Inpatient Substance Abuse Treatment Research Articles

Relational parenthood in addiction recovery.

Aims: The purpose of this research was to elicit how parents attending family-focused substance abuse treatment construct their parenthood in relation to other people. Design: Relational parenthood of addiction treatment attendees is scrutinised from seven thematic interviews carried out in a community-based inpatient substance abuse treatment unit in Finland. The core analytical concept of the research is relationality. The data were first content coded via Atlas.ti22 and the relations and codes classified into the five following parenthood types emerging from the data: (1) worn-out; (2) coping; (3) ambivalent; (4) changing; and (5) supported. Content codes and parenthood types were cross-tabulated to ascertain how these types are emphasised in different relationships. Results: Worn-out and coping parenthood types emerged in the closest relationships, mostly with their own children and the other parent. Ambivalent parenthood was present in all relations as expressions of inner conflict, which can lead to changing parenthood. Changing parenthood emerged in relation to interviewees' own children as an empowering experience. It also emerged in relation to other people as readiness to accept help. Supported parenthood was most often found in relation to significant others and professionals, presumably due to the context of the interviews. Conclusion: The parenthood types illustrate how parenting changes over time, which is also an important part of social identity change in recovering from addiction. In treatment, it is extremely important to understand the different sides of parenthood and to use the information to strengthen clients' parenthood.

Reducing Problematic Substance Use under Exceptional Circumstances-Effects of the COVID-19 Restrictions on Inpatient Substance Use Disorder Treatment in Finland.

The COVID-19 pandemic has affected people’s daily lives on multiple levels. At highest risk are the most vulnerable members of the society, whose lives were already affected by various risks even before the pandemic. This study investigates how clients in inpatient substance use disorder treatment experienced the COVID-19 restrictions and their influence on recovery. The research data consists of six focus group interviews conducted remotely using a semi-structured thematic interview method. The focus group clients (N = 19) were currently in inpatient substance abuse treatment during the pandemic and the ensuring restrictions. The data were analyzed using qualitative content analysis. The results show that the COVID-19 restrictions have influenced the clients’ desistance processes throughout the pandemic. The restrictions seemed to exacerbate substance abuse problems before treatment initiation and highlight the importance of peer support during treatment. Moreover, the restrictions seemed to change the function and hamper the management of social capital, raise concerns about returning home, as well as intensifying the inter-municipal segregation of services. To conclude, attention should be paid to facilitating and ensuring informal support and managing social capital. In light of this study, it seems necessary to explore the social conditions among clients in inpatient substance abuse treatment during the pandemic.

How access to addictive drugs affects the supply of substance abuse treatment: Evidence from Medicare Part D.

This paper documents how substance abuse treatment (SAT) providers and services respond to increases in population-level opioid addiction. I do this by exploiting the implementation of Medicare Part D as an exogenous increase in the availability of prescription opioids. Starting in 2006, states with higher shares of the population eligible for Medicare Part D experienced increases in residential and hospital inpatient SAT facilities, beds dedicated to SAT, and SAT facilities offering medication-assisted treatment, relative to states with lower shares. These results suggest that the supply of SAT in the United States is capable of responding significantly to changes in demand.

Professionals’ Views on Challenges in Inpatient Substance Abuse Treatment during COVID-19 Pandemic in Finland

The pandemic caused by COVID-19 (an acute respiratory illness caused by a coronavirus) has had harmful effects on people in need of special support. People with problematic substance use are recognized as such a group. The pandemic has raised the need for sufficient treatment and services during these unpredictable conditions. At the same time, it poses severe challenges to their production and provision. The purpose of the study was to use content analysis to qualitatively examine Finnish professionals’ (N = 22) views on (1) the challenges posed by COVID-19 in working in inpatient substance abuse treatment, (2) how these challenges have been addressed, and (3) what the consequences of the challenges and the solutions to them are. The findings confirmed that COVID-19 has caused drastic changes in the organization of treatment and daily practices. Professionals experience challenges in preventing infection from spreading into and within treatment units. They also describe difficulties in applying social distancing in treatment that is based on therapeutic communities. The pandemic has also challenged communication and co-worker support among professionals. These challenges have led to practical solutions that, in turn, have their own consequences for treatment practices. We conclude that the quality of treatment has to some extent been impaired because of the pandemic.

