User involvement and desired service developments in drug treatment: Service user and provider views

User involvement in interprofessional team meetings within services for substance use disorders

Background

People with substance use disorders (SUD) and concurrent mental health disorders often need prolonged, coordinated health and welfare services. Interprofessional team meetings are designed to tailor services to users' needs and should be based on interprofessional collaboration involving the user.

Aims

To investigate service users' experiences with interprofessional team meetings and to identify potential barriers to successful user involvement.

Methods

Semi-structured interviews with five male service users aged 27-36 years with concurrent substance use and psychiatric disorders, and observations of team meetings involving both users and relevant professionals. Users were interviewed shortly after commencing treatment and after the team meeting. A phenomenographical approach framed the data analysis.

Results

Users described the interprofessional team meetings as less than useful, and perceived that lack of a targeted process and of information hindered their collaboration with professionals. Observations revealed that users were given a subordinate role in the meetings, which largely undermined their involvement. Three categories reflecting lack of information as a core obstacle to user involvement emerged from the data material: (i) unclear role responsibilities and unclear professional role functions, (ii) unclear practices regarding rules and routines, and (iii) absence of user knowledge.

Conclusions

User involvement in team meetings may be improved by facilitating adequate information, clarifying role expectations, emphasising user knowledge, increasing professionals' awareness of the importance of collaboration, and by teaching skills that enhance user involvement.

Patient Assessments of the Factors Facilitating and Impeding User Involvement During the First Phase of Substance Abuse Treatment

User involvement in the first phase of treatment is essential for treatment satisfaction among patients with substance use disorders (SUDs). This study explores how patients perceive the first phase of specialized SUD treatment and identifies what promotes and inhibits user involvement. We used a qualitative approach, and semi-structured interviews were conducted with 14 informants admitted to a substance abuse treatment unit in central Norway. The analysis was inspired by a phenomenographical analysis approach, and 4 categories were identified as the core experiences of user involvement during the first phase of SUD treatment: (a) a new hold on life, (b) missing information, (c) the importance of a sense of community, and (d) ambivalence about the usefulness of the treatment. Overlapping elements with Aaron Antonovsky's theoretical framework of salutogenesis were used to support the main findings. The study indicates that activating personal resources (eg, the ability to envision a different life), conveying information in a matter sensitive to patients' current cognitive state, a sense of community, and therapeutic alliance are essential factors to promote user involvement in the first phase of specialized SUD treatment. Based on the findings, we suggest a salutogenesis approach to promote user involvement and provide several ways to employ this approach in the crucial first phase of specialized SUD treatment.

Empowered communities: Science, ideology and the limits of political action

Aims

Against the background of an increased interest in community participation in political processes, this article critically examines how the “community” is constituted as a political entity in the Communities That Care drug prevention programme.

Method

Through an examination of 14 publications written by the programme developers and other collaborators, I have analysed the programme's theoretical foundation.

Results

The programme seeks to constitute the community as an expert community, drawing on the principles of prevention science in its decision-making processes and thereby asserting the primacy of scientific reasoning in politics. Disagreement, otherwise regarded as the “essence” of democratic politics, is to be neutralised through the establishment of a common language based on prevention science. The programme constitutes needs as existing independently of any culturally and politically informed interpretations and promptly met by ready-tested, evidence-based interventions. By combining a consumer subject and an instrumental-rational subject, the programme establishes a specific kind of democratic subject expected to exert its choices on a market offering instant solutions to problems formulated outside of the community's decision-making processes.

Conclusion

The analysis points to a range of limitations and issues on how community empowerment and democratic participation are conceptualised in the programme. By asserting the primacy of scientific reasoning in drug-policy processes, the programme sets limits to what counts as a political problem and which responses are deemed legitimate. This risks exerting significant closure on the ability of communities to speak in properly political terms.

A vacation for the homeless: evaluating a collaborative community respite programme in Canada through clients' perspectives

This study assesses the Urban Breakaway Project, a collaborative project offering a structured vacation in the countryside of the province of Quebec intended for homeless (or street) youths. The objective of this study was to document participants' perspectives regarding this project by examining their satisfaction, intention to change following their stay and perceived improvement with respect to their life situation. Another goal of this research was to investigate the relationship between satisfaction level and perceived improvement of participants. One hundred and seven individuals participated in the study, during Urban Breakaway's first year of operation. Satisfaction with the project, assessed with the global Client Satisfaction Questionnaire-3 score, revealed a positive relationship with global scores of perceived improvement, as measured by the Perceived Improvement Questionnaire [PIQ; r = 0.37 (67), 95% CI (0.15; 0.56)]. Regarding intention to change, the data indicated that 95% of participants had moderate-to-definite intentions to do something to change their lives. Participants reported an improvement for most items covered by the PIQ. They experienced the greatest changes in relation to mood, leisure, appetite, physical condition and self-esteem. Results indicate that the Urban Breakaway Project reaches not only street youths but also an older homeless population. Participants, regardless of their age, were found to be very satisfied with services obtained, and their satisfaction was significantly correlated with the perceived improvement in their situation. Qualitative data indicate that characteristics of the programme, such as the countryside setting, the focus on basic needs, the climate and the opportunity for socialisation, peer support (or belonging) and personal growth were appreciated.

Treatment utilization and barriers to treatment: results of a survey of dependent methamphetamine users

Background

Australia has one of the highest rates of methamphetamine use in the world; however, treatment access for methamphetamine is comparatively low. This descriptive study aimed to identify patterns of treatment utilization and perceived barriers to accessing treatment among dependent methamphetamine users in the hope that such information will enable services to more appropriately respond to this group.

Methods

One hundred and twenty-six methamphetamine users who had a current or past history of methamphetamine dependence were interviewed about their experiences of, and perceived barriers to, treatment.

Results

Treatment utilization among methamphetamine users was reportedly low. One of the main reasons cited for not accessing treatment was that methamphetamine users did not perceive their drug use to be a problem (despite apparent levels of dependence). Self-detoxification with the use of other licit and illicit drugs was high among this group. Participants identified a lack of confidence in the ability of treatment services to address methamphetamine dependence and the 'opiate-centric' nature of treatment services as significant blocks to treatment entry. Suggestions for improvement by participants included operating specialist services for methamphetamine users, placing an emphasis on responsiveness and routinely involving case management services for this group.

Discussion and Conclusions

To improve service delivery, treatment services should reorient their services to better address the needs of methamphetamine users by making small changes such as specific opening times for methamphetamine users or using a dedicated space for methamphetamine treatment. Alternative options such as online treatments and specialist methamphetamine clinics should be considered for methamphetamine users.