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Home > Keltoi residential rehabilitation programme: outcome study.

Lyons, Suzi (2011) Keltoi residential rehabilitation programme: outcome study. Drugnet Ireland , Issue 39, Autumn 2011 , p. 20.

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Keltoi offers a residential therapeutic rehabilitation programme for problem opiate users, emphasising occupational work and with a strong focus on after-care and living drug-free. This study1 reports on follow-up interviews with clients who attended the programme between September 2002 and July 2004. It was done as part of a wider evaluation of the programme, which has already been published.2  

The study aim was to evaluate how effective the Keltoi programme had been in helping participants to remain drug free. During the evaluation period, 149 clients had entered Keltoi, 94 had participated in the original evaluation, and 80 of these participated in the follow-up interview, which was based on the Maudsley addiction profile (MAP). The interviews started in May 2004 and finished in July 2009. The average time between discharge and follow-up interview was 1.9 years (range 1.2 to 3.0 years). Two participants in the original evaluation had died before the follow-up interview took place, giving a mortality rate of 2.1% for the 94 participants. There was no control group. 
Half (51.3%) of the interviewees self-reported as fully abstinent (defined as abstinence from all substances including alcohol and prescription substitution drugs) in the 30 days before the interview. Most (88.1%) were still in contact with some type of drug treatment service. Those who were abstinent reported higher levels of well-being than those who reported that they were not abstinent. 
In the 30 days before the interview;
o    five (6.3%) interviewees reported injecting;
o    a lower proportion of those who were abstinent (3.8%) reported suicidal thoughts compared to the proportion who were not abstinent (18.8%);
o    over two thirds (77.5%) of those interviewed reported no criminal activities; and
o    half (50.0%) reported having undertaken paid employment.
Self-reported abstinence was recognised to be a limitation by the authors, but was felt to be reasonably reliable among this population as there were no negative consequences for the interviewees. Because of the methodology used it was not appropriate to undertake statistical analysis of the data looking for factors which might be associated with abstinence. The authors stated that, for the same reason, they were ‘wary of direct comparisons with the majority of current international literature’ (p. 358) in this area. This lack of comparability is an issue in many studies.
Compared to the completion rate among the abstinence cohort in the ROSIE study(66%),3 the rate of completion in Keltoi was higher (77%). The outcomes of the Keltoi also compare favourably with another Irish study, with Keltoi participants reporting abstinence rates of 51% at follow-up, compared to 23% in a study by Smyth et al.4
The authors found large gaps in outcome-based evaluations for treatment programmes in Ireland and recommended the introduction of a health outcomes monitoring system. They also concluded that the evidence from their studies and others done in this area showed that many of those who enter residential treatment do not have successful outcomes. It is important to find out what works and what does not work for different people.
1. White E, Browne C, McKiernan B and Sweeney B (2011) Keltoi rehabilitation programme: post-discharge outcome study. Drugs: education, prevention and policy, Early online: 1–8.
2. Sweeney B, Browne C, McKiernan B and White E (2007) Keltoi client evaluation study. Dublin: Health Service Executive.
3. Cox G, Comiskey C and Kelly P (2007) ROSIE Findings 3: http://summary of 1-year outcomes: abstinence modality. Dublin: National Advisory Committee on Drugs.  
4. Smyth BP, Barry J, Lane A, Cotter M, O'Neill M, QuinnC et al. (2005) In-patient treatment of opiate dependence: medium-term follow-up outcomes. British Journal of Psychiatry, 187: 360–365.
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p. 20
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Issue 39, Autumn 2011
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