Exploring Motivations and Challenges in Substance Abuse Education: Insights from Undergraduate Healthcare Students

Exploring Motivations and Challenges in Substance Abuse Education: Insights from Undergraduate Healthcare Students | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Exploring Motivations and Challenges in Substance Abuse Education: Insights from Undergraduate Healthcare Students Artur Ramos, João Maurício Castaldelli-Maia This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6280092/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The widespread use of psychoactive substances challenges healthcare professionals in forming effective care relationships, yet there is a shortage of trained specialists in this area. A focus group (n = 9) with undergraduate healthcare students from various disciplines involved in the *DE-IDENTIFIED* in 2023 explored motivations, understandings, and treatment perspectives. Thematic analysis revealed that students’ motivations stemmed from personal experiences with substance use in their families and social circles. Participants preferred harm reduction and community-based approaches, rejecting biomedical models and terms like "addiction". While emphasizing collective determinants such as social class, culture, and race, their therapeutic approaches often focused on individual-based interventions. Addressing personal experiences, conceptual resistances, and sociocultural contexts is essential in substance abuse education. Training should integrate theoretical and cultural factors to foster effective learning and specialization, although broader studies are needed to generalize these findings. Health Education Substance Abuse Harm Reduction Community Care Healthcare Students Introduction People who use psychoactive substances are present in healthcare services in various contexts. These patients are encountered in outpatient clinics 1 , hospital wards 2 , emergency units 3 , and are attended to by different types of specialists in these different settings 4 . As a result, professionals from various fields encounter individuals who present with the use of psychoactive substances not only as an aggravating factor of their specific clinical conditions but also as factors leading to poorer quality of life 5 , worse health indicators, and, above all, pose a challenge to establishing an effective care relationship 6 with the services due to various factors, including poor adherence to proposed treatments 7,8 ; stigma from family members 9,10 , community members, and healthcare professionals 11–15 ; poor understanding of psychopathology, cultural and social factors, and the influence of individual life histories on the development of the clinical picture by care teams 16,17 . Despite the high health impact caused by substance use, few healthcare professionals choose to specialize in this area 6,17 , leading to a shortage of trained and specialized professionals to treat this type of patient. Furthermore, education and training in substance use management are poorly systematized, resulting in the necessary competencies for the training, whether of the generalist or specialist professional, not being well-established 11 . Consequently, the training of professionals – and supervisors and teachers – is variable and mostly encompasses competencies involving the pharmacological management of withdrawal syndromes, intoxication, and other aspects of acute crises 6 . Even in large training centers, students' contact with substance users typically occurs in contexts where use is considered a comorbidity and is addressed secondarily 6 , thus constituting a complicating health problem in services, sometimes approached from the perspective of morality and deviation of virtue, so that throughout medical training, the stigma surrounding substance users grows among students. In general, little time in medical training is spent in longitudinal contact with substance users in non-crisis contexts 11,16 , focusing on factors involving use, associated social and cultural conditions, or even psychological factors and ways of establishing relationships with these individuals 17 . Preliminary studies have shown that brief interventions involving reflections on personal experience in a service dedicated to the treatment of substance users 18 , or the creation of a consultation service aimed at providing a direct approach to use 4 , have brought significant impacts on the understanding of use, reduction of stigma by the professionals involved, and even improvement in the health team's relationships with the patient. Therefore, it is essential to build a field of knowledge that allows the formation of care and training services where undergraduate students in healthcare areas can develop broader competencies to reduce the impact of substance use on the healthcare system 11,16,18 . In the Brazilian scenario, substance users care predominantly occurs in services of the Psychosocial Care Network (RAPS) 19–21 , mental health care branch of the Unified Health System (SUS) 22–24 , the country's public health system. The Brazilian RAPS was established by a decree from the Ministry of Health in December 2011 25 , after decades of political action by civil society in the Anti-Asylum Movement 26 . In this network, the Alcohol and Other Drugs Psychosocial Care Centers (CAPS-AD) play a central role; they are reference services for substance abuse treatment and are configured as community services, emphasizing care in liberty, group interventions, and territorial regional work. Within this context, specific strategies for teaching substance abuse management need to be considered to allow healthcare professionals to specialize in substance user care and for them to join the CAPS-AD work teams. Following a tradition dating back to the early 20th century, at the *DE-IDENTIFIED* , students organized themselves to propose an Academic League project where it would be possible to address the gap in chronic substance abuse management education at the university. Academic Leagues are groups of volunteer students who provide assistance for a specific health problem of their interest, supervised by a professor chosen by them 27 . Thus, the *DE-IDENTIFIED* began at the *DE-IDENTIFIED* from the mobilization of medicine students to develop skills in a service for substance users. Initially, this project was organized as an outpatient service where students could attend to patients with substance use demands longitudinally, in pairs. To overcome the initial limitations of the project, the *DE-IDENTIFIED* was reformed throughout the year 2021, in which new activities and approaches were proposed, expanding assistance and teaching possibilities. From these changes, the project was renamed as the *DE-IDENTIFIED* and began to include, in addition to outpatient care, weekly clinical meetings, interdisciplinary care with nursing, occupational therapy, and psychology professionals, and a didactic proposal developed to cover the knowledge of community care practiced in the CAPS-ADs. Thus, a potential field of investigation was created in this interdisciplinary project that brings together students from various areas with a particular interest in substance abuse management. That is, in this project, it is possible to investigate which factors are associated with the manifestation of a healthcare professional's interest in substance abuse in such a way that there is interest in specialization in the field. Methods The study sample consisted of 10 students from various health-related courses, who joined the *DE-IDENTIFIED* in 2023. The selection process for joining the *DE-IDENTIFIED* involved an introductory course with six classes conducted over three days, followed by a theoretical exam on the concepts covered during the course. The classes addressed various basic concepts that guide the care of alcohol and other drug users in a community context. The selection exam included nine questions delivered to the students through an online questionnaire, and the 10 students with the best performance were selected to participate in the project throughout the year. The questions in this questionnaire covered topics such as the components and functioning of the Psychosocial Care Network in Brazil, the paradigms and epistemology of contemporary psychiatry, the Brazilian National Drug Policy, the objectives of psychosocial rehabilitation, the psychopathology of substance use, psychiatric anamnesis applied to substance users, the vulnerability of substance users, and public policies for addressing open drug use scenes in the city of *DE-IDENTIFIED* . The League’s activities began on April 26, 2023. All new participants met with the supervisors and the returning students who continued as volunteers in the project in a classroom within the *DE-IDENTIFIED* . Brief introductions were made, with each new member, supervisor, and returning member speaking briefly about themselves to facilitate introductions. Then, the League’s activities for the year were presented, guiding the new members on the care processes and services provided to substance users there. After this presentation, all new members were invited to participate in this study. The students were informed by the League’s coordinator that those interested in participating in the research should follow him to another room, where a focus group would be conducted to better understand their views on substance use, its psychopathology, and possible treatments. It was assured that there would be no punishment or sanctions for those who chose not to participate, and everyone was informed that the League’s other activities for the day were concluded, that there were no scheduled appointments, and that those not participating in the research project were free to leave. Of the 10 students participating in the project, 9 agreed to participate in the research group. The distribution of age, gender, course, and academic period of the students is presented in the following table: Table 1 - Research group Once inside the classroom where the focus group was to be held, the new members of the League settled in a circle, each on a chair, and the League coordinator once again explained the objectives of the study. The informed consent form was then distributed to all participants for them to sign and clarify any questions they might have. Since no questions were raised, the audio recording was initiated using a mobile phone and a computer, positioned at opposite ends of the room to capture the sound from two different sources, aiming to minimize recording issues and ensure intelligibility of the recorded speeches. The group was facilitated by the League coordinator himself, *DE-IDENTIFIED* who, at the time of the group session, was volunteering at the *DE-IDENTIFIED* as the coordinator of this project, while also working as *DE-IDENTIFIED* in *DE-IDENTIFIED* . This same coordinator had previously taught one of the classes in the introductory course mentioned earlier, with the topic ‘The Brazilian Psychiatric Reform and Psychosocial Care Centers’, and was an advocate for community-based treatment models for alcohol and drug users. On the other hand, the *DE-IDENTIFIED* is known for its research primarily in the areas of clinical psychiatry and neuropsychiatry, and it has *DE-IDENTIFIED* . Both the institution where the research was conducted and the profile of the researcher could be factors that influence the opinions and views expressed during the group discussion. After the recording started, the researcher began data collection with the following trigger questions, which were presented gradually throughout the group session. A new question was only introduced when the group had fully discussed the previous one. What motivated you to join the League? What difficulties do you imagine you might face when talking about chemical dependency? What do you understand by chemical dependency? What is a person with chemical dependency like? Does chemical dependency require treatment? Why? What should be the goals of chemical dependency treatment? How does someone become chemically dependent? What challenges does a healthcare professional need to face when dealing with a patient? What do you consider most important in the relationship with a substance user? Do you have any additional comments? After the group session concluded, the students were dismissed from their activities and instructed to return the following week for the start of the League's teaching and care activities. The audio recordings from the session were transcribed with the help of transcription software and the transcription was thoroughly reviewed by the researcher to ensure their accuracy to the content of the audio recordings. Results and Findings The transcribed text was carefully read by the main researcher to reacquaint with the data contained within. From this preliminary reading, 28 relevant thematic codes were identified within the text. During a subsequent reading, the researcher highlighted 78 quotations, which were distributed among the codes as follows: Table 2 - Quotations distribution among codes These codes were then grouped into four categories: motivation to seek knowledge in the area of substance abuse, pre-existing concepts and resistances, collective determinants of substance use, and perspectives on suffering and clinical improvement. Table 3 - Codes distribution among categories The highlighted quotations were analyzed