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"Like an awakening" : transformative learning as identity transformation for men in recovery from addictions Jordan, Daniel James 2020

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 “LIKE AN AWAKENING”: TRANSFORMATIVE LEARNING AS IDENTITY TRANSFORMATION FOR MEN IN RECOVERY FROM ADDICTIONS  by DANIEL JAMES JORDAN B.A. (Hons.), Kwantlen Polytechnic University, 2017  A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF  THE REQUIREMENTS FOR THE DEGREE OF  MASTER OF ARTS in THE FACULTY OF GRADUATE AND POSTDOCTORAL STUDIES (Educational Studies)  THE UNIVERSITY OF BRITISH COLUMBIA  (Vancouver)  April 2020 © Daniel James Jordan, 2020   ii The following individuals certify that they have read, and recommend to the Faculty of Graduate and Postdoctoral Studies for acceptance, a thesis entitled:  “Like an awakening”: Transformative learning as identity transformation for men in recovery from addictions  submitted by Daniel James Jordan in partial fulfillment of the requirements for the degree of Master of Arts in Educational Studies   Examining Committee: Jude Walker, Assistant Professor, Educational Studies, UBC Supervisor  Robinder Bedi, Associate Professor, Educational and Counselling Psychology, and Special Education, UBC Supervisory Committee Member  Danya Fast, Assistant Professor, Medicine, UBC Supervisory Committee Member Pierre Walter, Professor, Educational Studies, UBC Additional Examiner     iii Abstract The purpose of this study was to examine the self-reported learning and transformation of men recovering from substance addiction who had attended a residential treatment centre in British Columbia (BC). Untreated addiction stems from and causes unacceptable levels of human misery and incurs serious social and economic costs. Treatment is a key strategy for lowering the costs associated with addiction. The thesis brings together transformative learning theory with theories of transformation from the recovery field to focus on identity transformation. It employed a narrative inquiry methodology due to its emphasis on subjective experiences of transformation. Data collected from a convenience sample of seven adult men were recorded, transcribed, and coded for themes. The study sought to answer three research questions: (1) What are some of the processes involved in personal transformation as reported by men recovering from addiction? (2) What are the contextual factors that facilitate, delay, or inhibit personal transformation as reported by these men in the context of residential addiction treatment? (3) How do the lives of these men, and their sense of identity as men, change as a result of their self-reported learning? The study concluded that (a) participants’ personal transformations involved rational and extrarational processes; (b) such transformations were facilitated by having a safe, private, and peaceful environment to engage in self-reflection and the presence of other men with whom they could relate and engage in meaningful conversation; and (c) participants’ identity transformations resulted in lifestyle changes—more meaningful relationships and work, helping others, and improved self-care—as well as positive changes in how they related to themselves, others, and the world. Study results have important implications for iv transformative learning theory and programs designed for men as adult learners situated in residential addiction treatment settings.   v Lay Summary This study looked at what happened to seven adult men who reported having had a personal transformation while, and subsequent to, attending residential addiction treatment. The men who experienced personal transformation reported significant changes in how they related to themselves, to others, and to the world. Changes in their personal identity included a greater sense of authenticity and spirituality. Participants also reported important lifestyle changes including more meaningful relationships, more fulfilling work, a desire to help others, and improved self-care. Important features of residential addiction treatment that assisted participants in their personal transformations included having a safe, private, and peaceful environment to engage in self-reflection and the presence of other men with whom they could relate and engage in meaningful conversation. This study is important for adult learners—or those working with them—in educational, therapeutic, and correctional settings.    vi Preface This thesis is original, unpublished, independent work by the author, Daniel James Jordan, and was granted ethical approval by the University of British Columbia Behavioural Research Ethics Board – Certificate Number H18-02636.   vii Table of Contents Abstract ................................................................................................................................... iii Lay Summary ........................................................................................................................... v Preface ..................................................................................................................................... vi Table of Contents ................................................................................................................... vii List of Tables ............................................................................................................................ x List of Figures ......................................................................................................................... xi Acknowledgements ................................................................................................................ xii Dedication .............................................................................................................................. xiii Chapter 1: Introduction .......................................................................................................... 1 Defining Recovery ................................................................................................................. 2 Defining—and Redefining—Transformative Learning ........................................................ 3 Why Study the Self-Reported Transformative Learning of Men Recovering From Addiction? ............................................................................................................................. 4 Social and economic consequences of untreated substance use and addiction and the need to improve current addiction recovery research. ....................................................... 4 The unique challenges of men as adult learners. ............................................................... 5 Contributing to the transformative learning research on men in residential addiction treatment settings and their recovery experiences following treatment. ........................... 7 Situating Myself, the Researcher ........................................................................................... 8 Personal interest. ................................................................................................................ 8 Professional interest. .......................................................................................................... 9 Sunshine Coast Health Centre ............................................................................................. 10 Purpose of Research ............................................................................................................ 10 Research questions. ......................................................................................................... 11 Significance of research ................................................................................................... 11 Chapter 2: Literature Review .............................................................................................. 13 Mezirow’s Perspective Transformation .............................................................................. 13 Part I: Identity and Transformation ..................................................................................... 16 Identity and identity transformation in transformative learning research ....................... 17 Identity and identity transformation in the addiction treatment and recovery literature. 19 Part II: The Processes of Transformative Learning ............................................................. 23 Transformative learning literature on rational and extrarational processes. ................... 24 Addiction treatment and recovery literature on psychological processes. ...................... 27 Contrasting Mezirow’s 10 phases of perspective transformation with the addiction treatment and recovery concepts of hitting bottom, turning point, and maintenance phase. ............................................................................................................................... 29 Hitting bottom, turning points, and maintenance in the addiction treatment and recovery literature. .......................................................................................................................... 30 Part III: Contextual Factors and Their Impact on Transformative Learning Outcomes ..... 36 viii Influences and transformative learning outcomes ........................................................... 38 Sociocultural contextual factors. ..................................................................................... 41 Material contextual factors. ............................................................................................. 42 Chapter 3: Methodology ....................................................................................................... 46 What Is Narrative Inquiry? .................................................................................................. 46 A Transformative Learning Argument for Narrative Inquiry ............................................. 48 Inclusion Criteria ................................................................................................................. 49 Participant Recruitment ....................................................................................................... 50 Overview of Participants ..................................................................................................... 51 Sampling Method ................................................................................................................ 51 Ethical Considerations ......................................................................................................... 52 Informed consent. ............................................................................................................ 53 Confidentiality. ................................................................................................................ 53 Rigour .................................................................................................................................. 54 Rapport building .............................................................................................................. 54 Reflexivity. ...................................................................................................................... 55 Data Collection .................................................................................................................... 56 Data Transcription and Analysis ......................................................................................... 57 Chapter 4: Results ................................................................................................................. 60 Part I: Holistic Analysis ....................................................................................................... 60 Eric’s story (#1). .............................................................................................................. 61 Sean’s story (#2). ............................................................................................................. 65 Ian’s story (#3). ................................................................................................................ 69 Nick’s story (#4). ............................................................................................................. 73 Scott’s story (#5). ............................................................................................................ 76 Ed’s story (#6). ................................................................................................................ 81 James’s story (#7). ........................................................................................................... 85 Part II: Synthesizing the Stories .......................................................................................... 91 Findings related to Research Question 1. ........................................................................ 91 Findings related to Research Question 2. ........................................................................ 94 Findings related to Research Question 3. ........................................................................ 96 Chapter 5: Discussion and Concluding Remarks ............................................................. 100 Part I: Putting the Research Findings in Context .............................................................. 100 Identity change. ............................................................................................................. 100 Phases of personal transformation. ................................................................................ 106 Types of personal transformation (transformative outcomes). ...................................... 107 Part II: Implications of Research Findings ........................................................................ 110 Implications for transformative learning theory ............................................................ 110 Implications for research on adult learning in residential addiction treatment and recovery settings. ........................................................................................................... 112 Limitations ..................................................................................................................... 114 Part III: Concluding Remarks ............................................................................................ 117 References ............................................................................................................................ 119 ix Appendices ........................................................................................................................... 140 Appendix A: Recruitment Ad ............................................................................................ 140 Appendix B: List of Counselling Services ........................................................................ 141 Appendix C: Consent Form ............................................................................................... 143 Appendix D: Research Interview Guide ............................................................................ 146   x List of Tables Table 1 The 10 Phases of Perspective Transformation ........................................................... 30 Table 2 Demographic Profile of Study Participants ............................................................... 52 Table 3 Summary of Turning Points by Participant ................................................................ 92 Table 4 Summary of Residential Treatment Contextual Factors by Participant .................... 94 Table 5 Summary of Identity and Lifestyle Changes by Participant ....................................... 97    xi List of Figures Figure 1. The three phases of personal transformation. ........................................................ 106 Figure 2. Progressive, restoring, and regressive transformations. ........................................ 108   xii Acknowledgements This project is indebted to the late Patricia Cranton for her skillful translation of transformative learning theory. Her book Understanding and Promoting Transformative Learning (3rd ed.) was my trusted reference and reminder not to overcomplicate my writing.    xiii Dedication To Cathy, Melanie, and Gina who, each in their own way, made this study possible.   1 Chapter 1: Introduction For the past 16 years, I have dedicated my professional life to Sunshine Coast Health Centre (“Sunshine Coast”), a 40-bed residential addiction treatment facility located in Powell River, British Columbia (BC). I had originally pursued a graduate degree in adult learning and education as part of a larger plan to improve the design and delivery of psychoeducation workshops offered daily at Sunshine Coast. Workshop attendance had been poor and program evaluations failed to identify any salient benefits for those who did attend. I quickly changed my focus from program planning and evaluation to an examination of transformative learning, and how it might relate to addiction recovery,1 after participating in an introductory theory course as a first-year master’s student. My inspiration for choosing transformative learning theory (Mezirow, 1978a) was the same then as it is now: The addiction field could benefit from a life-affirming theory that posits transformation—significant, enduring, and positive change (“meaningful change”)—as its central focus. A small but significant group of men who completed the program at Sunshine Coast reported having experienced moments of transformation before, during, and after treatment. Their stories of crisis followed by meaningful change are detailed and examined in this thesis.  