Social Indicators Research

, Volume 90, Issue 1, pp 107–126 | Cite as

Exploratory Study on Drug Users’ Perspectives on Quality of Life: More than Health-Related Quality of Life?

  • Jessica De MaeyerEmail author
  • Wouter Vanderplasschen
  • Eric Broekaert


In drug treatment outcome literature, a focus on objective and socially desirable indicators of change (e.g. no drug use) has predominated, while outcome indicators that are important for drug users themselves (e.g. quality of life, satisfaction with treatment) have largely been neglected. Nonetheless, Quality of Life (QoL) has become an important concept to evaluate effectiveness of treatment in mental health care research and disability studies. Given the almost exclusive focus on Health-related Quality of Life (HRQOL) in substance abuse research and the neglect of clients’ perspectives in this field, we explore in this study the concept of QoL as perceived by drug users. Focus group discussions (n = 9) were organised in various treatment settings and community services for drug users in the region of Ghent, Belgium to identify important dimensions of QoL and their interpretation by drug users. Data were clustered and analysed based on the theoretical framework of Robert Schalock (Quality of life. Volume 1: Conceptualization and measurement, 1996). The domains ‘personal relationships’, ‘social inclusion’ and ‘self-determination’ were discussed most frequently by the participants. They stressed the importance of a supportive social network in particular. It can be concluded that QoL is not primarily associated by drug users with health and it involves much more than the aspects typically represented in measures of HRQOL.


Quality of life Drug use Substance abuse treatment Focus groups Health-related quality of life Drug users Participative 


  1. Ager, A., & Hatton, C. (1999). Discerning the appropriate role and status of ‘quality of life’ assessment for persons with intellectual disability: A reply to Cummins. Journal of Applied Research in Intellectual Disabilities, 12, 335–339.CrossRefGoogle Scholar
  2. Allison, P. J., Locker, D., & Feine, J. S. (1997). Quality of life: a dynamic construct. Social Science & Medicine, 45, 221–230.CrossRefGoogle Scholar
  3. Anthony, J. C., & Chen, C. Y. (2004). Epidemiology of drug dependence. In M. Galanter & H. D. Kleber (Eds.), Textbook of substance abuse treatment (pp. 55–72). Arlington, VA: American Psychiatric Publishing.Google Scholar
  4. Barnett, P. G., & Hui, S. S. (2000). The cost-effectiveness of methadone maintenance. The Mount Sinai Journal of Medicine, 67, 365–374.Google Scholar
  5. Blumer, H. (1969). Symbolic interactionism: Perspective and method. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
  6. Boevink, W. A., Wolf, J. R. L. M., van Nieuwenhuizen, C., & Schene, A. H. (1995). Kwaliteit van leven van langdurig van ambulante zorg afhankelijke psychiatrische patiënten: een conceptuele verkenning. Tijdschrift voor Psychiatrie, 37, 97–109.Google Scholar
  7. Brindis, C. D., & Theidon, K. S. (1997). The role of case management in substance abuse treatment services for women and their children. Journal of Psychoactive Drugs, 29, 79–88.Google Scholar
  8. Brun, C., & Rapp, R. C. (2001). Strengths-based case management: Individuals’ perspectives on strengths and the case manager relationship. Social Work, 46, 278–288.Google Scholar
  9. Carr, A. J., & Higginson, I. J. (2001). Measuring quality of life: Are quality of life measures patient centred? British Medical Journal, 322, 1357–1360.CrossRefGoogle Scholar
  10. Carr, A. J., Thompson, P. W., & Kirwan, J. R. (1996). Quality of life measures. British Journal of Rheumatology, 35, 275–281.CrossRefGoogle Scholar
