an exploration of an addiction service in ireland

AN EXPLORATION OF AN

ADDICTION SERVICE IN

IRELAND

NIALL GAFFNEY BA (Hons) in Health Promotion

April 2017

Department of Health, Sport

and Exercise Sciences

School of Health Sciences

Waterford Institute of

Technology

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other person’s work (published or unpublished) and that it has not previously been submitted

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Acknowledgements

To start, I would like to thank my dissertation supervisor, Rosie Donnelly. Rosie was the

lecturer of the very first class I had here in WIT. Having had Rosie as a lecturer almost every

semester throughout my four years here, I have a lot to thank her for with regards to helping

me along my journey over the past four years studying Health Promotion. As a supervisor,

she was a constant source of support and possesses a wealth of information which aided me

in producing a piece of work which reflects the time and effort I have put in.

I would also like to thank my family and also, my girlfriend who was my chief proof-reader

and again, continues to be a constant source of support for me.

Finally, it is hugely important for me to acknowledge my class and in particular Damien,

Aoife, Leah, Jamie and Jeanelle. I firmly believe that my journey through these last four

years here in WIT would have been abundantly harder to get through if it wasn’t for this

group of people. If I ever had a question, they always had an answer for me but most of all,

not only were they a huge source of support and reassurance for me, but this group of people

made the last four years of my life a period which I will never forgot and will look back on

fondly in years to come.

I am sincerely grateful to anyone who has helped me in the last four years and I hope that the

friends and contacts I have made here will last a lifetime.

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Abstract

Overview: This study is an exploration into an addiction service setting based in Ireland. The

purpose of this study is to explore and assess the addiction service in terms of 5 different

areas: 1) Service Users’ Profile, 2) Service Usage, 3) Drop-out Rates, 4) Adherence Rates

and, 5) The Effectiveness of the Addiction Service. The information of sixty clients from The

Cornmarket Project in Wexford, Ireland will be used in order to answer the following

research questions:

1. What is the profile of the service users in an addiction service?

2. What is the difference in programme usage among the various low-threshold groups

within an addiction service setting?

3. What are the rates of dropout among the various low-threshold groups?

4. What are the rates of adherence for each addiction service programme?

5. How effective is the addiction service?

Methods: The data was collected from The Cornmarket Project Functional Analysis forms in

the Wexford Town branch of The Cornmarket Project. Using specifically designed data

collection forms, the relevant information was extracted from sixty Functional Analysis

forms and transferred onto these data collection forms. The information was then categorized,

grouped and used in order to create the results required to answer the specific research

questions set out for this study. Results: The results of this study varied. Due to the amount of

information gathered, a lot of conclusions could be drawn and it also opens the door to

further research into the area. A sample of the results found: Male service users’ dropped out

of addiction treatment at a higher rate than female service users’, most of the service users’

were aged between 36 and 50 years of age, the drop-in and one-to-one counselling

programmes had the highest adherence rates and the addiction service proved to be most

effective in treating its’ clients in the areas of ‘anger & emotions’ and ‘training

employability’. Conclusions: The findings made in the process of carrying out this study lay

the basis for further research into the area. They are important findings for not only further

research opportunities but are also potentially quite useful for addiction services in Ireland.

Results from this study may be used to pinpoint where we need to apply more attention to in

current addiction service practices which paves the way to the potential alteration and

improving of addiction services and treatment programmes within an addiction service.

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Contents

Chapter 1: Introduction & Literature Review 8

1.1 Introduction 8

1.2 Addiction 9

1.3 Types of Addictions 10

1.4 Prevalence of Addictions 10

1.5 Service Users 11

1.6 Solutions for the Service Users 12

1.7 The Cornmarket Project Profile 13

1.8 The Referral Process 13

1.9 The Monitoring Process 14

1.10 Effectiveness of Programmes 14

1.11 Functional Analysis Forms 15

1.12 Adherence Rates 16

1.13 Dropout Rates 16

1.14 Reasons for Dropout 17

1.15 Conclusion 18

1.16 Aim of Proposed Study 18

1.17 Rational for Research Questions 19

Chapter 2: Methodology 20

2.1 Research Design 20

2.2 Study Population & Sample 20

2.3 Concepts to be measured 21

2.4 Measurement Tools 23

2.5 Data Collection Procedure 23

2.6 Data Analysis 24

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2.7 Ethical Considerations 24

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Chapter 3: Results 26

3.1 Profile 26

3.2 Service Usage 28

3.3 Dropout Rates 30

3.4 Adherence Rates 32

3.5 Effectiveness of the Service 33

Chapter 4: Discussion 41

4.1 Discussion 41

4.2 Limitations 49

4.3 Conclusion 50

4.4 Implications 51

4.5 Recommendations 51

Chapter 5: References 52

Chapter 6: Appendices 56

Appendix A 57

Appendix B 59

Appendix C 60

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List of Tables

Table 1: Shows the number of clients who engaged and the % of clients who dropped out or

adhered to service criteria for each of the addiction service programmes 33

List of Figures

Figure 1: Gender profile of service users 26

Figure 2: Gender profile of each low-threshold group 26

Figure 3: Profile- Age of service users 27

Figure 4: Ages by each low-threshold group 27

Figure 5: Profile- Previous addiction service engagement 27

Figure 6: Additional history by each low-threshold group 27

Figure 7: Previous engagement with this service 27

Figure 8: Who the service users were referred by 28

Figure 9: Referral of each low-threshold group 28

Figure 10: Service Programme Usage 29

Figure 11: Service Usage- Low-threshold group 1 29

Figure 12: Service Usage- Low-threshold group 2 29

Figure 13: Service Usage- Low-Threshold group 3 30

Figure 14: Service Usage- Low-Threshold group 4 30

Figure 15: Dropout Percentage 30

Figure 16: The number of clients who dropped out in each low-threshold group 31

Figure 17: Dropout Percentage- Gender 31

Figure 18: Dropout Percentage- Age 31

Figure 19: Dropout Percentage- Referred by… 31

Figure 20: Dropout Percentage- Addiction History 31

Figure 21: Number of clients who adhered to service criteria vs dropped out of the service 32

Figure 22: The number of clients who showed improvements & those who showed no

improvement/stayed the same in relation to each of the addiction service programmes 34

Figure 23: The number of clients who improved and did not improve/stayed the same on the

accommodation antecedent 35

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drug & alcohol misuse antecedent 36


financial issues & debt antecedent 36


training employability antecedent 37


attitudes & cognitive style antecedent 37


offending behaviour antecedent 38


relationships & family issues antecedent 38


lifestyle & associates antecedent 39


anger & emotions antecedent 40


pro-social activities antecedent 40

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Chapter 1: Introduction & Literature Review

1.1 Introduction

Addiction is an issue for not only the individual but also society as a whole. According to

McLellan, et al. (1996), the cost of addiction easily surpasses the billion dollar mark while

addiction can be linked to up to one-sixth of all deaths (McLellan et al., 1996). Issues such as

increased mortality rates and costs along with increased chance of anti-social behaviour and

loss of productivity is why there is a need for addiction services. Addiction affects every

individual differently, depending on the addiction and the severity of that addiction. Also, the

way in which addiction has been treated has developed and drastically changed in the last 20

years and individuals react and respond to treatments differently (Wilbourne & Miller, 2002),

this means that addiction services and the constant exploration and assessment of these

addiction services is pivotal in helping to produce positive results in relation to the overall

treatment outcomes for service users. Not only do the effects of an addiction impact upon the

addicted individual themselves, but also their family and other loved ones. This poses a

particular challenge for addiction services in treating the client for their addiction and so, by

doing this it reduces costs to the criminal justice systems, social care, probation service and

social service responses (Gossop et. al., 1998).

The role of addiction services is comprehensively explained by McLellan (2002), he argues

that the majority of all addiction treatment services are being developed, carried out, assessed

and reimbursed with the expectation that the treatment they offer will produce lasting positive

effects for its service users’, long after their treatment has finished (McLellan, 2002). It could

be said that the role of addiction services is not only beneficial to the individual who directly

avail of its’ service, but also society as a whole. The addiction services often highlight the

role of each of its service users in society and equips them with the knowledge to become

more pro-social and to gain vital experience which will not only have a great impact on

themselves but also their families and surrounding communities. With up to around 104,000

children living in families who are directly affected by an addiction and harm-related costs

which are directly caused by alcohol consumption costing Ireland around 3.7 Billion every

year, there is constant need for addiction services (The Rise Foundation, 2017).

With facts like these in mind, it is important that there is research carried out which will

provide recent findings regarding the already existing addiction services in Ireland. This

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allows us to ensure that current addiction service practices are effective in providing

treatment to those affected by an addiction in Ireland. It is information like this which lays

the basis for the carrying out of studies like this one. The aim for this study is “to explore the

profile, usage, adherence and dropout rates and effectiveness of a typical addiction service for

low-threshold populations in Ireland”.

1.2 Addiction

Addiction (also known as Dependence Syndrome) is defined by Fenton, Aivadyan & Hasin

(2013) as “a primary, chronic, neurobiological disease, with genetic, psychosocial and

environmental factors influencing its development and manifestations characterized by

impaired control or compulsive engagement in a specific behaviour despite knowledge of

harmful consequences” (Fenton, Aivadyan & Hasin, 2013, p.23). With that in mind, addiction

can be defined in a number of ways but each will point in the direction of a number of

different reasons which will cause an individual to crave something, usually at an unnatural

level. Unfortunately, addiction does not just affect the individual alone, it causes pain and

stress to those around them, for example, family members. Across the world, in relation to

their relatives’ addiction, 100 million family members are reported to be affected (Orford et

al., 2013). Addiction is an issue which can be found in every corner of society, for those who

battle an addiction, it may come in a wide array of variations. An addiction is when an

individual engages in an activity (sex, shopping, gambling) or consumes a substance (alcohol,

nicotine, cocaine) for the purpose of pleasure but the act then becomes more frequent or

obsessive. This may then interfere with the individual’s own life, their relationships or their

health. Depending on the individual, awareness of an addiction comes at differing times and

stages (Psychology Today, 2016). Addictions become a hindrance when it begins to have a

negative effect on the person themselves and the lives they live. Engaging in an act to the

stage where it becomes obsessive leads to an individual prioritising that act. This means that

the individual can often neglect or forget aspects of their life which they once placed

considerable value upon, for example, their health, family or job.

Alcoholism, drugs and nicotine are generally viewed as the most harmful to our health

(addiction.com, 2014). However, people can be addicted to different things and it is not

always to alcohol, cigarettes and other drugs but these do tend to be the most common

addictions. The most common addiction in the world (as of 2014) was caffeine which is most

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commonly found in coffee, followed by gambling, anger, food, the internet & sex. These are

all higher than alcoholism, drugs and nicotine. The list of the most common addictions in the

world is completed with work/employment (Addiction.com, 2014).

