ArticleJournal of substance use and addiction treatment2025
Living with chronic structural vulnerability: A biopsychosocial-structural formulation of a patient exhibiting "medical noncompliance" in the setting of historical trauma and social suffering.
Article in Journal of substance use and addiction treatment, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThis qualitative case study explores the potential for operationalizing the social science framework of structural vulnerability through integrating it into the classic 4P model of biopsychosocial case formulation.
methodsThrough phenomenological analysis of data from a series of longitudinal in-depth interviews with the case study participant, a middle-aged Native American man recently initiated on buprenorphine-naloxone for opioid use disorder after undergoing below-the-knee leg amputation, the study developed a biopsychosocial-structural case formulation identifying predisposing, precipitating, perpetuating, and protective factors contributing to the participant's deteriorating health.
resultsKey findings from this case formulation facilitate reconceptualization of the participant's acute symptomology and high-risk behavior as manifestations of structural violence and historical trauma.
conclusionAdopting the diachronic approach inherent to the 4P factor model allowed for temporal expansion of analysis, which emphasizes the cumulative and compounding health effects of living with chronic structural vulnerability.
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