Barriers to Enrollment in drug abuse treatment and suggestions for reducing them: Opinions of drug injecting street outreach clients and other system stakeholders
Barriers to Enrollment in drug abuse treatment and suggestions for reducing them: Opinions of drug injecting street outreach clients and other system stakeholders
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DOI：
10.1081/ada-120029870
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发表时间：
2004-01-01
影响因子：
2.7
通讯作者：
Oldak, R
中科院分区：
文献类型：
--
作者：
Appel, PW;Ellison, AA;Oldak, R
酒精和其他药物滥用（AOD）治疗是预防艾滋病毒/艾滋病的主要手段，但街头外展方案（SOP）的客户是注射毒品使用者（IDU），以及外展工作人员和工作人员，报告各种障碍，以登记客户在AOD方案。本研究评估了高风险街道外展客户面临的AOD注册障碍，并获得了减少这些障碍的建议。数据来自半结构化实地访谈：1）纽约市（NYC）和北方郊区六个SOP的IDU外展客户（N = 144），由酗酒和药物滥用服务办公室（OASAS）支持，OASAS是纽约州预防和治疗AOD的唯一州机构，2）六个SOP的外展工作人员和工作人员（N = 55），3）在治疗注射吸毒者的主要方式中的排毒和AOD治疗方案的工作人员（N = 71），和4）OASAS、卫生部艾滋病研究所（处理纽约州艾滋病毒/艾滋病流行病的所有方面）和纽约市公共援助机构、人力资源管理局（HRA）的官员和管理人员（N = 11）。街头外展客户的主要障碍包括个人家庭问题，缺乏保险/医疗补助，无知，怀疑和/或厌恶AOD治疗（尤其是美沙酮维持），与医疗补助的“麻烦”，缺乏个人身份证，缺乏“插槽”，有限的摄入量，无家可归，儿童保育儿童监护问题。此外，约有18%的人没有接受AOD服务的愿望，报告说没有障碍，或者太沉迷于成瘾而无法注册。外展工作人员指出，潜在客户缺乏身份证和医疗补助，缺乏“插槽”，利益相关者机构的官僚作风。治疗工作人员列举了缺乏客户准备，“麻烦”所造成的福利改革，AOD计划自己的“繁文缛节”，等待名单，并接近排斥偏好的医疗补助资格。最后，机构管理人员列举了客户因素，资金不足和缺乏适当的计划，治疗计划的要求，以及社会对成瘾者的污名化。建议的补救措施包括取消身份证和入院保险要求，大幅增加资源，资助将外展客户治疗候选人运送到AOD服务点，教育和培训举措，增加机构间合作，以及利益相关者机构，特别是OASAS，更有效地将禁欲导向的AOD服务与减少危害和AOD问题的公共卫生方面结合起来。
Alcohol and other drug abuse (AOD) treatment is a major means of HIV/ AIDS prevention, yet clients of street outreach programs (SOP) who are injection drug users (IDU), and outreach workers and staff as well, report various obstacles to enrolling clients in AOD programs. This study assessed the barriers to AOD enrollment facing high risk street outreach clients and obtained suggestions for reducing them. Data were obtained from semistructured field interviews with: 1) IDU outreach clients (N = 144) of the six SOPs in New York City (NYC) and northern suburbs supported by the Office of Alcoholism and Substance Abuse Services (OASAS), the single state agency in New York State for AOD prevention and treatment, 2) outreach workers and staff of the six SOPs (N = 55), 3) staff of detox and AOD treatment programs in major modalities treating IDUs (N = 71), and 4) officials and administrators (N = 11) in OASAS, the AIDS Institute of the Department of Health (addresses all aspects of the HIV/AIDS epidemic in New York State), and the agency for public assistance in New York City, the Human Resources Administration (HRA). Principal barriers for street outreach clients included personal-family issues, lack of insurance/Medicaid, ignorance, suspicion, and/or aversion to AOD treatment (methadone maintenance especially), "hassles" with Medicaid, lack of personal ID, lack of "slots," limited access to intake, homelessness, childcare-child custody issues. Further, about 18% had no desire for AOD services, reported no barriers, or were too enmeshed in addiction to enroll. Outreach staff cited prospective client's lack of ID and lack of Medicaid, lack of "slots," and stakeholder agency bureaucracy. Treatment staff cited lack of client readiness, "hassles" posed by welfare reform, AOD programs' own "red tape," waiting lists, and near exclusionary preference for the Medicaid-eligible. Finally, agency managers cited client factors, inadequate funding and lack of appropriate programs, treatment program requirements, and societal stigmatization of addicts. Proposed remedies included dropping ID and insurance requirements for admission, major increases in resources, funding the transporting of outreach client treatment candidates to AOD services sites, education and training initiatives, increased inter-agency cooperation, and the need for stakeholder agencies, OASAS especially, to more effectively integrate abstinence-oriented AOD services with harm reduction and the public health aspects of AOD problems.