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Allison Garcia

on 21 May 2013

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Transcript of ORT

Opioid Replacement Treatment
at Westside Center of Change Description of Program An adult outpatient treatment clinic that is part of ARTS at University of Colorado Denver School of Psychiatry
Arts program aims to reduce death and help individuals to refrain from dying of an addictive disorder (Colorado, 2012).
Opioid Replacement Therapy focuses on pharmacological treatments and psychosocial area
Medicated Assisted Therapy- opioid replacement (methadone)
Individual therapy
Intensive Outpatient and regular group services
UA's Measurements Mission Statement It is the mission of the Addiction Research
and Treatment Services (ARTS) to save lives and improve the quality of life for persons struggling with substance abuse and the dependence, through the application of empirically supported treatments (Colorado,2012).
Westside Center of Change clinic was developed to help individuals with an addiction to substance abuse Population at Westside struggle with abusing opioids such as prescribed pain killers, non-prescribed pain killers and methadone, amphetamines, and heroin.
Demographics of the clinic are made up of 70% Caucasians and 30 % of minorities between the ages of 21-75
Clients are self referred or mandated by social services or the criminal justice system. Population Severity of Opioid Use According to SAMHSA "abuse of prescription pain relievers rose by over 400% from 2.2 % to 9.8% in 2008 (Hartman,2008).
SAMHSA studies show that involvement in medicated-assisted therapies due to pain relievers have tripled since 1998 from 6.8% to 26.5% (Hartman, 2010) Research Question Is there a relationship between Opioid Dependence Treatment at Arts Westside Center Clinic and the change of criminality with opioid users. Research Definitions opioid dependence: 3 of the following and occurring in a 12 month period- Tolerance, withdrawal, substance taken in large amounts and for a longer period than intended, lack of desire or unsuccessful effort to cut down or control opioid use, spending significant time in obtaining opioids, change or reduction of social, occupational or recreational activities, continue to use opioids despite the knowledge of having a physical or psychlogical problem" (Preda &Dunayevic, 2013). criminality: felonies Sample Quanitative design used because it will be focusing on data collection surrounding groups and observations (Royse, et al., 2010)
Data gathered will be done by probability sampling. It is used more frequently when comparing between groups as part of the research (Royse et al., 2010)
Under probability sampling, a specified sampling design known as systematic random sample will be used
This sample selects members from a larger population and starts at a starting point continuing using the same numeral interval
Over 300 methadone clients at Westside
Every 4th member will be selected from 35 sample clients that qualify with opioid dependence and hx of a felony/ies until 15 charts are reached Pre-existing data of criminal activity, attendance of groups and individual sessions, UA color or #, and income will be collected from 15 charts Data Collected Instruments Used Criminal Activity is assessed during intake by the ASI (Addiction Severity Index : the legal section of the ASI obtains information from severity of crime, frequency of crime, current and past convictions ASI also gathers information of current and past employment, as well as yearly income.
Gain information from TX plans updated monthly
Areas include employment, legal, and substance abuse Attendance of group is monitored by counselor of that group. Attendance sheet is given to clients at beginning of group and is placed in a monthly binder after session. Client must stay for the whole 1.5 hr for attendance to count.
Reports of the clients involvements and participation in group are dispersed to client's assigned counselor.
Individual session attendance retrieved from counselor An assign UA # or color is assigned to client at intake.
UA # is given if client is self-referred (UA once a month)
UA Colors are for more than once a month Attendance ASI Urine Analysis Redwood Laboratory gives results back to Westside Center 3-4 business days.
Counselors can retrieve information through Redwood webtoxicology reports via internet.
Reports show of positive and negative substances and within the system for several years Design Pre-experimental design: focuses on a one group pre-test and post-test O X O
Look at data before and during Opioid Replacement Therapy. will be able to depict if there is a relationship of change with criminality with opioid dependent users in ORT. Theory of Change Theory of the problem Time Frame Limitations 1-2 months
300 clients at Westside-gathering information from charts with a hx of criminal activity
webtoxicology reports
group attendance
Most time consuming is individual attendance Charts may not be updated due to Counselors case load
longevity of the client's involvement in Treatment (not focusing on a specific time period)
Age can effect crime involvement and employment
If outside sources influence clients involvement/behavior in program
Determining what groups have a bigger influence- IOP or regular group
Additional diagnoses influence treatment- ex PTSD, Bi-polar, personality disorder
individuals psychological characteristics Individuals who take Opioid like drugs illicitly are involved with the criminal justice system. Research supporting crime involvement while intoxicated or in withdrawal
One study showed results of 95% of 133 inmates being intoxicated with one or more substances as they commited crime. 57 of these crimes were labeled as felonies (Kourie et. al.,199.7) Individuals who take methadone daily and have involvement with the program: negative UAs, consistent attendance to individuals and group sessions, and steady income, are more likely to have a less criminal life. 246 opiate dependent males in methadone treatment 1989-1997: Findings showed antisocial traits, deficient empathy increased violence crimes
study expressed the importance of pro-social treatments along with methadone tx to prevent violent crimes. Clinical national sample of 2694 opioid dependent patients in Germany: findings indicated a decrease in criminal behavior in long term maintenance tx of methadone
A six year followup indicated a high rate of convictions before and during treatment but had a moderate reduction overtime (Soyokoa et. al., 2012)
Important to view how longevity of opioid replacement involvemnt is linked reduction in criminal activity Sample of 3221 heroin users admitted to Opioid Maintenance Treatment between 1997-2003
convictions looked at during the three years prior, during, and after treatment
Findings resulted in crime rates being reduced while participants in OMT compared to before treatment (Havnes, et al., 2012)
Women showed a reduction of crimes during OMT and males who left tx had a higher rate of crime compared to pre-treatment
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