A Process Analysis of Males and Females who Attended a Community Based Addiction Treatment Service: Towards an Expanded Paradigm

A process analysis was conducted in a community - based treatment programme for alcohol abuse. The aims of the study were: to evaluate assessment instruments and measures; to measure change following treatment; to monitor gender differences; to assess the importance of early and current relationships; and to evaluate the effects of therapists. Subjects (n=145, males 83/females 62) completed a semi-structured interview schedule, Severity of Alcohol Dependency Questionnaire (SADQ), Short Alcohol Dependence Data Questionnaire (SADD); General Health Questionnaire (GHQ 12), and Alcohol Problems Questionnaire (APQ). A further three non-standardised self-rated measures were devised by the author. Included was the opportunity to obtain qualitative data. Follow up data was collected at 3, 9 and 15 months following first assessment. The SADD, APQ and consumption measures using detailed drink diaries proved the most relevant assessment measures. Following treatment, there was significant reduction in clients' dependency levels at 3 months, maintained through 9 and 15 months. Key client-rated changes were progress in reducing consumption and alcohol problems leading to a better quality of life and health. Qualitative data augmented these quantitative results. Psychological and acquired cognitive behavioural skills emerged as the main reasons for positive change and the treatment programme was found to have played a significant role in their acquisition. It appears that addressing marital problems can lead to a reduction in alcohol dependency levels. Gender analysis showed that males and females were similar in demographic characteristics, alcohol history details and dependence levels. It was concluded that the differences found did not necessitate different treatment programmes for women. Early family relationships were more problematic for females. Therapist performance varied and that variance was reflected in their clients' outcomes.This resource was contributed by The National Documentation Centre on Drug Use.

Women and Cancer in Ireland: 1994-2001

Although prevention is the primary aim of cancer control, early diagnosis and effective treatment are also central to reducing disability and death from cancer. Research in Ireland and internationally has shown major differences between women in the stage (extent) of their cancer when first diagnosed, in access to screening, and in the type of treatment received. These factors have also been shown to determine the rate of cure of cancers and the length of survival for those not cured. Many countries, including Ireland, have developed cancer policies in the past decade, with the aim of improving access, and ensuring that all cancer patients have appropriate, and evidence-based, treatment. These changes have major implications for women in Ireland, for example in the provision of breast and cervical screening programmes and in the expansion of specialist treatment centres for breast cancer. This is a publication of the Women’s Health Council. Read the report (PDF, 1.37mb) Read the Summary (PDF, 120kb)

Family, Food & Fitness

NHS Warwickshire (NHSW), Warwickshire County Council (WCC) and partners aim to reduce childhood obesity in various ways including through the provision of evidence based structured nine week family based treatment programmes. These programmes will support families with overweight and/or obese children to maintain a healthy weight using a holistic approach. Two types of programmes will run across the county: the first programme will be aimed at families with overweight and/or obese children aged 4-7 and the second programme will be aimed at families with overweight and/or obese children aged 8-13.The target group for participating in this programme is children who are overweight (as defined by > 91st percentile) or obese (as defined by > 98th percentile). Programmes will established and delivered in a variety of venues and times. Objectives: - To deliver evidence based structured family based weight management programmes across Nuneaton, Bedworth and North Warwickshire. - To recruit families with overweight and/or obese children on to programmes, targeting the areas of highest need. - To promote sustained BMI maintenance and reduction amongst overweight (as defined by > 91st percentile) and obese (as defined by < 98th percentile) children and young people aged 4-7 and 8-13. - To support positive changes in behaviour (i.e. healthy eating, physical activity, positive mental well-being) by children and family members in order to achieve and maintain healthy weight over the course of the nine week programme. - To provide families with the information, skills and confidence to maintain healthy lifestyles in the longer term, including personalised exit strategies/sustainability plans for each participant. - To signpost families to community based and leisure services activities which contribute to maintaining a healthy weight. - To evaluate all programmes using the National Obesity Observatory Standard Evaluation Framework (SEF) and to produce a written evaluation report of the programme with recommendations on how to sustain healthy weight among children and families. - To evaluate the programme using validated diet and physical activity tools as recommended by the recent Worcester University (www.ifh.westmidlands.nhs.uk for the Worcester University Report) evaluation. Deliver eight programmes across Nuneaton and Bedworth and eight programmes across North Warwickshire for children aged 4 7 years by December 2012. Deliver eight programmes across Nuneaton and Bedworth and eight programmes across North Warwickshire for children aged 8 - 13 years by December 2012. Deliver a minimum of 32 taster sessions, with at least one prior to each programme start date. Reduce childhood obesity in primary aged children and their families. Improve healthy lifestyles in primary aged children and their families through healthy eating, physical activity and positive mental well-being.

