Agency
West Milwaukee Comprehensive Treatment Centers which is under Acadia HealthCare umbrella is located in West Milwaukee within Milwaukee County. West Milwaukee Comprehensive Treatment Centers provide medically assisted treatment with the use of Methadone and Suboxone. Moreover, the clinic provides both individual and group therapy which is aimed at addressing emotional and psychological challenges which are as a result of opioid addiction. The clinic staff consists of a medical director, nurses, medical assistant, program director, two clinical supervisors, and nineteen clinicians whose work is to ensure the patients are able to achieve their treatment objectives. The program is aimed to make a profit as well as generating revenue from managed health care but some patients who seek the facility’s services are self-sponsored. I enjoy working at the clinic due to the diverse population this facility hosts in addition to the fact that I like observing the transformation process of the patients as they stop using opiates. Furthermore, the program focuses on more than the pharmacotherapy and works to improve psychosocial ramifications surrounding addiction. In addition, the patients here get most of their psychological support in group sessions which are usually organized in this facility.
Program Elements and Problems
The West Milwaukee CTC program currently serves two hundred and fifty-nine patients in the outpatient clinic setting. The patients are aged from 18 to 70 years and they have been diagnosed with the severe opioid disorder. Moreover, 45 % of these patients are diagnosed with co-occurring diagnosis (Mood Disorder, Bi-Polar, and PTSD). When patients come into the program they are usually given assessment and intake by one of the therapists to determine the level of the impact by the opioids. The intake process is usually vigorous and challenging for both the staff and patients because the majority of these patients are usually going through withdrawal symptoms at the time of the admissions. The patient is first given a urinal analysis and electrocardiography (EKG) and later seen by the doctor before starting their first dose of methadone which is aimed at helping with the withdrawal symptoms. These withdrawal symptoms usually come as a result of an individual stopping the use of opiates since the body system has been programmed to have opiates doses at set intervals. The client is initially given a small dose of methadone which is usually 30 milligrams which are meant to help alleviate the withdrawal symptoms. The patient is then closely monitored over the next thirty days while trying to reach an optimal therapeutic dose which will ensure that the patient recovers fully from the addiction. The dose will continue to get adjusted until they are at a therapeutic dose and no longer experiencing withdrawal symptoms.
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Moreover, during the induction phase, the patient will meet with their therapist once a week for an individual session. During the session, the therapist checks on the patient’s psychological wellbeing, withdrawal symptoms, and work on building a therapeutic relationship with the client which will be built upon over time. Once the patient reaches the optimum therapeutic dose of methadone he or she is expected to stop all illicit drug use, attend individual therapy sessions, and have the option to attend group sessions. The program requires all patients to attend at least one individual therapy session per month. However, a patient has an option of attending more than one session which is usually available based on the patient need or as the counselors deem fit in the intended intervention steps.
Group therapy is usually available on four days a week which is optional and the individual patient has a choice of attending it which is, however, possible to patients who have seen the benefits of the intervention programs. Sadly, only 7% of the patients utilize the groups at West Milwaukee Comprehensive Treatment Centers which can be attributed to the continued use and abuse of illicit drug despite the efforts applied to reduce it. Failure of the patients to attend these group therapies poses a risk for such patients to being discharged from the program which means that the society will continue the negative social effects that come with continued use of opioids by its population. Group therapies in Milwaukee Comprehensive Treatment Centers are usually conducted from 0700 hours to 0900 hours on Mondays and Tuesdays and 0900 hours to 1200 hours on Wednesdays and Thursdays at the clinic precincts. The groups consist of Relapse Prevention, AODA Education, Art therapy, and Living Sills.
Patients are no longer in the induction phase once they reach a therapeutic dose but are usually in the first phase of the program and can take their Sunday dose at home since it is believed that they are on their way to recovery. Consequently, at this stage patients are expected to stop all illicit drug use and attend individual sessions without being pushed although the majority of the patients may have stopped opiate use but otherwise continue to use illicit drugs (e.g. cocaine, benzodiazepines, and marijuana). The program requires patients who continue in the use of illicit drugs, to make efforts to continue attending the group sessions as an intervention strategy to help them stop the use of these drugs altogether. The intervention groups aimed at completely ridding the patients of any substance abuse are mainly facilitated by mental health and substance abuse counselors specially trained in this area. The groups catering for substance users in the intervention methods or approaches vary from one group to the other but a unifying factor is that all these groups use cognitive behavior therapy to make interventions. The intervention groups are mainly intended to give patients physiological support, teach them coping and living skills as they work on their addictive behavior.
