Reasons for Illicit Drug Use in People With Schizophrenia
Reasons for Illicit Drug Use in People With Schizophrenia
Qualitative study carried out with people with a clinical diagnosis of schizophrenia. Ethical approval was obtained from Bolton Local Research Ethics Committee (LREC) and subsequently from Central Manchester LREC, reference numbers 02/BN/704.
Participants were people from two socially deprived areas of Greater Manchester, an inner city area and a smaller town within the conurbation. All had a diagnosis of schizophrenia, used substances and were known to local psychiatric services. Participants were not under the clinical care of either of the researchers. Participants of diverse demographic (age, sex, ethnicity) characteristics were sought in order to obtain a maximum variation sample. We approached all consultant psychiatrists in these services asking them to identify all service users who met our inclusion criteria. Recruitment and initial contact with the patients was by an opt-in letter sent on behalf of and with the agreement of their own consultant. We sought to recruit all those who met our inclusion criteria and were female or of Black Minority Ethnic (BME) groups; we recruited as many white male participants as were necessary to reach saturation of data (see below). To compensate for the difficulty we encountered in recruiting female clients and people from ethnic minorities, such patients were purposively sought by identifying potential interviewees from these groups and repeatedly requesting consultants to pass on opt-in letters to these patients in particular.
We asked individuals to describe in narrative form their history of drug misuse and mental health problems from earliest experiences, moving forward in time to the present, with concurrent descriptions of their social context.
We wrote an initial topic guide based on the literature as follows:
The interview covered items in the 'topic guide' and any additional material spontaneously suggested by the patient. We adapted the order and style of questions at each interview in response to cues from the participant. To gain the maximum information, all participants were encouraged to give their own detailed personal account of their drug use history in a chronological manner, with minimal prompts from the interviewer, including any associated memories or ideas that were meaningful for the participant. The interviews were for as long as it took for the participant to tell their story or as long as the participant could tolerate, hence they ranged from approximately 40 minutes to 2 1/2 hours. They were provided with snacks and could take breaks if desired.
All interviews were recorded, transcribed and anonymised. The transcripts were analysed utilising Grounded Theory. We read each transcript and added meaningful labels or 'codes' against words or phrases that were relevant to possible reasons for illicit drugs use. We constantly compared codes within and between interviews and condensed similar codes together. We analysed the data whilst we continued to carry out more interviews, adapting our topic guide as the study progressed. At all stages of the analysis, we compared our emerging ideas about reasons for drug use with the interview transcripts and we discarded any ideas if the data did not support them. We wrote lists of codes for each participant ('open coding memos') initially grouping the codes according to descriptive headings of which substances were used, how they were used, any unusual incidents, the individual's life/relationships and perception of self. We compared these lists between participants to look for meaningful groupings of codes or 'categories' and wrote 'theoretical memos' about possible causal links between categories. Our theoretical memos included inductively writing a 'story line' or composite of the interviewees' stories of their street drug use and constructing a wall chart of the data to look for emergent patterns. Wherever we found that the 17 participants could be divided into two or more groups according to a characteristic relevant to drug use, we closely examined how the groups compared and contrasted to explore why these differences occurred.
We continued recruiting subjects and analysing interviews until we had reached saturation of the data, in that there were no new themes emerging and we had tested all the categories for disconfirming cases and variations.
Methods
Design of Study
Qualitative study carried out with people with a clinical diagnosis of schizophrenia. Ethical approval was obtained from Bolton Local Research Ethics Committee (LREC) and subsequently from Central Manchester LREC, reference numbers 02/BN/704.
Participants
Participants were people from two socially deprived areas of Greater Manchester, an inner city area and a smaller town within the conurbation. All had a diagnosis of schizophrenia, used substances and were known to local psychiatric services. Participants were not under the clinical care of either of the researchers. Participants of diverse demographic (age, sex, ethnicity) characteristics were sought in order to obtain a maximum variation sample. We approached all consultant psychiatrists in these services asking them to identify all service users who met our inclusion criteria. Recruitment and initial contact with the patients was by an opt-in letter sent on behalf of and with the agreement of their own consultant. We sought to recruit all those who met our inclusion criteria and were female or of Black Minority Ethnic (BME) groups; we recruited as many white male participants as were necessary to reach saturation of data (see below). To compensate for the difficulty we encountered in recruiting female clients and people from ethnic minorities, such patients were purposively sought by identifying potential interviewees from these groups and repeatedly requesting consultants to pass on opt-in letters to these patients in particular.
Interviews
We asked individuals to describe in narrative form their history of drug misuse and mental health problems from earliest experiences, moving forward in time to the present, with concurrent descriptions of their social context.
We wrote an initial topic guide based on the literature as follows:
"What substances have you ever used?
Tell me about when you first started using substances.
What was life like at the time?
What effects do you get from each substance?
Tell me about how your substance use has been over time since then.
What has life been like?
How have you been in yourself?
Does anything help with that?
What are your opinions of different street drugs?
Why do you think that people who have psychosis would carry on using substances?"
The interview covered items in the 'topic guide' and any additional material spontaneously suggested by the patient. We adapted the order and style of questions at each interview in response to cues from the participant. To gain the maximum information, all participants were encouraged to give their own detailed personal account of their drug use history in a chronological manner, with minimal prompts from the interviewer, including any associated memories or ideas that were meaningful for the participant. The interviews were for as long as it took for the participant to tell their story or as long as the participant could tolerate, hence they ranged from approximately 40 minutes to 2 1/2 hours. They were provided with snacks and could take breaks if desired.
Analysis
All interviews were recorded, transcribed and anonymised. The transcripts were analysed utilising Grounded Theory. We read each transcript and added meaningful labels or 'codes' against words or phrases that were relevant to possible reasons for illicit drugs use. We constantly compared codes within and between interviews and condensed similar codes together. We analysed the data whilst we continued to carry out more interviews, adapting our topic guide as the study progressed. At all stages of the analysis, we compared our emerging ideas about reasons for drug use with the interview transcripts and we discarded any ideas if the data did not support them. We wrote lists of codes for each participant ('open coding memos') initially grouping the codes according to descriptive headings of which substances were used, how they were used, any unusual incidents, the individual's life/relationships and perception of self. We compared these lists between participants to look for meaningful groupings of codes or 'categories' and wrote 'theoretical memos' about possible causal links between categories. Our theoretical memos included inductively writing a 'story line' or composite of the interviewees' stories of their street drug use and constructing a wall chart of the data to look for emergent patterns. Wherever we found that the 17 participants could be divided into two or more groups according to a characteristic relevant to drug use, we closely examined how the groups compared and contrasted to explore why these differences occurred.
We continued recruiting subjects and analysing interviews until we had reached saturation of the data, in that there were no new themes emerging and we had tested all the categories for disconfirming cases and variations.
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