Using Timelines to Visualize Service Use Pathways to Alcohol Treatment

Many people in alcohol and other drug treatment are clients of other services, however there is limited consideration of the combinations and sequences of services and systems that they use. We used data visualization to analyze and re-present findings from a large research project on clients’ service use and referral sources in the year preceding alcohol treatment entry. Data were from 16 “high-end” service users with alcohol problems and analysis involved constructing individual text and timeline summaries and a visual encoding system to show service type and referral source. Three distinct service use pathways were identified and a visual model of alcohol treatment, other service use and continuity in treatment was constructed. Timelining was a useful means of developing a creative and illuminating perspective during analysis. Although there is a risk of over-simplification, data visualization appears useful for focusing on and communicating the diversity of people’s service use pathways

Using Realist Synthesis to Develop an Evidence Base from an Identified Data Set on Enablers and Barriers for Alcohol and Drug Program Implementation

The purpose of this paper is to show how “realist synthesis” methodology (Pawson, 2002) was adapted to review a large sample of community based projects addressing alcohol and drug use problems. Our study drew on a highly varied sample of 127 projects receiving funding from a national non-government organisation in Australia between 2002 and 2008. Open and pattern coding led to the identification of 10 barrier and nine enabler mechanisms influencing project implementation across the sample. Eight case studies (four demonstrating successful implementation; four demonstrating less than successful implementation) were used for depth exploration of these mechanisms. High level theories were developed, from these findings, on implementation effectiveness in projects addressing alcohol and other drug use problems

Adolescent drinking, social identity, and parenting for safety : Perspectives from Australian adolescents and parents

We explored young people and parents' views on adolescent drinking and safety in the locations where drinking may occur. Focus groups with adolescents and parents showed that many believed adolescent drinking and drunkenness is normative. Younger adolescents had more negative views of adolescent drinkers than their older peers. Adolescent drinking occurred in private settings and parents made decisions about allowing their adolescent children to attend social events based on the level of safety attributed to the location. If adolescent drinking was likely then home was the preferred location as it provided scope for risk minimisation. Positive portrayals of non-drinking adolescents and information to assist parents' decision-making are needed

Alcohol and other drug withdrawal: practice guidelines.

Clinical guidelines seek to direct clinical practice by outlining recognised, evidence-based treatment interventions. They draw on current literature and clinical practice expertise. These Guidelines provide guidance for clinical decision-making in the context of individual client requirements, withdrawal setting, treatment availability and individual service protocols. These Guidelines are consistent with the World Health Organisation’s (WHO) United Nations Principles of Drug Dependence Treatment (United Nations Office on Drugs and Crime and World Health Organization, 2008). They outline current best practice for the management of AOD-dependent clients accessing withdrawal care. 1 Introduction - page 1 2 Definitions of dependence and withdrawal - page 5 3 Principles of AOD withdrawal care - page 9 4 Continuity of Care - page 11 5 Features of AOD withdrawal - page 13 6 Special needs groups - page 19 7 Presentation to AOD withdrawal - page 29 8 AOD withdrawal settings - page 31 9 Assessment - page 37 10 Alcohol withdrawal - page 45 11 Opioid withdrawal - page 65 12 Benzodiazepines - page 87 13 Amphetamine-type substances (ATS) - page 99 14 Cannabis - page 111 15 Nicotine - page 121 16 AOD withdrawal for clients with a dual diagnosis - page 133 17 References - page 16

Improved Quality of Life Following Addiction Treatment Is Associated with Reductions in Substance Use

People seeking treatment for substance use disorders (SUD) ultimately aspire to improve their quality of life (QOL) through reducing or ceasing their substance use, however the association between these treatment outcomes has received scant research attention. In a prospective, multi-site treatment outcome study (‘Patient Pathways’), we recruited 796 clients within one month of intake from 21 publicly funded addiction treatment services in two Australian states, 555 (70%) of whom were followed-up 12 months later. We measured QOL at baseline and follow-up using the WHOQOL-BREF (physical, psychological, social and environmental domains) and determined rates of “SUD treatment success” (past-month abstinence or a statistically reliable reduction in substance use) at follow-up. Mixed effects linear regression analyses indicated that people who achieved SUD treatment success also achieved significantly greater improvements in QOL, relative to treatment non-responders (all four domains p 0.001). Paired t-tests indicated that non-responders significantly improved their social (p = 0.007) and environmental (p = 0.033) QOL; however, their psychological (p = 0.088) and physical (p = 0.841) QOL did not significantly improve. The findings indicate that following treatment, QOL improved in at least some domains, but that reduced substance use was associated with both stronger and broader improvements in QOL. Addressing physical and psychological co-morbidities during treatment may facilitate reductions in substance use

