UNDERSTANDING THE PROCESS OF RECOVERY FROM HEROIN ADDICTION: INITIATING ...

216 Pages·2012·11.81 MB·English

UNDERSTANDING THE
PROCESS OF RECOVERY
FROM HEROIN ADDICTION:
INITIATING AND
MAINTAINING FACTORS.

Lucy James
May, 2012

Dissertation submitted in partial fulfilment of the
requirement for the degree of D.Clin.Psy. at Cardiff
University, and the South Wales Doctoral Course in Clinical
Psychology

ACKNOWLEDGEMENTS

Firstly, I would like to sincerely thank all those people who gave up their time to participate
in this study and share their thoughts and experiences with me. I greatly appreciate their
willingness to share some difficult topics with me, and help me to learn from their
experiences and insights. They have taught me so much – thank you.

I am also very grateful for the support I have received from my supervisor, Neil Frude, for
reading through the endless work I would send him, calming me when I felt overwhelmed,
and teaching me a lot about grammar!!

My thanks also go to Pam Roberts for giving me a fantastic elective placement and for being
so understanding about the struggles of juggling thesis and placement work. Thanks for
picking me up with your encouraging words and helping me get through this!

Without a shadow of a doubt I could not have done this without the support of Cohort 2009
– thank you each and every one of you for keeping me sane, making me laugh, and getting
me through this in one piece! You are all amazing!

And last but certainly not least, I would like to say a massive thanks to my family and friends
for believing in me and tolerating me throughout this thesis!! You never gave up hope,
picked me up when I was down, and provided me with lots of entertainment in your own
special ways! And I promise there will be no more proof reading after this!
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ABSTRACT
There is increasing recognition that recovery from heroin addiction is possible but there is
limited understanding of the recovery process and of how services can support people in
that process. At present, most of the research concerning recovery from heroin addiction
comes from the United States where the treatment system is very different to that in the
UK. This study aimed to gain a better understanding of the recovery process from the
perspective of people who are in recovery from heroin addiction, with the aim of informing
service development and delivery in the South Wales area.
This study employed a grounded theory qualitative methodology to analyse data collected
from ten interviews with people in recovery from heroin addiction in the South Wales area.
The results revealed four core categories: i) initiating recovery, including the triggers for
recovery and what helps; ii) maintaining recovery, consisting of thought changes, lifestyle
changes and the role of supportive networks; iii) the reality of recovery, encompassing the
process of recovery and obstacles faced; and iv) service provision, encompassing current
problems, how support needs can be met and how wider needs can be addressed. The
findings highlighted some important considerations for the development of services
specifically designed to meet the needs of this client group, thus facilitating long term stable
recovery.
The findings are reviewed in relation to the wider literature regarding recovery from heroin
addiction. Implications for clinical practice and service delivery are also reviewed, and
suggestions provided for how services can incorporate recovery-orientated principles.
Suggestions for future research are also considered.
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CONTENTS
CHAPTER ONE - INTRODUCTION
1.1 OVERVIEW OF THESIS 1

1.2 HEROIN ADDICTION 2
1.2.1 Characteristics of addiction 2
1.2.1.1 Dependence/addiction 2
1.2.1.2 Relapse 2
1.2.1.3 Co-morbidity 3
1.2.1.4 Consequences of heroin addiction 3
1.2.2 Prevalence 5
1.2.2.1 Worldwide 5
1.2.2.2 UK 5
1.2.2.3 Wales 6

1.3 ADDRESSING HEROIN ADDICTION 6
1.3.1 Pharmacological intervention 6
1.3.2 Psychosocial interventions 8

1.4 RECOVERY FROM HEROIN ADDICTION 9
1.4.1 Prevalence 9
1.4.2 Definition 10
1.4.2.1 Is abstinence compulsory? 10
1.4.2.2 Betty Ford Institute Consensus Panel (BFICP) 11
1.4.2.3 William White 12
1.4.2.4 UK Drug Policy Commission 13

1.5 THEORIES OF RECOVERY FROM HEROIN ADDICTION 13
1.5.1 Stages of recovery 13
1.5.2 Turning points 14
1.5.3 The “Maturing out” hypothesis 15
1.5.4 Natural recovery 15
1.5.5 Spoiled identity 16

1.6 IMPORTANT COMPONENTS OF RECOVERY 18
1.6.1 Abstinence from heroin 18
1.6.2 Initiating recovery 19
1.6.3 Maintaining recovery 20

1.7 SYSTEMATIC REVIEW 22
1.7.1 Identification of literature 22
1.7.2 Critical review of literature 23
1.7.3 Implications of existing research 29

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1.8 THE CURRENT STUDY 30
1.8.1 Rationale 30
1.8.2 Research aims 31

CHAPTER TWO - METHODOLOGY
2.1 OVERVIEW OF CHAPTER 32

2.2 QUALITATIVE METHODOLOGY 32
2.2.1 Philosophy 32
2.2.2 Rationale 32
2.2.3 Ensuring quality 33

2.3 GROUNDED THEORY 36
2.3.1 Overview 36
2.3.2 Researcher’s theoretical orientation 37
2.3.3 Rationale 37

2.4 DESIGN 38
2.4.1 Research context 38
2.4.2 Researcher’s position 38

2.5 ETHICAL APPROVAL 39

2.6 PARTICIPANTS 39
2.6.1 Participant recruitment 39
2.6.2 Inclusion and exclusion criteria 40
2.6.2.1 Interviews 40
2.6.2.2 Focus groups 41
2.6.3 Description of participants (situating the sample) 41

