Constructing the Resilience-Induced Guise: A Grounded Theory Study of Opioid Use Experiences Among Black Women.

Opioid-related fatalities are increasing for Black women. Health officials responded with expanded Naloxone, new federal policies, and increased access to medications for opioid use disorders (MOUD). However, Black communities did not receive sufficient benefits from these initial efforts to end the opioid epidemic. The objective of this qualitative study was to understand the contextual factors influencing Black women's MOUD engagement patterns. We conducted individual interviews between January and May 2023 and analyzed the data using Constructivist Grounded Theory. We interviewed 30 Black women from across the United States. Two initiation categories were identified: (1) recreational opioid use to cope with emotional trauma (n = 22) and (2) initial opioid exposure through a prescription for physical pain (n = 8). All participants reported progression to addiction. Participants described improper grieving, challenges with disclosing mental health concerns before coping with opioids, and many could not view themselves as needing treatment. The final theory is coined resilience-induced guise. Our study demonstrates a maladaptive form of resilience anchored in sociohistorical conditions rather than individual behavior, which inherently contributed to opioid use and delayed care-seeking. Due to the paradoxical nature of this experience, this group struggled to find hope in care-seeking even though the combination of medication and behavioral therapy is the most effective intervention. We encourage future research to expand the Superwoman schema to formally incorporate care-seeking as a core strength, on equal footing with the framework's existing validated dimensions. Such a conceptual shift could support Black women who embody this identity in recognizing care-seeking as an expression of resilience rather than a departure from it. Future research should examine resilience-induced guise across the lifespan among Black women to build a stronger evidence base on how this phenomenon shapes engagement with MOUD.