatives and significant others
• Special events
• Review progress
• Self esteem
• Societal context – something to lose
• Constant search for motivating opportunity
Anger Treatment –
Ownership
February 2014 Effective communication
• Self monitoring of dialogue.
• Not a natural process.
• 3 syllables rule “natural process”
• Checking ”what have I just said” “now you tell me what………”
“ can someone explain it for everyone else ?”
• Recording on the flipchart
Setting an agenda – can be helpful
• Simpler at the beginning.
• More complex at the end.
Review homework (if possible).
How has my week been.
Important things that happened.
What I think and what I do.
How my body feel and what it makes me think.
Thinking , body, feeling and doing.
Exercise on the flipchart.
Set homework tasks. Simple tasks related to session.
SPORT
• It is an access programme for psychological therapy.
• Psycho education.
• In the context of sexual offending, or alcohol related
treatment, or anger treatment or treatment for alcohol
related violence.
• Knowledge of Anger Treatment
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Management of anger and violence
treatment programme. Anger treatment.
• Personal anger,
• Graded disclosure
• Simple hierarchy,
• Stress inoculation with imagery
• Positive self statements.
• Taking your pulse,
• Personal pictures/hierarchies.
• relationship between anger and aggression.
• Developing offence disclosure.
• Diary work.
• Relaxation.
Graded
disclosure.
No one is
too
exposed
ANGER TREATMENT. Mean Novaco Anger Scale (NAS)
(Taylor et al. (2005). Brit. J. of Clinical Psychology)
90
95
100
105
110
Screen Pre-Treatment Post-Treatment
Follow-Up
Anger treatment (AT)
Routine care (RC)
Willner, Rose et al (2013) BJP. Blind RCT
Carer Ratings
Re-offending at 9 Month Follow up Lindsay et al.
(2004) Clinical Psychology and Psychotherapy
Re-offending %
Treatment 14
Control 45
(X2
= 24.417; df 1, p < 0.01)
0
5
10
15
20
25
30
35
40
45
50
Treatment Control
% R
e-o
ffen
din
g
Research “What Works”
Gendreau 1996-2008; MacKenzie (2000), Sherman et al (1999),
• Addressing high risk and needs.
• Quality of the treatment intervention.
• Structured and focussed approaches.
• Focus on criminal needs (anger, impulsiveness, social networks,
cognitions, addictions)
• Develop vocational skills.
• Programmes developing personal skills using CBT methods.
• Programmes that contain an interpersonal problem solving
component.
• Contains individual sessions to augment the group programme
........... Individual concerns are addressed.
• contains a component to treat anger
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Intensive treatment increases reoffending for low risk offenders
(Gendreau 1996- 2012; Lowencamp & Latessa 2002-5)
-30
-20
-10
0
10
20
30
PRERCENT CHANGE IN CHANCE OF REOFFENDING
LOW RISK HIGH RISK
Decrease in Reoffending
Increase in Reoffending
“School for Crime”
CBT programmes for offenders. (Landenberger & Lipsey)
• Review of all CBT programmes for offenders.
• NOT ID.
• 58 studies; around 20,000 participants.
• Treatment providers not sophisticated – minimal training
• Reduction in recidivism – 25% - 50%
• BUT THEY HAD CERTAIN REQUIREMENTS
CBT programmes offenders. (Landenberger & Lipsey 2005)
What contributes to effectiveness.
-30
-20
-10
0
10
20
30
40
Decrease Effectiveness
Increase Effectiveness
Mixing
interventions
Branded
Programmes
Risk Level
Higher
Dropouts
Cog
Restructuring
Quality
Control
Anger
Treatment
Total
Hours
Support1:1
Sessions
Criminal Thinking and Social Problem Solving
Programmes “What Does Not Work”
• Programmes that address non criminogenic needs.
(outdoor activity, wilderness programmes, physical
activity, self esteem)
• Vague, Nondirective counselling.
• Targeting self esteem.
• Unstructured programmes.