2.7 PROCEDURE 44
2.7.1 Interview methodology 44
2.7.2 Interview content 44
2.7.3 Interview style 46
2.7.4 Focus group methodology 47
2.7.5 Focus group content 47
2.7.6 Focus groups style 47

2.8 DATA ANALYSIS 48
2.8.1 Grounded Theory 48

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CHAPTER THREE – RESULTS
3.1 OVERVIEW OF CHAPTER 50

3.2 CORE CATEGORY 1: INITIATING RECOVERY 53
3.2.1 Triggers 53
3.2.1.1 Being ready 53
3.2.1.2 Perceived benefits of recovery 57
3.2.2 What helps 60
3.2.2.1 Making changes 60
3.2.2.2 Learning from experience 63
3.2.2.3 Family support 66

3.3 CORE CATEGORY 2: MAINTAINING RECOVERY 68
3.3.1 Thought changes 68
3.3.1.1 Towards heroin 68
3.3.1.2 Towards self 70
3.3.1.3 Towards life 72
3.3.2 Lifestyle changes 74
3.3.2.1 Keeping busy 74
3.3.2.2 Self-improvement 76
3.3.3 Supportive networks 77
3.3.3.1 Building social networks 78
3.3.3.2 Recovery support 80

3.4 CORE CATEGORY 3: REALITY OF RECOVERY 84
3.4.1 Process of recovery 84
3.4.2 Obstacles in recovery 88

3.5 CORE CATEGORY 4: SERVICE PROVISION 93
3.5.1 Current problems 93
3.5.2 Meeting support needs 96
3.5.3 Addressing wider needs 101

3.6 MAKING SENSE OF HEROIN ADDICTION: A GROUNDED THEORY 106

3.7 FOCUS GROUP 107

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CHAPTER FOUR – DISCUSSION
4.1 OVERVIEW 111

4.2 RESEARCH FINDINGS AND THE EXISTING LITERATURE 111
4.2.1 Initiating recovery 111
4.2.2 Maintaining recovery 115
4.2.3 The process of recovery 117
4.2.3.1 Definition of recovery 117
4.2.4 Service Provision 119

4.3 IMPLICATION OF THIS RESEARCH 121
4.3.1 Clinical implications 121
4.3.2 Service implications 125
4.3.2.1 The way forward 130
4.3.3 Societal implications 131
4.3.4 Implications for clinical psychology 131
4.3.4.1 Clinical practice 132
4.3.4.2 Leadership 133
4.3.4.3 Research 133

4.4 METHODOLOGICAL LIMITATIONS OF THE STUDY 134
4.4.1 Design 134
4.4.2 Quality of research 134
4.4.3 Sample size 135
4.4.4 Sample bias 136

4.5 AREAS FOR FUTURE RESEARCH 137

4.6 CONCLUSIONS 138

REFERENCES 140

APPENDICES 167

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LIST OF FIGURES

Figure 3.1 Overall view of hierarchical relationships Page 50
between core categories, categories and sub-
categories

Figure 3.2 Core category 1: Initiating recovery Page 51

Figure 3.3 Core category 2: Maintaining recovery Page 66

Figure 3.4 Core category 3: Reality of recovery Page 82

Figure 3.5 Core category 4: Service provision Page 91

Figure 3.6 A grounded theory of recovery from heroin Page 104
addiction

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CHAPTER ONE - INTRODUCTION

1.1. OVERVIEW OF THESIS
The concept of recovery from heroin addiction has gained significant energy in recent years,
largely driven by extensive research in the United States of America (USA), and reports by
people who have overcome heroin addiction, promoting the idea that recovery is not only
possible, but probable (e.g. Laudet, 2007; White, 2008a). Historically, the concept of
recovery was predominantly associated with the 12-step fellowship, but in recent years the
USA has demonstrated a successful shift from a focus on addiction to a focus on recovery,
which has now been incorporated into government policies and research.
More recently, the UK has recognised the necessity for recovery to be a fundamental
component of the services provided to those affected by substance misuse (White, 1998)
and in Scotland and England government strategies for addressing substance misuse have
demonstrated a noticeable shift towards recovery. Previous government targets centred on
reducing the harm caused by addiction, in particular, reducing crime (Home Office, 1998),
but in 2008 the government strategy shifted the treatment focus towards a person-centred
approach and recognised the importance of life factors such as training and employment
(HM Government, 2008). The Scottish Government strategy (2008) demonstrated a further
shift in policy when publishing “The Road to Recovery” strategy which focused on an
approach to tackling problem drug use based firmly on the concept of recovery.
Within this introductory section, the prevalence and consequences of heroin addiction will
be considered, followed by a brief overview of how heroin addiction is currently addressed
in the UK. In addition, the prevalence and definition of recovery, and current theories of
recovery will be discussed followed by both an overview of what is known from the
literature regarding the initiation and maintenance of recovery, and a critical review of the
evidence base. The aims of this research are also presented.

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