Research
Conflict and user involvement in drug misuse treatment decision-making: a qualitative study
-
* Corresponding author: Jan Fischer jan.fischer@postgrad.manchester.ac.uk
1 School of Environment and Development, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
2 School of Health and Social Care, Oxford Brookes University, Jack Straws Lane, Marston, Oxford, OX3 0FL, UK
3 Centre for Drug Misuse Research, University of Glasgow, 89 Dumbarton Road, Glasgow, G11 6PW, UK
Substance Abuse Treatment, Prevention, and Policy 2008, 3:21 doi:10.1186/1747-597X-3-21
Published: 6 October 2008Abstract
Background
This paper examines client/staff conflict and user involvement in drug misuse treatment decision-making.
Methods
Seventy-nine in-depth interviews were conducted with new treatment clients in two residential and two community drug treatment agencies. Fifty-nine of these clients were interviewed again after twelve weeks. Twenty-seven interviews were also conducted with staff, who were the keyworkers for the interviewed clients.
Results
Drug users did not expect, desire or prepare for conflict at treatment entry. They reported few actual conflicts within the treatment setting, but routinely discussed latent conflicts – that is, negative experiences and problematic aspects of current or previous treatment that could potentially escalate into overt disputes. Conflict resulted in a number of possible outcomes, including the premature termination of treatment; staff deciding on the appropriate outcome; the client appealing to the governance structure of the agency; brokered compromise; and staff skilfully eliciting client consent for staff decisions.
Conclusion
Although the implementation of user involvement in drug treatment decision-making has the potential to trigger high levels of staff-client conflict, latent conflict is more common than overt conflict and not all conflict is negative. Drug users generally want to be co-operative at treatment entry and often adopt non-confrontational forms of covert resistance to decisions about which they disagree. Staff sometimes deploy user involvement as a strategy for managing conflict and soliciting client compliance to treatment protocols. Suggestions for minimising and avoiding harmful conflict in treatment settings are given.