University of Nevada, Reno, School of Public Health, ICF Next, Fairfax Virginia, University of Nevada, 1664 N. Virginia Street, Reno, NV, 89557, USA.
Roots to Wings Consulting, Reno, NV, USA.
Subst Abuse Treat Prev Policy. 2022 Nov 24;17(1):76. doi: 10.1186/s13011-022-00503-0.
Nevada, like the rest of the United States, is undergoing substantial challenges with opioid misuse and overdose deaths, further exacerbated by the COVID-19 pandemic. While much of the attention around opioid overdose prevention is centered on treatment and recovery, it is important to understand the factors that influence initiation of use, and the function opioids play in people's everyday lives. We conducted qualitative semi-structured individual interviews using purposive and snowball sampling among 35 people across Nevada with a current or prior history of illegal opioid or nonmedical opioid use. Our study aimed to understand why people start to use drugs, why they continue to use, what motivates them to continue to use or to seek treatment, and why individuals maintain recovery or return to use. We found five significant themes as perceived by the participants: that trauma is a risk factor for drug misuse; that the function of opioids in everyday life is a source of temporary relief but highly disruptive in the longer term; that recovery is most often a complicated and nonlinear process; that there are many barriers to accessing services that are both logistical and psychosocial; and that compassion, hope, and having a sense of purpose are crucial to the recovery process. The experiences of the study participants portray opioid use as a rational choice to escape the emotional ramifications of trauma. However, due to the physiological dependence and physical risk of opioids, drug policies that criminalize addiction, societal stigma, and the barriers to timely access of harm reduction, treatment, and recovery services, opioid users often become trapped in a distressing and dangerous cycle. Lastly, respondents indicated that hope, value, belonging, and purpose are powerful factors in cultivating intrinsic motivation for making positive changes and fostering resilience in the recovery process. Opioid misuse services should help meet basic needs and incorporate holistic approaches to recovery that acknowledge past trauma and the complexity of the recovery process.
内华达州与美国其他地区一样，正面临着阿片类药物滥用和过量死亡的巨大挑战，而 COVID-19 大流行进一步加剧了这一挑战。尽管围绕阿片类药物过量预防的大部分注意力都集中在治疗和康复上，但了解影响使用开始的因素以及阿片类药物在人们日常生活中的作用是很重要的。我们在内华达州进行了定性半结构化的个体访谈，采用目的抽样和滚雪球抽样方法，对 35 名有或曾经有非法阿片类药物或非医疗用阿片类药物使用史的人进行了访谈。我们的研究旨在了解人们为什么开始使用药物，为什么他们继续使用，是什么促使他们继续使用或寻求治疗，以及为什么个人保持康复或恢复使用。我们发现了五个参与者认为重要的主题：创伤是药物滥用的一个风险因素；阿片类药物在日常生活中的作用是暂时缓解的来源，但从长期来看极具破坏性；康复通常是一个复杂和非线性的过程；获得服务存在许多障碍，既有后勤方面的，也有心理社会方面的；同情、希望和有目的感对康复过程至关重要。研究参与者的经历描绘了阿片类药物使用是一种逃避创伤情绪后果的理性选择。然而，由于阿片类药物的生理依赖和身体风险，将成瘾定为犯罪的药物政策、社会污名、以及及时获得减少伤害、治疗和康复服务的障碍，使阿片类药物使用者经常陷入痛苦和危险的循环。最后，受访者表示，希望、价值、归属感和目标是培养积极改变内在动机和培养康复过程中韧性的强大因素。阿片类药物滥用服务应帮助满足基本需求，并采用整体方法来恢复，承认过去的创伤和康复过程的复杂性。
