Download Crack cocaine service

Integrity and Honesty
Four Minute Rule
Expectations and attitudes
“If you treat an individual...
as if he were what he
ought to be and could be,
he will become
what he ought to be and
could be”
Johann Wolfgang von
Goethe (1749-1832)
What Works
1.
2.
3.
4.
5.
6.
7.
User Involvement
Physical Environment
Good Assessment
Immediacy of Response
Evening and out of hours services
Specialised Materials
Wider Holistic Needs e.g. ETE, Housing
etc
8. Evidenced Based Interventions,
ITEP/CBT/CM
9. Complementary Therapies
Evidence that treatment can be
effective generally
• Content
– Psychological treatments
• Training, structured, supervised
– Utility of ancillary services
• Medical services
• Childcare
• Transportation
• Process
• Client / counsellor relationship
• Flexible and responsive services
What About the Therapeutic
Alliance?
• Studies outside substance abuse show this
accounts for a greater % of the variance
than specific techniques
• Different “specific” therapies yield similar
outcomes, but there is wide variability
across sites and therapists
• More therapist education/experience does
not improve efficacy
(Adapted from W.R. Miller, Oct 06)
Impact
• Over 50% of people with alcohol primary drug at
•
•
•
•
•
•
•
treatment start were abstinent or had demonstrated a
statistically significant reduction in use by review.
Self reported crime fell from 19.6% to 6.2%
Over 63% cocaine users were abstinent 13% significant
reduction in use by review.
Almost 50% of people presenting with crack as a primary
drug at treatment start were abstinent or had demonstrated
a statistically significant reduction in use by review.
Over 55% of people presenting with illicit heroin as a
primary drug at treatment start were abstinent or had
demonstrated a statistically significant reduction in use by
review.
Peoples reported use of powdered cocaine decreased
significantly from an average of over 8 days at treatment
start to less than 3 days.
Significantly fewer people reported homelessness or a
serious housing issue at review compared to when they
started treatment.
27% Increase in Quality of Life
Evidence-Based Principles
• Retention improves outcomes; we need to engage
•
•
•
•
•
people, not discharge them prematurely.
Addicts/alcoholics are a heterogeneous population,
not a particular personality type.
Addiction behaves like other chronic disorders
Problem-service matching strategies improve
outcomes. (Other matching strategies disappointing.)
Harm reduction approaches yield benefits in terms of
public health and safety.
Pts in methadone maintenance show a higher
reduction in morbidity and mortality and
improvement in psychosocial indicators than heroin
users outside treatment or not on MAT.
Suite of evidence-based clinical guidance
•NICE: National Clinical Practice Guideline No. 51.
Drug Misuse: Psychosocial Interventions
•Included in Orange Guidelines as well as other
evidence-based psychosocial interventions
Evidenced Based Treatment
• Motivational Interviewing
• Relapse Prevention
• Community Reinforcement
• Contingency Management
• Counselling and Supportive psychotherapy
• Family therapy
• ITEP Node link Mapping
Evidenced Based Treatment
•
•
•
•
1.
2.
3.
Social Behaviour Network theory
12 STEP
Factors associated with the therapist
Other factors
Speed entry
Duration rather than intensity
People with complex needs need more complex
interventions
Important Distinctions
• Evidence-based principles and practices
guide system development
– Example: care that is appropriately
comprehensive and continuous over time will
produce better outcomes
• Evidence-based treatment
interventions are important elements in
the overall picture. They are not a
substitute for overall adequate care.
Perils
What happened to the principle of
individualizing treatment?
When an evidence-based treatment doesn't
work for an individual, some staff members
conclude that the problem is that the
treatment isn't being implemented correctly,
rather than examining the possibility that it
does not fit the needs of the client.
Example from Dual Dx listserve
Recovery orientated addiction treatment
(W. White 2008)
 Re-orientate psycho-social/key work to include
building personal & social `recovery capital’
 Help client building peer and community
recovery support
 More family engagement at assessment and
treatment
 Assertive links to mutual aid and `employment’
of recovery coaches
 Shift in service/client relationship…..partnership
 Post treatment monitoring, contact, support
 Optimism in staff ….
Challenge
• A home
• A family and friends
• A job
• A purpose in life
• A sense of self worth and self
respect
• Passion