Trade-offs in substitution treatment: a qualitative study of an opioid substitution therapy clinic as an enabling and a risk-environment

This article present results from a study of clients experiences of attending a substitution treatment clinic in Copenhagen, Denmark. The study is part of a research project about the everyday lives of marginalized drug users in Copenhagen, their risk environments and their access to formal and informal resources. Thirty-eight clients participated in structured interviews, covering topics concerning, drug use, income, housing, social relations, violence, use of health and social services. A risk environment/enabling environment framework was developed to analyze the data. The research shows that the methadone clinic give the clients access to different material, social and affective resources, but that access to resources often involve different trade-offs. Such trade-offs include accepting control or socializing with drug users to get access to substitution medicine. Some clients accept such trade-offs, others do not and choose find other ways to get resources, exposing themselves to potential harm. This means that the clinic can function as an enabling, constraining and a risky environment for different clients.