iCARE: Aspects of treatment for substance use in primary care from the patient perspective (Jul '18)

The iCARE study: helpful aspects of treatment for substance use in primary care from the patient perspective. Dr. Paula Gomes Alves, Research Associate, University College London (UCL), presents her new NIHR-SPCR funded study:


When we are researching, planning or delivering any sort of healthcare, listening to the perspective of service users is key. In previous research studies conducted in specialist drug & alcohol services, service users have reported that “clinicians’ views about recovery are unrealistic” or that clinicians “have no idea” about their experience in treatment (Neale et al., 2015; Pulford, Adams, & Sheridan, 2009). But what do we know about their experience of treatment for substance use treatment in primary care?


My first contact with substance use services dates back to 2006 when I received training as a clinical psychologist in Lisbon, Portugal. Even though I was new to this career, and even less experienced in research, I felt that something should be done to improve the experience of those using the service.

Most of my thoughts emerged when I visited an inpatient unit, and observed adult patients constantly being told what they could, or could not, do, such as where they should sit or how they should share the food with the group.

Again, I was new to the field and I was in one of the best treatment services in my country; but I wondered: were these strategies working for them? Were they helpful, and in what way? Was this the kind of support they needed? Had someone ever asked what they thought?

These questions followed me and shaped what would become my career as a researcher in mental health. As such, most of my research has focused on how service users can contribute to healthcare delivery by sharing their views about their clinical situation, treatment plans and also the evaluation of treatment outcomes.

When I joined UCL’s Research Department of Primary Care and Population Health, the idea for this project started to emerge, as my knowledge about substance use treatment in primary care was limited.

The iCARE study

This project was born from initial discussions with GPs with a special interest, and expertise, in substance use treatment and a UCL-based expert in qualitative research. Later, a GP registrar with experience in shared care joined the team and the iCARE study emerged.

iCARE is a qualitative study which aims to explore the experience of service users whilst in treatment for substance use in primary care services. More specifically, we want to ask patients which aspects of their consultations have been helpful and hindering to them. To do this, we will be using a qualitative enquiry method called “Critical Incidents Technique”, to prompt service users to recall and discuss any events or situations (“incidents”) that were positive or negative to them, and why.

Our final goal is to create a thematic map illustrating the main helpful and hindering aspects of substance use treatment when provided in primary care. As a qualitative study, there are limits to the extent to which our findings will be generalisable to other services, geographical areas or even sub-populations. However, we believe that this study will contribute with 1) a qualitative methodological framework to study the patient perspective about the treatment process; 2) patient perspectives from an often stigmatised and overlooked group; 3) successful and unsuccessful aspects of substance use treatment, from the patient perspective; 4) further understanding about the positive and negative aspects of providing substance use treatment in primary care.

How can you help? 

We are currently seeking primary health care professionals anywhere in the UK who are happy to help us to recruit patients receiving substance use treatment in GP practices. Health professionals will kindly assist us by providing a flyer of our study to their patients, and asking them if they wish to be contacted by the researcher. We are currently waiting to be granted with NHS ethics approval and data collection is expected to begin in late August/early September.

Download the flyer.

If you would like to help us with recruitment please contact me via p.alves@ucl.ac.uk

We are also very much welcome any comments, suggestions or questions about our study, as well as opportunities for future collaboration.

Thank you very much!

Dr Paula Gomes Alves