Department of Humanities and Social Sciences, Mid Sweden University, 10 - 85170, Holmgatan, Sundsvall, Sweden.
Risk and Crisis Research Center, Mid Sweden University, Kunskapens väg 1, Stapelmohrs väg, 831 40, Östersund, Sweden.
Subst Abuse Treat Prev Policy. 2021 May 10;16(1):41. doi: 10.1186/s13011-021-00378-7.
A lack of conceptual modeling of how the components of opioid maintenance treatment (OMT) for opioid dependence (OD) work causes it to occasionally be labeled the "black-box" of treatment. This study had a two-fold objective: First, to analyze which factors related to OMT for OD contribute to the abstinence of problematic use of non-prescribed opioids and sustain recovery, from the patients' perspective; second, to understand which changes OMT produced in the individuals' lives might significantly contribute to relapse prevention.
We used qualitative methods of design, inquiry, and analysis from a convenience sample of 19 individuals in a Swedish treatment setting.
All the participants reported previous cycles of problematic use of non-prescribed opioids and other non-prescribed psychoactive substances, treatment, abstinence, recovery, and relapse before starting the current OMT program. During the pre-treatment stage, specific events, internal processes, and social environments enhanced motivation toward abstinence and seeking treatment. During the treatment stage, participants perceived the quality of the human relationships established with primary social groups as important as medication and the individual plan of care in sustaining recovery. From the participants' perspective, OMT was a turning point in their life course, allowing them a sense of self-fulfillment and the reconstruction of personal and social identity. However, they still struggled with the stigmatization produced by a society that values abstinence-oriented over medication-assisted treatments.
OMT is not an isolated event in individuals' lives but rather a process occurring within a specific social context. Structural factors and the sense of acceptance and belonging are essential in supporting the transformation. Treatment achievements and the risk for relapse vary over time, so the objectives of the treatment plan must account for characteristics of the pre-treatment stage and the availability and capacity of individuals to restructure their social network, besides the opioid maintenance treatment and institutional social care.
由于缺乏对阿片类药物维持治疗（OMT）治疗阿片类药物依赖（OD）各组成部分的概念模型，因此它偶尔会被贴上“治疗黑箱”的标签。本研究有两个目的：首先，从患者的角度分析哪些与 OD 的 OMT 相关的因素有助于非处方阿片类药物问题使用的戒除和维持康复；其次，了解 OMT 对个人生活产生的哪些变化可能对预防复发有重大贡献。
我们使用来自瑞典治疗环境的 19 名个体的方便样本，采用定性方法进行设计、探究和分析。
所有参与者均报告在开始当前 OMT 计划之前，曾经历过非处方阿片类药物和其他非处方精神活性物质的问题使用、治疗、戒除、康复和复发的循环。在治疗前阶段，特定事件、内部过程和社会环境增强了对戒除和寻求治疗的动机。在治疗阶段，参与者认为与主要社会群体建立的人际关系的质量与药物和个人护理计划一样重要，有助于维持康复。从参与者的角度来看，OMT 是他们人生轨迹的转折点，使他们获得了自我实现感，并重建了个人和社会身份。然而，他们仍然受到社会对以戒除为导向的治疗优于药物辅助治疗的污名化的影响。
OMT 不是个体生活中的孤立事件，而是在特定社会背景下发生的一个过程。结构因素和归属感是支持转变的关键。治疗效果和复发风险会随时间而变化，因此治疗计划的目标必须考虑到治疗前阶段的特点以及个体重新构建社交网络的能力和条件，除了阿片类药物维持治疗和机构社会关怀之外。
