Peer Reviewed Journal Article on Narcotics Anonymous Evidence

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• Published: 31 July 2020

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

Substance Corruption Treatment, Prevention, and Policy book 15, Article number:53 (2020) Cite this article

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Abstract

Background

Common aid organizations, such every bit Narcotics Anonymous (NA), can provide support in substance use disorder (SUD) recovery processes. However, research on NA and its recovery-supportive elements is scarce and perspectives of NA-members remain understudied, in item outside the The states. Therefore, this study aims to gain insight into recovery-supportive elements of NA, as experienced by its members.

Methods

To explore the perspectives on and experiences with recovery-supportive elements in NA, 11 in-depth interviews with NA-members were conducted in Flanders (Belgium). Interviews were audio-taped, transcribed verbatim and analyzed by using CHIME-D, a personal recovery framework (Connexion, Hope, Identity, Meaning in life, Empowerment, Difficulties) adult by Leamy and colleagues in 2011.

Results

Diverse recovery-supportive elements of NA were highlighted, with Connectedness as a key component including opportunities for building up a social network and for providing a rubber internet or sounding board. Elements that enabled Connectedness were 1) a non-judgemental approach, and 2) mutual understanding through sharing in NA. Other elements of the CHIME-D framework were less oftentimes mentioned, although these were inextricably linked to Connexion.

Conclusions

Connection appeared to exist the crucial recovery-supportive element in NA, emphasizing the relational character of SUD recovery. Although other elements of the CHIME-D framework were identified, these were closely related to and intertwined with the concept of connectedness.

Groundwork

Processes of substance use disorder (SUD) recovery are found to be unique and their idiosyncratic nature is best-selling [1, ii]. Consequently, in that location is great diversity in possible recovery pathways and a range of support and treatment options need to exist bachelor to support recovery [3,4,v,6]. The intervention spectrum includes, besides formal treatment and support services, also non-professionally assisted programs (e.g., mutual aid organizations) to support recovery processes [7,8,9,10,xi,12,13]. Recent research by Kelly and colleagues [6] has shown that such informal support groups are as important as formal treatment options to achieve recovery. In their sample of persons who resolved an alcohol and drug trouble by assisted means (53.9%, versus 46.1% in unassisted recovery), mutual-assist support was the most frequently utilized class of back up (45.one%).

Mutual aid organizations are diverse in type and design and 12-step programs such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are probably the most commonly known and largest organizations [11, 14]. AA was founded in 1935, implementing the 12 steps as an instrument for sober living and gradually developed its organizational principles in 12 traditions as it expanded over the years. The AA-program – with its specific focus on booze – was adapted to provide back up for individuals struggling with addictive substances, leading to the emergence of NA in 1953 [15]. The NA-program focuses – through NA-meetings and the implementation of NA's 12 steps in daily life – on personal growth, reduction of egocentrism, supporting others in their recovery journey and a life guided past spiritual principles [xi, 13, 16,17,18]. Whilst the NA philosophy was rooted in the illness model – including the belief in full abstinence – information technology also recognizes that a radical change in life(mode) is required and abstinence in itself is not sufficient to achieve and maintain recovery [13, 16]. The latter aligns with the 'personal recovery' paradigm, in which the idiosyncratic, dynamic, process-oriented and multidimensional nature of recovery is endorsed [i, 2, xix,twenty,21]. In their search for essential elements for promoting personal recovery, Leamy and colleagues [22] performed a systematic review of the mental health literature, resulting in the Chime framework. Chinkle refers to five recovery supportive elements: Connectedness (e.m., belonging, peer back up and relationships), Hope and optimism (entailing dreams, aspirations, and motivation), Identity (comprising a positive sense of identity), Meaning (covering meaning in life and spirituality), and Empowerment (including control over life and focus on strengths) [22]. Recently, the CHIME framework was expanded by Stuart and colleagues [23] who added an extra theme, 'Difficulties', including obstacles and challenges in recovery processes. The CHIME-D framework does not but seem suitable to support mental health recovery, but tin also be applied to gain insight in and strengthen recovery supportive elements in SUD treatment and mutual aid groups [24,25,26].

