Alcohol Treatment Agencies Research Articles

National census of UK alcohol treatment agencies: I. Characteristics of clients, treatment and treatment providers

A national census of all UK specialist alcohol treatment agencies was carried out in order to enquire about client characteristics and the broad features of the treatment service received by clients on a specific day (4 December 1996). A total of 728 agencies were eligible for the census and the overall response rate was 41 %. When the effects of response bias were examined, correcting for under- and over-representations of different types of agencies made very little difference to findings. A rough estimate from the census is that 10,000 individuals were seen for treatment or advice regarding an alcohol problem on census day in the UK. Treatment services are dominated by the non-statutory sector, which accounted for almost two-thirds of all clients seen on census day. Despite demographic changes in drinking patterns over the last 10-20 years, the ‘typical’ client attending treatment services is still a middle-aged man and the client sample as a whole showed evidence of major social disadvantage and dislocation. Compared with national figures, the sample showed an over-representation of ‘Irish’ clients in English agencies but there was no under-representation of other ethnic groups. The most common category of staff providing treatment was ‘counsellors’, and the complaint most often presented by clients concerned ‘psychological well-being’. Twenty-eight per cent of clients were recorded as being in residential treatment. The most common form of treatment received was therapy or counselling on a one-to-one basis, which accounted for two-thirds of clients receiving some form of psychosocial treatment. The majority of clients in detoxification (60%) received it as in-patients. Forty-two per cent of treatment episodes were estimated to have lasted for more than 3 months and 18% had continued for over a year. The most commonly cited use of other services was for Alcoholics Anonymous (AA), although AA was mentioned in relation to only 9% of all clients. Excluding cannabis, 85% of clients were recorded as having no illicit drug use. Suggestions are made as to how the response rate and other features of the census could be improved if the exercise were to be repeated.

National census of UK alcohol treatment agencies: II. Differences between types of treatment agencies in England and Wales

From data provided by a national census of treatment for alcohol problems in 1996, this paper reports findings on differences between types of treatment agencies in England and Wales. The overall response rate was 44% but no significant differences were found between responding and non-responding agencies in size and composition of staff. The highest mean number of clients per day was seen in NHS trust services and charitable organizations. Private (for profit) agencies showed both the highest mean age of clients and the highest proportion of men among agency types, while NHS trusts saw the highest proportion of women. Charities and voluntary organizations reported higher than average proportions of clients living in insecure accommodation. Private (for profit) agencies showed both the lowest proportion of unemployed clients and the highest proportion of those on sickness or invalidity benefits. Seventy-three per cent of clients attending NHS trust services were seen by nurses, medical or non-medical professionals; only 8% of clients attending private (for profit) agencies were seen by these professional groups. Worries about physical health were far more common among clients attending private (for profit) agencies and legal/financial problems occurred much more often among those attending voluntary/ statutory partnerships. The highest proportion of clients in residential treatment was shown in private (for profit) agencies and the lowest in voluntary/statutory partnerships and NHS trusts. Nearly all (90%) treatment carried out by voluntary/ statutory partnerships was in the form of ‘counselling’, while approximately half the clients seen by charities and independent (non-profit) organizations were in day or residential treatment. While in the overall sample, the mean percentage of clients also attending Alcoholics Anonymous (AA) was 9%, this rose to 23% of clients attending independent (non-profit) agencies. The highest proportions of clients with reported illicit drug use was in voluntary/statutory partnerships and the lowest in independent (non-profit) agencies. This paper provides a ‘snapshot’ of the variation in treatment services for alcohol problems in England and Wales, which can be used to detect trends in treatment provision in the future.

Expanding knowledge among Aboriginal service providers on treatment options for excessive alcohol use

Approaches to the prevention of alcohol problems among Aboriginal people in Australia have tended to emphasize primary and tertiary prevention, while neglecting secondary prevention or early intervention. In contrast, members of the wider Australian community can now access a variety of early interventions through general practice, in hospital settings and through drug and alcohol treatment agencies. As part of a survey of the use of brief interventions, 178 agencies throughout Australia were interviewed, and findings are presented from the 29 agencies in this sample which provided services primarily for Aboriginal people. Approximately half offered a variety of approaches including brief interventions, with goals of moderation; the other half were entirely abstinence-orientated. These findings are discussed in the context of expanding the options that might be offered by Aboriginal-run agencies.

