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A
Summary of Evaluative Research Projects Conducted by RISQ
in Addiction Rehabilitation Centres
Michel
Landry
with
Jacques
Bergeron, Serge Brochu, Louise Nadeau and Pascal Schneeberger
Presentation Objectives
•
Compare data from four evaluative studies conducted at two Quebec public
addiction rehabilitation centres
•
Identify similarities between studies
•
Improve our understanding of the processes and results in those studies
Studies Presented
•
NHRDP: general treatment at a Montreal centre (1991)
•
Specialized treatment for inmates in Montreal (1997)
•
Specialized substance abuse - mental health treatment in Montreal (1998)
•
Treatment for addict clientele in Montreal (1998)
•
General
treatment for inmates in Trois-Rivières (1997)
Method
•
Pre-post-type studies with at least two post-measurements at intervals
varying from 5 to 8 months
•
Changes measured in seven life areas
•
Measurement instrument: composite scores on the IGT-ASI
Method (2)
•
“Naturalistic” studies without control group (particular case: inmate
addicts)
•
Independent variable: exposure to treatment
•
Exposure to treatment is measured by a number of days in treatment and
number of hours of activities taken
Description of
clienteles studied
Data on Exposure to
Treatment
Hours and Days of
Exposure to Treatment
Observations from Data
on Exposure to Treatment
•
The average number of days in treatment is high and reaches the
recommended thresholds for good results (cf DARP and TOPS)
•
The average number of hours of exposure to treatment is generally low,
approaching data reported in the mental health and addiction treatment services
(cf Stark, 1992)
•
Subjects who continued in the study have more hours of treatment and
hours of activities
Observations from Data on
Exposure to Treatment (2)
•
The ratio of number of hours
of treatment to hours of exposure
to treatment reveals a very low intensity level: one activity every three weeks
in mental health and every two weeks in the adult and inmate addict (outpatient)
programs
•
The influence of absenteism on intensity of treatment is low
•
Users who were admitted as in-patients show higher intensity levels
Observations from Data
on Exposure to Treatment
(3)
•
One notable exception: the number of hours of exposure to treatment
(NHRDP): 2.5 to four times greater than the others
–
Different calculation method?
–
More users exposed to intervention in residence?
–
Presence of a mandatory “basic program” for everyone?
Changes in Subjects
during and after Treatment Based on results for the seven scales of the ASI
Alcohol
Drugs
Psychological Status
Family/Social
Comments on the Four
Previous Scales
•
There is a similar pattern in virtually all cases: significant
improvement in time 2 and maintenance of that improvement in times 3 and 4
•
Even for the “mental health” group, despite the significant increase
on the drug scale in time 3, time 3 remains significantly lower than time 1
Comments on the Four
Previous Scales (2)
•
In certain
studies, there is an observed interaction between improvement and exposure to
treatment and only on the drug and alcohol scales (NHRDP and inmate addict
subsample (brief by Geneviève Lefebvre))
Comments on the Four
Previous Scales (3)
•
With the type of analysis used, no link can be found between exposure to
treatment and the positive changes observed on the psychological and
family/social scales and, most often, alcohol and drugs
–
Natural remission in certain subjects?
–
Effect of initial motivation to seek help?
–
Natural development following a crisis?
Employment
Physical Health
Legal Status
Comments on the
Three Previous Scales
•
General tendency: little or no improvement on physical health,
employment/resources and legal scales
•
At least temporary deterioration in a number of groups on the physical
health scale
–
Reduced substance abuse results in an awareness of physical health
problems?
Comments on the Three
Previous Scales (2)
•
Legal scale: improvement in NHRDP groups and one inmate addict group
–
In the adult and mental health groups, there was no problem at the
outset, and thus no possible change
•
Employment scale: improvement for adult and mental health groups only
Conclusion and Discussion
•
Improvement areas are clearly concentrated in the areas of substance
abuse, psychological status and family relations
•
Consistent with our substance abuse rehabilitation mission
•
Consistent with our preferred intervention areas?
Conclusion and discussion (2)
•
Little improvement in users’ social situation.
•
The specific impact of our interventions is not clear.
•
A number of other change factors could be involved and interact in a
complex way.
•
Qualitative studies are necessary in order to understand.
Additional Findings
Based on the Other Studies as a Whole Group
Studies
•
Studies should also be conducted on those who do not improve
•
Single case method Matching
•
The jury is still out.
–
Some of the data confirm that matching is appropriate
–
This is consistent with clinical common sense
Motivation
•
A complex
phenomenon requiring further exploration.
–
Motivation could have an impact on perseverance in treatment and on
treatment results
–
Motivation changes during the first six weeks of treatment
–
Factors can be identified which influence changes in motivation:
organizational climate and feelings of competence
Ethical Considerations
•
Treatment is necessary even for those who do not improve: humanitarian
considerations take precedence over performance
•
Conduct research in a manner consistent with for the person: research
ethics committees