Available studies on recovery and mutual aid have often focused on peer-delivered or 12-step programs (in item on AA), indicating that these programs facilitate recovery processes by providing specific mechanisms of change (i.e., cognitive, social, melancholia and spiritual) [27]. A recent Cochrane review demonstrated the efficacy of AA participation for achieving abstinence [28]. Primarily uncontrolled, longitudinal studies indicate that, for example, the presence of and back up from peers and sponsors (i.eastward., peers who have more than experience in NA than the peers they support [sponsees]) – often resulting in hope and connexion – facilitates change [29,xxx,31,32,33,34]. Spirituality has been found to be a key chemical element for tackling problems [29, 34]. As a result, participation in mutual aid programs can subtract substance use or induce abstinence [9,10,11, 29, 35, 36], and can as well raise psychosocial functioning [36]. Furthermore, participation in mutual aid programs reduces wellness care expenses by its non-professionally assisted arroyo [xi, 28].

Relatively piddling inquiry has focused specifically on NA [37, 38] and its recovery-supportive elements. Available quantitative evidence on NA indicates that long-term involvement in NA-meetings is positively related to psychological well-being [38]. Moreover, regular attendance at NA-meetings and implementing the 12 steps can enhance social back up and reduce alcohol employ [39], while commitment to NA-peers and perceived spiritual awakening in NA contribute to decreased craving [40]. Qualitative enquiry that sheds light on personal experiences with NA-groups is limited and shows that recovery processes in NA are supported by personal and psychological factors (e.thousand., being role of NA, insight in substance utilise disorders), every bit well every bit social features (e.g., transforming social networks, reclaiming roles in lodge) [41], resulting in improved quality of life [42]. Recovery in NA entails developmental and transformative processes, supported past the available structure of the program (i.e., meetings and 12 steps), spirituality and the undeniable role of peers in sharing experiences and providing hope [43,44,45].

Given the express qualitative, in-depth enquiry conducted in NA, few information is available with regard to the personal perspectives and experiences of members on recovery-supportive elements of NA. Therefore, this exploratory study will focus on the recovery experiences of Flemish NA-members and their perspectives on NA and its recovery-supportive elements. To provide suitable and effective SUD recovery support, insight into what is experienced every bit recovery-supportive and how this works is valuable. This knowledge can be practical to promote participation in NA (or other mutual aid programs) and, possibly, to implement recovery-supportive elements of NA in formal support and treatment programs.

Methods

Setting and participants

To explore the perspectives of Flemish NA-members, in-depth interviews were conducted betwixt January and Apr 2018 with eleven persons in SUD recovery. Whilst NA has over 70,000 weekly meetings worldwide [46], NA was only recently implemented in Flemish region (the Dutch-speaking function of Belgium) and is relatively small with around xxx weekly meetings, compared to over 300 AA-groups [47, 48]. Subsequently consent of the Flemish area of NA Kingdom of belgium, data was posted on the website and members were informed about the study during meetings (past the contact person). Eligibility criteria were: ane) being over xviii years; 2) existence in self-defined recovery, 3) having received NA-back up during the recovery procedure, and 4) mastering the Dutch linguistic communication well enough to be able to take part in an interview. Interested NA-members contacted the first writer by electronic mail or telephone and individual interview appointments were made. An overview of participant characteristics can be found in Table ane.

Table ane Participant characteristics

Full size table

Data drove

This study was approved past the Research Ethics Committee at Ghent Academy and all participants provided informed consent prior to their interviews. All interviews started with identifying previous substance utilise to go some background data on this menstruation in the lives of the respondents. This enabled us to discuss transitions towards recovery. Perceived supportive and hindering factors in recovery were explored and the specific role of NA in their recovery procedure was discussed. These semi-structured qualitative interviews provided an opportunity for respondents to limited their experiences, emotions and perspectives, without being limited by fixed answering categories [49]. Though the researcher used an interview format including the afore-mentioned topics, the story of each respondent was put key and the format was merely used to cover some cadre topics such as general recovery experiences, supportive or hindering elements in the recovery journeying and experiences with NA. Interviews lasted betwixt lxx and 100 min. At the end of the interview, respondents received a 15 euro supermarket souvenir card.

