Social Capital in The Recovery of Current and Former Substance Users: A Qualitative Study in Greece

Substance use is a major multifactorial public health challenge [1], that requires a multilevel approach [2] (Shafiee, Razaghi, & Vadadhir, 2019). Individuals have always used various legal or illegal substances [3] either to relieve problems [4] or to fulfill different roles [5]. Addiction is an individual's intense attachment to an object or another person that makes it necessary or required to be able to respond to social roles [6]. The transition from casual use to addiction involves an interplay of factors, with curiosity and initial enjoyment leading to mental health issues as addiction progresses [7]. Understanding the barriers that prevent individuals from discontinuing substance use remains critical to formulating effective interventions [4]. 

Addiction, in its psychosocial dimension, is viewed as a symptom of both psychological and social dysfunction, highlighting the complex and intertwined relationship between these two factors [8]. To successfully stop using substances, individuals need to improve their health and social functioning by leveraging social resources and networks that enhance their recovery capital [9]. 

Recovery capital is theoretically based on the concept and dimensions of social capital [10]. Social capital encompasses moral obligations, norms, social relationships, and networks that collectively enhance individuals' engagement and contributions toward the common good [11].  In recent years, several studies have established the important role it plays in various anti-deviance, anti-crime phenomena [12], risky behaviors [13-15], and substance abuse [16]. Putnam (2001)¹⁵ distinguished three types of social capital [17]. 

• Bonding Social Capital: Refers to strong ties within homogeneous groups, such as family and close friends, offering emotional support and reinforcing shared values.
• Bridging Social Capital: Involves connections between diverse groups, fostering cooperation and collaboration across different social, ethnic, or religious backgrounds. This is critical for accessing new resources and opportunities.
• Linking Social Capital: Connects individuals to institutions and positions of power, enabling access to resources and support from authority figures [17]. This type of social capital helps individuals gain access to positions of power. 

A lack of social capital can lead to social network breakdown and involvement in negative networks can perpetuate deviant behaviors, highlighting the dark nature of social capital [15,18,19]. Positive social capital is a critical component of recovery capital, enhancing individuals’ interactions with their environment and increasing recovery and rehabilitation likelihood [20,21]. Recovery involves integrating resources, skills, and networks to achieve a positive outcome in education, employment, and social life [22,23]. Education and employment are vital components of bridging social capital and physical recovery capital [24]. Access to education fosters healthy social networks, job opportunities, and a new life perspective, enhancing all dimensions of recovery capital [25,26]. Employment supports rehabilitation by meeting basic needs and reinforcing positive traits, while unemployment hinders access to recovery capital, and positive change [24]. 

Parents and peers are primary sources of bonding social capital, particularly for young people [27]. Parents significantly impact children’s development, providing protection and guidance that reduces behavioral problems through active involvement and supervision [28,29]. Beyond the family, individuals participate in broader social networks that offer influence and benefits [30]. Social capital has a preventative effect on youth substance abuse through supportive relationships and informal social control networks [31]. Social capital plays a crucial role in rehabilitation, and reducing relapse risk [21]. Integrating recovering individuals into new, supportive social networks is essential for successful rehabilitation [22,32]. High-quality networks discourage substance use and contribute to recovery [22,33]. Limited bridging social capital restricts access to resources and support, making recovery more challenging [10,34]. 

Social recovery is realized when individuals develop the requisite skills, resources, and social networks needed to integrate effectively into society, with a focus on fostering constructive interactions within the broader social environment [10,35]. 

The present study aims to qualitatively investigate the influence of social capital as part of recovery capital in addicted and recovering individuals in Greece. Comprehending these patterns will guide social workers' creation of better interventions and support systems, enhancing recovery and integration back into society. The results will help develop plans to improve social and recovery capital, leading to better outcomes for individuals in recovery.

This research was conducted from February to July 2020 during the Covid-19 pandemic. To protect personal data, the research protocol was approved by the Ethics Committee of the Department of Social Work of the Hellenic Mediterranean University on 23/2/2020. Participants were thoroughly briefed about the study and gave their informed consent by signing a participation agreement. 

The study employed a snowball sampling method to select participants, comprising a total of twelve individuals: 6 current and 6 former substance users, aged 25-50 years old from various regions of Greece. The study inclusion criterion for the current substance users was to meet at least 2 out of 11 multiaxial criteria over the past 12 months as defined by the DSM-V [36]. The admission criterion for former substance users was a minimum of five years of abstinence from any illicit substance, not excluding non-problematic use of other legal substances such as alcohol and tobacco. This level of abstinence was categorized as stable recovery [23,35]. The data collection tool was designed to capture various dimensions of social capital. Bonding social capital was assessed through networks of relatives and friends not associated with illicit drug use. Bridging social capital was evaluated through networks related to rehabilitation services, religious networks, participation in social clubs and activities, and employment networks [35]. This tool, adapted from Boeri [35] and translated into Greek in line with cultural adaptation principles [37] also addressed factors such the economic crisis, the reduction of welfare services, the organization of addiction treatment services, and legislative regulations of drug criminalization. 

Following a pilot phase, additional thematic axes were incorporated into the tool, including a) life of management issues; b) the impact of social factors on illicit drug use; c) the interplay between drug use, social connections, and social networks over the life course; d) significant events in the trajectory of substance use; e) critical points in cessation, relapse and treatment; and f) structural and political causes in addiction and rehabilitation. Interviews which ranged from 1.5 to 2 hours, were conducted to gather comprehensive data. 

Data analysis was performed using thematic content analysis [38]. This involved coding interview content to identify emerging categories and subcategories, which are detailed in the results section and summarized in Table 1. 

Table 1: Influence of Social Capital Types.

Sample profile 

The sample of current substance users comprised four men and two women, aged between 26.5 and 43 years. Among these, 50% were secondary school graduates, while the remaining participants had tertiary education. The majority were employed, and their economic status varied from poor to satisfactory. Religious affiliation was diverse, with two individuals identifying as religious or spiritual and four as irreligious or atheist. 

The former substance users included three women and three men, aged between 30 and 45 years. All were secondary school graduates, with the majority currently pursuing higher education. Their financial status also ranged from poor to satisfactory, with three of them identifying as religious or spiritualists. 

In terms of substance use, individuals currently using substances mentioned hashish, cocaine, heroin, buprenorphine, MDMA, LSD, and methadone, while former ones mentioned hashish, heroin, cocaine, MDMA, pills, and buprenorphine. Two of the current users are currently undergoing addiction treatment using the medical-focused approach. 

Among the current users, two were undergoing treatment based on a medical-centered model. For the former ones, treatment experiences included two who had completed programs based on the medical-centered model, one who had undergone a psychosocial model program, two who had participated in a self-help program (Narcotics Anonymous), and one who achieved recovery without formal treatment. Detailed characteristics of the sample are summarized in Table 2.

