A critical analysis of user satisfaction surveys in addiction services: Opioid maintenance treatment as a representative case study

Background: Satisfaction with services represents a key component of the user's perspective, and user satisfaction surveys are the most commonly used approach to evaluate the aforementioned perspective. The aim of this discursive paper is to provide a critical overview of user satisfaction surveys in addiction treatment and harm reduction services, with a particular focus on opioid maintenance treatment as a representative case. Methods: We carried out a selective critical review and analysis of the literature on user satisfaction surveys in addiction treatment and harm reduction services. Results: Most studies that have reported results of satisfaction surveys have found that the great majority of users (virtually all, in many cases) are highly satisfied with the services received. However, when these results are compared to the findings of studies that use different methodologies to explore the patient's perspective, the results are not as consistent as might be expected. It is not uncommon to find that "highly satisfied" patients report significant problems when mixed-methods studies are conducted. To understand this apparent contradiction, we explored two distinct (though not mutually exclusive) lines of reasoning, one of which concerns conceptual aspects and the other, methodological questions. Conclusion: User satisfaction surveys, as currently designed and carried out in addiction treatment and harm reduction services, do not significantly help to improve service quality. Therefore, most of the enthusiasm and naiveté with which satisfaction surveys are currently performed and interpreted - and rarely acted on in the case of nonoptimal results - should be avoided. A truly participatory approach to program evaluation is urgently needed to reshape and transform patient satisfaction surveys. Keywords: patient satisfaction, substance abuse treatment services, harm reduction services, patient-centered evaluation, service user perspective, user involvemen

Aproximacions a la perspectiva de la persona en tractament de manteniment amb metadona: Reflexions a propòsit de 10 anys de recerca

Els tractaments de manteniment amb metadona (TMM) són un autèntic tractament psicofarmacològic de la dependència d'heroïna i, a la vegada, un element indispensable de les polítiques i les intervencions de reducció de danys. L'efectivitat dels TMM ha estat avaluada, gairebé de manera exclusiva, mitjançant la utilització d'indicadors anomenats durs. Intentant anar més enllà d'aquest enfocament tradicional, hem portat a terme, durant els darrers 10 anys, diversos estudis emprírics i assaigs teòrics que s'emmarquen dins d'un objectiu global de generar coneixement al voltant de -i amb- la perspectiva de la persona en TMM. En aquest article, resumim de manera selectiva les troballes més rellevants d'aquesta línia de recerca per discutir després algunes de les seves principals implicacions. Finalment, abordem alguns dels reptes -i suggerim alguns dels canvis necessaris- per a una avaluació dels TMM realment centrada en el pacient

Risk Factors of γ-Hydroxybutyrate Overdosing

The aim of this study was to identify in recreational drug users the factors which increase the risk of overdosing (OD) with γ-hydroxybutyrate (GHB). A purposive sample of 45 experienced GHB users was interviewed, equally divided into three groups (never OD, occasional OD, and repeat OD). The repeat OD group scored highest on many risk factors regarding GHB use, the occasional OD group scored intermediate, and the never OD group scored lowest. Participants, whether or not they had overdosed on GHB, most often perceived GHB use (e.g. using more GHB than usual, using GHB doses too closely together) as the main reason for GHB OD, and many participants who had overdosed on GHB reported that they had taken more GHB than usual at their most recent occasion of GHB OD. No significant differences in co-use of GHB with other substances were found between the three groups. Our findings indicate that using GHB in the company of groups of friends probably reduces, but does not eliminate, the risk of OD