Social and Structural Challenges to Drug Cessation Among Couples in Northern Mexico: Implications for Drug Treatment in Underserved Communities

•Social and structural contexts shape drug cessation efforts and recovery success.•Little research has examined couples’ drug cessation in resource poor settings.•Drug-involved couples in urban Northern Mexico struggled to access drug treatment.•Institutional and financial barriers prevented partners from accessing treatment together.•Affordable, evidence-based outpatient services are needed for drug-using couples.

BackgroundAvailable drug treatment modalities may inadequately address social and structural contexts surrounding recovery efforts.MethodsThis mixed methods analysis drew on (1) surveys with female sex workers and their intimate male partners and (2) semi-structured interviews with a subsample of 41 couples (n = 82 individuals, 123 total interviews) in Northern Mexico. Descriptive and content analyses examined drug cessation and treatment experiences.ResultsPerceived need for drug treatment was high, yet only 35% had ever accessed services. Financial and institutional barriers (childcare needs, sex-segregated facilities) prevented partners from enrolling in residential programs together or simultaneously, leading to self-treatment attempts. Outpatient methadone was experienced more positively, yet financial constraints limited access and treatment duration. Relapse was common, particularly when one partner enrolled alone while the other continued using drugs.ConclusionsAffordable, accessible, evidence-based drug treatment and recovery services that acknowledge social and structural contexts surrounding recovery are urgently needed for drug-involved couples.