Effect of Drug and Alcohol interventions

This study seeks to look at whether drug and alcohol interventions are of benefit to that of the service user, especially from an adult perspective. It will seek to address the help that is out there to help individuals who might recognise the need to be rid of their addiction and to be restored back to their normal routine life, before the addiction gets a hold of them any further. Qualitative researches tend to concentrate on specific issues that are health related, and that such matters are fundamental to the temperament of our thoughts and feelings. Issues that a qualitative approach might find much easier to address, such is not the case when dealing with quantitative data. Therefore it is not a matter of asking whether or not qualitative research is better than quantitative approach, but rather what is the best approach to gather information for a specific research question such as their lived experience which is what this research is based upon. Because I aim to investigate the benefits of interventions treatment provided by the healthcare and social care sectors therefore the best approach would be to use a qualitative approach. A qualitative approach will be used; this is to best understand the experience that they have faced, and the method of interviews will be used to help gather concrete data. When an individual becomes addicted, the user no longer consumes just for the fun of it or to get high. But in actual fact, the person with the addiction now relies on the alcohol or the drugs in order to perform on a day by day basis. One might say in some circumstances, the addicted person’s daily life will revolve around fulfilling their need from the substance on which they are now hooked. This study aims to help those who are not aware of services provided out there, to gain knowledge and know that there are different sectors as well as inter-professionals whether it be healthcare or social care intends to help them fight their fears. By talking about their experiences and feelings they are now faced with and the required actions they now should take in order to tackle their addiction, will best help one to understand what best intervention treatment is benefit able for each individual as others might be more severe and likewise not so severe.

Literature Review

Intervention is the course of action for which an individual take advantage of when all other options has been exploited in an attempt to help a person conquer a drug or alcohol problem. (Drug alcohol addiction-recovery). It is an intentional method used by which change is introduced into an individual’s thoughts, that of their feelings and behaviour. The process of drug intervention normally seeks reinforcement from a wide variety of service providers. In addition to specialist addiction services, this may include general practitioners, pharmacists, hospital staff, social workers, and those working in housing, education and employment services, who sees it crucial to approach individuals whom they recognise are self-destructing themselves. The National Treatment Agency for Substance Misuse (NTA) is a special health authority within the NHS, established by Government in 2001, to improve the availability, capacity and effectiveness of treatment for drug misuse in England (NTA, 2007). The NTA has reasoned that there is absolute need for combined and harmonised input from a diverse range of professional groups. However in such case it should be that the local regions offer substance misuse individuals the choice of generic and specialist interventions (NTA,2006).

“Illicit drug users have multiple and complex needs, including high levels of morbidity and mortality, domestic and family problems, homelessness, physical and sexual abuse, and unemployment” (Neale 2002).

However in order to get help the person struggling with the addiction must first of all recognised the need for help. Habitually, an individual with substance misuse issues finds it hard to come to terms in accepting the fact that they do have a problem, by acknowledging this it is as if the world around them is at fault or that one’s causing a commotion over nothing. Individuals who are uncompromising in regards to their addiction do not recognise the gravity of their problem. What matters to them is attaining the drug, despite the consequences. Neither health nor Legal implications are taken into considerations.

The International Treatment Effectiveness Project (ITEP) is branch of the National Treatment Agency’s Treatment Effectiveness strategy, which acknowledges matters for improving the excellence of treatment interventions. ITEP employs intervention to support care development which is referred to as “mapping” in the structure of a changing pattern guide. ‘Mapping is a visual communication tool for clarifying shared information between client and key worker. It helps clients to look at the causes and effects of their thinking and also assists in problem solving’. (NTA, 2007).

