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Dissertation By Damien Beatty

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Dissertation By Damien Beatty

  1. 1. The Attitudes of Irish Professionals using an Adventure Therapy approach in Drug Rehabilitation Centres Damien Beatty Galway Institute of Technology, Castlebar Campus 2016
  2. 2. 1 The Attitudes of Irish Professionals using an Adventure Therapy approach in Drug Rehabilitation Centres Damien Beatty This Dissertation was submitted in part fulfilment of the requirements for the Bachelor of Arts Degree in Outdoor Education at the Galway-Mayo Institute of Technology, Castlebar Campus. 2016 I hereby declare that this dissertation is my own work. _______________________________
  3. 3. 2 Acknowledgements This study is entirely dedicated to my mother (Catherine) and father (Damien) for their continuous support and encouragement throughout my years of study. I would not be in the position I am today without your advice. To my sisters (Shereen, Louise, and Katie), my brothers (Ian, and Jordan) for their continuous support and respecting my space to study within a busy household, I applaud your patience for accepting my adventurous and sometimes chaotic lifestyle. To my tutors Kevin O Callaghan and Stephen Hannon for their unlimited hours of advice, encouragement and belief in me. I do not envy your tutorial positions consisting of the vast amount of hours correcting dissertation drafts and research methods. With great respect I applaud your patience and professional guidance. To my student support worker Celine King who guided me through the thick and thin of this dissertation. At times I thought I would never get this research done. I definitely applaud your patience and professional advice, I am forever in debt for your unlimited time reading and correcting my dissertation over and over again. To my college counsellor Michelle Kerins O Brien for supporting me through a tough year of college. No matter how stressful and chaotic my college life became you were always there to support and listen to me. Thank you for your time and support. Finally to my sample group. Without having such professionals in the field of drug rehabilitation and adventure therapy. I thank you with great appreciation for taking time out of your busy schedules to participate in this study this research.
  4. 4. 3 Abstract This study focusses on the attitudes of Irish professionals using an Adventure Therapy approach in drug rehabilitation centres with adolescents. With the lack of literature surrounding Adventure Therapy in an Irish context this research will explore the link between Adventure Therapy, Adolescents, Substance Abuse Addiction and Substance Related Rehabilitation. It will examine the attitudes of professional drug rehabilitation therapists towards an Adventure Therapy Approach within Irish drug rehabilitation centres. The research methods used for this study were completed through a structured survey which included a mixed method approach of open ended and close ended questions. Contrasting the results attained from the Survey and findings of the Literature Review identified that Adventure Therapy could potentially be an approach adopted into Irish drug rehabilitation services considering the appropriate evidence and funding is acquired. This study concludes that an Adventure Therapy approach would benefit models identified in Irish drug rehabilitation programmes providing additional adequate resources are required. It also concluded that a professional qualification for Adventure Therapy should be considered with additional professional qualifications in the field of drug rehabilitation therapists. .
  5. 5. 4 Table of Contents Clarification of Terms ........................................................................................................... 7 Chapter 1 Introduction........................................................................................................... 8 1.1 Introduction ................................................................................................................. 8 1.2 Justification................................................................................................................ 10 1.3 Historical Background............................................................................................... 11 1.4 Background Information to this Topic ...................................................................... 12 Chapter 2 The Literature Review ........................................................................................ 13 2.1 Introduction ............................................................................................................... 13 2.2 Adventure Therapy.................................................................................................... 13 2.2.1 Defining Clinical Adventure Therapy................................................................ 14 2.2.2 Adventure Therapy Models................................................................................ 14 2.2.3 The Process of Adventure Therapy .................................................................... 16 2.3 Adolescence............................................................................................................... 18 2.3.1 Adolescents Role in Society............................................................................... 19 2.3.2 Key Issues involving Adolescents in today’s Society........................................ 19 2.4 Addiction ................................................................................................................... 20 2.4.1 Substance Related Addiction.............................................................................. 21 2.4.2 Common Trends of Substance Related Addiction amongst Adolescents .......... 22 2.4.3 Adolescents Experimenting with Drugs............................................................. 23 2.5 Substance Related Rehabilitation.............................................................................. 23 2.5.1 Substance Related Rehabilitation Models.......................................................... 24
  6. 6. 5 2.5.2 Processes of Substance Related Rehabilitation .................................................. 25 2.5.3 Irish Rehabilitation Centres for Young People with Addiction ......................... 26 2.6 Chapter Summary...................................................................................................... 28 Chapter 3 Methodology....................................................................................................... 30 3.1 Introduction ............................................................................................................... 30 3.2 Restatement of Research Question............................................................................ 30 3.3 Instrumentation.......................................................................................................... 30 3.4 Research Paradigm .................................................................................................... 31 3.5 Research Design ........................................................................................................ 31 3.6 Rationale for Research Design .................................................................................. 32 3.7 Sample Population..................................................................................................... 33 3.8 Scope ......................................................................................................................... 33 3.9 Limitations................................................................................................................. 34 3.10 Ethical Considerations............................................................................................. 34 3.11 Informed Consent and Confidentiality .................................................................... 36 3.12 Validity and Reliability ........................................................................................... 36 3.13 Survey Design ......................................................................................................... 37 3.14 Data Collection Procedure....................................................................................... 37 3.15 Data Analysis Plan .................................................................................................. 37 3.16 Chapter Summary.................................................................................................... 38 Chapter 4 Results................................................................................................................. 40 4.1 Introduction ............................................................................................................... 40
  7. 7. 6 4.2 Summary of Statistical Analysis................................................................................ 40 4.3 Tables and Figures of Results.................................................................................... 41 Chapter 5 Discussion........................................................................................................... 53 5.1 Introduction ............................................................................................................... 53 5.2 Literature Findings .................................................................................................... 53 5.3 Research Findings ..................................................................................................... 55 5.4 Contrasting Results.................................................................................................... 57 Chapter 6 Conclusion / Recommendations ......................................................................... 59 6.1 Introduction ............................................................................................................... 59 6.2 Summary of Main Findings....................................................................................... 59 6.3 Recommendations ..................................................................................................... 60 Section 7 Appendences........................................................................................................ 62 7.1 Appendix 1 Invitation to Participate in Survey ......................................................... 62 7.2 Appendix 2 Consent to Participation in Survey ........................................................ 63 7.3 Appendix 3 Survey Questions................................................................................... 64 7.4 Appendix 4 Identification of Illegal Substances........................................................ 67 7.5 Appendix 5 Qualitative Survey Results for Question 5 ............................................ 69 7.6 Appendix 6 Qualitative Survey Results for Question 6 ............................................ 71 Section 8 Bibliography........................................................................................................ 74
  8. 8. 7 Clarification of Terms Professional: “Belonging to or connected with a profession” (Oxford Dictionary Press, 2002, p. 1154). Attitude: “A settled opinion or way of thinking” (Oxford Dictionary Press, 2002, p. 87). Adventure: “An unusual and exciting experience” (Oxford Dictionary Press, 2002, p. 19). Therapy: “The treatment of physical or mental disorders” (Oxford Dictionary Press, 2002, p. 1496). Adolescent: “Between childhood and adulthood” (Oxford Dictionary Press, 2002, p. 18). Addiction: “The fact or process of being addicted, esp. the condition of taking a drug habitually and being unable to give it up without incurring adverse effects” (Oxford Dictionary Press, 2002, p. 15). Rehabilitate: “Restore to effectiveness or normal life” (Oxford Dictionary Press, 2002, p. 1215).
  9. 9. 8 Chapter 1 Introduction 1.1 Introduction The aim of this study is to examine the attitudes of Irish professional addiction therapists towards the use of Adventure Therapy as an approach in a drug rehabilitation setting with adolescents. Adventure Therapy has been an effective and successful approach to rehabilitation. This approach has been implemented by a number of institutes across the world since the late 1960’s (Tucker & Norton, 2012; Crisp, 1998; Gas, 1993; Kimball & Bacon, 1993). At present there are three separate types of programmes engaging a therapeutic approach in an outdoor setting which include: Adventure Therapy: Adventure Therapy is a term used by practitioners who emphasise that it is the journey in the outdoors and the adventure experience that connects the natural environment with the psychotherapeutic process of the individual (Richards, et al., 2011, p. 17). Wilderness Therapy: Wilderness Therapy was derived from the work of Kurt Hahn through Outward Bound. Although this therapeutic experience has no direct connection with Adventure Therapy, its use of therapeutic approaches in the wilderness environment have been for long periods of time (Usually up to 16 weeks). This therapeutic programme offered young men to develop their personal attributes through experiential learning in a place based environment (Gass, 1993, p. 12).
