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Kjeldsen NB, Holm T, Oute J. "We are a rehabilitation unit, at least on paper" - Competing representations of recovery-oriented rehabilitation in dual diagnosis treatment policy and practice. Soc Sci Med 2024; 357:117160. [PMID: 39111261 DOI: 10.1016/j.socscimed.2024.117160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 07/17/2024] [Accepted: 07/22/2024] [Indexed: 09/07/2024]
Abstract
Within dual diagnosis treatment, principles of recovery are increasingly acknowledged. Nevertheless, recovery-oriented rehabilitation often becomes an abstract concept, leaving professionals in various dilemmas. This article examines competing representations of recovery-oriented rehabilitation across Danish dual diagnosis treatment policy and practice from a post-structural, analytical perspective inspired by governmentality and problematization studies. The empirical foundation consists of a qualitative ethnographic study including conducting and examining 12 national policies relevant to contemporary Danish dual diagnosis treatment practice and 23 interviews with health/welfare professionals employed at a Danish in-patient, dual diagnosis rehabilitation unit. The analysis points to a complexity between three sets of competing representations reflected in 1) the conceptual relationship between rehabilitation and recovery, 2) perceptions of knowledge based on experience or evidence, and 3) ideals of optimization and emancipation. Finally, the article discusses convergences between the competing and, at times, conflictual ideals, attempting to explain the conceptual fluffiness, discrepancies, and dilemmas experienced by professionals in dual diagnosis treatment within broader epistemological and ideological debates in social sciences and humanities.
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Affiliation(s)
- Natja Bech Kjeldsen
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioral Science, School of Business and Social Sciences, Aarhus University, Denmark.
| | - Tine Holm
- Department of Clinical Medicine, Psychosis Research Unit, Aarhus University Hospital, Denmark
| | - Jeppe Oute
- Department of People and Technology, Roskilde University, Denmark
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2
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Salzer MS. Building on Recovery: Embracing Community Inclusion in Mental Health Policies and Services. Community Ment Health J 2024:10.1007/s10597-024-01309-z. [PMID: 38967842 DOI: 10.1007/s10597-024-01309-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 06/08/2024] [Indexed: 07/06/2024]
Abstract
Recovery is real and has had a transformative impact on mental health policies and services, including shifting the focus from chronicity and symptom management to the realization that individuals with mental health issues can lead meaningful lives. However, recovery has been defined, described, understood, and measured in a wide variety of ways that may account for misuses and abuses in its application and possible stagnation in its impact. It is argued that the mental health field must now build upon the strong foundations of recovery by integrating a well-established rights-oriented framework. While recovery emphasizes personal growth and hope, a rights-based perspective underscores inherent dignity, autonomy, and opportunities for acceptance and embrace in engaging in valued social roles. The addition of a rights-based framework - community inclusion, to conversations involving recovery, is aligned with the origins of recovery and how it is commonly understood, and also connects the mental health field to the dramatic positive impacts that have emerged from the longstanding centrality of this concept in the broader disability community.
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Faith LA, Hillis-Mascia JD, Wiesepape CN. How Does Individual Psychotherapy Promote Recovery for Persons with Psychosis? A Systematic Review of Qualitative Studies to Understand the Patient's Experience. Behav Sci (Basel) 2024; 14:460. [PMID: 38920792 PMCID: PMC11201174 DOI: 10.3390/bs14060460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/10/2024] [Accepted: 05/20/2024] [Indexed: 06/27/2024] Open
Abstract
Psychotherapy for individuals with psychosis is an effective treatment that promotes recovery in various ways. While there is strong quantitative evidence across modalities, less is known from the patient's perspective. There are many varied forms of psychotherapy, and gaining the patient's perspective can improve understanding of salient elements of psychotherapy and increase engagement, ultimately improving recovery rates. The purpose of this review is to identify and integrate data from published studies of patient perspectives of psychotherapy for psychosis to understand essential elements across approaches, differences between approaches, and how psychotherapy impacts recovery. We aimed to understand further: what are the perceptions about individual psychotherapy from the perspective of individuals with psychosis? The current study was a systematic review using PRISMA guidelines of studies that included qualitative interviews with persons with experiences of psychosis who participated in psychotherapy. All three authors participated in the literature search using Pubmed, APA PsycInfo, and Psychiatry Online. We identified N = 33 studies. Studies included cognitive therapies, acceptance and mindfulness approaches, trauma therapies, metacognitive therapy, and music therapy. All studies reported participants' perceived benefit with the therapeutic relationship as especially salient. Participants described diverse aspects of objective (e.g., symptoms, functioning) and subjective (e.g., self-experience or quality of life) recovery improvements, with perceived mechanisms of change, and with music therapy having some unique benefits. Participants also reported challenges and suggestions for improvement. Study findings highlight the salient aspects of psychotherapy identified by patients that may help therapists to individualize and improve approaches to psychotherapy when working with individuals experiencing psychosis. Overall, findings support the potential for integrative psychotherapy approaches for maximal treatment personalization.
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Affiliation(s)
- Laura A. Faith
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA
| | - Jaclyn D. Hillis-Mascia
- Psychosocial Rehabilitation and Recovery Center, Chillicothe VA Medical Center, Chillicothe, OH 45601, USA;
| | - Courtney N. Wiesepape
- Psychosocial Rehabilitation and Recovery Center, Austin VA Clinic, Austin, TX 78744, USA;
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Bahl NKH, Øversveen E, Brodahl M, Nafstad HE, Blakar RM, Landheim AS, Tømmervik K. Multiple psychological senses of community and community influences on personal recovery processes from substance use problems in later life: a collaborative and deductive reflexive thematic analysis. Int J Qual Stud Health Well-being 2023; 18:2190200. [PMID: 36924073 PMCID: PMC10026775 DOI: 10.1080/17482631.2023.2190200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
PURPOSE There is a pressing need for substance use services to know more about how to promote recovery from substance use problems, particularly in later life. Psychological sense of community (PSOC) is an important recovery dimension. This study aims to clarify in what ways PSOC and communities influence later life recovery processes. METHOD A collaborative and deductive reflexive thematic approach was used to analyse 23 interviews with older adults in recovery from different substance use problems. RESULTS The findings suggest that PSOC and recovery in later life include multiple communities (relational, geographical, substance use-related, ideal and service-related) and affective states (PSOC and NPSOC). Older adults' recovery, moreover, can be described as personal and heterogenic (with respect to community relationships, individual needs, type of substance use problem, age of onset and meaningful activities). CONCLUSIONS The findings confirm age of onset, type of substance use problem and community memberships as essential to later life recovery. They also supplement prior evidence on community resources and challenges to later life recovery. Importantly, the new findings extend and nuance current understandings of later life recovery. Taken together, the article illustrates MPSOC as a useful concept, with central practical and theoretical implications for later life recovery.
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Affiliation(s)
- Nina Kavita Heggen Bahl
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, Trondheim, Norway
| | - Emil Øversveen
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Morten Brodahl
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Mental Health Division, Innlandet Hospital Trust, Brumunddal, Norway
| | | | | | - Anne Signe Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
- Innlandet University of Applied Sciences, Faculty of Social and Health Sciences, Section for Mental Health and Rehabilitation, Campus Elverum, Norway
| | - Kristin Tømmervik
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, Trondheim, Norway
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Cano-Prieto I, Prat-Vigué G, Vilanova-Masana R, Guillaume-Cornet A, Giralt Palou R, Lana-Francos G, Simó-Algado S. MOSAIC, an example of comprehensive and integrated social and health care: care and practices oriented towards personal recovery. FRONTIERS IN HEALTH SERVICES 2023; 3:1174594. [PMID: 37600925 PMCID: PMC10437109 DOI: 10.3389/frhs.2023.1174594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023]
Abstract
Background The Mosaic project is a socio-health integration model that promotes the personal recovery of people with severe mental illness in a territory of Central Catalonia: the Bages region. The recovery approach in mental health care promotes meaningful activities and social inclusion for people with mental health disorders. The aim of this study is to examine the relationship between the level of meaningful activities and other factors associated with the mental health recovery model. Methods A cross-sectional design was used. Participants (n = 59) signed an informed consent and completed the following standardized instruments: Engagement in Meaningful Activities Survey; The Connor-Davidson Resilience Scale; Hert Hope Scale; and Recovery Assessment Scale. Results A Pearson correlation test was performed between the level of meaningful activities and life satisfaction, resilience, hope, and recovery. These data indicate that the amount of meaningful activities are strongly associated with variables related to the personal recovery process from mental health problems. Conclusions The integration process of MOSAIC confirms the need to accompany the recovery processes through significant occupations.
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Affiliation(s)
- Ivan Cano-Prieto
- Grup de Recerca en Innovació en Salut Mental i Benestar Emocional (ISaMBeS), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), Vic, Spain
| | - Gemma Prat-Vigué
- Grup de Recerca en Innovació en Salut Mental i Benestar Emocional (ISaMBeS), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), Vic, Spain
- Divisió de Salut Mental, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Spain
- Facultat de Medicina. Universitat de Vic-Central de Catalunya (UVIC-UCC), Vic, Spain
| | - Rut Vilanova-Masana
- Divisió de Salut Mental, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Aida Guillaume-Cornet
- Divisió de Salut Mental, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Rosa Giralt Palou
- Divisió de Salut Mental, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Gemma Lana-Francos
- Divisió de Salut Mental, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Salvador Simó-Algado
- Grup de Recerca en Innovació en Salut Mental i Benestar Emocional (ISaMBeS), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), Vic, Spain
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Martinelli TF, Roeg DPK, Bellaert L, Van de Mheen D, Nagelhout G. Understanding the Process of Drug Addiction Recovery Through First-Hand Experiences: A Qualitative Study in the Netherlands Using Lifeline Interviews. QUALITATIVE HEALTH RESEARCH 2023; 33:857-870. [PMID: 37279186 PMCID: PMC10426251 DOI: 10.1177/10497323231174161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Understandings of drug addiction recovery are still being debated. Research on perspectives from first-hand experiences with recovery is rare and often contains short-term experiences in the context of a treatment setting. We aim to gain further understanding of recovery by analyzing autobiographical data from persons in different stages of drug addiction recovery who are not linked to any specific treatment service. We conducted 30 in-depth qualitative interviews with participants from various parts of the Netherlands. Participants self-identified as being "in recovery" or "recovered" from drug addiction for at least 3 months. Men and women are equally represented, and the sample consists of an equal number of participants in early (<1 year, n = 10), sustained (1-5 years, n = 10), and stable (>5 years, n = 10) recovery. We undertook a data-driven thematic analysis. Participants described that recovery is a broad process of change because addiction is interwoven with everything (theme 1); that recovery is reconsidering identity, seeing things in a new light (theme 2); that recovery is a staged long-term process (theme 3); and that universal life processes are part of recovery (theme 4). Thus, Drug addiction recovery is experienced as an interwoven long-term process, including identity change and common or universal life processes. Policy and clinical practice should therefore be aimed at supporting long-term tailored recovery goals and disseminating first-hand recovery experiences to enhance long-term outcomes and reduce stigmatization.
