A
Ali Beheshti motlagh; mohammad narimani; Sajjad Basharpoor
Abstract
Objective: Substance use disorder is shaped by many factors, including biological, psychological, social, and cultural influences. Quantitative research has helped identify prevalence rates and common risk factors, but it often does not show how people themselves understand their first experiences with ...
Read More
Objective: Substance use disorder is shaped by many factors, including biological, psychological, social, and cultural influences. Quantitative research has helped identify prevalence rates and common risk factors, but it often does not show how people themselves understand their first experiences with substance use. This matters even more in contexts where substance use can feel “normal,” for example through family habits, peer influence, or misunderstandings about medical benefits. In Iran, substances have long been used not only for recreation but also as informal remedies for physical and emotional pain. For this reason, a phenomenological approach can offer a clearer view of how individuals make sense of early substance use and what meanings they attach to it. This study explored the lived experiences of individuals with substance use disorders, focusing on the factors that influenced how they first began using substances. It aimed to identify key themes and common patterns showing how personal, social, and psychological influences interact and shape early substance use. Method: This qualitative study used a phenomenological design based on Colaizzi’s method. Participants were recruited in 2023 from Narcotics Anonymous (NA) and Alcoholics Anonymous (AA) groups in Bojnord and Mashhad, Iran. In total, 121 men and women were selected through purposive sampling with maximum variation. We aimed for diversity in age, gender, educational level, socioeconomic status, and duration of abstinence. Recruitment continued until theoretical data saturation was reached. Data were collected through semi-structured, in-depth interviews. The interview guide was developed based on the study objectives and a review of relevant literature. It included open-ended questions about how participants began using substances, what they believed contributed to that decision, and what substance use meant to them at the time. During the interviews, probing questions were used to clarify points and encourage more detailed answers. Interviews were conducted face-to-face in safe locations agreed on by both sides and lasted 45 to 70 minutes. With informed consent, all interviews were audio-recorded and transcribed verbatim. Data analysis followed Colaizzi’s systematic seven-step approach. This included reading the transcripts several times, identifying significant statements, formulating meanings, clustering themes, and producing an exhaustive description of the phenomenon. To ensure rigor and trustworthiness, Lincoln and Guba’s criteria—credibility, dependability, confirmability, and transferability—were applied. Member checking, peer debriefing, and careful documentation of the analytic process were used to strengthen the findings. Results: The interview analysis identified three main themes and seventeen subthemes that reflect participants’ lived experiences of substance use initiation. Overall, the themes point to connected psychological, social, and contextual influences on early substance use. The subthemes were reported descriptively using qualitative frequency indicators (e.g., most participants, many participants, some participants), in line with qualitative research standards. The analysis produced three main themes: Pleasure-Seeking, Medical-Related Factors, and Internal and Psychological Problems. Participants often described starting substance use to experience pleasure, cope with emotional distress, manage physical pain, or gain social acceptance. Participants’ narratives showed that substance use often began in social or family settings where it was seen as normal. In these contexts, substances were sometimes viewed as harmless, useful, or even beneficial. Emotional deprivation, loneliness, and untreated psychological distress also appeared as especially important influences. Conclusion: The findings suggest that substance use initiation is a subjective, meaning-laden process shaped by pleasure-seeking motives, medical misconceptions, and unresolved psychological needs. These results highlight the need for prevention and relapse prevention programs that focus on emotional regulation, mental health awareness, and culturally embedded beliefs about substance use. Using individuals lived experiences to inform intervention design may improve the effectiveness of culturally sensitive and integrated prevention strategies.