“Alcohol & Drug Services has valued its involvement with ITEP. The project has delivered immediate and tangible, benefits for clients though mapping interventions that are clear, straightforward and meaningful.” Hogan. T. 2007. (Alcohol and Drug services)

This is used by qualified key workers along with their services users; this is in the format of maps which consist of five different stages and it shows the phase by which a client go through in order to get to the point where they then acknowledge that they may have a serious drug problem. Besides the mapping, the treatment manual included a concise intervention designed to change clients thinking patterns. This helps them to explore self and recognise the stage in which they are at, it highlights their strengths, things that matters to them most in life for example decision making, social relationships, careers and there morals and beliefs and how best they can improve their life It was envisage that services instigating this treatment manual would see a improved and encouraging change in service users self assessments of their treatment understanding over a period of time, in comparison to that of clients in services who had somewhat or no mapping. Research shows that the alcohol and drug services has valued the involvement with ITEP, it claimed that the project has provided direct and substantial assistance to that of the service users.

Another programme that works alongside National Treatment Agency is that of the Drug interventions programme. This plays an important role in dealing with drugs and the decline of crime. Instigated in the year 2003, it was aimed at adult substance misuse criminals who specifically use Class A drugs, like for example heroin and cocaine and this is was aimed at helping them to get out of crime and to get on treatment and other support that is available to them. (DIP, 2003). It is stated in the Drug Intervention Operational Hand Book that above £900m overall has shown interest in DIP since the programme has been established and readily available is constant financial support to guarantee that Drug Intervention Programme progression grows to be the reputable way of working with drug misusing offenders across England and Wales. (DIP, 2003). Majority of these offenders who makes use of the Drug Intervention Programmes are amongst the most difficult to reach and most challenging drug misusers, and are offenders who have not formerly had access to treatment in any significant way before. The advantage of DIP is that it concentrates on the requirements of the offenders by sighting innovative ways of inter-professional working, whilst linking pre-existing ones, across the criminal justice system, healthcare and drugs treatment services along with a variety of other assistance and rehabilitative services. It is stated that the Drug Intervention Programme and the Prolific other Priority Programme (PPO)are similar in their joint intention to diminish drug associated wrong doing by switching Prolific and other Priority Programmes into treatment, rehabilitation and other support services. The Improving Tier 4 provision quality service is a fundamental part of the National Treatment Agency’s (NTA) Treatment Effectiveness strategy. This associates the responsibility that the entire stakeholder sectors can participate in cooperation with finding solutions and improvements. The provision and quality programme consists of two different but related categories of service provision as defined by Models of Care: they are inpatient treatment (IP) and residential rehabilitation (RR). Aftercare (AC) is a closely related category of service provision. (NTA, 2008) The credentials investigate the types of provision that are being referred to at any time appointed by the IP, RR and AC. The NTA Improving quality “Tier 4” is referred to when the instruction may exercise all interventions treatments. It suggests that all indications to Tier 4 provisions ought to have incorporated care approach amidst Tier 3 or Tier 2 provision and with aftercare. (NTA, 2008). The Tier 4 service provision offers supportive responses to drug misuser’s whose consume has been ongoing, intake is quiet a substantial amount, individuals with complicated needs, and this can allow the drug users to move forward in the direction of long-term self-restraint when and where convenient. Institutionalise services can also admit and support disordered clients. However some Tier 4 service arrangement may perhaps also have a significant function to participate in whilst entertaining individuals aside from continual substance misusing livelihood by intervening early. In accordance with this, the NTA has already produced guidance on commissioning Tier 4 service provision, specifically the Models of Residential Rehabilitation for Drug and Alcohol Misuser’s (NTA, 2006d) and Commissioning Tier 4 Drug Treatment. (NTA, 2006b).

Inpatient treatment and residential rehabilitation are evidence-based interventions and have been shown to be effective in improving client outcomes across the range of domains. The NTA’s forthcoming review of the evidence base for drug treatment outlines the effectiveness of residential rehabilitation and detoxification. NTORS (2000) demonstrates the effectiveness of residential rehabilitation treatment in achieving positive outcomes in reducing both drug use and crime for clients, many of whom had more severe problems than those in community services.

Specialist in-patient interventions have traditionally been focused at and work well with clients who have complex drug, alcohol and other health needs, those in crisis, those requiring medication stabilisation e.g. on injectable or high dose opioids, or for effective detoxification. Recent evidence also indicates that they may be effective in providing detoxification for younger drug misusers who wish to be drug free. Evidence also indicates that inpatient detoxification is cost effective in achieving drug-free status. Drug-specific aftercare is normally required to maintain abstinence, together with appropriate housing and other support.

