"I wanted to close the chapter completely … and I feel like that [carrying naloxone] would keep it open a little bit": Refusal to carry naloxone among newly-abstinent opioid users and 12-step identity.
"I wanted to close the chapter completely … and I feel like that [carrying naloxone] would keep it open a little bit": Refusal to carry naloxone among newly-abstinent opioid users and 12-step identity.
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DOI：
10.1016/j.drugpo.2021.103200
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发表时间：
2021-08
影响因子：
4.4
通讯作者：
Wagner, K. D.
中科院分区：
文献类型：
--
作者：
Bowles, J. M.;Smith, L. R.;Mittal, M. L.;Harding, R. W.;Copulsky, E.;Hennessy, G.;Dunkle, A.;Davidson, P. J.;Wagner, K. D.
12步计划旨在通过戒酒解决与毒品相关的危害，例如阿片类药物过量。然而，戒除阿片类药物会降低耐受性，从而增加恢复后因服用阿片类药物过量而死亡的风险。最近的一项研究发现，戒毒的愿望抑制了参与带回家的纳洛酮计划的意愿，这与对与吸毒相关的减少伤害策略的看法有关。在本研究中，我们发现在拒绝携带纳洛酮的新戒酒参与者中也出现了类似的现象。这项研究对在整个南加州使用阿片类药物的人（包括最近戒断的人）中收集的更广泛的定性数据进行了分析。初步分析显示，新戒烟者在访谈结束时拒绝接受纳洛酮，因此我们开始对此进行探讨（N=44）。我们使用主题分析和作者定位来解释新兴现象，并应用社会认同理论来概念化研究结果。纳洛酮拒绝的机制包括其与新戒毒参与者试图退休的吸毒身份有关。由于怀疑再次目睹服药过量，携带纳洛酮也被认为是毫无意义的。此外，人们认为配备纳洛酮的想法与禁欲的身份并不相符，例如“我带着它[纳洛酮]让我觉得我要和那些[吸毒]这样做的人一起出去玩。”最近的戒毒增加了吸毒过量的可能性，其他新戒毒的同伴可能会做出反应，因为通过 12 步身份形成形成了纽带。然而，由于认为 12 步身份冲突，纳洛酮经常被该群体拒绝。虽然一些治疗空间分配纳洛酮，但 12 步身份相关的行为期望似乎与该策略相冲突。重新构建这些脱节对于扩大救生和纳洛酮社区安全网至关重要。
12-step programs aim to address drug-related harms, like opioid overdose, via abstinence. However, abstaining from opioids can diminish tolerance, which increases risk for overdose death upon resumption. A recent study found that desire to abstain from drugs inhibited willingness to participate in take-home naloxone programming, which was linked to perceptions of harm reduction strategies being tied to drug use. In the present study, we uncovered a similar phenomenon occurring among newly-abstinent participants who were refusing to carry naloxone. This study is an analysis of broader qualitative data collected throughout Southern California among persons who use opioids, including those recently abstinent. Preliminary analysis revealed that those newly abstinent refused to accept naloxone at the end of interviews, and so we began probing about this (N=44). We used thematic analysis and author positionality to explicate the emergent phenomenon ad applied social identity theory to conceptualize findings. Mechanisms underlying naloxone refusal included its tie to a drug-using identity that newly-abstinent participants were attempting to retire. Carrying naloxone was also viewed as pointless due to doubt of witnessing an overdose again. Furthermore, the thought of being equipped with naloxone was not believed to be congruent with an abstinent identity, e.g. “me carrying it [naloxone] is making me feel like I’m going to be hanging out with people that are doing it [using drugs].” Recent detoxification heightens vulnerability to overdose, which other newly-abstinent peers might be positioned to respond to as bonds are formed through 12-step identity formation. However, naloxone is often refused by this group due to perceived 12-step identity clash. While some treatment spaces distribute naloxone, 12-step identity associated behavioral expectations appear to conflict with this strategy. Reframing these disconnects is essential for expanding lifesaving and the naloxone community safety net.
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影响因子：
5.4
作者：
Bowles, J. M.;Smith, L. R.;Davidson, P. J.
通讯作者：
Davidson, P. J.
影响因子：
1.6
作者：
Fox, KJ
通讯作者：
Fox, KJ
影响因子：
2.8
作者：
Bennett, Alex S.;Bell, Alice;Davis, Corey
通讯作者：
Davis, Corey
影响因子：
3.2
作者：
Bowles, Jeanette M.;Lankenau, Stephen E.
通讯作者：
Lankenau, Stephen E.
影响因子：
2.9
作者：
Best, David;Beckwith, Melinda;Lubman, Dan I.
通讯作者：
Lubman, Dan I.