Enhancing motivation within a rapid opioid substitution treatment feasibility RCT: a nested qualitative study

Substance Abuse Treatment, Prevention, and Policy

Maggie Telfer³  Angela Beattie²  Jane Neale³  Avril Rees³  Jenny Ingram¹  Rachel Ayres³ 

[1] School of Social and Community Medicine, University of Bristol, Oakfield House, Bristol BS8 2BN, UK;School of Social and Community Medicine, University of Bristol, Canynge Hall, Bristol BS8 2PS, UK;Bristol Drugs Project, Brunswick Square, Bristol BS2 8PE, UK

关键词: Qualitative interviews;    Self-determination theory;    Cognitive dissonance;    Motivational interviewing;    Opioid substitution treatment;   

Others  :  1131525
DOI  :  10.1186/1747-597X-9-44

 received in 2014-06-06, accepted in 2014-10-25,  发布年份 2014

【 摘 要 】

Background

Opioid substitution treatment (OST) has multiple benefits for heroin injectors and is an evidence-based major component of international treatment. The current qualitative study sought to explore participants’ attitudes to and reasons for participating in a feasibility randomised trial in primary care offering ‘same day’ OST (methadone) for injecting heroin users compared to usual care.

Methods

Twenty injecting heroin users (8 intervention and 12 controls; 16 males and 4 females) were interviewed; purposive sampling was used to select a maximum variation sample from those who agreed; and analysis used thematic methods.

Results

Motivation to join the trial included the need to secure treatment set against some ambivalence due to previous negative experiences of trying to obtain OST. Positive effects of securing methadone via the trial, included self-reported improvements in health and self-care; reduction in crime, stress and drug use. Completing the baseline questionnaires at recruitment appeared to enhance motivation for treatment for all participants. For some control participants, this motivation seemed to increase a sense of self-efficacy and cognitive dissonance generated was resolved by seeking treatment from their GP. Self-determination theory suggests that behaviour change may have been initiated during the recruitment appointment, resulting in an increased determination to seek treatment amongst control participants.

Conclusions

Taking part in the ‘script in a day’ trial enabled participants in the intervention arm to gain same-day access to methadone and reduce their drug use. For those in the control arm, completing the baseline questionnaires at recruitment appeared to create cognitive dissonance between their current health state and own aspirations, so increasing motivation for treatment. Over 50% obtained and were still in receipt of OST (methadone or buprenorphine) at the 3 month follow-up. We suggest that a regular ‘health evaluation’ for injecting heroin users not in treatment, paired with low-barrier access to treatment, may be a way of exploring this and encouraging more into obtaining OST more quickly and at the best time for them. This intervention should be delivered without pressure for change.

Clinical trial registration

This trial is registered with International Standard Randomised Controlled Trial Number Register: SCript In a Day for injecting drug users: feasibility trial: ISRCTN16846554.

【 授权许可】

   
2014 Ayres et al.; licensee BioMed Central Ltd.

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