The role of social environment in pathways to recovery: a scoping review

Substance misuse is a problem with severe social and physiological consequences for the individual and society itself. Being addiction an overwhelmingly researched topic, through this review it´s intended to ascertain the social-environmental factors associated with the recovery of drug addiction, as well as possible research gaps.

The review was conducted through a wide search in 24 databases and 14 relevant sources of policy documents, thesis/dissertations, grey literature elements, and scientific articles, whether they were qualitative, quantitative or mixed methods. The studies focused on social and/or environmental factors involved in the recovery and social reintegration of drug abusers were included, except if they targeted the misuse of licit substances, included subjects exhibiting psychiatric or somatic comorbidities, were strictly descriptive, or regarded an extremely specific population, such as pregnant women. The recently-published PRISMA-ScR was followed to report the main findings. Out of the thirty studies selected for the final review, most were published after 2011. The main focus of the selected studies was the patient ´s point of view, with only one study focusing on the professional's perspective.

The most explored social-environmental factor was the network support from family and/or friends. Employment, stigma, 12-steps affiliation and socioeconomic conditions revealed some influence in the recovery and reintegration of the user. Furthermore, some articles highlight the marginal weight of spirituality, aftercare services and structured environments in the recovery process.

Two major research gaps were identified. For one, nearly all studies focused on the pharmacological aspect of the drug abusers’ recovery, neglecting the existence and importance of the psychotherapeutic context. On the other hand, the overexploitation that is given to the network support undermines the existing, as well as the unknown, factors, such as cyberbullying.

In future research, we advise that the factors in the psychotherapeutic context are surveyed, the perceptions of others are assessed, and that research relating to socioeconomic reintegration is further developed.

The present review was developed as the theoretical foundation for the DURESS (Drug Use Recovery, Environment and Social Subjectivity) project under the European Area Network on Illicit Drugs (ERANID), being financially supported by the Portuguese General Directorate for Intervention on Addictive Behaviors and Dependencies (SICAD).