Methadone & Alcohol Reduction & Cessation Project (MARCP)

1. Methadone & Alcohol Reduction & Cessation Project (MARCP) Gavin McPhail Occupational Therapist Addictions Service: North Ayrshire Locality gavin.mcphail@aapct.scot.nhs.uk

2. Aims of Presentation To discuss the Methadone & Alcohol Reduction & Cessation Project as well as the processes involved in planning, organising and running a ‘recovery orientated’ community signposting activity group within North Ayrshire Addictions Services.

3. MARCP Funding Alcohol & Drug Partnership (ADP) Necessary to provide quarterly monitoring reports Aim To provide recovery orientated additional/intensive support for patients receiving methadone script wishing to either reduce or detoxify from this. Inclusion Criteria - Phase 3 (stable and positive in attitude to recovery) - < 30mls methadone (this has now increased to anyone wishing to reduce or detox) - No diazepam script - No severe mental health issues Staff - Charge Nurse (co-ordinator) - Occupational therapist - Project Worker (North Ayrshire Council – Children & Families Social Services)

4. MARCP - Process • Filtering process for project (inclusion criteria met) • Patient lettered with invitation to appt • Joint assessment of need completed (C/N & OT) • COPM & CHRISTO assessment • ? NAC input (children/activity/social) • Provide intensive OT input if need identified • Suitable ? – Moving Forward Group

5. MARCP - Rationale • Similar needs expressed during ax. • Expressing a desire to move forward in recovery journey • Save replication of intervention • Increased care provision • Foot in the door approach • Indirect benefits from attending

6. Group Programme - Aims Introduce local services by facilitating group workshops aimed at increasing patient knowledge of available options through presentations, activity, engagement in bite sized interventions and opportunistic self referral… • Meaningful structure introduced to their day • Access services available to them independently and integrate back into their local community • Increase motivation to change • Increase in occupational participation • Increase in physical activity and personal well-being • Peer to Peer support (addiction/motivation/social) • Significant disparity between post COPM/CHRISTO scores • Patients feel satisfied and supported in their recovery journey

7. Group Programme

8. Group Programme – Information Participants 11 patients (3 male; 8 female) Staff 2 – 3 Staff per group (2 addictions staff + 1 NAC) Location Various Duration 9Weeks Budget £200 Group - Open to both OT and/or MARCP patients - Must attend all workshops/activity groups Transport - Patients to facilitate own transport arrangements - Graded support where appropriate

9. MARCP – Pre Group Preparation Letter sent to every patient who expressed an interest in attending, with group content and structure enclosed Map with individually tailored travel instructions / advice provided Telephone call requesting patients intent to attend Any special requests etc All group members provided intent to attend and declined any assistance with travel

10. MARCP – The Group 11/11 patients gave intent to attend – no special requests made WEEK 1 0/11 patients attended WEEK 2 1/11 patients attended WEEK 3 0/11 patients attended WEEK 4 0/11- group discontinued All patients were contacted after each group. All stated their intention to attend the following week’s group and only 1 requested any support to enable their attendance.

11. MARCP – Post Group Evaluation No formal post evaluation was completed; however, each patient was contacted to ascertain their reasons for non-attendance: - • Did not feel ready to join a group / anxious • Did not wish to mix with previous drug users • Gained employment • Family crisis • Could not be bothered • Town/village rivalry • Time did not suit

12. Evaluation – Organising Group Positive’s √ Opportunity to network with other professionals / agencies√ Increased my knowledge re: available services √ Interagency working Negative’s X Financial restrictions X Lack of suitable venues X Keeping everyone happy (time/availability) X iPatient DNA’s XPersonal experience & knowledge

13. Evaluation – Running Group Positive’s √ Multi purpose Hall with excellent facilities √ Positive experience with and interest expressed by external agencies Negative’s X Attendance X Lack of communication with patients

14. Evaluation – Evaluating Group Positive’s √ Enabled opportunity to reflect on own practice √ Existing contacts etc in place to replicate group Negative’s X Contacting and obtaining feedback from group members X Discontinued OT involvement

15. Hindsight… Evaluation Transportation Therapeutic Relationship Pre Group Visit

16. MARCP – Some Stats Statistics taken between Nov 2011 & Dec 2012 37 Patients 14 patients either : reduced methadone to zero (10), or completed a Suboxone detox (4) 5 / 37 unsuccessful Failed to attend (2), Started using Heroin again (2), or Decided against continuing (1) One patient who started using again has since completed a Suboxone detox 18 / 37 patients are continuing to reduce Total reduction in daily dispensed methadone = 441mls

17. MARCP – Some Stats • 81% of discharges were planned • 100% of patients who completed a pre and post assessment using the COPM improved their overall Performance & Satisfaction scores. Performance Initial - 3.05; Post - 6.73; Increase of >100% Satisfaction Initial - 2.95; Post - 6.52; Increase of >100%

18. MARCP – Some more stats • 82% of patients reduced their alcohol consumption • 100% of patients either demonstrated an Improvement or Stabilised their functioning when measured through CHRISTO assessment

19. MARCP – Patient Satisfaction Questionnaire Results Overall, how would you describe your experience as a user of the service? • I’ve found it to be a great help it has allowed me to change my life for the better which made my families life better. • Great, really friendly and helpful. • Explains things well. • Treated with respect and care. • I found the workers very helpful and very friendly, you can talk to them without them judging you. • Helpful. • Good service for people wanting off methadone. We are generally ignored and only seen once a year. • Everyone was helpful and friendly and went out of there way to help me.

20. MARCP – What Now??? • Funding extended until September 2013. • Now incorporate patients who wish to reduce or detoxify from alcohol. • Anyone can access the programme if they are wishing to reduce their methadone use.

21. Thanks for listening! Any further questions?