title: Understanding How People with Mental Health Difficulties Experience Substance Use.
abstract: BACKGROUND
  Quantitative studies dominate research exploring reasons for substance use and experiences of substance use by people with mental health difficulties. This limits the depth of understanding which can be gained about these experiences.
  
  
  OBJECTIVE
  In the present article, we synthesized current qualitative research in this area to provide enhanced theoretical knowledge of these experiences.
  
  
  METHODS
  Following a systematic literature search, we identified 12 studies which explored how people with mental health difficulties experienced using substances, and which met additional inclusion criterion. We used Noblit and Hare's metaethnographic approach to qualitatively synthesize these studies.
  
  
  RESULTS
  Synthesis led to the development of two themes; "substance use mediates acceptance and social inclusion" and "substance use provides perceived opportunities for control and power."
  
  
  CONCLUSIONS
  The findings suggest that in the studies reviewed people's motivation for substance use was embedded in social and psychological contexts. It indicated that substance use could provide perceived benefits such as mediating the impact of mental health stigma, enabling the development of alternative identities, increasing their sense of power and providing opportunities for social inclusion. Mental health and substance use workers should therefore aim to develop alternative opportunities for people with co-occurring disorders to gain such benefits, and seek to challenge mental health stigma.
authors.affiliation: a Division of Health Research, Lancaster University , Lancaster , United Kingdom.
authors.forename: Emma
authors.initials: E
authors.lastname: Chorlton
authors.forename: Ian C
authors.initials: IC
authors.lastname: Smith
mesh_terms: D055030:Drug Users / Q000523:psychology*; D006801:Humans; D001523:Mental Disorders / Q000150:complications* / Q000523:psychology*; D009042:Motivation; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology
keywords: Substance use; mental health; metaethnography; metasynthesis; service user experiences