"Personal recovery depends on NA unity": an exploratory study on recovery-supportive elements in Narcotics Anonymous Flanders

Is personal recovery a transdiagnostic concept? Testing the fit of the CHIME framework using narrative experiences

BACKGROUND

Personal recovery is operationalized in the CHIME framework (connectedness, hope, identity, meaning in life, and empowerment) of recovery processes. CHIME was initially developed through analysis of experiences of people mainly with psychosis, but it might also be valid for investigating recovery in mood-related, autism and other diagnoses.

AIMS

To examine whether personal recovery is transdiagnostic by studying narrative experiences in several diagnostic groups.

METHODS

Thirty recovery narratives, retrieved from "Psychiatry Story Bank" (PSB) in the Netherlands, were analyzed by three coders using CHIME as a deductive framework. New codes were assigned using an inductive approach and member checks were performed after consensus was reached.

RESULTS

All five CHIME dimensions were richly reported in the narratives, independent of diagnosis. Seven new domains were identified, such as "acknowledgement by diagnosis" and "gaining self-insight". These new domains were evaluated to fit well as subdomains within the original CHIME framework. On average, 54.2% of all narrative content was classified as experienced difficulties.

CONCLUSIONS

Recovery stories from different diagnostic perspectives fit well into the CHIME framework, implying that personal recovery is a transdiagnostic concept. Difficulties should not be ignored in the context of personal recovery based on its substantial presence in the recovery narratives.

Recovery-supportive interventions for people with substance use disorders: a scoping review

Background

Recovery-supportive interventions and strategies for people with substance use disorders are a cornerstone of the emergent recovery paradigm. As compared to other services, such approaches have been shown to be holistically focused and improve outcomes (e.g. substance use, supportive relationships, social functioning, and well-being). Even so, a comprehensive overview of the nature, extent, and range of research on the topic is lacking.

Methods

A scoping review of the literature was conducted to characterize the main topics on recovery-supportive interventions. A systematic search was conducted in three databases: Scopus, Web of Science, and PubMed from January 2000 to July 2023 using the PRISMA-ScR. Twenty-five studies published between 2005-2022 met the inclusion criteria.

Results

Most studies emanated from the United States, and we found a peak in publication frequency between 2018-2022 (n = 13) relative to other years. The most prominent lines of inquiry appear to concern recovery-oriented policies; principles of recovery-oriented services (challenges encountered when implementing recovery-oriented practices, relationships with service providers characterized by trust, and service user-service provider collaboration), and recovery capital (particularly recovery-supportive networks, employment, and housing). Seventeen studies addressed co-occurring disorders, and eight addressed substance use recovery.

Conclusion

To advance the field, more context-specific studies are required on supporting peer professionals, (including enabling cooperation with service users, and hiring experts by experience as staff), and training of professionals (e.g., nurses, psychologists, social workers, physicians) in the principles of recovery.

Efficacy of 12-step mutual-help groups other than Alcoholics Anonymous: a systematic review and meta-analysis

This paper offers a systematic review of quantitative and qualitative studies on the main twelve-step mutual-help (TSMH) groups (excluding Alcoholics Anonymous) and four meta-analyses exploring the correlation between (i) duration or involvement in TSMH groups and; (ii) severity of symptoms or quality of life. Systematic review was conducted following PRISMA guidelines. Searches of databases (MEDLINE, PsychInfo), a register (ClinicalTrials) and citations were conducted, from inception through November 01 2022. Fifty five articles were included (24 quantitative, 27 qualitative, 4 mixed-methods), corresponding to 47 distinctive studies. 68% of these studies were conducted in North America, 17% in Middle East, 11% in the European Union and 4% in Australia. The most studied TSMH group were Gamblers Anonymous (28% of the 47 studies), Narcotics Anonymous (26%), Double Trouble in Recovery (15%), Overeaters Anonymous (19%) and TSMH groups for compulsive sexual behaviors (11%). The four meta-analyses pooled data from 9 studies. Pooled mean age ranged from 36.5 to 40.5. 80-81% of participants were male. TSMH attendance and involvement were negatively correlated with severity of symptoms (high and medium levels of evidence) and positively correlated with quality of life (low levels of evidence). Twenty-one qualitative papers reported factors influencing recovery: Social (n = 15), emotional (n = 9), spiritual (n = 8), self-identification or psychological (n = 6) factors. Review provides characteristics of TSMH groups others than Alcoholics Anonymous, with implications for both research and healthcare practice. The perspective to implement TSMH groups targeting ontological addiction, at the root of all addiction, is discussed.Protocol registration: Prospero registration number: CRD42022342605.

