Exploring the Experiences of Individuals in Recovery from Substance Abuse: Through Photovoice

Exploring the Experiences of Individuals in Recovery from Substance Abuse: Through Photovoice

Ellamae S. Benoya, Albert R. Maasin, Rey D. Tejada, Angelita B. Alvarico, and Jose F. Cuevas Jr.
College of Criminology, Misamis University, Ozamiz City, Philippines.

DOI: https://dx.doi.org/10.47772/IJRISS.2023.7741

Received: 01 June 2023; Accepted: 10 June 2023; Published: 20 July 2023

ABSTRACT

Experiencing tragedy in life and facing a difficult situation is not easy to deal with. Like substance abuse which is known as harmful or excessive use of substances such as alcohol, tobacco, prescription medications, or illegal drugs. It involves the persistent and recurrent consumption of substances in a manner that negatively impacts an individual’s physical and mental health, social functioning, and overall well-being. It requires more courage and more positive thoughts to overcome the post-traumatic situation that might happen successfully. The study explored the journey of drug addicts living without substance abuse through a photovoice approach in the province of Misamis Occidental. There were eight (8) identified recovered drug addicts who were purposely chosen as part of the study. In gathering the needed data from the participants, the researcher employed a Photovoice method, and themes were determined from the participants’ responses. The researcher successfully gathered the needed data for the study with a photovoice approach with the identified participants. It is evident in the study that there were four (4) identified themes based on the responses of the participants such as (1) Discrimination [Stigma] after Discovery; (2) Psychological consequences; (3) Coping Styles and Mechanisms; and (4) Reflecting on Sense of Purpose and Accepting past life experiences. The participants experienced negative reactions from close relatives, discrimination, receiving a negative reputation, low self-evaluation, guilt and shame, and avoidance or isolation of self-situations, which are normal reactions for anyone who has experienced tragedy. All participants used “acceptance of identity,” “changing in social circle,” “clinging to spirituality,” and “sensing the purpose of ourselves” to overcome life’s challenges by becoming advocates/role models and better family members. Continuous monitoring of the victims should be considered to ensure that the victims are stable emotionally and psychologically. Further, intervention plans should be in place to maintain or continuously improve the coping mechanisms of drug addicts living without substance abuse.

Keywords: coping strategy, drugs, self-acceptance, self-evaluation, substance abuse, psychological consequences, purpose

INTRODUCTION

Despite its negative consequences, addiction is a chronic disease characterized by compulsive or difficult-to-control substance seeking and use (Kumar et al., 2019). Most people use drugs voluntarily at first, but persistent drug use can create brain alterations that put an addict’s self-control to the test and interfere with their ability to resist acute drug urges (WebMD & Dumain, 2022). Furthermore, these brain changes can endure for a long time, which is why drug addiction is referred to as a “relapsing” disease—people recovering from drug use disorders are more prone to relapse even after years of sobriety.

A small number of scholars developed a persistent scientific interest in drug addiction studies in the late nineteenth and early twentieth centuries (Skivington et al., 2021). Despite their innovative attempts to understand drug abuse in terms of general changes in biomedical science, the early twentieth-century medical literature is littered with now-discarded theories of substance dependence, such as autointoxication and antibody toxins, as well as failed treatment approaches (Renes, 2021). Substance use disorder, sometimes known as drug addiction, is a disease that affects the brain and behavior of a person, resulting in an inability to handle a legal or illegal substance or medicine. Drugs include substances such as alcohol, marijuana, and nicotine (Mayo Clinic, 2022).

Drug addiction can begin with the use of a recreational substance in social situations, and for some people, drug use leads to more frequent use (Kothapalli, 2019). Others, notably opioid addicts, become addicted to substances after consuming prescribed medications or receiving them from people with prescriptions. Physical dependency and tolerance are not the same as addiction (Wang, 2019). When a substance is abruptly terminated in cases of physical dependence, withdrawal symptoms develop (Lerner et al., 2019). Tolerance occurs when the dose of a substance becomes less effective with time (Cutler et al., 2021).

Most medications generate euphoria and flood the brain’s “reward circuit” with dopamine (Burmester, 2019). A well-functioning reward system encourages people to repeat life-sustaining actions like eating and spending time with family and friends (Morgan et al., 2019). Dopamine spikes in the reward circuit promote pleasurable but harmful behaviors such as drug use, causing people to repeat the action (Reid et al., 2022). The brain adjusts to drug usage by reducing the ability of reward circuit cells to respond to it. This reduces the person’s high in comparison to the high they had when first taking the medication, a phenomenon termed as tolerance (Kibaly et al., 2021). As a result, they may need more medication to achieve the same high. These brain changes typically result in the person experiencing less and less pleasure from formerly enjoyed activities such as food, sex, or social activities (Duresso, 2021). Even if they are aware of the negative repercussions, many drug users continue to use them, which is the nature of addiction (Pickard, 2021).

Drug dependence (or addiction) is defined by both DSM-IV and ICD-10 as drug-seeking behavior defined by compulsive use of one or more substances, either licit or illicit, for no obvious medical justification, resulting in significant impairment of health and social functioning (Dinis-Oliveira et al., 2020). Dependency is often followed by tolerance and withdrawal, and it is associated with a variety of social, legal, psychological, and medical concerns (Goldin et al., 2019). Patients with addiction seek out the drug and take it compulsively for nonmedical effects, as opposed to patients with chronic pain or persistent anxiety who seek treatment for a specific medical or psychiatric disorder over long periods of time (often resulting in tolerance and withdrawal) (O’Regan, 2020).

In 2021, there were approximately 41.5 thousand documented instances involving illegal narcotics in the Philippines, most of which were reported by the Regional Police Office of the National Capital Region (NCR). In the region, there were approximately 12.4 thousand reported cases of illegal drugs (Statista, 2021). Police authorities captured over PHP70 million worth of illegal drugs in the first two weeks of 2023, Philippine National Police (PNP) commander Gen. Rodolfo Azurin Jr. (Caliwan, 2023).

During that time, the police admitted to killing around 6,200 suspected drug users or dealers, most of whom were underprivileged Filipinos. Nonetheless, the PNP has been known to falsify statistics on extrajudicial killings associated with the campaign. In addition, according to research conducted by Human Rights Watch and other human rights organizations, police personnel often plant evidence such as illegal narcotics and firearms on the bodies of victims in order to justify their allegations that the victim fought back. During the Philippines’ Universal Periodic Review at the United Nations Human Rights Council earlier this month, the Filipino government presented false claims in defense of its human rights record. Nevertheless, all that has come from the new administration has been overblown rhetoric disguised as false claims (Robertson & Human Rights Watch, 2022).

Every 1.16 million Americans are jailed for drug-related offenses, according to Drug Related Crime Data. In addition, 80% of prison inmates are drug or alcohol addicts. Every year, 244K People are sentenced to prison for drug-related offenses, accounting for 26% of all arrests in the United States (National Center for Drug Abuse Statistics, 2023). Using, possessing, manufacturing, or distributing substances with the potential for abuse is illegal. Cocaine, heroin, marijuana, and amphetamines are examples of substances with abuse potential. Drugs are also linked to crime due to their effects on the user’s behavior and the generation of violence and other illicit activity associated with drug abuse (Goldin et al., 2019).

Each person’s body and brain are distinctive. Individuals also react differently to drugs. Therefore, no single factor can indicate whether a person would become addicted to drugs. Instead, a variety of factors influence the chance of addiction. The more risk factors a person possesses, the more likely drug use will progress to addiction (WebMD & Dumain, 2022). For instance: Biology. People’s inherited genes account for almost half of their risk of addiction. Gender, ethnicity, and other mental problems can all increase the likelihood of drug use and addiction (Brain & Behavior Research Foundation, 2019).

Environment. A person’s environment involves a wide range of factors, from family and friends to economic position and overall quality of life. Peer pressure, physical and sexual abuse, early drug exposure, stress, and parent involvement can all significantly impact a person’s chance of drug use and addiction (Nawi et al., 2021).

Development. Addiction risk is influenced by genetic and environmental variables as well as important developmental phases in a person’s life. For example, although drug use can begin at any age, the earlier it begins, the more likely it will escalate to addiction. In addition, teens may be more prone to dangerous activities, such as drug use, since parts of their brains that affect decision-making, judgment, and self-control are still growing (Renn, 2019).

Individuals use drugs for several reasons: they want to feel good, stop feeling terrible, or perform better at school or work, or they are intrigued because others are doing it, and they want to fit in (National Institute on Drug Abuse, 2022). The last reason is extremely common among teenagers. Drugs stimulate the areas of the brain that make an individual happy. Nevertheless, after a while of drug use, the feel-good portions of your brain become accustomed to it. Then you must take more of the drug to obtain the same high. Soon, your brain and body will require the drug to function normally. You feel nauseous, dreadful, worried, and irritable without the medicine. You no longer experience the positive sentiments you had when you first started using the substance. This is true whether you use illegal drugs or abuse pharmaceutical medicines. Misuse includes taking medicine in a way that is not prescribed by your doctor (for example, taking more or smashing pills to “shoot up” or snort), taking someone else’s prescription, or taking it solely to get “high” (Foundation for a Drug-Free World, 2022).

