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This study assesses the prevalence and individual and organizational predictors of occupational burnout among addiction therapists. A total of 452 addiction therapists from a representative sample of 184 Polish alcohol treatment facilities (outpatient and inpatient) participated in the study (facility response rate = 42%). The Oldenburg Burnout Inventory was used to measure occupational burnout, and 15 subscales of the Copenhagen Psychosocial Questionnaire II were administered to assess psychosocial work conditions. In addition, the Coronavirus Anxiety Scale, the Hospital Anxiety and Depression Scale and the abbreviated six-item De Jong Gierveld Loneliness Scale measured other important dimensions of addiction therapists' psychosocial functioning. Logistic regression was used for the analysis of the data. Occupational burnout was noticeably prevalent in the study group: 62% of respondents experienced exhaustion and 50% experienced disengagement from work, both to at least a moderate degree. Situational (organizational) variables were the most important predictors, explaining much more of the variance in both dimensions of burnout than the individual factors, of which only depression was significantly related to higher levels of exhaustion. Coronavirus anxiety played a marginal role in explaining the severity of burnout. The current study is one of the first attempts to assess the level of occupational burnout among addiction therapists and to comprehensively investigate the factors contributing to it. The findings provide useful information for the development of interventions aimed at preventing or reducing burnout in this professional group. [ABSTRACT FROM AUTHOR]

Background: Despite the extensive research and intense debate on coercion in psychiatry we have seen in recent years, little is still known about formally voluntarily admitted patients, who experience high levels of perceived coercion during their admission to a psychiatric hospital. Aims: The purpose of the present research was to explore forms of treatment pressure put on patients, not only by clinicians, but also by patients' relatives, during admission to psychiatric hospitals in Italy, Poland and the United Kingdom. Methods: Data were obtained via in-depth, semi-structured interviews with patients (N = 108) diagnosed with various mental disorders (ICD-10: F20–F49) hospitalised in psychiatric inpatient wards. Maximum variation sampling was applied to ensure the inclusion of patients with different socio-demographic and clinical characteristics. The study applied a common methodology to secure comparability and consistency across participating countries. The qualitative data from each country were transcribed verbatim, coded and subjected to theoretical thematic analysis. Results: The results of the analysis confirm that the legal classifications of involuntary and voluntary hospitalisation do not capture the fundamental distinctions between patients who are and are not coerced into treatment. Our findings show that the level of perceived coercion in voluntary patients ranges from 'persuasion' and 'interpersonal leverage' (categorised as treatment pressures) to 'threat', 'someone else's decisions' and 'violence' (categorised as informal coercion). Conclusion: We suggest that the term 'treatment pressures' be applied to techniques for convincing patients to follow a suggested course of treatment by offering advice and support in getting professional help, as well as using emotional arguments based on the personal relationship with the patient. In turn, we propose to reserve the term 'informal coercion' to describe practices for pressuring patients into treatment by threatening them, by making them believe that they have no choice, and by taking away their power to make autonomous decisions. [ABSTRACT FROM AUTHOR]

Background: While homelessness and problem gambling are both recognised as social and public health concerns and the prevalence of addictive disorders among homeless populations tends to be high. These questions have been studied predominantly independently. Aim: The aim of the study was to explore the co-occurrence of the two phenomena among the homeless population using shelters and night shelters in Warsaw, and, more specifically, to provide information about the forms and frequency of gambling in this homeless population. Method: Homeless persons (N = 690) were interviewed in rehabilitation-shelters (n = 17) and night-shelters (n = 2) in Warsaw from November 2015 until January 2016. The core component of the questionnaire was a screening test (Problem Gambling Severity Index). In addition, data regarding the intensity of gambling and various types of games or settings were collected. Results: The prevalence of problem gambling in this population of homeless people was 11.3%, whereas the prevalence of problem gambling in the general population in Poland is much lower (0.7%). Similarly to the general population, the most prevalent gambling games in the homeless population were lotteries; however, homeless people gambled in lotteries almost three times more often compared to the general population. Conclusions: This is the first study examining the prevalence of problem gambling in the homeless population in Poland. The findings of the study suggest that problem gambling among the homeless is a significant social and public health concern. High rates of problem gambling in the homeless population show the need to identify and monitor this problem in shelters and consequently to provide easier access to gambling treatment or prevention programmes. [ABSTRACT FROM AUTHOR]

