Patients in office-based opioid treatments’ definitions of treatment success and recovery are not well understood. This is important because traditional ways of defining and measuring success focus on consumption, and usually abstinence. This definition does not encompass medication-assisted treatment, such as office-based opioid treatment, which do not necessitate abstinence. Moreover, there is evidence to support the efficacy of office-based opioid treatment in reducing the harm associated with opioid misuse, which is important as opioid misuse has increased and leads to serious consequences for individuals, families, and society. To address this gap in the literature, using a qualitative design, this dissertation explored patients’ ideas on defining office-based opioid treatment success, recovery, facilitators and barriers to treatment success, and recommendations for measuring success. This was achieved by conducting a focus group with seven participants and subsequent interviews with seven participants, two of whom were also in the focus group, for a total of 12 office-based opioid treatment patients in rural Alaska. Grounded theory, directed content analysis, and a community-based participatory research approach were used to collect and analyze focus group and interview data. Findings suggest that patients’ definitions of office-based opioid treatment success extend beyond consumption and include four main themes: functioning, such as contributing to society and living a functional lifestyle; accomplishing, such as reappraising life goals and having an intrinsic belief that one can accomplish success; relationships, such as family, friendships, and restoring relationships; and psychological factors, such as emotional wellbeing and addiction. Recovery was understood as a construct that was related to success, yet distinct, and involved healing and growth, a process, and a recovery attitude. Facilitators and barriers to treatment success include treatment factors, contextual factors, and psychological factors. Participants also recommended measuring success in a way that is individualized and flexible. This study suggests that providers should take a multifaceted and patient-driven approach when attempting to define and measure office-based opioid treatment success. Specifically, findings suggest that patients experience success in office-based opioid treatment in ways that extend beyond substance consumption. Findings also suggest that contextual barriers, such as availability and accessibility of treatment, should be addressed on a systemic level.
Thesis (Ph.D.) University of Alaska Fairbanks, 2016
Table of Contents
Chapter 1: Introduction -- Background -- Defining and Measuring Success -- Patient-Driven Definition of Success -- Study Aims and Research Questions -- Chapter 2: Literature Review -- Section A: Opioid Misuse and Treatment -- Opioids, Opioid Use, and Opioid Misuse -- Models Informing Treatment Approaches -- Substance Use Treatment -- Methadone -- Buprenorphine -- Methadone Compared to Buprenorphine -- Treatment in Alaska -- Conclusion -- Section B: Defining and Measuring Success -- Recovery -- Success -- Measuring Success -- A Case for a Patient-Informed Definition of Success -- Chapter 3: Research Design and Methodology -- Overarching Study Design -- Detailed Methodological Approach -- Eligibility, Recruitment, and Sampling Considerations -- Participant Characteristics -- Data Collection -- Data Analysis -- Rigor -- Chapter 4: Findings -- Qualitative Findings -- Participants’ Experiences of Being in the Study -- Success/Recovery Tree: An Integrated Conceptual Model -- Chapter 5: Discussion -- Success -- Recovery -- Facilitators and Barriers -- Measurement -- Implications -- Other Considerations, Limitations, and Strengths -- Conclusion -- References -- Appendices.
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