Decreasing the self-stigma of substance use disorder through disclosure and recovery narratives.

Substance use disorder is highly stigmatised despite its contemporary medicalisation. Because of the criminalisation of substance use, parents with substance use disorder must often navigate recovery while interacting with the criminal legal and child welfare systems. Restitution narratives of illness do not sufficiently capture the recovery experiences of parents with substance use disorder whose recoveries may better align with a quest narrative. This study uses qualitative photovoice discussion data to examine the recovery narratives constructed by parents with substance use disorder as they navigate institutional and interpersonal obligations. Using template analysis of 23 transcripts from photovoice group sessions with 29 individuals who have substance use disorder, we find that criminal legal system and child welfare system obligations limit participants' ability to fully engage in the recovery process. Carceral institutions act as a barrier to substance use recovery and parenting capacity by conferring punitive consequences that prioritise restitution. Parents in recovery must navigate these restitutive institutions while seeking self-improvement and using their lived experiences to rebuild community with their families. Understanding parental recovery experiences may inform the improved design and implementation of parenting and behavioural health supports available to help break intergenerational cycles of trauma and addiction.

Though narrative studies have provided important insights on addiction and recovery, social desirability and self-protective factors may limit the richness and relevance of standard “life story” accounts. In marginalized populations, the “Life as Film” (LAAF) procedure has proved useful for addressing these concerns. Building on this literature, the present study adopted the LAAF approach with an objective to undercover features distinguishing addiction and recovery narratives. Achieving this objective serves to model addiction and recovery in terms of narrative constructions and reconstructions. Thirty-two participants, active or in recovery from addiction, were recruited, producing LAAF narratives of their lives. Interviewees completed a Recovery Inventory (RI), to compare narrative material with recovery outcomes. Content analysis revealed three structures: (1) a high prevalence Core Plot, featuring interpersonal conflict, negative arousal and self-management via substance use; (2) an Addiction Narrative, with themes of victimization, betrayal, compulsion, and escapist protagonists; and (3) a Recovery Narrative, with themes of redemption, self-mastery, caring, unity, and healer protagonists. Findings build on existing literature, suggesting narrative processes through which core conflicts become embedded in addiction stories and resolved in recovery stories. These processes indicate psychological pathways to positive change, carrying implications for interventions.

This discussion article examines narrative positioning related to pain management for people who use substances at the end of life. We explore how dominant narrative genres associated with biomedicine, such as ‘restitution’ and narratives common within the context of drug services such as ‘recovery’ can hinder effective pain management within this population. We argue that these discourses can marginalise the ethical self-identity of patients who use substances at the end of life. It can also trouble health and social care professionals in supporting patients and generating counter-narratives that challenge those often associated with substance use. Stigma is a common experience for this population with stereotyping as ‘junkies’ and associated with criminality. They are positioned as drug-seeking, and this requires more surveillance at the end of life when opioid therapy is potentially more available and authorised. This can make it challenging to generate ‘companion’ stories that are positive and maintain moral adequacy. Dominant biomedical narrative genres often prevent the recognition of the fractured stories that people using substances can often present with. This can lead to narrative silencing and to the under treatment of pain. The person’s self-identity is invested in narratives of recovery, and opioid use symbolises their addicted past because for practitioners, this population is at clinical risk with the potential for drug seeking behaviours. Whilst not requiring formal ethical review this discussion paper was constructed in accordance with good scientific practice with the work of other researchers respected and cited appropriately.

The purpose of this study was to explore factors that influence Latinas’ drug use and recovery process. Fourteen Latinas participated in in-depth interviews. Findings reveal that their families were at the heart of their stories, playing exacerbating or protective roles. Latinas whose family had a history of substance use encountered more challenges in their recovery process, as they had to break ties from unsupportive family members and had less support available, and were more likely to internalize negative stereotypes of Latinos as drug users. Latinas with no familial history of use received tremendous support (i.e., emotional, instrumental, and family members involved in treatment) from their family. They tended to challenge negative stereotypes of Latinos as drug users. Recommendations for improving services for this population include using peer mentoring groups, culturally grounded activities and interventions, and identifying supportive family and networks members to facilitate the recovery process.

Aim: This exploratory study analyses the interplay between the treatment philosophies of Alcoholics Anonymous (AA) and Relapse Prevention (RP) in personal stories of addiction. While the basic ideas of AA and RP are compatible in many ways, they also carry some fundamental differences. Methods: The data consisted of interviews with 12 individuals recovering from substance use problems, who had experience of both AA and RP. The analysis drew on a dialogical narrative perspective, and the concept polyphony was used to shed light on the interplay between different treatment philosophies in personal stories of relapse. Findings: Although sometimes resulting in incoherence, the treatment philosophies were combined idiosyncratically, in ways that appeared productive for the participants' self-images and recovery journeys. Conclusion: The combination of AA and RP philosophies in narratives of relapse and recovery may reflect a new treatment discourse where individualisation and responsibilisation stand in a complicated relationship with collectivism and surrendering to so-called addicting processes.

