Adults living with stimulant abuse and bipolar disorder: Experiences of service users at treatment centres

Abstract

The goal of the study was to explore how adults living with stimulant abuse and bipolar disorder experience treatment at treatment centres in the Gauteng Province. As the study was aimed at gaining an in-depth understanding of the lived experiences of service users in terms of treatment, a qualitative research approach was implemented. The research findings were aimed at adding knowledge to the field of social work, which could contribute to the development of treatment programmes and possible policy changes that could positively impact the recovery of individuals living with a dual-diagnosis, specifically the dual-diagnosis of bipolar disorder and stimulant abuse. A phenomenological research design was used as it allowed the researcher to discover and report on the details pertaining to the participants' experiences in terms of the treatment they received. The phenomenological research design also enabled the researcher to describe the commonalities and discords expressed by participants in relation to the phenomenon. The sampling process for the research study took place in three phases. In the first phase, purposive sampling was implemented to select three substance abuse treatment centres in the Gauteng Province, and more specifically the Tshwane Metropolitan Municipality. The second phase of sampling was also purposive sampling, where inclusion criteria were supplied to a social worker at each treatment centre who identified possible participants. During the third phase of sampling, possible participants were approached and informed of the study and ultimately four (N=4) individuals volunteered to participate in the study. Data was collected through the use of semi-structured one-on-one interviews which were guided by an interview schedule. Data gathered during the literature review and interviews were analysed through the process of thematic analysis and aimed at answering the research question "How do adults living with stimulant abuse and bipolar disorder experience services at treatment centres in the Gauteng Province?" The key findings indicate that admission to in-patient treatment programmes, for both stimulant abuse and psychiatric care, was prevalent among all participants, but re-occurring admissions to substance abuse treatment was more evident. Stimulants were primarily used as a means of coping with moods and emotions, as unstable mood patterns and emotions persisted regardless of the pharmacological treatment for bipolar disorder. The most helpful component of treatment which aided participants in managing their mood was counselling. When stimulants were not available and counselling was insufficient, other means of achieving psychological relieve were employed by participants, such as exercise, nicotine use, sweets and caffeine. The role of religion and spirituality in treatment is not clear, but all participants believe that religion and spirituality should be included in treatment. The need for education in terms of bipolar disorder, addictive behaviours, lifestyle changes and coping mechanisms were mentioned by most participants. In addition to education provided by professionals, participants expressed a need for sharing experiences with individuals that have managed to recover from bipolar disorder and/or stimulant abuse. When treatment plans and goals are set participants believe that they and their family should be included, a factor relevant to in-patient and reintegration services. With regards to in-patient treatment programmes, the psychosocial-cultural environment created within the physical environment was also mentioned as a component that needs to be considered. In order to deliver services that allow for the effective treatment and reintegration of individuals that abuse stimulants and are diagnosed with bipolar disorder the following recommendations are made: 1) Interventions, including prevention and early interventions, should be developed based on research findings focused on dual-diagnosis, to ensure that concurrent treatment and reintegration is achieved and sustained, thus promoting recovery, or the management, of both disorders. 2) Education in terms of stimulant addiction, cross-addiction, bipolar disorder, lifestyle changes, coping skills, as well as the interplay between these factors should be included in treatment programmes, however, education should be expanded to service providers and extended to family members too. 3) The role of religion and spirituality as part of dual-diagnosis treatment should be considered. 4) Treatment and support groups that focus on the specific dual-diagnosis of stimulant use and bipolar disorder, should be developed as part of in-patient treatment programmes, as well as supporting out-patient programmes, which could improve long-term recovery. 5) The physical and the psychosocial environments which are conducive to the recovery of dual-diagnosis patients should be established, as these environments could possibly be replicated, for example at home, and could ensure long-term recovery. 6) Service users and their families should be included in decisions regarding treatment planning and reintegration, as inclusion in this area of treatment could promote compliance to treatment. However, it should be stated that many of these recommendations are dependent on governing bodies, such as the Department of Social Development and the Department of Health, who are responsible for changing, developing and monitoring policies guiding treatment, which has a direct impact on the long-term recovery of individuals living with this dual-diagnosis. Future research studies that can contribute to understanding this phenomenon can focus on 1) Repeating the study within other private and government based treatment centres across South Africa in order to determine whether treatment needs differ or whether it presents the same results. 2) Comparing studies from different centres and areas of South Africa in order to establish treatment needs of individuals diagnosed with a dual-diagnosis. 3) Research should be done to determine the actual prevalence of the dual-diagnosis of stimulant abuse and bipolar disorder in South Africa, focused on admissions in both substance abuse treatment centres and psychiatric treatment facilities. 4) Treatment programmes developed from research findings should be implemented, and research should be conducted on the effectiveness of treatment. 5) Research on different combinations of dual-diagnosis is necessary to determine how treatment needs differ, as this will ensure the development of appropriate treatment. Individuals working at treatment centres (for both substance abuse and psychiatric disorders) should be aware of the needs of dual-diagnosis patients, and be educated on this phenomenon. 6) It is recommended that research should be done with the staff of psychiatric treatment centres, as well as staff at substance abuse treatment centres, to determine their views and knowledge in terms of dual-diagnosis. 7) Research focussed on the costs of not treating dual-diagnosis should be conducted. When the actual costs of non-treatment are established, government agencies and the private sector might be more prone to support treatment strategies. 8) Intervention strategies focused on families of dual-diagnosis patients should be implemented and the impact of these interventions on both patients and families should be researched. 9) More research in terms of this dual-diagnosis is necessary as this could allow for the development of effective treatment strategies that could lower relapse and readmission rates.