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Affiliation(s)
- T. F. Martinelli
- IVO Research Institute, Den Haag, Netherlands
- Tranzo Scientific Centre for Care and Wellbeing, School of Social and Behavioural Sciences, Tilburg University, Tilburg, Netherlands
| | - D. P. K. Roeg
- Tranzo Scientific Centre for Care and Wellbeing, School of Social and Behavioural Sciences, Tilburg University, Tilburg, Netherlands
- Kwintes Housing and Rehabilitation Services, Zeist, Netherlands
| | - L. Bellaert
- Department of Special Needs Education, Ghent University, Ghent, Belgium
| | - D. Van de Mheen
- Tranzo Scientific Centre for Care and Wellbeing, School of Social and Behavioural Sciences, Tilburg University, Tilburg, Netherlands
| | - G.E. Nagelhout
- IVO Research Institute, Den Haag, Netherlands
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, Netherlands
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Marciuch A, Birkeland B, Benth JŠ, Solli KK, Tanum L, Mathisen I, Weimand B. Personal recovery among people with opioid use disorder during treatment with extended-release naltrexone. Heliyon 2023; 9:e17516. [PMID: 37449176 PMCID: PMC10336734 DOI: 10.1016/j.heliyon.2023.e17516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 06/08/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
Background and aims Recovery from substance use disorders (SUD) has traditionally been equated with abstinence. "Personal recovery" however emphasizes recovery as a unique and personal process, supported by changes in connectedness, hope, identity, meaning and empowerment. This study aimed to examine personal recovery in people receiving extended-release naltrexone (XR-NTX); specifically investigate changes in personal recovery during treatment, identify groups of participants following distinct trajectories of recovery, and characteristics predicting group-belonging. Methods Overall change in recovery (Questionnaire about the Process of Recovery, QPR) score was assessed by linear mixed model in a subsample of 135 people with opioid use disorder (OUD) participating in a 24 + 28-week trial of XR-NTX. Growth mixture model was used to identify potential groups of people following distinct trajectories of personal recovery. Results Overall, there was a significant change in QPR score during treatment. Four groups with distinct recovery trajectories were identified: "initially low- increase" (G1), "initially average- no change" (G2), "initially high- no change" (G3) and "initially high- increase" (G4). The groups were different with regards to level of psychological distress, social support, and the use of benzodiazepines. In addition, previous participation in opioid agonist treatment programs, current pain, life satisfaction, employment, heroin craving and previous use of heroin also differed between groups. Conclusions Personal recovery among people receiving XR-NTX follows different trajectories, and various factors are associated with personal recovery. Particular attention regarding psychological distress, social support and heroin use among patients commencing XR-NTX treatment is important to facilitate successful recovery trajectories.
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Affiliation(s)
- Anne Marciuch
- Department of Research and Development in Mental Health, Akershus University Hospital, Loerenskog, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bente Birkeland
- Department of Psychosocial Health, University of Agder, Kristiansand, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Kristin Klemmetsby Solli
- Department of Research and Development in Mental Health, Akershus University Hospital, Loerenskog, Norway
- Norwegian Centre for Addiction Research, University of Oslo, Norway
- Vestfold Hospital Trust, Toensberg, Norway
| | - Lars Tanum
- Department of Research and Development in Mental Health, Akershus University Hospital, Loerenskog, Norway
- Faculty for Health Science, Oslo Metropolitan University, Oslo, Norway
| | - Ida Mathisen
- Faculty for Health Science, Oslo Metropolitan University, Oslo, Norway
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Norway
| | - Bente Weimand
- Department of Research and Development in Mental Health, Akershus University Hospital, Loerenskog, Norway
- Department of Health, Social and Welfare Studies, University of South-Eastern Norway, Drammen, Norway
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8
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Rubio G, Esteban Rodríguez L, Sion A, Ramis Vidal L, Blanco MJ, Zamora-Bayon A, Caba-Moreno M, Macias-Molina AI, Pérez-Sánchez D, Rubio-Escobar E, Ruiz-Diez J, Marin M, Arias F, Lora D, Jurado-Barba R. How, when, and to what degree do people with alcohol dependence recover their psychological wellbeing and quality of life? The Madrid Recovery Project. Front Psychiatry 2023; 14:1130078. [PMID: 37398602 PMCID: PMC10313403 DOI: 10.3389/fpsyt.2023.1130078] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/16/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction The consensus on recovery from alcohol use disorder (AUD) has shifted toward encompassing psychological wellbeing and quality of life dimensions. However, few studies have explored the long-term recovery process and its dimensions, timing, styles, and modes. The aim of this study was to investigate the extent, timing, and process of psychological wellbeing and quality of life recovery in alcohol use disorder (AUD) patients, as well as the relationship with classic dimensions of AUD recovery. Method A cross-sectional study has been carried out with 348 participants with AUD, in different abstinence periods (1 month-28 years), and 171 control subjects. Participants underwent a psychological evaluation, which included self-informed measures of psychological wellbeing, quality of life, negative emotionality, and coping strategies related to alcohol consumption avoidance. Statistical analysis included linear and non-linear regression models between psychological dimensions and maintenance of abstinence, as well as matching the scores of the sample with AUD to those of controls. Scatter plots were used to explore inflection points. In addition, mean comparison tests were performed between participants with AUD and controls and by gender. Results In general, according to the regression models, there were pronounced increases in indices of wellbeing and coping strategies (and pronounced decreases in negative emotionality) during the first 5 years of abstinence, followed by less pronounced improvements. The matching of AUD subjects in wellbeing and negative emotionality indices with controls occurs at different times: (a) 1 year or less: physical health; (b) 1-4 years: psychological health; (c) 4-10 years: social relationships, wellbeing, and negative emotionality; and (d) more than 10 years: autonomy and self-acceptance. There are statistically significant differences by gender for the negative emotionality and physical health variables. Conclusion Recovery from AUD is a long process that involves improvements in wellbeing and quality of life. Four stages can be described in this process, with the most pronounced changes occurring during the first 5 years of abstinence. However, AUD patients take more time to obtain similar scores to controls in several psychological dimensions.
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Affiliation(s)
- Gabriel Rubio
- Biomedical Research Institute, Hospital 12 de Octubre, Madrid, Spain
- Medicine Faculty, Complutense University of Madrid, Madrid, Spain
- Primary Care Research Network on Addictions (RIAPAd), Madrid, Spain
| | | | - Ana Sion
- Biomedical Research Institute, Hospital 12 de Octubre, Madrid, Spain
- Medicine Faculty, Complutense University of Madrid, Madrid, Spain
- Psychology Faculty, Complutense University of Madrid, Madrid, Spain
| | - Lilian Ramis Vidal
- Alcoholics Federation of the Community of Madrid (FACOMA), Madrid, Spain
| | - María J. Blanco
- Alcoholics Federation of the Community of Madrid (FACOMA), Madrid, Spain
| | | | - Marta Caba-Moreno
- Alcoholics Federation of the Community of Madrid (FACOMA), Madrid, Spain
| | | | | | | | - Joaquín Ruiz-Diez
- Alcoholics Federation of the Community of Madrid (FACOMA), Madrid, Spain
| | - Marta Marin
- Biomedical Research Institute, Hospital 12 de Octubre, Madrid, Spain
- Medicine Faculty, Complutense University of Madrid, Madrid, Spain
| | - Francisco Arias
- Biomedical Research Institute, Hospital 12 de Octubre, Madrid, Spain
- Medicine Faculty, Complutense University of Madrid, Madrid, Spain
| | - David Lora
- Biomedical Research Institute, Hospital 12 de Octubre, Madrid, Spain
- Faculty of Statistical Studies, Complutense University of Madrid, Madrid, Spain
| | - Rosa Jurado-Barba
- Biomedical Research Institute, Hospital 12 de Octubre, Madrid, Spain
- Medicine Faculty, Complutense University of Madrid, Madrid, Spain
- Department of Psychology, Education and Health Science Faculty, Camilo José Cela University, Madrid, Spain
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Searby A, Burr D, James R, Maude P. Service integration: The perspective of Australian alcohol and other drug (AOD) nurses. Int J Ment Health Nurs 2022; 31:908-919. [PMID: 35338569 PMCID: PMC9314025 DOI: 10.1111/inm.12998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 11/29/2022]
Abstract
The recently released Victorian Mental Health Royal Commission report has recommended a shift to integrated treatment, defined as treatment for alcohol and substance use disorders and mental ill health occurring in parallel, rather than distinct systems catering to each need. However, little work has sought to determine the perceptions of nurses working in alcohol and other drug (AOD) treatment towards integrating with mental health services. In this study, we explore the perspectives of specialist AOD nurses towards the integration of mental health and AOD treatment services. Secondary analysis of semi-structured interviews with Australian specialist AOD nurses (n = 46) conducted as part of a wider workforce study in 2019. Data were analysed using thematic analysis and reported using the COREQ guidelines. Of the interviews analysed, six were AOD nurses working in an Australian state that had recently undergone service integration; however, many participants expressed perceptions of service integration. Two key themes are reported in this paper: (i) perceptions of service integration, where AOD nurses participating in our study were concerned that integration would result in the model of care they worked under being replaced by a mental health-based model that was felt to be highly risk averse, and (ii) experiences of service integration. Concerns about the focus of care as well as the complexity of care differing between the two services demonstrated a contrast in both philosophical approaches to work with consumers and legislative difference in voluntary versus compulsory care provision.
