Rudzinski Katherine, O'Leary William, Perri Melissa, Guimond Tim, Guta Adrian, Chan Carusone Soo, Strike Carol
Dalla Lana School of Public Health, University of Toronto, 155 College St 5th floor, Toronto, ON M5T 3M7, Canada.
Casey House, 119 Isabella St, Toronto, ON M4Y 1P2, Canada.
J Subst Use Addict Treat. 2023 Apr;147:208974. doi: 10.1016/j.josat.2023.208974. Epub 2023 Feb 10.
Community reinforcement approach (CRA) is a behavioral intervention that has demonstrated favorable treatment outcomes for individuals with substance use disorders across studies. CRA focuses on abstinence; however, abstinence is not a desired goal among all people who use substances. Previous research has called for harm reduction-oriented treatment programs, especially within hospital settings. We examined the feasibility of a pilot CRA program, "Exploring My Substance Use" (EMSU), that integrates a harm-reduction perspective with structured recreation therapy at a specialty HIV hospital in Toronto, Canada.
The 12-week EMSU program was delivered alongside a feasibility study that ran for 24 weeks (including an additional 12 weeks after program completion). We recruited hospital in/outpatients with moderate to severe substance use disorder to participate in the program and study. The EMSU program combined weekly substance use groups with weekly recreation therapy sessions. We collected data at five timepoints throughout the study; this article focuses on qualitative data from the final (24-week) interviews, which examine participants' experiences of the program-an under-researched element in CRA literature. We conducted thematic analysis in NVivo12 and descriptive statistics in SPSSv28.
Of the n = 12 participants enrolled in the EMSU program, six completed the 12-week intervention. All participants completed the 24-week study interview. The average age of participants was 41.5 years; eight identified as cis-male; most identified as white, experienced food insecurity, and were unstably housed. All participants valued the program, including opportunities to learn new skills and examine function(s) of their substance use, and would enroll if it were offered again. Participants discussed the benefits of leisure activities introduced through recreation therapy, which fostered social connections and provided inspiration/confidence to try new activities. Participants cited a lack of support for those experiencing health/personal challenges and overly strict program attendance rules. To improve the program, participants suggested more tactile activities and incorporating incentives.
Our findings support the feasibility of a CRA-based program with an integrated harm reduction and a recreation therapy component within an outpatient setting. Future programs should consider building in more flexibility and increased supports for clients dealing with complexities as well as consider COVID-19 related contingencies.
社区强化法（CRA）是一种行为干预方法，在多项研究中已证明对患有物质使用障碍的个体具有良好的治疗效果。CRA侧重于戒酒；然而，戒酒并非所有使用物质者的期望目标。先前的研究呼吁开展以减少伤害为导向的治疗项目，尤其是在医院环境中。我们在加拿大多伦多的一家专科艾滋病毒医院，研究了一个试点CRA项目“探索我的物质使用”（EMSU）的可行性，该项目将减少伤害的视角与结构化娱乐治疗相结合。
为期12周的EMSU项目与一项为期24周的可行性研究同时开展（包括项目完成后的额外12周）。我们招募了患有中度至重度物质使用障碍的医院门诊/住院患者参与该项目和研究。EMSU项目将每周的物质使用小组与每周的娱乐治疗课程相结合。我们在整个研究过程中的五个时间点收集数据；本文重点关注最终（24周）访谈的定性数据，该访谈考察了参与者对该项目的体验——这是CRA文献中一个研究不足的要素。我们在NVivo12中进行了主题分析，在SPSSv28中进行了描述性统计。
在参加EMSU项目的n = 12名参与者中，6人完成了为期12周的干预。所有参与者都完成了24周的研究访谈。参与者的平均年龄为41.5岁；8人确定为顺性别男性；大多数人确定为白人，经历过粮食不安全，且居住不稳定。所有参与者都重视该项目，包括学习新技能和审视其物质使用功能的机会，并且如果再次提供该项目，他们会报名参加。参与者讨论了通过娱乐治疗引入的休闲活动的好处，这些活动促进了社交联系，并为尝试新活动提供了灵感/信心。参与者提到对那些面临健康/个人挑战的人缺乏支持，以及项目出勤规则过于严格。为了改进该项目，参与者建议增加更多触觉活动并纳入激励措施。
我们的研究结果支持在门诊环境中开展一个基于CRA的项目的可行性，该项目整合了减少伤害和娱乐治疗成分。未来的项目应考虑为应对复杂情况的客户建立更大的灵活性并增加支持，同时考虑与COVID - 19相关的意外情况。