  10. 10. 9 Outdoor Experiential Therapy: Outdoor Therapy involves the use of experiential challenges found in the out-of-doors environment which provides growth experiences that can help individuals make fundamental changes in their lives (The Addiction Recovery Guide, 2015). Outdoor Experiential Therapy focusses not only on a temporary escape from an individual’s problem but also focusses on the essential elements that is necessary to bring about a sustained transformation in the persons physical, emotional and spiritual wellbeing (Red Oak Recovery, 2016). These three therapeutic approaches define the modern sector of adventure therapy currently present in the Republic of Ireland (Active Connections, 2011; Comeragh Wilderness Camp, 2015). The Association for Experiential Education, (2013); Norton, et al., (2014); Gass, et al., (2012); Tucker & Norton, (2012); Richards, et al., (2011); Norton & Tucker, (2010); Tucker, (2009); Gillis & Gass, (2004); News & Bandoroff, (2004); Alvarz, & Stauffer, (2001); Itin, (2001); Crisp, (1998); Buie, (1996); Gass, (1993); Gillis & Thomson, (1996); Kimball & Bacon, (1993) all agree that Adventure Therapy works successfully and effectively for a number of mental health issues but with the right approach it could also work within the process of drug rehabilitation programmes. With substance related addiction becoming an overwhelming problem amongst adolescents across the Republic of Ireland in recent years (National Advisory Committee on Drugs, 2011; Butler & Mayock, 2005; Health Promotion Unit, 2003), it identifies that substance abuse is a growing issue. Substance related rehabilitation treatment and residential services are struggling to keep up with their day to day duties due to the rise in the number adolescent drug addicts in recent times (Irish Medical Organisation, 2015; Drugnet Ireland, 2011; Barnardos, 2010; Health Service Executive, 2007). With key issues arising such as
  11. 11. 10 substance abuse it might allow the use of an Adventure Therapy approach to build a relationship between the adolescent and a therapist while working on their problems through an experiential learning environment. While adventure activities are not the only approach towards effective drug addiction rehabilitation, there are also key methods to psychologically removing the individual from their life back home (Red Oak Recovery, 2016). Adventure Therapy components towards addiction rehabilitation may range from individual and group programmes. These methods provide nutritional education, boundary setting, communication skills and social skills development as part of the Adventure Therapy program (Red Oak Recovery, 2016). An Adventure Therapy approach would be resonable to presume that it may alleviate the pressure on present services providing beneficial outcomes for drug rehabilitation programmes with adequete training offered to providers. 1.2 Justification The aim of this study is to examine the attitudes of professional drug rehabilitation therapists who might use an Adventure Therapy approach in the process of substance related rehabilitation amongst adolescents in the Republic of Ireland. This research topic was selected as a result of a past personal experience witnessing on a first-hand basis, the impact of drug abuse amongst adolescents in one of Ireland’s most disadvantaged areas. Adventure Therapy has been identified to be an effective approach with challenging adolescent’s behaviour (Gass, et al., 2012).
  12. 12. 11 Due to the lack of written information within this area in the Republic of Ireland, the author wishes to examine the attitudes of professional drug rehabilitation therapists towards the use of an Adventure Therapy approach in an Irish context. 1.3 Historical Background The use of Adventure Therapy started in 1901 within the Manhattan State Hospital East, United States of America. The institute introduced tent therapy to isolate patients suffering with TB form other patients. By introducing this strategy the hospital found unexpected health benefits for patients related to being outside (Association for Experiential Education, 2013). In 1906, the San Francesco Psychiatric Hospital moved their patients into tents after an earthquake caused structural damage to the institute. The mental health of the patients witnessed dramatic improvements as the patients demonstrated improved social interactions (Association for Experiential Education, 2013). These two events documented the first cases of using the outdoor environment therapeutically which formed the foundation concept of Adventure Therapy. In 1929, the first approach of using camping as a therapeutic tool was designed by Camp Ahmek, Canada. This specialised programme witnessed the different changes in social behaviours amongst young males through socialising in a wilderness setting (Association for Experiential Education, 2013). The second programme that was designed using the outdoor environment therapeutically emerged in 1946 as part of the Salesmanship Club of Dallas. This club programme represented the camping experience seeking out its therapeutic application as their primary goal (Association for Experiential Education, 2013).
  13. 13. 12 With the lack of Irish documentation it is unclear when an Adventure Therapy approach was first introduced into the Republic of Ireland. Active Connections (2011) identify that their aims is “to have Adventure Therapy as an option for all people in need, and at risk in the country”, Comeragh Wilderness Camp (2015) also attempts to provide a “unique therapeutic programme for young males who are having difficulty in their home and school”. 1.4 Background Information to this Topic Ryan & Larissa (2012, p. 2) cited in Gillis & Thomsen (1993) noting that Adventure Therapy is an active experiential approach towards group psychotherapy and counselling. Not only does it utilise an activity base but also it employs real and or perceived risk as a clinical agent to bring about desired change. This experiential phase of therapy has had a successful record in North America helping young adults boost their self-esteem and self-concept by providing an environment in which they can remove themselves form their daily life distractions (Red Oak Recovery, 2016). While the therapeutic benefits of these programs include connecting with the natural out-of-doors environment, it also helps to improve the ability to trust ones judgement through the individual experience of teamwork, building on the attributes of self-control and taking responsibility for ones own individual actions (The Addiction Recovery Guide, 2015).
  14. 14. 13 Chapter 2 The Literature Review 2.1 Introduction This literature review will focus on themes within Adventure Therapy, Adolescents, Substance Related Addiction, and Rehabilitation. Many practitioners and professionals are beginning to identify the negative consequences of a clinicalised health system and that there are a variety of other potential approaches being explored (Kim, et al., 2009). Adventure Therapy is one such approach to which has shown to have significant success with adolescents suffering from physical and mental health difficulties (Gass, et al., 2012; Tucker & Norton, 2012; Gass, 1993). 2.2 Adventure Therapy Adventure Therapy as an approach benefits adolescents who abuse substances and is used amongst various professional practitioners however, Adventure Therapy is a wide topic. Richards, et al. (2011, p. 17) identifies a number of adventure therapy programmes that describe work which falls under the umbrella of Adventure Therapy. These include:  Adventure Based Counselling  Wilderness Therapy  Wilderness Adventure Therapy  Therapeutic Outdoor Programming  Bush Adventure Therapy (Australia)  Outdoor Behavioural Health Care  Nature Based Therapy  Eco Therapy  Horticultural Therapy For this research the author will focus directly on the area of clinical based Adventure Therapy.
  15. 15. 14 2.2.1 Defining Clinical Adventure Therapy Defining Adventure Therapy solely as a clinical tool which therapeutically changes behavioural patterns in individuals within a natural environment setting is difficult. However, many researchers agree on the terms and understanding of Adventure Therapy. Researchers have defined Adventure Therapy as a prescriptive use of adventure experiences. Using the natural environment to focus on group based therapy, Adventure Therapy is used as a clinical tool to engage individuals in programmes to promote therapeutic changes in their behaviour. It is agreed that this therapeutic intervention approach uses adventure activities to engage clients on cognitive, affective, and behavioural levels (Gass, et al., 2012; Tucker & Norton, 2012; Norton & Tucker, 2010; Tucker, 2009; News & Bandoroff, 2004; Alvarz, & Stauffer, 2001; Gass, 1993). Gass, et al., (2012) and Gass (1993) clearly identifies Adventure Therapy as practices that are placed in an out-of-doors environment were participants undergo extensive therapeutic changes. These group based programmes focus on a variety therapeutic outcomes while promoting changes in the individual behavior. Itin (2001) agrees that Adventure Therapy is identified as adventure based practice with change directed at the individual’s behavior patterns that support therapeutic change. 2.2.2 Adventure Therapy Models There are a number of Adventure Therapy models which contribute to modern clinical practices (Norton, et al., 2014; Tucker & Norton, 2012; Gass, 1993). The most common and significant Adventure Therapy models have been documented in a number of research reports from North America. A number of institutes in North America
  16. 16. 15 use Adventure Therapy models as an intervention tool towards a variety of mental health complications such as substance related addiction (substance abuse, dependency, health issues), continuous anti-social behaviour (property vandalism, robbery, assault), and family therapy (Wilderness Treatment Centre, 2015; Blue Fire Wilderness Therapy, 2015; Equinox Counselling & Wellness Center, 2016; Second Nature Wilderness Therapy, 2016; Elements Wilderness Program, 2014; Alaska Crossings, 2016). While Gass (1993, p. 9) notes that “Adventure Therapy has evolved into three distinct areas - Wilderness Therapy, Long Term Residential Camping, and Adventure Based Therapy”. This observation was added to in Gillis & Gass (2004, p. 2) the three distinct models were expanded: 1. “Challenge / ropes courses and through the initiative experiences associated with Adventure Therapy approaches, 2. Wilderness based therapy, example; Outward Bound 20-60 day wilderness travel programmes, 3. Long Term Residential camping therapy, example; stationary, primitive living programmes”. Previously Crisp (1997, p. 58) distinguishes Adventure Based Therapy as an emphasis on the contrived nature of the task. He identifies that Adventure Therapy programmes are designed around particular tasks influenced by the therapist to meet specific outcomes for the needs of each individual. This statement highlights the benefits of an Adventure Therapy approach and how it can potentially meet the needs of individuals who suffer from substance related addiction in a drug rehabilitation programme. While wilderness therapy is a therapeutic experience that occurs in a remote wilderness setting. These programmes commonly consist of small groups were the client participates in the programme for multiple days with round the clock intervention. This particular type of therapy is limited to one extensive experience, which often follow up contact with therapy is often limited (Gass, 1993, p. 9). Depending on the programmes goals, the
  17. 17. 16 outcomes for individuals involved are critical to achieve the difference in behaviour patterns. While this once off wilderness experiences focusses on an intense therapeutic experience it is short lived while other programmes such as Long Term Residential Camping Therapy consists of longer periods with follow up sessions. With long term residential camping therapy, these programmes value the wilderness environment for a long period of time and focus on the individual behaviour patterns (Gass, 1993, p. 10). Buie (1996) utilises the long term residential camping therapy model by “having a permanent base camp, and temporary camp sites built by campers (typically tent-covered wood platforms)”. This approach can benefit the outcomes by monitoring each site which can identify each group’s performance while participating in these specialised programmes. Although these models of Adventure Therapy focus on the therapeutic approach each developed programme must be taken with great care to ensure the success of its intended outcomes. Understanding the connection between these models in practice, it can acknowledge how each model can benefit towards an Adventure Therapy approach in an Irish context. Identifying this key link between these models and the research topic it constitutes that there is extensive background research done within this specialised area in North America. This current research supports additional background knowledge when examining the attitudes of professional drug rehabilitation therapists using an Adventure Therapy approach within an Irish context. 2.2.3 The Process of Adventure Therapy There are a number of different processes that utilise Adventure Therapy programmes such as “prevention, dropout, reintegration, and family” (Gass, et al., 2012), though it may have
  18. 18. 17 different effects on the outcome for many individuals. From continuous evaluations and assessments on newly developed programmes over the past decade, professional practitioners and theorists claim that adventure programming has had a positive affect while working with particular sub groups such as adolescents in an out-of-doors environment (Gass, et al., 2012; Gass, 1993). Gillis & Thomson (1996, p. 7) agree with this statement by identifying that Adventure Therapy works through “an active, experiential approach to group (and family) psychotherapy or counseling”. As they acknowledge that most of the therapeutic work goes on in one-to-one conversations between the therapist and client while participating in an activity, they emphasise that they must employ real or perceived risk to grasp that significant clinical agent for the success of the programme. With a different approach from Nold & Wilpers (1975, p. 155) they argue that “adventure programmes are only part of the rehabilitation process” in addiction groups. While this statement signifies that Adventure Therapy cannot be the only approach towards a rehabilitation process, Gass (1993, p. 5) also agrees that “Adventure Therapy is not used to replace other therapeutic interventions and practices; instead, it is used to enhance established treatment objectives and to provide a richer therapeutic environment for change so that the therapy itself is more successful”. The process of an Adventure Therapy model is a critical element in the development of a programme which witnesses its clients participating in a physically and mentally active role. This process allows the participant to develop through an experiential approach in an out-of-doors environment.
