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Hobden B, Freund M, Lawson S, Bryant J, Walsh J, Leigh L, Sanson‐Fisher R. The impact of organisational factors on treatment outcomes for those seeking alcohol or other drug treatment: A systematic review. Drug Alcohol Rev 2023; 42:1220-1234. [PMID: 37005012 PMCID: PMC10947488 DOI: 10.1111/dar.13653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 02/24/2023] [Accepted: 03/16/2023] [Indexed: 04/04/2023]
Abstract
INTRODUCTION Organisational factors have been found to be associated with health outcomes in a number of health-care settings. Despite likely being an important influence on the quality of care provided within alcohol and other drug (AOD) treatment centres, the impact of organisational factors on AOD treatment outcomes have not been extensively explored. This systematic literature review examines the characteristics, methodological quality and findings of published studies exploring the association between organisational factors and client AOD treatment outcomes. METHODS Medline, Embase, PsycINFO and the Cochrane database were searched from 2010 to March 2022 for relevant papers. Studies meeting the inclusion criteria underwent quality assessment using the Joanna Brigg's Institute critical appraisal tool for cross-sectional studies, followed by data extraction of key variables pertaining to the aims. A narrative summary was used to synthesise the data. RESULTS Nine studies met the inclusion criteria. Organisational factors examined included cultural competency, organisational readiness for change, directorial leadership, continuity of care practices, service access, service to needs ratios, dual diagnosis training, therapeutic optimism and the funding model/health-care system that treatment was delivered in. Outcome measures included duration, completion or continuation of treatment; AOD use; and patient perceptions of treatment outcomes. Seven out of nine papers found a significant interaction between at least one organisational variable and AOD treatment outcomes. DISCUSSION AND CONCLUSIONS Organisational factors are likely to impact treatment outcomes for patients seeking treatment for AOD. Further examination of the organisational factors that influence AOD outcomes is needed to inform systemic improvements to AOD treatment.
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Affiliation(s)
- Breanne Hobden
- Health Behaviour Research CollaborativeSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of NewcastleNewcastleAustralia
- Equity in Health and Wellbeing Program, Hunter Medical Research InstituteNewcastleAustralia
| | - Megan Freund
- Health Behaviour Research CollaborativeSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of NewcastleNewcastleAustralia
- Equity in Health and Wellbeing Program, Hunter Medical Research InstituteNewcastleAustralia
| | - Samuel Lawson
- Health Behaviour Research CollaborativeSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of NewcastleNewcastleAustralia
- Equity in Health and Wellbeing Program, Hunter Medical Research InstituteNewcastleAustralia
| | - Jamie Bryant
- Health Behaviour Research CollaborativeSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of NewcastleNewcastleAustralia
- Equity in Health and Wellbeing Program, Hunter Medical Research InstituteNewcastleAustralia
| | - Justin Walsh
- Health Behaviour Research CollaborativeSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of NewcastleNewcastleAustralia
- Equity in Health and Wellbeing Program, Hunter Medical Research InstituteNewcastleAustralia
| | - Lucy Leigh
- Clinical Research Design and StatisticsHunter Medical Research InstituteNewcastleAustralia
| | - Rob Sanson‐Fisher
- Health Behaviour Research CollaborativeSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of NewcastleNewcastleAustralia
- Equity in Health and Wellbeing Program, Hunter Medical Research InstituteNewcastleAustralia
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Shin HC, Marsh JC. Identifying relative strength of methadone versus health and social services in comprehensive substance use disorder treatment using a variance decomposition approach. EVALUATION AND PROGRAM PLANNING 2022; 92:102060. [PMID: 35247677 DOI: 10.1016/j.evalprogplan.2022.102060] [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] [Received: 08/03/2021] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The purpose of this study is to identify the relative strengths of association of medication and health and social services in comprehensive substance use disorder (SUD) treatment. OBJECTIVES The study uses a novel variance decomposition method to assess the relative strength of association of six active ingredients of comprehensive SUD treatment: methadone medication, access services, SUD counseling, matched service ratio, client-provider relationship, and treatment duration. METHODS The study uses data from the National Treatment Improvement Evaluation Study (1992-1997), a dataset with an unusual number of services and service strategies measured. The data include 3012 clients from 45 SUD treatment programs. Linear mixed models are used to assess the relation of service variables to the outcome of posttreatment substance use. Variance decomposition methods are used to assess the relative importance of the ingredients in the treatment model. RESULTS Along with a random intercept and background variables, receipt of methadone accounted for the greatest relative strength of association at 35.4%, compared with 23.8% for treatment duration, 15.4% for client-provider relationship, and 11.2% for matched service ratio. Access and SUD counseling accounted for modest strengths of association at 1% and 3% each. CONCLUSION Findings indicate somewhat greater strength of association of methadone compared with other services and service strategies and overall, reinforce the importance of both medication and services and service strategies in the design and development of effective models of service delivery. SIGNIFICANCE This study, among the first to evaluate the relative importance of specific services and service strategies of comprehensive SUD treatment, provides insights relevant to the development of effective models of service delivery.