  11. Costenbader, E. C., Zule, W. A., & Coomes, C. M. (2007). The impact of illicit drug use and harmful drinking on quality of life among injection drug users at high risk for hepatitis C infection. Drug and Alcohol Dependence, 89, 251–258.CrossRefGoogle Scholar
  12. Cummins, R. A. (2000). Objective and subjective quality of life: an interactive model. Social Indicators Research, 52, 55–72.CrossRefGoogle Scholar
  13. Cummins, R. A. (2005). Moving from the quality of life concept to a theory. Journal of Intellectual Disability Research, 49, 699–706.CrossRefGoogle Scholar
  14. De Jong, C. A. J., Roozen, H. G., van Rossum, L. G. M., Krabbe, P. F. M., & Kerkhof, A. J. F. M. (2007). High abstinence rates in heroin addicts by a new comprehensive treatment approach. American Journal on Addictions, 16, 124–130.CrossRefGoogle Scholar
  15. De Waele, I., & Van Hove, G. (2005). Modern times: An ethnographic study on the quality of life of people with a high support need in a Flemish residential facility. Disability & Society, 20, 625–639.CrossRefGoogle Scholar
  16. Drumm, R., Bride, D., Metsch, L., Page, J., Dickerson, K., & Jones, B. (2003). “The rock always comes first”: Drug users’ accounts about using formal health care. Journal of Psychoactive Drugs, 35, 461–469.Google Scholar
  17. Edgerton, R. B. (1996). A longitudinal-ethnographic research perspective on quality of life. In R. Schalock (Ed.), Quality of life. Volume 1: Conceptualization and measurement (pp. 11–22). Washington: American Association on Mental Retardation.Google Scholar
  18. European Monitoring Centre for Drugs, Drug Addiction (EMCDDA). (2007). 2007 Annual report on the state of the drugs problem in Europe. Luxembourg: Office for Official Publications of the European Communities.Google Scholar
  19. Farquhar, M. (1995). Definitions of quality of life: A taxonomy. Journal of Advanced Nursing, 22, 502–508.CrossRefGoogle Scholar
  20. Fischer, B., Rehm, J., & Kim, G. (2001a). Quality of Life (QoL) in illicit drug addiction treatment and research: concepts, evidence and questions. In B. Westermann, C. Jellinek & G. Belleman (Eds.), Substitution: Zwischen Leben und Sterben (pp. 21–40). Weilheim: Beltz Deutscher Studien Verlag.Google Scholar
  21. Fischer, B., Rehm, J., & Kim, G. (2001b). Whose Quality of Life is it, really? British Medical Journal, 322, 1357–1360.CrossRefGoogle Scholar
  22. Fischer, B., Rehm, J., Kim, G., & Kirst, M. (2005). Eyes Wide Shut?—A conceptual and empirical critique of methadone maintenance treatment. European Addiction Research, 11, 1–14.CrossRefGoogle Scholar
  23. Foster, J. H., Peters, T. J., & Marshall, E. J. (2000). Quality of life measures and outcome in alcohol-dependent men and women. Alcohol, 22, 45–52.CrossRefGoogle Scholar
  24. Foster, J. H., Powell, J. E., Marshall, E. J., & Peters, T. J. (1999). Quality of life in alcohol-dependent subjects: A review. Quality of Life Research, 8, 255–261.CrossRefGoogle Scholar
  25. Garg, N., Yates, W., Jones, R., Zhou, M., & Williams, S. (1999). Effects of gender, treatment site and psychiatric comorbidity on quality of life outcome in substance dependence. The American Journal on Addictions, 8, 44–54.CrossRefGoogle Scholar
  26. Giacomuzzi, S. M., Riemer, Y., Ertl, M., Kemmler, G., Rössler, H., Hinterhuber, H., et al. (2003). Buprenorphine versus methadone maintenance treatment in an ambulant setting: a health-related quality of life assessment. Addiction, 98, 693–702.CrossRefGoogle Scholar
  27. Giacomuzzi, S. M., Riemer, Y., Ertl, M., Kemmler, G., Rössler, H., Hinterhuber, H., et al. (2005). Gender differences in health-related quality of life on admission to a maintenance treatment program. European Addiction Research, 11, 69–75.CrossRefGoogle Scholar