together for each of the categories, and the results are presented below. Motivation to seek knowledge in the field of substance abuse Among the various factors that led students to seek knowledge about substance abuse management, the most frequent was the experience of having people who have or had substance abuse issues within their families. Students shared direct experiences involving first-degree relatives who had problems with substance use, some with treatment and others without, all of which impacted their personal experience to such an extent that it sparked curiosity and a desire to learn more about substance use disorders and the possibilities of care and treatment for these conditions (Q1). The experience of substance use within the family emerged in the group as a determining factor in shaping the perceptions that students bring regarding substance use and how care should be provided to people with these issues. The experiences of the treatment of their family members can be understood as either satisfactory or unsatisfactory from this familial perspective, prior to the perspective of a healthcare professional (Q2). Not only did this clinical understanding of different approaches to substance use prove to be influenced by family experiences, but also the perception of the determining factors that categorize a person as having a substance use disorder. Thus, collective and social issues were highlighted in the students' perspectives, overshadowing the biomedical understanding of addiction (Q3). All these influences from family experiences are sustained by the interest that students demonstrate in the area even when the family experience is indirect (Q4). The awakening of interest in the clinic of substance abuse emerged in the group through other early forms of contact with substance users beyond the family, such as friendships during adolescence, which also emerged as motivating factors for seeking knowledge (Q5). As we observed in relationships with family members, relationships with friends also contributed to the construction of the image that students brought of a person who abuses substances as someone determined by previous suffering and social issues (Q6, Q7) Following early contact with substance users in the family and in adolescent social circles, the second most frequent reason presented by students for their motivation to deepen their knowledge in the clinic of substance abuse was their previous experience in mental health within their respective regular courses, especially concerning practical internships in non-specific areas for substance abuse. This is because students perceived strong influences of substance use on other mental health issues, as exacerbating psychological symptoms or as a confounding agent in diagnoses, or even as a component left in the background in therapeutic approaches (Q8, Q9). Within this context of previous academic experience, some students pointed out that not having substance use as the focus of clinical approach was a weakness in the curriculum of their courses, and the desire to seek additional education also comes in filling this gap (Q10). Pre-existing concepts and resistances In the group, there was a clear manifestation of a series of preconceptions regarding the clinic of substance abuse and its different lines of thought, which significantly impacted the students' openness to possible discussions, particularly a juxtaposition between the biomedical view of the issue and social perspectives. The promotion of abstinence was rejected as an asylum practice, while harm reduction, along with the community logic of care in freedom, appeared as the most accepted care approaches. This divergence of lines of thought became even clearer due to the fact that the League took place in a psychiatry institute of a large teaching hospital, which stands out for its biomedical research. Therefore, students expressed apprehension about the work that could be developed in the project, resisting a possible biomedical approach. The promotion of abstinence, as a treatment approach, appeared in the students' conceptions associated with Christian religious behavior and police punitivism (Q11, Q12). On the other hand, harm reduction was understood as an alternative form, disconnected from religious or punitive influence, of establishing a care model associated with the anti-asylum struggle (Q13, Q14). Resistance to certain theoretical guidelines also manifested as concern regarding paternalism and saviorism. The possibility of delving into a clinic of substance abuse was accompanied by a desire for a deeper and more complex understanding of the subjects' suffering (Q15, Q16). The theoretical resistances demonstrated by the students in the group had their most concrete manifestation in a recurrent restriction on the use of certain terms that, from their perspective, would be associated with the lines of thought to which they resisted, especially the biomedical approach. Thus, terms like 'addiction' and 'treatment', whenever mentioned, were promptly rejected by the group and replaced by other forms such as 'substance abuse' and 'care', respectively (Q17, Q18) However, despite the theoretical preconceptions brought by the students being predominantly in the direction of resistance to the idea of cure, when they address their apprehensions regarding caring for substance users, the most frequent concern relates to the possibility of frustration (Q19, Q20, Q21). In addition to the possibility of frustration, students also worried about the risk of personal affectation when dealing with issues related to substance use (Q22, Q23). Frustration, in turn, appears as a possibility in the face of a romanticization of a certain clinic that students bring as preconceived and ideal. And during the group, the students themselves express this possibility (Q24, Q25). Collective Determinants of Substance Use Regarding the views presented by the students about substance abuse in relation to its characteristics and etiological determinants, collective determinants such as culture, social class, race, and gender stood out. Some students presented these factors based on an identification with substance users, seeing themselves as belonging to the same social groups as these individuals; others presented a curious external perspective, based on the idea of being in a different social organization than that of the patients. Either way, the user was described as a person who, due to their social conditions, suffers (Q26, Q27, Q28) Thus, it is possible to see in the students' speeches the fixation of the idea that substance use is directly related to less privileged social groups and that resisting certain clinical models correlates, in their view, with resisting the social behavior of excluding these groups. Therefore, the biomedical speech and the promotion of abstinence acquire, in the students' view, not only asylum characteristics but also racist, elitist, and sexist ones. In this way, the different substances of abuse, in different contexts, will be subject to different perspectives (Q29, Q30). Perspectives on Suffering and Clinical Improvement On the understanding of suffering and clinical possibilities in the face of substance abuse, it is worth reinforcing the participants' restriction on terms established in the group. Therefore, we do not mention ' diagnosis ' and ' treatment ' here, as these terms were rejected. However, it is also important to note that, at certain moments in the group, even with the refusal of terms, words like ' addiction ' and ' disease ' still appeared in some statements. When seeking the group's perspective on why someone has a problem with substance use, this is where the greatest tensions were found (Q31, Q32) However, both lines of thought converge when considering that substance abuse is related to a loss of autonomy (Q33, Q34, Q35). They understand that the restoration of this autonomy must come through the formation of a bond that allows access to the person's life story, and within this life story, it would then be possible to find the possibility of building autonomy. The bond is understood as an element of acceptance that ensures the user's adherence to the care offered (Q36). From this adherence, they hope to be able to listen attentively to the person's entire life story (Q37). On the other hand, the group also raises criticism about the impossibility of knowing an individual's entire story, which would make it impossible to find any determining factor in this story that conditions the problem with substance use (Q38). Discussion In light of the points identified in this group, it is important to consider the implications of the perspectives presented by students seeking complementary education in the field of substance abuse when planning courses, projects, and related disciplines. Understanding how these students think can provide insights into why there are few specialists and professionals interested in the field of substance abuse. According to the literature, students perceive a gap in the teaching of substance abuse clinical practices in the regular curricula of health-related courses 28 – 30 , which may lead to feelings of insecurity and unpreparedness to deal with such situations, potentially causing them to avoid this specialization area. However, the group in question viewed this teaching gap as a motivating factor to seek specialization. Therefore, it is necessary to discuss which elements of experience determine why certain students move away from the field while others choose to pursue further depth and specialization. At this point, the role of previous personal experience becomes crucial. Substance use, whether in its abusive, recreational, or any other form of voluntary acute intoxication, has an omnipresent nature. It is important to recognize that virtually all students have had contact with someone who uses or has used substances throughout their lives, if not being users themselves. Thus, unlike the teaching of other clinical entities, when discussing substance abuse, there is no conceptual distance between the patient and the student, and the identification between these two figures is more intense than in any other topic in the field of mental health. Due to this strong identification, students tend to adopt a defensive and resistant stance in the face of ambivalence, being both subjects and objects of diagnosis, care, and stigmatization simultaneously. The construction of these defenses leads to conceptual crystallizations and blocks in thought processes. The degree of identification students have with the imagined type of substance user will define certain thought choices. These choices are not random. They are influenced by previous personal experiences, including how substances of abuse appeared in their lives, as well as how concepts were introduced and presented in their academic experiences and political contexts. The group's content reveals an association between biomedical thinking and exclusionary social practices. Thus, individuals in the ambivalent position of student-patient risk being both oppressors and oppressed, turning the bond into a potential source of crisis, rupture, and violence. In the teaching of substance abuse management, the presentation of scientific facts and the acceptance of students' anxieties regarding identification and bonding are inseparable. A fixation on conceptual lines with a defensive character is evident because certain terms are rejected and replaced by equivalents, and views on substance use are contested. Words like 'dependence', 'addiction', 'disease', and 'treatment' were occasionally used and promptly corrected. Despite recognizing cultural, social, and collective factors as primary determinants of substance abuse, the proposed approach often remained individual-based, focusing on seeking traumas and understanding life stories. This mismatch between a sociocultural etiological hypothesis and a biographical therapeutic method, placed on the ambivalence of the student-patient, presents the possibility of offering care to substance users as an area of potential frustration and personal risk. Therefore, when considering training programs in substance abuse management, it is essential to balance the theoretical approach to bonding and identification, political, cultural, and social factors, and the rational articulation between different lines of thought on etiology, care, and treatment. The approach and choice of words must be carefully considered to avoid unnecessarily activating defenses and resistances, which could drive students away from the field and hinder effective learning. Conclusion This study provides insights into the motivations and challenges faced by undergraduate healthcare students who choose to deepen their knowledge in the field of substance abuse management. The findings highlight the strong influence of personal experiences, such as family and social relationships, in shaping students' perceptions of substance use and its care practices. Students demonstrated a preference for harm reduction and community-based approaches, rejecting biomedical models and stigmatizing language. The results underscore the need for educational programs that address these personal and sociocultural contexts, ensuring a balanced approach between theoretical foundations and practical applications. By fostering an understanding of the collective determinants of substance use and prioritizing the development of empathetic, patient-centered care models, training programs can better equip future professionals to meet the complex needs of this population. Future research should explore larger and more diverse samples to generalize these findings and examine how educational interventions can impact students’ long-term attitudes and practices. This knowledge is crucial for addressing the current shortage of specialists in substance abuse management and for improving healthcare outcomes in this critical area. Declarations Disclosure The authors declare no conflicts of interest regarding the publication of this article. This research was conducted without external funding. All participants provided informed consent, and the study adhered to ethical guidelines established by the *DE-IDENTIFIED* . The study has been submitted and approved by the ethics committee under the number *DE-IDENTIFIED* . The researchers acknowledge the potential influence of their personal and professional backgrounds on the study’s design and analysis. Efforts were made to minimize bias through rigorous data collection and thematic analysis. Author Contribution A.R. designed the study, conducted data collection through focus groups, performed the thematic analysis, and wrote the main manuscript text. J.M.C.