To Preserve, Strengthen, and Expand America’s Mental Health and Addictions Treatment Capacity

What features of drug treatment programs help, or not, with access? a qualitative study of the perspectives of family members and community-based organization staff in Atlantic Canada

BACKGROUND

Withdrawal management and opioid agonist treatment (OAT) programs help to reduce some of the harms experienced by people who use substances (PWUS). There is literature on how features of drug treatment programs (e.g., policies and practices) are helpful, or not helpful, to PWUS when seeking access to, or in, treatment. There is, however, relatively little literature based on the perspectives of family members/family of choice of PWUS and community-based organization staff within the context of Atlantic Canada. This paper explored the perspectives of these two groups on what was helpful, or not, about drug treatment programs in Atlantic Canada in terms of supporting access to, and retention in, treatment.

METHODS

One-on-one qualitative telephone interviews were conducted in 2020 with the two groups. Interviews focused on government-funded withdrawal management and OAT programs. Data were coded using a qualitative data management program (ATLAS.ti) and analyzed inductively for key themes/subthemes using grounded theory techniques.

RESULTS

Fifteen family members/family of choice and 16 community-based organization staff members participated (n = 31). Participants spoke about features of drug treatment programs in various places, and noted features that were perceived as helpful (e.g., quick access), as well as not helpful (e.g., wait times, programs located far from where PWUS live). Some participants provided their perceptions of how PWUS felt when seeking or accessing treatment. A number of participants reported taking various actions to help support access to treatment, including providing transportation to programs. A few participants also provided suggestions for change to help support access and retention such as better alignment of mental health and addiction systems.

CONCLUSIONS

Participants highlighted several helpful and not helpful features of drug treatment programs in terms of supporting treatment access and retention. Previous studies with PWUS and in other places have reported similar features, some of which (e.g., wait times) have been reported for many years. Changes are needed to reduce barriers to access and retention including the changes recommended by study participants. It is critical that the voices of key groups, (including PWUS) are heard to ensure treatment programs in all places support access and retention.

Relapse prevention for chemically addicted adolescents in recovery: so which model works?

In line with international trends, adolescent chemical addiction remains a significant challenge in South African communities, specifically in the Western Cape. Much emphasis is placed on prevention and treatment, while aftercare as part of treatment receives limited attention. Research does highlight specific aftercare needs of addicted adolescents, while literature provides different models of relapse prevention as part of aftercare, aimed at adults. However, the needs of addicted adolescents in recovery and the different models need to be linked. In this article the author first lists specific needs of chemically addicted adolescents, and secondly explores different models of care. Thirdly, functional elements related to the identified needs are identified. Recommendations for a comprehensive aftercare program are made based on the identified functional elements.

Aftercare to chemically addicted adolescents: An exploration of their needs

Treatment of chemical addiction includes preparation for treatment, formal treatment and aftercare. The latter appears to be a neglected area in service delivery to chemically addicted adolescents, contributing to the high relapse potential following treatment. The current qualitative study aimed at both exploring and describing the aftercare needs of chemically addicted adolescents. The chemically addicted adolescents included in this study received in-patient treatment as well as aftercare, but nonetheless experienced a relapse; necessitating further in-patient treatment. Purposive sampling was implemented to recruit 31 participants between the ages of 14 and 20 years. The sample size was determined by data saturation. Data for this exploratory, descriptive and contextual study were collected by means of narrative inquiry. Tesch’s framework for qualitative data analysis was employed and data verification was conducted through Guba’s model. The findings illustrated a need to attend to adolescents intrapersonal and interpersonal as well as environmental needs following treatment. The results can provide service providers with focus areas to be included in aftercare services to these adolescents.Die behandeling van chemiese afhanklikheid sluit die voorbereiding vir behandeling, formele behandeling en nasorg in. Laasgenoemde blyk ‘n afgeskeepte area te wees in die lewering van dienste aan chemies-afhanklike adolessente, wat bydra tot die hoë terugvalpotensiaal wat op die behandeling volg. Hierdie kwalitatiewe studie was daarop gerig om die nasorgbehoeftes van chemies-afhanklike adolessente te verken, sowel as te beskryf. Die chemies-afhanklike adolessente wat by hierdie studie ingesluit was het vantevore beide binnepasiëntbehandeling en nasorg ontvang, maar ten spyte hiervan teruggeval; wat verdere binnepasiëntbehandeling genoodsaak het. Doelbewuste steekproefneming is geïmplementeer om 31 deelnemers tussen die ouderdomme van 14 en 20 jaar te werf. Die steekproefgrootte was deur middel van data versadiging bepaal. Data vir hierdie verkennende, beskrywende en kontektuele studie is versamel deur middel van narratiewe ondersoek. Tesch se raamwerk vir kwalitatiewe data-analise is toegepas en dataverifikasie is uitgevoer aan die hand van Guba se model. Die bevindings illustreer ‘n behoefte om intrapersoonlike en interpersoonlike, asook omgewingsbehoeftes wat op behandeling volg, aan te spreek as deel van nasorg. Die resultate kan diensleweraars van fokusareas voorsien wat ingesluit kan word in nasorgdienste aan hierdie adolessente.

Biological and psychological interventions: trends in substance use disorders intervention research

Substance use disorders (SUDs) cause serious medical, financial, and social problems for individuals and society. Thus, understanding the large body of research exploring biological and psychological intervention trends is important to researchers and clinicians. Historically, psychological interventions have dominated the literature, in spite of modest outcome data. Recently, a refocus on biological intervention research has led to results suggested as efficacious in treatment of SUDs with promising clinical potential. The current review indicates that there seems to be some incongruence between this growing body of physiological research and psychological clinical research and practice. The current review explores these trends and argues for more solid integration of biological and psychological research and treatment strategies for SUDs, as well as heightened efforts toward translation of research into practice.