Background: Illicit injection drug use and its attendant harms are a key health and social concern. Resilience-based strategies have the potential to complement existing approaches, but there is a paucity of research on resilience. This study identifies and explores manifestations of resilience among illicit drug users (IDUs), including indicators of cognitive transformation at key turning points, and protective factors associated with enhanced resilience. Method: A secondary analysis was conducted on data collected from a larger qualitative study involving 41 injection drug users and 45 service providers and community leaders. A conceptualization of resilience as a relative and dynamic process manifesting at key 'turning points' provided a lens to frame the analysis, which was also informed by the resilience models of Garmezy [Garmezy, N. (1991). Resiliency and vulnerability to adverse developmental outcomes associated with poverty. American Behavioral Scientist, 34, 6-430.] and Werner and Smith [Werner, E., & Smith, R. (1982). Vulnerable but invincible: A longitudinal study of resilient children and youth. New York: McGraw-Hill.]; instances of cognitive transformation [Tebes, J. K., Irish, J. T., Vasquez, M. J. P., & Perkins, D. V. (2004). Cognitive transformation as a marker of resilience. Substance Use & Misuse, 39, 769-788.] were also identified. Analytic techniques of constant comparison and open coding [Morse, J. M., & Field, P. A. (1995). Qualitative research methods health professionals (2nd ed). Thousand Oaks, CA: Sage.] were used. Results: Key turning points reflecting resilience were captured by two themes. First, participants described how "Getting to the Point of Change" involved particular cognitive and emotional mechanisms encompassed within this theme: "Recognizing it's not Worth it", "Getting Scared" and "Recognizing an Inner Desire to Quit". The second manifestation of resilience centred on the enactment of hope in goal-setting, and entailed "Envisioning a Better Future." In contrast, descriptions of the need to dull past and present hopelessness and pain suggested the suppression of resilience. Hope and a sense of control were particular manifestations of resilience. Other factors (physical or emotional pain, frightening experiences, witnessing or experiencing negative costs) were protective for some individuals but suppressed resilience in others. Conclusion: The findings support the usefulness of the concept of resilience in understanding cognitive and behavioural change among IDUs, and provide a promising direction for future research. (C) 2008 Elsevier B.V. All rights reserved.