Table 2: Sociodemographic profile of interviewees.

Bonding Social Capital

1. Substance use free family networks

• Current substance users 

The majority of current substance users reported that their family of origin had a positive influence on their substance use behaviors. Many participants indicated that their families played a significant role in mitigating their drug use. Indicatively, here is what the Interviewee 5 (I.5) said: “Returning to my parents' house, after completing my university studies, contributed to my reducing substance use”. Additionally, individuals who established their own families often cited parenthood and pregnancy as factors that contributed to a reduction in substance abuse. Interviewee 1 (I.1) highlighted this, saying, “The most important experience of my life is the birth of my daughter. That is the most important of all, I think. I try to be a parent that is present to the needs of my daughter and not make her feel like she is deprived of things”. 

Many participants reported that fulfilling their familial roles led them to limit or conceal substance use, avoid using substances while in the presence of their family, and ultimately reduce their overall substance consumption. Close to them, Interviewee 2 (I.2) noted, “I only use substances when my child is asleep. I have never used drugs while he is awake”. This behavior, influenced by family responsibilities, often resulted in a moderate response to addiction and contributed to a weakening of their substance addiction.

Participants also described their families as a crucial support network, including spouses, children, parents, and siblings. The role of family relationships was emphasized by Interviewee 1 (I.1) who stated, “Since my daughter was born, my life’s stimuli have changed with the support I have had from OKANA [a medical-centered treatment program]”. However, the extent of family awareness and attitudes towards addiction varied. While many relatives were aware of the substance abuse, some were not. For instance, Interviewee 2 (I.2) mentioned, “My parents have no idea about my substance use. If they ever found out, it would send them to the hospital!”. In contrast, Interviewee 3 (I.3) shared, “One of my brothers is aware of my substance use, and we even use drugs together. My other brother didn't know initially, but he does now, and it makes him angry”. 

A minority of participants reported negative or neutral attitudes from their families regarding their addiction. For example, Interviewee 6 (I.6) described his mother's lack of awareness, stating, “My mother is unaware of my substance use because I maintain some level of functionality, holding down a job and living independently”. 

• Former substance users 

Former substance users often cite drug-free family networks as one of the most crucial factors supporting their recovery journey. Initially, two interviewees specifically highlighted the positive influence of their family of origin. For those who have started their own families, every participant acknowledged the supportive role their family played. For instance, Interviewee 10 (I.10) expressed, “Two of the most significant experiences in my life have been getting married and the birth of my child”. Nearly all respondents noted that their ability to perform family and social roles improved significantly following rehabilitation. While only a small portion currently serve as parents or spouses, the majority view these roles as future goals. Importantly, all participants reported regaining the familial roles they had lost during the addiction, which they found to be protective against relapse. As Interviewee 11 (I.11) stated, “I am determined to create a family of my own that will be different from the one I grew up in”. 

All recovered users in the study recognized their families—encompassing parents, spouses, children, and siblings—as a vital support network. While most family members were aware of the participants' substance use, a small percentage were initially unaware. Interviewee 8 (I.8) noted, “My mother knew from the very first year that I was using illicit substances”. The impetus for permanent cessation of drug abuse was largely attributed to encouragement from family members, as highlighted by Interviewee 10 (I.10): “I had family people around me, who loved me”. 

A significant number of former substance users received family support throughout their addiction treatment and rehabilitation processes. Interviewee 12 (I.12) shared, “My family took a loan to pay back my treatment in Narcotics Anonymous”. Similarly, Interviewee 7 (I.7) added “My family gave to me some flats for future income, with the condition that I stop using drugs. Now, I rent these flats through Airbnb and I have an income”.

Ultimately, the study found that the relationships between former substance users and their family members evolved during and after use. The new context in which these relationships were developed was typically supportive, allowing the former substance users to better navigate their path to recovery. This restructuring of family dynamics provided an environment conducive to maintaining sobriety and fostering long-term recovery goals.

2. Peer networks

• Current substance users 

Regarding the positive influence of friendships and other social networks, only one participant mentioned receiving encouragement to address unfinished education. Interviewee 4 (I.4) stated, “In my desire to develop my mind and further cultivate it, having a sharp-witted friend who encouraged me to return to school was incredibly helpful”. Many participants highlighted the importance of friendship, such as Interviewee 4 (I.4), who emphasized “This entire situation has had a negative impact on me, and I am eager to demonstrate to society and my friends that there is more to me than they see”. 

Most drug users reported involvement in social circles composed of friends and romantic partners who also used illicit drugs. Interviewee 1 (I.1) explained, “Eventually, your entire social circle consists of addicts, including your friends and partners”. Interviewee 5 (I.5) described, “I found myself regularly using drugs when I was in a relationship with someone who also used”. Only two out of six current users reported having drug-free networks. Interviewee (I.6) noted, “I generally try to avoid people who are high all day. I won't isolate anyone, but I also won't spend time with them. I won't use drugs unless the other person does, and I only take drugs if I'm with someone else”. 

In addition, Interviewee 3 (I.3) attributed his temporary cessation from illicit substance use to significant others in his life, stating, “Typically, my periods of sobriety were prompted by criticism from others, such as my romantic partner”. The majority of current users did not receive strong encouragement to quit substances permanently or seek addiction treatment. 

• Former substance users 

In contrast, all of the former users reported significant positive changes in their social roles and relationships following their recovery. They consistently described an enhanced responsiveness to existing relationships and improvements in their interactions with society. Additionally, many reported successfully establishing new, healthy, substance-free social networks. For example, Interviewee 7 (I.7) stated, “Upon discovering my drug use, my girlfriend ceased all communication with me. However, I have since re-established relationships with everyone, including neighbors, fellow students, and my family. They observe my renewed enthusiasm and progress at school, and they are pleased to see the positive changes in me”. Similarly, Interviewee 8 (I.8) noted, “Significant others in my life include friends from Narcotics Anonymous, who were once also struggling with addiction but are now in recovery. We support each other’s sobriety. Additionally, I formed new friendships while I was clean and working. Currently, I am also building connections with peers I have met during my university studies”. Interviewee 9 (I.9) further emphasized these observations, stating, “I have improved my ability to engage in relationships and successfully re-established some connections that I had lost during the addiction period”.

Bridging Social Capital

1. Education 

• Current substance users 

For two individuals in the sample, education played a significant role in reducing or ceasing drug use. Interviewee 6 (I.6) noted, “To focus on my studies, I had to reduce my drug use to maintain a clearer mind”. Similarly, Interviewee 4 (I.4) highlighted the positive influence of education, social support, and personal aspirations, stating, “I ceased drug use and redirected my focus toward education. This transition enabled me to establish clearer goals and supported my personal development. A particularly perceptive friend was instrumental in this process by encouraging me to resume my studies, which played a key role in my decision to quit drug use”. 