While individual perceptions vary, people often begin using drugs to escape or cover discomfort. The rush of pleasure from narcotics provides brief relief from suffering, which frequently arises from the following: Trauma or abuse, Psychiatric disease, low self-esteem, Poverty, Relationship issues, Loss of a loved one, Stress, Persistent pain, or medical issues. Unfortunately, whatever their motivation for starting, once addiction kicks in, the disease usually spirals out of their control (WebMD & Dumain, 2022).

Drugs prohibited for possession or use are illegal substances (Mazzeo et al., 2018). A substance that affects how the body functions and changes a person’s mental or physical state (Obidovna et al., 2022). They can affect how your brain works, feelings and behavior, understanding, and senses (Heilig et al., 2021). This makes them unpredictable and dangerous substances, especially for young children (Koehler, 2021). Illegal drugs are drugs people cannot own or use (Dietze et al., 2020). Drugs generally have a wide range of effects, including early drug exposure, stress, and parental guidance (Shaw et al., 2020). Illicit drugs also cause malfunction of the brain (Wang et al., 2022). These illegal drugs are different from legal drugs, which are not acceptable for use in medicine, unlike those that can be used for medical purposes (Thakkar et al., 2019).

The problem persists despite the existence of theories, investments, and diverse programs devoted to addiction recovery. It might signify different things to different people and have varied consequences in their lives. The bottom line is that there is still much to discover about addiction and recovery (Kibaly et al., 2021).

A person who has grown dependent on a certain chemical is known as a drug addict (Dunlop et al., 2020). An “ex-drug user” has successfully stopped taking drugs but is at risk of doing so. Drug addicts have a chemical or psychological dependence on a drug, particularly one that is illegal or was obtained improperly, like narcotics (Chiappini et al., 2020). Drugs alter how the brain functions, making addiction a disease of the brain. Even when they want to stop, drug addicts cannot do it. The phrase “ex-drug addict” or “recovered addict” tells the person that their time of substance abuse and addiction is over, and they may now begin to rebuild their lives from scratch (McDaniels, 2021). For many in recovery, this terminology reminds them that they will never be able to use drugs or alcohol normally again (Sultan, 2022). Addicts in recovery indicate daily labor to be done, which motivates them to work hard to maintain their recovery.

Drug addicts in the Philippines have increasingly surrendered to authorities as their last resort to get help (Ravanilla et al., 2022). This trend has been seen in recent years, with a significant increase in surrenders being made to authorities compared to previous years (Carpizo et al., 2019). This increase is likely due to the increase in rehabilitation services available as well as the increasing availability of rehab facilities in the Philippines. Drug addicts in the Philippines have a reputation as some of the hardest people in the world to deal with, which is well-earned (Murthy et al., 2020). There are few places in the world where surrendering to the police is a better option than staying on the streets, and the Philippines is one of them. In the Philippines, there has been an alarming number of drug addict surrenderees in the last year—enough that the government has decided to take notice (Lasco et al., 2022). According to the data provided to Caliwan 2021, the number of drug addicts who have surrendered today is 1.2 million. They have now completed serving their sentence as the law handed it down.

Illegal drug addiction may have a destructive impact on an addict’s life, both physically and mentally (Jainah, 2022). It is most likely because people who overuse illegal substances cannot experience the immediate gratification that their addiction provides. The lack of self-awareness can lead to disastrous consequences for the addict and those around them (Roop, 2022). It can also be self-actualizing, providing satisfaction and meaning in the addict’s life. Drug abuse can lead to a life situation in which addicts become hopeless and miserable (Gage et al., 2022)

Tens of millions of adults in the United States report that they have recovered from a substance abuse problem. “We do recover”: Further proof that tens of millions of adults in the United States have overcome a substance use disorder. According to this survey, 11.1% of adults in the United States, or 27.5 million people, have experienced a substance use problem at some point in their lives, while 74.8% – 8.3% of the entire US adult population – or 20.5 million adults are in recovery or have recovered from this problem. Furthermore, having a resolved mental health problem and receiving substance use treatment increased a person’s likelihood of reporting recovery from a recognized substance use problem in their lifetime, whereas having an unresolved mental health problem, identifying as non-Hispanic black, and using a variety of substances in the previous year decreased this likelihood (Recovery Research Institute, 2020). An intriguing finding from this study was that those who reported being in recovery from a drug use issue were twice as likely as those who were not to have undergone SUD treatment in the previous year and throughout their lifetime. Nevertheless, only 40% of those who had recovered from addiction had ever undergone SUD therapy (Goldberg, 2020).

These findings indicate that treatment may assist a person in resolving an alcohol or drug problem. However, most people will recover without using formal treatment, either through alternative recovery pathways (e.g., mutual-help organizations) or legal services (i.e., natural recovery). In addition, individuals in recovery were more likely than those not to disclose lifetime injectable drug usage (United Nations: Office on Drugs and Crime, 2018). Substance use disorders are likely on a spectrum, ranging from severe and chronic SUD with numerous substance-related repercussions to more discrete instances of binge drinking that may have resulted in a family or legal repercussion. Individuals with more severe substance use disorders may be more likely to suffer more severe and cumulative repercussions, increasing their likelihood of seeking SUD treatment and thereby boosting their odds of overcoming their problem. This also introduces them to the concept of abstinence and the importance of creating a social recovery identity (Cintron, 2022). This may explain why those in treatment are less likely than those who are not in recovery to disclose past-year substance use.

Although individuals in recovery were less likely to report past-year use of various substances, 32% reported past-month binge drinking, and 31% reported past-year marijuana use – the same as 40% of the National Recovery Study sample who classified as “in recovery” used one or more substances. (Recovery Research Institute, 2018). This contradicts the historical and cultural grassroots definition of “recovery,” which often entails abstinence from all substances. Hence, encouraging the broadest possible swath of individuals with substance use disorders to reduce or quit substance use is likely to necessitate a framework that includes, but also expands on, this shared cultural knowledge. Additionally, research is required to understand better how individuals perceive drug use disorders, treatment-seeking, and recovery identity, particularly across socio-demographic groups, to customize services and linkages to these services to specific populations (Nahar et al., 2020).

This study aims to raise awareness in the community about drug addicts who have surrendered themselves through self-actualization, implying the negative factors or effects on human morality and sanity (Parra et al., 2019). This was a qualitative study, and the data was collected through interviews and observation. The community needs to be mindful of this study in order to have a better understanding of addiction and its effects. Drug addiction is a serious issue that has been around for many years (Johnston et al., 2020). There are many people who are addicted to drugs, and this includes people who use drugs recreationally and people who use drugs to treat other medical conditions. So, community members should be aware of the negative consequences of using illegal drugs and avoid them at all costs. Doing so can lead to a serious legal outcome and even imprisonment (Gibbons et al., 2020). It could lead them to break the law and be charged with a felony, be placed on probation, or be subjected to a prison sentence (Parra et al., 2019).

MATERIALS AND METHODS

This study used a transcendental phenomenology (TPh) approach with photovoice, in which participants used photography and stories about their photos to identify and represent issues that were important to them, allowing researchers to gain a better understanding of the issue under study (Nowell, Berkowitz, Deacon, & Foster-Fishman, 2006; Palibroda, Krieg, Murdock, & Havelock, 2009; Wang, 2006). Husserl’s transcendental phenomenology (TPh) approach is a philosophical approach to qualitative research methodology that seeks to explain human experience (Alvesson & Sköldberg, 2017; Moustakas, 1994). It focuses on people’s interpretations of an idea or occurrence based on their lived experiences. It explains the core, or nature, of experiencing the events under investigation. Transcendental phenology with photovoice will be employed in this study to provide a voice for those with limited societal influence to be heard. It will enable participants to document community needs or strengths and foster critical conversation about the images among participants. The mentioned research design will be employed as a suitable strategy to address the study participants’ experiences.

The study was conducted in Ozamiz, one of the provinces of Misamis Occidental. Ozamiz City is close to the provinces of Zamboanga del Sur and Zamboanga del Norte, while Lanao del Norte is across the bay and 52 kilometers (32 miles) from Maria Cristina Falls, Mindanao’s main source of hydroelectric power. It has good agricultural resources, but due to its strategic location, it has become a business, health, transportation, and education center. The city has an excellent harbor location because its local port serves as the primary outlet for mineral deposits and agricultural and forest products from Misamis Occidental, Zamboanga del Norte, Zamboanga del Sur, Maguindanao, and parts of Lanao del Norte and Lanao del Sur. It is also a third-class component city in Misamis Occidental province in the Philippines. According to the 2020 census, it has a population of 140,334 people.

The study needs eight (8) ex-drug addicts who surrendered in the government’s war against illegal drugs. The purposive sampling technique was used to identify the participants of the study. The participants were chosen based on the following criteria: (1) Previous drug addict/dependent, (2) Legal age (3) Willingness to participate.

The researcher will use photos taken by participants and an interview guide to gather information from these important individuals. Participants were asked a series of questions about their use of illegal drugs during their addiction, and the interview will be recorded using recording devices to record the participants’ answers or responses.

