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- Research
Projects at the National Addiction Centre
The
National Addiction Centre is involved in a number of funded
projects
which are identified under the headings Planned Research,
Ongoing Research, Recently Completed, Publication and Dissemination
Ongoing, and Past Research. The work of NAC research graduates
and important NAC documents can also be viewed and downloaded
via this
site.
|
| Planned
Research |
Abstinence
vs Moderation in Obesity Treatment: The 'Problem Food'
Study
New
Zealand is in the grip of an obesity epidemic with over 25% of
the adult population registering a BMI =30. The obesity epidemic
is one
of the greatest contemporary challenges facing New Zealanders in
terms of morbidity, cost and intervention effectiveness. People
become obese by eating more than they need, but assisting people
to eat
a little less and exercise a little more with standard psychosocial
treatment has produced limited results. In addition, some foods
(what we call 'problem foods') encourage overeating, especially
in people
with obesity, although this varies amongst individuals. Despite
knowing that 'problem foods' play a role in maintaining obesity,
we do not
yet know what the best advice is to give people about how they
should handle their problem foods. This means that we do not know
whether
it is best to tell people to stop eating their problem foods altogether
(abstinence) or whether we should tell them to cut down on the
amount of their problem foods that they eat (moderation).
In the 'Problem
Food' Study, headed by Professor Doug Sellman, we are investigating
which advice is best to give to people with obesity to help them
lose weight and maintain that weight loss. This is a randomised
controlled trial of 250 obese participants (BMI 30-40) who are
randomised to one of three conditions i) abstinence from problem
foods, ii) moderation of problem foods or iii) wait list (receive
no treatment for six months before being randomised to moderation
or abstinence for six months). All participants receive six months
of active treatment focusing on lifestyle change with support
from a personal health coach. In addition, during that six months
those in the abstinence group will attend Overeaters Anonymous
groups and those in the moderation group will attend Weight Watchers.
Four key outcomes sought are loss of body fat, increased physical
fitness, improved nutrient intake and increased well-being. Recruitment
will commence in 2009.
BACK
TO TOP
|
Ongoing
Research |
Zonnic™ and
Patch (ZAP) Smoking Cessation Study
This three site study, funded by the Health Research Council,
commenced in February 2010. Headed by Professor Julian Crane from
the Wellington School of Medicine, the ZAP study is a randomised
controlled trial of nicotine patch plus Zonnic™ active
nicotine mouth spray compared to nicotine patch plus placebo Zonnic™ mouth
spray. We seek to test the effect on quit rates of giving Zonnic™ plus
standard therapy, using a double-blind randomised placebo design.
As 88% of tobacco smokers are unable to quit with nicotine patches
alone, Zonnic™ may provide a way
for them to quit and stay quit long-term.
All
participants will receive five months of nicotine patch therapy
and six months Zonnic™. Psychological
counselling is provided, using Appreciative Inquiry, in addition
to the NRT. The study has a duration of 13 months with participants
required to make five visits to a researcher at either the University
of Otago (Wellington or Christchurch) or Kokiri Marae in Wellington.
Quit rates at 12 months will be determined by self-report and
verified by biological measures. The trial is being coordinated
by Dr Brent Caldwell in Wellington and Dr Marie Ditchburn in
Christchurch. Any enquiries can be made directly to the ZAP 0800
number: 0800 318 167.
BACK
TO TOP
Treatment
Evaluation of Alcohol and Mood (TEAM) Study
This multi-site
study, funded by the Health Research Council and the Ministry
of Health, commenced in October 2006. Headed by Prof Doug
Sellman, the TEAM study is a randomised controlled trial of
combined
pharmacotherapy for patients with coexisting alcohol dependence
and a major depressive illness. All participants will receive
12 weeks of naltrexone, an anti-craving drug, and supportive
clinical case management over the 24 week course of the
study. Half of the group will be randomised to receive 12 weeks
of
Citalopram, an SSRI antidepressant, and half a placebo.
