External resilience in the context of drug use and socio-structural vulnerabilities: a qualitative exploration among women who use drugs and sell sex in Baltimore, Maryland.
External resilience in the context of drug use and socio-structural vulnerabilities: a qualitative exploration among women who use drugs and sell sex in Baltimore, Maryland.
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DOI：
10.1186/s12954-022-00678-6
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发表时间：
2022-08-24
影响因子：
4.4
通讯作者：
Sherman, Susan G.
中科院分区：
文献类型：
--
作者：
Tomko, Catherine;Nestadt, Danielle Friedman;Weicker, Noelle P.;Rudzinski, Katherine;Underwood, Carol;Kaufman, Michelle R.;Sherman, Susan G.
复原力是物质使用和心理健康研究中常用的概念。然而，它往往被狭隘地定义为只有其内部质量（例如，适应性、坚韧性）并忽视了其外部品质（例如，支持关系，导航一个人的环境）。此外，物质使用通常被视为与恢复力相对立，尽管像使用毒品和卖淫的妇女（WWUD-SS）这样的人群经历了巨大的困难。本研究旨在通过描述WWUD-SS之间的外部弹性并了解社会结构脆弱性（例如，贫穷、耻辱）和药物使用影响外部复原力。 WWUD-SS（N = 18）参加了一项正在进行的队列研究，对年龄、种族和招募地点进行了有目的的抽样，并参加了半结构化的深入访谈，旨在阐明外部弹性（即，社会支持和资源利用）。WWUD-SS被问及最近的困难经历，重点是他们如何使用或不使用社会支持或正式资源（例如，诊所、危机热线）。 参与者的中位年龄为37岁，50%被确定为黑人，50%报告目前正在注射毒品。与会者表示不愿意寻求支持，往往感到只能独自解决问题。参与者还区分了交易关系（帮助取决于获得回报）与真正的（非交易或利他）支持，包括使用和不使用毒品的家庭成员的作用。资源的利用是罕见的，通过使用药物的“自我药疗”是常见的，没有其他感知的帮助选择。外部复原力在WWUD-SS中似乎是有限的，并受到街头生活的社会和经济背景的影响。WWUD-SS的能力，行使外部弹性可能会削弱经历结构脆弱性和竞争的物质资源，创造交易关系，减少社会支持的感知价值。内化的污名，反映了更大的社会对吸毒、性工作和贫困的污名化观点，使WWUD-SS避开了外部来源的帮助。仅仅注重内部复原力，不能完整地反映吸毒人群的心理结构。改善与社区资源的联系可能是加强外部复原力的一个有针对性的方法，解决边缘化社区结构性脆弱性的政策也是如此。
Resilience is a commonly used construct in substance use and mental health research. Yet it is often narrowly defined by only its internal qualities (e.g., adaptability, hardiness) and overlooks its external qualities (e.g., supportive relationships, navigating one’s environment). Further, substance use is often viewed as antithetical to resilience despite populations like women who use drugs and sell sex (WWUD-SS) surviving significant hardships. This study aims to fill a gap in the literature by characterizing external resilience among WWUD-SS and understanding the ways that socio-structural vulnerabilities (e.g., poverty, stigma) and substance use shape external resilience. WWUD-SS (N = 18) enrolled in an ongoing cohort study were purposively sampled for age, race, and recruitment location and participated in semi-structured, in-depth interviews aimed to elucidate external resilience (i.e., social support and resource utilization). WWUD-SS were queried about recent difficult experiences with a focus on how they did or did not use social support or formal resources (e.g., clinic, crisis hotline) in response. Participants were a median age of 37 years, 50% identified as Black, and 50% reported currently injecting drugs. Participants described reluctance to ask for support and often felt resigned to address problems alone. Participants also distinguished between transactional relationships (help is contingent upon receiving something in return) versus genuine (non-transactional or altruistic) support, including the role of family members who do and do not use drugs. Resource utilization was rare, and “self-medication” through substance use was common absent other perceived options for help. External resilience appears limited among WWUD-SS and shaped by the social and economic contexts of a street-involved life. WWUD-SS’ ability to exercise external resilience may be undercut by experiencing structural vulnerabilities and competition for material resources that create transactional relationships and diminish the perceived value of social support. Internalized stigma, reflecting the larger society’s stigmatized views of drug use, sex work, and poverty, left WWUD-SS eschewing help from outside sources. Focus on internal resilience alone offers an incomplete picture of the construct in drug-using populations. Improving connections to community resources may be a targeted way to strengthen external resilience, as are policies addressing structural vulnerabilities for marginalized communities.
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DOI：
10.1097/01.alc.0000060879.61384.a4
发表时间：
2003-02-01
影响因子：
3.2
作者：
Baumeister, RF
通讯作者：
Baumeister, RF
影响因子：
17.7
作者：
Kendler, KS;Myers, J;Prescott, CA
通讯作者：
Prescott, CA
影响因子：
4.4
作者：
Dalgard, OS;Dowrick, C;Dunn, G
通讯作者：
Dunn, G
影响因子：
12.7
作者：
Deering KN;Amin A;Shoveller J;Nesbitt A;Garcia-Moreno C;Duff P;Argento E;Shannon K
通讯作者：
Shannon K
影响因子：
9.8
作者：
Farr, Sherry L.;Bitsko, Rebecca H.;Dietz, Patricia M.
通讯作者：
Dietz, Patricia M.