Before the actual interview, the researcher secured permission from the Dean of the College of Criminology to permit the researcher to conduct the study, and then submit a request letter to the barangay where the participant resides. The researcher identified the possible participants of the study. Then the researcher informed the participants of the purpose of the study and the manner in which the interview will be done. Then the researcher secured an informed consent from the participants by letting them sign in the Informed Consent Form after they have agreed to participate in the study to signify their willingness to proceed with the interview.

With the participant’s permission, the researcher used a voice recorder and take down notes during the interview to guarantee the accuracy of the responses of the informants. They were assured that their responses will be treated with utmost confidentiality. Interviews were done to draw out information about the experiences of the participants be it negative or positive.  Structured interviews using open ended questions with the participants were conducted for a systematic process of communication between the participants and the researcher to ensure that all key points were covered. The researcher used in-depth interviews because confidential information is needed. In this study, the results relied heavily on the data acquired from the women and the conducted interviews. The face to face and in-depth interview was conducted, the duration of the interview was about 45 minutes to 1 hour. Minimum health standards related to COVID-19 were observed during the conduct of the interview. The researcher adhered to the guidelines set by the Republic Act No. 10173, known as the “Data Privacy Act of 2012”.

Given the importance of ethics in conducting research and the challenges around conducting research, universities go to great lengths to protect the dignity and safety of research participants. In observance of research ethics, the researcher during the conduct of data or information needed, the approved transmittal letter and the Consent Form are given to the participants and affixed their signatures as a sign of willful consent to be interviewed for the study. The participants were informed regarding the purpose of the conduct of the study. It was emphasized as well that their identity will not be divulged, and that they will remain anonymous. The interview was recorded, after the transcription of the answers; it was deleted right away.

The following ethical guidelines were put into place for the research period. First, the participants appeared to engage freely in the conversations. This indicates that the interview process allowed the participants to share their stories in a safe environment and without being judged. Second, the dignity and wellbeing of the participants were protected at all times. Third, the researcher asked the assistance of a registered social worker during the conduct of the interview to assist her in addressing trauma issues of the participants during the data gathering. And lastly, the research data remained confidential throughout the study. Furthermore, face-to-face and in-depth interviews were conducted in a private area, preferably on the informant’s personal choice to ensure the informant’s privacy and comfort. Monetary compensation was provided to participants whose line of work was affected during the interview. The Misamis University Research Ethics board approved the conduct of the study before the actual data gathering took place. Research ethics related forms had been complied with by the researcher before the actual conduct of the data collection.

The data analysis process helps the researcher uncover, locate, and categorize emerging patterns and themes to help the reader or target audience understand the participants (Maxwell, 2013; Patton, 2002). The plan uses a thematic content analysis to examine the differences and similarities uncovered in the data (Rose, 2012). This type of research would also allow for the coding of transcripts assembled through interviews and personal narratives. The coding process depends on the kind of questions to be answered and the needs of the individuals or groups who used the information (Saldana, 2012).

In this study, the data were analyzed from the transcription from the interview and the photograph presented by the participants. The following are the six phases of photovoice method: 1) Initial focus group; 2) taking the photographs; 3) Follow-up semi-structured interview; 4) Second focus group; 5) Summarizing the participants’ key photographs and accompanying captions; and 6) Disseminate the findings.

The initial focus group. Participants are introduced to the method, photography and ethical training. Then they will receive digital cameras and be oriented to the phenomenon to be explored. They will be asked to photograph aspects related to the study. To limit the researcher’s influence over subject matter for participants’ photographs the photography task is kept very general. Participants are left free to take any objects/person/place that is related to the study.

Taking the photographs. Participants will take photographs over a period of week.

Follow-up semi-structured interview. Semi-structured interviews are conducted. During the interview, photographs are displayed on a laptop or any similar devices and shown to each participant who is requested to select the most meaningful to discuss in a subsequent focus group. Each participant discusses the meaning of the photographs using the SHOWeD technique consisting of different questions that relate to the photograph; what do you See here? What’s really Happening here? How does this relate to Our lives? Why does this problem, concern, or strength Exist? What can we Do about it?

Second focus group. Participants discuss their photographs during a second focus group. At the end of the focus group, participants are asked how they will experience the photovoice method and what could be improved in the future studies.

Summarizing the participants’ key photographs and accompanying captions. A brief summary is written based on the participants’ original description of the photograph (from interview and focus group transcripts) to accompany each photograph. To ensure that the stories reflected the intentions of the participants, the researcher show all photographs and associated summaries to each participant, who will review and edit the final summary and title prior to being printed or displayed in the photo exhibition (Foster-Fishman, Law, Litchy, & Aoun, 2010). The researcher asked the participants to review and agree on (i) the choice of the photographs and accompanying captions to display in the; and (ii) the different sub-heading used to group photographs and accompanying captions in the photo exhibition.

Disseminate the findings. A photo exhibition will be conducted. The aim of the exhibition is to provide a forum to disseminate study findings, and to encourage critical dialogue among invited participants, stakeholders, researchers and members of the community, and influence policy and social change.

The data analysis conducted on text and photographs in parallel, with the iterative cross-referencing emerging themes. Content analysis of the photographs explores similarities and differences between objects or people portrayed by the participants and aims to compliment the thematic analysis. The thematic analysis of the transcripts identifies themes and sub-themes from data. The transcript text was reviewed and evaluated through the photograph presented by the participants. To analyse the photographs, the researcher classified, categorized, and examined each photograph until saturation has arrived. After reviewing the transcription and photographs, the researcher began to name identified themes. Then, the photograph was labelled according to the themes that were connected.

To check and validate the developed themes, the researcher sought the assistance of the data analyst. The NVivo software was used to identify the codes that emerged from the statements for the participants. The statement was a tool for a qualitative analysis to guide the development of themes. With the assistance of the phenomenological analyst, the themes were identified.

RESULTS AND DISCUSSIONS

The participants of the study shared their personal experiences as ex-drug addicts or substance abusers with their chosen photographs and descriptions. The eight participants of this study were identified as drug surrenderees. This study generated the following themes: (1) Stigma after Discovery; (2) Psychological consequences; (3) Ways of Coping; and (4) Reflecting on Sense of Purpose and Accepting past life experiences.

Stigma after Discovery

The first theme describes how individuals were treated after it was found that they were drug users. It describes the participants’ external experiences with stigma during and after their drug use, focusing on negative reactions from relatives, workplace discrimination, and establishing a negative reputation. This was emphasized by the statement given by participants of the study.

“When I saw the boundary in between the two different structures of houses, symbolizing social exclusion, I recalled how they avoid me from my close relations (i.e., family and friends). How harsh treatment from the family members with negative and antagonistic treatments. I felt scared and worried when my family threatened to take my child and leave me after discovering I was a drug user. I see myself as a red individual who is struggling to connect and trying to communicate with my family and friends (blue) who I want to support me in my recovery.” (P8)

“At first, I denied it, “I’m not the one who uses drugs, I would never, It was my friend!” and my father would say, “If I confirm that you are the one who uses it, I will kill you!” And leave the house!” and things like that.  In the picture, I was like the red one who is alone and doesn’t have any friends who I can lean on. The first time I was caught, my parents beat me up and I was kicked out of the house. I was only 27 that time and I had nowhere to go.” (P3)

“I was experiencing negative reactions of my family and friends, the discriminations I got when I was recovering to the substance abuse, and I got statements of negatives “What a drug addict”, “Leave him alone, he’s not worth it” “You are not on our level, you can’t be with us, you are an addict, we’re good people” Something like that. (P5)

Figure 1. Social Exclusion: Negative Treatments and Discrimination

As shown in Figure 1, participant 8 saw himself in the situation experienced by the person living in that small house carries social exclusion because of social status. Participant 8 has trouble facing reality, harsh treatment, and threatened situations from family and friends. His life is full of scared and worried now after he recovered. He is struggling to fight to connect and communicate with his family and friends he abandoned.

While participant 3 shared her experience in life after the substance abuse happened. She was abandoned by the one she wanted to lean on. Participant 5 concludes all the external experiences with stigma during and after their drug use on how his family had negative reactions and reputation, treatments, and discrimination to the substance abuse when he was recovering.

Even though substance use disorders are chronic and treatable medical diseases, research demonstrates that persons with these disorders suffer discrimination and stigma (a collection of negative attitudes and beliefs) that can severely influence their health and well-being in various ways. This stigma extends to drug users who do not have a substance use disorder. (Verma & Vijayakrishnan, 2018)

On the other hand, participant 1 chose to explain gaining a negative reputation, as shown in Figure 2.

“They won’t talk to you; they will gossip about you. I hear others would say, “whatever happens, you are always be an drug addict; you do drugs, you can’t get rid of that substance abuse” or “Even you recover from that drugs, you will always come back to that and you can’t try and change the world by your advocacies” I hear this especially when I want to join outreach programs. How they belittle me and push me down to my situation.” (P1)

“Whenever I buy something in stores [neighbour] they will still ask me “do you still use it?” Ever since, the stigma of my circumstances has not been removed from my recovery.” (P2)

Figure 2. Gaining Negative Reputation

As shown in Figure 2, participant 1 saw herself in a situation where they gained a negative reputation after being discriminated against. The gossip spread widely, and how their neighbours and acquaintances whom they did not know personally began judging their drug substance abuse.

