learning to live again

382 Pages·2014·2.96 MB·English

LEARNING
 TO
 LIVE
 AGAIN:
 AN
 EXPLORATION
 OF
 AN
 EX-­‐
SERVICE
 USER
 LED
 PROJECT
 FOR
 ALCOHOL
 ADDICTION

RECOVERY

THOMAS
 JAMES
 PARKMAN

PhD

UNIVERSITY
 OF
 YORK

DEPARTMENT
 OF
 HEALTH
 SCIENCES

SEPTEMBER
 2013

  1
For
 my
 good
 friend
 Alex
 and
 my
 Auntie

  2
Abstract

Background
 and
 rationale:
 This
 thesis
 explores
 the
 impact
 of
 attendance
 and

participation
 at
 an
 ex-­‐service
 user
 led
 project
 in
 Leeds
 for
 alcohol
 dependency.

This
 thesis
 is
 important
 for
 two
 reasons.
 First,
 in
 the
 last
 few
 years,
 UK
 drug
 and

alcohol
 policy
 has
 implemented
 a
 strategy
 that
 aims
 to
 facilitate
 full
 recovery

from
 drug
 and
 alcohol
 dependency.
 Further
 research
 is
 needed
 to
 explore
 and

understand
 the
 issues
 surrounding
 addiction
 recovery.
 Second,
 a
 scoping
 review

of
 the
 literature
 found
 a
 significant
 lack
 of
 UK
 based
 studies
 exploring
 the
 impact

of
 attendance
 and
 involvement
 at
 self-­‐help
 groups
 for
 addiction
 recovery.

Methodology
 and
 Methods:
 A
 qualitative,
 ethnographic
 methodology
 was
 used

to
 gain
 a
 holistic
 understanding
 of
 the
 Learning
 to
 Live
 Again
 project
 (hereafter

LTLA).
 A
 convenience
 sample
 of
 service
 users,
 mentors
 and
 professional
 staff

who
  attended
  or
  were
  involved
  with
  the
  project
  was
  recruited.
  Participant

observation
 was
 conducted
 at
 the
 project
 in
 order
 to
 gain
 greater
 familiarity

with
 the
 project,
 followed
 by
 semi-­‐structured
 interviews
 with
 those
 involved

with
 the
 project.
 Data
 were
 analysed
 through
 a
 thematic
 framework
 approach.

The
 data
 were
 interpreted
 and
 explained
 based
 on
 the
 theoretical
 assumptions

of
 symbolic
 interactionism.

Findings:
 The
 main
 finding
 was
 that
 the
 LTLA
 project
 provides
 service
 users

with
  a
  recovery
  project
  that
  facilitates
  recovery
  on
  both
  an
  individual
  and

collective
 level.
 The
 culture
 of
 abstinence
 and
 the
 peer
 support
 service
 users
 had

access
  to,
  appeared
  to
  facilitate
  recovery
  by
  providing
  service
  users
  with
  a

recovery
  project
  that
  is
  built
  on
  firsthand
  experience
  of
  addiction
  recovery.

However,
 the
 data
 also
 demonstrated
 that
 some
 service
 users
 remain
 connected

to
 their
 addiction
 through
 their
 ‘over-­‐involvement’
 with
 the
 LTLA
 project.

Conclusions:
  This
  thesis
  contributes
  to
  the
  understanding
  of
  how
  and
  why

attendance
 at
 an
 ex-­‐service
 user
 led
 project
 for
 alcohol
 dependency
 impacts
 on

recovery,
 and
 contributes
 to
 the
 UK
 evidence
 base
 on
 research
 in
 this
 area.
 The

themes
 identified
 in
 this
 thesis
 lay
 the
 foundation
 for
 future
 research
 and
 further

contributes
 to
 the
 understanding
 of
 recovery
 in
 UK
 drug
 and
 alcohol
 policy.

