Many substance users report that they experience multiple barriers that produce significant challenges to linking with treatment services. Being on a waiting list is frequently mentioned as a barrier, leading some people to give up on treatment and to continue using, while prompting others to view sobriety during the waiting period as proof they do not need treatment. This ethnographic study examines the views that 52 substance users have of the waiting time before treatment and the strategies they created to overcome it. Understanding how substance users react to waiting time itself and in relation to other barriers can lead to services that are effective in encouraging treatment linkage.
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References
1.
AdairE.B.G.CraddockS.G.MillerH.G.TurnerC.F.1995Assessing consistency of responses to questions on cocaine use. Addiction, 90, 1497–1502.
2.
AddenbrookeW.M.RathodN.H.1990Relationship between waiting time and retention in treatment amongst substance abusers. Drug and Alcohol Dependence, 26, 255–264.
3.
American Psychiatric Association2001Diagnostic and statistical manual of psychiatric disorders (4th ed.). Washington, D. C.: American Psychiatric Association.
4.
American Society of Addiction Medicine2001Patient placement criteria for the treatment of substance-related disorders (2nd ed.). Chevy Chase, MD: American Society of Addiction Medicine.
5.
AppelP.W.EllisonA.A.JanskyH.K.OldakR.2004Barriers to enrollment in drug abuse treatment and suggestions for reducing them: Clients and other system stakeholders. The American Journal of Drug and Alcohol Abuse, 30 (1), 129–153.
6.
BellJ.CaplehornJ.R.M.McNeilD.R.1994The effect of intake procedures on performance in methadone maintenance. Addiction, 89, 463–471.
7.
BestD.NobleA.RidgeG.GossopM.FarrellM.StrangJ.2002The relative impact of waiting time and treatment entry on drug and alcohol use. Addiction Biology, 7, 67–74.
8.
BrownB.S.HickeyJ.E.ChungA.S.CraigR.D.JaffeJ.H.1989The functioning of individuals on a drug abuse treatment waiting list. American Journal of Drug and Alcohol Abuse, 15 (3), 261–274.
9.
BurkeB. L.ArkowitzH.MencholaM.2003The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials. Journal of Consulting and Clinical Psychology, 71 (5), 843–861.
10.
CarlsonR.G.2006Ethnography and applied substance misuse research: Anthropological and cross-cultural factors. InMillerW.CarrollK. (Eds.) Rethinking substance abuse: What science shows and what we should do about it (pp. 201–219). New YorkGuilford Publications.
11.
ClausR.E.BarronN.PascualK.A.2003The Target Cities participants: From centralized intake to treatment entry. InStephensR.C.ScottC.K.MuckR.D. (Eds.), Clinical assessment and substance abuse treatment—The Target Cities experience (pp 73–86). Albany: State University of New York Press.
12.
ClausR.E.KindlebergerL.R.2002Engaging substance abusers after centralized assessment: Predictors of treatment entry and dropout. Journal of Psychoactive Drugs, 34 (1), 25–31.
13.
DennisM.L.IngramP.W.BurksM.E.ValleyRachal J.1994Effectiveness of streamlined admissions to methadone treatment: A simplified time-series analysis. Journal of Psychoactive Drugs, 26 (2), 207–216.
14.
DonovanD.M.RosengrenD.B.DowneyL.CoxG.B.SloanK.L.2001Attrition prevention with individuals awaiting publicly funded drug treatment. Addiction, 96, 1149–1160.
15.
FarabeeD.LeukefeldC.G.HayesL.1998Accessing drug-abuse treatment: Perceptions of out-of-treatment injectors. Journal of Drug Issues, 28 (2), 381–394.
16.
FestingerD.S.LambR.J.KountzM.R.KirbyK.C.MarloweD.1995Pretreatment dropout as a function of treatment delay and client variables. Addictive Behaviors, 20 (1), 111–115.
17.
FieldingN.G.LeeR.M.1998Computer analysis and qualitative research. Thousand Oaks, California: SAGE.
18.
FriedmannP.Des JarlaisD.C.PeyserN.P.NicholsS.E.DrewE.NewmanR.G.1994Retention of patients who entered methadone maintenance via an interim methadone clinic. Journal of Psychoactive Drugs, 26 (2), 217–221.
19.
FriedmannP.D.LemonS.C.SteinM.D.D'AunnoT.A.2003Accessibility of addiction treatment: Results from a national survey on outpatient substance abuse treatment organizations. Health Services Research, 38 (3), 887–903.
20.
GardnerL. I.MetschL. R.Anderson-MahoneyP.LoughlinA. M.del RioC.StrathdeeS.SansomS. L.SiegalH. A.GreenbergA. E.HolmbergS. D., and the Antiretroviral Treatment and Access Study (ARTAS) Study Group2005Efficacy of a brief case management intervention to link recently diagnosed HIV-infected persons to care. AIDS, 19, 423–431.
21.
