Lifelong maintenance treatment or “positive” dropout?

Cordella, Barbara; Greco, Francesca; Elia, Paola; Varazi, Marta

doi:10.1080/14659891.2016.1223764

Cited by 3 publications

(4 citation statements)

References 4 publications

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“…Survivors of trauma often report feelings of shame and guilt (56), and if unresolved, the re-emergence of these feelings during tapering and detox may make this stage extremely challenging and could lead back to using drugs to manage the feelings (24,25,27,28). Experiencing repeated trauma is also known to contribute to difficulty in forming and maintaining relationships (57); something reflected in the experiences of service users in the included studies, who also reported experiences of relationships breaking down due to their drug use (20,22,37,39,58).…”

Section: Discussionmentioning

confidence: 99%

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Factors influencing recovery in opioid substitution treatment: a systematic review and thematic synthesis

Carlisle¹,

Maynard²,

Padmanathan³

et al. 2020

Preprint

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Background and Aims Recovery outcomes for opioid substitution treatment are poorer than those for alcohol and other drugs. In order to understand why this is and to synthesise the findings of a large number of qualitative studies, we conducted a systematic review and thematic synthesis to understand facilitators of and barriers to recovery from opioid dependency. Methods Electronic databases (Pubmed, PsychInfo, CINAHL and Embase) were searched. English language studies exploring the views of adult service user and stakeholders with experiences of opioid substitution treatment were considered for inclusion. Included studies were inductively analysed using thematic synthesis. During analysis, the socioecological model was selected as an analytical framework for organising and making links between themes as it captured the complexity of the topic well. ResultsFrom 3646 screened papers, we included 37 studies reporting the views of 1212 staff and service users. Studies highlighted complex interactions between factors influencing recovery across the five levels of the socioecological model (intrapersonal, inter-personal, organisational, community and policy). Early life experiences of trauma were common; lack of support (both psychological and social) was also a recurring theme resulting in feelings of disconnection and isolation. Stigma played a particularly important role in an individual’s capacity to recover from opioid dependency and cut-across all levels of the socioecological model. Conclusions Interventions targeted at the individual level fail to take account of the complexity of recovery within opioid substitution treatment and may ignore the complex socio-political context that service users and services exist within. Stigma permeates all levels of the opioid substitution treatment system; we suggest that addressing this is likely to improve healthcare encounters, help-seeking, increase access to social support and facilitate community reintegration for individuals receiving opioid substitution treatment.

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Section: Discussionmentioning

confidence: 99%

“…Several studies described experiences of relationship breakdowns with family and friends prior to entering treatment (20,25,31,37,39). For many service users, their drug using networks may be the only place they can continue to feel a sense of belonging.…”

Section: Inter-personalmentioning

confidence: 99%

Factors influencing recovery in opioid substitution treatment: a systematic review and thematic synthesis

Carlisle¹,

Maynard²,

Padmanathan³

et al. 2020

Preprint

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show abstract

“…There is a breadth of qualitative literature exploring experiences of OAT; however, these tend to focus on factors in isolation, for instance, fear [ 36 ]; social support [ 37 ]; or stigma [ 26 , 27 , 28 , 29 , 30 , 31 ]. Socioecological approaches allow for the exploration of issues across five levels: individual, intrapersonal, organisational, community and policy [ 38 ].…”

Section: Introductionmentioning

confidence: 99%

Should I Stay or Should I Go? A Qualitative Exploration of Stigma and Other Factors Influencing Opioid Agonist Treatment Journeys

Carlisle

Maynard

Bagnall

et al. 2023

IJERPH

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(1) The harm-reduction benefits of opioid agonist treatment (OAT) are well-established; however, the UK government’s emphasis on “recovery” may be contributing to a high proportion of people leaving treatment and low retention rates. We wanted to develop a rich and nuanced understanding of the factors that might influence the treatment journeys of people who use OAT. (2) We explored factors at each level of the socioecological system and considered the ways these interact to influence treatment journeys in OAT. We carried out semi-structured interviews with people who use OAT (n = 12) and service providers (n = 13) and analysed data using reflexive thematic analysis. (3) We developed three themes representing participant perceptions of treatment journeys in OAT. These were: (1) The System is Broken; (2) Power Struggles; and (3) Filling the Void. (4) Conclusions: The data suggest that prioritisation of treatment retention is important to preserve the harm-reduction benefits of OAT. Stigma is a systemic issue which presents multiple barriers to people who use OAT living fulfilling lives. There is an urgent need to develop targeted interventions to address stigma towards people who use OAT.

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“…Maintenance therapies, however, are not a viable long-term solution to substance dependency. Maintenance therapies do not address underlying issues with emotional regulation, meaning, once medications are ceased, problematic substance use may return and both clients and clinicians are reluctant to cease taking/prescribing medication (Cordella et al, 2017 ). This is problematic due to both the ongoing financial cost of prescribing and the continuous reinforcement that individuals need substances to cope (Joint Formulary Committee, 2020 ; Shamsalinia et al, 2017 ).…”

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confidence: 99%

“I don’t want to take buprenorphine for the rest of my life”: Acceptance and Commitment Therapy for a Client Struggling to Reduce Low-Dose Buprenorphine (a Hermeneutic Single-Case Efficacy Design)

Shepherd

Pritty

Tickle

et al. 2021

Int J Ment Health Addiction

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The misuse of substances is often maintained by both physical and psychological factors. Opioid-substitution medications manage physical aspects of addiction; however, difficulties with emotional regulation and avoidance perpetuate continued substance misuse. In the UK, individuals who misuse substances are often excluded from mental health services, meaning these underlying difficulties are not addressed. Acceptance and Commitment Therapy (ACT) seeks to reduce emotional avoidance. A hermeneutic single-case efficacy design was used to evaluate the effects of ACT within drugs and alcohol service. Quantitative and qualitative data was critically analysed to understand factors involved in identified changes. Analysis recognised the client progressed towards two of three of their goals, related to motivation and anxiety. Their psychological flexibility also increased. ACT processes played a key role in this; however, the therapeutic relationship and psychopharmacological factors were also noted. Study limitations and clinical and research implications are discussed.

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Lifelong maintenance treatment or “positive” dropout?

Cited by 3 publications

References 4 publications

Factors influencing recovery in opioid substitution treatment: a systematic review and thematic synthesis

Factors influencing recovery in opioid substitution treatment: a systematic review and thematic synthesis

Should I Stay or Should I Go? A Qualitative Exploration of Stigma and Other Factors Influencing Opioid Agonist Treatment Journeys

“I don’t want to take buprenorphine for the rest of my life”: Acceptance and Commitment Therapy for a Client Struggling to Reduce Low-Dose Buprenorphine (a Hermeneutic Single-Case Efficacy Design)

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