• Former substance users 

Several of former substance users reported that education played a significant role in their recovery and social reintegration. For many, pursuing education was a catalyst for ceasing substance use and redefining their personal and academic goals. For instance, Interviewee 9 (I.9) stated, “The exams marked a significant turning point in my life, representing a transition from one stage to another as I ceased drug use. This shift brought newfound meaning to my life. Stopping drug use profoundly changed my perspective, and having a clear goal has been instrumental in this transformation. Similarly, Interviewee 7 (I.7) reflected, “I never imagined I could achieve this. I used to look at others and wonder how they managed, thinking I could never do it myself. Now, I am genuinely thrilled to have succeeded in the national exams”. 

Education also facilitated the development of new roles and social networks, which positively impacted their rehabilitation. Interviewee 8 (I.8) remarked, “The friends I made at the University, are crucial to me”, and added, “Being a student has definitely influenced my role; it requires studying and consistency”. Additionally, education has provided new perspectives for future planning. Interviewee 12 (I.12) highlighted, “At 37, I am actively pursuing a degree, which has significantly empowered me. Should my degree in philosophy not yield the desired outcomes, I plan to capitalize on my training as a yoga instructor. I am diligently working on developing this alternative career path as well”.

2. Employability and work

• Current substance users 

Regarding employment, three current users are employed, while the remaining three are unemployed. Of these, only one participant, Interviewee 3 (I.3), noted that work plays a crucial role in preventing substance use. Interviewee 3 (I.3) stated, “I have started Pilates courses to become an instructor. I’ve earned my initial diploma and plan to continue. This job clearly helps me avoid drug use”. 

For two interviewees, employment served as a temporary motivation to cease substance use. Their commitment to fulfilling work responsibilities and addressing the challenges caused by addiction influenced their decision to stop using drugs. Specifically, Interviewee 3 (I.3) mentioned, “I refrained from drug use primarily due to its detrimental effect on my job performance, as I struggled to perform well at work the following day”. Similarly, Interviewee 6 (I.6) observed that employment motivated him to adopt a more serious and responsible attitude toward his work. 

• Former substance users 

For many former users, employment serves as a critical protective factor against relapse and helps maintain sobriety. For instance, Interviewee 9 (I.9) noted, “Throughout periods of education and employment, I remained abstinent from drug use”. Additionally, several participants expressed a strong desire to secure fulfilling job roles. Interviewee 8 (I.8) stated, “The primary role I aspire to is that of working in a job, one that provides a sense of fulfillment”. Interviewee 12 (I.12) further emphasized, “Regarding my role as an employee, I believe I deserve better than what I currently have”. 

Overall, four out of six former users reported that work played a significant role in their post-rehabilitation lives. For some, employment offered a sense of trust and purpose, while others found that it helped them maintain abstinence. Interviewee 10 (I.10) highlighted, “Now that I am clean, I can work. Achieving the ability to work after recovery has been the most significant accomplishment for me, as it occupies my time and reduces the temptation to use drugs”.

3. Participation in social and sport activities

• Current substance users 

A significant number of current users engage in sports or social activities within their communities. For instance, Interviewee 1 (I.1) notes, “I am actively involved in socio-political activities”. Regarding sports, Interviewee 5 (I.5) mentions, “I participate in individual sports activities and have resumed practicing martial arts”. Additionally, Interviewee 3 (I.3) states, “I engage in sports and I am training as a Pilates instructor”.

Participation in these activities has had a positive impact on the well-being of three out of six current substance users. Interviewee 1 (I.1) highlights the supportive role of socio-political involvement, saying, “Through my engagement in socio-political activities, I connected with individuals who helped me address my problem”. Similarly, Interviewee 3 (I.3) underscores the role of exercise in managing substance use, noting, “I consistently used exercise as a counterbalance, which was a crucial factor in my effort to reduce drug use”. 

• Former substance users 

During their recovery, most former substance users have actively engaged in sports and social activities, which has provided them with renewed purpose and fulfillment. For instance, Interviewee 7 (I.7) explains, “I am involved in various activities such as making herbal cosmetics and integrating this with my pharmacy studies. I also attend school, work, and enjoy walking on the beach. I have come to appreciate simple pleasures that I previously overlooked”. 

Furthermore, many individuals have developed new interests that were not feasible during their period of substance use. Interviewee 8 (I.8) highlights this transformation, stating, “Since overcoming drug use, I have cultivated a passion for exercise, sports, spirituality, meditation, and reading”. This newfound engagement in diverse activities has played a significant role in their recovery process by providing a sense of purpose and enhancing their overall quality of life. 

4. Religion – Spirituality

• Current substance users

The majority of current users in the study indicated that religion had little to no impact on their substance use or recovery. For example, Interviewee 1 (I.1) stated, “I am not religious at all. Over the years, I have increasingly distanced myself from religious practices”. 

Conversely, one participant reported a shift towards personal spirituality as a source of support during recovery. Interviewee 4 (I.4) explained, “Through self-reflection, I became a pragmatist and integrated a personal faith influenced by the teachings of Jesus Christ. However, I do not attend church or engage with traditional religious institutions”. This individual’s experience highlights a nuanced approach to spirituality, where personal beliefs, rather than organized religion, provided a framework for coping with drug use. 

• Former substance users 

Regarding religiosity, three former users reported that spiritual practices played a significant role in their recovery. Interviewee 7 (I.7) notes, “My confessor was instrumental in helping me quit drugs and maintain my sobriety, offering support through challenging times”. Similarly, Interviewee 8 (I.8) emphasizes, “Meditation practices were crucial in aiding my recovery process”. Interviewee 12 (I.12) adds, “After ceasing substance use, I engaged in meditation and prayer to support my well-being and personal growth”.

5. Addiction treatment

• Current substance users 

Among the current substance users, a significant number have not sought addiction treatment due to their perception of substance use as less severe or less impactful. For instance, Interviewee 6 (I.6) remarked, “I find it incongruous to seek therapy for cannabis use; I believe therapy is more suited to address more severe drug issues”. Similarly, Interviewee 2 (I.2) commented, “I haven’t pursued therapy because I don’t consider my use serious enough to warrant it”. This indicates a prevailing belief among these individuals that their level of substance use does not necessitate professional intervention. 

Additionally, there is a notable lack of awareness about available addiction treatment programs. Interviewee 3 (I.3) admitted, “I haven't heard about treatment options,” while Interviewee 6 (I.6) conceded, “I haven’t investigated this issue at all; I haven’t looked into treatment opportunities”. 

In contrast, two participants have engaged with rehabilitation programs, one through a biomedical approach and the other through psychosocial treatment. Interviewee 4 (I.4) described her experience with a biomedical treatment program, stating, “Upon entering the treatment unit, I ceased using heroin and cocaine”. However, she criticized the program for its lack of comprehensive psychosocial support, noting, “I believe that OKANA [the biomedical program] falls short in delivering a complete rehabilitation process. It is challenging for patients to reach a point where they feel fully recovered and ready to leave”. Interviewee 4 (I.4) has been on substitute medication for ten years, indicating ongoing issues with the program’s approach.