According to the researchers, narratives of drug addiction in the media are generally of street drug users in poor economic circumstances rather than those in the suburbs who were addicted to prescription opioids after chronic pain. Drug abusers who fail treatment are viewed as “falling off the wagon” rather than someone dealing with a chronic health condition that is difficult to control, they claim. They claim that encouraging stories of people who have overcome addiction and lived drug-free for many years are missing (Kin et al., 2021).

This implies that the discovery of substance abuse can often carry a stigma that can have significant social and psychological impacts on individuals. Stigma refers to the negative attitudes, beliefs, and stereotypes associated with a particular condition or behavior, in this case, substance abuse. When substance abuse is discovered, individuals may face judgment, criticism, and alienation from others. This stigma can come from various sources, including family, friends, colleagues, and even society as a whole. Some common stigmatizing attitudes and beliefs related to substance abuse include viewing it as a moral failing, lack of willpower, or a sign of weakness. The stigma associated with substance abuse can have detrimental effects on individuals who are struggling with addiction. It may prevent them from seeking help and support, as they may fear judgment and rejection from others. This can lead to increased isolation, worsening of substance abuse issues, and deterioration of mental health.

Psychological Consequences

The second theme describes the participants’ cognitive, emotional, and behavioral reactions to discrimination and shows the immediate negative consequences of confronting outward stigma. This was emphasized by the statement given by participants of the study.

“I chose this photo on the highway that implies “Wrong Way” how I perceived my self-evaluation and the feelings of guilt and shame. I felt ashamed towards my family and people I met. I’m in the wrong path, way but I still walk through this and this is the consequences I got from this” (P4)

“I always read that people can help you get through this substance abuse, but I realize that this is my consequence from the things I have done. And the only person who will help you with this is yourself.” (P7)

Figure 3. You are in the Wrong Path [way]

Based on the photo in Figure 3, Participant 4 said that from that stigma and discrimination (e.g., excluded and perceived as an inconvenience), he was immersed in the negative labels he got and the prejudices that he encountered.

While participant 7 permeated the feelings of guilt and shame. He coexisted with low self-evaluations and began thinking he was different. Some persons can have a ‘psychosis’ or a ‘psychotic episode’ due to drugs. This means a person has hallucinations (seeing, hearing, and feeling things that are not there), delusions (an unwavering belief in something false), confusing and disturbed thoughts, and a lack of self-awareness. Genes, drug action, peer pressure, emotional anguish, anxiety, depression, and environmental stress can all play a role. Many people who acquire a substance use disorder also have depression, attention deficit disorder, post-traumatic stress disorder, or another mental illness. (Recovery Research Institute, 2020)

The study’s results implied that the drug addicts living without substance abuse experienced mostly the same situation as others, such as low self-evaluation (inconvenience and exclusion) and feelings of guilt and shame to the external experience of stigma.

On the other hand, participant 6 chose to explain the avoidance and isolation himself has shown in Figure 4.

“I was the one who pulled and avoided people, I became distant. Even though I could not hear what others are saying, I always think that they are saying bad things to me- Just like that.” (P6)

Figure 4. The Avoidance or Isolation of External Experience

Behavior that involves avoiding or isolating oneself. Self-isolation and avoiding individuals who ostracized them was a frequent response among those subjected to the psychological effects of the exterior experience of stigma and its psychological influence. For example, one of the participants discussed how, due to his fear of being bullied, he did not attend their group dancing sessions as frequently as he would have liked to have done in the past. He expressed his regret for this. Likewise, participant 6 revealed that they did not attend social gatherings or reunions and were frequently absent from work.

Loneliness is more prevalent in drug users than non-users, who may feel alienated from the community. According to the interviews, drug usage resulted in violent behavior, relationship problems, and isolation. Furthermore, the resulting social isolation and probably limited access to detoxification facilities added to the psychological discomfort (Zaami et al., 2020)

The study results imply that the drug addicts living without substance abuse experienced the same situation as others, such as the participants’ cognitive, emotional, and behavioral reactions to the discrimination they encountered. In addition, they showed the immediate negative consequences of confronting outward stigma. Substance abuse can have profound psychological consequences for individuals, which can further compound the challenges they face. Substance abuse can lead to addiction, which is characterized by compulsive drug-seeking and drug use despite negative consequences. Addiction is a complex brain disorder that alters the brain’s structure and function, leading to intense cravings, loss of control, and a preoccupation with obtaining and using the substance. This can result in significant psychological distress and an impaired ability to manage one’s life effectively. Substance abuse and mental health disorders often coexist. Many individuals with substance abuse issues also struggle with mental health conditions such as depression, anxiety disorders, bipolar disorder, or post-traumatic stress disorder (PTSD). Substance abuse can either contribute to the development of these disorders or exacerbate pre-existing mental health conditions, leading to a dual diagnosis or co-occurring disorders. Substance abuse can impair cognitive function, including memory, attention, and problem-solving abilities. Prolonged drug or alcohol use can lead to structural and functional changes in the brain, affecting cognitive processes. Impaired decision-making is also common, with individuals prioritizing substance use over other responsibilities and engaging in risky behaviors.

Substance abuse can disrupt the brain’s natural mechanisms for regulating emotions, leading to emotional instability and difficulty managing stress. Individuals may experience intense mood swings, irritability, anger, and heightened anxiety. These emotional disturbances can strain relationships, contribute to isolation, and further fuel substance abuse as a coping mechanism. Substance abuse often leads to feelings of shame, guilt, and low self-esteem. The negative consequences associated with addiction, such as strained relationships, job loss, and legal issues, can take a toll on an individual’s self-perception. They may experience a loss of self-worth and struggle with feelings of hopelessness, contributing to a cycle of self-destructive behaviors. Substance abuse can be intertwined with experiences of trauma. Individuals may turn to substances as a way to cope with traumatic events or to numb emotional pain. Substance abuse can also increase the risk of experiencing trauma, such as violence or accidents, due to impaired judgment and risky behaviors. Trauma and post-traumatic stress disorder (PTSD) can further exacerbate substance abuse and complicate the recovery process.

Addressing the psychological consequences of substance abuse requires a comprehensive approach that includes integrated treatment for both substance abuse and co-occurring mental health disorders. Therapeutic interventions, support groups, counseling, and medication-assisted treatment can help individuals manage their psychological symptoms, develop healthier coping strategies, and work towards long-term recovery.

Ways of Coping

The third theme provides an overview of the coping mechanisms adopted by individuals to deal with their stigma experiences. It focuses on three coping strategies individuals adopt during and after drug use. This theme also includes participants’ reflections on the persons and coping strategies that were most helpful to them.

“What makes a mark on the situations and circumstances of what I was before, what am I now? To be better. I accept myself in these recoveries I have got and I will always continue this path to be better for myself and my family. It’s my choice to make this through. So with the discriminations I always heard, it is okay, it is really understandable, we are plagues. People will always have what they want to say on everything and we’re not here to fight them or what, but let’s keep it silence and do what we’ve got to be better” (P2)

“What makes me continue this path [recovery] is that I have my family and friends who will accept and help me to get through this. I don’t care what people may say but I am recovering from the substance abuse I did from the past.” (P4)

Figure 5. Acceptance and Change the Social Circle

Based on the photo in Figure 5, participants 2 and 4 said accepting one’s identity is what she/he wants to do. After their efforts to distance themselves from the label of drug addicts, the participants gradually realized that drug use is a part of their history and, hence, their identity. Some people experienced difficulty accepting this aspect of themselves. They saw stigma as a source of motivation in their quest for a better and drug-free existence.

Moreover, in adjusting their social circle, participants also modified whom they mingled with, avoiding those they thought would call them out for being involved with their drug use and those they thought would re-introduce them to drugs. In addition, individuals perceived stigma and bias to be typical and expected. For example, one participant said drug addicts must be “monitored and reprimanded.” Another, on the other hand, expressed sympathy for how such stigma exists.

This implies that coping with substance abuse implications can be challenging, but there are strategies and approaches that can help individuals navigate these difficulties and work towards recovery. It is crucial to reach out to healthcare professionals, therapists, or addiction counselors who specialize in substance abuse treatment. They can provide guidance, support, and evidence-based interventions to address the physical, psychological, and emotional aspects of addiction. Surround yourself with a supportive network of family members, friends, or support groups who understand and empathize with your struggles. Participating in support groups such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) can provide a sense of community, encouragement, and accountability. Explore and adopt healthy coping mechanisms to replace substance abuse. Engage in activities that promote physical and mental well-being, such as regular exercise, mindfulness or meditation practices, hobbies, and creative outlets. Finding alternative ways to manage stress, anxiety, and negative emotions can be essential in the recovery process.

