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Paroz S, Monnat M, Panese F, Saraga M, Daeppen JB. Caring for patients with substance use disorders: a qualitative investigation of difficulties encountered by hospital-based clinicians. J Addict Dis 2023:1-12. [PMID: 37369578 DOI: 10.1080/10550887.2023.2227307] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Background: Caring for patients with substance use disorders (SUD) is held in low regard and many clinicians resist treating them. To address this situation, numerous research projects assessed training program gaps and professional attitudes. In contrast, this study explored the actual clinical difficulties that a variety of hospital-based professionals encounter when treating patients with SUD. Methods: Qualitative multiple method design including: (1) individual semi-structured interviews with SUD experts and educators; (2) video-elicited, cross self-confrontation interviews with clinicians working in a specialist addiction unit; (3) paired semi-structured interviews with clinicians working in non-specialist units. Participants were recruited within one university hospital. Data collected at stages (1) and (3) relied on an interview guide and were analyzed using conventional content analyses. Data collected at stage (2) consisted of discussions of video recorded clinical interviews and were analyzed based on a participatory approach. Results: Twenty-three clinicians from seven hospital units participated. Forty-four difficulties were reported that we classified into six categories: knowledge-based; moral; technical; relational; identity-related; institutional. We identified seven cross-category themes as key features of SUD clinical complexity: exacerbation of patient characteristics; multiplication of medical issues; hybridity and specificity of medical discipline; experiences of stalemate, adversity, and role reversal. Conclusions: Our study, providing a comprehensive analysis of the difficulties of caring for patients with SUD, reveals a highly challenging clinical practice for a diversity of healthcare providers. They represent a complementary approach to addressing resistance as an important feature of a complex clinical system, and valuable material to discussing professional preparedness.
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Affiliation(s)
- Sophie Paroz
- Service of Addictions Medicine, Lausanne University Hospital and University of Lausanne, Canton of Vaud, Switzerland
| | - Martine Monnat
- Service of Community Psychiatry, Lausanne University Hospital and University of Lausanne, Canton of Vaud, Switzerland
- Public Health Service of Canton de Vaud, Department of Health and Social Action, Canton of Vaud, Lausanne, Switzerland
| | - Francesco Panese
- Institute of Humanities in Medicine, Lausanne University Hospital and University of Lausanne, Canton of Vaud, Switzerland
- Institute of Social Sciences, University of Lausanne, Canton of Vaud, Switzerland
| | - Michael Saraga
- Service of General Psychiatry, Lausanne University Hospital and University of Lausanne, Canton of Vaud, Switzerland
| | - Jean-Bernard Daeppen
- Service of Addictions Medicine, Lausanne University Hospital and University of Lausanne, Canton of Vaud, Switzerland
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Kaur A, Lal R, Sen MS, Sarkar S. Comparison of Recovery Capital in Patients with Alcohol and Opioid Dependence - An Exploratory Study. ADDICTION & HEALTH 2022; 14:105-114. [PMID: 36544508 PMCID: PMC9743817 DOI: 10.22122/ahj.2022.196722.1314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 01/12/2022] [Indexed: 12/24/2022]
Abstract
Background Recovery capital helps in the assessment of the personal strengths and challenges that exist in an individual with substance use which may have an impact on recovery process. This study aims at finding out the factors which help such individuals to sustain their recovery and how these factors differ across the two groups of people suffering from Alcohol Dependence Syndrome and Opioid Dependence Syndrome. Methods A cross-sectional observational was designed where sociodemographic and clinical variables, the recovery capital ARC (Assessment of Recovery Capital) Scale and Severity of substance use SDS (Severity of Dependence) Scale of patients diagnosed with Alcohol Dependence Syndrome (ADS group) and those with Opioid Dependence Syndrome (ODS group) were assessed among patients not reporting withdrawal symptoms. Findings A total of 49 subjects in the ODS group and 30 subjects in the ADS group were enrolled. The majority of the subjects in both groups were married, belonged to urban areas, practiced Hinduism, and were living in nuclear families. There was a significant difference between the educational status (p<0.001), religion practiced (p<0.001), age of onset of dependence (p<0.001), severity of dependence (p=0.11), and duration of abstinence (p<0.001) between the ADS and ODS groups. The mean scores on ARC Scale were 45.9 (S.D. =3.5) in the ODS group and 47.4 (S.D. =4.3) in the ADS group. ADS group had higher scores in Social Support Domain (p=0.034) and Housing and Safety domain (p=0.025). Other domains like global health, citizenship, meaningful activities, risk-taking, coping, and recovery experience did not significantly differ between the groups. Conclusion This study aims at comparing the recovery capital of ADS patients with ODS patients. It also suggests that tailored treatment plans for people with ADS and ODS especially in housing and social support and common treatment approach in other domains of recovery will help them sustain the state for a longer term.