Discourses of behavioural addiction, normalisation and techniques of governmentality in inpatient substance abuse treatment

ABSTRACT The concept of addiction has expanded in recent decades to include diverse behaviours in addition to addiction to specific substances. Hence, the understanding of what constitutes normal behaviour and what constitutes addiction has been constantly changing. Substance-abusing clients are typically seen as having additional behavioural addictions, which manifest during their substance abuse treatment. In this article, we study the constructions of normality, deviance and the techniques of governmentality, produced by the discourses of behavioural addiction found in interviews with workers in an inpatient substance abuse treatment unit. Five identified discourses – psychological, disease, sociocultural, family and normalizing – differ from each other as regards to what is understood as addictive behaviour as opposed to normality and how it is explained; normality can be construed, for example, as the balance between internal emotions, health and adequate parenting, which may be beyond the reach of those addicted. What is considered a behavioural addiction is questioned in the normalizing discourse. Discourses also differ as regards to the techniques of governmentality and in the ways individual responsibility is understood.

Changes in clients’ well-being (ORS) and state hope (SHS) during inpatient substance abuse treatment

Aims:During inpatient substance abuse treatment, professionals seek to help clients to achieve improvement in various life domains affected by substance abuse. Progress monitoring during substance abuse treatment has been called for, and in this study we examine how clients’ levels of well-being and hope change during inpatient substance abuse treatment.Methods:Clients (N = 168) entered the treatment facility between January 1, 2017 and August 31, 2018. The prospective data were gathered from one treatment unit located in central Finland on entry into treatment, during and at the end of treatment. Using the Outcome Rating Scale (ORS) as a therapeutic tool was standard procedure in the treatment unit. Demographic information on participants, information on their previous substance use and scores on the State Hope Scale (SHS) were collected through structured questionnaires. Non-parametrical tests (Mann–Whitney U test; Kruskal–Wallis χ2; Spearman’s rho) were used to study changes in indicators of well-being and hope.Results:As hypothesised, inpatient treatment had a positive effect on both ORS and SHS and they were interrelated. Differences in gender, living situation and previous admissions were found when studying how the background information of the participants was related to the change achieved in ORS and SHS.Conclusions:Inpatient substance abuse treatment seemed to enhance both well-being and hope of the clients of inpatient substance abuse treatment.

The Effectiveness of Trauma-Focused Psychodrama in the Treatment of PTSD in Inpatient Substance Abuse Treatment.

This single group pretest-posttest study explores the effectiveness of trauma-focused psychodrama in the treatment of post-traumatic stress disorder (PTSD) at an inpatient addiction treatment center. The results contribute to the limited research bases of both psychodrama and PTSD treatment outcomes in inpatient addiction treatment. The present study supports the potential effectiveness of two trauma-focused psychodrama models, the Therapeutic Spiral Model and the Relational Trauma Repair Model. Findings of the research demonstrate clinically significant reductions in overall PTSD symptoms (over 25% change) and each PTSD symptom cluster (i.e., re-experiencing and intrusion, avoidance and numbing, and hyper-arousal). Additionally, patient satisfaction exit survey data support overall treatment effectiveness and highlight its tolerability, and capacity for establishing emotional safety, connection, and group cohesion. Patients even described the trauma-focused psychodrama treatment approach as enjoyable and helpful. Overall, the results of this study are promising, and support continued clinical application of trauma-focused psychodrama treatment with other subpopulations diagnosed with PTSD. However, the ability to isolate effects of trauma-focused psychodrama in this study is compromised due to the absence of a control group and participants’ involvement in other inpatient treatment services.

Ulysses Coercion Through Psychiatric Advanced Directives in Homeless People With Substance Use Disorder: A Qualitative Study of the Colombian Perspective

Homeless substance users (HSUs) represent a public health challenge given their high social impact and the numerous barriers they have to overcome to receive mental health treatment. Recent public debate in Colombia is concerned with how to approach HSUs within the health system. The aim of this publication was to explore the possibility of implementing Psychiatric Advance Directives (PADs) in HSUs as an alternative to coercive treatment, to favor substance abuse treatment adherence and service retention in this population. For this purpose, the authors conducted 3 in-depth interviews of individuals who previously experienced homelessness and were voluntarily admitted to an inpatient substance abuse treatment ward at the moment of the interview. This research indicates that substance abuse in homeless individuals does not imply an impairment of their mental or legal capacity. Moreover, restraining HSUs during intense craving episodes within inpatient settings by implementation of PAD does not seem to be a viable option given the multiple risks and challenges it poses to mental health care providers. Finally, the use of any coercive measure toward HSUs, and this type of PADs in particular, could potentially be associated with violent episodes or human rights violations within mental health institutions.

