Participatory Development of a Virtual Reality Exercise Program for People with Chronic Pain.

Background: By describing how a participatory process led to changes in the design of a study of a virtual reality (VR)-guided exercise and mindfulness intervention tailored to people with chronic musculoskeletal pain, this article makes the case for including end user at an early stage when planning research within this field. Methods: A multidisciplinary panel including end-user representatives, researcher, clinicians, and VR developers participated in a 1-day workshop to design a randomized study and a VR-guided intervention. Results: Through the participatory process, changes were made to the original study design with respect to experimental design, duration, content of VR interventions and mode of delivery. Conclusion: This case exemplifies the importance of including end-user participants in the early phases of planning VR interventions for people with chronic pain.

Health Professionals' Experiences with Treatment Engagement Among Immigrants with Co-occurring Substance Use- and Mental Health Disorders in Norway.

Immigrants face barriers in seeking and accessing mental health and addiction services. Health professionals are crucial in providing and promoting healthcare and it is important to understand their experiences in order to enhance the access of mental healthcare. The aim of this paper is to explore and describe health professionals' experiences with treatment engagement among immigrants with co-occurring substance use disorders (SUD) and mental health disorders (MHD) in Norwegian mental health and addiction services. Within a collaborative approach, 3 focus group interviews were conducted with health professionals, who had provided various mental health and addiction care services to immigrants with co-occurring SUD and MHD. The focus group interviews were transcribed verbatim and analyzed using systematic text condensation. The analysis resulted in 5 main categories: (1) difficulties due to language barriers, (2) difficulties due to lack of culturally competent services, (3) difficulties due to social factors, (4) being curious and flexible improves the user-provider relationship, and (5) increasing access to mental health and addiction services. This study provides an enhanced understanding of how health professionals' experienced treatment engagement among immigrants with co-occurring SUD and MHD in the Norwegian context. Implications of the findings for clinical practice and future research are discussed.

Treatment Experiences with Norwegian Health Care among Immigrant Men Living with Co-Occurring Substance Use- and Mental Health Disorders.

Immigrants are considered at risk of psychological distress and therefore involvement in substance abuse, due to a variety of pre- and post-migration factors. Further, there is lower treatment engagement, a higher dropout rate, and less frequent hospitalizations among this group compared to the general population. There are few studies on the subjective understanding of co-occurring substance use disorder (SUD) and mental health disorder (MHD) among immigrants in Norway. This qualitative study aims to explore the treatment experiences of immigrant men living with co-occurring SUD and MHD. Within a collaborative approach, individual interviews were conducted with 10 men of immigrant background, living with co-occurring SUD and MHD, who had treatment experiences from the Norwegian mental health and addiction services. Data were analyzed using a systematic text condensation. The analysis yielded 6 categories where participants described their treatment experiences in mental health and addiction services in Norway as: lack of connection, lack of individually tailored treatment, stigma and discrimination preventing access to treatment, health professionals with multi-cultural competence, care during and after treatment, and raising awareness and reducing stigma. A significant finding was the mention by participants of the value of being seen and treated as a "person" rather than their diagnosis, which may increase treatment engagement. They further mentioned aftercare as an important factor to prevent relapse. This study provides an enhanced understanding of how immigrant men living with co-occurring SUD and MHD experienced being treated in Norwegian healthcare settings. These experiences may add to the knowledge required to improve treatment engagement.

Partnering with persons in long-term recovery from substance use disorder: experiences from a collaborative research project.

BACKGROUND: Traditional research about substance use disorder (SUD) treatment is considered, among an increasing number of service users, to be disempowering and poorly reflective of their priorities. Thus, this methodological article sought to examine the experiences of a peer research group (PRG), whose four members were in long-term SUD recovery, and a principal investigator (PI), when collaborating on a study of SUD recovery. This article has also aspired to discern the influence of peer researcher participation on the research process. The purpose of the qualitative research project that formed the basis of this methodological study was to examine the reasons provided and strategies employed for abstaining from problematic substance use among persons with SUDs. METHODS: The project took place from 2015 to 2018, during which time individual interviews were conducted with 18 persons in recovery from SUDs. The PRG contributed to all parts of the project and worked alongside the PI in preparing the study, during early stages of data analysis, and while writing up the findings. In total, ten group discussions were held over the course of 3 years. RESULTS: The study showed that the PRG offered important contributions with respect to developing the interview guide, preunderstanding among the PRG members, and discussing alternative forms of data collection. Key findings about how this collaborative research process was experienced relate to three matters: the group aspect of participation, the value of predictable routines and clear expectations, and the open sharing of private matters. The PI experienced the research process as having been enriched by alternative ways of asking questions and interpreting findings and as an interactive arena for reciprocal social and professional support. CONCLUSIONS: When establishing a PRG while studying recovery processes, it can be advantageous to include several peer researchers with diverse lived experiences concerning substance use, treatment, and recovery. If possible, at least one peer researcher with formal training or qualitative research experience might be included. The PI should be trained in collaborating with peer researchers or should be part of a research environment in which it is possible to discuss methodological challenges with other researchers.

Helpful Ingredients in the Treatment of Long-Term Substance Use Disorders: A Collaborative Narrative Study.

