title: Redefining retention: recovery from the patient's perspective.
abstract: This study examines the process of discharge and treatment reentry for six participants who entered treatment voluntarily but were administratively discharged from methadone treatment programs. The participants completed semistructured interviews at treatment entry and at four, eight and 12 months post-treatment entry. Grounded theory methodology was used to examine the phenomenon of treatment reentry from the perspective of the patients, who often viewed their recovery as an accumulation of positive changes. Differences in terms of the patients' goals and motivations for seeking treatment from those of the treatment programs, combined with difficulties encountered during the treatment process eventually led to discharge. However, these patients were then able to navigate their way through the treatment system in different ways in order to remain in treatment. The authors conclude that failure to abide by treatment clinic rules do not necessary constitute "treatment failure" from the perspective of patients, who often wish to remain in treatment even if it is not progressing optimally from the program's perspective. As a result, the recovery process can be more fragmented and is often characterized by a series of cyclical treatment episodes rather than continuous time in treatment, thereby impeding their progress towards recovery.
authors.affiliation: Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA. smitchell@friendsresearch.org
authors.forename: Shannon Gwin
authors.initials: SG
authors.lastname: Mitchell
authors.forename: Rika
authors.initials: R
authors.lastname: Morioka
authors.forename: Heather Schacht
authors.initials: HS
authors.lastname: Reisinger
authors.forename: James A
authors.initials: JA
authors.lastname: Peterson
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Kelly
authors.forename: Michael H
authors.initials: MH
authors.lastname: Agar
authors.forename: Barry S
authors.initials: BS
authors.lastname: Brown
authors.forename: Kevin E
authors.initials: KE
authors.lastname: O'Grady
authors.forename: Robert P
authors.initials: RP
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D001741:Black or African American; D015142:Baltimore; D005260:Female; D006040:Goals; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D009042:Motivation; D009294:Narcotics / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000523:psychology / Q000534:rehabilitation*; D010351:Patient Discharge; D010359:Patient Readmission; D010361:Patients / Q000523:psychology*; D020127:Recovery of Function; D016320:Substance Abuse Treatment Centers; D017211:Treatment Failure; D044465:White People
chemical_list: D009294:Narcotics; D008691:Methadone