Impact of blended treatment literacy and psychoeducation on methadone maintenance treatment outcomes in Yunnan, China

Abstract

BackgroundOutcomes of methadone maintenance treatment (MMT) in the management of opioid dependency can be impaired by poor adherence and retention, concomitant drug use, poor adjustment of methadone dosage, and low levels of awareness regarding methadone among drug users, among other factors. This study investigated the effects of intensive blended treatment literacy and psychoeducation on treatment compliance, methadone dose, and heroin use among MMT clients in China.MethodsA total of 492 MMT clients who tested positive for urine morphine at least once during a 12-week intervention period preceding the study were recruited from 16 MMT clinics. Employing a client-centred approach, a blended treatment literacy and psychoeducation intervention was then implemented between March and June 2014, comprising (1) intensified methadone treatment literacy sessions; (2) participatory goal setting; (3) continuous adherence monitoring and support; and (4) engagement of both peers and doctors in delivering psychoeducation. Wilcoxon signed-rank test was used to compare urine morphine positive rates, daily methadone dosage, and the number of days that clients successfully accessed methadone before and during the intervention.ResultsDuring the intervention, urine morphine positive rates reduced to 27 % from 49.3 % previously; p < 0.001. In response to client needs, methadone dosages increased among 74 % of participants, remained unchanged among 12.0 %, and reduced among 13.4 % during the intervention. In addition, the average daily methadone dose increased from 63.0 to 72.6 mg; p < 0.001, while the average number of days that clients successfully accessed methadone increased from 69.4 to 73.9 over a period of 12 weeks; p < 0.001.ConclusionsBlended treatment literacy and psychoeducation delivered by a combination of peers and doctors was associated with reduced heroin use, improved treatment adherence, and higher methadone doses among our sample of MMT clients.

Factors related to client satisfaction with methadone maintenance treatment in China

“…We observed treatment progression had a mediating effect between social support and treatment satisfaction, suggesting that clients’ views on progress toward their treatment goals can lead to greater treatment satisfaction and outcomes. This finding supports certain strategies in client-centered treatment programs; for example, clients are more likely to adhere to treatment plans and goals when they are involved in the decision-making process (Zhang et al, 2016b). Counseling rapport with the provider was associated with treatment satisfaction in our study, suggesting that clients who feel they have open and smooth communication with their MMT providers tend to be more satisfied with the overall services.…”

Dimensões Que Interferem Na Adesão À Medicação Nos Transtornos Relacionados Às Substâncias: Revisão Integrativa

“…Quanto aos fatores relacionados à adesão e não adesão na dimensão Tratamento, obteve-se destaque para a participação em outras modalidades terapêuticas, a dose adequada da medicação, efeitos colaterais e o longo tempo de tratamento, identificados como fatores que influenciam a adesão. Diante da complexidade de fenômenos envolvidos e a ampla diversidade de fatores que impactam os transtornos relacionados a substâncias, sabe-se que aliar diferentes modalidades terapêuticas à medicamentosa favorece a efetividade do tratamento e estimula o desenvolvimento de atitudes positivas do indivíduo, refletindo na prevenção da recaída e na manutenção da abstinência (5) .…”

“…Fatores de Não Adesão 1. Não se manter abstinente (5,(9)(10)(13)(14)17,(19)(20)(21)(22)(23)(24)28,(33)(34)(35)39,49) 19…”

“…Ter filhos (10) 13. Situação de prisão (5) 14. Falta de incentivo financeiro para a adesão (50) TOTAL 27…”

“…O tratamento contempla diversas modalidades terapêuticas, incluindo a medicamentosa. No entanto, esta terapêutica é marcada por diversos desafios, entre eles, a adesão (5) . Sabe-se que uma parcela significativa de pessoas com doenças crônicas necessita de medicações para o tratamento.…”