Keeping clients connected: exploring Australian alcohol and other drug clinicians’ perspectives on barriers and facilitators to treatment attendance

Abstract

Substance use contributes to significant individual and social harms. Although psychosocial treatment is effective, early treatment discontinuation is common. Despite this, exploration of clinicians’ perspectives on barriers and facilitators to attendance has been limited in scope (e.g. specialized settings, written responses). The current study used an in-depth approach to explore the views of clinicians on barriers and facilitators to attendance in psychosocial alcohol and other drug (AOD) treatment, with a view to translating these views to clinical practice. Semi-structured interviews were conducted with AOD clinicians from a range of professional backgrounds (n = 15: 7 female; 8 male) working in treatment settings in Australia. Thematic analysis was used to analyze interview content. Themes relating to attendance included client-related factors (motivation, expectations, beliefs; complexity, access, level of support), clinician-related factors (therapeutic relationship), organizational and systemic factors (individual service factors; systemic/sector wide factors), and stigma (experienced across clinician-related, organization and systemic domains). A complex combination of practical, psychosocial, and systemic/organizational factors intersect with, and influence, client attendance. These findings speak to the importance of client-centered and flexible approaches from clinicians and organizations. Such approaches might simultaneously mitigate a key barrier to attendance: stigma. This study highlights the impact of the therapeutic relationship on attendance despite organizational and funding constraints.

Keywords:

• Alcohol and other drug use
• primary care
• qualitative research
• recovery
• substance use disorder
• treatment retention

Ethical approval

Approval provided by Eastern Health Human Research Ethics Committee (Reference: E20/011/61428).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by a fellowship from the National Center for Clinical Research in Emerging Drugs (NCCRED), funded by the Commonwealth Department of Health (Australia).

Notes on contributors

Adam J. Rubenis

Adam J. Rubenis, Adam completed his doctorate in clinical psychology in 2018 and has since worked at Turning Point. Adam has worked across several clinical programs, one delivering treatment via telehealth to people with substance use or gambling concerns, and in two face-to-face dual diagnosis roles. Adam has also been involved in the delivery of two randomized controlled trials, the completion of treatment guidelines and redevelopment of tertiary teaching content. In 2020, Adam was awarded the Clinician Researcher Fellowship from the National Center for Clinical Research in Emerging Drugs and has an interest in strategies that improve treatment attendance in the drug and alcohol sector.

Anthony I. Barnett

Anthony Barnett, Tony joined Turning Point in 2018. Working in the Clinical and Social Research team, his work explores the social and cultural contexts of alcohol and other drug use, treatment (including novel therapeutic interventions) and policy change. His work draws on critical social science methods to provide in-depth accounts of consumers, carers and clinicians’ experiences of addiction treatment, care and recovery.

In 2020, Tony completed his PhD thesis at Monash University. His work explored clinicians’ views about the brain disease model of addiction and how neuroscientific models and interventions integrate within clinical practice. In 2021, he was awarded a Monash University Faculty of Medicine, Nursing and Health Sciences, Postdoctoral Bridging Fellowship focusing on telehealth for the treatment of alcohol and other drug concerns. Tony has contributed to a range of recent Turning Point projects, including client experiences of telehealth during COVID-19, patient experiences of depot buprenorphine for the treatment of opioid dependence and Australian Defence Force veterans’ experiences of transitioning to civilian life and the importance of social group engagement.

Shalini Arunogiri

Shalini Arunogiri, Shalini is a clinical addiction psychiatrist, clinical director at Turning Point, and a NHMRC Emerging Leadership Fellow. She has extensive experience working across alcohol and other drug (AOD) and mental health services. Her research focus is on clinical research into novel treatments for substance use disorders. Shalini has published over 50 peer reviewed publications, book chapters and technical reports. She is Chair of the RANZCP Faculty of Addiction Psychiatry, and is an elected board member and training officer for the International Society of Addiction Medicine. Shalini is a passionate advocate for clinician-researchers in mental health and addiction, and enjoys mentoring health professionals in advancing their research careers.