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Background: Studies investigating the subjective experiences of long-term recovery from substance use disorder are scarce. Particularly, functional and social factors have received little attention. Objectives: To investigate what long-term recovered service users found to build recovery from substance use disorder. Material and Methods: The study was designed as a phenomenological investigation subjected to thematic analysis. We interviewed 30 long-term recovered adult service users. Results: Our thematic analysis resulted in five themes and several subthemes: 1) paranoia, ambivalence and drug cravings: extreme barriers to ending use; 2) submitting to treatment: a struggle to balance rigid treatment structures with a need for autonomy; 3) surrendering to trust and love: building a whole person; 4) a life more ordinary: surrendering to mainstream social responsibilities; and 5) taking on personal responsibility and gaining autonomy: it has to be me, it cannot be you. Conclusions: Our study sample described long-term recovery as a developmental process from dependency and reactivity to personal autonomy and self-agency. The flux of surrendering to and differentiating from authority appeared to be a driving force in recovery progression. Participants called for treatment to focus on early social readjustment.

Background: The literature on antipsychotic medication in psychosis lack systematization of the empirical knowledge base on patients' subjective experiences of using antipsychotic drugs. Such investigations are pivotal to inform large-scale trials with clinically relevant hypotheses and to illuminate clinical implications for different subgroups of individuals. Aims: To re-analyze and summarize existing qualitative research literature on patient perspectives of using antipsychotic medication. Method: A systematic literature search was performed in September 2018 (Protocol registration no. CRD42017074394). Using an existing framework of meta-analyzing qualitative research, full text evaluation was conducted for 41 articles. Thirty-two articles were included for the final synthesis. Results: Four meta-themes were identified: (1) short-term benefits; (2) adverse effects and coping processes; (3) surrender and autonomy; (4) long-term compromise of functional recovery. Conclusions: While largely positive about acute and short-term use, patients are more skeptical about using antipsychotic drugs in the longer term. The latter specifically relates to processes of functional and social recovery. The clinical conversations about antipsychotic medication need to include evaluations of contexts of patient experience level, patient autonomy processes, patient values and risk preferences, and patient knowledge and knowledge needs in addition to assessing the severity of symptoms of psychosis.

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Acute phase antipsychotic treatment was mostly perceived as advantageous by this sample, who was in clinical recovery. However, costs were often seen as outweighing benefits beyond the acute stage. Findings clearly emphasize the need for a collaborative approach to be integrated across all phases of care. This study underscores the need to investigate sub-group differences with regard to long-term antipsychotic treatment.