Alcohol and other Drug Clients

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Alcohol and other Drug Clients

• Neos Zavrou and Jacinta Burgess
• Odyssey House Victoria

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Presentation Today

• About Us
• Working with AOD clients
• Motivational Interviewing Stages of Change
• Question time
• Research Outcomes

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Odyssey House Victoria

• Over 25 years experience
• Initially Therapeutic Community residential
  rehabilitation
• Complimented by suite of programs pre- and
  post-residential, plus alternative treatments and
  opportunities including
• Supported accommodation
• Individual and group therapies
• Vocational programs
• Youth and family programs
• Prison interventions
• National programs including research, RTO and PSP

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Drug dependence

• People do not develop substance dependence in
  isolation of other problems all drug abuse
  issues are complex
• Treatment of the substance problem must take into
  consideration all other contributing factors, not
  merely remove the drug
• Approx 70 client group have physical
  disabilities, 90 have psychiatric or
  psychological issues
• Almost half have attempted suicide at least once
• Almost half have post traumatic stress disorder
  resulting from victim or witness to assault,
  injury or death

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Developmental Pathways to Drug Use

• One model used in adolescent health involves
  viewing the young Persons health status as
  determined by a balance of Risk and Protective
  factors.
• (Hawkins, Catalano Miller 1992 Prior, Sanson,
  Smart Oberklaid 1983 -2000
• Bond, Thomas, Toumbourou, Patton, Catalano
  2000 Spooner, Hall Lynskey 2001)

Risk Factors
Protective Factors
Health
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Treatment modes

• Withdrawal
• Residential
• Outpatient
• Pharmacotherapy
• Overall research shows that treatment works
  reducing drug use, criminality, psychopathology
  and drug-related health problems
• Treatment however could do better

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The Client Group

• Clients of drug treatment will move greatly
  between treatment programs and service types
• Clients will almost always have more than one go
  at treatment before successful outcomes
  maintained (approx 70 clients had been
  previously treated by this agency, 45 by other
  agencies)
• Clients dont need to achieve outcome to learn
  from treatment even the smallest intervention
  will give them something to take away

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Working with the client group

• Complex set of issues of which drug dependence is
  only the surface
• Most have underlying history of trauma or abuse,
  paramount in initial drug use and development of
  dependence
• Since developing substance dependence, a larger
  group of issues evolves around the behaviour and
  lifestyle, including criminal history, large
  debt, health problems, legal problems, lack of
  secure accommodation, lack of employment or
  educational qualifications, lack of solid support
  network

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Working with the client group

• Inform yourself about drugs
• Non-judgmental approach
• Establish and maintain realistic expectations
• Relapse not failure
• Training in interactional and interventional
  skills
• Preparation to deal with reluctant/coerced
  clients
• Resistance to change
• Family as client
• Solid mutual service provision program
• Established relationship of trust
• Supportive environment as paramount
• Alternate contacts

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Dual Diagnosis Clients

• 90 people with substance dependence have
  psychiatric or psychological problems
• Many with depression, anxiety or PTSD
• Dual diagnosis generally refers to people with
  severely altered cognitive, perceptive and
  behavioural capabilities, including
  schizophrenia, ABI and drug-induced psychosis
• Causal relationship difficult to understand, and
  therefore difficult to treat
• Seek as much additional information as possible
• Create and utilise strong mutual service
  relationship

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Motivational Interviewing

• Principles of Motivational Interviewing
• Motivational interviewing rests on the following
  basic principles
• Express Empathy
• Unconditional acceptance of the clients
  position
• Skillful reflective listening
• View ambivalence and clients perspective as
  normal and understandable
• Do not label clients behaviour.
• Deploy Discrepancy
• Create and amplify the discrepancy between
  clients current behaviour and their goals
• Clarify important goals and explore the
  consequences of clients present behaviour that
  conflict with those goals
• Assist the client to argue for their own change.
• Avoid Argumentation
• Arguments are counterproductive
• Defending breeds defensiveness
• Client resistance is a signal to change
  strategies
• Roll with Resistance
• Dont push against the clients views
• Clients statements can be reframed to create a
  new momentum for change

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Motivational Interviewing

• In summary
• Express empathy by accurate listening that
  clarifies the clients experience, feelings and
  interpretations
• Amplify discrepancy between current behaviour and
  broader goal by weighing pros and cons
• Arguments are counterproductive and breed
  resistance
• When faced with resistance, review clients
  readiness to change
• Support belief in the possibility of change. The
  client is responsible for choosing and carrying
  out change.

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Activity Pros and Cons
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THE PROCESS OF CHANGE

• Effective counselling matches counselling
  strategies to the Change Stage
• Precontemplation Building rapport
• Contemplation expanding awareness
• Determination developing agreement
• Action implementing strategies
• Maintenance dealing with challenge
• People may be at different stages of the process
  in terms of different issues.
• Effective counsellor's pace with their client's
  present awareness prior to leading client to a
  new awareness.

