Substance Abuse Treatment Units 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.

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.

Patient Assessments of the Factors Facilitating and Impeding User Involvement During the First Phase of Substance Abuse Treatment.

User involvement in the first phase of treatment is essential for treatment satisfaction among patients with substance use disorders (SUDs). This study explores how patients perceive the first phase of specialized SUD treatment and identifies what promotes and inhibits user involvement. We used a qualitative approach, and semi-structured interviews were conducted with 14 informants admitted to a substance abuse treatment unit in central Norway. The analysis was inspired by a phenomenographical analysis approach, and 4 categories were identified as the core experiences of user involvement during the first phase of SUD treatment: (a) a new hold on life, (b) missing information, (c) the importance of a sense of community, and (d) ambivalence about the usefulness of the treatment. Overlapping elements with Aaron Antonovsky’s theoretical framework of salutogenesis were used to support the main findings. The study indicates that activating personal resources (eg, the ability to envision a different life), conveying information in a matter sensitive to patients’ current cognitive state, a sense of community, and therapeutic alliance are essential factors to promote user involvement in the first phase of specialized SUD treatment. Based on the findings, we suggest a salutogenesis approach to promote user involvement and provide several ways to employ this approach in the crucial first phase of specialized SUD treatment.

Effectiveness of the Dedicated Substance Abuse Treatment Unit in the Regina Correctional Centre: A seven-year retrospective analysis

The Dedicated Substance Abuse Treatment Unit (DSATU) is a specialized unit at the Regina Correctional Centre (RCC) that began providing comprehensive in patient addiction treatment to male sentenced offenders in 2008. The purpose of this paper is to report on the seven-year retrospective evaluation of the effectiveness of the DSATU. The study consisted of a retrospective analysis of the case files of DSATU participants (2008-09 to 2014-15 fiscal years; n=755) and a retrospective, case-control analysis of DSATU program data and Corrections’ Case Management Information System (CMIS) data from the Ministry of Justice. DSATU data spanned from 2008-2014, while CMIS data spanned from 2007-2015 (comparator group n = 535). The effectiveness of the DSATU was measured through Program Fidelity and Treatment Effectiveness, Changes in Institutional Misconduct upon completion of the program, and Changes in Contact with Correctional Services after leaving the correctional facility. Pre- and post-treatment measures of Treatment Effectiveness completed as part of the DSATU program were analyzed. Participants demonstrated statistically significant improvements in their knowledge, beliefs, attitudes, and skills in dealing with substance abuse issues. In the period of time between completing the DSATU program and their release from the RCC, DSATU participants had: a significantly lower rate of Institutional Misconduct (disciplinary offenses) relative to the control group (25.3 vs. 45.8%); a significantly lower rate of re-contact with Correctional Services (recidivism) six months (17.3 vs. 26.4% for the control group) and 12 months (28.3 vs. 40.0%) post-release; and DSATU participants who came into contact with corrections post-release took longer to do so than those in the control group (251.0 days compared to 158.0 days). This study demonstrated that the DSATU program has been highly effective at reducing recidivism.

An innovative service collaboration to reduce criminal recidivism for inmates with severe addictions

Agencies with overlapping mandates can form partnerships to aid development of effective programming. In 2008, the Dedicated Substance Abuse Treatment Unit (DSATU) opened at Regina Correctional Centre through a tripartite collaboration between the Saskatchewan (SK) Ministry of Justice, Corrections and Policing; Addiction Services, Regina Qu’Appelle Health Region; and the SK Ministry of Health. Stakeholders researched existing best practices in the field and developed an evidence-based substance abuse treatment program for sentenced inmates at high risk to re-offend. An evaluation of the DSATU program completed in 2016 concluded that the DSATU was effective, sustainable, and likely transferable to other correctional facilities wishing to offer this type of programming. The stakeholder partnership was a key ingredient in the program’s success. This paper describes the process by which the partners worked together to develop, implement, and sustain this innovative and evidence-based substance abuse treatment program. The partners’ willingness to compromise, to take a collaborative approach to building the partnership and developing the program, and to put clients ahead of individual organizational mandates all contributed to the success of the partnership.

