Amid the growth of addiction medicine randomized controlled trials (RCTs), scholars have begun examining participants’ study experiences, highlighting facilitators and barriers to enrollment. However, this work can overlook the interplay between trial participation and social-structural dimensions among people with substance use disorders linked to the social nature of use, socioeconomic marginalization, and time demands of substance procurement and use. To effectively conduct RCTs with this unique population, it is necessary to examine the broader social context of study participation. We conducted nested qualitative interviews with 22 participants involved in an RCT testing a treatment for alcohol and opioid use disorders in HIV clinics. Thematic analyses revealed social-structural circumstances shaping RCT participation as well as how participation constitutes a turning point, prompting individuals to reconfigure social networks, reorient to spatial environments, and reorganize day-to-day life—with implications for how substance use disorder RCTs should be approached by researchers.

随着成瘾药物随机对照试验 (RCT) 的发展，学者们开始研究参与者的学习经历，强调促进因素和入学障碍。然而，这项工作可能忽略了与物质使用的社会性质、社会经济边缘化以及物质采购和使用的时间需求相关的物质使用障碍患者的试验参与和社会结构维度之间的相互作用。为了有效地对这一独特人群进行随机对照试验，有必要检查参与研究的更广泛的社会背景。我们对参与随机对照试验的 22 名参与者进行了嵌套定性访谈，以测试 HIV 诊所中酒精和阿片类药物使用障碍的治疗方法。