Ledelse mellom sterke ideologier og lillebrorkomplekser – en eksplorerende studie i tverrfaglig spesialisert rusbehandling

Background: Substance use treatment has long traditions in Norway, but it was not until 2004 that it became part of the specialist health service, leading to new leadership requirements. The aim of this study was to understand how the field is perceived from a leadership perspective and how leaders perceive their leadership role. Method: The study is based on three focus group interviews with the mentors of 28 network groups. Data were analysed through systematic text condensation. Results: The analysis resulted in a clustering of four aspects the informants reported to characterise their perceptions of their leadership role: the inferiority complex, values ​​in substance use treatment, pragmatic leadership, and subjective leadership. Implications: The analysis shows that informal hierarchies of power, ideology, and expectations of interdisciplinarity in all decisions provide fertile ground for a flat structure and ambiguity in management. The findings reveal the need for measures to strengthen recognition of the field and develop the leadership role. Keywords: Substance use treatment, leadership, drugs, addiction, health, leadership development

Whose responsibility? Part 2 of 2: views of patients, families, and clinicians about responsibilities for addressing the needs of persons with mental health problems in Chennai, India and Montreal, Canada

Background Individuals with mental health problems have many insufficiently met support needs. Across sociocultural contexts, various parties (e.g., governments, families, persons with mental health problems) assume responsibility for meeting these needs. However, key stakeholders' opinions of the relative responsibilities of these parties for meeting support needs remain largely unexplored. This is a critical knowledge gap, as these perceptions may influence policy and caregiving decisions. Methods Patients with first-episode psychosis (n = 250), their family members (n = 228), and clinicians (n = 50) at two early intervention services in Chennai, India and Montreal, Canada were asked how much responsibility they thought the government versus persons with mental health problems; the government versus families; and families versus persons with mental health problems should bear for meeting seven support needs of persons with mental health problems (e.g., housing; help covering costs of substance use treatment; etc.). Two-way analyses of variance were conducted to examine differences in ratings of responsibility between sites (Chennai, Montreal); raters (patients, families, clinicians); and support needs. Results Across sites and raters, governments were held most responsible for meeting each support need and all needs together. Montreal raters assigned more responsibility to the government than did Chennai raters. Compared to those in Montreal, Chennai raters assigned more responsibility to families versus persons with mental health problems, except for the costs of substance use treatment. Family raters across sites assigned more responsibility to governments than did patient raters, and more responsibility to families versus persons with mental health problems than did patient and clinician raters. At both sites, governments were assigned less responsibility for addressing housing- and school/work reintegration-related needs compared to other needs. In Chennai, the government was seen as most responsible for stigma reduction and least for covering substance use services. Conclusions All stakeholders thought that governments should have substantial responsibility for meeting the needs of individuals with mental health problems, reinforcing calls for greater government investment in mental healthcare across contexts. The greater perceived responsibility of the government in Montreal and of families in Chennai may both reflect and influence differences in cultural norms and healthcare systems in India and Canada.

A national study of the availability of law enforcement agency wellness programming for officers: A latent class analysis

The purpose of this study is to understand the availability of employee wellness programs within law enforcement agencies (LEAs) across the United States, including physical fitness, resilience/wellness, coping skills, nutrition, mental health treatment, and substance use treatment. The research team investigated whether patterns of LEA wellness programming are identifiable and, if so, what characteristics describe these patterns. We assess using latent class analysis whether there are distinct profiles of agencies with similar patterns offering different types of wellness programs and explore what characteristics distinguish agencies with certain profiles of wellness programming. Data were from a nationally representative sample of 1135 LEAs: 80.1% municipal, 18.6% county and 1.3% other agencies (state-level and Bureau of Indian Affairs LEAs). We found that many agencies (62%) offer no wellness programming. We also found that 23% have comprehensive wellness programming, and that another group of agencies specialize in specific wellness programming. About 14% of the agencies have a high probability of providing resilience coping skill education, mental health and/or substance use treatment services programming. About 1% of the agencies in the United States limit their programming to fitness and nutrition, indicating that fitness and nutrition programs are more likely to be offered in concert with other types of wellness programs. The analyses revealed that agencies offering broad program support are more likely to be large, municipal LEAs located in either the West, Midwest or Northeast (compared with the southern United States), and not experiencing a recent budget cut that impacted wellness programming.