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Affiliation(s)
- Adam Searby
- Institute for Health Transformation, School of Nursing & Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Dianna Burr
- Institute for Health Transformation, School of Nursing & Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Russell James
- School of Nursing, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Phil Maude
- La Trobe Rural Health School, Violet Vines Marshman Centre for Rural Health Research, Latrobe University, Melbourne, Victoria, Australia
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Addiction and Recovery in Dutch Governmental and Practice-Level Drug Policy: What’s the Problem Represented to be? JOURNAL OF DRUG ISSUES 2022. [DOI: 10.1177/00220426221087590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Around 2009, ‘recovery’ was introduced in the Netherlands as a new approach to drug addiction and addiction services. Recovery is now featured in practice-level policy but is absent in governmental drug policy. To investigate whether the Dutch recovery vision is coherent with governmental drug policy, we apply Bacchi’s What’s the problem represented to be? approach to analyse problematizations of ‘drug addiction’. We analysed two influential practice-level policy documents and one governmental drug policy document. We found that governmental policy addresses the harms and public nuisance of drug addiction, whilst practice-level policy addresses the wellbeing of persons with addiction. Despite these different starting points, the Dutch recovery vision seems coherent with both problematizations. Its adoption in the Netherlands was less subject to political debate compared to other countries. This may be a result of recovery being driven by bottom-up efforts without government intervention, leading to constructive ambiguity between government- and practice-level policies.
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11
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Phulpin H, Goze T, Faure K, Lysaker PH. Centrality and Decentration: A Model for Understanding Disturbances in the Relationship of the Self to the World in Psychosis. J Nerv Ment Dis 2022; 210:116-122. [PMID: 34570062 DOI: 10.1097/nmd.0000000000001420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A considerable body of phenomenological research has described different ways in which the relationship of the person to the world in psychosis is affected. This literature, however, has lacked an accepted unifying theoretical model and means of quantitatively measuring these disturbances. To address this, the current article seeks to integrate a novel phenomenological model of psychosis offered by Henri Grivois, which is explicitly concerned with centrality or a person's sense of being the center of all things, with empirical research on the integrative model of metacognition, which allows for measurements of decentration or the degree to which persons can form integrated ideas about their place in their larger community. It is proposed that this literature may allow for a model of how psychotherapy can address centrality through the building of intersubjectivity and enhancing metacognition.
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Affiliation(s)
- Hugo Phulpin
- Service de Psychiatrie, Psychothérapies et Art-thérapie, Centre Hospitalier Universitaire de Toulouse
| | | | - Karine Faure
- Service de Psychiatrie, Psychothérapies et Art-thérapie, Centre Hospitalier Universitaire de Toulouse
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Bartram M. 'It's Really About Wellbeing': a Canadian Investigation of Harm Reduction as a Bridge Between Mental Health and Addiction Recovery. Int J Ment Health Addict 2021; 19:1497-1510. [PMID: 34790080 PMCID: PMC8578070 DOI: 10.1007/s11469-020-00239-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Recovery is a key concept driving system transformation in both the addiction and mental health sectors, with shared roots in advocacy and a shared focus on hope in the face of stigma, self-determination and meaningful lives. Nevertheless, while mental health recovery is possible even with on-going symptoms, addiction recovery generally starts with or leads to abstinence. This disconnection undermines coherence at the policy level and exacerbates fragmentation between services and supports in the mental health and addiction sectors in Canada and internationally. At the same time, harm reduction, which does not require abstinence, has been gaining ground in the Canadian addiction sector. This qualitative policy study explores the potential for harm reduction to bridge the gap between mental health recovery and addiction recovery in the Canadian context, drawing on diverse experiences from the mental health and addiction sectors. The findings could be adapted internationally to address similar policy challenges.
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Affiliation(s)
- Mary Bartram
- Faculty of Law and the Institute for Health and Social Policy, McGill University, Charles Meredith House, 1130 Pine Avenue West, Montreal, Quebec H3A 1A3 Canada
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13
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Leung K, Xu E, Rosic T, Worster A, Thabane L, Samaan Z. Sensitivity and specificity of self-reported psychiatric diagnoses amongst patients treated for opioid use disorder. BMC Psychiatry 2021; 21:520. [PMID: 34674668 PMCID: PMC8530009 DOI: 10.1186/s12888-021-03489-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/17/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with opioid use disorder (OUD) frequently present with comorbid psychiatric illnesses which have significant implications for their treatment outcomes. Notably, these are often identified by self-report. Our study examined the sensitivity and specificity of self-reported psychiatric diagnoses against a structured diagnostic interview in a cohort of patients receiving outpatient pharmacological treatment for OUD. METHODS Using cross-sectional data from adults receiving outpatient opioid agonist treatment for OUD in clinics across Ontario, Canada, we compared participants' self-reported psychiatric diagnoses with those identified by the Mini Neuropsychiatric Interview (MINI) Version 6.0 administered at the time of study entry. Sensitivity and specificity were calculated for self-report of psychiatric diagnoses. RESULTS Amongst a sample of 683 participants, 24% (n = 162) reported having a comorbid psychiatric disorder. Only 104 of these 162 individuals (64%) reporting a comorbidity met criteria for a psychiatric disorder as per the MINI; meanwhile, 304 (75%) participants who self-reported no psychiatric comorbidity were in fact identified to meet MINI criteria for a psychiatric disorder. The sensitivity and specificity for any self-reported psychiatric diagnoses were 25.5% (95% CI 21.3, 30.0) and 78.9% (95% CI 73.6, 83.6), respectively. CONCLUSIONS Our findings raise questions about the utility of self-reported psychiatric comorbidity in patients with OUD, particularly in the context of low sensitivity of self-reported diagnoses. Several factors may contribute to this including remittance and relapse of some psychiatric illnesses, underdiagnosis, and the challenge of differentiating psychiatric and substance-induced disorders. These findings highlight that other methods should be considered in order to identify comorbid psychiatric disorders in patients with OUD.
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Affiliation(s)
- Kelly Leung
- grid.25073.330000 0004 1936 8227Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Emily Xu
- grid.25073.330000 0004 1936 8227Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Tea Rosic
- grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario Canada ,grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Andrew Worster
- grid.25073.330000 0004 1936 8227Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario Canada ,grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Lehana Thabane
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada ,grid.416449.aBiostatistics Unit, Research Institute at St Joseph’s Healthcare, Hamilton, Ontario Canada ,grid.25073.330000 0004 1936 8227Departments of Pediatrics/Anesthesia, McMaster University, Hamilton, Ontario Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada. .,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
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14
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de Moura AP, e Sousa HFP, Dinis MAP, Ferros LL, Jongenelen I, Negreiros J. Outpatient Drug and Alcohol Treatment Programs: Predictors of Treatment Effectiveness. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-020-00235-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
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15
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Jørgensen K, Rasmussen T, Hansen M, Andreasson K. Recovery-oriented intersectoral care between mental health hospitals and community mental health services: An integrative review. Int J Soc Psychiatry 2021; 67:788-800. [PMID: 33100119 DOI: 10.1177/0020764020966634] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recovery-oriented intersectoral care is described as an aim in mental healthcare to create a holistic framework for planning that provides integration of treatment and rehabilitation. Existing studies show that nurses and other professionals do not take responsibility for the collaborative element of intersectoral care between mental health hospitals and community mental health services. The users of mental healthcare do not experience their patient journey as a cohesive process when they are discharged from a mental health hospital to community mental health services. AIM The integrative review aims to examine the professionals' experience with recovery-oriented intersectoral care between mental health hospitals and community mental health services. DESIGN Since the aim was to review user experience, we chose an integrative review as an obvious choice for design. ETHICAL APPROVAL Not applicable. FINDINGS Seven studies met the inclusion criteria. The interactive inductive and deductive analysis generated four themes, which clarify the experience of professionals with recovery-oriented intersectoral care between the mental health hospitals and community mental health services, namely 'structurally routine care', 'unequal balance of power between the sectors', 'bureaucracy as a barrier to recovery-oriented intersectoral care' and 'flexible mental healthcare approaches'. CONCLUSION This review achieves specific knowledge of recovery-oriented intersectoral care. The studies included show that recovery-oriented intersectoral care is not clearly defined. It is challenging to transfer intersectoral care to an organisation with different structural and linguistic barriers.
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Affiliation(s)
- Kim Jørgensen
- The Research Collaboration, Psychiatric Centre North Zealand, Hillerød, Danmark/Denmark
| | - Tonie Rasmussen
- Psychosocial rehabilitation consultant, Center for Quality and Development, Department of Social and Health, Rudersdal Kommune, Birkerød, Denmark
| | - Morten Hansen
- Peer support worker, Educator, FACT Team 1, Copenhagen, Denmark
| | - Kate Andreasson
- The Research Collaboration, Psychiatric Centre North Zealand, Hillerød, Danmark/Denmark
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16
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Multivariable modelling of factors associated with criminal convictions among people experiencing homelessness and serious mental illness: a multi-year study. Sci Rep 2021; 11:16610. [PMID: 34400747 PMCID: PMC8368183 DOI: 10.1038/s41598-021-96186-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 08/02/2021] [Indexed: 11/12/2022] Open
Abstract
People experiencing homelessness and serious mental illness exhibit high rates of criminal justice system involvement. Researchers have debated the causes of such involvement among people experiencing serious mental illness, including what services to prioritize. Some, for example, have emphasized mental illness while others have emphasized poverty. We examined factors associated with criminal convictions among people experiencing homelessness and serious mental illness recruited to the Vancouver At Home study. Participants were recruited between October 2009 and June 2011. Comprehensive administrative data were examined over the five-year period preceding study baseline to identify risk and protective factors associated with criminal convictions among participants (n = 425). Eight variables were independently associated with criminal convictions, some of which included drug dependence (RR = 1.53; P = 0.009), psychiatric hospitalization (RR = 1.44; P = 0.030), an irregular frequency of social assistance payments (compared to regular payments; 1.75; P < 0.001), and prior conviction (RR = 3.56; P < 0.001). Collectively, findings of the present study implicate poverty, social marginalization, crises involving mental illness, and the need for long-term recovery-oriented services that address these conditions to reduce criminal convictions among people experiencing homelessness and serious mental illness.