• Scare programmes, “Boot Camps”, fear of punishment
programmes.
• Increased surveillance (home confinement, urine testing,
intensive supervision).
• Allowing continuation of antisocial peers.
Social Problem solving and Offence Related Thinking.
(SPORT) Lindsay, Hamilton, Scott, Doyle, Moulton and McMurran, 2009.
• Moral development and egocentric reasoning. (Kohlberg 1984, Gibbs 2003).
• Many studies report offenders show lower levels of moral reasoning with a greater egocentric bias. (Palmer and Hollin 1998).
• Deficits in moral development linked to aggression and crime through mediating factor of poor cognitive skills and decision making.(Palmer2004,5)
• Several developments in mainstream offenders regarding cognitive thinking skills programmes,(Little and Robinson 1999, Menton 1999, Ross and Fabiano 1988)
• Skills programmes reduce reoffending in participants compared to controls (round 30% V 45%)
• 3 year project involving 3 sites, developments in assessment and programme development.
Social Problem solving and Offence Related Thinking.
(SPORT) Lindsay, Hamilton, Scott, Doyle, Moulton and McMurran, 2005a,b,sub.
• Analysis of problem situations.
• Understanding thinking errors.
• The relationship between thinking, arousal and behaviour.
• Dealing with emotion.
• Faulty (offending) problem solving.
• Generating non offending solutions.
• Appropriate assertion.
• Taking appropriate action.
• Discussion, role play, analysis, diaries, problem solving
exercises.
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Social Problem Solving Inventory- Revised
• Developed by D’Zurilla, Nezu, Maydeu-Olivares (2002)
• Self-assessment looking at problem solving
• Based on theory and empirically tested
• Multidimensional
• Easy to understand and administer
• Tested on a large sample N=2,312
D’Zurilla, T.J, Ph.D., Nezu, A.M., Ph.D., & Maydeu-Olivares, A (2002). Social
Problem-Solving Imventory- Revised. Multi-Health Systems Inc
Social Problem Solving Inventory- RevisedD’Zurilla, Nezu, Maydeu-Olivares (2002)
• 2 factors looking at adaptive dimensions
• Positive Problem Orientation
• Rational Problem Solving
• Three dysfunctional dimensions
• Negative Problem Orientation
• Impulsivity/Carelessness Style
• Avoidance Style
Social Problem Solving and Offence Related
thinking (SPORT)
• SPORT programme created for ID
• Simple CBT programme promoting clear problem solving techniques
• Promoting identification of thinking errors, problem situations etc.
• Promoting pro-social thinking to replace offending behaviours
• Replacing cognitive distortions with more positive values
SPORT Programme
• 15 sessions each lasting one hour approx
• Enjoyable, practical and meaningful
• Interactive sessions
• Same idea presented in number of different ways to reinforce message
• Each session completed with simple take home message that group members are given to make up a workbook
Sport Programme
• Session 1; Ice breakers and setting up rules
• Session 2: Looking at everyday problems
• Session 3: Identifying faulty problem solving
• Session 4: Relationship between the way we ACT, think and feel
• Session 5: Relationship between way we THINK, act and feel
• Session 6: Relationship between way we FEEL, think and act
• Session 7: Our emotions and the way we act
• Session 8: Self talk affecting the way we feel
Sport Programme
• Session 8: Self-talk affecting the way we feel
• Session 9: Self-talk to justify things
• Session 10: Getting all the information
• Session 11: Recognising difference between fact & Opinion
• Session 12: Correctly identifying the problem
• Session 13: Identifying Solutions
• Session 14: Looking at short and long term consequences
• Session 15: Identifying the best problem solving solution
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Example of a session
• Identifying the problem
• Spot the difference exercise encouraging looking for all the
information.
• Vignettes identifying that things are not always what they
seem.
• Ask “W” Questions to identifying what is going on eg…..
Diane stands alone in her kitchen
with a knife in her hand and
tears streaming down her face.
The window is smashed and
Bobby lies dead on the floor.
