Research project:

Addiction and recovery: a qualitative analysis of interviews with clients on an abstinence-based structured day-care programme

Gemma Salter, Sarah Davies and David Clark

Despite the vast sums of money devoted to the treatment of drug and alcohol problems in the UK, the processes by which recovery from addiction occurs remain fairly unclear. Moreover, we know relatively little about the contribution of treatment interventions and processes in facilitating such recovery.

The present study involved a detailed qualitative analysis into the processes involved in addiction and recovery, from the experiences of addicts currently in treatment, or recovering addicts using aftercare services following treatment, for drug and/or alcohol problems (all of whom were currently abstinent). Semi-structured interviews were conducted with fifteen participants, who were recruited from a drug and alcohol service which provides an abstinence-based, structured day care (community rehabilitation) programme. A Grounded Theory approach was adopted to analyse the transcribed data.

Seven major themes emerged from the analysis, which are referred to as: the nature of addiction and its development; the reasons/factors for use; the negative effects of use; the process of realisation; behaviour change; treatment; and recovery. The results have been integrated to form a model, which aims to provide a picture of the processes involved in developing a problem/addiction, the processes involved in behaviour change, the role of treatment, as well as the potential path to recovery.

It is suggested that the substance misuse problem was very powerful in nature, and after a rather gradual progression from participants' initial use, it resulted in a complete preoccupation with using. This led to a range of negative effects, which seemed to get rapidly out of control. Despite experiencing various negative effects, a wide range of factors/reasons seemed to promote participants' continued use of substances.

As the addiction developed, participants seemed to develop a realisation of the substance misuse problem and the need to change their behaviour, (influenced in part by an increase in the negative effects of use). The increase in the negative effects of use also seemed to be influential in tipping the balance in favour of behaviour change, rather than continued use, as these negatives gradually outweighed the opposing reasons/factors influencing continued use.

One of the most important factors in allowing successful behaviour change and promoting recovery was treatment, which seemed to produce a range of positive effects, although a range of other factors alongside treatment were also important in promoting behaviour change. In order to achieve the positive effects of treatment, certain positive components/needs were reported to be essential. A number of difficulties encountered in treatment were also identified.

This study has provided important information - from clients themselves - on the many factors that are important in achieving abstinence, in allowing recovery to be maintained in the longer term, and in potentially allowing an eventual exit from addiction.

If we are to improve the way that treatment is delivered and thereby reduce the problems that drugs and alcohol can cause to individuals, their families and friends, and communities we need to carry out research similar to this on a much larger scale. This qualitative approach must be adopted in studies with clients from a wide range of treatment services and interventions.

This will allow us to enhance our understanding of specific forms of treatment service/intervention, as well as make more generalised statements about treatment and recovery per se. This work will facilitate the planning and delivery of future services. Needless to say, we also need to carry out research with people who have recovered from a substance misuse problem without recourse to a treatment service.

Detailed report available in pdf format