Study Proposal

Research Articles

In every human’s life circle, there probably has come a time or a situation in which, they have experienced pain. This might consist of migraines, muscle aches, broken bone, post-surgical pain., and honestly, a slew of other medical reasons. Such pain can manifest as either acute or chronic. When the pain is mild, an over-the counter pain reliever can be prescribed (Skidmore-Roth, 2018). However, acute or chronic pains might be severe enough to prompt a physician to recommend and prescribe a stronger pain reliever known as opioids (Skidmore-Roth, 2018). Opioids are a class of medication known as narcotics and are both prescription and illicit in nature (Skidmore-Roth, 2018). Unfortunately, because the prescription strength is a controlled class II narcotic, they have the potential to become habit forming when misused, as noted by the ever-increasing crisis of opioid abuse and addiction (Skidmore-Roth, 2018). This paper, therefore, seeks to present investigative findings regarding whether or not the pharmacological maintenance treatment approach truly has the possibility of reducing the occurrence of addiction, but also in the management of drug related arrest, lowering the rate of sexually transmitted diseases, while still improving and restoring the individual’s functionality.

Critique Article 1

The first study that we will take a look at is the study conducted by Bolek, Yargic, and Ekinci (2016), “The effects of Buprenorphine/Naloxane Maintenance Treatment on the Quality of Life, Substance Use and Functionality in Opiate Dependence: A Follow-Up Study.”

Research Method

This research applied a quantitative method of research. A sample of 50 individuals between ages of 18 and 65 years was involved, each with an opiate dependency. Structured interviews were administered over the 6-month period of treatment (Bolek et al., 2016). The data collected was analyzed using several variables aimed at eliciting the stress levels, psychiatric status, quality of life and craving levels of the patients (Bolek et al., 2016).

Key variables or phenomena of the hypotheses

According to Bolek et al., (2016), four main variables were employed, namely stress level variables, craving level variables, addiction severity and quality of life. The stress level was measured using the perceived stress scale whereby patients rated certain feelings that they had experienced (Bolek et al., 2016). Bolek et al. (2016) asserted that a high score coincided with a high-stress level. Craving levels were evaluated by a visual analog scale, whereby the patients reported their levels of cravings. According to Bolek et al. (2016), a patient’s addiction severity was assessed using the Addiction severity index (ASI). The ASI assesses the patients' functioning in seven areas, i.e. medical, employment, legal, family/social, alcohol drug and psychiatric (Bolek et al., 2016). These seven areas are frequently affected by disorders related to substance abuse (Bolek et al., 2016). Quality of life measurement were obtained using the quality of life short form questionnaire consisting of 36 questions (SF-36). The SF-36 is a self-rating scale that assesses physical, mental, social, energy, pain, and emotional functions (Bolek et al., 2016).

Description of how the hypothesis was supported or not supported

The hypothesis of the study was if opioid maintenance treatment reduced the rate of illicit drug use, crime, the spread of sexually transmitted diseases, while increasing psychiatric, somatic and social functionality (Bolek et al., 2016). The opioid maintenance treatment used in this study were the medications Buprenorphine and Naloxane.

This hypothesis was supported by a series of facts based on the current study and comparison with previous studies on the same (Bolek et al., 2016). There was a marked decrease in substance craving, stress level, illicit drug use and an improvement of the quality of life (Bolek et al., 2016). According to Bolek et al. (2016), in accordance with the results, craving levels reduced from a baseline standard deviation of 79.80 in the first month to 44.40 in the 6th month. This reduction attributed to a reduction in stress levels primarily attributed to the use of Naloxane (Bolek et al., 2016). In terms of quality of life, all measured aspects of quality of life increased by a considerable margin in the months under study in relation to the baseline with positive milestones being reported (Bolek et al., 2016). Stress levels were also noted to have been reduced, as seen from the results of the PSS. A baseline level of 46.96 in the 1st month, reduced to 42.48 in the 3rd month and finally 41.52 within the last month (Bolek et al., 2016). These results generally supported the hypothesis since they pointed to a marked reduction in the use of opiates at the end of treatment using either Buprenorphine or Naloxane (Bolek et al., 2016). In comparison to other studies, all outlined studies in the research showed a marked reduction in substance use due to treatment at the end of twelve months (Bolek et al., 2016). The results obtained from this study coupled by comparison of other case studies supporting the hypothesis made.