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17
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Davidson L, Rowe M, DiLeo P, Bellamy C, Delphin-Rittmon M. Recovery-Oriented Systems of Care: A Perspective on the Past, Present, and Future. Alcohol Res 2021; 41:09. [PMID: 34377618 PMCID: PMC8336784 DOI: 10.35946/arcr.v41.1.09] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This paper provides a perspective on the recent concept of recovery-oriented systems of care with respect to its origins in the past and its status in the present, prior to considering directions in which such systems might move in the future. Although influential in practice, this concept has yet to be evaluated empirically and has not been the object of a review. Recovery-oriented systems of care emerged from the efforts of persons with mental health and/or substance use disorders who advocated for services to go beyond the reduction of symptoms and substance use to promote a life in the community. Subsequent efforts were made to delineate the nature and principles of such services and those required of a system of such care. Coincident with the U.S. Substance Abuse and Mental Health Services Administration dropping reference to behavioral health in its revised definition of recovery, confusions and limitations began to emerge. Recovery appeared to refer more to a process of self-actualization for which an individual is responsible than to a process of healing from the effects of a behavioral health condition and associated stigma. In response, some systems are aiming to address social determinants of behavioral health conditions that transcend the scope of the individual and to develop a citizenship-oriented approach to promote community inclusion.
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Affiliation(s)
- Larry Davidson
- Program for Recovery and Community Health, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.,Connecticut Department of Mental Health and Addiction Services, Hartford, Connecticut
| | - Michael Rowe
- Program for Recovery and Community Health, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Paul DiLeo
- Connecticut Department of Mental Health and Addiction Services, Hartford, Connecticut.,Yale University School of Medicine, New Haven, Connecticut
| | - Chyrell Bellamy
- Program for Recovery and Community Health, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.,Connecticut Department of Mental Health and Addiction Services, Hartford, Connecticut
| | - Miriam Delphin-Rittmon
- Program for Recovery and Community Health, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.,Connecticut Department of Mental Health and Addiction Services, Hartford, Connecticut
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18
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Damsgaard JB, Jensen A. Music Activities and Mental Health Recovery: Service Users' Perspectives Presented in the CHIME Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126638. [PMID: 34205491 PMCID: PMC8296349 DOI: 10.3390/ijerph18126638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/04/2021] [Accepted: 06/15/2021] [Indexed: 01/14/2023]
Abstract
Internationally, mental health service developments are increasingly informed by the principles of recovery, and the availability of arts and creative activities are becoming more common as part of provision. Mental health service users' experiences, reflecting on the complex nature of using music participation in recovery are, however, limited. This essay considers literature that explores how music can support mental health service users in a recovery process. We have selected studies that include a broad spectrum of music activities, as well as literature considering various concepts about recovery. The conceptual recovery framework CHIME, that includes five important components in the recovery process, is used as the backdrop for exploring music activities as a contribution to recovery-oriented practice and services in mental health care. Eleven key components are identified in which music can support the recovery process: Feelings of equality; Social and emotional wellbeing; Tolerance; Hope and social agency; Triggering encounters; Redefining and reframing; A social practice; Moments of flow and peak experiences; Moments of meaning; Continuity; and Potentials instead of limitations. This essay concludes that the experiential knowledge of music activities from service users' perspectives is essential knowledge when developing and using music activities in mental health recovery services. While this essay acknowledges that music activities can also produce unintended negative outcomes, the focus is on the positive contributions of music to mental health recovery processes.
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Affiliation(s)
- Janne Brammer Damsgaard
- Research Unit of Nursing and Healthcare, Institute of Public Health, Aarhus University, 8000 Aarhus, Denmark
- Correspondence:
| | - Anita Jensen
- Center for Primary Health Care Research, Region Skåne, 205 02 Malmö, Sweden;
- Department of Communication and Psychology, Aalborg University, 2450 Copenhagen, Denmark
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19
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Kerman N, Kidd SA. The Healthcare Triple Aim in the Recovery Era. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:492-496. [PMID: 31754880 DOI: 10.1007/s10488-019-00997-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Recovery is the guiding vision of mental health systems and policy. However, skepticism has emerged about whether the paradigm can achieve its sought goals. We argue that embedding recovery within a quality improvement framework, such as the Triple Aim, would increase leverage for systems change and advance recovery practice. The Triple Aim's goals of improving healthcare outcomes, quality, and costs are pertinent to mental health systems, although action is also needed to address the social determinants of health. Accordingly, we propose the recovery-oriented Triple Aim, which could be used to guide policy development and evaluation of mental health services.
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Affiliation(s)
- Nick Kerman
- School of Psychology, University of Ottawa, Ottawa, ON, K1N 6N5, Canada.
| | - Sean A Kidd
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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20
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Bellaert L, Martinelli TF, Vanderplasschen W, Best D, van de Mheen D, Vander Laenen F. Chasing a pot of gold: an analysis of emerging recovery-oriented addiction policies in Flanders (Belgium) and The Netherlands. DRUGS: EDUCATION, PREVENTION AND POLICY 2021. [DOI: 10.1080/09687637.2021.1915250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Lore Bellaert
- Department of Special Needs Education, Ghent University, Ghent, Belgium
| | - Thomas F. Martinelli
- IVO Research Institute, The Hague, The Netherlands
- Tranzo Scientific Center for Care and Wellbeing, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | | | - David Best
- Department of Criminology, University of Derby, Derby, UK
| | - Dike van de Mheen
- Tranzo Scientific Center for Care and Wellbeing, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Freya Vander Laenen
- Department of Criminology, Penal Law, and Social Law, Ghent University, Ghent, Belgium
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21
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Hadland SE. The Broken Care Continuum for Young Adults With Opioid Addiction. J Adolesc Health 2020; 67:735-736. [PMID: 33220792 PMCID: PMC7874886 DOI: 10.1016/j.jadohealth.2020.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Scott E. Hadland
- Grayken Center for Addiction / Department of Pediatrics, Boston Medical Center, One Boston Medical Center Place, Boston, MA, USA, 02118
- Boston University School of Medicine, Division of General Pediatrics, Department of Pediatrics, 88 East Newton Street, Vose Hall Room 322, Boston, MA, USA, 02118
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22
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Najavits LM, Clark HW, DiClemente CC, Potenza MN, Shaffer HJ, Sorensen JL, Tull MT, Zweben A, Zweben JE. PTSD / substance use disorder comorbidity: Treatment options and public health needs. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2020; 7:544-558. [PMID: 35444925 PMCID: PMC9017717 DOI: 10.1007/s40501-020-00234-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Purpose of Review Posttraumatic stress disorder (PTSD) commonly co-occurs with substance use disorder (SUD) and is challenging to treat. We review all behavioral therapy models with at least one randomized controlled trial in a current PTSD/SUD population. We identify factors in selecting a model for clinical use, emphasizing a public health framework that balances the need for evidence with the need for feasibility in frontline settings. Recent Findings Seven published models and 6 unpublished models are reviewed. Public health considerations for choosing a model include: whether it's been studied across a broad range of SUDs and in complex SUD patients; whether it can be conducted in group modality; its appeal to patients and providers; its cost; workforce requirements; and its ability to reduce substance use in addition to PTSD. Summary There are two broad types of models: those that originated in the PTSD field versus the SUD field. Overall, the latter are stronger on public health factors and more feasible in SUD settings. Published models in this category include Relapse Prevention, BRENDA, and Seeking Safety. PTSD/SUD research is at an early stage and there is a need for methodology that quantifies "level of burden" (patients' socioeconomic disadvantages) across trials.
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Affiliation(s)
| | | | | | - Marc N Potenza
- Departments of Psychiatry, Child Study and Neuroscience, Yale University School of Medicine
| | | | - James L Sorensen
- Department of Psychiatry and Behavioral Sciences, University of California at San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center
| | | | | | - Joan E Zweben
- University of California, San Francisco, Veterans Affairs Medical Center, San Francisco
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23
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Mawson K, Goodwin V. Is recovery‐orientated practice destined to reach drug and alcohol services in Australia? Nurs Health Sci 2020; 22:839-842. [DOI: 10.1111/nhs.12731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/24/2020] [Accepted: 04/23/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Kerry Mawson
- Northern Sydney Local Health District, Mental Health Drug and Alcohol Service Royal North Shore Hospital St Leonards New SouthWales Australia
| | - Val Goodwin
- Northern Sydney Local Health District, Mental Health Drug and Alcohol Service Royal North Shore Hospital St Leonards New SouthWales Australia
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24
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Martinelli TF, van de Mheen D, Best D, Vanderplasschen W, Nagelhout GE. Are members of mutual aid groups better equipped for addiction recovery? European cross-sectional study into recovery capital, social networks, and commitment to sobriety. DRUGS: EDUCATION, PREVENTION AND POLICY 2020. [DOI: 10.1080/09687637.2020.1844638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Thomas F. Martinelli
- IVO Research Institute, The Hague, The Netherlands
- School of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, The Netherlands
| | - Dike van de Mheen
- School of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, The Netherlands
| | - David Best
- International Center of Excellence in Policing and Criminal Justice, University of Derby, Derby, UK
| | | | - Gera E. Nagelhout
- IVO Research Institute, The Hague, The Netherlands
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands
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25
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Gueta K, Chen G, Ronel N. Maintenance of long-term recovery from substance use: a mixed methods study of self- and treatment-changers. DRUGS: EDUCATION, PREVENTION AND POLICY 2020. [DOI: 10.1080/09687637.2020.1800592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Keren Gueta
- Department of Criminology, Bar-Ilan University, Ramat-Gan, Israel
| | - Gila Chen
- Department of Criminology, Ashkelon Academic College, Ashkelon, Israel
| | - Natti Ronel
- Department of Criminology, Bar-Ilan University, Ramat-Gan, Israel
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26
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Kourgiantakis T, Hussain A, Ashcroft R, Logan J, McNeil S, Williams CC. Recovery-oriented social work practice in mental health and addictions: a scoping review protocol. BMJ Open 2020; 10:e037777. [PMID: 32819947 PMCID: PMC7440834 DOI: 10.1136/bmjopen-2020-037777] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Social work is a key profession in the field of mental health worldwide and the profession has values that are aligned with a recovery paradigm. However, there are gaps in understanding how social workers are applying the recovery paradigm in practice. This study will scope and synthesise the literature related to recovery and social work practice in mental health and addictions. There will also be an exploration of best practices and gaps in recovery-oriented social work practice. METHODS AND ANALYSIS Using a scoping review framework developed by Arksey and O'Malley, we will conduct our search in five academic databases: PsycINFO, Medline, CINAHL Plus, Sociological Abstracts and Social Services Abstracts. Articles meeting inclusion criteria will be charted to extract relevant themes and analysed using a qualitative thematic analysis approach. ETHICS AND DISSEMINATION This review will provide relevant information about best practices and gaps in recovery-oriented social work practice in mental health and addictions. The study will inform the development of mental health curricula in social work programmes and clinical settings. Results will be disseminated through a peer-reviewed journal and at conferences focusing on mental health, addictions, and social work education. Ethics approval is not required for this scoping review.