1.3 Types of Addictions

There are many types of addiction. One is often led to believe that addiction is only related to

harmful substances like drugs or alcohol. The most common one we hear about would

generally be cigarettes, in particular, nicotine. However, according to the Alberta Family

Wellness Initiative (2016), addictions can be split into 2 groups: substance-related addictions

and behavioural or process addictions. In the ‘substance-related addictions’ category tobacco,

alcohol, street drugs and prescription drugs are to be found. Additionally, the

‘behavioural/process addictions’ consists of gambling, food, sex, the internet, video games

and work (Alberta Family Wellness Initiative, 2016). The prevalence and rates of each type

of addiction in each country/region differ greatly.

1.4 Prevalence of Addictions

Addiction is part of human society and it is not specific to a certain country or region.

Addiction prevalence is evident in every corner of the earth. The WHO has produced the

following figures at a world-wide rate; harmful use of alcohol equates to 3.3 million deaths

each year. The figures regarding those with a substance misuse problem stands at 15.3

million and injecting drug use is reported in 148 countries (WHO, 2016). These figures

portray how widespread addiction is. In relation to addiction prevalence in Ireland, 26.4% of

Irish adults report using an illegal drug in their lifetime, 7.5% in the past year and 4.0% in the

past 30 days (National Advisory Committee on Drugs and Alcohol, 2009). In relation to

alcohol consumption and tobacco use, over 60% of the Irish population has consumed alcohol

in the past month while over a quarter of the population has smoked a tobacco product in the

past month (National Advisory Committee on Drugs and Alcohol, 2009).

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1.5 Service Users

The term ‘low-threshold populations/groups’ is commonly used as a term given to the

different groups who use an addiction service. In most cases, there are four different groups:

1) those with a substance misuse issue, 2) those with an alcohol dependency, 3) the homeless

and finally, 4) those with behavioural or anti-social behaviour issues. Substance misuse is the

term generally given to the individuals who present with an addiction to a substance (or

drug). The Health Service Executive (HSE) in Ireland defines substance misuse (or drug

misuse) as illegally or illicitly taking drugs or consuming alcohol which may lead one to

experience psychological, physical, social or legal issues related to inebriation or consistent

excessive consumption/dependence. This definition is self-explanatory, it defines the topic of

substance misuse very well and it lists the problems associated with substance misuse also,

such as ‘psychological’ and ‘physical’ problems (HSE, 2011).

In relation to alcohol dependency, another example of a low-threshold group, the World

Health Organisation’s definition of ‘dependence syndrome’ can be applied. Alcohol

dependency is defined as an individual whose consumption of alcohol takes on a greater

priority than any other behaviour of theirs which once had greater value (WHO, 2016).

The term ‘behavioural issues’ applies to an individual who has issues or problems with their

behaviour, this is usually associated with anti-social or harmful behaviour and it is when

there is a reoccurring issue regarding the particular behaviour for that individual. Finally,

another low-threshold group is homelessness. This is when an individual does not have their

own permanent dwelling and is forced to sleep rough, stay in temporary bed and breakfast

accommodation, stay in emergency hostels or shelters or stay with relative or friends as a

result of having nowhere else to go. Homelessness can be a mix or all of these scenarios for

an individual (Simon.ie, 2016).

The Simon Community is an Irish-run charity which focuses specifically on how to combat

the homelessness problem in Ireland. They view homelessness as having a number of factors

or conditions combined like having a drug and/or alcohol problem and not having a place to

live. All of which are evident here in Ireland: “Problem drug and alcohol use among the

homeless population is a serious concern with a significant number of homeless people

requiring access to treatment and rehabilitation services” (National Drug Strategy, 2009, p.

47). There are a number of services which aim to attend to low-threshold groups, one such

facility is The Cornmarket Project in Wexford.

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1.6 Solutions for the Service Users

In order to counteract the processes of an addiction, addiction services are required to offer

assistance to the individual seeking help with regard to their addiction. The National Drugs

Strategy (NDS) for Ireland (2001) outlined the aims for treatment for an addiction as the

following: “to enable people with drug misuse problems to access treatment and other

supports and to re - integrate into society; to reduce the risk behaviour associated with drug

misuse; and to reduce the harm caused by drug misuse to individuals, families and

communities” (NDS, 2001, p. 45). These aims can potentially act as a useful tool to use in

relation to the understanding of the rationale behind the addiction services offered to clients.

These services come in many forms including residential treatment, drop-in centres, weekly

programmes, outpatient treatment, and withdrawal management programmes (Drugs and

Alcohol Helpline, 2016) and are essential to not only helping the addicted individual, but also

the wider society.

For those who struggle with an addiction, be it alcohol, drugs, shopping or gambling, there

are usually a number of solutions available in order to combat their problem. However, this

depends on the severity of the addiction, how long the individual has been addicted and also,

crucially, their willingness to change. For some of the individuals, just stopping the addiction

can work, it is typically a tough route to take but it can work. However, most people who

struggle with an addiction require outside help. This may be in the form of a doctor’s or other

medical expert’s advice, group therapy (such as Alcohol Anonymous meetings) or through an

addiction service, which are typically situated in towns and built up areas in order to cater for

larger numbers of individuals seeking help. In relation to Ireland, there are addiction services

located all over the country. The HSE alone, has addiction services available in their 32

health offices all around the country. Some of the treatment services they offer are addiction

counselling, detoxification, medication, residential programmes and group support among

others. Other independent addiction services also exist in Ireland, for example, Aiséirí (which

has services in Waterford, Kilkenny, Tipperary and Wexford) and the Rutland Centre. The

addiction service used for the purpose of conducting this study is the Cornmarket Project in

Wexford town.

Examples of programmes within a service which a client can be referred to or may choose to

engage in are individual drug counselling, residential treatment, group therapy, outpatient

treatment programmes, harm reduction groups, anger management, acupuncture, mindfulness

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and meditation (Volkow, 2011). With the different addiction services that exist, the range or

programmes will differ somewhat between them all.

1.7 The Cornmarket Project Profile

The Cornmarket Project is an Addiction Service under the auspices of the Wexford Local

Development Authority and offers services in New Ross, Enniscorthy, Gorey and Wexford

town (all located in the county of Wexford). They also carry out work in the rest of the

county through their outreach service. Their mission is ‘to reduce substance misuse,

criminality and social exclusion in County Wexford by providing a range of best practice

evidence based programmes’. Their objective is to create safer communities in the county

and this is made possible by the Wexford Local Development Authority and their

collaboration with “the Department of Justice and Equality through the Probation Service, the

Department of Social Protection through Community Employment Schemes, the Department

of Health through the HSE, Wexford County Council through the Social Inclusion and

Community Activation Programme (SICAP) and the Local Education and Training Board”

(Wexford Local Development, 2016). The Cornmarket Project is unique in that it can offer a

wide range of programmes, those seeking help can quickly access these and barriers to

engagement with the services are at a minimum. Crucially, the service offers help to the

families of the individuals who engage with the service. The service has been running for the

past fifteen years and is constantly developing its programmes for the benefit of those in the

county who struggle with addictions. The Cornmarket Project is typical of any other

addiction service provider in Ireland and abroad.

1.8 The Referral Process

Staying with this example, The Cornmarket Project works in conjunction with the probation

service in Wexford and also the surrounding health care settings such as Wexford General

Hospital. This allows healthcare settings to refer clients to the Cornmarket Project as the

health professional and the client see this as the natural avenue for further to address their

addiction(s). The client can then use the programmes within the service to facilitate

progression and learn new, potentially helpful skills with regard to the handling of their

addiction. The probation services in the county may be working with a client who is

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potentially facing a conviction surrounding drugs, alcohol, another addiction or an issue

concerning their behaviour. The probation officer may then see it fit that the client seeks

assistance from the Cornmarket Project in order to reduce their chances of reoffending. The

Cornmarket Project can offer programmes such as anger management and harm reduction to

combat the client’s addiction or behaviour issue. Furthermore the Cornmarket Project places

an emphasis on pro-social behaviour. This means that they offer to teach the client new skills

such as cooking in the on-site kitchen and merchandise printing in the workshop, while also

providing courses such as manual lifting, forklift driving, food safety, etc. through their

partnership with Wexford Local Development.

1.9 The Monitoring Process

In any service, but in particular, an addiction service, it is important that they are able to

monitor the progression or their clients. For example, if the service offers a certain amount of

programmes, they must be able to find out whether their service users are progressing and

making positive changes. For example, Peloquin (2002) examines the Therapeutic Drug

Monitoring (TDM) as a way to monitor infectious diseases, in this case Tuberculosis. The

author goes on to explain that by using the monitoring system, clinicians are able to make

adjustments to treatment for some individuals and in turn, for the individuals who are already

responding to treatment, the clinician can determine that no adjustments or alterations are

required (Peloquin, 2002). This goes to show the importance of monitoring progression

within an addiction service setting also. If the addiction service is able to correctly monitor

the progression of its service users, they are then able to make alterations or adjustments to

current practice accordingly in order to make improvements to certain aspects of the service

such as adherence rates and the effectiveness of the service. In the Cornmarket Project, the

tool they use to monitor progression is called a Functional Analysis Form.

1.10 Effectiveness of Programmes

Effectiveness of programmes is an important element to explore when assessing an addiction

service. The effectiveness refers to whether there is positive or negative results generated in

terms of individual progression with regard to their addiction or behavioural issue(s).

Research suggests that when an individual’s treatment is assessed over a long period of time,

there is a general decrease in their level of criminal activity and an increase in their

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psychological, occupational and social functioning (Volkow, 2011). In terms of the

effectiveness of an addiction service, it is important to assess each programme. When a

service offers numerous programmes and treatment methods, each programme should be

explored individually (rather than collectively) in order to obtain accurate results. Ashton et

al. (2009), carried out a study exploring acupuncture and counselling as examples of

programmes within an addiction service. They aimed to describe the characteristics of the

clients who chose to avail of these methods of treatment. The study took place in the United

Kingdom and had a participant sample of 162 clients. They assessed the clients at entry, 2

months and at 6 months. These assessments included psychometric variables and

alcohol/drug consumption. They found that alcohol was the main preferred drug in both

groups (36 chose acupuncture and 126 chose counselling) and there was no significant

correlation between client’s characteristics and their choice of treatment. The study had some

limitations: it only covers 2 services (acupuncture and counselling) and there was no control

group. However, assessing clients at 3 separate stages is a big strength of this study as it leads

to more accurate findings. This study is useful to the researcher as it is an example of how a

programme(s) within a service can be assessed. With regards to effectiveness, for each

programme the take up rates and dropout rates should be looked at. Furthermore, client

and/or staff worker feedback or a successful client checkout/disengagement could be

considered as a feasible ways to assess effectiveness of a particular programme(s).

