Understanding the unique goals of complex support clients accessing alcohol and other drug treatment

Background: Actively involving clients of Alcohol and Other Drug (AOD) services in selecting their own treatment goals may help to align clients’ and service providers’ expectations of treatment and improve engagement with services. This study explored the type and frequency of client-selected treatment goals; self-reported progress towards their goals; client and clinician views of their progress, and the acceptability of selecting and tracking goals in a non-residential AOD treatment provider in New South Wales, Australia. Methods: A mixed method study was conducted. Clients selected their goals during AOD treatment then self-rated their progress towards goals using the validated 11-point goal-based outcome (GBO) rating tool. Qualitative interviews were conducted with clients and clinicians. Mean GBO ratings were reported for each timepoint. Goals were thematically analysed to identify type, then descriptively analysed to identify frequency. Interviews were thematically analysed by one researcher and reviewed by a second. Results: Among the 22 clients who completed the GBO at least once, the median number of self-identified goals was 3. The most common goals included: (1) managing mental health and (2) developing strategies to prevent relapse and manage AOD cravings. Most participants reported improvements in their selected goals; there were no participants who reported lower GBO scores at the second timepoint compared to the first. Qualitative themes demonstrate that while the GBO approach provided clarity for clients, was acceptable to clients and clinicians, and considered client expectations of treatment, the approach was difficult for those with limited literacy and reflexive thinking. Those experiencing lapse or relapse reported the linear GBO rating approach was potentially demotivating. Conclusions: Findings demonstrate that a goals-based outcome approach can promote shared decision-making between client and clinicians about treatment goals which are valued by clients. Service providers should be aware of potential complexity of recalling selected goals and completing ratings particularly among clients with co-occurring mental illness and memory impairment. Goals that are time-specific, realistic and relevant should be prioritised to minimise risks of demotivation arising from non-linear progress towards goals.