title: Assessment of alcohol problems using AUDIT in a prison setting: more than an 'aye or no' question.
abstract: BACKGROUND
  Alcohol problems are a major UK and international public health issue. The prevalence of alcohol problems is markedly higher among prisoners than the general population. However, studies suggest alcohol problems among prisoners are under-detected, under-recorded and under-treated. Identifying offenders with alcohol problems is fundamental to providing high quality healthcare. This paper reports use of the AUDIT screening tool to assess alcohol problems among prisoners.
  
  
  METHODS
  Universal screening was undertaken over ten weeks with all entrants to one male Scottish prison using the AUDIT standardised screening tool and supplementary contextual questions. The questionnaire was administered by trained prison officers during routine admission procedures. Overall 259 anonymised completed questionnaires were analysed.
  
  
  RESULTS
  AUDIT scores showed a high prevalence of alcohol problems with 73% of prisoner scores indicating an alcohol use disorder (8+), including 36% having scores indicating 'possible dependence' (20-40). AUDIT scores indicating 'possible dependence' were most apparent among 18-24 and 40-64 year-olds (40% and 56% respectively). However, individual questions showed important differences, with younger drinkers less likely to demonstrate habitual and addictive behaviours than the older age group. Disparity between high levels of harmful/hazardous/dependent drinking and low levels of 'treatment' emerged (only 27% of prisoners with scores indicating 'possible dependence' reported being 'in treatment'). Self-reported associations between drinking alcohol and the index crime were identified among two-fifths of respondents, rising to half of those reporting violent crimes.
  
  
  CONCLUSIONS
  To our knowledge, this is the first study to identify differing behaviours and needs among prisoners with high AUDIT score ranges, through additional analysis of individual questions. The study has identified high prevalence of alcohol use, varied problem behaviours, and links across drinking, crime and recidivism, supporting the argument for more extensive provision of alcohol-focused interventions in prisons. These should be carefully targeted based on initial screening and assessment, responsive, and include care pathways linking prisoners to community services. Finally, findings confirm the value and feasibility of routine use of the AUDIT screening tool in prison settings, to considerably enhance practice in the detection and understanding of alcohol problems, improving on current more limited questioning (e.g. 'yes or no' questions).
authors.affiliation: Institute for Social Marketing, University of Stirling, Stirling, UK. susan.macaskill@stir.ac.uk
authors.forename: Susan
authors.initials: S
authors.lastname: MacAskill
authors.forename: Tessa
authors.initials: T
authors.lastname: Parkes
authors.forename: Oona
authors.initials: O
authors.lastname: Brooks
authors.forename: Lesley
authors.initials: L
authors.lastname: Graham
authors.forename: Andrew
authors.initials: A
authors.lastname: McAuley
authors.forename: Abraham
authors.initials: A
authors.lastname: Brown
mesh_terms: D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011329:Prisoners; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
references.citation: Int J Prison Health. 2009;5(4):201-11
references.pmid: 25757521
references.citation: J Epidemiol Community Health. 2010 May;64(5):432-9
references.pmid: 20445212
references.citation: Public Health. 2009 Jun;123(6):415-8
references.pmid: 19482321
references.citation: Int Rev Psychiatry. 2003 Feb-May;15(1-2):150-2
references.pmid: 12745325
references.citation: J Trauma. 2010 Mar;68(3):644-9
references.pmid: 19918199
references.citation: BMJ. 1997 Jul 5;315(7099):18-21
references.pmid: 9233320
references.citation: Alcohol Alcohol. 2004 May-Jun;39(3):247-50
references.pmid: 15082463