Dual recovery among people with serious mental illnesses and substance problems: a qualitative analysis.
OBJECTIVE
Individuals with serious mental illnesses are more likely to have substance-related problems than those without mental health problems. They also face more difficult recovery trajectories as they cope with dual disorders. Nevertheless, little is known about individuals' perspectives regarding their dual recovery experiences.


METHODS
This qualitative analysis was conducted as part of an exploratory mixed-methods study of mental health recovery. Members of Kaiser Permanente Northwest (a group-model, not-for-profit, integrated health plan) who had serious mental illness diagnoses were interviewed four times over two years about factors affecting their mental health recovery. Interviews were recorded, transcribed, and coded with inductively derived codes. Themes were identified by reviewing text coded "alcohol or other drugs."


RESULTS
Participants (N = 177) had diagnosed schizophrenia/schizoaffective disorder (n = 75, 42%), bipolar I/II disorder (n = 84, 48%), or affective psychosis (n = 18, 10%). At baseline, 63% (n = 112) spontaneously described addressing substance use as part of their mental health recovery. When asked at follow-up, 97% (n = 171) provided codeable answers about substances and mental health. We identified differing pathways to recovery, including through formal treatment, self-help groups or peer support, "natural" recovery (without the help of others), and continued but controlled use of alcohol. We found three overarching themes in participants' experiences of recovering from serious mental illnesses and substance-related problems: Learning about the effects of alcohol and drugs provided motivation and a foundation for sobriety; achieving sobriety helped people to initiate their mental health recovery processes; and achieving and maintaining sobriety built self-efficacy, self-confidence, improved functioning and a sense of personal growth. Non-judgmental support from clinicians adopting chronic disease approaches also facilitated recovery.


CONCLUSIONS
Irrespective of how people achieved sobriety, quitting or severely limiting use of substances was important to initiating and continuing mental health recovery processes. Substance abuse treatment approaches that are flexible, reduce barriers to engagement, support learning about effects of substances on mental health and quality of life, and adopt a chronic disease model of addiction may increase engagement and success. Peer-based support like Alcoholics or Narcotics Anonymous can be helpful for people with serious mental illnesses, particularly when programs accept use of mental health medications.
['Green|Carla A|CA|', 'Yarborough|Micah T|MT|', 'Polen|Michael R|MR|', 'Janoff|Shannon L|SL|', 'Yarborough|Bobbi Jo H|BJ|']
D000293:Adolescent D000328:Adult D000341:Affective Disorders, Psychotic D000368:Aged D000369:Aged, 80 and over D001714:Bipolar Disorder D005260:Female D006801:Humans D008297:Male D001523:Mental Disorders D008875:Middle Aged D063868:Patient Outcome Assessment D011618:Psychotic Disorders D012559:Schizophrenia D012657:Self-Help Groups D012720:Severity of Illness Index D012944:Social Support D019966:Substance-Related Disorders D055815:Young Adult
Dual recovery serious mental illnesses schizophrenia schizoaffective disorder affective psychosis substance use biopolar disorder