1.11 Functional Analysis Forms

The Functional Analysis Form is the measurement tool which the Cornmarket Project uses

and it will also be examined as part of this study. This form was designed by a long-term

member of the Cornmarket Project staff and is used as a tool for staff members to log client

progression within the service and to assess what ‘stage’ a client is at with regard to their own

lives and their addiction. The forms includes 10 antecedents. These ten antecedents are

essentially, aspects of a client’s life which the addiction service aims to improve upon if

required as part of the clients treatment, these 10 antecedents include: 1) accommodation, 2)

drug & alcohol misuse, 3) financial issues and debt, 4) training and employability, 5)

attitudes and cognitive style, 6) offending behaviour, 7) relationships/family issues, 8)

lifestyle and associates, 9) anger and emotions and finally, 10) pro-social activities. The client

comments on each of these aspects with regard to their own life and along with the staff

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member, they will score themselves in each of these antecedents from 1-10. This allows the

staff member to reflect on where the client can improve their life. The form also includes

general information about the client (gender, age, addiction) and details of their engagement

with the service (reason for referral, programme engagement).

1.12 Adherence Rates

In terms of treatment, the health professional relies on the patient to adhere to their advice or

instruction in order to achieve positive results. A patient’s nonadherence can pose a

significant threat to treatment results or client progression. Due to misunderstanding,

forgetting or ignoring healthcare advice, more than 40% of patients put themselves at great

risk of ill-health or further ill-health (Martin et. al., 2005). If the patient fails to adhere to the

advice of the health professional, this could also increase their likelihood of dropout from

treatment. A study by Oslin, Pettinati & Volpicelli (2002) compared therapy and medication

adherence in older and younger adults for alcohol dependence which provided a useful

example of exploring treatment adherence in relation to addiction. Using naltrexone as a

means to treat alcohol dependency, participants in the study were subject to a placebo-

controlled, randomized, double blind efficacy trial. Results of the study show that older adults

had greater levels of adherence to the medication and attended the therapy sessions a lot more

often than the younger adults. The higher adherence rates in the older adult group

subsequently led to a reduced chance of relapse for participants in that group. From this

finding it is possible to state that adequate adherence to addiction treatment can potentially

equate to an overall positive treatment experience (Oslin, Pettinati & Volpicelli, 2002).

1.13 Dropout Rates

Swift & Greenberg (2012) state that “a client that drops out of therapy is one who does not

complete the recommended course of treatment” (Swift & Greenberg, 2012, p.379). The term

‘dropout’ refers to when an individual leaves treatment on a voluntary basis before the

treatment has finished. Psychologically, dropping out from treatment can have a negative

effect on the individual, furthermore, it will increase the likelihood that they will seek a

service on a number of occasions which will then, place an economic weight upon

civilisation. In order to explore this area further Swift & Greenberg looked at potential factors

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which influence dropout such as age, clinician definition of dropout, therapist experience,

type of therapy and therapy setting. To do this, over 650 studies had to be analysed. An

important finding made by Swift & Greenberg was the fact that over 20% of the clients

(83,000 clients across 669 studies) had dropped out/finished their treatment prematurely.

Dropout rates were higher for those seeking treatment for personal or eating disorders and the

youngest participants were more likely to dropout. They said, “By paying attention to these

variables and making adaptations where needed, clinicians may be able to reduce rates of

premature discontinuation in their work with clients” (Swift & Greenberg, 2012, p.379).

1.14 Reasons for Dropout

One of the main indicators for a successful/unsuccessful treatment of a client with an

addiction is whether or not he/she has dropped out or disengaged with the service, this means

that the client has ended regular treatment (Fassino, Pieró, Tomba & Abbate-Daga, 2009).

There are many reasons as to why a client may drop out of an addiction service. Family

issues, unrealistic expectations and relapse are all among the possible reasons for dropout.

Around 66% of patients who have successfully completed their treatment for a substance

misuse issue actually relapse within a window of approximately 3 months (Tucker,

Vuchinich & Harris, 1985). Furthermore, a lot of whether a client is likely to drop out of an

addiction treatment depends on a number of sometimes overlooked information including the

individual’s health status and physical stature, how often they may have been associated with

substance misuse and the potency of the drug which they use (Galanter, Kleber & Brady,

2014). A study by Lopez-Goni, Fernandez-Montalvo & Arteaga (2011) assessed addiction

treatment dropout. The study took place in Pamplona, Spain using 122 substance-dependent

patients. Participants were assessed by 4 questionnaires. Data regarding 1) Sociodemographic

characteristics, 2) Drug consumption was assessed using the EuropASI (European Addiction

Severity Index), 3) presence of pathophysiological symptoms was assessed using the SCL-

90-R (Symptom Checklist 90 Revised) which is a brief self-report psychometric tool and 4)

the prevalence of personality disorders was assessed using the MCMI-II (Millon Clinical

Multiaxial Inventory). The results were as follows. The patient dropout rate from the

intervention was 31.1% with unemployment being the main issue (43% of unemployed

participants dropped out). Also, 38.5% of alcohol-dependent participants dropped out. This

study was very thorough due to the 3 separate questionnaires covering many different

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elements allowing the researchers to pinpoint why the patients dropped out of treatment. With

regard to limitations the sample was relatively small and few women were included.

1.15 Conclusion

To conclude, addiction is a vast and very broad topic. There are not only a number of

addictions but each individual with an addiction is also unique in how their addiction can be

and is treated. There is a great need for addiction services in every corner of the globe

because it is an international issue. Each service will, generally, offer different types of

programmes but with the common aim of trying to improve the health and wellbeing of the

client. In order to assess these services, it is important to look at every aspect within the

service. In order to explore an addiction service, one is required to dissect and analyse every

minor detail. This is helpful, not just for the understanding of the rationale behind addiction

services but also for the service itself with regard to having access to facts and figures

regarding their own client-base and the programmes that the service offers and its

effectiveness.

The Cornmarket Project is an ideal setting for the proposed study as it is a typical addiction

service setting and offers a wide range of services and it also deals with a large proportion of

varying low-threshold groups, namely alcohol misuse, drug misuse, behavioural issues and

homelessness on a regular basis. This allows the researcher to explore, in depth, a setting

where there is a large, varying and contrasting client-base who have different addictions and

who have chosen different programmes to help them address their addiction. The Cornmarket

Project has also developed its own progression monitoring process (which is typical of any

addiction service) and so it offers the opportunity of adherence versus dropout to be analysed

as an effectiveness measurement of the service. This lays the basis for the aim of this

proposed study and gives the researcher the best opportunity to carry out a successful

exploration into a typical addiction service in Ireland.

1.16 Aim of proposed Study

The aim of this study is to explore the profile, usage, adherence and dropout rates and

effectiveness of a typical addiction service for low-threshold populations in Ireland.

20

1.17 Rationale for Research Questions

In order to know whether services in Ireland like the Cornmarket Project are worthwhile, it is

extremely useful to dissect the individual service and look at the programmes the service

offers to clients. To do this, there are 5 area/questions to assess: 1) the profile of the service

users, 2) the difference in programme usage among the various low-threshold groups, 3) rates

of dropout, 4) rates of adherence, 5) effectiveness is the addiction service. By using these 5

areas to assess an addiction service, one can attempt to unravel the different aspects within an

addiction service setting, with the aim of assessing if or how successful the service is. This

type of information could aid the development of programmes and services to combat social

and health consequences of substance misuse by an individual(s) (Ryall & Butler, 2011). It is

important to note the differences between the various programmes offered within an

addiction service as they can have different success rates or results. The addiction service

setting which will be assessed in this proposed study (The Cornmarket Project) is regarded as

a typical addiction service setting in Ireland. The rationale behind the exploration of a service

like the Cornmarket Project, is to comply with the Irish National Drugs Strategy which

outlines the thought-process behind the alteration and integration of service programmes in

order to respond to changing trends (National Drugs Strategy, 2009).

1. What is the profile of the service users defined as low-threshold populations in a typical

addiction service in Ireland?

2. What is the difference in programme usage among the various low-threshold populations

within an Irish addiction service setting?

3. What are the rates of and reasons for dropout among the various low-threshold populations

in a typical Irish addiction service setting?

4. What are the rates of adherence for each addiction service programme within an Irish

addiction service setting?

5. How effective is a typical Irish addiction service for addressing issues of addiction?

21

Chapter 2: Methodology

2.1 Research Design

This study set out to explore an addiction service in Ireland. The research design was

primarily quantitative in nature. The study was conducted by way of desk research within a

typical addiction service located in Wexford, Ireland. The study examined the records of the

addiction service which have been acquired over a sustained period and particularly

examined 5 specific concepts in detail: service users’ profile, service usage, dropout rates,

adherence rates and the effectiveness of the service. The addiction service which was

explored in this study was The Cornmarket Project. This addiction service is located in the

south-east of Ireland with four branches located in four Wexford towns: Enniscorthy, Gorey,

New Ross and Wexford Town. Hundreds of clients walk in and out of the doors of The

Cornmarket Project each day. This study explored the information regarding fifteen clients

from each of the four low-threshold groups, equalling a total of sixty client’s.

2.2 Study Population and Sample

The study was located in the Wexford town branch of the Cornmarket Project. The researcher

carried out the required research under the supervision of a senior employee. This research

was carried out within the main office in Wexford town which contains all the forms and is

secured by a combination lock. This study did not directly involve the service users’

themselves, instead it consisted of a sample of information already gathered from the clients

(which remained anonymous at all times). There is a substantial database of Cornmarket

Functional Analysis forms for each client who has engaged in or is currently engaging with

the service (regardless of how much or how little they have engaged). The previous two

years’ Cornmarket Functional Analysis forms were used as they were the most recent

‘completed’ batch of service users’ information. Using the most recent batch of forms keeps

the study up-to-date. Out of the entire database of Functional Analysis forms for the past two

years, 60 forms were chosen at random. To do this, the researcher plucked out a form from

the pile one-by-one in no particular order. Included in the population sample, there was

fifteen clients representing each of the four low-threshold population categories (alcohol

22

dependency, substance misuse, anti-social/behavioural issues & homelessness). In order to

ensure each low-threshold group was equally represented, once the researcher had picked out

15 forms for any low-threshold group, any extra picked out thereafter were returned to the

original pile. This process was repeated until there were 15 forms picked out representing all

four low-threshold groups, leaving the researcher with 60 Functional Analysis forms to assess

and explore in total. These forms include basic client information, information regarding the

service users’ initial addiction issue (why they are presenting to the Cornmarket). The forms

also include facts concerning the client’s engagement in the different programmes within the

addiction service. A key aspect of the form which was particularly useful was the 10

antecedents.

