Exploring the Daily Lives of People on Methadone Maintenance Treatment

143 Pages·2017·1.66 MB·English

Western University
Exploring the Daily Lives of People on Methadone Maintenance Treatment: An
Occupational Perspective

(Thesis format: Monograph)

by

Katrina Warren

Graduate Program in Health and Rehabilitation Sciences

A thesis submitted in partial fulfillment
of the requirements for the degree of
Master of Science

The School of Graduate and Postdoctoral Studies
The University of Western Ontario
London, Ontario, Canada

© Katrina Warren 2015
Abstract and Keywords
A study was undertaken with five people on Methadone Maintenance Treatment (MMT)
within London, Ontario. The objectives were to better understand the experiences and daily
routines of people on MMT through in-depth exploration of their everyday occupations and the
ongoing challenges and barriers they face to accessing treatment. This research employed a
qualitative intrinsic case study methodology (Stake, 1995). Using an occupational perspective
informed by a framework for occupational justice (Stadnyk et al., 2010), findings are presented
according to four themes highlighting key aspects of the participants' experiences: a) a ‘descent
into chaos’, b) ‘MMT as a bridge’ to recovery from addiction, c)a ‘new normal’ daily life, and d)
hopes for ‘moving forward’. These findings illustrate how structural factors and contextual
factors interact to create occupational injustices. Thus, MMT practices and policies should
consider the occupational implications described in this thesis to enhance patients’ experiences
and further support their recovery.

Keywords: activities of daily living, addiction, case study, methadone maintenance treatment
(MMT), occupation, occupational science, qualitative, routine

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Acknowledgements
There are so many people who I would like to thank. This thesis would not be possible if it were
not for all of the following individuals. First of all, to my supervisor, Suzanne Huot. Thank you
for your commitment, dedication and guidance throughout this whole process. I have learned so
much from working with you and all of your help has been greatly appreciated. To my co-
supervisor Lilian Magalhães and supervisory committee member Marilyn Evans. Thank you for
joining my committee and for all of your support and ongoing feedback.
To Lynn Shaw for agreeing to be my supervisor when I first started at Western. Thank you for
all of wisdom and all of your guidance in my first year as a Master’s student. To Susan Ray, my
co-supervisor who unexpectedly passed away last summer in the beginning stages of my thesis
development. Thank you for all of your input. I enjoyed getting to know you in the short time we
had together. You will be greatly missed.
To my incredible parents, Steven and Deborah Warren and my brother Alex Warren who have
always encouraged and supported me. I would not be where I am today without you and I am so
grateful to have the most amazing family. Also, to Dave for your continued love and support
throughout this journey. Thank you for coming on this wild ride with me.
I would like to thank all of the w onderful staff at the MMT clinic for allowing me to conduct my
research there and for helping me with the recruitment process. Lastly, to all of my participants,
thank you for your interest in my research and for taking the time to participate in my study . I
have learned so much from each of you. Thank you for contributing to the research community.

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Table of Contents
Abstract and Keywords……………………………………………….......................…………...ii
Acknowledgements………………………………………………………………………………iii
Table of Contents……………………...………………………………………………………….iv
List of Tables.……………………………………………………………………...………….....vii
List of Figures……………………………………………………………………………….......viii
List of Appendices………………………………………………………………….……...……..ix
List of Abbreviations……………………………………………………………….………..........x
Chapter One – Introduction…………………………………………………………………....….1
1.1.Introduction…………………………………………………………………………....1