Participants continue to receive clinical case management for
a following
12 weeks
after the end of the pharmacotherapy phase of the trial. A further
12-month
follow-up
will be conducted.
Additional
funding
is also being sought to investigate genetic and pharmacokinetic factors
in relation to treatment response. Recruitment is currently active
in Whangarei, Bay of Islands, Auckland, Hamilton, Christchurch, Nelson,
Blenheim and Dunedin.
BACK
TO TOP
Moana
House Evaluation Project
Moana
House is a Dunedin-based therapeutic community tailored to
the treatment needs of men with both addiction issues and
offending histories. It has a strong bicultural focus while
also accommodating a range of other cultures and individual
needs. Because of increasing concern at the unmet demand
for substance abuse treatment for offender populations, and
because of Moana House's reputation as a long-standing and
well respected programme working with the more difficult
end of this population, ALAC decided to fund an outcome evaluation
to determine how effective the programme was in achieving
its therapeutic goals and the feasibility of replicating
this treatment model in other locations. The NAC, led by
Dr Simon Adamson, is currently undertaking this evaluation
using a mixed methods approach, combining both objective
measures of residents at intake and change over the course
of treatment and discharge as well as in-depth interviews
with residents about their treatment experience. The evaluation
also involves interviews with a wide range of people involved
with the house: staff, ex-residents, whanau, referrers, funders
and community members. Assessments and interviews are scheduled
to continue through to early 2010, with a final report to
be submitted to ALAC later in the year.
Naturalistic
Treatment Outcome Study - Five Year Follow-up
We are about a quarter of the way through interviews
for this sample of 102 former patients from CADS Hamilton and
CADS Christchurch,
all of whom were interviewed at the time of a treatment episode
in 2000-2001
and again nine months later. Data generated from this study will
provide the best information to date on longer term treatment outcome
for New
Zealand AOD treatment clients, as well as service utilisation patterns.
Funded by ALAC, Dr Simon Adamson is principal investigator.
BACK
TO TOP
Youth
Retention Study
This study, led by Dr Ria Schroder, aims to
identify factors associated with retention or early dropout
from AOD treatment
for youth (ie those aged 14-18 for this study). This is being
investigated by interviewing 140 youth who have attended
AOD treatment services during 2003-2004 in seven centres
around New Zealand, covering residential, day programme,
and outpatient services. This study will also gather valuable
information on the current functioning of these former clients.
To supplement the interviews with youth the study also includes
questioning programme staff in relation to identified youth
and for their general views on factors affecting retention.
Clinical files are also accessed once permission has been
gained.
BACK
TO TOP
Odyssey
Youth Outcome Study
Currently part way through interviewing 80 consecutive
admissions to the Christchurch Odyssey Youth Day or Residential
Programme.
Interviews are conducted at treatment entry, six weeks, 12 weeks,
six months and 12 months. The study will be examining multi-dimensional
treatment outcome, including substance use, mental health, general
health, social functioning, criminal activity and personality
development, as well as gaining the youths' impressions of the
treatment they are receiving. Significant others are interviewed
at baseline, six months and 12 months to gain their views on
the appropriateness of treatment provided, quality of family
relationships and their impression of the youths' current functioning.
This study will also examine factors related to retention, as
well as predictors of outcome. The co-principal investigators
are Professor Doug Sellman and Dr Ria Schroder.
BACK
TO TOP
CUDIT
Revision Study
The
Cannabis Use Disorders Identification Test (Adamson & Sellman,
Drug & Alcohol Review, 2003;22(3):309-15) was developed
as a screening tool for cannabis abuse or dependence. A range
of alternate items are currently being explored to improve
the precision of this measure, led by Dr Simon Adamson and
in collaboration with colleagues from the University of Newcastle,
New South Wales. This study will also measure the test-retest
reliability of the CUDIT and investigate the CUDIT’s sensitivity
to change and therefore its potential as a brief measure
of treatment outcome. The CUDIT is also being employed in
the Odyssey Youth Outcome Study and Youth Retention Study
(see above) where its appropriateness for an adolescent population
will be examined.
