The First Step in Changing Behavior: Understanding the Reasons Behind It
The United Kingdom is shifting its primary substance use disorder (SUD) treatment philosophy from harm minimization (e.g., reducing crime, medical illness, etc.) to an abstinence-based model of recovery.
Understanding how patients currently engaged in harm minimization approaches view abstinence and recovery is important for adapting treatments and developing new interventions.
In this study, Notley and colleagues interviewed 27 participants with 5 or more years of participation in methadone maintenance as well as 10 members of treatment staff at a program in the UK to assess their perspectives on these issues.
Several themes emerged under the general categories of the experience of long term medication-assisted therapy and recovery barriers:
- participants communicated benefits consistent with harm reduction philosophy, notably medication offering “an escape from the chaos of drug use”
- opportunities to disengage from criminal activity
- replacement of the routine of daily drug use with daily medication adherence (some cited it only as a substitute for when they were unable to get their drug of choice (e.g., heroin), though most reported a shift from this purpose to one where they engaged more fully with the maintenance program).
- fears of opiate withdrawal and having been encouraged to come off methadone before being ready
- the risks of living in neighborhoods or with partners where drugs are prevalent were viewed as barriers to abstinence
- the stigma of being on methadone maintenance, and the discrimination faced particularly in work and health care settings.
Regarding barriers to recovery, authors found that many adopted a drug using identity, preventing them from imagining their lives completely abstinent from all drugs including alcohol. They also highlighted fears around emotion regulation and destabilized mental health if not taking methadone.
They described a pattern whereby participants experience heightened, if not unpleasant emotions, ultimately leading them to return to methadone, which helped regulate emotions, ultimately reinforcing their connection to the methadone program and drug using identity.
Qualitative research is a valuable method when studying a relatively new area or a new paradigm within the area. These data can convey a richness and complexity not afforded by quantitative data, and also may help generate hypotheses for future investigation.
In this study, authors sought to explore perceptions of abstinence and recovery to inform how best to respond to a philosophical shift in the UK treatment field away from its harm reduction emphasis.
Among conclusions drawn from this qualitative study, perhaps most important is the need for professional or ongoing support to help methadone patients face the challenges associated with abstinence, including heightened emotions, environmental and social risks, and addressing ambivalence.
Notley, C., Blyth, A., Maskrey, V., Pinto, H., & Holland, R. (2015). Exploring the concepts of abstinence and recovery through the experiences of long-term opiate substitution clients. Substance abuse, 36(2), 232-239.