-M. contributed to the study design, provided guidance on methodology, supervised the analysis, and critically reviewed and revised the manuscript. Both authors approved the final version for publication. References Friedmann, P. D., Lemon, S. C., Stein, M. D. & D’Aunno, T. A. Accessibility of Addiction Treatment: Results from a National Survey of Outpatient Substance Abuse Treatment Organizations. Health Services Research 38 , 887–903 (2003). Weinstein, Z. M., Wakeman, S. E. & Nolan, S. Inpatient addiction consult service: Expertise for hospitalized patients with complex addiction problems. Med. Clin. North Am. 102 , 587–601 (2018). Hansagi, H., Engdahl, B. & Romelsjö, A. Predictors of repeated emergency department visits among persons treated for addiction. Eur. Addict. Res. 18 , 47–53 (2011). McDuff, D. R. et al. A Substance Abuse Consultation Service. Am. J. Addict. 6 , 256–265 (1997). Colpaert, K., De Maeyer, J., Broekaert, E. & Vanderplasschen, W. Impact of addiction severity and psychiatric comorbidity on the quality of life of alcohol-, drug- and dual-dependent persons in residential treatment. Eur. Addict. Res. 19 , 173–183 (2013). Cape, G., Hannah, A. & Sellman, D. A longitudinal evaluation of medical student knowledge, skills and attitudes to alcohol and drugs. Addiction 101 , 841–849 (2006). Weiss, R. D. Adherence to pharmacotherapy in patients with alcohol and opioid dependence. Addiction 99 , 1382–1392 (2004). Daigre, C. et al. Treatment retention and abstinence of patients with substance use disorders according to addiction severity and psychiatry comorbidity: A six-month follow-up study in an outpatient unit. Addict. Behav. 117 , 106832 (2021). Park, S. & Park, K. S. Family Stigma: A Concept Analysis. Asian Nurs. Res. (Korean Soc. Nurs. Sci.) 8 , 165–171 (2014). Mora-Ríos, J., Ortega-Ortega, M. & Medina-Mora, M. E. Addiction-Related Stigma and Discrimination: A Qualitative Study in Treatment Centers in Mexico City. Substance Use & Misuse 52 , 594–603 (2017). Renner, J. A., Karam-Hage, M., Levinson, M., Craig, T. & Eld, B. What Do Psychiatric Residents Think of Addiction Psychiatry as a Career? Acad. Psychiatry 33 , 139–142 (2009). Cazalis, A., Lambert, L. & Auriacombe, M. Stigmatization of people with addiction by health professionals: Current knowledge. A scoping review. Drug Alcohol Depend. Rep. 9 , 100196 (2023). van Boekel, L. C., Brouwers, E. P. M., van Weeghel, J. & Garretsen, H. F. L. Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. Drug Alcohol Depend. 131 , 23–35 (2013). Brondani, M. A., Alan, R. & Donnelly, L. Stigma of addiction and mental illness in healthcare: The case of patients’ experiences in dental settings. PLoS One 12 , e0177388 (2017). Avery, J. D. The stigma of addiction in the medical community. in The Stigma of Addiction 81–92 (Springer International Publishing, Cham, 2019). Dove, H. W. POSTGRADUATE EDUCATION AND TRAINING IN ADDICTION DISORDERS. Psychiatr. Clin. North Am. 22 , 481–488 (1999). Greenberg, W. M., Ritvo, J. I., Fazzio, L., Bridgeford, D. & Fong, T. A Survey of Addiction Training Programming in Psychiatry Residencies. Acad. Psychiatry 26 , 105–109 (2002). Ballon, B. C. & Skinner, W. ‘Attitude is a Little Thing That Makes a Big Difference’: Reflection Techniques for Addiction Psychiatry Training. Acad. Psychiatry 32 , 218–224 (2008). Mateus, M. D. et al. The mental health system in Brazil: Policies and future challenges. Int J Ment Health SystInternational Journal of Mental Health Systems 2 , 12 (2008). Barros, S. & Salles, M. Mental health care management in the Brazilian National Health System. Rev. Esc. Enferm. USP 45 Spec No 2 , 1780–1785 (2011). Trapé, T. L., Campos, R. O. & P., G. C. A. Mental health network: a narrative review study of the integration assistance mechanisms at the Brazilian National Health System. International Journal of Health Sciences 3 , 45–53 (2015). Paim, J., Travassos, C., Almeida, C., Bahia, L. & Macinko, J. The Brazilian health system: history, advances, and challenges. Lancet 377 , 1778–1797 (2011). Castro, M. C. et al. Brazil’s unified health system: the first 30 years and prospects for the future. Lancet 394 , 345–356 (2019). Sampaio, L. F. R. The Brazilian health system: highlighting the primary health care reform. Ital. J. Public Health (2010) doi:10.2427/5693. Brasil, M. da S. Portaria 3.088, de 23 de dezembro de 2011. https://bvsms.saude.gov.br/bvs/saudelegis/gm/2011/prt3088_23_12_2011_rep.html (2011). Amarante, P. & Torre, E. H. G. ‘Back to the city, Mr. citizen!’ — psychiatric reform and social participation: from institutional isolation to the anti-asylum movement. Rev. ADM 52 , 1090–1107 (2018). Matheus, B. T. The important role of academic leagues (extensions) in Brazilian medical education. Rev. Assoc. Med. Bras. 65 , 98–99 (2019). Klimas, J. & Cullen, W. Addressing a training gap through addiction research education for medical students: letter to the editor. Subst. Abus. 36 , 3–5 (2015). Einstein, S. The addiction dilemma: Gaps in knowledge, information-dissemination, service and training. Int. J. Addict. 4 , 25–44 (1969). Wood, E., Samet, J. H. & Volkow, N. D. Physician Education in Addiction Medicine. JAMA 310 , 1673–1673 (2013). Tables Table 1 - Research group Participant Age Gender Course Academic period Participant 1 25 Female Psychology 5th year Participant 2 21 Female Occupational Therapy 3rd year Participant 3 20 Male Psychology 3rd year Participant 4 20 Female Occupational Therapy 3rd year Participant 5 23 Male Psychology 5th year Participant 6 22 Female Occupational Therapy 4th year Participant 7 20 Male Medicine 2nd year Participant 8 22 Female Occupational Therapy 4th year Participant 9 25 Male Medicine 3rd year Table 2 - Quotations distribution among codes Code Quotations Code Quotations Academic Experience 8 Multidisciplinarity 1 Autonomy 10 Peer Influence 1 Bonds 4 Personal Impact 4 Cultural Activities 2 Prejudice 5 Culture 3 Religion 5 Curiosity 1 Romanticization 2 Early Contact 4 Social Class 11 Educational Gap 1 Stereotypes 3 Family 9 Terminology Restriction 7 Frustration 7 Theoretical Conflicts 15 Illness 3 Well-being 2 Life History 6 Table 3 - Codes distribution among categories Category Code Category Code Motivation to seek knowledge in the area of substance abuse Early Contact Collective determinants of substance use Social Class Curiosity Culture Academic Experience Stereotypes Family Prejudice Peer Influence Perspectives on suffering and clinical improvement Cultural Activities Educational Gap Autonomy Multidisciplinarity Well-being Pre-existing concepts and resistances Personal Impact Social Class Theoretical Conflicts Illness Stereotypes Academic Experience Frustration Life History Prejudice Religion Terminology Restriction Bonds Romanticization Table 4 Q1 I think, like everyone else, there are family issues that bring the first experience, the first knowledge of the existence of alcohol and other drugs, and dealing with people who are users and having the experience as a family, which I think is the most impactful part. Q2 [...] my grandfather had stomach cancer and then he died as a result of it. But when he went to the hospital, he wasn't treated because they said 'oh, you smoke crack, so it's because of crack, take a pill and go away'. So, it's like, you know, he had... well, to understand the drug user only as a drug user and the drug as the only issue there for the person. But on the other hand, my mother is a former cocaine user and she had care in freedom, therapy, well, it's not the only way to be cared for. And it was very significant to see her issue [...] Q3 In terms of family issues, I have relatives who have used substances, alcohol, especially because most of my family comes from a peripheral region, black people, so, especially in the past, people used substances a lot. Q4 A bit of family history, like, an old relative, grandparent, those things, and we realize how it affects our lives today, even though I've never met the person. Q5 As I grew up, I think I also had a lot of contact through friendships in school, well, because, you know, I think most of my friends were users of some kind of drug and I had very complicated situations with some of them. Q6 When I was a teenager, I had very close friends with very deep suffering and with this suffering also associated with substance use, which even brought me closer to psychology itself, talking to these friends and realizing that it was something I liked to do, I liked to listen to them. Q7 My interest in this area comes from adolescence because I grew up in a peripheral area, where I heard stories from people who were using substances, kind of to forget about misery, it was the scenario of that time. Q8 But, in terms of academics, I think in OT (occupational therapy), we see a lot about mental health issues, not so much about alcohol and drugs, but in mental health one thing leads to another. So, this semester, for example, I'm interning. We have a subject called Supervised Practices II, and this semester I'm going to CAPS Itaim Bibi, which is not a CAPS-AD, but it's an Adult-CAPS 1 So, even though we have mental health issues there, there are people there who use alcohol and other drugs, and one thing leads to another. Q9 Within the university, I think my biggest experience was in CAPS, Adult-CAPS. So, there were always cases of people using some substance, but it was never the focus of care there in that CAPS, you know? So, I joined the League more out of curiosity about what it's like to work with the focus, maybe, on this use and care. Q10 [...] it was mainly because I think it's a big gap in the psychology course, because we focus a lot on standardized institutional clinics and it's like a bubble of care. Q11 And then I saw this, or saw a kind of prohibitive religious bias, I said 'no, guys, you can use it.' Q12 [...] I tried to think that it's a good way to relate to it, to not be in this kind of Proerd 2 thing [...]. Q13 Last year I had contact with the mental health discipline, I had a very strong contact with the anti-asylum struggle, I joke with my colleagues that I'm addicted to the anti-asylum struggle, I almost only talk about it. Q14 And I think in the context of caring for people who abuse, you have to have, well, a lot of, think a lot about anti-asylum logic and also anti-punitive, to be able to produce this care. Q15 And I think I wanted to get out of this logic of trying to heal the person, trying to save the person, this paternalistic saving logic of healing, and I wanted to get more into a logic of really understanding the subjectivity that is shown there and understanding the reasons of the use, if it makes sense for that person and try to get out of this psychological desire that we know, that we have, to try to take the person out of the bottom of the pit, which might not be their bottom, maybe it's a cool pit for them to be in. Q16 This is also related to this thing of saviorism, that sometimes we put ourselves in this place of wanting to find a way out for the person, even though that's not necessarily why we're there. Q17 I don't like the term addiction, usually in OT, we talk about substance abuse, which we understand that not all substance use is abusive or problematic. Q18 I think using the word treatment already puts the person as if they were sick, you're the savior who will treat it 'wow, how beautiful, I treated'. I already find it strange, like, this paternalism. Q19 I think there's another issue too that relates to this, which is, sometimes the problems, well, are very big, right? What leads to use, sometimes, are situations that are very macro, and sometimes this can be a bit too much to deal with, so it ends up generating a bit of a feeling of being lost there in those things, because things are all very big, so it's hard to see some ways out. Q20 I think it's a powerlessness. Q21 Or, in the case of not... It is, I think it was very much about this, the frustrations that can arise from you because of how the other person will deal with it, right? If it will really be something important for the person and maybe it won't be, and that's it, we'll have to deal with it. Q22 I think something