From political controversy to a technical problem? Fifteen years of opioid substitution treatment in Finland

BackgroundThe aim of the article is to analyze changes in opioid substitution treatments (OST) in Finland. OST spread in Finland in the late 1990s and early 2000s (Phase 1). Since then, OST has become an integrated part of Finnish drug policy and is provided in various substance abuse treatment units as well as in municipal health centers (Phase 2). MethodsThe paper analyses the policy around the implementation of opioid substitution treatment in Finland, focusing on identifying the key factors and the relations between them that have contributed to the implementation of OST in Finland. ResultsOST has become accepted in Finland during the past ten years as a crucial element of a harm reduction strategy. Present incentives behind this development are not as clearly related to drug-specific policies as in the late 1990s; rather, they stem from both the restructuring of health care services (e.g. cost-effectiveness) and the strengthening of the medical or technico-administrative approach to the development of OST. ConclusionSince the early 2000s, the development of substitution treatment in Finland has not taken place under explicit drug-political guidance, but largely as a result of many differing intended and unintended effects. One of the unintended effects is the fact that buprenorphine has replaced heroin as the most commonly misused opioid in Finland.

How outpatient substance abuse treatment unit director activities may affect provision of community outreach services

How outpatient substance abuse treatment unit director activities may affect provision of community outreach services

How outpatient substance abuse treatment unit director activities may affect provision of community outreach services

Aims: Community outreach services play an important role in infectious disease prevention and engaging drug users not currently in treatment. However, fewer than half of US substance abuse treatment units provide these services and many have little financial incentive to do so. Unit directors generally have latitude about scope of services, including the level of outreach provided to the community. The current study examines how directors’ interactions with external stakeholders affect substance abuse treatment units’ provision of community outreach services.Methods: Cross-sectional logistic and Poisson regression analyses were conducted on a national sample of US outpatient substance abuse treatment units (N = 547).Results: Findings suggest that the amount of time directors spent with licensing and monitoring associations was associated with provision of a greater number of community outreach services, while time spent with professional and occupational associations was associated with provision of off-site human immunodeficiency virus and hepatitis C testing. Several other director attributes and organizational characteristics also emerged as significant.Conclusions: External stakeholders with whom substance abuse treatment directors interact may influence community outreach through their effects on treatment directors’ strategic priorities. Implications for policy and prevention efforts are discussed.

A descriptive survey of types, spread and characteristics of substance abuse treatment centers in Nigeria.

BackgroundNigeria, the most populous country in Africa and the 8th most populous in the world with a population of over 154 million, does not have current data on substance abuse treatment demand and treatment facilities; however, the country has the highest one-year prevalence rate of Cannabis use (14.3%) in Africa and ranks third in Africa with respect to the one-year prevalence rate of cocaine (0.7%) and Opioids (0.7%) use. This study aimed to determine the types, spread and characteristics of the substance abuse treatment centers in Nigeria.MethodsThe study was a cross sectional survey of substance abuse treatment centers in Nigeria. Thirty-one units were invited and participated in filling an online questionnaire, adapted from the European Treatment Unit/Program Form (June 1997 version).ResultsAll the units completed the online questionnaire. A large proportion (48%) was located in the South-West geopolitical zone of the country. Most (58%) were run by Non-Governmental Organizations. Half of them performed internal or external evaluation of treatment process or outcome. There were a total of 1043 for all categories of paid and volunteer staff, with an average of 33 staff per unit. Most of the funding came from charitable donations (30%). No unit provided drug substitution/maintenance therapy. The units had a total residential capacity of 566 beds. New client admissions in the past one year totalled 765 (mean = 48, median = 26.5, min = 0, max = 147) and 2478 clients received services in the non-residential units in the past year. No unit provided syringe exchange services.ConclusionsThe study revealed a dearth of substance abuse treatment units (and of funds for the available ones) in a country with a large population size and one of the highest prevalence rates of substance abuse in Africa. The available units were not networked and lacked a directory or an evaluation framework. To provide an environment for effective monitoring, funding and continuous quality improvement, the units need to be organized into a sustainable network.