In-patient detoxification followed by residential rehabilitation is the most effective way for drug users to become drug free, if they are motivated to be drug free and this is the agreed objective3.

Commissioners should develop local drug treatment system plans annually in line with Models of Care, which outlines the now well established four-tiered model of drug and alcohol treatment interventions for adults. Commissioners should also commission in line with the Treatment Effectiveness Strategy, particularly the emphasis on whole treatment journeys and commission full pathways of care, including aftercare and other support to enable clients to maintain positive outcomes achieved in treatment.

One of the key principles which underpins the commissioning of the four-tiers is that drug and alcohol treatment services should be planned strategically. This means that the impact of the commissioning of any one intervention could be viewed in the strategic context of the drug and alcohol treatment system for a locality or region.

These key principles are a major feature of the treatment planning process5 led by the NTA, which forms the basis of effective strategic planning and commissioning. This is expected to be an integral part of local treatment planning and should be used by partnerships and commissioners to address local population needs in line with the national priorities and on the basis of evidence of what works.

Aim

To investigate the drug and alcohol interventions in health and social care benefits on service users?

Research Question

How do drug and alcohol interventions in health and social care benefit service users?

Methodology

Qualitative data

Qualitative data refers to expression or images, method used for interpretation. Qualitative data does not survive ‘out there’ waiting to be exposed, but are shaped by the way they are interpreted and used by the researcher. The character of qualitative data is seen to be wholesome and intact by the act of research itself. Qualitative approach investigates the importance of in depth understanding for a research topic as experienced by the participants of the research. The qualitative approach has been used to study extremely complex experience which can be understood without being expressed in words (Bradbury & Lichtenstein, 2000), others have suggested studies that justify answers like ” what” or “how” type questions would be careful in using qualitative approach (Lee et al.,1999). Qualitative research usually does not seek to calculate or evaluate objects under examination using numbers, as this is an approach which deals within the quantitative domain. The profundity of qualitative data develops on or after the conversation between the researcher and the participant; the insights achieved throughout this course of action can only be achieved given the interaction between the two.

Research Strategy:

The research strategy chosen is the plan of answering the research questions (Saunders et al, 2000). It is a choice on the methodology to be used and how it is to be used (Silverman, 2005). The research strategy seeks to classify the alternative strategies of inquiry according to quantitative, qualitative and mixed method approaches (Creswell, 1998). From this research strategy a phenomenology approach is used. A phenomenology sample comes from the word philosophy and it provides a framework for a method of research. ‘It is based within the Humanistic research theory and follows a qualitative approach’ Denscombe, 2003. The aim of phenomenological sampling is to investigate fully and describe ones lived experience. ‘It stresses that only those that have experienced phenomena can communicate them to the outside world’ . (Todres et al, 2004).

The phenomenological research strategy as a result answers questions of significance in accepting an experience from those who have experienced it. The phenomenological term ‘lived experience’ is identical with this research approach. ‘Phenomenology consequently aims to develop insights from the perspectives of those involved by them detailing their lived experience of a particular time in their lives’ (Clark, 2000).this sampling is about searching for meanings and essences of the experience. It gathers descriptions of experiences all the way through hearing the first-person accounts during informal one-to one interviews. These are then transcribed and analyzed for themes and meanings (Moustakas, 1994) allowing the experience to be understood. Husserl’s phenomenological enquiry originally came from the certainty that untried methodical study may perhaps not be the best to use to revise human phenomena and had become so detached from the fabric of the human experience, that it was in fact hindering our understanding of ourselves (Crotty, 1996). He then felt driven to start up a thorough discipline that found truth in the lived experience (LoBiondo-Wood and Haber, 2002).

Quantitative v Qualitative:

Quantitative data lend themselves to various forms of statistical techniques based on the principles of mathematics and probability. In contrast, qualitative research is suited to investigating and seeking a deeper understanding of a social setting or an activity as viewed from the perspective of participants (Bloomberg and Volpe, 2008).