  28. Giacomuzzi, S., Kemmler, G., Ertl, M., & Riemer, Y. (2006). Opioid addicts at admission vs slow-release oral morphine, methadone, and sublingual buprenorphine maintenance treatment participants. Substance Use & Misuse, 41, 223–244.CrossRefGoogle Scholar
  29. Gilbert, T. (2004). Involving people with learning disabilities in research: Issues and possibilities. Health and Social Care in the Community, 12, 298–308.CrossRefGoogle Scholar
  30. Goode, D., & Hogg, J. (1994). Towards an understanding of holistic quality of life in people with profound intellectual and multiple disabilities. In D. Goode (Ed.), Quality of life for persons with disabilities–international perspectives and issues (pp. 197–207). Cambridge, MA: Brookline Books.Google Scholar
  31. Habrat, B., Chmielewska, K., Baran-Furga, H., Keszycka, B., & Taracha, E. (2002). Subjective Quality of Life in opiate-dependent patients before admission after six months and one-year participation in methadone program. Przeglad Lekarski, 59, 351–354.Google Scholar
  32. Hser, Y. I., Polinsky, M. L., Maglione, M., & Anglin, M. D. (1999). Matching clients’ needs with drug treatment services. Journal of Substance Abuse Treatment, 16, 299–305.CrossRefGoogle Scholar
  33. Hunt, G., & Barker, J. (1999). Drug treatment in contemporary anthropology and sociology. European Addiction Research, 5, 126–132.CrossRefGoogle Scholar
  34. Kalman, D., Lee, A., Chan, E., Miller, D. R., Spiro, A., Ren, X. S., et al. (2004). Alcohol dependence, other psychiatric disorders, and health-related quality of life: A replication study in a large random sample of enrolees in the veterans health administration. American Journal of Drug and Alcohol Abuse, 30, 473–487.CrossRefGoogle Scholar
  35. Kaplan, C., & Verbraeck, H. (2001). Where have the field notes gone? The changing nature and politics of drugs ethnography in the Netherlands. Addiction Research & Theory, 9, 299–323.CrossRefGoogle Scholar
  36. Kitzinger, J. (1995). Qualitative Research–Introducing focus groups. British Medical Journal, 311, 299–302.Google Scholar
  37. Krueger, R. A., & Casey, M. A. (2000). Focus groups: A practical guide for applied research. Thousand Oaks, CA: Sage Publications.Google Scholar
  38. Kuckartz, U. (1998). WinMAX: Scientific text analysis for the social sciences, User’s guide. Berlin: Udo Kuckartz, BSS.Google Scholar
  39. Lasalvia, A., Bonetto, C., Malchiodi, F., Salvi, G., Parabiaghi, A., Tansella, M., et al. (2005). Listening to patients’ needs to improve their subjective quality of life. Psychological Medicine, 35, 1655–1665.CrossRefGoogle Scholar
  40. Maremmani, I., Pani, P. P., Pacini, M., & Perugi, G. (2007). Substance use and quality of life over 12 months among buprenorphine maintenance-treated and methadone maintenance-treated heroin-addicted patients. Journal of Substance Abuse Treatment, 33, 91–98.CrossRefGoogle Scholar
  41. Masthoff, E., Trompenaars, F., Van Heck, G., Hodiamont, P., & De Vries, J. (2005). Validation of the WHO Quality of Life assessment instrument (WHOQOL-100) in a population of Dutch adult psychiatric outpatients. European Psychiatry, 20, 465–473.CrossRefGoogle Scholar
  42. McLellan, A. T., Cacciola, J. C., Alterman, A. I., Rikoon, S. H., & Carise, D. (2006). The addiction severity index at 25: Origins, contributions and transitions. American Journal on Addictions, 15, 113–124.CrossRefGoogle Scholar
  43. McLellan, A. T., Lewis, D. C., O’Brien, C. P., & Kleber, H. D. (2000). Drug dependence, a chronic medical illness—implications for treatment, insurance, and outcomes evaluation. Journal of the American Medical Association, 284, 1689–1695.CrossRefGoogle Scholar
