Frank David, Walters Suzan M
Rory Meyers College of Nursing, New York University, New York, NY, United States.
Front Sociol. 2021 Feb 10;6:619677. doi: 10.3389/fsoc.2021.619677. eCollection 2021.
Often people assume that entry into drug treatment is a voluntary action for persons who use drugs (PWUD). This narrative informs the organizational and regulatory structure of most treatment programs and consequently affects patients' ability to exert agency over their own treatment. Yet, this view ignores the complex interplay between individual and structural factors in peoples' decision-making processes, particularly among people who use drugs who are stigmatized and criminalized. Treatment programs that assume voluntary entry may lack appropriate services for the populations of treatment seekers that they serve. This paper uses semi-structured interviews with 42 participants in Opioid Substitution Treatment (OST) (including patients, clinic doctors and staff, and advocates) informed by one of the author's own lived experience in OST, to examine patients' treatment decisions, and in particular, if and how, the structural context of drugs' illegality/criminalization affected their willingness to pursue treatment. A Critical Discourse Analysis was used to identify key themes. Interview data demonstrates that most people who use drugs enter treatment under constrained conditions related to drugs' illegality. Themes that emerged included: 1. A feeling of limited choices due to drugs' illegality; 2. Peer and family pressure; 3. Fear of losing children; and 4. Internalized stigma (i.e. feeling they are dirty or bad for using). Narratives that frame PWUD's treatment decisions as volitional provide political cover to policies that criminalize PWUD by obscuring their effect on PWUD's treatment decisions. Treatment models, particularly those that serve highly criminalized populations, should be re-conceptualized outside of normative narratives of individual choice, and be broadened to understand how larger structures constrain choices. By looking at macro-level factors, including the interplay of criminalization and drug treatment, programs can begin to understand the complexity of PWUD motivations to enter drug treatment. Recognizing the role of the War on Drugs as a force of oppression for people who use drugs, and that their treatment decisions are made within that setting, may enable people in treatment, and providers, to develop more productive ways of interacting with one another. Additionally, this may lead to better retention in treatment programs.
人们通常认为，对于吸毒者而言，进入戒毒治疗是一种自愿行为。这种观念影响了大多数治疗项目的组织和监管结构，进而影响患者对自身治疗施加影响的能力。然而，这种观点忽视了个体因素与结构因素在人们决策过程中的复杂相互作用，尤其是在那些受到污名化和刑事定罪的吸毒者当中。那些假定为自愿进入治疗项目的方案，可能缺乏为其服务的寻求治疗者群体提供适当的服务。本文通过对42名接受阿片类药物替代治疗（OST）的参与者（包括患者、诊所医生和工作人员以及倡导者）进行半结构化访谈，并结合作者自身在OST中的亲身经历，来研究患者的治疗决策，特别是药物非法性/刑事定罪的结构背景是否以及如何影响他们寻求治疗的意愿。运用批判性话语分析来确定关键主题。访谈数据表明，大多数吸毒者是在与药物非法性相关的受限条件下进入治疗的。出现的主题包括：1. 因药物非法性而感到选择受限；2. 同伴和家庭压力；3. 担心失去孩子；4. 内化的污名（即觉得自己吸毒是肮脏或不好的）。将吸毒者的治疗决策描述为自愿的叙述，通过掩盖其对吸毒者治疗决策的影响，为将吸毒者定罪的政策提供了政治掩护。治疗模式，尤其是那些服务于高度刑事定罪人群的模式，应该在个体选择的规范叙述之外重新构思，并加以扩展，以理解更大的结构如何限制选择。通过审视宏观层面的因素，包括刑事定罪与药物治疗的相互作用，各项目可以开始理解吸毒者进入药物治疗动机的复杂性。认识到禁毒战争对吸毒者而言是一种压迫力量，且他们的治疗决策是在这种背景下做出的，这可能使接受治疗者和提供者能够开发出更有效的相互交流方式。此外，这可能会提高治疗项目中的留存率。
