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Wolfe DM, Hutton B, Corace K, Chaiyakunapruk N, Ngorsuraches S, Nochaiwong S, Presseau J, Grant A, Dowson M, Palumbo A, Suschinsky K, Skidmore B, Bartram M, Garner G, DiGioacchino L, Pump A, Peters B, Konefal S, Eves AP, Thavorn K. Service-level barriers to and facilitators of accessibility to treatment for problematic alcohol use: a scoping review. Front Public Health 2023; 11:1296239. [PMID: 38106884 PMCID: PMC10722420 DOI: 10.3389/fpubh.2023.1296239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/03/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Services to treat problematic alcohol use (PAU) should be highly accessible to optimize treatment engagement. We conducted a scoping review to map characteristics of services for the treatment of PAU that have been reported in the literature to be barriers to or facilitators of access to treatment from the perspective of individuals with PAU. Methods A protocol was developed a priori, registered, and published. We searched MEDLINE®, Embase, the Cochrane Library, and additional grey literature sources from 2010 to April 2022 to identify primary qualitative research and surveys of adults with current or past PAU requiring treatment that were designed to identify modifiable characteristics of PAU treatment services (including psychosocial and pharmacologic interventions) that were perceived to be barriers to or facilitators of access to treatment. Studies of concurrent PAU and other substance use disorders were excluded. Study selection was performed by multiple review team members. Emergent barriers were coded and mapped to the accessibility dimensions of the Levesque framework of healthcare access, then descriptively summarized. Results One-hundred-and-nine included studies reported an extensive array of unique service-level barriers that could act alone or together to prevent treatment accessibility. These included but were not limited to lack of an obvious entry point, complexity of the care pathway, high financial cost, unacceptably long wait times, lack of geographically accessible treatment, inconvenient appointment hours, poor cultural/demographic sensitivity, lack of anonymity/privacy, lack of services to treat concurrent PAU and mental health problems. Discussion Barriers generally aligned with recent reviews of the substance use disorder literature. Ranking of barriers may be explored in a future discrete choice experiment of PAU service users. The rich qualitative findings of this review may support the design of new or modification of existing services for people with PAU to improve accessibility. Systematic Review Registration Open Science Framework doi: 10.17605/OSF.IO/S849R.
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Affiliation(s)
| | - Brian Hutton
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Kim Corace
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Substance Use and Concurrent Disorders Program, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- University of Ottawa Institute of Mental Health Research at the Royal, Ottawa, ON, Canada
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
- Informatics, Decision Enhancement, and Analytics Sciences (IDEAS) Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, United States
| | | | - Surapon Nochaiwong
- Department of Pharmaceutical Care, Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Justin Presseau
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Alyssa Grant
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | | | - Kelly Suschinsky
- Substance Use and Concurrent Disorders Program, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | | | - Mary Bartram
- Mental Health Commission of Canada, Ottawa, ON, Canada
- School of Public Policy and Administration, Carleton University, Ottawa, ON, Canada
| | - Gordon Garner
- Community Addictions Peer Support Association, Ottawa, ON, Canada
| | | | - Andrew Pump
- Community Addictions Peer Support Association, Ottawa, ON, Canada
| | - Brianne Peters
- Community Addictions Peer Support Association, Ottawa, ON, Canada
| | - Sarah Konefal
- Canadian Centre on Substance Use and Addiction, Ottawa, ON, Canada
| | - Amy Porath Eves
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Knowledge Institute on Child and Youth Mental Health and Addictions, Ottawa, ON, Canada
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Pharmaceutical Care, Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
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Scarfe ML, Haik AK, Rahman L, Todi AA, Kane C, Walji A, Dickerman SR, Kelly JF, MacKillop J. Impact of COVID-19 on alcohol use disorder recovery: A qualitative study. Exp Clin Psychopharmacol 2023; 31:148-162. [PMID: 35389679 PMCID: PMC10331226 DOI: 10.1037/pha0000560] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In March 2020, restrictions on in-person gatherings were introduced due to the coronavirus disease (COVID-19) pandemic, requiring alcohol use disorder (AUD) recovery resources to migrate to virtual platforms. This study investigated how these restrictions impacted recovery attempts and explored participant experiences with virtual resources using a qualitative approach. Participants attempting recovery from AUD (N = 62; Mage = 48.2; F = 53.2%; 71% White) completed virtual semistructured interviews from July 2020 to August 2020 on their experience during the COVID-19 lockdown, impacts on recovery, and experiences with online resources. Interviews were recorded, transcribed, and analyzed using a thematic coding process. Three overarching themes were identified: Effect on Recovery, Virtual Recovery Resources, and Effect on General Life. Within each overarching theme, lower order parent themes and subthemes reflected varied participant experiences. Specifically, one group of participants cited negative impacts due to COVID-19, a second group reported positive impacts, and a third group reported experiencing both positive and negative impacts. Participants reported both positive and negative experiences with virtual resources, identifying suggestions for improvement and other resources. Findings suggest that while individuals in AUD recovery experienced significant hardships, a proportion experienced positive impacts as well, and the positive and negative consequences were not mutually exclusive. Additionally, the results highlight the limitations of existing virtual resources. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Molly L Scarfe
- St Joseph's Healthcare Hamilton, Peter Boris Centre for Addictions Research
| | - Amanda K Haik
- Massachusetts General Hospital, Recovery Research Institute
| | - Liah Rahman
- St Joseph's Healthcare Hamilton, Peter Boris Centre for Addictions Research
| | - Akshiti A Todi
- Massachusetts General Hospital, Recovery Research Institute
| | - Claire Kane
- Massachusetts General Hospital, Recovery Research Institute
| | - Alyna Walji
- St Joseph's Healthcare Hamilton, Peter Boris Centre for Addictions Research
| | | | - John F Kelly
- Massachusetts General Hospital, Recovery Research Institute
| | - James MacKillop
- St Joseph's Healthcare Hamilton, Peter Boris Centre for Addictions Research
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