{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T20:26:15Z","timestamp":1774470375367,"version":"3.50.1"},"reference-count":60,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,2,10]],"date-time":"2021-02-10T00:00:00Z","timestamp":1612915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["5T32DA007233-35 P30 DA011041"],"award-info":[{"award-number":["5T32DA007233-35 P30 DA011041"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Sociol."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Often people assume that entry into drug treatment is a voluntary action for persons who use drugs (PWUD). This narrative informs the organizational and regulatory structure of most treatment programs and consequently affects patients\u2019 ability to exert agency over their own treatment. Yet, this view ignores the complex interplay between individual and structural factors in peoples\u2019 decision-making processes, particularly among people who use drugs who are stigmatized and criminalized. Treatment programs that assume voluntary entry may lack appropriate services for the populations of treatment seekers that they serve.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> This paper uses semi-structured interviews with 42 participants in Opioid Substitution Treatment (OST) (including patients, clinic doctors and staff, and advocates) informed by one of the author\u2019s own lived experience in OST, to examine patients\u2019 treatment decisions, and in particular, if and how, the structural context of drugs\u2019 illegality\/criminalization affected their willingness to pursue treatment. A Critical Discourse Analysis was used to identify key themes.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Interview data demonstrates that most people who use drugs enter treatment under constrained conditions related to drugs\u2019 illegality. Themes that emerged included: 1. A feeling of limited choices due to drugs\u2019 illegality; 2. Peer and family pressure; 3. Fear of losing children; and 4. Internalized stigma (i.e. feeling they are dirty or bad for using).<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> Narratives that frame PWUD\u2019s treatment decisions as volitional provide political cover to policies that criminalize PWUD by obscuring their effect on PWUD\u2019s treatment decisions. Treatment models, particularly those that serve highly criminalized populations, should be re-conceptualized outside of normative narratives of individual choice, and be broadened to understand how larger structures constrain choices. By looking at macro-level factors, including the interplay of criminalization and drug treatment, programs can begin to understand the complexity of PWUD motivations to enter drug treatment. Recognizing the role of the War on Drugs as a force of oppression for people who use drugs, and that their treatment decisions are made within that setting, may enable people in treatment, and providers, to develop more productive ways of interacting with one another. Additionally, this may lead to better retention in treatment programs.<\/jats:p>","DOI":"10.3389\/fsoc.2021.619677","type":"journal-article","created":{"date-parts":[[2021,2,10]],"date-time":"2021-02-10T16:51:04Z","timestamp":1612975864000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["\u201cI\u2019m Going to Stop Myself Before Someone Stops Me\u201d: Complicating Narratives of Volitional Substance Use Treatment"],"prefix":"10.3389","volume":"6","author":[{"given":"David","family":"Frank","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suzan M.","family":"Walters","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,2,10]]},"reference":[{"key":"B1","volume-title":"Trends in the Use of Methadone\/Buprenorphine, and extended-release naltrexone at substance abuse treatment facilities: 2003-1015","author":"Alderks","year":"2017"},{"key":"B2","volume-title":"The effectiveness of methadone maintenance treatment: patients, programs, services, and outcome","author":"Allison","year":"2014"},{"key":"B3","doi-asserted-by":"publisher","first-page":"179","DOI":"10.2165\/00002018-200022030-00002","article-title":"A risk-benefit analysis of methadone maintenance treatment","volume":"22","author":"Bell","year":"2000","journal-title":"Drug Saf."},{"key":"B4","volume-title":"Under the sign of hope: feminist methodology and narrative interpretation","author":"Bloom","year":"1998"},{"key":"B5","first-page":"122","volume-title":"From \u201cmagic bullets\u201d to medical maintenance. 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