In Mexico, community-based, non-biomedical treatment models for substance use are legally recognized in national drug policy, monitored by state-level Departments of Health, and in some cases publicly funded. Academic research on centers that utilize these forms of treatment have focused primarily on documenting their rapid spread and describing their institutional practices, particularly human rights abuses and lack of established biomedical efficacy. In Tijuana, these community-based therapeutic models are shaped by conceptions of health and illness from the local cultural context of the United States-Mexico border zone in ways that do not cleanly match western, biomedical notions of the illness “addiction.” In this article, I examine treatment ethics by exploring the contextually understood need for coerced treatment (i.e., why centers are locked) along with experiences of compulsion in a women’s 12 Step center. These discussions highlight the contested therapeutic value of coercion from multiple perspectives. Utilizing engaged listening around local care practices marks a path for global mental health researchers to understand and sit with difference in order to communicate across opposing viewpoints in the service of mental health equity and best care practices.

在墨西哥，基于社区的非生物医学药物滥用治疗模式在国家药物政策中得到法律认可，由州级卫生部监督，在某些情况下由公共资助。对利用这些治疗形式的中心的学术研究主要集中在记录其快速传播并描述其机构实践，特别是侵犯人权和缺乏既定的生物医学功效。在蒂华纳，这些基于社区的治疗模式是由美国-墨西哥边境地区当地文化背景的健康和疾病概念塑造的，其方式与西方生物医学对疾病“成瘾”的概念并不完全相符。在本文中，我通过探索背景理解的强制治疗需求（即为什么中心被锁定）以及在女性 12 步中心的强迫经历来审视治疗伦理。这些讨论从多个角度强调了强制的有争议的治疗价值。利用当地护理实践的参与式倾听，为全球心理健康研究人员理解和接受差异开辟了一条道路，以便在心理健康公平和最佳护理实践的服务中跨越相反的观点进行交流。