addiction treatment outcomes prof michael gossop national addiction centre maudsley...
Post on 20-Dec-2015
217 views
TRANSCRIPT
![Page 1: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/1.jpg)
Addiction Treatment Outcomes
Prof Michael Gossop
National Addiction Centre
Maudsley Hospital/Institute of Psychiatry
![Page 2: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/2.jpg)
• Why should we be interested in outcomes?
![Page 3: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/3.jpg)
Why should we be interested in outcomes?
• Natural history
![Page 4: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/4.jpg)
![Page 5: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/5.jpg)
Why should we be interested in outcomes?
• Treatment effectiveness
![Page 6: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/6.jpg)
The Clinical Fallacy
![Page 7: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/7.jpg)
•
Heavydrinking
Treatment Outcome
A common but mistaken model of treatment outcomes
![Page 8: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/8.jpg)
•
Heavydrinking
Treatment Outcome
(Pre-treatment problems affect outcomes)
![Page 9: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/9.jpg)
•
Heavydrinking
Treatment Outcome
Therapists respond to presenting problems by providing targeted interventions
![Page 10: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/10.jpg)
•
Heavydrinking
Treatment Outcome
[ - ]
[ + ][ + ]
Presenting problems lead to altered treatment interventionsas well as affecting post-treatment outcomes.
![Page 11: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/11.jpg)
•
Heavydrinking
Treatment Outcome
[ - ]
[ + ][ + ]
Presenting problems lead to altered treatment interventionsas well as affecting post-treatment outcomes.
Psych.factors
Content &Process
Environment
![Page 12: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/12.jpg)
Multidimensionality(multiple outcomes)
• Drug outcomes• Route of drug administration• Alcohol outcomes• Social adjustment (e.g. employment)• Crime• Mental health• Physical health• Mortality
![Page 13: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/13.jpg)
PROBLEMS
DEPENDENCE
Problems and Dependence: two separate dimensions
![Page 14: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/14.jpg)
NTORSThe National Treatment Outcome Research Study
• Prospective cohort study.
• 1075 clients admitted to treatment.
• Treatments representative of 4
national treatment modalities.
• Repeated follow-up over 5 years.
![Page 15: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/15.jpg)
Regular heroin use(NTORS methadone programmes)
0
25
50
75
100
Intake 1 Year 2 Years 5 Years
%
from Gossop et al., 2003)
![Page 16: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/16.jpg)
Regular heroin use(Methadone treatment : TOPS/US)
0
30
60
90
%
Intake 1 Year 2 Years 4-5 Years
![Page 17: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/17.jpg)
Related Outcomes
![Page 18: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/18.jpg)
Regular heroin use(NTORS methadone programmes)
0
25
50
75
100
Intake 1 Year 2 Years 5 Years
%
from Gossop et al., 2003)
![Page 19: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/19.jpg)
Regular non-prescribed methadone use
0
10
20
30
40
Intake 1 Year 2 Years 5 Years
%
![Page 20: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/20.jpg)
Regular benzodiazepine use
0
10
20
30
40
50
Intake 1 Year 2 Years 5 Years
%
![Page 21: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/21.jpg)
Injecting and sharing – methadone programmes
0
10
20
30
40
50
60
70
Intake 1 Year 2 Years 5 Years
%
Sharing Injecting
![Page 22: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/22.jpg)
Causes of death among opiate addicts (Norway)
Overdose
Somatic
Trauma
![Page 23: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/23.jpg)
Mortality RatesPrior to, during, and after maintenance treatment (Norway)
0
1
2
3
4
Pre During Post
%
![Page 24: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/24.jpg)
Anxiety and Depression(5 year outcomes: methadone programmes)
0
0.5
1
1.5
2
2.5
Intake 1 Year 2 Years 5 Years
Mea
n
![Page 25: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/25.jpg)
Time to follow-up
Is bigger better?
![Page 26: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/26.jpg)
Psychiatric symptom scores(Short-term outcomes: methadone programmes)
0
2
4
6
8
Intake 1 Month 6 Months
Mea
n
![Page 27: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/27.jpg)
Predictors of psychiatric symptoms at 6 months
• Pre-treatment symptom scores
• Heroin use at 6 months
• Illicit methadone use
• Benzodiazepine use
• Stimulant use
![Page 28: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/28.jpg)
Unrelated Outcomes
![Page 29: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/29.jpg)
Crack cocaine
Users and non-users at intake
0
20
40
60
80
100
Intake 1 Year 2 Years 5 Years
%
Use at intake Not at intake
![Page 30: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/30.jpg)
Frequency of drinking: methadone programmes
0
10
20
30
Intake 1 Year 2 Years 5 Years
Days
![Page 31: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/31.jpg)
Drinking quantity/day: methadone programmes
0
5
10
15
Intake 1 Year 2 Years 5 Years
Units
![Page 32: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/32.jpg)
Years since 1st injection
and positive hepatitis serostatus (Noble et al.,2000)
0
25
50
75
100
1 2--5 6--9 10--13 14--19 20+
Years of use
%
HCV
HBV
![Page 33: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/33.jpg)
Returning to …...