In contrast, Interviewee 1 (I.1) had a positive experience with a psychosocial rehabilitation program, specifically 18ANO. Interviewee 1 (I.1) expressed, “I am a strong advocate for rehabilitation programs focused on psychotherapy, such as 18ANO, which was instrumental in my recovery. It provided deep insights into myself and greatly aided my personal development”. Interviewee 1 (I.1) also praised the altruistic nature of the staff, noting, “At 18ANO, therapists often contributed their own resources to support the program”. 

Currently, Interviewee 1 (I.1) is attending a biomedical treatment program at OKANA, underscoring a shift in approach while maintaining a focus on treatment effectiveness. Both Interviewee 4 (I.4) and Interviewee 1 (I.1) highlighted significant personal motivations for engaging in treatment, such as family and personal growth. Interviewee 4 (I.4) emphasized her desire for personal development, stating, “I wanted to surround myself with positive influences and evolve as a person”. Similarly, Interviewee 1 (I.1) noted, “The birth of my daughter was a major factor in my commitment to therapy. My motivations for seeking treatment have been significantly influenced by her presence in my life”. 

• Former substance users 

The majority of former substance users have participated in various addiction treatment programs, and many have successfully navigated the recovery process. Among these, three individuals reported engaging with psychosocial treatment programs, but did not complete them. Interviewee 11 (I.11) provided a favorable assessment of the therapeutic community model, stating, “I view the therapeutic community as a valuable educational tool, provided one is committed and utilizes it effectively. Despite the therapists being volunteers, they embody the community’s philosophy”. Interviewee 11 (I.11) also highlighted personal achievements within the community, noting, “One significant benefit was obtaining my high school diploma. The community facilitated the completion of many goals I had previously set aside”. 

Two individuals achieved substantial progress through the Narcotics Anonymous (NA) self-help model. Interviewee 12 (I.12) praised the program, commenting, “The NA model suited me well. It is one of the most effective programs for maintaining sobriety and fostering personal transformation”. Their participation in NA marked a pivotal shift in their lives, leading both to pursue higher education. Interviewee 7 (I.7) reflected, “Therapy was beneficial as I connected with individuals who had similar experiences, enabling me to discuss my struggles openly. Subsequently, I secured a job and am now studying pharmacy, engaging in various activities”.

These participants developed strong connections with fellow members of NA, which provided a sense of security and support. Interviewee 7 (I.7) noted, “I greatly value the NA program for the supportive network it offers. It is a public and universally accessible resource”. Interviewee 12 (I.12) emphasized her active involvement in NA groups, stating, “I am committed to helping others understand that addiction can manifest in various forms, not just substance use but also other addictive behaviors”. 

Two individuals detoxified using the biomedical model and expressed positive views on substitution treatment. Interviewee 10 (I.10) observed, “The combination of treatment and exercise helped me rediscover myself. I got married and started a family”. Interviewee 8 (I.8) highlighted the personal growth achieved through treatment, noting, “As I continued with the treatment and abstained from other substances, my mind cleared, allowing me to set new goals and develop in new ways”. 

Motivation for treatment was often influenced by significant others. Interviewee 8 (I.8) reflected, “I noticed my family’s frustration; it became clear that a change was necessary”. Similarly, Interviewee 12 (I.12) mentioned the influence of co-treatment participants, stating, “I felt a sense of accountability and embarrassment seeing others make an effort while I was still struggling with alcohol”. 

Additionally, a significant number of former substance users formed lasting relationships with future partners, spouses, and friends through their treatment programs, further contributing to their successful recovery and reintegration. 

This research explores and compares the experiences of current and former substance users in terms of social capital types. The analysis seeks to understand how various aspects of social capital types – including family networks, peer networks, education, employment, social and sports activities, spirituality, and addiction treatment – differently impact and influence the lives of individuals who currently use substances compared to those who have successfully ceased use. By examining these differences, the analysis aims to identify which elements of social capital are most effective in supporting recovery and reducing substance use. 

In the context of the preceding analysis, former substance users generally possess stronger bonding social capital and higher levels of bridging social capital compared to current users. They tend to leverage these types of social capital more effectively by utilizing family support, peer networks, educational pursuits, employment, social activities, spirituality, and treatment programs to sustain their recovery. However, both groups tend to lack linking social capital, which involves connections to institutions or individuals with power and resources that could assist them in their recovery journey. 

Current users often lack or inconsistently experience the support that former users effectively leverage, which hinders their efforts to reduce or cease substance use. This comparison underscores the importance of enhancing social capital across these domains to support individuals in their recovery journey. By strengthening these areas of social capital, both current and former substance users may find better pathways toward sustained recovery and well-being. 

• Bonding social capital 

Family members play a significant role in influencing substance use behaviors among both current and former users [28]. For current users, the family can have a dual impact. On the one hand, some users feel pressure to reduce their substance use due to familial responsibilities such as parenthood and marital relationships, which often leads to a moderation of their substance use [39-41]. On the other hand, others may hide their drug use from family members who are either unaware of their addiction or hold negative attitudes toward it. This concealment is often influenced by family dynamics and can lead to situational breaks from substance use. 

Family networks play a critical role in either preventing or exacerbating addictive behaviors. Some family networks effectively support recovery and prevent addiction [42] while others may be ineffective in promoting recovery. In some cases, family support is partial or even negative, leading to the maintenance of dysfunctional situations without encouraging significant change [14,18]. In the current study, most family members are aware of the addiction issues faced by their relatives, but do not push them toward detoxification. This is often due to the perceived functionality of the current user, such as maintaining a job [43]. This perception contributes to a lack of understanding among current users about the severity of their problem. As a result, the substance users in this study are not receiving adequate support for rehabilitation. 

In contrast, former users consistently cite family networks as critical in supporting their recovery and reducing relapse risk [44]. Many former users receive strong support from their families during treatment and rehabilitation, such as financial assistance or encouragement. Many former users receive strong support from their families during treatment and rehabilitation, such as financial assistance or encouragement [45]. They also emphasize the importance of regaining familial roles lost during addiction as a protective measure against relapse. 

In summary, the realization of family and kinship roles varies significantly between current and former substance users. Current users often receive moderate and partial support, which may not be conducive to meaningful change [46]. However, former users tend to redefine their interactions with family roles, relying on family support to enhance their recovery [47]. This approach helps them build positive bonding social capital, which supports their development and recovery [20,21,23]. One of the key differences between current and former substance users in this study is the role of social relationships and peer networks both during substance use and after recovery. Among the six current users, only one reported receiving encouragement from peer networks to complete their studies. Furthermore, five out of six were involved in peer networks that facilitated their drug use. Only one of the six current users mentioned that they had temporarily stopped using substances due to influence from a romantic partner. 