  3
List
 of
 Contents

Dedication…………………………………………………………………………………………………….2
Abstract………………………………………………………………………………………………………...3
List
 of
 Contents……………………………………………………………………………………………..4

List
 of
 Figures……………………………………………………………………………………………...10

List
 of
 Tables…………………………………………………………………………………………….....11

List
 of
 Appendices…………………………………………………………………………………….....12

Acknowledgements……………………………………………………………………………………..1
3

Authors

declaration…………………………………………………………………………………….14

Chapter
 1:Introduction……………………………………………….15

1.1
  Why
 recovery?……………………………………………………………………………………15

1.2
  Local
 Context……………………………………………………………………………………...17

1.3
  Addiction,
 dependency,
 recovery
 and
 abstinence:
 The
 contestable
 nature

  of
 language…………………………………………………………………………………………20

1.4
  UK
 drug
 policy:
 “Building
 recovery”
 …………………………………………………….26

1.5
  Structure
 of
 this
 thesis………………………………………………………………………..30

Chapter
  2:
  Self-­‐help
  groups
  for
  alcohol
  addiction

recovery:
 A
 scoping
 review…………………………………………32

2.1
 Introduction…………………………………………………………………………………………..32

2.1.1
 Justification
 and
 rationale
 for
 this
 scoping
 review……………………………..32

2.2
 Methods………………………………………………………………………………………………..34

2.2.1
 Identifying
 relevant
 studies……………………………………………………………..34

  2.2.1.1
 Search
 strategy……………………………………………………………………………35

2.2.2
 Inclusion
 and
 exclusion
 criteria…………………………………………………………..39

2.2.2.1
 Inclusion
 Criteria……………………………………………………………………......39

2.2.2.2
 Exclusion
 Criteria……………………………………………………………………….39

2.2.3
 Data
 extraction………………………………………………………………………………......40

  4
2.2.4
 Analysis
 of
 the
 findings…………………………………………………………………….…41

2.3
 Findings
 of
 the
 scoping
 review……………………………………………………………….42

  2.3.1
 The
 importance
 of
 AA
 and/or
 12-­‐step
 attendance…………………………..43

  2.3.1.1
 Attenders
 verses
 non-­‐attenders:
 A
 straightforward
 association…...44

  2.3.1.2
 A
 closer
 analysis
 of
 attendance
 on
 abstinence…………………………….45

2.3.2
 The
 impact
 of
 involvement…………………………………………………………………..49

2.3.3
 Location……………………………………………………………………………………………...51

2.3.4
 Composition
 of
 social
 network……………………………………………………………..52

2.4
 ‘Non-­‐AA
 and
 non-­‐12-­‐step
 affiliated’
 SHGs………………………………………………..56

2.4.1
 ‘Clubs
 of
 Alcoholics
 in
 Treatment’……………………………………………………..56

2.4.2
 Rational
 Recovery…………………………………………………………………………...57

2.4.3
 The
 impact
 of
 CATs
 and
 Rational
 Recovery………………………………………..58

2.4.4
  Methodological
 issues
 surrounding
 the
 quantitative
 studies……………….59

2.5
 Qualitative
 studies
 located
 during
 this
 scoping
 review…………………………….61

2.5.1
 Excluded
 qualitative
 studies…………………………………………………………….61

2.5.2
 Findings
 of
 the
 qualitative
 studies
 investigating
 AA…………………………..62

2.5.3
 ‘Women
 for
 Sobriety’
 and
 ‘First
 Steps’………………………………………………68

2.6
 Concluding
 comments…………………………………………………………………………...71

2.6.1
 Aims
 and
 objectives
 of
 this
 thesis……………………………………………………..74

Chapter
  3:
  The
  theoretical
  framework
  of
  symbolic

interactionism……………………………………………………………75

3.1
 Introduction…………………………………………………………………………………………..75

3.1.1
 A
 theoretical
 framework………………………………………………………………….76

3.2
 The
 origins
 of
 symbolic
 interactionism……………………………………………….......78

3.2.1
 Mead’s
 influences………………………………………………………………………………..79

3.2.2
 Language
 and
 the
 symbol…………………………………………………………………….80

3.2.3
 Self:
 A
 brief
 introduction……………………………………………………………………...82

3.2.4
 The
 ‘I’
 and
 the
 ‘me’………………………………………………………………………….......83

3.2.5
 The
 ‘generalised
 other’………………………………………………………………………..84

3.3
 Culture
 and
 ‘definition
 of
 the
 situation’…………………………………………………..86

3.4
 Identity…………………………………………………………………………………………………89

  5
3.4.1
 Identity:
