I first interviewed a person with lived experience of substance use twenty years ago. Today, I wanted to pause and reflect on the key points in this long journey of adventures through qualitative interviewing around the globe.
Process of change in long-term residential therapeutic communities. (May 2004)
Eleven clients participated as part of my thesis for Masters in Psychology at Trnava University in Slovakia. We interviewed clients in two residential therapeutic communities with my supervisor, Dr Peter Halama. The clients perceived as helpful not just the regime of the community, but also psychotherapy and their own motivation.
Moving on- helping young people and their families deal with addiction issues. (2009)
A Leonardo Da Vinci Scholarship (funded by the European Union’s Lifelong Learning Program) took me to Cork city on the south of Ireland. Geoff Dickson mentored me in the city’s YMCA. A few miles away, in Ballincolig, Ivan McMahon overlooked my qualitative evaluation of youth programs for early school leavers and single parents. It was great to see the practical application of science in Ireland while doing my part time doctoral degree. I got to evaluate training programs, interview youth and providers, develop program databases and identify best practice approaches for real-life problems in the community.
Interpersonal relationships in therapeutic communities. (2010)
My PhD research project led me back to therapeutic communities for people in recovery from substance use disorder. The interviews followed after a comprehensive psychosocial assessment of client’s interpersonal problems, social supports, anxiety, impulsiveness, and coping skills. The results offered another in-depth look at the changes in the quality of social interaction before, during, and after periods of active substance use and treatment.
The EMCDDA (European Monitoring Centre for Drugs and Drug Addiction) has recently published a Fact sheet (No 9/2012) which contains “quotations gleaned from interviews with substance users in 16 countries over the period 1993–2012”. They report quotes my qualitative interviews when describing the value of support from people facing similar problems. For example, clients in therapeutic communities describe the highly valued psychosocial support gained from peer relations in the community. For example a Slovakian drug user said:
Back then, I deemed the relationships with lads (drug users) outside as important, but now, when I lost everything and I have only them (those in the therapeutic community), I value the relationships here.
Problematic alcohol use among people receiving methadone in primary care. (2011)
We interviewed both patients and their physicians individually in physician’s offices. Dr Walter Cullen oversaw this work leading towards a clinical practice guideline for General Practitioners. Patients did not mind talking about their drinking with their physicians but some feared the repercussions for their methadone treatment. Physicians saw a role of primary care in addressing problematic alcohol use but needed further supports.
Screening for alcohol problems in Portland, OR. (2013)
The INVEST fellowship (PI Dennis McCarty) from the National Institute on Drug Abuse allowed a mixed-method study using electronic chart review and focus group interviews. We compared screening practices in a primary care buprenorphine program and a specialty methadone clinic. While the prevalence rates were similar, the levels of assessment and documentation differed.
Implementation of alcohol guidelines in primary care – PINTA. (2014)
This was one of the first clinical trials conducted in Ireland in primary care funded by the Health Research Board of Ireland (PI Walter Cullen). A Cochrane systematic review sponsored by a competitive Cochrane fellowship informed the trial. Physicians were randomly assigned to receive training and support in alcohol screening and brief intervention or a delayed training. Qualitative interviews explored experiences of patients and physicians participating in the trial.
Better addiction medicine education for medical doctors and residents. (2015)
Fast forward across the Atlantic, postgraduate training fellowships for junior physicians started with the birth of the new discipline of Addiction Medicine. My modest contribution interviewed physicians in one such program at St Paul’s hospital, Vancouver, British Columbia (BC) in collaboration with Drs McNeil, Small and Wood. Both faculty, trainees, research and support staff expressed high appreciation of the program and made suggestions for scaling up this type of programs.
Interviewing allied health professionals and frontline workers. (2017)
The next step in the Canadian journey was to train professionals who provide much of the care for people recovering from substance use disorders – nurses, social workers – often referred to as allied health. These frequently-overlooked players received the first spots in the fellowship programs in North America. Gradually, we expanded to addiction medicine nursing, social work, and pharmacy followed by a foundational addiction medicine certificate, as well as training through a provincial opioid agonist program.
First-time prescriptions of opioid analgesics in primary care – REDONNA. (2022)
My most recent return to primary care saw focus groups with family medicine doctors and residents participating in a pragmatic randomized trial as a co-Principal Investigator with Dr Rita McCracken.
We examined the effectiveness of peer comparison letter, named Portrait, to Reduce Initiation of Opioid Analgesics among Opioid-Naïve People Experiencing Pain. This was the REDONNA trial.
All active BC’s prescribers were randomized to receive a peer comparison letter or a delayed letter – both groups receiving feedback on their prescribing and non-judgmental summary of evidence about first-time prescriptions to opioid naive patients. Over 200 prescribers joined the accompanying educational webinar and more than 50 contributed qualitative interviews.
The first in a series of upcoming publications from qualitative analyses identified willingness among medical residents to undertake further training but also lacking protected time to do so. Training more clinicians in evidence-based prescribing seemed like a logical step in mitigating the risks of the ongoing drug poisoning epidemic where safer pharmaceutical-grade alternatives to fentanyl-tainted drugs can save many human lives.
Whether part of safer-supply prescribing or pain management with opioids, medical professionals continue to have a role in the ever-changing relationships between psychoactive substances and their users.
Overall, the last two decades of qualitative research interviewing rewarded me with many personal stories shared by my participants, with diverse skills nurtured by my supervisors and skilled qualitative researchers, and with numerous lasting relationships with investigators, clinicians, research assistants, students, and collaborators whom I thank sincerely for all their help and advice, and with whom I enjoy keeping in touch as I’m stepping into the next decade of this wondrous investigation of life on our planet.
References:
Please visit google scholar profile for the full list of cited studies.
Article first published on LinkedIn.