Background: Understanding challenges in alcohol consumption is crucial when considering recovery approaches beyond abstinence. This study investigates the narratives that people with former alcohol or other drug (AOD) problems use to describe their alcohol use during recovery, focusing on abstinence, relapse, craving, problematic and unproblematic consumption. Methods: 33 individuals were interviewed 10 years after completed psychosocial treatment for AOD problems in Sweden. They were grouped based on their perspectives on alcohol consumption and analyzed thematically. Results: Participants who described alcohol use as a relapse used the terminology prevalent in treatment, particularly 12-step programs. Participants not defining alcohol consumption as a relapse described varying levels of consumption, from occasional use to extensive consumption that was understood as potentially problematic. In the latter group, narratives about alcohol use and consequence management appeared to be anchored in the participants’ self-perception and self-efficacy. Conclusions: Viewing recovery as a dynamic process challenges traditional relapse definitions. Alcohol problems exist on a continuum, making self-efficacy crucial. Concepts like relapse can both support and hinder recovery. Long-term and recurrent support interventions are recommended throughout the recovery process.

This article presents the outcome of the first phase in the development of a recovery capital-based assessment tool in a Swedish alcohol and drug treatment context. In the process of studying the potential usefulness of such a tool, other aspects besides psychometric properties and validity have been examined. The experience and knowledge of professionals in the Swedish alcohol and drug treatment context represent the empirical data. Five group interviews have been conducted with staff from different alcohol and drug treatment facilities in Sweden. The respondents were asked to discuss an outlined idea of a recovery capital-based assessment tool. The transcribed interviews were thematically analysed and divided into three themes: the impact and need for assessment and evaluation, the need for flexibility and simplicity, and the role of the professional. The findings indicate that there is a demand for a strength-based tool in the Swedish alcohol and drug treatment context. There was a divergence between the professionalism of the social work practitioners and the use of assessment tools. To meet this divergence, the professionals emphasized aspects such as simplicity and flexibility. The findings indicate that the conditions are favourable for the implementation of a recovery capital tool in a Swedish alcohol and drug treatment context, but certain questions remain unanswered. This requires further cooperation with professionals, and in particular provides them with the possibility to reflect on its usefulness and applicability, while applying it to their daily work and procedures. 

Recurrent factors contributing to a recovery process from co-occurring mental health and addiction problems mentioned by users and professionals have been analyzed as part of working alliances and helpful relationships. Still, we lack knowledge about how helpful relationships are developed in daily practice. In this article, we focus on the concrete construction of professional helpful relationships. Forty persons in recovery and fifteen professionals were interviewed. The interviews were analyzed according to thematic analysis, resulting in three themes presented as paradoxes (1) My own decision, but with the help of others; (2) The need for structures and going beyond them; and (3) Small trivial things of great importance. Micro-affirmations have a central role in creating helpful relationships by confirming the individuals involved as more than solely users or professionals. More attention and appreciation should be paid to practices involving micro-affirmations.

Recovery is an established term used to describe positive processes of change concerning problems related to alcohol and other drugs (AOD). The present article investigates first-person experiences of recovery self-identification over time in clients who have completed 12-step programs with a positive outcome (sobriety). The data comprises qualitative interviews with 47 individuals five years after the first post-treatment interview, analyzed in a process inspired by reflexive thematic analysis. Although all the individuals had continued their recovery, their recovery paths and how they identified themselves in relation to their AOD problems had taken different directions. Thus, many of the individuals described their recovery in a broader sense which ranges from abstinence to moderation. Some individuals perceived themselves as no longer in recovery. The multitude of recovery processes described in the study underlines the need for acceptance and respect for individual identity processes. Furthermore, the importance is stressed of supporting an individual’s perceptions of how their recovery process should best be outlined. The results should not be interpreted as a critique of the 12-step approach. Instead, there is a need for variety over time in the support and treatment options available for people in need of treatment for AOD problems. 

Evidence from Swedish and international studies show that a high proportion of children from out-of-home care (OHC) have poor school performance and that this is strongly associated with their substantial risk of adverse development in future life. However, risk factors for poor school performance and adverse development are difficult to disentangle since they are often interrelated and enforce each other over the life course. This study examines premature mortality in relation to early school failure (drop-out from compulsory school) and OHC experience in childhood (0–17 years of age) among clients who were in treatment for substance misuse in the early 1980s (N = 1,036). The analyses were based on record linkages between interview data collected during treatment and national register data covering approximately 30 years of follow-up, from exit from treatment until 2013. Our results showed that 54 per cent had been placed in OHC as children, half before their teens and half as teenagers. The OHC population had a higher prevalence of school failure compared with clients who had not been exposed to childhood OHC. OHC was associated with an excess mortality, although this was only significant for females who had entered OHC before their teens. Adjusting results for school failure reduced their excess mortality by half, and additional life course factors associated with mortality among people with substance misuse adjusted for most of the remaining excess mortality. School failure was strongly associated with the excess mortality of females, but not with the excess mortality of males.

