Background: Substance use disorders (SUDs) are an increasing public health concern in low- and middle-income countries, where treatment services often encounter individuals with heterogeneous and complex substance use that challenge treatment approaches organized around single substances. Empirical evidence describing such patterns among treatment-seeking populations in sub-Saharan Africa remains limited. This study identified distinct substance use patterns among individuals seeking SUD treatment in Uganda and examined their correlates. Methods: We conducted a cross-sectional analysis of baseline data from a longitudinal cohort of 445 individuals seeking SUD treatment at three treatment facilities in Uganda. Latent Class Analysis (LCA) identified distinct substance use patterns based on self-reported psychoactive substance use. Model fit was assessed using information criteria, entropy, and posterior classification probabilities. Multinomial regression was used to examine associations between participant characteristics and latent class membership, with the alcohol-dominant class as the reference group. Ridge-penalized regression was conducted as a sensitivity analysis. Results: A four-class model best characterized substance use patterns in the sample. The alcohol-dominant class (51.3%) was characterized by older age, rural residence, and formal employment. The cannabis–alcohol class (29.4%) comprised predominantly younger adults with housing instability, unemployment, urban residence, and elevated acute psychosis risk. The prescription drug class (10.8%) was marked by legal opioid, sedative-hypnotic, and anticholinergic misuse with strong association with injection drug use and acute psychosis risk. The high-risk illicit class (8.5%) showed near-universal illegal opioid (88.8%) and cocaine/crack cocaine (89.1%) use with the strongest association with injection drug use. Conclusion: Individuals seeking treatment for SUD in Uganda present with four clinically distinct patterns of substance use that differ substantially in severity, clinical complexity, psychosocial adversity, and broader structural vulnerabilities. These findings challenge the single-substance framing of existing treatment services and provide an empirical basis for differentiated, person-centred care including integrated mental health support, harm reduction and context-specific treatment approaches for high risk groups in Uganda and resource-limited settings.

This prospective multicenter cohort study examined changes in patient-reported outcome measures (PROMs) among 161 men and women entering residential substance use disorder (SUD) treatment in Belgium and explored how treatment setting and sociodemographic factors influence outcomes. PROMs were assessed at baseline and after 45, 90, and 180 days using the PROMIS-GH (general health), WHOQoL-BREF (quality of life), and SURE-NL (recovery). Linear mixed models showed significant improvements in mental and physical health, and in all quality of life (QoL) domains except for social relationships. Psychological and physical health improvements plateaued, while perceived QoL and environmental domains improved linearly. Males scored higher in psychological health whereas treatment modalities differed in psychological health and social relationships. Recovery scores remained consistently high, possibly due to ceiling effects, underscoring the importance of the timing and context of PROM assessment. Integrating PROMs into routine care has the potential to support patient-centered practices and enhance treatment outcomes in SUD services.

Background: People with intellectual disability (ID) are at increased risk of tobacco use, yet their perspectives and those of their families and professionals are understudied. Method: This qualitative study explored experiences and views on smoking among 12 adults with ID who smoke, 9 family members, and 11 support professionals from day services. Semi-structured interviews were analysed using an Interpretative Phenomenological Analysis. Four themes emerged: initiation of smoking, reasons for smoking, addressing tobacco use, and facilitators and barriers to cessation. Smoking typically began in adolescence through social influence, became part of daily routines, was managed through permissive support practices, and was hindered by limited cessation awareness. Results: Tensions arose between autonomy, smoking behaviours, and cessation approaches. Despite awareness of health risks, participants showed limited knowledge of psychological cessation aids and lacked sufficient support to quit. Conclusions: Effective cessation interventions should be evidence-based, rights-oriented, and person-centred, addressing both individual motivations and contextual influences. Adults with intellectual disability (ID) often start smoking during adolescence, influenced by peers and social norms. Smoking becomes part of daily routines, provides social belonging, and serves to express autonomy and self-determination, highlighting the complex social and emotional functions of tobacco use. Support providers in day services balance autonomy with safety, often normalizing smoking within routines. Limited knowledge of cessation tools and interventions hinders quitting, while social support emerges as a key facilitator, underscoring the need for tailored, evidence-based strategies that integrate both individual and contextual factors. Including lived experiences of people with ID in tobacco research is crucial for designing effective tailored, evidence- and rights-based interventions that promote informed, healthy choices within a person-centred approach considering context and support networks.