Personal recovery for special populations: a qualitative study exploring the role of special interest meetings within 12-step fellowships

BACKGROUND

This study explores how Special Interest Meetings (SIMs), also called topic-specific meetings (e.g., meetings for young people), support recovery in 12-Step fellowships for Special Populations like young people, women and LGBTQIA+ members. Despite their emergence to address the needs of these groups, the specific ways Special Interest Meetings contribute to recovery experiences are understudied.

METHODS

In-depth interviews were conducted with 12 participants who had attended Special Interest Meetings in 12-Step fellowships to explore the role of these meetings in recovery. The interviews were analysed using the CHIME-D personal recovery framework (Connectedness, Hope, Identity, Meaning in life, Empowerment, Difficulties).

RESULTS

Special Interest Meetings serve as recovery pathways for Special Populations, incorporating CHIME-D elements to aid recovery and address challenges. This study found four "Special Population Pathways" for recovery: Traditional, Hybrid, SIM-Only, and Outside-Sim Hybrid Pathway.

CONCLUSIONS

Special Interest Meetings address specific challenges like discrimination and exclusion faced by Special Populations in recovery. These meetings offer tailored support, deeper connections, improved recovery outcomes, and a sense of empowerment. The existence of "Special Population Pathways" emphasises the ongoing need to address diverse individuals' specific needs throughout the recovery process.

Narcotics Anonymous attendees' perceptions and experiences of substitute behaviors in the Western Cape, South Africa

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.

Personal recovery among people with opioid use disorder during treatment with extended-release naltrexone

Background and aims

Recovery from substance use disorders (SUD) has traditionally been equated with abstinence. "Personal recovery" however emphasizes recovery as a unique and personal process, supported by changes in connectedness, hope, identity, meaning and empowerment. This study aimed to examine personal recovery in people receiving extended-release naltrexone (XR-NTX); specifically investigate changes in personal recovery during treatment, identify groups of participants following distinct trajectories of recovery, and characteristics predicting group-belonging.

Methods

Overall change in recovery (Questionnaire about the Process of Recovery, QPR) score was assessed by linear mixed model in a subsample of 135 people with opioid use disorder (OUD) participating in a 24 + 28-week trial of XR-NTX. Growth mixture model was used to identify potential groups of people following distinct trajectories of personal recovery.

Results

Overall, there was a significant change in QPR score during treatment. Four groups with distinct recovery trajectories were identified: "initially low- increase" (G1), "initially average- no change" (G2), "initially high- no change" (G3) and "initially high- increase" (G4). The groups were different with regards to level of psychological distress, social support, and the use of benzodiazepines. In addition, previous participation in opioid agonist treatment programs, current pain, life satisfaction, employment, heroin craving and previous use of heroin also differed between groups.

Conclusions

Personal recovery among people receiving XR-NTX follows different trajectories, and various factors are associated with personal recovery. Particular attention regarding psychological distress, social support and heroin use among patients commencing XR-NTX treatment is important to facilitate successful recovery trajectories.

Transformation of identity in substance use as a pathway to recovery and the potential of treatment for hepatitis C: a systematic review

BACKGROUND AND AIM

People who inject drugs are at high risk of contracting hepatitis C (HCV). The introduction of direct acting antiviral (DAA) drugs to treat HCV has the potential to transform care; however, uptake of DAAs has been slower than anticipated. The strong link between HCV and injecting drug use frames HCV as a shameful, stigmatising disease, reinforcing an 'addict' identity. Linking HCV care to a recovery journey, 'clean' identity and social redemption may provide compelling encouragement for people to engage with treatment and re-evaluate risk and behaviours, reducing the incidence of HCV re-infection. The aim of this review was to identify actions, interventions and treatments that provide an opportunity for a change in identity and support a recovery journey and the implications for HCV care.