1. Introduction
• This session has very little to do with the process
of the group but is more a get to know you
session and establish some group rules in order
that the group will function as effectively as
possible. Issues covered are confidentiality,
punctuality, respect, hard work and politeness. It
also involves some simple problem solving games
to allow members to get to know each other,
2. Analysis of everyday social problems
• The function of this session is to demonstrate to
individuals that they are solving problems every
day even although they might not realise it.
• Take home message
You are solving problems all day every day – even
when you don’t know that you are.
3. Examples of faulty problem solving.
• Here we employ examples of faulty problem
solving such as stealing money in order to pay a
friend back and give examples of the way in which
problem solving is a skill to be developed.
• Take home message
sometimes we get problem solving wrong!!
but you can always improve on them and make
them better.
You are really angry as your football team has lost an
important match, A member of staff or a member of your
family is winding you up so you get angry and teach them a
lesson for winding you up and hit them.
What do you think of this problem solving idea?
Write answers on the board which the group members give
you.
Split the answers into good and bad things
about the solution and discuss which is the most important.
Look at any further problems that this solution may cause.
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4. Behaviour and action – what you do.
• This session is designed to establish the link between
action and thinking. An example of this section is the way
in which thinking is disrupted after exercise when
compared to a similar task before exercise.
Exercise: thinking/doing
Discussion.
• Its harder to concentrate when you are feeling wound up
and your body is working harder and faster.
• We have all agreed that we are all calm just now and our
pulse is slow so let us do a small experiment.
• Take pulse....... Ask some simple questions....... Age, where
you stay etc...........Then ask the group member to run
around outside or do ten star jumps so that their pulse is
racing. Ask questions/take pulse.
• So we know that when we angry or when we are excited
it is harder for us to think properly
• What we do affects how easy it will be to problem solve
5. Cognition – what you think.
• The group discuss the way in which thinking affects how
you feel.
• A number of examples are designed to generate faulty
thinking.
6. Physiological reaction
affects cognition.
• How you feel. In this section
physiology, thinking and behaviour are linked in
discussions of familiar functions such as eating.
Then the discussion moves on to the
consequences of mixing up the physiological
messages and getting them wrong.
• Eating a chilli. Are you still hungry and thinking
about food?
7. Emotion, action and cognition.
• Several examples. are role-played and discussed, leading
the group into an understanding that emotion will
determine behaviour. For example, a discussion is
generated on how one would act when happy as opposed
to acting when sad.
Exercise what you think affects how you feel
and what you do
• You are just getting ready to go on holiday when you
receive a phone call to tell you that a close family member
has been rushed into hospital and their condition is
serious.
• If this was you in this situation how do you think you
would feel?
• How would you feel about going on holiday?
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Exercise what you think affects how you feel
and what you do
• You are just getting ready to go on holiday when you
receive a phone call to tell you that a close family member
who has been seriously ill in hospital is now doing much
better, has been moved into a main ward and will be
ready to go home within a few days.
• If this was you in this new situation how do you think
you would feel?
• How would you feel about going on holiday?
8. Internal dialogues and self-talk.
• Using several examples of self talk this session explores
the way in which different individuals will use internal
dialogues.
• Imagine that it is a cold winters morning and you are
lying under a warm duvet in you nice warm bed. Your
alarm goes off and you think “bloody hell I can’t believe
it’s morning already, its so cold getting up and I can’t be
bothered.” How do you feel?
• you are lying in your nice warm bed on a cold day, your
alarm goes off and this time you say to yourself “ I’m
really looking forward to going into work today, it’s a
nice crisp day outside and I can’t wait to get up and get
organised”. Would it make a difference to the way you
feel?
9. Justifications and cognitive distortions.
• Here we use several everyday examples of cognitive
distortions used as excuses to make us feel better.
• One example is when a smoker, when trying to give up,
says that one cigarette won’t do any harm.
• Over the speed limit in the car.
• Climate change.