In the form, there are 10 antecedents which include categories such as pro-social behaviour,

accommodation, lifestyle & associates and financial issues & debt. These are essentially

designed to assess whether the client is making any progress. Each client is scored between 1

and 10 for each antecedent based on their own opinion and the staff member’s opinion. This

gives the staff member’s in-detail information regarding the client/service user.

By exploring the client’s pre and post-treatment antecedent scores, this allowed the

researcher to determine whether improvements were made in the client’s life. The service

users’ profile, their progress or regression is captured and recorded in these Functional

Analysis forms. Both the service user and their key staff worker have an input into the

scoring mechanism for each antecedent also, so therefore, these forms are considered to be a

useful tool for monitoring progression adherence, and dropout.

2.3 Concepts to be measured

As seen below, the study was broken into 5 parts. Each part consisted of a number of

concepts relevant to each research question designed for the purpose of this study.

There were 5 concepts measured in this study:

1. The Profile of the Service Users:

o Gender

o Age

o Addiction history

23

o Previous addiction service engagement

o Personal struggles

o Reasons for referral to the addiction service

o Identification of low-threshold population group

2. Service Usage:

o The types of programmes the low-threshold groups

engaged in.

o The programmes most used by each low-threshold

population.

o Identification of the most and least used

programmes within the addiction service.

3. Dropout Rates:

o Who, typically, drops out from a programme?

o What programmes have a particularly high rate of

dropout?

o Potential reasons for addiction service dropout.

4. Adherence Rates:

o Which programmes are adhered to?

o Who, typically, adheres to the required programme

adherence criteria?

5. Effectiveness of the service:

o How effective is the service in making

improvements to the lives of its users?

o How effective is the service in treating each of the

low-threshold populations for their reasons for

engagement?

24

2.4 Measurement tools

The only measurement tool required for this study was the specifically designed, Data

collection Form. An independent and unique Data Collection Form was specifically designed

by the researcher. These forms are unique forms which were uniquely designed for the

purpose of carrying out this study. The Data Collection Form was broken up into five

sections, each of these sections was designed to collect the information relevant to each of the

five research questions. They included each of the concepts to be measured and only the

relevant pieces of information were assessed in order to make the data collection process as

specific and efficient as possible. The forms were used to investigate the profile of the service

users, the usage of the addiction service among the different low-threshold populations.

Additionally, the forms were used to explore adherence verses dropout rates for each group in

this particular addiction service and which service programmes have the highest level of

client adherence rates compared to dropout rates. Using the information gathered in the 60

Functional Analysis forms, the Data Collection Forms were filled out accordingly by the

researcher.

Each staff member within The Cornmarket Project, works closely with a number of clients at

an individual level from each low-threshold population. They are required to fill out a

number of the Functional Analysis forms for each client/service user in order to track their

progression through the service or even to track if they are not progressing or showing signs

of improvement. These forms were created and devised by the Cornmarket project itself with

the aim of having a database for each staff member to observe in order to help their client to

progress in each of the ten antecedents. The researcher was then required to use the

information gathered in these forms to form the basis of what was to be explored in this

study.

2.5 Data Collection Procedure

All of the data required for this study was extracted from the Functional Analysis forms, as

the information needed for this study was all included in these forms. The procedures that

were followed in the data collection process were as follows: 1) contact was made with The

Cornmarket Project, 2) A meeting was set up with a senior member of staff in order to

25

discuss the purpose of the study, 3) informed consent was signed and permission was sought

to collect data, 4) the researcher was given access to the Functional Analysis Forms, 5) desk

research commenced. The researcher spent three days in the addiction service, they assessed

and explored each Functional Analysis from on-by-one, and then, using this information, they

were able to fill out the 60 Data Collection Forms accordingly. Each piece of gather

information through the Data Collection forms was manually entered into a Microsoft Word

document. The final procedure which took place was the entering of the data (categorised

into each research question) into a Microsoft Excel spreadsheet where graphs and charts were

used to present the findings.

2.6 Data Analysis

The data analysis process for this study was completed using the data which was extracted

from the Functional Analysis forms during the data collection procedure. The information

from the 60 data collection forms was transferred into a Microsoft Word File. All of the data

was grouped into each of the different categories according to the research questions. All of

the data was then inputted into a Microsoft Excel Spreadsheet where it was used to represent

the findings made by the researcher by way of graphs and charts. By entering the data into a

Microsoft Excel spreadsheet, the data analysis process was made a lot more proficient and it

also allowed the researcher to morph all of the results into answers for each of the research

questions in an explicit and easy-to-read manner.

2.7 Ethical Considerations

An agreement was drawn up by the researcher which both parties then signed. Considering

the nature of this study, the main ethical consideration which had to be made was

confidentiality. Within the addiction service (The Cornmarket Project), confidentiality had to

be secured and maintained for everyone with any links to the data which was used in this

study. To do this, all data was stored under a number and could only be accessed by the

researcher through a password-protected laptop. As part of their initial assessment (first

engagement) within the service, clients agree to their information being used at a later date in

order to improve the service and to alter specific aspects of the service so this is how

informed consent was granted by the Cornmarket Project as all clients had previously given

26

their consent. The clients’ names were not written or mentioned anywhere in the study. In

order to further maintain optimal confidentiality and privacy, this desk research was always

and only inside the Cornmarket Project premises under the supervision of a senior employee.

All forms used were coded (by numbers) to protect anonymity and no forms were printed or

transferred digitally to another storage device nor did they ever leave the office of the

addiction service throughout the entire duration of this study. All information extracted and

entered into the data collection forms left the addiction service premises stored under a

number (not a name) on a single password-protected laptop. The Microsoft Excel file and

Microsoft Word file containing the anonymous information were also be kept on the same

password-protected laptop. All digital information (Microsoft Word and Excel files) will be

deleted and all physical information (Data Collection forms) will be shredded under the

supervision of a senior staff member following this study.

27

Chapter 3: Results

The information regarding sixty clients was used for the purpose of carrying out this study.

All information was extracted from Cornmarket Functional Analysis forms and inputted into

sixty different data collection forms, each one representing sixty clients based in the typical

addiction service setting during the years 2015 and 2016, all of which were picked at random.

The results present the findings of this study which are all based on the five research

questions. The results are broken into five sections and represent all of the findings made in

relation to each of the research questions.

3.1 Profile

The profile of the client base includes gender, age, whether or not they have/had an addiction

history in the past and who they were referred to the addiction service by.

Figure 1: Gender profile of service users.

60%

40%

Gender

Male Female 9 7

10 10

6 8

5 5

02468

1012

Gender

Male Female

Figure 2: Gender profile of each low-

threshold group.

29

Figure 3: Profile- Age of service users. Figure 4: Ages by each low-threshold group.

Figure 5: Profile- Previous addiction

service engagement.

18-25 30%

26-35 23%

36-50 32%

50+ 15%

Age (Years)

18-25 26-35 36-50 50+6

1 2

9

4 5

2 3 3

7 8

1 2 2

3 2

0

2

4

6

8

10

Age (Years)

18-25 Years 26-35 Years 36-50 Years 50+ Years

9 8 7 9

6 7 8 6

0

5

10

15

20

Previous/Additional Addiction History

Yes No

Figure 6: Additional history by each low-

threshold group.

30

8 6

12

3 4

1 1

11

2

6

0 1 1

2 2 0

02468

101214

Referred to the Service by:

Self Probation GP HSE

Figure 7: Previous engagement with this service.

Figure 8: Who the service

users were referred by.

Figure 9:

Referral of each

low-threshold group.

55%

45%

Previous/Additional Addiction History

Yes No

49%

28%

15%

8%

Referred to the Service by:


7

9

7 7

8

6

8 8

5

7 7 7

0

2

4

6

8

10

1 2 3 4

Previous Addiction Service Engagement

Yes No In The Cornmarket Project

31

3.2 Service Usage

These results show the uptake of the various addiction service programmes. It simply

shows what services are being used the most and the frequency of the usage. This

heavily depends on each low-threshold population. Although, most

programmes/treatments are beneficial to each low-threshold population.

Figure 10: Service Programme Usage

Figure 11: Service Usage- Low-threshold group 1

7

9

0 1

3

3

14

HOMELESSNESS- SERVICE USAGE

11

13

1 2 3

2

8

ALCOHOL DEPENDENCY-

SERVICE USAGE

21%

28%

2%

8%

7%

9%

25%

Addiction Service- Programme Usage

Group Therapy One-to-One CounsellingOutpatient Anger ManagementAcupuncture/Mindfulness Employment Training (CE Scheme)Drop-in

Figure 12: Service Usage- Low-threshold

group 2

32

Fig

ure

13:

Service Usage- Low-Threshold group 3

3.3 Dropout Rates

This section presents the dropout data. In order to find the number of clients who have

dropped out of treatment prematurely, the incomplete forms had to be identified. This

means that the staff member who was working alongside the client could not complete the

form due to his/her early disengagement from the service. The number of those who

dropped out was then compared to the number of clients who completed treatment or

continued to engage until the programme(s) had finished.

Dropped out of

the Service

13%

Adhered to

Service Treatm

ent 87%

Dropout

7

10

1

4

3 4

8

SUBSTANCE MISUSE-SERVICE USAGE

7

10

0

5

2 4

8

ANTI-SOCIAL/BEHAVIOUR

AL ISSUES

Figure 14: Service Usage- Low-

Threshold group 4

33

Figure 15: Dropout Percentage

Figure 16: The number of clients who dropped out in each low-threshold group

Figure 17:

Dropout

Percentage-

Gender

Figur

e 18:

2 3 2 1

13 12 13 14

0

5

10

15

Dropout

Dropped out of the Service

Adhered to Service Treatment

62%

38%

Dropout Population- Gender

Male Female

25%

25% 37%

13%

Dropout Population- Age

18-25 Years 26-35 Years

36-50 Years 50+ Years

50%

0%

25%

25%

Dropout Population Referred to the Service

by:


62%

38%

Dropout Population- Do they have an Addiction

Service History?

Yes No

34

Dropout Percentage- Age

Figure 19: Dropout Percentage- Referred by…

3.4 Adherence Rates

Here, the actual adherence rates are displayed. Figure 21 outlines each programme which the

addiction service provides for clients. With regards to each programme, the number of clients

who met the adherence requirement rate is explored (different for most of the programmes,

e.g., group therapy typically lasts for approximately 8 weeks).