In this study, I argue that it is useful to explore how transformative learning theory and addiction recovery frameworks can be brought together to illuminate how some men undergo meaningful change in response to certain adult learning contexts, such as residential addiction treatment. In the remainder of this introductory chapter, I provide a definition of  1 Although this study does not interrogate the nature of addiction or explore addiction per se, it is useful for me to define addiction. Given that this study deals with men struggling with drug and alcohol use, I adopted the Centre for Addiction and Mental Health’s (n.d.) definition of ‘addiction’ as “the problematic use of a substance” (para. 1). 2 recovery; a definition—and proposed redefinition—of transformative learning; the rationale for this study, the purpose of the study; the questions I sought to answer; including my personal and professional interest in the research questions; and the study’s significance. Defining Recovery  My interpretation of recovery is intimately connected to my understandings of transformation. In this study, I drew on Deegan (1988) to define recovery as “a new sense of self and of purpose within and beyond the limits of disability” (p. 54). I have chosen this definition because it recognizes identity as the object of change and privileges subjective experiences of transformation. By using the term identity, I am referring to how we relate to ourselves, others, and the world. In recovery contexts like the one I studied, I argue that acquiring a new sense of self and purpose involves psychological processes which are facilitated, delayed, or inhibited by context. My definition of recovery also recognizes the importance of outcomes. An emphasis on behavioural change as an outcome is common in many definitions of addiction recovery. For example, often-cited Betty Ford Institute Consensus Panel (2007) defined recovery as a “voluntarily maintained lifestyle characterized by sobriety, personal health and citizenship” (p. 222). W. L. White (2007) defined recovery as abstinence from problematic substance use, enhancement of global health, and positive community engagement. However, I argue that recovery does now always involve complete abstinence from substance use. Instead, I examine recovery as a process of identity transformation that involves particular psychological processes, contextual factors, and outcomes that include, but also go beyond, abstinence from substance use.  3 Defining—and Redefining—Transformative Learning Adult educator Jack Mezirow introduced transformative learning theory in 1978, based on a study of mature female students returning to college (Mezirow, 1978a). Mezirow (1990) defined transformative learning as “the process of learning through critical self-reflection, which results in the reformulation of a meaning perspective to allow a more inclusive, discriminating, and integrative understanding of one’s experience, [and] acting on these insights” (p. xvi). The concept of meaning perspective is foundational to transformative learning; a meaning perspective refers to the “structure of assumptions within which new experience is assimilated and transformed by one’s past experience during the process of interpretation” (Mezirow, 1990, p. 2). Critical self-reflection involves an “assessment of the way one has posed problems and of one’s own meaning perspectives” (Mezirow, 1990, p. xvi).  For this study, I have adopted Mezirow’s (1978b) earlier definition of transformative learning in which he conceived of perspective transformation as “a structural change in the way we see ourselves and our relationships” (p. 100) and Merriam, Caffarella, and Baumgartner’s (2007) definition of transformative learning as a “dramatic, fundamental change in the way we see ourselves and the world in which we live” (p. 130). Both Mezirow (1978b) and Merriam et al.’s (2007) definitions connect directly to my understandings of identity (i.e., how we see ourselves and the ways in which we live). Defining transformative learning as such is a more holistic and integrative response to transformative learning contributor Kegan’s (2000) question, “What ‘form’ transforms?” (p. 35). In Chapter 2, I examine the literature from transformative learning and addiction to lend support for 4 Deegan’s (1988) definition of recovery and Mezirow’s (1978b) original definition of perspective transformation. Why Study the Self-Reported Transformative Learning of Men Recovering From Addiction? There are three main reasons I undertook this study and why it is significant to the fields of adult education and addiction treatment: (a) the urgency of the addiction crisis and the inadequacy of current research, (b) the unique challenges of men as adult learners, and (c) the need for research focused on transformative learning processes among men in residential addiction treatment and their recovery experiences following treatment. I explore all three reasons below. Social and economic consequences of untreated substance use and addiction and the need to improve current addiction recovery research. Untreated addiction has serious social and economic consequences. According to the Canadian Institute for Health Information (2019), 10 Canadians die in hospital every day due to harms caused by substance use. In April 2016, the province of BC declared opioid-related overdose deaths from drug poisoning a public health emergency. Since then, over 4,500 British Columbians have lost their lives to overdoses. For the first time in 40 years, Canadian life expectancy at birth did not increase from 2016 to 2017 due to the opioid crisis (Statistics Canada, 2019). In 2014, the costs associated with substance use and addiction in Canada—primarily lost productivity, healthcare, and criminal justice—amounted to $38.4 billion (Canadian Substance Use Costs and Harms Scientific Working Group, 2018). Research on addiction treatment has demonstrated a lack of treatment efficacy and a lack of theoretical integration. In a meta-analysis of published studies, Hester and Miller 5 (2003) found that only 19 of the 99 treatments for alcohol addiction demonstrated efficacy. According to Thompson (2014), dozens of theories of addiction have attempted to explain why individuals engage in addictive behaviours despite their recognition that such behaviours lead to negative consequences. Most theories of addiction provide partial explanations and lack the ability to integrate addiction’s biological, psychological, social, and spiritual dimensions (DiClemente, 2018). Given the current state of addiction theory and treatment, the present study explores adult education and learning, particularly transformative learning theory, as a possible alternative framework for understanding addiction and recovery from addiction.  The unique challenges of men as adult learners. The present study argues that transformative learning research and practice is highly applicable to Canadian men experiencing concurrent substance use and mental health disorders, who become adult learners when they enter treatment contexts. Educators, therapists, and researchers need to understand this group. Although men have advantages in terms of careers and pay when compared to women, they are relatively disadvantaged when it comes to health, including mental health and addiction (W. Courtenay, 2000; A. W. White, 2011). Culturally idealized forms of masculinity, or “hegemonic masculinities” (Donaldson, 1993, p. 645) mean that men are often more likely to engage in unhealthy lifestyles (De Visser, Smith, & McDonnell, 2009; Ryu, Park, Choi, & Han, 2014), high-risk or suicidal behaviours (Brownhill, Wilhelm, Barclay, & Schmied, 2005; Cleary, 2012, 2017; P. J. Fleming, Lee, & Dworkin, 2014; Keogh, 2015; Loef & Walach, 2012), and addictive behaviors (Cleary, 2012; Möller-Leimkühler, 2002; van Wormer, 1989). Canadian men are 2.56 times more likely than women to report symptoms consistent with substance use disorders (Pearson, Janz, & Ali, 6 2013). Since the province of BC declared the overdose crisis a public health emergency, men have accounted for 80 percent of suspected illicit drug toxicity deaths (British Columbia Coroners Service, 2019). Studies have found that men tend to have shorter residential addiction treatment stays (Choi, Adams, Morse, & MacMaster, 2015) and have relatively poorer addiction treatment outcomes compared to women (Dawson et al., 2005; Green, 2006; Green, Polen, Lynch, Dickinson, & Bennett, 2004; Weisner, Delucchi, Matzger, & Schmidt, 2003).  Research in adult education is needed to examine the impacts of hegemonic masculinities on men as adult learners in settings like recovery centres. Previous studies in general have found that cultural ideals of manhood which valorize physical resilience and self-reliance make it more difficult for men to self-disclose vulnerabilities, seek mental healthcare, engage in mental-health-promoting activities, and achieve positive mental health outcomes (W. Courtenay, 2000; Galdas, Cheater, & Marshall, 2005; Lynch, Long, & Moorhead, 2018; Seidler et al., 2016; Yousaf, Popat, & Hunter, 2015). According to Jewkes et al. (2015), “Allowing space to engage with men’s vulnerability is a key element in exploring masculine identities, as well as allowing men to feel supported and accepted” (S117–S118). Indeed, residential addiction treatment centres can create the space to allow men, who had previously been heavily invested in hegemonic notions of masculinity that centre on notions of self-reliance and strength, to open up about emotional problems and their problematic ways of dealing with them (e.g., substance use; Cleary, 2012). Gay men in particular may also benefit from safe spaces in which they can question idealized masculine norms, as these norms are perhaps constructed as “not gay” just as often as they are constructed as “not female” (Jewkes et al., 2015). For these reasons, there is much to learn 7 from the experiences of men who self-report experiences of transformation as a result of participating in residential addiction treatment. Contributing to the transformative learning research on men in residential addiction treatment settings and their recovery experiences following treatment. Overall, few studies have drawn on transformative learning theory to examine men’s experiences during and after residential addiction treatment; the present study is a contribution towards filling this gap in the literature. An exception is Voigt’s (2013) narrative study of participants in a faith-based residential addiction treatment centre. Male participants reported having greater self-awareness due to its “web of activities” (Voigt, 2013, p. 91) that included numerous opportunities for formal and informal learning. Two transformative learning studies have involved incarcerated women experiencing addiction (Brooks & Clark, 2001; Sandoval, Baumgartner, & Clark, 2016). Brooks and Clark (2001) profiled Reba, a woman of colour incarcerated for a drug-related crime, whose need to protect her son during her incarceration was problematized by a sense of powerlessness and ambivalence about giving up drugs. Sandoval et al.’s (2016) study found that offering incarcerated women programming that helped them learn from their experiences facilitated transformation.  The majority of studies employing transformative learning theory to examine recovery narratives have focused on members of Twelve Step support groups (Hansen, Ganley, & Carlucci, 2008; Hough, 1995; Turley, 2011; Ventresca, 2012). Turley’s (2011) study of human service workers in recovery found that participation in Alcoholics Anonymous (AA) and its culture of storytelling fostered a new identity in recovery. Hough’s (1995) study examined how the organizational structure of AA and the support of AA sponsors contributed to the transformation of AA members by facilitating critical self-8 reflection.2 Ventresca’s (2012) transformative learning study found that the storytelling element of Narcotics Anonymous (NA) meetings helped female attendees maintain their recoveries from cocaine addiction. Finally, Pereira’s (2008) research involving eight female members of AA in recovery found that questioning “dysfunctional myths” (p. v) developed in childhood sparked recovery. Participants in Pereira’s study were able to reframe negative self-concepts into positive ones with the support of their AA support groups, their children, and other significant relationships. Situating Myself, the Researcher This study is connected to both my personal and professional interests and experiences in specific ways.  Personal interest. My experience with personal transformation is consistent with Mezirow’s (1991) research. In my case, dropping out of university was the trigger event for my personal transformation. I was an excellent student in high school and had planned to become an engineer but had to withdraw in my freshman year at the University of Alberta due to poor grades. I was devastated. Fortunately, my mother Cathy had recently completed Erhard Seminar Training (EST)—a two-weekend intensive self-actualization course popular in the 1970s and 80s. She encouraged me to register, and I accepted. A few weeks later, I joined about 500 other participants in a large hotel ballroom in downtown Vancouver. Witnessing strangers share their stories was a transformative experience. I was able to reflect and get some needed perspective. After EST, I got on with my life. I married Gina and became a father. Although being the breadwinner for my family was difficult, I never lost hope, even after several unsuccessful business ventures. My fourth endeavour proved  2 An AA sponsor is a seasoned member of AA who provides support and guidance to more recent AA members.  9 successful: In 2004, I cofounded Sunshine Coast with my mother Cathy and sister Melanie. Sunshine Coast has since served over 3,000 men from all over Canada struggling with addiction and concurrent mental health disorders. To this day, I continue to draw strength from my transformative experience. Part of my motivation for this study was to better understand my own transformation by speaking with other men who have self-reported as having had similar experiences.   Professional interest. Another inspiration for this study was the exploration of identity transformation as a goal of addiction treatment. Addiction researchers W. L. White and Kurtz (2006) distinguished between “complete cessation of alcohol or other drug use in an otherwise unchanged life to a complete transformation of one’s personal identity and interpersonal relationships” (pp. 6–7). Similarly, AA cofounder Bill Wilson distinguished between sobriety and emotional sobriety, the latter being “real maturity . . . in our relations with ourselves, with our fellows, and with God” (Wilson, 1958, para. 1). I believe that reimagining recovery as identity transformation could prove inspirational to individuals in treatment, helping them navigate through the formidable challenges that are often part of the recovery experience.  I also believe strongly in giving voice to men with addiction, which can strengthen their prospects for recovery. Research by the U.S.-based Committee on the Science of Changing Behavioral Health Social Norms (2016) found that including the stories of people in recovery was also an effective way to change negative public opinion associated with mental health and addiction. It is for these reasons that I adopted a narrative approach to answering my research questions. It is my hope that these seven men’s stories will encourage 10 others in recovery to come forward to share their stories. Empowering those in recovery from addiction to tell their stories seems critical to transforming the way society views addiction.  Sunshine Coast Health Centre A brief overview of Sunshine Coast is necessary given that it was the setting for participants’ self-reported personal transformations. Sunshine Coast is part of my family’s 40-year involvement in residential healthcare. A provincially licensed, for-profit residential addiction treatment centre for men, Sunshine Coast is located on 12 acres of rural oceanfront near Powell River, BC. Opened in 2004, it followed a Twelve Step model of addiction treatment but switched in 2009 to a non–Twelve Step, integrated mental health model in response to the growing number of individuals who presented with concurrent trauma and addiction. Since its opening, Sunshine Coast has been an all-male facility based on research supporting gender-specific addiction treatment (Prendergast, Messina, Hall, & Warda, 2011; Sugarman et al., 2016). Individuals or their families, employers, or unions typically cover the cost of treatment at Sunshine Coast because it is a private-pay facility. Sunshine Coast also has an agreement with the federal government to treat active and retired members of the Canadian Armed Forces and with various provincial workers’ compensation boards to treat workers who are on disability due to occupational trauma.  