Service User Perceptions of Addiction Treatment Services in Barcelona: Barriers, Gender, Stigma, Employment, and Recommendations for Improvement

Aim: As part of the development of Barcelona's new Action Plan on Drugs, this study explored the perceptions and experiences of individuals receiving outpatient and residential addiction treatment services, integrating service users' perspectives into service planning. Methods: A qualitative descriptive design was employed, utilizing five focus groups (three with women, two with men) involving a total of 37 participants from outpatient and residential addiction treatment services. Data were analysed using thematic content analysis. Results: Participants often initiated treatment during personal crises, primarily through self-referral. Women reported discomfort in mixed-gender treatment environments, highlighting feelings of unsafety and exposure to aggression. A pervasive sense of social and familial stigma was identified, with women disproportionately affected. Employment was viewed as critical to recovery, yet treatment programs often discouraged contact with prior environments, including those offering job opportunities. Conclusions: Participants recommended service improvements, including increased availability of residential placements, especially for women; expanded emergency support; greater coordination across services; specialized training for general practitioners; and gender-sensitive approaches to care. These findings underscore the need for user-informed, evidence-based, and gender-responsive addiction services to enhance treatment effectiveness and long-term recovery outcomes.