"It's Not Just One Decision, It's a Whole Lifestyle Change": Mixed Methods Analysis of Factors Associated with Readiness to Change Substance Use Patterns Among Community Recruited People Who Inject Drugs.

Background

Understanding socio-cultural factors associated with motivation to seek treatment is critical to addressing persistent mortality related to injection and opioid drug use.

Objective

Using mixed methods, we examined factors associated with readiness to change substance use among structurally vulnerable people who inject drugs (PWID), recruited from Los Angeles and Denver (n = 472) between 2021 and 2022.

Results

Readiness was categorized into three stages: pre-contemplation (190/386; 49%), contemplation (120/386; 31%), and preparation (76/386; 20%) to quit drug use within six months, three months, or immediately, respectively. Pre-contemplation served as the referent category (n = 386) in multinomial logistic regression analyses controlling for confounding. We found contemplation stage was significantly associated with daily speedball use (mixture of opioid with cocaine) (Adjusted odds ratio [AOR] =4.88; 95% confidence interval [CI] = 1.65, 14.29) and infective endocarditis symptoms (AOR = 3.13;95% CI = 1.54, 6.58). Preparation was associated with infective endocarditis symptoms (AOR = 2.92; 95% CI = 1.28, 6.66) and receiving general relief (AOR = 2.27; 95% CI = 1.28, 4.00). Thematic analysis of semi-structured qualitative interviews with a sample of 30 PWID in Los Angeles revealed barriers to change, including lack of social support and difficulties in altering substance-use routines. Many PWID expressed interest in changing opioid use after significant life events (e.g., incarceration or non-fatal opioid overdose).

Conclusions

Findings suggest that major life events, infectious disease symptoms, and engagement with support programs contribute to increased readiness for substance use disorder treatment.