In contrast, former drug users generally highlight the positive impact of social relationships on their recovery. They argue that, through treatment, their social connections with friends, society, and the formation of new, healthy networks outside of substance use significantly improved [15]. The literature supports these findings, showing that social peer support is associated with lower rates of substance use [48]. Successful recovery is often characterized by reduced exposure to substance use, increased engagement with healthy social networks, and the development of coping skills for maintaining abstinence [33]. For current users, peer networks typically consist of other substance users, which can perpetuate addiction. This social reinforcement of drug use is consistent with Latkin et al. who found that networks of drug users increase the likelihood of continued substance use [49]. Current users often lack encouragement from peers to quit or seek treatment, with only a minority reporting supportive, drug-free social networks. 

In contrast, former users report significant improvements in their peer relationships after recovery. They build new, supportive networks that are crucial for maintaining sobriety. This development aligns with Litt et al. who emphasize the importance of supportive peer relationships in sustaining recovery [50]. Former users often connect with peers in recovery, fostering mutual support and accountability, which are essential for long-term sobriety.

In summary, while current users often face challenges from peer networks that reinforce their substance use, former users benefit from the development of new, healthy social connections that support their recovery and maintain their sobriety. 

• Bridging social capital 

In the present study, half of the current substance users reported being actively involved in the labor market, while the other half were unemployed. Among those who were employed, two out of six mentioned that work had positively influenced their temporary cessation of substance use at some point in their lives. This finding aligns with research indicating that substance use is related to living conditions and access to financial resources or employment. Individuals with limited financial resources may face increased stress, which can lead to harmful health behaviors, including substance use [51]. 

In contrast, among the six former substance users, four were employed, and the remaining two expressed a strong desire to enter the labor market. Those who were working highlighted the positive impact of employment on their post-rehabilitation life and their abstinence from substances. The literature supports this view, suggesting that employment has a beneficial effect on recovery from drug use and is crucial for maintaining sobriety. Employment provides personal stability and fulfillment, which are important even in early recovery stages, where individuals may face strong cravings, family alienation, social isolation, and other relapse risks [52]. For current users, employment serves primarily as a temporary motivator to reduce substance use. However, its effectiveness in preventing substance use is often inconsistent and sporadic. This observation is supported by Henkel who has noted that while employment can serve as a deterrent to substance use, its impact is generally limited without additional support systems [53]. Conversely, for former users, employment plays a critical role in their recovery. It provides a sense of purpose and helps maintain sobriety. This is consistent with findings by Laudet and White who have emphasized that meaningful employment is essential for supporting long-term recovery [54]. Former users are more likely to seek fulfilling job roles and find purpose in their work, which aids in rebuilding trust and contributing positively to society. 

In summary, while employment can act as a temporary motivator for current users, it is a crucial factor for former users in maintaining recovery and preventing relapse. The role of employment in providing stability and purpose is well-documented and critical for supporting both short-term and long-term sobriety. 

Education functions as a form of Bridging Social Capital, which reduces substance use and facilitates social recovery. Research by Koutra et al. demonstrates that educational involvement can offer new social networks and roles, contributing to the rehabilitation process [12]. 

Education plays a varied role in influencing substance use and recovery among substance users. For a small proportion of current users, education has contributed to reducing or even stopping substance use by providing focus and clarity. This finding is supported by research such as that by Merline et al. which indicates that engagement in education can serve as a protective factor against substance use [55]. In contrast, education has a more pronounced impact on former users. Many former drug users have found that participation in educational activities, including national examinations and the acquisition of new roles and networks related to education, significantly aids their social recovery and helps them stop using substances. This is consistent with the SIMOR model of social recovery, which suggests that transitioning from addiction to recovery involves changing social identity, participating in new functional networks, and distancing oneself from old networks associated with substance use [21]. Education provides a second chance and a powerful influence for the future, serving as a critical component of recovery [56]. For current users, education can offer temporary relief from substance use by providing structure and purpose. However, its impact is often less sustained compared to former users. Some current users may pursue education with aspirations influenced by their peers, but this is not always a significant factor in long-term recovery. For former users, education is often a turning point that redefines their goals and provides new social roles. Frenk et al. highlight that educational attainment is linked to better recovery outcomes by fostering personal growth and stability [57]. Education serves as a critical pathway for personal development, helping former users build new social networks, set new life goals, and maintain their sobriety. 

In summary, while education can offer temporary benefits for current users by providing focus, it is especially pivotal for former users. It plays a key role in their recovery by offering new social roles, networks, and perspectives, thus significantly contributing to their rehabilitation and long-term sobriety. 

A significant number of former users participate in neighborhood and sports activities, with some reporting that these activities have helped reduce their substance use. Increased involvement in social and sporting activities has given many addicts new meaning in their lives and contributed positively to their recovery [58]. The literature supports the idea that a strong identification with a social group can enhance the group's influence on an individual's behavior [59]. Engaging in meaningful activities and reconnecting with social networks with reciprocal obligations can be crucial for resisting substance use and achieving successful recovery [32]. For current users, engagement in sports and social activities offers some benefits, though participation tends to be inconsistent. Studies, such as those by Collingwood et al. suggest that while physical activities can promote a healthier lifestyle and reduce substance use, they are often insufficient on their own [60]. In contrast, former users find that participation in sports and social activities plays a crucial role in their recovery. These activities provide new interests and a sense of fulfillment, which aligns with findings from a study of Lisha & Sussman [61]. Structured involvement in activities helps improve self-esteem and social integration, supporting the recovery process by offering a renewed sense of purpose and social connection. 

Overall, participation in social and sports activities benefits both current and former users. For current users, these activities can help mitigate substance use but often in a limited and inconsistent manner. For former users, engaging in such activities is integral to their recovery, offering essential support, new interests, and personal fulfillment. This engagement in activities is a form of Bridging Social Capital that contributes significantly to both reducing substance use and aiding in social recovery. 

There is a notable difference in the role of religion and spirituality between current and former drug users. In the group of current users, only one participant mentioned faith as a higher power. In contrast, three out of six participants in the former ones cited spirituality as a crucial component of their rehabilitation journey. 

Spirituality has been shown to positively influence both physical and mental health and is instrumental in achieving and maintaining abstinence from substance use [62,63]. For current users, religion generally has minimal impact on their substance use, although some develop personal spiritual beliefs as a coping mechanism. De Li et al., observed that the impact of spirituality varies based on individual beliefs, with some current users finding personal spirituality helpful despite its limited influence on their overall substance use [64]. In contrast, for former users, spiritual practices such as meditation and prayer play a significant role in their recovery. Research by Kelly et al. highlights that spiritual engagement can significantly aid in maintaining sobriety, providing essential support and coping tools during recovery [33]. 

Overall, while spirituality may have a limited role for current users, it serves as a vital support mechanism for many former users, contributing significantly to their recovery and maintenance of abstinence.               

