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Andersson L. A transition of power in opioid substitution treatment: Clinic managers' views on the consequences of a patient choice reform. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 39:279-300. [PMID: 35720521 PMCID: PMC9152230 DOI: 10.1177/14550725221075003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/05/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives: Opioid substitution treatment (OST) is often described as a strict and highly regulated treatment method, in which patients have limited influence over their treatment. In 2014, a reform was introduced by the regional council of Skåne in southern Sweden, which allowed OST patients to choose their treatment provider, thus transferring power from care providers to patients. The aim of this study was to examine what this increase in patient influence has meant for the clinics that provide OST in Skåne, and how these clinics have dealt with the new competitive situation that has arisen following the introduction of the reform. Methods: The study is based on two waves of semi-structured interviews with clinic managers at all OST clinics in Skåne. Results: The clinic managers described the increase in patient influence as a positive change, which had led to the patients being treated with more respect. The competition among clinics was expressed, among other things, in the form of differing views on the prescription of benzodiazepines, which initially gave rise to dissatisfaction among clinics with a more restrictive approach to such prescriptions. The reform did not lead to any clear diversity between clinics, apart from different approaches to the prescription of benzodiazepines. The incentive for competition-based diversity is, however, limited by the strict national regulatory system and by the reimbursement system, which restricts the ways in which clinics can conduct treatment activities. Conclusion: OST-clinic managers were largely positive about the increased patient empowerment and the shift in power balance associated with the patient choice reform. The introduction of the reform did not lead to any clear diversity between treatment providers, apart from differing views on the prescription of benzodiazepines, which by some managers was regarded as unfair competition.
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Tavakoli Ghouchani H, Armat MR, Akbari H, Hojjat SK, Lashkardoost H, Asghari D, Gholizadeh N, Saadati H. Perceived barriers to addiction treatment: an inductive qualitative content analysis. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.1967482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Hamid Tavakoli Ghouchani
- Addiction and Behavioral Sciences Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
- Department of Health Education and Promotion, School of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Mohammad Reza Armat
- Department of Geriatric Nursing, School of Nursing and Midwifery, School of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Hadi Akbari
- Department of General Courses and Islamic Studies, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Seyed Kaveh Hojjat
- Addiction & Behavioral Sciences Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
- Department of Internal Medicine, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Hossein Lashkardoost
- Addiction and Behavioral Sciences Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
- Department of Epidemiology and Biostatistics, School of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Dordane Asghari
- Measurement & Measurement Field (Psychometric Field), Addiction & Behavioral Sciences Research Center (Researcher), Bojnurd, Iran
| | - Nazanin Gholizadeh
- General Psychology, Addiction & Behavioral Sciences Research Center, Bojnurd, Iran
| | - Hassan Saadati
- Addiction and Behavioral Sciences Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
- Department of Epidemiology and Biostatistics, School of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
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Andersson L, Johnson B. Patient choice as a means of empowerment in opioid substitution treatment: a case from Sweden. DRUGS: EDUCATION, PREVENTION AND POLICY 2020. [DOI: 10.1080/09687637.2019.1591342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Lisa Andersson
- Department of Social Work, Malmö University, Malmö, Sweden
| | - Björn Johnson
- Department of Social Work, Malmö University, Malmö, Sweden
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Kolind T, Hesse M. Patient-centred care-perhaps the future of substance abuse treatment. Addiction 2017; 112:465-466. [PMID: 28168786 DOI: 10.1111/add.13673] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 10/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Torsten Kolind
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Morten Hesse
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioural Sciences, Aarhus University, Copenhagen, Denmark
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Savic M, Fomiatti R. Producing “Progress” Through the Implementation of Outcome Monitoring in Alcohol and Other Drug Treatment. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/0091450916641979] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Outcome monitoring—a process in which clinicians use standardized tools to routinely measure client “progress” on predefined outcomes of interest over time—is increasingly being implemented in alcohol and other drug (AOD) treatment services as a way of demonstrating quality of care. However, relatively little is known about the implications and unintended consequences of implementing outcome monitoring in clinical and social practices. In this paper we draw on qualitative data emerging from focus groups with clinicians who piloted an outcome monitoring tool in Melbourne, Australia, using conceptual tools drawn from science and technology studies. Rather than acting as a stable empirical object, we argue that realities of progress are enacted multiply in relation to preexisting treatment discourses and policy, organizational practices of data collection and management, reporting tools, and clinician attitudes and practices. In particular, we trace how the tool orders the “problem” of drugs differently to the qualitative mode of ordering; how different modes of ordering progress hang together and the tensions and coordination strategies that are involved. And finally, we highlight an unintended consequence of the outcome monitoring process—the enactment of vulnerability and its distribution across the clinical relationship. We suggest that researchers, policy makers, and clinicians need to think reflectively and critically about the ways in which we and our tools and interventions are influential in producing AOD problems, what constitutes progress, and ultimately what the focus of treatment should be.
