'They can't solve the problem without us': a qualitative study of stakeholder perspectives on user involvement in drug treatment services in England

Patterson, Susan, Weaver, Tim ORCID: https://orcid.org/0000-0002-3437-3556, Agath, Kostas, Albert, Eliot, Rhodes, Timothy, Rutter, Deborah and Crawford, Mike (2008) 'They can't solve the problem without us': a qualitative study of stakeholder perspectives on user involvement in drug treatment services in England. Health and Social Care in the Community, 17 (1) . pp. 54-62. ISSN 0966-0410 [Article] (doi:10.1111/j.1365-2524.2008.00797.x)

Abstract

Case studies in six English commissioning areas explored the process and purpose of user involvement (UI) in drug treatment services. In-depth interviews with 139 respondents who commission, manage, deliver or use services were conducted. Researchers identified 'non-', 'passive-' and 'active participant' users. Active users were commonly motivated by a desire for social justice, a social conscience and personal development. UI was evidently influenced by multiple social organizational and personal factors. Some 'generic' factors have been reported in other settings. However, the illegality of drug use powerfully affects all stakeholders creating a context unique to drug treatment settings. Stigma and power imbalances were pervasive, and strong tensions concerning the goal and purpose of UI were apparent. Within the UK context, five organizational approaches to UI were identified. Based on rationale and objectives of UI, and the scope of influence accorded users, organizations could be characterised as protagonists, pragmatists, sceptics, abstainers or avoiders. It is concluded that many tensions apparent in local level UI have roots in UI policy, which is ambiguous about: (1) benefit and rights, and (2) the promotion of healthcare objectives within a UK drug strategy driven by a crime reduction agenda. This duality must be resolved for UI to flourish at local level.

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