Service collaboration ensures care continuity and recovery-oriented care for individuals with mental disorders (MD). A recovery-oriented system of care (ROSC) encompasses diverse person-centred services that collaborate to address individual needs and foster social integration. We examined the characteristics of care provision for individuals with MD in Belgium with regard to ROSC principles. Specifically, we analysed the structure of collaboration within existing mental health service networks, focusing on the division between mental health services and specialised services for substance use disorders (SUD). We conducted an online survey involving 309 services across five networks, of which 190 participated. We collected data on referrals and service characteristics. We used Social Network Analysis (SNA) to assess collaboration patterns within service networks, considering network density (i.e. number of ties), transitivity (i.e. tendency toward clustered collaboration), degree distribution (i.e. concentration of ties around certain services), service attributes (e.g. category, care function, and exclusion criteria), and homophily (i.e. tendency to connect with similar services). Exponential Random Graph Model (ERGM) was used to test whether observed collaboration patterns differed from random collaboration. Hospital units and specialised SUD services were central services. Specialised SUD services and generic mental health services were more likely to collaborate with similar services. Likewise, services with the same care function were more likely to collaborate, except hospital units. Networks showed significant transitivity. Mental health service networks appear to be structured around organisational boundaries, with limited collaboration between complementary services and a highly hospital-centred configuration. These patterns suggest a misalignment with ROSC principles and may constrain the capacity of care systems to support recovery processes.

Background:Perinatal substance use is a growing global health concern with significant risks for maternal health, child development, and parenting. Despite these risks, the perinatal period offers a "window of opportunity" for behavioral change and recovery initiation. However, research exploring how vulnerability and transformation interact in the context of perinatal substance use remains scarce. Existing studies are predominantly cross-sectional, deficit-oriented, and focused on relapse or the medical effects of prenatal exposure, leaving critical gaps in understanding maternal trajectories and psychosocial factors shaping the transition to parenthood. Objective:The PIPPA (Perinatal Insights into Parenting, Pathways, and Addiction) study identifies the maternal, psychosocial, and contextual factors associated with whether the perinatal period becomes a promising or challenging transition to parenthood for women with substance use problems. Specific outcomes include trajectories of maternal mental health, recovery capital, substance use patterns, mother-child relationship quality, parental stress, and contextual conditions, as well as custody and cohabitation outcomes. An important focus is how these factors shape short- and long-term maternal and child trajectories. Methods:PIPPA is a longitudinal, prospective, multicenter, mixed methods study in Flanders, Belgium (May 2025-November 2026). Fifty pregnant and parenting women with alcohol and/or other substance use problems are recruited through obstetric departments, general substance use services, specialized substance use services, child protection services, and social media. Participants are assessed at 2-3 points: during pregnancy, 2-6 weeks postpartum, and 6 months postpartum. Data are collected using validated questionnaires (Alcohol Use Disorder Identification Test-Consumption, Drug Use Disorder Identification Test-Consumption, Edinburgh Postnatal Depression Scale, Satisfaction with Life Scale, Brief Assessment of Recovery Capital-10, Maternal Antenatal Attachment Scale, Maternal Postnatal Attachment Scale, and Parental Stress Scale) and custom instruments. Qualitative data include Three-Minute and Five-Minute Speech Sample tasks to assess maternal representations and expressed emotion, and semistructured interviews with pregnant and parenting women and caregivers. Quantitative analyses will include descriptive, longitudinal, subgroup, and regression models, while qualitative analyses will include longitudinal thematic analysis and structured coding of expressed emotion. All data are managed in REDCap (Research Electronic Data Capture). Results:Recruitment began in May 2025 and is expected to be complete in November 2026. Data collection began in June 2025. As of April 2026, 13 participants have been recruited. Data analysis will be performed after data collection. The results are expected to be published by the end of 2027. Conclusions:This study will contribute to a more strengths-based and evidence-informed understanding of the transition to motherhood in the context of perinatal substance use. The PIPPA study will capture diverse experiences and the complex interplay among substance use, recovery, and early parenting. These insights will inform and strengthen integrated, responsive early interventions to support pregnant and parenting women with substance use problems and promote child well-being.