The Association between Trauma History, Trauma-Related Psychopathology and Treatment Completion at an Adolescent Inpatient Substance Abuse Treatment Center in Turkey

Some adolescents are at great risk for early attrition from inpatient substance abuse treatment. We aimed to examine the effect of sociodemographic features, substance use patterns, childhood traumas and trauma-related psychopathology on the completion of an adolescent substance abuse inpatient treatment program in order to acquire information about adapting treatment strategies to enhance patient retention. Our study included 105 adolescents who were referred with a diagnosis of substance use disorder to our Child and Adolescent Substance Abuse Treatment Center's inpatient treatment program in Istanbul, Turkey from February to December 2017. The Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version, the Hamilton Depression Rating Scale, the Conners-Wells Adolescent Self Report Scale, the Childhood Trauma Questionnaire, the Childhood Abuse and Neglect Question List, the Dependency Profile Index-Practitioner Form and the Adolescent Dissociative Experiences Scale were administered to the study group. The treatment completion rate was 26.7%. The patients who did not complete the inpatient treatment program had more history of childhood emotional neglect and/or abuse. The most common type of psychosocial trauma was emotional neglect (34%). Early attrition from the inpatient treatment program was related to dissociative amnesia, more severe attention deficit hyperactivity disorder, depression and synthetic cannabinoids use (p < 0.05). Our findings indicate that childhood psychosocial trauma and related clinical characteristics were associated with attrition from the adolescent inpatient substance abuse treatment program. Substance abuse treatment programs should adopt early assessment tools to identify those at risk for early attrition from treatment and provide targeted interventions for them.

Barriers and Facilitators to Treatment Engagement Among Clients in Inpatient Substance Abuse Treatment.

There is a call for drawing on client voice to provide a rich, nuanced understanding of factors influencing substance treatment engagement as to maximizing treatment benefits. We interviewed 60 clients in a short-term inpatient substance treatment program and examined facilitators and barriers to treatment engagement. Thematic analysis yielded four themes, including perceived treatment needs, trust and counselor rapport, peer inspiration, and organizational factors. Perceived treatment needs serve as both a facilitator and a barrier wherein the acknowledgment of needs led to greater treatment engagement whereas a lack of perceived needs hindered treatment engagement. The establishment of trust and counselor rapport and peer inspiration facilitated treatment engagement. Clients rated several organizational factors including a lack of treatment provision, gender-responsive treatment and infrastructure, and ineffective communication with nonclinical staff as barriers to treatment engagement. Clinical implications include enhancing treatment motivation and counselor rapport, establishing gender-responsive treatment programs, and providing trainings for staff.

Associations between pharmacotherapy for opioid dependence and clinical and criminal justice outcomes among adults with co-occurring serious mental illness

Adults suffering from a serious mental illness (SMI) and a substance use disorder are at especially high risk for poor clinical outcomes and also arrest and incarceration. Pharmacotherapies for treating opioid dependence could be a particularly important mode of treatment for opioid-dependent adults with SMI to lower their risk for overdose, high-cost hospitalizations, repeated emergency department visits, and incarceration, given relapse rates are very high following detoxification in the absence of one of the three FDA-approved pharmacotherapies. This study estimates the effects of methadone, buprenorphine, and oral naltrexone on clinical and justice-related outcomes in a sample of justice-involved adults with SMI, opioid dependence, and criminal justice involvement. Administrative data were merged from several public agencies in Connecticut for 8736 adults 18years of age or older with schizophrenia spectrum disorder, bipolar disorder, or major depression; co-occurring moderate to severe opioid dependence; and who also had at least one night in jail during 2002–2009. Longitudinal multivariable regression models estimated the effect of opioid-dependence pharmacotherapy as compared to outpatient substance abuse treatment without opioid-dependence pharmacotherapy on inpatient substance abuse or mental health treatment, emergency department visits, criminal convictions, and incarcerations, analyzing instances of each outcome 12months before and after an index treatment episode. Several baseline differences between the study groups (opioid-dependence pharmacotherapy group versus outpatient treatment without opioid-dependence pharmacotherapy) were adjusted for in the regression models. All three opioid-dependence pharmacotherapies were associated with reductions in inpatient substance abuse treatment, and among the oral naltrexone subgroup, also reductions in inpatient mental health treatment, as well as improved adherence to SMI medications. Overall, the opioid-dependence pharmacotherapy group had higher rates of arrest and incarceration in the follow-up period than the comparison group; but those using oral naltrexone had lower rates of arrest (including felonies). The analysis of observational administrative data provides useful population-level estimates but also has important limitations that preclude conclusive causal inferences. Large reductions in crisis-driven service utilization associated with opioid-dependence pharmacotherapy in this study suggest that evidence-based medications for treating opioid dependence can be used successfully in adults with SMI and should be considered more systematically during assessments of treatment needs for this population.