A Grounded Theory Model of the Counselling Referral Process in Primary Care Methadone Treatment in Ireland.

In terms of the treatment of illicit drug abuse, methadone maintenance is a well researched and widely applied systematic response. The approach to primary care methadone treatment in Ireland is based on the methadone protocol. Primary care plays a central role in the delivery of methadone treatment. Beginning with a view that a system evolves within the constraints and influencing factors of its context, the aim of this thesis is to model the process that has developed by which patients on primary care methadone treatment are referred to counselling. It investigates the role primary care practitioners perceive they have in relation to managing the psychosocial aspects of the methadone patient's treatment regime. It analyzes individual medical practitioner counselling referral mechanisms to determine what common processes operate across different practitioners. It identifies the factors that influence the use of counselling on primary care methadone programmes and structures these in a cause/effect model. This research used interviews and documentary analysis to acquire grounded data. The sample consisted primarily of medical practitioners involved in the delivery of methadone programmes. Others closely involved in the implementation of drug treatment in the primary care context made up the balance of interviewees. The study used a grounded theory methodology to induce the process that was latent in the grounded data. Concepts emerging were grouped under the headings of referral factors, decision making factors and factors related to the unique positioning of primary care at the interface between medicine and society. The core finding was that, in primary care in Ireland, there is no psychological model to complement the pharmacological intervention of methadone substitution. The findings from this study offer insight into the factors at work and their impacts, in the context of the use of counselling in primary care methadone treatment. The study suggests a possible direction for further evolution of opiate abuse treatment in Ireland which would transform it from a harm reduction to a holistic patient centric paradigm.This resource was contributed by The National Documentation Centre on Drug Use.

A Study of Alcohol Problems and Marriage from a Treatment Perspective

This thesis is concerned with alcohol problems and marital relationships. It is particularly interested in these dynamics from a treatment perspective. The study addresses theory, research and clinical practice in the field of alcohol problems. It specifically considers these areas as they relate to enhancing understanding of the dynamics between alcohol problems and marriage. The study examines three theoretical paradigms, the disease concept of addiction, behavioural/cognitive behavioural and systems based approaches to understanding alcohol addiction. This provides a multiple theory base from which research in the field and the clinical data collected in the current research is analysed and interpreted. The study reviews research findings that have contributed to the recognition of marital treatment interventions as significant in the alcohol field. It highlights the discrepancies between such research findings and developments in actual clinical practice. In doing so, the study illustrates the gap between theory, research and clinical practice. The need for a more effective framework of information exchange across these areas of activity is identified and a model for better exchange is presented and discussed. This model highlights the importance of including clients' experiences to influence policy, practice, theory and research. In the research, specific attention is focused on the experiences of couples in alcohol treatment. Clinical data is collected from a series of alcohol treatment couples group therapy sessions. The research analysis of the clinical data identifies and extracts concerns as expressed by couples in treatment. Interpretation of these identified concerns or themes is conducted by employing the theoretical constructs of the three selected theoretical paradigms in conjunction with group work theory. On the basis of the findings in this thesis a model for a maritally sensitive assessment framework is developed. The model identifies a number of factors that should be considered in order to enhance appreciation of the interaction between alcohol problems and marital dynamics. This has particular significance for treatment interventions.This resource was contributed by The National Documentation Centre on Drug Use.

Efficacy of Brief Behavioral Treatment for Chronic Insomnia in Older Adults

��Report: Background�� Chronic insomnia is a common health problemwith substantial consequences in older adults. Cognitive behavioraltreatments are efficacious but not widely available. The aimof this study was to test the efficacy of brief behavioral treatmentfor insomnia (BBTI) vs an information control (IC) condition.��Methods�� A total of 79 older adults (mean age, 71.7 years;54 women [70%]) with chronic insomnia and common comorbiditieswere recruited from the community and 1 primary care clinic.Participants were randomly assigned to either BBTI, consistingof individualized behavioral instructions delivered in 2 interventionsessions and 2 telephone calls, or IC, consisting of printededucational material. Both interventions were delivered by anurse clinician. The primary outcome was categorically definedtreatment response at 4 weeks, based on sleep questionnairesand diaries. Secondary outcomes included self-report symptomand health measures, sleep diaries, actigraphy, and polysomnography.��Conclusion�� We found that BBTI is a simple, efficacious,and durable intervention for chronic insomnia in older adultsthat has potential for dissemination across medical settings.����������