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Article
Publication date: 21 July 2022

Sotiris Lainas and Christos Kouimtsidis

Evidence suggests that the percentage of men seeking treatment for substance use disorders and other addictive behaviours is significantly higher than that of women. This fact…

205

Abstract

Purpose

Evidence suggests that the percentage of men seeking treatment for substance use disorders and other addictive behaviours is significantly higher than that of women. This fact raises several crucial questions concerning the field of addictions. This paper aims to emphasize to the study of addiction in the light of gender studies and especially in the light of theories of dominant/hegemonic masculinity.

Design/methodology/approach

The perspective of dominant/hegemonic masculinity in the field of addictions raises a number of questions: Can the dominant/hegemonic masculinity perspective contribute to the understanding of the phenomenon of addiction? What are the implications of male-dominated and male-centred treatment services on meeting the needs of other populations? Are androcentric approaches ultimately helpful for heteronormative men? This paper investigates the emerging questions through a critical review of the literature including the disciplines of psychology, sociology and anthropology.

Findings

The perspective of hegemonic masculinity can make an important contribution to the understanding of addiction as it sheds light on a dimension that is not well researched and used in the field of addictions. The influences of the androcentric approach to addiction treatment are significant and pose problems both in accessing and serving the needs of other populations. The androcentric approach to treatment is not helpful for heteronormative men either as there is a risk of not addressing the toxic dimensions of dominant/hegemonic masculinity that are directly linked to the problem of addiction.

Research limitations/implications

This paper poses interesting research questions for further research in the field.

Practical implications

This paper raises important issues for practitioners in the field and at the same time suggests alternative perspectives on the interpretation and treatment of addiction.

Social implications

The gender perspective that should further enrich psychosocial interventions is crucial for the equal access of all people with an addiction problem to appropriate support structures.

Originality/value

Gender studies can make an important contribution to further understanding of addiction problems and to the development of effective practices for dealing with it. The fact that in substance abuse treatment programmes the vast majority of participants are heteronormative men raises a number of concerns. These concerns relate to the extent to which structures are directed at meeting the needs of these men and whether because of this orientation the needs of other populations such as heteronormative women and those who do not meet the norms of heteronormativity are left uncovered. These concerns are linked to broader considerations of the role that dominant/hegemonic masculinity plays in the aetiology of addiction and in creating barriers to help-seeking for heteronormative men themselves.

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Article
Publication date: 17 June 2022

Caitlin Notley, Ben Houghton, Vivienne Maskrey, Richard Holland, Anne Lingford-Hughes, Bhaskar Punukollu, Theodora Duka and Christos Kouimtsidis

Dependent alcohol use is a severe addictive disorder with significant enduring consequences for health and social functioning. This study aims to inductively explore the process…

210

Abstract

Purpose

Dependent alcohol use is a severe addictive disorder with significant enduring consequences for health and social functioning. This study aims to inductively explore the process of identity change for alcohol dependent people progressing through a “pre-habilitation” intervention, alcohol detoxification and post-detoxification recovery support.

Design/methodology/approach

Qualitative study as a part of a process evaluation situated within a UK feasibility trial of a group-based intervention in preparation for structured alcohol detoxification. Semi-structured qualitative interviews (face-to-face or telephone) collected self-reported data on experiences of treatment provision as part of the feasibility trial. Thematic analysis of transcripts and iterative categorisation of identity-related themes and concepts was conducted with verification of analysis undertaken by a second coder.

Findings

Identity change was revealed in participant narratives around the meta themes of external (social-identity) and internal (self-identity) concepts. External influences impacting social identity were key, having influenced initiation into alcohol use, influencing acceptance of the stigmatised “alcoholic” label and then being central to the treatment journey. Internal influences on self-identity also impacted on the process of identity change. In recovery, there was hope in discovering a new “normal” identity or rediscovering normality.

Originality/value

Analysis demonstrates that moving from regular alcohol use to problematic use is a journey of identity change that is influenced at the macro (cultural), meso (group) and micro (relational) social levels. Throughout the treatment journey, social influences in gaining a new non-drinker identity are key. Findings suggest a need for long-term support through treatment and community-based groups specifically to foster positive identity change that may not have been addressed previously.

