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The Experience of Recovery from Alcohol/Drugs (AOD) By Joyce R. Dickens THOMAS VAIL, PhD, Faculty Mentor and Chair BARRY PERSKY, PhD, Committee Member STEVE SCHNEIDER, PhD, Committee Member David Chapman, PsyD, Dean Harold Abel School of Social and Behavioral Sciences A Dissertation Presented in Partial Fulfillment Of the Requirements for the Degree Doctor of Philosophy Capella University i Acknowledgements I, Joyce R. Dickens, School of Psychology, at Capella University would like to acknowledge Dr. Sandra Kostere for her timely review of and feedback on an earlier draft of this paper, and Dr. Thomas Vail for his insightful comments and encouragement through completion of this dissertation. This research has been not only an honor and privilege to conduct, but also a renewal of faith in the belief that if given the proper tools for long-term continuing care and maintenance then recovery will be enhanced and longer-term recovery will happen more often than not. The good news is that research shows that progress is being made, and by listening to the voices of those in recovery we can understand the needs of recovering people and that will help in developing better recovery maintenance programs. ii Abstract This dissertation contributes to the understanding of the early recovery experience of individuals recovering from alcohol and/or drug abuse by examining the narratives of individuals through their lived experiences. The research model was a qualitative study using the phenomenological approach. The primary research question addressed was: “How do people describe the experience of recovery from alcohol and/or drug addiction during early recovery?” The analysis focused on the overall statements participants make about their lived experiences as elicited by an open-ended, guided-question interview. The aim was to learn from these experiences what is helpful in recovery and what may be needed and not available. The insight and the knowledge gained from these ‘lived experiences’ will be useful in formulating theoretically grounded models of care. The findings concur with the wider literature to a large extent in that the data identified inadequacies with regard to service provision and highlighted the negative impact of issues of exclusion and stigma. A further identified concern was the lack of social support. Just as the literature research showed, this research also found it to be desirable and recommends a more inclusive, integrated approach for aftercare and recovery management to enhance long-term recovery. iii Table of Contents CHAPTER 1. INTRODUCTION TO THE PROBLEM 1 Background of the Study 2 Statement of the Problem 3 Purpose of the Study 5 Research Question 6 Nature of the Study 6 Significance of the Study 7 Definition of Terms 7 Limitations 9 Assumptions 10 Organization of the Remaining Chapters of the Dissertation 11 CHAPTER 2. LITERATURE REVIEW 12 Purpose of Literature Review 12 Early Recovery 12 Results of Addiction 14 Addiction as a Brain Disease 15 Early Recovery Support 16 Resources for Addiction Professionals 17 Reflection on Recovery 18 Recovery Support 19 Twelve-Step Programs and Recovery 20 iv Help for U.S. Citizens in Treatment and Recovery 22 Guiding Principles of Recovery 23 CHAPTER 3. METHODS 26 Purpose of the Study 26 Research Design 26 Target Population and Participant Selection 28 Procedures 29 Instruments 30 Data Collection and Data Analysis 31 CHAPTER 4. DATA COLLECTION AND ANALYSIS 37 Introduction 37 Participant Recruitment, Selection and Interview Process 37 Analysis of Data 39 Qualitative Data Management and Analysis 40 Participant 1 41 Participant 2 48 Participant 3 53 Participant 4 58 Participant 5 63 Participant 6 67 Participant 7 73 Participant 8 79 Participant 9 84 v Participant 10 89 Participant 11 94 Participant 12 101 Composite Descriptions of All Participants 108 Composite Textural Descriptions of Participants 108 Composite Structural Description of Participants 112 Theme 1: Relationship to Self 112 Theme 2: Relationships with Others 113 Theme 3: Causality 114 Theme 4: Structure of Time 115 Composite of Combined Textural-Structural Description of Participants 115 Textural-Structural Description 115 Conclusion 117 CHAPTER 5. SUMMARY, CONCLUSIONS, RECOMMENDATIONS 118 Discussion 119 Recommendations for Further Research 122 General Limitations 124 Significance of the Study 124 Discussion of Conclusions 129 REFERENCES 132 APPENDIX A. ADVERTISEMENT FLYER 138 APPENDIX B. INFORMED CONSENT 139 vi APPENDIX C. SEMI-STRUCTURED QUALITATIVE INTERVIEW 144 OF OPEN-ENDED QUESTIONS APPENDIX D. MEANING UNITS FOR EACH PARTICIPANT 145 vii CHAPTER 1. INTRODUCTION TO THE PROBLEM The focus of this study is to research the “lived experiences” of participants in early recovery from alcohol and/or other drugs. Understanding such experiences is important for health professionals in treatment planning and can