Experiences Of Substance Use Research Articles

Understanding the substance use of autistic adolescents and adults: a mixed-methods approach

SummaryBackgroundAutistic individuals might be more likely to misuse substances than non-autistic individuals. Better understanding of these patterns can help clinicians identify strategies to reduce substance use, protecting physical and mental health. The aim of this study was to compare the experiences of substance use between autistic and non-autistic adolescents and adults.MethodsThis study is a mixed-methods study, including both quantitative (closed-ended questions) and qualitative (one open-ended question) online assessments. Data were collected as part of a larger study, the Autism and Physical Health Survey, in which we administered an anonymised, online questionnaire to autistic and non-autistic individuals aged 16–90 years. In the present study, we investigated data on substance use or misuse, using two overlapping but separate samples from the survey (one sample with complete quantitative responses and one sample with complete qualitative responses). Binary measures of substance use were investigated using unadjusted and adjusted binomial logistic regression models. Content analysis was used to compare experiences of autistic and non-autistic adolescents and adults. We used Fisher's exact tests to assess differences in frequency of reporting particular qualitative themes and subthemes.FindingsSurvey recruitment was done between Feb 7, 2018, and Aug 26, 2019. At the end of the recruitment, 3657 individuals had accessed the survey. After excluding duplicates as well as participants with missing or incomplete responses, we had data from 2386 participants (1183 autistic and 1203 non-autistic participants; 1571 female and 815 male participants) for the quantitative analyses and data from 919 participants (429 autistic and 490 non-autistic participants; 569 female and 350 male participants) in the qualitative analyses. The samples for the quantitative and qualitative analyses were predominantly composed of female individuals, White individuals, UK residents, and those without intellectual disability. Autistic individuals were less likely than non-autistic individuals to report consuming alcohol regularly (16·0% of autistic individuals vs 22·2% of non-autistic individuals; adjusted model: odds ratio [OR] 0·69, 95% CI 0·55–0·86; p=0·0022) or binge-drinking (3·8% vs 8·2%; adjusted model: OR 0·38, 0·26–0·56; p<0·0001). Autistic male participants were less likely than non-autistic male participants to report ever having smoked (50·8% of autistic male participants vs 64·6% of non-autistic male participants; adjusted OR 0·50; 0·32–0·76; p=0·0022) or ever using drugs (35·4% vs 52·7%; adjusted OR 0·53; 0·35–0·80; p=0·0022). Regarding our qualitative analyses, among participants who reported a specific motivation for drug use, compared with non-autistic individuals, autistic individuals were nearly nine times more likely to report using recreational substances to manage behaviour (OR 8·89, 2·05–81·12; p=0·0017) and more likely to report using recreational substances to manage mental health symptoms (OR 3·08, 1·18–9·08; p=0·032). Autistic individuals were also more likely to report vulnerability associated with substance use (OR 4·16, 1·90–10·05; p=0·00027), including childhood use of drugs and being forced or tricked into using drugs.InterpretationAutistic individuals might be less likely than non-autistic individuals to report engaging in substance misuse. They also report using drugs to self-medicate. Clinicians should be aware of vulnerability linked to substance use among autistic patients and should work cooperatively with patients to effectively manage autistic and comorbid symptoms.FundingAutism Research Trust, Rosetrees Trust, Cambridge and Peterborough NHS Foundation Trust.

Re-contacting participants from the longitudinal Belfast youth development study (BYDS) after a decade using electronic tracing

ABSTRACT The longitudinal Belfast Youth Development Study (BYDS) followed a group of young people from age 11 to 21 years (from 2001 to 2011), charting their experiences of substance use, offending, education, and peer and family relationships. This allowed the investigation of risk and protective factors associated with different types of behavioural patterns and outcomes in adolescence and emerging adulthood. A feasibility study was carried out from 2018 to 2019 to test the success rate of electronically tracing 4,195 participants after almost a decade, in anticipation of carrying out an additional wave of data collection. The projected trace rate obtained using standard and forensic electronic tracing methods was considerably higher (86%) than traditional tracing methods (10%) for getting up-to-date contact details on participants. The electronic tracing methods were also cheaper (£9.72 per person traced) than traditional tracing methods (£20.62 per person traced). These findings will help maximise the potential of longitudinal social research.