Details

Drugs, Habits and Social Policy, vol. 23 no. 1
Type: Research Article
ISSN: 2752-6739

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Article
Publication date: 4 December 2017

Tatenda Kondoni and Christos Kouimtsidis

Opioid substitution treatment is effective in reducing harm for the person and society. However, the introduction of the recovery agenda has changed treatment philosophy…

190

Abstract

Purpose

Opioid substitution treatment is effective in reducing harm for the person and society. However, the introduction of the recovery agenda has changed treatment philosophy. Associated targets such as successful treatment completions have introduced new expectations from treatment providers and service users. The purpose of this paper is to provide a service user-centred evaluation of underlying reasons that might prevent them from considering completion of treatment.

Design/methodology/approach

Ten service users who were stable on opioid substitution treatment for more than five years were interviewed face-to-face using a semi-structured format. Detailed inductive coding and thematic analysis of all transcripts was conducted.

Findings

Most participants expressed fear of change to their treatment and in particular reduction of the prescribed medication, due to past traumatic withdrawal experience, fear of relapse, fear of negative impact on their mental and physical health. Nevertheless all were optimistic about their future lives and were hoping to be able to complete their treatment at some point. A three-month follow-up revealed little change, with most participants not considering changing their medication dose in the future.

Practical implications

It could be argued that treatment providers, instead of focussing their efforts on stable service users in promoting treatment exit, should focus on new service users, avoiding coercion to treatment aims and rushed detoxifications.

Originality/value

This small qualitative study confirms results of other recent studies on the same theme and argues for the importance of the quality of the treatment experience of new people accessing treatment.

Details

Drugs and Alcohol Today, vol. 17 no. 4
Type: Research Article
ISSN: 1745-9265

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Article
Publication date: 1 June 2015

Christos Kouimtsidis, Daniel Stahl, Robert West and Colin Drummond

The purpose of this paper is to test the discriminative validity of the Substance Use Beliefs Questionnaire (SUBQ) with alcohol dependent users, by assessing if the new tool can…

73

Abstract

Purpose

The purpose of this paper is to test the discriminative validity of the Substance Use Beliefs Questionnaire (SUBQ) with alcohol dependent users, by assessing if the new tool can successfully differentiate between two extreme groups.

Design/methodology/approach

The criterion used to select the two extreme groups was participation or not in treatment for alcohol dependence. Score of the Severity of Alcohol Dependence Questionnaire (SADQ) was used as a secondary confirmation criterion of extreme difference.

Findings

In all, 98 staff and 94 people in treatment for alcohol dependence were recruited. The treatment group scored 30.83 higher than the control on SADQ, 10.76 on positive and 28.98 on negative expectancies. Negative expectancies score had correctly classified 88.5 per cent and positive expectancies score only 66 per cent of the original grouped cases. The area under the Receiver Operating Characteristics (ROC) curve for negative expectancies was 0.94 (very good) with a cut-off point of 43.5 with 89 per cent sensitivity and 92 per cent specificity. The area under the ROC curve for positive expectancies was 0.73 (fair). Due to the shape it was difficult to identify a cut-off point.

Research limitations/implications

The results support the discriminative validity of the negative expectancies sub scale of the SUBQ between two extreme groups. With only the use of negative expectancies score participants could be classified correctly to those of the control and those of the treatment group.

Originality/value

SUBQ is the first tool to measure outcome expectancies across substances, facilitating relevant research with poly substance users. Future research needs to explore the discriminative validity of the tool with the other three substance groups (smokers, stimulant and opioids users), involved in the development and validation of the SUBQ.

Details

Drugs and Alcohol Today, vol. 15 no. 2
Type: Research Article
ISSN: 1745-9265

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Article
Publication date: 1 December 2007

Clarissa Broderick and Christos Kouimtsidis

Little research has been done on treatment for opioids dependence in prisons in the UK. Treatment programmes are coercive and are abstinence‐orientated, and maintenance…

131

Abstract

Little research has been done on treatment for opioids dependence in prisons in the UK. Treatment programmes are coercive and are abstinence‐orientated, and maintenance substitution treatment is rarely offered. This research aimed to investigate prisoners' perceptions of existing treatment and treatment choices offered by the service.A qualitative methodology was used with eight semi‐structured interviews with prisoners who were currently or had recently completed an opioid detoxification regime. The study took place in Wandsworth prison in south London, and interviews were recorded and analysed using theme analysis.Prisoners felt that substance misuse assessment failed to identify their needs. They had little if any input into the decision regarding substitute prescribing and they felt that their current treatment regime did not meet their needs. Not all prisoners felt coerced into treatment, however, they all described coercive measures. Homelessness compounded prisoners' substance use and treatment progress.There is significant dissonance between the services offered and the prisoners' own perceptions of service need. Many prisoners are not yet ready to achieve abstinence, the predominant treatment opportunity available. If coercion into substance misuse treatment is to be integral to the criminal justice system, treatment services should be tailored to clients' needs.