  44. Mellor, D.J., Cummins, R.A., Karlinski, E., & Storer, S.P. (2003). The management of subjective quality of life by short-stay hospital patients: An exploratory study. Health and quality of life outcomes, 1, 39–55.CrossRefGoogle Scholar
  45. Michalos, A. C. (2004). Social indicators research and health-related quality of life research. Social Indicators Research, 65, 27–72.CrossRefGoogle Scholar
  46. Millson, P. E., Challacombe, L., Villeneuve, P. J., Fischer, B., Strike, C. J., Myers, T., et al. (2004). Self-perceived health among Canadian opiate users. A comparison to the general population and to other chronic disease populations. Canadian Journal of Public Health, 95, 99–103.Google Scholar
  47. Mooney, A. (2006). Quality of life: Questionnaires and questions. Journal of Health Communication, 11, 327–341.CrossRefGoogle Scholar
  48. Moons, P., Budts, W., & De Geest, S. (2006). Critique on the conceptualisation of quality of life: A review and evaluation of different conceptual approaches. International Journal of Nursing Studies, 43, 891–901.CrossRefGoogle Scholar
  49. Morgan, D. L. (1998). The focus group guidebook. London: Sage Publications.Google Scholar
  50. Noll, H.H. (2000). Social indicators and social reporting: The international experience. Retrieved, January 15, 2008, from
  51. Oliver, J. P. J., Huxley, P. J., Priebe, S., & Kaiser, W. (1997). Measuring the quality of life of severely mentally ill people using the Lancashire Quality of Life Profile. Social Psychiatry and Psychiatric Epidemiology, 32, 76–83.CrossRefGoogle Scholar
  52. Padaiga, Z., Subata, E., & Vanagas, G. (2007). Outpatient methadone maintenance treatment program Quality of Life and health of opioid-dependent persons in Lithuania. Medicina (Kaunas), 43, 235–241.Google Scholar
  53. Power, R., Jones, S., Kearns, G., & Ward, J. (1996). An ethnography of risk management amongst illicit drug injectors and its implications for the development of community-based interventions. Sociology of Health & Illness, 18, 86–106.CrossRefGoogle Scholar
  54. Rapley, M. (2003). Quality of life research: A critical introduction. London: Sage Publications.Google Scholar
  55. Rapp, R. C. (2006). Strengths-based case management: Enhancing treatment for persons with substance abuse problems. In D. Saleebey (Ed.), The Strengths perspective in social work practice (pp. 128–147). Boston: Pearson Education.Google Scholar
  56. Romney, D. M., Brown, R. I., & Fry, P. S. (1994). Improving the quality of life: Prescriptions for change. Social Indicators Research, 33, 237–272.CrossRefGoogle Scholar
  57. Rosenfield, S. (1997). Labelling mental illness: The effects of received services and perceived stigma on life satisfaction. American Sociological Review, 62, 660–672.CrossRefGoogle Scholar
  58. Rudolf, H., & Watts, J. (2002). Quality of life in substance abuse and dependency. International Review of Psychiatry, 14, 190–197.CrossRefGoogle Scholar
  59. Ryan, C. F., & White, J. M. (1996). Health status at entry to methadone maintenance treatment using the SF-36 health survey questionnaire. Addiction, 91, 39–45.CrossRefGoogle Scholar
  60. Saleebey, D. (1996). The strengths perspective in social work practice: Extensions and cautions. Social Work, 41, 296–305.Google Scholar
  61. Saleebey, D. (2006). Introduction: Power in the people. In D. Saleebey (Ed.), The Strengths perspective in social work practice (pp. 1–24). Boston: Pearson Education.Google Scholar
  62. Schalock, R. (1996). Quality of life. Volume 1: Conceptualization and measurement. Washington: American Association on Mental Retardation.Google Scholar
  63. Schalock, R. (2005). Quality of life: introduction and overview. Journal of Intellectual Disability Research, 49(10), 695–698.CrossRefGoogle Scholar
