NDARC Technical Report No. 318 (2011)
Background: In February 2009 We Help Ourselves (WHOS) opened, and continues to develop its residential stabilisation program for individuals on opioid pharmacotherapy treatment, the first of its kind in Australia. This 10 bed, mixed-gender opioid stabilisation service (WHOS RTOD – Residential Treatment for Opioid Dependence) was funded by the Commonwealth Department of Health and Ageing and provides services for opioid maintained clients that may have mental health, physical health, justice and associated complex need issues.
The WHOS RTOD stabilisation service, a modified therapeutic community, specifically aims to provide a quality service that enables opioid maintained clients the opportunity to stabilise within a supportive environment and to foster health gains within an individualised and streamlined community-based treatment program. This service is complemented by incorporating the concepts of harm minimisation from substance misuse including the provision of education to minimise the spread of communicable diseases including HIV/AIDS.
Methodology: A raw electronic data file containing all admissions to the WHOS RTOD program was collected at WHOS RTOD from the 1st March 2009 to the end of August 2010 (the service‟s first 18 months), and was stored on the Network of Alcohol and other Drug Agencies (NADA) data system, the peak NGO body for NSW. Additional data collected by WHOS RTOD staff at client admission was added to the research database. Within this period a total of 75 unique clients began a total of 90 treatment episodes. Data collected consisted of data from the NSW Minimum Data Set (NMDS) questionnaire, the Brief Treatment Outcome Measure (BTOM) and research data collected by WHOS RTOD staff. These data collection tools covered areas of demographics, drug use history, treatment seeking, mental health, criminal history, treatment cessation and pharmacotherapy dose and mental health medication.
Results: There were four main findings from the present study. Firstly, the poor social functioning of clients presenting for treatment at WHOS RTOD. Secondly, the relatively high rates of treatment completion from WHOS RTOD. Thirdly, the successful stabilisation of clients on pharmacotherapy and mental health medication. Finally, the apparent lack of differences between male and female clientele.
Profile of clients presenting for treatment
Clients were in their early thirties and there was a high proportion of females identifying as Aboriginal and/or Torres Strait Islander. No clients reported that they were currently employed. There was a high amount of DOCS involvement in the 12 months preceding treatment admission amongst those that had children. There were also high levels of criminal history, with just under three-fifths reporting recent criminal involvement and recent arrests.
The majority of clients self-reported that their physical health was poor and there were high rates of both hospital admissions and overdose. Mental health diagnoses were high, and there were high rates of mental health medication amongst treatment admissions. Over one-third reported a previous suicide attempt. Poly-drug use in the month prior to admission was evident. There were low levels of self-referral.
Treatment completion and retention
Treatment completion rates were relatively high, and many clients remained in treatment over 90 days. Over two-thirds of re-admissions went on to complete treatment. There were no predictors of treatment retention or completion.
Clients reported not only receiving medical, dental and mental health support, but there were also high levels of education and support around health promotion, harm minimisation, relapse prevention, living skills, education, housing assistance and counselling.
There were high rates of service satisfaction from clients‟ with over 70% reporting that they were satisfied with the treatment they received at WHOS RTOD. A majority of these clients also reported that their health had improved since treatment admission.
Stabilisation of clients
Over 50% of clients had their pharmacotherapy dose reviewed and changed from the visiting medical officer (VMO), and over one-third had their mental health medication reviewed and modified. Over one-quarter were placed on a new mental health medication whilst in treatment.
There were very few differences between men and women in terms of demographics, drug use, current mental health and treatment retention.
WHOS RTOD was successful in appealing to clients who have complex needs and are therefore often considered too hard to rehabilitate. The success of the first 18 months suggests that such a service is necessary and would be greatly utilised by clients and members from the drug and alcohol field. The expansion of RTOD into rural areas and other states would be beneficial, considering it is the only one of its kind and limited to 10 beds at the present time.
Furthermore, it is necessary that these clients be followed-up in order to completely understand the effect that WHOS RTOD may have on outcomes such as drug use, mental health, physical health, family, housing, and social functioning once treatment is completed.
Conclusions: The types of clients presenting for treatment at WHOS RTOD were of complex needs and were functioning poorly socially, physically and mentally at the time of admission. Despite this, there was a high rate of retention and treatment completion. Furthermore, one of the main objectives of WHOS RTOD is to stabilise clients. This was achieved, as evidenced by the evaluation and review of pharmacotherapy doses and mental health medication, and changes to these when necessary. The vast majority of clients were satisfied with the treatment they received and furthermore, reported that their health had improved since treatment admission.
WHOS RTOD is the first residential service of its kind in Australia that has attempted to address an issue that has previously been neglected: the treatment of complex needs clients in opioid treatment programs. The first 18 months of the service has been successful in attracting its target group to treatment, stabilising them and providing them with not only medical and mental health services, but providing support and education, housing advocacy and coordinated 'through-care' back into the community