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Improvement in Access to Treatment for People with Alcohol and Drug Related Problems (IATPAD) was a European study that detected barriers and facilitators to accessing treatment for patients with alcohol and drug‐related problems. This article seeks to compare the findings from a qualitative study with patients and staff in Catalunya (Spain).

The paper describes a multi‐centre, qualitative study. A purposive sample of 47 staff, from a randomly selected sample of the three main entrance points to treatment for patients with alcohol and drug problems in Catalunya, were recruited from: Out‐patient General Psychiatry Centres (CSMA); Out‐patient Addiction Centres (CAS); and Primary Care Centres (CAP). In addition, open‐ended responses were collated from 142 additional staff on barriers and facilitators to accessing treatment for patients with alcohol and drug problems and how these barriers could be improved. A total of 25 patients from two CAS were interviewed in‐depth. The framework approach was used to interpret qualitative interviews.

The main barriers and facilitators to accessing treatment identified by staff and patients were patients' motivation, centres' opening hours, staff attitudes, the provision of information about services, and the co‐ordination and integration of different services – mainly the mental health and addiction sectors.

This paper describes and compares the main barriers and facilitators to accessing treatment from both staff and patients' point of view. Recommendations are made in order to improve service accessibility for patients with addiction problems and those with a dual diagnosis.

Dual diagnosis is a term that describes the co-occurrence of mental health disorders or illness and substance use or abuse disorders. Because this co-occurrence results in multiple diseases, layers of treatment are often needed to successfully create positive change in the individual. The purpose of this study is to explore factors of treatment that could facilitate improvements in functionality and quality of life for those with a dual diagnosis.

A secondary data analysis, using both quantitative and qualitative data, was completed. Secondary analysis is an empirical exercise that applies the same basic research principles as studies using primary data and has steps to be followed, including the evaluative and procedural steps commonly associated with secondary data analysis. Documentation data from the intensive mobile psychosocial assertive community treatment program was gathered for this analysis; this program was used because of the intensive and community-based services provided to patients with a dual diagnosis.

The major findings from this secondary analysis suggested that significant barriers included “denial” (e.g. evasion, suspension or avoidance of internal awareness) of diagnoses, complicated treatment and other barriers related to housing. Ultimately, these findings provided greater insight into potential effective treatment interventions for people living with a dual diagnosis.

This study adds to the growing body of literature showing that patient-centered care allows for more effective treatment and ultimately, improved health outcomes.

We investigate the relationships between violence, drug use and methadone maintenance treatment (MMT) for women injection drug users (IDUs). The data presented here come from a longitudinal study of 233 IDUs both in and out of MMT in the San Francisco Bay Area. Each was interviewed five times over a period of three years, both qualitatively and quantitatively. Using grounded theory principals, we analyze 55 women's accounts of violence. We find that violence acts both as a barrier to entry to treatment and to successful treatment outcomes. Violence is related to drug use and treatment in several ways, primarily in that violence is a traumatic experience to which some women respond by using drugs. Violence may include forced drug use or methadone diversion. Violence may cause women to interrupt or postpone treatment. Finally, two women experienced violence from their treatment providers, which forced them to leave their programs. We suggest that in order to maximize successful treatment outcomes and reduce drug‐related harm for women, violence must be addressed in the treatment process.

Purpose – Despite growing efforts to treat depression, engaging low-income and minority mothers continues to challenge providers. To address this issue, we conducted focus groups to identify responsive strategies for improving engagement of low-income and racially diverse mothers at high risk for depression.

Methods – Three focus group discussions (one prenatal, two postpartum) with 21 low-income and racially diverse mothers were held to determine their definition of depression, attitudes about depression treatment, and perceived barriers to treatment. Discussions took approximately 60 minutes and were audio-recorded. Detailed notes were taken during the discussions. The notes and audio recordings were analyzed using qualitative methods.

Results – Identification of the source of distress, assessing women's perception of treatment and their related costs and benefits, and addressing cultural and financial barriers to treatment emerged as key themes for improving engagement among participants.

Conclusion – To be responsive to women's depression care needs, treatments should be informed by patient perceptions and needs, while addressing barriers to care.