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Affiliation(s)
- Toula Kourgiantakis
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Amina Hussain
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Judith Logan
- John P. Robarts Library, University of Toronto, Toronto, Ontario, Canada
| | - Sandra McNeil
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Charmaine C Williams
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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27
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Skogens L, von Greiff N. Recovery processes among young adults treated for alcohol and other drug problems: A five-year follow-up. NORDIC STUDIES ON ALCOHOL AND DRUGS 2020; 37:338-351. [PMID: 35310920 PMCID: PMC8899242 DOI: 10.1177/1455072520936814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/23/2020] [Indexed: 12/04/2022] Open
Abstract
Aim Studies on recovery from alcohol and other drugs (AOD) among young adults are scarce. In the present study, young adults, previously interviewed with a focus on their recovery process shortly after they completed treatment, were re-interviewed five years later focusing on their recovery process during the last five years in relation to their former AOD problems, other problems and processes of change. Methods Twenty-one young adults were interviewed: 16 women and five men aged between 25 and 33 years. After transcribing the interviews, the material was analysed thematically. Results Three overall themes emerged: previous problems, mental illness and the search for identity. The results were discussed in relation to recovery capital, primarily focusing on human and social capital. The results indicate that the group in focus often needs professional support for mental health issues in order to reach a stable recovery. Conclusions Since the problems described were heterogeneous, this client group might benefit from individual treatment and extended support after treatment. Further, the results indicate that the established period of five years for a stable recovery might need to be extended for young adults.
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28
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Leclair MC, Lemieux AJ, Roy L, Martin MS, Latimer EA, Crocker AG. Pathways to Recovery among Homeless People with Mental Illness: Is Impulsiveness Getting in the Way? CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:473-483. [PMID: 31763933 PMCID: PMC7297503 DOI: 10.1177/0706743719885477] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study investigates the association between impulsiveness and six dimensions of recovery among homeless people with mental illness. METHOD The sample was composed of 418 participants of a randomized controlled trial of Housing First, a recovery-oriented program that provides immediate access to permanent housing. The reliable change index method was used to provide an estimate of the statistical and clinical significance of the change from baseline to 24 months (i.e., clinically meaningful improvement), on outcomes that pertain to recovery dimensions: psychiatric symptoms (clinical), physical health and substance use problems (physical), residential stability (functional), arrests (criminological), community integration (social), and hope and personal confidence (existential). We tested for the effect of impulsiveness, assessed with the Barratt Impulsiveness Scale-11, on clinically meaningful improvement on each specific outcome, adjusting for age, gender and intervention assignment, as both intervention arms were included in the analysis. RESULTS For every increase in total impulsiveness score by one standard deviation, the odds of experiencing clinically meaningful improvement decreased by 29% (OR = 0.71, 95% CI, 0.55 to 0.91) on the clinical dimension and by 53% (OR = 0.47, 95% CI, 0.32 to 0.68) on the existential dimension. However, changes in outcomes pertaining to physical, functional, criminological, and social dimensions were not significantly influenced by impulsiveness. CONCLUSIONS Findings highlight the importance of addressing impulsiveness in the context of recovery-oriented interventions for homeless people with mental illness. Further research may be required to improve interventions that are responsive to unique needs of impulsive individuals to support clinical and existential recovery.
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Affiliation(s)
- Marichelle C. Leclair
- Department of Psychology, Université de Montréal, Montréal, Québec,
Canada
- Institut national de psychiatrie légale Philippe-Pinel, Montréal,
Québec, Canada
| | - Ashley J. Lemieux
- Institut national de psychiatrie légale Philippe-Pinel, Montréal,
Québec, Canada
- School of Criminology, Université de Montréal, Montréal, Québec,
Canada
| | - Laurence Roy
- Institut national de psychiatrie légale Philippe-Pinel, Montréal,
Québec, Canada
- School of Physical & Occupational Therapy, McGill University,
Montréal, Québec, Canada
- Douglas Mental Health University Institute, Montréal, Québec,
Canada
| | - Michael S. Martin
- School of Epidemiology and Public Health, University of Ottawa,
Ottawa, Ontario, Canada
| | - Eric A. Latimer
- Douglas Mental Health University Institute, Montréal, Québec,
Canada
- Department of Psychiatry, McGill University, Montréal, Québec,
Canada
| | - Anne G. Crocker
- Institut national de psychiatrie légale Philippe-Pinel, Montréal,
Québec, Canada
- School of Criminology, Université de Montréal, Montréal, Québec,
Canada
- Department of Psychiatry & Addictions, Université de Montréal,
Montréal, Québec, Canada
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29
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Martinelli TF, Nagelhout GE, Bellaert L, Best D, Vanderplasschen W, van de Mheen D. Comparing three stages of addiction recovery: long-term recovery and its relation to housing problems, crime, occupation situation, and substance use. DRUGS: EDUCATION, PREVENTION AND POLICY 2020. [DOI: 10.1080/09687637.2020.1779182] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Thomas F. Martinelli
- IVO Research Institute, The Hague, The Netherlands
- Tranzo Scientific Center for Care and Wellbeing, School of Social and Behavioural Sciences, Tilburg University, Tilburg, The Netherlands
| | - Gera E. Nagelhout
- IVO Research Institute, The Hague, The Netherlands
- Department of Health Promotion and Department of Family Medicine, Maastricht University (CAPHRI), Maastricht, The Netherlands
| | - Lore Bellaert
- Department of Special Needs Education, Ghent University, Ghent, Belgium
| | - David Best
- The International Centre of Excellence in Policing and Criminal Justice, University of Derby, Derby, England
| | | | - Dike van de Mheen
- Tranzo Scientific Center for Care and Wellbeing, School of Social and Behavioural Sciences, Tilburg University, Tilburg, The Netherlands
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Jordan G, Malla A, Iyer SN. Service provider perceptions of posttraumatic growth experienced by service users receiving treatment for a first episode of psychosis. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2020. [DOI: 10.1080/00207411.2020.1776458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Gerald Jordan
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Verdun, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
- Yale Program for Recovery and Community Health, Yale University, New Haven, CT, USA
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Verdun, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Srividya N. Iyer
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Verdun, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
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Nesse L, Gonzalez MT, Aamodt G, Raanaas RK. Recovery, quality of life and issues in supported housing among residents with co-occurring problems: a cross-sectional study. ADVANCES IN DUAL DIAGNOSIS 2020. [DOI: 10.1108/add-10-2019-0014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Recovery for residents who experience co-occurring problems and live in supported housing takes place in everyday contexts. This study aims to explore residents’ self-reported recovery and quality of life and examine the relationships between these factors and issues in supported housing.
Design/methodology/approach
A cross-sectional study was conducted at 21 supported housing sites in six cities across Norway. A total of 104 residents (76 men and 28 women) responded to measures of recovery (Recovery Assessment Scale – Revised), life satisfaction (Manchester Short Assessment of Quality of Life), affect (single items), staff support (Brief INSPIRE) and sense of home (single items).
Findings
Linear regression analyses indicated associations between recovery and staff support (B = 0.01, 95% CI = 0.01-0.02, ß = 0.39), housing satisfaction (B = 0.15, 95% CI = 0.07-0.22, ß = 0.38), sense of home (B = 0.23, 95% CI = 0.14-0.32, ß = 0.49) and satisfaction with personal economy (B = 0.11, 95% CI = 0.05-0.17, ß = 0.33). Similarly, associations were found between life satisfaction and staff support (B = 0.03, 95% CI = 0.02-0.04, ß = 0.46), housing satisfaction (B = 0.63, 95% CI = 0.46-0.80, ß = 0.60), sense of home (B = 0.65, 95% CI = 0.42-0.87, ß = 0.51) and satisfaction with personal economy (B = 0.34, 95% CI = 0.19-0.50, ß = 0.39).
Originality/value
The findings imply that core issues in supported housing, namely, staff support, housing satisfaction, sense of home and satisfaction with personal economy, are associated with recovery and quality of life.
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De Ruysscher C, Vandevelde S, Tomlinson P, Vanheule S. A qualitative exploration of service users' and staff members' perspectives on the roles of inpatient settings in mental health recovery. Int J Ment Health Syst 2020; 14:15. [PMID: 32165919 PMCID: PMC7060519 DOI: 10.1186/s13033-020-00347-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background Today, international mental health care increasingly focuses on creating recovery-oriented systems of support. This study aims to unravel the daily practice of an inpatient psychiatric ward that engages with persons with complex mental health needs. Methods 17 in-depth interviews were conducted with patients and staff of the ward. Data was analyzed by means of thematic analysis. Results Three important functions of the ward were identified in the participants’ experiences. First, it functions as an asylum, a safe environment where patients can ‘simply be’. Second, the ward is experienced as a particularizing space, as support is organized in an individualized way and patients are encouraged to reconnect with their own identity. Third, the ward functions as a transitional space towards a valuable community life, in which finding adequate housing is of central importance. Conclusions The results show that inpatient forms of support tally with personal and social dimensions of recovery and fulfill important roles in recovery-oriented systems of support.
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Affiliation(s)
- Clara De Ruysscher
- 1Department of Special Needs Education, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Stijn Vandevelde
- 1Department of Special Needs Education, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | | | - Stijn Vanheule
- 3Department of Psychoanalysis and Clinical Consulting, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
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Rosic T, Worster A, Thabane L, Marsh DC, Samaan Z. Exploring psychological symptoms and associated factors in patients receiving medication-assisted treatment for opioid-use disorder. BJPsych Open 2020; 6:e8. [PMID: 31910933 PMCID: PMC7001483 DOI: 10.1192/bjo.2019.99] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/11/2019] [Accepted: 12/11/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients receiving treatment for opioid-use disorder (OUD) may experience psychological symptoms without meeting full criteria for psychiatric disorders. The impact of these symptoms on treatment outcomes is unclear. AIMS To determine the prevalence of psychological symptoms in a cohort of individuals receiving medication-assisted treatment for OUD and explore their association with patient characteristics and outcomes in treatment. METHOD Data were collected from 2788 participants receiving ongoing treatment for OUD recruited in two Canadian prospective cohort studies. The Maudsley Addiction Profile psychological symptoms subscale was administered to all participants via face-to-face interviews. A subset of participants (n = 666) also received assessment for psychiatric disorders with the Mini International Neuropsychiatric Interview. We used linear regression analysis to explore factors associated with psychological symptom score. RESULTS The mean psychological symptom score was 12.6/40 (s.d. = 9.2). Participants with psychiatric comorbidity had higher scores than those without (mean 16.8 v. 8.6, P<0.001) and 31% of those with psychiatric comorbidity reported suicidal ideation. Higher psychological symptom score was associated with female gender (B = 1.59, 95% CI 0.92-2.25, P<0.001), antidepressant prescription (B = 4.35, 95% CI 3.61-5.09, P<0.001), percentage of opioid-positive urine screens (B = 0.02, 95% CI 0.01-0.03, P<0.001), and use of non-opioid substances (B = 1.92, 95% CI 0.89-2.95, P<0.001). Marriage and employment were associated with lower psychological symptoms. CONCLUSIONS Psychological symptoms are associated with treatment outcomes in this population and the prevalence of suicidal ideation is an area of concern. Our findings highlight the ongoing need to optimise integrated mental health and addictions services for patients with OUD.