Qualitative research is concerned with the nature, explanation and understanding of phenomena. Unlike quantitative data, qualitative data are not measured in terms of frequency or quantity but rather are examined for in-depth meanings and processes (Labuschagne, 2003). Silverman (2006:42) warns that quantitative research can amount to a “quick fix” approach involving little or no contact with people or field and has been deemed inappropriate for understanding complex social phenomena.

Approach:

Typical methods used in qualitative research are structured interviews, surveys, structured observations and potentially a focus group. This is where the researcher places his or herself in the midst of the participant for a while, learns from that persons only when in the presence. Silverman (2006) recommends a qualitative philosophy to be appropriate when the researcher seeks to investigate an incompletely documented phenomena and aiming to provide a better means understanding of social phenomenon where processes are involved. Even without wanting to shift entirely away from a purely quantitative view of health, many people now appreciate that a basic understanding of qualitative research can have a positive effect on our thinking and practice. It offers new ways of understanding the complexity of health care, new tools for collecting and analysing data, and new vocabulary to make arguments about the quality of the care we offer. As a consequence of our enhanced learning, we come to realize that qualitative research is neither a sham science nor a poor substitute for experimentation.

Interviews:

Interviews will be my method by which to gather data for this research. They are generally used in assembling data in qualitative research. ‘They are typically used as a research strategy to gather information about participants’ experiences, views and beliefs concerning a specific research question or phenomenon of interest’ (Lambert and Loiselle, 2007). Important types of interviews are identified by Babbie (2007) they are known as standardized interview, the semi-standardized interview and the unstandardised interview. The distinctions regarding each type are predominantly concerned as to how the interview is structured.

Interview process:

Individuals will be chosen from a population 200 service users who attend on a weekly basis the local drug drop in centre for counselling, rehab or to be signed posted to other agencies who might be of help. Such individuals might be undergoing drug or alcohol interventions treatment to help them steer away from their addiction. Sample target will be aimed towards adults who may be institutionalised or living at home, but are faced with the challenges of been an addict and are trying to seek help. The size of participants will be 10 and have residency within the Northamptonshire area. Interviews notifications were sent in advance, as to prepare participant. A consent form prior to interviewers visit was sent (see Appendix A), and participants were provided with an outline of the types of questions (see Appendix B) that might be asked at the interview. This was to enable that they had adequate time to prepare and reflect what it is they would like to share and also to ensure interviewer collected the right information from interview. In a qualitative interview it is important that the questions capture the interviewee’s perceptions and not those of the researcher (Perry, 1998). This is mostly to verify that the responses given were not probed by the interviewer.

The interview was carried out the local drug and alcohol drop in center in a room away from other clients. This was to enable full concentration and for them to be more open, as they might feel embarrassed about the issue at hand. The researcher asked questions at the interview scheduled which can be found in (Appendix B).During the interview a soft approach was taken to give the participant a chance to settle down and relax. For such reason an easy question was asked to start off with, something which the interviewee might have had time to formulate views on already. The interviews took twenty five minutes per participant and notes were recorded during the interview. A convenience sample best represents the direction of this research as it generally assumes a consistent population, and that one person is pretty much like another.

Data Analysis

The presumption, by which qualitative data produce, ought to be honest. It is essential that there are evidence and reasonable argument to prove. The procedure carried out must be trustworthy and able to convince one that that the results obtained was not false. This is because the information that was gathered from the interviews ought to have value in order for inter-professional bodies to make use of it.

“Qualitative research must meet our expectations for rigorously conducted research and reliable information, but must be true to its underlying philosophies and methodologies”. (2009). International Journal of Therapy and Rehabilitation.

The data will going to analysed key themes from the ten respondents, and it is hope that this will help answer the research question. Thus the data gathered from the interviews shows concrete evidence in relation to that of the information shown in the literature review. Though not a sufficient amount of data from the literature review to speak on behalf of the service users as to how they felt whilst going through the different treatments, the interviews really helped in shedding some light as to what they thought. When asked the question how they recognised they needed help, some raised the issue that they recognise that their family lives were a mess, were not able to hold down employment and other issues. Responses received from the interviews where somewhat shocking, as some found they were still struggling to be rid of their addiction whilst others were trying to get back to norm within society. The individuals who shared that they were still finding it a bit difficult was due to the fact that the environment which they still remained in, did not help them to refrain but rather tempted them more, for some this was the challenges they faced. Others recognised that the intervention treatment centres out there were readily available to help them which one can say is a good sign for them.