BACK
TO TOP
The
Effectiveness of Naltrexone in Reducing the Craving of People
with Pathological Gambling
This randomised controlled trial, which forms part of Dr
Dominic Lim’s PhD work, is testing the effect of Naltrexone
on gambling-related craving and gambling behaviour. It is
nearing the end of the patient recruitment phase and the
preliminary data analysis supports a positive role for naltrexone
in reducing gambling craving and gambling behaviour.
BACK
TO TOP
Resilience
in Indigenous Health Networks
This
project is being undertaken in collaboration with a Canadian
indigenous research group, with Dr Paul Robertson as the
principal investigator of the New Zealand arm. In addition
to a stocktake, interviews with 57 Mäori working in
various roles in the health sector have provided the basis
for developing a framework for resilient indigenous health
worker networks. Although the study is broadly focused on
the range of health workers, Dr Robertson has a particular
interest in the development and maintenance of Mäori addiction
worker networks. The initial results of the study have been
presented at conferences and hui in both Canada and New Zealand
and a number of joint articles are currently being written
up for publication.
BACK
TO TOP
Nicotine
Study
A
survey of attitudes and service practices towards nicotine addiction
and smoking cessation by the Canterbury Mental
Health and Addiction Workforce.
A postal survey
of 250 randomly selected mental health and alcohol and other
drug clinicians in the Canterbury District Health Board
has recently been conducted. Lead by Dr Mark Wallace-Bell and Dr
Marie Ditchburn, the main purpose of this survey is to determine
the prevalence and attitudes towards tobacco smoking and smoking
cessation in mental health clinicians and their patients. It is
hoped that the results of this study may help services and health
care professionals develop and implement programmes to treat nicotine
addiction.
BACK
TO TOP
Development
of Mäori AOD Services and
Workforce in Aotearoa New Zealand
Tami Cave is the principal investigator for
this project (funded through Matua Raki,
the National Addiction Treatment Workforce Development Programme).
The results of this study are in part based on interviews
with 14 key informants - people who have played critical
roles in the development of Mäori AOD services over
the years. The study found that passion, committment and
sound foundation
in the principles and practices of Te Ao Mäori have
been central to the successful development of the Mäori
addiction treatment sector. As well as recording the history
of the field, the results of the project provides the basis
for identifying further areas for development as the Mäori
addiction treatment sector continues to flourish, despite
challenges in a number of areas. The initial results have
previously been presented at a number of hui, as well as
at the Cutting Edge Conference, however the full results,
which are to be published in book form thanks to the efforts
of Terry Huriwai, will be released at the end of March 2009
at a ceremony to be held at Owhata Marae, Rotorua.
BACKTO
TOP
|
Recently
Completed |
Te
Ariari o te Oranga: The Assessment and Management of People
with Co-existing Mental Health and Substance Use Problems
2010
This
document is designed to update the 1998 clinical guidelines
The Assessment and Management of People with Co-existing
Substance Use and Mental Health Disorders (Todd et al. 1998).
Much
of the content of the 1998 guidelines remains relevant, but
there have been important developments in research and practice. This
document is now available to be downloaded from the Ministry
of Health website.
BACK
TO TOP
Takarangi
Competency Framework
This competency
framework was been developed and piloted in a variety of
addiction and mental health services and involved a range
of practitioners. It builds on the work of a number of people
and hui held over the past decade and is a fusion of clinical
and Mäori features leading to a competent practitioner.
The Takarangi Framework is Mäori-centric and has a strong
quality assurance feature. It has synergies with the Real
Skills project and currently Matua Raki is holding
discussions with a number of other competency frameworks
and professional bodies to ensure alignment. For further
information contact terry.huriwai@otago.ac.nz.