Figure 20: Dropout Percentage-

Addiction History

35

Figure

21: Number of clients who adhered to service criteria vs dropped out of the service

Addiction Service

Programme

Number of

Clients who

Engaged in

the

Programme

Met the

required

Adherence

Rate (%)

Dropped

Out of

Programme

(%)

Group Therapy 32 87.5% 12.5%

One-to-One Counselling 42 90.5% 9.5%

Outpatient 2 50% 50%

Anger Management 12 91.67% 8.33%

Acupuncture/Mindfulness 11 90.9% 9.1%

Employment Training

(CE Scheme)

13 84.6% 15.4%

0 5 10 15 20 25 30 35 40

Group Therapy

One-to-One Counselling

Outpatient

Anger Management

Acupuncture/Mindfulness

Employment Training (CE Scheme)

Drop-in

Adherence v Dropout Rates

Pro

gram

me

Programmes- Adherence v Dropout

Adherence Dropout

36

Table 1:

Shows

the number of clients who engaged and the % of clients who dropped out or adhered to

service criteria for each of the addiction service programmes.

3.5 Effectiveness of the Addiction Service

The clients work closely with one member of staff who tracks their progress throughout their

engagement with the service. The member of staff along with the client, scores each aspect of

the clients life (antecedent) at the start of treatment and again at the end of their treatment.

This allows the researcher to compare score and determine whether an improvement has been

made with regards to each of the 10 antecedents. A total of 8 clients dropped out of the

service prematurely. Because of this, their results could not be included as they did not

complete their treatment, thus, there was no way to find out whether they made any

improvements regarding the 10 antecedents. This leaves a sample of 52 clients.

Drop-in 38 86.85% 13.15%

37

Figure 22: The number of clients who showed improvements & those who showed no

improvement/stayed the same in relation to each of the addiction service programmes

Effectiveness of Service- Antecedents

Each antecedent is scored out of 10 at the start of the client’s treatment, again at varying

intervals of their treatment depending on how long they have spent engaging with the service

and at the end of the client’s treatment within the addiction service. Each antecedent is scored

but the client themselves along with a member of staff who works closely with them.

Together they discuss the topic of the antecedent and score it. The lower the score, the worse

the clients feels they are performing in that aspect of their life. For instance, a particularly

low score in the accommodation antecedent might mean that the client has become homeless

or is currently struggling to pay rent and is at risk of eviction. In order to measure whether the

client has made any improvements to their lives, this study compared the scores the client

provided at the start of treatment to the scores that were provided at the end of treatment. By

doing this, the researcher was able to accurately determine whether the treatment was

effective as the information was not only based on the views of a staff members but also the

clients themselves. Below, each antecedent will be described and for each low-threshold

population, it will be determined which antecedents were most improved or unimproved.

24 25 23

26

17

22 23

18

26

16

28 27 29

26

35

30 29

34

26

36

0

5

10

15

20

25

30

35

40

No

. of

Clie

nts

Antecedent

Effectiveness of Service Programmes

Improved in this area post treatment Remained the same/did not improve post treatment

38

Accommodation- this antecedent is designed to measure the client with regards to their

home/living environment. It measures whether the client has stable living conditions which

they can afford.


accommodation antecedent.

Drug and Alcohol Misuse- This antecedent measures how the client is performing in terms

of drug and alcohol use. Depending on the addiction that the client is treating, this score will

vary. For instance, a client who is a heavy user of a Class A drug such as Heroin may score

themselves lower if they feel they are using the drug less frequently lately. However, if

someone is seeking treatment for a drug addiction and they are using the drug far less

frequently in comparison, they may score themselves a high mark if they have used it more

than the already little amount than they usually would. It all heavily depends on each

individual, but it still provides accurate information as it will still determine whether there

was an improvement for each of the clients with regards to their own drug or alcohol misuse.

3

5 6

10 11

7 7

3

0

2

4

6

8

10

12

Accommodation

Improved Post-Treatment

Did not Improve/Stayed the same

39


drug & alcohol misuse antecedent.

Financial Issues & Debt- Like most of the 10 antecedents, this one is moderately self-

explanatory. This antecedent related to how financially stable the client is. They will score

poorly on this antecedent if they are in debt or owe a sum of money to someone. Conversely,

the client will score highly if they are financially stable and have little or no circumstances in

the near future that may change this.


financial issues & debt antecedent.

4

6

10

5

10

6

3

8

0

2

4

6

8

10

12

Drug & Alcohol Misuse



4 5

4

10 10

7

9

3

0

2

4

6

8

10

12

Financial Issues & Debt



40

Training Employability- This antecedent is based on whether the client has a job or not, is

ready for employment or is even seeking or interested in seeking employment. A lower score

indicates a lack of interest in seeking employment and a high score indicates a high interest in

potential employment or the client currently has a stable job.


training employability antecedent.

Attitudes & Cognitive Style- This antecedent refers to the client’s attitude, the client’s way

of thinking and also the level of optimism or negativity the client possesses in relation to

his/her life/addiction. Portraying negative thoughts and beliefs regarding his/her addiction

and/or treatment progress will lead to a low score. A high score will mean that the client is

optimistic and adamant to make positive changes to their lives and responds well to others.

7 6

5

8 7

6

8

5

0123456789

Training Employability



4 4 4 5

10

8 9

8

0

2

4

6

8

10

12

Attitudes & Cognitive Style



41


attitudes & cognitive style antecedent.

Offending Behaviour- This antecedents refers to the level to which the client engages in

criminal/offending behaviour whether they have been in trouble with the law or not. This

addiction service is a private and confidential environment, however, if the client has

engaged in a particularly high-scale negative behaviour where either they or another person is

at risk then it is reported to the required services.


offending behaviour antecedent.

Relationships & Family Issues- This antecedent is scored in relation to the client’s

relationships with their partner or family members. It also refers to whether there are any

existing issues present within their relationships which may affect the client in a negative

manner.

8

2

8

4

6

10

5

9

0

2

4

6

8

10

12

Offending Behaviour



42


relationships & family issues antecedent.

Lifestyle & Associates- The scoring of this antecedent is based on the lifestyle which the

client leads and also who they associate with (i.e. their peer group). If the client leads a

lifestyle or associates with certain individuals which had a negative impact on them/their

addiction, then they are given a low score. A high score will reflect an attempt by the client to

improve their lifestyle and associate themselves with more positive figures in their lives.


lifestyle & associates antecedent.

Anger & Emotions- This antecedent refers to the level of anger the client possesses. It is

also scored in their emotions and whether they are predominantly positive or negative

6 6 5

6

8

6

8 7

0123456789

Relationships & Family Issues



7

4 4 4

7 8

9 9

0123456789

10

Lifestyle & Associates



43

focused. A client will have low score for this antecedent if they have a hard time processing

anger and other negative emotions. A high score, though, will reflect a client who is able to

and actively processes his/her own anger and other negative emotions into positive emotions

and thinking.


anger & emotions antecedent.

Pro-social Activities- This antecedent is scored in relation to any pro-social activities the

client engages in. These activities must be based around the aim of helping others. Examples

include charity work, volunteer work or simply helping out others such as friends, family and

neighbours. A high score shows that the client is eager to or is currently participating in pro-

social activities and a low score reflects the opposite, were the client shows no interest in

taking part in any pro-social activities.

8 8

6

4

6

4

7

9

0123456789

10

Anger & Emotions



6

3 4

3

8 9 9

10

0

2

4

6

8

10

12

Pro-Social Activities



44


pro-social activities antecedent.

Chapter 4: Discussion Chapter

4.1 Discussion

The research questions outlined prior to the collection of data for this study were carefully

constructed and designed in order to make the findings in the data collection process relevant

to the title and aim proposed by the researcher for the purpose of this study. Each one of the

research questions were then adequately represented within the data collection procedure

through the designing of the data collection forms. This form was split into 5 separate

categories. Each category acting as a representative for all of the research questions and then

given an overarching term, they were as follows: 1) Profile, 2) Service Usage, 3) Dropout

Rates, 4) Adherence Rates, and 5) Effectiveness of the Addiction Service. All of the findings

made in this study were gathered from a single addiction service. The findings were extracted

from records regarding sixty clients (chosen at random). The information and results gathered

throughout the process of this study are findings from an addiction service in Ireland and act

as a representation of a ‘typical’ population sample for a study of this nature. This study was

conducted using quantitative data in order to accurately assess the addiction service, unlike

the work of Neale et al. (2014), who used qualitative data (focus groups) in order to compare

the addiction recovery in terms of the service users’ view and the service provider’s views

(Neale et. al., 2014). Both styles are useful in carrying out an assessment of an addiction

service, however, with this addiction service and information at hand, the use of quantitative

data was chosen for this study.

The ‘profile’ section aims to explore who uses this addiction service and was based around

the following variables: age, gender, previous addiction service engagement, their addiction

history and who they were referred to the service by. The term ‘service usage’ is used to

explain and show which programmes are most often used within the service and by whom

(e.g., the difference between each low-threshold population group and the programmes they

engage in). Almost self-explanatory, the sections labelled ‘dropout rates’ and ‘adherence

rates’ simply display the rates of dropout in comparison to adherence rates. Furthermore, both

populations (dropout population and those who adhered to service requirements/completed

treatment) were also explored separately. Finally, the ‘effectiveness of the addiction service’

ties all of the information together by measuring whether the addiction service helped to

45

improve the lives of the clients’’, this is based on 10 antecedents. These antecedents are a

drug-use term which are split into 10 life circumstances or aspects which are known to be

typical influential factors of future drug use or other addiction behaviours (Fergusson, Boden

& Horwood, 2008). In this addiction service, these 10 antecedents are explored and scored by

the client and a member of staff, collectively, prior to their engagement with the service and

also following the clients’ respective treatment(s). Links between all of these categories were

deemed important and relevant by the researcher in order to adequately and accurately fulfil

the aim of this study which is to explore the profile, usage, adherence and dropout rates and

effectiveness of a typical addiction service for low-threshold populations in Ireland.

Research Question 1: What is the profile of the service users defined as low-threshold

populations in a typical addiction service in Ireland?

