title: A qualitative study of treatment-seeking heroin users in contemporary China.
abstract: BACKGROUND
  Heroin has emerged as the primary drug of concern in China, with as many as three million contemporary users. Once a Chinese citizen has been identified by Chinese law enforcement as a 'drug addict', that individual is 'registered' in an official government tracking system for the rest of his or her life, independent of verified rehabilitation and recovery. Most of what is known about heroin users in China is based on studies of registered heroin users participating, often involuntarily, in government-sponsored treatment.
  
  
  METHODS
  Using Grounded Theory Methodology, we collected and analyzed in-depth interviews of heroin users voluntarily seeking treatment at a new, non-government-sponsored, for-profit, addiction treatment hospital in Beijing, China.
  
  
  RESULTS
  We identified three major themes among our participants: (1) intense social stigma towards individuals with drug addiction; (2) a desire for anonymous, confidential treatment to avoid social stigma and the loss of personal freedom that accompanies participation in government-sponsored treatment; and (3) a deep mistrust of government-sponsored treatment and a search for more effective alternatives.
  
  
  CONCLUSIONS
  Despite a desire for treatment, our subjects were reluctant to access government-sponsored treatment facilities because of fear of a stigmatized identity, fear of loss of personal freedom, and lack of faith in the efficacy and safety of government-sponsored treatments. Their willingness to pay cash at a new, non-government-sponsored, addiction treatment facility illustrates the lengths to which they will go to remain 'unregistered' and to discover better alternatives. That the Chinese government allows such facilities to operate outside of government surveillance suggests a new openness to alternative options to combat China's rising drug epidemic. The efficacy of these alternative options, however, remains in question.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, 94306, USA. alembke@stanford.edu.
authors.forename: Anna
authors.initials: A
authors.lastname: Lembke
authors.affiliation: Department of Neurology, Stanford University School of Medicine, Stanford, CA, 94306, USA. nzhang5@stanford.edu.
authors.forename: Niushen
authors.initials: N
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000068476:Beijing; D003219:Confidentiality; D005260:Female; D006556:Heroin Dependence / Q000523:psychology* / Q000628:therapy*; D016304:Hospitals, Private; D006779:Hospitals, Public; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D036301:Qualitative Research; D057545:Social Stigma; D016320:Substance Abuse Treatment Centers