BACKTO
TOP
Intravenous
Opioid Dependence
in New Zealand
This
research project, funded by the Ministry of Health and led by the
National Addiction Centre, was undertaken
in collaboration with the Aotearoa Alcohol and Other Drug Consumer
Network, Needle Exchange Services (NEST) and Needle Exchange NZ (NENZ)
Trusts and the University of Auckland. The research addressed six
key questions related to the prevalence of opioid dependence in New
Zealand, demand for treatment, barriers to treatment, the number
of people being treated with opioid substitution treatment (OST)
in specialist services and by GPs in primary care, waiting times
for treatment and the influence of the methamphetamine epidemic.
The research primarily consisted of two surveys; one of regular opioid
users (daily or almost daily) of whom some were receiving treatment,
some had received treatment in the past and some had never received
treatment, and the other of the 18 OST Services.
Key findings were: 1) the number of people estimated to be
daily (or near daily opioid drug users) was 9,953 of whom
about half were
receiving treatment (4,608) and 2) that even though there continues
to be in many localities considerable waiting time for treatment,
the opioid user survey indicated that there is considerable ambivalence,
not only on the part of those not currently receiving OST but also
those in treatment, about the delivery of OST. With the exception
of staff attitudes, similar barriers to treatment were identified
by both service providers and opioid users. These included lack
of treatment flexibility and the impact of stigma. Almost
all specialist
service providers identified resource issues and barriers to transferring
clients to primary care for continuing treatment following stabilisation.
The primary treatment recommendation, supported by eight secondary
recommendations was for a renewed effort to attract people with
opioid dependence into treatment with the aim of integrating
OST with mainstream
health services and OST clients into their communities. Secondary
recommendations focused on improving client centred treatment including
accessibility, reviewing staffing qualifications and treatment
philosophies, increasing consumer input into programmes
and establishing peer support
roles, ensuring adequate psychosocial resources, funding buprenorphine
as an alternative substitution medication and increasing primary
care OST prescribers, including nurse practitioners. Dr Daryle
Deering is continuing to lead research into opioid addiction
at the NAC.
The
report and accompanying appendices one,
two and three are
available for viewing and downloading.
BACK
TO TOP
Experiences
and Needs of Mäori Methadone
Maintenance Treatment (MMT) Patients
Under the supervision of Dr Paul Robertson
and Christchurch Methadone Programme staff Ra Bates and Wiki
Crofts, a Mäori medical student (Courtney Hore) interviewed
nine Mäori MMT patients, asking about their wants, needs
and experiences of MMT. All participants identified the benefits
of attending a Mäori focused whanau clinic, with several
also noting how re-engaging with Te Ao Mäori was contributing
to their recovery. Courtney has presented the results at
a seminar at the University of Otago, Christchurch, and it
is hoped that the results will be published in the near future.
BACK
TO TOP
The
Alcohol and Drug Outcomes Project (ADOPT) - Part II
ADOPT II, which led to the development and psychometric
testing of the brief, generic Alcohol and Drug Outcome Measure
(ADOM) was funded by Te Pou, The National Centre of Mental Health
Research, Information and Workforce Development, and led by Dr
Gail Robinson (Waitemata DHB) and Dr Daryle Deering (NAC). ADOPT
II
built on the foundation work undertaken in ADOPT I of implementing
routine outcome measurement with clients in alcohol and other drug
(AOD) treatment services (refer to Alcohol and Drug Outcomes
Project (ADOPT) (Deering et al 2004) which is freely available
for downloading at the Te
Pou website.
The
ADOM was designed for routine use by AOD clinicians and their
clients to monitor client outcomes during treatment with a view
to increasing client participation in their treatment and improving
treatment responsiveness. The development of the ADOM was informed
by an expert panel of AOD clincians, key informant interviews
and a pilot with clients and their respective clinicians. The
psychometric properties (validity, test-retest reliability and
sensitivity to change) of the ADOM were then tested with clients
across a range of outpatient AOD treatment services in two urban
settings. Psychometric testing showed excellent results for Part
A covering type and frequency of substance use and injecting
risk. Results for Part B, covering physical and mental health
and social issues, were less impressive, but generally satisfactory
and highlighted areas for further developmental consideration.
