Aims and method
To identify
the patient characteristics and rates of retention in a residential
rehabilitation drug and alcohol service (Springhill) based on an eclectic model
of care. Patients were assessed using the Alcohol and Drug Outcome Measure
(ADOM), a brief tool designed for the New Zealand setting. We looked at
correlations between demographic, social and drug use parameters. Logistic
regression assessed the relative impact of each variable on completion.
Results
The 183 patients who completed the data collection did not differ from 47
non-completers by demographic data; 62.2% of patients completed the programme,
with equal number of men and women. One in five participants was Maori, the
indigenous minority. Alcohol (51.9%) was the commonest drug of misuse, with
methamphetamine (16.4%) and cannabis (14.2%) also significant. Completers were more
likely to be Maori, have conflict with family and housing problems, although
the last became non-significant in logistic regression.
Clinical implications
Retention rates are higher in Springhill than in comparable programmes.
Ethnicity and family conflict predict completion, although the reasons for this
are unclear. ADOM is an effective tool that can be used in a clinical setting
to enable analysis of service provision.
...Significant morbidity is reported in physical, psychological
and social domains by the patients in this study. These problems are directly
related to drug use and small changes in use are likely to be associated with
significant benefits to health, relationships and well-being. Previous economic
analysis indicates major benefits associated with effective addictions
intervention also.36 The
relative failure of community intervention for this cohort argues in favour of
residential intervention, particularly if retention is high, and implies
improved prognosis. This is the case for Springhill and may relate to positive
longer-term outcomes.37,38 Follow-up
studies will enable further examination of longer-term benefits and overcome
the limitation of using completion as a proxy marker for improved prognosis.
Identifying who is likely to benefit most from
residential treatment allows for a more targeted approach to management. Prior
research has recommended a ‘non-discriminatory approach to referral’ and no
clear indicators are apparent in the current literature base. Using regression
analyses to consider the impact of several factors likely to alter treatment
completion, we are able to show that Maori, the indigenous minority in New
Zealand, and those with conflict in the home are more likely to complete the
programme. The programme includes the capacity for patients to engage with a
cultural assessment but does not include individual or group activities that
are specifically culturally oriented. Previous research identifies greater
social morbidity in Maori in an out-patient addictions setting39 and
greater satisfaction with a culturally specific service. Cultural factors have
been a point of focus in policy debate about the provision of services,29 with
some advocating for a culturally appropriate approach research methodology
frame, although support (and the application) of this is very limited. The
current findings suggest Maori manage well in a generic eclectic setting. This
does not indicate a generic service is likely to outperform a culturally
specific service; rather, Maori are more likely than clients of other
ethnicities to complete this programme. Ethnicity is not a proxy marker for
social disadvantage as measured by social role difficulties, employment,
housing problems and crime in this study as the linear regression of model D
elucidates. Understanding the impact of homelessness in dependence is complex,40 although
the parsimonious explanation of having basic needs met does not preclude the
potential for recovery and may be an important component of successful
recovery...
Full article at: http://goo.gl/Z2pxRJ
By:
Correspondence to Giles Newton-Howes (Email: zn.ca.ogato@sewoh-notwen.selig)
Dr Giles Newton-Howes BA, BSc, MBChB, MRCPsych, FRANZCP is senior lecturer at the Department of Psychological Medicine, Wellington School of Medicine, Otago University, Wellington, New Zealand, and honorary senior lecturer at Imperial College London, UK. Dr James Stanley PhD is a research fellow at Wellington School of Medicine, Otago University.
BJPsych Bull. 2015 Oct;39(5):221-7. doi: 10.1192/pb.bp.114.047639.
More at: https://twitter.com/hiv insight
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