Multiple psychological senses of community and community influences on personal recovery processes from substance use problems in later life: a collaborative and deductive reflexive thematic analysis

Figures & data

Table I. Participants’ background and community belonging.

Participant	Interviewer	Region	Health care services for persons with substance use problems	Current use of substances?	Onset of substance use problems	Way of contact	Problematic substances	Relational communities	Geographical communities	Ideal communities	Substance use related communities	Service-related communities
M66 (E1)	5	East	Housing, housing allowance, NAV, organized physical exercise, general practitioner, low threshold offer (meals)	No	Early	Employer made contact	Amphetamine/Alcohol (Polysubstance use)	Family + Friends ±	Housing from the municipality +		Work related-	Group arranged by Norwegian Labour and WelfareAdministration +
M67 (E2)	4	East	Housing, contractual early retirement pension scheme (AFP) in the public sector, earlier: three different institutions, home nursing,	No	Early	Injury/hospitalization	Opioids/Alcohol (Polysubstance use)	Family + Friends +	Housing from the municipality			Interdisciplinary specialized treatment of substance use problems (ISTS) +
M77 (E3)	5	East	NAV, disability pension,	Yes	Early	Lack of income	Alcohol	Family - Friends -	Neighbourhood -		Alcohol related -
M71 (W4)	2	West	Contractual early retirement pension scheme (AFP) in the public sector, general practitioner, earlier: institution, NAV Assistive Technology Centre, institution	No	Early	Self-initiated contact	Alcohol/sleeping pills (Polysubstance use)	Family + Friends +	Housing (private) +	Meaningful activities	Alcohol related +	ISTS + Volunteer community: The soup car +
F68 (E5)	5	East	Housing, Specialized health care (somatic) after injury, AV, Work assistance allowance (AAP), transport service card, general practitioner, physiotherapy, Earlier: six institutions	No	Early	Suicide attempt/hospitalization	Alcohol/Morphine (Polysubstance use)	Family + Friends +				Institution/ISTS ±
M68 (W6)	2	West	NAV, Crisis centre for victims of violence and abuse from partner or family, contractual early retirement pension scheme (AFP) in the public sector, organized physical exercise, earlier: institution	No	Early	Violence in the home (partner)	Alcohol	Family + Partner - Friend +	Neighbours +	Health adapted service (housing)		ISTS +
M80 (E7)	4	East	Housing, pension (not specified), outreach service, home nursing, earlier: institution	No	Early	Recommended by family to make contact	Alcohol	Family +	Neighbours +	Work		ISTS +
M77 (C8)	1	Central	Pension (not specified), home nursing, housing, NAV Assistive Technology Centre, general practitioner, geriatric psychologist, Earlier: recovery centre, physiotherapy,	No	Late	Recommended by home nurses to make contact	Alcohol	Family ± Friends +	Neighbours +	Meaningful activity		Elder care institution +
M76 (C9)	1	Central	Pension (not specified), home nursing, NAV Assistive Technology Centre, earlier: institution, general practitioner	Yes	Very late (after 60 years)	Recommended by home nurses to make contact	Alcohol	Family ±		Meaningful activity Health and age adapted service
F65 (C10)	1	Central	NAV, contractual early retirement pension scheme (AFP) in the public sector, earlier: organized physical exercise for chronical illness, follow-up service, centre for mapping and follow‐up	No	Late	Chronic muscular pain lead to hospitalization	Alcohol	Family ± Friends +				ISTS + Service group from the municipality +
M68 (C11)	1	Central	Pension (not specified), physiotherapy, home nursing, earlier: institution (specialized health care),	No	Late	Friend assisted in making contact	Alcohol	Friends ±		Health and age adapted service
F68 (C12)	1	Central	Housing, contractual early retirement pension scheme (AFP) in the public sector, earlier: institution,	No	Early	General practitioner made contact	Alcohol	Family ± Friends -		Health and age adapted service		Elder care ±
F73 (E13)	4	East	Pension (not specified), organized physical exercise, general practitioner, short-term specialized treatment of alcohol addiction, earlier: institution (twice), home nursing	Yes	Late (20 years)	Injury (fall)/hospitalization	Alcohol	Family + Friends	Neighbours +			ISTS ±
M76 (E14)	4	East	Pension (not specified), non-governmental organization for persons with alcohol dependence (Norske lenker), nursing home, physiotherapy, social worker, earlier: institution	No	Early	Injury (fall)/hospitalization	Alcohol	Family + Friends (new in Norwegian)+ Former friends -				Elder care + Volunteer community: The Norwegian Chains +
F66 (E15)	4	East	Housing (municipality), psychologist, home nursing, disability benefits, drug-assisted treatment, interdisciplinary team meetings Flexible Assertive Community Treatment, NAV (economic manager), general practitioner, transport service card, earlier: institution psychiatric/substance use	No	Early: Medicine, Late: Heroin (40 years old)	Death of husband who was co-addict	Medicine, heroin, amphetamine (Polysubstance use)	Family – Friends +	Housing from themunicipality +	A place to be/available communities (open at all hours)		ISTS (poly) ±
M66 (E16)	5	East	Housing, disability benefits, drug-assisted treatment, NAV, general practitioner, earlier: institutions	No (methadone)	Early	Personal contact at NAV made contact	Heroin		Housing from the municipality + Neighbourhood +			ISTS (poly) +
M69 (E17)	5	East	Pension (not specified), NAV (management of economy), department of mental health, general practitioner, interdisciplinary team meetings home nursing, earlier: institution, cancer nurse,	No	Early (not specified, but had problems in working age)	Self-initiated contact with hospital due to suicide ideation	Alcohol		Neighbour +			ISTS + Volunteer community: Salvation Army +
M69 (E18)	5	East	Housing, drug-assisted treatment, general practitioner, old-age pension, polyclinic treatment for persons with substance use problems where alcohol is the only or dominant problematic substance, low-threshold health and care offer for those with substance use problems, social worker, interdisciplinary team, earlier: psychologist, institution	No	Early	Quit work to become clean (self-sufficient), made contact due to starvation	Heroin, alcohol, amphetamine (Polysubstance use)	Family ±	Housing from the municipality +		Former member of the substance use related communities +
M69 (C19)	1	Central	Housing, home nursing, social worker, centre for mapping and follow‐up, district psychiatric centre, earlier: institutions	No	Early	Made contact due to suicide ideation	Alcohol, medicine (Polysubstance use)	Family -	Housing from the municipality -	Meaningful activity
M70 (C20)	1	Central	Nursing home, pension (not specified), NAV (economic management), general practitioner, social worker, earlier: institutions (detoxification/substance use treatment)	No	Early	General practitioner referred to hospital (acute)	Alcohol	Family ±Friends +		Health and age adapted service Meaningful activity		Elder care ± ISTS +
F70 (C21)	1	Central	Home nursing, pension (not specified), psychiatric nurse, general practitioner, physiotherapy, occupational therapy, primary contact (at department of health and welfare), earlier: follow-up service	No	Late (40 years old)	Hospital made contact after operation	Medicine, alcohol (Polysubstance use)	Family + Friends
F73 (C22)	3	Central	Old age pension, organized physical exercise, physiotherapist, psychologist, psychiatrist, general practitioner, home nursing, earlier: institution	No	Very late	After hospitalization (acute)	Alcohol	Family ±	Neighbours +			ISTS +
M72 (C23)	1	Central	Old age pension, daily social offer including physical exercise (9–14), geriatric care, general practitioner, home nursing, earlier: institution (detox)	No	Early		Alcohol	Family + Friends +		Health and age adapted community		Service group from the municipality +

