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An Exploration of the Relational Autonomy of People with Substance Use Disorders: Constraints and Limitations

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Abstract

The concept of relational autonomy was used to investigate how people with substance use disorders (SUDs) exercise their autonomy when using mental health services, according to stakeholders’ perspectives. A qualitative study, using a critical approach, was conducted with participants from a mental health service facility. We performed in-depth individual and group interviews with 15 participants, conducted observations, and analyzed patients’ records and service reports. People with SUDs’ autonomy were constrained by three relational dimensions: (a) the broader social context of coercion and its influence on the values and attitudes of stakeholders; (b) the oppressive systems and structures within the treatment setting; and (c) the limited personal capacity to exercise autonomy in people with SUDs. This work revealed the multidimensionality of people with SUDs’ limitations in exercising their autonomy within a mental health care setting. An understanding of autonomy as relational could promote reflection and stimulate innovation when approaching patients within these facilities.

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Acknowledgments

This study was supported by two Brazilian public funding agencies: (1) Health Ministry (SGTES/Pró-Saúde/PET-Saúde) document no. 24, December 15, 2011; and (2) Health Ministry (Decit/SCTIE/MS/CNPq/FAPAC/SESACRE) document no. 18/2013; 3) Education Ministry (CAPES) process no. 99999.010807/2014-04. The authors declare that they have no conflicts of interest to disclose. The views expressed in this article are entirely those of the authors and do not represent the view of any service, organization, or department.

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  1. Rozilaine Redi Lago

    Present address: Health Science and Sports Center, Federal University of Acre, Room no. 214, University Campus, BR 364 Road, Km 04, Industrial District, Rio Branco, AC, Brazil

Authors and Affiliations

  1. School of Public Health, University of São Paulo, São Paulo, Brazil

    Cláudia Maria Bógus

  2. L. S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada

    Elizabeth Peter

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Author Rozilaine Redi Lago has received three research grants, as follows: (1) Brazilian Health Ministry - SGTES/Pró-Saúde/PET-Saúde – document n. 24, December 15, 2011; (2) Brazilian Health Ministry - PPSUS MS/CNPq/FAPAC/SESACRE – document n.18/2013; and (3) Brazilian Education Ministry – CAPES Foundation – document no. 99999.10807/14-4. Rozilaine Redi Lago, Elizabeth Peter, and Cláudia Maria Bógus declare that they have no conflict of interest.

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

This article does not contain any studies with animals performed by any of the authors.

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Lago, R.R., Bógus, C.M. & Peter, E. An Exploration of the Relational Autonomy of People with Substance Use Disorders: Constraints and Limitations. Int J Ment Health Addiction 18, 277–292 (2020). https://doi.org/10.1007/s11469-018-9957-x

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