Transcript An exploratory qualitative study seeking participant views
An exploratory qualitative study seeking participant views evaluating
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
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
6 weeks CBT groups (stabilisation, control, reduction, lifestyle changes) •
community (70%) or inpatient •
10 weeks Relapse Prevention groups
• • •
NW Herts CDAT:
– 2004/05 (audit, prep &RP groups)
– 123% increased capacity – 57% (2004) / 93% (2005) detox completion – Mean attendance: prep=7.2>6 & RP=4<6
– 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?
(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
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.
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.
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
Preferred alcohol specific groups Information about groups important Implementation of boundaries appreciated Common structure, theoretical approach, one provider for all 3 stages
It seems likely that the theoretical basis of the groups contributed towards clients’ positive ratings and the impact on their own behaviours.
• 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