OUTCOMES RESEARCH

An evaluation of the maintenance to abstinence (MTA) program in achieving abstinence in opioid users and improving mental health and quality of life

Authors: Madeleine M. Southey, Trent Rees, Margaret Rolfe and Sabrina Pit

The Buttery gratefully acknowledges the support of Mrs Rosemary Warnock who funded this research as part of the John Shaw Warnock Research Grant.

ABSTRACT

Background:

Residential opioid rehabilitation aims to improve the mental health and quality of life of opioid users through abstinence and residential program participation. This study aimed to determine the depression, anxiety, stress and quality of life amongst maintenance to abstinence (MTA) program residents. Secondary study aims were to assess the personal characteristics of MTA clients, addiction and risk taking behaviours, factors associated with program completion, as well as to assess the reliable change in participants’ mental health and quality of life on exit.

Methods:

Retrospective analysis of routinely collected data (2013–2017) from surveys completed by 100 clients. Outcome measures were: Depression, Anxiety, Stress Score (DASS-42), World Health Organisation Quality of Life 8 questions (WHOQOL-8) and Kessler Psychological Distress Scale (K10). Other variables included demographics, drug use, other addictions, aggression, self-harm, suicidal ideation/attempts, and risk taking behaviours. Statistical methods included Chi-square, Fisher’s exact, t-tests, repeated measures analysis of variance and the Reliable Change Index.

Results:

All mean DASS-42, WHOQOL-8 and K10 scores improved significantly in all participants from entry to exit (p < 0.001). The majority of participants demonstrated reliable improvement across all psychometric measures. Completion rates for the MTA program were 51%. Depression (p =0.023), anxiety (p =0.010) and stress (p = 0.015) DASS-42 scores decreased significantly more in completers compared to non-completers. The rate of improvement in mean WHOQOL-8 scores and psychological distress scores (K10) was not statistically significantly different between completers and non-completers over time. There was no significant difference between completers and non-completers on socio-demographics, self-reported drug addiction or risk taking behaviour on program entry, except for suicidal thoughts while intoxicated (p =0.033). Completers were more satisfied with their relationships (p =0.044) and living place (p =0.040) on program entry.

Conclusion:

Overall, completers and non-completers demonstrated improved mental health and quality of life from entry to exit, regardless of program completion. Depression, anxiety and stress reduced more markedly in program completers. Policy makers and programmers could use these findings to further validate their own programs to improve mental health and quality of life of opioid users.

Keywords: Anxiety, Depression, Quality of life, Abstinence, Opioid use, Mental health, Residential rehabilitation, DASS, WHOQOL-8, K10

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