The \u201cblack box\u201d of treatment: Patients\u2019 perspective on what works in opioid maintenance treatment for opioid dependence

Teresa C Silva,Fredrik B Andersson

doi:10.1186/s13011-021-00378-7

Teresa C Silva, Fredrik B Andersson

Open Access

https://doi.org/10.1186/s13011-021-00378-7

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Abstract

BackgroundA lack of conceptual modeling of how the components of opioid maintenance treatment (OMT) for opioid dependence (OD) work causes it to occasionally be labeled the “black-box” of treatment. This study had a two-fold objective: First, to analyze which factors related to OMT for OD contribute to the abstinence of problematic use of non-prescribed opioids and sustain recovery, from the patients’ perspective; second, to understand which changes OMT produced in the individuals’ lives might significantly contribute to relapse prevention.MethodsWe used qualitative methods of design, inquiry, and analysis from a convenience sample of 19 individuals in a Swedish treatment setting.ResultsAll the participants reported previous cycles of problematic use of non-prescribed opioids and other non-prescribed psychoactive substances, treatment, abstinence, recovery, and relapse before starting the current OMT program. During the pre-treatment stage, specific events, internal processes, and social environments enhanced motivation toward abstinence and seeking treatment. During the treatment stage, participants perceived the quality of the human relationships established with primary social groups as important as medication and the individual plan of care in sustaining recovery. From the participants’ perspective, OMT was a turning point in their life course, allowing them a sense of self-fulfillment and the reconstruction of personal and social identity. However, they still struggled with the stigmatization produced by a society that values abstinence-oriented over medication-assisted treatments.ConclusionOMT is not an isolated event in individuals’ lives but rather a process occurring within a specific social context. Structural factors and the sense of acceptance and belonging are essential in supporting the transformation. Treatment achievements and the risk for relapse vary over time, so the objectives of the treatment plan must account for characteristics of the pre-treatment stage and the availability and capacity of individuals to restructure their social network, besides the opioid maintenance treatment and institutional social care.

Highlights

A lack of conceptual modeling of how the components of opioid maintenance treatment (OMT) for opioid dependence (OD) work causes it to occasionally be labeled the “black-box” of treatment
During the second step of the analysis, we used a grounded theory approach [58, 59] to answer the question, “What existential changes does OMT promote that might contribute to relapse prevention?” We developed a coding scheme to categorize common themes and elaborated patterns and linkages between categories, carrying out constant comparisons between codes, concepts and categories as suggested by Strauss and Corbin [60]
We found that the motivation to abstain from problematic use of non-prescribed opioids (NPO) and eventually other non-prescribed psychoactive substances (NPPS) during the pre-treatment stage that moved the individuals to seek OMT worked jointly with factors occurring during the treatment stage to explain treatment outcomes

Summary

Introduction

A lack of conceptual modeling of how the components of opioid maintenance treatment (OMT) for opioid dependence (OD) work causes it to occasionally be labeled the “black-box” of treatment. The scientific literature has consistently reported the association between OMT and outcomes reflecting positively on health administration, social services, and criminal justice, besides the personal benefit for those suffering from an OD. Despite the repeated empirical demonstration of OMT’s positive outcomes, the treatment mechanisms that make a sustained recovery possible are not well understood yet, and in that regard, this treatment is occasionally categorized as a “black box” [11]. Best and colleagues [14] assessed recovery experiences among individuals enrolled in drug treatment services in the UK and found that the use of some psychoactive substances was not inconsistent with a recovery journey for some individuals. The expression “sustained recovery” indicates the maintained abstinence of non-prescribed opioids (NPO) and other non-prescribed psychoactive substances (NPPS)

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