Data-analysis

All interviews were sound-recorded and transcribed verbatim. All transcripts were read several times to get immersed in the data. During this process information technology became credible that Connexion stood out equally a recovery-supportive element and was related to, impacted by and impacted on other supportive elements, which corresponded well with the Chinkle-D framework for personal recovery among mental wellness populations [22, 23]. Therefore, this framework [22, 23] was used to analyse the data. Transcripts were coded line by line based on the principal themes (i.e., CHIME-D) and subthemes were added using thematic analysis [50]. Master and subthemes were put in separate tables for each interview. After constructing this codebook per individual interview, master and subthemes from all interviews were brought together to proceeds insight into and construction the main recurring themes every bit structured by the Chinkle-D framework. The codebook was then extended with quotes related to master and subthemes to have a reliability check between the codes and original data. Throughout the process of data analysis, the kickoff writer (AD) discussed and reflected upon the preliminary findings with the second writer (SV). The latter was included in this study as a co-researcher with extensive knowledge and lived feel in NA. Involvement of this co-researcher (SV) enabled in-depth and thorough analyses of the data, by combining 'outsider' and 'insider' perspectives [51]. Throughout the data analysis, it appeared that Connectedness was past far the most frequently mentioned master theme in coding the data. Therefore, this theme volition be the starting signal of the results department presented below. Additionally, Connexion is used to talk over other elements of the Chime-D framework as it appeared that Hope, Identity, Pregnant in life and Empowerment are almost inseparably linked to this theme. Difficulties were hardly mentioned every bit stand-alone items, but were mentioned in relation to various components of the CHIME framework.

Results

During data analysis 2 core elements came to the surface, related to respectively the 'what' and 'how' of recovery support within NA: (1) Connectedness every bit a primal factor for supporting personal recovery; and (ii) NA features facilitating Connectedness. Likewise, elements of Hope, Identity, Pregnant in life and Empowerment that are closely related to and associated with connectedness are discussed. Given the undeniable interrelatedness of these themes, these elements are presented as intertwined with Connectedness, since a dissever presentation would contradict their mutual relation.

Connectedness as a key gene for supporting personal recovery

'I go every week [to an NA-coming together] and that gives me – considering I am fairly new at that place – a sense of belonging, and I hope I give something back.' (Male, 40s).

Respondents mentioned that Connectedness is the main impetus for recovery and is provided in NA-meetings and by fellows. Most respondents mentioned togetherness as an important asset. This means relationships are built towards friendships and for some even towards 'family unit-like' bonds. Consequently, respondents no longer felt alone. Under the common denominator of recovery, people who usually do not necessarily cross paths came together in NA and found connectedness with and support from each other. Rudi mentioned he finally feels like he is 'at abode' in NA:

'Recently, I was at an NA Christmas party […]. Y'all sit at the table with strangers and you merely sit at that place chatting about feelings, emotions, most things that you have experienced that were difficult for you. […] I thought that was really great. I experience at home in that location. When I become to a meeting similar that I experience at home […]. And so I tin can say: "I'thou Rudi, I'thou an addict" and that'south okay'. (Male, 20s).

In order to build and incorporate this feeling of Connectedness, four respondents mentioned that information technology is crucial to oftentimes attend NA-meetings. By doing so, bonds with other members and the NA-program were perpetuated. Some mentioned that when cutting downwards on meeting attendance, for instance when life and recovery become seemingly well, they felt Connectedness began to dilute which often resulted in a setback in the recovery process. Staying connected therefore seemed vital. Cerise compares it to a yearly car maintenance:

'Information technology'south pretty much like having my yearly car maintenance. Information technology makes my machine drive better, longer, further [ …]. If I don't have the maintenance done – ok information technology [the maintenance] does cost me 200 Euros – and and so something breaks downwardly, it is usually something serious. And actually, NA-meetings are merely some sort of weekly maintenance. I come with my 'machine' and my 'car' drives better. And yeah, it will not immediately pause down if I do not go into 'maintenance', just you must be enlightened of what you are doing and then.' (Female, 40s).

