Abstract Background People with alcohol and other drug (AOD) problems are offered treatment by a variety of organisations in the non-government sector, many of which have religious affiliations. Little is known about the actual treatment offered, and whether the ideology of the organisation has an impact on the choice of treatment provided. Christian churches were amongst the first service-delivery organisations in the Australian AOD sector, and those remaining in the sector appear to have evolved from providing overt Christian-care to providing some evidence-based care in line with the move to best practice under Australia’s National Drug Strategy. It remains to be determined, however, whether the approach to treatment and service provision by religiously-affiliated agencies is influenced by their religious background and orientation. To resolve this gap in knowledge a national survey of non-government AOD agencies was conducted in late 2005–early 2006. Methods Survey participants consisted of all identified non-government AOD agencies in Australia. The operational definition of AOD agencies was in keeping with definitions used in other investigations in the sector. The sample frame was compiled using the most recent directories and databases available. Two questionnaires were posted to 331 agencies throughout Australia. Responses were sought from both the director/coordinator and a staff member working directly with clients. Completed questionnaires were received from 169 (51 per cent) of agencies. A completed questionnaire from both the director/coordinator and an AOD worker was received from 90 of these 169 agencies. Where this was the case, the response from the director/coordinator was taken to be the ‘agency response’. Questions were about the agency’s profile, goals, activities, the respondent’s own view of substance dependence and the respondent’s demographic characteristics. Qualitative methods were also used to gain further information and clarification from key informants, both prior to and after the quantitative survey. Findings There was surprising homogeneity amongst all agencies in their use of the eight treatment orientations studied (12-step, therapeutic community, cognitive behaviour, psychodynamic, rehabilitation, dual diagnosis, medical, and family). Cognitive behaviour therapy was the most popular treatment across all types of agencies in contrast to the 12-step approach which was only a major focus for a small number of agencies. Psychodynamic and therapeutic community orientations were also widely used but family and rehabilitation orientations were amongst the least popular orientations. With the family orientation there was a wide discrepancy between agencies that had family goals but not family activities. In regard to accessing treatment, mothers accompanied by their children and couples were the two groups least likely to be accepted into treatment (44 per cent and 40 per cent respectively did not accept couples). Directors interviewed in this study indicated that not accepting mothers accompanied by their children was due to the cost of providing relevant services. Of the agencies surveyed, 42 per cent were affiliated with a church organisation. Although 85 per cent of church-affiliated agencies indicated that they received some contribution towards policy from a religious organisation, results suggested that there was very little difference between church-affiliated and non-church-affiliated agencies in service delivery. One area of significant difference between church-affiliated and non-church-affiliated agencies was access. Church-affiliated agencies were significantly more likely than non-church-affiliated agencies to not accept couples, Indigenous people, and people referred from the criminal justice system. Church-affiliated agencies were also significantly more likely to take into consideration a prospective client’s motivation to succeed. Across all agencies activities of a spiritual nature (e.g. meditation/prayer, talking with clients about spirituality/religion) were only a major feature for a small number of agencies; although 70 per cent of agencies included developing a client’s spiritual self in their goals. The majority of directors/coordinators indicated that they have a broad set of beliefs about substance use that allows for various social and psychological understandings and treatment responses. Conclusion Overall, there was uniformity in the type of treatment goals and activities offered by the non-government AOD agencies. The findings suggest that churches are becoming indistinguishable from secular organisations in their delivery of AOD services. Where once there may have been faith in religion as a basis of service provision there now appears to be faith in science. This is in the context that the ‘best evidence’ of effective treatments suggests that most treatments are relatively weak predictors of a positive outcome, and that the choice of treatment may not impact on treatment outcomes. The evidence-based medicine movement may have become a form of religion and, in association with a population health approach, is dominating the AOD service delivery sector. Although successful drug treatment programs may well require that the client/patient undergo moral and value changes, these may occur without connection to organised religion. Ideology in the form of religious belief has historically played a central role in treatment choices and it continues to do so in the form of an ideology giving priority to best practice, despite the likelihood that best practice may nevertheless continue to produce poor outcomes.
| Identifer | oai:union.ndltd.org:ADTP/279389 |
| Creators | Fairlie McIlwraith |
| Source Sets | Australiasian Digital Theses Program |
| Detected Language | English |
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