Service user involvement in methadone maintenance programmes: The ‘philosophy, the ideal and the reality’

Abstract

Internationally, service user involvement has become a common feature of public policy and more specifically public health policy in the recent decades. In a general context, the involvement of service users in health services has been well documented; however, less evidence is available within the area of drug treatment service provision. This study, which was conducted in Ireland, sought to address this gap in the knowledge and understanding of service user involvement within this setting. Qualitative in-depth interviews were undertaken with a broad range of participants. The sample, which totalled 20 individuals, comprised both service users and service providers. Meanings, and mechanisms of and limits to user involvement were explored. This study highlights the ambiguity that exists between policy recommendations on service user involvement and actual practice within treatment services. Although, participants acknowledged that services could and should learn from the individual and collective experiences of service users, they were found to be passive players in planning, developing, evaluating and delivering the services they received. The study suggests that in order to change the rhetoric of policy recommendations into a reality within this context, a much more committed approach which includes the education and training of all involved in drug treatment services is required.

“An Emotional Roller-Coaster:" Stressors Faced by Peer Workers in Overdose Response Settings

“…Our ndings are consistent with several studies which have shown that experiential workers are not always accepted and respected in the workplace due to their history of substance use [32,33,65,66]. Some studies have also reported that support workers without lived experience of substance use have negative attitudes towards experiential workers, rooted in stereotypes and stigma towards PWUD [31][32][33]65]. These negative attitudes are apparent in the terminology used by support workers to de ne experiential workers, including "unstable," "manipulative," "untrustworthy," and "lacking capacity to participate" [31][32][33]65].…”

“…This explains why 40% of the survey participants listed "work situation, including working conditions" as one of their top three stressors. Our ndings are consistent with several studies which have shown that experiential workers are not always accepted and respected in the workplace due to their history of substance use [32,33,65,66]. Some studies have also reported that support workers without lived experience of substance use have negative attitudes towards experiential workers, rooted in stereotypes and stigma towards PWUD [31][32][33]65].…”

“…Some studies have also reported that support workers without lived experience of substance use have negative attitudes towards experiential workers, rooted in stereotypes and stigma towards PWUD [31][32][33]65]. These negative attitudes are apparent in the terminology used by support workers to de ne experiential workers, including "unstable," "manipulative," "untrustworthy," and "lacking capacity to participate" [31][32][33]65]. The negative attitudes lead to othering of experiential workers who are relegated to menial labour, excluded from bene t programs, and shirked of professional development opportunities [34].…”

Barriers to progressing through a methadone maintenance treatment programme: perspectives of the clients in the Mid-West of Ireland’s drug and alcohol services

“…Her study suggests that despite the fact that providers understand the potential benefits of incorporating client experiences into the drafting delivery and assessment of services they remain ‘passive players’ in the equation [ 31 ]. Over the intervening time, Irish research has attempted to address this deficit.…”

Addiction Studies at Trinity College Dublin

“…The articles by Randall (2011) and King (2011), dealing respectively with the rationality of drug policy and with service user involvement in drug treatment and rehabilitation systems, reflect themes which are to be found more or less universally within modern, managerial-type, drug strategies. Randall uses mixed methods in her quest for the elusive research-policy interface within the Irish drug policy process, before concluding that no such interface exists and that drug policy is unlikely to ever attain the degree of rationality suggested by the managerial rhetoric of current policy documents.…”