Insight in Opioid Use Disorder: A Person-Centered and Recovery-Oriented Reconceptualization

The United States is currently experiencing an "opioid epidemic" in which individuals are overdosing and experiencing opioid use disorder (OUD) at high rates (Lyden & Binswanger, 2019). Despite these mortality and morbidity rates, people with OUD have low service utilization rates. The present theoretical thesis aimed to explore potential reasons why people aren't seeking services by examining psychosocial and structural factors associated with insight, often defined as problem recognition and motivation to seek help. Literature on clinical insight and general mental health is first reviewed, highlighting the consistency of findings indicating that clinical insight can lead to depression and demoralization through increased stigma (e.g., Cavelti et al., 2012). Research on insight and substance use disorder (SUD) is then reviewed, which indicated that people with SUD face unique structural and social circumstances and barriers that can impact insight. Finally, this thesis proposes a person-centered, recovery-oriented reconceptualization of insight in OUD that broadens the scope of factors understood to impact insight. This reconceptualization also focuses on how opportunities for personal growth and perceptions of a fulfilling life and recovery in the future might be inherent to insight, with a recommendation for clinicians to initially focus on facilitating growth and perceptions of a fulling future, rather than insight as classically defined.