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Abstract
Background: Little has been published on the effect of geography on methadone treatment outcomes. Objective: To measure the effect of place on longitudinal outcomes Methods: From 2003 to 2006, 215 clients were recruited to a cohort study of methadone treatment. Participants had their address and clinic geocoded. Treatment outcomes were measured at intake, at one and three years posttreatment using the Maudsley Addiction Profile instrument. Spider diagrams and buffer rings were used to visually map clinics and clients. Regression models were used to measure the effect of place. Results: Client's accommodation and social and criminal problems in the region had a medium to large effect on heroin use. Analysis of buffer rings revealed that clients located within a 10-km radius of a major clinic demonstrated poorer outcomes in terms of heroin use. Conclusion/Importance: Findings illustrated the relevance of geography on drug treatment outcomes and the planning of services.
THE AUTHORS
Professor Catherine Comiskey holds a B.A. (Mod) degree in Mathematics and Philosophy from Trinity College, Dublin University, Ireland, and M.Sc. and Ph.D. degrees in Biomathematics with Statistics and Epidemiology from Dublin City University, Ireland. In 2012 she was appointed by the Government as Chairperson of the National Advisory Committee on Drugs and Alcohol. Professor Comiskey has over 20 years’ research experience and has a particular interest in the design, implementation, and execution of evaluations of treatment and intervention programs with a view to providing research-based evidence for policy and service delivery decisions. She has a particular interest in using biomathematical and statistical models to identify key factors which improve the outcomes from these treatments and interventions. Areas of application that Professor Comiskey has worked in include physical and mental health outcomes for children from disadvantaged areas, substance misuse, treatment for heroin and opiate use, cocaine use, prevalence estimation of hidden phenomena, infectious diseases including HIV and AIDS, measles, HIB meningitis, HPV and cervical cancer, immunizations, clinical trials, and randomized control trials. On a personal side, Catherine is married to architect Peter Carroll and they have four children ranging in ages from 12 to 21 years.
Dr Emma L. Murphy, Ph.D., has a higher diploma in Applied Statistics and in Geographical Information Systems (GIS). Her Ph.D. was originally started within an Applied Mathematics and Statistics Department but she subsequently moved with Professor Comiskey to the leading research School of Nursing and Midwifery within Ireland. She is currently a part time postdoctoral fellow at the School within Trinity College Dublin, Ireland. Her previous work experience was concerned with the interpretation of data linked to poverty and social inclusion. She is interested in working in the area of social inclusion with health as a particular focus. Having also previously worked on drug treatment outcomes research, she would like to expand into other areas such as research involving children and health. On a personal side, she has two sets of twins with all four children currently under four years of age.