These patients in Milwaukee Comprehensive Treatment Centers live in Milwaukee County with 60 percent of them living on the South side of Milwaukee with the majority of these patients are being Caucasian. These patients have different economic backgrounds as well as different education levels which makes dealing with them to be quite an uphill task since all these differences have to be factored in while choosing intervention strategies. Opiate addiction has many negative impacts on the community as a whole such as increased crime spread of blood borne diseases and high unemployment rates all of which burden the society. Research findings indicate that Milwaukee has at least 500% increase in overdoses since 2012 which can be considered to be extreme and which definitely comes with a lot of negative implications in the community. Although the use of heroin in the United States appears to have declined significantly in recent years since the 1970s which witnessed the highest rates, (SAMHSA, 2007). The rates of heroin usage have in contrast according to Substance Abuse and Mental Health Services Administration (2007) increased in quite a significant way from 2005 to 2006.
Purpose of the Evaluation/Research Question
The purpose of this evaluation is to determine whether the patients that attend group therapy may have a better quality of life than the patients who do not attend these group sessions. The evidence from multiple studies’ shows that the most effective Methadone Treatment Clinics are the ones that offer comprehensive treatment services for their patients. The important components of a comprehensive program are medical care, treatment for substance use, counseling as well as support (Kreek et al., 2010). In this study, I will examine the effectiveness of group therapy within the program by measuring the quality of life of the patients attending group therapy and the quality of life of patients who do not attend group therapy. The evaluation will be a valuable tool for determining the extent to which the program is meeting its set objectives of improving program delivery. Furthermore, this study will help the policy makers to determine if group therapy is effective and if it is employed across the various treatment centers. Is the program having positive long-term outcomes for the society? Examples of these positive outcomes that are long-term include reduced morbidity as well as mortality caused by dependence on opioid, reduced crime rates and reduced economic and social costs of dependence on opioid (Kreek et al., 2010).
The research question for this evaluation will be as follows: Is group therapy at West Milwaukee Comprehensive Treatment Centers an effective psychological support to improve patient’s quality of life? To answer this research question this evaluation will measure the life quality of the patients attending group sessions and the life quality of patients not attending group therapy. The patient will be required to complete surveys and answer questionnaires aimed at measuring their quality of life (housing, employment, criminality and social improvements). More so, the results of this evaluation will help the involved stakeholders and policymakers to develop a more comprehensive program which is meant to serve the patients in a better manner at the clinic. Furthermore, the evaluation can be a valuable tool since it can prevent potential overdoses among the patients in future and therefore avert the negative implications of such overdoses. Consequently, the patients will eventually have improved outcomes in their overall recovery journey from addiction and be completely rid of any desire to indulge in opioid usage.
Literature Review
There is an abundant amount of research which has been conducted by scholars on methadone treatment programs. Most of the literature and research is based on harm reduction and preventing the spread of HIV which is closely tied to the use of opioids. In this study, I will examine the effectiveness of group therapy and how effectively it helps with the psychosocial aspect and wellness of the involved patients. Psychosocial service and health needs which may be related to addiction in opioid may hamper the success of treatment on the patients who attend maintenance in methadone treatment programs (Pilling, Hesketh & Mitcheson, 2010). Consequently, patients need a comprehensive approach to support their recovery efforts which are the main reason for this program evaluation which will focus on the dynamics which supports the psychosocial supports that are available.