that can happen to me is to absorb the stories too much, most of them are stories of suffering, they are very intense stories, somehow, absorb this and not feel too bad. Q23 A friend said something that I don't know if it's good or bad, I found it extremely impactful, to treat, you go together with the person in madness, you dive together with them, to a certain extent, but you dive together to be able to help them in some way to get out. I find it very difficult to do this because in this thing of creating a bond with the person and having a relationship, even if it's in the consultation or in other ways, we are affected and it's very difficult to remove, many times, our prejudice, our bias about the situation. Q24 I think that's it, not to see the person with neutrality, because there is no such thing, but also not to take the risk of romanticizing this trajectory too much and end up getting even more frustrated. Q25 Sometimes I feel that I have a very... I don't know, that I'm afraid of romanticizing the situation too much, like, you know? Q26 And I think this is also an experience of talking to a person from a completely different background than mine, because I am from a very wealthy class. I don't know, I think the circle of opinions and things I hear often doesn't match reality. I wanted to see what it's like, and also have this contrast of seeing a person from a different background. Q27 [...] because I think the use of the term addiction, when someone reads it, depends a lot on what they think an addict is, the image they have. Generally, they refer to a stereotype, they usually associate it with the crack user living in the streets, anyway. It will be difficult, by the way, for a person like that to use this term with someone who is rich, white, and is using cocaine. You know, there's always... the speech always means something. Generally, the person is very biomedical when they get into this idea, ‘oh, the addict, whatever’, soon they come and they're calling them sick, like that. Q28 Who in the media is called an addict are black people, poor people, people on the street. These people are called addicts. As mentioned, a white middle-class person who has an abusive use will not appear in the media being called an addict. Q29 I think there are also many cultural factors, depending on the environment where you live, one substance is more normalized than the other. For example, alcohol, nowadays, in various scenarios, is a bit more freely accepted, in a calmer way, but sometimes a person is abusing it in that context and it's not perceived because it's not a focal substance. Q30 If that person is, for example, in a religious context, perhaps the use and abuse of substances in that context have a much lower threshold than in another context. Q31 It's the people who are sick, who are already in a bad state, and they use it to make their situation worse. Q32 There's a genetic factor, I don't know what percentage that influences. Q33 In my mind, the substance abuser is precisely a person who has lost their autonomy, who bases their decisions to sustain the addiction or that feeling. Q34 I think we need to see if they are suffering from this and if they want to treat the suffering. Not treat, sorry. I'll use another word. Q35 I also think that if abusive use is a loss of autonomy, a narrowing of possibilities, the objectives could be to restore that autonomy, sometimes to restore the possibility of critical thinking, reflection, redefining certain things, and also to broaden the person's horizon. Q36 Showing myself attentive, interested in this person's story, and wanting to know not only about this use but also about everything they want to tell me about. I think that bonding with the person makes a lot of difference in being able to have some adherence to care in the future [...] Q37 I think in my mind the first step is always to listen to this person's story about use and about their entire life story. Q38 But I also think that, like, then we go there and talk to a person who uses. They tell you their story and you can't identify it in their story. Because I also think it depends on how they subjectify all the situations they experience. [...] It's not like 'oh, I found a reason, so you use drugs because of this, so everything will get better.' Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6280092","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":433390005,"identity":"7a246734-3528-4387-b073-cf3ed2ed85cf","order_by":0,"name":"Artur Ramos","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxUlEQVRIiWNgGAWjYJADxgcg0oCwQmYEy4BkLWwSRGnhn33+mHQFwz153fb2Z9U8f+4wmEsfwK9F4lwym+QZhmLDbWfOmN3mbXvGYNmXQMCaM8xskg0MCYzbbuSw3eZtOMxgcIaADnmoFvttN9KfFfP8IUKLAVRL4rYbCWbMPGxEaDE8w2xs2WCQkAz0i7Hk3LZnPJY9BLTInWF8eLOhIsF22/H2hx/e/LkjZ85DQAvUeXDWAeI0IIMDJOsYBaNgFIyC4Q8AoZY+0gXzKjQAAAAASUVORK5CYII=","orcid":"","institution":"Universidade de São Paulo","correspondingAuthor":true,"prefix":"","firstName":"Artur","middleName":"","lastName":"Ramos","suffix":""},{"id":433390007,"identity":"0514d63a-bde1-4132-9154-36263511ddee","order_by":1,"name":"João Maurício Castaldelli-Maia","email":"","orcid":"","institution":"Universidade de São Paulo","correspondingAuthor":false,"prefix":"","firstName":"João","middleName":"Maurício","lastName":"Castaldelli-Maia","suffix":""}],"badges":[],"createdAt":"2025-03-21 20:08:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6280092/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6280092/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84076381,"identity":"afa21a5f-0ec7-4861-8d4c-ecf32470c11d","added_by":"auto","created_at":"2025-06-06 13:17:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4750763,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6280092/v1/7e7d4a9e-adaa-4dd2-8bd9-0078614f5c56.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploring Motivations and Challenges in Substance Abuse Education: Insights from Undergraduate Healthcare Students","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePeople who use psychoactive substances are present in healthcare services in various contexts. These patients are encountered in outpatient clinics\u003csup\u003e1\u003c/sup\u003e, hospital wards\u003csup\u003e2\u003c/sup\u003e, emergency units\u003csup\u003e3\u003c/sup\u003e, and are attended to by different types of specialists in these different settings\u003csup\u003e4\u003c/sup\u003e. As a result, professionals from various fields encounter individuals who present with the use of psychoactive substances not only as an aggravating factor of their specific clinical conditions but also as factors leading to poorer quality of life\u003csup\u003e5\u003c/sup\u003e, worse health indicators, and, above all, pose a challenge to establishing an effective care relationship\u003csup\u003e6\u003c/sup\u003e with the services due to various factors, including poor adherence to proposed treatments\u003csup\u003e7,8\u003c/sup\u003e; stigma from family members\u003csup\u003e9,10\u003c/sup\u003e, community members, and healthcare professionals\u003csup\u003e11\u0026ndash;15\u003c/sup\u003e; poor understanding of psychopathology, cultural and social factors, and the influence of individual life histories on the development of the clinical picture by care teams\u003csup\u003e16,17\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eDespite the high health impact caused by substance use, few healthcare professionals choose to specialize in this area\u003csup\u003e6,17\u003c/sup\u003e, leading to a shortage of trained and specialized professionals to treat this type of patient. Furthermore, education and training in substance use management are poorly systematized, resulting in the necessary competencies for the training, whether of the generalist or specialist professional, not being well-established\u003csup\u003e11\u003c/sup\u003e. Consequently, the training of professionals \u0026ndash; and supervisors and teachers \u0026ndash; is variable and mostly encompasses competencies involving the pharmacological management of withdrawal syndromes, intoxication, and other aspects of acute crises\u003csup\u003e6\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eEven in large training centers, students\u0026apos; contact with substance users typically occurs in contexts where use is considered a comorbidity and is addressed secondarily\u003csup\u003e6\u003c/sup\u003e, thus constituting a complicating health problem in services, sometimes approached from the perspective of morality and deviation of virtue, so that throughout medical training, the stigma surrounding substance users grows among students.\u003c/p\u003e\n\u003cp\u003eIn general, little time in medical training is spent in longitudinal contact with substance users in non-crisis contexts\u003csup\u003e11,16\u003c/sup\u003e, focusing on factors involving use, associated social and cultural conditions, or even psychological factors and ways of establishing relationships with these individuals\u003csup\u003e17\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003ePreliminary studies have shown that brief interventions involving reflections on personal experience in a service dedicated to the treatment of substance users\u003csup\u003e18\u003c/sup\u003e, or the creation of a consultation service aimed at providing a direct approach to use\u003csup\u003e4\u003c/sup\u003e, have brought significant impacts on the understanding of use, reduction of stigma by the professionals involved, and even improvement in the health team\u0026apos;s relationships with the patient.\u003c/p\u003e\n\u003cp\u003eTherefore, it is essential to build a field of knowledge that allows the formation of care and training services where undergraduate students in healthcare areas can develop broader competencies to reduce the impact of substance use on the healthcare system\u003csup\u003e11,16,18\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eIn the Brazilian scenario, substance users care predominantly occurs in services of the Psychosocial Care Network (RAPS)\u003csup\u003e19\u0026ndash;21\u003c/sup\u003e, mental health care branch of the Unified Health System (SUS)\u003csup\u003e22\u0026ndash;24\u003c/sup\u003e, the country\u0026apos;s public health system. The Brazilian RAPS was established by a decree from the Ministry of Health in December 2011\u003csup\u003e25\u003c/sup\u003e, after decades of political action by civil society in the Anti-Asylum Movement\u003csup\u003e26\u003c/sup\u003e. In this network, the Alcohol and Other Drugs Psychosocial Care Centers (CAPS-AD) play a central role; they are reference services for substance abuse treatment and are configured as community services, emphasizing care in liberty, group interventions, and territorial regional work. Within this context, specific strategies for teaching substance abuse management need to be considered to allow healthcare professionals to specialize in substance user care and for them to join the CAPS-AD work teams.\u003c/p\u003e\n\u003cp\u003eFollowing a tradition dating back to the early 20th century, at the \u003cstrong\u003e*DE-IDENTIFIED*\u003c/strong\u003e, students organized themselves to propose an Academic League project where it would be possible to address the gap in chronic substance abuse management education at the university. Academic Leagues are groups of volunteer students who provide assistance for a specific health problem of their interest, supervised by a professor chosen by them\u003csup\u003e27\u003c/sup\u003e. Thus, the \u003cstrong\u003e*DE-IDENTIFIED*\u003c/strong\u003e began at the \u003cstrong\u003e*DE-IDENTIFIED*\u003c/strong\u003e from the mobilization of medicine students to develop skills in a service for substance users.\u003c/p\u003e\n\u003cp\u003eInitially, this project was organized as an outpatient service where students could attend to patients with substance use demands longitudinally, in pairs.\u003c/p\u003e\n\u003cp\u003eTo overcome the initial limitations of the project, the \u003cstrong\u003e*DE-IDENTIFIED*\u003c/strong\u003e was reformed throughout the year 2021, in which new activities and approaches were proposed, expanding assistance and teaching possibilities. From these changes, the project was renamed as the \u003cstrong\u003e*DE-IDENTIFIED*\u003c/strong\u003e and began to include, in addition to outpatient care, weekly clinical meetings, interdisciplinary care with nursing, occupational therapy, and psychology professionals, and a didactic proposal developed to cover the knowledge of community care practiced in the CAPS-ADs.\u003c/p\u003e\n\u003cp\u003eThus, a potential field of investigation was created in this interdisciplinary project that brings together students from various areas with a particular interest in substance abuse management. That is, in this project, it is possible to investigate which factors are associated with the manifestation of a healthcare professional\u0026apos;s interest in substance abuse in such a way that there is interest in specialization in the field.