Understanding How People with Mental Health Difficulties Experience Substance Use

ABSTRACT

Background: Quantitative studies dominate research exploring reasons for substance use and experiences of substance use by people with mental health difficulties. This limits the depth of understanding which can be gained about these experiences. Objectives: In the present article, we synthesized current qualitative research in this area to provide enhanced theoretical knowledge of these experiences. Methods: Following a systematic literature search, we identified 12 studies which explored how people with mental health difficulties experienced using substances, and which met additional inclusion criterion. We used Noblit and Hare's metaethnographic approach to qualitatively synthesize these studies. Results: Synthesis led to the development of two themes; “substance use mediates acceptance and social inclusion” and “substance use provides perceived opportunities for control and power.” Conclusions/Importance: The findings suggest that in the studies reviewed people's motivation for substance use was embedded in social and psychological contexts. It indicated that substance use could provide perceived benefits such as mediating the impact of mental health stigma, enabling the development of alternative identities, increasing their sense of power and providing opportunities for social inclusion. Mental health and substance use workers should therefore aim to develop alternative opportunities for people with co-occurring disorders to gain such benefits, and seek to challenge mental health stigma.

KEYWORDS:

• Substance use
• mental health
• metaethnography
• metasynthesis
• service user experiences

Glossary

• Co-occurring disorders: Co-occurring disorders means when two or more disorders occur in one person at the same time. In the case of this article, it refers to when mental health problems and substance use disorders occur at the same time in one individual.

• Mental health difficulties: Mental health difficulties is a term used to describe the thoughts, emotions and behaviours people present with when they are experiencing intense emotions, which are grouped together to form diagnoses, such as depression, anxiety, bipolar disorder, and psychosis.

• Mental health stigma: This means when people are more likely to be identified as bad, strange, different, or dangerous because of their mental health difficulties.

• Metaethnographic: Using a metaethnographic approach means to use the techniques of induction and interpretation to synthesize qualitative research findings. It therefore uses a process which is similar to that used by the studies which are being synthesized.

• Qualitative approach: A qualitative approach is primarily an exploratory research method, which involves gathering detailed data about people's perceptions, views, motivations, and perspectives (qualitative data).

• Substances: In this study substances refers to illicit drugs (such as heroin, cannabis) and alcohol.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Additional information

Notes on contributors

Emma Chorlton

Dr. Emma Chorlton is a Clinical Psychologist who has worked in the UK National Health Service since qualifying from Lancaster University in 2013. She currently works in a low-secure inpatient service for women with learning disabilities. She has research interests in the experiences of people with co-existing mental health and substance use difficulties, mental health inpatient settings, and people with co-existing mental health difficulties and intellectual disabilities.

Ian C. Smith

Dr. Ian C. Smith is a Consultant Clinical Psychologist who has worked in the UK National Health Service for almost twenty years. He is also a Lecturer in Lancaster University's Division of Health Research and a senior tutor on the University's Doctoral Training Programme for Clinical Psychologists. He has research interests in the lived experiences of service users, and the experiences of services for people with mental health difficulties and intellectual disabilities.