A study by Wu (2009) which was aimed at investigating whether services from other professionals who are outside the program brings about benefits for outcomes in drug treatment outcomes in a sample taken randomly of 356 male patients (N = 356). Each of the participants was then interviewed thrice in a span of 6 months, which was meant to check if progress had been made. Since the study under observation did not use assignment which was random, score in propensity matching the query was used to strengthen the causal validity of the effect estimates. Findings from this investigation supported hypotheses that actual reception of additional services off-site had significant benefits in increasing the probability of assistance from heroin, cocaine and any other use of illicit drug in the following 6 to 12 months period. The Psychosocial treatments are usually considered as vital aspects of any treatment program dealing with substance use as their effectiveness have been proven time and again through intense research. Psychosocial interventions aimed at the treatment of drug and alcohol usually cover quite a wide array the available treatment options and strategies, with different backgrounds theoretically. These intervention strategies are concerned with bringing about changes in a patient’s behaviors in the use of drugs in addition to other factors like emotion and cognition of patients during their interaction with a therapist. ‘The major criterion of efficacy is such that therapy should lead to a reduction, total abstinence and overall improvements in wide range of areas of functioning. These improvements include physical and psychological health and reduction in HIV and hepatitis behaviors considered risky. More so there is usually an improvement in one’s interpersonal relationships, employment and criminal behavior which point towards the overall effectiveness of psychological support at the clinic sessions’ (Jhanjee, 2014). Moreover, these interventions in the psychosocial domains may be employed in various treatment areas as independent kinds of treatment or combined with pharmacological strategies. These treatment options may be conducted individually or in groups which are mostly done by qualified health workers. These psychosocial treatments according to Jhanjee (2014) can either be brief in nature or intensive as well as specialized aimed at producing results both in short term and long term respectively. Consequently, psychosocial treatments are usually considered as the basis for both drug and alcohol treatment mostly for the drugs where the use of pharmacological treatment has not been evaluated significantly.
Psychosocial interventions which have been used regularly in assisting individuals recovering from substance use can be classified into various categories. Low-intensity intervention is a category which represents interventions that are conducted by the key workers and the interventions are aimed at reducing substance misuse. A staff member in this kind of intervention usually acts as a facilitator especially in the common health problems of the mind (Pilling, Hesketh & Mitcheson, 2010). More so the low-intensity interventions are aimed at supporting and treating in behavior emanating from drug use and aims at reducing the harm of these drugs On the other hand high-intensity interventions are the formal therapies which are conducted by a psychological therapist who is a specialist in a specified institution. These high-intensity interventions are usually aimed at dealing with drug misuse and are care-planned, evidence-based in addition to being conducted by practitioners who are competent with adequate training as well as supervision (Pilling et al., 2010).
A study which was conducted by Perreault et al. (2010) had two objectives of evaluating the relationship that existed between the perceived improvement in a patient as well as that patient’s satisfaction with the intervention strategies and the evaluation of the psychometric properties of Perceived Improvement Questionnaire (PIQ). In this study, 232 patients in a maintenance methadone treatment program got involved in the task of filling out questionnaires in addition to two questions which were open-ended meant to measure improvement in substance use as well as their satisfaction level with the intervention options that were provided in the institution. Three subscales of the Perceived Improvement Questionnaire that analyzed social relations, emotional physical health were put out to the patients (Murphy, Herman, Hawthorne, Pinzone & Evert, 2000). Most clinics are usually mandated with the responsibility of ensuring and conducting patient satisfaction surveys in order to establish the effectiveness of their programs. The clinic I will be evaluating is required to complete client satisfaction surveys in order to be CARF accredited.
An evaluation by Cox (2002) featured a “shared care” methadone program which was carried out in North Wales in the United Kingdom. The evaluation was meant to determine the effectiveness of the perceiver with the actual outcomes of a program conducted in Northern parts of Wales. This study mainly developed four versions of the same questionnaires for each group with a sole aim of determining the level of intervention and its impact on the patients whether positive or negative consequences of a reduction in methadone doses or total withdrawal and the advantages and disadvantages of intervention programs. Moreover, this program was designed for two years which was considered to be the adequate time necessary to get effective results reflecting the real impact of the intervention program (Cox, 2002). The results which were based upon the program evaluation revealed to a great extent the program was quite successful in spite of identification of some gaps within the program which can be considered normal in any trial. These gaps are very important since they help inform the researcher on areas to consider if he or she was to conduct a similar research within a similar program. In addition to the stated gaps, it was noted that the professionals involved in the study had poor communication with the patients they were treating which further hampered the effectiveness of the intervention program. More so, the satisfaction questionnaires were given to the patient with an aim of identifying the gap which would be quite useful in the planning and implementation of future intervention programs. In addition, there was the use of qualitative evaluation which was conducted in order to check out on areas where improvement would be required and for measuring the actual success of the intervention program (Cox, 2002). In conclusion, the researchers involved in that specific study were able to use the collaborative approach which was very useful since it gave more comprehensive findings that could be useful in future studies.