Related Outcomes
![Page 34: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/34.jpg)
Crime
What is it?
Where does it come from?
![Page 35: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/35.jpg)
Since it came to power in 1997, the New Labour Government created more than three and a half thousand new ways of becoming a criminal.
![Page 36: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/36.jpg)
“The more laws, the less justice”
German proverb
![Page 37: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/37.jpg)
“The more laws, the more offenders”
Thomas Fuller, MD, 1732
![Page 38: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/38.jpg)
Selling a grey squirrel. Importing Polish potatoes.Offering to sell a game bird killed on a Sunday.Allowing an unlicensed concert in a church hall.To enter the hull of the Titanic.
![Page 39: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/39.jpg)
To cause a nuclear explosion.
![Page 40: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/40.jpg)
![Page 41: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/41.jpg)
•
![Page 42: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/42.jpg)
Types of acquisitive crime before admission to treatment
(percent of NTORS cohort)
0
20
40
60
Shoplifting Fraud Burglary Robbery Other theft
%
(from Stewart et al., 2000)
![Page 43: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/43.jpg)
Total crimes reported before admission to treatment (NTORS)
0
5000
10000
15000
20000
25000
Shoplifting Fraud Burglary Robbery Other theft
n
(from Stewart et al., 2000)
![Page 44: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/44.jpg)
Involvement in acquisitive crime during 90 days before admission to treatment (NTORS)
0
25
50
75
No crime Low High
%
(from Stewart et al., 2000)
![Page 45: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/45.jpg)
The majority of the acquisitive crimes were committed by a small minority of the NTORS clients
• Over three quarters (76%) of the total number
of acquisitive crimes were committed by just
10% of the sample.
![Page 46: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/46.jpg)
Acquisitive crime: methadone programmes
0
20
40
60
Intake 1 Year 2 Years 5 Years
%
![Page 47: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/47.jpg)
The association between drug use and acquisitive crime
• Heroin: Odds = 11.4 (4.1-32.0, 95% CI)
• Cocaine Odds = 3.1 (1.9-5.0, 95% CI)
![Page 48: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/48.jpg)
Acquisitive crime: methadone programmes
0
20
40
60
Intake 1 Year 2 Years 5 Years
%
![Page 49: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/49.jpg)
Regular heroin use(NTORS methadone programmes)
0
25
50
75
100
Intake 1 Year 2 Years 5 Years
%
from Gossop et al., 2003)
![Page 50: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/50.jpg)
Acquisitive crime: methadone programmes
0
20
40
60
Intake 1 Year 2 Years 5 Years
%
![Page 51: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/51.jpg)
Measures of Crime
Offending Behaviour
Arrests
Convictions
![Page 52: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/52.jpg)
Criminal convictions (all): NTORS clients
0
10
20
30
40
Intake 1 Year 2 Years 5 Years
%
![Page 53: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/53.jpg)
Criminal convictions (all)NTORS clients: Methadone and Residential
0
10
20
30
40
50
Intake 1 Year 2 Years 5 Years
%
Methadone Residential
![Page 54: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/54.jpg)
Acquisitive crime convictions: NTORS clients
0
10
20
30
40
Intake 1 Year 2 Years 5 Years
%
![Page 55: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/55.jpg)
Drug selling convictions: NTORS clients
0
2.5
5
7.5
10
Intake 1 Year 2 Years 5 Years
%
![Page 56: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/56.jpg)
Exceptions to the general pattern of reductions in crime
• Robbery and serious crime• Women
![Page 57: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/57.jpg)
Violent crime convictions: NTORS clients
0
2.5
5
7.5
10
Intake 1 Year 2 Years 5 Years
%
![Page 58: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/58.jpg)
Addiction disorders within the criminal justice system
![Page 59: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/59.jpg)
Drug use by prisoners in year before custody
0
20
40
60
80
Any drug Heroin Tranq Crack Cocaine Amphet
%
Men Women(from Stewart et al., 2008)
![Page 60: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/60.jpg)
Management of opiate withdrawal syndrome after arrest
![Page 61: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/61.jpg)
Persistence of drug use during imprisonment
![Page 62: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/62.jpg)
Risk of overdose after release of detoxified opiate dependent offenders
from prison
![Page 63: Addiction Treatment Outcomes Prof Michael Gossop National Addiction Centre Maudsley Hospital/Institute of Psychiatry](https://reader031.vdocuments.us/reader031/viewer/2022032105/56649d4c5503460f94a2b1c7/html5/thumbnails/63.jpg)