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Affiliation(s)
- Michael Savic
- Turning Point, Eastern Health, Fitzroy, Australia
- Faculty of Medicine, Nursing & Health Sciences, Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Renae Fomiatti
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Australia
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Brunelle N, Bertrand K, Landry M, Flores-Aranda J, Patenaude C, Brochu S. Recovery from substance use: Drug-dependent people’s experiences with sources that motivate them to change. DRUGS: EDUCATION, PREVENTION AND POLICY 2015. [DOI: 10.3109/09687637.2015.1021665] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Vanderplasschen W, Naert J, Vander Laenen F, De Maeyer J. Treatment satisfaction and quality of support in outpatient substitution treatment: opiate users’ experiences and perspectives. DRUGS-EDUCATION PREVENTION AND POLICY 2014. [DOI: 10.3109/09687637.2014.981508] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lancaster K, Santana L, Madden A, Ritter A. Stigma and subjectivities: Examining the textured relationship between lived experience and opinions about drug policy among people who inject drugs. DRUGS-EDUCATION PREVENTION AND POLICY 2014. [DOI: 10.3109/09687637.2014.970516] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pedersen MU, Hesse M, Thylstrup B. Research in substance abuse treatment: Contributions by the Centre for Alcohol and Drug Research. DRUGS-EDUCATION PREVENTION AND POLICY 2013. [DOI: 10.3109/09687637.2013.840460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Empowerment in drug treatment: Dilemmas in implementing policy in welfare institutions. Soc Sci Med 2011; 73:201-8. [DOI: 10.1016/j.socscimed.2011.04.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 03/25/2011] [Accepted: 04/06/2011] [Indexed: 11/17/2022]
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De Maeyer J, Vanderplasschen W, Camfield L, Vanheule S, Sabbe B, Broekaert E. A good quality of life under the influence of methadone: a qualitative study among opiate-dependent individuals. Int J Nurs Stud 2011; 48:1244-57. [PMID: 21481390 DOI: 10.1016/j.ijnurstu.2011.03.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 03/17/2011] [Accepted: 03/19/2011] [Indexed: 12/16/2022]
Abstract
BACKGROUND Attention from researchers and health care workers to the quality of life (QoL) of opiate users is growing, but most studies are quantitative, giving limited attention to the consumer's perspective. No information is available on how opiate-dependent individuals themselves perceive QoL and what they see as the important components that contribute to a good QoL. OBJECTIVES This qualitative study aims to expand our knowledge concerning opiate-dependent individuals' perceptions of a good QoL and the impact of methadone on components of a good QoL. METHODS In-depth interviews were conducted with 25 opiate-dependent individuals aged between 26 and 46 years old who started a methadone maintenance treatment at least 5 years ago. Purposive sampling was used to recruit participants with different socio-demographic characteristics and drug use profiles. The interviews were audio-tape recorded, transcribed verbatim and analysed thematically. RESULTS Thematic analyses revealed five key themes contributing to a good QoL for opiate-dependent individuals: (1) having social relationships, (2) holding an occupation, (3) feeling good about one's self, (4) being independent and (5) having a meaningful life. Opiate-dependent individuals valued methadone's ability to help them function normally, overcome their psychological problems and dependence on illicit opiates, and support them in achieving certain life goals. On the other hand, stigmatisation, discrimination, dependence on methadone and the drug's paralysing effects on their emotions were mentioned as common negative consequences. CONCLUSIONS The findings of this study highlight the importance of supporting opiate-dependent individuals in their daily life by means of practical, social and environmental support (alongside pharmacological treatment) in order to improve their QoL. This study further illustrates the ambivalent influence of methadone on opiate-dependent individuals' QoL, and demonstrates how something commonly perceived as a 'good' can also be a 'bad' for some people. Efforts should be made to limit the negative consequences of methadone on opiate-dependent individuals' QoL, while increasing its potential benefits.
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Kenny P, Harney A, Lee NK, Pennay A. Treatment utilization and barriers to treatment: results of a survey of dependent methamphetamine users. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2011; 6:3. [PMID: 21320347 PMCID: PMC3046906 DOI: 10.1186/1747-597x-6-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 02/14/2011] [Indexed: 11/10/2022]
Abstract
Background Australia has one of the highest rates of methamphetamine use in the world; however, treatment access for methamphetamine is comparatively low. This descriptive study aimed to identify patterns of treatment utilization and perceived barriers to accessing treatment among dependent methamphetamine users in the hope that such information will enable services to more appropriately respond to this group. Methods One hundred and twenty-six methamphetamine users who had a current or past history of methamphetamine dependence were interviewed about their experiences of, and perceived barriers to, treatment. Results Treatment utilization among methamphetamine users was reportedly low. One of the main reasons cited for not accessing treatment was that methamphetamine users did not perceive their drug use to be a problem (despite apparent levels of dependence). Self-detoxification with the use of other licit and illicit drugs was high among this group. Participants identified a lack of confidence in the ability of treatment services to address methamphetamine dependence and the 'opiate-centric' nature of treatment services as significant blocks to treatment entry. Suggestions for improvement by participants included operating specialist services for methamphetamine users, placing an emphasis on responsiveness and routinely involving case management services for this group. Discussion and Conclusions To improve service delivery, treatment services should reorient their services to better address the needs of methamphetamine users by making small changes such as specific opening times for methamphetamine users or using a dedicated space for methamphetamine treatment. Alternative options such as online treatments and specialist methamphetamine clinics should be considered for methamphetamine users.
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Affiliation(s)
- Pauline Kenny
- Turning Point Alcohol and Drug Centre, 54-62 Gertrude Street, Fitzroy, Victoria 3065, Australia
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Wylie LWJ. Assessing user perceptions of staff training requirements in the substance use workforce: A review of the literature. DRUGS: EDUCATION, PREVENTION AND POLICY 2010. [DOI: 10.3109/09687631003705538] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kolind T, Frank VA, Dahl H. Drug treatment or alleviating the negative consequences of imprisonment? A critical view of prison-based drug treatment in Denmark. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2010; 21:43-8. [DOI: 10.1016/j.drugpo.2009.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Revised: 03/19/2009] [Accepted: 03/24/2009] [Indexed: 10/20/2022]
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PENNAY AMYE, LEE NICOLEK. Barriers to methamphetamine withdrawal treatment in Australia: Findings from a survey of AOD service providers. Drug Alcohol Rev 2009; 28:636-40. [DOI: 10.1111/j.1465-3362.2009.00074.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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