+ is used when the participant speaks about the community in any way related to the four dimensions of PSOC (membership, influence, integration and fulfilment of needs or emotional connection). – is used for NPSOC related descriptions (distinctiveness, abstention, frustration or alienage). Both signs are used for communities addressed in both ways. If no sign is added, the participant did only report belonging to the community and nothing further. All communities besides from ISTS are current communities which the participant where part of when the interview was undertaken.

Figure 1a. (Continued).

Figure 1b. (Continued).

Figure 1. Theme development.

Table II. Overview of community elements participants described as influencing their recovery processes.

Communities	Elements promoting potential for recovery	Elements representing challenges to recovery
1. Relational (family, partners and friends)	Social resources (e.g., information about services, initiating and maintaining contact with services, practical and emotional support in contact with services). Openness about substance use problems. Sources of positive PSOC.	Trauma and exposure to substances. Loss of partner and friends.
2. Geographical (Housing from the municipality and neighbourhood)	Housing from the municipality: Stable housing with appropriate standard and transport offers. Neighbourhood: Everyday positive PSOC, support in situations of illness or help with everyday tasks.	Housing from the municipality: Exposure of substance use, alienage to housing from municipality as a young community and frustration over unsatisfied needs for mobility (restricted transport offers).
3. Substance use-related communities		Positive PSOC Substance use related membership and identity. Normalizing problematic substance use
4. Ideal (envisioned communities)	Support in community participation. Housing adapted to health situation. Peer persons. Meaningful activities.	Lack of information about available services and users rights.
5. Service-related communities (Public health care institutions, religious and volunteer communities)	Elder care institutions: Fulfilment of physical and social needs. Specialized treatment of substance use problems: Openness, respect for individual needs. Religious and volunteer communities: Positive PSOC, new friends, purpose, someone to collaborate with and get support from in the recovery process.