A Randomised Controlled Trial

(1)

Efficacy of the KISS Programme:

Self Control of Drug Consumption in

Severely Dependent Drug Addicts:

ICMI Conference 2012, Venice

Gabi Becker (managing director, Integrative Drogenhilfe Ffm., IDH) Prof. Dr. Hans Volker Happel, (University of Applied Sciences, Ffm.) Prof. Dr. Joachim Körkel, (University of Applied Sciences, Nürnberg) Prof. Dr. Gero Lipsmeier, (University of Applied Sciences, Ffm.)

(2)

KISS – Implementation and Evaluation in Frankfurt

Overview

IDH Frankfurt

KISS Programme

Research Questions

Study Design

Results

(3)

Integrative Drogenhilfe

•

founded in 1986 in the City of Frankfurt/Germany

•

runs 8 low treshold institutions

Overnight accomodation for homeless drug addicts,

flatsharing community,

crisis centers,

safe injection rooms,

handicraft-workshops,

vocational training facilities

shelter and counselling for sex workers

Consultancy and guidance for (HIV*+) children and their

drug using parents

•

150 employees (social workers, craftsmen,

psychologists, administrators, manager)

•

5.000 different clients per year

(4)

IDH-Institutions with KISS groups („Study centers“)

Eastside

(Shelter, contact center, safe injection room,

working programs, methadone maintenance

treatment, psychosocial care)

Niddastraße

(Safe injection room in the red-light district)

FriedA

(Contact center with

methadone maintenance

(5)

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KISS – Implementation and Evaluation in Frankfurt

Starting point 2005

All 150 employees were trained in Motivational Interviewing

(social workers 7 days, the rest 4 days)

We had 2 goals, when we started to have MI as a

foundation of our work:

•

Increase of competence and satisfaction of our employees

•

Increase of the willingness for change in our clients

The main question became: How to raise the motivation for

change of the consumption behaviour of our clients

Consequence: Search for suitable programmes

Result: KISS Programme

(7)

Definition: Self Controlled Consumption

Self-controlled drug intake = a person is following a

predetermined consumption plan set up by himself/ herself.

This means to plan ahead for one week:

•

the number of abstinent days

•

the maximum number of standard consumption units (SCU)

on a consumption day

•

the maximum number of SCU in the whole week

•

and to set other constraints (such as when, where, and with

whom to consume)

(8)

KISS – Implementation and Evaluation in Frankfurt

Characteristics of „KISS“

created by Prof. Dr. Joachim Körkel

•

Group programme (max. 12 participants), also

available as individual programme, 1-2 skilled

KISS-trainers

•

Goal: Reducing the use of legal / illegal drugs.

Abstinence is of course also possible!

•

In the strict sense of MI: Client decides, which

drugs to reduce and how quick it will be changed.

•

Structure of behavioral therapy (BSCT), ca. 3,5

months:

Ö

1-2 preliminary talks

Ö

12 structured weekly

modules (à 2¼ hrs.)

Ö

Contents

(9)

Content of the 12 KISS Modules

1. Basic knowledge of drugs

2. Pros & cons for change

3. Consumption balance

4. Initial definition of individual goals

5. Strategies for reaching the goal (control)

6. Dealing with risky situations

7. Handling episodes

8. Leisure activities

9. Identifying strains

10. Dealing with strains

11. Social competences („Say-no“)

(10)

Crack

1 Stein = 10 €

3

14

1

4

6

2

3

12

2

x

1

0

2

1

2

1

0

4

2

1

Consumption Diary (Example)

Consumption

Diary

(

Example

)

1

(11)

Research Questions for the Evaluation

•

Is KISS attractive for socially excluded,

heavily addicted drug users, do they

cooperate and stick to the programme?

•

Does KISS reduce substance consumption?

•

Is KISS effective in reducing addictions?

•

Does KISS have positive effects on other

important areas in the life of addicts?

