Implementation Issues in an Innovative Rural Substance Misuser Treatment Program

Abstract

This article is essentially the story of the development, implementation, and testing of a treatment protocol designed specifically for rural individuals who are substance misusers. Although the treatment protocol that emerged from this process seemed to be valuable for clients, the researchers were not able to establish with statistical significance that it was better than conventional treatment. In some ways, this was a failure. This article explores some of the possible reasons why new treatment approaches, tested in real clinical situations, may have difficulty establishing their effectiveness. The factors involved are many and complex.

Keywords :

• adherence
• treatment manual
• technology transfer
• treatment implementation

Notes

¹ The journal's style utilizes the category substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be abused. Editor's note.

2 Treatment can be usefully defined as a planned or unplanned, goal directed, temporally structured change process, of necessary quality, appropriateness and conditions (endogenous and exogenous), which is implemented under conditions of uncertainty and is bounded (culture, place, time, etc.), which can be (un)successful (partially, and/or totally) as well as, at times, being associated with iatrogenic harms, and can be categorized into professional-based, tradition-based, mutual-help-based (AA, NA, etc.), and self-help (natural recovery) models. There are no unique models or techniques used with substance users –of whatever types and heterogeneities –which are not also used with nonsubstance users. Whether or not a treatment technique is indicated or contraindicated, and its selection underpinnings are considered (theory-based, empirically-based, “principle of faith-based, tradition-based, etc.) continues to be a generic and key treatment issue. In the West, with the relatively new ideology of “harm reduction” and the even newer quality of life (QOL) and conflict resolution treatment-driven models, there are now new sets of goals in addition to those derived from/associated with the older tradition of abstinence driven models. Treatment is implemented in a range of environments; ambulatory as well as within institutions which can include controlled environments Treatment includes a spectrum of clinician–caregiver–patient relationships representing various forms of decision-making traditions/models: (1) the hierarchical model in which the clinician-treatment agent makes the decision(s) and the recipient is compliant and relatively passive, (2) shared decision-making which facilitates the collaboration between clinician and patient(s) in which both are active, and (3) the "informed model" in which the patient makes the decision(s). Editor's note/