Organizational support for frontline harm reduction and systems navigation work among workers with living and lived experience: qualitative findings from British Columbia, Canada

BackgroundThe inclusion of people with lived and living experience of substance use is essential to effective and client-centered harm reduction services and strategies. The aim of this study is to critically examine and characterize peer worker roles and the definition, recognition, and support for these roles within harm reduction organizations.MethodsFifteen interviews were conducted with peer workers—people with lived and living experience of substance use engaged in harm reduction service delivery—in British Columbia, Canada. An interpretive descriptive approach to data analysis was used to generate themes that best illustrated the roles of peer workers.FindingsTwo interrelated and overarching themes are presented: (1) peer work in practice; (2) organizational support. Our findings illustrate that peer work is incredibly complex and demanding, requiring peers to be at the forefront of support within their communities while simultaneously navigating the oppressive structures within which they work. While peer workers found a high degree of purpose and meaning in their day-to-day work, their roles lacked definition within organizations, which produced feelings of ineffectiveness and being undervalued. A lack of organizational understanding and recognition of their roles was evident from unclear "peer" role titles, a lack of role communication and expectations, the representation of experiential knowledge, and a lack of role support and training.ConclusionsThese findings may help harm reduction organizations understand peer work and worker roles which may inform and promote equity in future harm reduction initiatives that include people with living and lived experience of substance use.

Organizational support for frontline harm reduction and systems navigation work among workers with living and lived experience: qualitative findings from British Columbia, Canada

BACKGROUND The inclusion of people with lived and living experience of substance use is essential to effective and client-centered harm reduction services and strategies. The aim of this study is to critically examine and characterize worker roles and the definition, recognition, and support for these roles within harm reduction organizations. METHODS Fifteen interviews were conducted with workers-people with lived and living experience of substance use engaged in harm reduction service delivery-in British Columbia, Canada. An interpretive descriptive approach to data analysis was used to generate themes that best illustrated the roles of workers. FINDINGS Two interrelated and overarching themes are presented: (1) work in practice; (2) organizational support. Our findings illustrate that work is incredibly complex and demanding, requiring peers to be at the forefront of support within their communities while simultaneously navigating the oppressive structures within which they work. While workers found a high degree of purpose and meaning in their day-to-day work, their roles lacked definition within organizations, which produced feelings of ineffectiveness and being undervalued. A lack of organizational understanding and recognition of their roles was evident from unclear peer role titles, a lack of role communication and expectations, the representation of experiential knowledge, and a lack of role support and training. CONCLUSIONS These findings may help harm reduction organizations understand work and worker roles which may inform and promote equity in future harm reduction initiatives that include people with living and lived experience of substance use.

Facilitators and barriers to substance-free pregnancies in high-income countries: A meta-synthesis of qualitative research

BackgroundPrevious studies have associated substance use (alcohol, illicit drugs and smoking) to negative pregnancy outcomes, including higher risk of stillbirth. AimThis study aims to identify facilitators and barriers reported by women to remain substance free during pregnancy. MethodsA systematic search was conducted in six databases from inception to March 2019 and updated in November 2020. Qualitative studies involving pregnant or post-partum women, from high-income countries, examining women’s experiences of substance use during pregnancy were eligible. Meta-ethnography was used to facilitate this meta-synthesis. FindingsTwenty-two studies were included for analysis. Internal barriers included the perceived emotional and social benefits of using substances such as stress coping, and the associated feelings of shame and guilt. Finding insensitive professionals, the lack of information and discussion about risks, and lack of social support were identified as external barriers. Furthermore, the social stigma and fear of prosecution associated with substance use led some women to conceal their use. Facilitators included awareness of the health risks of substance use, having intrinsic incentives and finding support in family, friends and professionals. DiscussionPerceived benefits, knowledge, experiences in health care settings, and social factors all play important roles in women’s behaviours. These factors can co-occur and must be considered together to be able to understand the complexity of prenatal substance use. ConclusionIncreased clinical and community awareness of the modifiable risk factors associated with substance use during pregnancy presented in this study, is necessary to inform future prevention efforts.

Isolation, Solitude and Social Distancing for People Who Use Drugs: An Ethnographic Perspective.