The research team recommended field testing of the ADOM in a
small number of services with particular attention paid to uptake
and
perceived clinical utility and with a view to further refinements
of Part B. The peer reviewed report titled Preliminary Work
Towards Validating a Draft Outcome Measure for Use in the Alcohol
and Drug Sector (Deering et al 2009), a summary report and
fact sheet are freely available for downloading from the Te
Pou website. The implementation of ADOM nationally is being
considered by the Ministry of Health. Dr Deering continues to
be the NAC
contact person with respect to the ADOM.
BACK
TO TOP National
Telephone Survey - 2008
In
2008 we repeated the successful telephone surveys of the
AOD workforce previously conducted in 1998 and 2004, allowing us
to continue to monitor changes in the qualifications, practice, knowledge
and attitudes of our workforce, as well as obtain a nationally representative
snapshot of clients. The current
survey is now available to be downloaded.
BACK
TO TOP
National
Telephone Survey of the AOD Workforce
This
data continues to be disseminated and papers on the client profile,
identification of nicotine use, and a vision for the future of
the AOD workforce are in the pipeline. In addition to the 'main'
study, there were two follow-on studies. All Mäori AOD workers
interviewed agreed to a further interview with a Mäori research
assistant. Paul Robertson and Tami Gibson have disseminated some
of the findings and a paper is in preparation. All nurses taking
part in the main study were asked to participate in a further
interview to explore issues of nursing practice on AOD settings.
A paper is currently being prepared for publication.
BACK
TO TOP
BTP
Five Year Follow-up
The
five year follow-up data from this randomised controlled trial
of motivational enhancement therapy was presented to a conference
in Santa Fe, New Mexico in January 2006.
BACK
TO TOP
Project
on Adolescent Cannabis and Cognition (PACC)
Meg Harvey (former Assistant Research Fellow) analysed
and wrote up her PhD research on cannabis use and cognition
in an adolescent sample.
BACK
TO TOP
Youth
and Nicotine Study
Marie Ditchburn (Research Fellow) analysed
baseline and follow-up data over a four year period for this clinical
youth population in relation to their nicotine use as part of her
PhD work. The main aims of this research were to 1) determine the
prevalence rate of tobacco smoking among patients presenting with
symptoms of mental disorders at an outpatient adolescent mental
health service; 2) ascertain the overall stability of smoking behaviour
and estimate regular smokers degree of nicotine dependence over
time; and 3) investigate potential factors and mechanisms associated
with the continuation and discontinuation of smoking.
Smoking
was found to be common among adolescents presenting to an outpatient
mental health service. For the vast majority of smokers first
identified, smoking remained stable over time, with only five
who were smoking tobacco at baseline discontinuing by follow-up.
The hallmarks of dependence present at baseline persisted over
time, with the severity of dependence generally increasing. Only
problematic alcohol use and peer influences continued to be uniquely
associated with smoking over time. However, as subjects got older,
smokers displayed more symptoms of depression than non-smokers.
BACK
TO TOP
Brief
Intervention Training for GPs
Doug
Sellman (Director) evaluated the impact of a brief intervention
training session with a group of general practitioners.
BACK
TO TOP
Pre-post
Smoking Ban Study
As part of the same research group, Mark was part of a study which took breath
and air samples in casinos and bars before and after the Smokefree Environments
Amendment Bill came into effect in December 2004.
BACK
TO TOP
|
Publication
and Dissemination Ongoing |
Perceptions
of Cannabis Use and Social Policy
Geoff
Noller prepared a paper on harm reduction
and the National Drug Policy as part of his PhD work.