 Goffman’s
 perspective…………………………………………………….....90

3.4.2
 The
 ‘virtual
 social
 identity’
 and
 the
 ‘actual
 social
 identity’…………………92

3.4.3
 Stigmatisation,
 stereotyping
 and
 symbolisation…………………………….....93

3.5
 A
 structural
 symbolic
 interactionist
 approach:
 A
 brief
 introduction………..96

3.5.1
 Sheldon
 Stryker’s
 identity
 theory…………………………………………………….96

3.5.2
 Peter
 Burke’s
 identity
 theory…………………………………………………………..99

3.5.3
 Combining
 the
 two
 theories……………………………………………………………101

3.6
 The
 identity
 of
 ‘space’…………………………………………………………………………..103

3.7
 Concluding
 comments………………………………………………………………………….105

Chapter
 4:
 Methodology
 and
 Methods………………………107

4.1
 Introduction……………………………………………………………………………………….107

4.2
 Methodology:
 a
 brief
 introduction……………………………………………………….108

4.2.1
 A
 qualitative
 approach………………………………………………………………...108

4.2.2
 An
 ethnographic
 approach…………………………………………………………...109

4.2.3
 Research
 design…………………………………………………………………………...110

4.3
 Methods…………………………………………………………………………………………......113

4.3.1
 Participant
 observation:
 the
 rationale…………………………………………...113

4.3.2
 Structure
 of
 the
 observations………………………………………………………...115

4.3.3
 My
 role
 in
 the
 participant
 observation…………………………………………...115

4.3.4
 Taking
 field
 notes………………………………………………………………………...116

4.3.5
 Sampling
 for
 observations…………………………………………………………….117

4.3.6
 The
 Hawthorne
 Effect…………………………………………………………………..118

4.3.7
 The
 interview
 stage:
 the
 rationale…………………………………………………119

4.3.8
 Developing
 the
 topic
 guide…………………………………………………………...121

4.3.9
 Sampling
 for
 interviews……………………………………………………………….121

4.3.10
 Conducting
 the
 interviews………………………………………………………….124

4.4
 Ethical
 considerations
 for
 this
 research……………………………………………….125

4.5
 Promoting
 credibility
 and
 trustworthiness………………………………………….127

4.6
 Method
 of
 Analysis……………………………………………………………………………..128

4.7
 Summary
 of
 methodology
 and
 methods………………………………………………132

  6
Chapter
  5:
  The
  culture
  of
  the
  LAU
  and
  the
  LTLA

project……………………………………………………………………...134

5.1
 Introduction…………………………………………………………………………………………134

5.2
 The
 history
 of
 the
 LAU………………………………………………………………………….134

5.3
 ‘Referral’
 from
 the
 LAU
 to
 the
 LTLA
 project…………………………………………..137

5.4
 The
 LTLA
 project:
 Its
 history
 and
 current
 structure……………………………....141

5.4.1
 Culture…………………………………………………………………………………………143

5.4.2
 The
 LTLA
 projects
 goal………………………………………………………………….146

5.4.3
 The
 name:
 ‘Learning
 to
 Live
 Again’………………………………………………...147

5.4.4
 The
 activities………………………………………………………………………………..149

5.5
 Concluding
 Comments…………………………………………………………………………150

Chapter
 6:
 The
 LTLA
 project:
 An
 Individual
 Impact….152

6.1
 Introduction………………………………………………………………………………………….152

6.2
 The
 identity
 of
 the
 LAU
 and
 the
 LTLA
 project………………………………………....153

6.3
 The
 identity
 of
 being
 ‘normal’…………………………………………………………….162

6.3.1
 ‘Being’
 normal………………………………………………………………………………..163

6.3.2
 Normal
 functioning………………………………………………………………………...165

6.3.3
 Employment…………………………………………………………………………………..168

6.4
 The
 identity
 of
 recovery
 ………………………………………………………………………..173

6.4.1
 ‘Recovering’
 or
 ‘recovered’?
 ……………………………………………………………174

6.4.1.1
 A
 recovering
 identity:
 The
 mentors……………………………………………….174

6.4.1.2
 A
 recovering
 identity:
 The
 service
 users…………………………………………177

6.4.1.3
 A
 recovered
 case
 study…………………………………………………………………179

6.4.1.4
 The
 story
 of
 mentor
 ♯3:
 Truly
 recovered?
 ……………………………………...179

6.4.2
 Reaffirmation
 of
 Self……………………………………………………………………….187

6.5
 The
 identity
 of
 a
 mentor:
 Does
 it
 benefit
 recovery?
 ………………………………...191

6.5.1
 The
 ‘mentor’
 label…………………………………………………………………………..193

6.5.2