Creating a structured daily routine can help bring stability and purpose to your life. Set specific goals, prioritize self-care activities, and maintain a consistent sleep schedule. A structured routine provides a sense of stability and reduces the likelihood of falling back into old patterns of substance abuse. Prioritize self-care activities that promote overall well-being. This may include getting enough sleep, eating a balanced diet, engaging in regular physical activity, and engaging in activities that bring joy and fulfillment. Taking care of your physical and emotional needs can support your recovery journey. Identify triggers that can lead to substance abuse cravings or relapse. Triggers can be people, places, emotions, or specific situations. Develop strategies to manage these triggers, such as avoiding certain environments or establishing healthier coping mechanisms to deal with stress or negative emotions. Understanding the nature of addiction and its implications can help you gain insight into your own experiences and challenges. Education empowers individuals to make informed decisions, challenge stigmatizing beliefs, and develop effective strategies for recovery. Be kind to yourself and practice self-compassion throughout your recovery journey. Acknowledge that recovery is a process and setbacks may occur. Learn from past mistakes, forgive yourself, and focus on moving forward with a positive mindset. Recovery is a lifelong journey, and ongoing treatment and aftercare are crucial for long-term success. Attend counseling sessions, support group meetings, and follow through with any recommended treatment plans or medications. Continued support can help you maintain sobriety and navigate challenges that may arise.

Reflecting on a Sense of Purpose and Accepting Past Life experiences.

Participant 4 chose to explain the coping sources of a sense of spirituality and to cling and immersing to activities shown in Figure 6.

“Now, I have my devotion groups wherein I become a role model and advocate what drug substance abuse was a negative experience for me in the past years, how I recover from the temptations, guilt, shame, and how I want to become better to my family members. I was happy to be back in my house and also, they were happy that I am recovering. I share my testimonies and I sympathize to make change. I always say to them that they need to trust God whatever happens, cling on to God, and be blessed to what is happening because God will always provide and guide you through. I am happy to see the changes in my life.” (P6)

“I am reflecting on my sense of purpose and accepting past life experiences is a transformative journey that allows me to find meaning, embrace personal growth, and build a foundation for a fulfilling future. By examining my values, passions, and strengths, I can discover a sense of purpose that guides our actions and brings deeper meaning to my life. Simultaneously, accepting my past life experiences, both triumphs and tribulations, enables me to cultivate self-compassion, learn valuable lessons, and create a foundation of resilience. Together with my family and my faith to God the process of reflection and acceptance empowers me to embrace my unique journey, embrace personal growth, and embrace the possibilities of a brighter tomorrow.”(P8)

“Reflecting on my sense of purpose and accepting past life experiences allows me to cultivate a deeper understanding of myself, especially my weakness during dark times. I am referring to those times during illegal substance [drugs} abuse and embark on a journey of personal growth and healing through prayers and cleaning myself spiritually. By embracing my past, with the help of prayers circle of devoted friends and always reading the bible, singing Christian songs, I embraced both the triumphs and the challenges, because of those bad experiences of I can gain valuable insights that shape my present and future, leading to a greater sense of clarity, resilience, and fulfillment.” (P3)

Figure 6. Clinging to Spirituality

They held onto spirituality when individuals’ sense of spirituality was an important form of coping. They would cling to prayer and God’s word, especially when they felt sad and useless. Participants reported that being introduced to church support groups, immersing themselves in prayer, and performing church services restored their fulfillment and pleasure.

The fuel theme focuses on the participants’ sense of purpose as more involved members of their families and society. It also details how participants indicated their desire to become advocates and share their experiences with others. Finally, the theme depicts how they transitioned and changed their ways, focusing on their current selves as former drug addicts. After reflecting on and accepting their prior life experiences, participants’ commitment to living drug-free lifestyles emerged as an emergent theme.

Moreover, becoming role models and advocates, several participants became drug recovery and help-seeking champions. They believed they could relate with and be compassionate to individuals now dealing with their drug usage. They felt empowered to tell their tales as persons who were able to recover from motivating those who were also recovering.

The findings suggested that the recovered drug users were looking on the bright side of things now that they had moved on from the adversity they had previously experienced. (National Institute on Drug Abuse, 2022) Filipinos can progressively triumph over challenging circumstances as they adopt a more optimistic perspective on life. This is good evidence of this. These are the characteristics of a person who is capable of recovering and moving on with their life, despite the difficulties that they have experienced in the past.

This results implies that reflecting on our sense of purpose and accepting past life experiences carries several important implications for personal growth and well-being. This may helps us develop a deeper understanding of ourselves, our values, and our aspirations. This self-awareness allows us to align our actions and choices with our authentic selves, leading to a greater sense of fulfillment and personal satisfaction. Contemplating our sense of purpose helps us find meaning in our lives. By understanding what truly matters to us and what drives us, we can establish clear goals and priorities. This clarity provides a sense of direction and enables us to make choices that are in line with our values, leading to a more purposeful and fulfilling life. Accepting past life experiences, both positive and negative, is essential for healing and personal growth. By acknowledging and processing past traumas, mistakes, or regrets, we can learn valuable lessons and gain wisdom. This process of acceptance allows us to move forward with a greater sense of emotional well-being, resilience, and compassion for ourselves and others.

Reflecting on our past experiences fosters empathy and understanding towards others who may have gone through similar challenges. It deepens our capacity to connect with and support others who are on their own journeys of self-discovery and healing. Through sharing our stories and experiences, we can create meaningful connections and contribute to a more compassionate and supportive community. Engaging in self-reflection and accepting past experiences enables us to redefine our understanding of success and fulfillment. It helps us move beyond external measures of success and societal expectations, allowing us to cultivate a more authentic and holistic view of what it means to lead a fulfilling life. This shift in perspective allows us to focus on personal growth, well-being, and the pursuit of goals that align with our true selves.

Ultimately, reflecting on our sense of purpose and accepting past life experiences empowers us to embrace our journey with greater self-awareness, resilience, and compassion. It opens the door to personal transformation, meaningful connections, and a life that is aligned with our values and aspirations.

CONCLUSIONS

This study aimed to investigate how formerly dependent individuals on drugs in the Philippines perceive their status in society. The findings reveal the participants’ experiences of discrimination after it was discovered that they had been using drugs and other related consequences. The findings also reveal how the participants coped and lived with the stigma and how they have grown to move beyond it to find a sense of purpose. According to the study, encountering stigma and overcoming it lies in the interplay of social, structural, and personal processes underpinned by a desire to better oneself.

RECOMMENDATIONS

Based on the findings and conclusions of the study, the researchers’ would like to recommend that the:

To the participants. It is important to consult with professionals and tailor the strategies to your specific circumstances. Each individual’s journey to recovery is unique, and finding the right combination of support, treatment, and coping strategies is key. They may identify individuals in your life who can offer support, understanding, and accountability, communicate your needs and goals to them, and lean on them during challenging times. Having a reliable support system can make a significant difference in your recovery process. They may stay informed about resources available in your community, such as treatment centers, support groups, and helplines. Reach out to these resources whenever you need guidance, assistance, or additional support. Recovery is a process that takes time, and setbacks may occur along the way. Be patient with yourself and maintain a persistent mindset. Focus on the progress you have made and the steps you can take to continue moving forward.

Local Government Unit. May implement comprehensive awareness campaigns to educate the community about the risks and consequences of substance abuse. This can include information on the effects of different substances, signs of addiction, available treatment options, and resources for support. Target specific groups such as youth, parents, and community leaders to ensure widespread knowledge. They may develop and implement evidence-based prevention programs in schools, community centers, and other relevant settings. These programs can focus on promoting positive coping skills, resilience, and healthy lifestyles. Engage with schools, local organizations, and healthcare providers to establish a coordinated approach to prevention efforts. They may Increase access to affordable and quality treatment and rehabilitation services for individuals struggling with substance abuse. This can involve partnering with healthcare providers, establishing treatment centers, and allocating resources for counseling, detoxification, and long-term recovery support. Ensure that services are inclusive, culturally sensitive, and tailored to the specific needs of the community. They may enhance collaboration between the LGU, healthcare providers, law enforcement agencies, educational institutions, and community organizations. Establish interagency partnerships to address substance abuse comprehensively. Share resources, data, and best practices to ensure a coordinated and effective response to substance abuse issues within the community. May develop programs and initiatives to support individuals in their transition from treatment to reintegration into society. This can include vocational training, job placement services, and initiatives to reduce stigma and discrimination against individuals in recovery. Partner with local businesses and organizations to create employment opportunities and supportive environments. May establish a system for collecting and analyzing local data on substance abuse, including trends, demographics, and the effectiveness of interventions. This data can inform evidence-based decision-making, resource allocation, and the evaluation of programs and policies. Engage in advocacy efforts at higher levels of government to promote policy changes that support substance abuse prevention, treatment, and recovery. This can involve advocating for increased funding, improved access to healthcare services, and the development of comprehensive addiction policies. And may regularly evaluate and monitor the effectiveness of substance abuse programs and interventions implemented by the LGU. You may use data and feedback from the community to make informed decisions, identify areas for improvement, and ensure that resources are allocated to the most impactful initiatives. It is important to adapt and tailor strategies to the specific needs and resources available in each locality, involving community stakeholders in the planning and implementation process.

To the Family. They may provide guidance and support for parents dealing with the challenges of substance abuse. It is important to adapt these suggestions to your specific circumstances and seek professional advice when necessary. Remember, each individual and family situation is unique, and finding the right approach that suits your child’s needs is key.

To the Future Researcher. They may aim to include diverse populations in their future research, considering factors such as age, gender, cultural background, and socio-economic status. This inclusive approach will provide a more comprehensive understanding of substance abuse and its implications across different groups and larger communities.

