Recovery-promoting Care as Experienced by Persons with Severe Mental Illness and Substance Misuse

  • Gunilla CruceEmail author
  • Agneta Öjehagen
  • Monica Nordström


This paper explores recovery-promoting care as experienced by persons with concomitant severe mental illness and substance misuse. Sixteen in-depth interviews, based on an interview guide concerning their experiences of health, life situation and care, were held with eight participants in an outpatient treatment programme. The analysis aimed to identify themes reflecting the diversity and complexity of the phenomenon recovery-promoting care. Six themes emerged: “entirety”, “participation and reciprocal relations”, “stability”, “symptom control”, “mindfulness”, and “dignity and autonomy”. The participants reported that care conveying experiences of meaningfulness and providing empowerment increased their motivation and their capacity to take an active part in the recovery process. The findings of the study underscore the importance of incorporating the patients’ perspectives on what promotes recovery when offering mental health services.


Severe mental illness Substance misuse Recovery Qualitative study 


  1. Alverson, H. S., Drake, R. E., Carpenter-Song, E. A., Chu, E., Ritsema, M., & Smith, B. (2007). Ethnocultural variations in mental illness discourse: some implications for building therapeutic alliances. Psychiatric Services, 58(12), 1541–1546.PubMedCrossRefGoogle Scholar
  2. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, 4th edn. Washington DC.Google Scholar
  3. Anthony, W. A. (1993). Recovery from mental illness: the guiding vision of the mental health service system in the 1990s. Psychosocial Rehabilitation Journal, 16(4), 11–23.Google Scholar
  4. Antonovsky, A. (1996). The salutogenic model as a theory to guide health promotion. Health Promotion International, 11(1), 11–18.CrossRefGoogle Scholar
  5. Barnett, J. H., Werners, U., Secher, S. M., Hill, K. E., Brazil, R., Masson, K., et al. (2007). Substance use in a population-based clinic sample of people with first-episode psychosis. The British Journal of Psychiatry, 190, 515–520.PubMedCrossRefGoogle Scholar
  6. Bejerholm, U., & Eklund, M. (2007). Occupational engagement in persons with schizophrenia: relationships to self-related variables, psychopathology, and quality of life. The American Journal of Occupational Therapy, 61(1), 21–32.PubMedCrossRefGoogle Scholar
  7. Bishop, S. R. (2004). Mindfulness: a proposed operational definition. Clinical Psychology: Science and Practice, 11(3), 230–241.CrossRefGoogle Scholar
  8. Cruce, G., Öjehagen, A., & Nordström, M. (2008). Experiences of alcohol and other drugs in individuals with severe mental illness and concomitant substance use disorders. Mental Health and Substance Use: Dual diagnosis, 1(3), 228–241.Google Scholar
  9. Davidson, L., & White, W. (2007). The concept of recovery as an organizing principle for integrating mental health and addiction services. The Journal of Behavioral Health Services & Research, 34(2), 109–120.CrossRefGoogle Scholar
  10. Davidson, L., Lawless, M. S., & Leary, F. (2005). Concepts of recovery: competing or complementary? Current Opinion in Psychiatry, 18(6), 664–667.PubMedCrossRefGoogle Scholar
  11. Drake, R. E., Essock, S. M., Shaner, A., Carey, K. B., Minkoff, K., Kola, L., et al. (2001). Implementing dual diagnosis services for clients with severe mental illness. Psychiatric Services, 52(4), 469–476.PubMedCrossRefGoogle Scholar
  12. Drake, R. E., Wallach, M. A., & McGovern, M. P. (2005). Future directions in preventing relapse to substance misuse among clients with severe mental illnesses. Psychiatric Services, 56(10), 1297–1302.PubMedCrossRefGoogle Scholar
  13. Drake, R. E., McHugo, G. J., Xie, H., Fox, M., Packard, J., & Helmstetter, B. (2006). Ten-year recovery outcomes for clients with co-occurring schizophrenia and substance use disorders. Schizophrenia Bulletin, 32(3), 464–473.PubMedCrossRefGoogle Scholar
  14. Fitzsimons, S., & Fuller, R. (2002). Empowerment and its implications for clinical practice in mental health: a review. Journal of Mental Health, 11(5), 481–499.CrossRefGoogle Scholar
  15. Frankl, V. E. (1968). Livet måste ha en mening [Man’s search for meaning.](Swedish translation Margareta Edgardh). Stockholm: Alb. Bonniers boktryckeri. (Original work published 1962).Google Scholar
  16. Giorgi, A. (1975). An application of phenomenological method in psychology. In I. A. Giorgi, C. Fisher, & E. Murray (Eds.), Duquesne studies in phenomenological psychology, II (pp. 82–103). Pittsburgh: Duquesne University Press.Google Scholar