COVID-19 has resulted in deepened states of crisis and vulnerability for people who use drugs throughout Europe and across the world, with social distancing measures having far-reaching implications for everyday life. Prolonged periods of isolation and solitude are acknowledged within much addiction literature as negatively impacting the experiences of those in recovery, while also causing harm to active users – many of whom depend on social contact for the purchasing and taking of substances, as well as myriad forms of support. Solitude, however, is proposed by the authors as inherent within some aspects of substance use, far from particular to the current pandemic. Certain forms of substance use engender solitary experience, even where use is predicated upon the presence of others. Adopting a cross-disciplinary perspective, this paper takes as its focus the urgent changes wrought by the pandemic upon everyday life for people who use drugs, drawing on recent ethnographic fieldwork with substance users in Scotland. Beyond the current crises, the paper proposes solitude, and by extension isolation, as an analytical framework for better apprehending lived experiences of substance use.

An N-of-1 study of daily alcohol consumption following minimum unit pricing implementation in Scotland.

Background and aimsWithin the context of Scotland's policy change to implement a minimum unit price (MUP) per unit of alcohol sold in licensed premises, this study used an N‐of‐1 design to assess between‐person differences in the psychological and social factors associated with daily alcohol consumption.Design and settingA mixed‐methods approach combined N‐of‐1 observational studies, comprising daily surveys followed by qualitative social network interviews (not reported here). Peer researchers with lived experience of substance use were involved in the study design and fieldwork was conducted in towns and rural areas in the East of Scotland.Participants/casesTwenty‐five adults with current or recent history of alcohol dependence recruited for three 12‐week waves: 11 in wave 1 (pre‐MUP), 11 in wave 2 (pre‐ and post‐MUP) and three in wave 3 (post MUP).MeasurementsGender, age, alcohol and other drug use history. Daily surveys for 12 weeks captured information about factors in the last 24 hours, e.g. amount and type of alcohol consumed, stress, social contact.FindingsEach participant was in the daily survey for a mean of 64 days [standard deviation (SD) = 42; median = 59], with a response rate of 48%; 15 participants provided sufficient data for analysis. Factors related to daily alcohol consumption differed between individuals. Models suggested that some individuals with high initial consumption reduced drinking after MUP, but explanatory factors differed, e.g. changing motivation was important for some, while alcohol availability was important for others.ConclusionsAdapting N‐of‐1 methods for an observational study uncovered differences in alcohol consumption change before and after minimum unit pricing implementation in Scotland, evidence of individual differences in the factors relating to alcohol consumption patterns and some evidence that post‐MUP consumption changes may be related to changing psychosocial factors.

“It hurts so much to live for nothing”: Lived Experiences of Substance Use Among Refugee Youth in Displacement

Tremendous traumas relating to refugee situations have substantially hindered the mental and behavioral health of refugee youth. Prolonged and cumulative adversities during forced migration have led refugee populations to be exposed to a high risk of substance misuse as part of a coping mechanism. This study aims to explore the role played by substances within the lives of Somali refugee youth who are displaced in low-resource, urban settings. We conducted in-depth individual interviews with twenty Somali refugee youth who are involved in gang activities in urban Kenya. Using a thematic analysis, this study revealed how substances have been used to cope with the negative impacts of trauma and how substances operate as a strategic tool for survival within the lives of displaced Somali refugees. This study discussed the implications for breaking the cycle of substance use.

“I have to be around people that are doing what I'm doing”: The importance of expanding the peer recovery coach role in treatment of opioid use disorder in the face of COVID-19 health disparities

The COVID-19 pandemic and ongoing opioid epidemic are causing notable morbidity and mortality among low-income and minority populations. Peer recovery coaches (PRCs), people with lived experience of substance use and recovery, are uniquely positioned to support underserved, minority individuals who face the greatest barriers to care. This commentary combines research and clinical perspectives to describe the potential role of PRCs in reaching and supporting particularly vulnerable populations in the setting of substantial changes in the opioid use disorder (OUD) recovery landscape during COVID-19. During this time, PRCs can provide guidance from their own experience navigating changes to routines and social support systems, reduce social isolation, build trust and buy-in, and support engagement in care. Specific barriers include access to technology and underlying distrust of public and medical authorities. This article highlights the importance of expanding the reach of the PRC workforce as well as supporting their specific needs at this time to combat the intersecting devastation of two epidemics.

