Organizational Stress and Trauma: Impediments to the Delivery of User-Involvement Models of Care in Substance Use Disorder Treatment

Abstract

Objective: The objective of the qualitative study reported in this paper was to expand knowledge of substance use disorder (SUD) care best practices, by examining the experiences of residential SUD care participants with user-involvement/oriented care models. These included person-centered, shared decision-making, recovery model and patient/person participation. The goal of the study was to provide a better understanding of the following: each user-involvement model as it relates to residential SUD care from the perspective of residential SUD care participants, the importance of concretizing the concepts for future empirical studies and the development of a nomenclature for the synthesis of the models to inform future empirical studies and assist practitioners with applying the core concepts of the four models in a way that is congruent with the outcomes of empirical studies. Methods: The author collected data by conducting semi-structured, open-ended, one-on-one interviews with a convenience sample of 12 study subjects between the ages of 24 and 65 years (11 males and 1 female) who selfidentified as having successfully completed at least one residential care program for substance use disorder(s). All interviews were recorded and transcribed, and grounded theory methodology was used to analyze the results. The study design was approved by the University of Pennsylvania Institutional Review Board, February 2016. Results: Data collected from the study subjects represented some degree of experience with all four userinvolvement models in residential substance use disorder care. Data also revealed experiences that represented the opposite of the models, and was indicative of care affected by organizational stress and trauma (e.g. burnout, vicarious trauma) and a lack of trauma-informed care. Conclusion: Subjects perceived the care to be most beneficial in the presence of the user-involvement models; however, quality care was compromised and negated by the presence of organizational stress and trauma and a lack of trauma-informed care. The current study finds organizational stress and trauma and a lack of traumainformed care not only serves as an impediment to the delivery of user-involvement/oriented care models, but becomes the overarching phenomena that undermines and negates the delivery of user-involvement models of care in residential substance use disorder treatment.