Equally mentioned by seven respondents, attending NA-meetings enabled them to build a social network. For some, this NA-network is complementary to an existing social network non related to substance employ or recovery (e.g., non-using friends). For others, the NA-network is filling the gap that is left by abandoning their one-time 'user' network. Whilst respondents mentioned the demand for an extended recovery-supportive network (i.e., a network that is broader than NA-peers), the NA-network tin exist a starting point from which NA-members tin can socialize (over again) and build new relationships.

Some respondents stated that the NA-peer group – in contrast to, for example, peer groups in a therapeutic community – is continuously supplemented with new members. As a event, in that location is e'er a group of peers available to connect with and provide promise (Hope). Rudi suggests this allows to 'stick with the winners':

'I attended my first meeting and at that place were two people who were in the program for xx and even 30 years. That provided hope. In a TC program, you run into people leave and come back after 3 weeks and who relapse over and over again. In NA, this too happens, but less. They say 'Stick with the winners' and when I come across them [the winners], that really means hope for me.' (Male, 20s).

Eight respondents mentioned the group is experienced as a rubber net or a sounding board. This safety net ways having a network that understands their situation, challenges, and that is available, too outside meetings, when recovery is hampered by, for example, peckish. Some respondents referred to the group as a sounding board that offers – through confrontation and connection – new perspectives. Also, when they are doing well, a brief conversation with NA-peers may be needed to confirm this status.

Spirituality has an important recovery-supportive role in NA according to 9 respondents, for case in finding a 'power greater than yourself' (Significant in life). NA does not decide in advance what this ability is or can be, simply NA-members are encouraged to discover what this power could be for them (due east.k., the NA-group, meditation, a god). This 'higher' ability provides support and can function equally something to rely on.

NA features facilitating connectedness

Since unconditional Connectedness is a key factor in NA, we further elaborate on ii features that enable Connectedness according to respondents: ane) a place costless of judgement; and 2) sharing and listening to experiences, resulting in common understanding and the creation of a new identity.

A place free of judgement

Several respondents pointed out they specially appreciate the withholding of judgement in NA-relationships and meetings. A non-judgemental arroyo is stated to exist beneficial on both ends of the calibration for NA-members: when sharing their ain story, even so also when listening to other NA-members sharing their story. When sharing their story, NA-members felt safe, understood and accustomed, since no judgement was given in the absence of cross-talk. As Tess (female, 20s) mentioned, being able to share your story – maybe even multiple times – provides a chance to gain insight in your own story without the interference and judgement of others (Empowerment). This not-judgemental and condom space enhances motivation for change and provides opportunities for growth.

'I think that is interesting considering you can hear yourself talk, literally, all the time. [ …] You need to hear yourself talk and sometimes people share the same thing five times, because they are stuck in it. And the half-dozen ^th fourth dimension, they experience like: "What am I actually proverb?". Yous come across, they suddenly understand, they suddenly hear their ain story and they experience like: "Ah yes ok, I empathize. I know what to do" . That is the thing and actually you do it together, but still you need to grow from the inside.' (Female person, 20s).

On the other hand, respondents state they learn from listening to others who share their (mostly recognizable) stories without the demand to interfere with these stories. Past avoiding cross-talk, NA-members learn to move away from judgement and (unwanted) advice, and larn how to listen to others.

Sharing experiences resulting in common understanding

Related to the above, sharing – by giving and receiving – with NA-peers was perceived to exist of vital importance to experience mutual understanding.

Finding pregnant through 'giving'

Giving can entail the mentioned opportunity to share personal stories with NA-peers. As a outcome of the safe context in NA, some respondents share a lot more with NA-peers compared to what they share with families and friends.

'I share more at meetings or with fellows than with my brother or my parents. Aye, my brother knows nigh about me at least outside of NA, simply NA knows everything.' (Male, 20s).

Past sharing with NA-peers, it became possible to vent feelings and to provide openness for discussion with regard to difficult situations. Furthermore, five respondents stated that by sharing their story, they appreciated they could inspire others and give promise to others that recovery is possible (Hope). Also, by sharing their story with others, they did no longer have to bear it all by themselves:

'You tell someone and and then it is out at that place. You lot and so no longer take to bear it completely on your own.' (Female, 20s).