Purpose of Research The purpose of the present study was to examine the form, psychological processes, and contextual factors identified by men in recovery from addiction as contributing to their self-reported personal transformations before, during, and after residential addiction 11 treatment.3 It is important to note that this study was not an attempt to identify the most effective method of treating addiction, nor was it a critique of residential addiction treatment. Rather, my goal was to better understand the experiences of men in recovery through the lens of transformative learning and theories of transformation from the addiction treatment and recovery field. Furthermore, this study examined how their experiences could inform transformative learning theory and theories of recovery.  Research questions. The research questions for this study were as follows: (1) What are some of the processes involved in personal transformation as reported by men recovering from addiction? (2) What are the contextual factors that facilitate, delay, or inhibit personal transformation as reported by these men in the context of residential addiction treatment? (3) How do the lives of these men, and their sense of identity as men, change as a result of their self-reported learning? I used the terms self and identity throughout this study and treated them as equivalent in meaning.4 Significance of research. This research furthers current understandings of the processes and learning that can be involved in personal transformation via addiction treatment and recovery. The findings of this study have implications for residential addiction treatment settings, for addiction treatment more generally (and what aspects of it are funded), for educators interested in fostering transformative learning among their adult students, and for adult learners interested in understanding their own journeys of transformation. Further,  3 I use the terms man/woman/person/individual or men/women/persons/people with an addiction or in recovery instead of alcoholic, addict, or recovering addict. This practice is consistent with the American Psychiatric Association’s (2013) Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which classifies mental disorders, not human beings.  4 Tennant’s (2005) review of self and identity in transformative learning concluded there was no agreed-upon distinction between the terms, and thus it was best to consider them interchangeable. 12 this thesis can be understood as a translational piece promoting cross-learning between the fields of adult education and addiction treatment and recovery, by drawing on literature from across diverse disciplines.  The remainder of this thesis is organized as follows. Chapter 2 is a review of the literature on identity transformation, the processes of transformative learning (including its psychological processes and phases), and transformative learning outcomes as partially determined by sociocultural and material contextual factors. Chapter 3 details the study’s methodology. I present the results in Chapter 4. Chapter 5 discusses the study’s results and its implications.    13 Chapter 2: Literature Review The objective of this literature review is to lend support for the integration of transformative learning and addiction recovery frameworks to reveal how some men undergo meaningful change in some addiction treatment and recovery contexts. The literature review is arranged in three parts. Part I examines the adult education, transformative learning, and addiction treatment and recovery literature as it relates to identity and identity transformation. Part II concerns processes of transformation, which include psychological processes and phases of transformation. Part III examines the transformative learning literature on contextual factors and transformative outcomes. Part III also includes an examination Lawrence and Cranton’s (2015) facilitating, delaying, and inhibiting influences and Illeris’s (2014) progressive, restoring, and regressive transformations.  Mezirow’s Perspective Transformation Before examining the notion of transformative learning as identity transformation, it is necessary to examine the traditional view of transformative learning as perspective transformation and five important concepts considered fundamental to perspective transformation: namely, disorienting dilemmas, critical self-reflection, reflective discourse, and the differences between epochal and incremental perspective transformation. Mezirow (1978b) first developed the notion of perspective transformation in the 1970s while reflecting on the powerful learning undergone by women returning to college. In developing his theory, Mezirow drew on educator and philosopher Paulo Freire’s (1970) concept of conscientization, which described the coming to a greater consciousness of how the world is—in particular with regards to historical and current power and material inequities and injustice—resulting in a desire to engage in social action. Yet Mezirow, as with many others 14 who have contributed to transformative learning theory, focused much more on individual transformative learning processes rather than processes of social transformation. This is similarly the case in this study, which privileged individual identity transformation as subjectively experienced by the men I interviewed.   Perspective and perspective transformation are central to Mezirow’s transformative learning theory. Mezirow (1990) defined a perspective, or meaning perspective, as the “structure of assumptions within which new experience is assimilated and transformed by one’s past experience during the process of interpretation” (p. 2). A meaning perspective acts as a filter on “what we do and do not perceive, comprehend, and remember” (Mezirow, 1990, p. 4). Meaning perspectives provide the criteria for people’s beliefs and values and are typically acquired, often uncritically, during childhood through socialization with authority figures (e.g., parents, teachers, and peers). Perspectives are the object of transformation in transformative learning (i.e., perspective transformation). Mezirow (1994) considered perspective transformation to be the “engine of adult development” (p. 224). He defined perspective transformation as the process of becoming critically aware of how and why our presuppositions have come to constrain the way we perceive, understand, and feel about our world; of reformulating these assumptions to permit a more inclusive, discriminating, permeable, and integrative perspective; and of making decisions or otherwise acting upon these new understandings. (Mezirow, 1990, p. 14)  Adulthood provides an opportunity to evaluate the assumptions acquired during childhood. However, perspective transformation is difficult work. When perspectives are challenged, people experience discomfort. Mezirow (1990) referred to an experience which challenges fundamental assumptions as a disorienting dilemma. Mezirow (1991) described challenges to existing meaning perspectives as difficult because “they often call into question deeply held personal values and threaten our very sense of self” (p. 168).  15 Disorienting dilemmas often follow “externally imposed events” (Mezirow, 1990, p. 13) which act as triggers for critical self-reflection, e.g., an acute personal crisis involving employment, relationships, or health; or an acute social crisis such as a natural or human-made disaster (Taylor, 2008). Critically reflecting on assumptions can lead to “significant personal and social transformation” (Mezirow, 1998, p. 186). Mezirow (1990) defined critical self-reflection as “reassessing the way we have posed problems, and reassessing our own orientations to perceiving, knowing, believing, feeling, and acting” (p. 13). In numerous works, Freire (1970, 1985, 1992, 1998; see also Freire & Freire, 1994) spoke to the centrality of critical reflection and dialogue to conscientization, and how educators can facilitate the learning, and ultimately self-empowerment, of individuals and communities. Freire’s (1970) impact on transformative learning theory is evident in this regard. As with Freire, dialogue is central to Mezirow’s (1990) transformative learning theory. Mezirow (2006) used the term reflective discourse (formerly rational discourse) to distinguish between ordinary and meaningful conversations. When people engage in reflective discourse, they suspend prior judgements and biases, revealing otherwise hidden beliefs, feelings, and values (Mezirow, 2006).  According to Mezirow (2006), transformations in meaning perspectives can be epochal or incremental. Epochal transformations are sudden and dramatic reorientations in meaning perspectives, whereas incremental transformations involve a series of changes in points of view that accumulate into a transformed meaning perspective. Cranton (2016) considered incremental transformation the more common variety. Dirkx’s (2000) application of Jung’s individuation to transformative learning involved incremental transformation instead of the “burning bush” (p. 247) variety and is discussed further below.  16 In sum, perspective transformation is central to understanding other transformative learning concepts, including critical self-reflection, reflective discourse, disorienting dilemmas, and epochal and incremental perspective transformations. These concepts were also central to this study and its goal of developing a more integrative and holistic transformative learning theory, particularly as it applies to addiction treatment and recovery contexts. In the remainder of this review, I examine the literature on identity transformation as a reframing and extension of perspective transformation. I focus on: emotional, spiritual, imaginative, and unconscious processes as important additions to Mezirow’s (2006) mostly rational processes of critical self-reflection and reflective discourse; addiction treatment and recovery notions such as hitting bottom, turning points, and maintenance phases as alternatives to Mezirow’s (1991) 10 phases of perspective transformation; and Illeris’s (2014) progressive, restoring, and regressive transformations as an expansion of Mezirow’s (2006) epochal and incremental transformations.  Part I: Identity and Transformation  I argue that identity is central to both transformative learning and recovery from addiction. Recall that my definition of identity is consistent with Mezirow’s (1978b) definition of perspective transformation as “a structural change in the way we see ourselves and our relationships” (p. 100) and Deegan’s (1988) definition of recovery as “a new sense of self and of purpose within and beyond the limits of disability” (p. 54). Part I of this literature review lends support to the idea that identity is a unifying and integrating concept in transformative learning theory and can usefully be employed to understand the experiences of men who self-reported as having experienced personal transformation while attending residential addiction treatment. I begin with a review of the transformative learning literature 17 that has described identity as the object of transformation. Part I concludes with a review of the addiction treatment and recovery literature on identity transformation.  Identity and identity transformation in transformative learning research. A review of the transformative learning literature found numerous references to identity and identity transformation, starting with Mezirow’s (1978b) work mentioned above. Tisdell (2012) suggested that a person’s “very core identity or worldview” (p. 25) transforms when one has a transformative learning experience. According to Tisdell (2012), Mezirow was “primarily concerned with [transformative learning experiences] that facilitate major identity or worldview shifts” (p. 25). Illeris (2014) proposed a new definition of transformative learning as “all learning which implies change in the identity of the learner” (p. 40). For Dirkx (2007), “transformative learning suggests a fundamental shift in our sense of who we are or ways of being-in-the-world, a movement towards the truth of our story” (p. 111). Merriam et al. (2007) defined transformative learning as a “dramatic, fundamental change in the way we see ourselves and the world in which we live” (p. 130).  According to Tennant (2005), transformative learning studies “contain within them [implicit and explicit] assumptions about self and identity and the relevance of society to personal formation of change” (p. 102). A brief review of Tennant’s (2005) categories of self is relevant to the findings of this study. Conceptions of the authentic (real or core) self make two assumptions. First, the notion of an authentic self assumes that there is an “essential” self that “remains constant with the flux of changing relationships and roles” (Tennant, 2012, p. 17). Psychological theories range in the extent to which they posit an essential self. For example, one view is that the self is largely inherited and thus biologically predetermined. Other psychological theories recognize a larger role for relationships and a comparatively 18 diminished essential self. Second, the notion of an authentic self assumes that society can have a “distorting and distracting influence” (Tennant, 2005, p. 104) on the self, leading individuals to pursue goals, such as working long hours as a means of attaining material wealth, that are not aligned with their true selves. Conceptions of an authentic self are based on humanistic and developmental psychology, as well as psychoanalytic and Jungian theory. Transformative learning proponents of an authentic self include Cranton (2006), Daloz (1986), Dirkx (2001), Fenwick (1998), Illeris (2014, 2016), Kegan (2000), and Mezirow (1991).  Tennant (2005) also put forward the concept of a storied self in the transformative learning literature. One version of the storied self understands stories as narratives that are jointly constructed by the person and their culture. Stories have an integrative function that bring meaning and coherence to a person’s past, present, and anticipated future. Stories can be constrained by the social settings within which they are situated. The second version of the storied self sees selves as “multiple, shifting, open-ended, and ambiguous” (Tennant, 2005, p. 106) or as a “multiplicity” (Dirkx, 2007, p. 113). Rather than a unitary sense of storied self, a multiple sense of storied self assumes a self consisting of interacting “self-narratives and relational narratives” (Dirkx, 2007, p. 113). Research by Clark (2001, 2010), Clark and Dirkx (2000), and Rossiter (1999, 2004, 2007) are examples of transformative learning that assume a storied self. Rossiter (2007) distinguished a narrative understanding of identity in which the “self is understood as unfolding story rather than as a static state” (p. 92).  Separately, Dirkx (2007) identified the influences of transpersonal psychology and the wisdom traditions in transformative learning’s conception of the transcendent self. 19 Transformative learning research on the transcendent self conceives of transformation in more spiritual terms—as the process of becoming aware that transpersonal forces are at work, influencing how one understands the self, self-change, and one’s place in the universe. A study by B. C. Courtenay and Milton (2004) found that adult learners in their study described spirituality as a “dynamic force that acted in and through their lives” (p. 103), whereas adult educators defined spirituality as an “awareness of a transcendent force or energy that is beyond self” (p. 103). English’s (2000) study of adult learners found that adults engaging with other adult learners and instructors facilitated the development of a “stronger sense of self, which is integral to spiritual development” (p. 30). Research by Fenwick and English (2004) on the self and spirituality identified a Judeo-Christian spirituality in which “surrender of self is a key dimension” (p. 54).5 The authors identified how this view of spirituality often clashes with the spiritual view of self that seeks to “celebrate and glorify self . . . and pamper one’s ‘authentic’ self” (Fenwick & English, 2004, p. 54). These different views of the spiritual self are relevant to this study’s findings and are discussed further in Chapters 4 and 5.   Identity and identity transformation in the addiction treatment and recovery literature. There is a large body of literature in the addictions recovery field that focuses on identity and identity transformation. The pioneering psychologist William James (1917) equated recovery from addiction as identity transformation. James (1917) described individuals experiencing addiction as suffering from a divided self, in which the reality of the current self stands in contrast to the anticipated and desired self. Intoxication is a way to help  5 AA also emphasizes religious surrender. According to W. L. White (2007), AA posits recovery as a “surrender and transcendence of self” (p. 238).  