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Purpose The possibility of recovery for persons with co-occurring addiction and mental health problems has been contested. Though, recent studies show that recovery might happen, but without connection to specific treatment interventions. The purpose of this paper is to analyse professionals’ perceptions of their contribution to improvement. Design/methodology/approach In all, 15 experienced professionals were interviewed. The interviews were analysed using thematic analysis. Findings Recovery processes were dependent of the persons’ access to different forms of recovery capital (RC). Lack of RC was often associated with lack of trust in one’s self and others (identity and personal capital). Professionals had to be accepted as trustful agents through co-creating changes in the person’s life. Trusting a professional might be a basis for trusting one’s self as an agent in one’s recovery process and develop a social network (identity and relationship capital). Other aspects stressed by the professionals were to manage their own fragmentized organisations and societal shortcomings (economic capital). Practical implications Recovery has been described as a profoundly individual journey. However, it is also deeply social, involving other persons and contextual factors. Focusing on just one level might counteract the complex work behind double recovery. Originality/value Improvement was described as dependent on the presence of personal, inter-personal, organisational and societal factors. The findings give a deep and concrete understanding of the process constituting the development of a working alliance and its dependence on factors outside the direct relation between the staff member and the person.

Alcohol misuse among substance abusers might have a negative impact on mortality rates. Methodological changes in how drug related deaths is registered affects the interpretation of the statistics of cause of death. Further analysis on the relation between drug related cause of death and drug misuse related death is needed.

In social work practice, the role of substance use is often encountered in the context of other social problems such as child abuse and domestic violence. This article compares descriptions of important factors for initiating and maintaining positive changes among male and female clients treated for alcohol and/or drug problems. The results have a bearing both on substance use treatment and on other areas in social work practice where these problems are encountered. Studies highlighting gender perspective indicate differences regarding experience of alcohol and drug problems and treatment. An advantage of the study is the qualitative analysis of a rather comprehensive material (n ¼ 90) enabling more general conclusions than in previous research with a limited number of clients.Findings: Women more often than men stress poor mental health and their children as important for initiating change. When referring to partners, women report abusive rather than supportive partners while the opposite applies to men. For maintaining change, male clients more often stress changes in ways of thinking and feeling as important. Men also report becoming more sensitive while women get more active. This can be understood as transcending of gender with possibilities of a broader repertoire of how to act.Applications: A challenge for practical treatment work is to create possibilities for clients to broaden their repertoire of ways of living and thinking about themselves, expressed by women as the importance of taking space and speaking up and by the men of showing emotion and listening more.

Recovery is an established term used to describe positive processes of change concerning problems related to alcohol and other drugs (AOD). The present article investigates first-person experiences of recovery self-identification over time in clients who have completed 12-step programs with a positive outcome (sobriety). The data comprises qualitative interviews with 47 individuals five years after the first post-treatment interview, analyzed in a process inspired by reflexive thematic analysis. Although all the individuals had continued their recovery, their recovery paths and how they identified themselves in relation to their AOD problems had taken different directions. Thus, many of the individuals described their recovery in a broader sense which ranges from abstinence to moderation. Some individuals perceived themselves as no longer in recovery. The multitude of recovery processes described in the study underlines the need for acceptance and respect for individual identity processes. Furthermore, the importance is stressed of supporting an individual's perceptions of how their recovery process should best be outlined. The results should not be interpreted as a critique of the 12-step approach. Instead, there is a need for variety over time in the support and treatment options available for people in need of treatment for AOD problems.

The overall aim of this study is to increase the understanding of operative factors in the treatment process by studying how clients and treatment unit staff perceive the relevance and value of the alcohol treatment intervention for a positive process of change. The specific research questions are: (1) How do clients describe the relevance and importance of treatment interventions in their own process of change?(2) How do treatment staffs describe experience and perceptions of how their work can contribute to a successful change process among treated clients? (3) How do client and the treatment staff descriptions relate to each other? Interviewees (40 clients and eight professionals) were recruited from four treatment units in the Stockholm area. In the results, the three treatment components most emphasised by clients are structure and regularity, friendship and support of the group and the personal conduct and professionalism of the staff. Both of the components referring to the client group and to the staff were also brought forward by the professionals interviewed. In treatment, the client group is used as an important tool for creating a sense of trust, confidence, acceptance and collaboration -all central components of the treatment alliance concept. With reference to the notion of rebuilding/extending recovery capital, it is suggested that in addition to the addiction problem intervention, a more extended system of support is vital for more marginalised clients.

Purpose The purpose of this paper is to investigate the internal and social factors that persons with experience from severe mental illness and alcohol and other drugs problems, and who have received treatment for these problems, describe as important for initiating and maintaining a recovery process. Design/methodology/approach In total, 40 persons were interviewed and asked to describe factors they perceived as important for initiating and maintaining recovery. The software Nvivo was used to categorise data in internal and social factors with subcategories. Findings There is significant variation in how recovery emerged but involved in general having a proper social situation and finding meaning in life. Initially, the majority had a marginalised situation with need of assistance with housing, employment, financial and social support. Research limitations/implications The change process in the investigated group is interpreted as related to individual resources rather than belonging to a group defined as having “double trouble”. Practical implications The study implies that in addition to professional help to handle diagnosed problems, the group in focus also need support and interventions that address individual complex needs. Social implications Supporting activities/peer support seem to be important for those lacking support from family. At the same time, it is important to recognise the risk of being forced into a recovery identity which might lead to worsening the situation for those who do not fit into this. Originality/value By using the same design as in previous studies, comparisons with other groups are possible while still keeping the qualitative meaning of the investigated factors.

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