  19. 19. 18 2.3 Adolescence As this study focusses on the attitudes of Irish professionals using an Adventure Therapy approach in drug rehabilitation centres with adolescents, it is obligatory to emphasise the importance of why adolescents experiment with drugs and identify the common trends within this industry. It also explores the impact of substance related addiction and how adolescents don’t recognise future consequences from experimenting with such substances. As the topic of this subject focusses in part on adolescence and substance abuse, addiction is therefore important to identify the concept of adolescence and explore the different roles that adolescents play in society along with key issues they face during this period in life. Kaplan (2004, p. 1) defines the term adolescence to be “the period of life between childhood and adulthood”. While Leener (2010, p. 1) supports this definition by acknowledging that it is a period in one’s life when they transform childlike behaviour patterns to adult like behaviour patterns, he considers that it is important to recognise one’s characteristics in order for a change to develop into an adolescent. Gass (1993, p. 39) agrees that the transition from adolescents into adulthood is a difficult one. As some adolescents who do not develop certain attributes and responsibilities before reaching a certain age may be ill equipped for the life journey ahead of them. During this period in a young person’s life, they develop a more physically advanced change in their body known as puberty which usually takes place between the ages of twelve to eighteen years old (BBC, 2015). They develop an understanding of society and how the world works through various forms of education and experiences. This not only offers an opportunity for them to create an identity in society but also encourages them to express their needs and interests amongst peers (Kaneshiro, 2015; American Psychological Association, 2002; Dunham, et al., 1995; Archer & Waterman, 1983; Erikson, 1959).
  20. 20. 19 2.3.1 Adolescents Role in Society Adolescents find their role in society through active searching which leads to discoveries about themselves (James, 1986). As an adolescent turns eighteen years of age, society entrusts them with certain privileges such as voting, driving, serving in armed forces, purchasing and drinking alcohol, further education, legal sexual relationships and marriage which acknowledge their roles as adults (James, 1986). Perkins (2007, p. 1) identifies that an adolescents identity is influenced by their current culture trends. While acknowledging these trends he also concludes that there are a number of important developmental roles for adolescents to develop their identity in society. The desire to achieve social responsibility one must acquire a set of ethical values to prepare for an economic career with possible interests of marriage and family life. This study allows an understanding of the role of adolescents in today’s society, while focusing on the young person creating their own identity through a range of different experiences. It can also include an opportunity for experimentation that can potentially lead to some form of substance related abuse. 2.3.2 Key Issues involving Adolescents in today’s Society Key issues involving adolescents in today’s society is an important aspect for this study. While adolescents get a sense of independence, risk taking is on high demand as they want to experiment to find their own identity therefore there is a high emphasis on approval of peers (ReCAPP, 2007). This involves experimenting and experiencing Physical Development, Cognitive Development, Emotional Development, Social Development, and Behavioral Development (National Institute on Drug Abuse, 2014; American Academy of
  21. 21. 20 Child and Adolescent Psychiatry, 2011). Part of this psychological transition, it offers an adolescent the opportunities to experiment with new behaviors which can result in risk taking, a normal part of adolescent development. Risk taking behavior includes developing realistic assessments of themselves while gaining peer acceptance and respect. This behavior helps to shape their identity by exploring new decision making skills, but unfortunately may pose a real treat to their own health and wellbeing (ReCAPP, 2007). While an adolescent begins to achieve a realistic sense of identity they also experiment with the different ways they appear and behave. Although they may approach these different transitions in his or her own unique way (American Psychological Association, 2002, p. 15) they also explore other areas of concern such as education, sexual relationships, drug and alcohol abuse (American Psychological Association, 2002, p. 29). Adolescence is “a time when experimenting with alternatives is developmentally appropriate, except when it seriously threatens the youth’s health or life” (American Psychological Association, 2002, p. 15). In Adventure Therapy adolescents have the opportunity to take risks in a safe and controlled environment. Where the risk may be real are perceived and is controlled. 2.4 Addiction Medilexicon (2015) defines addiction as “An individual who does not have control over what they are doing, taking or using. Their addiction may reach a point where it becomes problematic which may cause harm to themselves our others around them”. However the Norlien Foundation (2014) broadens this definition by breaking it into three categories:
  22. 22. 21  Behavioural / Process Addiction example: Gambling, Food, Sex, Internet, Video Games, Work  Substance Related addictions example: Tobacco, Alcohol, Street Drugs, Prescription Drugs  Multiple Addictions and Co-morbid Factors example: Any type of addiction plus depression, anxiety. 2.4.1 Substance Related Addiction Substance related addiction is one of the most recognisable forms of addiction in Irish society as the physical and mental impact upon one’s body can vary depending on their usage of a substance related drug (Butler & Mayock, 2005; Corrigan, 1986; Dean, et al., 1985). American Psychiatric Association (2000) defines substance related addiction in the Diagnostic and Statistical Manual of Mental Disorders as: “A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring any time in the same 12-month period: 1. Tolerance. 2. Withdrawal. 3. Substance quantity increases. 4. Persistent desire to reduce quantity of substance. 5. More time consumption to obtain substance. 6. Personal interests are reduced because of substance use. 7. Continued usage despite knowledge of physical and psychological problems”. Substance related addiction is a psychological or physiologic dependence of a substance which is beyond an individual’s voluntary control. With persisting usage of a substance despite problems related to its dependency it may be diagnosed. While trying to withdraw
  23. 23. 22 from an addictive substance the individual may experience psychological and/or physical withdrawal symptoms (MediLexicon, 2015; American Psychiatric Association, 2013). Although these statements clearly define substance related addiction as a term used for an addict who does not have full control over their behavior towards a substance. The influence of a substance within an individual’s body may put themselves and others at risk through their actions, therefore their dependency for the substance becomes addictive. 2.4.2 Common Trends of Substance Related Addiction amongst Adolescents There are a number of trends for substance related addiction in today’s society. The National Advisory Committee on Drugs (2011, p. 8) recognise that the most common substance related addiction in the Republic of Ireland alone relates to Tobacco and Alcohol. While other illegal drugs are also easy accessible to the adolescent group the most common ones can be found in Appendix 4. The Global Drug Survey (2014, p. 14) clarifies that the most common illegal substances consumed in Irish society are Opioid Pain Killers and Benzodiazepines which is a common substance taken by young people. The Health Promotion Unit (2003) acknowledges all forms of drugs stated in Appendix 1 and recognises the same trends as expressed in other studies presented by the Global Drug Survey (2014, p. 14) and the National Advisory Committee on Drugs (2011, p. 8).
  24. 24. 23 2.4.3 Adolescents Experimenting with Drugs Both Drug.ie (2015) and Irishhealth.com (2015) agree on the reasons as to why adolescents take drugs. An adolescent believes that in taking drugs they feel and look grown up; they take them to feel good and for fun; because their friends do and for the experience or out of curiosity. Those surveyed also suggested that they use drugs to escape problems (Irishhealth.com, 2015). According to National Advisory Committee on Drugs (2011, p. 8) experimentation amongst young people starts off on other substances such as tobacco and alcohol, dependency on these substances can potentially lead to more explicit drugs such as cannabis and with extensive use of such substance can lead to an addiction (The Children's Research Centre, 1997, p. 8; Smyth, 2006). Adulterer evidence suggests that during the adolescent stage in life there are certain behaviours that influence ones approach of risk taking. The reason why adolescents experiment with substances such as drugs is because it is part of forming an identity, leading them into adulthood and also shows the importance of social bonding with their peers. 2.5 Substance Related Rehabilitation While this study focusses on the attitudes of Irish professionals using an Adventure Therapy approach in drug rehabilitation centres with young drug addicts, this section identifies models of rehabilitation that exist within the republic of Ireland. This section also explores the current processes and availability of services and institutes to adolescents who suffer from substance related addiction within the republic of Ireland.