Developing an integrated information system for specialized addiction treatment agencies.

This article outlines the development of an integrated information system for specialized alcohol and drug treatment agencies in Ontario, Canada. The system is being developed following a strategic planning process involving provincial funding ministries and coalitions of service providers. An overview of the system's development is provided and the implementation of one subcomponent, a client-tracking system, is described. Some challenges to the implementation of this component are identified.

Service to parents who abuse substances: Literature to inform a practice-research initiative

Children of parents who abuse substances have become a concern of child protection agencies, family support services, family preservation services and increasingly of drug and alcohol treatment agencies. In the context of a formative evaluation of a specialised intensive family support service designed to address the needs of families at this interface, a literature review has been undertaken. From that review, themes relating to women as substance abusers, the children of substance abusers, and services to enhance parenting in these situations are reported. Implications for intensive home-based practice are identified.

Controlled drinking as a treatment goal in Australian alcohol treatment agencies.

Under the broad umbrella of harm minimisation, the Australian National Drug Strategy has emphasised the development of services aimed at reducing hazardous alcohol consumption in problem drinkers thereby shifting the focus of treatment from abstinence to moderation goals. The objective of the present study was to determine the extent to which alcohol treatment agencies offered advice and treatment aimed at moderation of alcohol consumption (i.e., controlled drinking). Of the 179 agencies (40% of identified treatment agencies across Australia) approached, 66% (115) reported giving advice about controlled drinking as a treatment goal. The reported therapeutic strategies used to assist in the attainment of a controlled drinking goal are empirically supported. Thus, controlled drinking as a treatment goal is widely offered by Australian treatment agencies, by workers who appear well versed in validated strategies and techniques used to obtain such a goal. This finding is discussed in relation to comparison studies conducted in the UK and the USA.

The epidemiology of combined alcohol and drug use within treatment agencies: a comparison by gender.

As clinical and research attention focuses on the phenomenon of combined alcohol- and drug-related problems and alcohol and drug systems merge, important questions remain regarding the role of gender across treatment systems. This study examines epidemiologic characteristics in a comprehensive sample of female and male clients in one county's separately administered alcohol treatment (N = 381) and drug treatment (N = 304) systems. Large differences were found between women in alcohol and drug treatment agencies on measures of alcohol and drug patterns and problems. Women in alcohol treatment reported more combined use of problem attribution than women in drug treatment. The same patterns were found for men in comparisons across the two systems. A multivariate model predicting membership in drug versus alcohol treatment discriminated better between women than between men. An unexpected finding was that for all measures of alcohol and drug use and problems, gender differences within treatment systems were smaller than differences comparing women and comparing men between the two treatment systems. The findings point to the heterogeneous nature of both women and men in alcohol and drug programs, and call for further examination of these differences in planning treatment strategies in combined alcohol and drug programs.

Book Reviews

Book reviewed in this article:Alcohol—The National Hangover DR JEAN LENNANEKey Issues in Methadone Maintenance Treatment JEFF WARD, RICHARD MATTICK & WAYNE HALLDrugs Policy: Fact, Fiction and the Future RUSSELL FOX & IAN MATTHEWSEvaluate Yourself: A Handbook for Alcohol and Other Drug Treatment Agencies F. McDERMITT, P. PYETT & M. HAMILTONDrugs in Australian Society: Patterns, Attitudes and Policies IAN MCALLISTER, RHONDA MOORE & TONI MAKKAIHeroin Treatment—New Alternatives Proceedings of a Seminar held on 1 November 1991 Ian Wark Theatre, Becker House, Canberra GABRIELE BAMMER & GRAYSON GERRARD (Eds)

A DESCRIPTIVE STUDY OF ALCOHOL-DEPENDENT WOMEN ATTENDING ALCOHOLICS ANONYMOUS, A REGIONAL COUNCIL ON ALCOHOLISM AND AN ALCOHOL TREATMENT UNIT

A total of 86 women, attending three different agencies, were interviewed on their help-seeking behaviours for problem drinking. Each agency represented a different type of help available in the community. Self-help was represented by Alcoholics Anonymous; the non-statutory sector by a regional council on alcoholism's offices; and the statutory sector by an alcohol treatment unit's out-patient department. Differences between the groups in terms of demography and drinking history are explored in this paper. It was found that the regional council group resembled the female problem drinkers in other alcohol treatment agencies in terms of alcohol dependency, pattern of alcohol consumption and drinking styles, but differed in age and abstinence behaviour.

