Substance Use and Community Integration Among Individuals with Serious Mental Illnesses

Background and Purpose: Social connection, robust social networks (SNs), and community integration are recognized as essential components of health and well-being. For individuals with serious mental illnesses (SMIs) and substance use issues, SNs can offer vital support and resources that can facilitate their recovery processes. Unfortunately, the SNs of individuals with SMIs and SUDs tend to erode over the course of their illness, which has implications for the help that they can rely upon. This study aims to broaden the understanding of SNs, processes of community integration, and recovery of individuals with SMIs and current or past substance use.

Methods: This mixed method study explores semi-structured interviews and SN data from a sample of racially and ethnically diverse individuals with SMIs and current or past substance use (N=33) and in services in public outpatient mental health clinics in New York and in California. For the qualitative analysis, three researchers analyzed interviews using the ResearchTalks’ “Think and Shift, Sort and Sift” approach that includes diagramming, memoing, creating individual participant episode profiles, and monitoring of topics using a combination of descriptive, in vivo, and process codes. Thematic analyses identified risk and protective factors that shaped the structure, function, and experiences of their social relationships that, in turn, all influenced their community integration. The SN analyses used fixed effects conditional logistic regressions to estimate the odds ratios of the availability of emotional support, instrumental support, stigma, and sense of belonging between four relationship categories of family, friends, mental health providers, and others.

Results: In the qualitative data, participants identified major barriers to integration including histories of substance use, trauma, homelessness, incarceration, and stigma for their mental health and substance use. Current substance use also adversely impacted many of their current social relationships. Protective factors, largely drawn from their experiences in mental health services, included their development of new skills, progress towards mental health and substance use treatment goals, and receipt of important benefits and resources. Many reported strong social supports built from their social networks, such as mental health providers and peers. Stigma was commonly experienced not only for their mental health but also for their sobriety from friends and family who continue to use substances. SN analyses supported many of the relationships noted in the qualitative data. Family members and mental health providers did not differ in the odds of providing instrumental support, but participants reported higher odds of feeling close to a family member than providers (OR= 6.13, p < .05). Participants experienced significantly more stigma from family members (OR= 7.22, p < .05), friends (OR= 3.18, p = .002), and acquaintances (OR= 2.66, p = .016) compared to mental health providers.

Conclusions and Implications: These findings highlight the complexity of relationships and SNs among people with SMIs while identifying unique barriers to their community integration. Understanding the barriers and protective factors for this vulnerable population can enhance both mental health and substance use services, while offering strategies for strengthening social ties integral to community integration.