“There Were People like Me There That Used like I Did, but Yet Had Found a Way out.” a Qualitative Study of Long-Term Narcotics Anonymous Participants

Background and Purpose: Substance use is an ongoing problem that effects millions. Opioid and polysubstance users are at increased risk for negative outcomes, including death. Despite extensive research on various substance use disorder (SUD) interventions, overdose deaths continue to rise, and the mechanisms of change leading to positive outcomes are not well understood.

Methods: The current study employed a retrospective qualitative analysis of the experiences of opioid and polysubstance users that have achieved long-term recovery in Narcotics Anonymous (NA), asking them what they recall as instrumental to maintaining recovery. 14 semi-structured interviews were conducted by the researcher via Zoom, transcribed and coded for semantic and inductive thematic analysis. Thematic Analysis (TA) was used to construct themes of internal change processes that led to compounding positive outcomes, which participants attributed to their involvement in the NA program.

Results: An emergent theory of mechanisms of behavior change (MOBC) was comprised of the following themes and subthemes as described by participants and organically and critically interpreted by the researcher: (1) believing life can be different, with subthemes of (1.1) readiness/commitment for change, (1.2) hope, and (1.3) open-mindedness; (2) knowing and loving self with subthemes (2.1) self-acceptance, (2.2) self-discovery, (2.3) giving grace; and (2.4) mental clarity; and (3) pro-social regard for others with subthemes (3.1) honesty, (3.2) selflessness and (3.3) trust and dependability.

Conclusions and Implications: Thematic results are supported by prior research that indicates internal processes of change are important mechanisms in achieving positive outcomes in substance use intervention. The results have the potential to inform future research that can test and generalize emergent MOBC, encourage more equitable policy approaches, contribute to effective practice interventions, and lessen stigma faced by people who use drugs by humanizing their experiences through their own words.