‘Things that you can’t really suppress’: Adverse childhood experiences in the narratives of people with opioid use disorder

A Global Call for Action to Prioritize Healthcare Worker Suicide Prevention During the COVID-19 Pandemic and Beyond.

Using TikTok in recovery from substance use disorder

Clients with co-occurring and complex needs represent an important segment of the alcohol and other drug (AOD) treatment population. Retaining and engaging individuals in AOD treatment is challenging, and this pursuit is further impeded when clients present with complex support needs. This study sought to establish the feasibility and acceptability of a newly developed psychoeducation program for this clientele, attending a non-residential treatment service in New South Wales. The study employed a mixed methods approach. The team analysed aggregated non identifiable routinely collected data, including alcohol and other drug use, psychological distress and quality of life metrics pre and post intervention. Qualitative semi-structured interviews were also conducted with consenting clients and clinicians to complement quantitative data. Twenty-five eligible clients consented to have their data used for this study and nine consented to participate in an interview. Results show a significant decrease in psychological distress among clients at exit compared to baseline, however no significant change in quality-of-life scores or substance use was quantitatively observed. Some clients self-reported a reduction in substance use and most appreciated the flexibility of the one-on-one service offering. Our findings show that the psychoeducational program delivered to clients with complex support needs at Rendu House is feasible and acceptable to both clients and clinicians, and that the use of routinely collected data to measure treatment outcomes is viable within this setting. Our findings also demonstrate the value of qualitative inquiry in situating narratives of recovery among clients with complex needs where improvements may be incremental.

Substance use disorder (SUD) is a prodigious public health issue characterized by a substantial treatment gap. Despite challenges, millions have resolved a prior significant alcohol or drug problem, increasingly using online supports as a part of their recovery efforts (e.g., virtual mutual-help group meetings, traditional social networking sites [SNS]). However, the content surrounding SUD recovery-related discussion on SNS such as Twitter remains largely unexamined. To fill this gap, we explored public tweets using SUD recovery-related hashtags. From January 1, 2022, to December 31, 2022, 455,968 public tweets were collected using SUD recovery-related hashtags. Natural language processing was used to identify and remove irrelevant groupings of tweets from the dataset, resulting in a final corpus of 186,460 tweets. A random subsample of 1800 tweets was extracted for content analysis, involving codebook development, manual annotation by trained coders, and inter-rater reliability assessment (average Cohen's κ = 0.77). Nearly half (41.7%) of SUD recovery-related posts were from individuals in or seeking recovery, while 21.3% originated from addiction treatment industry accounts. Common themes included addiction treatment marketing (27.4%; some of which promoted scientifically unsupported products or services), emotional support (15.6%), celebrating a recovery milestone (15.4%), alcohol/drug-related sociopolitical commentary (14.7%), expressions of gratitude (11.5%), and mutual-help group participation (8.7%). SUD recovery-related content on Twitter reflected individuals seeking social support during efforts to initiate or maintain recovery. However, these accounts may be met with marketing material from entities that misrepresent their services or promote products based on unsubstantiated claims. Stricter (or enforcement of existing) regulations may be warranted to protect vulnerable SNS platform users from entities seeking to exploit them for financial gain.

This chapter discusses the recovery and treatment of people with addiction. Within the 12-step model, recovery refers to lifetime abstinence from drugs coupled with greater compassion for and service to others, restitution to victims, and a spiritual state of serenity. Other concepts of recovery focus more on improved individual health and reduced substance use. Recovery typically involves significant work to attain and maintain, which can bring increased feelings of worth in contrast to the years of active addiction. The chapter then shares narratives of recovery and treatment. It also clarifies the differences between addiction treatment and detoxification. Addiction treatment can include many components, including medication, information, education, emotional support, role modeling, motivational interviewing, contingency management, and teaching cognitive and behavioral skills.