A qualitative exploration of substance misuse among homeless women in Addis Ababa, Ethiopia

BackgroundSubstance use among homeless people is higher compared to the general population. In some studies, reported rates of problematic drug use among the homeless vary, with estimates ranging from 25 to 70%. There is a common perception that substance abuse and homelessness are linked, but there is considerable debate about the direction of the relationship. Despite observations of high levels of substance use among the homeless population in Addis Ababa, there are limited studies to date conducted on the topic. This study aims to explore the factors associated with onset of substance use and its continued use, patterns of substance use and its social and health consequences among female residents of a shelter in Addis Ababa, Ethiopia.MethodsA qualitative study was conducted in 2019. In-depth interviews were conducted on 14 study participants who were selected purposively. The qualitative data analysis software QDA Miner 5.0.30 was used for data processing and analysis.ResultsFour major thematic areas were identified and they comprised the categories under which sub-themes were identified and coded. The major segments or categories included the following: reasons for the onset of substance use after becoming homeless, experiences of substance use and reasons for continued use, the harms which resulted on them from substance use, and the means of obtaining supply of the substances.ConclusionFactors related to life on streets were strong reasons for onset of substance use, as well as for its continued use. Homeless women suffered untimely death, addiction, and ill health from use of substances; however, they gave priority to obtaining substances than any other thing, and used every means to grab a supply of the substances.

Use of Alcohol, Tobacco, and Caffeine and Suicide Attempts: Findings From a Nationally Representative Cross-sectional Study.

In this study, the association between students’ substance use and suicide attempts in the past 1 year was examined using secondary data from the 13th Korea Risk Behavior Web-based Survey. Participants were 7th- to 12th-grade students and 50.9% were male. A binominal logistic regression analysis was used to investigate the association between past experience of substance use (alcohol, tobacco, and caffeine) and suicide attempts after controlling for sociodemographic and psychological factors. Compared with no use, daily use of alcohol (odds ratio [OR] = 8.00), caffeine (OR = 2.13), and tobacco (OR = 1.41) was associated with increased odds of suicide attempts. These results indicate that school-based suicide prevention programs should cover awareness, surveillance, and treatment referral for these 3 substances. Moreover, mental health professionals should monitor intake of these substances when evaluating risk of suicide attempts in youth.

‘Communities are attempting to tackle the crisis’: a scoping review on community plans to prevent and reduce opioid-related harms

ObjectivesWe sought to understand the implementation of multifaceted community plans to address opioid-related harms.DesignOur scoping review examined the extent of the literature on community plans to prevent and reduce opioid-related...

Association of Cohort and Individual Substance Use With Risk of Transitioning to Drug Use, Drug Use Disorder, and Remission From Disorder

Limited empirical research has examined the extent to which cohort-level prevalence of substance use is associated with the onset of drug use and transitioning into greater involvement with drug use. To use cross-national data to examine time-space variation in cohort-level drug use to assess its associations with onset and transitions across stages of drug use, abuse, dependence, and remission. The World Health Organization World Mental Health Surveys carried out cross-sectional general population surveys in 25 countries using a consistent research protocol and assessment instrument. Adults from representative household samples were interviewed face-to-face in the community in relation to drug use disorders. The surveys were conducted between 2001 and 2015. Data analysis was performed from July 2017 to July 2018. Data on timing of onset of lifetime drug use, DSM-IV drug use disorders, and remission from these disorders was assessed using the Composite International Diagnostic Interview. Associations of cohort-level alcohol prevalence and drug use prevalence were examined as factors associated with these transitions. Among the 90 027 respondents (48.1% [SE, 0.2%] men; mean [SE] age, 42.1 [0.1] years), 1 in 4 (24.8% [SE, 0.2%]) reported either illicit drug use or extramedical use of prescription drugs at some point in their lifetime, but with substantial time-space variation in this prevalence. Among users, 9.1% (SE, 0.2%) met lifetime criteria for abuse, and 5.0% (SE, 0.2%) met criteria for dependence. Individuals who used 2 or more drugs had an increased risk of both abuse (odds ratio, 5.17 [95% CI, 4.66-5.73]; P < .001) and dependence (odds ratio, 5.99 [95% CI, 5.02-7.16]; P < .001) and reduced probability of remission from abuse (odds ratio, 0.86 [95% CI, 0.76-0.98]; P = .02). Birth cohort prevalence of drug use was also significantly associated with both initiation and illicit drug use transitions; for example, after controlling for individuals' experience of substance use and demographics, for each additional 10% of an individual's cohort using alcohol, a person's odds of initiating drug use increased by 28% (odds ratio, 1.28 [95% CI, 1.26-1.31]). Each 10% increase in a cohort's use of drug increased individual risk by 12% (1.12 [95% CI, 1.11-1.14]). Birth cohort substance use is associated with drug use involvement beyond the outcomes of individual histories of alcohol and other drug use. This has important implications for understanding pathways into and out of problematic drug use.