Most suicides happen following maladaptive coping among suicide survivors; however, coping mechanisms adopted by refugee suicide survivors, especially in Uganda, have hardly been studied. This study assessed the coping mechanisms adopted following suicide attempts among refugees in humanitarian settings in Northern Uganda. A concurrent mixed-methods design was used to study adult refugee-suicide survivors of South Sudanese origin. They were consecutively sampled across four settlements and engaged in structured, in-depth interviews. Data were analyzed in SPSS version 25 using descriptive statistics, while qualitative data were analyzed thematically. Fewer than a quarter (17%) of suicide attempts were coped with adaptively. Most refugees coped emotionally by rarely accepting sympathy and understanding (37.5%), frequently trying to keep their feelings to themselves (50.0%), self-blame (50.0%), self-isolation (62.5%), making a plan to act (37.5%), bursting out in anger and other emotions (75.0%), and having fantasies or wishes about how things might turn out (62.5%). These coping mechanisms were congruent with those identified in the qualitative exploration. Refugees in Northern Uganda with a history of suicide attempts maladaptively cope with that history, implying that they could be at high risk of repeated suicide attempts and potentially suicide, based on evidence shown in previous studies.

Substance Use Disorder (SUD) treatment in sub-Saharan Africa remains poorly understood from the perspectives of those who deliver and receive it. We integrated the perspectives of service users (SUs) and front-line health care workers (HCWs) within a single analytic frame to map SUD treatment trajectories and identify multilevel barriers and facilitators shaping treatment and recovery outcomes in Uganda. We conducted a qualitative study nested within a parent cohort of adults treated for SUDs at two public treatment facilities in Uganda. We conducted in-depth interviews with 43 SUs from this cohort and 10 HCWs directly involved in SUD care. We analysed the data using reflexive thematic analysis. SU and HCW data accounts were first analysed separately before applying integrative mapping to generate cross-cutting meta-themes. We identified four interrelated meta-themes. First, systemic and structural constraints, including human resource gaps, medication stockouts, and inadequate infrastructure, undermined care consistency and quality. Second, accounts suggested that SUD care was only partially aligned with the biopsychosocial model, with acute biomedical stabilisation more consistently implemented than psychosocial support, individualised care, and recovery planning. Third, participants described returning to high-risk post-treatment environments marked by stigma, weak family support, peer and environmental triggers, economic insecurity, and untreated comorbidities, which increased perceived relapse vulnerability. Fourth, they identified supportive anchors for recovery, including faith and spirituality, active coping, family and community engagement, peer mentorship, task-sharing, and strengthened multidisciplinary care. Participants’ accounts indicate that SUD care and recovery in Uganda are shaped by a self-reinforcing cycle of system constraints, fragmented care, and high-risk post-discharge environments. Reorienting SUD care towards a recovery-oriented continuum will require stronger links between facility-based treatment and community support, alongside investment in psychosocial care, workforce capacity, service infrastructure, and locally available recovery resources.

While harm reduction has become increasingly embedded in urban drug policy across Europe, its local implementation remains a site of tension and controversy. Despite being backed by strong public health evidence, harm reduction services (e.g., drug consumption rooms, opioid agonist treatment centers) intersect with contested urban dynamics and diverging stakeholder expectations. This study explores how harm reduction services are perceived within the socio-spatial fabric of four cities in Belgium: Brussels, Li & egrave;ge, Ghent, and Antwerp. Twelve focus group discussions were conducted with local residents, social and healthcare professionals, and local authorities (n = 95 participants). Data were thematically analyzed, with attention to how harm reduction is framed in relation to care, safety, and urban governance. Three intersecting themes emerged. First, services were seen as essential infrastructures of care for people who use drugs in highly precarious situations. Second, they also provoked socio-spatial tensions around perceptions of nuisance, neighborhood livability, and the appropriate place of such services in the city. These tensions were shaped by differing stakeholder narratives, emphasizing public safety, health, or human rights. Third, participants underlined the need for cross-sector collaboration and more inclusive community engagement in decision-making. Overall, harm reduction services operate at the intersection of care, control, and contested urban belonging. Moving beyond binary notions of support or resistance, this study points to the importance of context-sensitive strategies that embed harm reduction within broader urban policy, social investment, and participatory governance.