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe study sample consisted of 10 students from various health-related courses, who joined the \u003cstrong\u003e*DE-IDENTIFIED*\u003c/strong\u003e in 2023. The selection process for joining the \u003cstrong\u003e*DE-IDENTIFIED*\u0026nbsp;\u003c/strong\u003einvolved an introductory course with six classes conducted over three days, followed by a theoretical exam on the concepts covered during the course. The classes addressed various basic concepts that guide the care of alcohol and other drug users in a community context. The selection exam included nine questions delivered to the students through an online questionnaire, and the 10 students with the best performance were selected to participate in the project throughout the year. The questions in this questionnaire covered topics such as the components and functioning of the Psychosocial Care Network in Brazil, the paradigms and epistemology of contemporary psychiatry, the Brazilian National Drug Policy, the objectives of psychosocial rehabilitation, the psychopathology of substance use, psychiatric anamnesis applied to substance users, the vulnerability of substance users, and public policies for addressing open drug use scenes in the city of \u003cstrong\u003e*DE-IDENTIFIED*\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eThe League\u0026rsquo;s activities began on April 26, 2023. All new participants met with the supervisors and the returning students who continued as volunteers in the project in a classroom within the \u003cstrong\u003e*DE-IDENTIFIED*\u003c/strong\u003e. Brief introductions were made, with each new member, supervisor, and returning member speaking briefly about themselves to facilitate introductions. Then, the League\u0026rsquo;s activities for the year were presented, guiding the new members on the care processes and services provided to substance users there. After this presentation, all new members were invited to participate in this study. The students were informed by the League\u0026rsquo;s coordinator that those interested in participating in the research should follow him to another room, where a focus group would be conducted to better understand their views on substance use, its psychopathology, and possible treatments. It was assured that there would be no punishment or sanctions for those who chose not to participate, and everyone was informed that the League\u0026rsquo;s other activities for the day were concluded, that there were no scheduled appointments, and that those not participating in the research project were free to leave.\u003c/p\u003e\n\u003cp\u003eOf the 10 students participating in the project, 9 agreed to participate in the research group. The distribution of age, gender, course, and academic period of the students is presented in the following table:\u003c/p\u003e\n\u003cp\u003eTable 1 - Research group\u003c/p\u003e\n\u003cp\u003eOnce inside the classroom where the focus group was to be held, the new members of the League settled in a circle, each on a chair, and the League coordinator once again explained the objectives of the study. The informed consent form was then distributed to all participants for them to sign and clarify any questions they might have. Since no questions were raised, the audio recording was initiated using a mobile phone and a computer, positioned at opposite ends of the room to capture the sound from two different sources, aiming to minimize recording issues and ensure intelligibility of the recorded speeches.\u003c/p\u003e\n\u003cp\u003eThe group was facilitated by the League coordinator himself, \u003cstrong\u003e*DE-IDENTIFIED*\u003c/strong\u003e who, at the time of the group session, was volunteering at the \u003cstrong\u003e*DE-IDENTIFIED*\u0026nbsp;\u003c/strong\u003eas the coordinator of this project, while also working as \u003cstrong\u003e*DE-IDENTIFIED*\u0026nbsp;\u003c/strong\u003ein \u003cstrong\u003e*DE-IDENTIFIED*\u003c/strong\u003e. This same coordinator had previously taught one of the classes in the introductory course mentioned earlier, with the topic \u0026lsquo;The Brazilian Psychiatric Reform and Psychosocial Care Centers\u0026rsquo;, and was an advocate for community-based treatment models for alcohol and drug users.\u003c/p\u003e\n\u003cp\u003eOn the other hand, the \u003cstrong\u003e*DE-IDENTIFIED*\u003c/strong\u003e is known for its research primarily in the areas of clinical psychiatry and neuropsychiatry, and it has \u003cstrong\u003e*DE-IDENTIFIED*\u003c/strong\u003e. Both the institution where the research was conducted and the profile of the researcher could be factors that influence the opinions and views expressed during the group discussion.\u003c/p\u003e\n\u003cp\u003eAfter the recording started, the researcher began data collection with the following trigger questions, which were presented gradually throughout the group session. A new question was only introduced when the group had fully discussed the previous one.\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cem\u003eWhat motivated you to join the League?\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eWhat difficulties do you imagine you might face when talking about chemical dependency?\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eWhat do you understand by chemical dependency?\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eWhat is a person with chemical dependency like?\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eDoes chemical dependency require treatment? Why?\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eWhat should be the goals of chemical dependency treatment?\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eHow does someone become chemically dependent?\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eWhat challenges does a healthcare professional need to face when dealing with a patient?\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eWhat do you consider most important in the relationship with a substance user?\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eDo you have any additional comments?\u003c/em\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eAfter the group session concluded, the students were dismissed from their activities and instructed to return the following week for the start of the League\u0026apos;s teaching and care activities. The audio recordings from the session were transcribed with the help of transcription software and the transcription was thoroughly reviewed by the researcher to ensure their accuracy to the content of the audio recordings.\u003c/p\u003e"},{"header":"Results and Findings","content":"\u003cp\u003eThe transcribed text was carefully read by the main researcher to reacquaint with the data contained within. From this preliminary reading, 28 relevant thematic codes were identified within the text. During a subsequent reading, the researcher highlighted 78 quotations, which were distributed among the codes as follows: \u003c/p\u003e\n\u003cp\u003eTable 2 - Quotations distribution among codes\u003c/p\u003e\n\n\u003cp\u003eThese codes were then grouped into four categories: motivation to seek knowledge in the area of substance abuse, pre-existing concepts and resistances, collective determinants of substance use, and perspectives on suffering and clinical improvement.\u003c/p\u003e\n\n\u003cp\u003eTable 3 - Codes distribution among categories\u003c/p\u003e\n\n\u003cp\u003eThe highlighted quotations were analyzed together for each of the categories, and the results are presented below.\u003c/p\u003e\n\u003ch3\u003eMotivation to seek knowledge in the field of substance abuse\u003c/h3\u003e\n\u003cp\u003eAmong the various factors that led students to seek knowledge about substance abuse management, the most frequent was the experience of having people who have or had substance abuse issues within their families. Students shared direct experiences involving first-degree relatives who had problems with substance use, some with treatment and others without, all of which impacted their personal experience to such an extent that it sparked curiosity and a desire to learn more about substance use disorders and the possibilities of care and treatment for these conditions (Q1). The experience of substance use within the family emerged in the group as a determining factor in shaping the perceptions that students bring regarding substance use and how care should be provided to people with these issues. The experiences of the treatment of their family members can be understood as either satisfactory or unsatisfactory from this familial perspective, prior to the perspective of a healthcare professional (Q2).\u003c/p\u003e\n\u003cp\u003eNot only did this clinical understanding of different approaches to substance use prove to be influenced by family experiences, but also the perception of the determining factors that categorize a person as having a substance use disorder. Thus, collective and social issues were highlighted in the students\u0026apos; perspectives, overshadowing the biomedical understanding of addiction (Q3). All these influences from family experiences are sustained by the interest that students demonstrate in the area even when the family experience is indirect (Q4).\u003c/p\u003e\n\u003cp\u003eThe awakening of interest in the clinic of substance abuse emerged in the group through other early forms of contact with substance users beyond the family, such as friendships during adolescence, which also emerged as motivating factors for seeking knowledge (Q5). As we observed in relationships with family members, relationships with friends also contributed to the construction of the image that students brought of a person who abuses substances as someone determined by previous suffering and social issues (Q6, Q7)\u003c/p\u003e\n\u003cp\u003eFollowing early contact with substance users in the family and in adolescent social circles, the second most frequent reason presented by students for their motivation to deepen their knowledge in the clinic of substance abuse was their previous experience in mental health within their respective regular courses, especially concerning practical internships in non-specific areas for substance abuse. This is because students perceived strong influences of substance use on other mental health issues, as exacerbating psychological symptoms or as a confounding agent in diagnoses, or even as a component left in the background in therapeutic approaches (Q8, Q9). Within this context of previous academic experience, some students pointed out that not having substance use as the focus of clinical approach was a weakness in the curriculum of their courses, and the desire to seek additional education also comes in filling this gap (Q10).\u003c/p\u003e\n\u003ch3\u003ePre-existing concepts and resistances\u003c/h3\u003e\n\u003cp\u003eIn the group, there was a clear manifestation of a series of preconceptions regarding the clinic of substance abuse and its different lines of thought, which significantly impacted the students\u0026apos; openness to possible discussions, particularly a juxtaposition between the biomedical view of the issue and social perspectives. The promotion of abstinence was rejected as an asylum practice, while harm reduction, along with the community logic of care in freedom, appeared as the most accepted care approaches. This divergence of lines of thought became even clearer due to the fact that the League took place in a psychiatry institute of a large teaching hospital, which stands out for its biomedical research. Therefore, students expressed apprehension about the work that could be developed in the project, resisting a possible biomedical approach.\u003c/p\u003e\n\u003cp\u003eThe promotion of abstinence, as a treatment approach, appeared in the students\u0026apos; conceptions associated with Christian religious behavior and police punitivism (Q11, Q12). On the other hand, harm reduction was understood as an alternative form, disconnected from religious or punitive influence, of establishing a care model associated with the anti-asylum struggle (Q13, Q14). Resistance to certain theoretical guidelines also manifested as concern regarding paternalism and saviorism. The possibility of delving into a clinic of substance abuse was accompanied by a desire for a deeper and more complex understanding of the subjects\u0026apos; suffering (Q15, Q16).\u003c/p\u003e\n\u003cp\u003eThe theoretical resistances demonstrated by the students in the group had their most concrete manifestation in a recurrent restriction on the use of certain terms that, from their perspective, would be associated with the lines of thought to which they resisted, especially the biomedical approach. Thus, terms like \u0026apos;addiction\u0026apos; and \u0026apos;treatment\u0026apos;, whenever mentioned, were promptly rejected by the group and replaced by other forms such as \u0026apos;substance abuse\u0026apos; and \u0026apos;care\u0026apos;, respectively (Q17, Q18)\u003c/p\u003e\n\u003cp\u003eHowever, despite the theoretical preconceptions brought by the students being predominantly in the direction of resistance to the idea of cure, when they address their apprehensions regarding caring for substance users, the most frequent concern relates to the possibility of frustration (Q19, Q20, Q21). In addition to the possibility of frustration, students also worried about the risk of personal affectation when dealing with issues related to substance use (Q22, Q23). Frustration, in turn, appears as a possibility in the face of a romanticization of a certain clinic that students bring as preconceived and ideal. And during the group, the students themselves express this possibility (Q24, Q25).