Aims Treatment of patients with comorbidity of mental health problems and alcohol use disorder (AUD) constitutes a challenge in many countries. The article aimed at exploration of personal experiences of clinicians and patients with the comorbidity regarding its assessment, treatment and organization of care in Poland and the UK. Methods Data were collected via in-depth, semi-structured interviews with clinicians (N = 28) and patients (N = 81) in both countries, according to a unified study protocol. Maximum variation sampling was applied to both study groups. All interviews' transcripts were coded (CAQDA) and the consistency of coding across centres was assessed. Data analysis was performed according to the principles of thematic analysis. Results Our data show that most patients with AUD admitted at the psychiatric wards—apart from assessment which is a standard procedure during admission—receive only minimal support during their hospital stay. This is the consequence of two factors: lack of trained staff prepared to help those patients and a priority given to self-referrals by AUD units. At the same time, it is recognized by clinicians and patients that more support is needed to encourage the utilization of AUD services and to prevent the drop-out. Conclusions In order to improve the system response, the use of screening instruments in the process of the assessment of AUD and establishment of special procedures supporting motivation and adherence to treatment and preventing drop-out merits consideration. Moreover, the psychiatric wards and the AUD services could possibly profit from formalization of the collaboration between services. [ABSTRACT FROM AUTHOR]

Background: Popular views of addictive substances and behaviors constitute an important research topic because these views have an impact upon the functioning of treatment systems and societal responses to substance use disorders.Methods: The analysis is based on a random sample ofN= 1000 telephone interviews collected in Poland in 2013. Questionnaire measures targeted such issues as the perceived risks of addictions and beliefs about potential recovery from various types of addictions.Results: First, a coherent view of the addiction potential of various addictive substances and/or behaviors emerges, distinguishing licit drugs and types of behavior from illicit drugs. Second, treatment optimism proves to be quite high independent of the type of addictive behavior, while chances of recovery without treatment are considered less likely. Third, chances for assisted change (change with treatment) and self-change are considered largely independent of perceived addiction-related risks and are not perceived as contradictory.Conclusions: The results point to the persistence of the disease model of addiction in Poland, placing responsibility for addiction on the individual and pairing it with the expectation of undergoing specialized treatment. This individualistic approach was applied as a framework for addiction problems in the 1950s to deflect from the shortcomings of the ‘‘new socialist society.’’ Neo-liberal market reform and socioeconomic changes have provided reinforcement for this individualistic framework. [ABSTRACT FROM PUBLISHER]

Background:The study presented here sheds light on factors promoting or impeding change in the Polish treatment system, by focusing on the specific case of reduced risk drinking (RRD) as treatment objective and modality. More specifically, treatment providers’ perceptions of implementation, barriers and potential chances of adoption of RRD in practice were explored. Method:The 26 alcohol addiction professionals working in 13 outpatient facilities in different parts of Poland took part in four focus group interviews conducted from June to August 2015. The computer assisted qualitative data analysis followed an inductive–deductive procedure. Initially, the transcripts were inductively coded ‘sentence by sentence’ in order to capture the meaning of data. Afterwards, the codes were linked with the deductive, theoretical categories. Results:In their assessment addiction therapists drew upon their individual experience and organizational context, but also stressed system and societal aspects. Five types of barriers to the adoption of RRD programs emerged from the qualitative data analysis: (a) Potential conflicts between RRD and abstinence-oriented programs; (b) Professional routines and paradigms; (c) Information deficits and knowledge requirements; (d) Feasibility and implementation problems and (e) Evaluation issues. Conclusions:The typology of barriers to reduced risk drinking identified among treatment providers will inform policy efforts to plan changes and to anticipate dynamics within the addiction treatment systems more successfully and reduce the treatment gap. [ABSTRACT FROM PUBLISHER]

