Transcript Slide 1

Reasons to cut down on drinking
and drug use: The role of
treatment
Jessica Storbjörk
Centre for Social Research on Alcohol and Drugs (SoRAD),
Stockholm University
[email protected]
Presented at the Nordic Alcohol and Drug Researchers’ Assembly, Reykjavik, Iceland, 23-25/8-10.
Background I
• Outcome (OC) studies generally study the effect of treatment (Tx)
methods
• Tx can be beneficial (Moos & Moos 2005; Prendergast et al 2002; Weisner et al
2003b), but Tx is ONE ingredient of recovery
• Other important factors: social context, social environment, social
situation (income, etc.), social networks (loneliness, quality and
general support, abstinence oriented/supportive of soberness),
severity, life-events and personal factors
• Treatment important for reduced drinking after 1 year (Weisner et al
2003b) but effect diminish (5 yrs, (Weisner et al 2003a).
• Informal network (non-misusers, AA) more strongly related to
reduction in drinking (5 years) than treatment (Weisner et al 2003a)
• Correlations between variables…
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Background II
•
Clients’ perspective on/explanations for change: quantitative (cf. Matzger et al
2005) and qualitative research (cf. Orford et al 2006; McIntosh & McKeganey
2000).
•
Matzger et al 2005: Reasons cut down endorsed among the treated (alc):
73% weighting pros/cons; 68% major change in life; 67% hit rock bottom; 58%
drinking cause health problems; 45% traumatic experience; 43%
religious/spiritual awakening; 38% spouse wanted cut down; 37% affected by
seeing someone drunk/high; 32% doctor’s warning health problems/cut down;
31% someone know quit.
•
Theory/model of change by Orford et al 2006 (the UKATT study):
Pre-treatment catalysts (pressures seek tx, accelerating problems etc),
treatment (incl. assessment), self-directed change, family and friend support,
thinking differently, acting differently, seeing the benefits.
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 Aim and questions
The aim is to explore clients’ endorsed reasons for cutting down
on alcohol and drug use (from a list of potential factors), among
alcohol and drug users one (and 5) year(s) after initiating a
treatment episode:
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•
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Which reasons are endorsed and viewed as (most) important for
cutting down?
- Hypothesis: social, personal/self-evaluative and networkrelated reasons are more important than treatment.
Are there patterns of reasons for cutting down? Do some
reasons occur together?
For whom is treatment the most influential reason for cutting
down – when and for whom does treatment work?
Are there differences by sex?
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Data & Method
• Large, representative and naturalistic treatment system sample
(Stockholm County, covering the range of treatment on offer in
health and social welfare system)
• 1210 alcohol and drug misusers interviewed and re-interviewed (12
months): 65-80% response rate depending on calculation
• List of 10 reasons to cut down (adapted from Matzger, Kaskutas &
Weisner 2005) asked of those who reported a reduction in drinking
or use of main drug of choice in the last year.
- n=613 alcohol users (52% had cut down) and 434 drug users
reported a reduction (64%) and were asked for their reasons.
• Preliminary: Reasons to cut down after 5 years, random sample
followed-up (items reformulated to better fit Matzger et al 2005)
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Characteristics of
followed-up clients
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•
•
•
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At baseline (BL): 1/3 women, mean age 43 yrs
56% had own apartment/house
27% work as main occupation (30 days)
24% married/cohabiting, 33% had children <18
21% had NOT been in tx last year, 32% had 90+ days in tx
•
•
•
•
Changed consumption between BL and follow-up (FU)
Mean no. alc using days out of 30:
8  4,7
Mean no. 5+ drinks out of 30:
7,4  3,9
Main drug among those who had used drugs (12 months): 40%
opiate, 22% cannabis, 18% amphetamines, 14% benz, 6% other
• Mean no. drug using days out of 30:
14,4  5,2
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Reasons to cut (% yes)
Reason contributed to cut down…
Alc
Got tired of the life I was living
72
Stopped/decreased on my own
69
Got treatment at recruitment unit ¤
56
53
Got other treatment (help-organization) ¤
45
57
Started hang out with non-misusers
33
Housing/occupation changed
28
An overwhelming experience (got children, death)
25
Met a new partner
10
Became religious
6
Started to use another drug (alc. incl)
Sex
♂↑
♀↑
♀↑
Drugs
Sex
76
♂↑
61
42
♂↑
33
♂↑
28
10
♀↑
7
♀↑
2
8
♀↑
Mean no. of reasons
3,5
3,7
n
c 610
c 420
¤ ANY TREATMEN, at recruitment or other unit
74
78
Factor analyses (note: 0/1 endorsed)
ALC
DRUG
ALL respondents
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Treatment (recruitment/other)
.669
.227
Tired of life
.724
.663
New house/occupation
.550
.661
Hang out non-misusers
.567
Religious
.401
2
3
.311
1
2
3
.744
.686
New partner
.696
.630
New drug
.698
.482
Decrease by self
.754
Over-whelming experience
.586
.736
.323
1. “Assisted and comprehensive make-over”, 2 “New influential relationships”,
3 “Felt self-change spurred by life circumstances”
.341
Most important (%)
Reason contributed to cut down…
Alc
Sex
Drugs
Sex
Got tired of the life I was living
28
Sig.
30
Sig.