The power of giving goes beyond sharing personal stories, information technology tin can likewise include finding satisfaction in giving back to NA or NA-peers. Ruby-red (female, 40s) does so by supporting the continuation of NA and beingness continuously present at NA(-meetings), as she noticed the need for participation of NA-peers with considerable 'clean time' (in her case, 18 years). Being able to provide support for NA-peers is plant to be important and may include being a sponsor for a fellow. For five others, giving means 'serving' in NA (i.eastward., being responsible for a specific element of NA(-meetings) such as a java-person). Through this 'service' respondents embrace new roles that are meaningful to them (Pregnant in life) which provide a satisfying connexion (Connection) and a sense of responsibility (Empowerment).

'In NA, I do service. I accept three different roles: I am responsible for the literature, I am the coffee person and I am responsible for the events throughout Flanders. Then, yous try to give something back to NA.' (Female, 30s).

'Friday evening I do service, I am the treasurer. It is some kind of obligation. I go every week and that gives me, because I am fairly new here, some sense of belonging and I promise I tin can give something dorsum. I pay the hire, count the money, pay the coffee, the literature. It is not a difficult job, simply it is an important 1 [ …]. I am really consequent and information technology affects me if I cannot do this service, then I crawl back into my shell.' (Male, 40s).

Moreover, being supported past NA-peers to take on a specific 'service' tin enhance cocky-conviction (Identity).

'Because of these NA social events, I was trusted by the people because they saw that I was doing very well and I was still coming to meetings later those 90 days. [ …] So that means having confidence and you get information technology.' (Male, 30s).

6 respondents mentioned taking on new roles is mostly accompanied by changes in their daily routines (Meaning in life). Respondents stated that by attending NA-meetings, by working on their 12 steps and past connecting with NA-peers, they developed new routines. Equally respondents redesigned their lives, their weekly schedule was often afflicted past NA-membership with meetings taking a substantial function of their time resource allotment. Furthermore, they often spent leisure time with NA-peers.

'It [attending NA meetings] has become a structural part of my life. I never questioned that I will continue this for the residual of my life. I will never use again and I will never stop attending NA meetings.' (Male, 40s).

Building on others

Respondents highlighted that also giving, they also receive from NA and NA-peers. For example, support from a sponsor during recovery tin can be extremely helpful, since more than experienced NA-peers can provide suitable and tailor-made support based on shared experiences and Connection and attuned to the needs of sponsees (e.g., back up in the event of breaking up a relationship, practicing how to communicate about emotions). Philip (male person, 30s) mentioned his sponsor had a very specific arroyo that focused on 'ruining' his relationship with substance use:

'He told me from the beginning, I'g not going to help your recovery, I'm going to screw upwards your use. And that's pretty cool, because if you await at it that way: he is non going to assistance me with my recovery, but there are sure things that I say, and he only repeats them, just says information technology out loud to me. And and so yous volition hear it [what you say] from someone else. [ …] And so he'due south never going to tell me what to practise.' (Male, 30s).

To receive further included what NA-participants larn from peers and during meetings. By listening, without judgement, to stories from peers, respondents gained insight into their own change processes. Non only stories of experienced NA-members were valued, but also stories of those new to NA and recovery were as important. Although stories of experienced and new NA-members clearly differ, they are both seen as relevant and complementary.

To install Hope and motivation for recovery, respondents tin can phone call upon a wide range of NA-peers. Promise arises on the one hand by observing and listening to those who are in long-term recovery, as the idea that stable recovery is possible enables trust. On the other hand, newcomers are a constant reminder of the downsides of substance employ. They counterbalance the sometimes diminishing sensation of the negative experiences with substance use for those who have been in recovery for some fourth dimension.

6 respondents mentioned their self-efficacy (Empowerment) grew by attending NA-meetings. Moreover, some expressed that the NA-plan facilitated time to reverberate about the question 'who am I?' (Identity). Getting to know themselves offered the opportunity to have themselves for who they are, yet also to take the challenge to further develop a new identity throughout the recovery process. Connectedness enables the construction of a new identity as a person in recovery (Identity). Eight respondents felt empowered in dealing with emotions and difficulties (Empowerment) through peer contacts, equally Edgar (male, 50s) mentioned:

'I used to be non so open [in communication] and now I am much more open and I am able to listen and get suggestions and proceeds insight. I used to think I was always right and that I knew it all. I was going to practice it all myself, but habit cannot be addressed solely by yourself, you cannot. That is why the NA group is so important, because we are together to address information technology together.' (Male person, 50s).