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Affiliation(s)
- Apinderjit Kaur
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lal
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
| | - Mahadev Singh Sen
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India,Correspondence to: Mahadev Singh Sen; Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India;
| | - Siddharth Sarkar
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
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Pro G, Hayes C, Brown CC, Goree J, Zaller N. Individual and Health Policy Factors Associated With Positive Heroin and Opioid Treatment Response: United States, 2018. Am J Public Health 2022; 112:S66-S76. [PMID: 35143268 PMCID: PMC8842205 DOI: 10.2105/ajph.2021.306503] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To identify client- and state-level factors associated with positive treatment response among heroin and opioid treatment episodes in the United States. Methods. We used national data from 46 states using the Treatment Episode Dataset‒Discharges (2018) to identify heroin and opioid treatment episodes (n = 162 846). We defined positive treatment response as a decrease in use between admission and discharge. We used multivariable regression, stratified by race/ethnicity, to identify demographic, pain-related, and state-level factors associated with positive treatment response. Results. Lower community distress was the strongest predictor of better treatment outcomes across all racial/ethnic groups, particularly among White and American Indian/Alaska Native episodes. A primary opioid of heroin was associated with worse outcomes among White and Hispanic episodes. Legislation limiting opioid dispensing was associated with better outcomes among Hispanic episodes. Buprenorphine availability was strongly associated with better outcomes among Black episodes. Conclusions. State-level variables, particularly community distress, had greater associations with positive treatment outcomes than client-level variables. Public Health Implications. Changes in state-level policies and increased resources directed toward areas of high community distress have the potential to improve opioid use disorder treatment and reduce racial/ethnic disparities in treatment outcomes. (Am J Public Health. 2022;112(S1):S66-S76. https://doi.org/10.2105/AJPH.2021.306503).
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Affiliation(s)
- George Pro
- George Pro and Nickolas Zaller are with Department of Health Behavior and Health Education and the Center for Public Health and Criminal Justice Research, University of Arkansas for Medical Sciences, Little Rock. Corey Hayes is with the Center for Health Services Research, College of Medicine, University of Arkansas for Medical Sciences, and the Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock. Clare C. Brown is with the Department of Health Policy and Management, University of Arkansas for Medical Sciences. Johnathan Goree is with the Department of Anesthesiology, College of Medicine, University of Arkansas for Medical Sciences
| | - Corey Hayes
- George Pro and Nickolas Zaller are with Department of Health Behavior and Health Education and the Center for Public Health and Criminal Justice Research, University of Arkansas for Medical Sciences, Little Rock. Corey Hayes is with the Center for Health Services Research, College of Medicine, University of Arkansas for Medical Sciences, and the Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock. Clare C. Brown is with the Department of Health Policy and Management, University of Arkansas for Medical Sciences. Johnathan Goree is with the Department of Anesthesiology, College of Medicine, University of Arkansas for Medical Sciences
| | - Clare C Brown
- George Pro and Nickolas Zaller are with Department of Health Behavior and Health Education and the Center for Public Health and Criminal Justice Research, University of Arkansas for Medical Sciences, Little Rock. Corey Hayes is with the Center for Health Services Research, College of Medicine, University of Arkansas for Medical Sciences, and the Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock. Clare C. Brown is with the Department of Health Policy and Management, University of Arkansas for Medical Sciences. Johnathan Goree is with the Department of Anesthesiology, College of Medicine, University of Arkansas for Medical Sciences
| | - Johnathan Goree
- George Pro and Nickolas Zaller are with Department of Health Behavior and Health Education and the Center for Public Health and Criminal Justice Research, University of Arkansas for Medical Sciences, Little Rock. Corey Hayes is with the Center for Health Services Research, College of Medicine, University of Arkansas for Medical Sciences, and the Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock. Clare C. Brown is with the Department of Health Policy and Management, University of Arkansas for Medical Sciences. Johnathan Goree is with the Department of Anesthesiology, College of Medicine, University of Arkansas for Medical Sciences
| | - Nickolas Zaller