• Always tie the messages to offending – its ok to steal the
car; he needed to get out my way; its ok to steal the beer
.
10. Information gathering in risky situations.
• Using examples of ambiguous situations the group can
explore faulty conclusions in situations.
• Examples You are eating your lunch when the father of
the family sitting opposite you suddenly starts thumping
the little boy on the back and no-one seems to be doing
anything.
• a policeman talking to a member of the public.
11. Judgements and interpretations.
• This section follows from the last and fosters a knowledge
about the importance of being clear about what is actually
factual about a situation.
• A quiz on facts and opinions is also conducted.
Quiz – fact or opinion – split the group in 2.
• Football is the greatest sport in the world.
• Tejay van Garderen is a cyclist.
• Swimming in a good way to keep fit.
• Dogs are the best pets you can get.
• Summer is the best time of the year.
• Smoking is an unhealthy habit.
• Smoking is a horrible habit.
• The last James Bond film is by far the best.
• The last James Bond film made the most money.
• Washington is the capital of the USA.
• Cycling is the greatest sport in the world.
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12. Identifying problems.
• This section concentrates on gathering information about
problems. Examples of obvious problems ( a fire starting)
and less obvious problems (someone crying in the kitchen
with a knife in their hand) are used as well as practical
examples such as knowing there is likely to be trouble at a
football match you want to go to.
Identifying problems
• Me and four of my mates are going out clubbing tonight.
• Is going to be great . We have been planning it for ages
and have
• Four free tickets to a new club in town VIP!!!
Gathering information
• Betty stands in her kitchen with a knife in her hand and
tears streaming down her face.
13. Identifying solutions.
• Here a number of practical problems are presented and
the group have to work out a range of solutions. Then
they consider given that there is more than one way to
solve many problems, it is important to establish that you
have the resources to complete the solutions.
Solution - think of all the ideas. Look at the
resources and consequences of each decision
• We have learned the correct way to identify what the
problem is
• What we need to learn to do now is to identify the correct
solution
Brainstorming exercise – any idea.
ITS 10 O’CLOCK AND YOU HAVE MISSED THE LAST BUS
HOME, YOU NEED TO BE HOME BY 10.30 BUT YOU HAVE
VERY LITTLE MONEY AND THERE ARE NO MORE BUSES.
Analyse each solution for resources and consequences.
14 Short and long term consequences.
• This section continues to explore the nature of multiple
solutions to problems establishing that several may have
good outcomes in the short term but unfortunate long
term consequences.
• One example would be using your money to have fun but
then having no money for food, and stealing it.
DISCUSSION GROUPS
• GETTING DRUNK
• DOING EXERCISE
• It may seem like a good idea at the time but think about
what will happen in the long run.
• Think about all the aspects and try not to let our emotions
affect the way we feel about decisions.
• The short term consequences are the things which
happen immediately after the problem has been solved.
• The long term consequences are the things which happen
a while after we have solved the problem.
• Consider the short and long term consequence.
4/28/2014
12
15. Good solutions and bad solutions.
• The final session explores the importance of
slowing down and making a good decision from
the alternatives.
• problem solving is a skill. Slowing down and
gathering all the facts is part of the skill.
• There then follows a recap on the whole
programme.
SPORT
ANGER
MANAGEMENT
SEX
OFFENDER
TREATMENT
INDIVIDUAL
TREATMENT
ALCOHOL AND DRUG
AWARENESS
FIRE INTEREST
Psychological Treatment Process
1989 - 2010
Treatment of criminal issues,
ISB, anger, fire interest
Community integration, family social
contact..
Individual treatment
SPORT and Social Skills.
Work and occupation.
Offender treatment.
Psychiatric review and management
Impulsivity/Carelessness Style
0
2
4
6
8
10
12
14
16
Pre Mid Post Follow-Up
Time of Assessment
Mea
n Sc
ore
ICS ScaleControl
F(3,27)=11.32, p<0.001, d=2.18
Exp. Gp.=10Cont. Gp=10
Positive Problem Orientation
0
2
4
6
8
10
Pre Mid Post Follow-Up
Time of Assessment
Mea
n Sc
ore
PPO ScaleControls
F=9.08, p<0.001, d=1.96
DPI scores for the treatment and control groups.
