The overarching aim of this study is to explore the dynamics of (behavioural rather than substance) substitute addictions. The study aims to determine the occurrence, typical features and development of substitute addictions among substance abusers during and after residential treatment and to assess service providers’ and service users’ perceptions and experiences regarding this phenomenon.
While there is a proliferation of research on addictive behaviours and co-occurring psychiatric disorders worldwide (see Sinclair, Lochner & Stein, 2016), the literature base on substitute addiction is limited and merits further exploration (Sussman & Black, 2008). In the South African context in particular, the need to screen for multiple addictions in treatment populations has been emphasized, but hardly been addressed (SACENDU, 2015). Moreover, limited attention has been accorded to relapse rates and mechanisms contributing to relapse. Likewise international research to “better understand the prevalence and functions of, and solutions to substitute addictions” is needed (Sussman & Black, 2008, p. 167). The attention given to substitute addiction in practice and research can thus be regarded inadequate up to now. The National Institute of Drug Abuse (NIDA, 2012), the premier authority on addiction practice and research in the US and worldwide, advised that for treatment to yield optimal outcomes, it must (1) be sensitive to individual needs of service users by tailoring the setting, treatment approach and services to their characteristics (which may include the propensity to substitute addictions); (2) address SUDs and an array of other needs in the course of treatment, again underscoring the need to be attendant to co-occurring or sequential addictions and (3) be modified, based on ongoing assessments, to ensure that changing needs are met (underscoring the importance of detecting substitute addictions in order to address these appropriately). Consequently, treatment providers must be formally trained to recognise substitute addictions in substance abusers, and have an in-depth understanding of its implications for treatment engagement, retention and outcomes. The envisioned research thus stands to play an important role in establishing knowledge on the extent of substitute addictions in service users; how they are viewed by treatment providers and understanding service users’ experiences of substitute addiction. These findings will be used to inform interventions, and have the potential to augment the relatively recent postgraduate training programme that seeks to address theoretical and skills deficits in treatment professionals (see Pasche, Kleintjes, Wilson, Stein & Myers, 2015). The outcomes of the research will therefore be relevant to service providers in South Africa and other developing countries who have a critical role in facilitating harm reduction with regard to HIV/AIDS among substance abusers.
Aims of the study
The overarching aim of this study is to explore the dynamics of (behavioural rather than substance) substitute addictions. The study aims to determine the occurrence, typical features and development of substitute addictions among substance abusers during and after residential treatment and to assess service providers’ and service users’ perceptions and experiences regarding this phenomenon. The ultimate goal is thus to enhance the performance of treatment services. More specifically the study intends:
To understand the phenomenon of substitute addiction, identify gaps in the literature, and to contextualise its features;
To monitor relapse and occurrence of substitute addiction among service users and its evolution during the first 6 months after starting treatment in an inpatient substance abuse treatment facility
To explore service users’ recovery trajectories following engagement with treatment
To examine addiction severity over time especially as it pertains to recovery after receiving treatment
To explore perceptions of substitute addiction among service providers and substance abusers