- George Pro and Nickolas Zaller are with Department of Health Behavior and Health Education and the Center for Public Health and Criminal Justice Research, University of Arkansas for Medical Sciences, Little Rock. Corey Hayes is with the Center for Health Services Research, College of Medicine, University of Arkansas for Medical Sciences, and the Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock. Clare C. Brown is with the Department of Health Policy and Management, University of Arkansas for Medical Sciences. Johnathan Goree is with the Department of Anesthesiology, College of Medicine, University of Arkansas for Medical Sciences
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Pro G, Liebert M, Remiker M, Sabo S, Montgomery BEE, Zaller N. Homeless Opioid Treatment Clients Transitioning to Dependent and Independent Housing: Differential Outcomes by Race/Ethnicity. Subst Use Misuse 2022; 57:867-875. [PMID: 35232321 DOI: 10.1080/10826084.2022.2046097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Purpose: Homeless opioid treatment clients who transition into housing generally demonstrate better outcomes, but housing environments vary widely and may not benefit racial/ethnic minority populations equally. We sought to identify how race/ethnicity moderates the association between positive opioid treatment response and moving into dependent or independent living environments. Methods: We used the Treatment Episode Dataset-Discharges (2018-2019) to identify outpatient treatment clients who were homeless at admission and indicated heroin or other opioids as their primary drug of choice (n = 20,021). We defined positive treatment response as a reduction in opioid use between admission and discharge. We used multivariable logistic regression to model treatment response. We included an interaction between housing at discharge (remained homeless [reference], dependent living, or independent living) and race/ethnicity, and adjusted for relevant confounders. Results: Transitioning from homeless to dependent living was positively associated with treatment response among White (aOR = 3.57, 95% CI = 3.15-4.06), Hispanic (aOR = 2.11, 95% CI = 1.55-2.86), and Black clients (aOR = 1.79, 95% CI = 1.41-2.27), but no association was observed for homeless American Indian/Alaska Native clients. Transitioning from homeless to independent living was strongly associated with treatment response among all groups with the strongest association observed among White clients (aOR = 4.70, 95% CI = 4.26-5.19). Conclusions: Interventions aimed at improving OUD treatment outcomes among homeless clients should identify individual and structural factors that support moving into fully housed and independent living environments. Dependent living offers needed support during crises, but should be temporary and priority should be placed on independent, permanent, and autonomous living environments.
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Affiliation(s)
- George Pro
- Southern Public Health and Criminal Justice Research Center, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Melissa Liebert
- Department of Anthropology, Northern Arizona University, Flagstaff, Arizona, USA
| | - Mark Remiker
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Samantha Sabo
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Brooke E E Montgomery
- Southern Public Health and Criminal Justice Research Center, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Nickolas Zaller
- Southern Public Health and Criminal Justice Research Center, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Sahker E, Park S, Garrison YL, Yeung CW, Luo Y, Arndt S, Furukawa TA. State population indices predict Asian American and Pacific Islander successful substance use treatment completion: An exploratory observational study. J Ethn Subst Abuse 2021; 21:1-16. [PMID: 33413042 DOI: 10.1080/15332640.2020.1864539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Cultural capital is a known factor supporting success in substance use disorder (SUD) treatment. We investigated Asian American and Pacific Islander (AAPI) State population metrics in relation to SUD treatment completion for US clients from 2006-2017 (N = 5,404,374). Metrics that may signify greater available cultural capital were State AAPI Percentage, State AAPI Percent Change, and State AAPI Population. AAPI Percentage, AAPI Percent Change were positively associated, while AAPI Population was negatively associated with treatment completion (p < 0.001). Findings suggest treatment agencies in areas with low AAPI densities may improve outcomes by supporting AAPI community and cultural social networks.
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Affiliation(s)
- Ethan Sahker
- Graduate School of Medicine/School of Public Health, Kyoto University, Sakyo-ku, Kyoto, Japan
- Japan Society for the Promotion of Science (JSPS), Chiyoda-ku, Tokyo, Japan
| | - Soeun Park
- University of Pennsylvania, Philadelphia, PA, USA
| | - Yunkyoung Loh Garrison
- The University of Iowa, Iowa City, IA, USA
- Colorado State University Health Network, Fort Collins, CO, USA
| | - Chi W Yeung
- The University of Iowa, Iowa City, IA, USA
- Washington DC Veterans Affairs Medical Center, Washington, DC, USA
| | - Yan Luo
- Graduate School of Medicine/School of Public Health, Kyoto University, Sakyo-ku, Kyoto, Japan
| | | | - Toshi A Furukawa
- Graduate School of Medicine/School of Public Health, Kyoto University, Sakyo-ku, Kyoto, Japan
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