•

How do participants evaluate the programme

(12)

KISS – Implementation and Evaluation in Frankfurt

Study Design

•

Randomized clinical trial with participants randomly

assigned to

either

a KISS Group starting within the

near future

or

a waiting-list control group

•

Computer assisted personal interviews at 3 to 4

occasions:

a) Pre-Assessment

b) Post-Assessment (KISS-clients after completion of

programme and waiting-list clients after 3 months

c)

Waiting-list clients after their completion of

programme

d) Follow-Up (6 months after last interview)

•

Extensive urine sample analysis at each interview

occasion and half way through the programme

(13)

Participants of the study

230 people showed interest in KISS

123 came to an interview, 113 took part in the study

81 men, 32 women

2,5 : 1

Average age: 38.9 years

89 % detoxification, 60 % abstinence oriented therapy,

82% counselling

72 % methadone maintenance treatment

90% living on social welfare, 70% unemployed

48 % homeless

70 % single

(14)

KISS – Implementation and Evaluation in Frankfurt

(15)

Consumption Information 1

Standard Consumption Units (SCU)

alcohol:

0,5 l beer

1 SCU

0,50 €

cannabis:

1 joint, 0,2 g

1 SCU

1,00 €

heroin:

1 pack, 0,2 g

1 SCU 10,00 €

crack:

1 stone, 0,2 g

1 SCU 10,00 €

cocaine:

0,2 g powder

1 SCU 20,00 €

(16)

(17)

(18)

KISS – Implementation and Evaluation in Frankfurt

Consumption Information 2

Client Nr. 64

monthly consumption at t1

alcohol

336 SCU

168 €

cannabis

28 SCU

28 €

heroin

245 SCU

2.450 €

crack

84 SCU

840 €

cocaine

2 SCU

40 €

benzos.

56 SCU

84 €

total costs

3.610 €

(19)

Number of substances used at t1 (n=113)

1 substance

13 persons

2 substances

28 persons

3 substances

28 persons

4 substances

19 persons

5 substances

16 persons

6 substances

5 persons

Plus: 111

persons are smokers!

81 persons take methadone

Ø 4,5 substances

(20)

Substance number of

Average per

maximum

users

amount

Alcohol

45

81,66 SCU

448 SCU

Cannabis

63

80,20 SCU

515 SCU

Heroin

67

91,15 SCU

560 SCU

Crack

70

57,55 SCU

525 SCU

Cocaine

28

15,25 SCU

100 SCU

Benzos

66

59,00 SCU

300 SCU

(21)

96 66 63 60 60 46 29 39 58 ₅₆ 48 27 21 18

0

10

20

30

40

50

60

70

80

90

100

Cigarettes Crack Heroin Benzod. Cannabis Alcohol Cocaine Consumption (last 28 days)

Desire for Changes

Consumption Frequency and Desire for Change

at the Beginning of the Study all Participants, N = 113)

(22)

Number of KISS-Sessions attended (KISS-ITT, N= 59)

0 5 10 15 Frequency 0 1 2 3 4 5 6 7 8 9 10 11 12 KISS-Sessions attended

TPP-Subsample

(23)

Pre-Post-Reductions in all consumption –

relevant alteration indicators

(%)

-30

-19

-31

-36

-6

-3

-10

-3

-40

-35

-30

-25

-20

-15

-10

-5

0

Overall

consumption

days with

consumption

number of

diagnosis

money spent

for drugs

KISS-ITT

Warte-KG

(24)

Reduction of the total amount of

substances consumed

233 156 284 162 141 298 245 120 140 160 180 200 220 240 260 280 300

Pre Post Follow up

to ta l a m ount of s u bs ta nc e s c ons um e d i n w e ig ht e d S C U (N u tts I n d e x) _{KISS ITT (n=44)}

ITT mit Kata (n=37) WG (n=37)

(25)

Reduction of the total amount of money

spent for drugs

522 310 681 437 321 728 703 300 350 400 450 500 550 600 650 700 750

Pre Post Follow up

m o ne y s p e n t f o r dr ugs pe r m o nt h i n Eur o KISS ITT (n=44) ITT mit Kata (n=37) WG (n=34)

(26)