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Affiliation(s)
- Tea Rosic
- Department of Psychiatry and Behavioral Neurosciences, McMaster University; and Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada
| | - Andrew Worster
- Department of Health Research Methods, Evidence, and Impact, McMaster University; and Department of Medicine, McMaster University, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University; Department of Medicine, McMaster University; Departments of Pediatrics/Anesthesia, McMaster University; and Biostatistics Unit, Research Institute at St Joseph's Healthcare, Canada
| | - David C. Marsh
- Northern Ontario School of Medicine; and Canadian Addiction Treatment Centres, Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioral Neurosciences, McMaster University; and Department of Medicine, McMaster University, Canada
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Oute J, Bjerge B. Ethnographic reflections on access to care services. JOURNAL OF ORGANIZATIONAL ETHNOGRAPHY 2019. [DOI: 10.1108/joe-12-2017-0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is twofold: to explore how gatekeepers’ ways of regulating the researchers’ access to knowledge in/about care services reflect the systemic and interpersonal values that inform Danish welfare systems’ daily workings at the street level; and also explore how the authors’ methodological experiences mirror the value-informed regulatory strategies that professionals and users themselves experience in their daily encounters in the same local practices that the authors have studied.
Design/methodology/approach
The paper takes its empirical point of departure in a multisited ethnographic field study of the management of citizens with complex problems in Danish welfare systems.
Findings
By means of Michael Lipsky’s outline of access regulation, the authors will analyze the following regulatory strategies that are identified during the fieldwork: “Gatekeepers’ sympathy and creaming,” “Queuing and delay,” and ‘Withdrawal of consent and “no resources.” The paper suggests that trust, shared goals and sympathy seem to be key to the process of getting access.
Originality/value
Despite principles of neutrality, equal rights and access to services in welfare systems, the authors’ experiences thus tend to support other research within bureaucratic and care organizations, which has found that interpersonal relations, sympathy, dislikes, norms and values, etc., can heavily influence timely access to services, tailored information and support.
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Robinson LD, Kelly PJ, Deane FP, Reis SL. Exploring the Relationships Between Eating Disorders and Mental Health in Women Attending Residential Substance Use Treatment. J Dual Diagn 2019; 15:270-280. [PMID: 31519142 DOI: 10.1080/15504263.2019.1660019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Comorbid eating disorders (EDs) and ED symptoms are highly prevalent among women with substance use disorders and may be a barrier to recovery. Higher rates of psychiatric illness are common when more than one disorder is present. Yet little is known about the rates and risk factors for EDs/ED symptoms in women attending treatment centers in Australia. The primary aim is to examine the prevalence of ED symptoms among women attending treatment centers. This study also examines past physical and sexual abuse and mental health as specific predictors of EDs/ED symptoms. Methods: Participants were 1,444 women attending residential treatment for substance use issues provided by the Salvation Army in Australia. Measures included the Addiction Severity Index, the Eating Disorder Screen for Primary Care, medication use, hospitalization, mental health, and past abuse. Results: Alcohol was the primary substance of concern for 53.3% of the women, followed by amphetamines (17.5%), and the mean age was 37.83 years (SD = 10.8). Nearly 60% of women screened positive for ED symptoms and 32% reported a previous or current ED. Women with a history of sexual abuse had significantly greater odds (1.96) of positive screening for an ED compared to those without a history of sexual abuse. Similarly, compared to women without a history of physical abuse, those who did have a history had significantly higher odds (1.59) of a positive screen for an ED. These women were also significantly more likely to have had a health care provider recommend they take medications for psychological or emotional problems in the past 30 days, χ2(1) = 8.42, p = .004, and during their lifetime, χ2(1) = 17.89, p < .001. They also had a significantly greater number of overnight hospitalizations for medical problems compared to those who screened negative, t(137) = -2.19, p = .03. Conclusions: Women with comorbid substance use issues and EDs are highly likely to have a history of past abuse. This combination of comorbidities makes treatment and recovery difficult. Increased awareness and research are required to explore integrated approaches to treatment that accommodate these vulnerabilities and improve long-term outcomes.
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Affiliation(s)
- Laura D Robinson
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Institute for Mental Health, University of Wollongong, Wollongong, Australia
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Institute for Mental Health, University of Wollongong, Wollongong, Australia
| | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Institute for Mental Health, University of Wollongong, Wollongong, Australia
| | - Samantha L Reis
- School of Psychology, University of Wollongong, Wollongong, Australia
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Bahl NKH, Nafstad HE, Blakar RM, Landheim AS, Brodahl M. Multiple senses of community and recovery processes. A pilot study for a national evaluation of the experiences of persons with substance use problems receiving help and services from Norwegian municipalities. JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 47:1399-1418. [PMID: 31038224 PMCID: PMC6767461 DOI: 10.1002/jcop.22194] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/08/2019] [Accepted: 04/14/2019] [Indexed: 06/09/2023]
Abstract
AIMS This pilot study uses a multifaceted concept of sense of community (SOC)-multiple senses of community (MPSOC)-to understand how the multiple communities of persons with substance use problems, including those with a positive, negative and neutral SOC, influence processes of substance use recovery. METHODS Semi-structured interviews were conducted with 16 informants from different Norwegian municipalities and regions. A collaborative research design and thematic analyses with a peer researcher were applied. RESULTS The findings confirm prior findings of key ingredients related to recovery. However, they also illustrate that for communities to promote recovery, they need to fulfil individual needs, provide distance from pretreatment status, identity and roles and harmonise with individual meaning systems of an ideal community. CONCLUSION Experiences of positive and negative community connections within geographical, relational and ideal communities take part in recovery processes. Community participation is suggested to be included in individual outpatient treatment and posttreatment plans.
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Affiliation(s)
- Nina Kavita Heggen Bahl
- Department of Research and DevelopmentClinic of Substance Use and Addiction Medicine, St. Olavs University HospitalTrondheimNorway
| | | | | | - Anne Signe Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health DisordersInnlandet Hospital TrustBrumunddalNorway
- Norwegian Centre for Addiction ResearchUniversity of OsloOsloNorway
- Innlandet University of Applied Sciences, Campus ElverumElverumNorway
| | - Morten Brodahl
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health DisordersMental Health Division, Innlandet Hospital TrustBrumunddalNorway
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Predictors of Mental Health Recovery in Homeless Adults with Mental Illness. Community Ment Health J 2019; 55:631-640. [PMID: 30519803 DOI: 10.1007/s10597-018-0356-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
Abstract
For people with mental illness, experiences of homelessness can complicate mental health recovery processes. This study used longitudinal data from a randomized controlled trial of housing first (HF) to examine predictors of recovery among homeless people with mental illness. Findings showed that health and community predictors were most strongly associated with mental health recovery. Receipt of HF did not have any effect on changes in recovery scores at follow-up. Overall, the findings suggest that interventions aimed at preventing chronic homelessness, strengthening social networks and community involvement, and providing case management services will facilitate mental health recovery.
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Maagerø-Bangstad ER, Sælør KT, Ness O. Encountering staff-directed aggression within mental health and substance abuse services: exploring conceptions of practice following education. Int J Ment Health Syst 2019; 13:20. [PMID: 30984286 PMCID: PMC6444818 DOI: 10.1186/s13033-019-0277-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background Staff-directed aggression represents a considerable concern in mental health and substance abuse services, and presents a substantial challenge to the quality and continuity of service provision for people with mental health and substance abuse problems. The practitioners themselves frequently request increased competence as a way to mediate the negative effects of staff-directed violence and aggression. The aim of this study is to explore how practitioners in municipal mental health and substance abuse services conceptualize practice in prevention and management of staff-directed violence. Furthermore, we seek to explore how these conceptions change following participation in two complementary and specially developed courses advancing respectively, qualified risk assessment and situational awareness and disempowerment-sensitive and de-escalation principles for practice. Method The study was conducted by using a qualitative phenomenographic research approach. The data-material comprised two-step semi-structured interviews with ten participants from various parts of community mental health and substance abuse services in the Municipality of Oslo, Norway. Results The analysis resulted in the development of five qualitatively different, hierarchically ordered, yet logically interrelated conceptual categories of practice concerning prevention and management of staff-directed aggression in community mental health and substance abuse services. These are: (1) Observation, reporting and expectation of organizational intervention, (2) Application of personalized de-escalating skills and behaviour, (3) Delivery of team-based and standardized services, (4) Provision of perceptive and responsive services, and (5) Facilitation of sensitive, involving and reflexive care. The categories vary according to the participants' attentional focus on either the responsibility of the organization, staff members' personally developed skills and techniques, team-based solutions, knowledgeable information processing in making professional judgements and reflexive, interpersonal service provision, as well as according to what meaning participants assign to practice. The authors have identified varying degrees of conceptual change following education in half of the participants. Conclusion The results of this study both show that practitioners conceptualize practice in aggressive encounters quite differently. The study also indicate that it is important to consider participant awareness of the phenomenon of interest when devising educational activities for personnel in mental health and substance abuse services.