Ways of problem solving as predictors of relapse in alcohol dependent male inpatients

Aim The purpose of this study was to identify how remitters and relapsers view their everyday problem solving strategies. Method A total of 128 male alcohol dependent male inpatients who were hospitalized at the Ankara University Psychiatry Clinic, Alcohol and Substance Abuse Treatment Unit were recruited for the study. Subjects demographic status and alcohol use histories were assessed by a self-report questionnaire. Also, patients were evaluated with The Coopersmith Self-esteem Inventory (CSI), The Spielberger State-Trait Anxiety Scale (STAI-I-II), and The Problem Solving Inventory (PSI). Patients were followed for six months with monthly intervals after hospital discharge. Drinking status was assessed in terms of abstinence and relapse. Data were assessed with Student t-test, and univariate and multivariate analyses. In the logistic regression analysis, age, marital status, employment status and PSI subscores were taken as the independent variables and drinking state at the end of six months as the dependent variable. Results There were significant differences in reflective and avoidant styles, and monitoring style of problem solving between abstainers and relapses. It was found that subjects who perceived their problem solving style as less avoidant and less reflective were at greater risk to relapse. Conclusions The findings demonstrated that active engagement in problem solving like utilizing avoidant and reflective styles of problem solving enhances abstinence. In treatment, expanding the behavior repertoire and increasing the variety of ways of problem solving ways that can be utilized in daily life should be one of the major goals of the treatment program.

Sleep Profile in Patients With Chronic Opioid Abuse

Background Sleep disturbances occur in various stages of substance abuse, which might have a significant impact on the treatment success. Despite this fact, the number of researches studying sleep in substance abuse patients is relatively scarce. Objectives To study the profile of sleep in opioid abusers, after the period of detoxification, highlighting whether there is a remote effect of opioid abuse on sleep or not, exploring the nature of such sleep disturbances, if present. Methodology The case group comprised 33 opioid-dependent male patients who were admitted to the substance abuse treatment unit at the Institute of Psychiatry, Ain Shams University from June 1, 2006 to May 31, 2008, and who fulfilled the inclusion criteria and agreed to participate in the study. They were assessed 3 weeks after admission and after resolution of most of the withdrawal symptoms using Addiction Severity Index, Beck Depression Inventory, Comprehensive Sleep Disorder Questionnaire, and all-night polysomnography. Ten healthy matched volunteers were taken as controls to be assessed using Sleep Questionnaire and all-night polysomnography. Results Significant differences in sleep complaints included reports of insomnia, hypersomnolence, increased sleep latency, and reduced sleep time in the group of patients. Regarding polysomnography, patients differed significantly from controls, in having prolonged sleep latency, decreased sleep efficiency, increased arousal index, increased stages I and II, and decreased slow wave sleep (SWS). Patients with moderate and severe depressive states had significantly lower SWS than those with mild depressive state. Conclusions Patients with opioid dependence suffer from sleep disturbances that continue for a period of time, even after discontinuation of the abuse drug. The nature of sleep disturbance is related more to NREM sleep, especially SWS and sleep continuity, as well as efficiency parameters. No significant correlation was found between sleep profile and various abuse variables such as duration of abuse and type of opioids.

Public Managed Care and Service Access in Outpatient Substance Abuse Treatment Units

The continued growth of public managed behavioral health care has raised concerns about possible effects on services provided. This study uses a national sample of outpatient substance abuse treatment units surveyed in 2005 to examine associations between public managed care and service access, measured as both the types of services provided and the amount of treatment received by clients. The percentage of clients funded through public managed care versus other types of public funding was positively associated with treatment units' odds of providing some types of resource-intensive services and with the odds of providing transportation to clients, but was negatively associated with the average number of individual therapy sessions clients received over the course of treatment. In general, public managed care does not appear to restrict access to outpatient substance abuse treatment, although states should monitor these contracts to ensure clients receive adequate courses of individual treatment.

