Transcript Rowdy Yates
Different Strokes for Different Folks Exploring the differing characteristics in two treatment populations P. R. Yates, Senior Research Fellow, Scottish Addiction Studies, Department of Applied Social Science, University of Stirling, Stirling, Scotland. e-mail: [email protected] url: http://www.dass.stir.ac.uk/sections/scot-ad/ Contents • • • • • A brief description of the study Unplanned findings Differences in the two populations Some possible reasons for the differences Why these findings are important to the treatment debate • Problems with existing treatment policy The Study - Aims • To measure prevalence within drug treatment populations • To examine any correlation in severity of the two conditions • To record the views of individual dyslexics regarding connections • To record the views of individual dyslexics regarding the impact on their treatment “experience”. The Study - Aims • To measure prevalence within drug treatment populations • To examine any correlation in severity of the two conditions • To record the views of individual dyslexics regarding connections • To record the views of individual dyslexics regarding the impact on their treatment “experience”. The Study - Methods • • • • • Extensive literature review LADS dyslexia software Maudsley Addiction Profile Brief interview schedule Testing and profiling of 25 men in community drug treatments • Testing and profiling of 25 men in therapeutic community settings • 10 in-depth interviews with “positives” Unplanned findings • Not the original intention to analyse the differences in the two populations • Little difference seen in comparative reasoning ability or positive dyslexia scores • Difference in the MAP indices, though, was marked • These differences were further explored Overall drug use • All reported using at least one drug daily • 94% were using more than one substance • Daily use levels were high – heroin: 0.5 – 3.5 gms and alcohol: 8 – 60 units • 68% were using methadone plus at least one other drug • Residential cohort was more likely to have been injecting 80% (compared to 36%) • In the residential cohort, almost all consumption was illicit methadone. Differences in the Two Populations Drugs Total number of substances used in the residential (n = 25) and non- residential (n = 25) cohorts. 8 7 6 5 Residential Non-residential 4 3 2 1 0 1 drug 2 drugs 3 drugs 4 drugs 5 drugs 6 drugs 7 drugs Differences in the Two Populations Drugs MAP drugs/days in medium and high-risk consumption categories by treatment type (n = 50). Non-residential Residential Moderate Risk High Risk Differences in the Two Populations Physical Health MAP physical health indices in medium and high-risk categories by treatment type (n = 50). Residential Non-residential Moderate Risk High Risk Differences in the Two Populations Mental Health MAP psychological health indices in medium and high-risk categories by treatment type (n = 50). Residential Non-residential Moderate Risk High Risk Summary of the Differences • The residential cohort scored significantly higher in terms of moderate/high risk • The residential cohort scored significantly higher in terms of moderate/high incidence of psychological distress • In addition, they scored consistently higher in terms of: injecting practice, needle sharing (twice as likely to share) • But little evidence of difference between cohorts in terms of physical health (this includes withdrawal symptoms) Possible reasons for the differences • • • • Drug preference – no significant differences Age – no significant differences Gender – only men included in this study Culture – only two appeared to be from a different cultural tradition • User career – not analysed • Length of time before treatment engagement – not analysed • Referral policies which favour “cheaper” community interventions Importance • The continuing debate regarding comparative treatment outcomes • Concern regarding the relative cost of treatment interventions • Current imbalance in the treatment array • Exposure of our lack of rigour in assessment Problems • • • • • • • Time-scaling of cost-benefit analyses Lack of rigour in cost-benefit analyses Drug users are worthless Departure from the recovery paradigm Erosion of faith in recovery – professionals Erosion of faith in recovery – clients Incapacity to respond to “non-susceptible” cliaents Summary of the Differences • The residential cohort scored significantly higher in terms of moderate/high risk • The residential cohort scored significantly higher in terms of moderate/high incidence of psychological distress • In addition, they scored consistently higher in terms of: injecting practice, needle sharing (twice as likely to share) • But little evidence of difference between cohorts in terms of physical health (this includes withdrawal symptoms) Study Details Complete study report is available for download from: Scottish Addiction Studies On-line Library at: http://www.drugslibrary.stir.ac.uk Bad mouthing, bad habits and bad, bad boys