Doctor’s Log

Dr Nicholas Murdoch PhD MA BA (Hons) PGCert (Res) RGN RNM is Care after Combat’s resident Doctor. On this page you will find some of his latest work.


Alcohol and substance misuse represent major public health concerns in the United Kingdom. Alcohol is mentioned in around a third of drug misuse deaths annually in England, with heroin related deaths increasingly, also involving other substances. Although the main burden of both chronic alcohol-related disease and substance misuse is in adults, its’ foundations often lie either in adolescence, characterised by drug experimentation and engagement in health-risky behaviours, or attributable to “the relevance of early life experience.”. The link between drugs and crime can be seen to be a costly relationship both socially and economically, whilst the number of prisoners reporting problems with drugs and/or alcohol on arrival in prison remains worryingly high.

In his Annual Report (2016) Chief Inspector of Prisons, Peter Clarke reported that psychoactive substances, such as Spice, are “having a dramatic and destabilising effect in many of our prisons” and continue to be linked to violence, debt, organised crime and medical emergencies. More than one in 10 (13%) adult men surveyed by inspectors reported that they had developed a problem with illicit drugs since they had arrived at prison, whilst a survey of nearly 700 people by User Voice found that the top three reasons for using psychoactive substances whilst in prison were ease of access, lack of drug testing and alleviating boredom. Psychoactive substances, (predominantly Spice) are the most prevalent drug type in prison, accounting for 60% of positive drug test samples in the year to March 2018. One in 10 men in prison reported that they had developed a problem with using prescription medication meant for other people whilst in prison.

Although a range of interventions exist to reduce alcohol/substance misuse within HM Prisons they generally focus upon health promoting input whilst outcomes are not routinely evaluated and are difficult to measure. If the aim is to reduce the consequences of alcohol/substance misuse whilst in prison levels of violence, self -harm, and suicide would assume primacy, secondary to recovery. However, recovery whilst in prison is arguably based on different precepts to that following release. It is not a unilateral concept – rather it is multidimensional and has historically been considered through the academic lens of identity (McIntosh and McKeganey, 2002), resilience (Harper and Speed, 2012) and motivation (Ryan and Deci, 2000).

Several decades of research indicate that acute alcohol/drug intake during adolescence may induce anomalies in behaviour (poor decision-making, altered impulse control, and brain functioning). Likewise, an alteration in the inhibitory control may constitute a vulnerability factor and consequently lead to an escalation of violence within a custodial setting. The decision to change behaviour and recover therefore presents a different set of criteria as opposed to the tools and skills acquired to support this decision.

Reconnect is an innovative alcohol/substance misuse programme, specifically designed for HMPPS, delivered whilst in prison and following release. The programme includes a great deal of medical information together with active components based on well-tried psychological principles acquired from clinical experience over many years. It prepares prisoners for their release into the community, reduces their likelihood of reoffending and therefore the number of potential victims, and is tailor made for those within the criminal justice system.

Introduced at HMP Winchester in October 2018 Reconnect is a brief intervention programme. The term brief intervention is a cost effective and preventative approach, encompasses a range of therapeutic process from education to group discussion and is typically delivered in short sessions on four or more occasions. Teachable moments, in which the connection between alcohol/substance misuse and its adverse consequences can be highlighted, whilst opportunistic screening and brief intervention have shown efficacy. The effectiveness of this intervention will be fully reported later this year.

The programme has the full support of Head of Reducing Reoffending, and outcomes are keenly awaited. Early signs are positive with the nature of each intervention rich in narratives. Evidence suggests that motivation coupled with education and contingency management delivered by a trained professional in a group of veterans and non-veterans is proving to be of reciprocal value. We are collectively exploring “the rooms of epiphany” and in doing so may find that moment of revelation.