Interoceptive accuracy and interoceptive sensibility in individuals with alcohol use disorder–Different phenomena with different clinical correlations?

BackgroundInteroception may contribute to substance use disorder as it relates to the body’s experience of substance use or withdrawal. However, only a few studies have directly investigated associations between interoception and alcohol use. The objective of this study was to compare individuals with alcohol use disorder (AUD) and healthy controls on interoceptive sensibility and accuracy. MethodsThe sample was comprised of two groups: individuals meeting criteria for AUD (N = 114) and healthy controls (N = 110) not meeting criteria for AUD. Interoceptive sensibility was assessed with a self-report measure (the Private Body Consciousness subscale) and interoceptive accuracy – with a behavioral measure (the Schandry test). In addition, associations between interoception and other well-recognized correlates of AUD (sleep problems, depressive and anxiety symptoms, impulsivity) were tested. Barratt’s Impulsiveness Scale, Brief Symptom Inventory, and Athens Insomnia Scale were utilized to assess psychopathological symptoms as covariates. ResultsWhen controlling for level of anxiety, sleep problems, age, sex and education, individuals with AUD scored significantly higher on self-reported interoceptive sensibility and lower on interoceptive accuracy in comparison to healthy controls. Higher interoceptive sensibility was associated with more severe sleep problems and anxiety symptoms. ConclusionsThese results have to be treated as preliminary and need to be replicated; however, findings indicate that interoception may present a novel therapeutic target for treatment of AUD.

Experience Assessment of Tobacco Smoking, Alcohol Drinking, and Substance Use Among Shahroud University Students by Crosswise Model Estimation –The Alarm to Families

Background In this study, we considered to determine the estimation of experience of substance use, cigarette smoking, and alcohol drinking among Iranian students, using the crosswise model estimation. Methods The Cross-sectional study was done in November 2012 to February 2013. A total of 1500 students were selected from Shahroud Universities, using multistage sampling. Three pairs of questions were designed, based on the crosswise model, and the questionnaire was presented to the students after written consent forms were obtained. Data were analyzed using Ch2, t-test and crosswise test. Results The Mean ±SD age of girls was 20.26±1.49 vs boys 20.32±1. 575. Based on the findings, the prevalence of cigarette smoking, alcohol drinking, and substance abuse among students was 20%, 33%, and 7%, respectively. Conclusion Considering the high prevalence of drug use among Iranian students and the unbiased design of this study, it is suggested that the necessary skills be incorporated and introduced in the school curriculum for students at primary schools.

Representations of women and drug use in policy: A critical policy analysis

Contemporary research in the drugs field has demonstrated a number of gender differences in patterns and experiences of substance use, and the design and provision of gender-responsive interventions has been identified as an important policy issue. Consequently, whether and how domestic drug policies attend to women and gender issues is an important question for investigation. This article presents a policy audit and critical analysis of Australian national and state and territory policy documents. It identifies and discusses two key styles of problematisation of women’s drug use in policy: 1) drug use and its effect on women’s reproductive role (including a focus on pregnant women and women who are mothers), and 2) drug use and its relationship to women’s vulnerability to harm (including violent and sexual victimisation, trauma, and mental health issues). Whilst these are important areas for policy to address, we argue that such representations of women who use drugs tend to reinforce particular understandings of women and drug use, while at the same time contributing to areas of ‘policy silence’ or neglect. In particular, the policy documents analysed are largely silent about the harm reduction needs of all women, as well as the needs of women who are not mothers, young women, older women, transwomen or other women deemed to be outside of dominant normative reproductive discourse. This analysis is important because understanding how women’s drug use is problematised and identifying areas of policy silence provides a foundation for redressing gaps in policy, and for assessing the likely effectiveness of current and future policy approaches.

Prevalence, Trends, and Consequences of Substance Use Among University Students: Implication for Intervention.