N=26, n=16
Pre 1st 2nd 3rd Post
t=0.89
p=0.34
t=3.03
p=0.007
t=2.63
p=0.013
Treatment
WL Control
40
30
20
10
4/28/2014
13
Referred
ISBViolenceAlcoholFiresetting
12 mths 24 mths
Responsivity to criminogenic need. Lindsay, Carson, Holland, Taylor et al 2013, Journal of Intellectual Disability Research
Treatment Treatment
Treatment across 24 months: Violent index offence
(Lindsay, Carson, Holland, et al 2012)
0
5
10
15
20
25
30
35Referred
12 Mths
24 Mths
Gen. Community Foren. Community Low/Med secure High Secure
Treatment across 24 months: Sexual index offence
(Lindsay, Carson, Holland, et al 2012)
0
5
10
15
20
25
30
35Referred
12 Mths
24 Mths
Gen. Community Foren. Community Low/Med secure High Secure
Treatment across 24 months: Combined Index offence
(Lindsay, Carson, Holland, et al 2012)
0
5
10
15
20
25
30
35
40
45
50Referred
12 Mths
24 Mths
Gen. Community Foren. Community Low/Med secure High Secure
Harm Reduction (Lindsay, et al CBMH 2013): Reduction in
number of incidents(total cohort)
0
200
400
600
800
1000
1200
1400
SEX OFF OTHER OFF WOMEN
2 YEARSBEFORE UP TO 20YRS AFTER
*
*
Conclusions.
• Cognitive behavioural/ problem solving programmes for offence related issues. Evidence suggests they are better than anything else.
• There are good assessments out there
• There are decent treatment programmes
• Programmes have to be fun. They cannot be didactic.
• Evaluation difficult in a comprehensive system.
• Evaluating a whole programme is ok. Social validity is the essential outcome.
• Evaluation seems reliable – pilot optimism.
4/28/2014
14
Assessment and Treatment of Alcohol Related Violence
Prof. Bill LindsayCstlebeck, DarlingtonUniv Abertay,Dundee, Bangor Univ.Deakin Univ., Geelong.
Email: [email protected]
Research on alcohol and ID
• Going to pubs highly valued
• Alcohol more readily available now: changing relationship with
alcohol
• Around 40% drink any alcohol and those who do report drinking
far fewer units. (McGillicuddy et al, Lindsay et al)
• Those who do drink - a higher level of problematic behaviour –
13% have serious probs (Krishef and DeNitto)
• Lower level of alcohol consumption produces problems
(Rimmer)
Alcohol Problems and Offending in
People with ID• Hayes and colleagues – 66% - 90% of offending is alcohol related.
• Klimecki et al (1994) – 45% - 87% of offenders have alcohol
problem
• McGillivray and Moore (2001) – 60% of offenders have alcohol or
drug use problem.
• Sondenaa et al (2008) – 40% Norwegian prisoners with ID
• Lunsky et al (2011) – 5% Canadian offenders with ID
• Plant et al (2011)– 40% alcohol problem and 21% cannabis prob.
• Lindsay et al (2013) – 9% - 13% alcohol problem.
• Lindsay et al (2010) – 447 offenders with ID – 10%-36% alcohol
problem
Alcohol assessments
• Section 1 – General Knowledge of Alcohol
• Section 2 – alcohol units and strengths
• Section 3 - sensible limits.
Section 1 – General Knowledge of
Alcohol1. Is drinking lots of alcohol good for you?
2. When do people drink alcohol? 3 reasonable
responses required.
3. Does drinking help you think more quickly?
4. Can too much alcohol damage a person’s health?
5. Can alcohol help you to relax and deal with your
problems better?