Tobacco-Free Policy Outcomes for an Inpatient Substance Abuse Treatment Center

We assessed changes in patient census, smoking prevalence, and intention to remain abstinent associated with the voluntary enactment of a campus-wide tobacco-free policy in a for-profit residential addictions treatment center. Employing nationally recognized tobacco-free policy strategies, steps toward implementation were tailored to addictions treatment settings. Census data and survey of client tobacco use data were collected for 1 year before the policy began and for 1 year following the policy. Average daily census increased for both the inpatient and extended residential treatment programs after enactment of the tobacco-free policy. Number of tobacco users admitted to treatment increased significantly, while the number of tobacco users who left treatment early did not significantly change. In addition to reducing smoking, the policy was associated with a significant increase of patients reporting the intention to remain abstinent after discharge. Contrary to common concern, a tobacco-free policy implemented in an inpatient residential addictions treatment setting did not negatively affect census rates. This study suggests potential clinical and organizational benefits for campus-wide tobacco-free policies.

Beliefs and Behaviors of Pregnant Women with Addictions Awaiting Treatment Initiation.

Substance use during pregnancy poses clear risks to children's healthy development. However, women with addictions face unique barriers to accessing substance abuse treatment and often delay or avoid treatment seeking. The objective of this study was to examine women's beliefs about the impact of use on the developing baby and to examine the protective behaviors that women with addictions engage in during the period of time between when they first find out they are pregnant and when they begin substance abuse treatment. Semi-structured interviews were conducted with 15 women who were either pregnant or postpartum and who had used illicit substances during pregnancy. All participants were currently receiving inpatient substance abuse treatment services to address their addiction and were asked to retrospectively report on their experiences. Interviews were transcribed, imported into a qualitative data analysis software, and iteratively coded for themes. Women reported being concerned about the impact of substance use on the developing baby, in particular, about the physical and long-term developmental consequences of prenatal exposure. Given these concerns, women described trying to protect the baby from harm on their own, outside of accessing traditional treatment services. They sought information anonymously, increased their engagement in health-promoting behaviors, and decreased their use of alcohol and other drugs. The results suggest that women who use alcohol and other drugs during pregnancy are often motivated to protect their baby from harm and are engaging in harm reduction behaviors prior to accessing treatment services.

Reductions in Alcohol Craving Following Naltrexone Treatment for Heavy Drinking

The role of craving for alcohol as a response to alcohol treatment is not well understood. We examined daily diary ratings of craving over the course of 28 days among individuals participating in an inpatient substance abuse treatment program. Participants were alcohol dependent patients (n=100) in the Hazelden residential treatment program who were offered and agreed to take naltrexone and an age- and gender-matched comparison group (n=100) of alcohol-dependent patients in the same program who declined the offer of treatment with naltrexone. Changes in craving over time were compared between the two groups. The naltrexone-treated group reported a more rapid decrease in craving than the usual care group. The change in the trajectory of craving is consistent with prior reports suggesting that craving reduction is a mechanism of naltrexone's efficacy in treating alcohol dependence. Providing naltrexone to individuals seeking treatment for alcohol dependence may accelerate a reduction in their craving, consistent with a primary target of many addiction treatment programs. Craving ratings by 100 residential patients taking naltrexone for alcohol dependence were compared to ratings by 100 patients who did not take naltrexone. Craving for alcohol decreased more rapidly in the patients taking naltrexone. Providing naltrexone to individuals seeking treatment for alcohol dependence may accelerate a reduction in craving, which may benefit treatment efforts.

Veteran Returns to Homelessness following Exits from Permanent Supportive Housing: Health and Supportive Services Use Proximal to Exit

Permanent supportive housing (PSH) programs have been shown to increase housing retention for “hard to house” individuals and been used to address veteran homelessness. Departures from PSH (referred to as “exits”) can represent a positive outcome for some veterans, while others may return to homelessness. This study analyzed administrative and primary data to identify individual- and institutional-level factors associated with veterans' returns to homelessness following exits from a PSH program. Findings suggest that a number of factors increase the risk of a return to homelessness, including admissions to inpatient substance abuse and behavioral health treatment programs and emergency department visits both pre- and post-exit. Targeted interventions may reduce the likelihood of subsequent homelessness.

Do Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) Scores Predict Readmission to an Inpatient Substance Abuse Treatment Program for Adolescents?