Purpose – Treatment for alcohol and drug addiction in correctional settings has become commonplace throughout much of the United States. The delivery of treatment services in prisons is a promising approach and has certain advantages relative to outpatient and voluntary treatment, including (i) certainty of program enrollment and participation by individuals who would not likely seek treatment on their own (i.e., coerced participation/guaranteed delivery of treatment); (ii) program modalities specific to residential settings as treatment options – in effect, more intensive treatment; and (iii) the parole process ensures participation in post-release aftercare services. During this era wherein reentry is a pronounced theme throughout American corrections, substance abuse treatment is fundamental in terms of rehabilitating offenders, increasing public safety, and lowering recidivism rates and, ultimately, the overall prison population.

Methodology – Using data from a process evaluation of an in-prison alcohol treatment program in Texas, this study examines the environmental barriers to effective recovery present in correctional settings and considers the strengths and weaknesses of coercive treatment, generally.

Findings – Findings indicate that offenders can indeed become motivated to change through coerced treatment. However, study findings also suggested that a certain number of offenders will not become engaged in treatment and fail to develop any internal motivation, which can be problematic for a number of reasons.

Practical implications – The highly coercive and restrictive nature of correctional facilities may negate the overall rehabilitative intent of treatment programs.

The purpose of this paper is to identify risk factors for interruptions in opioid dependence treatment and barriers to (re) entering effective treatment through real-world insight on current opioid dependence treatment in the UK.

Project Access UK, a national survey deployed across multiple regions in England, Wales and Scotland, collected data on the perspectives of patients receiving medication-assisted treatment (MAT) for opioid dependence (n=248), out-of-treatment opioid users (n=196), and physicians (n=100).

Both patients and users reported multiple prior episodes of MAT and detoxification. Among patients, 57 per cent reported continuing illicit drugs use in addition to their treatment, 25 per cent had misused (injected or snorted) and 30 per cent had diverted (sold or given away) prescribed opioid medications. Diverted medications were currently being used by 26 per cent of out-of-treatment users; of these, 21 per cent used methadone. Supervised dosing was rated as the condition of treatment with the biggest impact on daily life. Daily supervision was a requirement for 44, 34 and 23 per cent of patients receiving methadone, mono-buprenorphine and buprenorphine-naloxone, respectively.

Interruptions to opioid dependence treatment in various forms can hamper the recovery of opioid-dependent patients. The benefits of MAT may not be fully realised if treatment is interrupted due to compliance failure, or inflexible treatment programmes leading to premature treatment exit. These findings serve to highlight areas in which treatment disruption can potentially be addressed.

Consideration of these findings may aid in the optimisation of treatment delivery practices to better meet the UK policy of recovery, and ultimately improve patient outcomes.

The UK Mental Health Act (MHA) Reform (2021) on race and ethnicity promotes new governmental strategies to tackle inequalities faced by ethnically racialised communities detained under the MHA. However, there is a scarcity in personality disorder and ethnicity research. This study aims to investigate what is available in the UK in relation to prevalence, aetiology and treatment provisions of personality disorder for ethnically diverse patients, and to understand their interconnectedness with mental health and criminal justice service provisions. Three key areas of investigations were reviewed, (1) UK prevalence of personality disorder amongst ethnically diverse individuals; (2) aetiology of personality disorder and ethnicity; (3) treatment provisions for ethnically diverse individuals diagnosed with personality disorder.

A scoping study review involved a comprehensive scanning of literature published between 2003 and 2022. Screening and data extraction tools were co-produced by an ethnically diverse research team, including people with lived experience of mental health and occupational expertise. Collaborative work was complete throughout the review, ensuring the research remained valid and reliable.

Ten papers were included. Results demonstrated an evident gap in the literature. Of these, nine papers discussed their prevalence, three papers informed on treatment provisions and only one made reference to aetiology. This review further supports the notion that personality disorder is under-represented within ethnic minority populations, particularly of African, Caribbean and British heritage, however, the reasons for this are multi-facetted and complex, hence, requiring further investigation. The evidence collected relating to treatment provisions of personality disorder was limited and of low quality to reach a clear conclusion on effective treatments for ethnically diverse patients.

The shortage of findings on prevalence, aetiology and treatment provisions, emphasises the need to prioritise further research in this area. Results provide valuable insights into this limited body of knowledge from a UK perspective.