 The
 benefits
 of
 being
 a
 mentor………………………………………………………...196

6.5.3
 The
 supporting
 role
 of
 the
 mentor……………………………………………………198

6.5.4
 Over
 representation
 of
 females
 in
 the
 mentor
 team…………………………...201

  7
6.5.4.1
 The
 identity
 of
 motherhood…………………………………………………….201

6.5.4.2
 A
 perceived
 female
 orientation………………………………………………203

6.6
 Concluding
 comments………………………………………………………………………….207

Chapter
 7:
 The
 LTLA
 project:
 A
 Collective
 Impact……210

7.1
 Introduction……………………………………………………………………………………….210

7.2
 Firsthand
 experience…………………………………………………………………………..210

7.2.1
 Gaining
 perspective
 and
 trust………………………………………………………..216

7.2.2
 A
 collective
 social
 conscience…………………………………………………………219

7.3
 The
 story
 of
 stigma………………………………………………………………………………221

7.3.1
 Experiencing
 stigma……………………………………………………………………..221

7.3.2
 The
 stigma
 of
 recovery………………………………………………………………….225

7.3.3
 The
 LTLA
 project:
 A
 non-­‐stigmatising
 culture…………………………………227

7.4
 Peer
 Support……………………………………………………………………………………….231

7.4.1
 Under-­‐engagement
 with
 the
 LTLA
 project………………………………………232

7.4.2
 Over-­‐involvement
 with
 the
 LTLA
 project…………………………………………236

7.4.3
 The
 ‘Goldilocks
 group’……………………………………………………………………239

7.5
 The
 activities:
 Addressing
 boredom
 and
 providing
 structure………………….243

7.6
 Power…………………………………………………………………………………………………..248

7.6.1
 A
 professional
 influence………………………………………………………………….252

7.6.2
 ‘Counter-­‐addiction’…………………………………………………………………………253

7.7
 Concluding
 comments……………………………………………………………………………257

Chapter
 8:
 Discussion………………………………………………261

8.1
 Introduction…………………………………………………………………………………………261

8.2
 Contribution
 of
 this
 thesis…………………………………………………………………….261

8.3
 Interpretation
 of
 the
 findings……………………………………………………………….252

8.3.1
 An
 over-­‐involvement
 to
 the
 LTLA
 project…………………………………………265

8.3.2
 The
 ‘stages
 of
 recovery’…………………………………………………………………..268

8.4
 Theoretical
 engagement……………………………………………………………………….272

8.4.1
 The
 LTLA
 project:
 A
 ‘community
 of
 recovery’
 within
 the

 ‘imagined

recovery
 community’……………………………………………………………………………….276

  8
8.5
 Methodological
 engagement…………………………………………………………………279

8.5.1
 Being
 a
 ‘complete
 participant’………………………………………………………282

8.5.2
 Reflections
 on
 the
 quality
 of
 this
 research…………………………………………284

8.5.2.1
 Credibility
 and
 reflexivity……………………………………………………………284

8.5.2.2
 Transferability………………………………………………………………………….286

8.5.2.3
 Dependability
 and
 an
 iterative
 approach…………………………………….286

8.5.2.4
 Confirmability
 and
 transparency………………………………………………...288

8.5.2.5
 Triangulation…………………………………………………………………………….288

8.5.2.6
 Reflections
 on
 the
 method
 of
 analysis…………………………………………..289

8.6
 Implications
 of
 this
 research
 for
 policy
 and
 practice……………………………290

8.6.1
 Understanding
 recovery:
 Staged
 recovery?
 ……………………………………291

8.6.2
 Wellbeing…………………………………………………………………………………….293

8.6.3
 Citizenship……………………………………………………………………………………294

8.6.4
 Freedom
 from
 dependence……………………………………………………………..295

8.6.5
 Recovery
 capital……………………………………………………………………………297

8.6.6
 Community
 recovery
 champions……………………………………………………..298

8.7
 Future
 research……………………………………………………………………………………300

8.8
 Concluding
 comments……………………………………………………………………………302

Appendices………………………………………………………………304

List
 of
 Abbreviations…..……………………………………………353

List
 of
 literature
 review
 references………………………….355

List
 of
 references……………………………………………………..358

  9
List
 of
 Figures

Chapter
 2

Figure
 2.1:

  A
 consort
 flow
 diagram
 of
 the
 search
 strategy………………………….36

Chapter
 8

Figure
 8.1:
  The
 ‘stages
 of
 recovery
 model’....................................................................270

  10