20 a person feel alive, to tap into a mystic consciousness one craves: “Sobriety diminishes, discriminates, and says no; drunkenness expands, unites, and says yes. It is in fact the great exciter of the Yes function in man. It brings its votary from the chill periphery of things to the radiant core” (James, 1917, p. 387). Although seeking alcohol or drug-induced highs can indeed offer people a feeling of being alive, James ultimately concluded that drink is incapable of uniting a divided self because the experience it brings is fleeting: “The sway of alcohol over mankind is unquestionably due to its power to stimulate the mystical faculties of human nature, usually crushed to earth by the cold facts and dry criticisms of the sober hour” (James, 1917, p. 387). For James (1917), unification of a divided self, which is “[the] sense that there is something wrong about us as we naturally stand, . . . [is a] sense that we are saved from the wrongness by making proper connection with the higher powers” (p. 499).  Spontaneous recovery, quantum change, and the Twelve Step’s addict identity are three contemporary examples of identity transformation located in the addiction treatment and recovery literature. Research on the phenomenon of spontaneous recovery—defined as recovery that does not involve attending mutual support group meetings or addiction treatment—has linked identity to recovery from addiction. For example, Biernacki (1986) interviewed 101 untreated adults living in San Francisco who had been in recovery from opiates for a minimum of two years. Biernacki located three identity-related recovery pathways: (a) returning to a preaddiction identity, (b) switching to another identity that coexisted with the identity associated with addiction, and (c) adopting a newly emergent identity. Research by Klingemann (1991) found that individuals who achieved spontaneous recovery went through three stages: an initial motivation to change, a decision to implement change, and, finally, the adoption of a new identity. Castel et al. (1998, as cited in Taïeb, 21 Révah-Lévy, Moro, & Baubet, 2008) studied 51 adults in recovery who had not previously received addiction treatment and concluded that “recovery could be some form of mastery over the autobiographical discourse, an acquired ability to see oneself through an image, through a determined, coherent, structured identity that can in some cases be positive” (p. 56).  Another spontaneous recovery study by Stall and Biernacki (1986) found that many individuals in recovery from addiction defined themselves based on societal roles and a subjectively more “ordinary” identity while rejecting being identified with their history of addiction (p. 11; see also Johansen, Brendryen, Darnell, & Wennesland, 2013). A significant life event, traumatic or otherwise, can often act as a “powerful catalyst to irrevocably change and reorient the remitter’s self-concept and corresponding perspective” (Stall & Biernacki, 1986, p. 16). A study by Tuchfeld (1981) identified a crisis of identity as a reason for initiating spontaneous recovery. Finally, Walters’s (2000) spontaneous recovery study found that individuals relied upon identity transformation strategies to maintain their recovery.  Quantum change is another example of identity transformation found in the addiction treatment and recovery literature. Addiction researcher William Miller (2004) described quantum change as a change in “identity, [a person’s] fundamental perceptions of self and reality” (p. 458). Participants in Miller’s research on quantum change reported changes in values and priorities, relationships, and worldviews. Participants also attributed their abstinence from alcohol as having had experienced a “sudden and complete loss of the desire to drink” (Miller & C’de Baca, 1994, p. 272). Finally, Miller and C’de Baca (2001) found that quantum change differed from incremental change based on its emotional intensity, suddenness, positive impact, and permanence of effect.  22 Identity transformation is also at the heart of Twelve Step programs, which have long been a form of peer support and addiction treatment.6 Those attending Twelve Step meetings introduce themselves in a way that cultivates an “addict identity”: “Hello, my name is _______, and I am an alcoholic/addict.” Addiction researchers have studied how Twelve Step members develop addict identities (Cain, 1991; Peteet, 1993; Prussing, 2007; Schnall, 1980; see also Burrell & Jaffe, 1999; Denzin, 1993; Hurst, 1997; Larkin & Griffiths, 2002; Ringwald, 2002; Shinebourne & Smith, 2009). Cain’s (1991) study of AA participants found that recovery involves a “transformation of identity, of how one understands oneself—from a drinking to a non-drinking alcoholic” (p. 244). A study of Native American women attending AA examined how recovery involved a socially negotiated identity change that differed by generation (Prussing, 2007). For older women, recovery meant returning to Native American traditions practiced as children. For younger women whose childhoods were already chaotic due to alcoholism, the Twelve Steps provided a new, non-drinking identity, formed through an “extended process of psychological transformation” (Prussing, 2007, p. 514). Research by Schnall (1980) posited Twelve Step recovery as a process of identity reconstruction involving internalizing new attitudes and values, assuming new roles and responsibilities, and developing supportive relationships. According to Peteet (1993), “Identification with the [Twelve Step] Program becomes not only a turning point, but [participants’] primary identity” (p. 264).   6 I used the term Twelve Steps collectively to refer to mutual support groups that are based on the Twelve Steps of Alcoholics Anonymous, such as Cocaine Anonymous and Narcotics Anonymous. References that are specific to a particular group are stated as such. SMART Recovery (which stands for self-management and recovery training) provides non–Twelve Step mutual support and is not, therefore, considered a Twelve Step program. 23 Part II: The Processes of Transformative Learning Having examined the literature on identity and identity transformation, I now turn to the processes involved in transformation as described in the transformative learning and the addiction treatment and recovery literature. Part II is divided into two sections. In the first section, I examine the transformative learning literature, which makes two references to processes that are relevant to this study: psychological processes and phases as processes. Briefly, transformative learning contributors have identified both rational and extrarational psychological processes. In the second section, I review the addiction treatment and recovery concepts of hitting bottom, turning points, and maintenance. These concepts are important to this study given that they resemble Mezirow’s (1991) 10 phases of perspective transformation, which I describe in detail below.  A brief note on terminology is necessary before proceeding further. I use the term psychological processes but could have just as easily used other transformative terms with similar meanings (e.g., dimensions, ways of being, life domains, and approaches). Mezirow (1991), for example, argued that “perspective transformation often involves profound changes in self, changes with cognitive, emotional, somatic, and unconscious dimensions” (p. 177, emphasis added). Barton, Ivanic, Appleby, Hodge, and Tusting (2007) described adult learners’ ways of being—their social, psychological, and affective characteristics—which formed their identities (p. 18). Tisdell (2012) described the transformation of one’s self as involving multiple life domains—the rational and cognitive, emotional, spiritual, and physical. Tisdell’s (2003) use of the term spirituality reflects a life domain perspective (see below). Following Stuckey, Taylor, and Cranton (2014), who distinguished transformative learning processes from transformative learning outcomes, I prefer the term processes. 24 According to Cranton (2016), separating processes from outcomes “may be helpful in understanding how an integrative theory can be developed” (p. 41).  Transformative learning literature on rational and extrarational processes. Mezirow (2009) described transformative learning as “essentially a metacognitive process of reassessing reasons supporting our problematic meaning perspectives” (p. 96). Kegan (2000) concluded that transformative learning involves a transformed epistemology, or way of knowing, to distinguish it from “informational kinds of learning” (p. 47) or a “change in behavioral repertoire” (p. 48). Mezirow (2006) identified critical self-reflection and reflective discourse as the primary mechanisms by which transformation occurs. According to Feinstein (2004), “Without these processes, it is unlikely that an act of learning will be truly transformative” (p. 109). Other transformative learning contributors, however, have criticized the theory for being too narrowly defined as a cognitive and rational process and have argued for the inclusion of other learning processes (Dirkx, 1997; Mälkki, 2010; Merriam & Caffarella, 1999). Dirkx (2012) posited that transformative learning is a meaning-making form of learning that involves both rational and extrarational processes. According to Cranton (2016), understanding the processes involved in transformative learning and how they “coexist” (p. 41) is important to developing an integrated and holistic theory. I now provide a brief overview of the main extrarational processes found in the transformative learning literature—emotional, spiritual, imaginative, unconscious, and relational processes.  Emotional processes. According to O’Sullivan (2012), the difference between a transformative and nontransformative event is its accompanying emotions. Adult educators have long understood that emotions represent a significant and distinct way of knowing 25 (Heron, 1992) and a “means of more fully grasping the wholeness of one’s experience” (Clark & Dirkx, 2008, pp. 91–92). Emotional processes often overlap with other psychological processes.   Spiritual processes. Tisdell (2003, 2012) has made several contributions to the transformative learning research linking spirituality and identity transformation. Tisdell’s (2003) study of adult educators found that spirituality helped women and people of colour develop a more integrated sense of identity. Charaniya’s (2012) research found that spirituality has transformative potential, changing how adult learners see “the world, how they see their own identities, and how they see their own role in the world” (p. 238). Imaginative processes. Mezirow (2000) recognized the importance of art and imagination to transformative learning: “Art, music, and dance are alternative languages. Intuition, imagination, and dreams are other ways of making meaning” (p. 6). Elsewhere, Mezirow (2006) wrote that “imagination of how things could be otherwise is central in the initiation of the transformative process” (p. 29). Dirkx (2001) recognized the role of imaginative processes and identity transformation: “Personally significant and meaningful learning is fundamentally ground in and derived from the adult’s emotional, imaginative connection with the self and with the broader social world” (p. 64). Engaging the emotions through imagination work—e.g., dance, poetry, or the visual arts—provides an opportunity for adult learners to experience firsthand the role emotions play in how they make sense of their lives.  Unconscious processes. Mezirow (2012) recognized the influence of unconscious processes on the adult learner: “Transformation theory’s focus is on how we learn to negotiate and act on our own purposes, values, feelings, and meanings rather than those we 26 have uncritically assimilated from others” (p. 76). Jung (1921/1971) made important contributions to the inclusion of the unconscious dimension and identity in transformative learning theory. Jung’s theory of individuation described a process of becoming aware of who we are as persons and our relation to others. Cranton and Roy (2003) described transformation as “the emergence of the Self” (p. 92), distinguishable from other conceptions of the “self” (denoted by its lower case ‘s’) by the inclusion of its unconscious dimension. Dirkx (2006) identified how the learning experience can trigger powerful, unconscious emotional responses, which “suggests deep involvement of the learner’s psyche or self” (p. 20). Left unexamined, the selves that make up the unconscious can become the basis for how people construct their lives; alternatively, examining unconscious processes can lead to a transformed sense of self (Dirkx, 2012). Working with emotion-laden images, educators can help adult learners become aware of their destructive tendencies—e.g., addiction and depression—and, ultimately, “become more conscious of their sense of self in relation and/or separate from the collective of humanity” (Lawrence & Cranton, 2015, p. 72).  Transformative learning research has also examined unconscious processes and the relationship between transformative learning and trauma. A brief overview of this research is necessary because of its relevance to this study’s findings. Meaning perspectives can be transformed by reflecting on psychic distortions (Gould, 1988, as cited in Mezirow, 1990), which Mezirow (1990) defined as “presuppositions generating unwarranted anxiety that impedes taking action” (p. 16). Childhood traumatic events are repressed from consciousness but continue to generate feelings of anxiety in adulthood which, in turn, make it more challenging for an individual to be assertive, feel sexual, or take risks (Gould, 1988, as cited in Mezirow, 1990).  27 Relational processes. Transformative learning research has recognized learner–learner (group) support as an important form of relational support. According to Mezirow (2000):  Our identity is formed in webs of affiliation within a shared life world. Human reality is intersubjective; our life histories and language are bound up with those of others. It is within the context of these relationships, governed by existing and changing cultural paradigms, that we become the persons we are. (p. 27) For Dirkx (2012), “Our sense of self and ways of coming to know are intimately bound up with our deep relationships with ourselves, as well as one another, our social contexts, and the broader world” (p. 126). In a study by Sands and Tennant (2010), participants who joined a suicide bereavement group found the support to be a transformative experience. Participants reported being able to use their grief to develop a new, more empowering sense of self and relationship with the deceased. Research involving community-based agencies has profiled how group support helped women transform their identities as individuals and, collectively, as feminists (Cooley, 2007). Dialogue within these supportive groups often involved “constructive conflict” (English & Peters, 2012, p. 114) that initiated transformation.  Addiction treatment and recovery literature on psychological processes. A brief review of the addiction treatment and recovery literature on cognitive (or rational) and emotional, spiritual, and relational processes is necessary. Research by Burman (2003) found that cognitive processes are important to the recovery process regardless of the pathway, e.g., no mutual-support group or addiction treatment attendance (natural recovery), mutual-support group attendance only (AA, NA, SMART, etc.), or addiction treatment attendance only. Engaging in a cognitive cost-benefit analysis was also part of the recovery process, regardless of the pathway. 28 Both positive and negative emotions have been examined in the addiction treatment and recovery literature. Positive emotions are an important element of transformation as described in the addiction literature on conversion experiences, spiritual awakenings, quantum change, peak experiences, and awe (see next section). Negative emotions also have transformative potential. Tedeschi and Calhoun (2004) argued that the experience of guilt can initiate self-reflection and lead to positive change. Rather than eliminating guilt, the authors encouraged therapists to work with individuals to “weave it into their lives with the experience as part of their new reality” (Tedeschi, Shakespeare-Finch, Taku, & Calhoun, 2018, p. 69).7 Research by Skalski and Hardy (2013) and W. L. White (2004) has also highlighted the need to allow individuals with addiction the opportunity to experience difficult emotions as potential gateways for transformative experiences.  