| dc.description.abstract | Research question and aim: My research question for this thesis is “How are people with opioid-use disorder impacted by and manage stigmatisation before and after entering heroin-assisted treatment?” My study aims to understand how people with opioid-use disorder (OUD) experience and manage stigmatisation, and whether and how being in HAT changes this. The objectives of the study are to explore 1) How the participants experience stigmatisa-tion, 2) How they manage stigmatisation, and 3) Whether and how being in HAT changes how they experience and manage stigmatisation. My study links the stigmatisation, social ex-clusion, and criminalisation of people who use drugs to Norway’s contemporary debate on whether hard drug use should be met with help or punishment, and I argue that having a knowledge base on the individual and social effectiveness of harm-reduction initiatives like HAT as alternatives to punitive drug policies is essential for criminology to partake in this de-bate. Theoretical framework: I use Goffman’s (1963) stigmatisation theory as my overarching theoretical perspective, supported by Sykes and Matza’s (1957) neutralisation theory. I define stigma as a trait that goes against the norms of a particular social group and by that leads to experiences of discrimination and social exclusion. The theories are used to gain an under-standing of the participants’ experiences with stigmatisation through analysis of their encoun-ters and awareness of it, and how stigmatisation is managed through analysis of their respons-es to it. Methods: My research is a qualitative study that took an inductive and iterative approach to-wards exploring the participants’ experiences and management of stigmatisation. I visited the HAT-clinic in Oslo somewhere between 15-20 times to conduct participant observation, inter-view the purposively sampled participants, and get insight from the staff on how the clinic works and who the patient group is. The interviews were audio-recorded, transcribed in f4transcript, and coded in NVivo. I used thematic analysis for the categorisation and coding of the data. The thematic analysis resulted in three themes that are linked with the study’s objectives, and are explored in chronological order through sub-themes. Data: Nine transcripts from interviews with patients that had been enrolled in the HAT-program in Oslo for 1-3 months. The participant group consists of six male and three female patients with OUD and the age group is 38-54 (average age 47). Seven of the participants in-ject the medication at the clinic in liquid form and two consume it in solid tablet form. Findings: Institutional stigma was experienced through rules and regulations in MAT and/or HAT that restrict the patients' agency, which further lead to the internalisation of stigma. Stigma was managed through neutralisation techniques that demonstrate control and rationali-ty, and symbolic boundaries that alter the perspectives on delinquent acts. The patient-centred approach in HAT has a mediating effect on how the participants experience stigma and facili-tates feelings of coherency to the conventional society, improved self-efficacy, and a positive self-perception. Overall, my findings suggest that HAT can be an effective harm-reduction strategy for mediating how patients are affected by stigmatisation, but that the patient-centred approach is an essential element of this success. Conclusion: Stigmatisation of norm-breaking individuals with substance-use disorders may have adverse consequences where the formation of sub-groups creates a community where deviant behaviour is accepted and contextually justified, which in turn can promote neutralisa-tions of guilt and shame related to delinquent behaviour. Stigmatisation may also reinforce expectations and fears of social exclusion and discrimination, which further promotes the use of neutralisation techniques that justify or rationalise deviant and/or delinquent behaviour be-fore, during, and after engagement. HAT challenges the stereotyped idea of a person who uses drugs as deviant, criminal, and dangerous and can reduce the impact of stigmatisation and facilitate successful recovery for people with OUD through a patient-centred approach where the staff play a key part in the patient’s recovery process. The medical discourse from seeing illicit drug use as a behavioural issue to a health issue also includes some critiques where this group’s challenges related to structural and social factors may be overlooked. In-creasing the public’s understanding of OUD may contribute to reducing the stigmatisation towards this group. | eng |