METHODS

Databases (MEDLINE, EMBASE, PsycINFO, ProQuest Public Health, ProQuest Sociological Abstracts, CINAHL and Web of Science) were searched following our published strategy and a grey literature search conducted. A narrative synthesis was undertaken to collate themes and identify common threads and provide an explanation of the findings.

RESULTS

Thirty-two studies fulfilled the inclusion criteria. The narrative synthesis of the studies identified five over-arching analytical themes: social factors in substance use and recovery, therapeutic communities, community treatment, online communities, and finally women and youth subsets. The change from an 'addict' identity to a 'recovery' identity is described as a key aspect of a recovery journey, and this process can be supported through social support and turning point opportunities.

CONCLUSIONS

Recovery from addiction is a socially mediated process. Actions, interventions and treatments that support a recovery journey provide social connections, a recovery identity and citizenship (reclaiming a place in society). There is a gap in current literature describing how pathways of care with direct acting antivirals can be designed to promote recovery, as part of hepatitis C care.

Perspectives of researchers with lived experience in implementation science research: Opportunities to close the research-to-practice gap in substance use systems of care

Background

The field of implementation science acknowledges the importance of diversity within research teams including members from diverse disciplines and with lived expertise in practical implementation (e.g., administrators, front-line workers, patients/clients). Gaps remain in the successful implementation of proven substance use treatment interventions.

Methods

This paper will outline the rationale for the purposeful inclusion of researchers with lived experience (RLE) related to substance use disorder (SUD) within implementation science research studies focused on improving SUD services.

Results

We posit that researchers with such experience can help address research-to-practice gaps by (1) building strong community partnerships, (2) engaging in conversations around effective interventions through knowledge translation, (3) providing community-congruent approaches to evaluation, and (4) aiding in dissemination and sustainability efforts.

Conclusions

We end by offering recommendations for researchers without lived experience as they intentionally collaborate with RLE.

Addiction recovery stories: Lauren Wearing in conversation with Lisa Ogilvie

Purpose

This purpose of this paper is to contribute to a series of recovery stories that examine candid accounts of addiction and recovery. Shared components in the recovery process are considered, along with the change and growth needed to support the transition from addiction to recovery.

Design/methodology/approach

The connectedness, hope, identity, meaning in life and empowerment (CHIME) framework comprises five elements important to recovery. CHIME provides a standard to qualitatively study recovery. As a model, it has been extended to include growth (G-CHIME), an element that is important for sustained addiction recovery. In this paper a first-hand account of addiction recovery is presented, followed by a semi-structured e-interview with the author of the account that is based on the G-CHIME model.

Findings

This paper shows that addiction recovery is a remarkable process that can be effectually explained using the G-CHIME model. The significance of each element in the model is apparent from the biography and e-interview presented.

Originality/value

Each account of recovery in this series is unique, and as yet, untold.

Journey to wellness: A socioecological analysis of veterans in recovery from substance use disorders

Substance use disorders are increasingly prevalent among veterans in the United States. Veterans in recovery face unique challenges, such as high rates of psychiatric comorbidities, difficulties adjusting to civilian life, and inadequate housing and mental health services. While prior research has explored veterans' experiences in recovery, studies have not implemented a multilevel perspective in their analyses. The current qualitative study examined how individual veteran experiences intersect with interpersonal and systemic factors. Semistructured focus groups were conducted with veterans who were former or current residents of recovery homes (N = 20). Thematic analysis was utilized to explore veterans' personal experiences through the CHIME-D framework (connectedness, hope & optimism, identity, meaning in life, empowerment, and difficulties). The data were further analyzed within a socioecological model (intrapersonal, interpersonal, and community). Each component of the CHIME-D framework was salient across all focus groups, with connectedness, empowerment, and difficulties being the most prominent themes that occurred across all socioecological levels. Results suggest that recovery initiatives can effectively assist veterans by promoting empowerment, facilitating social connections, and addressing cooccurring difficulties across multiple socioecological contexts. Additionally, treatment programs should encourage veterans to take on meaningful roles in their communities. Future research should continue to explore veterans' recovery experiences using a socioecological model.

