Improving psychosocial health and employment outcomes for individuals receiving methadone treatment: a realist synthesis of what makes interventions work

Abstract

BackgroundFor over 50 years, methadone has been prescribed to opioid-dependent individuals as a pharmacological approach for alleviating the symptoms of opioid withdrawal. However, individuals prescribed methadone sometimes require additional interventions (e.g., counseling) to further improve their health. This study undertook a realist synthesis of evaluations of interventions aimed at improving the psychosocial and employment outcomes of individuals on methadone treatment, to determine what interventions work (or not) and why.MethodsThe realist synthesis method was utilized because it uncovers the processes (or mechanisms) that lead to particular outcomes, and the contexts within which this occurs. A comprehensive search process resulted in 31 articles for review. Data were extracted from the articles, and placed in four templates to assist with analysis. Data analysis was an iterative process and involved comparing and contrasting data within and across each template, and cross checking with original articles to determine key patterns in the data.ResultsFor individuals on methadone, engagement with an intervention appears to be important for improved psychosocial and/or employment outcomes. The engagement process involves attendance at interventions as well as an investment in what is offered. Three intervention contexts (often in some combination) support the engagement process: a) client-centered contexts (or those where clients’ psychosocial and/or employment needs/issues/skills are recognized and/or addressed); b) contexts which address clients’ socio-economic conditions and needs; and, c) contexts where there are positive client-counselor and/or peer relationships. There is some evidence that sometimes ongoing engagement is necessary to maintain positive outcomes. There is also some evidence that complete abstinence from drugs (e.g., cocaine, heroin) is not necessary for engagement.ConclusionsIt is important to consider how the contexts of interventions might elicit and/or support clients’ engagement. Further research is needed to explore how an individual’s background (e.g., involvement with different interventions over an extended period) may influence engagement. Long-term engagement may be necessary to sustain some positive outcomes although how long is unclear and requires further research. Engagement can occur without complete abstinence from such drugs as cocaine or heroin, but additional research is required as engagement may be influenced by the extent and type of drug use.Electronic supplementary materialThe online version of this article (doi:10.1186/s40359-014-0026-3) contains supplementary material, which is available to authorized users.

Evaluation of a hepatitis C education intervention with clients enrolled in methadone maintenance and needle/syringe programs in Malaysia

“…In contrast, MMT patients are generally more stable, more likely to be employed, and less likely to be using drugs or be engaged in criminal activity when compared to PWIDs that are not engaged in treatment. (Jackson, et al, 2014; Sun, et al, 2015). Several studies also indicate that in order for a health education intervention to be successful, they must be combined with structural level approaches that aim to change the political, economic, social and community context of drug use, and that social determinants of health must be taken into account (Aggleton, 2005; Galea & Vlahov, 2002; Nutbeam, 2000).…”

Struggling to achieve a ‘normal life’: A qualitative study of Vietnamese methadone patients

“…Since employment directly impacts quality of life and treatment engagement (De Maeyer et al, 2011;Jackson et al, 2014), Vietnamese methadone programmes should apply a more patient-friendly dosing schedule to attract and retain service users, especially to accommodate those with traditional eight-to-five work schedules. As M. Harris & Rhodes (2013) argued, 'generous constraints' would be beneficial in improving patients' sense of control, in assisting their self-sufficiency, and in reducing risks.…”

A realist review of family-based interventions for children of substance abusing parents

“…Other realist reviews have identified engagement as an important feature of program success (e.g. [ 18 ]). In the present realist review, two instances were identified where successful program engagement yielded positive outcomes: (a) responsiveness to client socio-economic needs and (b) matching to client lived experience.…”

“…Despite the fact that engagement has not previously been noted within COSAP program literature, it has been validated elsewhere. Findings from Jackson and colleagues’ [ 18 ] realist review of methadone treatment programs emphasized the importance of client engagement, specifically within the contexts of client-centred treatment, attention to client SES conditions and positive therapeutic relationships. From a broader perspective, other health care fields such as nursing have also emphasized the importance of patient engagement.…”

“…As such, multiple forms of evidence are included in a realist review, including qualitative research and grey literature, both of which are typically excluded from traditional systematic reviews. Decisions on the merits of document inclusion favour their potential for theoretical contribution over methodological hierarchy of empirical studies [ 18 , 19 ]. Many COSAP programs are delivered in community settings, which often lack the resources to rigorously evaluate their interventions.…”