Spirituality persists as a mechanism of behavior change for addiction recovery. The aim of this project was to carefully attend to how those in recovery construct meaning of their experience of addiction, regardless of the addiction treatment modality or ideological framework. Participant accounts reflected the increased public interest in and research funding based on the brain disease model of addiction (BDMA). The qualitative study used interpretive phenomenological analysis to investigate the experiences of six adults (age range from 24 to 72) with at least three years of sustained recovery from substance use disorders. In-depth key informant interviews tracked their construction of their experiences and their understanding of addiction. Participants who entered recovery after 2010 sought to integrate BDMA-related constructs into their understanding of addiction and recovery. Addiction recovery narratives featuring BDMA-related constructs integrated neuroscience-related ideas with spirituality-related constructs rather than completely replacing the latter. Notable innovations and paradoxical tensions were found within participant accounts. Such features echo the insights on secularity of Harvard philosopher Charles Taylor, particularly his notion of the “buffered self,” which offers a theoretical framework for understanding these shifts in meaning-making. For persons entering recovery in the twenty-first century, the brain disease model of addiction carries more explanatory authority than it does for previous generations, despite the lack of agreement across addiction-related neuroscientific findings. As a model, it engenders more mechanistic, agential, brain-centered (“buffered”) senses of self, ostensibly making it less compatible with spiritual understandings of addiction than other medical models of addiction. However, this study’s findings indicate that those in recovery are likely to devise complex narratives of the etiology of addiction that combine elements from various models.

The relationship between trauma and subsequent substance use has been extensively studied. Substance dependence and its consequences are a source of further traumatization. This explorative qualitative study is an analysis of the recovery narratives of persons with polydrug dependence, using mainly novel psychoactive substances (NPSs). NPS use, with its unpredictability and major health risks poses a challenge to treatment systems, but only few studies are available on NPS users’ recovery processes. In this longitudinal study, authors explore processes of identity reconstruction in the emotionally valent episodes of 10 respondents’ life interviews. The interviews had been conducted with 77 patients at the beginning of their residential treatment and were repeated a year later with those in recovery and available for the study, altogether 10 persons. Narrative Oriented Inquiry was used as a framework, focusing on the key themes and changes in the narrative mode. Our results support the findings on previous and subsequent NPS use-related traumatization. In this perspective, NPS use corresponds to revictimization. Contrary to available but sporadic evidence suggesting a marked difference between the recovery processes of users of classical substances and NPS users, the respondents in this study could utilize the traditional cultural stock of recovery stories during their treatment. Changes involved more reflective and responsible attitudes and the broadening of a healing social network. Contents describing care/self-care and the emergence of hopeful attitudes were also identified. Further research, involving larger samples and cross-cultural comparisons, could deepen our understandings of NPS users’ recovery processes.

The concept of recovery has emerged as a prominent paradigm to understand processes of change in individuals with substance use problems. To date, most studies have focused on personal recovery as the key driving force of recovery journeys, generally individualizing the often-disabling social realities that persons in recovery face. To counterbalance this bias, this paper focuses on the contextual dynamics at stake during recovery processes, based on the lived experiences of 30 persons in drug addiction recovery in Flanders (Belgium). A Lifeline Interview Method was applied to elicit recovery narratives, which were thematically analysed. We found that interpersonal relationships, enabling and disabling places, and socio-economic factors facilitate or impede recovery in meaningful ways. The findings also show how these diverse contextual dimensions are interrelated and ambiguous. Researchers, policymakers, and treatment providers should acknowledge the relational nature of recovery and the invalidating impact of stigma across the three identified contextual levels.

Beal and her colleagues are to be commended, and congratulated, for venturing forth in exploring the everyday experiences of people with serious mental illnesses as they go about meeting the challenges of establishing lives for themselves in the community following extended inpatient care. As community integration increasingly becomes the goal of community mental health services, the relatively uncharted territory of how people with severe and persistent mental illness navigate their immediate social environments becomes both a timely and important focus for empirical study. The contribution of Beal and her colleagues advances a growing body of research in this area describing various processes involved in the person’s efforts to manage his or her psychiatric condition as he or she goes about trying to reclaim his or her life. In addition to those references cited in Beal et al.’s paper, this body of research includes work by Barham (1992, and with Hayward, 1998), Corin (1990, 1998, and with Lauzon, 1992, 1994), Davidson and colleagues (1992, 1995, 1997, 2001, 2001, 2003; Sells, 2004), Estroff (1989, 1994, 1995a, 1995b), Lovell (1997), Ridgway (2001), and others. I would like, briefly, to consider the specific contribution of Beal and her colleagues within this broader context. Several of the findings of this study are noteworthy. First, the investigators note that people with schizophrenia need to “venture forth” into the world in order to “connect” to others, even though at times these others may be virtual or delusional in nature. Second, they describe ways in which environmental factors, activities, objects, and past experiences may be used to facilitate these processes of venturing forth and connecting, as well as some ways in which they might impede these processes. Finally, they recognize that the processes they have identified and described in the lives of people with schizophrenia being discharged from long–term inpatient care “should be seen as relatively normal ones and as part of the struggle we all face in living in the world together.” In other words, people with schizophrenia appear to engage in the same strategies for navigating community life that the rest of us (i.e., those of us who do not have schizophrenia) engage in when we find ourselves in similar circumstances (e.g., being newly relocated or visiting a foreign country for the first time). Although the investigators present their findings in this order, we would like to reverse their order of consideration in Psychiatry 68(3) Fall 2005 243