Patient experiences with a transitional, low-threshold clinic for the treatment of substance use disorder: A qualitative study of a bridge clinic

Background: A minority of patients with substance use disorder (SUD) receives treatment, indicating the need for innovation in care for individuals with SUD. Transitional and low threshold models of care for SUD are utilized to address this treatment gap, but there is limited evidence about their effectiveness or patient perspectives on these models. Methods: Patients participated in semi-structured interviews (N = 29) which explored their experience in a transitional, low threshold, Bridge clinic for the treatment of SUD. In order to reach a diverse patient population across age, gender, housing status, type of SUD, length of stay, and patient status in the clinic, researchers employed maximum variation sampling. Interviews were conducted until no new central concepts emerged. Codes were developed and assigned using an inductive as well as a mixed inductive-deductive approach. Results: Patients identified flexibility and accessibility of services, compassionate approach of providers and staff, use of peers in recovery, and the emphasis on harm reduction as positive features of the model. Patients struggled with transitioning out of the clinic. Conclusion: Patients reported positive experiences in a transitional, low threshold clinic for SUD, comparing it favorably to other programs. Patients maintained sobriety more consistently and increasing motivation to adhere to treatment. Patients almost universally appreciated the flexible and harm reduction-oriented model of treatment. Future quantitative research is needed to further examine the effects of low threshold programs on treatment outcomes, including ongoing substance use, treatment retention and overdose mortality, as compared to traditional treatment programs.