Activation in Persons with Opioid Use Disorders in Intenstive Outpatient Treatment

Abstract

Persons with opioid use disorder (OUD) often receive intensive outpatient treatment (IOT) but these programs are associated with low rates of completion and high rates of relapse. Enhancing patient activation - taking an active role in one’s healthcare - would likely improve outcomes for persons with OUD in IOT. The overarching purpose of this dissertation is to describe how persons with OUD experience IOT, especially regarding activation. The dissertation includes three components. The first is an integrative review of 29 studies of activation in persons with mental health disorders generally. Results revealed that activation was related to several heath and treatment-related factors and some interventions, most notably educational programs, increased activation. The second and third components were based on interviews with 14 persons who had been enrolled in an IOT program in academic health centers. The second component was a constructivist grounded theory study conducted to describe the process people undergo as they participate in an IOT program. Participants described a process of connecting and disconnecting that included eight stages: (1) connecting with drugs, (2) disconnecting from everyday life, (3) connecting with the IOT program, (4) connecting with others in the IOT program, (5) disconnecting from drugs, (6) reconnecting with others, (7) reconnecting with self, and (8) disconnecting from the IOT program. The third component was a qualitative descriptive study conducted to describe types of instances in which persons play an active role in their IOT (activation). Participants described six types of instances: (1) making and enacting one’s own treatment decisions, (2) actively engaging in treatment planning with staff, (3) choosing to actively engage in groups, (4) making a commitment to treatment, (5) taking responsibility for one’s own recovery, and (6) taking actions to avoid relapse. The results of this dissertation will inform the development of strategies to enhance activation among persons with OUD in IOT with the goal of improving engagement and program outcomes.