The profile of the clients/addiction service users is very much split. Of the sixty clients

included in this study, 60% (or 36) were male, meaning that 40% of the sample population

was made up of female clients. Each of the low-threshold population groups were well

represented by both genders with 9 males and 6 female clients making up the substance

misuse group, the alcohol dependency group differed as the majority was made up of female

clients, but only just. This group included 7 males and 8 females. In the other 2 low-threshold

population groups (homelessness and anti-social/behavioural issues), male clients dominated

both groups, with each group made up of 10 males and 5 female clients (a ratio of 2:1). The

ages of the population sample used in this study was split into four categories: 1) 18-25 years,

2) 26-35 years, 3) 36-50 years and 4) 50 years and over. Clients aged between 36-50 years

made up 32% of the population sample, this was followed by clients aged between 18 and 25

which made up 30% of the population, leaving clients aged between 26 and 35 making up

23% of the population and those aged 50 and over with 15% of the sample population.

Additionally, 55% of the entire population sample used in this study have a history of

addiction service usage. This means that they have attended an addiction service before. This

may have been a different addiction service to The Cornmarket Project (the addiction service

being assessed in this study). However, most of the clients who have attended an addiction

service before did attend The Cornmarket Project. This means that 45% of the clients in this

study were at this time, attending an addiction service for the very first time. When exploring

the profile of the service user within an addiction service in Ireland, it is important to

examine who they were referred to the service by. The findings were particularly interesting

for this study as they portray the fact that most clients attending this addiction service

46

actually referred themselves. To put this into perspective, Cunningham & Breslin (2004),

reported that only 1 in every 3 individuals who struggle with an alcohol dependency (a group

who represent a quarter of the sample population in this study) actually seek treatment for it

(Cunningham & Breslin, 2004). This, not only highlights the need for addiction services but

also the need to assess the current addiction treatment practices in order to make them more

appealing options for those who struggle with an addiction. In this study, 49% of the clients

were engaging in the addiction service by themselves, i.e., they chose to attend of their own

accord. The Probation Service referred 28% of the clients to the service, this means that these

clients had gotten into trouble with the law regarding a crime which may have been drug-

related, alcohol-related or an issue involving a degree of anti-social behaviour. The rest of the

clients were then referred to the service by their local GP’s (general practitioner) or the

Health Service Executive (HSE), both representing 15% and 8% of the population sample

respectively. Others ways in which clients may be referred to an addiction service is via

Needle Exchange Treatment Centres, Satellite Clinics and Community Support Clinics

(Health Service Executive, 2016). However, none of these applied to any of the service users

included in this study. These results may differ to similar research carried out in the past as

there are a lot of different variables such as the actual addiction service itself, the location of

the addiction service, the size of the addiction service and so on. However, these results

simply act as a representation of the profile of addiction service users in a typical addiction

service in Ireland. Examining the profile of the addiction service users is important as it

forms the basis for a comprehensive assessment of an addiction service.

Research Question 2: What is the difference in programme usage among the various

low-threshold populations within an Irish addiction service setting?

The second part which this study explored was the topic of service usage. Here, the

researcher sought to explore which of the programmes within the addiction service was most

used and by which low-threshold population. The programmes (or types of treatment) which

this addiction service offers to clients includes group therapy, one-to one counselling,

outpatient (a client engaging out of the service premises, usually from their homes), anger

management, acupuncture/mindfulness, employment training (known as CE Schemes) and

drop-in. The usage rates of these programmes is widespread. Of the sixty clients used in this

study, 28% of them availed of the one-to-one counselling treatment, 25% engaged in the

drop-in programme, 21% availed of the group therapy treatment option, 9% of the clients

took part in the employment training programme, 8% availed of the anger management

47

programme, leaving 7% of clients engaging in the acupuncture/mindfulness programme and

2% of the clients availing of the outpatient treatment option. The programme most used by

each of the low-threshold population groups was the one-to-one counselling treatment

programme except for the homelessness low-threshold group, who mostly availed of the

drop-in service programme.

Research Question 3: What are the rates of and reasons for dropout among the various

low-threshold populations in a typical Irish addiction service setting?

The third part which this study looked at was dropout rates. While examining the

information, some of the data regarding the clients was incomplete. This means that the staff

member who was working with the client could not complete the functional analysis form for

that client as they had dropped out of the addiction service prior to the completion of their

treatment. According to Schulte, Meier, Stirling & Berry (2010), improving assessment

procedures is important in addressing the link that exists between dropout and co-morbidity

but it could be argued that assessment is important in addressing the link between dropout

and any other variable associated with an addiction service such as the profile of service

users, addiction service programmes and so on (Schulte, Meier, Stirling & Berry, 2010). Of

the sixty clients assessed in this study, 13% had dropped out (8 clients). According to

Brorson et al. (2013), it is more likely that a patient will drop out of addiction treatment as

opposed to completing (Brorson et al., 2013). However, the results of this study prove the

opposite.

Two of the clients who dropped out of the service came from the substance misuse low-

threshold population, 3 of the clients were alcohol dependent, 2 were engaging in the service

due to homelessness and 1 client was engaging in the service due to anti-social/behavioural

issues. Of the clients/service users who dropped out, 62% were male and 38% were female.

This did not come as a surprise as 60% of the entire population sample was made up of male

clients, meaning that it was likely that males would also dominate the dropout rate figure,

purely due to sample size. Similarly, with regards to the ages of those clients who dropped

out, 37% were aged between 36 and 50 years which was also unsurprising given that fact that

this age group made up the majority of the population sample also. The age groups of 18-25

years and 26-35 years each made up a quarter (25%) of the clients who dropped out leaving

clients aged 50 years and over making up 13% of the drop out figure.

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Also examined in terms of the clients who had dropped out of the service, is who those

clients were referred to the service by. Of the clients who dropped out, 50% were referred to

the service by themselves, 25% of the clients were referred to the service by their GP’s and a

further 25% were referred to the service by the HSE. This means that none of the clients that

had prematurely dropped out of the addiction service were referred by the Probation Service.

This is unsurprising as those clients who were referred by The Probation Service were

required by The Probation Service to meet the adherence rates for their treatment as part of

their engagement with the addiction service, meaning that those particular group of clients are

less likely to drop out of the service. With all other modes of referral (HSE, GP’s & self-

referral), there is a much higher chance of dropout due to the nature of their referral being

based around choice. With all referral modes, except referral via The Probation Service, the

client essentially made the final decision to actually attend and engage with the addiction

service. Finally, with reference to dropout rates, 62% of the clients that dropped out of the

service had attended an addiction service before and 38% of the clients hadn’t actually

attended an addiction service prior to this instance. It could be said that, perhaps this might

mean that the clients had not gotten the benefits they had expected they would by engaging

with an addiction service. Conversely, it may also mean that they had negative experiences

with an addiction in the past (they felt that the treatment didn’t work) and this instance of

addiction service engagement showed signs of proving the same. With regards to the clients

who dropped out and were engaging with an addiction service for the first time, it may be

suggested that they simply did not like the service or staff members or felt that it wasn’t

working and prioritised something else instead of continuing to attend the service (i.e. other

addiction treatment options such as rehabilitation, detoxification, etc.).

When assessing dropout rates in an addiction service, the researcher is essentially trying to

find out why client’s drop out. A number of factors may be responsible for this such as

relapse, family issues, relationship issues or other commitments such as their occupation.

However, this information is often next to impossible to obtain as if the client has stopped

attending/dropped out, the service cannot work with the client to assess why he/she has

dropped out. This essentially means that all an addiction service can do is explore what

factors may be responsible for dropout rates, factors such as the ones assessed in this study,

for example, age, gender and previous addiction service history.

Research Question 4: What are the rates of adherence for each addiction service

programme within an Irish addiction service setting?

49

Naturally, the topic to explore following dropout rates within an addiction service was

adherence rates. Lack of or non-adherence/compliance is a serious health issue we face in

today’s society (Vermeire, Hearnshaw, Van Royen & Denekens, 2001). For the purpose of

this study, adherence rates were explored in relation to each of the treatment programmes

which the service offers: 1) drop-in, 2) employment training, 3) acupuncture/mindfulness, 4)

anger management, 5) outpatient, 6) one-to-one counselling, and 7) group therapy. For each

of these programmes, the rates of adherence (i.e., how many clients within each low-

threshold population group met the adherence requirement for each of the programmes) are

compared to the rates of drop out from the service. As the one-to-one counselling, drop-in

and group therapy programmes were the programmes most used by clients, it comes as no

surprise that these programmes have the highest level of adherence. It is important to mention

that only 50% of the clients availing of the ‘outpatient’ treatment option actually met the

required adherence rate. There was only a small number of clients (2) actually availing of this

programme who were included in this study but it is an important statistic nonetheless. Those

clients who were engaging in the outpatient programme are largely engaging with the service

from their own homes. A member of staff usually calls to the client’s home in order to allow

the client to tackle their addiction from home, without actually having to physically present

themselves before the service. Given this fact, it could be argued that they do not receive the

same degree of treatment as others who physically engage with the service as they do not

avail of the other programmes on offer such as drop-in, where they can approach a member

of staff if they are struggling with something such as a an addiction trigger for instance or

they feel like they are going to relapse into their habit/addiction.

However, these results largely make for good reading for addiction services in Ireland as in

all programmes (except for the outpatient programme), the level of clients who met the

required adherence rates and continued to engage with the service programmes greatly

outweighs the rate of those who dropped out of the service. If the rate of adherence was

particularly low for one or more of the addiction service programmes then it might suggest

that the programme should be altered or changed in order to raise the adherence rates and in

turn, lower the dropout rates from that particular programme(s). Lowest adherence rates were

recorded in the outpatient programme (50%), the employment training programme (84.6%),

followed by the drop-in programme (86.85%). With the employment training programme, the

main goal is to teach the client new skills which will aid them in seeking permanent or even

part-time employment. So, if the client is offered a job, it is their decision as to whether they

50

will take it or not. Additionally, the staff at the cornmarket project often sets up work

experience for the clients engaging in the employment training programme. All of these

factors may influence the adherence rates. Also, regarding the drop-in programme, this in

entirely voluntary, unless the client is waiting for an appointment for one of the other

programmes. The clients who come into the drop-in area are required to record this in a ‘sign-

in’ book. While in the drop-in area, the clients are often seeking advice or guidance from a

member of staff and it is seen as a prime opportunity for staff members to assess how the

client is feeling or behaving. They may then engage in a carefully monitored group

conversation or may avail of the telephone or internet services. Adherence rates for this are

largely distorted or altered by clients who actually have completed some treatment

programmes or have stopped engaging with the drop-in service in order to avail of one of the

other services instead. All of the rest of the programmes are well represented by the groups of

clients who adhered to the programmes, thus, suggesting that these programmes are seen as

useful and beneficial to the clients. Finally, in relation to adherence rates, the entire group of

clients who adhered to the programme they engaged in were assessed. Each of the low-

threshold population groups were well represented here with 27% of the group made up of

anti-social/behavioural issues clients, the homelessness group and substance misuse group

each making up 25% of the group each followed by the alcohol dependency group making up

the last 23% of the group of clients who adhered to service treatment.