  25. 25. 24 The World Health Organisation (2011, p. 96) defines rehabilitation as “a set of measures that assist individuals who experience, or are likely to experience, disability to achieve and maintain optimal functioning in interaction with their environments”. Oxford Dictionary (2002, p. 1439) defines substance related abuse as “An intoxicating, stimulation, or narcotic chemical or drug, especially an illegal one”. When combining both aspects of substance related abuse and rehabilitation the Department of Community, Rural and Gaeltacht Affairs (2007, p. 7) conclude that substance related rehabilitation is “A structured developmental process whereby individuals are facilitated to become fully involved in the process of regaining their capacity for daily life free from the impact of problem drug use”. The undersanding of these statements acknowledge that substance related rehabilitation is directly referred to the rehabilitation of those who suffer from a chronic substance related addiction. This defrintiates ones overall context of rehabilitation to a more specific rehabilitation setting such as substance related rehabilitation. The connection between substance related rehabilitation and the study topic is in fact an important element for the justification of professional clinical therapists. While exploring their methods of practice within the work place it might identify a gap that could promote the use of an adventure therapy approach in a rehabilitation setting. 2.5.1 Substance Related Rehabilitation Models There are a number of rehabilitation models available for those who suffer from substance related addiction. The Department of Community, Rural and Gaeltacht Affairs (2007, pp. 20 - 21) noted in the National Drugs Strategy 2001 - 2008 that due to the broad socio- demographic use of drugs there is not one over all model that will suit all. However it is
  26. 26. 25 also recognised that in all models there are some constraints that must be in place to provide a successful and effective programme, these include:  Preparation for and rapid access to rehabilitation  Social and environmental factors  Retention in a residential programme where appropriate. Doyle & Ivanovic (2010, p. 9) adds to these measures, noting that an individual’s needs and experiences must also be taken into consideration in order to improve a successful outcome. The measures considered include:  Drug Specific Intervention  Family Support and Childcare  Aftercare The Centre for Substance Abuse Treatment (2005) distinguishes two models of substance related rehabilitation by using an outpatient programme and a residential programme approach. From the research provided it concludes that all models of current rehabilitations are developed to meet the individual needs of addicts. All the models of rehabilitation programmes aim towards one goal which is to successfully rehabilitate an individual suffering from addiction and re-conform them back into society. 2.5.2 Processes of Substance Related Rehabilitation Considering the models recommended by Doyle & Ivanovic (2010), the Department of Community, Rural and Gaeltacht Affairs (2007) and the Centre for Substance Abuse Treatment (2005), the process of substance related rehabilitation must also judge what is suitable for each individual case. The World Health Organisation (2011) who overview the population of world health, identifies the process of substance related rehabilitation by
  27. 27. 26 addressing such problems and addressing the needs of each individual. These factors include adapting the problem to appropriate measures taken for each individual such as planning, implimenting and coordinating interventions and assessing the after effects. The National Institute on Drug Abuse (2009) and Nordqvist (2009) recognise that drug addiction is a complex illness that often goes untreated. They add that there are many effective approaches to treatments including programmes, medications, and behavioural treatments including psycotherapy (National Institute on Drug Abuse , 2009; Nordqvist, 2009). All of whom help with withdrawl symptoms from addictions to depressants, stimulants, and opioids. The Department of Community, Rural and Gaeltacht Affairs, (2007, p. 12) in tandem with the World Health Organisation (2011), the National Institute on Drug Abuse (2009) and Nordqvist (2009) suggest that specific treatment options in tackling addiction for adolescents can vary in methods and approaches. These processes identify that there are a variety of treatments available to those who suffer from substance related addiction and are undergoing rehabilitation programmes. As addiction is targeted from a number of angles, rehabilitation therapists offer help to the individual to conform back into society from their illness which many of these practices are also recognised in the Irish context! 2.5.3 Irish Rehabilitation Centres for Young People with Addiction There are two main identified residential centres in the Republic of Ireland that focus specifically on adolescents who suffer from addiction which are: 1. Aiseiri (Aislinn) Treatment Centre, Co Kilkenny 2. Matt Talbot Treatment Centre
  28. 28. 27 Aiseiri (Aislinn) Treatmeant Centre (2015) state that their centre was established in 1998, making them the country’s first adolescent residential addiction treatment centre. Their treatment programmes are residential up to twelve young people at any given time and offer a number of therapies in the facility that range from:  One to One Counselling  Group Therapy  Recreational Therapy  Behavioural Therapy  Peer Groups  Crises Intervention  Motivational Interviewing  Social, and Life Skills The Matt Talbot Treatment Centre (2015) was Irelands second established residential treatment centre for adolescent boys aged 14 – 18 years old with serious substance misuse and co-existing psycho-social challenging issues. Their treatment programmes can reside up to twelve adolescent boys at any given time and can offer therapies in their facility ranging from strategies offered in the Aislinn Centre but also focussing on therapies such as:  Harm Reduction  Motivational Therapy  Personal Development Skills Other facilities in the Republic of Ireland whom offer non-residential treatment for adolescents with their fight against addiction include: 1. YODA Project, County Dublin 2. Youth Health Services, County Cork 3. Canal Community Local Drugs Task Force, County Dublin 4. ACRA Treatment Facility, County Dublin
  29. 29. 28 These non-residential facilities offer a number of treatment approaches and aftercare support for young people. In conclusion, Residential services play a critical role in rehabilitating these young people from their illness and reintroducing them back into society with the higher concepts of conforming and reducing further harm to themselves and others around them. 2.6 Chapter Summary Adventure Therapy programmes are utilised through active participation of a variety of tasks / challenges which comprehend effective decision making. This is what influences the change of an individual’s attitude and behavior towards a variety of issues through a method of therapeutic practice within the wilderness context. Clinical Adventure Therapy use these therapeutic intervention tools through a variety of models to focus in on one to one conversations between the therapist and the client to build a trusting relationship to underpin the individual’s problems. Although Adventure Therapy programmes are only part of the process it can influence the individual’s physical and mental participation in the rehabilitation process. Through utilising these Adventure Therapy programmes it has an active experiential approach which was a positive effect on a number of sub groups including adolescents. As adolescents take high risks in developing an identity in society through behavioral developments, it is essential that their role in society is processed through active searching which leads to discoveries about themselves and finding independence. While key issues involving behavioral development access the experimentation process in risk taking, it may pursue a more dramatic threat to their health and wellbeing through the use of tobacco, alcohol and drugs.
  30. 30. 29 With current research stating that substance abuse is increasing amongst adolescents in Irish Society, it acknowledges that addiction poses a real threat to their health and wellbeing. Common trends of substance abuse amongst adolescents identifies that there are number of drugs that are easily assessable to this group. Adolescents acknowledge that there are many reasons for experimenting with such substances and it is part of forming their identity in society. As continuous substance abuse forms an addiction there are currently a lack of facilities for these young people to get help in the Republic of Ireland. Identifying current models in place to intervene in such circumstances the process can be complicated as addiction is recognised as a complex illness. Drug rehabilitation services play a critical role in reintroducing these adolescents back into society with higher concepts of the young person avoiding such substances in future. Forming a link from this chapter back to the research question identifies a connection of an Adventure Therapy approach that could potentially benefit young people who suffer from substance related addiction in drug rehabilitation centres in the Republic of Ireland. Acknowledging such an approach the researcher would like to examine the attitudes of Irish professionals currently in this field on the use of this approach in drug rehabilitation programmes in Ireland.
