Journeys of Recovery following a Hospital based Alcohol Detoxification Programme Lucy Dorey MPhil/PhD Student

2 ALCOHOL DETOXIFICATION RECOVERY FROM ALCOHOL DEPENDENCE

3 Queen Alexandra Hospital (QAH)

Alcohol Specialist Nurse Service at QAH(ASNS) Those who are identified as at higher risk of alcohol harm are referred to the ASNS (4% of those screened in the hospital). likely to be alcohol dependent increased risk of alcohol related disease e.g. liver disease admitted younger and die younger more admissions and ED attendances 40% require detoxification Westwood et al. submitted 4

500 patients per year who complete detoxification follow two pathways: Portsmouth City 5 Fareham, Gosport & South Eastern Hampshire Twelve months ASNS Health & Recovery Focused Outpatients appointments Twelve months ASNS Health & Recovery Focused Outpatients appointments Referral to Community Alcohol & Drug Services Supported to engage with a range of recovery services One ASNS Health & Recovery Focused Outpatients appointment

Recovery Context 6 Recovery is a Personal Process of Change

Research Questions Is there a difference between the recovery outcomes for alcohol dependent patients following the Portsmouth and Hampshire pathways? What is the process of change in early recovery for this patient group? What treatment and non-treatment factors are seen as initiating, supporting and posing barriers to recovery? 7

Literature Review Literature Review of “post detoxification” and “Alcohol Dependence” 252 Studies screened and 14 identified after critique and exclusions - medical interventions (97), neurological recovery (59), drug and alcohol (70) 8 14 Studies 1 RCT 1 Pilot RCT 4 Quasi Experiments 8 Cohort Studies No Qualitative Studies

9 RETROSPECTIVE ANALYSIS OF ROUTINE DATA Data sources: Alcohol Specialist Nurse Service QAH Patient Administration System Hampshire Health Record Analysis National Drug Treatment and Monitoring System (aggregated) All detoxed patients Mixed Methods Research Design PROSPECTIVE LONGITUDINAL STUDY Data sources: 20 Participants Pathway A 20 Participants Pathway B Purposive selection Interviews and questionnaires: 1 week 3 months 6 months 12 months Statistical analysis comparing pathways Combined Data Analysis Thematic analysis comparing pathways

Semi–structured interviews What changes have you or others noticed since our last meeting? What changes have you been deliberately making or attempting? Can you give me any specific examples of when you did something differently? What changes you have been considering but haven’t acted on yet? What or who has helped you? Anything or anyone else that helped? What or who have been obstacles for you? Anything or anyone else that were obstacles? What does the word “recovery” mean to you? 10

Questionnaires 1.Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) 2.Acceptance and Action Questionnaire for Substance Abuse (AAQ –SA) 3.Values Questionnaire (VQ) Contextual Behavioural Sciences (Hayes et al 2012) 11 Behaviour Towards Valued Living Away from Unwanted Experience

12 RETROSPECTIVE ANALYSIS OF ROUTINE DATA Data sources: Alcohol Specialist Nurse Service QAH Patient Administration System Hampshire Health Record Analysis National Drug Treatment and Monitoring System (aggregated) All detoxed patients Mixed Methods Research Design PROSPECTIVE LONGITUDINAL STUDY Data sources: 20 Participants Pathway A 20 Participants Pathway B Purposive selection Interviews and questionnaires: 1 week 3 months 6 months 12 months Statistical analysis comparing pathways Combined Data Analysis Thematic analysis comparing pathways

13 This study is being supported by: Alcohol Research UK NIHR CLARHC Wessex Portsmouth Hospitals NHS Trust Supervisors: Professor Judith Lathlean Professor of Health Research at the University of Southampton Dr Greta Westwood Head of Nursing, Midwifery and AHP Research/Clinical Academic Coordinator Portsmouth Hospitals NHS Trust and University of Southampton Professor Paul Roderick Professor of Public Health within Medicine at the University of Southampton Acknowledgements