A growing body of research on spirituality and addiction recovery exists (Chitwood, Weiss, & Leukefeld, 2008; Cook, 2004; Longshore, Anglin, & Conner, 2009). Research has demonstrated the benefits of spirituality for individuals with addiction. For example, a study found that significant increases in client-reported spirituality during treatment was associated with recovery six months following treatment discharge (Robinson, Cranford, Webb, & Brower, 2007). Sterling et al.’s (2007) research found that maintaining spiritual growth was crucial to maintaining recovery. Research by Peteet (1993) found that the Twelve Step’s focus on spirituality provided members with an enhanced sense of identity, integrity, and interdependence within a larger, transcendent context.  7 Tedeschi and Calhoun’s (1995) posttraumatic growth model focused on trauma, but a handful of researchers has applied their theory to addiction (see Haroosh & Freedman, 2017; Washton, 2007). 29 Finally, research has confirmed the important role that social support plays in addiction recovery (Blomqvist, 2002; Groh, Jason, Davis, Olson, & Ferrari, 2007; Kang, Kim, & Shin, 2018). Social support works to lower feelings of loneliness and social isolation (Havassy, Hall, & Wasserman, 1991). Social support has also been found to increase the likelihood of treatment completion and positive treatment outcomes (Gruber & Fleetwood, 2004; Lewandowski & Hill, 2009). Research has found AA to be an effective means of developing social support (Chen, 2006; Humphreys & Noke, 1997; Toumbourou, Hamilton, U’Ren, Stevens-Jones, & Storey, 2002). According to Wong (2006), whose meaning therapy forms the foundation of Sunshine Coast’s approach, treatment means more than mere abstinence. Instead, “the recovery process needs to move beyond healing of brokenness to personal transformation and full integration into society” (Wong, 2006, p. v).  Contrasting Mezirow’s 10 phases of perspective transformation with the addiction treatment and recovery concepts of hitting bottom, turning point, and maintenance phase. The second important aspect of transformative learning processes that I examine in this study is Mezirow’s (1991) 10 phases of perspective transformation (see Table 1). A brief overview is necessary. Perspective transformation begins with a disorienting dilemma. According to Mezirow (1978a), “For a perspective transformation to occur, a painful reappraisal of our current perspective must be thrust upon us” (p. 12). Without such a dilemma, there may be no need to engage in critical self-reflection: “Disorienting dilemmas of adulthood can dissociate one from long-established modes of living and bring into sharp focus questions of identity, of the meaning and direction of one’s life” (Mezirow, 1978a, p. 12). Phases 1 to 6 can be understood as a progressive engagement of critical self-reflection. Phases 7 to 9 are action steps, with Phase 10 marking a 30 maintenance stage in which an adult learner acquires a stable and ultimately transformed perspective. Mezirow (2012) summed up his 10 phases of perspective transformation as a process by which adult learners “become more aware of the context of their problematic understandings and beliefs, more critically reflective on their assumptions and those of others, more fully and freely engaged in discourse, and more effective in taking action on their reflective judgments” (p. 93).  Table 1 The 10 Phases of Perspective Transformation Phase Description 1 A disorienting dilemma. 2 A self-examination with feelings of guilt or shame.a 3 A critical assessment of epistemic, sociocultural, or psychic assumptions. 4 Recognition that one’s discontent and the process of transformation are shared and that others have negotiated a similar change. 5 Exploration of options for new roles, relationships, and actions. 6 Planning of a course of action. 7 Acquisition of knowledge and skills for implementing one’s plan. 8 Provisional trying of new roles. 9 Building of competence and self-confidence in new roles and relationships. 10 A reintegration into one’s life on the basis of conditions dictated by one’s perspective.  Note. a Mezirow would later expand this phase to also include fear and anger.  Adapted from Transformative Dimensions of Adult Learning by J. Mezirow, 1991, pp. 168–169. Copyright 1991 by Jossey-Bass.  Hitting bottom, turning points, and maintenance in the addiction treatment and recovery literature. Numerous attempts have been made to describe the change process involved in addiction and eventual recovery, the most obvious being the Twelve Steps of AA 31 (Alcoholics Anonymous [AA], 2001). A five-step model of recovery developed by Prochaska, DiClemente, and Norcross (1992) begins with a prereflective stage (precontemplation), continuing with reflective and planning stages (contemplation and preparation), an action stage, and continuing ad infinitum with a maintenance stage. J. M. White (2000) proposed a model of alcoholism stages based on identity development. This study follows a tripartite model of change, similar to the practice of describing addiction and addiction recovery in The Big Book as “what we used to be like, what happened, and what we are like now” (AA, 2001, p. 58). Addiction treatment and recovery and adult education research provide additional support for a tripartite approach. For example, Burman (2003) found that regardless of the pathway—self-help group, treatment, or spontaneous recovery—recovery typically included three events: a decision to change, action taken towards that goal, and maintenance efforts to prevent relapse (p. 32). Barton et al. (2007) similarly argued that learner identities, their circumstances, and their future plans can be expressed chronologically as “what has happened in people’s pasts, who they are now, what is happening in their lives now, and where they may want to go” (p. 18).  I now examine the addiction treatment and recovery literature on hitting bottom, turning points, and maintenance. In my proposed model, a hitting bottom phase represents the initiation of critical self-reflection and is roughly analogous to Mezirow’s (1991) Phases 1 to 6 (planning stage). A turning point phase represents the initiation of identity transformation and is analogous to Mezirow’s (1991) Phases 7 to 9 (action stage). Finally, a maintenance phase is analogous to Mezirow’s (1991) Phase 10 (maintenance phase).  My decision to use the terms hitting bottom and turning points in this study is based on their long history in the addiction treatment and recovery literature and their eventual 32 adoption in certain areas of addiction research. Alcoholics Anonymous: The Big Book (AA, 2001), originally published in 1939 and now in its fourth edition, referred to hitting bottom and turning points metaphorically, without defining them: e.g., “We didn’t wait to hit bottom because, thank God, we could see the bottom” (p. 279); “Half measures availed us nothing. We stood at the turning point. We asked His protection and care with complete abandon” (p. 59).   In the present study, I make a distinction between hitting bottom and turning points and offer four advantages for doing so. First, distinguishing the terms clarifies their respective meanings. Much has been written about the important role that the experience of hitting bottom and turning points play in the addiction recovery process. AA considered hitting bottom as a culmination of negative events: People “have to be pretty badly mangled before they really commence to solve their [alcohol] problems” (AA, 2001, p. 43). A systematic review of the term hitting bottom found no operationalized definition due, in part, to its subjective nature (Chen, 2018; Kirouac, Frohe, & Witkiewitz, 2015). Some individuals experience hitting bottom soon after experiencing one or two negative consequences (e.g., an impaired driving charge), whereas others may experience multiple negative consequences over the course of many years before they experience hitting bottom.   Second, distinguishing between the two terms can serve to delineate the process of recovery. The work of Best et al. (2016) distinguished between recovery initiation and early-stage recovery maintenance, much the way I distinguish between hitting bottom and turning points. The authors identified multiple recovery initiation factors, including accidental overdoses, intentional harm to self or others, and memory blackouts (an inability to recall one’s actions while intoxicated), which could prompt individuals to make changes in their 33 lives. Initiation factors occurred prior to individuals attending treatment or attending Twelve Step meetings. Early-stage recovery maintenance factors included participating in addiction treatment, attending Twelve Step meetings, and reaching out to friends and family for help. Sustaining recovery maintenance factors occurred after completing treatment and included activities such as participation in group activities (e.g., mutual aid meetings, fitness classes, team sports, family time) or individual pursuits (e.g., exercise, hobbies, going back to school). In the present study, I used the term maintenance factors to represent the sustaining recovery maintenance factors described by Best et al.  Third, distinguishing between hitting bottom and turning points allows for the latter to include positive catalysts for transformation in addition to negative ones. Research on peak experiences and awe is a case in point. Humanist psychologist Abraham Maslow (1964) used the term peak experience to describe profound subjective experiences as “shift[s] in attention, in the organization of perception” (pp. 77–78). Maslow found that brief but intense emotional experiences—awe—often accompany peak experiences. Keltner and Haidt (2003) identified supernaturality as a “flavour” (p. 304) of awe. Supernaturality, or supernatural causality, typically involves unexplainable encounters involving, for example, wild animals or coincidences. Supernatural causality is linked to both self-transcendence and a sense of connectedness to others. AA’s spiritual awakening as the desire for self-transcendence is akin to supernatural causality (AA, 2001). Awe as self-transcendence reduces a focus on the self and increases a sense of connectedness to others and a greater whole, leading to greater life satisfaction (Krause & Hayward, 2015).  Fourth, distinguishing turning points as the beginnings of identity transformation helps explain why individuals who arrive at a turning point are transformed in a way that is 34 not always the case with those who merely hit bottom. Engaging in self-reflection is necessary but not sufficient for personal transformation. According to anthropologist Gregory Bateson (1971/1992): “‘Bottom’ is a spell of panic which provides a favorable moment for change, but not a moment at which change is inevitable” (p. 451). Psychology and addiction treatment and recovery research suggests that a second phase—a turning point—may be necessary prior to experiencing a change in how one relates to oneself and others. Research by McIntosh and McKeganey (2000) found considerable agreement among addiction researchers for turning points as the “point in which the decision to give up drugs is taken and/or consolidated” (p. 1502). In his research on chronic illness, social psychologist Anselm Strauss (1962/2002) described turning points as “certain critical incidents that occur to force a person to recognize that ‘I am not the same as I was, as I used to be’” (p. 67). This is the point that changes everything. A study by Prins (2008) of Dutch heroin addicts found that participants needed to experience a crisis before they reached a “turning point in the drug addiction trajectory” (para. 89). Radcliffe’s (2011) study of women experiencing addiction found that pregnancy served as a turning point, coinciding with a “normal, unremarkable” (p. 984) sense of self after assuming the role of motherhood.  Turning points as experiences of personal adversity followed by positive change are roughly analogous to other concepts found in the psychology and addiction treatment and recovery literature, including death rebirth experience (James, 1909), spiritual awakening (AA, 2001), tragic optimism (Frankl, 1946/1985), disintegration (Dabrowski, 1964/2016), peak experience (Maslow, 1964), shattered assumption (Janoff-Bulman, 1989), posttraumatic growth (Tedeschi & Calhoun, 1995), and a redemptive sequence (McAdams, 2006). James (1909) coined the term death rebirth experience in reference to religious experiences “of an 35 unexpected life succeeding upon death” (p. 301). James’s (1909) reference to death in this quote alludes to the experience of frustration and despair or death of some former self in some iteration, not physical death. James (1909) also recognized that such experiences can lead to personal growth: a renewed sense of meaning and purpose followed such death experiences.  James’s (1909) writings on death rebirth experiences, or spiritual experiences, were highly influential on Bill Wilson, cofounder of AA. Wilson (as cited in AA, 1957/1985), wrote:  Spiritual experiences, James thought, could have objective reality; almost like gifts from the blue, they could transform people. Some were sudden brilliant illuminations; others came on very gradually. Some flowed out of religious channels; others did not. But nearly all had the great common denominators of pain, suffering, calamity. Complete hopelessness and deflation at depth were almost always required to make the recipient ready. The significance of all this burst upon me. Deflation at depth—yes, that was it. Exactly that had happened to me. (p. 64) The Big Book (AA, 2001) included a quote by Jung, who described spiritual awakenings as “huge emotional displacements and rearrangements. Ideas, emotions, and attitudes which were once the guiding forces of the lives of these men are suddenly cast to one side, and a completely new set conceptions and motives begin to dominate them” (p. 27). Psychologist and Holocaust survivor Viktor Frankl (1946/1985) coined the term tragic optimism after observing firsthand how human beings could triumph and remain defiant in the face of oppression and death. Dabrowski (1964/2016) used the term disintegration in his theory of positive disintegration to describe human development as an emotionally difficult but, ultimately, positive process. Difficult emotional states provide the necessary motivation to “question one’s beliefs and values, to seek new answers, to discover one’s deeper self, and to move toward the expression of individuality” (Dabrowski, 1964/2016, p. xvii). Janoff-Bulman (1989) studied the reactions of individuals who experienced extreme negative 36 events, resulting in trauma. According to her theory of shattered assumptions, individuals typically question their worldviews only after experiencing a deeply distressing event. Tedeschi and Calhoun’s (1995) model of posttraumatic growth described the process of positive change that individuals undergo after experiencing a life-altering event. Finally, McAdams (2006) defined redemption sequence as what happens when a “bad or emotionally negative scene turns suddenly good or emotionally positive” (p. 9).  In sum, transformative learning appears to involve rational and extrarational processes. Whereas Mezirow (1991) described mostly rational processes, other contributors have argued for the inclusion of extrarational processes. Research from psychology and addiction has lent support for the latter, describing hitting bottom and turning points as highly emotional and even spiritual experiences. Mezirow’s (1991) 10-phase model of perspective transformation has many parallels with the addiction treatment and recovery literature on hitting bottom, turning points, and maintenance phases, which I will draw out further in subsequent chapters.  Part III: Contextual Factors and Their Impact on Transformative Learning Outcomes So far, I have described transformative learning and its processes from a personal and psychological perspective. However, as adult learning theorist Peter Jarvis (1987) pointed out, “learning is not just a psychological process that happens in splendid isolation from the world in which the learner lives” (p. 11). Context matters. Early in the development of transformative learning theory, contributors Clark and Wilson (1991) criticized Mezirow’s theory for focusing on psychological processes at the expense of context. Later writings by Mezirow and others addressed Clark and Wilson’s criticism; they posited context, or learner experience, as a core element of transformative learning, alongside critical reflection and 37 reflective discourse (Mezirow, 2000, 2009; Snyder, 2008; Taylor, 2003, 2007). Two years prior to his passing, Mezirow (2012) wrote that “critical reflection, discourse, and reflective action always exist in the real world in complex institutional, interpersonal, and historical settings, and these inevitably significantly influence the possibilities for transformative learning and shape its nature” (p. 88). My own review of the literature, however, found few transformative learning studies that have examined contextual factors, which suggests that more research is needed to address the impact of contextual factors on transformative learning. Part III is presented in three sections. The first section examines transformative learning literature that has linked contextual factors with transformative outcomes. Here I introduce Lawrence and Cranton’s (2015) notions of facilitating, delaying, and inhibiting influences. In this study, I equated Lawrence and Cranton’s term influences with contextual factors. I then examine Illeris’s (2014) proposed expansion of transformative learning outcomes to include restored and regressive transformations. Illeris (2014) referred to conventional notions of transformation—Mezirow’s (2006) epochal and incremental transformations—as “progressive” transformations. The remaining sections of Part III review research from transformative learning literature that illustrates facilitating and delaying/inhibiting contextual factors, respectively.  