  31. 31. 30 Chapter 3 Methodology 3.1 Introduction This methodology Chapter will consider the research question, identifying the research paradigm, exploring the research design and the rationale behind the research design. It examines the sample population and concluding how the sample group was identified through sampling techniques. The scope, limitations, ethical considerations, informed consent and confidentiality statement. The instrumentation used for this study, its reliability and validity of the sample group towards this research and its survey design will be explained. Finally it will examine the data collection procedures identifying a plan of how the data collected will be analysed and presented in the results Chapter. 3.2 Restatement of Research Question The aim of this study was to examine the attitudes of professional addiction therapists towards the use of adventure therapy as an approach in a drug rehabilitation setting with adolescents. 3.3 Instrumentation Instrumentation used to conduct surveys were used through a mixed method approach. While the survey consisted of fourteen questions of both open and closed ended questions, it is evident that the Likert scale was used for a number of questions. The Likert scale explored quantitative methods of research while other forms of qualitative research explored the attitudes of respondents and their perceptions towards the topic of study. With a mixed method approach it offered a variety of results to be collected from the sample group allowing the researcher to explore the attitudes of Irish Professional Therapists using
  32. 32. 31 both qualitative perceptions of adventure therapy and quantitative perceptions of an adventure therapy approach being used in a drug rehabilitation programme. 3.4 Research Paradigm The mixed method approach allows a combination of methodologies within the same study as it offers research techniques that suits the research topic. The link between both positivist, post-positivist paradigms and the methodology type for this study allowed attitudes to be examined from the sample population (Guthrie, 2010, p. 45). The appropriate measure used for this study allowed a high level of reliable results to be collected from the sample source (Guthrie, 2010, p. 43). Considering this method it identified the importance of having a mixed method approach to examine the attitudes of Irish professionals using an adventure therapy approach in drug rehabilitation centres. 3.5 Research Design The research was located in six Irish residential and non-residential institutes that work with the rehabilitation of young people who suffer from substance addiction. The reason for choosing the mixed method approach was that the population of the focused group is based across a wide area. The quantity of the samples were of a sufficient amount to research this study from a number of clinical rehabilitation institutes across the Republic of Ireland. An additional reason for choosing this method was due to time constraints as the study was based over an eight month period. The research involved sending out fifty individual questionnaire surveys by email to the intended sample groups who work directly with adolescents in rehabilitation services in a number of institutes across the country. The survey consisted of fourteen questions relating
  33. 33. 32 to an adventure therapy approach in the process of a substance related rehabilitation amongst adolescents. The mixed method approach that had been used throughout the survey consisted of a number of open ended and closed ended questions that collaborated a series of professional attitudes towards an adventure therapy approach in substance related rehabilitation centres across the Republic of Ireland. Not only focusing directly on their attitudes but the questionnaire survey also looked at the possible approaches for Adventure Therapy to be used in Irish rehabilitation centres. The reason behind chosen multiple institutes across the Republic of Ireland was that it created an overview of the study in multiple institutes and not only focussing on one rehabilitation centre. 3.6 Rationale for Research Design The rationale for using a mixed method questionnaire survey approach was that it would “obtain information from a representative selection which can be analysed and patterns extracted and comparisons made” (Bell, 1999, p. 13). This method for collecting data offered a personal perspective from the respondents on their attitudes of using an Adventure Therapy approach. These findings included a number of different institutes therefore acknowledging if an Adventure Therapy approach could be adopted into the rehabilitation process in Ireland. While researching “Doing your Research Project” (Bell, 1999) the conclusion was to use a mixed method open ended and closed ended questionnaire survey approach. This survey was emailed to the identified sample group as the economical methods were cost effective and easily accessed. A survey method was found to offer more friendly open and closed ended questions which was suitable for this type of study and within the available
  34. 34. 33 timeframe. This would provide a more dynamic and accurate result on the research in question which could be initially analysed for the final result. 3.7 Sample Population The description of the sample population included over eighteen years old, mixed gender, clinical rehabilitation therapists who work directly with adolescents suffering from substance related addiction in rehabilitation centres across the Republic of Ireland. Samples researched and considered for this research consisted of fifty professional clinical therapists who work directly with young people who suffer from substance related addiction. These samples consisted of two residential centres and four non-residential centres. The two residential centres which were the Aiseiri Aislinn Treatment Centre (Kilkenny) and Matt Talbot Treatment Centre (Cork) included ten surveys to each centre. The four non-residential centres which had been selected for this study included YODA Project (Dublin), Youth Health Services (Cork), Canal Community Local Drugs Task Force (Dublin), ACRA (Dublin) which each centre received five surveys. An additional ten surveys were emailed to individuals whom have a direct connection in working in the area of Adventure Therapy and addiction within drug rehabilitation institutes. 3.8 Scope The scope of this study focused on a broad range of academic articles, journals, reports, books, and online literature. With key areas of the primary research focussing on Irish
  35. 35. 34 materials, other sources of information were selected from a number of literature based in North America and Europe. 3.9 Limitations The limitations of this study was limited to the Republic of Ireland. While acknowledging the time constraints of the study this also limited the size of the intended sample group. Individuals who wished to participate in this study must have been over the age of eighteen years old. Although the study itself focussed around adolescents they were not asked to participate in the research. 3.10 Ethical Considerations Ethical considerations was a critical element of conducting research. These considerations that needed to be addressed for this study were: 1. An agreement between tutor and pupil of finalised research survey before submitting it to any institutes. 2. No minor under the age of eighteen years old will be considered for this research. 3. Ensure respondents that participation is entirely voluntary. 4. Ensure that all respondents that participate in the survey are entirely safe from any harm. 5. Include a written information front sheet (See Appendix 1) detailing the proposed study and research area which shall include:  Study title  Invitation paragraph  What is the purpose of the research
  36. 36. 35  What will happen to the person if they take part  What is to be done with the information they will provide  Who will review this study 6. All participants will mark an X on a consent to participate in survey if they wish or do not wish to respond to the survey. 7. The use of offensive, discriminatory, or other unacceptable language needs to be avoided in the formulation of the questionnaire survey. 8. Inform participants in writing of their right to withdraw from the research at any time. 9. Maintain the highest level of respect in discussions and analyses throughout the research. 10. Additional contact information for researcher and reviewing Institute. In this case Galway Mayo Institute of Technology Castlebar Campus. 11. All respondent’s information will be kept strictly confidential under the Data Protection Act (2015). Bell (1999, p. 46) stated that the researcher must “decide whether participants will receive a copy of the report as there are cost and time implications”. All participants who wish to request a copy of this particular research may do so in writing to the reviewing institute. In this case it is Galway Mayo Institute of Technology Castlebar Campus. These ethical considerations were adopted into this study. Other ethical considerations that had been identified during this research were not practical or relevant for this type of study, consisted of risk assessments of the samples and a debriefing session if a form of deception was included.
  37. 37. 36 3.11 Informed Consent and Confidentiality An Informed consent and confidentiality agreement to participate in the study consisted of a hand written document between the respondent and the researcher (See Appendix 2). 3.12 Validity and Reliability The validity and reliability of the study was supported by professional therapists from a number of backgrounds in clinical addiction rehabilitation. A number of professional clinical therapist respondents from different drug rehabilitation institutes within the Republic of Ireland provided reliable results for the research by not supporting biased and intentional incomplete results. This method of collecting data from a number of drug rehabilitation institutes would identify if respondents were directed to responding to the survey in a particular way by their institute. A validity approach was to ensure that questions being asked in the survey was valid to the study topic. Identifying the focussed sample group also insured that participants who responded were a valid source for appropriate results towards the study and not the general public who could potentially provide inaccurate results. Reliable and valid approaches for collecting data were critical aspects for this study. As it focussed on the attitudes of Irish clinical professionals in drug rehabilitation centres and not the general public it allowed the researcher to build on the understanding and perceptions of an Adventure Therapy approach used in the Republic of Ireland which may influence further research in this field.
  38. 38. 37 3.13 Survey Design Based on current research of Adventure Therapy approaches in North America and Substance related rehabilitation methods in the Republic of Ireland, the researcher identified a number of questions to examine the attitudes of Irish Professional therapists working in the area of substance related addiction with adolescents. These selection of questions were carefully identified and selected to be viable for this study (Appendix 3). Not only did the researcher acknowledge other Adventure Therapy approaches in North America and Europe but he designed the survey to be judgemental free. It also gave the opportunity for the researcher to examine the attitudes of the sample group towards Adventure Therapy approaches and correspond them with literature research highlighted in the Literature Review Chapter. 3.14 Data Collection Procedure Data collection procedures for receiving surveys were through either online submission at g00318491@gmit.ie or by post to the researcher’s home address at 11 Brookview Drive, Brookfield, Tallaght, Dublin 24. 3.15 Data Analysis Plan Qualitative and Quantitative data that was collected for this study was conducted through a number of surveys. The results required different types of data analysis which were synthesised through categorisation and description. These included:
  39. 39. 38 Question Sequence Data Sequence 1, 2, 3, 4 Measurement Data 5, 6 Qualitative Data 7, 8, 9, 10, 11, 12 Measurement Data 13, 14 Scaled Data 3.16 Chapter Summary In summary, the Methodology Chapter focused on research methods that had been based on the research question “The Attitudes of Irish Professionals using an Adventure Therapy Approach in Drug Rehabilitation Centres”. Within this Chapter it explored the different approaches that were available to carry out this study. The instrumentation that was used to conduct research consisted of a mixed method approach survey. This survey included fourteen open and closed ended questions to examine the attitudes of Irish professionals working in the field of drug rehabilitation and their perceptions of the use of an Adventure Therapy approach. While acknowledging the research paradigm as both a positivist and post-positivist, the appropriate research design allowed for reliable results from the sample group. The sample group included a number of drug rehabilitation institutes across the Republic of Ireland along with individuals already working in the field of Adventure Therapy. The rationale for using a mixed method questionnaire survey approach was that it offered a personal perspective of respondents and offered viable results. Due to the timeframe of the research the study was limited to a selected sample group and introducing economical methods that were cost effective the surveys were emailed to the sample group.
  40. 40. 39 Considering the scope and limitations to the study, it focussed on adolescents but with the research considering vulnerable young people they were not asked to participate in the study as all respondents needed to be over the age of eighteen years old. Ethical considerations were carefully considered as the author was researching a particularly new area of study in the Republic of Ireland. All respondents who wished to participate in this study done so at a voluntarily and anonymous basis. In order to participate in this study respondents were required to mark an informed consent and confidentiality agreement. As the validity and reliability of this study was supported by professional rehabilitation therapists it ensured the results to be adequate and appropriate for this particular research. With current research based on Adventure Therapy approaches in North America and Substance related rehabilitation methods in the Republic of Ireland it offered an opportunity for the researcher to examine the attitudes of Irish professionals working in rehabilitation centres. Data collection procedures allowed for a quick and effective collection of surveys for this research. While the data analysis plan allowed for the questions to be categorised into four different measurements for easy and effecting reading of the results.