Determination and explanation of whether the study was (or was not) conducted safely and ethically by the authors

According to Bolek et al. (2016), ethical and safety measures were highly adhered to and followed. An appropriate sample was used in terms of age i.e., 18-65 years (Bolek et al., 2016). This age bracket is considered to be adults and who are capable of making sound judgments. This study was done on a voluntary basis and no monetary compensation was offered (Bolek et al., 2016). No individual was forced or coerced into being part of the research. The authors excluded pregnant women, breastfeeding mothers, patients with psychiatric disorders and those who were illiterate. This shows the authors ethical perspective since they did not want to bother the above-mentioned groups of individual and they had the uttermost respect considering their states (Bolek et al., 2016). Safety precautions were adhered to as well as confidentiality. There was no report of any unsafe methods and practices conducted by the volunteers.

Critique Article 2

The second article that was analyzed was Baumeister and his colleagues (2014) “The association between methadone dose and concomitant cocaine use in methadone maintenance treatment: a register-based study.”

Research Method

The main method of research used was the quantitative approach, involving the use of surveys. Data collected was obtained from the methadone registry of Basel City in Switzerland (Baumeister et al., 2014). A survey sample of 613 patients under methadone treatment was used (Baumeister et al., 2014). Baumeister et al. (2014) then divided these samples into three groups: 1) low dose group, 2) medium dose group, and 3) high dose group. Data analysis was conducted in a statistical manner using the IBM SPSS software and a retrospective analysis conducted (Baumeister et al., 2014).

Key variables or phenomena of the hypotheses

Two main dependable variables were used namely, coexistence of heroin use and coexistence of cocaine use (Baumeister et al., 2014). According to Baumeister et al. (2014), there were four main elements or sub-variables consisting of methadone dose, specialized centers, days with take home and employment status. The methadone dose was then divided into low dose methadone (LDM) < 60 mg/dl, medium dose methadone (MDM) 60-100mg/dl, and high dose methadone (HDM) >100mg/dl (Baumeister et al., 2014).

Description of how the hypothesis was supported or not supported

The hypothesis was if higher methadone doses would result in lower coexistence of heroin and or cocaine use (Baumeister et al., 2014). The research aimed at proving this hypothesis, however, it was not supported by the findings of the research. The findings dictated that patients in the low dose group had fewer cocaine intake days in comparison to patients in the recommended dose range i.e. > 60mg/dl (Baumeister et al., 2014). The article compared other recent studies to fully elaborate on their hypothesis. One study, Kennedy et al. (2013), conducted a randomized study on methadone doses of >100 mg/day, combined with contingency management, in which the results did not support the hypothesis. However, Peles et al. (2005) found that a higher methadone dose significantly reduced illicit opioids when used in methadone maintenance treatments (MMT), thus supporting the hypothesis.

Determination and explanation of whether the study was (or was not) conducted safely and ethically by the authors

The study was guided in both an ethical manner and safely. The data collected was approved by the local ethics committee (Baumeister et al., 2014) and followed the legalities behind data collection of Basal City. A uniform criterion was used in the sampling with no bias identified. This criterion was backed up with data recorded in the registry and prescription records. The data was anonymized (Baumeister et al., 2014) i.e., patients' name and bio data were not revealed, hospitals and prescribing doctors' names were kept confidential and no unsafe practices were conducted or noted throughout the research. Data was used in a logical manner to avoid any errors and gave an accurate and elaborate picture (Baumeister et al., 2014).

Critique Article 2

The final research article that will be addressed is that of Alim and her colleagues (2012) “Resilience to Meet the Challenge of Addiction: Psychobiology and Clinical Considerations.”