This review of the transformative learning literature does not include research on personal and socioeconomic/structural contextual factors, although I acknowledge their significant impact on the ability of adult learners to achieve favourable transformative outcomes. Indeed, these factors are important: Mezirow (1998) noted that critical self-reflection also involved examining “economic, ecological, educational, linguistic, political, 38 religious, bureaucratic, or other taken-for-granted cultural systems” (p. 193; see also Brookfield, 2000, 2009, 2012). In this study, however, I intentionally did not ask participants to share their life stories or detailed accounts of their socioeconomic status; such questions would have detracted, I suggest, from this study’s emphasis on Sunshine Coast’s contextual factors. Nonetheless, it is important to mention the large body of previous work which has examined the relationship between transformative learning and personal, socioeconomic, and structural contextual factors. For example, previous studies have found negative impacts of low levels of functional literacy (L. R. Cohen, 1997; Quigley, 1992; Tett, 2019; Walker, 2017), adverse childhood experiences (Jonker, 2006; Rogers, 2003; Tennant, 2006), and the schooling environment (Rogers, 2003), on transformative learning. Rogers (2003) found that many adults who struggled in grade school continued to have negative experiences in structured settings as adult learners, in spite of having demonstrated competence in on-the-job learning.8  Influences and transformative learning outcomes. In this section on contextual factors and outcomes I make frequent references to the work of Lawrence and Cranton (2015) on facilitating, delaying, and inhibiting influences, and the work of Illeris (2014) on progressive, restoring, and regressive transformations. I believe that linking these concepts provides a useful way to understand the contextual factors that shape transformative learning  8 Transformative learning studies have also examined delaying/inhibiting personal contextual factors, including cognitive disability (Gronsky, 2015), mental illness (Dowie & Gibson, 2006), sexual orientation (Kincaid, 2010), HIV/AIDS (Baumgartner, 2002, 2005, 2007, 2012, 2014; Baumgartner & David, 2009; Baumgartner & Niemi, 2013; B. C. Courtenay, Merriam, & Reeves, 1998; B. C. Courtenay, Merriam, Reeves, & Baumgartner, 2000; Merriam, 2006), race/ethnicity (Baumgartner, 2010, 2014; Baumgartner & Johnson-Bailey, 2010a, 2010b; Bridwell, 2013), incarceration (Baumgartner & Sandoval, 2017, 2018; Sandoval et al., 2016), and poverty (Clover, 2016; Groen & Hyland-Russell, 2010; Hyland-Russell & Groen, 2011). 39 and recovery outcomes. A brief overview of their research, and how their findings link to this study, is warranted.  Lawrence and Cranton (2015) used the metaphor of seed cultivation to describe transformative learning. Seeds represent the growth potential of adult learners (personal factors). As mentioned above, in this study I set aside personal contextual factors. The planting of the seed represents a catalyst or disorienting dilemma; an opportunity for transformation but not a guaranteed transformation. I equate the planting of a seed to the hitting bottom phase in my model. Multiple factors determine whether a seed germinates into a seedling: rain, sunlight, pollinators, fertilizer, etc. In my proposed model, I consider a seed’s germination a turning point; furthermore, I treat the equivalent of rain, sunlight, pollinators, and fertilizer as material contextual factors. Material factors can help, hinder, or end a seed’s germination or growth. For example, the right amount of rain can lead to germination and growth, whereas not enough—or too much—rain can either slow or end growth. Lawrence and Cranton referred to these influences as facilitating, delaying, or inhibiting.  Lawrence and Cranton (2015) used the metaphor of the gardener in a way that I equate with sociocultural factors. Whereas a neglectful gardener plants a seed and hopes for the best, a nurturing gardener applies the right amount of fertilizer at the right time, waters the plant when necessary, etc. Similar to material contextual factors, sociocultural contextual factors can also act as facilitating, delaying, or inhibiting influences. Finally, Lawrence and Cranton’s growth model also includes metaphors for transformative outcomes. With sufficient rain, sunlight, and fertilizer, and the presence of a nurturing gardener, a seed grows 40 into a healthy plant. Conversely, poor growing conditions and a neglectful or unskilled gardener can result in a plant that grows but only moderately or withers and dies.  Having explained Lawrence and Cranton’s (2015) concepts of facilitating, delaying, and inhibiting influences—and their relationship to material and sociocultural contextual factors, and transformative outcomes—I now turn to Illeris’s (2014) transformative learning research. Lawrence and Cranton’s model did not provide terms analogous to the three types of transformative outcomes, represented by the healthy plant, stunted plant, and withered plant. Enter Illeris’s (2014) progressive, regressive, and restoring transformations.  Briefly, progressive transformations refer to a type of transformation, or outcome, that is positive in nature (Illeris, 2014). The bulk of transformative learning research has examined positive transformations. According to the literature, progressive outcomes typically occur if certain elements for transformation are present. Taylor’s (2009) literature review identified six “core elements” (p. 4) necessary for transformative learning: an appreciation of adult learners’ life experience,9 critical self-reflection, reflective dialogue, the inclusion of emotional and relational ways of knowing (“holistic orientation”),10 awareness of context, and authentic educator–learner relationships. Illeris (2014) considered Mezirow’s (2006) epochal and incremental transformations as varieties of positive transformation; recall that Mezirow described epochal transformations as sudden and dramatic reorientations in meaning perspectives, whereas incremental transformations involved a series of changes in points of view that accumulate into a transformed meaning perspective.   9 I used the term personal factors in this study in a way similar to Taylor’s (2009) term individual experience. As noted, I did not examine participants’ individual experiences in this study.  10 I used the term psychological processes in this study instead of Taylor’s (2009) term ways of knowing. 41 Regressive and restoring transformations differ from progressive transformations. Regressive transformations occur when individuals must retreat after committing to undergo significant self-change (what I call a turning point), whereas a restoring transformation is a compromise position after committing to undergo significant self-change. Illeris (2014) recognized that adult learners can often experience a sense of overwhelm after committing to change; an adult learner’s commitment to change can also be negatively impacted by additional, unanticipated negative events. In response, adult learners have two options. The first option is to withdraw and accept one’s current situation: a regressive transformation. The second option is to pursue an alternative position after concluding that a preferred position is unattainable: a restoring transformation. Illeris (2014) emphasized the fluidity of all three transformations; e.g., a regressive transformation can change to a restoring or a progressive transformation. Consistent with the addiction treatment and recovery literature on turning points, Illeris (2014) found that regardless of whether individuals experience a progressive, regressive, or restoring transformation, “it is subjectively or objectively impossible to return to the point of departure, and a change, therefore, is unavoidable” (p. 94). I examine progressive and restoring transformations further in Chapters 4 and 5. Sociocultural contextual factors. Numerous studies have stressed the important role sociocultural contexts play in transformative learning (Cranton, 2016; Illeris, 2018; Taylor, 2000). Jarvis (2012) described the process of learning as the development of an identity in relation to one’s environment: “It is the whole person who learns and that the person learns in a social situation” (p. 12). Transformative learning research has recognized the importance of providing adult learners with safe space in which to exchange ideas, appreciate diversity, acquire sufficient self-knowledge, and identify self-deception. Barlas (2001) found that a 42 supportive learning context included having a culturally and socially diverse group of learners who were afforded frequent opportunities to engage in meaningful dialogue. Dialogue was possible in spite of their differences because they had developed safe and trusting relationships. A study by Hyland-Russell and Groen (2011) of homeless women found that having a learning space perceived as safe and free from intimidation facilitated transformative learning. Southern’s (2007) research in transformative learning examined how teachers create a “safe space for vulnerability . . . by sharing openly the challenges we [teachers as mentors] have encountered and what we have learned about ourselves” (p. 330). According to Vogel (2000), “Adult educators need to create safe and shameless space where learners are free to grow toward wholeness” (p. 20). Creating a safe space for learning encourages learners to “risk examining assumptions and entertaining some alternate possibilities for ways to do and be” (Vogel, 2000, p. 20). J. B. Cohen and Piper’s (2000) adult education study involving Ben, a mature student who attended a nine-day residential addiction treatment retreat as part of his baccalaureate studies, is particularly relevant to this study. As a Vietnam veteran in recovery from addiction, Ben wanted to share his story with his mostly female colleagues but struggled with emotional disclosure. Having others in the treatment group share their own stories of crisis and addiction helped Ben realize the need to be more vulnerable and self-reflective.  Material contextual factors. I conceive of residential treatment settings as material contextual factors that can promote transformative learning and recovery from addiction. Research by Schacht (1960) on residential learning settings found six advantages of these settings when compared to more traditional learning contexts, which I have grouped as follows: (a) detachment and change in environment, (b) concentration and time, and (c) 43 intimacy and community. Schacht defined detachment as “temporarily suspended responsibility from the demands of office, shop, or home” (1960, p. 2). Participants in J. B. Cohen’s (2004) transformative learning study found residency to be an initially disorienting experience. Students left their homes and families to live with a group of strangers in another city. A change in environment, particularly one that is friendly and accepting, encourages learner creativity and experimentation. J. B. Cohen concluded that having opportunities to engage in the arts was transformative. Participants in the study were encouraged to be artists, whether through crafts, music, dance, or writing. Many of the participants rekindled their love for art developed in grade school but forgotten in the pursuit of higher education, careers, and raising a family. Art projects became, according to J. B. Cohen, “nonlinguistic ways of making meaning that promote deep change” (2004, p. 249). A change in environment also facilitates perspective transformation: Brown (2005) found that “changes in context [encourage adult learners to examine their] basic assumptions of the world” (p. 7). Residential learning also has the advantages of concentration and time. Schacht (1960) used the term concentration to refer to the round-the-clock nature of residential learning. The extended opportunities for learning available in residential settings provide the necessary time not only to present information but also for learners to assimilate it through discussion and practice. A study by J. E. A. Fleming (1998) found that meaningful conversations in residential learning settings could start and stop and start again over the course of a day, or several days. A participant in the J. B. Cohen (2004) study reported that discussions could “go on for days without being interrupted” (p. 245) and often became trigger events for personal transformation. According to Illeris (2014), “The most important contextual condition is probably about the time that is available, because the democratic 44 process, the possibility of taking up all relevant issues, endeavours of coming to agreement, critical reflection and dialogue are all time-consuming processes” (p. 9). Similarly, Taylor (2009) identified “temporal constraints” (p. 12) as one of the most important contextual factors of transformative learning.  Residential learning allows time to engage in informal learning, which is often derived from meaningful conversations that occur outside of the classroom. Merriam et al. (2007) described informal learning as “the experiences of everyday living from which we learn something” (p. 24). Informal learning lacks structure and can be self-directed, unintentional, and even unconscious (Schugurensky, 2000) and is distinct from both formal and nonformal education which typically occurs in the classroom with an educator and, in the case of formal education, involves a certificate, diploma, or degree upon successful completion (Coombs & Ahmed, 1974). Merriam et al. (2007) defined nonformal learning as “organized activities outside educational institutions, such as those found in community organizations, cultural institutions such as museums and libraries, and voluntary associations” (p. 24). To this list I would add residential addiction treatment facilities.  Residential learning is also intimate and provides a sense of community. According to Schacht (1960), residential learning allows for learners to get to know their fellow learners and instructors outside of the classroom. Schacht considered community to be the most valuable aspect of residential learning due to its ability to facilitate “respect, understanding, and kinship” (1960, p. 4). J. B. Cohen and Piper’s (2000) study highlighted community support as an important aspect of residential learning. Students reported a greater degree of helping one another, both in the classroom and during informal activities.  45 In conclusion, the objective of this literature review was to lend support for this study’s integration of transformative learning and addiction recovery frameworks to reveal how some men may undergo meaningful change in certain addiction recovery contexts. The three parts of this review examined the literature on identity and identity transformation, the processes of transformative learning, and contextual factors and transformative outcomes, respectively. The next chapter concerns the study’s methodology.     46 Chapter 3: Methodology The research questions that informed the design and methodology for this study were as follows: (1) What are some of the processes involved in personal transformation as reported by men recovering from addiction? (2) What are the contextual factors that facilitate, delay, or inhibit personal transformation as reported by these men in the context of residential addiction treatment? (3) How do the lives of these men, and their sense of identity as men, change as a result of their self-reported learning? I utilized a narrative inquiry approach to address this study’s research questions because it is an effective methodology for examining participants’ retrospective accounts of transformation and recovery. This chapter opens with an overview of narrative inquiry as a methodology, followed by a transformative learning argument for narrative inquiry. Subsequent sections describe participant inclusion criteria and recruitment, study participants, sampling method, ethical considerations, and rigour. I conclude with a section on data collection and analysis.  