Coercive Treatment for Alcohol Misuse: An Interactive and Relational Analysis
| Author | Dr Jo Ashby, Professor Christine Horrocks |
| Pages | 23-39 |
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COERCIVE TREATMENT FOR ALCOHOL MISUSE: AN
INTERACTIVE AND RELATIONAL ANALYSIS
Dr Jo Ashby, University of Bradford & Professor Christine Horrocks, Manchester
Metropolitan University
Abstract
Alcohol misuse has become central for policy makers with approaches to addressing and
providing solutions a persistent challenge. Alcohol Treatment Requirements (ATRs) were
introduced through the legislation of the Crimin al Justice Act 2003, making available to the
courts an ATR as one of the possible requirements of a community order for o ffenders who
have committed an alcohol-related offence. This form of ‘coercive treatment’ is delivered
collaboratively with the criminal justice system and the National Health Service (NHS)
working in partner ship. Those sentenced to the ATR are predominantly young male,
persistent offenders presenting with severe alcohol problems. As part of a research project
funded by the NHS, qualitative participa nt observations were undertaken during treatment
delivery on the ATR. This paper presents an analysis of the interactions observed between
male offenders and female alcohol workers. Explored is the nature of coercive treatment
and how young men sentenced to treatment engage with the process. The analysis utilises
positioning theory to show how control and compliance operate within a complex,
relational and interactive encounter that while foc ussed on alcohol consumption and
behaviour change are impacted upon by wider cultural and social issues.
Key words: alcohol misuse, offending, coercive treatment, behaviour chan ge, relational
British Journal of Community Justice
©2013 Sheffield Hallam University, Sheffield
ISSN 1475-0279
Vol. 10(3):23-39
Ashby & Horrocks
24
Background
Alcohol related crime and drinking patterns
There is mounting evidence h ighlighting the social and economic impact of alcohol misuse
in the UK. Nutt, King and Lawrence (2010) recently reported that whilst heroin, crack
cocaine, and metamfetamine were found to be the most damaging to individuals, alcohol
was found to b e one of the most harmful to others. Research has consistently shown that
alcohol use is present in a high proportion of criminal offences (Budd, 2003; Richardson
and Budd, 2003; Hall and Innes, 2010; Flately et al. 2010; Chaplin, Flately and Smith, 2011;
Home Office 2012a; Home O ffice 2012b) with approximately half of all violent crimes, and
360,000 incidents of d omestic abuse, linked to alcohol misuse (Strategy Unit, 2004; Home
Office 2012b). Moreover, a study by Felson, Burchfield and Teasdale, (2007) found that for
violence involving strangers, offenders were more likely to have consumed alcoho l,
whereas victims were more likely to be sober.
In order to understand better the impact of alcohol consumption there now exists a
growing body of research exploring specific drinking patterns associated w ith crimin al
behaviour (see for example Klingemann, 2001; Richard son and Budd, 2003; Dingwall,
2006). For example, ‘heavy episodic’ drinking has been found to contribute to the risk of
interpersonal violence and aggression for some people (Wells and Graham, 2003). Notably,
the UK has been found to hav e high rates of ‘explosive’ drinking patterns, in which alcoho l
is consumed less frequently but then drunk to intoxication, leading to an increased risk of
an alcohol-related crime being committed. Indeed Richardson and Budd (2003) found that
‘binge’ drinkers were five times more likely to admit to committing an offence involving
fighting than those defined as ‘regular drinkers’.
Bearing in mind the evidence on drinking pat terns, Models of Care for Alcohol Misuser s
[MOCAM] (National Treatment Agency, NTA, 2006) identifies ‘hazardous’ an d ‘harmful
drinkers’ as alcohol mi susers. According to NHS Choices (2009) hazardous drinker s are
described as a person who drinks over the recommended weekly limit (currently 21 units
for men and 14 units for women) and harmful drinkers are described as a person who
drinks over th e recommended weekly li mit and has experienced health problems directly
related to alcohol. MOCAM states that these hazardous and harmful drinkers do not have
significant evidence of alcohol dependence and thus advice and brief interventions are
often suitable to meet the needs of both these groups. Drinking behaviour categorised as
‘dependent’ includes those with an increased drive to use alcohol and difficulty controlling
its use despite negative consequences; with severe dependence associated usually with
physical withdrawal symptoms upon cessation. Given gr owing evidence around drinking
patterns and the social and economic impact it is unsurprising, although worrying, to know
that the UK is reported to hold eighth position in the ‘hard drinking’ nations of Europe
(British Medical As sociation, 2008). Furthermore, on a regional level, the highest levels of
binge drinking, drin king with increasing risk and alcohol dependency, were found to be in
the northern regions of England in particular in Yorkshire and Humberside, (Yorkshire and
Humber Public Health Observatory 2005; 2010). In this paper we explore the delivery and
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