Research Design
The study will engage in a quasi- experimental design with one group pretest-posttest design (O1X O2) utilizing a mixed method of qualitative and quantitative designs. Quasi-experimental design in research is usually very similar to the true experimental design, but participants are not assigned to groups in a random manner (Mertens, 2010). Quasi-experimental design, however, attempts to find out a cause-and-effect relationship as well as demonstrate the connection that exists between the intervention strategies and the outcomes of those interventions. This quasi-experimental study will, in turn, explore the impact of group therapy on the concerned patients (IV). The patients (DV) will be giving a Quality of Life measurement scale initially before attending group therapy and again after attending group therapy which will be useful in the determination of the effectiveness of the intervention program (Mertens, 2010). As a result, the researcher will be able to come up with findings and conclusions in additions to recommendations for further research as well as intervention programs in the future.
Factors that tend to threaten the internal validity of the test are inadequate material for the group, as well as inadequate support from outside the group which would probably compromise the validity of the intervention program. Patients may also not attend group on a regular basis or may actually drop out of the program eventually which would compromise the effectiveness of the intervention program. In addition, the patients may not fully engage in the group but only attend to stay in the program for the sake of it without giving it much thought on why they are there and how they stand to benefit from this program (Vanagas, Padaiga, & Subata, 2004). The education levels of the patients are different which may cause some patients to have a hard time in comprehending group material which may further hamper the effectiveness of this program. Furthermore, the time allocated for the group's sessions may compromise group attendance since these are usually the hours that most individuals would be doing productive work in their places of work. This may, therefore, mean that one may have to get a leave or stop working or studying altogether in order to attend these sessions which do not seem feasible in the long run. All these threats to the validity of the program make it more difficult for the researcher to exhaustively and objectively generalize the study’s findings.
Logic Model
West Milwaukee Comprehensive Treatment Centers is a program which is mainly designed to help patients who struggle with opioid addiction. The program d not only focuses on alleviating the withdrawal symptoms of the patients it admits but also in helping these patients with the needed psychological support for correcting behaviors in order to achieve long-term recovery. The following logic model illustrates the ultimate outcome for participants. Figure 1 Logic Model .
Figure 1. Logic Model
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Measuring Tool 3
This study will use Quality of life (QoL) which is an assessment of the outcomes of maintenance of certain treatment interventions on the functioning of the addict and their well-being. According to Burckhardt & Anderson (2003), QoL is a valid and reliable measurement tool which can be effectively used in the measurement of the quality of life from a patient’s perspective and can be used across different cultural gender and language groups. QoL measuring tool has become a necessary measurement tool in health interventions outcomes appraisal. In addition, it helps provide a meaningful explanation of the impact of the interventions put in place just in case the patients are not cured completely (Burckhardt & Anderson, 2003). The quality of Life concept typically reflects the perception which is mostly subjective of addicts functioning and well-being which pertains to emotional, physical and social aspects in addition to the patient’s everyday life activities (Blome & Augustin, 2015). QoL measurements are increasingly being incorporated into pharmaceutical trials in order to give real- time results and findings.
The aim of the QoL evaluation is going past the perceived severity and perception of disease symptoms or side effects of treatment, through an examination of how addicted patients experience and perceive their effects on their lives. This information may be used by both the drug-addicted patients and clinicians to make decisions in treatment since there is nothing as important as basing the decision on the drug-addicted patient’s own Quality of Life assessment (Blome &Augustin, 2015). QoL is defined as e-assessment which is subjective on the impact of a disease and treatment across the psychological, physical, social and somatic aspects of an individual’s well-being and functioning. QoL moreover has an advantage in that it can be responsive to changes as per the specific treatments programs; its adaptability makes it a reliable measurement tool.