Common understanding as building block for Connectedness

Being able to experience connected and to give and receive from NA-peers eventually results in mutual understanding. One-half of the respondents explicitly mentioned that Connectedness grows past recognizing yourself in NA-peers. The identification with stories from NA-peers enhanced mutual agreement. Furthermore, knowing and understanding what peers have been through, enabled them to back up and confront each other and limited the options to 'keep up appearances'. With SUD and recovery as the common denominators, peers connect with each other equally Tess (female person, 20s) puts it:

'I don't know, y'all feel less weird at that place, because you hear people talk about themselves and you lot hear yourself constantly. I recall it is very recognizable. You lot feel like: "Ah I have that too, I am exactly similar that". You feel less weird, I remember. [ …] I don't know it is a kind of unity or something. That you feel like, okay you know, maybe I am weird, merely we are all the same and that is ok.' (Female person, 20s).

Discussion

With this study we aimed to explore personal recovery amongst Flemish NA-participants and recovery-supportive elements broader than abstinence in NA groups in Flemish region, using the Chime-D recovery framework [22, 23]. Based on 11 interviews, various recovery-supportive elements were found in NA, with Connectedness equally a central component. Though we focused almost unilaterally on specific recovery-supportive elements of NA, it must exist noted that recovery support goes beyond the setting of NA. NA provides mutual assistance based on regular meetings in the community, supporting recovery processes of NA-members that are grounded in individuals' 'natural' personal, social and societal contexts [13, 16, twenty, 52]. As a result, there is a continuous interplay between these settings and related recovery-supportive (or impeding) elements [twenty, 53]. Keeping this in mind, we focus here on the central role of Connection and the relational nature of personal SUD recovery in NA. In addition, we reflect on the complexity and multidimensionality of SUD recovery processes and how this relates to the awarding of the CHIME-D framework [22, 23].

Connectedness equally foundation for change

In this exploratory report, Connectedness (e.k., with peers, sponsors, sponsees) emerged equally the master recovery-supportive element in NA, complementing the current personal recovery paradigm [one, 2, 20, 21, 54]. Meeting others in a place that is costless of judgement, where they can build common understanding through sharing their perspectives and learning from others' experiences was mentioned as crucial for initiating and maintaining recovery [1, nineteen, 55, 56]. In NA, members have continuous options for Connexion, even when individuals retreat from participation (eastward.chiliad., in the instance of relapse). Mudry and colleagues [57] have underscored the importance of 'healing interpersonal patterns' to substitute 'pathologizing interpersonal patterns' that were present during active substance use. In NA, numerous healing interpersonal patterns are installed through common agreement and Connectedness, creating an temper that facilitates recovery through connections with others [43, 44, 57]. Nonetheless, whilst potent bonds in recovery-supportive groups can enhance recovery, they may induce a feeling of 'u.s.a.' and 'them', resulting in barriers towards exploring and utilizing support outside the ain group [58]. Consequently, several challenges remain to bridge the gap between the recovery-supportive environs of NA and the wider community where NA-members live and work.

To build Connectedness and back up recovery Abedi and colleagues [43] and the present study emphasize that 'experienced' NA members equally well every bit 'newcomers' are important (i.due east., 'experienced' peers provide hope that stable recovery is possible, 'newcomers' provide hope by sharing their initial recovery steps and besides face up members with the negative effects of substance utilise). Interestingly, this finding is in sharp contrast with the study past Snyder and Fessler [59] who indicated that despite the egalitarian principles of NA serious status differences may sally between more 'experienced' members and 'newcomers'. These unlike findings might exist explained by sampling differences (eastward.g., 'enthusiasts' in the present written report) and potential barriers NA-members experience in raising difficulties they encounter in NA as put forrard by Christensen [threescore]. Therefore, a comprehensive arroyo is warranted when studying experiences with NA, in society to capture essential supportive components but also experienced difficulties from the perspectives of a variety of respondents (e.g., enthusiasts, 'drop outs').

