A 10-year follow-up study of drug users in treatment. Grethe Lauritzen, SIRUS

Transcription

1 A 10-year follow-up study of drug users in treatment Grethe Lauritzen, SIRUS

2 A prospective co-hort study 10-year observation period ( ) 481 clients interviewed in 20 treatment facilities in and around Oslo purposely selected 13 residential units 7 out-patient units, 3 Psychiatric Youth Teams specialized for drug treatment (PUT) and 4 Opioid Substitution Teams (OST)

3 4 groups of treatment facilities 11 residential units for adults (n=276) 2 residential units for youth (n= 31) 3 PUT teams (n=100) 4 OST teams (n= 74)

4 Material follow-up interviews Period Number Response percentages After 1 year «2 years «7 years «10 years

5 Instruments All the clients were interviewed in person within the first 2 weeks after entering treatment with the European Addiction Severity Index (EuropASI) Alcohol and drug use, physical and psychological health, family and social problems, education/work and income situation, criminal behaviour. Life time and last 30 days Self-administered instruments for assessing anxiety, depression and personality disorders: Hopkins Symptom Checklist 25 (HSCL-25) Millon Clinical Multiaxial Inventory II (MCMI II) Childrens Trauma Questionaire Data from The Cause of Death Registry ( )

6 The clients at treatment entry (baseline) All Youth in residential PUT Adults in residential OST Women% Age, average Born in Norway % Have one or more children % Have daily responsibility for one or more children % Lived alone in a stable residence % (past 6 months) Lived with partner/spouse with or without children % (past 6 months) Leisure time spent mainly with friends/acquaintances with drug/alcohol problems

7 Education, employment and sources of income All Youth in residential PUT Adults in residential OST Learning and/or behavioural problems in primary school Completed high school % Student/pupil % Income from own employment/ sick leave pay the past 30 days % Disability benefit past 30 days % Social welfare benefits past 30 days % Income from selling drugs past 30 days % Income from other criminal activites past 30 days % Income from prostitution past 30 days %

8 Background burdens All Youth in residential PUT Adults in residential OST Alcohol problems mother and/or father % Drug/medication problems mother and/ or father % Psychiatric problems mother and/or father% CTQ Emotional neglect/abuse, moderate/serious serious/extreme CTQ Physical neglect/abuse, moderate/serious serious/extreme CTQ Sexual abuse moderate/serious serious/extreme Time spent mostly with friends/acquaintances who have drug and alcohol problems %

9 Drug and alcohol use Heroin no. Years high frequency All Youth in residential PUT Adults in residential Amphetamine Cannabis Sedativa /hypnotica Alcohol for intoxication Needle use (share) OST Overdosed (share) NOK used on drugs last month

10 Physical health All Youth in residential PUT Adults in residential OST Chronic physical injuries/diseases % HCV infected % HIV tested % HIV positive % Considerably/severely afflicted or concerned about physical problems in the last 30 days

11 Mental/psychological health All % Youth in residential % PUT % Adults in Residential % Seriously depressed Serious anxiety Suicide attempts Cognitive difficulties (in understanding, memorizing, consentration) Medications for mental problems past 30 days OST%

12 Basic personality disorders (>84 MCMI-II) (%) Scale All Men Women (n=481) (n=324) (n=157) Basic personality disorders Schizoid * Evasive Dependent Histrionic *** Narcissistic ** Antisocial Aggressive sadistic * Compulsive Passive aggressive Self-deprecating *

13 Basic personality disorders (>84 MCMI-II) cont. Scale All Men Women (n=481) (n=324) (n=157) Severe personality disorders: Schizotype Borderline Paranoid

14 Prevalence of personality disorders (PD) 75% has one or more PD (same share as in ROP study, Oppland/Hedmark) The most serious and frequent personality disorders were antisocial PD and borderline PD Not surprising that a group with such large mental burdens during childhood, and major psycho-social burdens for many years as substance abusers, develop relationship problems/pd End of description

15 Completion of treatment Completion percent Number of days/consultations (average) Youth Residential days PUT consultations Adult Residential days OST 66 (cont.)

