“A Scarlet Letter”: Stigma and other Factors Affecting Trust in the Health Care System for Women Seeking Substance Abuse Treatment in a Community Setting

Abstract

Background: Trust in health care has been shown to influence health care utilization, perceptions of fair treatment, and health outcomes in the general population. The literature on trust in health care in individuals with a history of substance use disorder (SUD) is more limited, primarily examining the patient-provider relationship. Women seeking substance abuse treatment in community-based programs have higher rates of prior trauma and health disparities compared with male counterparts and the general population. With higher rates of prior trauma, this population is theoretically at high risk of decreased interpersonal trust and altered interpersonal relationships. Objective: This study sought to identify factors influencing trust in the health care system for women seeking substance abuse treatment in a community-based residential treatment program. Methods: Six client focus groups ( n = 30), 1 provider focus group ( n = 7), and 2 individual clinical administrator interviews ( n = 2) were conducted between November 2016 and August 2017. Focus groups and interviews were audio recorded and transcribed. Coding and coding reconciliation were conducted by 2 independent coders. Themes were extracted and analyzed from sorted and coded quotes. Results: Six themes emerged. Factors that influence trust in the health care system in this population include (1) prior experiences with diagnosis, treatment, and outcomes; (2) stigma of addiction; (3) payment and reimbursement structure; (4) patient rights and protections; (5) efficiency-driven care; and (6) the health care system's role in causing and/or enabling addiction. Conclusions: These themes demonstrate a general distrust of the health care system by women in this population. Distrust is influenced by a perception of a health care system providing care that is variable in quality, often stigmatizing, unaffordable, efficiency driven, and often influencing individuals’ SUD. This aligns with and extends prior literature around trust of health care in individuals with SUD. Future directions in research include formally assessing the impact of trust on health outcomes such as treatment entry and retention.

Caring for women with substance use disorders through pregnancy and postpartum during the COVID-19 pandemic: Lessons learned from psychology trainees in an integrated OBGYN/substance use disorder outpatient treatment program

“…Another driver of the decreased telepsychology attendance is likely related to compromised ability to engender patient-provider trust and relationships. Many women with SUD note high level of mistrust of the health care system related to repeated prior stigmatizing interactions with health care providers related to substance use (Cockroft et al, 2019). Not being able to perform "warm handoffs" between medical and BH providers in the clinic limits the ability for clinical team members to gradually gain patients' trust, which then likely compromises their uptake of telepsychology services with a new team member who they have not been able to meet yet in person.…”

Revisiting the Fetal Assault Law in Tennessee: Implications and the Way Forward

“…Mistrust of providers due to prior mistreatment in a care setting, the social stigma of substance use in pregnancy, and the common cultural misperception that recovery (i.e., being "clean") is only achieved through detoxification further complicates treatment decisions (Cockroft et al, 2019;Ostrach & Leiner, 2019). While counties in TN lacking access to mental health services are associated with higher rates of NAS (Patrick et al, 2019), comprehensive psychosocial and behavioral support services are limited for these women due to the lack of coordinated funding and limited number of health organizations accepting Medicaid coverage for these services, which are often deemed medically unnecessary (Division of TennCare, 2018).…”

Quality of Life and its Related Factors in Women with Substance Use Disorders Referring to Substance Abuse Treatment Centers

“…According to a study, 78.1% of women with substance use disorder problems report repeated sexual abuse and 82.1% reported repeat physical abuse (14). However, most women with drug dependence and drug use disorders conceal their problems as they fear stigma and discrimination (11,15). Nowadays, improving the quality of life (QoL) is one of the most important goals of treatment intervention programs.…”