Pharmacological interventions for alcohol misuse in correctional settings: A systematic review

Background The prevalence of alcohol use disorder (AUD) is estimated to be ten times higher amongst individuals in the criminal justice system compared to 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) (e.g., naltrexone, disulfiram), and this critical 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 and sixty-two articles were initially screened, and 14 eligible articles were included in the final review. Four articles examined disulfiram, and ten articles examined naltrexone. Results The studies on disulfiram were considerably older, predating contemporary scientific standards. In terms of outcomes, 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 on alcohol-related measures, but the 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 compared to placebo. Conclusions A small number of studies on pharmacological interventions for AUD in the correctional population suggest that MAT is useful for addressing alcohol consumption, although report mixed results regarding recidivism. On balance, the evidence was more convincing for 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 behavioural interventions is warranted.