\u003c/p\u003e\n\u003ch3\u003eCollective Determinants of Substance Use\u003c/h3\u003e\n\u003cp\u003eRegarding the views presented by the students about substance abuse in relation to its characteristics and etiological determinants, collective determinants such as culture, social class, race, and gender stood out. Some students presented these factors based on an identification with substance users, seeing themselves as belonging to the same social groups as these individuals; others presented a curious external perspective, based on the idea of being in a different social organization than that of the patients. Either way, the user was described as a person who, due to their social conditions, suffers (Q26, Q27, Q28)\u003c/p\u003e\n\u003cp\u003eThus, it is possible to see in the students\u0026apos; speeches the fixation of the idea that substance use is directly related to less privileged social groups and that resisting certain clinical models correlates, in their view, with resisting the social behavior of excluding these groups. Therefore, the biomedical speech and the promotion of abstinence acquire, in the students\u0026apos; view, not only asylum characteristics but also racist, elitist, and sexist ones. In this way, the different substances of abuse, in different contexts, will be subject to different perspectives (Q29, Q30).\u003c/p\u003e\n\n\u003cp\u003ePerspectives on Suffering and Clinical Improvement\u003c/p\u003e\n\u003cp\u003eOn the understanding of suffering and clinical possibilities in the face of substance abuse, it is worth reinforcing the participants\u0026apos; restriction on terms established in the group. Therefore, we do not mention \u0026apos;\u003cem\u003ediagnosis\u003c/em\u003e\u0026apos; and \u0026apos;\u003cem\u003etreatment\u003c/em\u003e\u0026apos; here, as these terms were rejected. However, it is also important to note that, at certain moments in the group, even with the refusal of terms, words like \u0026apos;\u003cem\u003eaddiction\u003c/em\u003e\u0026apos; and \u0026apos;\u003cem\u003edisease\u003c/em\u003e\u0026apos; still appeared in some statements. When seeking the group\u0026apos;s perspective on why someone has a problem with substance use, this is where the greatest tensions were found (Q31, Q32)\u003c/p\u003e\n\u003cp\u003eHowever, both lines of thought converge when considering that substance abuse is related to a loss of autonomy (Q33, Q34, Q35). They understand that the restoration of this autonomy must come through the formation of a bond that allows access to the person\u0026apos;s life story, and within this life story, it would then be possible to find the possibility of building autonomy. The bond is understood as an element of acceptance that ensures the user\u0026apos;s adherence to the care offered (Q36). From this adherence, they hope to be able to listen attentively to the person\u0026apos;s entire life story (Q37).\u003c/p\u003e\n\u003cp\u003eOn the other hand, the group also raises criticism about the impossibility of knowing an individual\u0026apos;s entire story, which would make it impossible to find any determining factor in this story that conditions the problem with substance use (Q38).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn light of the points identified in this group, it is important to consider the implications of the perspectives presented by students seeking complementary education in the field of substance abuse when planning courses, projects, and related disciplines. Understanding how these students think can provide insights into why there are few specialists and professionals interested in the field of substance abuse.\u003c/p\u003e \u003cp\u003eAccording to the literature, students perceive a gap in the teaching of substance abuse clinical practices in the regular curricula of health-related courses\u003csup\u003e\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e, which may lead to feelings of insecurity and unpreparedness to deal with such situations, potentially causing them to avoid this specialization area. However, the group in question viewed this teaching gap as a motivating factor to seek specialization. Therefore, it is necessary to discuss which elements of experience determine why certain students move away from the field while others choose to pursue further depth and specialization.\u003c/p\u003e \u003cp\u003eAt this point, the role of previous personal experience becomes crucial. Substance use, whether in its abusive, recreational, or any other form of voluntary acute intoxication, has an omnipresent nature. It is important to recognize that virtually all students have had contact with someone who uses or has used substances throughout their lives, if not being users themselves. Thus, unlike the teaching of other clinical entities, when discussing substance abuse, there is no conceptual distance between the patient and the student, and the identification between these two figures is more intense than in any other topic in the field of mental health.\u003c/p\u003e \u003cp\u003eDue to this strong identification, students tend to adopt a defensive and resistant stance in the face of ambivalence, being both subjects and objects of diagnosis, care, and stigmatization simultaneously. The construction of these defenses leads to conceptual crystallizations and blocks in thought processes. The degree of identification students have with the imagined type of substance user will define certain thought choices.\u003c/p\u003e \u003cp\u003eThese choices are not random. They are influenced by previous personal experiences, including how substances of abuse appeared in their lives, as well as how concepts were introduced and presented in their academic experiences and political contexts. The group's content reveals an association between biomedical thinking and exclusionary social practices. Thus, individuals in the ambivalent position of student-patient risk being both oppressors and oppressed, turning the bond into a potential source of crisis, rupture, and violence. In the teaching of substance abuse management, the presentation of scientific facts and the acceptance of students' anxieties regarding identification and bonding are inseparable.\u003c/p\u003e \u003cp\u003eA fixation on conceptual lines with a defensive character is evident because certain terms are rejected and replaced by equivalents, and views on substance use are contested. Words like 'dependence', 'addiction', 'disease', and 'treatment' were occasionally used and promptly corrected. Despite recognizing cultural, social, and collective factors as primary determinants of substance abuse, the proposed approach often remained individual-based, focusing on seeking traumas and understanding life stories. This mismatch between a sociocultural etiological hypothesis and a biographical therapeutic method, placed on the ambivalence of the student-patient, presents the possibility of offering care to substance users as an area of potential frustration and personal risk.\u003c/p\u003e \u003cp\u003eTherefore, when considering training programs in substance abuse management, it is essential to balance the theoretical approach to bonding and identification, political, cultural, and social factors, and the rational articulation between different lines of thought on etiology, care, and treatment. The approach and choice of words must be carefully considered to avoid unnecessarily activating defenses and resistances, which could drive students away from the field and hinder effective learning.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides insights into the motivations and challenges faced by undergraduate healthcare students who choose to deepen their knowledge in the field of substance abuse management. The findings highlight the strong influence of personal experiences, such as family and social relationships, in shaping students' perceptions of substance use and its care practices. Students demonstrated a preference for harm reduction and community-based approaches, rejecting biomedical models and stigmatizing language.\u003c/p\u003e \u003cp\u003eThe results underscore the need for educational programs that address these personal and sociocultural contexts, ensuring a balanced approach between theoretical foundations and practical applications. By fostering an understanding of the collective determinants of substance use and prioritizing the development of empathetic, patient-centered care models, training programs can better equip future professionals to meet the complex needs of this population.\u003c/p\u003e \u003cp\u003eFuture research should explore larger and more diverse samples to generalize these findings and examine how educational interventions can impact students\u0026rsquo; long-term attitudes and practices. This knowledge is crucial for addressing the current shortage of specialists in substance abuse management and for improving healthcare outcomes in this critical area.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eDisclosure\u003c/h2\u003e\n\u003cp\u003eThe authors declare no conflicts of interest regarding the publication of this article. This research was conducted without external funding. All participants provided informed consent, and the study adhered to ethical guidelines established by the \u003cstrong\u003e*DE-IDENTIFIED*\u003c/strong\u003e. The study has been submitted and approved by the ethics committee under the number \u003cstrong\u003e*DE-IDENTIFIED*\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eThe researchers acknowledge the potential influence of their personal and professional backgrounds on the study\u0026rsquo;s design and analysis. Efforts were made to minimize bias through rigorous data collection and thematic analysis.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA.R. designed the study, conducted data collection through focus groups, performed the thematic analysis, and wrote the main manuscript text. J.M.C.-M. contributed to the study design, provided guidance on methodology, supervised the analysis, and critically reviewed and revised the manuscript. Both authors approved the final version for publication.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFriedmann, P. D., Lemon, S. C., Stein, M. D. \u0026amp; D\u0026rsquo;Aunno, T. A. Accessibility of Addiction Treatment: Results from a National Survey of Outpatient Substance Abuse Treatment Organizations. \u003cem\u003eHealth Services Research\u003c/em\u003e \u003cstrong\u003e38\u003c/strong\u003e, 887\u0026ndash;903 (2003).\u003c/li\u003e\n\u003cli\u003eWeinstein, Z. M., Wakeman, S. E. \u0026amp; Nolan, S. Inpatient addiction consult service: Expertise for hospitalized patients with complex addiction problems. \u003cem\u003eMed. Clin. North Am.\u003c/em\u003e \u003cstrong\u003e102\u003c/strong\u003e, 587\u0026ndash;601 (2018).\u003c/li\u003e\n\u003cli\u003eHansagi, H., Engdahl, B. \u0026amp; Romelsj\u0026ouml;, A. Predictors of repeated emergency department visits among persons treated for addiction. \u003cem\u003eEur. Addict. Res.\u003c/em\u003e \u003cstrong\u003e18\u003c/strong\u003e, 47\u0026ndash;53 (2011).\u003c/li\u003e\n\u003cli\u003eMcDuff, D. R. \u003cem\u003eet al.\u003c/em\u003e A Substance Abuse Consultation Service. \u003cem\u003eAm. J. Addict.\u003c/em\u003e \u003cstrong\u003e6\u003c/strong\u003e, 256\u0026ndash;265 (1997).\u003c/li\u003e\n\u003cli\u003eColpaert, K., De Maeyer, J., Broekaert, E. \u0026amp; Vanderplasschen, W. Impact of addiction severity and psychiatric comorbidity on the quality of life of alcohol-, drug- and dual-dependent persons in residential treatment. \u003cem\u003eEur. Addict. Res.\u003c/em\u003e \u003cstrong\u003e19\u003c/strong\u003e, 173\u0026ndash;183 (2013).\u003c/li\u003e\n\u003cli\u003eCape, G., Hannah, A. \u0026amp; Sellman, D. A longitudinal evaluation of medical student knowledge, skills and attitudes to alcohol and drugs. \u003cem\u003eAddiction\u003c/em\u003e \u003cstrong\u003e101\u003c/strong\u003e, 841\u0026ndash;849 (2006).\u003c/li\u003e\n\u003cli\u003eWeiss, R. D. Adherence to pharmacotherapy in patients with alcohol and opioid dependence. \u003cem\u003eAddiction\u003c/em\u003e \u003cstrong\u003e99\u003c/strong\u003e, 1382\u0026ndash;1392 (2004).\u003c/li\u003e\n\u003cli\u003eDaigre, C. \u003cem\u003eet al.\u003c/em\u003e Treatment retention and abstinence of patients with substance use disorders according to addiction severity and psychiatry comorbidity: A six-month follow-up study in an outpatient unit. \u003cem\u003eAddict. Behav.\u003c/em\u003e \u003cstrong\u003e117\u003c/strong\u003e, 106832 (2021).\u003c/li\u003e\n\u003cli\u003ePark, S. \u0026amp; Park, K. S. Family Stigma: A Concept Analysis. \u003cem\u003eAsian Nurs. Res. (Korean Soc. Nurs. Sci.)\u003c/em\u003e \u003cstrong\u003e8\u003c/strong\u003e, 165\u0026ndash;171 (2014).\u003c/li\u003e\n\u003cli\u003eMora-R\u0026iacute;os, J., Ortega-Ortega, M. \u0026amp; Medina-Mora, M. E. Addiction-Related Stigma and Discrimination: A Qualitative Study in Treatment Centers in Mexico City. \u003cem\u003eSubstance Use \u0026amp; Misuse\u003c/em\u003e \u003cstrong\u003e52\u003c/strong\u003e, 594\u0026ndash;603 (2017).\u003c/li\u003e\n\u003cli\u003eRenner, J. A., Karam-Hage, M., Levinson, M., Craig, T. \u0026amp; Eld, B. What Do Psychiatric Residents Think of Addiction Psychiatry as a Career? \u003cem\u003eAcad. Psychiatry\u003c/em\u003e \u003cstrong\u003e33\u003c/strong\u003e, 139\u0026ndash;142 (2009).\u003c/li\u003e\n\u003cli\u003eCazalis, A., Lambert, L. \u0026amp; Auriacombe, M. Stigmatization of people with addiction by health professionals: Current knowledge. A scoping review. \u003cem\u003eDrug Alcohol Depend. Rep.