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“If It Wasn’t for Him, I Wouldn’t Have Talked to Them”: Qualitative Study of Addiction Peer Mentorship in the Hospital

  • Devin CollinsEmail author
  • Juliet Alla
  • Christina Nicolaidis
  • Jessica Gregg
  • Deborah Jane Gullickson
  • Alisa Patten
  • Honora Englander
Original Research

Abstract

Background

Hospitalizations related to substance use disorders (SUD) are skyrocketing. Hospital providers commonly feel unprepared to care for patients with SUD and patients with SUD commonly feel discriminated against by hospital staff. This tension can lead to provider burnout and poor patient outcomes. Research in ambulatory settings suggests that peer mentors (PMs) can improve substance use outcomes and patient experience. However, no study has examined the role of peer mentorship for patients with SUD in hospitals.

Objective

Understand how peer mentorship affects care for hospitalized patients with SUD, and how working in a hospital affects PMs’ sense of professional identity.

Design

Qualitative study utilizing participant observation, individual interviews, and focus groups related to the PM component of the Improving Addiction Care Team (IMPACT), a hospital-based interprofessional addiction medicine consult service.

Participants

IMPACT providers, patients seen by IMPACT, PMs, and a PM supervisor.

Approach

Qualitative thematic analysis.

Key Results

PMs occupy a unique space in the hospital and are able to form meaningful relationships with hospitalized patients based on trust and shared lived experiences. PMs facilitate patient care by contextualizing patient experiences to teams and providers. Reciprocally, PMs “translate” provider recommendations to patients in ways that patients can hear. Respondents described PMs as “cultural brokers” who have the potential to transfer trust that they have earned with patients to providers and systems who may otherwise be viewed as untrustworthy. While PMs felt their role led to professional and personal development, the intensity of the role in the hospital setting also put them at risk for emotional drain and stress.

Conclusions

While integrating PMs into hospital care presents substantial challenges, PMs may act as a “secret weapon” to engage often marginalized hospitalized patients with SUD and improve patient and provider experience.

KEY WORDS

substance-related disorders qualitative research peer recovery hospital physician-patient relations 

Notes

Acknowledgments

Authors would like to acknowledge O’Nesha Cochran, Chris Colasurdo, Kim Brandt, Meg Devoe, Richard Gil, Melissa Weimer, Daren Ford, Stacey Mahoney, Jessica Brown, Claire Dorfman, and the entire IMPACT clinical team. The IMPACT is supported by OHSU and CareOregon.

Funding Information

This work was supported by the Oregon Clinical and Translational Research Institute (OCTRI) grant UL1TR0023693.

Compliance with Ethical Standards

Study protocol was approved by the Oregon Health & Science University institutional review board.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2019_5311_MOESM1_ESM.docx (19 kb)
ESM 1 (DOCX 19 kb)

