Searching for Sobriety: How Persons with Severe Mental Illness Experience Abstaining from Substance Use

Abstract

Individuals diagnosed with severe mental illness (SMI) are more vulnerable to substances than are other people. Many people with SMI tend to attain full remission of their substance use, but others relapse frequently. There is more research on the reasons for substance use than on the reasons for abstaining among these individuals. Information from the latter may contribute to a better understanding of how individuals with SMI experience abstaining from substance use. Objective: The aim of this explorative study was to examine experiences of abstaining from substances of persons diagnosed with SMI. We examined both the reasons given and the requirements and strategies used when abstaining. Methods:A qualitative study with semi-structured interviews was conducted, and a descriptive and explorative design was applied. This study included a purposeful sample of 11 patients with SMI and substance use being treated by assertive community treatment teams. Results:The main reasons for quitting substance use were social relationships and meaningful activities. The stated requirements and strategies used in the search for sobriety were detachment towards people and places, positive thinking, controlling feelings and emotions, and fear of dependency. Conclusion:Our results are consistent with those from other qualitative studies on the importance of social relationships and meaningful activities as expressed reasons for abstaining. The strategy of actively avoiding a former adverse milieu to reach sobriety is consistent with findings from one similar study. The strategies of fear of adverse consequences, positive thinking, and controlling feelings and emotions found in the present study have not been reported by other qualitative studies.

How Social Relationships Influence Substance Use Disorder Recovery: A Collaborative Narrative Study

“…Previous studies have reported similar findings concerning the avoidance of certain people and places. 7,11,47 Although the samples in these studies consisted of clients with considerably shorter periods of abstinence than our sample, they underscore the importance of establishing new acquaintances and avoiding their former milieu, as part of reaching stable recovery. According to the cultural capital construct embedded in the RC model, it is often harder to create new systems of meaning that keep sobriety or unproblematic substance use in the forefront than to do any other step in the recovery process.…”

“…Compared with previous research on factors important for SUD recovery, [37][38][39][40][41][42][43] our findings support the importance of recognition by peers or service providers, and attest to the value of social environment changes. 7,11,47 The importance of the sibling relationship to SUD recovery has not been described previously, although the role of a close family member has been mentioned in other studies in the contexts of both mental illness and SUD. 9,45 SUD treatment providers should involve clients' networks to a greater extent when designing new treatment approaches.…”

“…For example, several studies have shown that most individuals with a SUD need a change to their social network to initiate and maintain abstinence from substance use. 7 – 11 Furthermore, research suggests that social support can be even more powerful for maintaining sobriety when combined with practical support. 12 , 13 This indicates that mutual activity directed toward a shared goal can catalyze the attainment of stable recovery.…”

Dilemmas in recovery-oriented practice to support people with co-occurring mental health and substance use disorders: a qualitative study of staff experiences in Norway

“…This also appears in first-person experiences of co-occurring disorders [ 21 , 34 – 36 ]. Importantly, there seems to be considerable individual variation in how substance use relates to recovery among people with co-occurring disorders [ 37 ], as well as in reasons for quitting substance use [ 38 ], and a categorical total abstinence approach seems to be at odds with recovery principles of supporting each individual’s goals and interests. Further, as is reflected in team members’ descriptions in the present study, demanding total abstinence in community services may indirectly exclude citizens from services.…”