1.2.Background………………....…………………………………….……………...……1
1.2.1. Overview of Methadone Maintenance Treatment (MMT)……………………..2
1.2.2. How MMT Works………………………………………………………………5
1.2.3. Accessing Treatment and Daily Life on MMT…………………………..……..9
1.3. Applying an Occupational Perspective to the Study of MMT Experiences………...10
1.4. Study Purpose/Objectives……………………………………………………….......16
1.5. Self as a Researcher…………………….…………………………………...……....15
1.6. Thesis Outline................................ …………….…………………………….……..17
Chapter Two – Literature Review……………....…………….………………………….……....18
2.1. Introduction................................................................................... ......................... .....18
2.2. Literature Review Methodology................................................... ..............................18
2.2.1. Stage 1: Identifying the Research Questions……………..……………….19
2.2.2. Stages 2 and 3: Selection and Identifica tion of Relevant Studies…….. ..…20
2.2.3. Stages 4 and 5: Data Extraction and Summarizing Results...........…….….22
2.3. Results of Scoping Review........................................................... ..............................22
2.3.1. Stigma……………………………………………………………………..23
2.3.2. Self-Concept and Identity…………………………………………………25
2.3.3. Personal Relationships……………………………………………..……...27
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2.4. Discussion...................................................................................................................29
2.5. Conclusion..................................................................................................................30
Chapter Three – Methodology and Methods………………………......................................…...32
3.1. Introduction…………………………………………………………...….…...…..…32
3.2. Study Design...............................................................................................................32
3.2.1. Paradigmatic Positioning………………………………………....……….29
3.2.2. Occupational Justice Framework.................................................................31
3.2.3. Methodology…………………………………………...……………….....33
3.3. Methods………………………………………………………………...…………....34
3.3.1. Boundary Setting and Participant Recruitment............................................35
3.3.2. Site Description………………………………………...………….………37
3.3.3. Data Collection………...………………….…….....…………….…...…...38
3.4. Data Management……………………………………………………………….......40
3.5. Data Analysis……………………………..................………………………………41
3.6. Ethical Considerations………………………………………………...……....…….42
3.7. Quality and Trustworthiness Criteria…………………………....…………………..43
3.8. Conclusion………………………………………….……………………………….49
Chapter Four – Findings……………………………………………………………………....…50
4.1. Introduction…………………………………………………………………....….....50
4.2. Introducing the Participants…………....…………………………………....……....50
4.3. Findings……………………………………………………………………………..60
4.3.1. Descent into Chaos………………………………………………………..61
4.3.2. Methadone Maintenance Treatment as a Bridge………………………….65
4.3.3. Liminality in the New Normal…………………………………………….74
4.3.4. Moving Forward…………………………………………………………..78
4.4. Conclusion……………………………………………………………………..........83
Chapter Five – Discussion and Conclusion……………………………………………....……...86
5.1. Introduction………………………………………………………………...………..86
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5.2. Discussion…………………………………………………………………………...87
5.2.1. Structural Factors……...…………………………………………………..88
5.2.2. Contextual Factors……………………………………...…………………91
5.2.3. Occupational Outcomes……………………...……………………………94
5.3. Return to Reflection.................................................................................................100
5.4. Recommendations………………………………………………………………….101
5.5. Study Strengths/Limitations and Future Research Directions……………………..102
5.6. Conclusion.……………...…………………………………………....………....…103
References………………………………………………………………………………………107
Appendices………………………………………………………..…………………………….116
Vita…………......….…………………………………………………...…………………….…132

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List of Tables
Table 2.1: Search terms.................................................................................................................20
Table 2.2: Relevancy criteria.........................................................................................................21

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List of Figures
Figure 3.1. Framework for Occupational Justice...........................................................................35
Figure 4.1. Participants’ Experiences of MMT.............................................................................61
Figure 5.1. Framework for Occupational Justice……….……………………………………..…88

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List of Appendices
Appendix A: Articles Included in the Scoping Review..................................................... ..........116
Appendix B: Recruitment Advertisement..……………..……………………………...…….…120
Appendix C: Letter of Information and Consent Form..……………………………………….121
Appendix D: Interview Guide...………………………………………………………….……..126
Appendix E: Mapping Facilitation Questions...…………………………………...……….…...127
Appendix F: Demographic Questionnaire……………………………………….….…...……..128
Appendix G: Ethics Approval from the University of Western Ontario…………...…….…….130
Appendix H: Example of an Occupational Map..........................................................................131

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