Introduction
Theoretical Framework: The Role of Mattering in Recovering from Substance Use Problems in Later Life.
Current study
Methods
Sample and recruitment
Participanta | Interviewerb | Region | Services received | Current use of substances? | Onset of substance use problems | Way of contact with services | Problematic substances | Available relational communities |
---|---|---|---|---|---|---|---|---|
M66 | 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 |
M67 | 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 |
M77 | 5 | East | NAV, disability pension, | Yes | Early | Lack of income | Alcohol | Family Friends |
M71 | 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 |
F68 | 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 |
M68 | 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 |
M80 | 4 | East | Housing, pension (not specified), outreach service, home nursing, earlier: institution | No | Early | Recommended by family to make contact | Alcohol | Family |
M77 | 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 |
M76 | 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 |
F65 | 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 |
M68 | 1 | Central | Pension (not specified), physiotherapy, home nursing, earlier: institution (specialized health care), | No | Late | Friend assisted in making contact | Alcohol | Friends |
F68 | 1 | Central | Housing, contractual early retirement pension scheme (AFP) in the public sector, earlier: institution, | No | Early | General practitioner made contact | Alcohol | Family Friends |
F73 | 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 |
M76 | 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 |
F66 | 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 |
M66 | 5 | East | Housing, disability benefits, drug-assisted treatment, NAV, general practitioner, earlier: institutions | No (methadone) | Early | Personal contact at NAV made contact | Heroin | |
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 | |
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 |
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 |
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 |
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 |
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 |
Data material
Substance use services and sociocultural context
Approach to enquiry
Data analysis
Results
Relational experiences of mattering and not mattering
P2: And, then the fight (for help) started. Because there wasn’t any offer that wanted to take me in. So, then I said that “I have to get an offer now”. And my son said the same. “If not, she is going to die”.I: So, your son came to the rescue?P: Yes, he supported me.I: What meaning has it had for you that the family and your children have been involved in the recovery process?P: That has meant everything to me. If I had been alone in that process, then….I’m not so sure I would be here today. Then I don’t think I would have felt that I mattered or had anything to live for, frankly.I: Can you elaborate on that?P: Just that you gain your courage to live. Because that was completely gone (in the beginning of the process).
…Once I celebrated Christmas with a close relative and her children when they were still little children. I had brought gifts for them, and their mother (his relative) had opened their gifts and decided that they should not have those gifts and thrown them in the bin. So, when I asked the children if they liked the gifts, they just looked at me as question marks. I have no words. It was so rude! After that, I didn’t want to celebrate Christmas with my family.
P: You know. Sometimes I wonder, what is the point of living? You know (cries)?I: Can you talk to someone about that?P: No, I haven’t done that. My partner died many years ago…And I miss him so much….two or three months ago I thought about ending my life. In the mornings I wake up and put my hand over at his side of the bed…then I feel that he is gone…everything has been heavy and empty after he died…
…She (his friend) has been there for me (in the recovery process). We both think that one of the staff in the home service is terrible. So, we support each other. Make sure we get what we should have. That makes it easier for me to make claims. That my needs matter.
Service-related experiences of mattering and not mattering
P: I talked with my doctor, and he was very nice. Very welcoming. I got a lot out of taking to him.I: Can you say a little more about what you mean?P: Yes, he was very good. I have to say.I: But if you were to describe what you valued? What was it that he did?P: I don’t know.I: Was it that he talked with you?P: He talked with me and not to me.I: And what would you say is the main difference? Of talking with and to?P: To talk to, it to kind of say «now you will do that and that»…I: Like a command?P: Yes. But he didn’t do that. He was welcoming and understood.I: And, talking with. What is that?P: That he could see my problems. That they mattered and that he would try to fix those problems.
P: X (geriatric psychologist) knew that I had tried to end my life, so she had something concrete to deal with. It was evident that I needed to get back on my feet. For a long time, everything was so insecure. I just felt that I and my general practitioner couldn’t make my life matter to me. I ran. Exercised every day and did all that I could (to manage health), but things were just not right. But with X, she made me see the value in things.I: What significance has that had for you?P: Very much. Like I matter.
I was admitted to hospital for alcoholism…and I was there for a while, and then I felt that I got a really good follow-up in the way that I was prioritized, or given attention, right? That “you have a need and we will help you”…that mattered a lot to me.
I think they could add a little to the conversation. “How are you?” “Are you doing good?” Ask a little bit about those things. I feel that is lacking in these home services. They don’t have the time to talk to people…That gives me a negative experience.
I: If you could get any help that you desired (for your recovery)? How would that service look like?P: Well…I have to base my answer on my own experience. And…that is that you have to be so sick that you are dying (before you get help). It shouldn’t be necessary to fight to get help. In that case the offer should be there. I am aunt of two persons who have taken their life. Both being drug addicts. And they were calling for help but weren’t prioritized. So, I am not impressed (by the services offered).
Recovery, psychological sense of community and mattering as interrelated phenomena
…Contrary to many others I have maintained a close relationship with my family…And that of course matters a lot to me in my recovery. Because I hear…I speak to others with substance use problems, and they don’t have any contact with their family. They (the family) have been there for me. Not pointing any finger…respecting me.
When I started to feel better, I was about to go to The Church City Mission and ask if they needed a hand. When I get better again, I want to do that…most likely, that is what I will do when I have recovered. Make an effort, a volunteering effort in my community. As long as my body can take it.
…there are a lot of us (with substance use problems) who experience great value in giving back to society…there are people like me who have the need to “OK, I know how you should do that, and I can assist you and help you”. That is important and shouldn’t be ignored.
Discussion
Theme 1: Relational experiences of mattering and not mattering |
Family, partner and friend-related experiences of mattering |
Family-related experiences of not mattering |
Theme 2: Service-related experiences of mattering and not mattering |
Being respected, understood and seen |
Being ignored and neglected |
Theme 3: Recovery, psychological sense of community and mattering as interrelated phenomena |
Interrelations in feeling valued by self and others |
Interrelations in adding value to others |