REFERENCE

1. Allen, B., Harocopos, A., & Chernick, R. (2020). Substance use stigma, primary care, and the New York State prescription drug monitoring program. Behavioral Medicine, 46(1), 52-62.
2. Bechara, A., Berridge, K. C., Bickel, W. K., Morón, J. A., Williams, S. B., & Stein, J. S. (2019). A neurobehavioral approach to addiction: implications for the opioid epidemic and the psychology of addiction. Psychological Science in the Public Interest, 20(2), 96-127. Retrieved from: shorturl.at/hyJVY on November 03, 2022.
3. Botvinick, M., Ritter, S., Wang, J. X., Kurth-Nelson, Z., Blundell, C., & Hassabis, D. (2019). Reinforcement learning, fast and slow. Trends in cognitive sciences, 23(5), 408-422. Retrieved from: shorturl.at/nPV18 on November 03, 2022.
4. Brady, L. A., Wozniak, M. L., Brimmer, M. J., Terranova, E., Moore, C., Kahn, L., … & Thomas, M. (2022). Coping strategies and workplace supports for peers with substance use disorders. Substance Use & Misuse, 57(12), 1772-1778.
5. Brain & Behavior Research Foundation. (2019, March 12). The Biology of Addiction. Retrieved March 7, 2023, from https://www.bbrfoundation.org/event/biology-addiction.
6. Busch, C., & Barkema, H. (2021). From necessity to opportunity: Scaling bricolage across resource‐constrained environments. Strategic Management Journal, 42(4), 741-773. Retrieved from: shorturl.at/yHJM4 on January 30, 2023.
7. Burmester, V. (2019). The effects of oxytocin on appetite in humans (Doctoral dissertation, Kingston University). Retrieved from: https://shorturl.at/afhp3 on April 17, 2023.
8. Carpizo, E. M., & Sansano, A. G. S. (2019, December). Impact of the Moral Recovery Program for Drug Surrenderees in Cavite. In Abstract Proceedings International Scholars Conference (Vol. 7, No. 1, pp. 901-908). Retrieved from: shorturl.at/bjnPR on September 27, 2022.
9. Caliwan, C. L. (2023). PNP seizes over P70-M illegal drugs in first 2 weeks of 2023. Philippine News Agency. Retrieved March 7, 2023, from https://www.pna.gov.ph/articles/1192803.
10. Caron Treatment Centers. (2023). Psychodynamic Approach to Addiction. Retrieved March 7, 2023, from https://www.caron.org/addiction-101/substance-abuse/psychodynamic-approach-to-addiction.
11. Chen, I. H., Chang, K. C., Chang, C. W., Huang, S. W., Potenza, M. N., Pakpour, A. H., & Lin, C. Y. (2022). Temporal associations between problematic use of the internet and self-stigma among people with substance use disorders: a cross-lagged model across one year. Journal of Psychiatric Research, 156, 339-348.
12. Chiappini, S., Guirguis, A., Corkery, J. M., & Schifano, F. (2020). Misuse of prescription and over-the-counter drugs to obtain illicit highs: How pharmacists can prevent abuse. The Pharmaceutical Journal, 305(7943). Retrieved from: shorturl.at/bfkS6 on September 27, 2022.
13. Chinchella, N., & Hipólito, I. (2023). Substance addiction: cure or care?. Phenomenology and the Cognitive Sciences, 1-20. Retrieved from: https://t.ly/n2yf on March 18, 2023.
14. Cichoń, J., Płaszewska‐Żywko, L., & Kózka, M. (2023). Emotional intelligence and coping strategies among intensive care unit nurses. Nursing in critical care, 28(2), 322-328.
15. Cintron, K. (2022). The Addiction Epidemic in Rhode Island: A Mini Lecture Series.
16. Cutler, D. M., & Glaeser, E. L. (2021). When innovation goes wrong: technological regress and the opioid epidemic. Journal of Economic Perspectives, 35(4), 171-96. Retrieved from: https://shorturl.at/ijuFZ on April 17, 2023
17. Dietze, P. M., & Peacock, A. (2020). Illicit drug use and harms in Australia in the context of COVID‐19 and associated restrictions: anticipated consequences and initial responses. Drug and alcohol review, 39(4), 297-300. Retrieved from: shorturl.at/BRXYZ on January 30, 2023.
18. Dittrich, D., & Schomerus, G. (2022). Intersectional Stigma in Substance Use Disorders. The stigma of substance use disorders, 88.
19. Douglass, C. H., Lim, M. S., Block, K., Onsando, G., Hellard, M., Higgs, P., … & Horyniak, D. (2022). Exploring stigma associated with mental health conditions and alcohol and other drug use among people from migrant and ethnic minority backgrounds: a protocol for a systematic review of qualitative studies. Systematic Reviews, 11(1), 1-11.
20. Dinis-Oliveira, R. J., & Magalhães, T. (2020). Abuse of licit and illicit psychoactive substances in the workplace: medical, toxicological, and forensic aspects. Journal of clinical medicine, 9(3), 770. Retrieved from: https://shorturl.at/fqvS5 on April 17, 2023.
21. Dunlop, A., Lokuge, B., Masters, D., Sequeira, M., Saul, P., Dunlop, G., … & Maher, L. (2020). Challenges in maintaining treatment services for people who use drugs during the COVID-19 pandemic. Harm reduction journal, 17(1), 1-7. Retrieved from: shorturl.at/dmvxZ on September 27, 2022.
22. Duresso, S. (2021). Psychopharmacological Perspectives and Diagnosis of Substance Use Disorder. In Addictions-Diagnosis and Treatment. IntechOpen.
23. Elam, K. K., Mun, C. J., Connell, A., & Ha, T. (2023). Coping strategies as mediating mechanisms between adolescent polysubstance use classes and adult alcohol and substance use disorders. Addictive behaviors, 139, 107586.
24. Foundation for a Drug-Free World. (2022). Why Do People Use Drugs? How Do Drugs Work? Retrieved March 7, 2023, from https://www.drugfreeworld.org/drugfacts/drugs/why-do-people-take-drugs.html.
25. Fuchshuber, J., & Unterrainer, H. F. (2020). Childhood Trauma, Personality, and Substance Use Disorder: The Development of a Neuropsychoanalytic Addiction Model. Frontiers in Psychiatry, 11, 531. https://doi.org/10.3389/fpsyt.2020.00531
26. Gage, S. H., Brewer, G., Steen, M., & Lyons, M. (2022). Living with Drug Use and Addiction during the COVID-19 Pandemic. Substance Use & Misuse, 57(10), 1504-1510. Retrieved from: shorturl.at/hp289 on September 27, 2022.
27. Gibbons, F. X., Fleischli, M. E., Gerrard, M., Simons, R. L., Weng, C. Y., & Gibson, L. P. (2020). The impact of early racial discrimination on illegal behavior, arrest, and incarceration among African Americans. American Psychologist, 75(7), 952. Retrieved from: shorturl.at/gpUWX on September 27, 2022.
28. Giordano, P. C., Copp, J. E., Manning, W. D., & Longmore, M. A. (2019). Linking parental incarceration and family dynamics associated with intergenerational transmission: A life‐course perspective. Criminology, 57(3), 395-423. Retrieved from: shorturl.at/nFS25 on January 30, 2023.
29. Goldin, D., Salani, D., & Mckay, M. (2019). Kratom: Implications for health care providers. Journal of psychosocial nursing and mental health services, 57(12), 15-20. Retrieved from: https://t.ly/QNx20 on Merch 18, 2023.
30. Goldberg, A. E. (2020). The (in) significance of the addiction debate. Neuroethics, 13(3), 311-324.
31. Golshaie, A. (2022). Challenging stigma around alcohol misuse. The Lancet Gastroenterology & Hepatology, 7(9), 795.
32. Ghosh, A., Naskar, C., Sharma, N., Choudhury, S., Basu, A., Pillai, R. R., … & Mattoo, S. K. (2022). Does online newsmedia portrayal of substance use and persons with substance misuse endorse stigma? A qualitative study from India. International Journal of Mental Health and Addiction, 1-19.
33. Gutierrez, D., Crowe, A., Mullen, P. R., Pignato, L., & Fan, S. (2020). Stigma, Help Seeking, and Substance Use. Professional Counselor, 10(2), 220-234.
34. Heilig, M., MacKillop, J., Martinez, D., Rehm, J., Leggio, L., & Vanderschuren, L. J. (2021). Addiction as a brain disease revised: why it still matters, and the need for consilience. Neuropsychopharmacology, 46(10), 1715-1723. Retrieved from: shorturl.at/fiouM on January 30, 2023.
35. Hilliard, F., Goldstein, E., Nervik, K., Croes, K., Ossorio, P. N., & Zgierska, A. E. (2023). Voices of Women With Lived Experience of Substance Use During Pregnancy: A Qualitative Study of Motivators and Barriers to Recruitment and Retention in Research. Family & Community Health, 46(1), 1-12.
36. Jainah, Z. O. (2022). Legal Policy in the Implementation of Rehabilitation for Drug Addicts in Lampung Province. LEGAL BRIEF, 11(3), 1650-1659. Retrieved from: shorturl.at/nrVX2 on September 27, 2022.
