Acceptability of nonabstinent treatment outcome goals among addiction treatment providers in Ukraine.

Abstract

We examined whether acceptability of nonabstinence treatment outcome goals varied as a function of a patient's severity of diagnosis (ICD-10 harmful use vs. dependence syndrome; World Health Organization, 1992), finality of outcome goal (intermediate vs. final), and type of substance (e.g., tobacco, alcohol, cannabis), among addiction treatment providers in Ukraine. We surveyed 44% of Ukrainian treatment providers (n = 446/1023; Mage = 40.4, SD = 8.6; Male = 67%; MYears Of Experience = 10.2, SD = 7.2). For tobacco use, most respondents (78%-93%) rated nonabstinence as acceptable, regardless of diagnostic severity or finality of outcome goal (i.e., intermediate, final). Most respondents also rated nonabstinence as acceptable as an intermediate or final goal for patients with harmful use of alcohol (70% to 86%) or cannabis (71% to 93%); however, nonabstinence was less commonly indicated by respondents as an intermediate goal for patients with a dependence syndrome (alcohol = 52%; cannabis = 68%). Regarding other drug use, although most rated nonabstinence acceptable as an intermediate goal for patients with harmful use of opioids (68%) or sedatives (64%), fewer rated nonabstinence acceptable as a final goal (26% to 33%), particularly for patients with a dependence syndrome (10% to 27%). Very few providers (5% to 15%) rated nonabstinence acceptable for other substances. Patients in Ukraine who wish to moderate cannabis or tobacco use will find that their provider is typically accepting of this goal; however, providers are mixed regarding whether alcohol and opioid moderation is appropriate, particularly for those with dependence. Findings support education and research efforts to better understand how provider and patient alignment regarding goals impact patient outcomes following substance use treatment in Ukraine. (PsycINFO Database Record

Controlled drinking—non‐abstinent versus abstinent treatment goals in alcohol use disorder: a systematic review, meta‐analysis and meta‐regression

“…Consistent with our findings, accumulating evidence confirms the achievability of non‐abstinent recovery and—importantly—the associated improvements in physical and mental health [26], mortality [17], psychiatric comorbidity and quality of life [58,59] and social functioning [60,61]. Our findings seem particularly relevant to the field, given the low acceptability of non‐abstinent treatment goals among clinicians in several countries [14,15,62,63].…”

Abstinence or controlled drinking – a five-year follow-up on Swedish clients reporting positive change after treatment for substance use disorders

“…All the interviewees had attended treatment programmes following the 12-step philosophy and described abstinence as crucial for their recovery process in the initial interview, five years ago. In previous research, several indicators of whether CD is possible are mentioned (Klingemann and Rosenberg, 2009;Klingemann, 2016;Davis et al, 2017;Luquiens et al, 2011;Berglund et al, 2019). Clients reporting CD in the present study only met one of these criteriaan initial period of abstinence (Booth, 2006;Coldwell and Heather, 2006).…”

“…It caused heated debates, and for a long time, it has had a rather limited impact on professional treatment systems (Coldwell and Heather, 2006). Recently, in many European countries (Klingemann and Rosenberg, 2009;Klingemann, 2016;Davis et al, 2017) and in the USA (Coldwell, 2005;Davis and Rosenberg, 2013), professionals working with clients with severe problems and clients in inpatient care tend to have abstinence as a treatment goal . However, CD is a widely accepted treatment goal in Australia, Britain and Norway (Luquines et al, 2011).…”

The impact of integrated care in community‐based substance use treatment in Brazil: A longitudinal study

“…The options are generally shelters, therapeutic communities or the Residential Unit -UA, similar to this study except for referral to therapeutic communities, not considered a housing option in Brazilian policy (Davis et al, 2018).…”

“…This model promotes access and accepts an improvement of individuals not only by abstinence, prioritising interventions that reduce the risk and the harms of substance use and improve the quality of life. With this, it allows people to take ownership of their difficulties and their care, without blaming themselves for the different results that they can present about consumption, becoming aware of the complexity of their situation in the issue of addiction (Costa et al, 2018;Davis et al, 2018).Globally, the burden of this disease is increasing based on the complex health needs of this population on ageing process linked with drug use (Han & Moore, 2018).Research has been exploring community-based care focusing on reducing consumption of psychoactive substances and found…”