A qualitative examination of substance use service needs among people who use drugs (PWUD) with treatment and service experience in Ontario, Canada

Background People who use drugs (PWUD) often have complex health and social support needs related to substance use, yet face numerous barriers to service access, resulting in unmet treatment needs and a corresponding gap in treatment. While initiatives to scale up substance use services for PWUD in Canada - and Ontario - have been undertaken, these have excluded PWUD’ perspectives, and their needs have largely been defined by other actors. As end-users of services, PWUD’ perspectives are vital to understanding what services are required, and whether existent services are adequate, appropriate and effective. Thus, the present study aimed to elicit in-depth knowledge from PWUD with lived experience of accessing services to better understand their unmet treatment and service needs, towards closing the service and treatment gap in Ontario. Methods This qualitative study included one-on-one interviews conducted with a cohort of n = 45 adult PWUD with substance use and treatment experience in Ontario, Canada. Participants were recruited from substance use services based on ConnexOntario’s directory of all provincial addiction services, as well as by word-of-mouth. Questions focused on participants’ experiences and perspectives on substance use services towards understanding their service needs. Data underwent an inductive thematic analysis based on key themes that emerged. Results Participants commonly engaged in polysubstance use, and identified a number of unmet substance use service needs including complex factors within the current service system that influenced access to available programs. Specifically, participants suggested the need to address stigmatization and system fragmentation, increase service provision and capacity, and scale up specific services and related supports such as harm reduction, counseling, treatment, and housing. Conclusions This study identified PWUD’ needs in relation to substance use service provision in Ontario, Canada, and highlighted important areas for policy change and program planning and implementation. Concrete recommendations include the development of a government-funded, low-barrier, comprehensive and integrated service delivery and referral models that include PWUD as collaborators and program facilitators to ensure that services are as accessible, effective, and cohesive as possible. Results from this study can be used to enhance provincial substance use treatment and service provision.

Changes in youth mental health, psychological wellbeing, and substance use during the COVID-19 pandemic: A rapid review

Background: The focus of this review was to assess changes in youth mental health, psychological wellbeing, or substance use, as well as changes or disruptions to the delivery of mental health or substance use services for young people during the COVID-19 pandemic. Method: We conducted a rapid review of the literature on our outcomes of interest among youth (age <=25) in the context of the COVID-19 pandemic. Primary studies and systematic reviews on change were eligible for inclusion. Searches were conducted in PubMed and Embase in May 2021, and two reviewers screened studies for inclusion. We report results using a narrative synthesis.Results: We included 156 primary publications. A variety of methods were used to assess change, including prospective assessment of longitudinal cohorts, retrospective recall by participants in cross-sectional and qualitative studies, and comparison of peri-pandemic data to pre-pandemic normative values. Publications regarding mental health (n = 121) and psychological wellbeing (n = 26) generally indicated poor outcomes during the pandemic period. Publications on substance use (n = 41) revealed overall declines or unchanged patterns of use, though certain groups reported increased or problematic use. Studies of service delivery (n = 11) indicated a generally positive reception for helplines and telehealth, although some youth experienced difficulties accessing mental health services. Conclusions: The evidence indicates negative impacts of the COVID-19 pandemic on young people’s mental health, although declines in alcohol and nicotine use were also found. Services will need to continue to adapt as the pandemic progresses, particularly to support disadvantaged youth who lack access to telehealth resources.

Using the Behaviour Change Wheel to design an intervention for partner abusive men in drug and alcohol treatment

