In the UK there has been growing concern about the relationship between levels of alcohol consumption and offending behaviour. The Alcohol Treatment Requirement (ATR) was introduced to the UK in 2007 and was piloted in a District in the north of England in July 2007. The ATR is a coercive form of treatment delivered jointly by the probation service and the National Health Service (NHS) and was funded by the NHS. The ATR centres on supporting offenders to cease their offending behaviour and reduce or end their alcohol misuse. Two female alcohol treatment workers have been appointed to specifically deliver the ATR. Therefore this study aimed to investigate the delivery of the ATR, and more specifically, aimed to explore what impact the ATR might have in relation to positive behaviour change and rehabilitation for offenders with alcohol problems. In order to meet the expectations of producing ¿outcome¿ data for the NHS funders, and indepth theoretical data worthy of an academic PhD, this research took a pragmatic methodological approach which enabled different social realities of the ATR to be explored. To this end, a mixed methods design was employed involving quantitative and qualitative data collection methods. The data for this research was generated in three phases with Phase One aiming to explore quantitatively the characteristics, impacts and outcomes of those sentenced to the ATR. This phase revealed that the ATR is being delivered to predominantly young, male, alcohol dependent, violent, persistent offenders. This analysis further revealed that the ATR was effective in bringing about positive treatment outcomes and in reducing reoffending. In order to explore further how this positive change was occurring, Phase Two consisted of qualitative participant observations of the treatment interaction involving the female alcohol treatment workers and the male offenders. By drawing on positioning theory, the analysis considered the complexity of the gendered interactions that occurred during these encounters. It was found that the two female alcohol treatment workers resisted positions of ¿feminine carer¿ offered up by these young men in order to occupy positions of control. Indeed this analysis provided great insight into the constant flow of negotiations and manoeuvring of positions that occurred between the alcohol treatment worker and the offender, argued to be vitally important in working towards positive behaviour change. During Phase Three ten offenders were interviewed in order to explore through a dialogical lens (Bakhtin, 1982) how they constructed and experienced treatment on the ATR. In exploring the offenders¿ stories dialogically, the analysis highlighted how the ATR was enabling, in that it offered a ¿space¿ for these offenders to engage and internalise a dialogue that draws on the authoritative voice of therapy. Therefore it was revealed that through dialogue with the ¿other¿, offenders were able to re-author a more ¿moral¿ and ¿worthy¿ self. Moreover, the ATR has been found to be successful in enabling the offenders¿ hegemonic masculine identities to be both challenged and protected as a result of the multilayered interactions that occurred during these treatment encounters. This research therefore concludes that coercive treatment, rather than being a concern, should be embraced as a way of enabling change for offenders with alcohol problems. Furthermore, this research has highlighted the value of the relational aspect of treatment in bringing about positive behaviour changes. Finally this research has shown that community sentences offer a more constructive way of engaging with offenders than those who receive a custodial sentence.

Reduction of long-term mortality risk, an important clinical outcome for people in alcohol dependence treatment, can rarely be established in randomized controlled trials (RCTs). We calculated the reduction in all-cause mortality risk using data from short-term (6 and 12 months) double-blind RCTs comparing as-needed nalmefene treatment to placebo, and mortality risks from meta-analyses on all-cause-mortality risk by reduction of drinking in people with alcohol dependence. A reduction in drinking in the RCTs was defined by shifts in drinking risk levels established by the European Medicines Agency. Results showed that the reduction of drinking in the nalmefene group was associated with a reduction in mortality risk by 8% (95% CI: 2%, 13%) when compared to the placebo group. Sensitivity analyses confirmed a significant effect. Thus comparing the difference between nalmefene and placebo in reduction in drinking levels with results on all-cause mortality risk from meta-analyses indicated a clinically relevant reduction in mortality risk. Given the high mortality risk of people with alcohol dependence, abstinence or a reduction in drinking have been shown to reduce mortality risk and should be considered treatment goals.

Background: The tradition of specialised institutional alcohol treatment in what is now the Czech Republic dates back over a hundred years. The first modern institution aimed at treating alcohol dependency began to operate on 7 September 1948. While formally constituting an organisational unit of the Psychiatric Clinic, the "U Apolináře" facility, headed by Dr. Jaroslav Skála, was an independent workplace which gave rise to a distinct treatment approach. Becoming known as the "Apolinar" treatment model, this approach was adopted by all the residential alcohol treatment facilities which came into existence or operated in Czechoslovakia from 1948 to 1989. Before the establishment of this department, three similar treatment facilities existed on the historical territory of Czechoslovakia - Velké Kunčice (1911 to 1915), Tuchlov (1923 to 1938), and Istebné nad Oravou (1937 to 1939/1949). Aim: The aim of the dissertation thesis was to describe the analysis of the conditions which had an influence on the origin, development, operation, and dissolution of the three oldest specialised alcohol treatment institutions on the historical territory of what is now the Czech Republic and Slovakia from 1900 to 1945. Methods: The research involved qualitative content analysis of historical materials, mainly written...

Background: The tradition of specialised institutional alcohol treatment in what is now the Czech Republic dates back over a hundred years. The first modern institution aimed at treating alcohol dependency began to operate on 7 September 1948. While formally constituting an organisational unit of the Psychiatric Clinic, the "U Apolináře" facility, headed by Dr. Jaroslav Skála, was an independent workplace which gave rise to a distinct treatment approach. Becoming known as the "Apolinar" treatment model, this approach was adopted by all the residential alcohol treatment facilities which came into existence or operated in Czechoslovakia from 1948 to 1989. Before the establishment of this department, three similar treatment facilities existed on the historical territory of Czechoslovakia - Velké Kunčice (1911 to 1915), Tuchlov (1923 to 1938), and Istebné nad Oravou (1937 to 1939/1949). Aim: The aim of the dissertation thesis was to describe the analysis of the conditions which had an influence on the origin, development, operation, and dissolution of the three oldest specialised alcohol treatment institutions on the historical territory of what is now the Czech Republic and Slovakia from 1900 to 1945. Methods: The research involved qualitative content analysis of historical materials, mainly written...