Feasibility
Trial: Pre-quit NRT
Mark
Wallace-Bell is part of a research group based
at the University of Auckland and has completed a feasibility trial
of nicotine replacement therapy initiated prior to smoking cessation.
Brief
Treatment Programme for Alcohol Dependence (BTP)
This
was a randomised controlled trial of Motivational Enhancement Therapy
(MET). A book chapter (Sellman et al.) is currently in press and
I intend to publish findings on the prediction of treatment outcome
in the sample. Samadhi Campbell (Masters candidate) will be coding
audiotapes of MET sessions to test hypotheses related to the interaction
between client and therapist behaviour and impact on outcome. A
second potential masters student is currently considering examining
this data also.
BACK
TO TOP
Naturalistic
Treatment Outcome Project (NTOP)
Baseline
data on coexisting conditions and mental health treatment utilisation
is currently in press (Adamson et al.) and further papers are to
follow examining treatment outcome at nine months and examination
of groups with specific co-existing conditions such as social phobia.
Steve Marshall (Masters candidate) is analysing data on the association
between cannabis use and depression in the sample.
BACK
TO TOP
Methadone
Treatment Index (MTI) Development
Daryle
Deering (Senior Lecturer) continued to develop this brief multi-dimensional
outcome instrument designed for routine use with clients receiving
opioid substitution treatment as part of her PhD (completed 2007)
with a paper on its psychometric properties recently published
in Substance Use and Misuse, refer: Deering D, Sellman JD, Adamson
S, Horn J, Frampton C. Development of a
brief treatment instrument for routine clinical use with methadone
maintenance treatment clients: The Methadone Treatment Index. Substance
Use and Misuse 2008;43(11):1666-1680. Copies of
the Methadone Treatment Index are available
to be downloaded.
BACK
TO TOP
Körero
Te Hïkoi - Mäori Men Talk the Walk of Addiction
Treatment
The work undertaken
by Paul Robertson (Senior Lecturer Hauora Mäori) for his PhD on the experience and beliefs
of Mäori men who have undertaken addiction treatment
continues to be disseminated, including via recently submitted
articles for peer reviewed publication.
BACK
TO TOP
Christchurch
Outcome of Treatment for Depression Study
Fraser
Todd (Senior Lecturer) is a co-investigator on this study and is
using data on the association between cannabis use and psychotic
symptoms and cannabis use as a predictor of treatment response
to form the basis of his nearly completed PhD.
BACK
TO TOP
Early
Psychosis Study
Again
Fraser Todd is a co-investigator and is particularly interested
in the role of cannabis use in the emergence and course of psychosis
in this population of first-presentations with psychosis.
BACK
TO TOP
Spirituality
in Addiction Treatment
Michael
Baker (PhD candidate) is in the latter stages of his PhD work having
undertaken a thorough investigation of spirituality with a prospective
inpatient treatment population.
BACK
TO TOP
|
Past
Research |
Christchurch
Alcoholic Relapse Study (CARS)
This
study examined the results
of a Prolactin response to Fenfluramine test administered
to this sample. Prolactin levels in the bloodstream are
used as a marker of CNS serotonin activity. It is hypothesised
that reduced serotonin activity may predict worse treatment
outcome.
BACK
TO TOP
The
Collaborative Mäori Project was
the first NAC investigation into optimum treatment for Mäori
with alcohol and drug problems. It consisted of a survey of Mäori
currently being treated for alcohol and drug problems in two Mäori
dedicated services and four non-Mäori services. A series of
questions put to the 105 Mäori participants aimed to assess
how important cultural factors are considered to be in the provision
of optimal treatment for Mäori. Over 90% of those interviewed
considered that experiencing and learning Mäori protocols
and practices was an important ingredient in an effective treatment
programme.
