Addiction Treatment Research

This study found that 73.4% of respondents who attended treatment at Castle Craig were totally abstinent from all drugs or alcohol at follow-up (after about one year). 91.8% of those questioned were either living with reduced alcohol or drug use or abstinent.

This study followed 233 patients admitted to Castle Craig between 2011-2012 for alcohol, drug and gambling addictions. 158 people responded to the survey.

75% of patients questioned completed treatment, others prematurely self-discharged against medical advice, and a small number were prematurely discharged for rule violations or on medical grounds.

We received a 70.9% response rate (158 of the sample) which showed that of those that responded:

• 91.8% of patients improved, 8% remained the same, and none got worse.
• 73.4% were totally abstinent from all drugs or alcohol at follow-up.
• 81.6% achieved low problem severity at follow-up.

The report concludes that not only do a vast number of patients leaving Castle Craig show significant improvements in their quality of life, and drug and alcohol use habits, but these changes continue for extended periods of time. A secondary finding is that patients readmitted to treatment following a relapse are significantly more likely to achieve a good outcome.

To download the full study download this PDF.

*The statistics do not include the 75 patients that could not be contacted.

Independent analysis of outcome data, Christo Research Systems.

In this study is was found that 61% of respondents who attended treatment at Castle Craig were totally abstinent from all drugs or alcohol at follow-up (after 67 weeks). 89% of those questioned were either living with reduced alcohol or drug use or totally abstinent.

Outcomes evaluation for one patient with a primary gambling addiction, 89 drug and 66 alcohol-dependent patients from the Netherlands entering Castle Craig Hospital between 7th May 2007 to 16th December 2008 and staying in treatment for more than 1 day.

Summary of findings

• One patient with a primary gambling addiction, and 89 drug and 66 alcohol-dependent patients from the Netherlands entered Castle Craig Hospital between 7th May 2007 to 16th December 2008 and stayed in treatment for more than 1 day.
• Most patients were addicted to alcohol or cocaine.
• Patients were generally quite dysfunctional at intake. The average intake CISS total score of the 156 patients was 11.0 and their greatest problems were with drug or alcohol use, lack of support, psychological problems, lack of occupation, and poor health.
• Drug-dependent patients tended to have greater problems with social functioning, viral risk, and criminality.
• Alcohol-dependent patients tended to have greater problems with health and working relationships.
• Patients were generally more dysfunctional than those attending outpatient alcohol or drug services (based on the CISS comparison scores see Appendix).
• The patients’ average wait between referrals to treatment entry was 7.3 weeks.
• 62% of patients completed treatment, 32% of patients prematurely self-discharged against medical advice, 6% of patients were prematurely discharged for rule violations, and one patient was prematurely discharged on medical grounds.
• The average treatment duration for patients’ taking a planned discharge was 21 weeks, and the average treatment duration for prematurely discharged patients was 9 weeks.
• Premature treatment discharge was a little more likely among the drug users.
• Follow-ups were successfully completed on 113 of the 156 patients (72.4% response rate).
• Thirty-nine patients could not be contacted and four patients died.
• The average follow-up period was 67 weeks.
• 92% of followed-up patients improved, 8% remained the same, and none got worse.
• 63% of patients completing treatment did well, whereas only 35% of patients taking an unplanned discharge (for whatever reason) had a good outcome.
• The average intake CISS score of the 113 followed-up patients was 10.6 and the average follow-up CISS score was 4 indicating a highly significant improvement in general functioning.
• Reductions in drug/alcohol use at follow-up were accompanied by improvements in all other CISS domains.
• Even those who were not totally abstinent at follow-up appeared to have benefited from their experience in treatment, probably by gaining a period of respite during which to recover from the consequences of their excessive drinking or drug use.
• The following success rates are conservatively based by including all 156 patients on the assumption that the 43 patients, not followed-up (response rate = 72.4%) showed no improvement or otherwise had poor outcomes.
• Being totally abstinent from all drugs or alcohol at follow-up 46%
• Achieving low problem severity at follow-up (CISS < 6, see appendix) 52%
• Showing any reduction in measured levels of dysfunction 69%.

In reality, the success rates are most likely to be higher because some of the missing patients would not have been contactable due to having recovered and being in full time occupation.

The following success rates are thus more liberally based by including the 4 patients that died but not including the other 39 patients that could not be contacted for follow-up (n = 117).