16 Prediction for completion of treatment PD was a negative predictor for completion/continuation in all modalities 3 or more previous residential treatments is a negative predictor for completion among clients in residential modalities Use of heroin for 3 or more years is a negative predictor for completion among PUT clients Changes

17 Income status Last 30 days Income from work Social security Disability pension Selling drugs Other criminal activity Admission 1 year 2 years 7 years 10 years *P-verdi < < < < <0.001 Prostitution <0.001

18 Change in use of substances/medications (p-value = admittance to ten years) Last 30 days (%) Admittance 1 year 2 years 7 years 10 years *p-value (n=481) (n=428) ((n=410) (n=348) (n=296) Heroin <0.001 Methadon/Buprenorphin <0.001 Other opiates <0.001 Amphetamine <0.001 Sedativa/hypnotica <0.001 Cannabis <0.001 Cocaine ns Alcohol for intoxication <0.05

19 Changes in substance use

20 Change in use of syringes Admit. 1 year 2 years 7 years 10 years *p value (n=481) (n=428) (n=410) (n=348) (n=296) Use of syringes past 30 days (%) Daily use of syringes (%) p< p<0.001

21 Change in non-fatal overdoses 1 year (n=428) 2 years (n=410) 7 years (n=348) All (%) Youth in residential PUT Adults in residential OST years (n=296)

22 Change in mental problems (EuropASI) The year prior to follow-up (%) 1 year 2 years 7 years 10 years (n=428) (n=410) (n=348) (n=296) Seriously depressed Serious anxiety Problems concentrating / understanding/ remembering Prescribed medications for mental problems Suicidal thoughts Suicide attempts

23 Change in mental health SCL- 25 and Europ-ASI (composite score)

24 Change in criminal behaviour Chargedoftypes of crime: (%) last year prior to followup Possession/sale of drugs Crime of gain other than drug sale 1 year (n=428) 2 years (n=410) 7 years (n=348) 10 years (n=296) Crime of violence

25 Change in criminal behaviour Illegal activities to earn money Admittance (n=481) 1 year (n=428) 2 years (n=410) 7 years (n=348) 10 years (n=296) P. value <0.001

26 Mortality rate 74 persons died in the course of 10 years (10 women) Average age at death was 32 years Mortality rate 1.5 per 100 person/years 2.0 for men 0.6 for women

27 Causes of death (n=74) % Number Overdoses Violent deaths (traffic accident, drowning, fires, suicide, homicide, etc) Hepatitus C 1 1 HIV/AIDS 3 2 Unknown cause 8 6 Total

28 Differences in client characteristics dead and surviving clients Dead (n=74) Not dead (n=407) P- value Age ns Alcohol abuse years (before entering treatment, b.e.t) p<0.05 Overdoses (numbers) (b.e.t) p<0.05 Years using syringes (b.e.t.) ns Months in prison (b.e.t.) p<0.05 Days in index treatment p<0.05

29 Thank you for listening to me! What can we learn from this study?

30 Strength and weaknesses with a longitudinal co-hort study like this? Strategies for prevention on behalf of this study? Comments on treatment systems/organisation of treatment? New research questions?

31 Clients in OST last year prior to follow-up interviews (from the different recruitment groups) % 1 year (n=428) Youth in residential 2 years (n=410) 7 years (n=348) 10 years (n=296) PUT Adults in residential OST

32 Clients in out-patient treatment prior to follow-up interviews (from the different recruitment groups) % 1 year (n=428) 2 years (n=410) 7 years (n=348) 10 years (n=296) Youth in residential PUT Adults in residential OST

33 Clients in residential treatment prior to the follow-up interviews (from the different recruitment groups) % 1 year (n=428) 2 years (n=410) 7 years (n=348) 10 years (n=296) Youth in residential PUT Adults in residential OST

34 Gender differences Generally few large gender differences Women reported to have been more emotionally, physically and sexually abused than men Women reported more mental problems than men upon admittance to treatment, the differences were gone after 10 years Women equally violent as men

35 Gender differences The women were less likely to use heroin, amphetamines and cannabis throughout the entire observation period Women less antisocial than men A smaller share of the women reported criminal behaviour A smaller share of the women died A smaller share of the women died of (90% vs. 59%)

36 Gender differences The share of women involved in education was characteristically higher than the men in the entire observation period Women more satisfied with civil status after 10 years Many of the women lived with partners that had substance use problems throughout the entire observation period Women more involved in social networks

37 Strength and weaknesses with such a longitudinal co-hort design? Strategies for prevention on behalf of this study? Comments on treatment systems/organisation of treatment? New research questions?