\u003c/em\u003e \u003cstrong\u003e9\u003c/strong\u003e, 100196 (2023).\u003c/li\u003e\n\u003cli\u003evan Boekel, L. C., Brouwers, E. P. M., van Weeghel, J. \u0026amp; Garretsen, H. F. L. Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. \u003cem\u003eDrug Alcohol Depend.\u003c/em\u003e \u003cstrong\u003e131\u003c/strong\u003e, 23\u0026ndash;35 (2013).\u003c/li\u003e\n\u003cli\u003eBrondani, M. A., Alan, R. \u0026amp; Donnelly, L. Stigma of addiction and mental illness in healthcare: The case of patients\u0026rsquo; experiences in dental settings. \u003cem\u003ePLoS One\u003c/em\u003e \u003cstrong\u003e12\u003c/strong\u003e, e0177388 (2017).\u003c/li\u003e\n\u003cli\u003eAvery, J. D. The stigma of addiction in the medical community. in \u003cem\u003eThe Stigma of Addiction\u003c/em\u003e 81\u0026ndash;92 (Springer International Publishing, Cham, 2019).\u003c/li\u003e\n\u003cli\u003eDove, H. W. POSTGRADUATE EDUCATION AND TRAINING IN ADDICTION DISORDERS. \u003cem\u003ePsychiatr. Clin. North Am.\u003c/em\u003e \u003cstrong\u003e22\u003c/strong\u003e, 481\u0026ndash;488 (1999).\u003c/li\u003e\n\u003cli\u003eGreenberg, W. M., Ritvo, J. I., Fazzio, L., Bridgeford, D. \u0026amp; Fong, T. A Survey of Addiction Training Programming in Psychiatry Residencies. \u003cem\u003eAcad. Psychiatry\u003c/em\u003e \u003cstrong\u003e26\u003c/strong\u003e, 105\u0026ndash;109 (2002).\u003c/li\u003e\n\u003cli\u003eBallon, B. C. \u0026amp; Skinner, W. \u0026lsquo;Attitude is a Little Thing That Makes a Big Difference\u0026rsquo;: Reflection Techniques for Addiction Psychiatry Training. \u003cem\u003eAcad. Psychiatry\u003c/em\u003e \u003cstrong\u003e32\u003c/strong\u003e, 218\u0026ndash;224 (2008).\u003c/li\u003e\n\u003cli\u003eMateus, M. D. \u003cem\u003eet al.\u003c/em\u003e The mental health system in Brazil: Policies and future challenges. \u003cem\u003eInt J Ment Health SystInternational Journal of Mental Health Systems\u003c/em\u003e \u003cstrong\u003e2\u003c/strong\u003e, 12 (2008).\u003c/li\u003e\n\u003cli\u003eBarros, S. \u0026amp; Salles, M. Mental health care management in the Brazilian National Health System. \u003cem\u003eRev. Esc. Enferm. USP\u003c/em\u003e \u003cstrong\u003e45 Spec No 2\u003c/strong\u003e, 1780\u0026ndash;1785 (2011).\u003c/li\u003e\n\u003cli\u003eTrap\u0026eacute;, T. L., Campos, R. O. \u0026amp; P., G. C. A. Mental health network: a narrative review study of the integration assistance mechanisms at the Brazilian National Health System. \u003cem\u003eInternational Journal of Health Sciences\u003c/em\u003e \u003cstrong\u003e3\u003c/strong\u003e, 45\u0026ndash;53 (2015).\u003c/li\u003e\n\u003cli\u003ePaim, J., Travassos, C., Almeida, C., Bahia, L. \u0026amp; Macinko, J. The Brazilian health system: history, advances, and challenges. \u003cem\u003eLancet\u003c/em\u003e \u003cstrong\u003e377\u003c/strong\u003e, 1778\u0026ndash;1797 (2011).\u003c/li\u003e\n\u003cli\u003eCastro, M. C. \u003cem\u003eet al.\u003c/em\u003e Brazil\u0026rsquo;s unified health system: the first 30 years and prospects for the future. \u003cem\u003eLancet\u003c/em\u003e \u003cstrong\u003e394\u003c/strong\u003e, 345\u0026ndash;356 (2019).\u003c/li\u003e\n\u003cli\u003eSampaio, L. F. R. The Brazilian health system: highlighting the primary health care reform. \u003cem\u003eItal. J. Public Health\u003c/em\u003e (2010) doi:10.2427/5693.\u003c/li\u003e\n\u003cli\u003eBrasil, M. da S. Portaria 3.088, de 23 de dezembro de 2011. https://bvsms.saude.gov.br/bvs/saudelegis/gm/2011/prt3088_23_12_2011_rep.html (2011).\u003c/li\u003e\n\u003cli\u003eAmarante, P. \u0026amp; Torre, E. H. G. \u0026lsquo;Back to the city, Mr. citizen!\u0026rsquo; \u0026mdash; psychiatric reform and social participation: from institutional isolation to the anti-asylum movement. \u003cem\u003eRev. ADM\u003c/em\u003e \u003cstrong\u003e52\u003c/strong\u003e, 1090\u0026ndash;1107 (2018).\u003c/li\u003e\n\u003cli\u003eMatheus, B. T. The important role of academic leagues (extensions) in Brazilian medical education. \u003cem\u003eRev. Assoc. Med. Bras.\u003c/em\u003e \u003cstrong\u003e65\u003c/strong\u003e, 98\u0026ndash;99 (2019).\u003c/li\u003e\n\u003cli\u003eKlimas, J. \u0026amp; Cullen, W. Addressing a training gap through addiction research education for medical students: letter to the editor. \u003cem\u003eSubst. Abus.\u003c/em\u003e \u003cstrong\u003e36\u003c/strong\u003e, 3\u0026ndash;5 (2015).\u003c/li\u003e\n\u003cli\u003eEinstein, S. The addiction dilemma: Gaps in knowledge, information-dissemination, service and training. \u003cem\u003eInt. J. Addict.\u003c/em\u003e \u003cstrong\u003e4\u003c/strong\u003e, 25\u0026ndash;44 (1969).\u003c/li\u003e\n\u003cli\u003eWood, E., Samet, J. H. \u0026amp; Volkow, N. D. Physician Education in Addiction Medicine. \u003cem\u003eJAMA\u003c/em\u003e \u003cstrong\u003e310\u003c/strong\u003e, 1673\u0026ndash;1673 (2013).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 - Research group\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"600\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipant\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCourse\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAcademic period\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eParticipant 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003ePsychology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e5th year\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eParticipant 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eOccupational Therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e3rd year\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eParticipant 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003ePsychology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e3rd year\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eParticipant 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eOccupational Therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e3rd year\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eParticipant 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003ePsychology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e5th year\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eParticipant 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eOccupational Therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e4th year\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eParticipant 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMedicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e2nd year\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eParticipant 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eOccupational Therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e4th year\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eParticipant 9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMedicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e3rd year\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 - Quotations distribution among codes\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"596\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 225px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCode\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuotations\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCode\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuotations\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 225px;\"\u003e\n \u003cp\u003eAcademic Experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp\u003eMultidisciplinarity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 225px;\"\u003e\n \u003cp\u003eAutonomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp\u003ePeer Influence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 225px;\"\u003e\n \u003cp\u003eBonds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp\u003ePersonal Impact\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 225px;\"\u003e\n \u003cp\u003eCultural Activities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp\u003ePrejudice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 225px;\"\u003e\n \u003cp\u003eCulture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp\u003eReligion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 225px;\"\u003e\n \u003cp\u003eCuriosity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp\u003eRomanticization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 225px;\"\u003e\n \u003cp\u003eEarly Contact\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp\u003eSocial Class\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 225px;\"\u003e\n \u003cp\u003eEducational Gap\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp\u003eStereotypes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 225px;\"\u003e\n \u003cp\u003eFamily\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp\u003eTerminology Restriction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 225px;\"\u003e\n \u003cp\u003eFrustration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp\u003eTheoretical Conflicts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 225px;\"\u003e\n \u003cp\u003eIllness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp\u003eWell-being\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 225px;\"\u003e\n \u003cp\u003eLife History\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 298px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 - Codes distribution among categories\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"602\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCode\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCode\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMotivation to seek knowledge in the area of substance abuse\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eEarly Contact\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCollective determinants of substance use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eSocial Class\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eCuriosity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eCulture\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eAcademic Experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eStereotypes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eFamily\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003ePrejudice\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003ePeer Influence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"9\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerspectives on suffering and clinical improvement\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eCultural Activities\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eEducational Gap\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eAutonomy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eMultidisciplinarity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eWell-being\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-existing concepts and resistances\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003ePersonal Impact\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eSocial Class\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eTheoretical Conflicts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eIllness\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eStereotypes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eAcademic Experience\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eFrustration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eLife History\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003ePrejudice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eReligion\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eTerminology Restriction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eBonds\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eRomanticization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 301px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 4\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"600\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eI think, like everyone else, there are family issues that bring the first experience, the first knowledge of the existence of alcohol and other drugs, and dealing with people who are users and having the experience as a family, which I think is the most impactful part.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003e[...] my grandfather had stomach cancer and then he died as a result of it. But when he went to the hospital, he wasn\u0026apos;t treated because they said \u0026apos;oh, you smoke crack, so it\u0026apos;s because of crack, take a pill and go away\u0026apos;. So, it\u0026apos;s like, you know, he had... well, to understand the drug user only as a drug user and the drug as the only issue there for the person. But on the other hand, my mother is a former cocaine user and she had care in freedom, therapy, well, it\u0026apos;s not the only way to be cared for. And it was very significant to see her issue [...]\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eIn terms of family issues, I have relatives who have used substances, alcohol, especially because most of my family comes from a peripheral region, black people, so, especially in the past, people used substances a lot.