  64. Schalock, R., & Verdugo Alonso, M. A. (2002). Handbook on quality of life for human service practitioners. Washington: American Association on Mental Retardation.Google Scholar
  65. Senbanjo, R., Wolff, K., & Marshall, J. (2006). Excessive alcohol consumption is associated with reduced quality of life among methadone patients. Addiction, 102, 257–263.CrossRefGoogle Scholar
  66. Smith, K. W., & Larson, M. (2003). Quality of life assessments by adult substance abusers receiving publicly funded treatment in Massachusetts. The American Journal of Drug and Alcohol Abuse, 29, 323–335.CrossRefGoogle Scholar
  67. Stein, M. D., Mulvey, K. P., Plough, A., & Samet, J. H. (1998). The functioning and well being of persons who seek treatment for drug and alcohol use. Journal of Substance Abuse, 10, 75–84.CrossRefGoogle Scholar
  68. Taillefer, M. C., Dupuis, G., Roberge, M. A., & Le May, S. (2003). Health-related quality of life models: systematic review of the literature. Social Indicators Research, 64, 293–323.CrossRefGoogle Scholar
  69. Taylor, J., & Bogdan, R. (1996). Quality of life and the individual’s perspective. In R. Schalock (Ed.), Quality of life. Volume 1: Conceptualization and measurement (pp. 11–22). Washington: American Association on Mental Retardation.Google Scholar
  70. Torrens, M., San, L., Martinez, A., Castillo, C., Domingo-Salvany, A., & Alonso, J. (1997). Use of the Nottingham Health Profile for measuring health status of patients in methadone maintenance treatment. Addiction, 92, 707–716.CrossRefGoogle Scholar
  71. Vanagas, G., Padaiga, Z., & Bagdonas, E. (2006). Cost-utility analysis of methadone maintenance treatment: A methodological approach. Substance Use & Misuse, 41, 87–101.CrossRefGoogle Scholar
  72. Vanderplasschen, W., & De Maeyer, J. (2007). The practice of case management for substance abusers: what’s in a name? Adiktologie, 7, 460–469.Google Scholar
  73. Vanderplasschen, W., Rapp, R. C., Wolf, J., & Broekaert, E. (2004). The development and implementation of case management for substance use disorders in North America and Europe. Psychiatric Services, 55(8), 913–922.CrossRefGoogle Scholar
  74. Vandevelde, S., Vanderplasschen, W., & Broekaert, E. (2003). Cultural responsiveness in substance-abuse treatment: a qualitative study using professionals’ and clients’ perspectives. International Journal of Social Welfare, 12, 221–228.CrossRefGoogle Scholar
  75. Van Loon, J. (2001). Arduin. Ontmantelen van de instituutzorg. Emancipatie en zelfbepaling van mensen met een verstandelijke handicap. Leuven-Apeldoorn: Garant.Google Scholar
  76. van Nieuwenhuizen, C., Schene, A. H., & Koeter, M. W. J. (2002). Quality of life in forensic psychiatry: an unreclaimed territory? International Review of Psychiatry, 14, 198–202.CrossRefGoogle Scholar
  77. Ventegodt, S., & Merrick, J. (2003). Psychoactive drugs and quality of life. The Scientific World Journal, 3, 694–706.Google Scholar
  78. Walmsley, J. (2001). Normalisation, emancipatory research and inclusive research in learning disability. Disability and Society, 16, 187–205.CrossRefGoogle Scholar
  79. World Health Organization (WHO). (2004). Global status report on alcohol 2004. Geneva: World Health Organization, Department of Mental Health and Substance Abuse.Google Scholar
  80. Zautra, A., & Goodhart, D. (1979). Quality of life indicators: A review of literature. Community Mental Health Review, 4, 1–10.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  • Jessica De Maeyer
    • 1
    Email author
  • Wouter Vanderplasschen
    • 1
  • Eric Broekaert
    • 1
  1. 1.Department of OrthopedagogicsGhent UniversityGhentBelgium

Personalised recommendations