title: Social and Structural Challenges to Drug Cessation Among Couples in Northern Mexico: Implications for Drug Treatment in Underserved Communities.
abstract: BACKGROUND
  Available drug treatment modalities may inadequately address social and structural contexts surrounding recovery efforts.
  
  
  METHODS
  This mixed methods analysis drew on (1) surveys with female sex workers and their intimate male partners and (2) semi-structured interviews with a subsample of 41 couples (n=82 individuals, 123 total interviews) in Northern Mexico. Descriptive and content analyses examined drug cessation and treatment experiences.
  
  
  RESULTS
  Perceived need for drug treatment was high, yet only 35% had ever accessed services. Financial and institutional barriers (childcare needs, sex-segregated facilities) prevented partners from enrolling in residential programs together or simultaneously, leading to self-treatment attempts. Outpatient methadone was experienced more positively, yet financial constraints limited access and treatment duration. Relapse was common, particularly when one partner enrolled alone while the other continued using drugs.
  
  
  CONCLUSIONS
  Affordable, accessible, evidence-based drug treatment and recovery services that acknowledge social and structural contexts surrounding recovery are urgently needed for drug-involved couples.
authors.affiliation: Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 4th floor, Boston, MA 02118, USA. Electronic address: abazzi@bu.edu.
authors.forename: Angela R
authors.initials: AR
authors.lastname: Bazzi
authors.affiliation: Department of Anthropology, The Ohio State University, 4046 Smith Laboratory, 174W. 18th Avenue, Columbus OH 43210, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Syvertsen
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla CA 92093-0507, USA; Facultad de Medicina, Universidad Xochicalco, Rampa Yumalinda 4850, Colonia Chapultepec Alamar C.P. 22540, Tijuana, Baja California, México.
authors.forename: María Luisa
authors.initials: ML
authors.lastname: Rolón
authors.affiliation: Federación Mexicana de Asociaciones Privadas, Plutarco Elías Calles No. 744 Norte, Col. Progresista, C.P. 32310, Ciudad Juárez, Chihuahua, México.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Martinez
authors.affiliation: Comisión de Salud Fronteriza México-Estados Unidos, Sección México, Paseo del Centenario #10851, Zona Río. C.P. 22010, Tijuana, Baja California, México; Secretaría de Salud, Homero 213, piso 19, Col. Chapultepec Morales, Delegación Miguel Hidalgo C.P. 11570, México, D.F.
authors.forename: Gudelia
authors.initials: G
authors.lastname: Rangel
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla CA 92093-0507, USA; Facultad de Medicina, Universidad Xochicalco, Rampa Yumalinda 4850, Colonia Chapultepec Alamar C.P. 22540, Tijuana, Baja California, México.
authors.forename: Alicia
authors.initials: A
authors.lastname: Vera
authors.affiliation: School of Social Work and Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Montgomery Ross Fisher Building, Room 221 669W. 34th St., Los Angeles, CA 90089.
authors.forename: Hortensia
authors.initials: H
authors.lastname: Amaro
authors.affiliation: Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla CA 92093-0849, USA; California School of Professional Psychology, Alliant International University-San Diego, San Diego, CA.
authors.forename: Monica D
authors.initials: MD
authors.lastname: Ulibarri
authors.affiliation: School of Medicine, University of California, Davis, 4610 X Street, Sacramento, CA 95817, USA.
authors.forename: Daniel O
authors.initials: DO
authors.lastname: Hernandez
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla CA 92093-0507, USA.
authors.forename: Steffanie A
authors.initials: SA
authors.lastname: Strathdee
mesh_terms: D000328:Adult; D005195:Family Relations; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008507:Medically Underserved Area; D008800:Mexico; D010342:Patient Acceptance of Health Care; D012309:Risk-Taking; D060386:Sex Workers; D012747:Sexual Partners / Q000523:psychology*; D015819:Substance Abuse, Intravenous / Q000191:economics / Q000534:rehabilitation*; D011795:Surveys and Questionnaires
keywords: Couples; Drug treatment; Drug use; Medication-assisted therapy; Methadone; Mexico