Drug Treatment Outcomes Research Study: Qualitative Findings

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Drug Treatment Outcomes Research Study
Qualitative Findings

• Matt Barnard, Stephen Webster, William OConnor
• National Centre for Social Research
• October 2008

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Overview of today

• Study background
• Methodology
• Findings
• Implications

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Background to study

• Drug Treatment Outcomes Research Study (DTORS)
• Follow up to NTORS (1995-2000)
• Commissioned by Home Office
• Significant increase in funding
• More people in treatment
• More people staying for 12 weeks
• Use of proactive diversionary schemes
• Increase in crack cocaine use

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DTORS components

• Survey
• Measure impact of treatment
• Prospective longitudinal design
• Qualitative study
• Interviews with 32 treatment providers
• Interviews with 44 treatment seekers
• Cost benefit analysis

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Qualitative 1 Treatment providers

• 4 Drug Action Teams based on size
• Number clients at triage
• No of CJS clients
• All tier 3 and tier 4 providers
• Structured or residential
• Chaotic drug users
• Diversity of providers
• Substitute prescribing, structure day care,
  residential rehabilitation, drug intervention
  programmes (DIP)
• Frontline treatment workers

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Qualitative 2 Treatment seekers

• Sampled from second wave of survey
• Same 4 Drug Action Teams 2 additional
• Additional sampling criteria
• Treatment status (in treatment/ dropped out)
• Age
• Previous treatment history (no of episodes)
• Type of drug used (predominantly heroin, also
  crack cocaine, amphetamine, cannabis, alcohol)

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Conduct and analysis

• Unstructured in-depth interviews
• Topic guide to ensure consistency
• Participants choice of location
• Treatment providers workplace
• Treatment seekers residence
• All interviews transcribed verbatim
• Analysis using Framework

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Qualitative objectives

• Map range of treatment needs
• Identify factors affecting treatment outcomes
• Identify factors affecting response of providers
• Describe range of outcomes

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Treatment needs Buried Pyramid Model
Pyramid increase in complexity Buried
can be hidden Not ice-berg variation in
depth
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Buried pyramid - strata

• Reward
• Approach (high)
• Avoidance (blocking)
• Need
• Rattling
• Feel normal
• Cognitive dependence
• Mental addiction
• More powerful than physical

• Impacts of dependence
• Emotional impacts
• Coping mechanism
• Identity impacts
• Underlying vulnerabilities
• Childhood problems
• Adult crisis
• Adult trauma
• Inherent conditions

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Treatment seekers factors influencing recovery

• Motivation
• Surface motivation vs deep motivation vs
  non motivated
• Capacity
• Ability to process
• Reduction in impulsiveness
• Life skills
• Context
• Relationships (emotional, practical, policing)
• Triggers to relapse (housing, other drug users)
• Non-specialist services (GP, housing, employment,
  police)

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Barriers to treatment

• Engagement
• Waiting times
• referral loop
• Referral
• Lack of services
• Loss of funding
• Mental health services

• Assessment
• Communication
• Assumptions
• Delivery
• Capacity
• Lack of training
• Ethos
• Attitude

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Outcomes

• Recovering
• Low drug use
• good mental state
• Moving forward
• Stalled
• Low drug use
• Poor metal state
• Not moving forward
• Substance replace
• High drug use
• Poor metal state
• Not moving forward

• Relapsed
• High drug use
• Poor metal state
• Moving backwards
• No change
• High use of drugs
• Mixed metal state
• Not moving forward

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Influence of CJS

• Same set of pressures
• Diversionary no effect on motivation
• Some impact possible for non-motivated clients
• Potential increased access to services
• Impact on providers
• Undermining independence
• Pressure from increased through put
• Disruption from non-motivated clients

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Implications

• Match treatment to treatment needs
• Review competitive, target-driven structure
• Increase opportunities for training
• Reduce pressure on services
• Address local barriers
• m.barnard_at_natcen.ac.uk

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