Characteristics of clients receiving treatment in Australian drug and alcohol agencies: a national census

The first Australian national census of clients of drug and alcohol treatment agencies was undertaken to document the characteristics of clients attending these facilities. Of the agencies surveyed nationwide, 431 (85.2%) completed and returned census forms describing demographic and drug use details of their clients. A total of 6175 clients were reported to have received services (beyond methadone maintenance alone) in the responding agencies on the census day. Ninety percent of the clients seen were substance users, and 10% of clients were relatives or friends of a substance user. The mean age of the clients was 34 years and two-thirds were male. The majority were Australian born, with 10% described as Aborigines or Torres Strait Islanders. The majority of the clients were not in paid employment. Fifty-five percent of all clients received treatments services on a non-residential basis. The most frequent presenting drug problem reported was alcohol, followed by opiates and tobacco. Thirty-three percent of the substance users were reported to have injected illicit drugs in the past 12 months.

Quality assurance in drug and alcohol treatment: the development of standards for treatment content

The need for minimum standards of service delivery in drug and alcohol treatment agencies is outlined, and the Australian standards developed to date are discussed. It is argued that such standards are insufficient to assure the efficacy of treatment approaches used in treatment agencies, although they are an important and necessary precursor to the implementation of patterns of optimum care. The nature of optimum care standards is outlined and one methodology for developing optimum standards is described.

Sick love and sick religion: exposing our dependencies.

Rev. William Lenters, DMin, is currently a campus minister for the Christian Reformed Fellowship at Purdue University. He is a certified addictions counselor and served for eight years as chaplain and executive director of a drug and alcohol treatment agency in Phoenix, Arizona.

Sex-role values and bias in alcohol treatment personnel.

During a two day training workshop with 45 alcohol treatment agency personnel, the impact of sex-role bias on clinical practice with alcoholic clients was examined. More specifically, data were gathered on: 1) client comfort level of surrogate clients as related to perceived sex-role values of treatment personnel; and 2) the impact of patient sex and sex-linked characteristics of presenting problems (whether problems are "typically" male or female, and whether "sex-appropriate") on each of the following: perceived importance of client's presenting problems, specificity of the treatment plan to problems presented, and clinician's estimate of client prognosis. The results suggest that sex-role values of treatment personnel influence client comfort, that female clients are seen as having a poorer prognosis than males, and that presenting problems are perceived to be more important if they are sex-appropriate than if they are not sex-appropriate (the least important problems being female problems in a male client).

Treatment staff attitudes toward the combined treatment of drug and alcohol abusers.

The literature on combined treatment has suggested that the attitudes of staff members toward combining treatment for drug and alcohol abusers are important determinants of its success. A survey measuring attitudes thought relevant to the issues of combined treatment was mailed to treatment staff from a nationwide sample of drug, alcohol, and combined treatment agencies. Results indicated that combined treatment staff had more favorable attitudes toward combined treatment than did drug or alcohol staff, and that significant differences existed in the attitudes of drug, alcohol, and combined staff toward drug and alcohol abusers. In addition, it was found that staff background and attitudes toward drug and alcohol abusers were significantly related to attitudes toward combined treatment. Treatment staff who worked at combined treatment agencies and were White were likely to have favorable attitudes toward combined treatment. In terms of attitudes toward drug or alcohol abusers, it was found that staff members who held unfavorable stereotypes or moral views about drug or alcohol abusers tended to be opposed to combined treatment. These empirical results support clinical impressions of combined treatment advocates as reported in the literature. The results are discussed in terms of the relevance of staff attitudes for the effectiveness of combined treatment and for agencies which are considering the initiation of combined treatment.