An exploratory qualitative study seeking participant views

Report
An exploratory qualitative study
seeking participant views evaluating
Preparation for Alcohol Detoxification 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)
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)
Psychiatric
assessment &
treatment
Carers
assessment
NO
COMPLETION PREP GROUP
(6 sessions within 12 weeks)
OTHER SERVICES
NO
REVIEW BY KEYWORKER
(aftercare plan)
Assessment
HOME DETOX
RP
medication
INPATIENT DETOX
RELAPSE PREVENTION GROUP (10 sessions)
STRUCTURED DAY PROGRAMME
PACT (1-1 COUNSELLING)
AA
NO
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
Purposively sampled to ensure maximum variation in
key constituencies, following completion of the groups
and prior to detoxification.
in
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 8th, 2012).
• Kouimtsidis C. & Ford L. 2011. A staged programme approach
for alcohol dependence: Cognitive Behaviour Therapy groups
for detoxification preparation and aftercare; preliminary
findings. Short report. Drugs: Education, Prevention and
Policy, 18 (3), 237-239.
Thank you
[email protected]

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