References

  1. 1.
    Ronan MV, Herzig SJ. Hospitalizations related to opioid abuse/dependence and associated serious infections increased sharply, 2002-12. Health Aff (Millwood). 2016;35:832–7.CrossRefGoogle Scholar
  2. 2.
    Wakeman SE, Pham-Kanter G, Donelan K. Attitudes, practices, and preparedness to care for patients with substance use disorder: results from a survey of general internists. Subst Abus. 2016;37:635–41.CrossRefGoogle Scholar
  3. 3.
    Englander H, Collins D, Perry SP, Rabinowitz M, Phoutrides E, Nicolaidis C. “We’ve learned it’s a medical illness, not a moral choice”: qualitative study of the effects of a multicomponent addiction intervention on hospital providers’ attitudes and experiences. J Hosp Med. 2018;13:752–8.Google Scholar
  4. 4.
    Ford R. Interpersonal challenges as a constraint on care: the experience of nurses’ care of patients who use illicit drugs. Contemp Nurse. 2011;37:241–52.CrossRefGoogle Scholar
  5. 5.
    McGillion J, Wanigaratne S, Feinmann C, Godden T, Byrne A. GPs’ attitudes towards the treatment of drug misusers. Br J Gen Pract. 2000;50:385–6.Google Scholar
  6. 6.
    van Boekel LC, Brouwers EP, van Weeghel J, Garretsen HF. Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. Drug Alcohol Depend. 2013;131:23–35.CrossRefGoogle Scholar
  7. 7.
    Merrill JO, Rhodes LA, Deyo RA, Marlatt GA, Bradley KA. Mutual mistrust in the medical care of drug users: the keys to the “narc” cabinet. J Gen Intern Med. 2002;17:327–33.Google Scholar
  8. 8.
    Velez CM, Nicolaidis C, Korthuis PT, Englander H. “It’s been an experience, a life learning experience”: a qualitative study of hospitalized patients with substance use disorders. J Gen Intern Med. 2017;32:296–303.CrossRefGoogle Scholar
  9. 9.
    Sleeper J, Bochain S. Stigmatization by nurses as perceived by substance abuse patients: a phenomenological study. J Nurs Educ Pract. 2013;3:8.Google Scholar
  10. 10.
    Brener L, Von Hippel W, Kippax S, Preacher KJ. The role of physician and nurse attitudes in the health care of injecting drug users. Subst Use Misuse. 2010;45:1007–18.CrossRefGoogle Scholar
  11. 11.
    Bassuk EL, Hanson J, Greene RN, Richard M, Laudet A. Peer-delivered recovery support services for addictions in the United States: a systematic review. J Subst Abus Treat. 2016;63:1–9.CrossRefGoogle Scholar
  12. 12.
    Reif S, Braude L, Lyman DR, et al. Peer recovery support for individuals with substance use disorders: assessing the evidence. Psychiatr Serv. 2014;65:853–61.CrossRefGoogle Scholar
  13. 13.
    Pantridge CE, Charles VA, DeHart DD, et al. A qualitative study of the role of peer support specialists in substance use disorder treatment: examining the types of support provided. Alcohol Treat Q. 2016;34:337–53.CrossRefGoogle Scholar
  14. 14.
    Gillard S, Gibson SL, Holley J, Lucock M. Developing a change model for peer worker interventions in mental health services: a qualitative research study. Epidemiol Psychiatr Sci 2015;24:435–45.CrossRefGoogle Scholar
  15. 15.
    Watson E. The mechanisms underpinning peer support: a literature review. J Ment Health. 2017;1–12.Google Scholar
  16. 16.
    Chappell Deckert J, Statz-Hill M. Job satisfaction of peer providers employed in mental health centers: a systematic review. Soc Work Ment Health. 2016;14:564–82.CrossRefGoogle Scholar
  17. 17.
    Cronise R, Teixeira C, Rogers ES, Harrington S. The peer support workforce: results of a national survey. Psychiatr Rehabil J. 2016;39:211–21.CrossRefGoogle Scholar
  18. 18.
    Moran GS, Russinova Z, Gidugu V, Gagne C. Challenges experienced by paid peer providers in mental health recovery: a qualitative study. Community Ment Health J. 2013;49:281–91.CrossRefGoogle Scholar
  19. 19.
    Englander H, Weimer M, Solotaroff R, et al. Planning and designing the Improving Addiction Care Team (IMPACT) for hospitalized adults with substance use disorder. J Hosp Med. 2017;12:339–42.CrossRefGoogle Scholar
  20. 20.
    Englander H, Brandt K, Mahoney S, Brown J, Nydahl A, Weimer M, Gregg J. Tools to support hospital-based addiction care: core components, values, and activities of the Improving Addiction Care Team (IMPACT). J Addict Med.  https://doi.org/10.1097/ADM.0000000000000487.
  21. 21.
    Englander H, Gregg J, Gullickson J, et al. Recommendations for integrating peer mentors in hospital-based addiction care (in press). Subst Abus.  https://doi.org/10.1080/08897077.2019.1635968.
  22. 22.
    Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3:77–101.CrossRefGoogle Scholar
  23. 23.
    Austin E, Ramakrishnan A, Hopper K. Embodying recovery: a qualitative study of peer work in a consumer-run service setting. Community Ment Health J. 2014;50:879–85.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Devin Collins
    • 1
    Email author
  • Juliet Alla
    • 1
  • Christina Nicolaidis
    • 1
    • 2
  • Jessica Gregg
    • 1
  • Deborah Jane Gullickson
    • 3
  • Alisa Patten
    • 1
  • Honora Englander
    • 1
  1. 1.Department of MedicineOregon Health & Science UniversityPortlandUSA
  2. 2.School of Social WorkPortland State UniversityPortlandUSA
  3. 3.Mental Health Association of OregonPortlandUSA

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