‘Doctor, I’m not here to quit drugs!’ Hidden goals that undermine shared decision-making during access to services by young people who use substances

Abstract

Young people who use substances rarely access addiction services. When access does occur, the relationship between professionals and users is often described as difficult because of mutual distrust. This results in low motivation for treatment and limited involvement in decision-making. This study aims to investigate the perspectives of young who used substances to understand their motivations for access, both stated and unexpressed. Four focus groups were conducted with twenty people who used substances and had access to an addiction service during youth. The narratives were analyzed through thematic analysis and identity positioning. Participants reported three reasons for accessing the service: ‘Legal issues’, ‘Obtaining substances’ and ‘Reassuring the family’. Various personal positions emerged with respect to access, differing by content but united by a prevailing role passivity. The findings allow us to rethink some of the limitations inherent in established service practices. Some reflections ensue about the ways in which more authentic dialogue could be fostered, favoring the explication of those ‘truths’ that are generally not shared in early encounters and that pose a threat to the success of many therapeutic pathways.

Keywords:

• Addiction services
• involvement
• motivations
• youth
• shared decision-making
• distrust

Acknowledgements

Special acknowledgement goes to all the people who participated in this research by making their stories available for the purpose of helping clinicians and users of future addiction services. Finally, thanks are also due to doctoral student (Ludovica Aquili) for the ideas and spirit she transmitted to the working group in designing the present research.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of the School of Psychology of the Padova University (No. 4838). Informed consent was obtained from all patients for being included in the study.

Author contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Michele Rocelli and Francesco Sdrubolini. The first draft of the manuscript was written by Michele Rocelli, Elena Faccio e Francesco Sdrubolini and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. The first, the third and the fourth author contributed substantially to the conception and design of the work; the first and the second author drafted the paper and the fourth author revised it critically for important intellectual content. The second author collected the data. All authors participated in the analysis and interpretation of the data.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Transcripts of all focus groups can be received by contacting the authors.

Notes

1 We have referred to the criteria proposed by the WHO for the age division of the participants (WHO). WHO defines 'Adolescents' as individuals in the 10–19 years age group and 'Youth' as the 15–24 years age group. While 'Young People' covers the age range 10–24 years (World Health Statistics 2022).

Additional information

Funding

Partial financial support was received from University of Padova. Author Michele Rocelli and Elena Faccio received partial research support from the University of Padova.