  41. 41. 40 Chapter 4 Results 4.1 Introduction This Chapter will provide all results and data attained from responded surveys examining the attitudes of Irish Professionals using an Adventure Therapy approach in Drug Rehabilitation Centres with Adolescents. The study conducted a fourteen question survey on fifty clinical rehabilitation therapists and adventure therapy therapists across a number of institutes in the Republic of Ireland. 4.2 Summary of Statistical Analysis Of the fifty survey’s sent out for this study twenty one were received completed correctly and deemed viable for this research. This identified a respondent rate of 42%. The results of the survey show a number of professional therapist’s attitudes and perceptions towards the use of an Adventure Therapy approach with Adolescents in an Irish Drug Rehabilitation context.
  42. 42. 41 4.3 Tables and Figures of Results Figure 1. The above chart identifies the distribution of gender within the survey. It shows the male population of respondents at 57% and the female population of respondents at 42% which highlights the overall quantity of the 21 respondents who participated in the study.
  43. 43. 42 Figure 2. The above chart identifies the distribution of the age breakdown amongst the population of the survey. Of the 21 viable respondents 10% were between the ages of 18 and 24, 40% were between the ages of 25 and 34, 35% were between the ages of 35 and 44, and 15% were between the ages of 45 and 54.
  44. 44. 43 Figure 3. The above chart identifies the distribution of Professional Occupation analysis within the survey. These results show that the 21 respondents were made up of 5% of Councellors, 15% of Psychologists, 5% of Psychotherapists, 10% of Social Workers, 10% of Nurses, and 55% of other occupations such as Adventure Therapists, and Social Care Workers while only 1 respondent skipped this question. This was an unexpected result as the researcher was focussing on a specific sample group which thought might have produced more clinical therapist respondents.
  45. 45. 44 Figure 4. The above chart identifies if the respondents organisation provide an Adventure Therapy approach in its programmes. While all 21 respondents successfully answered 52% of them answered “yes” that their organisation does provide an Adventure Therapy approach while 48% of them answered “no” to the question. Qualitative Data: Question 5 in the survey consisted of a qualitative response from the respondents which focussed on why their “organisation do / do not utilise an Adventure Therapy approach”. The results showed a number of interesting and valuable points as to why their organisation do and do not utilise an Adventure Therapy approach in drug rehabilitation centres (See Appendix 5).
  46. 46. 45 Question 6 in the survey also consisted of a qualitative response from the respondents which focussed on the respondent’s perception of Adventure Therapy as an approach, in a drug rehabilitation setting. These results showed that many respondents believed that it was a successful and effective approach in a drug rehabilitation setting in the Republic of Ireland while others argued that the approach is not a stand-alone service and needs to be implemented properly into the rehabilitation ethos and theory evidence. (See Appendix 6). Figure 7. The above chart identifies the respondent’s answers by acknowledging that 70% of them agree with between the ages of 13 and 18 Adventure Therapy would be most beneficial. This result was closely followed by 65% of the respondents agreeing that 18 to 25 year olds would also benefit from the use of an Adventure Therapy approach in a drug
  47. 47. 46 rehabilitation centre. Surprisingly 45% of the respondents also agree that an Adventure Therapy approach as young as 8 years old can benefit from its intervention with a drug rehabilitation program followed by 35% agreeing that 25+ would benefit from this approach. Figure 8. The above chart identifies which gender would benefit more from using Adventure Therapy as an approach during their rehabilitation process. 95% of the respondents concluded that males would benefit more from this approach compared to 65% concluding that females would also benefit from this process.
  48. 48. 47 Figure 9. The chart above identifies the respondent’s interests towards an Adventure Therapy approach and acknowledges where an Adventure Therapy programme would suit best. 40% of the respondents conclude that Adventure Therapy programmes would be more beneficial towards an intervention programme, while an equal 30% of respondents state that an Adventure Therapy approach would also benefit prevention and aftercare programmes.
  49. 49. 48 Figure 10. The chart above identifies which Adventure Therapy programme would be most beneficial towards adolescents suffering from substance abuse addiction. 70% of respondents conclude that group residential programmes would be most beneficial while 30% of respondents state that one on one day programmes would be most beneficial towards an Adventure Therapy approach involving adolescents suffering from substance abuse addiction.
  50. 50. 49 Figure 11. The chart above identifies what duration should an Adventure Therapy programme be delivered as part of a drug rehabilitation process. 45% of respondents conclude that a programme lasting 12 to 16 weeks would benefit the rehabilitation process most, were 30% of the respondents state that a programme lasting 4 to 8 weeks in duration would also have a beneficial affect followed by 25% of the respondents state that 8 to 12 weeks would be an appropriate duration for an Adventure Therapy approach in a drug rehabilitation process. Surprisingly none of the respondents selected the 1 – 4 weeks duration suggesting that an intervention programme should be based over a longer period of time.
  51. 51. 50 Figure 12. The chart above identifies where the most beneficial positioning of an adventure experience within the therapy programme. With 60% of the respondents concluding an adventure experience would benefit most in the middle of the programme, 45% of the respondents state that it should be positioned at the beginning of the programme and 35% concluding that it would benefit most near the end of the programme. With not much difference positioning an adventure experience between the different stages of a therapy programme it might be fair to say that some form of an adventure experience should be present throughout the programme.
  52. 52. 51 Figure 13. The chart above measures the attitudes of professional rehabilitation therapists towards an Adventure Therapy approach by working with professional outdoor educational individuals throughout a structured programme. 52% of the respondents stated that they would be very willing to work with outdoor educational professionals offering an Adventure Therapy approach in their programme, while 29% said that they would be willing, and 19% stated that they might be interested. None of the respondents identified that they would not be willing to work with outdoor educational professionals using an Adventure Therapy approach.
  53. 53. 52 Figure 14. The chart above measures the attitudes of professional rehabilitation therapists towards gaining additional training to promote the use of Adventure Therapy in a drug rehabilitation setting. 52% of the respondent conclude that they are very willing to gain additional training, while 14% state that they would be willing, 29% of the respondents said that they might be interested in gaining additional training were only 5% said that they were not willing to gain additional training.
  54. 54. 53 Chapter 5 Discussion 5.1 Introduction In this Chapter, results attained from the survey will be discussed further and compared with the findings in the Literature Review. Discussion requires two or more points of view therefore the structure of this Chapter is an important element in this study. Identifying four themes in the Literature Review helped outline the importance of the questions selected for the survey. As there is a lack of evidence on literature surrounding Adventure Therapy in an Irish context, it was the researcher’s ambition to examine the attitudes of Irish professionals working in a drug rehabilitation setting on an approach for Adventure Therapy programmes. 5.2 Literature Findings The literature introduces the concept to a number of different Adventure Therapy approaches and how they have been used as successful and effective tools towards mental health issues in North America. Following the Adventure Therapy ethos it offers an individual a therapeutic adventure experience focussing on underpinning their problems and working on their behaviour patterns to overcome the issue at hand. This approach is evident to successfully work in North America but there is a lack of knowledge and theory behind its approach in an Irish context. Using Adventure Therapy is identified to be a clinical tool that engages the client in an intervention process that contributes to their cognitive, affective and behavioural levels. Adventure Therapy models use a wilderness based programmes through a number of different challenges focusing on an active experiential approach. These approaches are essential elements that bring about sustained transformation in the persons psychological
  55. 55. 54 state. Identifying a deliberate intentional psychotherapeutic programme located in the out- of-door environment it achieves a number of therapeutic benefits but does not necessarily reflect on structured psychotherapeutic strategies in the programme itself. The integration of psychotherapeutic theory and practices in the outdoor environment is an important approach in developing the field of Adventure Therapy. Although Adventure Therapy is considered an intervention tool many authors conclude that the tool itself should not remove other important interventional measures in programmes. As more international practices tackle the imbued nature of psychological distress, it encourages openness so as to offer a variety of theoretical approaches. This enables practitioners to tailor programmes and interventions to meet the unique needs of their clientele. As this study focusses on the attitudes of Irish professionals using an Adventure Therapy approach in drug rehabilitation centres with adolescents, therefore it is important to emphasise why adolescents experiment with drugs. In Chapter 2.4.3, it is identified that an adolescence behavior increases in level with risk taking when in company with peers and friends as they want to fit into an identity role within their social group. It also states that experimenting with drugs is part of a coping strategy when faced with challenges that have unclear outcomes. There is a wide availability and easy accessibility of illegal drugs at present in Irish society which recognises that more young people can experiment with drugs. It is evident that one of the key issues involving adolescents in today’s society is substance related abuse. It is acknowledged that continuous abuse of a substance can potentially lead to an addiction. Substance related addiction is one of the most recognisable forms of addiction in the Republic of Ireland. Common trends in drugs previously identified are
  56. 56. 55 being easily accessed by Irish adolescents. It recognises the negative effects that drugs has towards a young person’s future of forming a self-identity and an active role in society. Examining Irish substance related rehabilitation models acknowledges that the main target group that is focused on in Irish society is adults. Exploring the services specifically available to young people, it is identified in Chapter 2.5.4 that there is a lack of facilities and resources available to them across the Republic of Ireland. A number of treatment models within the substance related rehabilitation framework has distinguished that there are procedures in place to meet specific outcomes of structured programmes. A number of different treatments such as medications, clinical therapy and behavioral treatments illustrates a connection with an Adventure Therapy approach that could benefit adolescents who suffer from substance related addiction in rehabilitation programmes within the Republic of Ireland. When reviewing the four Chapters of the Literature Review and studying the influence of Adventure Therapy on adolescents. They are shown to contribute to an effective approach towards an Adventure Therapy programme with adolescents suffering from a substance related addiction in drug rehabilitation centres across the Republic of Ireland. 5.3 Research Findings Analysing all twenty one results and data attained from respondents identified the different attitudes towards the use of an Adventure Therapy approach in drug rehabilitation centres. Learning about the distribution of the selected sample population the researcher identified key areas such as gender breakdown, age breakdown, and professional occupation to distinguish each individual respondent background.
