The data generated as part of The Big Picture project was funded by the Economic and Social Research Council (ESRC) and the Arts and Humanities Research Council (AHRC) as part of the UK Global Challenges Research Fund (GCRF) ES/S00047X/1. The project was led by Professor Anna Madill (University of Leeds) with University of Leeds CoIs Professor Paul Cooke, Dr Siobhan Hugh-Jones, and Professor Tolib Mirzeov with CoI Dr Rebecca Graber (University of Brighton). The project Research Fellow was Dr Raginie Duara. The data was collected between 2019 and 2020 in the city of Guwahati, Assam. With regards to this data, our use of photovoice involved photo-led/elicitation interviews in which each participants was invited to prepare for interview by taking, and/or collecting, photographs/images relevant to the topic of research. Hence the interview incorporate discussion of the images. The project data consists of transcripts and images from photo-elicitation interviews with 30 young Assamese people, 15 from resilience-to-risk (R2R) and 15 from resilience-for-recovery (R4R) group.India has committed to implement Mental Health Action Plans and to achieve Sustainable Development Goals, two of which relate to mental health (3.4 & 3.5: National Mental Health Survey of India 2015-16). Assam, one of the states in the northeast of India, presents a complex picture around mental health, constituting an apposite region to explore risk, resilience and recovery. With relatively low mental health problems, Assam offers an opportunity to understand psychological, social and cultural resilience. However, mental health stigma in the region is high and there is an immense mental health treatment gap. Substance Use Disorder (SUD) is acknowledged as an urgent, public health problem in Assam. SUD is particularly high in metro areas (such as Guwahati) and is widespread in school-going males 14-16 years. There is a worrying level of solvent abuse amongst young people, particularly of low socioeconomic status and young age of substance use initiation (8-13 years). The prevalence of substance use within certain social groups and peer cohorts suggests that learning how young people successfully negotiate this risky context would constitute significant new knowledge. Moreover, a resilience approach attends to a full range of mechanisms enabling contextually-appropriate, tailored interventions. We worked with two groups of young people: (i) those successfully refraining from substance use despite being at increased risk (R2R) aged 15-18 years (N=15); and (ii) those in successful recovery from SUD (R4R) aged 19-24 years (N=15). Our overall goal is divided into three inter-related aims and associated research questions as follows. 1. Increase knowledge: To enhance psychological, social and cultural insights into the experience of risk, resilience and recovery with regard to youth substance use in Assam. 2. Enhance voice: To promote young Assamese people’s voice with respect to substance use in order to reduce stigma, raise public awareness and inform mental- and public-health policy and practice. 3. Inform practice: To learn if and how photovoice can be adapted in culturally-sensitive ways to enhance local mental health services seeking to prevent and treat youth substance use in Assam. Participants were invited to generate or collate photographs/images (over 7-10 days) to represent the experiences they want to share at interview around risk, recovery and resilience. Given assumed power differentials, young people may: perceive a standard interview as interrogatory; be unsure about expectations for self-disclosure; fear revelations may be used against them; feel exploited with no direct benefit to them. Photovoice minimises these risks. There is evidence that it facilitates engagement with traditionally ‘hard to reach’ populations and there is reason to believe it can be adjusted to support culturally-sensitive modes of engagement. There is growing evidence that photovoice itself can have therapeutic effects, and the photographs – with or without participant narratives – can be an effective way of documenting and increasing the impact of local interventions. Exploring protective and enabling factors around risk and recovery shed light on complex psychological, familial, social and cultural pathways to, and away from, SUD.

One-to one photo-elicitation interviews were conducted face-to-face in three locations: two rehabilitation facilities and one Wellness Centre, all of which are situated in Guwahati. The three organisations also provided access to relevant participants and helped us recruit. Two demographic groups were of interest. One group consists of young people 15-18 years (7 males; 8 females) not currently abusing substances but self-report as being at risk of doing so, for example via the experience of a relative with SUD and/or peer pressure: the research seeks to understand the experience of this demographic and, in particular, their resilience to substance abuse. A second group consists of young adults 19-24 years (11 males; 4 females) who are in successful recovery from substance abuse, defined as having abstained from use for at least one year. We recruited 15 participants from each group: resilience-to-risk (R2R) and resilience-for-recovery (R4R). The Research Fellow communicated with potential participants (telephone, e-mail, face-to-face as appropriate), to explain the process of data collection which involved participants taking or collecting photographs and/or images which capture their experiences of resilience and/or recovery in relation to addictive substances of abuse. After the photos/images were gathered, the Research Fellow interviewed each participant with a focus on the images they brought. The template used for the interview prompts is included in Supporting Documents. Interviews were audio- recorded with consent and later transcribed under confidential agreement with the transcribers. Interviews conducted in the local language (Assamese) were translated to English by the transcribers. The transcripts were checked for anonymity and confidentiality, and reference to photos added into the transcript by the Research Fellow. Each transcript was again sent to a third party (with who we have confidentiality agreement) to check for anonymity and confidentiality. Any photos/images that could potentially reveal participant identity were anonymised by blurring relevant parts of the photos/images.