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Affiliation(s)
- Erlend R Maagerø-Bangstad
- Faculty of Health and Social Sciences, Dept. of Health and Social and Welfare Studies, Centre for Mental Health and Substance Abuse, University of South-Eastern Norway, P.O. box 7053, 3007 Drammen, Norway
| | - Knut Tore Sælør
- Faculty of Health and Social Sciences, Dept. of Health and Social and Welfare Studies, Centre for Mental Health and Substance Abuse, University of South-Eastern Norway, P.O. box 7053, 3007 Drammen, Norway
| | - Ottar Ness
- Faculty of Health and Social Sciences, Dept. of Health and Social and Welfare Studies, Centre for Mental Health and Substance Abuse, University of South-Eastern Norway, P.O. box 7053, 3007 Drammen, Norway.,2Dept. of Education and Lifelong Learning, Norwegian University of Science and Technology, P.O. box 8900, 7491 Trondheim, Norway
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Return to Work Interventions for Cancer Survivors: A Systematic Review and a Methodological Critique. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16081343. [PMID: 31014004 PMCID: PMC6518012 DOI: 10.3390/ijerph16081343] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/11/2019] [Accepted: 04/12/2019] [Indexed: 12/24/2022]
Abstract
Cancer patients are more at risk of being unemployed or having difficulties to return to work (RTW) compared to individuals without health concerns, and is thus a major public health issue. The aim of this systematic review is to identify and describe the interventions developed specifically to help cancer patients to RTW after treatment. Two researchers independently screened the articles for inclusion and Critical Appraisal Skills Program (CASP) checklists were used to assess the methodology of the included studies. Ten manuscripts met the inclusion criteria. The type of studies were three quasi-experimental studies, three longitudinal studies, three randomized controlled trials (RCTs) and a qualitative study. RTW interventions were conducted in or outside the hospital (n = 6 and 3 respectively), or both (n = 1). Improvements in RTW were only observed in quasi-experimental studies. No improvement in RTW was noted in RCTs, nor in other measures (e.g., quality of life, fatigue). Lack of statistically significant improvement does not necessarily reflect reality, but may be attributed to non-adapted research methods. This systematic review underscores the need for researches in the RTW field to reach a consensus on RTW criteria and their assessment. Recommendations to this effect are suggested.
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A Stabilizing and Destabilizing Social World: Close Relationships and Recovery Processes in SUD. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s40737-019-00137-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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van Os J, Guloksuz S, Vijn TW, Hafkenscheid A, Delespaul P. The evidence-based group-level symptom-reduction model as the organizing principle for mental health care: time for change? World Psychiatry 2019; 18:88-96. [PMID: 30600612 PMCID: PMC6313681 DOI: 10.1002/wps.20609] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The content and organization of mental health care have been heavily influenced by the view that mental difficulties come as diagnosable disorders that can be treated by specialist practitioners who apply evidence-based practice (EBP) guidelines of symptom reduction at the group level. However, the EBP symptom-reduction model is under pressure, as it may be disconnected from what patients need, ignores evidence of the trans-syndromal nature of mental difficulties, overestimates the contribution of the technical aspects of treatment compared to the relational and ritual components of care, and underestimates the lack of EBP group-to-individual generalizability. A growing body of knowledge indicates that mental illnesses are seldom "cured" and are better framed as vulnerabilities. Important gains in well-being can be achieved when individuals learn to live with mental vulnerabilities through a slow process of strengthening resilience in the social and existential domains. In this paper, we examine what a mental health service would look like if the above factors were taken into account. The mental health service of the 21st century may be best conceived of as a small-scale healing community fostering connectedness and strengthening resilience in learning to live with mental vulnerability, complemented by a limited number of regional facilities. Peer support, organized at the level of a recovery college, may form the backbone of the community. Treatments should be aimed at trans-syndromal symptom reduction, tailored to serve the higher-order process of existential recovery and social participation, and applied by professionals who have been trained to collaborate, embrace idiography and maximize effects mediated by therapeutic relationship and the healing effects of ritualized care interactions. Finally, integration with a public mental health system of e-communities providing information, peer and citizen support and a range of user-rated self-management tools may help bridge the gap between the high prevalence of common mental disorder and the relatively low capacity of any mental health service.
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Affiliation(s)
- Jim van Os
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychosis Studies, King's College London, King's Health Partners, Institute of Psychiatry, London, UK
| | - Sinan Guloksuz
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Thomas Willem Vijn
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, The Netherlands
| | | | - Philippe Delespaul
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Mondriaan, Heerlen/Maastricht, The Netherlands
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MacDonald K, Fainman-Adelman N, Anderson KK, Iyer SN. Pathways to mental health services for young people: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2018; 53:1005-1038. [PMID: 30136192 PMCID: PMC6182505 DOI: 10.1007/s00127-018-1578-y] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 07/30/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE While early access to appropriate care can minimise the sequelae of mental illnesses, little is known about how youths come to access mental healthcare. We therefore conducted a systematic review to synthesise literature on the pathways to care of youths across a range of mental health problems. METHODS Studies were identified through searches of electronic databases (MEDLINE, PsycINFO, Embase, HealthSTAR and CINAHL), supplemented by backward and forward mapping and hand searching. We included studies on the pathways to mental healthcare of individuals aged 11-30 years. Two reviewers independently screened articles and extracted data. RESULTS Forty-five studies from 26 countries met eligibility criteria. The majority of these studies were from settings that offered services for the early stages of psychosis, and others included inpatient and outpatient settings targeting wide-ranging mental health problems. Generally, youths' pathways to mental healthcare were complex, involved diverse contacts, and, sometimes, undue treatment delays. Across contexts, family/carers, general practitioners and emergency rooms featured prominently in care pathways. There was little standardization in the measurement of pathways. CONCLUSIONS Except in psychosis, youths' pathways to mental healthcare remain understudied. Pathways to care research may need to be reconceptualised to account for the often transient and overlapping nature of youth mental health presentations, and the possibility that what constitutes optimal care may vary. Despite these complexities, additional research, using standardized methodology, can yield a greater understanding of the help-seeking behaviours of youths and those acting on their behalf; service responses to help-seeking; and the determinants of pathways. This understanding is critical to inform ongoing initatives to transform youth mental healthcare.
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Affiliation(s)
- Kathleen MacDonald
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Prevention and Early Intervention Program for Psychosis (PEPP) and ACCESS Open Minds (pan-Canadian youth mental health services research network), Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Nina Fainman-Adelman
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Prevention and Early Intervention Program for Psychosis (PEPP) and ACCESS Open Minds (pan-Canadian youth mental health services research network), Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, ON, Canada
- Department of Psychiatry, The University of Western Ontario, London, ON, Canada
| | - Srividya N Iyer
- Department of Psychiatry, McGill University, Montreal, QC, Canada.
- Prevention and Early Intervention Program for Psychosis (PEPP) and ACCESS Open Minds (pan-Canadian youth mental health services research network), Douglas Mental Health University Institute, Montreal, QC, Canada.
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Ørjasæter KB, Stickley T, Hedlund M, Ness O. Transforming identity through participation in music and theatre: exploring narratives of people with mental health problems. Int J Qual Stud Health Well-being 2018; 12:1379339. [PMID: 28956505 PMCID: PMC5654009 DOI: 10.1080/17482631.2017.1379339] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: There is a growing understanding that mental health problems and prolonged contact with mental healthcare systems can affect people’s identities. Working with identity is an important element in mental health recovery. Purpose: In this article, we explore the significance of participation in a music and theatre workshop in terms of people`s experiences of identity. Design and methods: This is a qualitative study based on a hermeneutical phenomenological epistemology. Data were collected from in-depth interviews with 11 participants at a music and theater workshop, analysed through a narrative analysis and presented in an ideographical “long” narrative form. The music and theater workshop is not overtly therapeutic although the activity takes place in a Norwegian mental health hospital for adults living with long-term mental health problems. Results: We identified three crosscutting themes: (1) becoming a whole person, (2) being allowed to hold multiple identities and (3) exploring diverse perspectives. Conclusion: Findings show that participation in the music and theatre workshop transformed the participants’ experiences of identity on two levels: individually and collectively. The participants developed a broader picture of themselves through their creative work with others. When they developed new identities, the narratives of themselves expanded.
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Affiliation(s)
- Kristin Berre Ørjasæter
- a Faculty of Nursing and Health Sciences , Nord University , Bodø , Norway.,b Faculty of Medicine and Health Sciences , Norwegian University of Science and Technology , Trondheim , Norway
| | - Theodore Stickley
- c Faculty of Medicine and Health Sciences , University of Nottingham , Nottingham , UK
| | - Marianne Hedlund
- a Faculty of Nursing and Health Sciences , Nord University , Bodø , Norway.,d Faculty of Social and Educational Science , Norwegian University of Science and Technology , Trondheim , Norway
| | - Ottar Ness
- a Faculty of Nursing and Health Sciences , Nord University , Bodø , Norway.,d Faculty of Social and Educational Science , Norwegian University of Science and Technology , Trondheim , Norway.,e Department of Health, Social and Welfare Studies , University College of Southeast , Drammen , Norway
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Dilemmas in recovery-oriented practice to support people with co-occurring mental health and substance use disorders: a qualitative study of staff experiences in Norway. Int J Ment Health Syst 2018; 12:30. [PMID: 29930698 PMCID: PMC5992690 DOI: 10.1186/s13033-018-0211-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/02/2018] [Indexed: 11/10/2022] Open
Abstract
Background Recovery-oriented practice is recommended in services for people with co-occurring mental health and substance use disorders. Understanding practitioners’ perceptions of recovery-oriented services may be a key component of implementing recovery principles in day-to-day practice. This study explores and describes staff experiences with dilemmas in recovery-oriented practice to support people with co-occurring disorders. Methods Three focus group interviews were carried out over the course of 2 years with practitioners in a Norwegian community mental health and addictions team that was committed to developing recovery-oriented services. Thematic analysis was applied to yield descriptions of staff experiences with dilemmas in recovery-oriented practice. Results Three dilemmas were described: (1) balancing mastery and helplessness, (2) balancing directiveness and a non-judgmental attitude, and (3) balancing total abstinence and the acceptance of substance use. Conclusions Innovative approaches to practice development that address the inherent dilemmas in recovery-oriented practice to support people with co-occurring disorders are called for. Electronic supplementary material The online version of this article (10.1186/s13033-018-0211-5) contains supplementary material, which is available to authorized users.
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Skogens L, von Greiff N, Topor A. Initiating and maintaining a recovery process – experiences of persons with dual diagnosis. ADVANCES IN DUAL DIAGNOSIS 2018. [DOI: 10.1108/add-09-2017-0016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to investigate the internal and social factors that persons with experience from severe mental illness and alcohol and other drugs problems, and who have received treatment for these problems, describe as important for initiating and maintaining a recovery process.