BACK
TO TOP
The
National Telephone Survey (1998 and 2004) of alcohol and
drug treatment workers in New Zealand investigated the current
practice,
knowledge
and attitudes of clinicians working with alcohol and drug patients
in New Zealand. In addition, it provided a description
of the level
of experience and qualification of clinicians as well as revealing
a picture of a representative sample of clients seen at
dedicated
alcohol and drug services. Two subsequent studies were:
BACK
TO TOP Survey
of School Guidance Counsellors in the Christchurch Area was
a follow-on from the national survey of alcohol and drug workers
and gathered similar information relating to the current practice
and attitudes of school guidance counsellors.
BACK
TO TOP
The
Rolling Telephone Survey started in June 1999 and
was a follow on from the National Telephone Survey. From
1999 to 2002 this project investigated
patterns of drug use by those
presenting for alcohol and drug treatment in New Zealand. It involved
yearly random samples of alcohol and drug clinicians in New Zealand
and collecting data about the drug use of the last client they
assessed.
Part of this study involved compiling and updating a complete database
of alcohol and drug services and workers in New Zealand and monitoring
the workforce.
BACK
TO TOP
The
Degree of Drug Use Index Validity Study (DDIVS)
The
investigators are Daryle Deering (Principal Investigator),
Doug Sellman, Simon
Adamson (National Addiction Centre) and Tuari Potiki (Ngai Tahu
Development). This study, conducted in a research setting, comprised
part of the research undertaken by Daryle Deering (Lecturer) for
her PhD on methadone treatment in New Zealand. The overall goal
of this project, funded by the Health Research Council of New Zealand,
was to further develop the Methadone Treatment index (MTI), a multi-dimensional
brief outcome instrument for routine use with clients receiving
methadone treatment. More specifically, this project investigated
feasibility and psychometric properties of the first section of
the MTI, the Degree of Drug Use Index (DDI), with random samples
of Mäori and non-Mäori clients receiving methadone treatment.
Feedback on feasibility characteristics was also sought from clinical
staff
members working in a range of methadone treatment programme settings.
Results showed that the DDI was acceptable to both Mäori and
non-Mäori
clients, was a valid instrument and sensitive to measuring changes
in clients' reported substance use. An important issue raised by
clients and staff was the issue of validity of self-report within
clinical settings in which clients perceived that negative sanctions
may be invoked for illicit substance use. A paper on the development
of the Methadone Treatment Index and
psychometric properties is currently in press (Substance Use & Misuse).
BACK
TO TOP Te
Aka Roa o Te Oranga (TAROTO)
(The far reaching vines of wellness)
Mäori
Alcohol and Drug Treatment Evaluation and Development
Investigative
Team:
Paul
Robertson (Kai Tahu) - Project Leader, National Addiction
Centre, Christchurch;
-
Titari
Eramiha (Ngati Mahia, Ngapuhi) - Kaumatua, Te Roopu Whakapiringa,
Dargaville;
-
Pam
Armstrong (Ngati Whatua, Ngati Wai) - Interim Mäori
Project Manager, Matua Raki;
-
Annette
Harris (Ngati Kahungunu) - Alcohol and Drug Service Team
Leader, Hastings;
-
Suzanne
Pitama (Ngati Kahungunu), Mäori/Indigenous Health
Institute (MIHI), Christchurch;
-
Fraser
Todd, National Addiction Centre, Christchurch;
-
Terry
Huriwai (Te Arawa/Ngati Porou), Ministry of Health, Christchurch.
The main objective
of this project was to articulate, evaluate and develop elements
of Mäori focused alcohol and drug treatment.
TAROTO was developed as a result of several consultation hui with
key people from the national Mäori alcohol and drug field.
Phase 1, funded
by ALAC, consisted of a developmental evaluation of two existing
Mäori
services. This pilot phase involved gathering information from
a variety of sources, including clients,
whanau, staff (including kuia and kaumatua) and management. The
framework included consideration of the context in which a service
is delivered.
The primary
outcome of the pilot was development will be an evaluation tool
consisting
of five components/questionnaires which focus on:
1) the client; 2) the whanau; 3) Tikanga; 4) the staff, 5) systemic
and structural issues. It is envisaged that services will use this
tool to audit their provision of service to Mäori clients.