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Affiliation(s)
- Hee-Choon Shin
- Independent Researcher, 2232 University Drive, Naperville, IL 60565, USA.
| | - Jeanne C Marsh
- University of Chicago, Crown Family School of Social Work, Policy and Practice, 969 E. 60th Street, Chicago, IL 60637, USA.
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Blakey JM, Grocher KB. "Keeping It Real": The Relational Effects of Trauma Among African American Women and Their Substance Abuse Treatment Counselors. JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:3405-3436. [PMID: 29294757 DOI: 10.1177/0886260517708403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
African American women experience disproportionately high rates of trauma. Interpersonal forms of trauma often make it much more difficult for trauma survivors to initiate and maintain positive, healthy relationships with others. This study examined the kinds of relationships women with extensive histories of trauma and substance had with their substance abuse treatment counselors and the characteristics that they believe contributed to connected and disconnected client-counselor relationships. Using the case study method, 26 in-depth interviews were conducted with African American women. Data analysis revealed three primary kinds of relationships women had with their substance abuse treatment counselors: reparative, damaging, and transactional. Eighteen (69%) of the 26 women had reparative relationships with their counselors. Reparative relationships had two primary characteristics: empowering and mattering. Two (8%) of the 26 women had damaging relationships with their substance abuse treatment counselors. Damaging relationships had two primary characteristics: unimportant and untrustworthy. Six of the women (23%) had transactional relationships with their substance abuse treatment counselors. Transactional relationships were task-focused and superficial. Healing from interpersonal experiences of trauma is possible only within the context of trusting relationships. Substance abuse treatment counselors have an opportunity to help African American women with histories of trauma heal and recover. Creating positive, therapeutic relationships between clients and professionals is essential.
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Marchand K, Beaumont S, Westfall J, MacDonald S, Harrison S, Marsh DC, Schechter MT, Oviedo-Joekes E. Conceptualizing patient-centered care for substance use disorder treatment: findings from a systematic scoping review. Subst Abuse Treat Prev Policy 2019; 14:37. [PMID: 31511016 PMCID: PMC6739978 DOI: 10.1186/s13011-019-0227-0] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 09/02/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Despite ongoing efforts aimed to improve treatment engagement for people with substance-related disorders, evidence shows modest rates of utilization as well as client-perceived barriers to care. Patient-centered care (PCC) is one widely recognized approach that has been recommended as an evidence-based practice to improve the quality of substance use disorder treatment. PCC includes four core principles: a holistic and individualized focus to care, shared decision-making and enhanced therapeutic alliance. AIMS This scoping review aimed to explore which PCC principles have been described and how they have defined and measured among people with substance-related disorders. METHODS Following the iterative stages of the Arksey and O'Malley scoping review methodology, empirical (from Medline, Embase, PsycINFO, CINAHL and ISI Web of Science) and grey literature references were eligible if they focused on people accessing treatment for substance-related disorders and described PCC. Two reviewers independently screened the title/abstract and full-texts of references. Descriptive analyses and a directed content analysis were performed on extracted data. FINDINGS One-hundred and forty-nine references met inclusion from the 2951 de-duplicated references screened. Therapeutic alliance was the most frequent principle of PCC described by references (72%); this was consistently defined by characteristics of empathy and non-judgment. Shared decision-making was identified in 36% of references and was primarily defined by client and provider strategies of negotiation in the treatment planning process. Individualized care was described by 30% of references and included individualized assessment and treatment delivery efforts. Holistic care was identified in 23% of references; it included an integrated delivery of substance use, health and psychosocial services via comprehensive care settings or coordination. Substance use and treatment engagement outcomes were most frequently described, regardless of PCC principle. CONCLUSIONS This review represents a necessary first step to explore how PCC has been defined and measured for people accessing substance use disorder treatment. The directed content analysis revealed population and context-specific evidence regarding the defining characteristics of PCC-principles that can be used to further support the implementation of PCC.
