Rachel L Snow1, Rachel E Simon2, Helen E Jack3, Devin Oller4, Laura Kehoe2, Sarah E Wakeman5. 1. Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. 2. Division of General Internal Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA. 3. Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA; Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK. 4. Division of General Internal Medicine, University of Kentucky College of Medicine, 800 Rose Street MN 150, Lexington, KY 40506, USA. 5. Division of General Internal Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA. Electronic address: swakeman@partners.org.
Abstract
BACKGROUND: A minority of patients with substance use disorder (SUD) receives treatment, indicating the need for innovation in care for individuals with SUD. Transitional and low threshold models of care for SUD are utilized to address this treatment gap, but there is limited evidence about their effectiveness or patient perspectives on these models. METHODS: Patients participated in semi-structured interviews (N = 29) which explored their experience in a transitional, low threshold, Bridge clinic for the treatment of SUD. In order to reach a diverse patient population across age, gender, housing status, type of SUD, length of stay, and patient status in the clinic, researchers employed maximum variation sampling. Interviews were conducted until no new central concepts emerged. Codes were developed and assigned using an inductive as well as a mixed inductive-deductive approach. RESULTS: Patients identified flexibility and accessibility of services, compassionate approach of providers and staff, use of peers in recovery, and the emphasis on harm reduction as positive features of the model. Patients struggled with transitioning out of the clinic. CONCLUSION: Patients reported positive experiences in a transitional, low threshold clinic for SUD, comparing it favorably to other programs. Patients maintained sobriety more consistently and increasing motivation to adhere to treatment. Patients almost universally appreciated the flexible and harm reduction-oriented model of treatment. Future quantitative research is needed to further examine the effects of low threshold programs on treatment outcomes, including ongoing substance use, treatment retention and overdose mortality, as compared to traditional treatment programs.
BACKGROUND: A minority of patients with substance use disorder (SUD) receives treatment, indicating the need for innovation in care for individuals with SUD. Transitional and low threshold models of care for SUD are utilized to address this treatment gap, but there is limited evidence about their effectiveness or patient perspectives on these models. METHODS:Patients participated in semi-structured interviews (N = 29) which explored their experience in a transitional, low threshold, Bridge clinic for the treatment of SUD. In order to reach a diverse patient population across age, gender, housing status, type of SUD, length of stay, and patient status in the clinic, researchers employed maximum variation sampling. Interviews were conducted until no new central concepts emerged. Codes were developed and assigned using an inductive as well as a mixed inductive-deductive approach. RESULTS:Patients identified flexibility and accessibility of services, compassionate approach of providers and staff, use of peers in recovery, and the emphasis on harm reduction as positive features of the model. Patients struggled with transitioning out of the clinic. CONCLUSION:Patients reported positive experiences in a transitional, low threshold clinic for SUD, comparing it favorably to other programs. Patients maintained sobriety more consistently and increasing motivation to adhere to treatment. Patients almost universally appreciated the flexible and harm reduction-oriented model of treatment. Future quantitative research is needed to further examine the effects of low threshold programs on treatment outcomes, including ongoing substance use, treatment retention and overdosemortality, as compared to traditional treatment programs.
Authors: Shashi N Kapadia; Judith L Griffin; Justine Waldman; Nicolas R Ziebarth; Bruce R Schackman; Czarina N Behrends Journal: Subst Use Misuse Date: 2021-12-10 Impact factor: 2.164
Authors: Leah Harvey; Jessica L Taylor; Sabrina A Assoumou; Jessica Kehoe; Elissa M Schechter-Perkins; Edward Bernstein; Alexander Y Walley Journal: J Addict Med Date: 2021 Nov-Dec 01 Impact factor: 3.702
Authors: Helen E Jack; Eric D Denisiuk; Brett A Collins; Dan Stephens; Kendra L Blalock; Jared W Klein; Elenore P Bhatraju; Joseph O Merrill; Kevin A Hallgren; Judith I Tsui Journal: Subst Abus Date: 2022-12 Impact factor: 3.984
Authors: Sabrina A Assoumou; Carlos R Sian; Christina M Gebel; Benjamin P Linas; Jeffrey H Samet; Judith A Bernstein Journal: Drug Alcohol Depend Date: 2021-01-11 Impact factor: 4.492
Authors: Sarah K Moore; Elizabeth C Saunders; Bethany McLeman; Stephen A Metcalf; Olivia Walsh; Kathleen Bell; Andrea Meier; Lisa A Marsch Journal: Int J Drug Policy Date: 2021-04-29
Authors: Sabrina A Assoumou; Samantha M Paniagua; Priscilla Gonzalez; Jianing Wang; Curt G Beckwith; Laura F White; Jessica L Taylor; Kristen Coogan; Jeffrey H Samet; Benjamin P Linas Journal: AIDS Behav Date: 2021-03-22
Authors: Delia Motavalli; Jessica L Taylor; Ellen Childs; Pablo K Valente; Peter Salhaney; Jennifer Olson; Dea L Biancarelli; Alberto Edeza; Joel J Earlywine; Brandon D L Marshall; Mari-Lynn Drainoni; Matthew J Mimiaga; Katie B Biello; Angela R Bazzi Journal: J Gen Intern Med Date: 2020-09-11 Impact factor: 5.128
Authors: Jessica L Taylor; Samantha Johnson; Ricardo Cruz; Jessica R Gray; Davida Schiff; Sarah M Bagley Journal: J Gen Intern Med Date: 2021-06-22 Impact factor: 5.128