IntroductionThe perinatal period is widely recognized as a time of profound transition and heightened vulnerability, particularly for women with substance use disorders (SUD). Adopting a strengths-based perspective, this qualitative study aims to explore how professionals across healthcare, child welfare, substance use, and child protection services in Belgium perceive this period as a window of opportunity for change in women with SUD.MethodSemi-structured interviews were conducted with 43 professionals, and thematic analysis identified key themes related to barriers, opportunities, and facilitators to achieve change.ResultsBarriers include disconnected bodily awareness, mutual avoidance between women and professionals, limited insight and (self-) reflection on SUD and motherhood, and insufficient support across interpersonal, socioeconomic, and systemic levels. However, professionals also identified several areas that could be reinforced to unlock the period’s transformative potential, reflecting a gradual shift from a deficit-oriented view toward a more strengths-based understanding of perinatal SUD. Empowerment was seen as crucial through open conversations on family planning, psychoeducation on fertility and contraception, access to appropriate contraceptives, and trauma-sensitive, body-oriented approaches that foster connection to pregnancy and the unborn child, as well as the integration of the infant mental health perspective. The perinatal period itself was considered a naturally occurring window of opportunity for change, driven by processes of identity transformation and growing maternal motivation. Professionals emphasized the importance of enhancing professional capacity, particularly in healthcare, and improving screening and referral by midwives and gynecologists. At the care system level, increased and more consistent contact with healthcare services during pregnancy was described as a contextual opportunity for timely support; however, intersectoral collaboration and integrated care were considered essential, alongside a legal prenatal framework that enables early, non-punitive interventions to support both mother and (unborn) child.DiscussionThese findings underscore the need to move beyond hegemonic discourses that frame strength and deficit, mothering and substance use, or vulnerability and opportunity as binary opposites. Recognizing the ways these dimensions coexist and intersect is vital for developing responsive, relational, and ethically grounded models of perinatal care.

Treatment is regarded as a core resource to initiate recovery and build recovery capital. In this chapter, we assess the role of treatment and support services in building recovery capital and explore how recovery capital is related to a range of treatment outcomes. Based on a comprehensive literature review, we provide an overview of quantitative and qualitative studies of recovery capital in treatment populations, its impact on outcomes and treatment participation, and related service provider and service user perspectives. Overall, studies in in- and outpatient settings show considerable growth of recovery capital during and after treatment, which is closely related to improved substance use outcomes. Treatment retention and completion are central to building recovery capital. According to service users’ and providers’ perspectives, social support and recovery supportive environments are crucial for building recovery capital, as well as more personalized and strengths-based approaches.

Background Recovery colleges (RCs) support personal recovery through education, skill development and social support for people with mental health problems, carers and staff. Guided by co-production and adult learning principles, RCs represent a recent mental health innovation. Since the first RC opened in England in 2009, RCs have expanded to 28 countries and territories. However, most RC research has been conducted in Western countries with similar cultural characteristics, limiting understanding of how RCs can be culturally adapted. The 12-item Recovery Colleges Characterisation and Testing (RECOLLECT) Fidelity Measure (RFM) evaluates the operational fidelity of RCs based on 12 components, but cultural influences on these components remain underexplored.Aims To assess associations between Hofstede’s cultural dimensions and RFM items to identify cultural influences on fidelity components.Methods A cross-sectional survey of RC managers was conducted across all 221 RCs. Mixed-effects regression models examined associations between Hofstede’s country-level cultural dimensions and item-level RFM scores, adjusted for healthcare expenditure and income inequality. Four cultural dimensions, obtained from Hofstede, were analysed: individualism (prioritising personal needs), indulgence (enjoyment-oriented), uncertainty avoidance (preference for predictability) and long-term orientation (future-focused).Results The RFM was completed by 169 (76%) RC managers. Seven RFM items showed associations with cultural dimensions. Equality was linked to short-term orientation, while learning was associated with individualism and uncertainty avoidance. Both individualism and indulgence influenced co-production and community focus. Commitment to recovery was shaped by all four cultural dimensions, with the strongest associations seen for individualism and indulgence. Individualism enhanced explicit focus on strengths-based practice, while uncertainty avoidance influenced course distinctiveness.Conclusions This study demonstrates how culture shapes RC fidelity components, providing actionable insights for cultural adaptation. Incorporating under-represented dimensions, such as collectivism and restraint, could improve the RFM’s global applicability, facilitating implementation. Future research should explore cultural nuances, engage diverse stakeholders and refine fidelity measures to enhance RC inclusivity and effectiveness worldwide.

