Form or content: The application of user perspectives in treatment research

Abstract

As part of a general trend in modern society, the voice of the ‘consumers’ of the services of the welfare state has gained increased legitimacy. However, this is not the case when it comes to drug-treatment users. The continuing neglect of this group's experiences is also reflected in methadone maintenance treatment research. This article seeks to counter this imbalance by exploring users’ experiences with enhanced psychosocial methadone maintenance treatment. The findings rest on an evaluation of the Danish Methadone Project. As part of the evaluation 37 semi-structured qualitative interviews with users were made, and two months of participant observation were conducted in the clinics. An important finding is that the users highlighted the form of the treatment as much as the actual content. It was not primarily the content of the services, but how the services were carried out that mattered. Most crucially, the users highlighted the attitude of the counsellor, the accessibility of spontaneous counselling, and spaces that facilitated non-stigmatizing social encounters. While drug users do not provide the definitive statement about the value of drug service provision, listening to their voices is a necessary step in building an ethically sound approach to drug treatment, with a high degree of client support where the treatment provided meets the consumers needs.

• Drug-treatment research
• users' view
• drug services
• psychosocial methadone maintenance treatment

Notes

Notes

[1] Case management is not a solid and well defined method. However, a survey of relevant literature shows the existence of six core elements: assessment, intervention, co-ordination, planning, monitoring, and evaluation (Graham & Timney, 1995; Moxley, 1989; Ridgely & Willenbring, 1992; Vanderplasschen, 2004). When I term the form of case management applied in the project as ‘loose’, it is because the four projects only rather sparsely operated with elements of monitoring and evaluation.

[2] There was, however, a dilemma attached to the users’ use of the drop-in centres. At the same time as the centres functioned as shelters of a kind protecting the users from the street life, this very street life was also imported into the centres by the users, as for instance when they talked about drugs, dealt drugs, paid debts, and so on (for similar observation see Grytnes, 2004). I mention these dilemmas in order to show that even though many users evaluated the methadone maintenance projects positively, dilemmas and negative experiences were also attached to the programmes. The focus of this paper, however, is the users’ positive evaluations.

[3] For a thorough analysis of the results of case management in drug treatment see Vanderplasschen (2004).