The researcher aims at self-administering QoL through the completion of questionnaires in West Milwaukee Comprehensive Treatment Centers or through emails to the patients who are almost done for the rehabilitation program. In addition, QoL assessment can be done through interviewing the patients who are involved in the treatment interventions which can either be oral or written interviews. Consequently, this task can be completed within 5 minutes which makes this measurement tool to be very reliable since the researcher can get immediate results (Burckhardt &Anderson, 2003). The researcher will then add the scores from each item in the QoL assessment to get the total tally of this measurement tool. According to Burckhardt & Anderson (2003), the Quality of Life scores usually ranges from 16 which is the lowest to 112 which is the highest. Ultimately a higher score reveals a higher quality of life with a lower score indicating a lower quality of life. As a result, this measurement tool can be very important in giving the researcher valid and reliable results which in turn will help evaluate if the program is beneficial to the patients.
Sample Size/Strategy
The researcher has the option of using experimental or quasi-experimental research design which should consist of 21 participants per group under study (Mertens, 2010). The sample size for this study will be 20 participants (n=20) which according to the researcher is a good representative sample of the total patients under the program in this institution. The sample will be comprised of those patients who are receiving group therapy as an intervention strategy to help them deal with substance use. The sampling strategy which will be used in this study is stratified sampling and convenience sampling where the selection of the practice to be evaluated and the sample for the study was selected partly based on its availability (Mertens, 2010).
This type of sampling is considered effective especially in the initial exploration of the research setting as well as when conducting a pilot study to determine the anticipated shortcomings. However, this sampling technique has a limitation in that it is unable to generalize findings and is highly susceptible to bias and sampling errors (Pandey & Pandey, 2015). The researcher then needs to incorporate this sampling strategy with stratified sampling. Stratified sampling will help the researcher categorize the research participants into two categories. The first category is the patients who attend group therapy and the second category is the patients who do not attend group therapy. The advantage of stratified sampling is the fact that the results can be generalized and has less bias and subjectivity (Pandey & Pandey, 2015). On the other hand, stratified sampling has a weakness since only one variable can be measured at a time
Each of the members of the group will then proceed to complete a consent form (Appendix A) once referred and then complete a QoL scale individually once referred to group therapy by their primary counselor which will be present. The members will then fill out the scale at 3 months and again at 6 months for comparison for posttest to find out their progress.
The members of the group under study will consist of 16 Caucasian males between the age of 22-40 and 4 Caucasian females aged 26-30. All of these members are diagnosed with the opioid disorder by certified substance abuse counselors so they qualify for the study. The risk for eventual use of opiate disorder may be related to family, individual, social or environmental factors (Kindler et al., 2013). Diagnostic criteria for opioid use disorder perform well across many race and ethnic groups which make a neutral kind of finding without objectivity and bias. All the members of the group under study live on the Southside of Milwaukee in economically challenged neighborhoods which mean that they display similar characters and the findings may not have greater variations. The group may, however, be comprised of some patients who have been forced into group therapy in contrast to patients who are in therapy out of their own willingness which in its own may present some challenges. Furthermore, there may be other support offered to these patients besides the group therapy which is aimed at further enforcing and substituting the already available treatment procedures.
Data Collection
The aim of collecting data in a study is for the sole reason of learning something about the impact of group therapy and treatment on individuals in West Milwaukee Comprehensive Treatment Centers. The specific groups of subjects under this study are patients who are recovering from opioid addiction and who are undergoing therapy and methadone treatment to help in reducing the withdrawal symptoms that they may present at the initiation of the intervention program. Furthermore, the data to be collected in this study will be very vital in the determination of the effectiveness of the intervention programs, strategies and procedures which are employed at West Milwaukee Comprehensive Treatment Centers. All the data for this specific study will be collected onsite at the Comprehensive treatment Centers since the researcher will get first-hand information on the present patients and if need be data can be collected concerning the previous patients. The researcher has the liberty of enlisting help from the health workers in this facility to help him to collect data or they can collect the data by themselve to ensure consistency (Mertens, 2010). This can be very important especially if the researcher would like to compare data across various time periods. In addition, the consent forms will be handed to the patients before the actual data collection begins so that they know what is expected of them beforehand. This prior arrangement will ensure that the researcher readies the respondents to avoid last minute disappointments and delays. If the consent forms are completed on time, the researcher may consider pretest data collection in order to find and seal loopholes that may present themselves when it comes to the actual data collection. This pretest may be conducted twice a week at different times of the day say in the morning and in the evening or the afternoon to check for consistency (Mertens, 2010). At this point, the researcher may note down the effectiveness of the treatment in order to use this information at the end of the intervention program in order to check for its effectiveness. Moreover, the researcher may consider post-test data collection once the intervention program is complete from a post-positivist viewpoint where one can get more objective and desirable measures since they tend to rule out biases (Mertens, 2010).