Connectedness emerged as a central supportive element in NA throughout this study. The importance of Connectedness has been established in previous studies in mental health likewise equally SUD recovery research. For example, the recent study by Mudry and colleagues [57] suggests that potent Connectedness between professionals and service users promotes modify in recovery processes. The current written report, even so, contributes to specific insights on Connectedness within NA and the role NA can take in supporting recovery in Flanders. The organization of SUD treatment and support in Belgium and other European countries is - as opposed to, for instance, the U.s.a. – not only based on nor grounded in 12-step facilitation programs [61, 62]. SUD treatment in Belgium entails a wide range of services, from universal prevention to long-term treatment in drug-costless therapeutic communities, also including outpatient counselling centers, damage reduction services and diverse hybrid (not 12-footstep based) residential programs [63]. Consequently, NA (and AA) are not closely related to nor office of the formal treatment organization and, therefore, referrals to NA as an alternative to professional handling or as a type of continuing intendance are less mutual in Kingdom of belgium. Enhanced participation in NA tin can exist stimulated by informing professional SUD workers on NA and mutual aid in general, since previous research [64,65,66,67,68] demonstrated that referral to mutual aid groups may be impeded by their negative perceptions or limited knowledge on mutual assist groups. As Best and colleagues [64] establish, providing preparation for professionals almost common aid groups and its office in stimulating Connexion can increment professionals' understanding and expand the referral options for the persons they work with. Boosted research in Belgium and other countries where NA is not widely implemented could focus on the perceptions of professionals who work with persons with SUDs and the demand to make professionals more acquainted with peer-based back up and the important part these groups can have in a recovery-oriented organization of care [69]. By raising awareness amongst professionals, these groups become more visible and accessible for those seeking back up and for their social network looking for adequate support for their loved ones [64, 70].

Furthermore, boosted inquiry on the supportive features that emerged from this modest-calibration study on NA in Flanders – such as Connection, not-judgemental approach, common agreement and the cosmos of a new identity – could exist designed more rigorously and past combining qualitative and quantitative methods to further explore specific hypotheses. Eventually, this volition contribute to an enriched pallet of support options, with mutual aid programs every bit an integral function of an integrated organisation of SUD support [69, 71].

In short, NA provides support that enables and reinforces Connectedness, which is, in turn, constitute to be an essential component of personal recovery processes [22]. Emphasizing the essential role of Connectedness affirms recovery as a unique and personal, yet relational process, illustrating its social nature [41, 52, 57, 72, 73]. Consequently, an interactional perspective on SUD recovery is warranted [52, 57, 72]. Recovery goes beyond individuals' responsibilities and the necessity of connections with and support from a social network and guild at large is widely recognized (east.yard., the importance of social and community recovery capital) [2, 20, 72, 74, 75]. Agreement recovery as a relational and social process is essential to provide adequate recovery support [52, 73].

Chime-D: bogus categories or a holistic approach?

By analyzing the data using the CHIME-D framework – originally developed in the field of mental health recovery, only besides establish applicable in the field of SUD [22, 24, 25] – Connectedness was identified as the pivotal supportive element for SUD recovery in NA. As recovery is a relational procedure [52, 57, 72, 73], changes in Identity, Hope, Significant in life, and Empowerment can merely take identify in relation to others (Connexion). For example, past embracing a new meaningful role by providing services in NA (Significant in life) or rebuilding identity through connections with and common understanding between NA-members (Identity). Change occurs during encounters with others in a multitude of relationships [73]. While Connection has been identified as the key cistron for personal recovery, it does not unilaterally bear upon on Hope, Identity, Meaning and Empowerment as the development of these elements tends to affect – in plow – on (strengthening) the sense of Connexion. Consequently, based on this study with NA-members in SUD recovery, the CHIME-D elements appear strongly intertwined with and related to each other and a strict segmentation seems artificial. Moreover, the boosted category 'Difficulties', an extension of the CHIME framework by Stuart and colleagues [23], practise non stand for with our exploratory findings equally these bespeak that difficulties occurred in connection with others and were related to (a lack of) Connexion, Identity, Meaning in life, Promise, or Empowerment. Instead of a separate category, difficulties emerged inside all CHIME categories and should be perceived as such. Additional research could shed further light on the application of the CHIME-D framework in SUD recovery, with item attending for the undeniable interconnectedness of these categories identified in this explorative study. When doing so, a holistic perspective which takes into account the multiplicity and complexity of man beings should exist applied [76].

