According to the United Nations (n.d.), in 2019, a global population exceeding 35 million individuals experienced drug use disorders, but only one out of every seven persons received treatment [1]. In Sweden, where this study was conducted, 1.8% of the population had a substance use disorder in 2017 [2]. Approximately 50% of individuals diagnosed with a substance use disorder specifically, alcohol and/or drug dependence often experience comorbidity with other psychiatric illnesses or conditions. It has also been demonstrated that individuals with mental health issues are at an increased risk of developing substance use disorders [3]. In Sweden, the opportunities for receiving treatment for comorbidity, where an individual receives treatment for both their substance use disorder and psychiatric illness, are relatively limited. This has an impact on treatment outcomes. This study aims to describe how individuals with a primary diagnose of substance use disorders perceived an integrated intensive outpatient addiction-treatment intervention. To contribute to the knowledge and evidence regarding alternative treatment options, it is crucial to study the experiences of individuals with substance use disorders. Furthermore, there is a need for increased knowledge among professionals who work with and encounter individuals with substance use disorders, such as those in healthcare and social services.
Substance dependence can be characterised by its potential to give rise to social problems, such as problematic relationships and difficulty in completing major work or school tasks [4]. The risk of using alcohol and drugs has been shown to be higher among individuals with psychiatric disorders, such as anxiety disorders, depression, bipolar disorder, schizophrenia and obsessive-compulsive disorder, than among those without psychiatric diagnoses [3]. Today, drug use is becoming more normalised, and drugs are increasingly accessible, with easy methods of acquisition, such as through the internet [5]. While drug use has increased, alcohol consumption in Sweden has decreased. Among adults, 4% of the population had alcohol dependence in 2017. Although one study revealed no significant gender difference in Sweden, more men than women still have alcohol dependence [2]. Top of FormBottom of Form
Treatment of Substance Use Disorders: Psychological and Psychosocial Interventions
The National Board of Health and Welfare [6] recommends integrated programs, medication and psychological and psychosocial interventions for the treatment of substance use disorders with concurrent psychiatric issues. Two of the psychological and psychosocial interventions that may be included in integrated care are the 12-step programme and relapse prevention [6]. Both the 12-step programme and cognitive behavioural therapy (CBT) are standardised treatment methods within the field of substance abuse and addiction care and are offered at multiple locations throughout the country [7].
The 12-step programme is based on the 12-step programmes of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). AA and NA are non-profit self-help organisations for individuals with substance use issues through which they can support each other in maintaining sobriety. The treatment consists of 12 steps through which the individual is expected to progress during the treatment process. Some of the steps involve acknowledging powerlessness over the substance, examining personal values, admitting shortcomings and making amends to individuals harmed by one’s substance use [8]. The 12-step programme largely focuses on processing one’s relationship with substance use and becoming aware of the barriers to recovery, and according to Donovan et al. [8], individuals are expected to abstain from substance use, attend meetings and be willing to seek help. The programme is implemented in both public and private addiction treatment settings and is used in both inpatient and outpatient care. In outpatient care, the programme continues for 1 year, with daily group meetings in the initial months and longer intervals between meetings as treatment progresses. In inpatient care, the treatment follows a more intensive schedule, including 6 weeks of daily group therapy and 1 year of follow-up care [7].
CBT is a psychotherapeutic treatment method that has been shown to be effective for individuals with substance use disorders and comorbid psychiatric conditions [6]. During the 1970s, classical CBT emerged, focusing on identifying, addressing and modifying undesirable behaviours and negative thoughts [9]. Our behaviour is not primarily based on an actual event but rather on our perception of the situation. This perception, or conceptualisation, can be divided into three categories: core beliefs, dysfunctional assumptions and negative automatic thoughts [10]. By identifying one’s thoughts and emotions and becoming aware of one’s behaviour, one develops the ability to manage the problem using new strategies. In CBT, the management of thoughts and behaviours is referred to as coping, which encompasses the strategies used to control negative thoughts and behaviours [11]. CBT is a commonly used treatment approach in the field of substance abuse and addiction. The goal is to help clients develop more adaptive ways of thinking and acting that lead to improved mental health and well-being.
Complementary healthcare methods can be used in conjunction with the aforementioned treatment approaches. Various complementary methods are employed to alleviate symptoms associated with substance use disorders, depression, anxiety or stress when conventional treatment is deemed insufficient [12]. The application of complementary methods within healthcare is limited due to the requirement that all healthcare be based on scientific evidence and proven experience, as stipulated by the Swedish Healthcare Act [13]. Although the evidence for several complementary methods is currently limited, where evidence exists, such methods may only be used in consultation with the individual receiving care under the condition that they do not replace other forms of care and treatment.
Substance use disorders involve harmful substance use and dependence. Co-occurring psychiatric conditions are commonly present in individuals with substance use disorders, often requiring multiple interventions, such as social support, psychological support and medication. It is important to adopt a person-centred approach for these individuals to provide treatment that addresses their overall situation. However, opportunities to receive integrated treatments are limited. The current offerings in addiction care often consist of a combination of medical treatment and CBT, with little opportunity for participation in a programme that includes both psychological and psychosocial treatments. The inadequate availability of integrated treatments is a weakness in addiction care. The problem is that individuals with substance use disorders are not offered treatment options to the extent necessary to address their overall co-occurring psychiatric condition. This may be due to a lack of sufficient evidence regarding integrated treatment programs or the need to evaluate the experience of CBT-based integrated intensive outpatient treatment for individuals with substance use disorders. It is important to study this aspect to enhance the knowledge and competence of healthcare and social service professionals who encounter individuals with substance use disorders and co-occurring psychiatric conditions in their work.
The aim of this study is to describe how individuals with substance use disorders experienced the treatment provided at an integrated intensive outpatient addiction care clinic.