Table 2.
Barriers to Successful Methadone Treatment Outcomes
| Table 2a – Direct Barriers to Successful Methadone Treatment Outcomes | |||
|---|---|---|---|
| Barriers | Description | Patient* | Provider* |
| Individual | |||
| Mental health | -Mental health diagnosis or description of symptoms consistent with mental health diagnosis in addition to addiction | X | X |
| Poor physical health or pain | -Chronic or acute physical symptoms or medical diagnosis in addition to addiction and not including opioid withdrawal symptoms | X | X |
| Low motivation | -Not feeling like or wanting to engage in treatment/ recovery activates | X | X |
| Readiness for change | -Specific mention of feeling or being ready for change related to SU | X | X |
| Lack of perceived self-worth | -Not having meaning in life, lacking sense of purpose, and not deserving good things | X | |
| Responsibilities and demands on time† | -Individual priorities that patients need to attend to for themselves, like sleep, self-care, and self-improvement | X | X |
| Interpersonal and Social | |||
| Social circle that influences use | -People in a patient’s life who influence their substance use -This only came up in the context of people who promote SU by making drugs available or otherwise making patients feel like they want to use |
X | X |
| Lack of social support | -Not having people in their lives that support recovery | X | X |
| Lack of connection with care providers | -How patients feel around care providers (usually in the context of methadone treatment providers) -Difficulty in communication -Incongruence of goals between patients are care providers |
X | |
| Responsibilities and demands on time† | -Responsibilities related to work, family, or other relationships | X | X |
| Institutional/Structural | |||
| Lack of institutional coordination of care | -Description of needs not met between services are spread out or otherwise not accessible -Often described as mental health and social services unavailable |
X | X |
| Program policies and schedule | -Methadone treatment policies: assigned dosing times, requirements for take-home doses, required meetings with counselors and other treatment providers, toxicology testing | X | |
| Unstable housing | -Homelessness or other housing uncertainty | X | X |
| Distance from treatment/ transportation | -Lack of access to reliable transportation to the clinic -Difficulty with unreliable and complex public transportation (requiring multiple transfers) -Needing to walk |
X | X |
| Community/Environmental | |||
| Environmental triggers of SU | -“People, places, and things” that cause patients to experience cravings or otherwise feel drawn to use drugs | X | X |
| Community violence | -Violence and concerns about safety in different communities, both where patients live and where the clinic is located | X | X |
| Stigma | -Any level of stigma (internalized, anticipated, or enacted) related to any aspect of patient’s identify or experience -SUD, methadone treatment, and mental health were all mentioned as stigmatized |
X | X |
| Table 2b - Interrelationships Between Barriers | |||
| Barriers | Social-ecological Levels | Patient* | Provider* |
| Unstable housing and mental health and motivation | Institutional/Structural Individual | X | X |
| Unstable housing and social circle that influences SU | Institutional/Structural Interpersonal | X | |
| Transportation and poor physical health or pain | Institutional/Structural Individual | X | |
| Transportation and responsibilities and demands on time | Institutional/Structural Interpersonal | X | |
| Program policies and schedule and responsibilities and demand on time | Institutional/Structural Interpersonal | X | |
| Stigma and physical/mental health | Stigma (cross-cutting) Individual | X | X |
*
Patient, provider, or both types of participants provided responses that received this code