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Findings 1 - Summary of 1-Year Outcomes

Principal Investigator: Dr. Catherine Comiskey
Project Manager: Dr. Gemma Cox
National University of Ireland,
Maynooth, Co. Kildare.

Objective

This research was commissioned in 2002 by the National Advisory Committee on Drugs (NACD) as required by the National Drug Strategy Action 99.

This action was charged with commissioning an outcome study to establish the impact of treatment on both individual health and on offending behaviour.

Design and Methods

Between September 2003 and July 2004 the study recruited 404 individuals within their first month of a new treatment episode. All individuals were interviewed in months 1, 6 and 12 after the start of their treatment.

In total 44 agencies providing 54 services located in rural, urban and inner city areas of Ireland were involved in the study. In addition over 30 GP’s also contributed to the study.

Recruitment

Recruitment occurred in both in-patient and outpatient settings across 4 modalities of treatment

Coverage

The National Drug Treatment Reporting System (NDTRS) reports that in 2003 4,900 individuals commenced or recommenced treatment for problem drug use.

ROSIE approximate minimum national coverage rate is then 8.2% Coverage of all new methadone treatments at national level is approximately 17%.

Coverage of all detoxification cases is approximately 12%.

Study Instrument

The research instrument is based primarily on DORIS (& the Maudsley Addiction Profile (MAP) & Opiate Treatment Index(OTI). The main outcomes being:

• Demographics (gender, age, education, children)
• Drug Use (drug type, frequency, quantity & cost)
• Health (10 point physical & mental health assessment)
• Social Functioning (employment, accommodation, family)
• Harm (injecting behaviour & experience of overdose)
• Crime (offending behaviour, arrest, legal status, prison)
• Mortality

Follow up

Four contacts of location were sought from each client. Extensive time and effort was invested in finding clients at 1 year. As a result and with the assistance of service providers,

• 92% (n=373) of all clients were located at 1 year,
• 75% (n=305) completed 1-year follow-up interview,
• 0.5% (n=2) were deceased,
• 4% (n=16) withdrew from study
• 12% (n=50) were not interviewed

Participants

• 25% were female, 75% male .
• Average age was 28 years (median 27, range 18-57).
• 28% left school before the age of 15 years.
• 21% had some employment over the 3 months prior to intake interview.
• 77% had social welfare payments as their main source of income.
• 56% were parents of children under 18 years and of these over half did not have their children in their care.
• 18% had a period on homelessness in the previous 3 months

Summary Outcomes at 1 Year

• Significant reductions in heroin and other drug use were observed in the followed up population.
• Extensive reductions in criminal activity were found.
• Extensive reductions in injecting drug use were observed but no changes were found in injecting related risk behaviour.
• Notable reductions in a range of physical and mental health complaints were found.
• Increased contact with GP, employment, educational and social services were observed.

Drug Use Outcomes

• Significant increase in drug abstinence rates from 7% to 27%.
• Significant reduction in the percentages reporting the use of all drugs (except for alcohol and cannabis use among women).
• Significant reduction in the mean number of days individuals reported the use of all drugs (except for alcohol among women)
• Significant reduction in the average quantity of all drugs used except cannabis (for population and males and alcohol for women)
• Significant reduction on the average amount spent on heroin, cocaine powder and crack cocaine. In addition women reported a significant reduction in the amount spent on cannabis.
• In addition the percentages reporting the take up of drugs was low.

Injecting Risk Outcomes

• Significant reduction in percentages reporting injecting across all drugs (heroin, benzodiazepines and cocaine)
• Significant reduction in average number of days and average times per day individuals injected.
• No significant change in injecting related risk behaviours.
• No significant changes in overdose rates.

Crime Outcomes

• Significant reduction in percentages reporting selling/supplying drugs (31% to 11%).
• Significant reduction in acquisitive crime (31% to 14%)
• Males reported a reduction in all but 3 of 12 offences (theft from a house/home, theft of a vehicle, soliciting).
• Females reported a reduction in 4 offences (theft from a person, theft from a shop, handling stolen goods, soliciting).

Health Outcomes

• Percentages reporting each of 10 physical health symptoms were reduced and significant reductions in 5 of the 10 symptoms were found.
• Females reported a significant reduction in only one health symptom (poor appetite)
• Males reported a significant reduction in 3 (poor appetite, muscle pains and tremors/shakes)

Mental Health Outcomes

• Percentages reporting each of 10 mental health symptoms were reduced and significant reductions in 7 of the 10 symptoms were found.
• Females reported a significant reduction in no mental health symptoms
• Males reported a significant reduction in 6 (feeling tense, suddenly scared, feeling fearful, feeling worthless, feeling lonely and thoughts of ending life).

Service Contact Outcomes

• 38% still in index treatment at 1 year.
• Women more likely than men to report this (51% vs. 33%).
• 30% successfully completed their index treatment (men more likely than women, 33% vs. 20%).
• Significant increase in contact with GP, employment/educational services and housing/homeless services.
• Significant increase in proportion of women contacting out patient services.

Conclusions

• Strong positive outcomes observed for mortality rates, drug use, abstinence rates and crimes committed
• Some positive outcomes for physical and mental health despite the relatively short follow up period.
• The ROSIE study is ongoing and outcomes for the 3 year follow up will provide information on whether these positive outcomes are sustainable over time and if less positive outcomes will improve with time.
• Finally the Rosie study clearly demonstrates that involvement in drug treatment has a positive impact on the individual.

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