Redefining Retention: Recovery from the Patient's Perspective

Mitchell, Shannon Gwin; Morioka, Rika; Reisinger, Heather Schacht; Peterson, James A.; Kelly, Sharon M.; Agar, Michael; Brown, Barry S.; O’Grady, Kevin E.; Schwartz, Robert P.

doi:10.1080/02791072.2011.587392

Cited by 30 publications

(24 citation statements)

References 28 publications

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“…Similar to a study of alcohol dependence (Klingemann 2012), a wide range of recovery maintenance strategies was identified, and as reported by Mitchell et al (2011), many respondents described their experience with abstinence and recovery as an accumulation of positive changes (i.e., “building momentum” and achieving incremental successes over time). Similar proportions of the treatment and no treatment samples endorsed specific themes as important facilitators of abstinence, including supportive social networks, productive use of time, physical and mental health concerns and external pressures.…”

Section: Discussionmentioning

confidence: 92%

A Qualitative Study of Methamphetamine Users’ Perspectives on Barriers and Facilitators of Drug Abstinence

Herbeck

Brecht

Christou

et al. 2014

Journal of Psychoactive Drugs

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To better understand methamphetamine (MA) use patterns and the process of recovery, qualitative interviews were conducted with adult MA users (n=20), comparing a sample that received substance abuse treatment with those who had not received treatment. Respondents provided detailed information on why and how they changed from use to abstinence, and factors they considered to be barriers to abstinence. Audio recordings and transcripts were reviewed for common themes. Participants reported a range of mild/moderate to intensely destructive problems, including loss of important relationships and profound changes to who they felt they were at their core, e.g., “I didn’t realize how dark and mean I was... I was like a different person.” Initial abstinence was often facilitated by multiple external forces (e.g., drug testing, child custody issues, prison, relocation), but sustained abstinence was attributed to shifts in thinking and salient realizations about using. The treatment group reported using more and different resources to maintain their abstinence than the no treatment group. Findings indicate individualized interventions and multiple, simultaneous approaches and resources were essential in reaching stable abstinence. Understanding long-term users’ experiences with MA use, addiction and abstinence can inform strategies for engaging and sustaining MA users in treatment and recovery.

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Section: Discussionmentioning

confidence: 92%

A Qualitative Study of Methamphetamine Users’ Perspectives on Barriers and Facilitators of Drug Abstinence

Herbeck

Brecht

Christou

et al. 2014

Journal of Psychoactive Drugs

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“…As the main access and entry barriers to OAT in Ukraine, including registration requirements, fear of police harassment, lack of available spaces, being placed on interminable waiting lists, and fears and misperceptions about OAT medications, have been previously described for Ukraine's PWID (Bojko et al, 2015; Mazhnaya et al, 2015), this paper focuses on the qualitative data analysis of the coded segments related to experiences and beliefs associated with OAT retention since retention in treatment is crucial to achieve optimal treatment benefits for the individual and for society (Gwin Mitchell et al, 2011). …”

Section: Methodsmentioning

confidence: 99%

The Future of Opioid Agonist Therapies in Ukraine: A Qualitative Assessment of Multilevel Barriers and Ways Forward to Promote Retention in Treatment

Bojko

Mazhnaya

Marcus

et al. 2016

Journal of Substance Abuse Treatment

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Opioid agonist therapies (OAT) to treat opioid addiction in people who inject drugs (PWID) began in Ukraine in 2004. Scale-up of OAT, however, has been hampered by both low enrollment and high attrition. To better understand the factors influencing OAT retention among PWID in Ukraine, qualitative data from 199 PWIDs were collected during 25 focus groups conducted in five Ukrainian cities from February-April 2013. The experiences of PWID who were currently or previously on OAT or currently trying to access OAT were analyzed to identify entry and retention barriers encountered. Transcribed data were analyzed using a grounded theory approach. Individual beliefs about OAT, particularly misaligned treatment goals between clients and providers, influenced PWID's treatment seeking behaviors. Multiple programmatic and structural issues, including inconvenient hours and treatment site locations, complicated dosing regimens, inflexible medication dispensing guidelines, and mistreatment by clinic and medical staff also strongly influenced OAT retention. Findings suggest the need for both programmatic and policy-level structural changes such as revising legal regulations covering OAT dispensing, formalizing prescription dosing policies and making OAT more available through other sites, including primary care settings as a way to improve treatment retention. Quality improvement interventions that target treatment settings could also be deployed to overcome healthcare delivery barriers. Additional patient education and medical professional development around establishing realistic treatment goals as well as community awareness campaigns that address the myths and fears associated with OAT can be leveraged to overcome individual, family and community-level barriers.

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“…Unfortunately, buprenorphine detoxification has not lead to increased rates of abstinence following withdrawal (Dunn et al, 2011; Horspool, Seivewright, Armitage, & Mathers, 2008), and as such, the practice of BMT discontinuation may be perpetuated by the provider expectation that abstinence is likely to follow (Newman, 2009). Furthermore, some providers may feel that abiding by program rules is necessary for BMT success to the extent that BMT is discontinued for rule infractions; however, patients often find benefit in remaining in programs despite failure to achieve program-imposed criteria (Mitchell et al, 2011). …”

Section: Introductionmentioning

confidence: 99%

Discontinuation of Buprenorphine Maintenance Therapy: Perspectives and Outcomes

Bentzley¹,

Barth²,

Back³

et al. 2015

Journal of Substance Abuse Treatment

141

100

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Buprenorphine maintenance therapy (BMT) is increasingly the preferred opioid maintenance agent due to its reduced toxicity and availability in an office-based setting in the United States. Although BMT has been shown to be highly efficacious, it is often discontinued soon after initiation. No current systematic review has yet investigated providers’ or patients’ reasons for BMT discontinuation or the outcomes that follow. Hence, provider and patient perspectives associated with BMT discontinuation after a period of stable buprenorphine maintenance and the resultant outcomes were systematically reviewed with specific emphasis on pre-buprenorphine-taper parameters predictive of relapse following BMT discontinuation. Few identified studies address provider or patient perspectives associated with buprenorphine discontinuation. Within the studies reviewed providers with residency training in BMT were more likely to favor long term BMT instead of detoxification, and providers were likely to consider BMT discontinuation in the face of medication misuse. Patients often desired to remain on BMT because of fear of relapse to illicit opioid use if they were to discontinue BMT. The majority of patients who discontinued BMT did so involuntarily, often due to failure to follow strict program requirements, and 1 month following discontinuation, rates of relapse to illicit opioid use exceeded 50% in every study reviewed. Only lower buprenorphine maintenance dose, which may be a marker for attenuated addiction severity, predicted better outcomes across studies. Relaxed BMT program requirements and frequent counsel on the high probability of relapse if BMT is discontinued may improve retention in treatment and prevent the relapse to illicit opioid use that is likely to follow BMT discontinuation.

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Redefining Retention: Recovery from the Patient's Perspective

Cited by 30 publications

References 28 publications

A Qualitative Study of Methamphetamine Users’ Perspectives on Barriers and Facilitators of Drug Abstinence

A Qualitative Study of Methamphetamine Users’ Perspectives on Barriers and Facilitators of Drug Abstinence

The Future of Opioid Agonist Therapies in Ukraine: A Qualitative Assessment of Multilevel Barriers and Ways Forward to Promote Retention in Treatment

Discontinuation of Buprenorphine Maintenance Therapy: Perspectives and Outcomes

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