Once the profile of the client’s/addiction service users, service programme usage, dropout

rates and adherence rates are assessed and explored, the final section to assess is the

effectiveness of the service, in other words, how effective is the service/does the service

work?. In order to explore this, the Cornmarket Project Functional Analysis forms were

used as a very useful tool in this study. These forms included 10 antecedents which the

clients were measured on (1)accommodation, 2) drug & alcohol misuse, 3) financial issues &

debt, 4) training employability, 5) attitudes & cognitive style, 6) offending behaviour, 7)

relationships & family issues, 8) lifestyle & associates, 9) anger & emotions and, 10) pro-

social activities) . These antecedents were designed to cover each aspect of the client’s life

and are scored in order to assess where the most focus needs to be applied by staff members

working closely with each client. Each client is given a score out of 10 by themselves along

with a member of staff, this process was carried out at the beginning of the clients treatment

and again at random intervals followed by one last time at the end of the client’s treatment. In

this study, the scores for each client at the beginning of their treatment were compared to the

51

scores they reported for each antecedent at the end of their treatment. By doing this, the

researcher was able to assess whether the client had made any improvements across the 10

antecedents (i.e., the score they were given at the end of their treatment had improved

compared to the score they got prior to the beginning of their addiction treatment), thus,

exploring the effectiveness of the addiction service.

Research Question 5: How effective is a typical Irish addiction service for addressing

issues of addiction?

To determine the effectiveness of any service but, in particular, an addiction service, a

comprehensive evaluation or assessment of an addiction service must be carried out. The

effectiveness of an addiction service is based on its ability to determine whether current

practices have the ability to create lasting symptom remission for its service users (McLellan,

2002) and it is the role of the addiction service assessment to explore this. For the purpose of

this study, findings regarding the effectiveness was broken down into the 10 individual

antecedents and then further broken down into each of the four low-threshold population

groups. It is important to mention that the clients who dropped out of the service, could not

be included in this section of the study as their functional analysis forms were incomplete and

therefore, could not me measured. Finally, the clients’ whose scores did not improve or

remained the same may not equal an ineffective service treatment. It may simply mean that

they either had high scores to begin with for that antecedent (it wasn’t an issues or problem

for them). It may also mean that their scores were less post-treatment, meaning that either the

service was ineffective for them or the programmes they engaged in did not suit them or their

addiction.

The first antecedent which the effectiveness of the service is measured on is accommodation.

Interestingly, those clients in the homelessness group showed the most improvement with 10

clients reporting an improved score. This is an important finding as the antecedent which one

would imagine applies most to the homelessness group is accommodation. Conversely, only

3 clients from the anti-social/behavioural issues population group showed an improvement

while 5 alcohol dependency clients and 6 substance misuse clients improved after their

treatment. In the drug & alcohol misuse antecedent, 6 clients in the alcohol dependency

population group showed an improvement while 10 clients in the substance misuse group

showed an improvement. This is a particularly interesting finding as it may point to the fact

that this particular addiction service may be more beneficial to those with a substance misuse

52

issue rather than an alcohol dependency issue. In the other 2 low-threshold population groups

(homelessness and anti-social/behavioural issues), the majority of the clients showed no

improvement or their scores stayed the same post-treatment.

Moving onto the third antecedent, financial issues & debt, the majority of clients in each low-

threshold group remained the same or did not improve with the exception of the

homelessness group, where 10 out of 13 clients showed an improvement in this antecedent. In

the training employability antecedent, the number of clients who improved was the same as

those who did not improve or stayed the same for the groups of anti-social/behavioural issues

and alcohol dependency. The majority of the clients in the substance misuse group did not

improve/stayed the same while most of the homelessness group expressed an improvement

again. The evidence so far would suggest that this particular setting (an addiction service)

proves to be quite effective for homeless individuals. Across all four of the low-threshold

groups, most of the clients showed no improvement in the attitudes & cognitive style

antecedent.

The results of the offending behaviour antecedent is a mixed as only 2 clients in the alcohol

dependency group and 4 clients in the homelessness group showed an improvement post-

treatment. However, the majority of clients in the substance misuse and anti-

social/behavioural issues group showed an improvement. This finding is particularly

interesting as the majority of those engaging with the service in the anti-social/behavioural

issues group were referred by The Probation Service. This means that they had gotten into

trouble with the law for their offending behaviour so the fact that most of the clients in this

group improved in the offending behaviour antecedent means that the service is effective in

that respect. The antecedent of relationships & family issues does not apply directly to any

one of the low-threshold groups as it may affect any of the clients attending an addiction

service. In this study, a generous portion of clients from each low-threshold group showed an

improvement post-treatment, 6 clients improved in the anti-social/behavioural issues, alcohol

dependency and homelessness groups while 5 clients had improved scores post-treatment in

the substance misuse group. In the lifestyle & associates and pro-social activities antecedents,

the majority of all clients did not have improved scores post-treatment or their scores

remained the same. The final antecedent which the effectiveness of the service was measured

on was anger & emotions. Most of the clients in both the anti-social/behavioural issues and

alcohol dependency groups had improved their scores for this antecedent while 6 substance

misuse clients and 4 homelessness clients reported an improvement post-treatment.

53

4.2 Limitations

As this study was carried out using information gathered by staff members of an addiction

service, it was essentially an assessment of second hand research. As study of this kind then

means that there is an increased likelihood of slight inaccuracies in the findings due to human

error. Staff members filing out the Functional Analysis forms in The Cornmarket Project may

have unintentionally written or forgotten to write some potentially important information.

Furthermore, although much care was taken, there is always a slight chance of human error

on the part of the researcher where they may have extracted or neglected to extract some

information for the purpose of filing out the data collection forms. Also, this study included

sixty service users’ from one addiction service in the south east of Ireland, a larger study

which consists of an assessment of multiple addiction services and a much larger sample size

might prove more useful for future research and studies. The inclusion of multiple addiction

services not only in Ireland but also internationally would prove results and findings on a

much larger scale, thus, potentially proving much more useful in the future. Similarly, a

larger population sample would include much more service users, thus, making the study a

much larger-scale, comprehensive piece of research. Finally, when assessing an addiction

service, the researcher must rely on the service users’ providing accurate information about

themselves. Due to worries about confidentiality and a potential lack of trust in the service or

its staff may lead to service users’ information being filtered in order to protect themselves.

Although each of the service users’ were assured of full confidentiality prior to their

engagement with the addiction service, there is always the chance that they may feel

threatened or obligated to provide only some information. This depends on a lot of variables

such as their age, the treatment stage and their level of trust in the service and its staff and

would, in turn, have an effect on the results of this study.

4.3 Conclusion

In conclusion, there are many reasons as to why addiction service assessments are helpful.

According to McGovern et al. (2006), an assessment of an addiction treatment service is

useful as it has the ability to produce quick and accurate estimates of key factors such as

prevalence, barriers to certain practices and current practices (McGovern et al., 2006).

54

Another reason for carrying out an assessment of any service but in particular, an addiction

service, is to improve the quality of the service. According to Wisdom et al. (2006), in order

to achieve the prioritization of measurement, collection and analysis of data within an

addiction service with the view to making improvements is to provide adequate resources,

train the staff members accordingly and to share important results found in different addiction

services (Wisdom et. al., 2006). This study was carefully designed and carried out in order to

provide results which may be beneficial to not only this addiction service but also, other

addiction services nationwide.

4.4 Implications

The implications of the findings made in this study are abundant. The purpose for most

studies similar to this one is to gather information which will be useful for future research in

the areas of addictions, addiction service users’, drop out, adherence to treatment and also,

the improvement of current practices in current addiction services. Furthermore, the findings

made in this study are potentially useful to the addiction service which was assessed as it

provides results which are specific to that service and may be used in the future with the aim

of exploring which programmes are and are not working and where more attention needs to

be applied in order to provide a comprehensive and functional addiction service (e.g., which

low-threshold populations are experiencing less positive results from and reactions to

treatment).

4.5 Recommendations

Research like this study is particularly useful as it allows addiction services to use the

findings to their advantage in order to alter and change their services with the aim of

improving their service for its users’. Some useful recommendations include 1) using a large

population sample across multiple addiction services. This would facilitate a much larger-

scale study which would mean that the findings are more relevant to more addiction services.

2) Perhaps, gathering some first-hand information might be useful as it decreases the

likelihood of human error being present, however, doing this can be tricky due to potential

ethical complications. 3) Along with quantitative data, some qualitative data may also be

useful along with it, for example, interviews. Interviewing not only addiction service users

55

but also, addiction service staff members potentially opens the door to more insightful and

interesting information which could be used in a study. 4) The use of the 10 antecedents was

useful in carrying out this study as it was used as a way to calculate the effectiveness of this

study. Looking more in-depth into each of these antecedents might pave the way for future

researchers in the area to further explore how addiction services are can be

effective/ineffective in successfully treating its users’.

Chapter 5: References

Addiction, (2014). Top 10 Addictions in 2014: Sex Makes The List. Retrived:

19/10/2016, URL: https://www.addiction.com/4249/sex-among-top-10-addictions/

Albert Family Wellness, (2016). What is Addiction? Retrieved: 18/10/2016, URL:

http://www.albertafamilywellness.org/what-we-know/what-is-addiction

Ashton, H., Nodiyal, A., Green, D., Moore, B., Heather, N. (2009). Acupuncture or

counselling: outcomes and predictors of treatment choice in a non-statutory addiction

service. Journal of Substance Use, 14(3–4): 151–160.

Brorson, H. H., Arnevik, E. A., Rand-Hendriksen, K., & Duckert, F. (2013). Drop-out

from addiction treatment: A systematic review of risk factors. Clinical psychology

review, 33(8), 1010-1024.

Cunningham, J. A., & Breslin, F. C. (2004). Only one in three people with alcohol

abuse or dependence ever seek treatment. Addictive behaviours, 29(1), 221-223.

Drug and Alcohol Helpline, (2016). Types of Drug and Alcohol Services in Ontario.

Retrieved: 05/11/2016, URL:

http://www.drugandalcoholhelpline.ca/Search/ServiceTypes

Fassino, S., Pieró, A., Tomba, E., & Abbate-Daga, G. (2009). Factors associated with

dropout from treatment for eating disorders: a comprehensive literature review. BMC

psychiatry, 9(1), 67.

http://www.albertafamilywellness.org/what-we-know/what-is-addiction

http://www.drugandalcoholhelpline.ca/Search/ServiceTypes

56

Fenton, M. C., Aivadyan, C., & Hasin, D. (2013). Epidemiology of Addiction.

