Waiting for inpatient detoxification A qualitative analysis of patient experiences

A new paper by Prof. Wulf Livingston and colleagues from Kings College London and Figure 8 Consultancy published in January 2024 explores patients’ experiences of waiting for inpatient detoxification.

Background

Detoxification, aiming to remove toxins and manage substance withdrawal, is crucial for those dependent on substances, but it alone can't address complex psychological issues. Scarcity of inpatient detoxification can lead to waiting lists and act as a barrier. In 2021, the UK Government increased the capacity for  detoxification services in England. In 2002 they then commissioned an evaluation on the impact of this new funding.

Method

A diverse team of qualitative researchers, familiar with Alcohol and Other Drug (AOD) treatment services, conducted the study starting in March 2022. The overall design was longitudinal one and involved pre and post detox interviews. 

To ensure consistency, team members attended briefing sessions about a common interviewing and analysis process. Semi-structured interviews followed a topic guide, covering participants' backgrounds, substance use, waiting experiences, and expectations. Audio recordings were transcribed and analysed using MAXQDA software.

This paper reflects the analysis of the pre detox initial interviews. Analyses were informed by new materialist thinking, treating ‘waiting’ as a complex practice influenced by relational and contingent factors.

Participants

Thirty two individuals from ten consortia across England were interviewed, comprising 20 males and 12 females aged 25–67. All participants were white and had recently been offered inpatient detoxification, were waiting for admission, and had diverse living arrangements. The majority reported current physical (29) and mental (30) health problems, with none currently employed. Most were waiting for alcohol detox (23), while others awaited detox for opioids (8) or ketamine (1).

Findings

The waiting experience was shaped by five main dimensions: duration, support, information, preparations, and emotions. Regarding duration, participants appreciated the multifaceted process leading to detoxification but varied in their perceptions of wait lengths, some feeling it was short, while others found it long. Delays were attributed to individual factors, service-related issues, and, at times, the need for greater commitment to sobriety. Support from AOD workers played a crucial role, with mixed perceptions of their effectiveness. Group attendance during the wait had diverse effects, offering support and challenges. Information about the detoxification process, transport, and daily routines alleviated stress for participants. Preparations involved reducing substance use, packing, and planning for life after detoxification. Emotions ranged from optimism to anxiety, with complex, fluctuating feelings throughout the waiting period.

Discussion

This study explored patients' experiences of waiting for inpatient AOD detoxification to identify potential improvements to service-level policies and practices. The study identified five main dimensions of the waiting experience. These dimensions operated through various social, material, and affective forces, shaping the waiting experience for individuals. The waiting experience was diverse, with participants expressing varying feelings about the duration, effectiveness of support groups, the need for information, and the preparations for detoxification. The study highlighted the enduring nature of waiting in inpatient detoxification in England, with the speed of entry influenced by factors beyond resource availability. The findings suggested strategies to enhance the waiting experience, including engaging patients in pre-treatment activities, providing information in accessible formats, offering virtual tours of detoxification services, regular check-ins through text messages or calls, and promoting transparency in explaining delays. The study proposed potential improvements to waiting experiences, considering psychological aspects and offering practical strategies to mitigate the challenges associated with waiting for detoxification.

Recommendations:

1. Capacity Focus: Recommendations primarily focus on changes within existing capacity rather than advocating for increased inpatient detoxification services.
2. Routine Implementation: Some suggested improvements might already be in practice but not yet routine, and the study may not capture ongoing changes.
   
   
3. Structural Constraints: Certain proposals depend on structural factors that may not be easily modified at a service level, such as changes in patients' capacity to absorb information and engage with electronic media.
   
   
4. Responsibility Clarification: The study does not delineate which strategies should be led by community services versus inpatient detoxification services, leaving a need for clarity on responsibilities and actions among professionals.
   
   
5. Patient Perspective: The research solely focuses on the patient perspective, and the lack of data on professional perspectives may limit the understanding of clearly defined responsibilities in the waiting process.

Waiting for inpatient AOD detoxification is a complex experience. While not all aspects of waiting are negative, improvements are needed to address its symbolic powerlessness, reduce uncertainty, demonstrate fairness, and alleviate isolation. The waiting experience can exacerbate stigma and feelings of undeserving support, particularly for individuals already facing barriers in accessing treatment. Enhancing the waiting period is crucial to improving the overall journey for people seeking detoxification services in England.

Read the full paper.