  57. 57. 56 Highlighting the respondent’s background, the researcher identified if the respondents organisation provides an Adventure Therapy approach within their programmes. This offered an opportunity for the researcher to ask the respondents two qualitative questions surrounding why their organisation do or do not utilise an Adventure Therapy approach and what is their own individual perceptions of Adventure Therapy as an approach, in a drug rehabilitation setting. This information provided more in depth questions about Adventure Therapy and who would benefit from using such approaches in a drug rehabilitation setting. These included identifying an appropriate age group and acknowledging a gender difference. Understanding the background of potential individuals who would benefit from using such an approach in a drug rehabilitation setting, it was viable to find out were an Adventure Therapy approach would be most beneficial within the programme. This was identified through a prevention tool, intervention tool, or as an aftercare tool. Concluding that an Adventure Therapy approach should be used as an intervention model it was important to distinguish either which a one on one day programme or a group residential programme was more beneficial towards adolescents suffering from substance abuse addiction. Identifying a duration of an Adventure Therapy programme being delivered as part of a drug rehabilitation process is an important element which the most favourable option from respondents being twelve to sixteen weeks. Examining a positioning strategy for an adventure experience within a therapy programme the most priority was in the middle of the programme. These concepts made an important statement concerning the professional rehabilitation therapist’s attitudes towards an Adventure Therapy approach which opened up an interesting point as to how willing are these therapists in working with outdoor educational
  58. 58. 57 professionals promoting the use of an Adventure Therapy approach and how willing are they to further their own training to provide such programmes. 5.4 Contrasting Results Having carefully explored the number of themes covered within the Literature Review and analysing the final results from the survey illustrated a number of important aspects. These were considered when examining the attitudes of professionals who might use an Adventure Therapy approach in drug rehabilitation centres. While an Adventure Therapy approach is a successful and effective intervention tool in North America there are a number of barriers for this approach to be adopted into an Irish context. The main constraint acknowledged by respondents in the survey is access to funding and cost for facilitating such a programme. With the lack of drug rehabilitation facilities and resources designed for adolescents in the Republic of Ireland, a policy specifically designed to intervene with such an approach involving young people could become problematic if the structure is not properly supported by current evidence. It was identified that a positive pattern towards the attitudes of Irish professional therapists who stated that they would be willing to work with other outdoor professionals through an Adventure Therapy approach in a drug rehabilitation programme. The respondents also shared similar attitudes towards additional professional training in this field. There was a mixed response in surveys towards an Adventure Therapy approach in drug rehabilitation programmes. One individual noted that “it would provide those in need of drug rehabilitation with a natural setting where they would feel free to explore the reasons behind their drug use. Group based activities would encourage people to open up and engage with others who have experienced similar addictions”. Another individual disagreed with the approach by stating that Adventure Therapy is “An effective tool but it is
  59. 59. 58 not a standalone service …… lighter activities are more effective than typical "adventure therapy" activities. Activities with less adrenaline leads to more constructive reviews and less post active euphoria, which leads participants to the belief that change has occur but once back in the mainstream of their lives they refer back to old patterns”. Acknowledging that rehabilitation therapists are highly qualified to work with adolescents in a drug rehabilitation setting, two respondents noted that there are no professional qualifications currently in the Republic of Ireland to work as an Adventure Therapist. With self-proclaimed Adventure Therapists operating in the Republic of Ireland they are identified as not being actual professional therapists. This might be an indication that it is now time to introduce a recognised professional qualification for this area of expertise. Adventure Therapy is a tool and should not be a stand-alone intervention method. It is important not to underestimate its successful recognition of approaches in North America. Identifying that professional rehabilitation therapists have a positive attitude towards understanding more about this approach opens up more awareness into a professional approach in this specialised field.
  60. 60. 59 Chapter 6 Conclusion / Recommendations 6.1 Introduction In this Chapter, the author will conclude his summary of the main findings towards this study on examining the attitudes of Irish professionals using an Adventure Therapy approach in drug rehabilitation centres with adolescents. Following the conclusion the author will express any recommendations for further research on this topic including important factors considering a follow up study of this research. 6.2 Summary of Main Findings Summary of the main findings have illustrated that a number of Adventure Therapy approaches have been used as successful and effective tools towards mental health issues by providing a therapeutic adventure experience through an intervention process in North America. These therapeutic focussed programmes consist of long durations with a continuous one on one around the clock intervention. With a number of processes involved in a Adventure Therapy programmes it highlights the effectiveness of having a structured programme with an experiential approach. Evidence states that an Adventure Therapy approach has a successful rate amongst sub groups such as adolescents. During the period of adolescence the young person strives to create an identity for themselves in society by trying new experiences and experimenting with new things such as social relationships, sexual relationships, substances such as tobacco, alcohol and sometimes drugs. Comparing a young person’s behaviour with risk taking and experimentation during adolescence identifies a possible issue of drug abuse which could potentially lead to an addiction problem if untreated. Examining a number of treatment models within addiction rehabilitation services illustrates that there are a number of
  61. 61. 60 programmes available for individuals but there is a lack of facilities and resources available for adolescents in the Republic of Ireland. While surveying a number of different professional rehabilitation therapists, the results identified a positive attitude towards an adventure therapy approach. It also illustrated the respondents concerns about using an effective Adventure Therapy approach in a drug rehabilitation setting with the lack of evidence based in an Irish context and funding restrictions. There was a close margin of respondent’s organisations offering and not offering Adventure Therapy approaches within their rehabilitation programmes. The results also identified the therapist’s attitudes towards an Adventure Therapy approach by finding that it is the most beneficial approach towards developing an Adventure Therapy programme. These findings included gender breakdown, age breakdown, type of programme, position of Adventure Therapy approach within a programme, and the duration of a programme. Analysing the results attained from the research survey and comparing them with the findings of the Literature Review not only illustrate the significance between Adventure Therapy and other rehabilitation methods but offers a new intervention approach for drug rehabilitation therapists. These results from the study were only achieved by examining the attitudes of Irish professional therapists using an Adventure Therapy approach in drug rehabilitation centres. 6.3 Recommendations With the lack of evidence supporting Adventure Therapy in an Irish context it is recommended that a more straight forward approach towards Adventure Therapy should be studied. While this research focussed on a specialised area surrounding adolescents,
  62. 62. 61 substance related addiction and rehabilitation models, the author found the study itself difficult to remain focussed in that specific area. Although the study was narrowed down as small as possible for the author’s best interests it still remained a large area to study. Two recommended follow up studies towards this research can include (1) Identifying a professional qualification framework for Adventure Therapists operating in the Republic of Ireland and (2) Identifying a policy for best practice of an Adventure Therapy approach in the Republic of Ireland.
  63. 63. 62 Section 7 Appendences 7.1 Appendix 1 Invitation to Participate in Survey The Attitudes of Irish Professionals using an Adventure Therapy approach in Drug Rehabilitation Centres Damien Beatty The researcher would like to invite you to participate in a fourteen question survey which is part of a dissertation study on the Attitudes of Irish Professionals using an Adventure Therapy approach in Drug Rehabilitation Centres for Young People within the Republic of Ireland. The purpose of this study is to explore the attitudes of drug rehabilitation therapists on the use of an adventure therapy approach amongst adolescents in an Irish context. Respondents who wish to voluntarily participate in this study will have all their information and details kept strictly private and confidential and will not be passed on or shared with any third parties. This study will only be reviewed by Galway-Mayo Institutes of Technology, Castlebar Campus. Any further enquiries about this study can contact Mr Kevin O Callaghan (Supervising Tutor of Galway-Mayo Institute of Technology) at Kevin.OCallaghan@gmit.ie. Participants have the right to withdraw from this study at any time and if have any questions about this study can contact the researcher either by g00318491@gmit.ie or 085 746 2990.
