Evaluation of a digital Cognitive Behavioural Therapy programme for prison residents with histories of substance misuse (“Breaking Free”): Comparison of delivery models employed in the United Kingdom and the United States

Abstract

Substance misuse is a criminogenic risk factor—however, substance-involved prison residents may have limited access to support and services that might be able to help them overcome their substance misuse. Research around the efficacy of the “Breaking Free” digital Cognitive Behavioural Therapy programme for substance-involved prison residents demonstrates that this digital technology may overcome barriers to support. Breaking Free is the first digital programme for substance misuse that has been implemented in prisons. In the United Kingdom (U.K.) the programme is delivered via secure desktop and laptop computers in staff-facilitated group sessions, and in the United States (U.S.) is delivered via individual secure tablets that prison residents can access independently, without staff support. This study compares U.K. and U.S. prison residents who have engaged with Breaking Free on a number of baseline measures (sociodemographic factors, types of problem substances reported, clinical complexity, and criminogenic risk factors). The delivery models employed in these two jurisdictions are compared in relation to their associations with prison residents’ engagement with the programme and the clinical outcomes experienced. Differences between U.K. and U.S. prison residents in baseline clinical and psychosocial factors were identified, including greater clinical complexity in the U.K. group. U.K. prison residents, who were supported by staff when using Breaking Free, demonstrated higher levels of engagement with the programme than U.S. prison residents who were not supported by staff. The different delivery models employed in the United Kingdom and United States appeared to be associated with group differences in clinical outcomes. Guidance for the optimal implementation of Breaking Free, based on findings from this study, is provided. Further analyses will explore how the different approaches to the delivery of Breaking Free might interact with the differences in prison resident characteristics identified in this study (sociodemographic, clinical and criminogenic), in order to influence prison resident engagement with the programme and clinical outcomes.