HESTEFORSK The Impact of Horse Assisted Therapy on Addiction Treatment and Outcomes

Summary: This project at Oslo University Hospital (OUS) aimed to assess the impact of Horse Assisted Therapy (HAT) on addiction treatment and outcomes for young male & female patients. Project output includes a review of literature, quantitative & qualitative studies of HAT?s impact on patient treatment & co-occurring illnesses, plus assessment of video intervention therapy (VIT) as an innovative tool in HAT. An RCT, commenced in 2013, is ongoing. A cost-benefit analysis will be finalized after the RCT is completed. The results (statistically significant positive findings & rich qualitative data) have been well received at national & international addiction & horse therapy conferences, and in popular media. Articles & PhD thesis are planned for publication in 2015. The project provides a firm basis for improved clinical practice, wider distribution of evidenced based HAT by qualified therapists at the local level and improved contributions to international HAT research and practice. It should contribute to the standards, educational qualifications and accreditation processes needed for sound clinical practice and protection of vulnerable groups from mal practice. RIDING OUT OF ADDICTION? "The only thing that keeps me in this..... place is the horses" Recent research into addiction treatment outcomes has found that young people who undertake therapy involving horses have almost a four times better chance of a positive treatment outcome. Patients claim the horses are helpful and motivating, saying the horses "keep me in treatment" or "they teach me more than all the talk in an office or meeting room" Many add "and it's fun." Horses have worked with patients at Oslo University Hospital (previously known as Gaustad) since 1974. Skilled therapists, who are also qualified riding instructors are responsible for the horse assisted therapy program. Now a major research study, funded by the Research Council of Norway, is measuring the impact of the horses on addiction drop out and treatment. The study includes assessing the evidence of whether horse assisted therapy works and if so, why patients and clinicians think it helps. Preliminary results have been reported internationally to the International Scientific Addiction Medicine (ISAM) Conference in Geneva in 2012, the Horses4Humans Conference in Germany 2013 and the Second Nordic Seminar on Equine Assisted Psychotherapy, Stockholm 2014. These show that patients who had horse assisted therapy as part of their treatment program had a much high possibility of remaining in treatment and obtaining a successful outcome than those who did not do work with the horses. The therapy involves a range of, ground based (grooming, leading, etc), mounted and driving activities. During the early therapy sessions patients get to know the horses, learn about horse behavior, safety and how to do basic tasks such as grooming, leading and tacking up. Even patients with previous horse experience do these introductory sessions, often taking on a supporting role to those who have little or no experience. In the following eight sessions the patient, horse and therapist undertake activities and exercises aimed at addressing specific agreed objectives, such as dealing with anxiety, aggression, the need to set and maintain safe boundaries, etc. Many therapists and clients who have experienced horse assisted therapy believe it is effective but there is little scientific evidence to convinces health service providers or insurance companies to fund it. The Horse Assisted Therapy Research Project includes six completed studies. Others are still underway. They have involved a combination of quantitative and qualitative research which was conducted as part of the hospital's ethically approved Youth Addiction Treatment Evaluation Project (YATEP). Patient participation is voluntary and subject to informed and signed consent. A series of scientific papers will report the results in appropriate journals. Many patients thought the horses were big and scary when they first met them. But after they worked with them, patients said the horses seemed to understand how they were feeling and responded in a way that helped. Many patients said they felt good when they were with the horses who did not judge them, as people often did. They said they were learning from the horses and often felt a sense of "mastering", not just of the horse but of themselves as well. This project was undertaken at a hospital. However, horse assisted therapy can be community based if it is provided by trained and accredited therapists. Community based horse activity programs may enable ex-patients to join with other non-addicts and engage in healthy, pleasurable and rewarding, outdoor activity. In other words it may help ex-drug addicts to make a new start in life. For more see http://www.rus.no/id/820.0 & http://www.famo.no/TSB/AnnKern/vimeo.html

The value of including horses in therapeutic work is a scientific issue with social & health implications. Challenges include increasing provision of horse assisted therapy (HAT) of variable quality to vulnerable population groups, little substantive evid ence due to lack of research & design issues, mainstream clinicians'/scientists' scepticism of "alternative therapy" & associated difficulties in attracting top researchers & funding . The study will illustrate horses' significance to society & should in fluence future developments in the Nordic horse & health industries. Material & Infrastructure: Oslo University Hospital's (OUS) Dept of Addiction Treatment (Youth) presents unique research/evaluation potential for HAT. It will treat almost 200 patient pe r year & HAT will be integral to the therapeutic program. Strong emphasis on data & research will provide the professional support & evidence base needed for a sound, large scale study in an emerging area of science & therapy. In 2011-13 approx 200 patie nts will participate in 12 structured HAT sessions. Objective: to assess the impact of HAT on addiction treatment and outcomes for males & females 16-26 years. The study will describe HAT, the impact on treatment, drop out/ relapse rates, & the associat ed costs. It will provide evidence & guidance on the suitability/best practise of HAT for treatment of addiction plus the appropriateness & practicality of assessment methods. Method: 1) a literature review bringing together knowledge of youth addiction & HAT, 2) collection of Quantitative & Qualitative data on the impact of the therapy on patients' treatment & co-occurring illnesses/conditions, 3) a randomised control trial of dropout/relapse rates, 4) a study of the Costs. Necessary approvals & pat ient agreements will be sought. The researcher has 30 years experience in health related administration & 8 years in HAT. Technical support will be provided by OUS, SERAF & an international HAT expert group.