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Stigma and Social Vulnerability as Barriers to Integrated Care: The Importance of Family Medicine in the Context of Chemical Dependency

Emilly BARBOZA RASMUSSEN, Cely CAROLYNE PONTES MORCERF and João MAZZONCINI DE AZEVEDO MARQUES

Drug addiction and helplessness are strongly linked concepts shaping chemical dependence. Family medicine is crucial for understanding the determinants of mental suffering in psychosocial care and inpatient services, coordinating care through teaching and clinical actions.This report presents a study of three cases using the INTERMED tool to assess the impact of social determinants of health on the suffering and quality of life of patients with mental disorders in a Psychosocial Care Center. We also examined perceptions of social stigma regarding psychoactive substance use, mental health treatment, previous hospitalizations, and the influence of family and societal prejudice on patient engagement, treatment adherence, and changes in life perspective. All patients had physical, mental, and social multimorbidity and documented problems related to substance misuse. INTERMED was applied at the first consultation, and patients were evaluated three times during their stay in the mental health service. They were interviewed about the role of stigma in their lives, and all reported that societal prejudice created barriers to attempts at behavioral change, such as returning to work or school, improving lifestyle, and reducing chemical dependence. The study was approved by the Research Ethics Committee.This is a pioneering use of the INTERMED instrument to visualize the impact of social vulnerabilities and health-related stigma on the functioning of patients with severe mental disorders and substance use in the context of family medicine in Brazil.Mental suffering emerges from life histories marked by social and personal disruptions. The abusive use of drugs is linked to external stressors and the individual's capacity to manage stress and adopt behavioral changes that support quality of life and well-being.The INTERMED score above 20 indicated complexity due to interacting factors like chronic diseases, polypharmacy, and fragmented care. Stigma made patients feel devalued, leading to poor psychopharmacology adherence due to fear of dependence. They noted medication alone would not improve function. Fragile family structures, limited social support, poverty, housing issues, and difficulty accessing primary care contributed to disorganized care.Integrating mental health services into family medicine training and practice is highly relevant for strengthening health care through a biopsychosocial perspective.