Stopped/decreased on my own
25
0,042
16
0,075
Got other treatment (help-organization) ¤
12
22
An overwhelming experience (got children, death)
11
11
Got treatment at recruitment unit ¤
11
9
Housing/occupation changed
8
7
Met a new partner
3
2
Started to use another drug (alc. inlc)
1
2
Started hang out with non-misusers
1
1
Became religious
0
<.5
Nothing contributed
1
<.5
n
c 600
c 415
¤ ANY TREATMENT
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Correlates/log reg variables –
when/for whom tx most influential
• Demographics/social situation: (sex), age, housing, living situation
last 3 years, live with alc/drug misuser, hang out with misusers or
not, have at least one close friend, education, main source of
income, severity - no of dependence criteria (for alc, drugs) and
simultaneous alc/drug dependence (3+ ICD-10), Tx need alc, drugs,
physical health, judicial problems, family, mental health
• BL treatment: recruited from Health system (HS) detox, HS special
programs, HS outpatient, Social services (SS) outpatient, SS
housing, SS residential + No of months in tx last year (history)
• Treatment BL-FU: HS addiction inpatient, HS addiction outpatient,
HS mental health, HS general health care, SS residential, SS
housing, SS outpatient, criminal justice system, voluntary
organization/self-help group, private sector + continuity/coordination
scale
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Sig. Odds ratios
– Treatment most important cut down on..
ALCOHOL
• Higher no of alc dep criteria (0-6):
OR 1,20
• Drug dependence 2,71
• Institution last 3 yrs (vs
partner/children 3,89
• Tx need judicial problems 0,71
• Elementary school (vs university,
ref) 0,32
DRUGS
• Higher no of drug dep criteria: OR
1,24
• Main source of income illegal
activity (vs work): 2,52
• Tx need judicial problems 0,72
• Live with misuser 0,47
• Hang out misusers and nonmisusers (vs mainly non): 0,43
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Baseline tx – NS
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Baseline tx – NS
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SS residential 2,48
Continuity of care 1,33
HS mental health 0,41
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SS outpatient 0,60
Private sector 4,88
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5 years: Reasons to cut (% yes)
Very preliminary! (n= c 350 alc, 140 drug)
Reason contributed to cut down…
Alc % yes
Most imp.%
Drugs %
Most
Stopped/decreased on my own
34
19
30
13
Got tired of the life I was living
22
6
17
4
Doctor said/I realized damage health
10
5
11
7
Family situation improved
13
4
12
1
Got treatment (help-organization)
14
3
18
7
Family/close pushed me to stop
8
3
7
2
Met a new partner
3
1
3
1
Housing/occupation/income improved
7
<.5
5
2
Started hang out with non-misusers
9
1
12
0
Housing/occupation/income worsened
3
1
1
<.5
Authorities pushed me to stop
7
1
7
<.5
Hit rock bottom
10
<.5
10
2
Traumatic experience
3
<.5
3
1
Family situation worsened
2
<.5
3
0
Became religious
1
<.5
3
0
Started to use another drug (alc. inlc)
<.5
<.5
2
<.5
Someone I knew quit
3
0
6
<.5
To sum up
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Treatment IS important for cutting down on alc/drugs, according to clients –
hypothesis falsified (Note: treated sample)
Personal/self-evaluative reasons also important (tired of life,
stopped/decreased by self)
Treatment more important for more severe problems (no. of dep criteria).
Tendency: inpatient treatment - more likely say tx most influential.
Non-misusing social networks (and social situation – housing etc) – not as
important for change/recovery as in international literature
Treatment interact with other factors (jfr Orford et al 2006), but separated from
self-directed change (cf “Assisted and comprehensive make-over”)
Women more likely than men reduce drinking because of changes in circle of
friends, overwhelming experience, becoming religious. Men stress selfdirected change. Stereotypical images  more research is needed
5 year data validates findings from 1 year (preliminary)
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Discussion
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Cultural differences in change/recovery?
Religion/hit rock bottom much more important in US than in Sweden –
influence of AA? Treatment more important when easily available
(Sweden)?
 Further international comparisons needed!
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Useful way study change? How measure? Who is to judged what works –
client, researcher, practitioner, correlates... combination?
Constructions/narratives of change?
•
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Thank you for listening!
REFERENCES
Berglund, M., Thelander, S., Salaspuro, M., Franck, J., Andréasson, S., Öjehagen, A. 2003. Treatment of
alcohol abuse: An evidence-based review. Alcoholism: Clinical and Experimental Research, 27(10),
1645-1656.
Matzger, H., Kaskutas, L.A., Weisner, C. 2005. Reasons for drinking less and their relationship to
sustained remission from problem drinking. Addiction, 100(x), 1637-1646.
McIntosh, J. & McKeganey, N. 2000. Addicts’ narratives of recovery from drug use: constructing a nonaddict identity. Social Science & Medicine, 50(10), 1501-1510.
Moos, R., Moos, B. 2005. Sixteen-year changes and stable remission among treated and untreated
individuals with alcohol use disorders. Drug and alcohol dependence, 80(3), 337-347.
Orford, J. et al. on behalf of the UKATT Research Team. 2006. The clients’ perspective on change during
treatment for alcohol problem: Qualitative analysis of follow-up interviews in the UK Alcohol Treatment
Trial. Addiction, 101, 60-68.
Prendergast, M., Podus, D., Chang, E. & Urada, D. 2002. The effectiveness of drug abuse treatment: a
meta-analysis of comparison group studies. Drug and Alcohol Dependence, 67(1), 53-72.
Weisner, C., Delucchi, K., Matzger, H., Schmidt, L. 2003a. The role of community services and informal
support on five-year drinking trajectories on alcohol dependent and problem drinkers. Journal of Studies
on Alcohol, 64, 862-873.
Weisner, C., Matzger, H. & Kaskutas, L. 2003b. How important is treatment? One-year outcomes of
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