Relational parenthood in addiction recovery.

Aims: The purpose of this research was to elicit how parents attending family-focused substance abuse treatment construct their parenthood in relation to other people. Design: Relational parenthood of addiction treatment attendees is scrutinised from seven thematic interviews carried out in a community-based inpatient substance abuse treatment unit in Finland. The core analytical concept of the research is relationality. The data were first content coded via Atlas.ti22 and the relations and codes classified into the five following parenthood types emerging from the data: (1) worn-out; (2) coping; (3) ambivalent; (4) changing; and (5) supported. Content codes and parenthood types were cross-tabulated to ascertain how these types are emphasised in different relationships. Results: Worn-out and coping parenthood types emerged in the closest relationships, mostly with their own children and the other parent. Ambivalent parenthood was present in all relations as expressions of inner conflict, which can lead to changing parenthood. Changing parenthood emerged in relation to interviewees' own children as an empowering experience. It also emerged in relation to other people as readiness to accept help. Supported parenthood was most often found in relation to significant others and professionals, presumably due to the context of the interviews. Conclusion: The parenthood types illustrate how parenting changes over time, which is also an important part of social identity change in recovering from addiction. In treatment, it is extremely important to understand the different sides of parenthood and to use the information to strengthen clients' parenthood.

Treatment for problematic substance use in Nordic youth: a narrative review from the viewpoint of social services.

BACKGROUND: Youth mortality from drugs is worryingly increasing in Europe. Little is so far known about what substance use services are available to young people. An out-of-home care placement is often used but does not suffice alone as an intervention in problematic substance use among youth. Additional interventions are needed. OBJECTIVE: This narrative review investigated what has been done, what works, and what is needed in treating youth substance use in the Nordic countries from the viewpoint of social services. This study brought together previous Nordic studies on this topic and presented responses to youth substance use in Nordic social welfare system to the wider international audience. METHODS: A search of the ProQuest and EBSCOhost databases revealed seven interventions reported in 17 papers. Narrative synthesis was used. RESULTS: Interventions included the Cannabis Cessation Program (CCP), the Icelandic version of the Motivation to Change Inventory for Adolescents, the Norwegian multisystemic therapy program (MST), the Structured Interview Manual UngDOK implemented in the Swedish Maria clinics, the Finnish ADSUME-based intervention in school health care, and the Swedish Comet 12-18 and ParentStep 13-17 programs. Many interventions had originated in the US rather than in the Nordic countries and most of them were adapted from adult interventions when youth specificity was lacking. Parental involvement was deemed important, but ineffective without involving the adolescent themself. Interventions and ways for dealing with young offenders required reconsideration from the perspective of the best interests of the child. The current research focuses on universal prevention while more knowledge about selective and indicative prevention was called for. CONCLUSIONS: Not enough is known about the cessation of problematic youth substance use and subsequent rehabilitation in social services. We would encourage further research on the multi-producer system, subscriber-provider-cooperation in youth substance use services, non-medical youth-specific substance use interventions in social services, and rehabilitative juvenile drug offense practices.

Reducing Problematic Substance Use under Exceptional Circumstances-Effects of the COVID-19 Restrictions on Inpatient Substance Use Disorder Treatment in Finland.

The COVID-19 pandemic has affected people's daily lives on multiple levels. At highest risk are the most vulnerable members of the society, whose lives were already affected by various risks even before the pandemic. This study investigates how clients in inpatient substance use disorder treatment experienced the COVID-19 restrictions and their influence on recovery. The research data consists of six focus group interviews conducted remotely using a semi-structured thematic interview method. The focus group clients (N = 19) were currently in inpatient substance abuse treatment during the pandemic and the ensuring restrictions. The data were analyzed using qualitative content analysis. The results show that the COVID-19 restrictions have influenced the clients' desistance processes throughout the pandemic. The restrictions seemed to exacerbate substance abuse problems before treatment initiation and highlight the importance of peer support during treatment. Moreover, the restrictions seemed to change the function and hamper the management of social capital, raise concerns about returning home, as well as intensifying the inter-municipal segregation of services. To conclude, attention should be paid to facilitating and ensuring informal support and managing social capital. In light of this study, it seems necessary to explore the social conditions among clients in inpatient substance abuse treatment during the pandemic.

Factors predicting satisfaction in outpatient substance abuse treatment: a prospective follow-up study.