BackgroundThere is increasing recognition that incorporating patient perspectives into substance use disorder (SUD) treatment planning and evaluation is essential for tailoring care to individual goals, enhancing the overall quality of care, and supporting recovery. This qualitative study explores how individuals starting SUD treatment describe recovery and view the role of treatment services in supporting recovery.MethodsWe conducted 21 in-depth interviews with 16 participants from residential and five from outpatient SUD settings. Data were analyzed using thematic analysis.ResultsFour themes were identified, reflecting participants' views on SUD treatment and recovery: (1) participants reported a need to feel connected, valued and respected; (2) they wanted to gain a better understanding of their substance use and how to manage it; (3) finding stability in life was considered part of treatment and recovery; and (4) participants wanted to stay in control of the content of their treatment and care pathway.ConclusionsPatients' individual goals and needs may be overlooked when SUD services prioritize their own, often narrow, conceptions of treatment and recovery. Patient-centered, recovery-oriented treatment should support individualized and continuous care, integrated with recovery support services.

People with substance use disorders (SUD) have multiple associated health and social conditions that may lead to unmet needs, even among those receiving professional support. Furthermore, the fragmented nature of care provision may also contribute to unmet needs. Therefore, we assessed the needs of service users with SUD and identified their need profiles and their determinants. We aimed to identify possible gaps in care that were likely to hamper recovery pathways and to examine whether the care supply was tailored to users’ needs. A convenience sample of 562 service users with SUD drawn from diverse mental health services in Belgium, including specialised services for SUD, were assessed using the Camberwell Assessment of Needs– Short Appraisal Schedule (Patient version). Additional indicators, including social integration, substance use behaviours, service utilisation, and well-being, were also collected. A Latent Class Analysis was performed to identify need profiles. Three classes of need profiles were identified. The largest class comprised 40

BACKGROUND:Relational rather than individualistic understandings of recovery in the context of alcohol and other drug (AOD) problems have gained recognition. Social identity models, such as the Social Identity Model of Recovery (SIMOR) highlight recovery as a process of social identity transformation. However, these developments are primarily grounded in treatment and peer support settings, potentially underemphasizing the complex dynamics of social identity processes across alternative recovery pathways. Informed by critical drug studies and a relational recovery perspective, the current study contributes to a more nuanced and contextually sensitive understanding of social identity processes across diverse recovery pathways. METHODS:This study consists of a secondary thematic analysis of two independently collected datasets comprising in-depth interviews of participants in addiction recovery with (n = 15) and without (n = 15) addiction treatment histories. SIMOR was used as a sensitizing concept for the analysis. RESULTS:Three themes emerged from the analysis: (1) Substance use and narrowing networks: participants often experienced reduced social ties while experiencing AOD problems, though not universally or completely; (2) Transformations in social networks during recovery: recovery coincided with shifts in social networks, including redefined relationships with people who use drugs (PWUD) and the development of multiple identities; and (3) Accessibility of social identities: highlighting the role of stigma, difference, and structural factors in shaping connection and belonging. CONCLUSIONS:Findings support a relational and pluralistic approach to recovery and social identity. This approach challenges normative assumptions and acknowledges diversity and social complexity in recovery trajectories.

The concept of agency in substance use recovery remains contested, positioned between deficit-based models emphasizing dependence and recovery paradigms highlighting personal strengths and capacities. However, the latter approach has faced criticism for individualizing responsibility, overemphasizing independence, and promoting normative notions of citizenship. This is particularly visible in the context of recovery without treatment. Commonly referred to as "natural recovery," many people recover without engaging with formal addiction treatment or mutual aid. This study explores the lives of individuals in recovery without treatment, using an assemblage perspective to capture its complexity and relational nature. Eighteen in-depth interviews with participants in recovery without treatment from alcohol and/or other drug problems were conducted following the lifeline interview method. Transcripts were analyzed using reflective thematic analysis informed by assemblage theory. Two overarching themes emerged: (1) "agency while losing and gaining control," illustrating addiction as an ambivalent aspect of subjectivity that both enables and constrains; and (2) "agency, multiplicity, and emergence," demonstrating how agency operates within dynamic assemblages of shifting elements and forces, rather than as a fixed state. Our findings imply an understanding of agency as interdependent and emergent within multiplicities. Hence, we argue that recovery and the influential strengths-based concept of recovery capital should be cautious of simplifying practices that risk reproducing individualist and normative notions of recovery. We discuss recovery as a practice of freedom and identify avenues for further research.