The participation in addiction treatment varies significantly between current and former drug users. Among the current users, only two out of six have engaged in any form of treatment. This low rate is largely attributed to their perceptions of substance use and its severity. Recent trends indicate a decreasing perception of danger associated with substances like cannabis, partly due to more favorable legislation and increased availability [65]. For these two participants, one was motivated to seek treatment by family support, while the other was driven by a desire for personal development. Both participants are involved in a biomedical treatment program, although one previously had positive experiences with a psychosocial program. 

Pharmacological approaches often focus on reducing or stopping illicit substance use rather than achieving complete abstinence [66]. In contrast, five out of six former users have participated in some form of addiction treatment. For these individuals, family support, classified as Bonding Social Capital, was the primary motivation for seeking treatment. This support also played a crucial role in completing the treatment programs, with one participant specifically noting that support from co-treatment partners was instrumental in her success. 

The effectiveness of treatment can vary. Three of the rehabilitated participants were referred to psychosocial programs, but were unable to complete them. This highlights the need for person-centered approaches in psychosocial treatment programs to address the diverse needs of substance users [67]. One participant spoke positively about the therapeutic community, noting its role in achieving personal goals. Therapeutic communities are a key tool in the psychosocial model, particularly beneficial for chronic users with severe psychosocial problems [66,67]. The remaining two former users underwent detoxification through biomedical programs. They found these programs helpful for stabilization but noted deficiencies in psychosocial support. Post-rehabilitation, these individuals experienced new life perspectives, such as starting a family and pursuing higher education. Additionally, two former users benefitted from self-help programs, like Narcotics Anonymous (NA), which they found transformative and well suited to their needs. Self-help groups play a critical role not only in halting substance abuse but also in improving overall functioning [68]. Participation in NA facilitated the formation of positive relationships and a sense of safety. 

In summary, current users often do not seek treatment due to a lack of perceived severity and awareness of available options. Conversely, former users generally have more positive experiences with treatment programs, including psychosocial and self-help models, which play a significant role in their recovery and reintegration. The effectiveness of these treatments underscores the importance of individualized and person-centered care to enhance service quality and recovery outcomes [69,70].

The research highlights several significant restrictions that need to be recognized. Initially, the sample size was quite small, potentially restricting the findings' applicability. The diverse range of substances used in the sample makes it harder to generalize across various substance use situations. This variability could influence the reliability and consistency of the outcomes, which could consequently impact the strength of the conclusions made. 

Also, the interviews took place during the lockdown of the SARS-CoV-2 pandemic, which limited the researchers' access to a varied and inclusive sample. The study's reach may have been affected by the pandemic's restrictions, potentially leading to biases in participant timing and accessibility. This limitation could have impacted the thoroughness and diversity of the collected data. 

Moreover, the research did not involve any follow-up interviews, thus restricting the capacity to authenticate and validate the reliability and consistency of the data shared by the respondents. The lack of longitudinal data hinders the evaluation of changes over time and the confirmation of initial results. 

Improving these constraints in future research could boost the study's credibility and accuracy. Expanding the number of samples, ensuring increased participant diversity, and including follow-up interviews would lead to a more thorough and strong examination of social capital in relation to substance use and recovery.

In summary, the study reveals significant differences in how social capital influences substance use and recovery between current and former drug users. Bonding Social Capital plays a crucial role in the recovery process. Former users often have stronger and higher-quality bonding social capital, primarily through family support, which helps them achieve and sustain positive change. They benefit from enhanced social connections that aid their recovery and reintegration into society. In contrast, current users generally have less effective bonding social capital, which limits their ability to achieve substantial improvements in their substance use behaviors. During rehabilitation, former users develop Bridging Social Capital by engaging in education, work, and healthy social networks – areas where current users often fall short due to their lack of treatment-seeking behavior. This new engagement provides former users with supportive social networks and opportunities for personal growth, contributing significantly to their recovery. Both groups, however, lack Linking Social Capital, which could facilitate connections with broader societal institutions and resources. 

The findings highlight that greater participation in positive support systems and social networks enhances the potential for recovery and sustained abstinence from substance use. This underscores the importance of integrating social and recovery capital into addiction treatment programs. Professionals should focus on holistic approaches, incorporating person-centered care that addresses the unique needs of each individual. 

In the realm of social work education, several critical priorities should be emphasized to enhance the effectiveness of addiction treatment programs. Primarily, it is important to focus on strengthening bonding social capital by bolstering family and peer support systems. This strategy aims to assist current substance users in developing robust social networks that facilitate and sustain recovery. Equally important is the promotion of bridging social capital. This involves fostering involvement in educational pursuits, employment, and social activities to create new and constructive networks. Such networks are beneficial for both current and former use toward providing access to additional resources and support. Moreover, integrating person-centered approaches into treatment programs is crucial. This entails customizing interventions to meet the distinct needs of individuals, considering their social, economic, and personal contexts. Adopting a holistic approach is also essential; incorporating elements such as spirituality, social engagement, and participation in self-help groups can offer comprehensive support that addresses multiple facets of recovery. Finally, enhancing awareness and improving accessibility to diverse treatment options are necessary steps. By clearly communicating the benefits and availability of various treatment options, individuals are more likely to seek and engage with the support they need. Prioritizing these aspects will help addiction treatment programs more effectively support individuals in their recovery journey and assist them in developing the social capital essential for long-term abstinence and successful reintegration into society.

This publication is financed by the Project "Strengthening and optimizing the operation of MODY services and academic and research units of the Hellenic Mediterranean University", funded by the Public Investment Program of the Greek Ministry of Education and Religious Affairs.

Funding: The study received no external funding 

Conflict of interest: The authors declare no conflicts of interest 

Ethical approval: Ethical approval obtained from Ethics Committee of the Department of Social Work of the Hellenic Mediterranean University on 23/2/2020. Participants were thoroughly briefed about the study and gave their informed consent by signing a participation agreement. All procedures complied with the relevant ethical standards