  17. Hamann, J., Cohen, R., Leucht, S., Busch, R., & Kissling, W. (2007). Shared decision making and long-term outcome in schizophrenia treatment. The Journal of Clinical Psychiatry, 68, 992–997.PubMedCrossRefGoogle Scholar
  18. Kabat-Zinn, J. (2005). Vart du än gå är du där. Medveten närvaro i vardagen. [Wherever you go there you are]. (Swedish translation Ann Björkhem). Stockholm: Natur& Kultur. (Original work published 1994)Google Scholar
  19. Kvale, S. (1997). Den kvalitativa forskningsintervjun. [The qualitative research interview]. Lund: Studentlitteratur.Google Scholar
  20. Laudet, A. B. (2007). What does recovery mean to you? Lessons from the recovery experience for research and practice. Journal of Substance Misuse Treatment, 33(3), 243–256.CrossRefGoogle Scholar
  21. Laudet, A. B., Magura, S., Vogel, H. S., & Knight, E. (2000). Support, mutual aid and recovery from dual diagnosis. Community Mental Health Journal, 36(5), 457–476.PubMedCrossRefGoogle Scholar
  22. Levitt, A., Mueser, K., DeGenova, J., Lorenzo, J., Bradford, D., Barbosa, A., et al. (2009). Randomized controlled trial of illness management and recovery in multiple-unit supportive housing. Psychiatric Services, 60(12), 1629–1636.PubMedCrossRefGoogle Scholar
  23. Mancini, M. A., Hardiman, E. R., & Lawson, H. A. (2005). Making sense of it all: consumer providers’ theories about factors facilitating and impeding recovery from psychiatric disabilities. Psychiatric Rehabilitation Journal, 29(1), 48–55.PubMedCrossRefGoogle Scholar
  24. Margolese, H. C., Malchy, L., Negrete, J. C., Tempier, R., & Gill, K. (2004). Drug and alcohol use among patients with schizophrenia and related psychoses: levels and consequences. Schizophrenia Research, 67(2–3), 157–166.PubMedCrossRefGoogle Scholar
  25. McDowell, D., Galanter, M., Goldfarb, L., & Lifshutz, H. (1996). Spirituality and the treatment of the dually diagnosed: an investigation of patient and staff attitudes. Journal of Addictive Diseases, 15(2), 55–68.PubMedCrossRefGoogle Scholar
  26. McGlasham, T. H., Addington, J., Cannon, T., Heinimaa, M., McGorry, P., O’Brien, M., Penn, D., Perkins, D., Salokangas, R. K., Walsh, B., Woods, S. W., & Yung, A. (2007). Recruitment and treatment practices for help-seeking “prodromal” patients. Schizophrenia Bulletin, 33(5), 715–726.CrossRefGoogle Scholar
  27. Regier, D. A., Farmer, M. E., Rae, D. S., Locke, B. Z., Keith, S. J., Judd, L. L., et al. (1990). Comorbidity of mental disorders with alcohol and other drug misuse. Results from the Epidemiologic Catchment Area (ECA) Study. The Journal of the American Medical Association, 264(19), 2511–2518.CrossRefGoogle Scholar
  28. Silverstein, L. B., Auerbach, C. F., & Levant, R. F. (2006). Using qualitative research to strengthen clinical practice. Professional Psychology: Research and Practice, 37(4), 351–358.CrossRefGoogle Scholar
  29. SOU [Swedish Government Official Reports]. (2006). Ambition och ansvar. Nationell strategi för utveckling av samhällets insatser till personer med psykiska sjukdomar och funktionshinder. Retrieved 02 20 2011 from
  30. Sowers, W. (2005). Transforming systems of care: The American Association of Community Psychiatrists guidelines for recovery oriented services. Community Mental Health Journal, 41(6), 757–774.PubMedCrossRefGoogle Scholar
  31. Svedberg, P., Jormfeldt, H., & Arvidsson, B. (2003). Patients’ conceptions of how health processes are promoted in mental health nursing. A qualitative study. Journal of Psychiatric and Mental Health Nursing, 10(4), 448–456.PubMedCrossRefGoogle Scholar
  32. Tew, J. (2005). Social perspectives in mental health. Developing social models to understand and work with mental distress. London: Jessica Kingsley Publishers.Google Scholar
  33. Velpry, L. (2008). The patient’s view: issues of theory and practice. Culture, Medicine and Psychiatry, 32(2), 238–258.PubMedCrossRefGoogle Scholar
  34. World Health Organization [WHO]. (1992). International Classification of Diseases (ICD). Retrieved 01 27 2011 from
  35. World Medical Association [WMA]. (2008). Declaration of Helsinki: Ethical principles for medical research involving human subjects. Retrieved 05 06 2011 from

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Gunilla Cruce
    • 1
    Email author
  • Agneta Öjehagen
    • 1
  • Monica Nordström
    • 2
  1. 1.Department of Clinical Sciences, Division of PsychiatryLund University, Skane University HospitalLundSweden
  2. 2.Department of Social WorkGothenburg UniversityGothenburgSweden

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