ABSTRACTThis study investigated factors associated with readmission to an inpatient treatment program for adolescents with substance abuse disorders. Participants were 546 adolescents (68% male, N = 372). Mean age was 16.0 years. Approximately 12% of adolescents treated in this program were readmitted for a second episode of treatment. The average time to readmission for these adolescents was approximately three months (median = 82.5 days, mean = 107 days). Participants completed the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES; Miller & Tonigan, 1996) at admission and discharge. Based on previous research, it was hypothesized that adolescents’ level of readiness to change at the end of the initial inpatient treatment episode would predict readmission for additional inpatient treatment. The findings for this study did not support this hypothesis. Adolescents readmitted for a second episode of treatment did not differ from adolescents who were not readmitted on any SOCRATES subscale score at time of initial admission for inpatient treatment. Moreover, there were no differences between these groups when these adolescents completed the first episode of inpatient treatment. Overall, the present findings indicate that adolescents’ readiness to change, or level of motivation, when discharged from inpatient treatment is not associated with the likelihood of readmission for additional inpatient substance abuse treatment.

An empirical study of attachment dimensions and mood disorders in inpatient substance abuse clients: The mediating role of spirituality

Adult attachment style has been related to both spirituality and psychopathology. This study aimed to test the possible mediating role of two dimensions of spirituality (purpose and meaning in life and perceived relationship with God/higher power) between two attachment dimensions (anxiety and avoidance) and three mood disorders (major depressive disorder, dysthymia and bipolar). In total, 305 clients receiving inpatient substance abuse treatment completed a battery of self-report questionnaires. Path analyses revealed negative associations between the anxiety attachment and all the mood disorders. No significant associations were found for attachment avoidance and the mood disorders. Results also indicated negative associations between the two attachment dimensions and purpose and meaning in life. Concerning the perceived relationship with God/higher power, attachment avoidance was the only dimension that showed a significant negative association. Mediating effects of meaning in life and the perceived relationship with God/higher power were found between both attachment dimensions and two of the mood disorders: major depressive disorder and dysthymia. Further analyses of the mediating effects revealed that purpose and meaning in life was the factor accounting for the mediating effects. Clinical implications and future direction for research were discussed.

A qualitative study of referring agents' perceptions of access barriers to inpatient substance abuse treatment centres in the Western Cape.

BackgroundDespite empirical support for the individual and public health benefits of treating substance use disorders (SUDs) , access to these services is impeded by several barriers. Although many studies on access barriers have been put forward in the literature, few have explored the barriers to accessing state-funded inpatient substance abuse treatment or the views of referral agents.MethodsA qualitative study was conducted to explore referring agents’ perceptions of the barriers to accessing state-funded inpatient substance abuse treatment centres in the Western Cape Province of South Africa. Six individual in-depth interviews were conducted and analysed using theoretical thematic analysis.ResultsThe key barriers to emerge from the analysis pertained to referring agents’ perceptions of the following: service users, the substance abuse referral and treatment system and community dynamics.ConclusionsRecommendations are made for interventions to address the identified barriers.

A Peer Support Scale for Adults Treated for Psychoactive Substance-Use Disorder: A Rasch Analysis.

The literature suggests that peer support is protective of relapse for adults treated for substance-use disorder. However, to our knowledge there is no standard measure of peer support. Therefore, the purpose of this research was to use Rasch analysis to assess a 13-item peer support scale used in a group of adults treated for primary psychoactive substance–abuse disorder. The participants (n = 408) are adults who were discharged from an inpatient substance-abuse treatment program from five successive years, 2004–2009. Overall, it is acceptable to surmise that items 1–12 are part of the same dimension for the 13-item scale. Given the prominence of therapeutic communities as a mode of primary treatment and the importance of peer support, it is important to both the academic and treatment communities to have a standard way to measure peer support. The scale presented here can be useful for this purpose.HIGHLIGHTSWe asses a peer support scale for those treated for substance abuse.We examine characteristics of the peer support scale.We provide an option to measure peer support for those treated for substance abuse.

Adolescent Substance Use Treatment: The Moderating Effects of Psychopathology on Treatment Outcomes

The present study tested the influence of co-occurring mental health diagnoses on the relationship between length of stay and treatment outcome among adolescents residing in an inpatient substance abuse treatment facility. Data were collected via record review. Follow-up information was obtained at 7 days and 3 months post-discharge. Treatment outcome was defined as abstinence and engagement in recovery activities. Hierarchical linear regression demonstrated that comorbidities differentially moderated the relationship between length of stay and treatment outcome. Results suggest that these adolescents attempt to engage in recovery activities independent of abstinence and may need supplemental aftercare assistance to maintain their efforts.