also provide insight into relapse prevention. The insight and knowledge gained from the “lived experiences” of people in early recovery may help health professionals in formulating better models of care for individuals in early recovery. Without sufficient data relating to the “lived experiences” of people in early recovery; the best support, assistance, and relapse prevention planning is limited. It is hoped that data collected from this study of “lived experience” will improve our understanding of the stigma, hurdles, discrimination, and barriers people in early recovery face in getting on with their lives. In addition, the analysis of the “lived experiences” that comprise this study may reveal what helps and what hinders individuals in early recovery from alcohol and/or other drugs. This chapter provides an introduction to the study, including the background of the study, the statement of the problem and the purpose of the study. The research question that guides the study is presented, the nature of the study is discussed and the limitations of the research design are acknowledged. The chapter continues by making a case for the significance of this research and providing a list of relevant definitions that will be used throughout the study. The chapter concludes with an overview of the organization of the remainder of the study. 1 Background of the Study A good example of what individuals go through in early recovery is explained by Rick Glantz (2001), a practicing addictions clinician, who described early recovery as the time when clients need to understand both physiological and psychological factors involved in cravings to addictions whether the addiction is chemical or behavioral. To discover how individuals can have a more successful early recovery from alcohol and/or drugs and move forward to long-term recovery, we need to find out what factors best support recovery, and which may inhibit it. Research shows that participation in substance abuse treatment has consistently proven effective in reducing substance use. However, often treatment gains are often not maintained; relapse may occur rapidly after treatment ends, and relapse risk remains high for several years (Hammond & Gorski, 2005). Not much is known about the change processes underlying the benefit or the harm that a recovering person faces on a daily basis more research is need where the voices of those in recovery are heard. (Laudet White, 2004). Recovery from substance addiction is a reality for millions of people throughout the world. Formal treatment can be an avenue for change; however, recovery that is sustained is nurtured by stable factors in people’s lives, such as informal help and ongoing social resources, play an important role in recovery (Moos, Finney, & Cronkite, 1990; Vaillant, 1995). People with addictive disorders, like anyone else, live in a complex web of social forces, and the evolving conditions of their life play an important role in the process of recovery. People who are able to maintain remission from addictive disorders offer hopeful signs that these disorders need not become chronic (Laudet, & White 2004). It 2 has been noted that individuals who establish a course of stability in their early recovery period often can attain normal life functioning, become productive members of society, and assume valued roles (Glantz, R., 2002). This study seeks to achieve a better understanding about the factors that promote or hinder the recovery process by examining the lived experiences of individuals during early recovery. Further, the study will strive to elucidate the role of environmental and social factors in recovery. Identifying significant risk factors in early recovery can aid educational efforts to assist clients in relapse prevention planning. This, in turn, will support long term recovery, and new and improved ideologies of care that maximize positive recovery outcomes can be developed. Being able to identify specific risk and protective factors can help ensure better relapse prevention planning by informing the recovery community, helping family members, helping the recovering person with their careers, assisting in the identification of needed resources, and inform public policy. Statement of the Problem A great deal is known about addiction, but unfortunately, not much is known about recovery (Moos, 2003). The prevalent view today is that addiction is a chronic disorder on par with other chronic conditions such as diabetes and asthma (McLellan, Lewis, O’Brien, & Kebler, 2000; White, Hoyle, & Loveland, 2002). Substance abuse high jack’s the brain’s natural motivational control circuits, resulting in use becoming the sole, or at least the top motivational priority for the individual. Thus, the majority of the biomedical community considers addition to be a brain disease (Lehsner, 1999). Dr. Thomas McLellan, (2009), deputy director of the White House’s Office of National Drug 3