"A lot better than it used to be": A qualitative study of adolescents' dynamic social recovery capital

Background

Substance use recovery is a dynamic process for youth, and social networks are tied to the recovery process. The Recovery Capital for Adolescents Model (RCAM) situates the resources accessible through social networks - social recovery capital (SRC) - in a larger framework of developmentally-informed recovery resources. This study aims to investigate the social network experiences among recovering youth enrolled in a recovery high school to understand how social influences help to build, or act as barriers to building, recovery capital.

Methods

To gain insight into these networks, Social Identity Maps and semi-structured interviews were conducted with ten youth ages 17-19 years (80% male; 50% non-Hispanic White). Study visits were conducted virtually, recorded, transcribed, and thematically analyzed using the RCAM as an organizing framework.

Results

Results supported that adolescent social networks play a unique and multifaceted role in the recovery journey. Three key nuances emerged: change permeates adolescent networks throughout the treatment and recovery process; shared substance use history and non-stigmatizing attitudes play a key role in connecting with others; and SRC is interconnected with human, financial, and community recovery capital.

Conclusions

With adolescent recovery receiving increased attention from policy makers, practitioners, and researchers, the RCAM may be a useful way to contextualize available resources. Findings suggest SRC as a crucial, yet complex component intertwined with all other forms of recovery capital.

Examining the role of social support in treatment for co-occurring substance use disorder and posttraumatic stress disorder

Objective

Social support may be a critical mechanism in the treatment of co-occurring substance use disorder (SUD) and posttraumatic stress disorder (PTSD). However, no studies have examined how social support changes as a function of treatment or predicts treatment outcome in a Veteran population with co-occurring SUD and PTSD.

Method

The current study is a secondary analysis that examined social support over the course of treatment for co-occurring SUD and PTSD (N = 81). Analyses were conducted to examine if a) social support predicts change in substance use and PTSD symptoms, respectively, over the course of treatment and during follow-up, and b) substance use and PTSD symptoms, respectively, predicts change in social support over treatment and during follow-up.

Results

The findings revealed that between-person social support moderated decreases in substance use (B = -0.17, SE = 0.07, p = 0.017) and PTSD symptom severity (B = -0.12, SE = 0.05, p = 0.009) during treatment but not during follow-up. Within-person substance use and PTSD symptom severity predicted social support but substance use and PTSD symptoms did not moderate changes in social support during treatment or follow-up.

Conclusions

The findings highlight the critical role of social support during treatment in enhancing outcomes for individuals with co-occurring SUD and PTSD.

Addiction recovery stories: Paul Makin in conversation with Lisa Ogilvie

Purpose

The purpose of this paper is to contribute to a series of recovery stories that examine candid accounts of addiction and recovery. Shared components in the recovery process are considered, along with the change and growth needed to support the transition from addiction to recovery.

Design/methodology/approach

The connectedness, hope, identity, meaning in life and empowerment (CHIME) framework comprises five elements important to recovery. CHIME provides a standard to qualitatively study recovery. As a model, it has been extended to include growth-CHIME (G-CHIME), an element that is important for sustained addiction recovery. In this paper, a first-hand account of addiction recovery is presented, followed by a semi-structured e-interview with the author of the account that is based on the G-CHIME model.

Findings

This paper shows that addiction recovery is a remarkable process that can be effectually explained using the G-CHIME model. The significance of each element in the model is apparent from the biography and e-interview presented.

Originality/value

To the best of the authors’ knowledge, each account of recovery in this series is unique and, as yet, untold.

Self-help group experiences among members recovering from substance use disorder in Kuantan, Malaysia

This qualitative study aims to explore the factors that motivate people in recovery from substance use disorder in Kuantan to remain in a self-help group. A total of five recovering self-help group members participated in this study. The findings indicated that people in recovery decided to continue their participation in a self-help group in order to obtain support that helps them sustain their recovery. Furthermore, respondents explained that the self-help group empowers them to give back to society. The respondents in this study also emphasized that the presence of a positive group leader is vital in maintaining their motivation to continue their participation in the self-help group.

