Category: Motivation

Retention versus continuity of care?

Retention in treatment has been traditionally regarded as a key outcome measure of addiction treatment. Thinking about this indicator brings us to fundamental questions of what a success in treatment is and how it can be measured.
The longer drug users stay in treatment, the higher their chances of success. Their health improves; they commit less crime and have more stable daily routine. Early identification and treatment of drug problems is also associated with better outcomes. NIATx, for instance, is an easy to use model of process improvement designed specifically for behavioral health. It helps substance abuse and mental health treatment organizations improve user access to and retention in treatment, defined as “attendance at the second, third, or fourth outpatient treatment sessions”. Others regard 12-month retention in care as success.
Rowdy Yates said, at the INEF conference in Dublin, 2011 that drug users seeking treatment want to give up drugs and what they get from us? Methadone [a replacement opioid]. This statement reflects the inability of many treatment systems to offer a menu of options and tailor them to individual needs of drug users. Medicating drug problem is one of the solutions that work for a large population of treatment seekers. Other options should be offered too.
Dr Okruhlica, in Slovakia, agrees with the diagnosis of addiction by the International Classification of Disorders (ICD) or Diagnostic and Statistical Manual DSM. This definition lists several symptoms of addiction. If somebody has certain number of these symptoms, they receive the diagnosis. If the person doesn’t have symptoms for a year, they cannot be regarded as ill any longer. Harm reduction experts believe that while the medical diagnosis of addiction could be helpful in understanding the problem, even the most dependent users have control over their drug use and choice plays an important role in their life. Dr Zinbergwas a pioneer of this approach with his monograph The Basis for Controlled Intoxicant Use. Studies on uncontrolled drug use followed. These views are regarded as extreme by many. Their believability is further undermined by the fact that non-problem drug users live in anonymity. For example, very few scientific studies manage to engage with non-problematic heroin users.
On the other hand, the recovery-oriented movements, especially AA, maintain that once a person “gets” addiction, they will become ill forever. This opinion can be very helpful for people in treatment, but can actually harm people out of treatment. Ex-users seeking re-integration into job markets are viewed as irresponsible and incapable of holding jobs for long time – result of a society stigmatization.
Because retention in treatment, as a robust outcome indicator, is highly esteemed in the drug addiction field, most professionals working in the addiction are able to place them somewhere on the continuum delineated by the two extremes – illness for life vs. uncontrolled drug use. See figure 1 below.
Figure 1 Continuum of opinions
Alongside the controversy around medicalization of drug use runs another debate about language. For many, language doesn’t matter too much and is a matter of political correctness. Opposite to them, I would like to hope, stand the language-believers. For them, the words we use shape and influence the world we live in. If we call drug users “junkies” they will become “junkies” – whatever that word represents to those who use it. Similarly, the term retention could be too close to detention; people are not kept in treatment to help them regain life, but to help sustain the treatment centre. Just like in the prison, where the inmates have little control over their length of stay, the people detained or retained in treatment have little control over length of their treatment. Opponents of the word retention propose continuity of care as an alternative, more humane, term to describe this golden-standard treatment outcome indicator. For them, it incorporates also the individual willingness to receivecare. But, are patients aware of it? I ask.

Language shapes and influences the drug treatment systems that we study or work for. It is important to recognize that even though retention and continuity of care could be the same thing – looked at from different angles – we have to choose the words we use in treatment carefully and make sure people who use our services are aware of it.

Do you work on holidays?

Does holiday work pay off? If you find answering this question difficult, my experience and benefits that I see in working on a holiday may help you.

I always take too much stuff to work during holidays. I don’t know whether you work on vacations or not, but if you do, you may be struggling with overscheduling too. Holiday work may seem unjustified to many, but for me it brings fresh air and pleasure to my research work. The pleasure lies, surprisingly, in working slowly, without pressure. To work outside business hours is an attempt to catch up on tasks, to put urgent matters to sleep, or to squeeze extra tasks into fully-booked schedule. None of these apply to me. Working around the clock causes the work to dominate and the initial motivation to fall into background. The first impulse for work is passion. For me and other researchers, it’s passion about science. Daily routine of research career provides many opportunities for loosing this passion. Emails accumulate in the work inbox faster than ever before. Meetings after meetings wear down even the most resilient among us.

When I go on vacation, all of these unpleasant things stay behind, in the office. I pack only the duties that I enjoy; I nurture my passion. The lack of tender-loving-care makes my passion too hungry though and I often pack too many books to read, print too many articles to review, and save too many draft manuscripts on my memory stick. The inability to go through this mountain of work poses an obvious trap of labeling this as another failure to meet my goals. I avoid it swiftly by commending myself on the progress of decreasing the amount of these failures over years. Next year, I’ll pack less.

People work on holidays for many different reasons. If rekindling the passion for work isn’t enough for you to sacrifice holidays, Jacquelyn Smith writes about 8 other benefits of working on a holiday in the Forbesmagazine: money, recognition, extra vacation days, celebrations during off-peak times, chance to show-off leadership, and team play. Read her full article here. http://www.forbes.com/sites/jacquelynsmith/2013/11/25/the-8-benefits-of-working-on-a-holiday-this-year/

Does enthusiasm improve outcomes?

What drives you at your research work?

What do you want to do when you grow up?

What jobs did you have before your career in research?

These, and other, questions came to me during my recent sabbatical in Portland, Oregon. I had time to reflect and step back from the hectic research life. The frenetic chase for money and articles can disconnect researchers from their internal motivation – their primary drive.

If goals are too distant, and are obstructed by too many obstacles, they can get out of site. Continuous re-connection with personal motivated and awareness of own goals keep us driven. Enthusiasm can improve professional performance.

In his book, Clueless in Academe (2003), Gerald Graff argues that schools should use students’ drive to read sports or music magazines for academic purposes. Their interest, if directed properly, should one day bring them to libraries, he hopes.

Many students are not interested in academic topics. Their motivation is weak and affects results. At my final undergraduate exam from personality psychology, the examining professor disagreed with Graff’s assertion. He was convinced that students should spend more time studying subjects which they disliked than their favourite subjects.

Although I disagreed with him, I fully endorsed his conclusion that the disliked subjects are likely to attract less practice time, followed by academic failure, provided that students’ talents do not compensate for lack of practice. At the same time, I think that students need not to excel in every subject. Each day has only 24 hours and no one can do everything – some things have to be neglected. Students need to prioritize their activities. The decisions about preferences shape their lives and future careers. Natural interests are likely to draw students closer to themselves, leading to better self-understanding. Natural interests should be supported.

Book:
Gerald Graff (2003). Clueless in Academe: How Schooling Obscures the Life of the Mind. New Haven, CT: Yale University Press, 2003, 320 pages