When the non‐sharing of therapeutic goals becomes the problem: The story of a consumer and his addiction to methadone

Abstract

Accessible Summary What is known on the subject? It is well known that psychotropic drugs, besides having beneficial effects, may become a source of addiction. Drug therapy involving methadone is traditionally considered an essential medicine in the treatment for heroin dependence since it significantly reduces drug injecting and death rates associated with opioid dependence. What the paper adds to existing knowledge? This paper investigates a paradoxical situation: the use of methadone therapy to maintain a condition of addiction rather than to overcome it. The story is told jointly by the head of a rehab centre and a young man who has developed a methadone addiction and kept it hidden for years from the operators of the addiction centre, who supplied him with the substance. What are the implications for mental‐health nursing? The young man's story offers a key example which can be of interest not only for addiction centres but also for all mental‐health services that supply drugs as therapy. This study examines what happens when a person taken over by a service pursues goals that are in contrast to the service mission. Specific communication strategies have to be implemented to update and negotiate goals in continuity with the personal live project of the service user. This story is a warning to not rely on consolidated operational practices, ignoring the investigation of personal meanings and aims of those who experience them. Abstract IntroductionMental health services typically follow standardized intervention protocols and systematic operating practices. Aim/QuestionThis paper explores what happens when a service relies exclusively on fixed practices rather than on the negotiation of objectives and the differentiation of procedures according to the needs of the user. MethodThe analysis of the narratives produced in first person by Oliver, a former substance user, emphasizes the need of constructing a therapeutic plan in close cooperation, promoting an user active role and strengthening his affiliation in the change process. Results and DiscussionIn this specific case, the involvement of the user meant the identification of the peculiar meanings he attributed to the “substance of use,” which paradoxically coincided with the “therapeutic substance” (methadone). Implications for PracticeOliver's story is an effective mirror for rethinking staff conduct when it assumes that the drug is therapeutic in itself, regardless of the way the person experiences and means it, it also offers a description of the interactive ways in which the relationship between a young person and service staff proved to be effectively therapeutic.

‘ALL ABOUT MY IDEAL MENTAL HEALTH SERVICE’: Users, family members and experts by experience discussing a co‐designed service

“…The material collected comprises the transcripts of the meetings conducted during the project and content from the book Psychiatry as Protagonists , which was read and signed by all participants before publication. In addition, two interviews were conducted with privileged witnesses before this article was written 43,44 . The material collected is summarised as follows: …”

“…In addition, two interviews were conducted with privileged witnesses before this article was written. 43,44 The material collected is summarised as follows:…”

“…In addition, two interviews were conducted with privileged witnesses before this article was written. 43 , 44 The material collected is summarised as follows: Two interviews with the leaders of the two groups, one initial and one final. Analysis of the transcripts of the 30 meetings (15 for Group A and 15 for Group B).…”

Grounding co‐writing: An analysis of the theoretical basis of a new approach in mental health care

“…Listening to the voices of those receiving care is just the beginning. The challenge is to use these narratives to improve practice and the patient experience, to explore the unintended consequences of communication between a nurse and a patient, as well as how the environment in which patients find themselves can relay important messages (Faccio, Aquili et al, 2021, Faccio, Author et al, 2021Petty et al, 2018). This paper has identified and briefly described four non-clinical epistemological paradigms on which co-writing is grounded: ethnography, value-based practice, narrative care and phenomenology.…”

What is <em>therapeutic</em>? Analysis of the narratives available on Italian Addiction Rehab Centres’ Sites to present the therapeutic programme

“…There are various examples of how this type of approach can be declined with respect to the single case (Faccio, 2011;Faccio, Author, Rocelli 2021;Faccio, Centomo & Mininni, 2011;Faccio, Mininni & Rocelli, 2011;Salvini et al 2012). It offers important lenses for reading experience and personal discomfort, while bringing with it all the limits of an idiographic approach, where the focus is on the individual and cannot be extended or generalized (Faccio, Aquili, Anonymous, & Rocelli, 2022).…”