Sociopolitical contexts for addiction recovery: Anexos in U.S. Latino communities

Abstract

Background Anexos are community-based recovery houses that were created in Mexico to serve people struggling with addiction to alcohol and other drugs. Brought to the U.S. by Mexican migrants, anexos provide residential care to primarily male Latino migrants and immigrants who are unable or unwilling to access formal treatment. While some Mexican anexos have come under fire for coercion, confrontational treatment methods, and corporal punishment, little is known about treatment practices in U.S. anexos. Methods We conducted a two-year ethnographic study of three anexos in urban Northern California. The study included over 150 hours of participant observation and semi-structured interviews with 42 residents, 3 directors, 2 assistant directors, and 3 former directors (N = 50). Qualitative data were analyzed thematically using ATLAS.ti software. Results The anexos in our study differed in important ways from Mexican anexos described in the scientific literature. First, we found no evidence of corporal punishment or coercive internment. Second, the anexos were open, allowing residents to leave the premises for work and other approved activities. Third, the anexos were self-supported through residents’ financial contributions. Fourth, collective decision-making processes observed in the California anexos more closely resembled sober living houses than their authoritarian counterparts in Mexico. Conclusion Anexos may operate differently in the U.S. versus Mexico due to variations in sociopolitical context. This exploratory study suggests that anexos are addressing unmet need for addiction treatment in U.S. Latino immigrant and migrant communities. As a community-created, self-sustained, culturally appropriate recovery resource, anexos provide important insights into Latino migrants’ and immigrants’ experiences with substance abuse, help-seeking trajectories, and treatment needs.

Violence narratives of Mexican women treated in mutual-aid residential centers for addiction treatment

“…Such episodes of gender violence against women are also common in different parts of Latin America because of the widespread misogynist gender culture. Other forms of structural violence in CRAMAAs have been reported elsewhere: rotten food, physical torture and harassment [15–17]. However, women live through permanent forms of sexual violence that is impregnated in psychological and physical abuse expressed in CRAMAAs.…”

“…Regarding violence within CRAMAAs, data showed that rules and norms are extremely endorsed within these centers, on occasions, leading to subtle and explicit expressions of violence against women [15, 17], which generated fear, a fear that stopped them from speaking up regarding being victims of any sort of violence, or about things that made them feel uncomfortable. This keeping quiet not only allowed women to not be singled out or located in further positions of subordination, but it also allowed reinforcing feminine stereotypes as passive and docile.…”

“…Many of these organizations in Mexico, denominated by Marín-Navarrete et al [14] as mutual-aid residential centers for addiction treatment (CRAMAA, for its acronym in Spanish), have based their interventions on interpretations of the twelve-step philosophy that gained popularity during the 80’s and 90’s [15]. These groups began to transform into centers that provided meetings 24 h a day, and later into residential centers for addiction treatment [15]. However, most of these centers operate outside the law, and hold their residents against their will [14, 16] and suffer from constant forms of violence [14, 16–18].…”

Sexually transmitted infections and substance use disorders: evidence and challenges in Mexico

“…Accordingly, the past 20 years have seen a growing offer of non-profits with more than 2000 self-help based residential centers. Pagano, García, Recarte & Lee 2016). It has also been documented that most of these residential centers lack the physical infrastructure and qualified professionals for proper patient care Pagano, García, Recarte & Lee, 2016), and in extreme cases, violations of patients' human rights have been reported (Lozano-Verduzco, Romero-Mendoza & Marín-Navarrete, 2016; Lozano-Verduzco, Marín-Navarrete, Romero-Mendoza & Tena-Suck, 2016).…”

“…Pagano, García, Recarte & Lee 2016). It has also been documented that most of these residential centers lack the physical infrastructure and qualified professionals for proper patient care Pagano, García, Recarte & Lee, 2016), and in extreme cases, violations of patients' human rights have been reported (Lozano-Verduzco, Romero-Mendoza & Marín-Navarrete, 2016; Lozano-Verduzco, Marín-Navarrete, Romero-Mendoza & Tena-Suck, 2016). This hampers the implementation of algorithms for early detection of STIs and reference and counter-reference procedures designed to reduce the treatment dropout due to the patient's navigation in a complex, divided health system.…”