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Unemployment and Drug Abuse

• Worldwide research shows that drug abuse and
  unemployment go hand in hand
• Aust statistics 12 people with substance abuse
  problems full-time employed
• These people experience job instability, poor
  occupational achievement, and reduced incomes

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Problems for the jobseeker with drug history

• Discrimination
• Physical and psych disability
• Transportation issues
• Childcare issues and costs
• Lack of work skills, education or experience
• Lack of jobsearch or interviewing skills
• Gaps in work history due to time using, in
  treatment, in jail etc.

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Problems (cont.)

• Criminal record
• Bad credit rating and financial problems
• Health problems, e.g. Hep C
• Treatment commitments conflicting with work
• Low self-confidence
• Inability to return to a previous life
• Difficulties in new work environment, e.g.
  communication, social drug/alcohol use etc.

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The evidence for employment

• Research shows that drug treatment outcomes are
  better when the client is employed
• Relapse rates are lower
• Legitimate employment source of self-esteem and
  self-support, and key means of integration or
  resocialisation into community

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General Vocational Programs

• Jobseekers with the greatest barriers to
  employment felt the current vocational services
  system to be the least helpful of all client
  groups
• People suffering from the most social isolation
  are least likely to benefit from those services
  set up to help them
• Recycling through vocational programs (50 of
  participants have been through before, 25 been
  through twice before)
• Issues with viewing Centrelink as the support and
  assistance centre, as well as the enforcer of
  compulsory requirements and breaches
• AOD clients face difficulty accessing general
  vocational programs
• It our experience that vocational programs are
  best provided in close partnership with the
  clients treatment program, within it if
  possible.

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Aims of AOD Vocational Program

• To reduce contact with drugs and the using
  lifestyle
• To create a sense of belonging
• To provide healthy supports and occupations
• To reduce trauma
• To create enterprise and self-sufficiency
• To promote optimism and opportunity

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AOD Vocational Program delivery

• Set individualised, tangible goals e.g.
  identified job or learning opportunity
• Practical opportunities e.g. work experience,
  jobsearch training, skill-based learning
• Intensive support delivery within supportive
  environment and maintained ongoing relationship
• Commitment from all stakeholders and clients
• Time clients need to learn new skills and
  habits, to build confidence, to deal with
  personal problems, and to adapt to new
  environments
• Start early better if include early in
  treatment program, not tacked onto end.
• Long-term aftercare and crisis intervention to
  ensure goals achieved are not lost
• AOD knowledge delivery by workers with
  understanding of AOD and surrounding issues

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Odyssey Vocational Programs

• Personal Support Programme
• Registered Training Organisation
• Moving On pre-vocational workshops
• RAVE inc. computers, art
• Workforce Participation Partnerships
• Traineeships
• Worksearch services
• Brokerage funds

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Questions?
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PSP Evaluation

• Odyssey in partnership with DEWR conducting
  2-year longitudinal evaluation of social and
  economic outcomes of specialist AOD vocational
  program PSP
• Final measures taken Sept 2006, project results
  published Oct 2006
• Participants are measured
• Baseline details at commencement
• Time series follow-up every 3 months
• For 2-year period
• Results analysed to date reflect the first 12-15
  months of program

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PSP Evaluation

• Baseline measures include
• Background Information form
• General Health questionnaire
• Quality of Life questionnaire
• 3 monthly follow up includes
• Individual Participant progress report
• General Health questionnaire
• Quality of Life questionnaire
• Analysis of results included comparison between
  types of treatment program (residential vs.
  non-residential), and participation in treatment
  (voluntary vs. mandatory)

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PSP Evaluation - Measures

• Demographics
• Global Assessment of Functioning
• Substance Use History
• Leeds Dependence Questionnaire
• Employment status
• Income sources
• Licences held
• Children, inc primary care
• Debts
• Accommodation and living arrangements

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• Personal presentation
• Communication skills
• Eating habits and nutrition
• Physical and mental health
• Criminal background
• Social support networks
• Recreational outlets
• General Health
• Quality of Life
• Assistance required from the PSP
• PSP participation
• Interventions provided by the PSP

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PSP Evaluation - Demographics

• The sample is 67 male and 32 female (1 not
  stated)
• The mean age of the participant sample was 32
  years of age, with ages ranging from 16 years to
  59 years
• 83 of the participants were born in Australia
• 81 of participants reported an Australian/Anglo
  cultural heritage
• 12 of the sample were Aboriginal or Torres
  Strait Islander
• 68 of participants had never been married, and
  only 3 were married currently
• 48 had children of that number 65 were not the
  primary care-giver of their children

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PSP Evaluation - Outcomes

• Lower level of dependence
• Reduction in criminality
• Improved communication skills
• Improved physical and mental health
• Improved nutrition
• Increased social interaction including family,
  friends, recreational outlets, and number of
  non-using supports
• Improved general level of functioning
• Improved quality of life
• Reduction in the use of services

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PSP Evaluation - Outcomes

• Increase in independent living (35 to 73)
• Increase in wages as primary source of income (2
  to 17)
• Increase in casual and part-time employed
• Less people unemployed
• Increase in volunteer work
• Increase in full-time study

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Thanks

• Odyssey House Victoria
• 660 Bridge Rd Richmond VIC 3121
• 03 9420 7610
• jburgess_at_odyssey.org.au
• nzavrou_at_odyssey.org.au
• www.odyssey.org.au