Stigmatization of medications for opioid use disorder in 12-step support groups and participant responses
Stigmatization of medications for opioid use disorder in 12-step support groups and participant responses
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DOI：
10.1080/08897077.2021.1944957
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发表时间：
2021-06-30
期刊：
影响因子：
3.5
通讯作者：
Randall-Kosich, Olivia
中科院分区：
文献类型：
--
作者：
Andraka-Christou, Barbara;Totaram, Rachel;Randall-Kosich, Olivia
背景资料：12步组是美国管理阿片类药物使用障碍（OUD）的最常见方法，OUD药物治疗（MOUD）是预防阿片类药物滥用和复发的最有效工具。以前的研究已经确定了12步组MOUD的耻辱。目标：我们试图确定MOUD污名是如何在12步组中运作的，并确定对污名的反应。研究方法：我们从美国的三个注射器交换计划中招募了具有MOUD经验和12步小组经验的个人，使用雪球抽样。我们于二零一八年及二零一九年进行个别电话半结构式访谈。我们在Dedoose软件中对数据进行编码，并使用迭代分类进行主题分析。结果：我们招募了30名符合纳入标准的个体。确定了以下污名化方法：禁止使用MOUD的人在会议上发言;鼓励缩短MOUD治疗的持续时间;拒绝赞助使用MOUD的人;拒绝让使用MOUD的人要求恢复时间。对污名的反应包括：感到羞耻;感到愤怒;为不同的群体购物，离开该群体，或成立一个新的群体;不透露MOUD的使用或只告诉赞助商;代表MOUD发言;使用认知方法来避免污名内化。认知方法包括相信反MOUD的耻辱是违反12步原则的;根据一个人对MOUD好处的经验，无视不准确的陈述;接受所有人类群体都有一些无知的人。结论：医疗保健系统应帮助解决12步组患者所经历的MOUD耻辱，例如提供非12步替代组，并鼓励MOUD医疗保健提供者为患者可能面临的潜在耻辱做好准备。一些污名应对方案，如为不同的群体购物，在农村地区或对刚康复的参与者来说可能不可行。
Background: 12-step groups are the most common approach to managing opioid use disorder (OUD) in the U.S. Medications for OUD (MOUD) are the most effective tool for preventing opioid misuse and relapse. Previous research has identified stigma of MOUD in 12-step groups. Objectives: We sought to identify how MOUD stigma is operationalized in 12-step groups and to identify responses to stigma. Methods: We recruited individuals with both MOUD experience and 12-step group experience from three syringe exchange programs in the U.S. using snowball sampling. We conducted individual telephone semi-structured interviews during 2018 and 2019. We coded data in Dedoose software and conducted thematic analysis using iterative categorization. Results: We recruited 30 individuals meeting our inclusion criteria. The following stigma operationalization methods were identified: prohibiting people using MOUD from speaking at meetings; encouraging shortened duration of MOUD treatment; refusing to sponsor people using MOUD; and refusing to let people using MOUD claim recovery time. Responses to stigma included the following: feeling shame; feeling anger; shopping around for different groups, leaving the group, or forming a new group; not revealing MOUD utilization or only telling a sponsor; speaking out on behalf of MOUD; and using cognitive approaches to avoid stigma internalization. Cognitive approaches included believing that anti-MOUD stigma is contrary to 12-step principles; disregarding statements as inaccurate based on one's experience of MOUD benefits; and accepting that all groups of humans have some ignorant people. Conclusion: Healthcare systems should help address MOUD stigma experienced by patients in 12-step groups, such as by offering non-12-step alternative groups and encouraging MOUD healthcare providers to prepare patients for potential stigma they may face. Some stigma response options, like shopping around for different groups, may not be feasible in rural areas or for participants newer to recovery.