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eA bit of family history, like, an old relative, grandparent, those things, and we realize how it affects our lives today, even though I\u0026apos;ve never met the person.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eAs I grew up, I think I also had a lot of contact through friendships in school, well, because, you know, I think most of my friends were users of some kind of drug and I had very complicated situations with some of them.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eWhen I was a teenager, I had very close friends with very deep suffering and with this suffering also associated with substance use, which even brought me closer to psychology itself, talking to these friends and realizing that it was something I liked to do, I liked to listen to them.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eMy interest in this area comes from adolescence because I grew up in a peripheral area, where I heard stories from people who were using substances, kind of to forget about misery, it was the scenario of that time.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eBut, in terms of academics, I think in OT (occupational therapy), we see a lot about mental health issues, not so much about alcohol and drugs, but in mental health one thing leads to another. So, this semester, for example, I\u0026apos;m interning. We have a subject called Supervised Practices II, and this semester I\u0026apos;m going to CAPS Itaim Bibi, which is not a CAPS-AD, but it\u0026apos;s an Adult-CAPS\u003ca href=\"#_ftn1\" name=\"_ftnref1\" title=\"\"\u003e\u003csup\u003e\u003cstrong\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003c/sup\u003e\u003c/a\u003e So, even though we have mental health issues there, there are people there who use alcohol and other drugs, and one thing leads to another.\u003c/em\u003e\u003c/h4\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eWithin the university, I think my biggest experience was in CAPS, Adult-CAPS. So, there were always cases of people using some substance, but it was never the focus of care there in that CAPS, you know? So, I joined the League more out of curiosity about what it\u0026apos;s like to work with the focus, maybe, on this use and care.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003e[...] it was mainly because I think it\u0026apos;s a big gap in the psychology course, because we focus a lot on standardized institutional clinics and it\u0026apos;s like a bubble of care.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eAnd then I saw this, or saw a kind of prohibitive religious bias, I said \u0026apos;no, guys, you can use it.\u0026apos;\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003e[...] I tried to think that it\u0026apos;s a good way to relate to it, to not be in this kind of Proerd\u003ca href=\"#_ftn2\" name=\"_ftnref2\" title=\"\"\u003e\u003csup\u003e\u003cstrong\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/sup\u003e\u003c/a\u003e thing [...].\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eLast year I had contact with the mental health discipline, I had a very strong contact with the anti-asylum struggle, I joke with my colleagues that I\u0026apos;m addicted to the anti-asylum struggle, I almost only talk about it.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eAnd I think in the context of caring for people who abuse, you have to have, well, a lot of, think a lot about anti-asylum logic and also anti-punitive, to be able to produce this care.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eAnd I think I wanted to get out of this logic of trying to heal the person, trying to save the person, this paternalistic saving logic of healing, and I wanted to get more into a logic of really understanding the subjectivity that is shown there and understanding the reasons of the use, if it makes sense for that person and try to get out of this psychological desire that we know, that we have, to try to take the person out of the bottom of the pit, which might not be their bottom, maybe it\u0026apos;s a cool pit for them to be in.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eThis is also related to this thing of saviorism, that sometimes we put ourselves in this place of wanting to find a way out for the person, even though that\u0026apos;s not necessarily why we\u0026apos;re there.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eI don\u0026apos;t like the term addiction, usually in OT, we talk about substance abuse, which we understand that not all substance use is abusive or problematic.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eI think using the word treatment already puts the person as if they were sick, you\u0026apos;re the savior who will treat it \u0026apos;wow, how beautiful, I treated\u0026apos;. I already find it strange, like, this paternalism.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eI think there\u0026apos;s another issue too that relates to this, which is, sometimes the problems, well, are very big, right? What leads to use, sometimes, are situations that are very macro, and sometimes this can be a bit too much to deal with, so it ends up generating a bit of a feeling of being lost there in those things, because things are all very big, so it\u0026apos;s hard to see some ways out.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eI think it\u0026apos;s a powerlessness.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eOr, in the case of not... It is, I think it was very much about this, the frustrations that can arise from you because of how the other person will deal with it, right? If it will really be something important for the person and maybe it won\u0026apos;t be, and that\u0026apos;s it, we\u0026apos;ll have to deal with it.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eI think something that can happen to me is to absorb the stories too much, most of them are stories of suffering, they are very intense stories, somehow, absorb this and not feel too bad.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eA friend said something that I don\u0026apos;t know if it\u0026apos;s good or bad, I found it extremely impactful, to treat, you go together with the person in madness, you dive together with them, to a certain extent, but you dive together to be able to help them in some way to get out. I find it very difficult to do this because in this thing of creating a bond with the person and having a relationship, even if it\u0026apos;s in the consultation or in other ways, we are affected and it\u0026apos;s very difficult to remove, many times, our prejudice, our bias about the situation.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eI think that\u0026apos;s it, not to see the person with neutrality, because there is no such thing, but also not to take the risk of romanticizing this trajectory too much and end up getting even more frustrated.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eSometimes I feel that I have a very... I don\u0026apos;t know, that I\u0026apos;m afraid of romanticizing the situation too much, like, you know?\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eAnd I think this is also an experience of talking to a person from a completely different background than mine, because I am from a very wealthy class. I don\u0026apos;t know, I think the circle of opinions and things I hear often doesn\u0026apos;t match reality. I wanted to see what it\u0026apos;s like, and also have this contrast of seeing a person from a different background.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003e[...] because I think the use of the term addiction, when someone reads it, depends a lot on what they think an addict is, the image they have. Generally, they refer to a stereotype, they usually associate it with the crack user living in the streets, anyway. It will be difficult, by the way, for a person like that to use this term with someone who is rich, white, and is using cocaine. You know, there\u0026apos;s always... the speech always means something. Generally, the person is very biomedical when they get into this idea, \u0026lsquo;oh, the addict, whatever\u0026rsquo;, soon they come and they\u0026apos;re calling them sick, like that.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eWho in the media is called an addict are black people, poor people, people on the street. These people are called addicts. As mentioned, a white middle-class person who has an abusive use will not appear in the media being called an addict.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eI think there are also many cultural factors, depending on the environment where you live, one substance is more normalized than the other. For example, alcohol, nowadays, in various scenarios, is a bit more freely accepted, in a calmer way, but sometimes a person is abusing it in that context and it\u0026apos;s not perceived because it\u0026apos;s not a focal substance.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eIf that person is, for example, in a religious context, perhaps the use and abuse of substances in that context have a much lower threshold than in another context.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eIt\u0026apos;s the people who are sick, who are already in a bad state, and they use it to make their situation worse.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eThere\u0026apos;s a genetic factor, I don\u0026apos;t know what percentage that influences.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eIn my mind, the substance abuser is precisely a person who has lost their autonomy, who bases their decisions to sustain the addiction or that feeling.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eI think we need to see if they are suffering from this and if they want to treat the suffering. Not treat, sorry. I\u0026apos;ll use another word.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eI also think that if abusive use is a loss of autonomy, a narrowing of possibilities, the objectives could be to restore that autonomy, sometimes to restore the possibility of critical thinking, reflection, redefining certain things, and also to broaden the person\u0026apos;s horizon.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eShowing myself attentive, interested in this person\u0026apos;s story, and wanting to know not only about this use but also about everything they want to tell me about. I think that bonding with the person makes a lot of difference in being able to have some adherence to care in the future [...]\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eI think in my mind the first step is always to listen to this person\u0026apos;s story about use and about their entire life story.\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eQ38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 545px;\"\u003e\n \u003ch4\u003e\u003cem\u003eBut I also think that, like, then we go there and talk to a person who uses. They tell you their story and you can\u0026apos;t identify it in their story. Because I also think it depends on how they subjectify all the situations they experience. [...] It\u0026apos;s not like \u0026apos;oh, I found a reason, so you use drugs because of this, so everything will get better.\u0026apos;\u003c/em\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cdiv id=\"ftn2\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Health Education, Substance Abuse, Harm Reduction, Community Care, Healthcare Students","lastPublishedDoi":"10.21203/rs.3.rs-6280092/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6280092/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe widespread use of psychoactive substances challenges healthcare professionals in forming effective care relationships, yet there is a shortage of trained specialists in this area. A focus group (n\u0026thinsp;=\u0026thinsp;9) with undergraduate healthcare students from various disciplines involved in the \u003cb\u003e*DE-IDENTIFIED*\u003c/b\u003e in 2023 explored motivations, understandings, and treatment perspectives. Thematic analysis revealed that students\u0026rsquo; motivations stemmed from personal experiences with substance use in their families and social circles. Participants preferred harm reduction and community-based approaches, rejecting biomedical models and terms like \"addiction\". While emphasizing collective determinants such as social class, culture, and race, their therapeutic approaches often focused on individual-based interventions. Addressing personal experiences, conceptual resistances, and sociocultural contexts is essential in substance abuse education. Training should integrate theoretical and cultural factors to foster effective learning and specialization, although broader studies are needed to generalize these findings.\u003c/p\u003e","manuscriptTitle":"Exploring Motivations and Challenges in Substance Abuse Education: Insights from Undergraduate Healthcare Students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-01 11:35:54","doi":"10.21203/rs.3.rs-6280092/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4ed92cb8-87dd-46d3-a085-35d5fb276e25","owner":[],"postedDate":"April 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-06T13:08:50+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-01 11:35:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6280092","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6280092","identity":"rs-6280092","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}