Problematizing the DSM-5 criteria for opioid use disorder: A qualitative analysis

Boyd, Susan; Ivsins, Andrew; Murray, Dave

doi:10.1016/j.drugpo.2020.102690

Cited by 8 publications

(6 citation statements)

References 21 publications

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“…Generally, this population engage with long term entrenched opiate usage and are disproportionately impacted by negative outcomes issues such as homelessness and poor physical outcomes (Office for Health Improvements and Disparities, 2021). This population also experience 'failing' the offered OST treatment on a number of occasions which can create shame and stigma (Boyd et al, 2020). However, some suggest that it is the treatment services on offer which have failed this population due to not being able to meet their needs (Boyd et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Diamorphine assisted treatment in Middlesbrough: a UK drug treatment case study

Poulter

Moore

Crow

et al. 2022

Journal of Substance Use

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Diamorphine Assisted Treatment (DAT) is a treatment offer for individuals with Opiate Dependency (OD), who have failed to benefit from standard treatment. Self-administered injectable synthetic heroin (diacetylmorphine) is offered to participants twice daily, under the supervision of medical staff in a controlled and safe environment. This case report evidences outcomes from the first DAT service implemented in the UK. Data from participants who engaged with year 1 of operation ( n=14) is presented detailing engagement, harm reduction, psychosocial outcomes, and criminal behaviour of the cohort. We present this work as an example of bottom-up policy making within the context of UK drug treatment and implications for practice discussed.

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Section: Introductionmentioning

confidence: 99%

Diamorphine assisted treatment in Middlesbrough: a UK drug treatment case study

Poulter

Moore

Crow

et al. 2022

Journal of Substance Use

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“…The findings of our research were consistent in a shared critique of the biomedical model which constrained the ability to address social factors noted by our participants as central to understanding the development of a substance use and/or addiction and measures required to ‘recover’. For example, members of a peer-led drug user group (SNAP) diagnosed with opioid use disorder stated that the DSM-5 criteria failed to encompass their diverse experiences of opioid use or capture the complexities of their lived experience (Boyd, et al, 2020 ). They believed that the DSM-5 constructed an idea of these experiences and the addicted person based on a list of symptoms that often obscured their structural and cultural vulnerability by shifting the focus away from political and social issues.…”

Section: Resultsmentioning

confidence: 99%

Dismantling Addiction Services: Neoliberal, Biomedical and Degendered Constraints on Social Work Practice

Ross

Brown

Johnstone

2022

Int J Ment Health Addiction

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Background This research was conducted in response to concerns reported by social work practitioners to a Canadian College of Social Work which indicated that their practice was constrained by ideological and system limitations in publicly funded mental health and addiction systems. Method The dislocation theory of addiction which posits globalization and neoliberalism is linked to addiction rates worldwide, serves as an analytical frame to examine findings from fifty interviews, three focus groups and an online survey with one hundred and fifteen respondents. Results Themes specific to social work practice in addiction services referred to neoliberalism, stigma, biomedicalization, trauma and addiction, elimination of women services, shrinking services and privatization. Conclusion Social workers expressed a dissonance between their training rooted in relational approaches and biopsychosocial models of practice and system expectations. Our findings indicate concern about the erosion of core social work values within addiction services, the reduction of state funded programming and need for further research.

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Section: Heroin Assisted Treatment -Service Users' Perspectivesmentioning

confidence: 99%

“…A recent ethnographic and interview study, also conducted in Canada, explored patient motivations for initiating injectable opioid treatment (25) but did not report explicitly on service users' treatment experiences. Boyd and colleagues have produced a body of qualitative research exploring the experiences of participants from Vancouver's HAT trials (41,42,43). Again, ndings reported positive impacts of HAT on illicit substance use, crime, and health (44).However, Boyd's research also raises important concerns regarding the ethics of providing injectable opioids in a clinical trial setting, as treatment discontinuation negatively impacted participants, in some cases resulting in a return to illicit heroin use and DRD (41).…”

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confidence: 99%

‘I feel like I found myself again’ – Rethinking ‘recovery’ in a qualitative exploration of Heroin Assisted Treatment (HAT) service users’ experiences

Riley

Harris

Ahmed

et al. 2022

Preprint

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Background Heroin Assisted Treatment (HAT) is an enhanced harm reduction programme designed for treatment-refractory opioid dependent individuals. The first HAT service in England was established in 2019, involving twice-daily supervised injections of medical-grade heroin (diamorphine). International research has produced promising evidence for HAT in reducing a range of intravenous drug-related harms and promoting myriad social benefits such as reduced criminal activity, increased social engagement and improved wellbeing. However, strict regulatory controls may constrain service users’ opportunities for social re-integration, inadvertently prioritising abstinence-focused treatment goals and definitions of ‘recovery’. The impact of HAT delivery from service user’s perspectives is not well documented, and this is the first qualitative research conducted within a fully operational HAT service in England. Methods We conducted semi-structured interviews with HAT service users in a North-East England drug treatment service (N=12). Data was subjected to thematic analysis, with common themes emerging inductively from the data. Results Participants overcame barriers to engagement and retention through self-motivation and commitment, supportive staff relationships and de-stigmatising treatment experiences that increased service users’ self-efficacy and sense of belonging. They reported multiple physical, emotional and social impacts, including minimised street heroin use and criminal behaviour, improved physical health, increased social engagement and emotional wellbeing. Conclusions Physical, social and psychological healing interacted throughout the course of HAT to facilitate holistic improvements in quality of life and wellbeing. However, HAT’s intensive treatment schedule was restrictive of patient’s daily activities, which could be mitigated through greater flexibility in treatment regulations. Middlesbrough HAT is an example of innovative drug treatment that offers continuing opportunities for success within a broad definition of recovery, in which abstinence sits on a spectrum alongside diverse forms of social, physical and psychological recovery from drug-related harms.

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Problematizing the DSM-5 criteria for opioid use disorder: A qualitative analysis

Cited by 8 publications

References 21 publications

Diamorphine assisted treatment in Middlesbrough: a UK drug treatment case study

Diamorphine assisted treatment in Middlesbrough: a UK drug treatment case study

Dismantling Addiction Services: Neoliberal, Biomedical and Degendered Constraints on Social Work Practice

‘I feel like I found myself again’ – Rethinking ‘recovery’ in a qualitative exploration of Heroin Assisted Treatment (HAT) service users’ experiences

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