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The thesis focuses on the subjectively perceived changes in the lives of persons in the methadone maintenance treatment program, on their experiencing of the changes and subjective judgment of the treatment. The topic is treated according to the Bio-Psycho-Socio-Spiritual Model of Addiction. The theoretical part deals with the quality of life and the subjectively perceived well-being and defines six dimensions of well-being on which the practical part of the thesis is based. It also elaborates on the Bio-Psycho-Socio-Spiritual Model of Addiction in the context of the methadone maintenance treatment. Moreover, it describes the factors in life change and the motivation to change. The last theoretical chapter focuses on the opioid substitution treatment as such and more specifically on the methadone maintenance treatment. The practical part presents the results of the research. The aim of the thesis is to analyse how the persons in the methadone maintenance treatment program in České Budějovice perceive life changes. A qualitative research was chosen for that purpose. The data were obtained through the technique of narrative interview. The research group consisted of four respondents who were on the methadone maintenance treatment program. The results show that the subjectively perceived changes in the lives of the persons in the methadone maintenance treatment program relate to five out of six dimensions of well-being. No changes were recorded in the dimension concerning the sense of life, in other words, even after a several month methadone maintenance treatment these persons perceive no goal of their lives. Important consequences for work with these persons can be drawn from that, especially for therapists in opioid substitution centres, who should develop spirituality aspects of persons.

To advance social work practice and decrease the research practice gap, this dissertation followed a model development paradigm consisting of several phases. Based on the task-centered model of social work practice and motivational interviewing, a new combined model was construed. The two underlying models were analyzed and synthesized, using technical eclecticism as the integrative approach. The resulting combined model was described by guidelines and manualized. To test the combined model in an applied setting, a study was designed in collaboration with social workers at a substance abuse counseling center. There, the combined model intervention was implemented in an outpatient medication assisted treatment program dispensing methadone and buprenorphine to a mainly African-American population. The agency program aimed at detoxification, but also provided methadone maintenance. It offered additional groups and acupuncture. Ten clients and four social work practitioners participated in the intervention study. The study used a mixed-method approach in data collection and analysis. Client practitioner verbal interaction was recorded using digital audio recording. The digital audio files were loaded directly into Atlas.ti software to be used for analysis. Qualitative data analysis with Atlas.ti was performed for two research tasks, a) assessing implementation fidelity of the manual based intervention and b) exploring model development aspects to improve model guidelines. Treatment fidelity was analyzed through deductive coding and frequency counts. Model development analysis was performed similar to a grounded theory model and used content analysis and constant comparison methodologies. Addiction Severity Index and Readiness Ruler, urine drug screens, problem change, and task accomplishment ratings were used as quantitative outcome measures to produce time series data in order to chart individual case progress in a single system design. After testing the intervention, a focus group with participating practitioners was conducted. Overall beneficence with clients improving and progressing successfully in the program was found. The integration of the underlying models was deemed successful. Their elements were found to be complementary and intricately linked. Crucial for successful implementation is that the program environment supports and accepts client choices. Model guidelines were reviewed and improved for further field testing.

Introduction: Malgré des taux d’efficacité comparable du traitement antiviral de l’hépatite C (VHC) entre utilisateurs de drogues par injection (UDIs) et non-UDIs, il y a encore d’importantes barrières à l’accessibilité au traitement pour cette population vulnérable. La méfiance des UDIs à l’égard des autorités médicales, ainsi que leur mode de vie souvent désorganisé ont un impact sur l’initiation du traitement. L’objectif de cette étude est d’examiner les liens entre l’initiation du traitement du VHC et l’utilisation des services de santé chez les UDIs actifs. Methode: 758 UDIs actifs et séropositifs aux anticorps anti-VHC ont été interrogés durant la période de novembre 2004 à mars 2011, dans la région de Montréal. Des questionnaires administrés par des intervieweurs ont fourni des informations sur les caractéristiques socio-économiques, ainsi que sur les variables relatives à l’usage de drogues et à l’utilisation des services de santé. Des échantillons sanguins ont été prélevés et testés pour les anticorps anti-VHC. Une régression logistique multivariée a permis de générer des associations entre les facteurs relatifs aux services de santé et l’initiation du traitement contre le VHC. Resultats: Parmi les 758 sujets, 55 (7,3%) avaient initié un traitement du VHC avant leur inclusion dans l’étude. Selon les analyses multivariées, les variables significativement associées à l’initiation du traitement sont les suivantes: avoir vu un médecin de famille dans les derniers 6 mois (Ratio de Cote ajusté (RCa): 1,96; Intervalle de Confiance à 95% (IC): 1,04-3,69); plus de 2 ans sous traitement de la dépendance à vie, sans usage actuel de méthadone (RCa: 2,25; IC: 1,12-4,51); plus de 2 ans sous traitement de la dépendance à vie, avec usage actuel de méthadone (RCa: 3,78; IC: 1,85-7,71); et avoir déjà séjourné en prison (RCa: 0,44; IC: 0,22-0,87). Conclusion: L’exposition à des services d’aide à la dépendance et aux services médicaux est associée à l’initiation du traitement du VHC. Ces résultats suggèrent que ces services jouent leur rôle de point d’entrée au traitement. Alternativement, les UDIs ayant initié un traitement du VHC, auraient possiblement adopté une attitude proactive quant à l'amélioration de leur santé globale. D’autre part, l’incarcération ressort comme un obstacle à la gestion de l’infection au VHC. / Introduction: In spite of comparable hepatitis C virus (HCV) treatment efficacy between injection drug users (IDUs) and non-IDUs, there are still important barriers impeding antiviral treatment access in this vulnerable population. Mistrust between IDUs and health care providers, along with IDU disorganised lifestyle, affect HCV treatment uptake. The objective of this study is to examine the association between HCV treatment initiation and the use of healthcare services among active IDUs. Methodology: 758 active IDUs, seropositive for anti-HCV antibody, were surveyed from November 2004 to March 2011 in Montreal. Interviewer-administered questionnaires elicited information on socio-demographic factors, drug use related behaviors and health care service utilization. Blood samples were collected and tested for HCV antibodies. Multivariate logistic regression analysis was conducted to identify the health service correlates of HCV treatment initiation. Results: Among the 758 subjects, 55 (7.3%) had initiated an HCV treatment prior to enrolment. In multivariate analysis, variables independently associated with treatment initiation included: having seen a general practitioner in the last 6 months (adjusted Odds Ratio (aOR): 1,96; 95% Confidence Interval (CI): 1,04-3,69); more than 2 years of lifetime addiction treatment exposure without current methadone use (aOR: 2,25; CI: 1,12-4,51); more than 2 years of lifetime addiction treatment exposure with current methadone use (aOR: 3,78; CI: 1,85-7,71); and having spent time in prison (aOR: 0,44; CI: 0,22-0,87). Conclusion: Exposure to addiction and medical services is associated with HCV treatment initiation. These results suggest that such services efficiently play their role as entry points for HCV treatment. Alternatively, IDU who have initiated HCV treatment, regardless of the viral response outcome, may have adopted a proactive stance towards improving their overall health. Incarceration on the other hand seems to be an obstacle to HCV treatment uptake.

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