"A Double Decline in Character": A Grounded Theory Analysis of Female Drug User Experiences in Iran.

Using a constructivist grounded theory design, this study explores the perception and experience of Iranian women living with drug use, identifying everyday conflicts and coping strategies that enable them to manage their situation. We conducted unstructured, in-depth interviews with abstinent drug users (11) and healthcare professionals (2) at three rehab centers in Tehran, Iran. In line with our grounded theory aspirations to explore the social meanings of women's drug use and addiction, we supplemented the interviews with a surrounding material consisting of articles published in the main national newspaper from 2015 to 2018 and a film documentary (10 parts, 3 h) entitled "Iranian Women of Addiction," () (2010-2011). Our analysis resulted in two main bundles of meaning-making that we claim are permeating the everyday lives of Iranian women with drug use: the double decline in character, and self-shielding. The study reveals the simultaneous presence of two stigmatized identities: drug use and sex work (). It shows that the stigma of sex work is closely connected to a drug-related identity, irrespective of whether women are actively involved in sex work or not. The findings illustrate how societal views are biased against drug user women in the domain of drug use, diminishing their presence and voice. The interviewees tried to manage by developing a peer network, adopting a protective role, and becoming intrinsically motivated to quit drug use. The study furthers our understanding of women's alarming and complex realities in traditional Islamic and familistic patriarchal structures.