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Background The international Life In Recovery (LiR) surveys have provided an important message to the public and policy makers about the reality of change from addiction to recovery, consistently demonstrating both that there are marked gains across a range of life domains and that the longer the person is in recovery the better their recovery strengths and achievements. However, to date, no attempt has been made to quantify the Life In Recovery scales and to assess what levels of change in removing barriers and building strengths is achieved at which point in the recovery journey. Methods The current study undertakes a preliminary analysis of strengths and barriers from the Life in Recovery measure, using data from a European survey on drug users in recovery ( n  = 480), and suggests that the instrument can be edited into a Strengths And Barriers Recovery Scale (SABRS). The new scale provides a single score for both current recovery strengths and barriers to recovery. Results The resulting data analysis shows that there are stepwise incremental changes in recovery strengths at different recovery stages, but these occur with only very limited reductions in barriers to recovery, with even those in stable recovery typically having at least two barriers to their quality of life and wellbeing. Greater strengths in active addiction are associated with greater strengths and resources in recovery. Conclusion As well as demonstrating population changes in each of the domains assessed, the current study has shown the potential of the Life In Recovery Scale as a measure of recovery capital that can be used to support recovery interventions and pathways.

Background Mutual aid organizations, such as Narcotics Anonymous (NA), can provide support in substance use disorder (SUD) recovery processes. However, research on NA and its recovery-supportive elements is scarce and perspectives of NA-members remain understudied, in particular outside the US. Therefore, this study aims to gain insight into recovery-supportive elements of NA, as experienced by its members. Methods To explore the perspectives on and experiences with recovery-supportive elements in NA, 11 in-depth interviews with NA-members were conducted in Flanders (Belgium). Interviews were audio-taped, transcribed verbatim and analyzed by using CHIME-D, a personal recovery framework (Connectedness, Hope, Identity, Meaning in life, Empowerment, Difficulties) developed by Leamy and colleagues in 2011. Results Various recovery-supportive elements of NA were highlighted, with Connectedness as a key component including opportunities for building up a social network and for providing a safety net or sounding board. Elements that enabled Connectedness were 1) a non-judgemental approach, and 2) mutual understanding through sharing in NA. Other elements of the CHIME-D framework were less frequently mentioned, although these were inextricably linked to Connectedness. Conclusions Connectedness appeared to be the crucial recovery-supportive element in NA, emphasizing the relational character of SUD recovery. Although other elements of the CHIME-D framework were identified, these were closely related to and intertwined with the concept of connectedness.

Therapeutic communities (TCs) for addictions are drug-free environments in which people with addictive problems live together in an organized and structured way to promote change toward recovery and reinsertion in society. Despite a long research tradition in TCs, the evidence base for the effectiveness of TCs is limited according to available reviews. Since most of these studies applied a selective focus, we made a comprehensive systematic review of all controlled studies that compared the effectiveness of TCs for addictions with that of a control condition. The focus of this paper is on recovery, including attention for various life domains and a longitudinal scope. We searched the following databases: ISI Web of Knowledge (WoS), PubMed, and DrugScope. Our search strategy revealed 997 hits. Eventually, 30 publications were selected for this paper, which were based on 16 original studies. Two out of three studies showed significantly better substance use and legal outcomes among TC participants, and five studies found superior employment and psychological functioning. Length of stay in treatment and participation in subsequent aftercare were consistent predictors of recovery status. We conclude that TCs can promote change regarding various outcome categories. Since recovering addicts often cycle between abstinence and relapse, a continuing care approach is advisable, including assessment of multiple and subjective outcome indicators.

Introduction Research has established natural recovery (NR) as an important pathway to substance use recovery. Studies investigating correlates of NR have mainly focused on demographic and substance use variables rather than life circumstances. This study seeks to better understand the phenomenon of natural recovery by (i) validating the international scientific literature concerning demographic and substance use indicators of NR in Flanders and (ii) assessing the additional explanatory power of recovery strengths and barriers during active addiction, controlling for demographic and substance use covariates. Methods A total of 343 persons in recovery from alcohol or drug use problems (≥ 3 months) completed an online cross-sectional survey in Flanders. Participants in NR and in recovery after following treatment were compared using multivariate linear regression models. Reasons for not following treatment were analyzed using inductive thematic analysis. Results Higher education level, lower severity of dependence, and cannabis use as the main problem substance (vs. alcohol) were statistically significant ( p  < 0.05) correlates of NR. When scores for the number of barriers and strengths associated with active addiction were added, barriers (but not strengths) were significantly associated with NR. When barrier items were individually tested, having untreated emotional or mental health problems, having a driver’s license revoked and damaging property were statistically significant correlates. The most reported reason for not entering treatment was not experiencing any need to do so. Conclusion The results highlight the importance of a holistic approach to recovery support across multiple life domains. Limitations and opportunities for further research are discussed.