GaritiP.AltermanA.I.Holub-BeyerE.VolpicelliJ.R.PrenticeN.O'BrienC.1995Effects of an appointment reminder call on patient show rates. Journal of Substance Abuse Treatment, 12 (3), 207–212.
22.
GlaserB.G.StraussA.L.1967The discovery of grounded theory: Strategies for qualitative research. Chicago, Illinois: Aldine Publication Company.
23.
GuydishJ.MooreL.GleghornA.DavisT.SearsC.HarcourtJ.2000Drug abuse treatment on demand in San Francisco: Preliminary findings. Journal of Psychoactive Drugs, 32 (4), 363–370.
24.
GuydishJ.MuckR.1999The challenge of managed care in drug abuse treatment. Journal of Psychoactive Drugs, 31 (3), 193–195.
25.
HenikW.DominoG.1975Alterations in future time perspective in heroin addicts. Journal of Clinical Psychology, 31 (3), 557–564.
26.
HserY.MaglioneM.PolinskyM.L.AnglinM.D.1998Predicting drug treatment entry among treatment seeking individuals. Journal of Substance Abuse Treatment, 15 (3), 213–220.
27.
McLellanA.T.AltermanA.I.MetzgerD.S.GrissomG.R.WoodyG.E.LuborskyL.O'BrienC.P.1994Similarity of outcome predictors across opiate, cocaine, and alcohol treatment: Role of treatment services. Journal of Consulting and Clinical Psychology, 62 (6), 1141–1158.
28.
MillerW. R.RollnickS.ConfortiK.2002Motivational interviewing: Preparing people for change (2nd ed.). New York, N.Y.: Guilford Press.
29.
MooreB.A.BudneyA.J.2002Abstinence at intake for marijuana dependence treatment predicts response. Drug and Alcohol Dependence, 67, 249–257.
30.
MunnN.D.1992The cultural anthropology of time: A critical essay. Annual Review of Anthropology, 21, 93–123.
31.
NeedleR.FischerD.G.WeatherbyN.ChitwoodD.BrownB.CesariH.BoothR.WilliamsM.L.WattersJ.AndersenM.BraunsteinM.1995Reliability of self-reported HIV risk behaviors of drug users. Psychology of Addictive Behaviors, 9, 242–250.
32.
PorterJ.1999The street/treatment barrier: Treatment experiences of Puerto Rican injection drug users. Substance Use & Misuse, 34 (14), 1951–1975.
33.
RappR. C.2006Strengths-based case management: Enhancing treatment for persons with susbtance abuse problems. InSaleebeyD. (Ed.), The strengths perspective in social work practice (4th ed.) (pp. 128–147). Boston: Pearson.
34.
RappR.C.XuJ.CarrC.LaneT.WangJ.CarlsonR.G.2006Factor analysis of treatment barriers identified by substance abusers following assessment at a centralized intake unit. Journal of Substance Abuse Treatment.
35.
RichardsL.1999Using NVivo in qualitative research. Thousand Oaks: SAGE.
36.
SiegalH.A.FalckR.S.WangJ.CarlsonR.G.2002Predictors of drug abuse treatment entry among crack-cocaine smokers. Drug and Alcohol Dependence, 68 (2), 159–166.
37.
SiegalH. A.LiL.RappR. C.2002Case management as a therapeutic enhancement: Impact on post-treatment criminality. Journal of Addictive Diseases, 21 (4), 37–46.
38.
StarkM.J.CampbellB.K.BrinkerhoffC.V.1990“Hello, may we help you?” A study of attrition prevention at the time of the first phone contact with substance-abusing clients. American Journal of Drug and Alcohol Abuse, 16, 67–76.
39.
StasiewiczP.R.StalkerR.1999A comparison of three “intervention's’ on pretreatment dropout rates in an outpatient substance abuse clinic. Addictive Behaviors, 24 (4), 579–582.
40.
StephensR.C.ScottC.K.MuckR.D.2003Clinical assessment and substance abuse treatment—the Target Cities experience (pp. 73–86). Albany: State University of New York Press.
41.
StraussA.CorbinJ.1998Basics of qualitative research: Techniques and procedures for developing grounded theory. Thousand Oaks, CA: SAGE.
42.
TsogiaD.CopelloA.OrfordJ.2001Entering treatment for substance misuse: A review of the literature. Journal of Mental Health, 10 (5), 481–499.
43.
TuckerJ.A.1995Predictors of help-seeking and the temporal relationship of help to recovery among treated and untreated recovered problem drinkers. Addiction, 90, 805–809.
44.
WengerL.D.RosenbaumM.1994Drug treatment on demand—not. Journal of Psychoactive Drugs, 26 (1), 1–11.
45.
YancovitzS.R.Des JarlaisD.C.PeyserN.P.DrewE.FriedmannP.TriggH.L.RobinsonJ.W.1991A randomized trial of an interim methadone maintenance clinic. American Journal of Public Health, 81 (9), 1185–1191.