What Is Narrative Inquiry? In this section I provide an overview of narrative inquiry as a methodology, review the different ways of approaching narrative inquiry methodologically, and conclude by highlighting Fraser’s (2004) specific approach to narrative inquiry that I chose to follow in this study. Bruner (1986) described narrative as the filter through which individuals makes sense of their actions and the world around them, and the mould that shapes their life experiences. Riessman (2008) argued that narratives serve to construct individual and group identities through the process of storytelling. Narrative inquiry posits people as storytelling animals (Polkinghorne, 1988) and focuses on stories because they reveal the sociocultural contexts in which they are constructed (Ezzy, 2002). Stephens and Breheny (2013) found that 47 narrative inquiry is ideal for examining participant stories and understanding how “identity and experience are constructed at the intersection of personal, interpersonal, and cultural narratives” (p. 15). Riessman (2008) went further to consider narrative inquiry a joint construction of narrative and meaning involving the researcher and participant (Riessman, 2008). Ellis and Bochner (2000) advocated narrative inquiry as a methodology because it “make[s] the researcher’s own experience a topic of investigation in its own right. As researchers, “we are part of the storied landscapes we are studying” (Clandinin, 2013, p. 24).  Research by Chase (2005) identified five primary approaches to narrative inquiry, each having strong ties to a specific discipline. Narrative psychology involves an examination of the impact that people’s stories have on their lives. Narrative sociology concerns how individuals use stories to construct their identities or use language for meaning construction and sense-making. Narrative anthropologists engage with individuals or small groups over extended timeframes to create ethnographies, or co-constructed explanations of cultural practices. Finally, there are ‘autoethnographers’ who do not identify with a particular discipline but use various narrative-based techniques to document their experiences. This study adopted a mostly narrative psychology approach; my focus was on the experiences of men who self-reported as having experienced personal transformation while attending residential addiction treatment. At the same time, this study also focused on elements traditionally associated with narrative sociology, such as sociocultural context and identity.  Although I had decided on a narrative inquiry approach at a fairly early stage in this study’s development, it was not until I was introduced to Fraser’s (2004) seven-phase approach to narrative inquiry transcription that I felt I had finally found a roadmap to guide me through the study process as a novice qualitative researcher. With only slight 48 modifications, Fraser’s seven phases helped me to organize my approach to data collection and analysis and included specific instructions on technical matters, such as listening to interview recordings, incorporating my reflections into participant data, and looking for themes. I examine each of Fraser’s seven phases in greater detail in the Data Collection section below.  A Transformative Learning Argument for Narrative Inquiry  Narrative inquiry is an obvious choice for examining transformative learning. Narrative is an important aspect of learning: people “learn by constructing and reconstructing narratives to make meaning of information and events” (Brooks & Clark, 2001, n.p.; see also Clark, 2010). Narratives are rearrangements of nonlinear stories that sequence events into a beginning, middle, and end timeline (McKeon, 2001, cited in Tyler & Swartz, 2012). Moreover, stories become narratives when they are told and retold, during which time they are practiced and edited (Boje, 2001). Creating a coherent life story requires that we as individuals interpret the past to help us make sense of the present (Linde, 1993).  Adult education differs from other forms of education in its emphasis on life experience (Knowles, 1980; Lindeman, 1961). Storytelling can help one understand the process of transformative learning and the nature of change (Brooks & Clark, 2001; Clark & Dirkx, 2000; Kroth & Cranton, 2014; Tyler & Swartz, 2012). Tyler and Swartz (2012) defined storytelling as “the conveyance of personal experience, as distinct from the telling of myths, fables, or folklore . . . a relational, emergent, and nonlinear exchange” (p. 455). When people have a personal insight event that no longer fits the story they have about themselves and the world, they may respond by changing their story (Merriam et al., 2007). Transformation, however, is not only a personal experience—it is also an intersubjective 49 process. Stories imply both a storyteller and an audience (Brooks & Edwards, 1997). Research in transformative learning, therefore, lends support for the notion that stories are an effective facilitator of reflection and dialogue, which Mezirow (2006) considered essential for perspective transformation.  Inclusion Criteria The participants for this study were recruited based on self-reporting to have had a transformative experience while participating in the men-only addiction treatment program at Sunshine Coast. They were required to meet three criteria for inclusion. First, participants were required to have completed a minimum stay of 30 days at Sunshine Coast. Treatment stays at Sunshine Coast run from a minimum of 30 days to a maximum of 90 days. Second, participants had to have completed their treatment at least 90 days prior to being interviewed. I decided that participants would need to have at least 90 days of life experience to be able to describe how their lives had changed after completing treatment. Third, participants had to be willing to share their experiences of personal transformation.  It is important to note that I did not require evidence that participants experienced transformation, nor did I require that participants remain abstinent after completing treatment. I only required participants to self-report as having experienced personal transformation while attending residential addiction treatment. As a result, I did not interview staff or participants’ family members or collect participants’ medical or clinical files from Sunshine Coast as a means of corroborating participant interview data. I did not require participants to maintain abstinence as such a requirement would have omitted two important groups from this study: men who returned to consuming alcohol or their drug of choice without experiencing negative consequences and men who experienced negative 50 consequences after returning to problematic substance use but, at the time of interview, were back in recovery from addiction.  Participant Recruitment For the present study, I used social media to recruit participants. Sunshine Coast maintains a private members page on Facebook exclusively for program alumni. I placed a Facebook ad on that page with a hyperlink to a recruitment ad (see Appendix A) posted on the Sunshine Coast website ( The website page instructed prospective participants to email me, the researcher, at my university email address. The Facebook ad was removed after 13 program alumni emailed expressing their interest in participating in the study. Eight of the 13 program alumni who expressed interest in participating were eventually interviewed. I chose not to schedule additional interviews because those participants had already provided rich enough stories to be able to adequately address the three research questions. I dropped one of the eight interviews because I could not reorganize the data into a coherent narrative. A reflection I recorded after the interview identified three potential reasons for the difficulties. First, it was my first online interview and I was experiencing technical difficulties. Second, because the participant attended Sunshine Coast on two separate occasions, I found it difficult to organize events into a before, during, and after timeline. Third, the participant reported having ongoing struggles with trauma, which may have affected his ability to recall events. Early in our interview, the participant disclosed: “I don’t like remembering difficult experiences. I put those aside.” After dropping this interview, I had a total of seven interviews.  51 Overview of Participants  As shown in Table 2, participants for the present study consisted of seven Sunshine Coast alumni. They constituted a representative sample of the treatment centre clients, even though I was not striving to obtain such a sample. All participants were Canadian citizens. One participant, James,11 was Indigenous; the remaining participants were White. Participants’ length of stay was typical of Sunshine Coast treatment stays. Participants were middle-class in terms of socioeconomic status: two participants were self-employed, one participant was on disability assistance with a comfortable pension, two participants worked for the government, and two participants were employed in the private sector. Participants ranged in age from 35 to 52 years, which is typical of clients who attend Sunshine Coast, although not representative of the total treatment population of BC.  Sampling Method The present study incorporated convenience sampling, which is a method of selecting participants based on their willingness and availability to participate in a study (Creswell, 2008). Consistent with qualitative research, sampling for this study was also purposeful (selection of participants based on their ability to provide meaningful data) and criterion-based (based on their having experienced a certain phenomenon, e.g., personal transformation; see Morrow, 2005). As a company director, I had access to Sunshine Coast’s pool of approximately 3,000 former clients, built up over its 15-year history.      11 All names are pseudonyms.  52 Table 2 Demographic Profile of Study Participants Name Age Drug(s) of choice Years since treatment Length of stay (days) Work status, marital status  and dependents, sexual  orientation, ethnicity Eric 39 Alcohol, ecstasy 9 30 Full-time, engaged, no children, queer, White Sean 41 Cocaine, alcohol 5 30 Full-time, divorced, three children, heterosexual, White Ian 35 Opioids, alcohol, cocaine 2 75 Full-time, single, no children, heterosexual, White Nick 52 Cocaine, alcohol 10 30 On disability, married, one child, heterosexual, White Scott 43 Alcohol a 2 35 Self-employed, married, no children, heterosexual, White Ed 48 Alcohol 7 30 Self-employed, married, two children, heterosexual, White James 39 Alcohol 1 60 Full-time, divorced, two children, heterosexual, Indigenous Note. Data based upon information provided at time of interview.  a Scott also reported having a gambling addiction prior to attending Sunshine Coast. Ethical Considerations I identified two key risks for participants in the present study. The first risk for participants was the potential for coercion due to my role as a company director at Sunshine Coast. Although I have no direct contact with program attendees, nor do I work at the facility, I was still mindful of the risk of coercion. To minimize this risk, participants in the study were limited to past clients. Current clients may have perceived that their treatment stay would be jeopardized if they declined to participate in the study. Another step taken to avoid possible coercion was inviting participants to participate through a recruitment ad rather than inviting them directly by email or telephone.  53 The second risk pertained to the subject matter of the study. Addiction is a disorder characterized by difficult emotions and situations (Centre for Addiction and Mental Health, n.d.). I notified participants prior to the start of their interviews of the potential risk that recalling their past experiences of addiction could arouse strong emotions and that a list of local outpatient counsellors (see Appendix B) was available upon request. I did not observe any extreme emotional arousal, nor did any participant ask for the list of counsellors. Finally, I advised participants that they could elect to refuse to answer a question, take a break, or terminate the interview at any time and for any reason. No participant elected to take advantage of any of these options. Informed consent. Before each interview, each participant was emailed a copy of the consent form (see Appendix C). Before the start of each interview, I read the consent form to the participant. Any questions participants had about consent or confidentiality were addressed prior to the start of the interview. Participants who agreed to meet in person signed two printed copies of the consent form, one of which they kept. Participants who were interviewed over the telephone or via Skype provided verbal consent. In these cases, I noted the verbal consent date and time on a consent form I had printed beforehand.  Confidentiality. I took three precautions in order to maintain the confidentiality of study participants. First, I assigned each participant a participant number and a pseudonym. Each consent form was identified by a participant number instead of the participant’s actual name. For identification purposes, after the interviews had been transcribed, I wrote the participant’s pseudonym on each printed transcript. I also created a master file linking participant names to their assigned pseudonyms and participant numbers. I kept the master file in a locked filing cabinet in my home office. Second, transcriptionists were instructed to 54 omit potentially identifying information—names of participants or third parties and place of residence or employment—from the transcript. I blacked out any potentially identifying information on the printed transcript that the transcriptionist had overlooked. Third, as the principal investigator, I will store printed documents (interview transcripts, transcribed interview reflections, and signed consent forms) and the USB drive containing digital files (audio recordings of interviews and interview reflections) for 5 years, after which time they will be shredded or erased.  Rigour Rigour in qualitative research is defined as the strength of a study’s research design and ability of its method to answer the research questions (Morse, Barrett, Mayan, Olson, & Spiers, 2002). My goal was to represent participants’ stories in as accurate a manner as possible, while recognizing that experience as relayed through stories is always subjective, situated, relative, and cocreated by interviewer and interviewee. I will now describe how rapport building and reflexivity enhanced rigour in this study.  Rapport building. As narrative inquiry is fundamentally a “relational methodology” (Clandinin, 2013, p. 17), rapport building was an important strategy to enhance the methodological rigour of this study. In order to build rapport with participants, I approached interviews using Morrow’s (2005) notion of “naïve inquirer” (p. 254). As Morrow described, such an approach involves continually “asking for clarification, and delving ever more deeply into the meaning of participants” (2005, p. 254). At the same time, “The fewer questions [a researcher] asks, the more likely [he or she] is to elicit stories and deeper meanings from participants” (Morrow, 2005, p. 255). As much as possible, therefore, I limited myself to asking short questions that prompted participants to share long stories of 55 transformation before, during, and after treatment (e.g., Kvale, 1996). Rapport building contributed to the study’s rigour by foregrounding participant experiences while minimizing my impact on how they told their stories.  Reflexivity. The second strategy I used to enhance rigour in this study was reflexivity, which Cypress (2017) described as “researchers actively engag[ing] in critical self-reflection about their potential biases and predispositions that they bring to the qualitative study” (p. 259). Narrative inquiry as a methodology encourages reflexivity; according to Clandinin (2013), “Narrative inquirers need to continually inquire into their experiences before, during, and after each inquiry” (pp. 82–83). Before I began this study, I had already worked for 15 years in residential addiction treatment. Moreover, my research interests involved bringing together insights from transformative learning theory with ideas from recovery such as hitting bottom. During interviews with participants, I made a conscious attempt to foreground their unique stories. However, I also undoubtedly shaped the stories that they told and how they told them (Coghlan & Brydon-Miller, 2014).  In some ways, I could be considered an insider (Aguilar, 1981) in relation to this study given that, like the participants, I was familiar with the social world of residential addiction treatment, and Sunshine Coast in particular. Yet it is important to note that I personally have not been through residential addiction treatment and inhabit a different position within that world, so perhaps I am better understood as an insider–outsider. However, as insiders, study participants and I shared particular ways of understanding and speaking about addiction and recovery based on our knowledge of, and experience with, residential addiction treatment. Although a discourse analysis of addiction treatment and recovery was beyond the scope of this study, it is worth acknowledging that shared 56 understandings and ways of speaking about addiction treatment and recovery are evident in the narratives collected as a part of this study, as well as in my analysis.  