Substance use outcomes following treatment : findings from the Australian Patient Pathways Study

Background and Aims: Our understanding of patient pathways through specialist Alcohol and Other Drug (AOD) treatment and broader health/welfare systems in Australia remains limited. This study examined how treatment outcomes are influenced by continuity in specialist AOD treatment, engagement with non-AOD community services, and mutual aid, as well as exploring differences between clients who present with a primary alcohol problem compared to those presenting with a primary drug issue. Method: In a prospective, multi-site treatment outcome study, 796 clients from 21 AOD services in Victoria and Western Australia completed a baseline interview between January 2012 and January 2013. 555 (70%) completed follow-up assessment of subsequent service use and AOD use outcomes 12-months later. Results: Just over half of the participants (52.0%) showed reliable reductions in use of, or abstinence from, their primary drug of concern. This was highest among clients who reported meth/amphetamine (66%) as their primary drug of concern and lowest among those who reported alcohol (47%), with 31% achieving abstinence from all drugs of concern. Continuity of specialist AOD care was associated with higher rates of abstinence than fragmented AOD care. Different predictors of treatment success emerged for clients with a primary drug problem as compared to those with a primary alcohol problem; mutual aid attendance (OR=2.5) and community service engagement (OR=2.0) for clients with alcohol as PDOC, and completion of the index treatment (OR=2.8) and continuity in AOD care (OR=1.8) for those with primary drug issues. Conclusion: This is the first multi-site Australian study to include treatment outcomes for alcohol and cannabis users, who represent 70% of treatment seekers in AOD services. The results suggest a substantial proportion of clients respond positively to treatment, but that clients with alcohol as their primary drug problem may require different treatment pathways, compared to those with illicit drug issues, to achieve desirable outcomes

Negotiating Closed Doors and Constraining Deadlines: The Potential of Visual Ethnography to Effectually Explore Private and Public Spaces of Motherhood and Parenting

Pregnancy and motherhood are increasingly subjected to surveillance, by medical professionals, the media and the general public; and discourses of ideal parenting are propagated alongside an admonishment of the perceived ‘failing’ maternal subject. However, despite this scrutiny, the mundane activities of parenting are often impervious to ethnographic forms of inquiry. Challenges for ethnographic researchers include the restrictions of becoming immersed in the private space of the home where parenting occurs, and an institutional structure that discourages exploratory and long-term fieldwork. This paper draws on four studies, involving 34 participants, which explored their journeys into the space of parenthood and their everyday experiences. The studies all employed forms of visual ethnography including artefacts, photo-elicitation, timelines, collage and sandboxing. The paper argues that visual methodologies can enable access to unseen aspects of parenting, and engender forms of temporal extension, which can help researchers to disrupt the restrictions of tightly time bounded projects

Pathways of care

This chapter provides a brief description of the pathways into and through alcohol and other drug (AOD) specialist treatment, with a focus on the role of the medical practitioner in general practice. Three areas are described: treatment modalities and features that support treatment success, pathways into AOD care, and barriers faced by clients. The chapter closes with an outline of strategies health services use to support people’s access to treatment

Embracing the visual: Using timelines with in-depth interviews on substance use and treatment

People typically seek treatment for addiction only when faced with a major crisis. Understanding the trajectory of substance use and treatment seeking may assist in identifying points for intervention. In this study I explored the use of visual methods with in-depth interviews to represent people\u27s substance use, critical events, and treatment pathways. Ethics approval was granted with the condition that only aggregate findings would be presented, although occasional quotes could be used for illustration. Typical timelines were developed, along with text vignettes describing hypothetical participants whose experience matched that shown in these timelines. Benefits of the timelines include the combination of aural and visual data, along with the concise and holistic form of presentation. However, the use of typical timelines and hypothetical vignettes meant a loss of the richness found in individual portrayals of experience. Alternative approaches, such as the use of individual and summary timelines with text illustrations would preserve the conciseness of representation while enabling the voice of the participant to be heard