1. Volkow ND, Poznyak V, Saxena S, Gerra G, UNODCWHO Informal International Scientific Network (2017) Drug use disorders: impact of apublic health rather than a criminal justice approach. World Psychiatry 16: 213-214.
2. Shafiee SA, Razaghi EM, Vadadhir A (2019) Multi-Level Approach to Theories of Addiction: A Critical Review. Iranian Journal of Psychiatry and Behavioral Sciences 13: 1-12.
3. Merleaux A (2020) Drugs, Empire and U.S. Foreign Policy. In: CR Dietrich (eds.) A Companion to U.S. Foreign Relations: Colonial Era to the Present, John Wiley & Sons, Inc.
4. Dailey SL, Howard K, Roming SM, Ceballos N, Grimes T (2020) A biopsychosocial approach to understanding social media addiction. Human Behavior and Emerging Technologies 2: 158-167.
5. Pickard H (2021) Addiction and the self. NOÛS 55: 737-761.
6. Lewczuk K, Nowakowska I, Lewandowska K, Potenza MN, Gola M (2021) Frequency of use, moral incongruence and religiosity and their relationships with self-perceived addiction to pornography, internet use, social networking and online gaming. Addiction 116: 889-899.
7. Klein RJ, Gyorda JA, Jacobson NC (2022) Anxiety, depression, and substance experimentation in childhood. PLOS ONE 17.
8. Poudel A, Sharma C, Gautam S, Poudel A (2016) Psychosocial problems among individuals with substance use disorders in drug rehabilitation centers, Nepal. Substance Abuse Treatment, Prevention, and Policy 11.
9. Kimball TG, Shumway ST, Bradshaw SD, Soloski KL (2020) A Systemic Understanding of Addiction Formation and the Recovery Process. In: KS Wampler, M Rastogi, R Singh (eds.) The Handbook of Systemic Family Therapy, John Wiley & Sons Ltd.
10. Mawson E, Best D, Lubman DI (2016) Associations between social identity diversity, compatibility, and recovery capital amongst young people in substance use treatment. Addictive Behaviors Reports 15: 70-77.
11. Boeri M, Gardner M, Gerken E, Ross M, Wheeler J (2016) I Don’t Know What Fun Is: Examining the Intersection of Social Capital, Social Networks, and Social Recovery. Drugs Alcohol Today 16: 95-105.
12. Putnam RD (1993) The Prosperous Community: Social Capital and Public Life. The American Prospect 4: 35-42.
13. Best D, Sondhi A, Hoffman L, Best J, Leidi A, et al. (2024) Bridging the gap: building and sustaining recovery capital in the transition from prison to recovery residences. Journal of Offender Rehabilitation 63: 21-36.
14. Koutra K, Papadovassilaki K, Kalpoutzaki P, Kargatzi M, Roumeliotaki T, et al. (2012) Adolescent drinking, academic achievement and leisure time use by secondary education students in a rural area of Crete. Health & Social Care in the Community 20: 61-69.
15. Koutra K, Kritsotakis G, Orfanos P, Ratsika N, Kokkevi A, et al. (2014) Social capital and regular alcohol use and binge drinking in adolescence: A cross-sectional study in Greece. Drugs: Education, Prevention and Policy 21: 299-309.
16. Koutra K, Kritsotakis G, Linardakis M, Ratsika N, Kokkevi A, et al. (2017) Social Capital, Perceived Economic Affluence, and Smoking During Adolescence: A Cross-Sectional Study. Substance Use & Misuse 52: 240-250.
17. Bourdieu P, Wacquant LJ (1992) An Invitation to Reflexive Sociology, Polity Press, Cambridge.
18. Putnam RD (2001) Bowling Alone: The Collapse and Revival of American Community. Simon & Schuster, New York.
19. Kabayama M, Watanabe C, Ryuno H, Kamide K (2017) Positive and negative associations of individual social capital factors with health among community-dwelling older people. Geriatrics & Gerontology International 17: 2427-2434.
20. Glaeser S (2016) The Irony of Social Trust: Individual-level and Contextual-level Links with Protest Intention and Radical Right Support in Switzerland. Journal of Community & Applied Social Psychology 26: 110-124.
21. Hennessy EA (2017) Recovery capital: a systematic review of the literature. Addiction Research & Theory 25: 349-360.
22. Best D, Beckwith M, Haslam C, Haslam A, Jetten J, et al. (2015) Overcoming alcohol and other drug addiction as a process of social identity transition: the social identity model of recovery (SIMOR). Addiction Research & Theory 24: 111-123.
23. Neale J, Stevenson C (2015) Social and recovery capital amongst homeless hostel residents who use drugs and alcohol. International Journal of Drug Policy 26: 475-483.
24. Granfield R, Cloud W (2001) Social context and "natural recovery": the role of social capital in the resolution of drug-associated problems. Substance Use & Misuse 36: 1543-1570.
25. Irish A, Bowen EA, Hawthorne AN, Palombi L (2020) “Me, the street, and a backpack”: employment, income, and physical capital in rural recovery. Journal of Social Work Practice in the Addictions 20: 194-207.
26. Croff JM, Hartwell ML, Chiaf A, Crockett EK, Washburn IJ (2021) Feasibility and reliability of continuously monitoring alcohol use among female adolescents and young adults. Drug and Alcohol Review 40: 1143-1154.
27. Cornell D, Huang F (2016) Authoritative school climate and high school student risk behavior: A cross-sectional multi-level analysis of student self-reports. Journal of Youth and Adolescence 45: 2246-2259. 
28. Emmering SA, Astroth KS, Woith WM, Dyck MJ, Kim M (2018) Social capital, health, health behavior, and utilization of healthcare services among older adults: A conceptual framework. Nursing Forum 53: 416-424.
29. Parcel TL, Bixby MS (2015) The Ties That Bind: Social Capital, Families, and Children's Well-Being. Child Development Perspectives 10: 87-92.
30. Sánchez-Prieto L, Orte C, Ballester L, Amer J (2020) Can better parenting be achieved through short prevention programs? The challenge of universal prevention through Strengthening Families Program 11–14. Child & Family Social Work 25: 515-525.
31. O'Neil M, Broca S (2020) Peer Production and Social Change. In: M O'Neil, C Pentzold, S Toupin (eds.) The Handbook of Peer Production, John Wiley & Sons, Inc.
32. Wen M (2017) Social Capital and Adolescent Substance Use: The Role of Family, School, and Neighborhood Contexts. Journal of Research on Adolescence 27: 362-378.
33. Pettersen H, Landheim A, Skeie I, Biong S, Brodahl M, et al. (2019) How Social Relationships Influence Substance Use Disorder Recovery: A Collaborative Narrative Study. Substance Abuse: Research and Treatment 13: 1-8.
34. Kelly JF, Stout RL, Green MC, Slaymaker V (2014) Young adults, social networks, and addiction recovery: post treatment changes in social ties and their role as a mediator of 12-step participation. PLOS ONE 19.
35. Schess J, Kumar S, Velleman R, Adhvaryu A, Nadkarni A (2020) ‘He was trapped in his own web’-Dependent drinking as a poverty trap: A qualitative study from Goa, India. Drug and Alcohol Review 39: 713-720.
36. Boeri M, Gibson D, Boshears P (2014) Conceptualizing Social Recovery: Recovery Routes of Methamphetamine Users. The Journal of Qualitative Criminal Justice and Criminology 2: 5-38.