This study was conducted to examine the prevalence, trends, and consequences of substance use among university students. The prevalence of substance use, the trends of substance use, and the differences among sociodemographic variables in the experiences of substance use as well as the consequences of substance use among university students were assessed in this study. Using stratified sampling method, 1,156 students were chosen. Descriptive statistics, chi-square, one-way analysis of variance, and Pearson correlation coefficient were used for data analysis. The findings revealed that 70%, 79%, and 99% of the participants are users of tobacco product, chat, and alcoholic beverage; the trends of substance use are increasing from time to time. The study also revealed that substance use has negative consequences on duty accomplishment of the users. It is indicated that the trends of substance use are increasing, and substance use has significant consequences on the users and their families. This implies that a special attention needs to be given by policy makers, researchers, humanitarian organizations, and the community, and mainly universities, to overcome this issue.

Developing harm reduction in the context of youth substance use: insights from a multi-site qualitative analysis of young people\u2019s harm minimization strategies

BackgroundYouth substance use programming and educational strategies are frequently informed by prevention approaches that emphasize abstinence goals, which often do not resonate with youth in their lack of acknowledgment of young people’s social context and how young people perceive positive effects of substance use. Further, approaches to drug prevention have been critiqued as adopting a one-size-fits-all approach and therefore inadequate in addressing substance use in the context of population variation and inequities. In response to the limitations of current approaches to prevention, programming informed by harm reduction principles that aims to minimize harms without requiring abstinence is emergent in school settings. However, youth perspectives informing harm reduction are limited in both research and program development.MethodsThis paper draws on data from the Researching Adolescent Distress and Resilience (RADAR) study, which utilized an ethnographic approach to bring youth voice to the literature on mental health and substance use. Qualitative data collection included individual interviews (n = 86) with young people aged 13–18 across three communities—representing urban, suburban, and rural geographies—in British Columbia, Canada. A multi-site qualitative analysis of interview data was conducted to identify themes across and within each research site.ResultsAcross all three sites, young people’s individual experiences of substance use were shaped by geographic, socio-cultural, and political contexts, with youth describing their use in relation to the nature of substance use in peer groups and in the broader community. To manage their own substance use and reduce related harms, youth employed a variety of ad hoc harm minimization strategies that were reflective of their respective contexts.ConclusionsThe findings from this study suggest the importance of harm reduction approaches that are contextually relevant and responsive to the lived experiences of youth. Youth perspectives in the development of harm reduction programming are needed to ensure that approaches are relatable and meaningful to young people, and effective for promoting the minimization of substance-related harms.

Understanding How People with Mental Health Difficulties Experience Substance Use

ABSTRACTBackground: Quantitative studies dominate research exploring reasons for substance use and experiences of substance use by people with mental health difficulties. This limits the depth of understanding which can be gained about these experiences. Objectives: In the present article, we synthesized current qualitative research in this area to provide enhanced theoretical knowledge of these experiences. Methods: Following a systematic literature search, we identified 12 studies which explored how people with mental health difficulties experienced using substances, and which met additional inclusion criterion. We used Noblit and Hare's metaethnographic approach to qualitatively synthesize these studies. Results: Synthesis led to the development of two themes; “substance use mediates acceptance and social inclusion” and “substance use provides perceived opportunities for control and power.” Conclusions/Importance: The findings suggest that in the studies reviewed people's motivation for substance use was embedded in social and psychological contexts. It indicated that substance use could provide perceived benefits such as mediating the impact of mental health stigma, enabling the development of alternative identities, increasing their sense of power and providing opportunities for social inclusion. Mental health and substance use workers should therefore aim to develop alternative opportunities for people with co-occurring disorders to gain such benefits, and seek to challenge mental health stigma.

A Qualitative Exploration of U.K. Prisoners’ Experiences of Substance Misuse and Mental Health Difficulties, and the Breaking Free Health and Justice Interventions

This qualitative study explored prisoners’ lived experiences of substance use and mental health difficulties and aimed to examine perceived links between these two areas and how they might be associated with recovery during engagement with the Breaking Free Health and Justice (BFHJ) treatment programs. Interviews were conducted with 32 prisoners receiving treatment for substance use in North-West England. Emerging from prisoners’ interviews were themes relating to difficult life experiences from childhood into adulthood, how these experiences played a role in the emergence of their multiple and complex difficulties, their treatment experiences, and how their current involvement with the criminal justice system acted as a catalyst for positive change, including engagement with the BFHJ programs. This study identified the roles of substance use and mental health difficulties in the lives of participants, identified how their multiple and complex difficulties might be addressed, and provided insights into prisoners’ interpretations of their life experiences.