KISS – Implementation and Evaluation in Frankfurt

Reduction of the number of additional

diagnoses

1,46 0,73 1 1,43 0,97 1,45 1,63 0,7 0,8 0,9 1 1,1 1,2 1,3 1,4 1,5 1,6 1,7

Pre Post Follow up

N u m b e r of a d di ti ona l di a g nos is KISS ITT (n=49) ITT mit Kata (n=37) WG (n=35)

(27)

consumption-free days

19,1 18,1 15,7 19,4 16,2 16,2 15,8 15 15,5 16 16,5 17 17,5 18 18,5 19 19,5 20

Pre Post Follow up

co n s u m p ti o n fr e e d ays p e r m o n th KISS ITT (n=45) ITT mit Kata (n=37) WG (n=35)

(28)

KISS – Implementation and Evaluation in Frankfurt

How strongly are you currently stressed by….

0

1

2

3

4

5

6

t1

t2

t1

t2

Waiting-list

KISS-TPP

not at

all

Very

strong

(29)

(at Post-assesement, TPP-analysis)

5 5,7 5 5,5 4,9 5,1 4,5 5,2 5,2 0 1 2 3 4 5 6 Satisfaction w ith K ISS-Progr am overall Satisfaction with KI SS-trainer KISS helped with redu ctio n … the KISS users guide? … the definition of weekly goals? ... the c onsumption behaviour graph? … it, to d o KISS in group s? … the weekly recurrence? … the KISS-consumption d iar y ?

Rating

from

0 (very

low) to 6 (very

h

igh / a lot)

(30)

Conclusions

•

Many drug addicts can be motivated to reduce their drug

consumption – even seemingly „hopeless“ cases.

•

The motivation for change is enormous (2,77 substances on

average).

•

KISS seems to work: Significant reductions in consumption

level and DSM-IV addiction diagnoses.

•

Clients (and trainers) are very satisfied with the different

aspects of KISS.

•

KISS opens the door to abstinence for some clients.

•

KISS seems to be a suitable additional treatment option for

many different settings (e.g. MMT, shelters, safe injection

rooms …)

(31)

Thank you very much for your attention!

Contact:

Gabi Becker, IDH Frankfurt, Germany

g.becker@idh-frankfurt.de

www.idh-frankfurt.de

www.kiss-heidelberg.de

(32)

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N = 46

Waiting-list

control group

with Post-Assesement

N = 113

Cl. with complete entrance diagnostics

N = 55 (ITT)

KISS-ITT

-Cl. with

Post-Assesement

N = 20

Joined 0-3

KISS-sessions

N = 54

Waiting-list

control group

N = 59

KISS

-group

N = 23

‚KISS‘ WL

N = 39

Joined min 4

KISS-sessions

N = 37 (TPP)

KISS-TPP

-Cl. with

Post-Assesement

N = 30

WL with

KISS

t4

t2

t3

t1

N = 8

‚Pure‘ WL

N = 46

KISS-ITT

N = 30

KISS-TPP

(35)

5´ Welcoming and overview

10´

Flashlight

45´

7- Day review

& exchanges

15´ Break

50´ Working

on new topic

10´ Final &

feedback

e.g.. ,

balancing,

appointing new weekly goals,

choosing the strategies,

(36)

KISS – Implementation and Evaluation in Frankfurt

Pre-Post-Reductions in all consumption –

relevant alteration indicators

(%)

(37)

Changes in Addiction I:

Number of DSM-IV Addiction Diagnosis at

t1

(TPP, N = 83)

22

11

5

11

43

28

13

4

41

0

10

20

30

40

50

0

1

2

3

4

KISS-TPP (N = 37)

Waiting-list (N = 46)

Mean KISS-TPP:

1.38

Mean Waiting-list:

1.57

(38)

KISS – Implementation and Evaluation in Frankfurt

Changes in Addiction II:

Number of DSM-IV Addiction Diagnosis at

t2

(TPP, N = 83)

46

11

5

0

13

41

30

13

2

38

0

10

20

30

40

50

0

1

2

3

4

KISS-TPP (N = 37)

Waiting-list (N = 46)

Mean KISS-TPP:

0.76

Mean Waiting-list:

1.50

(39)

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