Background There is growing evidence on the importance of a gendered understanding of recovery. Gender differences have been reported in relation to the nature and extent of substance use, pathways to and through substance use disorder and recovery capital acquisition and maintenance. There is little existing research on factors associated with recovery capital growth by gender. Methods The current paper uses the European Life in Recovery database to assess specific domains of the Strengths and Barriers Recovery Scale (SABRS) that best predict growth of recovery capital amongst people in recovery from drug addiction. The 1313 participants were drawn from the REC-PATH study and recruited by the Recovery Users Network (RUN) from across Europe. Bivariate and multivariate analyses were performed to identify relationships between specific SABRS items and gender, as well as differences in the dimensions of the SABRS scale most likely to predict recovery capital growth by gender. Results Between their time in active addiction and in recovery, females show greater growth in strengths, despite females reporting fewer recovery strengths during active addiction than males, and males have greater reductions in barriers to recovery compared to females. Multivariate analyses show that strengths specifically related to prosocial meaningful activities are found to be highly significant for growth of recovery capital amongst males, whereas strengths related to both prosocial meaningful activities and general health management seem particularly relevant for growth of recovery capital amongst females. Conclusions We conclude that this further demonstration of gender differences in recovery pathways should suggest gender-specific approaches adopted in recovery community organisations to address these different needs.

Aims: Although treatment barriers are different for men and women, research is dominated by males’ and practitioners’ perspectives rather than women’s voices. The purpose of this study in Belgium was to identify and obtain a better understanding of the barriers and facilitators for seeking treatment as experienced by substance (ab)using women themselves. Methods: In-depth interviews were conducted with 60 female substance users who utilise(d) outpatient and/or residential treatment services. A content analysis was performed on women’s personal accounts of previous treatment experiences as well as their experiences with services along the continuum of care, resulting in practical implications for the organisation of services. Results: Female substance users experience various overlapping – and at times competing – barriers and facilitators when seeking treatment and utilising services. For most women, the threat of losing custody of their children is an essential barrier to treatment, whereas for a significant part of the participants it serves as a motivation to seek help. Also, women report social stigma in private as well as professional contexts as a barrier to treatment. Women further ask for a holistic approach to treatment, which stimulates the healing process of body, mind and spirit, and emphasise the importance of feeling safe in treatment. Participants suggested several changes that could encourage treatment utilisation. Conclusion: Our findings demonstrate the need for a gender-sensitive approach within alcohol and drug services that meets the needs of female substance users, as well as gender-sensitivity within prevention and awareness-raising campaigns, reducing the stigma and facilitating knowledge and awareness among women and society.

Perinatal substance use is a growing global health concern with significant risks for maternal health, child development, and parenting. Despite these risks, the perinatal period offers a \"window of opportunity\" for behavioral change and recovery initiation. However, research exploring how vulnerability and transformation interact in the context of perinatal substance use remains scarce. Existing studies are predominantly cross-sectional, deficit-oriented, and focused on relapse or the medical effects of prenatal exposure, leaving critical gaps in understanding maternal trajectories and psychosocial factors shaping the transition to parenthood. The PIPPA (Perinatal Insights into Parenting, Pathways, and Addiction) study identifies the maternal, psychosocial, and contextual factors associated with whether the perinatal period becomes a promising or challenging transition to parenthood for women with substance use problems. Specific outcomes include trajectories of maternal mental health, recovery capital, substance use patterns, mother-child relationship quality, parental stress, and contextual conditions, as well as custody and cohabitation outcomes. An important focus is how these factors shape short- and long-term maternal and child trajectories. PIPPA is a longitudinal, prospective, multicenter, mixed methods study in Flanders, Belgium (May 2025-November 2026). Fifty pregnant and parenting women with alcohol and/or other substance use problems are recruited through obstetric departments, general substance use services, specialized substance use services, child protection services, and social media. Participants are assessed at 2-3 points: during pregnancy, 2-6 weeks postpartum, and 6 months postpartum. Data are collected using validated questionnaires (Alcohol Use Disorder Identification Test-Consumption, Drug Use Disorder Identification Test-Consumption, Edinburgh Postnatal Depression Scale, Satisfaction with Life Scale, Brief Assessment of Recovery Capital-10, Maternal Antenatal Attachment Scale, Maternal Postnatal Attachment Scale, and Parental Stress Scale) and custom instruments. Qualitative data include Three-Minute and Five-Minute Speech Sample tasks to assess maternal representations and expressed emotion, and semistructured interviews with pregnant and parenting women and caregivers. Quantitative analyses will include descriptive, longitudinal, subgroup, and regression models, while qualitative analyses will include longitudinal thematic analysis and structured coding of expressed emotion. All data are managed in REDCap (Research Electronic Data Capture). Recruitment began in May 2025 and is expected to be complete in November 2026. Data collection began in June 2025. As of April 2026, 13 participants have been recruited. Data analysis will be performed after data collection. The results are expected to be published by the end of 2027. This study will contribute to a more strengths-based and evidence-informed understanding of the transition to motherhood in the context of perinatal substance use. The PIPPA study will capture diverse experiences and the complex interplay among substance use, recovery, and early parenting. These insights will inform and strengthen integrated, responsive early interventions to support pregnant and parenting women with substance use problems and promote child well-being.

