Professionals’ Views on Challenges in Inpatient Substance Abuse Treatment during COVID-19 Pandemic in Finland

Round 1

Reviewer 1 Report

1. This is a very meaningful study. 

2. But the introduction and background study are too terse . I think "inpatient substance abuse" and "treatment" need more unpacking for the readers. These elaboration should also be backed up by strong references. 

3. At the end of introduction, authors shuld have a short paragraph to orientate the readers to the other sections.

4. Can i also ask the authors to enhance their presentation? it is currently very wordy without any figures as illustration which make the reading very difficult.

5. I believe the current study will benefit by discussing the following relevant/recent works [especially in section 3 and 4 / Table 1, which mention many aspects of the COVID situation without any references] : 
(a) Relieving Cost of Epidemic by Parrondo's Paradox: A COVID‐19 Case Study - how lockdown affects a country in general

(b) Superposition of COVID‐19 waves, anticipating a sustained wave, and lessons for the future - i beleive this reference will help to enhance the literature review of the current study which is currently very terse. 

(c) Introducing the 21st century’s New four horsemen of the coronapocalypse - finally, for a study like this, i think we should pay attention to provide some disclaimer and how such approach can form part of the solution with many others.

6. Finally, the authors should have a section on "Limitations of their study" and spell out clearly for the readers. The current n = 22 is really small and i am wondering if the authors can improve the sample size(?) before resubmission. 

7. "We conclude that because of the pandemic the quality of treatment has been impaired to some extent"- i think this needs to be further quantified. 

8. your survey seems very qualitative. is there any testing of means that can be carried out via some statistical analysis? that will certainly strengthen the work immensely. 

 

Author Response

1. This is a very meaningful study. 
2. But the introduction and background study are too terse . I think "inpatient substance abuse" and "treatment" need more unpacking for the readers. These elaboration should also be backed up by strong references. 

A: We added more information of inpatient treatment.

3. At the end of introduction, authors shuld have a short paragraph to orientate the readers to the other sections.

A: Guidance for reading added.

4. Can i also ask the authors to enhance their presentation? it is currently very wordy without any figures as illustration which make the reading very difficult.

A: Table of interview themes added.

5. I believe the current study will benefit by discussing the following relevant/recent works [especially in section 3 and 4 / Table 1, which mention many aspects of the COVID situation without any references] : 
   (a) Relieving Cost of Epidemic by Parrondo's Paradox: A COVID‐19 Case Study - how lockdown affects a country in general

(b) Superposition of COVID‐19 waves, anticipating a sustained wave, and lessons for the future - i beleive this reference will help to enhance the literature review of the current study which is currently very terse. 

(c) Introducing the 21st century’s New four horsemen of the coronapocalypse - finally, for a study like this, i think we should pay attention to provide some disclaimer and how such approach can form part of the solution with many others.

A: Thank you for the references, we have added Lai et Cheong to the appropriate section.

6. Finally, the authors should have a section on "Limitations of their study" and spell out clearly for the readers. The current n = 22 is really small and i am wondering if the authors can improve the sample size(?) before resubmission.

A: We have stated limitations more clearly. Unfortunately we have no possibilities for conducting more focus group interviews.

7. "We conclude that because of the pandemic the quality of treatment has been impaired to some extent"- i think this needs to be further quantified.

A: We have added examples of the impairments.

8. your survey seems very qualitative. is there any testing of means that can be carried out via some statistical analysis? that will certainly strengthen the work immensely. 

A: Conducting statistical analysis on data gathered via focus group interviews and with this sample size is unfortunately not possible. 
In addition: Language check has been done.

We thank the reviewer for the comments and helpful suggestions!

Reviewer 2 Report

Review of manuscript entilted: “Professionals’ views on challenges in inpatient substance abuse treatment during COVID-19 pandemic” authored by Eeva Ekqvist, Tuija Karsimus, Arja Ruisniemi, Marjaana Hiironmäki, Katja Kuusisto

 

Substance abuse disorder is still growing problem worldwide. During the COVID-19 outbreak and pandemic availability of group therapies or individual meetings with psychotherapist is very limited.

In the presented manuscript, authors tried to present opinion of professionals working with patients dependent to psychoactive substances. Introductions provides sufficient information about the undertaken problem. Materials and methods are written comprehensively. Results are presented clearly. Discussion is written logically and based on obtained results.

I have only minor concerns.  

Major concerns:

None

Minor concerns:

• Title – I would suggest to provide location of current study, since right now it suggest that study is worldwide
• I do not know if term “clients” in relation to patients is appropriate
• What is the meaning of e.g. (W3 in I2) in quotation in results part? Please provide explanation.
• Line 65 – misplaced “.”
• Line 69 – [24,10,17] – numbers are not sorted
• Line 77 – misplaced “.”

Author Response

• Title – I would suggest to provide location of current study, since right now it suggest that study is worldwide

A: Title has been changed to “Professionals’ views on challenges in inpatient substance abuse treatment during COVID-19 pandemic in Finland”.

• I do not know if term “clients” in relation to patients is appropriate

A: “Client” has been changed to “patient”.

• What is the meaning of e.g. (W3 in I2) in quotation in results part? Please provide explanation.

A: Explanation has been added.

