Barriers and Facilitators to Substance Abuse Treatment Program within Inpatient Settings

This paper discusses and critiques the research study conducted by Yang et al. (2018) in accordance with the COREQ checklist and aims to identify the strength and weakness of the paper. The study aimed to explore the factors that hinder or facilitate treatment engagement in patients taking part in short term substance treatment programs. The paper identifies the major themes that serve as barriers to substance abuse treatment and provide promising scope of research in future.

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Name of the Student:
Name of the University:
Author Note:

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Introduction:
Substance abuse has emerged out to be one of the major mental health issues globally.
Studies reveal that on an average approximately, 15.1 million Americans suffer from alcohol
abuse and other problems related to substance abuse. In addition to this, it has further been
stated that annually 88,000 deaths occur every year in U.S on account of alcohol abuse. It
should also be noted that out of 88,000 deaths, 10,000 deaths are caused due to drunk driving
accidents (WHO, 2014). In order to control the growing seriousness of the issue as presented
by the statistical evidences, control measures such as rehabilitation has emerged out to be a
popular intervention. Rehabilitation Units across different healthcare organizations make use
of therapeutic interventions to assist people overcome substance abuse. However, it should be
critically stated that a number of barriers have been identified in the process of delivering
treatment to service users affected with substance abuse (Whiteford et al.,2013). This paper
intends to vividly discuss and critique the research study conducted by Yang et al. (2018) in
accordance with the COREQ checklist and aims to identify the strength and weakness of the
paper.
Body:
COREQ stands for Consolidated Criteria for Reporting Qualitative Research. It comprises of
32 checklist items that helps in critically analysing a qualitative paper (Tong, 2007). This
section of the paper aims to evaluate the effective strengths and weakness of the paper on the
basis of the three COREQ domains, Research and Reflexivity, Study Design and Analysis
and Findings.

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Research and Reflexivity:
The study was conducted by the authors of the paper Yang Yang, David R. Perkins
and A. Elizabeth Stearns. The credentials of the authors have been mentioned in the paper for
each of the three authors. The first author Yang Yang has been reported to be an assistant
professor of Psychology at the University of Louisiana at Lafayette. The second author David
R. ‘Rick’ Perkins is a PhD and has been reported to work as an associate Professor of
Psychology at the University of Louisiana at Lafayette. The third author Elizabeth Stearns
has been reported to work as an assistant professor of Criminal Justice at the University of
Louisiana. Regarding the occupation of the authors at the time of the study, it can be said that
all three of the authors were working as professors at the University of Louisiana. The
researchers Yang Yang and Elizabeth Stearns were females and the second author David r.
‘Rick’ Perkins was a male researcher. The paper has not presented any appropriate
information with regard to the prior research training of the authors. However, it can be said
that the authors are experienced researchers as all three of them have published high impact
factor value papers which proves that the researchers were extremely efficient. No substantial
evidence has been obtained in terms of establishing a positive relationship between the clients
and the interviewer. The paper significantly mentions that the researchers proceeded with
obtaining a formal consent from the Institutional Review Board of the authors’ University.
Also, substantial information in terms of the participants being aware of the primary research
objective is missing in the paper. Further, there is no substantial evidence about the
participants being made aware about the assumptions, interests and reasons of the researcher
to the participants in a detailed basis.
Study design:

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Yang, Perkins and Stearns (2018) used phenomenology as a methodological
orientation for conducting the research. Phenomenology is a research methodology mostly
used in qualitative inquiry to describes the experience of people related to a phenomenon of
interest. It is a suitable method of investigation when the purpose is to delve into
perspectives, feelings and understanding of an individual related to a live phenomenon
(Matua, 2015). The selection of this methodological orientation is appropriate for the article
as it aimed to explore the factors that hinder or facilitate treatment engagement in patients
taking part in short term substance treatment programs. Phenomenological orientation can
help in accurately interpreting the perception of participants related to the phenomenon of
taking part in the substance abuse program.
Sample selection:
The main sample for the study included samples taken from a short-term inpatient
facility. Purposive sampling strategy was employed to recruit research participants and
eligibility criteria and referrals from clinical agencies and drug court or diversion programs
were used to recruit research participants. Purposive sampling technique is a type of non-
probability sample where participants are recruited based on characteristics and objective of
the study (Etikan, Musan & Alkassim, 2016). Similar to this approach, Yang, Perkins and
Stearns (2018) used his judgment to select sample from short term inpatient facility as this
helped to get those samples who can take part in the substance abuse program and report
about their experiences. However, purposive sampling technique has not been explicitly
applied because of lack of reporting about the eligibility criteria for sample recruitment. One
limitation found in the article is that the eligibility criteria used for selecting research
participant is not understood and this affects the transparency of the research.

