An exploratory qualitative study seeking participant views

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Transcript An exploratory qualitative study seeking participant views

An exploratory qualitative study seeking participant views evaluating

P

reparation for

A

lcohol

D

etoxification groups C. Kouimtsidis, A. Croxford, C. Notley, V. Maskrey, R. Holland C. Kouimtsidis MBBS MRCPsych MSc PhD; Consultant Psychiatrist Surrey and Borders Partnership NHS Foundation Trust

Alcohol Research UK

provided funding to allow this project to happen

Evidence

Planned detoxes, relapse within 12 weeks (SCAN / NICE) Abrupt detoxification with or without medication associated with impaired learning (Duca 2004; 2011) Detoxification medication partially effective: no protection (seizures, relapse, brain damage) (BAP/ NTA) CBT type interventions more evidence (Miller et al., 2003; Raistrick et al., 2006)

HERTS 3 stages programme

Preparation:

6 weeks CBT groups (stabilisation, control, reduction, lifestyle changes) •

Detoxification:

community (70%) or inpatient •

Immediate aftercare:

10 weeks Relapse Prevention groups

Development

• • •

NW Herts CDAT:

– 2004/05 (audit, prep &RP groups)

Evaluation 2006/07:

– 123% increased capacity – 57% (2004) / 93% (2005) detox completion – Mean attendance: prep=7.2>6 & RP=4<6

Evaluation 2009:

– 70% Prep groups; 92% completed detox; 50% RPG; 74.5% 1 month abstinence (vs 60% RH)

Psychiatric assessment & treatment Carers assessment RP medication TRIAGE ASSESSMENT

Info about programme SADQ & 2 weeks drink diaries Appropriate for CDAT?

PRE-DETOX GROUP

(3 sessions within 6 weeks)

REVIEW BY KEYWORKER

(Type of detox)

COMPLETION PREP GROUP

(6 sessions within 12 weeks)

REVIEW BY KEYWORKER

(aftercare plan) Assessment

HOME DETOX INPATIENT DETOX

NO OTHER SERVICES NO NO

RELAPSE PREVENTION GROUP (10 sessions) STRUCTURED DAY PROGRAMME PACT (1-1 COUNSELLING) AA RESIDENTIAL REHABILITATION

Aims

Client experience of participating in CBT pre alcohol detoxification (PAD) groups. • Generic group effect?

• Specific theory predicted effect?

Concepts: enhanced control, self-efficacy, coping skills, lifestyle changes for aftercare.

Design Setting Participants

13 individual semi-structured interviews 4 ethnographic observations of groups 4 NHS specialist Hertfordshire community alcohol teams in Purposively sampled to ensure maximum variation in key constituencies, following completion of the groups and prior to detoxification.

Analysis

Thematic approach in 4 stages: 1. Close listening and brief notes of important themes 2. Line by line inductively coding for themes, aided by NVivo 9 3. Second coding focused around underlying CBT concepts 4. Summarising key themes and concepts across the individual cases (axial coding)

Findings 1: didactic/therapeutic

Aware of the structured nature of the groups. Able to discuss own goals and motivation. Learning about safely cutting down.

Findings 2:

Generic group effect

Experience was broadly very positive.

Key benefits perceived: • social support • sense of mutual understanding gained from other group members

Findings 3: Specific effect

Increased self efficacy & coping skills: Described changes achieved Developed personal strategies for cutting down Able to avoid high risk situations

Findings 4

Preferred alcohol specific groups Information about groups important Implementation of boundaries appreciated Common structure, theoretical approach, one provider for all 3 stages

Conclusions

It seems likely that the theoretical basis of the groups contributed towards clients’ positive ratings and the impact on their own behaviours.

Other publications

• Kouimtsidis C. Drabble K & Ford L. 2012. Implementation and evaluation of a three stages community treatment programme for alcohol dependence. A short report. Drugs: Education, Prevention and Policy, 19 (1), 81-83.

• Kouimtsidis C. 2011. Community alcohol detoxification; the challenge of changing service provision. Short report. Journal of Substance Use (posted on line February 8 th , 2012).

• Kouimtsidis C. & Ford L. 2011. A staged programme approach for alcohol dependence: Cognitive Behaviour Therapy groups for detoxification preparation Policy, 18 (3), 237-239.

and aftercare; preliminary findings. Short report. Drugs: Education, Prevention and

Thank you

[email protected]