Motivators for help-seeking among people with opioid use disorder: An interpretative phenomenological analysis

A substantial proportion of individuals with opioid use disorder (OUD) never engage with specialist substance use treatment, despite strong evidence that treatment participation reduces overdose and mortality risk. Understanding the subjective experiences that drive or inhibit help-seeking may inform approaches that increase service engagement.

Using Interpretative Phenomenological Analysis (IPA), in-depth semi-structured interviews were conducted with six men currently attending a community drug treatment service in Bristol, UK. Interviews explored lived experiences of OUD and the personal meanings attached to seeking professional help. Audio-recorded interviews were transcribed verbatim and analysed following Smith, Flowers, and Larkin's idiographic procedures, progressing from line-by-line coding to subordinate and superordinate theme development.

Four overarching themes captured the help-seeking process: (1) addiction as a peer-facilitated and peer-maintained response to psychological vulnerability; (2) psychological inflexibility (the ability to be present, open to experiences, and act in accordance with one's values) and experiential avoidance (avoidance of uncomfortable internal experiences); (3) rejection of the addiction lifestyle as ego-dystonic (cognitions, behaviours, or impulses that are in conflict with one's personal values); and (4) the treatment service as a safe and supportive environment. Participants described trauma and loss preceding opioid initiation, strong social influences sustaining use, and ambivalence stemming from shame, guilt, and identity conflict. Help-seeking was motivated primarily by moral self-discrepancy and a wish to realign behaviour with valued roles and relationships.

Help-seeking among men with OUD was less a response to health risk than a turning point in personal identity reconstruction. Treatment services were valued as safe, accepting spaces that supported this transition. Clinical services could enhance engagement by fostering environments that promote belonging and psychological safety, and by incorporating interventions (e.g., motivational and acceptance-based therapies) that address shame, avoidance, and values conflict.