37. Joshi, A., Roy, S., Manik, R. K., & Sahoo, S. K. (2023). Scientific Philosophy: Exploring Existential, Metaphysical, and Ethical Research Philosophy Behind the Question “WHO AM I?”. Journal of Pharmaceutical Negative Results, 1648-1671.
38. Johnston, L., Miech, R., O’Malley, P., Bachman, J., Schulenberg, J., & Patrick, M. (2020). Monitoring the Future national survey results on drug use, 1975-2019: Overview, key findings on adolescent drug use. Retrieved from: shorturl.at/jkP48 on September 27, 2022.
39. Journal of Criminal Law and Criminology (2022). The Drug Addict: Patient or Criminal. https://www.jstor.org/stable/1137200. Retrieved from: shorturl.at/aoPR3 on September 27, 2022.
40. Kibaly, C., Alderete, J. A., Liu, S. H., Nasef, H. S., Law, P. Y., Evans, C. J., & Cahill, C. M. (2021). Oxycodone in the opioid epidemic: high ‘liking’,‘wanting’, and abuse liability. Cellular and molecular neurobiology, 41, 899-926. Retrieved from: https://shorturl.at/vHVX5 on April 17, 2023.
41. Kin, S. T. C. (2021). An Interpretative Phenomenological Analysis of Singapore Ex-addict Prisoners’ Motivation to Remain Drug Free after Release (Doctoral dissertation, Walden University). Retrieved from: https://shorturl.at/bgjp4 on April 17, 2023.
42. Koehler, D. (2021). Violent extremism, mental health and substance abuse among adolescents: towards a trauma psychological perspective on violent radicalization and deradicalization. In Violent Extremism (pp. 103-120). Routledge. Retrieved from: shorturl.at/aqBES on January 30, 2023.
43. Kothapalli, P. B. (2019). Analysis of Drug Use Dataset to Aid Drug Abuse Prevention in Youth.
44. Kumar, A., Dangi, I., & Pawar, R. (2019). Drug addiction: A big challenge for youth and children’s. Int. J. Res. Pharm. Pharm. Sci., 4, 35-40.
45. Ledingham, E., Adams, R. S., Heaphy, D., Duarte, A., & Reif, S. (2022). Perspectives of adults with disabilities and opioid misuse: Qualitative findings illuminating experiences with stigma and substance use treatment. Disability and Health Journal, 15(2), 101292.
46. Livingston, J. D. (2020). Structural stigma in health-care contexts for people with mental health and substance use issues. Mental Health Commission of Canada: Ottawa, ON, Canada.
47. Lasco, G., & Yarcia, L. E. (2022). The Politics of Drug Rehabilitation in the Philippines. Health and Human Rights, 24(1), 147. Retrieved from: shorturl.at/alsZ7 on September 27, 2022.
48. Lerner, A., & Klein, M. (2019). Dependence, withdrawal and rebound of CNS drugs: an update and regulatory considerations for new drugs development. Brain Communications, 1(1), fcz025. Retrieved from: https://shorturl.at/ER489 on April 17, 2023
49. Lüscher, C., Robbins, T. W., & Everitt, B. J. (2020). The transition to compulsion in addiction. Nature Reviews Neuroscience, 21(5), 247-263. Retrieved from: shorturl.at/nPRY1 on November 03, 2022.
50. Mayo Clinic. (2022, October 4). Drug addiction (substance use disorder) – Symptoms and causes. Mayo Foundation for Medical Education and Research. Retrieved March 7, 2023, from https://www.mayoclinic.org/diseases-conditions/drug-addiction/symptoms-causes/syc-20365112
51. Mazzeo, F., & Raiola, G. (2018). An investigation of drugs abuse in sport performance. Retrieved from: shorturl.at/FHJV9 on September 27, 2022.
52. McDaniels Sr, L. (2021). Redemption and Recovery in the African American Baptist Church (Doctoral dissertation, Berkeley School of Theology). Retrieved from: shorturl.at/efKXY on January 30, 2023.
53. Mitra, N., Hill, R. P., Chaudhuri, H. R., & Chaudhuri, A. (2022). Identity management as a coping strategy for stigmatization: the case of Indian sex workers in a libidinal market. Journal of Public Policy & Marketing, 41(2), 124-140.
54. Moustafa, A. A., Tindle, R., Cashel, S., Parkes, D., Mohamed, E., & Abo Hamza, E. (2022). Bidirectional relationship between heroin addiction and depression: Behavioural and neural studies. Current psychology, 41(8), 5195-5211. Retrieved from: shorturl.at/ENXY0 on October24, 2022.
55. Morgan, O. J. (2019). Addiction, Attachment, Trauma and Recovery: The Power of Connection (Norton Series on Interpersonal Neurobiology). WW Norton & Company. Retrieved from: https://shorturl.at/cCKNT on April17, 2023.
56. Muncan, B., Walters, S. M., Ezell, J., & Ompad, D. C. (2020). “They look at us like junkies”: influences of drug use stigma on the healthcare engagement of people who inject drugs in New York City. Harm reduction journal, 17, 1-9.
57. Muir, C., Adams, E. A., Evans, V., Geijer-Simpson, E., Kaner, E., Phillips, S. M., … & McGovern, R. (2022). A systematic review of qualitative studies exploring lived experiences, perceived impact, and coping strategies of children and young people whose parents use substances. Trauma, Violence, & Abuse, 15248380221134297.
58. Murthy, V. H., & Murthy, V. H. (2020). Together. Harper Collins Publishers. Retrieved from: shorturl.at/fJOZ6 on September 27, 2022.
59. Nahar, S., Any, O. H., Afrin, M., & Laila, R. (2022). Understanding of Drug Addiction Drug Abuse and Popular Drug Slang: A Narrative Review. Journal of National Institute of Neurosciences Bangladesh, 8(1), 84-89.
60. National Center for Drug Abuse Statistics. (2023). Drug Related Crime Statistics [2023]: Offenses Involving Drug Use. NCDAS. Retrieved March 7, 2023, from https://drugabusestatistics.org/drug-related-crime-statistics/
61. National Institute on Drug Abuse. (2022, November 23). The Science of Drug Use: A Resource for the Justice Sector | National Institute on Drug Abuse. Retrieved March 7, 2023, from https://nida.nih.gov/drug-topics/criminal-justice/science-drug-use-resource-justice-sector
62. Nawi, A. M., Ismail, R., Ibrahim, F., Hassan, M. R., Manaf, M. R. A., Amit, N., … & Shafurdin, N. S. (2021). Risk and protective factors of drug abuse among adolescents: a systematic review. BMC public health, 21(1), 1-15. Retrieved from: shorturl.at/boxIW on January 30, 2023.
63. Nelson, L. A., Collins, S. E., Birch, J., Burns, R., McPhail, G., Onih, J., … & Squetimkin-Anquoe, A. (2023). Content Analysis of Preferred Recovery Pathways Among Urban American Indians and Alaska Natives Experiencing Alcohol Use Disorders. Journal of Cross-Cultural Psychology, 54(1), 142-160.
64. Obidovna, D. Z., & Sulaymonovich, D. S. (2022). Physical activity and its impact on human health and longevity. Достижения науки и образования, (2 (82)), 120-126. Retrieved from: shorturl.at/ruDNS on January 30,2023.
65. O’Regan, R. (2020). WA needs addiction specialists to lead the difficult conversations. Medicus, 60(6), 24-25.
66. Othman, A., Ghani, M. S. A. A., Taib, F., & Mohamad, N. (2022). Psychological distress and coping strategies among the caretakers of children with transfusion-dependent thalassemia. Frontiers in Pediatrics, 10.
67. Parkes, T., Matheson, C., Carver, H., Foster, R., Budd, J., Liddell, D., … & MacLennan, G. (2022). Assessing the feasibility, acceptability and accessibility of a peer-delivered intervention to reduce harm and improve the well-being of people who experience homelessness with problem substance use: the SHARPS study. Harm Reduction Journal, 19(1), 10.
68. Parra, D. C., Wetherell, J. L., Van Zandt, A., Brownson, R. C., Abhishek, J., & Lenze, E. J. (2019). A qualitative study of older adults’ perspectives on initiating exercise and mindfulness practice. BMC geriatrics, 19(1), 1-11. Retrieved from: shorturl.at/BEVW1 on September 27, 2022.
69. Petracek, L. J. (2023). The DBT Workbook for Alcohol and Drug Addiction: Skills and Strategies for Emotional Regulation, Recovery, and Relapse Prevention. Jessica Kingsley Publishers.
70. Philippine Statistics Authority | Republic of the Philippines. (2022, September 23). Philippine Statistics Authority | Republic of the Philippines. Retrieved March 7, 2023, from https://psa.gov.ph/press-releases/id/144112.
71. Pickard, H. (2021). Addiction and the self. Noûs, 55(4), 737-761. Retrieved from: https://shorturl.at/cfjqR on April 17, 2023