Purpose - The purpose of this paper is to investigate how clients - five years after completing treatment interventions endorsing abstinence - view abstinence and the role of Alcoholics Anonymous (AA) in their recovery process.

Design/methodology/approach - Interviews with 40 clients were conducted shortly after them finishing treatment and five years later. All the interviewees had attended treatment programmes based on the 12-step philosophy, and they all described abstinence as crucial to their recovery process in an initial interview.

Findings - At follow-up, the majority remained abstinent. For many, attending AA meetings was still important - some described attending as a routine, whereas others stressed that the meetings were crucial for remaining abstinent. For those who reported controlled drinking (CD), this was described either as a natural step in their recovery process or as associated with worries and self-doubts.

Research limitations/implications - The results suggest the importance of offering interventions with various treatment goals and that clients choosing CD as part of their sustained recovery would benefit fromsupport in this process, both from peers and professionals.

Originality/value - There are heterogeneous views on the possibilities of CD after recovery from substance use disorder both in research and in treatment systems. This study on client views on abstinence versus CD after treatment advocating total abstinence can contribute with perspectives on this ongoing discussion.

Aim: Studies on recovery from alcohol and other drugs (AOD) among young adults are scarce. In the present study, young adults, previously interviewed with a focus on their recovery process shortly after they completed treatment, were re-interviewed five years later focusing on their recovery process during the last five years in relation to their former AOD problems, other problems and processes of change. Methods: Twenty-one young adults were interviewed: 16 women and five men aged between 25 and 33 years. After transcribing the interviews, the material was analysed thematically. Results: Three overall themes emerged: previous problems, mental illness and the search for identity. The results were discussed in relation to recovery capital, primarily focusing on human and social capital. The results indicate that the group in focus often needs professional support for mental health issues in order to reach a stable recovery. Conclusions: Since the problems described were heterogeneous, this client group might benefit from individual treatment and extended support after treatment. Further, the results indicate that the established period of five years for a stable recovery might need to be extended for young adults.

The study focus on how clients with co-occurring problems describe the importance of treatment factors for the recovery process and how these descriptions relates to professional descriptions. 40 client interviews and 15 interviews with professionals were conducted. Three major themes emerge in the results: medication, methods and the professionals.

The amount of contact with psychiatry and social services that these clients often have through the years can lead to a ‘learned passivity’ towards their own recovery process. Thus, an important task for the professionals is to break through passivity and isolation. This can be done by treating the client like an ‘ordinary fellow human’. Besides the actual professional tasks, small things seem to be important; greeting the person, paying respect when entering some one’s home, etc.

When a social network is missing, the professional can sometime fill this gap, but if this is to promote recovery, it seem important that the professional social network is used as a bridge to other social networks.

The professionals as a group, including the environment, emerge as important. Accordingly, to be supportive as a group, and be able to act like ‘social role models’, the professionals need to have working alliances also between themselves. The environment can also offer tools that can be used for socialization that interfere with the ‘learned passivity’ and instead includes and respects the client. This, together with the results highlighting the importance of creating safe milieus, confident and secure professionals, puts focus on how the professional work is organized.

Background: Differing results on gender specific factors related to mortality risks among substance misusers highlights the need for further research. The present article is based on a 30-year follow-up study on substance misusers treated in residential care for drug problems in Sweden in 1982-1983 aiming to identify and compare gender differences in predictors of mortality.

Method: Original data consists of personal interviews with 1163 substance misusers treated in inpatient units in Sweden during 1982-1983. The outcome variable is death retrieved from the National Cause of Death Register held by the National Board of Health and Welfare. Gender differences and similarities regarding predictors of mortality was estimated in univariate and multivariate models, using Cox proportional hazards models.

Results: School failure, imprisonment and being a parent without custody of the child seem to constitute risk factors for mortality among women, but not among men. A social network of friends seemed to be more important for men. Treatment-dropout was a significant risk factor for premature death among men, but not among women. Both gender reporting alcohol as their self-reported most dominant substance misuse showed higher mortality risks compared with those with stimulants as dominant substance misuse.

Conclusions: Imprisonment was highly predictive of mortality for the women, suggesting that this group is important to pay particular attention to. Suggested differences in the importance of social factors need to be investigated more thoroughly. The substantial hazard revealed for women with polydrug misuse including alcohol calls for attention to this in treatment for substance misuse.