Advisor

Nurit Fischer-Shemer

Course

Practice-Informed Research in Health Systems

Document Type

Capstone

Publication Date

Fall 12-1-2024

Purpose

This study explores the elaborate relationship between Opioid Use Disorders (OUD) and loss, and grief experiences among adults. The research focused specifically on the population undergoing Opioid Use Disorder treatment at Sacramento Comprehensive Treatment Center in Sacramento California. Opioid Use Disorder is a pervasive issue with far-reaching implications, impacting both individuals, family members, and communities. Past research indicates that loss and grief significantly affect those struggling with OUD, potentially leading to relapse or exacerbating opioid use and resulting in maladaptive coping mechanisms to deal with their loss and grief experiences. These experiences can stem from the loss of a job, housing, relationships and the death of loved ones. Such traumatic events often heighten emotional distress, creating a vicious cycle leading to increased opioid use as a form of self-medication. The presence of grief in individuals has been identified as a predictor of complicated grief, surpassing other common risk factors such as age, gender, and socioeconomic status. The criminal justice system often fails to adequately support individuals with OUD due to prevailing stigmatization and the lack of psychoeducation on loss and grief symptoms while incarcerated. Limited access to comprehensive treatment options, insurance challenges, and insufficient support networks during incarceration contribute to poor treatment outcomes when this population is later released into communities. Their loss and grief experiences are rarely addressed or treated furthermore impacting their recovery journey. Positive relationships with probation staff were shown to enhance treatment success, yet stigma among justice personnel hinders these supportive interactions. There are significant social determinants of health disparities in OUD treatment access, particularly affecting racial and ethnic minorities. Factors such as poverty, lack of awareness of available resources, and systemic racism exacerbate these disparities. Many individuals with OUD are unaware of the healthcare resources available to them, which impedes their ability to receive necessary treatment and support, especially for co-occurring mental health issues. Organizational challenges, such as high staff turnover and the demanding nature of treatment center operations, limit counselors' ability to adequately address loss and grief with patients. Although macro-level policies have become less stringent, allowing for better access to medication-assisted treatment (MAT), micro-level organizational policies need to adapt to better support both staff and patients in addressing grief-related issues within these settings.

Methods

The study utilized a mixed quantitative and qualitative research design involving interviews with 17 participants from Sacramento Comprehensive Treatment Center, a facility providing medication-assisted treatment (MAT) for OUD. Participants were interviewed in a confidential manner, they all answered 27 questions and were given grief resources if needed. Thematic analysis was utilized to identify patterns related to the experiences of loss and grief among the participants.

Findings & Conclusions

Key themes included the direct impact of loss and grief on opioid use, the effects of incarceration and access to grief support, and the critical role of initial support systems during the grieving process. The data revealed a strong link between experiences of loss and grief and increased opioid use, indicating that these emotional challenges may act as triggers for relapse in patients undergoing OUD treatment. The data also strongly revealed a correlation between loss and grief experiences and compliance to treatment services including medication and counseling sessions.

Recommendations

Participants that experienced loss and grief became less compliant with their treatment. The grief experienced by individuals with OUD is often unrecognized and untreated, further complicating their recovery journey. Lastly, participants that were previously incarcerated face additional significant barriers to accessing grief and loss support. This impacts their ability to process traumatic events, which can exacerbate opioid use post-release. This study underscores the need for a holistic approach to OUD treatment that includes addressing loss and grief as core components of recovery. Enhanced collaboration between the justice system, healthcare providers, and treatment centers is crucial in reducing stigma and improving access to comprehensive care. Treatment centers have many options to better support individuals with OUD. Treatment centers can integrate specialized grief counseling services and trauma-informed care into existing treatment models within the clinic setting, as well as provide training for justice system personnel to reduce stigma and improve support for individuals with OUD. By addressing the emotional complexities of loss and grief alongside OUD treatment, there is potential to improve overall patient outcomes and reduce the cyclical nature of opioid use relapse triggered by unprocessed loss and grief experiences.

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