Background: Drug dependence is a recognized medical condition and therefore, right to health applies in the same way to drug dependence as it does to any other health condition. The human rights in patient care framework - which refers to the application of basic human rights principles in the delivery of health care services - was used to explore the experiences of equality in the dignity and rights protected by Polish law within four different specialist drug treatment settings in Poland. The views of patients and staff were examined and compared.Methods: Focus group interviews were conducted in 12 drug treatment facilities: three inpatient therapeutic communities, three outpatient programs, three opioid substitution programs and three harm reduction programs (drop-in/needle exchange/support). Interviews were conducted with a total of 43 staff and 73 patients. All interviews were audio-recorded with participants' prior consent and transcribed verbatim. Data were analysed according to the problem-centred interview methodology, using CAQDA.Results: Patients described instances of abuse of their rights regarding dignity, privacy, confidentiality, personalized treatment, and respect of patient's time, right to information and to complain. Those accounts were complemented by the perspective of professionals working in drug treatment. Patients of Polish opioid substitution programs reported experiencing more humiliation and disenfranchisement than patients in other drug treatment settings.Conclusion: Drug testing and control, fuelled by prejudices of health professionals, are leading to discriminatory practices in substitution treatment and damaging the chances of therapeutic success. The concept of epistemic injustice illuminates the reasons behind discrimination against patients on opioid substitution programs, who are seen as continuously sick and their illness perceived as a mark of moral, social and epistemic failure. [ABSTRACT FROM AUTHOR]

Aims: To assess views on the feasibility and acceptability of reduced-risk drinking (RRD) strategies within the very homogenous and abstinence-oriented Polish alcohol treatment system. Methods: By online survey in 2014/15 we enquired into current attitudes of nationwide sample of professionals working in outpatient alcohol treatment facilities regarding non-abstinence goals as a function of severity of the disorder (abuse/dependence) and the finality of the outcome goal. Results: Questionnaires were completed by experienced addiction therapists, trained primarily in cognitive-behavioral therapy (n = 246, response rate = 50%). Only one third accept RRD for alcohol dependent clients (fully or partially), the three fourths accept RRD for alcohol abusing clients (fully or partially). RRD as an intermediate goal of treatment is more accepted than when set up as a final treatment objective. RRD had significantly higher level of acceptance among younger professionals. Compared to male respondents, females were more open to offering RRD to patients experiencing alcohol-related problems. Finally, therapists working according to the principles of motivational interviewing or solution focused brief therapy were significantly more in favor of RRD than others. Conclusion: Comparing with other countries, the acceptance of RRD as a therapeutic objective in Poland is moderately low. Mistrust toward RRD strategies is mainly fueled by a belief that this strategy is not effective plus its inconsistency with therapists’ own therapeutic philosophy. [ABSTRACT FROM AUTHOR]

The study presented here explores the usefulness of visual data when assessing addiction careers from various methodological perspectives. The database consists of 14 “free life-course drawings” produced by seven Swiss and seven Polish male alcohol ex-users, and their life history narratives collected in the context of earlier studies on self-change. The analysis follows the principles of the Barthian visual semiotics approach including the author and the viewer perspective. This is followed by the investigation of the interplay between drawings and narratives in Polish and German. Compared to the detailed narratives following few sub-storylines at the same time, the drawings provide a more coherent and differentiated overall picture especially of the emotional state over the life course: the relative subjective importance of highs and lows; and clearer visualisation of mixed positive and negative feelings; as well as identity concepts, such as the interplay between Mead's I & me. [ABSTRACT FROM PUBLISHER]