6. Is it alright to take medicines with alcohol?
7. What will help someone with a hangover?
8. When are you not allowed to have alcoholic drinks? 2
reasonable responses required.
9. Can you name three alcoholic drinks?
10. Can you name three non-alcoholic drinks?
11. How can you tell the difference between alcoholic
and non-alcoholic drinks? 2 reasonable responses
required.
12. Is drinking spirits more dangerous than drinking
beer?
4/28/2014
15
Section 2 – Units and Strengths –
what has most alcohol
1. A whisky or a pint of beer - or are they the same?
2. A vodka or a half pint of beer - or are they the same?
3. How much alcohol is in a coke - none, a little or a lot?
4. A glass of wine or a glass of whisky – or are they the same?
5. How much alcohol is in ginger beer – none, a little or a lot?
6. A bottle of spirits or a bottle of wine – or are they the same?
7. How much alcohol is in a cup of coffee – none, a little, a lot?
8. A bottle of wine or a bottle of beer – or are they the same?
Section 3 – Sensible Limits
1. How many units is it safe for a man to drink in a week?
2. How many units is it ok for a woman to drink in a week?
3. Is there any difference between pub measures and drinks at
home?
4. How long does it take the body to get rid of one drink – one
unit of alcohol?
5. How long does it take the body to get rid of two drinks – two
units of alcohol?
6. What could you do in a pub apart from drinking alcohol? 3
reasonable responses required.
Alcohol and Alcohol Related Violence
Sessions 1 & 2
• Introductions and rules
• Games and quizzes
• E.g. Any word to do with alcohol, then take turns to say other
words.
• Interesting associations can be discussed
• Team quiz on alcoholic and non-alcoholic drinks
• When it is OK and not OK to consume alcohol
• Discussion on appropriate drinking and its effects
Alcohol education and treatment
Sessions 3, 4 and 5
• Differences between alcoholic and non-alcoholic drinks
• How to tell them apart.
• The cost - Price is not a guide.
• Effects of alcohol has the body and brain
• How the body gets rid of alcohol and how long it takes
• Strengths of different drinks
• Standard units.
• Sensible and hazardous limits for men and women
• Use Quizzes and Games instead of didactic methods
Alcohol education and treatment
Session 6 and 7. • Risks of alcohol misuse
• Relationship between alcohol and violence
• Safe limits (again)
• Strategies for sensible drinking in bars and at home,
• Role-plays asking for a non alcoholic drink or refusing a drink
• Idiomatic role plays link alcohol and anger programme
• Continue in the anger programme
• Relapse prevention sessions combining violence and alcohol
• Session 8 – revision with quizzes.
ALCOHOL RELATED VIOLENCE -
IMAGES• Be careful. Images can be attractive e.g. HIV drug abuse
images from the 1990s.
• What is happening here?
• What will happen now?
• Will anyone get hurt?
• How drunk is she/he?
• How does he/she feel?
4/28/2014
16
Alcohol Treatment (Lindsay, Tinsley and Miller 2013):
Increases in Knowledge Scores.
10
15
20
25
30
35
PRE POST FU
Treatment
Control
*
* N=18
N=18
Angie – anger and adaptive responses.Lindsay & Tinsley, 2012, in McMurran (ed) Alcohol Related
Violence.
0
5
10
15
20
25
30
35
40
45
50
1 2 3 4 5 6 7 8
ANGERRESPONSE
Treatment of Violence and alcohol misuse. – anger
and adaptive responses. 6M, 2FLindsay, Smith, Macer and Miller, 2012,
0
5
10
15
20
25
30
35
40
PRE MID POST 3mth FU 9 mth fu 18 Mth
ANGER (DPI)Alcohol Knowledge
Conclusions.
• Anger treatment, social problem solving and
• Generally manualised
• Overly didactic – require considerable adaptation and development for ID to be interactive.
• Adaptations seem to produce an enjoyable programme
• Evaluation difficult in a comprehensive system.
• Evaluation seems reliable – pilot optimism.
