Exploring the Concepts of Abstinence and Recovery through the Experiences of Long-Term Opiate Substitution Clients

Abstract

Participants experienced long-term OST as a transition between illicit drug use and recovery. Recovery was seen as a process rather than a fixed goal, confirming that there is a need for services to negotiate individualized recovery goals, spanning harm minimization and abstinence-oriented treatment approaches.

A qualitative study of reasons for seeking and ceasing opioid substitution treatment in prisons in New South Wales, Australia

“…Several participants believed that exposure to their peers at clinics would trigger illicit drug use or offending, which they wished to avoid. This is a common theme in the literature, with continued association with ‘drug users’ at OST clinics seen by patients as preventing them from moving on from illicit drug use and developing a new identity that is not centred around drug use . Others cited restrictions on their mobility imposed by daily clinic attendance, or concerns about stigma attached to OST, especially methadone.…”

“…The reasons why people may seek to cease OST prior to release are not clear, but research with community OST patients has highlighted that opioid‐dependent people often feel considerable ambivalence towards OST, and that motivations for starting, remaining in and leaving treatment can be complex. Although there is an emerging body of qualitative literature exploring the experiences of patients on OST in custody , no studies have specifically addressed the clinically important question of why patients choose to cease OST in custody. Therefore, we sought to explore the intentions of opioid‐dependent prisoners with regards to OST in custody and following release.…”

Clonidine Increases the Likelihood That Abstinence Can Withstand Unstructured Time in Buprenorphine-maintained Outpatients

“…The complement to these findings is that unstructured time—time spent in behavior with no strict schedule or urgent goal—was associated with more craving, more stress, and worse mood, a phenomenon that we have begun to call “the risk of unstructured time.” This phrase suggests unidirectional causation, which we acknowledge is unlikely to be the case, but patients who relapse during treatment have frequently cited boredom, or unstructured time, as a cause (Bradley et al 1989, McKay et al 2006, Notley et al 2015), and in our EMA data, we have shown prospectively that reports of having felt bored in the past hour increase linearly in the five hours leading up to cocaine use and heroin craving (Epstein et al 2009). Taken together, these findings support the idea that unstructured time can cause problems during treatment.…”

Dosis de metadona y su relación con calidad de vida, satisfacción, psicopatología, rendimiento cognitivo y consumo adicional de sustancias no prescritas

“…La razón de este desprecio hay que buscarla en la predominancia de un modelo de enfermedad cerebral de la adicción que convierte al adicto en incapaz de tomar decisiones adecuadas o verter juicios valorables, con un cerebro secuestrado por la droga (Leshner, 1997). Algunas voces se han levantado, denunciando que los servicios médicos han adoptado, en ocasiones, un rol de control social sobre estos pacientes, tenidos por incapaces de regular su comportamiento y las políticas sanitarias de dosis altas han favorecido la cronificación del trastorno y los tratamientos, convirtiendo al paciente en un mero recipiente del tratamiento (Harris y McElrath, 2012), agravando la estigmatización y provocando que muchas personas en tratamiento se vean obligadas a vivir en excesivo estado de sedación, impotencia, malestar físico y emocional, e incapaces de participar activamente en la vida cotidiana de su comunidad Notley, Blyth, Maskrey, Pinto y Holland, 2015).…”