Home > Analysis of treatment outcomes in the south east.

Carew, Anne Marie and Kidd, Martina and Bellerose, Delphine and Long, Jean (2008) Analysis of treatment outcomes in the south east. Drugnet Ireland , Issue 27, Autumn 2008 , pp. 1-3.

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 Service providers in the south east of Ireland agreed to pilot the National Drug Treatment Reporting System (NDTRS) exit form in 2007. The south east includes counties Carlow, Kilkenny, Waterford, Wexford and South Tipperary. The exit form records all treatment interventions received by a client during a treatment episode, along with details of their treatment outcome at the time of discharge or transfer to another service. Drug treatment options include psycho-social interventions (brief intervention, counselling, group therapy, family therapy, psychotherapy, complementary therapy, and/or life-skills training) and medical interventions (detoxification, methadone reduction, substitution programmes and psychiatric treatment). Service providers in the south east recorded exit details for all clients discharged from their service in 2007. 

 The NDTRS collects data on episodes of treatment, rather than the number of individual people treated each year. This means that individuals may appear more than once if they attended and were discharged from more than one treatment service in a calendar year.
 
The main findings from the pilot project are:
  •  In 2007, 1,630 cases exited treatment in the south east. Complete data were provided for 1,586 cases. Table 1 shows the number of these cases by the year they entered treatment.
 
Year entered treatment
n
%
2003
3
0.2
2004
6
0.4
2005
24
1.5
2006
146
9.2
2007
1,407
88.7
Total
1,586
100.0
 
  • Of the 1,586 cases exiting treatment, 1,319 (83.2%) lived in the south east, 262 (16.5%) lived in another area of Ireland, and 5 (0.3%) lived outside of Ireland. 
  •  Treatment for problem alcohol and drug use in Ireland is provided by statutory and non-statutory services, including residential centres, community-based addiction services, general practices and prison services. Of the 1,586 cases exiting treatment in 2007, 1,101 (69.4%) received treatment in an outpatient setting, and 485 (30.6%) in an inpatient setting. Low-threshold services (outpatient setting) provided treatment to 77 (4.9%) cases. General practitioners and prisons were not invited to participate in the pilot study as their data are not collected through the HSE South Drug Co-ordination Unit.
  •  The majority (69.3%) of clients exiting treatment in 2007 were male.
  •  The main problem substances reported by clients on entry to treatment were alcohol (69.2%), cannabis (11.8%), opiates (8.3%), and cocaine (5.8%). Other cases reported ecstasy, other stimulants (such as amphetamines), volatile inhalants, or benzodiazepines as their main problem drug.
  •  Just over two-fifths (41.4%) reported problem use of more than one substance (polysubstance use) on entry into treatment.
  •  One-fifth (20%)of referrals to treatment were made by hospitals/medical agencies, and 12.7% by the courts, probation services or police.
  •  Of the 106 clients who reported that they had injected at some point in their life, over half (54.7%) reported that had shared injecting equipment.
  •  Treatment interventions can be classified as psycho-social or medical. Clients may receive a number of interventions during a treatment episode. Of these, service providers identified one as the main treatment intervention when completing the exit form. Psycho-social interventions accounted for 94.5% of the main treatment interventions provided, while the remaining 5.5% were medical interventions. 
  •  The main psycho-social interventions provided were counselling (46.9%), medication-free therapy (26.4%) and brief intervention (17%). Sixty-one cases (3.8%) received an alcohol detoxification as a main treatment intervention, 57 (3.6%) cases completed an education/awareness programme, and 8 (0.5%) cases received methadone substitution as a main treatment intervention.
  •  The client’s condition on discharge was classified by service providers as stable if they had responded to treatment, and unstable if they had not responded. Of the 1,586 cases analysed, 1,099 (69.3%) were stable, 433 (27.3%) were unstable, 46 (2.9%) were classified as ‘other’ and 8 (0.5%) had died. 
  •  Less than half (44%) of cases completed treatment; 25% refused further sessions or did not return for subsequent appointments; 13.2% did not wish to attend further sessions as they considered themselves to be stable; 11.3% were transferred to another site for further treatment; 4.7% exited because of non-compliance, 1.2% exited for other reasons, and 0.5% died.
  •  Figure 1[SEE PDF] presents the relationship between clients’ condition on exit (stable or unstable) and treatment outcomes. Over half of the cases who did not complete treatment (clients who considered themselves stable and clients who did not return for subsequent appointments) were stable on exit.
  •  In relation to the 75 (4.7%) cases who exited treatment because of non-compliance, the reasons recorded were: failure to observe rules (60%), drug taking (33.3%), and violent behaviour (6.6%).
  •  The majority of cases (60%) did not have family members involved in their treatment. 
  •  Figure 2 [SEE PDF] presents the relationship between the median1 number of days in treatment and the main problem substance for the 698 cases who completed treatment . Half of the cases reporting alcohol as their main problem substance were in treatment for more than 31 days, while half of the cases reporting opiates and other stimulants were in treatment for more than 67 and 89 days respectively.
  • Figure 3 [SEE PDF] presents the relationship between the median number of days in treatment and polydrug use for the 698 cases who completed treatment. Of the cases reporting a drug as their main problem substance, those who used more than one drug spent approximately twice as many days in treatment as those reporting single substance use. The median number of days spent in treatment was the same for cases who reported alcohol as their main problem substance, regardless of whether they used other drugs or not
 Exit data for psycho-social treatment interventions have become available for the first time in Ireland through the completion of the exit form. Analysis shows that treatment outcomes in the south east are largely positive. Service providers in Donegal, Sligo and Leitrim have agreed to pilot the exit form in 2008, and in 2009 the exit form will become available to all service providers throughout Ireland.
 
 
The NDTRS team would like to express sincere thanks to all the service providers who completed the exit form in 2007. Their co-operation is very much appreciated.
 
1. The median is the value at the mid-point in a sequence of numerical values ranged in ascending or descending order. It is defined as the value above or below which half of the values lie. Unlike the mean (average), the median is not influenced by extreme values (or outliers). For example, in the case of five drug users aged 22, 23, 24, 24 and 46 years respectively, the median (middle value) is 24 years, whereas the mean is 27.8 years. While both the median and the mean describe the central value of the data. In this case, the median is more useful since the mean is influenced by the one older person.
 

 

Item Type:Article
Issue Title:Issue 27, Autumn 2008
Date:2008
Page Range:pp. 1-3
Publisher:Health Research Board
Volume:Issue 27, Autumn 2008
EndNote:View
Accession Number:HRB (Available)
Subjects:VA Geographic area > Europe > Ireland > Waterford
HJ Treatment method > Treatment outcome
VA Geographic area > Europe > Ireland > Kilkenny
VA Geographic area > Europe > Ireland > Carlow
VA Geographic area > Europe > Ireland > Wexford
VA Geographic area > Europe > Ireland > Tipperary

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