Reported Barriers to Hepatitis C Treatment among Pregnant and Early-Parenting Mothers Undergoing Substance Use Disorder Treatment in One U.S. State

Nationwide, the prevalence of the hepatitis C virus (HCV) has risen in recent years. At least 90% of infected persons must be treated to achieve global elimination targets. The current study aimed to explore barriers to, and facilitators of, direct-acting antiviral (DAA) HCV treatment uptake amongst pregnant and early-parenting women undergoing comprehensive substance use treatment. Twenty participants with documented HCV antibody positivity were recruited from two substance use treatment centers in central Kentucky. Semi-structured interviews were conducted to explore knowledge about HCV, previous experiences, and intentions to seek care. Themes were extracted using an inductive analytical approach. Most participants were aware of the dangers posed by HCV infection. However, there was a high degree of misinformation about transmission mechanisms and treatment eligibility requirements. Low priority for HCV treatment also surfaced as a barrier to treatment uptake. Participants reported being unable to seek care due to time and resource limitations in the presence of a highly demanding treatment process. Findings from the current study suggest that more work is needed to eliminate residual barriers that limit access to HCV treatment among pregnant and early-parenting women in treatment for substance use disorder.

A gendered difference? Female experience of drug and alcohol treatment in New Zealand

<p>This study examined women’s experiences of drug and alcohol treatment in New Zealand, with a focus on Methadone Maintenance Treatment (MMT). The qualitative literature on the treatment experiences of substance-using women is scarce, especially in a New Zealand context, with the majority of literature being quantitative, male-focused, and lacking the female voice. Available literature suggests that substance-using women have unique needs and experiences which must be addressed and acknowledged in treatment for a long-lasting positive change. This thesis aims to explore the experiences of women who have or are attending substance use treatment in New Zealand and their recommendations for improving substance use treatment for women. Areas examined include the experience of stigma, connections and relationships in treatment, and the importance of knowledge. These factors culminate in an exploration of participants’ suggestions for improvement. The current study is qualitative, feminist-informed and employed the use of semi-structured interviews with 11 women who have been or are currently in treatment as well as two service providers. The data from these interviews was analysed using Thematic Analysis, finding that women in this study overall had positive experiences. However, there were several areas for improvement suggested by participants including a need for greater access to treatment options, particularly gender-sensitive, holistic approaches. A need for greater knowledge amongst service providers, especially General Practitioners (GPs), on how to treat problematic substance use and the available treatment options was also expressed. Women on MMT had similar, yet varied, experiences compared to those attending other treatments.</p>

A gendered difference? Female experience of drug and alcohol treatment in New Zealand

<p>This study examined women’s experiences of drug and alcohol treatment in New Zealand, with a focus on Methadone Maintenance Treatment (MMT). The qualitative literature on the treatment experiences of substance-using women is scarce, especially in a New Zealand context, with the majority of literature being quantitative, male-focused, and lacking the female voice. Available literature suggests that substance-using women have unique needs and experiences which must be addressed and acknowledged in treatment for a long-lasting positive change. This thesis aims to explore the experiences of women who have or are attending substance use treatment in New Zealand and their recommendations for improving substance use treatment for women. Areas examined include the experience of stigma, connections and relationships in treatment, and the importance of knowledge. These factors culminate in an exploration of participants’ suggestions for improvement. The current study is qualitative, feminist-informed and employed the use of semi-structured interviews with 11 women who have been or are currently in treatment as well as two service providers. The data from these interviews was analysed using Thematic Analysis, finding that women in this study overall had positive experiences. However, there were several areas for improvement suggested by participants including a need for greater access to treatment options, particularly gender-sensitive, holistic approaches. A need for greater knowledge amongst service providers, especially General Practitioners (GPs), on how to treat problematic substance use and the available treatment options was also expressed. Women on MMT had similar, yet varied, experiences compared to those attending other treatments.</p>

Substitute Behaviors following Residential Substance Use Treatment in the Western Cape, South Africa

The dynamics of substitute behaviors and associated factors remain poorly understood globally, and particularly in low- and middle-income contexts. This prospective study describes the prevalence and types of substitute behaviors as well as predictors, correlates, and motivations associated with substitution in persons (n = 137) admitted to residential substance use treatment in the Western Cape province of South Africa. The brief assessment of recovery capital, overall life satisfaction scale, and an adapted version of the addiction matrix self-report measure were completed during and post-treatment. Results indicate that substitutes were employed consciously for anticipated appetitive effects, for time-spending, (re)connecting with others, and enjoyment. At follow-up, 36% of service users had substituted their primary substance(s) with another substance or behavior; 23% had relapsed and 40% had maintained abstinence. While some service users may be especially vulnerable to developing substitute behaviors, targeted prevention and intervention efforts can reduce this risk.