Addiction recovery stories: John Nelson in conversation with Lisa Ogilvie

Purpose

This paper aims to explore the transition from addiction to recovery. It is the third in a series of recovery stories that examine candid accounts of addiction and recovery. Shared components of recovery are considered, along with the change and growth needed to support the transition.

Design/methodology/approach

The connectedness, hope, identity, meaning in life and empowerment (CHIME) framework comprises five elements important to recovery (connectedness, hope, identity, meaning in life and empowerment). It provides a standard to qualitatively study mental health recovery, having also been applied to addiction recovery. In this paper, an element for growth is included in the model (G-CHIME), to consider both recovery and sustained recovery. A first-hand account of addiction recovery is presented, followed by a semi-structured e-interview with the author of the account. This is structured on the G-CHIME model.

Findings

This paper shows that addiction recovery is a remarkable process that can be effectually explained using the G-CHIME model. The significance of each element in the model is apparent from the biography and e-interview presented.

Originality/value

Each account of recovery in this series is unique, and as yet, untold.

Addiction recovery stories: Neil Curran in conversation with Lisa Ogilvie

Purpose

This paper aims to explore the transition from addiction to recovery. It is the second in a series of recovery stories that examine candid accounts of addiction and recovery. Shared components of recovery are considered, along with the change and growth needed to support the transition.

Design/methodology/approach

The CHIME framework comprises five elements important to recovery (Connectedness, Hope, Identity, Meaning and Empowerment). It provides a standard to qualitatively study mental health recovery, having also been applied to addiction recovery. In this paper, an element for Growth is included in the model (G-CHIME), to consider both recovery, and sustained recovery. A first-hand account of addiction recovery is presented, followed by a semi-structured e-interview with the author of the account. This is structured on the G-CHIME model.

Findings

This paper shows that addiction recovery is a remarkable process that can be effectually explained using the G-CHIME model. The significance of each element in the model is apparent from the biography and e-interview presented.

Originality/value

Each account of recovery in this series is unique, and as yet, untold.

Addiction recovery stories: Jerome Carson in conversation with Lisa Ogilvie

Purpose

The purpose of this paper is to explore the accomplishments of those who realise addiction recovery. To the best of the authors’ knowledge, this is the first in a series of recovery stories, where candid accounts of addiction and recovery are examined. In doing so, shared components of recovery are considered, along with the change and growth necessary to facilitate it.

Design/methodology/approach

The CHIME (Connectedness, Hope, Identity, Meaning and Empowerment) framework comprises five elements important to recovery. It provides a standard to qualitatively study mental health recovery, having also been applied to addiction recovery. In this paper, an additional element for Growth has been introduced to the model (G-CHIME), to consider both recovery and sustained recovery. A first-hand account of addiction recovery is presented, followed by a semi-structured e-interview with the author of the account. This is structured on the G-CHIME model.

Findings

This paper shows that successful and sustained recovery from alcohol addiction can be effectively explained using the G-CHIME model. Each element was well represented in the described process of reaching recovery.

Originality/value

Each account of recovery in this series is unique, and as yet, untold.

Substitute Behaviors following Residential Substance Use Treatment in the Western Cape, South Africa

The dynamics of substitute behaviors and associated factors remain poorly understood globally, and particularly in low- and middle-income contexts. This prospective study describes the prevalence and types of substitute behaviors as well as predictors, correlates, and motivations associated with substitution in persons (n = 137) admitted to residential substance use treatment in the Western Cape province of South Africa. The brief assessment of recovery capital, overall life satisfaction scale, and an adapted version of the addiction matrix self-report measure were completed during and post-treatment. Results indicate that substitutes were employed consciously for anticipated appetitive effects, for time-spending, (re)connecting with others, and enjoyment. At follow-up, 36% of service users had substituted their primary substance(s) with another substance or behavior; 23% had relapsed and 40% had maintained abstinence. While some service users may be especially vulnerable to developing substitute behaviors, targeted prevention and intervention efforts can reduce this risk.