Notwithstanding the innovative approach of this study, some limitations should exist noted. Beginning, the respondents were by and large NA-enthusiasts. They pointed out the beneficial effects of NA on their recovery process and planned NA-participation in the future. They mentioned very little difficulties with and disquisitional concerns related to NA. Christensen [60] found that NA-members might feel difficulties in questioning the NA-programme due to its neoliberal perspective on SUD and recovery. This approach may urge NA-members to focus primarily on their individual responsibility, with little attending for societal and contextual factors related to SUD and recovery. Since we did not elaborate on this topic in the interviews, it remains unclear whether Christensen's theory [60] applies to the respondents in this study. To broaden the telescopic on experiences with NA, it is recommended to include not only 'enthusiasts' in future research but to involve also individuals with other perceptions on NA. By doing so, the narratives on NA could be extended with perceived difficulties and barriers to recovery support in NA. Second, using a theoretical framework such as Chinkle-D [22, 23] has its pitfalls, for example, the risk of indiscriminately applying a model during data analysis. We tried to tackle this by using CHIME-D as the broader framework for our coding tree, nonetheless supplemented with sub-codes that arose through thematic assay.

Determination

Connectedness was found to exist a crucial recovery-supportive element within NA, highlighting the relational character of SUD recovery. NA-specific features such every bit a non-judgmental approach and mutual understanding through sharing create a climate in which Connexion can develop. Other CHIME-D elements were mentioned, albeit less oftentimes and intrinsically linked to Connexion. It is through Connectedness with others that Hope tin sally, Identity is (re)build, Meaning in life is caused, and Empowerment is adult. Given the key role of Connectedness, it is important to increment attention for Connectedness in NA Flanders and its role in the wider treatment arrangement. Furthermore, when supporting individuals confronted with SUD and recovery, professionals in Belgium and other countries should be aware of the ability of mutual aid organizations, as well as its pitfalls and limitations.

Availability of information and materials

The information generated and analyzed in this study are not publicly available in lodge to protect the participants' anonymity but are bachelor from the corresponding writer on reasonable request.

Abbreviations

NA:

Narcotics Anonymous

AA:

Alcoholics Anonymous

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Acknowledgments

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Funding

No external funding sources were provided for this study.

Author information

Affiliations

1. Department of Special Needs Education, Ghent Academy, Henri Dunantlaan 2, 9000, Ghent, Kingdom of belgium

   Anne Dekkers & Wouter Vanderplasschen

2. Yes We Can Clinics, Groenendaal 1, 5081 AM, Hilvarenbeek, The Netherlands

   Sam Vos

Contributions

Advert was the main researcher, designed the study, collected the information, carried out the qualitative analysis, and wrote the draft of the paper. WV contributed to the design of the study. AD discussed and reflected upon the preliminary findings with SV. SV and WV critically revised the draft of the paper and the last article. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Anne Dekkers.

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Approval to conduct the study was granted past the Upstanding Commission of the Faculty of Psychology and Educational Sciences, Ghent University (awarding 2015/48). Informed written consent was received from all participants.

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Non applicable.

Competing interests

The authors declare that they have no competing interests. However, the second other is closely involved with NA and therefore included as an skilful in the analysis of this study.

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Dekkers, A., Vos, S. & Vanderplasschen, W. "Personal recovery depends on NA unity": an exploratory report on recovery-supportive elements in Narcotics Anonymous Flanders. Subst Abuse Treat Prev Policy 15, 53 (2020). https://doi.org/10.1186/s13011-020-00296-0

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• Received: 18 October 2019

• Accepted: 21 July 2020

• Published: 31 July 2020

• DOI : https://doi.org/10.1186/s13011-020-00296-0

Keywords

• Recovery
• Addiction
• Mutual aid organizations
• Narcotics Anonymous
• Qualitative inquiry
• CHIME-D

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