Data Analysis
The data analysis method used for this study is t-test which is used to compare the averages or the means of the various data sets in the study in order to find out if there are statistically significant variations in data outcomes. The use of t-test is very important in this study especially when it comes to comparing the data outcomes so as to establish whether the interventions used have positive outcomes and implications by the use of a comparison group. The datasets used for this study are independent of one another and such kind of unrelated data is usually referred to as independent- sample t-test (Mertens, 2010). The patients QoL measurement scores taken before attending group therapy sessions are to be compared with QoL measurements scores obtained after attendance of group therapy sessions.
References
Blome, C. & Augustin, M. (2015). Measuring Change in Quality of Life: Bias in Retrospective Evaluation. Value in Health, 18 (1): 110-115.
Burckhardt, C.S. &Anderson, K.L. (2003). The Quality of Life Scale (QOLS): Reliability, Validity and Utilization. Health and Quality of Life Outcomes, 2003; 1:60. doi: 10.1186/1477-7525-1-60
Cox, W. (2002). Evaluation of a Shared-Care Program for Methadone Treatment of Drug Abuse: An International Perspective. Journal of Drug Issues, 32 (4), 1115-1124.
Jhanjee, S. (2014). Evidence-Based Psychosocial Interventions in Substance Use. Indian Journal of Psychological Medicine, 36 (2), 112-118.
Kindler, K. S, Jacobson K. C, Prescott, C. A., Neale, M. C. (2003). Specificity of Genetic and Environmental Risk Factors for Use and Abuse/Dependence of Cannabis, Cocaine, Hallucinogens, Sedatives, Stimulants and Opiates in Male Twins. American Journal of Psychiatry 160 (4) 687-695, 2003.
Kreek, M. J. et al. (2010). Pharmacotherapy in the Treatment of Addiction: Methadone. Journal of Addictive Diseases, 29 (2):200-216
Mertens, D. M (2010). Research and Evaluation in Education and Psychology: Integrating Diversity with Qualitative, Qualitative and Mixed Methods, 3rd Edition . Thousand Oaks, CA: Sage Publications.
Murphy, B, Herman, H, Hawthorne G, Pinzone T, Evert H. (2000). Australian WHOQL Instruments: User’s Manual and Interpretation Guide, Report . Melbourne: Australian WHOQoL Field Study Centre.
Pandey, P. & Pandey, M.M. (2015). Research Methodology: Tools and Techniques. Romania: European Union.
Perreault, M. et al. (2010). Relationship between Perceived Improvement and Treatment Satisfaction among Clients of a Methadone Maintenance Program Evaluation and Program Planning, 33(4): 410-417.
Pilling, S., Hesketh, K. & Mitcheson, L. (2010). Routes to Recovery: Psychosocial Interventions for Drug Misuse . London: The British Psychological Association.
Substance Abuse and Mental Health Services Administration. (2007). Results from the 2006 National Survey on Drug Use and Health: National Findings (No. DHHS Publication No. Sma 07-4293). Rockville, MD: Substance Abuse and Mental Health Services Administration.
Wu, E., El-Bassel, N., Gilbert, L., Chang, M., & Sanders, G. (2010). Effects of Receiving Additional Off-Site Services on Abstinence from Illicit Drug Use among Men on Methadone: A Longitudinal Study. Evaluation & Program Planning, 33 (4), 403-409. Doi:10.1016/J.Evalprogplan.2009.11.001.
Vanagas, G., Padaiga Z, & Subata E. (2004). Drug Addiction Maintenance Treatment and Quality of Life Measurements. Medicina, 40 (9): 833-841.
Appendix A
Data Collection Instrument
Appendix B
: Data Collection Instrument
Appendix C: Data Collection Instrument
Appendix D