Socially-supportive norms and mutual aid of people who use opioids: An analysis of Reddit during the initial COVID-19 pandemic

BACKGROUND

Big events (i.e., unique historical disruptions) like the COVID-19 epidemic and its associated period of social distancing can transform social structures, social interactions, and social norms. Social distancing rules and the fear of infection have greatly reduced face-to-face interactions, increased loneliness, reduced ties to helping institutions, and may also have disrupted the opioid use behaviors of people who use drugs. This research used Reddit to examine the impact of COVID-19 on the social networks and social processes of people who use opioids.

METHODS

Data were collected from the social media forum, Reddit.com. At the beginning of the COVID-19 pandemic in the U.S. (March 5, 2020, to May 13, 2020), 2,000 Reddit posts were collected from the two most popular opioid subreddits (r/OpiatesRecovery, r/Opiates). Posts were reviewed for relevance to COVID-19 and opioid use resulting in a final sample of 300. Thematic analysis was guided by the Big Events framework.

RESULTS

The COVID-19 pandemic was found to create changes in the social networks and daily lives among persons who use opioids. Adaptions to these changes shifted social networks leading to robust social support and mutual aid on Reddit, including sharing and seeking advice on facing withdrawal, dealing with isolation, managing cravings, and accessing recovery resources.

CONCLUSIONS

Reddit provided an important source of social support and mutual aid for persons who use opioids. Findings indicate online social support networks are beneficial to persons who use opioids, particularly during big events where isolation from other social support resources may occur.

Bridging the Gap: The Compatibility of CBT-Based Approaches with Twelve-Step Programs in the Treatment of Substance Use Disorders

Background: Cognitive-behavioral therapy is an umbrella term which encompasses a wide range of distinct, yet related interventions, several of which have been shown to be efficacious in the treatment of substance use disorders. However, 12-Step programs (including Alcoholics Anonymous and Narcotics Anonymous) are traditionally the most widely known and commonly used approaches to managing alcohol and substance abuse. Objectives: Therefore, this paper attempts to offer a summary of the compatibility of CBT-based approaches and 12-Step philosophy, in order to assist clinicians who work with patients with a strong adherence to 12-Step ideology. Results: Specific passages from AA's Big Book, NA's Basic Text, and ancillary 12-Step literature will be highlighted where appropriate. Moreover, common roadblocks to synthesis (e.g. belief in a "higher power;" acceptance of one's "powerlessness") will also be addressed. Conclusions: Clinicians who are committed to evidence-based, CBT-related practices are ultimately advised to adopt flexibility when working with patients who identify with the cultural values of 12-Step programs.

Substitute addictions in the context of the COVID-19 pandemic

The global spread of COVID-19, subsequent stay-at-home requirements, spatial distancing measures, and long-term isolation present additional challenges for persons in recovery. Using an illustrative case from South Africa, we discuss COVID-19 related pornography use through the lens of relapse and substitute addiction. South Africa is the epicenter of the pandemic in Africa, and has issued an alcohol and cigarette ban. Historical examples suggest that responses to forced abstinence may include compliance and abstinence, but also seeking alternatives to the original addiction and substitution. Substitution of alternative activities/objects may provide similar appetitive effects to fill the void of the terminated addictive behavior, temporarily or in the long-term. While substitutes do not necessarily portend a relapse, coupled with isolation and reduced recovery support, they can potentiate relapse to the former or 'new' addictive behavior. Addiction professionals should be aware of the potential for such negative impacts during and after the COVID-19 pandemic.

Recovery capital among migrants and ethnic minorities: A qualitative systematic review of first-person perspectives

This systematic review of 15 qualitative studies explores recovery capital among migrants and ethnic minorities (MEM). The results of the framework analysis indicate that addressing barriers to recovery and (often minority-related) root causes of problem substance use is vital to recovery among MEM, as well as building recovery capital on personal, social and community level. The review unpacks the importance of "cultural" and "spiritual" elements of recovery capital both inside and outside treatment, the interconnectedness of the different dimensions of recovery capital, as well as their intertwinement with root causes of substance use and barriers to recovery. The results point out the importance of offering culturally and trauma-sensitive relational support and building recovery capital through recovery-oriented systems of care. Moreover, this study highlights the need for further research concerning recovery in MEM populations.