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Literature Update: Consumer Perspective on MAT
An article recently published by Hewell et al in the journal Substance Abuse Treatment, Prevention, and Policy entitled "Systemic and individual factors in the buprenorphine treatment-seeking process: a qualitative study" sought to better understand treatment seeking behavior using qualitative methods in a sample of 11 participants living in or around Fairbanks, Alaska. Study participants included individuals 18 years of age or older living in Alaska who had been diagnosed with an opioid use disorder at some point in their life and had been impacted by medication-assisted therapy (MAT) service delivery in any way, including receipt of service, denial of services, encountered barriers to service, or avoided seeking service. The study was particularly interesting in that it closely parallels the HOPE Consortium service area in a number of ways, including population size, rural geography, and cultural values informed by the presence of a Native Alaskan population.
The full article provides a fascinating in-depth discussion from the consumer perspective regarding factors that serve as both barriers and facilitators to the receipt of MAT. Important themes that emerge from the work clearly identify factors related to cultural assumptions, policy, and funding as barriers to MAT. In contrast, factors related to motivation, familial support, and treatment programs were most often facilitators to MAT. Given these findings, the authors suggest that MAT-related programming should focus on a bottom-up approach, with an emphasis on encouraging the client belief that change is in their power:
"Self-efficacy, defined as confidence in one's ability to do something (e.g., be abstinent or not use), and perceived locus of control, defined as the belief that change is within one's power, play important roles in overcoming substance use disorders. Participants viewed buprenorphine as a tool for gaining such control - a stepping-stone to recovery."
While current National Institute on Drug Abuse (NIDA) principles of effective treatment include biopsychosocial factors, this study takes this concept a step further to also consider societal attitudes, cultural norms, access to resources, and policies that influence how treatment is delivered. In addition to focusing on personal factors by empowering the belief in change, the authors also highlight the importance of addressing stigma in increasing both patient and community health literacy regarding treatment options for substance use disorders to challenge attitudes about the use of MAT.
Hewell et al provide an excellent overview of barriers and facilitators to MAT from the consumer perspective in a way that is particularly relevant to the HOPE Consortium given the unique rural challenges faced by the population studied. Upon review, the article supports the approach of the HOPE Consortium in which partner organizations work together to develop and deliver treatment and support paradigms specific to the population being served. The full text article is available free of charge through PubMed Central here.
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