Background We aimed to establish what core elements were required in a group therapy programme for men who disclose perpetrating intimate partner abuse in a substance use setting and develop, and test the feasibility of delivering an intervention in this setting. Methods We describe the theoretical development and feasibility testing of an integrated substance use and intimate partner abuse intervention (‘ADVANCE’) for delivery in substance use services. We employed a comprehensive eight-stage process to guide this development applying the ‘COM-B’ (‘capability’, ‘opportunity’, ‘motivation’ and ‘behaviour’) model for intervention design which specifies the following: (1) define the problem, (2) select the target behaviour, (3) specify the target behaviour, (4) identify what needs to change, (5) identify intervention functions, (6) identify policy categories, (7) select behaviour change techniques, and (8) design a mode of delivery. The development was informed by primary research conducted by the authors, consulting with organisation steering groups and by those with personal experiences. The identified targets for intervention and mode and method of delivery were then refined over 4 intervention development meetings, using the nominal group technique with the ADVANCE experts, then further refined following consultation with service user groups and wider expert groups via a learning alliance meetings. Results Our final intervention, the ADVANCE intervention consisted of a group intervention comprising of up to four pre-group individual interviews, followed by 12 × 2-h group sessions supported by integrated safety work for victim/survivors, and risk and safety support and integrity support for the professionals. The main targets for change were personal goal planning, self-regulation, and attitudes and beliefs supporting intimate partner abuse. The intervention was regarded as very acceptable to both staff and clients in substance use services, with group attendees reported positive behaviour changes and development of new skills. Conclusion We have demonstrated the ability to employ a structured eight-step process to develop an integrated intervention to address substance use-related intimate partner abuse that is acceptable to staff and clients in substance use services. This led to a feasibility study (ISRCTN 79435190) involving 104 men and 30 staff at three different locations across the UK was conducted to assess the feasibility and acceptability of the intervention and to refine the content and approach to delivery (BMC Public Health, 21: 980, 2021).

Patient and Family Engagement

British Columbia Mental Health and Substance Use Services (BCMHSUS) provides mental health services, education, and health promotion initiatives to people with mental health and substance use issues across the province of BC. As a Project Coordinator in the Patient and Community Engagement portfolio, I performed a variety of work to support patient and family engagement under the newly created Patient Engagement Framework. Engaging patients and families as active participants and co-designers of their own care is an important component of patient-centred care that improves healthcare quality, health outcomes, and overall experiences of care at a system level. To work towards this goal, I developed a trauma-informed policy and procedure for BCMHSUS on patient and family engagement to serve as a guideline for giving patients and families a voice in the design and delivery of their mental health care. I also drafted two patient engagement playbooks called Managing Conflict and Respecting Emotions and Engaging Mandated and Incarcerated Patients, which focus on barriers and solutions to engaging patients in vulnerable circumstances. Moreover, I worked with provincial stakeholders to write the annual report for the BC Partners, which is a collaborative mental health promotion partnership between BCMHSUS and 7 provincial organizations with different mental health and substance use specialties (e.g. BC Schizophrenia Society, The Mood Disorders Association of BC, Canadian Institute for Substance Use Research, etc.). I also performed a literature review of the evidence supporting family engagement in patient- and family-centred care, and I made infographics and other visual designs to translate research and knowledge in visually appealing ways. Overall, my practicum helped me contribute towards advancing public mental health by valuing patients' knowledge, skills, and lived experience in the health system and working on a variety of initiatives to promote mental health in the province.

The Necessity of a Trauma-Informed Paradigm in Substance Use Disorder Services

OBJECTIVE To raise awareness and understanding about the role of trauma in the development of substance use and to define and clarify the need for trauma-informed care within the treatment of patients with substance use disorders (SUDs). METHOD This article reviews the up-to-date literature on how and why traumatic life experiences promote a neurobiological vulnerability to development of SUDs and combines this with a discussion of the principles of trauma-informed care for SUDs, as well as a review of the role of stigma and structural violence as foundational concepts in the implementation of trauma-informed care for people with SUDs. RESULTS Shifting to a trauma-informed care paradigm in treating SUDs more effectively serves patients by improving patient experiences and accounting for a chronic disease model, wherein multiple episodes of SUD care are often necessary. CONCLUSIONS This article reviews the ways in which nurses and other service providers can increase SUD patient retention and decrease recurrence by understanding the role of trauma in the development of SUDs, exploring the role of stigma, and identifying and interrupting structural violence as it relates to SUDs. This article also offers actionable steps that all nurses can take now as well as areas for further inquiry into trauma-informed care substance use services.