Phase 2 of TAROTO (yet to be fully developed and funded) will involve
validation of this tool at several other services around New Zealand,
both Mäori and non-Mäori.
TAROTO was
firmly based in a kaupapa Mäori research framework,
as described by a number of Mäori researchers (for example,
Linda and Graham Smith, Fiona Cram). In light of this efforts were
made to ensure that:
The
objectives of the project explicitly reflected Mäori values,
beliefs and experiences;
-
The research process included processes to ensure ongoing accountability
to the people from whom the information was gathered;
-
Appropriate cultural protocols are followed within the research
process as a whole and individual interviews to support joint
ownership and accountability to participants;
-
Appropriate
tools and analytic frameworks were employed to minimise bias
in analysis and ensure protection of Mäori values,
beliefs and experiences;
-
Results
and other information about the project were disseminated
in ways that were accessible to the range of people involved
in the project.
The
Alcohol and Drug Outcomes Project (ADOPT) investigated
alcohol and other drug treatment outcome measures with a
view to preliminary work towards a measurement system. Daryle
Deering (NAC) and Gail Robinson of the Clinical Research
and Resource Centre (CRRC), Auckland, were Co-Principal Investigators
on this project which was commissioned by Mental Health Research
and Development Strategy. Paul Robertson, Simon Adamson and
Meg Harvey (NAC)) were also Investigators along with Amanda
Wheeler (CRRC), Gareth Edwards (CRRC), Grant Paton-Simpson
(Waitemata Health) and Helen Warren (University of Auckland).
The
ADOPT
report is now available to be downloaded.
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The
South Island Methadone Project Report was
commissioned by the Ministry of Health. It investigated and
described methadone treatment provision in the South Island
in terms of referral and access, waiting list management
and transfers between programmes. The report highlights a
serious crisis within at least three of the six South Island
programmes and makes several recommendations aimed at reducing
waiting times and increasing consistency.
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document in pdf format directly :  (90
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for Clinical Process Self-Evaluation in Alcohol and Drug
Treatment Agencies were developed in 1997-1998 through
a process of literature review and consultation with providers,
consumers and funders. The guidelines, which compliment relevant
accreditation standards and the Ministry of Health Mental
Health Standards (1997) were published and disseminated to
agencies by ALAC in 1999. Helen Mitchell-Shand is currently
funded to provide a consultation service to assist agencies
with implementation.
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document in pdf format directly: (4475
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and Management of Co-existing Substance Use and Mental Health
Disorders is a project which aims to provide practical
guidelines for clinicians and services, both mental health
and alcohol and drug, in their work with comorbidity patients.
The project is focused on eight clinical vignettes designed
to cover the common, difficult comorbidity problems that
arise in New Zealand and considers a wide range of factors
impacting on maintenance and treatment of these problems,
including cultural variables.
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of Treatment for People with Opioid Dependence in New Zealand was
the paper produced in the course of the National Addiction
Centre's first development project in 1996 and was commissioned
by the Ministry of Health. It was estimated then that there
are 13,500 - 26,600 people with opioid dependence in New
Zealand, with this population predicted to grow by 15% per
year for the foreseeable future. A range of options for delivering
treatment to this expanding group of patients were assembled
and carefully considered including a cost-benefit analysis.
An "integrated model" was finally recommended in which it
was anticipated that 80% of opioid dependent patients would
be cared for directly by general medical practitioners
in primary care with the balance managed by specialist clinics.
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this document in pdf format directly: (529
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Or visit the Ministry
of Health website.
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download these files you will need Adobe Reader. To obtain a
free copy please visit the Adobe website:
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| NAC
RESEARCH GRADUATES |
|
Since
its inception in 1996, the National Addiction Centre has seen
a number of its students
graduate to MHealSci and PhD level. Abstracts of research
graduates are now available to view and download.
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