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Between simplification and complexity – structured interviews and treatment results in substance abuse treatment AIM The article draws on an empirical case study to analyse and discuss the application of structured interviews in evaluating outcomes of substance abuse treatment. METHODS The empirical example, a follow-up study, is based on the structured interview DOK (a Swedish interview instrument similar to the ASI) with 39 clients at an inpatient substance abuse treatment unit, at intake and six months after completed treatment. Changes in self-reported data were analysed between intake and follow-up. The analyses differentiate between subjective client estimations and verifiable data. This is followed by an analysis of individual variations in changes of alcohol and drug use. RESULTS The study shows how it is possible within a sample from a local treatment unit to illustrate relatively big changes on a group level in some of the objective, verifiable variables. Further, depending on the time period (last 30 days or last 6 months), the clients reported significantly differently on their use of the primary drug of abuse. At group level, there was a reduction of self-reported problems within all life areas. There were indications of some relation between verifiable variables and estimation variables. All clients reported, however, that their estimated problems in all life areas persisted to a relatively high degree at follow-up. In order to further point at individual variations in the patterns of change, the results of three different verifiable variables within the area of Alcohol and drugs are reported. The share of positive treatment results vary between 13–64 %, depending on definition and operationalisation. CONCLUSIONS The study is an example of an analytical model that can be applied in a local treatment unit with data from structured interviews. The results illustrate the problems with using questions about alcohol and drug use only for the last 30 days in follow-up studies. The results also indicate that subjective evaluations have no self-evident relation to reported changes within one life area. It is thus problematic to use a self-reported problem as an outcome measure or mix this measure with other outcome data.

Factors Associated With Use of ASAM Criteria and Service Provision in a National Sample of Outpatient Substance Abuse Treatment Units

Standardized patient placement criteria such as those developed by the American Society of Addiction Medicine are increasingly common in substance abuse treatment, but it is unclear what factors are associated with their use or with treatment units' provision of related services. This study examined these issues in the context of a national survey of outpatient substance abuse treatment units. Regressions using 2005 data revealed that both public and private managed care were associated with a greater likelihood of using American Society of Addiction Medicine criteria to develop client treatment plans. However, only public managed care was associated with a greater likelihood of offering more resource-intensive services. Associations between client population severity and resource-intensive service provision were sparse but positive.

Employing super-efficiency analysis as an alternative to DEA: An application in outpatient substance abuse treatment

A common technique for conducting efficiency analyses consists of a two-stage procedure that combines data envelopment analysis (DEA) with Tobit regression. As the DEA scores are censored at one, this method has the drawback of masking important information at the upper tail of the distribution of scores. In this paper, we present a DEA-based methodology for a two-stage efficiency analysis where the upper bound constraint of one for the efficiency scores is relaxed. This method, super-efficiency DEA, is contrasted with the two-stage approach that employs traditional, bounded DEA scores. We use data from the National Drug Abuse Treatment Survey to examine how the relative efficiency of the treatment units is affected by the organizational structures, operating characteristics and treatment modalities of a nationally representative sample of outpatient substance abuse treatment units. Our results show that the super-efficiency DEA approach offers advantages over the traditional methodology. It is easy to implement, and, for the same sample size provides more information.

Top Manager Effects on Buprenorphine Adoption in Outpatient Substance Abuse Treatment Programs

To examine the influence of top managers' characteristics on the adoption of buprenorphine for opioid dependence among U.S. outpatient substance abuse treatment units, this investigation analyzed a cross-sectional national study of 547 such units in the 2004-2005 wave of the Drug Abuse Treatment System Survey. Administrators reported their demographics, training, and treatment orientation, as well as features of the unit and its pattern of use of buprenorphine. Nationally, 15.8% of programs offered any buprenorphine services. Greater adoption of buprenorphine correlated with directors' younger age, longer tenure, male gender, and weaker endorsement of abstinence as the most important treatment goal. Availability of naltrexone and medical services also correlated positively with buprenorphine adoption. The authors conclude that leaders' characteristics are related to the adoption of innovative practices in addiction treatment programs. Future work should examine whether leadership development for community addiction programs might speed up the diffusion of buprenorphine and other innovative, evidence-based practices.

