Counselling Utilization Experiences among Methadone Maintenance Treatment Clients in Rural and Small Urban Communities/Expériences De L'utilisation Du Counseling Parmi Les Clients Subissant Un Traitement De Maintien À la Méthadone Dans Les Communautés Rurales et Les Petites Communautés Urbaines
Bibliographic record
Abstract
The association between opiate dependence and methadone maintenance treatment (MiMiT) has been extensively investigated, and research literature suggests it is an effective means of treatment (Ffealth Canada, 2002; New Brunswick Department of Ffealth, 2005; Ponizovsky & Grinshpoon, 2007). Methadone is a medical synthetic opioid agonist appropriate for maintenance therapy because it is an efficient and long-lasting method of relieving the intense cravings and withdrawal symptoms associated with opiate detoxification. Although the effec- tiveness of MMT is well documented, little research has been conducted on the utilization of counselling by MMT participants. Furthermore, the majority of existing research has been completed in large urban centres, potentially limiting the transferability of findings into smaller urban and rural settings. Taking into consideration the rising rates of opiate dependence experienced within Atlantic Canada in the past decade, the present study aimed to expand this research to examine the counselling experiences of MMT participants living in small urban and rural communities within Atlantic Canada.COUNSELLING AND METHADONE MAINTENANCE TREATMENTA small body of literature suggests there are additional benefits experienced by MMT clients who access counselling services as part of their opiate dependence treatment (Fischer, Chin, Kuo, Kirst, & Vlahov, 2002; Gossop, Stewart, & Marsden, 2003, 2006; New Brunswick Department of Health, 2005; Vigilant, 2008). Furthermore, many studies have found that better treatment outcomes occur when clients include some form of counselling as part of their recovery plan rather than relying solely on methadone to treat their opiate dependence (Gossop et al., 2003, 2006). Addiction and psychiatric focused counselling, including individual, group, couple, or family counselling, may contribute to providing important support, education, coping strategies, and skill development to the methadone maintained clients (Fals-Stewart, O'Farrell, & Birchler, 2001; Gossop et al., 2003; New Brunswick Department of Health, 2005). Furthermore, the behavioural and cognitive changes that occur when MMT is implemented have been found to be strongly associated with increased access to counselling services (Gossop et ah, 2006; Sigmon & Stitzer, 2005).Fischer et al. (2002) and Quigley (2003) found that MMT clients believed that counselling participation was an important element of their recovery efforts. However, attendance in counselling among the MMT population often remains very low. Sigmon and Stitzer (2005) reported only one third of the MMT population they surveyed accessed counselling services regularly. It has been suggested that low attendance may be the result of MMT participants wanting flexibility and active involvement in the decision-making process with regard to the counselling they receive (Fischer et al., 2002; Quigley, 2003). When given a choice in their counselling, opiate-dependent clients reported they felt the process was empowering. In addition, clients favoured counsellors who were flexible in their availability to schedule appointments. MMT participants stated they preferred a counsellor who could be available for them both physically and psychologically, with an understanding of the special needs of their population (Quigley, 2003). These participants felt that methadone gave them the ability to address their concerns therapeutically, examining their addictions in greater detail and offering a chance to rebuild important relationships hurt by their addictions (Vigilant, 2008).COUNSELLING SERVICES AND RURAL COMMUNITIESThe literature has repeatedly noted that individuals living in smaller urban and rural communities may face additional challenges to accessing counselling services for their substance abuse. Sexton, Carlson, Leukefeld, and Booth (2008) categorized these barriers into five areas: physical, financial, societal, organizational, and psychological. …
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.005 | 0.002 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".