Relatively few individuals with a substance use disorder (SUD) seek or receive treatment, and knowledge about the effective ingredients in SUD treatment, from the perspective of those who receive it, is scarce. Our study purpose was to explore the experiences of those with long-term SUDs and the aspects they found helpful during treatment and long-term recovery. Semi-structured interviews were conducted with 18 participants, each of whom had been diagnosed with a long-term SUD, and who had been abstinent for at least 5 years. A resource group of peer consultants in long-term recovery from SUDs contributed to study planning, preparation, and initial analyses. Participants preferred individualized, long-term treatment, and support from both therapists and other clients. They further acknowledged the importance of their own sense of responsibility for their treatment and recovery success. Greater focus should be placed on viewing long-term SUD as a long-term condition, similar to somatic diseases, and SUD treatment services should place greater emphasis on developing partnership care models, long-term monitoring and support, and actively engaging recovered clients in the care of others in SUD treatment.

How Social Relationships Influence Substance Use Disorder Recovery: A Collaborative Narrative Study.

Individuals with a substance use disorder (SUD) often have fewer social support network resources than those without SUDs. This qualitative study examined the role of social relationships in achieving and maintaining stable recovery after many years of SUD. Semi-structured interviews were conducted with 18 participants, each of whom had been diagnosed with a SUD and each of whom had been abstinent for at least 5 years. A resource group of peer consultants in long-term recovery from SUDs contributed to the study planning, preparation, and initial analyses. The relationship that most participants described as helpful for initiating abstinence was recognition by a peer or a caring relationship with a service provider or sibling. These findings suggest that, to reach and maintain abstinence, it is important to maintain positive relationships and to engage self-agency to protect oneself from the influences of negative relationships. Substance use disorder service providers should increase the extent to which they involve the social networks of clients when designing new treatment approaches. Service providers should also focus more on individualizing services to meet their clients on a personal level, without neglecting professionalism or treatment strategies.

Why Do Those With Long-Term Substance Use Disorders Stop Abusing Substances? A Qualitative Study.

Although a significant proportion of adults recover from substance use disorders (SUDs), little is known about how they reach this turning point or why they stop using. The purpose of the study was to explore the factors that influence reasoning and decision making about quitting substance use after a long-term SUD. Semistructured interviews were conducted with 18 participants, each of whom had been diagnosed with a SUD and had been abstinent for at least 5 years. A resource group of peer consultants in long-term recovery from SUDs contributed to the study's planning, preparation, and initial analyses. Participants recalled harmful consequences and significant events during their years of substance use. Pressure and concern from close family members were important in their initial efforts to abstain from substance use. Being able to imagine a different life, and the awareness of existing treatment options, promoted hope and further reinforced their motivation to quit. Greater focus on why those with SUDs want to quit may help direct treatment matching; treatment completion may be more likely if the person's reasons for seeking help are addressed.

Engagement in assertive community treatment as experienced by recovering clients with severe mental illness and concurrent substance use.

BACKGROUND: Clients with severe mental illness (SMI) who use substances are less engaged in treatment than those who do not use substances, and assertive community treatment (ACT) engages and retains clients with SMI and concurrent substance use at a higher rate compared with traditional treatment. This qualitative study aimed to explore the experiences of being recruited to, and remaining in, ACT among recovering clients diagnosed with SMI and concurrent substance use. METHODS: Twenty semi-structured interviews were undertaken among 11 clients with SMI and concurrent substance use who were included in ACT teams. The inclusion criteria were SMI and concurrent substance use and improvement after a minimum of 12 months in treatment regarding one or several of the following parameters: quality of life, general functioning and substance use. Systematic text condensation was applied in the analyses. RESULTS: The experiences of building trust through enduring involvement and receiving benefits were most important for the acceptance of ACT by clients. A feeling of exclusiveness, perceiving ACT as a safety net and the clients' own personal responsibility for taking part in the treatment were stated as the most important factors for remaining in treatment. CONCLUSIONS: The implications of the results of the present study are that service providers have to prove that they can be trusted in the initial phase of the clients' contact with the team. The feeling by clients with SMI and concurrent substance use that service providers in ACT believe they can improve their client's quality of life, is of importance for feeling exclusive, having hope for the future and remaining in treatment.

Walking the fine line: self-reported reasons for substance use in persons with severe mental illness.

Many theoretical models have been proposed to explain the relationship between severe mental illness (SMI) and substance use. Because many of these are contradictory quantitative American studies, a qualitative, exploratory study of a Scandinavian sample may offer a new perspective. The aim of the study is to explore reasons for substance use through analysis of the participants' experiences. A qualitative study with semistructured interviews was used. Purposeful sampling (N=11) of patients with substance use disorder (SUD) and SMI, who were included in assertive community treatment teams, was completed. Inclusion criteria are increased quality of life or increased general functioning, and decreased substance use, after a minimum of 12 months in treatment. Reasons given for using substances were categorized as (a) controlling the symptoms of mental illness, (b) counteracting medication side effects, or (c) balancing the ambiguity. The conclusion is that the study findings mainly support secondary substance use models in explaining the comorbidity of SMI and substance use. However, there is some support for the traditional self-medication hypothesis (SMH), iatrogenic vulnerability, and the supersensitivity model. This may be because the majority of the study participants reported having a mental illness with subsequent substance use. The expressed ambivalence to substance use also lends some support to bidirectional models.