Home > Unmet needs and benzodiazepine misuse among people in treatment.

Lyons, Suzi (2012) Unmet needs and benzodiazepine misuse among people in treatment. Drugnet Ireland , Issue 43, Autumn 2012 , p. 27.

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Many problem opiate users in treatment also misuse other substances. This presents a challenge to addiction services as often one single service cannot address the complex needs of such clients. A study carried out in the Drug Treatment Centre Board examined clients’ perceptions of unmet needs and the association between misuse of non-prescribed benzodiazepines and extent of unmet needs.1  

The authors used the Camberwell Assessment of Need Short Appraisal Schedule – Patient-rated version (CANSAS-P) as the measurement tool for this study.2
 
CANSAS-P provides scores based on the client’s ratings of 22 items in terms of total needs, unmet needs and met needs. Unmet needs can be used as a predictor of perceived quality of care. The authors believe this is the first study to use this tool to assess unmet needs among clients of addiction services.
 
Clients who were opiate dependent and receiving methadone for at least three months were eligible to participate in the study. Clients with acute or end-stage medical problems were excluded. Over half (107, 56%) of 191 eligible clients took part. There were no statistically significant differences between the socio-demographic characteristics of those who took part and those who did not. 
 
Of the 107 participants, 52 (49%) reported using non-prescribed benzodiazepines in the previous month. Of these, only one reported both oral and intravenous use. The mean number of days on which benzodiazepines were used was 14, and 90% had benzodiazepine-positive urine samples in the previous month. The group who misused benzodiazepines had statistically more frequent use of both cocaine (mean 2.4 days versus mean 1.6 days) and heroin (mean 12.3 days versus mean 5.3 days) compared to the group who did not misuse benzodiazepines. Table 1 shows the mean number of met and unmet needs in both groups.

The highest proportions of unmet needs related to the following items in the assessment tool: substance misuse treatment, daytime activities, social company, money budgeting and benefits, psychological distress, and physical health. There were statistical differences between the two groups in relation to substance misuse and daytime activities. Needs that were generally rated as met included accommodation, food, telephone access, self-care, childcare and transportation. 

Multivariate linear regression showed that a higher number of days of benzodiazepine misuse was significantly associated with a higher unmet needs rating. The authors stress that this was a study of needs assessment and that it ‘does not propose that fulfilling unmet needs will necessarily alter benzodiazepine misuse among opioid users’. They recommend a more formal and active assessment of the needs of clients on methadone treatment and rapid access to evidence-based treatment for benzodiazepine misuse.
 
 
1. Apantaku-Olajide T, Ducray K, Byrne P and Smyth PB (2012) Perception of unmet needs and association with benzodiazepine misuse among patients on a methadone maintenance treatment programme. The Psychiatrist, 36(5): 169–174. www.drugsandalcohol.ie/17746
2. The CANSAS-P tool was chosen as it has good reliability and validity for measuring unmet needs and has been positively evaluated by clients. Ratings of unmet needs by clients have been found to be more reliable than those by staff. This tool has 22 items and the client themselves rate whether or not the need is being met:
0 = no need
1 = not a serious problem because of help received
2 = current serious despite help being received i.e. unmet need.
Item Type:Article
Issue Title:Issue 43, Autumn 2012
Date:2012
Page Range:p. 27
Publisher:Health Research Board
Volume:Issue 43, Autumn 2012
EndNote:View
Accession Number:HRB (Electronic Only)
Subjects:HJ Treatment method > Substance disorder treatment method
VA Geographic area > Europe > Ireland
J Health care, prevention and rehabilitation > Treatment and maintenance > Treatment factors
B Substances > Sedatives or tranquillisers (CNS depressants) > Benzodiazepine
HJ Treatment method > Substance disorder treatment method > Substance replacement method (substitution) > Methadone maintenance
G Health and disease > Substance use disorder > Multiple substance use (Poly-drug /Poly-substance)

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