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