Doctor of Philosophy (Clinical Psychology)
School of Psychology
Background: The physical health burdens and health-related behaviours (e.g., smoking, poor nutrition, sedentariness) associated with substance use disorders necessitate an integrated treatment response. Yet service fragmentation can preclude physical health from being addressed within specialist alcohol and other drug (AOD) treatment services that typically operate outside of primary care settings. Relative to the general population, people living with substance use problems are at an increased risk for developing many types of chronic illness, including cardiovascular disease, respiratory disorders, hepatitis C, and diabetes. Moreover, individuals who attend AOD treatment are 2.3-2.7- times more likely to have multiple (i.e., two or more) physical diseases when compared to those who never attend AOD treatment. Despite this, there has been little research attention given to understanding how the physical health disparities of substance using populations can be managed during specialist AOD treatment. Social ecological models recognise the multiple environmental influences that interact to affect the provision of treatment and treatment outcomes. Recovery capital approaches suggest that treatment of substance use disorders needs to promote resources among individual service users, augmenting the short-term effects of clinical intervention. Using social ecological models and recovery capital as a conceptual base, this thesis comprises four studies which aim to explore the integration of physical health care within specialist AOD treatment. The aim of Study 1 was to examine what empirically based guidance was available to the AOD workforce when addressing the physical health of those attending treatment. Study 2 aimed to better understand the nature and prevalence of physical health morbidities of people attending treatment for substance use disorders and how these are identified. Study 3 sought to examine the facilitators and barriers to the integration of physical health care within specialist AOD treatment settings. The aim of Study 4 was to explore the perceived role of physical health in the process of recovery from the perspective of the AOD workforce and people attending treatment for substance use disorders.
Method: Study 1 consisted of a systematic review of 33 clinical practice guidelines for the treatment of substance use disorders. A grey literature search was used to identify guidelines from Australia and other international jurisdictions. Eligible guidelines were subject to data extraction that included i) guideline characteristics, ii) the physical health problems identified by the guidelines and iii) the recommendations made by the guideline for managing physical health and health-related behaviours. Appraisal of guideline quality and rigour was conducted using the Appraisal of Guidelines Research and Evaluation II (AGREE-II) tool. Study 2 was a retrospective file review of client files (N = 127) collected as part of routine care at a specialist residential AOD treatment service in New South Wales, Australia. Studies 3 and 4 adopted a qualitative approach, where interviews were conducted with service users (n = 20) and staff (n = 13) of residential and outpatient treatment services in New South Wales, Australia. Interview data was transcribed and then systematically coded and analysed using iterative categorisation.
Results: Study 1 found that 14 guidelines for the treatment of substance use disorders were considered high quality based on AGREE-II scores. Neurological conditions (90.9%) and hepatitis (81.8%) were the most frequent health problems addressed. Most guidelines recommended establishing referral pathways to address physical health comorbidities (90.9%). Guidance on facilitating these referral pathways was less common (42.4%). Guidelines were inconsistent in their recommendations related to oral health, tobacco use, physical activity, nutrition and the use of standardised assessment tools. Findings of Study 2 indicated that most clients attending residential treatment for substance use had at least one physical health comorbidity (80.7%). Just over half of clients (55.5%) with a co-occurring physical health condition were reported to have received a referral to a primary health service or practitioner. In Study 3 a social ecological approach helped to identify personal, professional and structural barriers and facilitators that may affect the capacity of the AOD workforce to adequately address client physical health. Study 4 found that opportunities to improve their physical health were valued by those attending treatment for substance use, and that enhanced physical health was perceived to offer variegated pathways for building recovery capital.
Conclusions: Studies of this thesis suggest that a more proactive approach to addressing the physical health of people attending treatment for substance use disorders is needed. Findings highlight challenges for AOD services when assessing and managing client physical health and identify strategies that may be utilised to ameliorate such barriers. Improvements to physical health and health-related behaviour change were perceived by participants as providing a connection to sustained recovery, generating recovery resources that extended beyond disease management. Collectively, thesis findings suggest potential avenues for enhancing the integration of physical health care within routine AOD treatment that takes place outside of primary care.
Osborne, Briony, Examining the integration of physical health in the treatment of substance use disorders, Doctor of Philosophy (Clinical Psychology) thesis, School of Psychology, University of Wollongong, 2022. https://ro.uow.edu.au/theses1/1712
FoR codes (2008)
170106 Health, Clinical and Counselling Psychology
Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.