Details

Drugs and Alcohol Today, vol. 7 no. 4
Type: Research Article
ISSN: 1745-9265

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Article
Publication date: 25 November 2014

Christos Kouimtsidis, Daniel Stahl, Robert West and Colin Drummond

The purpose of this paper is to develop a brief outcome expectancies questionnaire applicable across nicotine, alcohol, opioid and stimulant users seeking or willing to seek…

176

Abstract

Purpose

The purpose of this paper is to develop a brief outcome expectancies questionnaire applicable across nicotine, alcohol, opioid and stimulant users seeking or willing to seek treatment and to assess its construct and predictive validity.

Design/methodology/approach

The items were generated using semi-structured interviews. A cross-sectional study was used to determine the factor structure and internal reliability, to compare the factor structure across the groups and to assess construct validity. Scores were used to predict reduction in dependence at three-month follow-up.

Findings

The qualitative study produced 98 items. For the cross-sectional study 99 nicotine, 96 alcohol, 98 opioid and 77 stimulant misusers were recruited. Factor analysis produced a two-factor (positive and negative expectancies) solution, similar across groups. A 28-item common version had scale correlations above 0.94 with the long versions of each group, and high internal consistency (Cronbach's α>0.90). The Positive expectancies sub-scale was positively correlated with urges across all groups, and negatively correlated with self-efficacy in three groups. Negative sub-scale scores were positively correlated with motivation sub-scales and self-efficacy in three groups. Urges and negative expectancies predicted reduction of dependence at three months.

Research limitations/implications

The study suggested that outcome expectancies are similar across substance sub-groups. The new tool appears to have good construct and predictive validity. Further validation with larger samples is required.

Originality/value

This is the first tool to measure outcome expectancies across substances, facilitating relevant research with poly-substance users.

Details

Drugs and Alcohol Today, vol. 14 no. 4
Type: Research Article
ISSN: 1745-9265

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Article
Publication date: 26 August 2014

Christos Kouimtsidis, Daniel Stahl, Robert West and Colin Drummond

The purpose of this paper is to review the substance misuse literature on how outcome expectancies are measured, how they are related with the level of use and other factors as…

355

Abstract

Purpose

The purpose of this paper is to review the substance misuse literature on how outcome expectancies are measured, how they are related with the level of use and other factors as well as their role into treatment and recovery.

Design/methodology/approach

A narrative review of the literature for all major substances of abuse was undertaken.

Findings

Existing measurement tools are substance specific. Most research has been in the field of alcohol, and involved students or light and moderate drinkers. Positive expectancies have been found to be related to initiation and level of alcohol, nicotine and cannabis use and also to be modifiable with repeated cue exposure. Negative expectancies have been found to be associated with prevention of smoking, positive changes in drinking and positive effect on treatment outcome for alcohol.

Research limitations/implications

Both positive and negative outcome expectancies have been found to predict development of substance misuse and recovery from it respectively, but cross-substance comparisons are hindered by lack of appropriate measures.

Originality/value

The concept of outcome expectancies is present in several theories of addiction. To date there has been no comprehensive review of the extent to which different types of expectancy play a role in different substances and their treatment.

Details

Drugs and Alcohol Today, vol. 14 no. 3
Type: Research Article
ISSN: 1745-9265

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Article
Publication date: 2 March 2015

Indiresh Anand, Avril Smith, Kelly-Jo Charge and Christos Kouimtsidis

The purpose of this paper was to evaluate and improve the quality of the aftercare services we provide for alcohol dependence. This presentation discusses the patient satisfaction…

233

Abstract

Purpose

The purpose of this paper was to evaluate and improve the quality of the aftercare services we provide for alcohol dependence. This presentation discusses the patient satisfaction of the Relapse Prevention Group.

Design/methodology/approach

This was a prospective service users' satisfaction survey of those who attended the relapse prevention group programme at the Community Drug and Alcohol Team for the first 11 months of programme implementation.

Findings

In all, 33 out of 36 people participated in the evaluation. The overall results were positive for the whole programme and people felt that the programme helped them in their recovery.

Originality/value

Monitoring of service users’ satisfaction with aftercare services could provide insight into the barriers compromising engagement.

Details

Drugs and Alcohol Today, vol. 15 no. 1
Type: Research Article
ISSN: 1745-9265

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