Aims: The study provides an in-depth qualitative understanding of the maintenance stage when recovering from alcohol dependence with a focus on the broader social context of change of addictive behaviour. It explores the recovery as a subjective process within the abstinence-oriented Polish treatment system organized on the basis of the Minnesota model and is probes for group differences between treated and non-treated populations. Methods: The study is based on qualitative data from a media-recruited sample of 29 treated and non-treated former alcohol dependents (ICD-10) in Warsaw/Poland 2006/2007. They reported a recovery time of at least 2 years (Mrecovery = 11, SD = 9). In-depth, semi-structured interviews were analysed according to the problem-centred interview method using ATLAS.ti software. Results: A wide range of maintenance strategies potentially contributing to the stabilization of recovery from alcohol dependence was identified. However, from the respondents’ point of view, the change process is contingent upon the subjective weighing of specific maintenance factors and the importance attributed to their interplay. This includes time management as well as one's ability to invest available resources and strengths in shaping and pursuing personal goals. Conclusion: More commonalities than differences can be observed between groups during the maintenance stage, regardless of respondents’ type of the pathway out of addiction. However, when confronting professional concepts of recovery with subjective accounts, only a subgroup conforms to the invasive, potentially normative definitions of recovery, while others do not link their recovery with identity transformation. [ABSTRACT FROM AUTHOR]

The study identifies and categorizes concepts of addiction among treated and non-treated former alcohol dependents, and their function in the process of recovery from addiction within the post-communist treatment system dominated by the Minnesota model. This qualitative study is based on a media recruited sample of 29 former alcohol dependents (ICD-10) in Warsaw/Poland 2006/2007. They reported a recovery time of at least 2 years ( Mrecovery == 11, SD == 9). In-depth interviews were analysed according to the Problem-Centred Interview method using Atlas.ti software. The applied triangulation procedures ensure reliability and validity of the data collected and the analysis of the narrative accounts. The results of the study show that professional concepts of addiction reconstructed on the basis of narratives from treated respondents resemble the disease model of addiction. A first category of lay concepts of self-changers adopt a medical--moral model of dependence including strong will as a key element of the successful recovery. A second category describes dependence as a symptom of maladaptive social functioning and recovery as a process of understanding one's role in society and fulfilling social expectations. While self-changers relied on one of these lay concepts, treated respondents were confronted with a conflict between lay and professional definition of dependence. It is argued that lack of recognition of lay concepts of addiction by treatment providers may weaken help-seeking and increase drop-out rates. The disease model implies the stability of the status of the alcoholic -- which potentially weakens the individual's chance to reach the stage of stable recovery. [ABSTRACT FROM AUTHOR]

Background: People with severe mental illness often struggle with social relationships, but differences among diagnostic groups are unclear. We assessed and compared objective and subjective social relationship indicators among patients with psychotic, mood and neurotic disorders one year after hospitalisation in five European countries (Belgium, Germany, Italy, Poland and United Kingdom)., Methods: The number of social contacts, including family members and friends during the previous week (Social Network Schedule), and satisfaction with the number and quality of friendships (Manchester Short Assessment of Quality of Life Quality) were assessed by face-to-face interview. Linear regression models were used to analyse associations with diagnostic groups., Results: Participants (n = 2155) reported on average 2.79 ± 2.37 social contacts overall in the previous week, among whom, a mean of 1.65 ± 1.83 (59.2 ± 38.7%) were friends. Satisfaction with friendships was moderate (mean 4.62, SD 1.77). In the univariable model, patients with psychotic disorders reported having less social contact with friends than those with either mood (p < 0.05) or neurotic disorders (p < 0.001), but this difference disappeared when adjusting for socioeconomic and clinical variables (β = - 0.106, 95% CI - 0.273 to 0.061, p = 0.215). Satisfaction with friendships was similar across diagnostic groups in both univariable (β = - 0.066, 95% CI - 0.222 to 0.090, p = 0.408) and multivariable models (β = 0.067, 95% CI - 0.096 to 0.229, p = 0.421). The two indicators showed a weak correlation in the total sample (total social contacts, r s  = 0.266; p < 0.001; friends, r s  = 0.326, p < 0.001)., Conclusion: While objective and subjective social relationship indicators appear to be weakly correlated concepts, there is no variation in either indicator across diagnostic groups when confounders are taken into account among patients with severe mental illness. Interventions specifically targeting social relationships are needed, but they do not necessitate diagnosis-specific adaptations.