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Estimation of accurate sample size as per the research design and research objective is
also important to promote transparency in research and increase the reliability of research
findings. According to Faber and Fonseca (2014), neither too big nor too small size can be
taken as both can compromise the conclusions drawn for the study. Too small sample size
can prevents extrapolation of the research and too large sample size can amplify the detection
of difference. Hence, deciding on appropriate sample size is important to detect clinically
relevant differences in outcome and accurately interpret a study. The sample size use in the
study by Yang, Perkins and Stearns (2018) was 60. Although no formal procedure was used
to estimated sample size, however sample size of 60 is considered appropriate considering the
fact that qualitative method of inquiry has been taken as a method of analysis.
Apart from sample size, details about non-participation and drop-out rate were also
provided in the study. Yang, Perkins and Stearns (2018) specified that 13 participants
declined to take part because of health issues and being busy with discharge. Hence, in the
section reporting about sample recruitment, it has been found some aspects has been ignored
(like details about eligibility criteria) and some has been reported well (like reasons for non-
participation). Lack of approach taken to accurately report about the eligibility criteria for
sample recruitment is one major limitation is that eligibility criteria is the main framework for
deciding whether appliacnst meet the selection criteria or not and not reporting about
eligibility criteria leaves a major gap in research methodology. It affects the credibility and
quality of the research work too.
Data collection:
Interview was the main method used to collect data related to perception of
participants related to barriers and facilitators faced during participation in substance abuse
program. One of the steps that increased the quality of interview during research is

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conducting pilot interviews to ensure that the questionnaire and structure of the interview is
appropriate for the research. The main advantage of using pilot interview is that it increases
the feasibility of the research and confirms the credibility of the interview questionnaire. The
need to consider pilot testing was considered by Yang, Perkins and Stearns (2018) too as
graduate research assistants were trained and made familiar with the interview question by
conducting pilot interview. This process ensures that no hiccups or barriers come during the
interview process.
Consideration about duration and mode of interview is also important to enhance the
quality of data collection. The duration of interview was 20 minutes and one-on-one
interview was done in a private room and the recordings of the interview were transcribed
verbatim for analysis. No field notes were taken. The duration of the interview is considered
appropriate as it was a qualitative inquiry. The duration ensured maximum participants give
consent for participation in the interview. However, the interview transcripts were not
returned to participants to promote validity of the data. However, Yang, Perkins and Stearns
(2018) took the approach to ensure validity of the transcripts by engaging in groups
discussions with all authors regarding the themes identified from transcript. Despite this step,
the process took place during data analysis and taking feedback from participants would have
helped to understand whether the transcripts truly reflect their perception or experiences or
not (Thomas, 2017).
During the process of interview, few questionnaires focused on rapport building by
asking background questions from research participants. This helped to ensure participants
were comfortable and prepared to give response for the main section of the interview. After
this, different types of questions related current treatment experience, characteristics of the
program and the factors influencing engagement in the program was evaluated (Yang,

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Perkins & Stearns 2018). This helped to ensure that both demographics and core data were
collected.
Analysis and Findings:
The three authors who conducted the research study coded the obtained results using
the philosophy of Phenomenology analysis. The authors proceeded with coding the data on
the basis of ATLAS.ti, which is a qualitative analysis software. The themes were identified
after the coding of the research findings. The analysis of the collected responses proceeded
with the generation of broad codes. The authors independently coded the data and met
biweekly so as to eliminate the repetitive codes. A 90% inter-coding reliability was
deciphered which was tested by the authors in two-phases. The first step proceeded with the
three coders applying the codes to five random scripts and calculating the percentage of
agreement prior to discussion. On the other hand, the second coding proceeded with the
calculation of the agreement based on the remaining coded data. It should be noted that the
authors encountered a lot of independent codes which were fused into other themes for
conveniently designing the themes. The information related to the feedback of the
participants after the validation of the findings is missing in the research study. Yes, the study
proceeded clearly with the identified quotations of the participants and then linking it to the
derived themes of the research study. The quotes were tightly linked to the themes and to the
number of the participants presenting the similar theme. A consistency between the data
presented and the findings were retrieved that proved the research was authentic and the
themes obtained were retrieved from the direct response of the participants. Also, it should be
critically stated here that the major as well as the minor themes were both discussed
appropriately in the research study with proper relevance to the findings which has been
stated to validate a qualitative research (Tong et al., 2007)

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Identifying Strengths and Weaknesses:
The research study was conducted on a restricted sample size that comprised of
clients who had completed their 28-day trial and were about to be discharged. This can be
considered as a major limitation of the research paper because the response of the clients who
are undergoing treatment or are at their initial phase of the treatment are equally important to
facilitate effective themes. Moreover it should also be noted that, the paper essentially
focused on the inclusion of gender-responsive treatment to facilitate an effective treatment
procedure. However, the research study did not validate appropriate underlying factors that
cause disparity in the treatment process which has been reported to be important to promote
future research ideas (Chen et al., 2013). The researchers however have efficiently identified
the major themes that serve as barriers to substance abuse treatment and provide promising
scope of research in future.
Conclusion:
Hence to conclude, it can be said that the researchers have presented an effective
qualitative study to identify the barriers and facilitators to substance abuse treatment program
within Inpatient settings. It should be critically stated here that studies reveal a significantly
higher number of patients resuming substance abuse after the treatment procedure. It is
increasingly important to identify the barriers that has led to the identified cause and this
proved to be the central idea of the research. Further, it should be mentioned that the
methodology followed was efficient but included a smaller sample size that comprised of an
unequal ethnic background of the clients. This can be identified as a limitation that has
narrowed down the scope of generalizing the research. However the research seems to be
promising in terms of further research studies.

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References:
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