Theses and Dissertations from UMD
Permanent URI for this communityhttp://hdl.handle.net/1903/2
New submissions to the thesis/dissertation collections are added automatically as they are received from the Graduate School. Currently, the Graduate School deposits all theses and dissertations from a given semester after the official graduation date. This means that there may be up to a 4 month delay in the appearance of a give thesis/dissertation in DRUM
More information is available at Theses and Dissertations at University of Maryland Libraries.
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Item Experiences of substance use and medication for opioid use disorder stigmas in an underserved, rural community(2024) Anvari, Morgan; Magidson, Jessica F; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Overdose rates related to opioid and stimulant use have been steadily increasing in underserved, rural areas of the U.S. for over 10 years. Access to and retention in medication for opioid use disorder (MOUD) care are persistent challenges nationally and in underserved rural communities. Stigma around substance use (SU) and MOUD specifically are barriers to engagement in opioid use disorder and MOUD care. However, little is known regarding how SU and MOUD stigmas manifest and affect patients in rural settings. Given their shared lived experiences, peer recovery specialists (PRSs), individuals with lived substance use and recovery experience who are formally trained to support others’ recovery, may be unique resources to shifting stigma barriers. Yet, few studies have examined if and how PRS engagement shifts stigma, particularly in underserved, rural communities. This qualitative study sought to understand: 1) how substance use and MOUD stigmas manifest in a low-resource, rural community; 2) how these stigmas influence patients’ treatment experiences and preferences; 3) if and how PRS-delivered intervention may shift these stigmas and improve MOUD outcomes. Patients (n = 25) and staff (n = 5) at a telemedicine-mobile treatment unit (MTU) in an underserved, rural community completed semi-structured qualitative interviews. Transcripts were analyzed using thematic analysis, guided by the interview guide and Stigma Mechanisms Framework. Study findings demonstrated the pervasive role of multiple forms of stigma in a rural community, negatively impacting substance use treatment outcomes. Experiences of these stigmas were found to be uniquely influenced by rural living conditions. Additionally, results revealed that PRS-delivered interventions have potential in shifting these stigmas and improving MOUD outcomes by leveraging PRSs’ shared lived experiences. Identifying and understanding patient experiences of substance use and MOUD stigmas are vital in developing innovative solutions to target stigma reduction and support recovery. Future research may continue to develop and evaluate how PRS interventions can reduce stigma and support positive recovery outcomes.Item “It’s more than just the act of not using. It's a feeling of finally completing something.”: Patient-centered definitions of successful treatment outcomes in methadone treatment in Baltimore City(2024) Bradley, Valerie Diane; Magidson, Jessica F.; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background. Successful outcomes in substance use disorder treatment are often narrowly defined as retention in care, substance use cessation, and the prevention of recurrent substance use. These widely utilized benchmarks may overlook key patient-centered indicators of success. Few studies have sought patient perspectives to establish a representative definition of successful treatment outcomes for opioid use disorder (OUD), with historically marginalized individuals facing the least representation and the largest inequities in care. With overdose-related deaths increasing to over 112,000 in the 12 months preceding May 2023 and a disproportionate impact on racially minoritized populations, understanding comprehensive patient-centered definitions of successful treatment in minoritized populations is an imperative endeavor for research, treatment planning, and policy. This study aimed to understand how patients and providers at an outpatient methadone treatment program in Baltimore City describe patient-centered successful treatment outcomes.Methods. We conducted qualitative interviews and focus groups with 32 patients, staff, and peer recovery specialists (PRSs) at a Baltimore-based outpatient methadone treatment program predominantly serving low-income, racially minoritized individuals with OUD. Semi-structured interview guides prompted patients (n=20) to describe success in methadone treatment and staff and PRSs (n=12) to describe their observations of patients' success in treatment. Qualitative data were transcribed, coded, and analyzed using thematic analysis. We utilized the Health Equity Implementation Framework to contextualize findings across multiple domains and explore potential influences on equitable outcomes of treatment success. Results. Five key themes emerged to demonstrate how patients and their providers define patient-centered successful methadone treatment outcomes, including (1) improvements in general health, (2) productivity and accomplishment, (3) social improvements, (4) substance use changes, and (5) treatment engagement. Patients and providers were generally in agreement on these five overarching themes. Conclusion: Findings suggest patient-centered definitions of success in methadone treatment span psychosocial, environmental, behavioral, health-related, and other factors beyond the traditionally measured outcomes of treatment retention and substance use abstinence. Working toward a more representative definition of methadone treatment success—integrating patient perspectives, particularly minoritized individuals who often face the greatest obstacles in care—may have significant clinical, research, and policy implications for improving the patient experience and outcomes in methadone treatment.