Background Prisoners report much higher prevalence rates of drug use and more harmful consumption patterns than the general population. People who use drugs have above-average experiences with the criminal justice system in general, and the prison system and subsequent release situations in particular. Release from prison is associated with increased mortality rates among drug users due to the risk of overdose. The EU-funded project ‘My first 48 hours out’ aimed to address the gaps in continuity of care for long-term drug users in prison and upon release, with a special focus on drug user’s perspectives on needs and challenges upon release. Methods A multi-country (Belgium, France, Germany and Portugal) qualitative study was set up to explore drug users’ perceptions of drug use and risk behaviour upon prison release, experiences of incarceration and release, and strategies to avoid risks when being released. In total, 104 prisoners and recently released persons with a history of drug use participated in semi-structured interviews and focus groups discussions on these topics. Results Respondents pointed out that there are numerous challenges for people who use drugs when released from prison. Lack of stable housing and employment support were frequently mentioned, as well as complex administrative procedures regarding access to services, health insurance and welfare benefits. Besides structural challenges, individual issues may challenge social reintegration like ‘old habits’, mental health problems and disrupted social networks. As a result, (ex-)prisoners adopt individual strategies to cope with the risks and challenges at release. Conclusion Measures to prepare prisoners for release often do not focus on the individual and specific challenges of persons who use drugs. Psychosocial and medical support need to be improved and adjusted to drug users’ needs inside and outside prison. To improve the quality and continuity of care around release, the perspectives and coping strategies of people who use drugs should be used to better address their needs and barriers to treatment.

Background Much remains unknown about the dynamics of substitute behaviors during addiction recovery among persons attending recovery support groups. Insight into the nature, motives for, and course of substitute behaviors could help to shape recovery support and harm reduction services. Methods Twenty-three semi-structured in-depth interviews ( n  = 14 males and n  = 9 females) were conducted with a convenience sample of Narcotics Anonymous attendees from a number of groups in the Western Cape, South Africa. Participants ranged in age from 22—55 years (M = 39.3, SD = 9.35). Results Thematic analysis yielded four themes: (i) substance-to-substance substitution; (ii) substance-to-behavior substitution; (iii) substitute behaviors and harm (reduction) and (iv) support needs to manage and resolve substitute behaviors. According to the study, participants’ substitute behaviors developed across recovery stages; were temporary or long-term replacements for substance use disorders and were engaged for distraction, isolation from others, calming, assuaging boredom, keeping occupied, filling a perceived experiential void, modifying mood and to self-medicate. While substitutes were utilized for harm reduction or relapse prevention, the potential for ostensibly healthy behaviors to threaten recovery and lead to relapse was also recognized. Conclusions Self-monitoring, ongoing vigilance, and awareness of when substitutes become genuine addictions are critical for timely, suitable interventions.

Background The recovery processes of persons with complex mental health needs take a slow and unpredictable course. Despite the fact that a number of essential building blocks of recovery in this population have been identified (e.g. social relationships, treatment, personal beliefs), the actual process of recovery in persons with complex mental health needs largely remains a black box. The aim of this study was to gain insight into how the recovery processes of persons with complex mental health needs take place, by applying a relational geographical approach and scrutinizing the place-making dynamics of one low-threshold meeting place in Belgium engaging with this group. Methods Data collection took place during the height of the COVID-19 pandemic by means of 11 in-depth interviews with different involved actors (service users, staff members, volunteers) and analyzed thematically. Results Results showed how the daily practice of the meeting place is continuously reproduced through place-making rituals that create an inclusive space of hospitality, are fueled by creative processes and form an indispensable counterweight for service users’ mental health needs. Conclusions To further open up the ‘black box’ of recovery in persons with complex mental health needs, it is vital to focus our analytic gaze onto recovery as a dynamic and relational practice.