72. Potik, D. (2020). Psychodynamic Approaches for Treatment of Drug Abuse and Addiction: Theory and Treatment. In Routledge & CRC Press (Vol. 208). https://www.routledge.com/Psychodynamic-Approaches-for-Treatment-of-Drug-Abuse-and-Addiction-Theory/Potik/p/book/9780367087029
73. Ravanilla, N., Sexton, R., & Haim, D. (2022). Deadly Populism: How Local Political Outsiders Drive Duterte’s War on Drugs in the Philippines. The Journal of Politics, 84(2), 1035-1056. Retrieved from: shorturl.at/cdekP on September 27, 2022.
74. Recovery Research Institute. (2018, March 5). National Recovery Study Findings in 30 Seconds. Retrieved March 7, 2023, from https://www.recoveryanswers.org/media/national-recovery-study-30-seconds/.
75. Recovery Research Institute. (2020, October 26). “We do recover”: More evidence that tens of millions of adults in the United States have recovered from a substance use problem. Retrieved March 7, 2023, from https://www.recoveryanswers.org/research-post/millions-americans-in-united-states-report-recovery-from-substance-use-problem/.
76. Reddy, Y. J., Sudhir, P. M., Manjula, M., Arumugham, S. S., & Narayanaswamy, J. C. (2020). Clinical practice guidelines for cognitive-behavioral therapies in anxiety disorders and obsessive-compulsive and related disorders. Indian journal of psychiatry, 62(Suppl 2), S230.
77. Reid, L. D. (2022). New Theory on Addictions. J Addict Res Ther, 13(461), 2. Retrieved from: https://t.ly/xnXx on Mrch 18, 2023
78. Renes, C. M. (2021). Alexis Wright’s The Swan Book: Indigenous-Australian Swansong or Songline?. Humanities, 10(3), 89. Retrieved from: https://t.ly/f03N on March19, 2023.
79. Renn, A. S. (2019). An Examination of Factors Impacting Adolescent Opioid Drug Misuse (Doctoral dissertation, Regent University). Retrieve from: https://rb.gy/tnkjci on March 18, 2023.
80. Ribeiro, A. P., Piquet-Pessôa, M., Félix-da-Silva, C., Mühlbauer, J. F. E., de-Salles-Andrade, J. B., & Fontenelle, L. F. (2022). Subjective assessments of research domain criteria constructs in addiction and compulsive disorders: a scoping review protocol. BMJ open, 12(8), e059232. Retrieved from: shorturl.at/alnYZ on October 24, 2022.
81. Robertson, P. & Human Rights Watch. (2022, November 17). Philippines Undercounts Recent ‘Drug War’ Deaths. Philippines Undercounts Recent ‘Drug War’ Deaths | Human Rights Watch. Retrieved March 7, 2023, from https://www.hrw.org/news/2022/11/17/philippines-undercounts-recent-drug-war-deaths
82. Robinson, B. A. (2021). “They peed on my shoes”: foregrounding intersectional minority stress in understanding LGBTQ youth homelessness. Journal of LGBT Youth, 1-17. Retrieved from: shorturl.at/qIK06 on January 30, 2023.
83. Roop, J. (2022). Addiction and leadership: How authentic and transformative leaders are emerging from the adversity of substance use disorder. Retrieved from: shorturl.at/bGJNW on September 27, 2022.
84. Sattar, K., Yusoff, M. S. B., Arifin, W. N., Yasin, M. A. M., & Nor, M. Z. M. (2022). Effective coping strategies utilised by medical students for mental health disorders during undergraduate medical education-a scoping review. BMC medical education, 22(1), 1-13.
85. SChuLTZ, D. (2018). The failed war on drugs. Legal Marijuana: Perspectives on Public Benefits, Risks and Policy Approaches, 51. Retrieved from: shorturl.at/cfhKS on September 27, 2022.
86. Shaw, K. J., & Ibrahim, A. S. (2020). Fosmanogepix: a review of the first-in-class broad spectrum agent for the treatment of invasive fungal infections. Journal of Fungi, 6(4), 239. Retrieved from: shorturl.at/rvD58 on January 30, 2023.
87. Silverstein, S. M., Rivera, J., Gainer, D., & Daniulaityte, R. (2023). ‘Things that you can’t really suppress’: Adverse childhood experiences in the narratives of people with opioid use disorder. SSM-Mental Health, 100185.
88. Skivington, K., Matthews, L., Simpson, S. A., Craig, P., Baird, J., Blazeby, J. M., … & Moore, L. (2021). A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. bmj, 374. Retrieved from: https://shorturl.at/bgDU9 on April 17, 2023.
89. Smith, M. A. (2021). Social learning and addiction. Behavioural Brain Research, 398, 112954. Retrieved from: shorturl.at/rtCPU on January 30, 2023.
90. Spiller, K. J., Bi, G. H., He, Y., Galaj, E., Gardner, E. L., & Xi, Z. X. (2019). Cannabinoid CB1 and CB2 receptor mechanisms underlie cannabis reward and aversion in rats. British journal of pharmacology, 176(9), 1268-1281. Retrieved from: shorturl.at/GHX46 on January 30, 2023.
91. Statista. (2021). Philippines: reported cases involving drugs by region 2021. Retrieved March 7, 2023, from https://www.statista.com/statistics/1171104/philippines-crime-incidents-involving-drugs-by-region/
92. Sullivan, M. D. (2018). Depression effects on long-term prescription opioid use, abuse, and addiction. The Clinical journal of pain, 34(9), 878-884. Retrieved from: shorturl.at/bntKW on November 03, 2022.
93. Sultan, A. (2022). Enacting Recovery: Process or Endpoint?. In Recovering Assemblages (pp. 233-259). Palgrave Macmillan, Singapore. Retrieved from: shorturl.at/cloqS on September 27, 2022.
94. Taheri Zadeh, Z., Rahmani, S., Alidadi, F., Joushi, S., & Esmaeilpour, K. (2021). Depresssion, anxiety and other cognitive consequences of social isolation: drug and non‐drug treatments. International journal of clinical practice, 75(12), e14949. Retrieved from: shorturl.at/akrW2 on January 30, 2023.
95. Thakkar, S., Anklam, E., Xu, A., Ulberth, F., Li, J., Li, B., … & Tong, W. (2020). Regulatory landscape of dietary supplements and herbal medicines from a global perspective. Regulatory Toxicology and Pharmacology, 114, 104647. Retrieved from: shorturl.at/auY09 on January 30, 2023.
96. Toubiana, M., & Ruebottom, T. (2022). Stigma hierarchies: The internal dynamics of stigmatization in the sex work occupation. Administrative Science Quarterly, 67(2), 515-552. Retrieved from: https://shorturl.at/lprBH on April 17, 2023.
97. UNESCO. (2022). World Drug Report 2022. United Nations : Office on Drugs and Crime. Retrieved March 7, 2023, from https://www.unodc.org/unodc/data-and-analysis/world-drug-report-2022.html
98. United Nations : Office on Drugs and Crime. (2018). World Drug Report 2018: opioid crisis, prescription drug abuse expands; cocaine and opium hit record highs. Retrieved March 7, 2023, from https://www.unodc.org/unodc/en/frontpage/2018/June/world-drug-report-2018_-opioid-crisis–prescription-drug-abuse-expands-cocaine-and-opium-hit-record-highs.html
99. Verma, M., & Vijayakrishnan, A. (2018). Psychoanalytic psychotherapy in addictive disorders. Indian Journal of Psychiatry, 60(8), 485. https://doi.org/10.4103/psychiatry.indianjpsychiatry_16_18
100. Wahidah, E. Y., Yuminah, Y., In’ami, M., & Ulfa, U. (2022). IMPLEMENTING SIGMUND FREUD’S PSYCHOANALYSIS THEORY IN THE ACADEMIC ARENA: A CRITICAL STUDY. IMTIYAZ: Jurnal Ilmu Keislaman, 6(2), 72-87. Retrieved from: https://t.ly/xnXx on March 18, 2022.
101. Wang, S. (2019). Historical review: opiate addiction and opioid receptors. Cell transplantation, 28(3), 233-238. Retrieved from: https://shorturl.at/aqAP3 April 17, 2023
102. Wang, S. C., Chen, Y. C., Chen, S. J., Lee, C. H., & Cheng, C. M. (2020). Alcohol addiction, gut microbiota, and alcoholism treatment: A review. International journal of molecular sciences, 21(17), 6413. Retrieved from: shorturl.at/x1589 on January 30, 2023.
103. Wastesson, J. W., Morin, L., Tan, E. C., & Johnell, K. (2018). An update on the clinical consequences of polypharmacy in older adults: a narrative review. Expert opinion on drug safety, 17(12), 1185-1196. Retrieved from: shorturl.at/FLSW6 on October 23, 2022.
104. WebMD, & Dumain, T. (2022, December 18). Drug Addiction: Know the Warning Signs. WebMD. Retrieved March 7, 2023, from https://www.webmd.com/mental-health/addiction/drug-abuse-addiction
105. Witte, T. H., Wright, A., & Stinson, E. A. (2019). Factors influencing stigma toward individuals who have substance use disorders. Substance Use & Misuse, 54(7), 1115-1124.
106. Zaami, S., Marinelli, E., & Varì, M. R. (2020). New trends of substance abuse during COVID-19 pandemic: an international perspective. Frontiers in Psychiatry, 11, 700. Retrieved from: https://shorturl.at/pLM09 on April 17, 2023.