Principles of Addiction: Comprehensive Addictive Behaviours and Disorders, 1, 23.

Fergusson, D. M., Boden, J. M., & Horwood, L. J. (2008). The developmental

antecedents of illicit drug use: evidence from a 25-year longitudinal study. Drug and

alcohol dependence, 96(1), 165-177.

Galanter, M., Kleber, H. D., & Brady, K. (Eds.). (2014). The American Psychiatric

Publishing textbook of substance abuse treatment. American Psychiatric Pub.

Good Therapy, (2012). Who Is Most Likely to Drop Out of Therapy and Why?

Retrieved: 03/11/2016, URL: http://www.goodtherapy.org/blog/why-clients-drop-out-

therapy-0809123

Gossop, M., Marsden, J., Stewart, D., Lehmann, P., Edwards, C., Wilson, A., &

Segar, G. (1998). Substance use, health and social problems of service users at 54

drug treatment agencies. Intake data from the National Treatment Outcome Research

Study. The British Journal of Psychiatry, 173(2), 166-171.

Health Service Executive (2016). Addiction Service. Retrieved: 01/11/2016, URL:

http://www.hse.ie/eng/services/list/5/addiction/

Health Service Executive, (2011). Definition of Drug Misuse. Retrieved: 01/11/2016,

URL: http://www.dtcb.ie/faq/article.asp?FID=58&T=F

HRB National Drugs Library (2009). National Drugs Strategy (interim) 2009-2016.

(Report No. 4736). Dublin. Department of Community, Rural and Gaeltacht Affairs

Lopez-Goni, J.J., Fernandez-Montalvo, J., & Arteaga, A. (2011). Addiction Treatment

Dropout: Exploring Patent’ Characteristics. The American Journal on Addictions, 21:

78-85.

Martin, L. R., Williams, S. L., Haskard, K. B., & DiMatteo, M. R. (2005). The

challenge of patient adherence. Ther Clin Risk Manag, 1(3), 189-199.

McGovern, M. P., Xie, H., Segal, S. R., Siembab, L., & Drake, R. E. (2006).

Addiction treatment services and co-occurring disorders: Prevalence estimates,

treatment practices, and barriers. Journal of Substance Abuse Treatment, 31(3), 267-

275.

http://www.dtcb.ie/faq/article.asp?FID=58&T=F

57

McLellan, A. T. (2002). Have we evaluated addiction treatment correctly?

Implications from a chronic care perspective. Addiction, 97(3), 249-252.

McLellan, A. T., Woody, G. E., Metzger, D., McKay, J., Durell, J., Alterman, A. I., &

O'Brien, C. P. (1996). Evaluating the effectiveness of addiction treatments: reasonable

expectations, appropriate comparisons. The Milbank Quarterly, 51-85.

Neale, J., Tompkins, C., Wheeler, C., Finch, E., Marsden, J., Mitcheson, L., & Strang,

J. (2015). “You’re all going to hate the word ‘recovery ‘by the end of this”: Service

users’ views of measuring addiction recovery. Drugs: education, prevention and

policy, 22(1), 26-34.

Orford, J., Velleman, R., Natera, G., Templeton, L., & Copello, A. (2013). Addiction

in the family is a major but neglected contributor to the global burden of adult ill-

health. Social Science & Medicine, 78, 70-77.

Oslin, D. W., Pettinati, H., & Volpicelli, J. R. (2002). Alcoholism treatment

adherence: older age predicts better adherence and drinking outcomes. The American

Journal of Geriatric Psychiatry, 10(6), 740-747.

Peloquin, C. A. (2002). Therapeutic drug monitoring in the treatment of

tuberculosis. Drugs, 62(15), 2169-2183.

Psychology Today, (2016). What is Addiction? Retrieved: 04/11/2026, URL:

https://www.psychologytoday.com/basics/addiction

Robertson, E. B., David, S. L., & Rao, S. A. (2003). Preventing drug use among

children and adolescents: A research-based guide for parents, educators, and

community leaders. Diane Publishing.

Robertson, E. B., David, S. L., & Rao, S. A. (2003). Preventing drug use among

children and adolescents: A research-based guide for parents, educators, and

community leaders. Diane Publishing.

Ryall, G., & Butler, S. (2011). The great Irish head shop controversy. Drugs:

education, prevention and policy, 18(4), 303-311.

Schulte, S. J., Meier, P. S., Stirling, J., & Berry, M. (2010). Unrecognised dual

diagnosis–a risk factor for dropout of addiction treatment. Mental Health and

Substance Use: Dual Diagnosis, 3(2), 94-109.

https://www.psychologytoday.com/basics/addiction

58

Simon Community, (2016). About Homelessness. Retrieved: 01/11/2016, URL:

http://www.simon.ie/Homelessness/Homelessness.aspx

Swift, J. K., Greenberg, R. P., Whipple, J. L., & Kominiak, N. (2012). Practice

recommendations for reducing premature termination in therapy. Professional

Psychology: Research and Practice, 43(4), 379.

The Rise Foundation, (2017). Facts about Addiction. Retrieved: 21/03/2017, URL:

http://www.therisefoundation.ie/facts-about-addiction

Tucker, J. A., Vuchinich, R. E., & Harris, C. V. (1985). Determinants of substance

abuse relapse. In Determinants of substance abuse (pp. 383-421). Springer US.

Vermeire, E., Hearnshaw, H., Van Royen, P., & Denekens, J. (2001). Patient

adherence to treatment: three decades of research. A comprehensive review. Journal

of clinical pharmacy and therapeutics, 26(5), 331-342.

Walsh, C., MacMillan, H. L., & Jamieson, E. (2003). The relationship between

parental substance abuse and child maltreatment: findings from the Ontario Health

Supplement. Child abuse & neglect, 27(12), 1409-1425.

Wexford Local Development, (2016). The Cornmarket Project. Retrieved:

03/11/2016, URL: http://www.wld.ie/programmes/the-cornmarket-project/

Wilbourne, P. L., & Miller, W. R. (2002). Treatment for alcoholism: Older and wiser?

Alcoholism Treatment Quarterly, 20(3-4), 41-59.

Wisdom, J. P., Ford II, J. H., Hayes, R. A., Edmundson, E., Hoffman, K., & McCarty,

D. (2006). Addiction treatment agencies’ use of data: A qualitative assessment. The

journal of behavioural health services & research, 33(4), 394-407.

World Health Organisation, (2016). Management of Substance Abuse: Dependence

syndrome. Retrieved: 16/10/2016, URL:

http://www.who.int/substance_abuse/terminology/definition1/en/

World Health Organisation, (2016). Management of Substance Abuse: Facts and

Figures. Retrieved: 18/10/2016, URL: http://www.who.int/substance_abuse/facts/en/

http://www.simon.ie/Homelessness/Homelessness.aspx

http://www.therisefoundation.ie/facts-about-addiction

http://www.wld.ie/programmes/the-cornmarket-project/

http://www.who.int/substance_abuse/terminology/definition1/en/

http://www.who.int/substance_abuse/facts/en/

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Chapter 6: Appendices

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Appendix A

Data Collection Form

Section 1: Profile

1. Start date:____________

2. Gender: Male Female

3. Age:_____________ (18-25 26-35 36-50 50+)

4. Low-threshold population/group: Substance misuse Alcohol dependency

Anti-social/behavioural issues Homelessness

5. Additional history: Drugs Alcohol Homelessness

Anti-social/behavioural issues Other None

6. Previous addiction service engagement: Yes No

(In cornmarket: Yes No)

7. Personal Struggles:

Accommodation: Yes No

Drug and Alcohol Misuse: Yes No

Financial Issues and Debt: Yes No

Training Employability: Yes No

Attitudes and Cognitive Style: Yes No

Offending Behaviour: Yes No

Relationships and Family Issues: Yes No

Lifestyle and Associates: Yes No

Anger and Emotions: Yes No

Pro-social Activities: Yes No

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8. Referred to the service by:____________

Section 2: Service Usage

1. Service Programmes the client has engaged in:

Group Therapy (Harm Reduction) One-to-One Counselling Outpatient

Anger Management Acupuncture/Mindfulness Employment Training

Drop-in Other

2. Choice: Yes No

3. Finishing Date:_____________

Section 3: Dropout v Adherence (Effectiveness of service/programmes)

1. Did the client dropout (leave treatment prematurely): Yes No

2. Incomplete form: Yes No

3. Reason for dropout stated: Yes No

Section 4: Actual Adherence Rate

1. Did the client meet the required adherence rate for:

Programme Yes No

One-to-One Counselling

Outpatient

Anger Management

Acupuncture/Mindfulness

Employment Training

Drop-in

Other

Group Therapy

Section 5: Effectiveness

Antecedent Start Score End Score Improvement

(Yes/No)

Accommodation

Drug & Alcohol misuse

Financial Issues & Debt

Training Employability

Attitudes & Cognitive Style

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Offending Behaviour

Relationships & Family

Issues

Lifestyle & Associates

Anger & Emotions

Pro-social Activities

Appendix B

Research Clearance Form

Approval has been granted for the research methodology outlined by

_______________________ (student) and clearance has now been given for the research to

proceed.

Signed: (Advisor)

Note: All students who wish to test or measure human subjects should supply the Physiology

Lab Technician (Bruce Wardrop) with a signed copy of this form and the approved

methodology. Failure to comply with these requirements may result in disciplinary action as

well as a failed grade.

Student’s signature

………………………………………………

Date…………………………………………

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Appendix C

Permission to Collect Data

Title of Study: An exploration of an Addiction Service in Ireland.

Purpose of the Study

The aim of this study is to explore the profile, usage, adherence and dropout rates and

effectiveness of a typical addiction service for low-threshold populations in Ireland. The steps

involved include:

1. The collection of data using already gather data regarding 60 clients/addiction service

users.

2. Using this data to create a database of accurate results.

3. Writing up and displaying results which will be based on five concepts: 1)The profile

of service users, 2)Addiction Service programme usage, 3)dropout rates, 4)Adherence

rates and 5)the effectiveness of the service.

The Addiction Services Role

Provide access to the information of its service users. As part of the ethical considerations for

this study, a supervisor must be present during the data collection procedure.

Note: All ethical issues have been considered and full privacy/confidentiality will be

maintained for all service users included in this study.

I______________________ as a senior member of staff in The Cornmarket Project,

Wexford, agree to take up the role of supervisor for this study and provide permission to the

researcher to use data gather by The Cornmarket Project.

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Signed: ____________________________________ (Addiction Service staff member)

Signed: ____________________________________ (Researcher)

an exploration of an addiction service in ireland

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