• Being totally abstinent from all drugs or alcohol at follow-up 61%
• Achieving low problem severity at follow-up (CISS < 6, see appendix) 69%
• Showing any reduction in measured levels of dysfunction 89%.
• Report in PDF format

Summary Discussion:

Castle Craig Hospital provides a service to people with a range of addiction severity.
Those in this group are significantly drug or alcohol dependent people and often have
the additional complications of varying degrees of co-morbidity, lack of support, poor
health, and psychological problems. However, good outcomes are achieved, despite
overall high levels of associated problems at intake. Their patients are generally more
dependent and less functioning than those attending outpatient drug or alcohol services and it is unlikely that many of them would have been able to engage with an outpatient treatment intervention. Although the goal of Castle Craig’s treatment is abstinence, it should be noted that those who fail to achieve that goal still report reduced levels of problem severity at follow-up. Thus, even the treatment ‘failures’ appeared to have benefited from their experience in treatment, possibly by gaining a period of respite during which to recover from the consequences of their excessive drinking or drug use.
Castle Craig Hospital continues to demonstrate their ability to produce high quality
research within the limitations of a busy service setting. The notion of evidence led
practice is frequently discussed, but it could be argued that experienced practitioners
already make best use of their resources. Thus, the purpose of such research could
only be to illustrate that the experts know what they are doing (e.g., practice led
evidence). This view may well be partially justified, as many of the findings in this study are obvious to those who are familiar with the field. However, some findings here are obvious only with the benefit of hindsight and others may yet inform better practice and commissioning.

This study finds complete abstinence at follow-up in 66% of patients who responded to the survey, and reduced alcohol or drug use at 84%.

Outcomes evaluation for all cocaine-addicted patients admitted between 15th January 2004 and 31st July 2006 and staying in treatment for more than one day.

Summary of findings

The sample comprised all cocaine-addicted patients who entered treatment between 15th January 2004 to 31st August 2006 and stayed in treatment for one or more days.
Out of 141 patients contacted, 107 responded to questionnaire.

• Demographic: 74 from Scotland, 66 from the Netherlands, and 1 from the USA.
• Scottish patients’ average age of 34 years was significantly lower than the Dutch patients’ average age of 37 years.
• Scottish patients’ average CISS total score of 14.1 was significantly higher than the Dutch patients’ average CISS total score of 12.6.
• Patients’ greatest problems were with drug or alcohol use, lack of occupation, lack of support, and psychological problems.
• Patients with higher levels of complexity at intake tended to either drop out of primary or go on to extended care.
• In comparison to those entering extended care, dropouts from primary (excluding 21 primary completers) were more likely to have greater social functioning problems, greater criminal involvement, and greater compliance problems.
• 48% of patients left treatment prematurely. However, 92% of patients completed detoxification.
• The average treatment duration of 19 weeks for patients completing treatment was significantly longer than the prematurely discharged patients’ average treatment duration of 8 weeks.
• The average CISS total score of 12.3 for patients completing treatment was significantly lower than the prematurely discharged patients’ average CISS score of 14.5.
• At treatment entry, completers tended to have fewer social functioning problems, fewer occupation problems, less criminal involvement, and fewer compliance problems.
• Patients’ age, gender, nationality, and drug use patterns were unrelated to premature discharge.
• Follow-ups were successfully completed on 107 of the 141 patients (76%).
• The average follow-up period was 79 weeks.
• Patients completing treatment were significantly more likely to have a good outcome.
• The average treatment duration (16 weeks) of the 84 good-outcome patients was significantly longer than the average treatment duration (10 weeks) of the 57 poor-outcome patients.
• Patients entering extended care were significantly more likely to have a good outcome.
• Patients’ gender, nationality, drug use pattern, age, and CISS total score at treatment entry were unrelated to the outcome.
• There was no significant relationship between CISS total scores at treatment entry and subsequent outcomes among the 60 patients who did not go into extended care.
• Among the 81 patients entering extended care, the average CISS score of 12.8 for patients with a good outcome was significantly lower than the poor outcome patients’ average CISS score of 14.2.
• Reductions in all of the 10 CISS outcome domains were highly significant. Thus indicating that reductions in drug/alcohol use were generally accompanied by improvements in all other aspects of the patients’ lives.
• For all 141 patients, 92% successfully completed detoxification.

For all 141 patients, the following ‘Success’ rates are conservatively based on the assumption that the 34 patients not followed-up all showed no improvement or otherwise had poor outcomes.

• Being totally abstinent from all drugs or alcohol at follow-up 46%
• Achieving low problem severity at follow-up (CISS < 7, see appendix) 60%
• Showing any reduction in measured levels of dysfunction 74%

For the 73 Patients who completed all their treatment, the following ‘Success’ rates are conservatively based on the assumption that the 10 patients not followed up all showed no improvement or otherwise had poor outcomes.

