Pharmacological interventions for alcohol misuse in correctional settings: A systematic review. (8th December 2021)

• Record Type: Journal Article
• Authors: Slavin‐Stewart, Claire; Minhas, Meenu; Turna, Jasmine; Brasch, Jennifer; Olagunju, Andrew Toyin; Chaimowitz, Gary; MacKillop, James
• Is Part Of: Alcoholism. Volume 46:Number 1(2022)
• Page Start: 13
• Page End: 24
• Publication Date: 2021-12-08
• Subjects: alcohol use -- corrections -- disulfiram -- naltrexone -- pharmacological treatment; Alcoholism -- Periodicals; Alcoholism -- Periodicals; Alcoolisme; Electronic journals; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.861005
• DOI: 10.1111/acer.14751
• Languages: English
• ISSNs: 0145-6008

Abstract

Abstract: Background: The prevalence of alcohol use disorder (AUD) is estimated to be 10 times higher amongst individuals in the criminal justice system than the general population. Alcohol use is also one of the strongest modifiable risk factors for recidivism. One intervention that has been shown to be effective in reducing alcohol consumption in the general population is medication‐assisted treatment (MAT), and this systematic review synthesized the existing evidence on MAT for AUD in correctional settings. Methods: Empirical, peer‐reviewed studies on approved medications for AUD in correctional populations were searched in major databases. One hundred sixty‐two articles were initially screened and 14 eligible articles were included in the final review. Four articles examined disulfiram, and 10 articles examined naltrexone. Results: The studies on disulfiram were considerably older than those on naltrexone, predating contemporary scientific standards. Disulfiram in combination with substantial contingencies in a supervised setting significantly reduced alcohol‐related measures of consumption and recidivism and had acceptable safety and tolerability. All naltrexone studies showed significant reductions in alcohol‐related measures, but effects on recidivism were mixed. The naltrexone studies indicated that it was highly acceptable and well tolerated. In addition, offenders receiving naltrexone had significantly greater medication adherence, treatment attendance, and treatment duration than with placebo. Conclusions: A small number of studies on pharmacological interventions for AUD in the correctional population suggest that MAT is effective in reducing alcohol consumption, although results on recidivism are mixed. On balance, the evidence was more supportive of naltrexone in reducing alcohol‐related outcomes than disulfiram and it may also be a more feasible intervention in correctional settings. Further research on MAT to address AUD in correctional populations with larger sample sizes, longer duration, and in combination with behavioral interventions is warranted. Abstract : This systematic review examined the literature on medication assisted treatment (MAT) for alcohol use disorder (AUD) in correctional populations. Only 14 articles met inclusion criteria. Four studies on disulfiram found evidence that it reduced alcohol consumption and recidivism, although the studies predated contemporary methodological standards. Nine studies examined naltrexone, finding significant reductions in alcohol consumption, although re‐arrest data were mixed. Overall, despite a small literature, MAT for AUD appears to reduce alcohol consumption and potentially reduce recidivism in correctional settings.