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This chapter documents experiences of being a partner in a long-term recovery process. The research about long-term recovery from substance use gives the impression that recovery processes are about single people. However, this is illusory, and reflects the focus of most research into substance-use difficulties. In this chapter, we look at romantic relationships in long-term recovery from a Norwegian perspective. This is a perspective involving the context of the Scandinavian welfare state, well-established public services and countries with high levels of gender equality. The aim of this chapter is to exemplify, from interviews, how women talk about their lives as partners to men in long-term recovery. By doing so, the chapter provides insight into some of the complex experiences of being a partner in a long-term recovery process, and how these women’s experiences are related to their social and cultural context.

Close relationships with partners, family and friends are the factors that most affect human health and well-being (Dunbar, 2018), and this also applies in the case of long-term recovery from substance use. The role of people’s close relationships is not only important in relation to their motivation for treatment or in the short term but also in their day-to-day lives and ongoing recovery: ‘Being connected to others gave meaning to the hardships of working towards recovery. For many of them, this was a life-long process in which the continual presence of family and friends was key’ (Veseth et al, 2019, p 100).

There is a growing research interest in the role and importance of families in the recovery of individuals with substance-use difficulties (Timpson et al, 2016; Ventura and Bagley, 2017).

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The fact that opioid users now have longer life expectancy is largely due to the availability of well-developed medical and psychosocial care for substance users. In Germany, all citizens have access to extensive social welfare provision and a highly developed healthcare system. Opioid substitution treatment (OST) using methadone or other medication is the standard treatment for opioid users. According to the Substitution Register report, which is published by the German Federal Institute for Drugs and Medical Devices (FIDMD), the number of patients receiving OST rose from 46,000 in 2002 to 79,700 in 2019 (FIDMD, 2020).

However, whilst OST helps substance users to stay off heroin, it often remains a part of their lives for many years or even decades. Although studies have shown that the social situations of older opioid users (OOUs) improve when they are receiving OST (EMCDDA, 2010; Wittchen et al, 2011a), there are often wider institutional factors that can have negative impacts for both service users and professionals. For example, finding employment or rewarding activity can be particularly difficult for people associated with long-term opioid use due to previous life circumstances. This can result in limited options and frustration for everyone involved. Many studies indicate that older substance users are not only affected by psychosocial impairments but also by multiple health conditions that may lead to a loss of mobility and a need for care at an earlier age than in the general population (Reece, 2007; Vogt, 2011).

This chapter describes the situation of opioid users aged 45 and over in Germany, and considers aspects such as the health-related and social characteristics of this group, as well as indicators for the provision of professional support regarding treatment and recovery.

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This chapter aims to describe the diverse long-term change processes that are often required when individuals with present or former substance dependence want to develop meaning and purpose in their lives. It draws on the author’s work in a Norwegian study, the Stayer study, that involves long-term follow-up of people who use, or previously used, substances (Svendsen et al, 2017). A brief summary of the nature and extent of substance use in Norway, the welfare state model and organisation of substance-use treatment services is presented. The chapter continues with a description and discussion of how the multifaceted term ‘long-term recovery’ is linked to substance dependence and substance-use recovery research. Several examples from the Norwegian Stayer study are provided to illustrate the value of long-term research on change processes in substance-use recovery. Finally, practical improvements for long-term recovery services and research regarding individuals with both present and former substance-use dependence are suggested.

Compared to most European countries, Norway has a low prevalence of inhabitants that use substances, including alcohol and cigarettes. Cannabis is the most commonly used illicit drug in Norway. In 2017, one in ten young adults reported cannabis use in the previous 12 months, while use of other illicit substances such as MDMA, ecstasy and cocaine is reported to be significantly lower; substance use is mostly reported by young adults, with higher prevalence rates among males than females (EMCDDA, 2019). The number of high-risk drug users in Norway, linked to injecting amphetamines and opioids, primarily heroin, was estimated at around 8,700 in 2016 (2.5 per 1,000 inhabitants aged 15–64 years).

