ATCA Conference, Auckland

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Methadone in the TC We Help Ourselves WHOS
ATCA Conference, Auckland New Zealand
2006 Presented by Lyn Roberts (WHOS Manager)
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Acknowledgements

• Garth Popple - Executive Director, WHOS
• Peter Connie -Treatment Services Manager, WHOS
• Carla Janssen - Research Officer, WHOS
• Shane Darke - Associate Professor, National Drug
  and Alcohol Research Centre (NDARC)
• WHOS MTAR staff and clients

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This Presentation

• WHOS - We Help Ourselves
• MTAR - Methadone to Abstinence Residential
• WHOS research project
• Conclusions

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We Help Ourselves

• WHOS was established in 1972
• First AOD Therapeutic Community (TC) in
  Australia
• Users self-funded and ran the service
• Name of We Help Ourselves due to self-help nature
• Five TCs in NSW and one in Queensland

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WHOS MTAR

• Methadone to Abstinence Residential
• First MTAR TC in Australia (1999)
• Established through demand
• (approximately 25,000 people on Methadone 1999)
• Exit strategy required to assist people off MMT

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MTAR - A Modified TC

• 4 to 6 months program plus aftercare
• Methadone / Buprenorphine Withdrawal Regime
• Drug free treatment goal
• Harm minimisation strategies included
• Main differences from traditional TC

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Research Aims

• Client population profile
• Treatment episodes (duration, early departure,
  achievement of treatment milestones)
• Drug use, life style and well-being at follow up
  
• Comparing baseline and follow up data
• Feedback on treatment program

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Research Methodology

• Baseline data collected on admission and stored
  on external health funded database
• N 72 treatment episodes (1 July 03 - 31 Dec
  04)
• Development of follow up data collection tool
• Conducted follow up interviews with ex-clients
• Compared pre- and post-treatment data

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Demographics

• Gender 63 males, 37 females
• Mean age 33 (range 20 - 53)
• 9 Aboriginal/Torres Strait Islander descent
• 93 born in Australia

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Client Profile at Follow Up

• 83 - drug use became problematic before reaching
  21st birthday
• Mean age first started using heroin18 (range 11
  28)
• Mean age first enrolled into opioid substitution
  program 25 (range 14 - 43 years old)
• On average this was 7 years after starting using
  heroin (range 1 - 30 years)
• 71 had used street methadone

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Health

• In the three months before admission
• 23 spent time in hospital
• 17 disclosed suicidal thoughts and 6 attempted
  suicide
• 10 had at least one overdose
• 26 on psychiatric medication
• (40 females, 20 males)

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Drug Use Baseline vs follow up

• Drug use in the month preceding interview

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Drug Use - Continued

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Reasons for Relapse

• 90 difficulty in handling negative feelings such
  as depression, anxiety and/or anger
• 63 leaving treatment prematurely
• 60 stressful event or situation
• 53 problems or conflicts with partner and/or
  family
• 53 difficulty in handling positive feelings

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Duration of Stay Outcomes

• Average duration treatment episode 103 days

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Research Limitations

• Research timeline ideally clients to be
  interviewed at a consistent time after admission
  or cessation
• Attributing changes in clients drug use, health
  and social situation to WHOS MTAR treatment
• Small sample size

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Conclusions (1)

• Respectable follow up rate of 71
• Almost half of ex-clients (46) interviewed were
  abstinent from alcohol and other drugs in the
  month before follow up and over half of this
  group had been abstinent continuously since
  leaving WHOS MTAR

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Conclusions (2)

• Those that were abstinent at follow up had
  significantly better social functioning and lower
  psychological distress levels than those not
  abstinent
• Those that were abstinent at follow up had
  improved significantly in social functioning and
  psychological distress levels when compared with
  their functioning before MTAR treatment
• Longer treatment duration shows improved outcomes
  at follow up

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Where To From Here

• Development of Stabilisation Service
• (Treatment Goal gt Stabilisation not Abstinence)
• For people who cannot comply with abstinence
• People who have developed mental health
  challenges during MTAR treatment (Time out)
• Problematic complex needs clients, clients
  discharged from MTAR
• Clients released from prison / drug court