• Being totally abstinent from all drugs or alcohol at follow-up 66%
• Achieving low problem severity at follow-up (CISS < 7, see appendix) 78%
• Showing any reduction in measured levels of dysfunction 84%

2007 Cocaine Report Download

Independent analysis of outcome data, Christo Research Systems.

Outcomes evaluation for 28 drug and 61 alcohol-dependent patients (48 males, 41 females) from the Lanarkshire area admitted between 5th August 2002 to 20th February 2004 and staying in treatment for more than 3 days, who left follow-up contact addresses or telephone numbers with the hospital. The study finds complete abstinence at follow-up in 45% of cases.

The 2004 evaluation for Lanarkshire patients admitted between 5th August 2002 and 20th February 2004.

Summary of Findings

• • 28 drug and 61 alcohol-dependent patients (48 males, 41 females) from the Lanarkshire area entered Castle Craig between 5th August 2002 to 20th February 2004 and stayed in treatment for more than 3 days and also left follow-up contact addresses or telephone numbers with the hospital.

• • Their average length of stay in primary treatment was 5 weeks. 35% then went on to extended care where their average length of stay was 10 weeks.

• • Females were more likely to enter extended care than males.

• • 67 of 89 patients were followed up on average about 50 weeks later. 89% improved, 9% remained the same, and 2% got worse.

• • These patients were generally quite dysfunctional at intake. The average intake CISS total score of the 67 patients was 11.9 and their greatest problems at intake were with drug or alcohol use, lack of occupation, lack of support, psychological problems and health problems.

• • Drug-dependent patients tended to have greater problems with social functioning, viral risk, criminality, compliance and working relationships. They were thus also more likely to leave primary treatment prematurely.

• • Patients were generally more dysfunctional than those attending outpatient alcohol or drug services (based on the CISS comparison scores see Appendix).

• • The average follow-up CISS score was 4.1, thus indicating a highly significant improvement.

• • Reductions in drug/alcohol use at follow-up were accompanied by improvements in all other CISS domains.

• • Even those who were not totally abstinent at follow-up appeared to have benefited from their experience in treatment, probably by gaining a period of respite during which to recover from the consequences of their excessive drinking or drug use.
  • The following ‘success’ rates for all Lanarkshire patients are conservatively based on the assumption that the 21 patients not followed up all showe

  • • • Being totally abstinent from all drugs or alcohol at follow-up 45%
    • • Achieving low problem severity at follow-up (CISS < 6, see appendix) 54%
    • • Showing any reduction in measured levels of dysfunction 67%.
      • Report in PDF format

Outcomes evaluation for 60 alcohol-dependent patients funded by Fife NHS Health Board area admitted between 12th December 1999 to 12th March 2002 and staying in treatment for more than 3 days.

A follow up at 1.3 years after discharge shows 90% improved, 45% still abstinent. The study finds complete abstinence at follow up in 45% of cases.

Their average length of stay in primary treatment was 5.3 weeks. 20% then went on to extended care were their average length of stay was 10.4 weeks.

Even those who were not totally abstinent at follow-up appeared to have benefited from their experience in treatment, probably by gaining a period of respite during which to recover from the consequences of their excessive drinking.

The following success rates for all patients from Fife are conservatively based on the assumption that the 11 patients not followed-up all showed no improvement or otherwise had poor outcomes.

Report in PDF format

Outcomes evaluation of 206 clients referred to the Extended Care Unit at Castle Craig between 31st September 1997 and 31st August 1999. All clients, including those leaving without completing treatment were included in the study, no one was excluded.

The study finds that 31% of the total group had achieved continuous unbroken abstinence, and an additional 13% of the total group were classified as in a good outcome category, (i.e. no more than 3 brief relapses and with a minimum period of 3 months continuous abstinence prior to assessment.) As well as detailed statistics, the paper contains a discussion on the cost-effectiveness of residential treatment for addiction.

Report in PDF format

Dr Margaret McCann, MB BCh Medical Director, Castle Craig Hospital

A study in 1999 investigated the results of 96 severely dependent patients who were admitted into the extended care programme after the first phase of treatment was complete.

The results showed that 62% of those who completed treatment had remained abstinent for a minimum, of 3 months and up to a minimum of 420 days.

Report in PDF format

Dr. R. Hughes

This study analysed a consecutive sample of 96 alcohol-dependent people entering treatment who were in employment. The follow-up period was an average of 21 months (6-35 months). Data were obtained from a Castle Craig follow-up questionnaire and the response rate was 78%. The results were as follows:

41% had been continually abstinent during the follow-up period
19% had a good “outcome” (i.e. they had a period of continuous abstinence of six months duration prior to follow-up)
In total 60% of clients were abstinent for at least 6 months prior to following up.