BACKGROUND: While treatment satisfaction has been associated with better outcomes in substance abuse treatment, there is an obvious need for a more profound understanding of what predicts client's satisfaction with treatment. This study elucidates factors relevant to treatment outcome measured at follow-up in terms of satisfaction with the treatment received. METHODS: The research was implemented as a multisite study in outpatient clinics (N = 7) in southern and western Finland. Data consists of therapists (N = 33) and their clients (N = 327). Each consenting client beginning a treatment period was accepted as a research subject and all therapists at the clinics in question participated. The study was conducted as part of the clinic's normal activity. Clients were allocated to therapists according to a randomization list drawn up in advance. Apart from the randomisation and the completion of questionnaires, it did not interfere with the progress of treatment. Follow-up lasted 6 months. Multiple Classification Analysis (MCA) was used through combinations of variables organized by content, e.g. client demographics, previous substance use, therapist's characteristics and client's expectations. The analyses were based in part on conventional statistical testing (t -test, χ2-test, ANOVA). RESULTS: Among 37 independent variables few were statistically significant in the final model. The results suggest that high treatment expectations at baseline are a strong predictor of satisfaction at follow-up. Also, previous substance use predicted treatment satisfaction; people using multiple substances were less satisfied than those taking only one substance. Stronger predictors reduced the statistical significance of those independent variables that were statistically significant in the first analyses. Therefore, therapist's role in recovery and readiness to change should be also seen as antecedents to treatment satisfaction. CONCLUSIONS: It seems that treatment expectations are fulfilled among those participating in follow-up. Yet many are lost during treatment and by follow-up. Service users have experiential knowledge that differs from professionals' and policymakers' knowledge. It is clinically relevant to understand what factors affect client's satisfaction. Hence, it is possible to identify the population whose treatment should receive the most attention, how the client's experience, their commitment to treatment, and treatment effectiveness could be improved.

Changes in clients' well-being (ORS) and state hope (SHS) during inpatient substance abuse treatment.

Aims: During inpatient substance abuse treatment, professionals seek to help clients to achieve improvement in various life domains affected by substance abuse. Progress monitoring during substance abuse treatment has been called for, and in this study we examine how clients' levels of well-being and hope change during inpatient substance abuse treatment. Methods: Clients (N = 168) entered the treatment facility between January 1, 2017 and August 31, 2018. The prospective data were gathered from one treatment unit located in central Finland on entry into treatment, during and at the end of treatment. Using the Outcome Rating Scale (ORS) as a therapeutic tool was standard procedure in the treatment unit. Demographic information on participants, information on their previous substance use and scores on the State Hope Scale (SHS) were collected through structured questionnaires. Non-parametrical tests (Mann-Whitney U test; Kruskal-Wallis χ2; Spearman's rho) were used to study changes in indicators of well-being and hope. Results: As hypothesised, inpatient treatment had a positive effect on both ORS and SHS and they were interrelated. Differences in gender, living situation and previous admissions were found when studying how the background information of the participants was related to the change achieved in ORS and SHS. Conclusions: Inpatient substance abuse treatment seemed to enhance both well-being and hope of the clients of inpatient substance abuse treatment.

Pre-treatment expectations in clients: impact on retention and effectiveness in outpatient substance abuse treatment.

BACKGROUND: Common factors are important for the therapy outcome and also mediate the specific factors of therapy. As one of the common factors, client's expectations towards treatment have been understudied. AIMS: The aim was to examine the pre-treatment expectations of outpatient substance abuse treatment clients (N=327, 111 females, 216 males) and its impact on retention, effectiveness and satisfaction at 6-month follow-up. METHOD: Dependent variables included the clients' attitudes towards the twelve-step principles and participation, medical treatment and therapists' role. RESULTS: An emphasis on the importance of medical treatment at baseline predicted dropping out. Similarly, it predicted a lower percent days abstinent (PDA6) at 6 months follow-up in comparison to those who did not consider medical treatment important for recovery. Percent days abstinent increased with a more positive attitude to mutual support. At follow-up, those who had assessed the therapist's role in recovery to be most important at the baseline were most satisfied with the treatment. CONCLUSIONS: The client's pre-treatment expectations have an impact on treatment retention and effectiveness. Further effort should be made to study how clients' image of treatment could be improved and also how the commitment of the clients with multiple problems could be improved.