Year

2016

Degree Name

Doctor of Philosophy (Clinical Psychology)

Department

School of Psychology

Abstract

Comprehensively capturing the social, emotional and psychological wellbeing of individuals with substance use disorders is important to accurately represent the experience of recovery beyond just abstinence from alcohol and other drugs. Complete mental health is considered the presence of emotional wellbeing in conjunction with high levels of social and psychological functioning. This thesis aimed to investigate complete mental health in individuals seeking treatment for alcohol and drug misuse, and the social capital variables which contribute to improved mental health. Three empirical studies investigated the relationship between complete mental health, civic and social engagement in the context of entry to, and discharge from, residential substance abuse treatment provided by The Australian Salvation Army.

Study 1 described the levels and rates of mental health for 794 individuals (79.5% male) at entry to treatment, and 3- and 12-month post-discharge follow-ups. Results indicated at entry to treatment there were higher rates of languishing compared to population estimates, yet greater rates of flourishing at all time points compared to community normative data. Mental health was rated significantly higher by individuals who were abstinent than those that had used substances at 3-month post-discharge follow-up. Additionally, results suggested that improved mental health was a consequence of reduced severity of alcohol and other drug abuse, and followed reductions in cravings.

Study 2 investigated the association between community participation and mental health for 1815 individuals (70% male) at entry to residential treatment. Results indicated that despite participants having lower levels of community participation compared to Australian community population norms, those participants who were experiencing flourishing mental health had higher rates of community participation than Australian norms. Keeping in touch with friends and family was the most common form of community participation. Informal xi social connectedness and civic engagement were the strongest predictors of mental health over and above more traditional substance use outcomes such as cravings.

Study 3 assessed the longitudinal connections between social networks, substance use and complete mental health. Participants comprised the same 1815 participants from Study 2 at entry to treatment but expanded on this by focusing on 188 participants (71% male) who had provided complete responses to a 3-month post-discharge follow-up interview. Results indicated that changes in general support provided from friends and informal social connectedness were the strongest social predictors of mental health at 3-month follow-up. Mediation analyses indicated change in friends' support for abstinence had no effect on mental health while change in general social support had a direct effect on mental health. Only the relationship between change in informal social connectedness and mental health was partially mediated by alcohol use severity.

Together the empirical studies provide a unique insight into how complete mental health relates to social capital variables and recovery from substance misuse. While informal social connectedness and general support from friends were most strongly related to mental health, there is a need for further research that has longer longitudinal follow-up durations. Additionally, identifying population norms for Australian complete mental health prevalence would help contextualise findings for participants seeking treatment for addictions. A discussion of the clinical and policy implications of this research is included, with a particular focus on how the findings can inform person-centred approaches to treatment.

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