Intimate Partner Relationship Influence on Stigma on the Re-Entry Period for People with Opioid Use Disorder: Preliminary Qualitative Results from a Substance Use Disorder Treatment and Community Corrections Setting

Background and Significance: The year after release from incarceration can be an important intervention point for reducing recidivism and preventing accidental overdoses. People with opioid use disorder (OUD) face multiple levels of stigma, a variety of unmet needs, and repeated exposure to triggers (Binswanger et al., 2012; Moore et al., 2016). Positive post-release support can mitigate the stress of reentry and renewed exposure to environmental triggers (Binswanger et al., 2012). Conversely, negative post-release support can worsen recidivism and overall well-being (Fahmy & Wallace, 2019; Kjellstrand et al., 2022). While positive family relationships can moderate environmental stressors and provide motivation to participate in OUD treatment (Binswanger et al., 2012), the role of intimate partnerships can alleviate or exacerbate the effects of stigma. This paper explores how formerly incarcerated people in OUD treatment describe their intimate partner’s role in reducing or increasing the effects of stigma during the re-entry period. The following research questions were answered: 1) In what ways did participants perceive their intimate partner relationships as negative or positive forces in their re-entry period and OUD treatment?; and 2) What subthemes emerge in relation to participant perceptions of their partner’s role in worsening or lessening stigma?

Methods: Ten semi-structured interviews were conducted with individuals who have an OUD, have been released from incarceration in the past 12 months, and received services in a substance use disorder treatment/community corrections setting. Themes covered social support from significant others, recovery capital, and stigma during the times of pre-release, transitioning back into the community, and participation in OUD treatment and probation/parole. Interview transcripts were transcribed verbatim and explored thematically through rapid qualitative analysis.

Results: Thematic analysis of the qualitative interviews resulted in the identification of two negative support subthemes regarding intimate partners and stigma: stigma as means of control, being stigmatized as a trigger. Similarly, analysis resulted in two positive support subthemes: partners lessening the effects of stigma by encouragement, and partners advocating against stigma directed at the participants. Participants reported their intimate partner relationships as both highly negative and highly positive forces in their reentry and OUD treatment experiences. Negative partner relationships often described abuse and partners using shame about prior/current use to control the actions of the participant or influence them to return to use as a coping mechanism for stress or abuse. Positive partner relationships described partners who encouraged and held participants accountable to their recovery and reentry goals and partners who were willing to advocate for participants when faced with stigma in the community or familial settings.

Conclusion and Implications: Findings suggest that intimate partner relationships during re-entry and OUD treatment have the potential to shield the recently released person with OUD from the effects of stigma or further entrench them in stigma, even in their home environments. Future research will examine the integration of positive intimate partner relationships directly into OUD treatment as a path to reducing stigma and isolation during the re-entry period.