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A key strength of this edited collection is the diversity of experiences it reflects, both in the ways in which it explores how recovery has been adopted in seven different nations, as well as the ways in which recovery is experienced by a range of different groups of people. Many of the chapters are based on empirical research, and all make reference to the voices of people with lived experience. In this concluding section, we seek to consider some of the important elements of learning we, as editors, see emerging from it, as well as to identify issues and questions we see as requiring more attention in future research and writing on the subject. In the introduction we began by looking back at how the idea of recovery has become a central facet of policy and practice in many different national contexts in recent years. In this concluding chapter we reflect on the idea of long-term recovery, considering whether this collection of work manages to register anything distinctive about the ways in which this term is important and useful, and if using the language of ‘long term’ offers any new and important ways of considering and conceiving of recovery. Further, it draws out key messages from and for people with lived experience who were partners and/or participants in the empirical research the chapters are based on, as well as presenting implications for policy, practice and future research.

The fact that the language and idea of recovery has been adopted in so many different national contexts in the same era demonstrates just how persuasive and plausible the idea of recovery has proved to be as a seemingly new direction for substance-use policy and practice.

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In everyday contexts, recovery is often thought of as something highly personal, involving changes in aspects of an individual’s life not restricted to immediate behavioural or psychological presentations. In research on alcohol and other drug use, recovery has been framed in a range of ways, from studies that examine narrowly defined treatment outcomes to those which explore broader changes in lifestyle and social circumstance. This already complex picture is further complicated by questions about how recovery should be understood and/or evaluated at the level of policy, practice and lived experience, and whether the main concern of research studies should be evidencing causation, correlation, attribution or contribution. Given the vastness of such possibilities, this chapter critically examines whether measuring long-term recovery is possible or even desirable? It draws on the author’s research and writing, with particular regard to recent shifts in methodological approaches to research on alcohol and other drug use. Specifically it considers moves towards greater inclusivity of people with lived experience as active partners in research, as well as the use of theory-driven approaches to programme and strategy evaluation. These applied considerations are interwound with key messages and other examples taken from a broad range of literature.

Recovery-orientated alcohol and drug policy has become firmly established in the UK in the last ten years. A number of factors have influenced the mainstreaming of recovery, including influential reports (for example the Scottish Government’s 2008 Road to Recovery) and the active promotion of recovery as a policy idea by key governmental organisations like the English National Treatment Agency for Substance Use.

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The impact of substance use on the family unit remains an under-researched topic in Iceland. Research by one of the authors of this chapter (Ólafsdóttir, 2020) seeks to fill this gap, making an important contribution to understanding the impact of substance use upon various family members in Icelandic culture. The study on which this chapter is based focussed on the impact of substance use on a range of subgroups within the family system as a whole. This included parents, siblings, spouses, children and ‘adult children’ (that is, people who are now adults and who had grown up in a family setting where substance use was a feature) (Ólafsdóttir, 2020).

While the primary focus of the core empirical study sought to understand the psychosocial, behavioural and physical effects of being brought up in a family impacted by substance use (Ólafsdóttir, 2020), we seek to extend this focus to consider the extent to which a notion of long-term recovery for adult children is evident or supported within the Icelandic public health agenda.

We begin with a brief overview of research, policy and practice within Iceland to provide background and context. First, we introduce the family as a key psychosocial influence, establishing a contrast between healthy family systems and the potential consequences of dysfunctional relations within families experiencing substance-use disorder (SUD). We continue with a description of the wider Icelandic public health and specific substance-use policy agenda, outlining the current support available to adult children who have grown up with parents engaged in problematic alcohol use. We finish this section by offering a broad introduction to recovery as a concept, before developing our thinking further with the introduction of a number of models and concepts pertinent to the recovery landscape.

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European Perspectives

In this much-needed text, leading international experts explore crucial aspects of people’s experience of long-term recovery from substance use.

Centred around the voices of people who use substances, the book examines the complex and continuing needs of people who have sought to change their use of substances, investigating the ways in which personal characteristics and social and systemic factors intersect to influence the lives of people in long-term recovery. With perspectives from Sweden, Norway, Germany, Belgium, Iceland and the United Kingdom, it also considers the role and needs of family members, and puts forward clear recommendations for improving future research, policy and practice.

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