• Line 65 – misplaced “.”

A: Citation refers to several sentences, thus dot has been put inside the brackets. If this is not correct citation style, it can be later amended.

• Line 69 – [24,10,17] – numbers are not sorted

A: Numbers have been sorted and changed due to added references.

• Line 77 – misplaced “.”

A: Citation refers to several sentences, thus dot has been put inside the brackets. If this is not correct citation style, it can be later amended.

We thank the reviewer for the comments and helpful suggestions!

Reviewer 3 Report

First, I want to thank for the opportunity to review the manuscript titled “Professionals’ views on challenges in inpatient substance abuse treatment during COVID-19 pandemic”. Based on the title, topic of the manuscript deals with issues of relevance for the journal and the Special Issue. I believe the paper offers interesting insight. However, after reading the manuscript I have some suggesions regarding the paper.

The introduction considers different topics and it could be more focused. I suggest the authors to get better to the point, consistent with the paper research question and then the discussion. The introduction could serve as a basis for introducing the literature that is discussed with results in the fourth section. The discussion could be revised accordingly.

I suggest the authors to expand the literature review concerning recent literature on the topic, and in an international vein. The authors just reported three studies (24, 10, 12), of which only two are in English. Other recent studies authors could refer to might be:

• Lin, C., Clingan, S. E., Cousins, S. J., Valdez, J., Mooney, L. J., & Hser, Y. I. (2022). The impact of COVID-19 on substance use disorder treatment in California: Service providers' perspectives. Journal of Substance Abuse Treatment, 133, 108544.
• Treitler, P. C., Bowden, C. F., Lloyd, J., Enich, M., Nyaku, A. N., & Crystal, S. (2022). Perspectives of opioid use disorder treatment providers during COVID-19: Adapting to flexibilities and sustaining reforms. Journal of substance abuse treatment, 132, 108514.

In methodology, authors state: “Interviews followed roughly a thematic interview frame including questions: how pandemic has affected the clients’ possibilities to enter the treatment and their well- being at entry, how practices and the treatment provided have changed in treatment unit, and how aftercare has changed. In this article we focus on how practices in the treatment unit have changed and professionals’ descriptions of solutions they have made in this changed and challenging situation.” However, a better explanation of the interplay between the aim of the research and the interview protocol would help. Authors might also think to provide the interview protocol in Appendix. This could also help in better understanding how data were analysed.

A list of interviewees (with some details such as type of organization and role) could also support the comprehension of the findings.

Authors could stress more the implications of the study (i.e. managerial and professional implications), in terms of practical actions that could be put in place to address the challenges emerging in the study.

I wish good luck to the authors with their paper.

Author Response

First, I want to thank for the opportunity to review the manuscript titled “Professionals’ views on challenges in inpatient substance abuse treatment during COVID-19 pandemic”. Based on the title, topic of the manuscript deals with issues of relevance for the journal and the Special Issue. I believe the paper offers interesting insight. However, after reading the manuscript I have some suggesions regarding the paper.

The introduction considers different topics and it could be more focused. I suggest the authors to get better to the point, consistent with the paper research question and then the discussion. The introduction could serve as a basis for introducing the literature that is discussed with results in the fourth section. The discussion could be revised accordingly.

 

A: Some changes to Introduction and Discussion has been changed and the literature being used in both sections has been checked.

 

I suggest the authors to expand the literature review concerning recent literature on the topic, and in an international vein. The authors just reported three studies (24, 10, 12), of which only two are in English. Other recent studies authors could refer to might be:

• Lin, C., Clingan, S. E., Cousins, S. J., Valdez, J., Mooney, L. J., & Hser, Y. I. (2022). The impact of COVID-19 on substance use disorder treatment in California: Service providers' perspectives. Journal of Substance Abuse Treatment, 133, 108544.
• Treitler, P. C., Bowden, C. F., Lloyd, J., Enich, M., Nyaku, A. N., & Crystal, S. (2022). Perspectives of opioid use disorder treatment providers during COVID-19: Adapting to flexibilities and sustaining reforms. Journal of substance abuse treatment, 132, 108514.

A: Thank you for references, Lin et al. has been added to appropriate sections.

In methodology, authors state: “Interviews followed roughly a thematic interview frame including questions: how pandemic has affected the clients’ possibilities to enter the treatment and their well- being at entry, how practices and the treatment provided have changed in treatment unit, and how aftercare has changed. In this article we focus on how practices in the treatment unit have changed and professionals’ descriptions of solutions they have made in this changed and challenging situation.” However, a better explanation of the interplay between the aim of the research and the interview protocol would help. Authors might also think to provide the interview protocol in Appendix. This could also help in better understanding how data were analysed.

A: Interview themes has been added as a table to the text.

A list of interviewees (with some details such as type of organization and role) could also support the comprehension of the findings.

A: We have added information on number of professionals in each role to the text describing the interviewees.

Authors could stress more the implications of the study (i.e. managerial and professional implications), in terms of practical actions that could be put in place to address the challenges emerging in the study.

A: We have stated more clearly how quality of treatment has been impaired in the Discussion.

I wish good luck to the authors with their paper.

A: We thank the reviewer for the comments and helpful suggestions!

Round 2

Reviewer 1 Report

the revised manuscript can be accepted