Research Method

This research article incorporated qualitative research as the main research method. The article used secondary data, evidence, and material from other researches and disciplines in order to develop their thesis (Alim et al., 2014). It employed the use of observation, interviews and grounded theories. It was exploratory and its goal was aimed at shedding light on the topic (Alim et al., 2014).

Key variables or phenomena of the hypotheses

According to Alim et al. (2012), a number of these variables were used in this research. The main variable was stress responsivity across organisms (Alim et al., 2014). The elements or sub-variables were noted as psychological differences in coping with stress, variability within genetic make-up, quality of early life experiences, an interaction between genetic make-up and quality of early life (Alim et al., 2012). Alim et al. (2012) explained that genetic makeup is a variable in and of itself and encompasses gene-environment interactions, any alterations in gene expression and difference or discrepancies within the genetic code. Other variables included in the research article included hormonal changes during stress and coping mechanism during stress (Alim et al., 2012).

Description of how the hypothesis was supported or not supported

This hypothesis was supported with explanations and evidence-based data obtained from other publications (Masten, 2001). This information and data was then divided into two main branches of psychological factors associated with resilience and neurochemistry of resilience (Alim et al., 2012). Studies on psychosocial factors proved that certain social attributes and history of adversity contribute to resilience (Alim, et al., 2012). The authors highlighted various studies to prove this point. Alim et al. (2012) utilized a few early studies that were conducted by Masten (2001) and Rutterin (1985), each of these previous studies emphasized and concluded that children with prior adversity exposure had developed psychosocial factors that had increased resilience. To support specific psychosocial attributes such as the ability to fathom emotions, both positive and negative Alim et al. (2012) referenced the work of Fredrickson’s (2001) concept or how the role of positive emotions contributed or linked to there being more positive outcomes to support the above argument.

According to Alim et al. (2012), in neurochemistry of resilience, the article explains the various neurochemical pathways attributed to resilience including the hypothalamic–pituitary–adrenal (HPA)axis and the endocrine system. In the endocrine system, norepinephrine, serotonin, and dopamine systems were analyzed and specific scientific studies referenced to prove the outlined points (Alim et al., 2012).

Determination and explanation of whether the study was (or was not) conducted safely and ethically by the authors:

This study was conducted ethically by the authors. The authors acknowledge the work of other writers and did not disregard their finding in any way (Alim et al., 2012). All referred materials were clearly referenced and the appropriate acknowledgment and credit given to previous research as well as to the organizations that supported the research process through a financial disclosure (Alim et al., 2012). In addition to the references to the previous studies used, the names of the participants, locality or descriptions were not mentioned hence retaining their privacy and protection of their confidentiality was maintained and protected (Alim et al., 2012).

Conclusion

In summary, the use of opioids, on one hand, can be beneficial and medically necessary, but if misused or abused, lends itself to the alarming statistics of addiction. On the other hand, managing recovery through the employment of Buprenorphine or Naloxane maintenance treatment improves the affected individuals’ quality of life (Bolek et al., 2016). Based on the study findings, it can be inferred that the pharmacological intervention approach significantly reduces relapse (Bolek et al., 2016). Moreover, Baumeister et al. (2014) concluded that it contributed to a decrease in the use of illicit substances noted in the reduced conditions of cravings and generally lead to an improvement in the quality of life, free from opioid dependence. Even though, the treatment process and the recovery process might be quite long, the remedy has been proven to exhibit encouraging results within the first twelve months of using medications such as Naloxane (Bolek et al., 2016).

References

Baumeister, M., Vogel, M., Dürsteler-MacFarland, K., M., Gerhard, U., Strasser, J., Walter, M., Petitjean, S. A. (2014). Association between methadone dose and concomitant cocaine use in methadone maintenance treatment: A register-based study. Substance Abuse Treatment, Prevention, and Policy, 9(1), 46. Retrieved from http://library.capella.edu

Bolek, S., Yargic, I., & Ekinci, O. (2016). The effects of Buprenorphine/Naloxane maintenance treatment on the quality of life, substance use and functionality in opiate dependence: A follow-up study. Klinik Psikofarmakoloji Bulteni, 26(2), 141-151. Retrieved from http://library.capella.edu