It is well established that women face multiple barriers accessing treatment for problematic and unhealthy alcohol use, but less is known about how their interconnected problems affect how they seek help from, and access, alcohol-treatment services. This study aims to explore the dynamic nature of women’s help-seeking for problematic and unhealthy alcohol use and how this can be compounded by unsuitable treatment services, especially when women present with complex needs.

Thirteen semi-structured interviews with women who had accessed alcohol-support services were conducted, audio-recorded, transcribed and analysed thematically using the complexity theory.

For women with complex needs, the process of seeking help may trigger unpredictable behaviours, health or social problems and intermittent serial access to treatment. Current services do not always address women’s holistic needs. Unless services focus on addressing interconnected problems – including historic trauma – they may compound the complexity of women’s problems. Complexity theory offers novel insights into this process, a concept not applied to problematic and unhealthy alcohol use treatment previously.

Services should adopt the complexity-focused perspective featured in this study. While the authors acknowledge the increase in gender-responsive provision, the limitations of this study include a small sample size, the self-selecting nature of the sample and retrospective reporting. Participants were recruited and selected by service staff resulting in gatekeeping and possible sampling bias.

Services should adopt non-linear approaches to treatment. Implementing complexity approaches to treating women’s problematic and unhealthy alcohol use should capture the dynamics, complexity and non-linear nature of women’s help-seeking journeys as well as their internal and external responses that may result in relapse. The authors recommend complexity-focused, multiple-component and integrated collaborative strategies to address not only addiction but also all components of women’s needs, including past trauma.

Applying complexity-thinking to help-seeking experiences for alcohol treatment and recovery services is novel and proved useful in understanding the variety of women’s experiences and how these interact with their help-seeking behaviours, including treatment environments.

The purpose of this paper is to illustrate how local drug services use their senior staff to respond to emerging ethnic groups presenting to treatment using flexible thinking and innovative processes.

The methodology was a case study design that used a semi-structured questionnaire that looked at two drug services and their staff’s influence on service delivery in different boroughs of east London.

The research found very innovative findings from the two boroughs. The boroughs had different racial mixes and therefore differing populations presenting to their local drug services. However, they used flexible approaches to structure their services to engage with emerging ethnic minority populations in drug treatment. From the findings, these different approaches and structures of providing drug treatment were very important. Approaches, for example, of clinical staff offering a “rapid assessment” are particularly important in engaging and retaining ethnic minority populations. Also, using flexible thinking within the staff team enables drug services to adapt treatments to be flexible in responding to emerging ethnic populations.

This paper shows that thinking in designing approaches to drug treatment shows that ethnic minority populations can be successfully engaged in drug treatment. This has implications for drug treatment nationally and across Europe where there are “emerging” ethnic populations presenting for drug treatment.

This paper shows that drug services can adapt and change to their different ethnic minority populations if they can able to be flexible in their clinical approach to service provision.

The objectives of the current interim report are to measure the extent of the access to care problem, identify and compare the types of patient- and system-based barriers experienced by Vietnam veterans at risk for suicide when seeking care for physical, psychiatric, and substance abuse conditions, analyze patient-perceived quality of care for individuals who obtained access to care, and identify how the care-seeking experience effected future care seeking. This study is based on a longitudinal sample of 494 Vietnam veterans discharged from military service in September 1971 and subsequently identified as at risk for suicide (306 low risk; 188 high risk). Seventy-one percent (350) of 494 participants completed an extensive qualitative and quantitative interview covering, among other topics, physical conditions, psychiatric conditions, substance use, barriers to care, facilitators of care, and quality of care. Barriers, satisfaction, and effect of the experience were compared by type of condition and suicidal risk category using χ2 analysis and Fisher's as appropriate. The analysis is based on 257 interviews (73 percent) with qualitative data transcribed thus far. Results: Of the 195 patients with self-reported health conditions, 76 (39.0 percent) and 45 (23.1 percent) expressed system-based barriers to care, respectively. The group at higher risk of suicide was significantly more likely (p<0.01) to report patient-based barriers to care and system-based barriers to care (p<0.05), and more likely (p<0.05) to experience negative effects of the care-seeking experience. Both self-perceived and system-based barriers to care pose obstacles for patients at high risk of suicide. Targeted interventions are required to reach out to these patients to address needs for care currently unmet by the health care system and to reduce negative effects of the health care experience.