37. American Psychiatric Association (2022) Diagnostic and statistical manual of mental disorders (Fifth Edition, Text Revision eds).
38. Wild D, Grove A, Martin M, Eremenco S, McElroy S, et al. (2005) Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: Report of the ISPOR Task Force for Translation and Cultural Adaptation. Value in Health 8: 94-104.
39. Braun V, Clarke V, Weate P (2016) Using thematic analysis in sport and exercise research. In: B Smith, AC Sparkes, Routledge handbook of qualitative research in sport and exercise. Taylor & Francis (Routledge), London.
40. Zhang SY, Demant J (2021) Effects of self-control, drug-use peers and family attachment on drug use among Chinese users: A gender-specific analysis. Drug and Alcohol Review 40: 1369-1376.
41. Gaspari A (2016) Inheriting Your Mother's Eyes, Hair, and Drug Addiction: Protecting the Drug-Exposed Newborn By Criminalizing Pregnant Drug USE. Family Court Review 54: 96-111.
42. Guttmannova K, Hill KG, Bailey JA, Hartigan L, Small CM, et al. (2017) Parental Alcohol Use, Parenting, and Child On-Time Development. Infant and Child Development 26.
43. Cristini F, Scacchi L, Perkins DD, Bless KD, Vieno A (2015) Drug use among immigrant and non-immigrant adolescents: Immigrant paradox, family and peer influences. Journal of Community & Applied Social Psychology 25: 531-548.
44. Castaldelli-Maia JM, Nicastri S, Cerdá M, Kim JH, De Oliveira LG (2018) In-transition culture of experimentation with cannabis in Latin American college students: A new role within a potential drug use sequencing pattern. Drug and Alcohol Review 37: 273-281.
45. Buu A, Dipiazza C, Wang J, Puttler LI, Fitzgerald HE, et al. (2009) Parent, family, and neighborhood effects on the development of child substance use and other psychopathology from preschool to the start of adulthood. Journal of Studies on Alcohol and Drugs 70: 489-498.
46. McCrady BS, Epstein EE, Sell RD (2003) Theoretical bases of family approaches to substance abuse treatment. In: F Rotgers, DS Keller, J Morgenstern (eds.) Treating Substance Abuse: Theory and Technique (2 ed). The Guilford Press.
47. Tajalli F, Zarnaghash M (2017) Effect of Family Communication Patterns on Internet Addiction. Practice in Clinical Psychology 5: 159-166.
48. Gunn A, Samuels GM (2018) Promoting Recovery Identities Among Mothers with Histories of Addiction: Strategies of Family Engagement. Family Process 59: 94-110.
49. Dudovitz RN, Chung PJ, Wong MD (2017) Teachers and Coaches in Adolescent Social Networks Are Associated With Healthier Self-Concept and Decreased Substance Use. Journal of School Health 87: 12-20.
50. Latkin C, Edwards C, Davey-Rothwell MA, Tobin KE (2017) The relationship between social desirability bias and self-reports of health, substance use, and social network factors among urban substance users in Baltimore, Maryland. Addictive Behaviors 73: 133-136.
51. Litt MD, Kadden RM, Kabela-Cormier E, Petry NM (2009) Changing Network Support for Drinking: Network Support Project Two-Year Follow-up. Journal of Consulting and Clinical Psychology 77: 229-242.
52. Teixidó-Compañó E (2018) Differences between men and women in substance use: the role of educational level and employment status. Gaceta Sanitaria 32: 41-47.
53. Walton MT, Hall MT (2016) The Effects of Employment Interventions on Addiction Treatment Outcomes: A Review of the Literature. Journal of Social Work Practice in the Addictions 16: 358-384.
54. Henkel D (2011) Unemployment and substance use: a review of the literature (1990-2010). Current Drug Abuse Reviews 4: 4-27.
55. Laudet AB, White W (2010) What are your priorities right now? Identifying service needs across recovery stages to inform service development. Journal of Substance Abuse Treatment 38: 51-59.
56. Merline A, Jager J, Schulenberg JE (2008) Adolescent Risk Factors for Adult Alcohol Use and Abuse: Stability and Change of Predictive Value across Early and Middle Adulthood. Addiction 103: 84-99.
57. Rosenthal PJ, Buckalew-Hedin J (2021) College Student Recovery and Identity Development. New Directions for Student Services 2020: 63-72.
58. Frenk SM, Gu Q, Bohm MK (2019) Prevalence of Prescription Opioid Analgesic Use Among Adults: United States, 2013-2016. National Center for Health Statistics, National Health and Nutrition Examination Survey.
59. Koutra K, Roy AW, Kokaliari ED (2020) The effect of social capital on non-suicidal self-injury and suicidal behaviors among college students in Greece during the current economic crisis. International Social Work 63: 100-112.
60. Jetten J, Haslam C, Haslam SA, Dingle G, Jones JM (2014) How Groups Affect Our Health and Well-Being: The Path from Theory to Policy. Social Issues and Policy Review 8: 103-130.
61. Kumar H, Manoli AE, Hodgkinson IR, Downward P (2018) Sport participation: From policy, through facilities, to users’ health, well-being, and social capital. Sport Management Review 21: 549-562.
62. Lisha NE, Sussman S (2010) Relationship of high school and college sports participation with alcohol, tobacco, and illicit drug use: A review. Addict Behaviour 35: 399-407.
63. Oliveira AL, Feitosa CD, dos Santos AG, Lima L (2017) Spirituality and religiosity in the context of drug abuse. Rev Rene 18: 283-290.
64. Temme LJ, Kopak AM (2016) Maximizing recovery through the promotion of mindfulness and spirituality. Journal of Religion & Spirituality in Social Work: Social Thought 35: 41-56.
65. De Li S, Lu J, Chen Y (2022) The Relationship between Christian Religiosity and Adolescent Substance Use in China. International Journal of Environmental Research and Public Health 19.
66. Choi NG, DiNitto DM, Marti CN (2018) Older marijuana users’ marijuana risk perceptions: associations with marijuana use patterns and marijuana and other substance use disorders. International Psychogeriatrics 30: 1311-1322.
67. De Leon G, Perfas FΒ, Joseph A, Bunt G (2015) Therapeutic Communities for Addictions: Essential Elements, Cultural, and Current Issues. In: N el-Guebaly, G Carrà, M Galanter (eds.), Textbook of Addiction Treatment: International Perspectives, Springer, Milano.
68. Fernández-Calderón D, Fernández F, Ruiz-Curado S, Verdejo-García A, Lozano ÓM (2015) Profiles of substance use disorders in patients of therapeutic communities: link to social, medical and psychiatric characteristics. Drug and Alcohol Dependence 149: 31-39.
69. DeLucia C, Bergman BG, Formoso D, Weinberg LB (2015) Recovery in Narcotics Anonymous from the Perspectives of Long-Term Members: A Qualitative Study. Journal of Groups in Addiction & Recovery 10: 3-22.
70. Marchand K, Beaumont S, Westfall J, MacDonald S, Harrison S, et al. (2019) Conceptualizing patient-centered care for substance use disorder treatment: findings from a systematic scoping review. Substance Abuse Treatment, Prevention, and Policy 14.