Ethical Consideration

Qualitative research confronts ethical issues and dispute exclusively to the study of human beings. Standard knowledge in areas such as physics, chemistry and biology permits the researcher to presume a point of view separate from the purpose of study occurrence in questioning.

Confidentiality is an important ethical concern for most when considering a rehab program or other drug interventions treatment. Each individual in recuperation may have experiences they may not feel comfortable sharing with everyone. It is therefore important for not just doctors, but for other inter-professional members to respect the confidentiality of each person that they are treating. Giving permission for the individual to come to terms with their experience which is part of the rehab procedure, and it is not somewhat to be hastened or taken for granted. Permitting the individual who might be feeling emotional the opportunity to heal their wounds from the drug and alcohol abuse is vital for recovery. This is why it is imperative that a client enquire what the confidentiality policies are before registering unto a treatment program. Likewise one can pose a risk of harm to that of the client and this is not by being aware of the restraint imposed by the institutions order. The professional team has to ensure that their influence over the clients is not predominant and they have sufficient knowledge in regards to the plan of their treatment. Though the individual might not have the capacity to make choices, conduct them self in terms of their personal values and beliefs, however if all has failed that guardian has to attempt to reach a decision as best as the individual would do if they were able.

“The ethical principle of beneficence, the desired to do what is considered best for the clients and promoting their growth and wellbeing, is essential to the practise of rehabilitation counselling”, ( Howie et al, 1992).

Conclusion

The confrontation of providing best care for every service user at the towards the end of their treatment are considerable. Success is vital, and works best when all services and practioners understand each other’s roles and find means of working together. It is anticipated that the information received from the research will be used to improve inter- professional working and improve services. In-patient and residential rehabilitation drug and alcohol services should be commissioned as part of Integrated Care Pathways..These Integrated Care Pathways should be commissioned with clear routes into inpatient services, which seamlessly lead to residential rehabilitation (if required) followed by a community-based substance misuse support package,.

Housing, education and employment support is important for individuals who have completed treatment and returned to the community if they are to sustain the gains made from Tier 4 treatment. Commissioners of drug treatment systems, should have in place the appropriate local links to work in close liaison with other local commissioners in the development of health, social care and housing strategies to ensure those leaving in-patient and residential rehabilitation services have access to the wide range of services necessary to provide comprehensive and effective packages of care. A key issue is the availability of housing support services and move-on accommodation for drug and alcohol users leaving in-patient and residential rehabilitation services. The data gathered showed that

Appendix A

August 2010

To whom this may Concern,

My name is — a researcher from the University of Northampton. I got hold of your information from the organisation which you attend daily drop in sessions, so therefore I decided to contact you. My research requested access from you in order to conduct it, as I understand that you fit my criteria for my area of study.

As part of my research, I am undertaking an examination to see whether the interventions provided by the healthcare and social care services are of great benefit to you, and does it help you steer away from your addiction. The objective of my study is to best understand what it is like for you to deal with the addiction once it has gone so far.

In order to undertake this research, I would be really grateful if you could give consent for me to carry out my research in the form of short interviews which will last up to 45 minutes with just myself been the researcher in your own domain. Notes will be taken at the interview and everything said will remain confidential between us.

I look forward to your reply and for us to discuss the matter at hand further.

Yours sincerely

(NAME)

Appendix B

Interview schedule

How did you recognise you needed help to stop taking drugs or drinking alcohol excessively?

What support did you get from the inter-professional workers?

Explain the challenges you faced in your decision to stop taking the drugs or alcohol?

What benefits do you think you’ve gained from the interventions been introduced to you?

What has been your experience from using the interventions services?

Do you think there are enough services around to help you, if and when you do decide to refrain drugs or alcohol?