  64. 64. 63 7.2 Appendix 2 Consent to Participation in Survey By agreeing to participate in this survey I understand that I can remain anonymous and that the data is to be used solely for an undergraduate dissertation study on the Attitudes of Irish Professionals to an Adventure Therapy approach in Drug Rehabilitation Centres for Young People within the Republic of Ireland. In addition I understand that if I am responding to the survey that I should complete and submit the relevant information no later than Tuesday 05th April 2016. I understand that if I have any questions or concerns regarding this research, am free to contact the researcher Mr Damien Beatty at g00318491@gmit.ie or on 085 746 2990. Agree to participate _____________ (Place X mark here) Do not wish to participate _____________ (Place X mark here)
  65. 65. 64 7.3 Appendix 3 Survey Questions Please tick boxes with a clear X: 1. Gender: Male Female 2. Age: 18 – 30 30 – 40 40 – 50 65+ 3. Occupation: Counsellor Psychologist Psychotherapist Social Worker Nurse Other:__________ Adventure therapy is the prescriptive use of adventure experiences often conducted in natural settings that kinesthetically engage clients on cognitive, affective, and behavioral levels (Gass, et al., 2012). Its focus is on a group-based activity therapy in which adventure activities are used as a clinical tool to promote therapeutic changes in clients (Tucker & Norton, 2012). 4. Does your organisation provide an adventure therapy approach in its programmes? Yes No 5. Please outline why your organisation does / does not utilise an adventure therapy? _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________
  66. 66. 65 6. What is your perception of adventure therapy as an approach, in a drug rehabilitation setting? _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ 7. Which age group do you think would benefit most from using an adventure therapy approach? 8 – 13 13 – 18 18 – 25 25+ 8. Which gender would benefit more from using adventure therapy as an approach during their rehabilitation process? Male Female 9. Do you think an adventure therapy approach be more beneficial towards a: Prevention Programme Intervention Programme Aftercare Programme 10. Which adventure therapy programme do you think would most beneficial towards adolescents suffering from substance abuse addiction? One on One Day Programmes Group Residential Programmes
  67. 67. 66 11. What duration should an adventure therapy programme be delivered as part of a drug rehabilitation process? 1 – 4 Weeks 4 – 8 Weeks 8 – 12 Weeks 12 – 16 Weeks 12. Where would be the most beneficial positioning of an adventure experience within the therapy programme? Beginning of Programme Middle of Programme End of Programme 13. Rate your willingness to work with Outdoor Educational Professionals in using Adventure Therapy? (Not willing) 1 2 3 4 5 (Very Willing) 14. Rate your willingness to gain additional training to promote the use of adventure therapy in a drug rehabilitation setting would you as an individual? (Not willing) 1 2 3 4 5 (Very Willing) Please submit this survey either online to g00318491@gmit.ie or by post to 11 Brookview Drive, Brookfield, Tallaght, Dublin 24 by Tuesday 05th April 2016. Thank you for participating in this survey, if you have any queries about this survey please don’t hesitate to contact the researcher on either g00318491@gmit.ie or 085 746 2990.
  68. 68. 67 7.4 Appendix 4 Identification of Illegal Substances Cannabis: “A hemp plant of the genus Cannabis” (Oxford Dictionary Press, 2002, p. 213). Heroin: “A highly addictive crystalline analgesic drug derived from morphine” (Oxford Dictionary Press, 2002, p. 661). Methadone: “A potent narcotic analgesic drug used to relieve severe pain” (Oxford Dictionary Press, 2002, p. 909). Other Opiates: “Drugs containing, derived from, or resembling opium” (Oxford Dictionary Press, 2002, p. 1019). Cocaine: “A drug derived from coca or prepared synthetically, used as a local anaesthetic and as a stimulant” (Oxford Dictionary Press, 2002, p. 278). Amphetamines: “A synthetic drug used esp. as a stimulant” (Oxford Dictionary Press, 2002, p. 44). Ecstasy: “A powerful stimulant with hallucinatory drug” (Oxford Dictionary Press, 2002, p. 446). LSD: “A potent hallucinogenic and psychedelic drug” (Oxford Dictionary Press, 2002, p. 853) Magic Mushrooms: “A toadstool of the genus Psilocybe, containing psilocybin” (Oxford Dictionary Press, 2002, p. 865). Solvents: “A dissolving or weakening agent” (Oxford Dictionary Press, 2002, p. 1380).
  69. 69. 68 Poppers: “A small vial of amyl nitrite used for inhalation” (Oxford Dictionary Press, 2002, p. 1127). Tranquillizers: “A drug used to diminish anxiety” (Oxford Dictionary Press, 2002, p. 1529). Anti-Depressants: “A drug or agent that alleviates depression” (Oxford Dictionary Press, 2002, p. 57) Opioid Pain Killers: “Any Compound resembling cocaine and morphine in its addictive properties or physiological effects” (Oxford Dictionary Press, 2002, p. 1019). Benzodiazepines: “A heterocyclic organic compound of a kind including several tranquillizers such as Librium and Valium” (Oxford Dictionary Press, 2002, p. 133).
  70. 70. 69 7.5 Appendix 5 Qualitative Survey Results for Question 5 Respondents who agree that their organisation do utilise an Adventure Therapy approach in drug rehabilitation centres state that:  The organisation would use adventure therapy as an activity for some service users as part of their individualised day services. It would be used in promoting trust, building relationships, for guided participation and learning new skills. It can also be relevant for inclusion in group programmes where service users would otherwise be alone with staff in individualised services.  We offer therapeutic outdoor activities that focus on behaviour and substance misuse. We do this because the outdoors offer a relaxing environment and breaks down barriers between client and worker.  We utilise AT as it allow relationship to be established swifter, it has a high engagement rate and the combination of physically and psychologically demanding activities deliver direct and instant results with regard building experiences.  Yes we do as we find that it provides an opportunity for clients (Young People) to re-acquire self-discipline and self-worth in recovering from addiction.  I work in a rehabilitation centre and we bring the young people on nature walks and plant flower pots with them. We also work through art and team challenges.  To reduce stress, build confidence and self worth.  Because we feel it can greatly benefit recovering users.  Because it works, you are dealing with practical minded people engage them with a practical hands topic.  We have found it to be effective.  It is a part of the Program.
  71. 71. 70 While respondents whose organisation did not utilise an Adventure Therapy approach argued that it was due to:  Cost (Perceived) B. Evidence Based C. Its "New".  Cost of Providing and Lack of Evidence.  Funding restraints.  Lack of funding.  Something we have not explored.  Predominantly medical model in a healthcare setting. We meet people weekly for 1:1 work.  Lack of facilities and funds.  Never heard of it.  The efficacy of using adventure therapy is not fully understood. Most of the courses focus on teaching students bodies of knowledge rather than addressing approaches to learning and development. I also believe that there are no suitable qualified staff to deliver adventure therapy.  Not employing qualified therapists. While all of the staff are highly qualified in outdoor education, psycho-analysing clients should be left to professional therapists that spend hundreds of hours in training specifically in the field of psychology and therapy.
  72. 72. 71 7.6 Appendix 6 Qualitative Survey Results for Question 6 Respondent’s perceptions of Adventure Therapy as an approach in a drug rehabilitation setting agree that:  It is an excellent way of helping people step outside their comfort zone and measure their potential.  It is a holistic, natural therapy that uses nature as a catalyst for change.  I think would be very beneficial in rehabilitation. It channels a persons energy in a safe environment. I believe it would help build an individual's morale, learning skills, having another focus, engaging with peers.  It's great because getting out and doing something fun or creative is of huge benefit to keeping active and maintaining positive mental health.  I think it is a creative approach. It provides people with a purpose and meaning in a fun and relaxed environment. May help keep people motivated on their journey of recovery and believe in themselves.  Our perception on an adventure therapy approach in a drug rehabilitation setting is that it offers a unique psychoanalysis through experiential learning in a wilderness context.  It helps to overcome addiction by learning more about themselves and what is important to them.  As an approach it would provide those in need of drug rehabilitation with a natural setting where they would feel free to explore the reasons behind their drug use. Group based activities would encourage people to open up and engage with others who have experienced similar addictions.  I believe that AT give the participant challenge and close to instant reward, it also give people natural based highs
  73. 73. 72  Keep people occupied and away from drugs.  It would be very interesting to see it in practice with the right policies in place.  I have not used it myself but would have heard from colleagues (in a clinical setting) who have utilised such an approach. They comment on its usefulness in engaging the client in a supportive environment, which help to develop coping and management skills that are not addressed in the more 'conventional' drug rehabilitation programmes. Some of these would be developing a sense of purpose, self efficacy and trust (in oneself and in others). While respondents who do not agree with an Adventure Therapy approach in a drug rehabilitation setting argue that:  It would depend on the overall ethos and theory of the drug rehab setting. Adventure therapy could be swallowed up in a traditional approach (which might have little or no evidence base) and be offered as an add on.  It works not all the time, the sports are really the vehicle, it's the positive experience, and lack of free time to use it, also gives s positive release of endorphins too.  Adventure therapy for me in drug rehabilitation can be an effective tool but it is not a standalone service. Links/transference onto their lives back home need to be conducted in order for real change to occur. It is important that adventure activities are not used because we perceived them to be beneficial. The needs of the client need to be taken into account and then the activity built around that need or desired outcome. I have found lighter activities more effective than typical "adventure therapy" activities. Activities with less adrenaline leads to more constructive
  74. 74. 73 reviews and less post active euphoria, which leads participants to the belief that change has occur but once back in the mainstream of their lives they refer back to old patterns. This is why for me adventure therapy is great tool but there is a lot to consider when taking a group out such a programme.  Using risk and fear for personal growth with clients that already lead precarious lives is simply another negative in their life. Do they need to be challenged? What if they fail at the rock climb? Or high ropes course? What does this reinforce? The outdoors has so much more potential than just providing adventurous activities. Safe and predictable environments have shown that clients respond better to personal growth. Berman and Davis-Berman 2002, 2005.  I do not know enough about it.  I have no knowledge of it.  It is not practical.

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