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Affiliation(s)
- Kirsten Marchand
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.
| | - Scott Beaumont
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Jordan Westfall
- Canadian Association for Safe Supply, 46 East Hastings St, Vancouver, BC, V6A 1N1, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings St, Vancouver, BC, V6B 1G6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings St, Vancouver, BC, V6B 1G6, Canada
| | - David C Marsh
- Northern Ontario School of Medicine, 935 Ramsey Lake Road, Sudbury, ON, P3E 2C6, Canada
| | - Martin T Schechter
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
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Lopian KM, Chebolu E, Kulak JA, Kahn LS, Blondell RD. A retrospective analysis of treatment and retention outcomes of pregnant and/or parenting women with opioid use disorder. J Subst Abuse Treat 2019; 97:1-6. [DOI: 10.1016/j.jsat.2018.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/15/2018] [Accepted: 11/08/2018] [Indexed: 12/25/2022]
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Worley MJ, Trim RS, Tate SR, Roesch SC, Myers MG, Brown SA. Self-efficacy and social networks after treatment for alcohol or drug dependence and major depression: disentangling person and time-level effects. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2014; 28:1220-9. [PMID: 25347018 DOI: 10.1037/a0037901] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Proximal personal and environmental factors typically predict outcomes of treatment for alcohol or drug dependence (AODD), but longitudinal treatment studies have rarely examined these factors in adults with co-occurring psychiatric disorders. In adults with AODD and major depression, the aims of this study were to: (a) disaggregate person-and time-level components of network substance use and self-efficacy, (b) examine their prospective effects on posttreatment alcohol/drug use, and (c) examine whether residential environment moderated relations between these proximal factors and substance use outcomes. Veterans (N = 201) enrolled in a trial of group psychotherapy for AODD and independent MDD completed assessments every 3 months during 1 year of posttreatment follow-up. Outcome variables were percent days drinking (PDD) and using drugs (PDDRG). Proximal variables included abstinence self-efficacy and social network drinking and drug use. Self-efficacy and network substance use at the person-level prospectively predicted PDD (ps < .05) and PDDRG (ps < .05). Within-person, time-level effects of social networks predicted future PDD (ps < .05) but not PDDRG. Controlled environments moderated person-level social network effects (ps < .05), such that greater time in controlled settings attenuated the association between a heavier drinking/using network and posttreatment drinking and drug use. Both individual differences and time-specific fluctuations in proximal targets of psychosocial interventions are related to posttreatment substance use in adults with co-occurring AODD and MDD. More structured environmental settings appear to alleviate risk associated with social network substance use, and may be especially advised for those who have greater difficulty altering social networks during outpatient treatment.
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Affiliation(s)
- Matthew J Worley
- Department of Family Medicine, University of California, Los Angeles
| | - Ryan S Trim
- Veterans Affairs San Diego Health Care System
| | | | | | | | - Sandra A Brown
- Department of Psychiatry, University of California, San Diego
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