Design/methodology/approach
In total, 40 persons were interviewed and asked to describe factors they perceived as important for initiating and maintaining recovery. The software Nvivo was used to categorise data in internal and social factors with subcategories.
Findings
There is significant variation in how recovery emerged but involved in general having a proper social situation and finding meaning in life. Initially, the majority had a marginalised situation with need of assistance with housing, employment, financial and social support.
Research limitations/implications
The change process in the investigated group is interpreted as related to individual resources rather than belonging to a group defined as having “double trouble”.
Practical implications
The study implies that in addition to professional help to handle diagnosed problems, the group in focus also need support and interventions that address individual complex needs.
Social implications
Supporting activities/peer support seem to be important for those lacking support from family. At the same time, it is important to recognise the risk of being forced into a recovery identity which might lead to worsening the situation for those who do not fit into this.
Originality/value
By using the same design as in previous studies, comparisons with other groups are possible while still keeping the qualitative meaning of the investigated factors.
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Topor A, Skogens L, von Greiff N. Building trust and recovery capital: the professionals’ helpful practice. ADVANCES IN DUAL DIAGNOSIS 2018. [DOI: 10.1108/add-11-2017-0022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The possibility of recovery for persons with co-occurring addiction and mental health problems has been contested. Though, recent studies show that recovery might happen, but without connection to specific treatment interventions. The purpose of this paper is to analyse professionals’ perceptions of their contribution to improvement.
Design/methodology/approach
In all, 15 experienced professionals were interviewed. The interviews were analysed using thematic analysis.
Findings
Recovery processes were dependent of the persons’ access to different forms of recovery capital (RC). Lack of RC was often associated with lack of trust in one’s self and others (identity and personal capital). Professionals had to be accepted as trustful agents through co-creating changes in the person’s life. Trusting a professional might be a basis for trusting one’s self as an agent in one’s recovery process and develop a social network (identity and relationship capital). Other aspects stressed by the professionals were to manage their own fragmentized organisations and societal shortcomings (economic capital).
Practical implications
Recovery has been described as a profoundly individual journey. However, it is also deeply social, involving other persons and contextual factors. Focusing on just one level might counteract the complex work behind double recovery.
Originality/value
Improvement was described as dependent on the presence of personal, inter-personal, organisational and societal factors. The findings give a deep and concrete understanding of the process constituting the development of a working alliance and its dependence on factors outside the direct relation between the staff member and the person.
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Oute J, Tondora J, Glasdam S. ‘Men just drink more than women. Women have friends to talk to’-Gendered understandings of depression among healthcare professionals and their implications. Nurs Inq 2018; 25:e12241. [DOI: 10.1111/nin.12241] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2018] [Indexed: 01/16/2023]
Affiliation(s)
- Jeppe Oute
- Department of Psychology and Behavioral Sciences; School of Business and Social Sciences; Centre for Alcohol and Drug Research; Aarhus University Denmark
| | - Janis Tondora
- Yale Program For Recovery and Community Health; Yale School of Medicine, Department of Psychiatry; New Haven CT USA
| | - Stinne Glasdam
- Faculty of Medicine; Division of Nursing; Lund University Sweden
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Lysaker PH, Hamm JA, Hasson-Ohayon I, Pattison ML, Leonhardt BL. Promoting recovery from severe mental illness: Implications from research on metacognition and metacognitive reflection and insight therapy. World J Psychiatry 2018; 8:1-11. [PMID: 29568726 PMCID: PMC5862649 DOI: 10.5498/wjp.v8.i1.1] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/04/2017] [Accepted: 01/07/2018] [Indexed: 02/05/2023] Open
Abstract
Research indicates that individuals with schizophrenia recover. Recovery, however means different things to different individuals and regardless of what kind of experiences define recovery, the individual diagnosed with the serious mental illness must feel ownership of their recovery. This raises the issue of how mental health services should systematically promote recovery. This paper explores the practical implications for research on metacognition in schizophrenia for this issue. First, we present the integrated model of metacognition, which defines metacognition as the spectrum of activities which allow individual to have available to themselves an integrated sense of self and others as they appraise and respond to the unique challenges they face. Second, we present research suggesting that many with schizophrenia experience deficits in metacognition and that those deficits compromise individuals’ abilities to manage their lives and mental health challenges. Third, we discuss a form of psychotherapy inspired by this research, Metacognitive Reflection and Insight Therapy which assists individuals to recapture the ability to form integrated ideas about themselves and others and so direct their own recovery. The need for recovery oriented interventions to focus on process and on patient’s purposes, assess metacognition and consider the intersubjective contexts in which this occurres is discussed.
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Affiliation(s)
- Paul Henry Lysaker
- Department of Psychiatry, Roudebush VA Med Ctr and the Indiana Univeristy School of Medicine, Indianapolis, IN 46254, United States
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46254, United States
| | - Jay A Hamm
- Department of Psychiatry, Eskenazi Health, Midtown Community Mental Health, Indianapolis, IN 46202, United States
- Eskenazi Health, Midtown Community Mental Health, Indianapolis, IN 46202, United States
| | - Ilanit Hasson-Ohayon
- Department of Psychology, Hasson-Ohayon, I, Bar Ilan Univ, Dept Psychol, Ramat Gan 5290002, Israel
| | - Michelle L Pattison
- Department of Psychology, University of Indianapolis, College of Applied Behavioral Sciences, Indianapolis, IN 46227, United States
| | - Bethany L Leonhardt
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46254, United States
- Eskenazi Health, Midtown Community Mental Health, Indianapolis, IN 46202, United States
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Stott A, Priest H. Narratives of recovery in people with coexisting mental health and alcohol misuse difficulties. ADVANCES IN DUAL DIAGNOSIS 2018. [DOI: 10.1108/add-08-2017-0012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Existing literature has examined what recovery means to people with co-occurring difficulties, but does little to examine experiences of recovery as a process. The purpose of this paper is to use a narrative approach to explore the process of recovery as an individual journey in a social context. It focuses on people who use alcohol in order to explore the impact of alcohol’s specific cultural meanings on the recovery journey.
Design/methodology/approach
Ten interviews with people with coexisting mental health and alcohol misuse difficulties were conducted, audio-recorded, and transcribed. The transcriptions were analysed using narrative analysis.
Findings
Most participants’ narratives shared a three-part structure, from a traumatic past, through an episode of change, to an ongoing recovery phase. Change and recovery were attributed to several factors including flexible and practical support from services, therapeutic relationships with key professionals, and peer support. Some participants redefined themselves and their alcohol use in relation to ideas of what it is to be “normal”.
Research limitations/implications
The research excluded people who recover outside of services, replicating a shortcoming of much research in this area.
Practical implications
The value placed on professionals having specialised therapeutic skills in working with trauma highlights the need for training in this area. The role for practical and material support underlines the importance of multi-agency working.
Originality/value
The narrative methodology enables the study to draw links between personal stories of recovery and wider social influences, allowing comment on the implications for services. Further, the experiences of people with coexisting mental health and alcohol misuse difficulties have rarely been studied apart from the dual diagnosis population in general, so this paper is able to investigate the specific challenges for this population.
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Watson DP, Ray B, Robison L, Xu H, Edwards R, Salyers MP, Hill J, Shue S. Developing Substance Use Programming for Person-Oriented Recovery and Treatment (SUPPORT): protocol for a pilot randomized controlled trial. Pilot Feasibility Stud 2017; 3:73. [PMID: 29270312 PMCID: PMC5732423 DOI: 10.1186/s40814-017-0212-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 11/22/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is a lack of evidence-based substance use disorder treatment and services targeting returning inmates. Substance Use Programming for Person-Oriented Recovery and Treatment (SUPPORT) is a community-driven, recovery-oriented approach to substance abuse care which has the potential to address this service gap. SUPPORT is modeled after Indiana's Access to Recovery program, which was closed due to lack of federal support despite positive improvements in clients' recovery outcomes. SUPPORT builds on noted limitations of Indiana's Access to Recovery program. The ultimate goal of this project is to establish SUPPORT as an effective and scalable recovery-oriented system of care. A necessary step we must take before launching a large clinical trial is pilot testing the SUPPORT intervention. METHODS The pilot will take place at Public Advocates in Community Re-Entry (PACE), nonprofit serving individuals with felony convictions who are located in Marion County, Indiana (Indianapolis). The pilot will follow a basic parallel randomized design to compare clients receiving SUPPORT with clients receiving standard services. A total of 80 clients within 3 months of prison release will be recruited to participate and randomly assigned to one of the two intervention arms. Quantitative measures will be collected at multiple time points to understand SUPPORT's impact on recovery capital and outcomes. We will also collect qualitative data from SUPPORT clients to better understand their program and post-discharge experiences. DISCUSSION Successful completion of this pilot will prepare us to conduct a multi-site clinical trial. The ultimate goal of this future work is to develop an evidence-based and scalable approach to treating substance use disorder among persons returning to society after incarceration. TRIAL REGISTRATION ClinicalTrials.gov (Clinical Trials ID: NCT03132753 and Protocol Number: 1511731907). Registered 28 April 2017.
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Affiliation(s)
- Dennis P. Watson
- Department of Social and Behavioral Sciences, Indiana University Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN 46202 USA
| | - Bradley Ray
- School of Public and Environmental Affairs, Indiana University-Purdue University Indianapolis, 801 W. Michigan St., Indianapolis, IN 46202 USA
| | - Lisa Robison
- Department of Social and Behavioral Sciences, Indiana University Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN 46202 USA
| | - Huiping Xu
- Department of Biostatistics, Indiana University Fairbanks School of Public Health, 410 W. 10th St., Indianapolis, IN 46202 USA
| | - Rhiannon Edwards
- Public Advocates in Community Re-Entry, 2855 N. Keystone Ave, Indianapolis, IN 46218 USA
| | - Michelle P. Salyers
- Department of Psychology, Indiana University-Purdue University Indianapolis, 420 N Blackford St., Indianapolis, IN 46202 USA
| | - James Hill
- Department of Computer Science, Indiana University-Purdue University Indianapolis, 402 N. Blackford, Indianapolis, IN 46202 USA
| | - Sarah Shue
- School of Health and Rehabilitation Sciences, Indiana University-Purdue University Indianapolis, 1050 Wishard Blvd, Indianapolis, IN 46202 USA
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