Who Cares for Involuntary Clients?

ABSTRACT The objectives of this study were to compare characteristics of outpatient substance abuse treatment (OSAT) units that serve high proportions of involuntary clients (ICs) with those that serve a low percentage of such clients. The authors analyze unit-level 1995–2005 data from the National Drug Abuse Treatment System Survey (NDATSS). Approximately 1/6 of OSAT units draw the dominant majority of their clients from involuntary referrals. OSAT units that treat a high proportion of ICs are less likely to be accredited by professional organizations, have fewer treatment staff with advanced degrees, and have shorter average treatment duration than do OSAT units that serve few ICs. OSAT units that serve ICs are more likely to offer legal and domestic violence services but are less likely to offer mental health services or aftercare. OSAT units that serve ICs are less likely to be hospital-affiliated than are other units. Clients at such facilities are more likely to be convicted of driving while intoxicated (DWI), are younger, are less likely to have received prior treatment, are more likely to remain abstinent after treatment, but are more likely to be remanded back to courts. The authors conclude that ICs are an important market niche in OSAT care. DWI is by far the most common offense reported in units that specialize in ICs. Aside from legal and domestic violence services, units with a high proportion of ICs appear to offer somewhat less intensive and professionalized services than do other facilities; however, clients at these units are more likely to be abstinent at the end of treatment and but more likely to be remanded back to the courts.

Factors Associated With Use of ASAM Criteria and Service Provision in a National Sample of Outpatient Substance Abuse Treatment Units

Factors Associated With Use of ASAM Criteria and Service Provision in a National Sample of Outpatient Substance Abuse Treatment Units

Organizational determinants of outpatient substance abuse treatment duration in women

Longer treatment duration has consistently been related to improved substance use outcomes. This study examined how tailored women's programming and organizational characteristics were related to duration in outpatient substance abuse treatment in women. Data were from two waves of a national outpatient substance abuse treatment unit survey ( n = 571 in 1999/2000, n = 566 in 2005). Analyses were conducted separately for methadone and nonmethadone programs. Negative binomial regressions tested associations between organizational determinants, tailored programming, and women's treatment duration. Of the tailored programming services, childcare was significantly related to longer duration in the nonmethadone programs, but few other organizational factors were. Tailored programming was not associated to treatment duration in methadone programs, but ownership, affiliation, and accreditation were related to longer duration. Study findings suggest evidence for how external relationships related to resources, treatment constraints, and legitimacy may influence women's treatment duration. Methadone programs may be more vulnerable to external influences.

Organizational determinants of boundary spanning activity in outpatient substance abuse treatment programmes

Substance abuse treatment programmes depend on boundary spanning to identify opportunities and threats, and represent their interests to stakeholders such as licensing entities and regulators. This study sought to identify director, client, unit and market factors associated with active director boundary spanning. Using data from the 1995, 1999-2000 and 2005 waves of a national survey of outpatient substance abuse treatment units, generalized estimating equation regression models tested associations between predictors and five aspects of directors' self-reported boundary spanning. Directors licensed as substance abuse treatment counsellors spent more time than average consulting with other treatment providers and making presentations in the community. Older directors spent less time consulting with other treatment providers, making community presentations and liaisoning with monitoring organizations. The few associations between client unemployment and director boundary spanning were positive; the two associations between the percentage of clients who were African-American and boundary spanning were negative. Private ownership and being based in larger organizations were negatively associated with some types of boundary spanning. Perceived competition for public support was positively associated with all measures of boundary spanning. Directors of treatment organizations may improve treatment practices and political leverage by directly, but selectively, interacting with key external stakeholders.