‘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.