Drug use relapse rates are high following residential detoxification. This study examined the aftercare plans and desired services of participants currently enrolled in residential detoxification programs. Participants completed a survey regarding their aftercare plans and services that they desired from an aftercare program. Participants (98%) reported some form of aftercare plans following detoxification. Among the services that participants endorsed wanting were individual counseling, help with finding a job, and Narcotics Anonymous (NA) meetings. With low rates of enrollment in aftercare programs, the findings of this study may be of help in determining what services will best assist individuals recovering from addiction.

While the use of visual methods in qualitative research is gaining recognition, there has been less attention to timelines. This paper addresses this gap and contributes to the overall literature on qualitative research design and analysis. In a randomized trial of extended release naltrexone for youth with opioid use disorder timelines were used as a part of the semi-structured interview process. Timelines were constructed in a participatory manner in which both youth and their caregivers were separately asked to recount significant events related to substance use, treatment, and criminal justice involvement that took place between interview time points. This paper suggests that using timelines in qualitative, substance use research offers two main advantages: 1) improving the data collection process, and 2) advancing understandings of temporally contextualized narratives through a visual format. Here, timelines were an integral tool for summarizing and illustrating the complexity of youths’ experiences following residential drug treatment.

Background and Aims Opioid overdose deaths among adolescents and young adults have risen sharply in the United States over recent decades. This study aimed to explore the nature of adolescent and young adult perspectives on overdose experiences. Design This study involved thematic analysis of interviews undertaken as part of a mixed‐methods, randomized trial of extended release naltrexone (XR‐NTX) versus treatment‐as‐usual (TAU) for adolescents and young adults (aged 15–21 years) with opioid use disorder (OUD). Setting Participants were recruited during a residential treatment episode at Mountain Manor Treatment Center, in Baltimore, MD, USA. Participants/cases As part of the qualitative component of this study, 35 adolescents/young adults completed up to three interviews: at baseline, 3 and 6 months after release from residential opioid use disorder treatment. Measurements Semi‐structured interviews solicited participant experiences with opioid use disorder treatment; their satisfaction with the medications used to treat opioid use disorder; counseling received; current substance use; issues related to treatment retention; their treatment goals; and their future outlook. Findings Four broad themes emerged: (1) adolescents/young adults had difficulty identifying overdoses due to interpreting subjective symptoms and a lack of memory of the event, (2) this sample had difficulty perceiving risk that is misaligned with traditional understandings of overdose intentionality, (3) adolescents/young adults did not interpret personal overdose events as a catalyst for behavior change and (4) this sample experienced a greater impact to behavior change through witnessing an overdose of someone in their social network. Conclusions The sample of US adolescents and young adults in treatment for opioid use disorder expressed difficulty identifying whether or not they had experienced an overdose, expressed fluctuating intentionality for those events and did not have clear intentions to change their behavior. Witnessing an overdose appeared to be as salient an experience as going through an overdose oneself.

Background: As hospitals in the US face pressures to reduce lengths of stay, healthcare systems are increasingly utilizing skilled nursing facilities (SNFs) to continue treating patients stable enough to leave the hospital, but not to return home. Substance use disorder (SUD) can complicate care of patients transferred to SNFs. The objective of this paper is to understand SNF experiences for this population of patients with comorbid SUD transferred to SNFs and examine care experiences in these facilities. Methods: This secondary mixed-methods analysis focuses on SNF experiences from a clinical trial of patient navigation services for medically-hospitalized adults with comorbid opioid, cocaine, and/or alcohol use disorder. This study compared baseline assessments and medical record review for participants (N = 400) with vs. without SNF transfer, and analyzed semi-structured qualitative interviews with a subsample of 15 participants purposively selected based on their transfer to a SNF. Results: Over 1 in 4 participants had a planned discharged to a SNF (26.8% sub-acute, 3.3% acute). Compared to participants with other types of discharge, participants discharged to a SNF had longer initial hospitalizations (4.9 vs. 11.8 days, p < 0.001), and were more likely to be White (38.6 vs. 50.8%; p = 0.02), female (38.9 vs. 52.5%; p = 0.01), have opioid use disorder (75.7 vs. 85.0%, p = 0.03), and be hospitalized for infection (43.6 vs. 58.3%; p = 0.007), and less likely to have worked prior to hospitalization (24.3 vs. 12.5%; p = 0.006). Qualitative narratives identified several themes from the SNF experience, including opioid analgesic dosing issues, challenges to the use of opioid agonist treatment of OUD, illicit opioid dealing/use, and limited access to addiction recovery support services during and following the SNF stay. Conclusions: SNFs are a common disposition for patients in need of subacute services following hospitalization but may be ill-equipped to properly manage patients in need of new or continuing SUD treatment.

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