BackgroundWomen with substance use disorders face distinct and compounding barriers to addiction treatment, including trauma histories, caregiving responsibilities, stigma, and structural inequality. Despite increased interest in gender-responsive treatment, few studies centre women's lived experiences to inform trauma-informed and transformative care.MethodsThis qualitative study draws on in-depth interviews with 60 women engaged in alcohol and drug services across Belgium, including women-only as well as mixed-gender programmes. Data were analysed using conventional content analysis to identify key themes related to gender-responsive and trauma-informed care.ResultsFive core themes emerged: (1) safety - emotional, relational, and environmental - as a foundation for recovery; (2) nuanced preferences for women-only versus mixed-gender settings; (3) the importance of peer support and lived experience in fostering trust and motivation; (4) the need for holistic, person-centred, and body-aware treatment; and (5) comprehensive care that respects women's social roles and realities. Women emphasized that meaningful recovery extends beyond abstinence to dignity, connection, and systemic support.ConclusionGender-responsive alcohol and drug treatment goes beyond mere adaptation to transformation of power, practice and purpose. Centering women's voices reveals the need for flexible, trauma-informed, and structurally aware care that addresses both individual recovery and the social conditions that shape it.

Substance use disorders (SUDs) are increasingly recognized as a significant public health concern in Africa, placing considerable strain on the economy, healthcare system, and society at large. Given the dual disease burden of both infectious and non-communicable diseases, African countries may not prioritize addressing the emerging epidemic of SUDs. There is a paucity of scientific literature on SUD treatment outcomes following their management across the African continent. Therefore, this systematic review aimed to address this gap. We conducted an electronic search of Web of Science, CINAHL, Embase, Medline (PubMed interface), Scopus, and PsycArticles. We included studies with participants who were diagnosed and treated for SUDs following internationally recognized diagnostic criteria in the African region as defined by geographical boundaries and had at least one treatment outcome measured and reported. Studies were assessed for risk of bias using the Joanna Briggs Institute critical appraisal tool. This systematic review was registered in the PROSPERO database (CRD42022362926). Thirteen research studies were included across four African countries (South Africa − 8, Uganda − 2, Zambia − 2, and the Democratic Republic of Congo − 1). The treatment completion rates across all treatment modalities averaged 71.4

Substance use during the perinatal period is a growing global public health concern, associated with significant risks for maternal health, child development, and parenting. Despite these risks, the perinatal period is often described as a “window of opportunity” for behavioral change and the initiation of recovery. However, research exploring how vulnerability and transformation interact in the context of perinatal substance use remains scarce. Existing studies are predominantly cross-sectional, deficit-oriented, and focused on relapse or medical effects of prenatal substance use exposure, leaving critical gaps in understanding maternal trajectories and the psychosocial factors shaping the transition to parenthood. The PIPPA (Perinatal Insights into Parenting, Pathways, and Addiction) study addresses these gaps by adopting a strength-based, exploratory approach. It aims to examine how maternal, psychosocial, and contextual factors influence whether the perinatal period represents an (un)promising transition to parenthood for women with substance use disorders (SUD), and how maternal and child trajectories unfold over time. PIPPA is a longitudinal, prospective, multicentre mixed-methods study conducted in Flanders, Belgium (May 2025–November 2026). Fifty (pregnant) mothers with alcohol and/or other substance use problems are recruited through obstetric departments, general substance use services, specialized substance use services for (expecting) parents, child protection services, and social media. Participants are assessed at two or three time points: during pregnancy, 2–6 weeks postpartum, and six months postpartum. Data collection combines quantitative and qualitative measures: validated questionnaires (AUDIT-C, DUDIT-C, EPDS, SWLS, BARC-10, MAAS, MPAS, Parental Stress Scale), custom instruments capturing sociodemographic and contextual factors, and speech tasks (Three-Minute and Five-Minute Speech Samples) to assess maternal representations and parent–child relationship quality. Semi-structured interviews with mothers and involved caregivers complement these assessments. All data are securely managed in REDCap. Quantitative analyses will include descriptive, longitudinal, subgroup, and regression models; qualitative data will be analyzed using longitudinal thematic analysis and structured coding of expressed emotion. Recruitment began in May 2025, and data collection began in June 2025. Completion is expected by November 2026, when all infants reach six months of age. Data analysis will be performed after full data collection. This research seeks to contribute to a more strengths-based and evidence-based understanding of the transition to motherhood in the context of perinatal substance use. By integrating maternal narratives, psychosocial dynamics, and contextual influences, PIPPA will provide nuanced insights into the complex interplay between substance use, recovery, and parenting. Findings will inform integrated care models and early interventions aimed at supporting mothers with SUD and safeguarding child well-being.