Data Collection Data collection for this study involved one-on-one interviews. Narrative inquiry often uses one-on-one interviews—which can be understood as venues for storytelling—to comprehend how people create meaning in their lives (Clandinin & Connelly, 2000). According to Riessman (2008), “Interviews are narrative occasions” (p. 23). Interviews have been described elsewhere as identity work (Butler, 1993; Riessman, 1993), which is relevant to this study’s focus on transformation as identity change. Of the seven semistructured interviews included in this study, three were performed person-to-person, two were conducted via telephone, and two via Skype. I followed up each participant interview with writing a personal interview reflection. Interview reflections provided an opportunity to document participants’ nonverbal behaviours, unexpected logistical challenges, the impact of my presence on participant responses, my bias as an interviewer, and contextual aspects of the interview not captured by interview data. During the data analysis phase, I made note of my interview reflections.  An interview guide (see Appendix D) facilitated systematic data collection while also allowing less structured conversation and going off script when necessary (Patton, 2002). After collecting some basic demographic information, I asked participants to tell their stories of personal transformation in a tripartite format, similar to the practice of describing recovery in The Big Book as “what we used to be like, what happened, and what we are like now” (AA, 2001, p. 58).  57 Data Transcription and Analysis A cellular phone was used to record all interviews and interview reflections. Audio files were then uploaded to a secure server. A paid transcriptionist transcribed the audio file using Microsoft Word. I emailed participants each a copy of their transcript and offered to remove any content upon request. No participant responded to my offer.  The present study followed a seven-phase approach to narrative inquiry transcription and analysis based on, and slightly modifying, the work of Heather Fraser (2004). During Phase 1, I listened to the recordings and made note of any emotional expressions, such as laughter, crying, difficulty speaking, and long pauses. I also added to the transcript any other nonverbal behaviour that I had observed and subsequently recorded in my interview reflection.  Fraser’s (2004) Phase 2 involved transcribing interview recordings. Given that I commissioned a transcriptionist, I used Phase 2 to listen to the interview recordings a second time, correct transcript errors, and fill in any text that the transcriptionist had found inaudible. During Phase 2, I also rearranged participant stories into a chronologically ordered, tripartite—before, during, and after treatment—event timeline.  Phase 3 was the data analysis phase (Fraser, 2004). Here I stopped listening to the recordings and focused instead on the written transcripts. In narrative research, it is often necessary to “read [each transcript] several times until a pattern emerges, usually in the form of foci of the entire story” (Lieblich, Tuval-Mashiach, & Zilber, 1998, p. 62). I conducted a search of each transcript for data pertaining to the theme of identity within each story. I then assigned a story name, as Fraser (2004) did, to represent each story’s identity-related theme.  58 Fraser’s (2004) Phase 4 involved scanning across stories to identify different “domains of experience” (p. 191). For Fraser, domains of experience included the intrapersonal, interpersonal, cultural, and structural aspects of stories. My use of the terms psychological processes and contextual factors is similar to how Fraser used the term domains of experience. I created a spreadsheet to help organize and identify psychological processes and contextual factors across all participant stories. The results of Phase 4 are included in the Categorical Analysis section of Chapter 4. Fraser’s (2004) Phase 5 involved “linking ‘the personal with the political’” (p. 193). Fraser recommended looking for “dominant discourses and their attendant social conventions” (2004, p. 193). For the present study, I used a fifth phase of analysis to look for participant data that demonstrated their adoption of recovery discourse and reflect on my own adoption of recovery discourse in my interactions with participants. I further discuss how recovery discourse shaped this study in Chapter 5.  Phase 6 of Fraser’s (2004) approach to narrative inquiry involved looking for change-related themes across participant narratives. In Phase 6, I assigned names to common themes shared by multiple participant narratives. I then created a short-list of common themes either by combining smaller themes into larger ones or based on the number of stories that shared a theme. Phase 6 results were then summarized in a spreadsheet and are included in the section of Chapter 4 entitled Categorical Analysis. Phase 7 is the final phase of Fraser’s (2004) approach to narrative inquiry and involves the writing stage of data analysis. I adopted Fraser’s two recommendations for this stage; namely (a) to tie participant narratives and narrative themes to the study’s research 59 questions and (b) to remain reflective throughout the writing stage to ensure that it accurately reflects participant narratives.  Through this approach to narrative inquiry, I gained important insights into my study participants’ transformative learning journeys through addiction treatment and recovery.   60 Chapter 4: Results Narrative inquiry proved to be a viable method of gaining insights into the lived experience of former Sunshine Coast residents and how they created meaning out of a retelling of those experiences. Narratives provide a way to connect the past, present, and future (Brooks & Clark, 2001). Each participant story in this chapter includes an introduction and a recovery timeline. As noted in Chapter 3, Fraser’s (2004) approach to narrative inquiry included analysis of data relating to the themes within each story (Phase 3) and themes across participant stories (Phase 6). In the present study, I borrowed terminology from Lieblich et al. (1998) who distinguished between holistic and categorical narrative inquiry (see also Beal, 2013, for an application of their framework). Holistic approaches consider stories in their entirety; each story part is interpreted in terms of how it relates to other story parts. Categorical approaches, by contrast, examine categories, or themes, across participant stories. In this chapter, Part I examines results from a holistic analysis, and Part II examines results from a categorical analysis.  Part I: Holistic Analysis In order to provide the coherence considered essential to narrative (Linde, 1993), the recovery stories that follow have been edited for clarity and follow a before, during, and after treatment timeline under the headings Hitting Bottom Moment, Turning Point Moment, and Life Since Completing Treatment, respectively. Research by Barton et al. (2007) found that “attention to the key transition points of people’s histories can be a very revealing way of understanding the relationship between lives and learning” (p. 20). According to Chanfrault-Duchet (1991), chronological order is an effective way to organize interview material. In the following holistic analysis, I identify the rational and extrarational processes, sociocultural 61 and material contextual factors, and identity-related data involved in each participant’s self-reported transformation. In this chapter (and in Chapter 5) I repeat certain participant quotes as a means of emphasizing key findings.  Eric’s story (#1). Eric self-identified as queer and has had a long-term relationship with his partner, Andrew. Eric grew up on the Canadian prairies to parents who both struggled with alcohol addiction. His mom, Susan, was the provider for the family. Susan would divorce, only to remarry a man who also shared her addiction to alcohol. To compound matters, Eric’s stepfather physically abused Susan and the rest of the family. At the age of 16, Eric left home and endured homelessness and several foster homes before graduating from high school and finding work in public health. Eric is currently employed as a mental health case manager.  Eric’s hitting bottom moment. Eric attributed his problems with alcohol to a profoundly life-altering betrayal involving his former partner, Ivan. On numerous occasions over the course of 18 months, Ivan drugged Eric with a powerful anesthetic during evenings out dancing. After Eric passed out, Ivan would bring him back to their shared apartment and rape him. Eric would wake up with no memory of the night before. Ivan always had a credible explanation for why Eric would find himself naked and sleeping late into the afternoon. One night while getting ready for another evening out, Eric caught Ivan adulterating his drink. Eric quickly ended the relationship after learning that Ivan was responsible for his frequent blackouts.  A few months after breaking up with Ivan, Eric met Andrew. Although Andrew was always supportive and loving, Eric started drinking heavily to cope with painful memories of being raped. Over the course of four years, his drinking escalated. Prior to learning about 62 Ivan’s sexually abusive behaviour, Eric had been a social drinker. Now, his drinking was out of control: “I could drink like half a 60-ounce bottle [of gin] in one night and drink the whole other half the next day.” Somehow, Eric continued to succeed as a university student and as a mental health case manager: “I got A’s [at school]. I excelled at my job.” Eventually, however, he developed pancreatitis and was hospitalized. Fearful that he was going to lose Eric, Andrew contacted Eric’s two siblings, Teresa and Jenn. Together, they performed a family intervention after Eric returned home from the hospital. That same night, Eric departed for Sunshine Coast to begin his treatment.  Eric’s turning point moments. Eric identified two turning point moments in treatment. The first involved a fellow attendee, Tristan. During a group therapy session, Tristan shared that he had been repeatedly molested by one of his minor hockey coaches. Eric was so moved by Tristan’s story that he told the group he was queer and shared his own experience of sexual abuse. Eric had never before told anyone about being raped, not even Andrew. Eric described the group session as a  powerful moment for both [Tristan and me]. . . . He gave me a great hug [laughs], which was amazing. I had never said it [voice cracks] out loud. That was the first time I had said out lout what had happened.  Eric’s second turning point involved his participation in nontraditional therapies. He described hypnotherapy as “transformative to my whole life.” Eric identified group meditation sessions as another beneficial therapy at Sunshine Coast: “We would lay and listen to, like, meditation music and talk about reality and one’s own experiences in reality and things like that around spirituality and self and identity and meaning.”  Eric’s life since completing treatment. After completing treatment, Eric promptly returned to work and his studies. His personal life in the months following treatment had its ups and downs. He had a falling out with his sisters, Teresa and Jenn. Fortunately, Eric was 63 able to maintain his composure: “I maintained myself during that time . . . because of the hypnotherapy.” At the time of interview, Eric remained on good terms with his siblings: “I don’t carry hate in my heart.” His relationship with Andrew blossomed after he returned home. Eric finally told Andrew about being raped: “That was really hard to do.” At the time of interview, Eric and Andrew were engaged to be married after living together for the past 13 years. Eric’s social life has returned, too: “I never went out with people and that changed. I was suddenly able to go out.” His problematic use of alcohol was no longer an issue. Eric abstained from alcohol for two years after completing treatment. Since then, he has engaged in social drinking: “I was honest during [my stay at Sunshine Coast] that I was not going to abstain for my whole life.” Summing up his current relationship with alcohol, he said: “I believe in harm reduction.”  Contextual factors Eric identified as part of his personal transformation. Eric identified both sociocultural and material contextual factors that initiated and facilitated personal transformation during his stay at Sunshine Coast. I describe these factors separately.  Sociocultural factors. Eric confirmed the importance of two sociocultural contextual factors: a sense of safety and the diversity and solidarity of the peer group. Eric reported that both staff and the peer group were important for instilling a sense of safety and credited the first staff person he met with making him feel welcome: “The woman who did my intake was very compassionate.” Reflecting on the therapists at Sunshine Coast, Eric complimented them for understanding that their jobs were “really about empowering you back into your reality as if you had control, as if you had to find meaning in your world.” Asked about his overall experience with staff, he replied, “The staff were fantastic. Everybody was really professional and kind and nice and interested in your well-being.”  64 Eric, however, did not always feel safe with his peer group. As mentioned earlier, he recalled being initially apprehensive about joining the mostly heterosexual group as a queer man. He expressed disappointment in the peer group’s response after he and Tristan shared their stories: “The full group gave us nothing—all straight guys.” Eventually, however, Eric reported being welcomed by some of his peers:  I felt othered quite a bit at first and so there was a couple [of men] that were just like forced me to join them. And that was pretty great. And it got better. . . . By the end everyone was like, loved me, and it was great. But at the beginning it was just really difficult.  Eric also reported the importance of having a diverse peer group and, at the same time, having someone in the group who shared his experience of being raped by a man:  That is one of the good aspects of going to a program group because you get all these different experiences. And there was somebody in there that had something kind of similar, and it was interesting to talk to him. I return to Eric’s experience as a queer man in an all-male peer group as an example of the challenges of navigating hegemonic masculinities in residential treatment settings in the Categorical Analysis section.  Material factors. Eric identified time to reflect, a peaceful environment, privacy, and programs and policies as important material factors. Before going to Sunshine Coast, his life was a “chaos” of school, work, and drinking: “[I] never [had] any time to really think and reflect.” During his treatment stay, he was able to engage in quiet self-reflection: “Suddenly I had space to just focus on myself.” Eric commented on the importance of Sunshine Coast’s peaceful environment: “I would walk along the beach. . . . [It] was just a place to be peaceful.” He recognized the importance of new surroundings: “It’s just good to be taken out of your environment.” He was also appreciative of the privacy afforded by Sunshine Coast’s remote location: “I didn’t want to go to a facility where anyone would know me.” At the 65 same time, Eric was critical of Sunshine Coast for having semiprivate rooms: “I think you should absolutely have your own space. You shouldn’t have to share with people. [It is] another way to dehumanize you and not give you the space you need to heal.” Finally, Eric identified both positive and negative aspects of Sunshine Coast’s program philosophy and policies. He reported benefiting from Sunshine Coast’s strengths-based focus, integration of trauma therapies, and non–Twelve Step, secular harm reduction approach. However, he was critical of Sunshine Coast for being a “very heteronormative straight environment.” He also criticized Sunshine Coast’s intake procedures involving bag searches, “jarring and dehumanizing” urine drug tests, and “hyperpersonal information” collection.  The main identity-related themes of Eric’s story: An integration of selves and rediscovery of a core self. Eric’s sense of self is suggested by his references to “compartmentalizing” during the peak of his problematic use of alcohol. When asked how he managed to succeed in his job and studies while drinking lethal amounts of alcohol, he explained, “I can compartmentalize exceptionally well.” The compartments that Eric alluded to can be understood as referencing various identities associated with his personal life, work, and school. Recall Dirkx’s (2007) reference to a “multiplicity” of selves (p. 110). Eric sense of self in relation to others to was also impacted by his past experience of being raped: “I[’d] forgotten who I was. . . I didn’t know how to be loved, to be touched.” Eric’s experience is consistent with Mezirow’s (1990) notion of psychic distortions leading to an inauthentic self (p. 16).  Sean’s story (#2). Sean is a 41-year-old divorced man living in a small rural community; he and his ex-wife Megan have joint custody of their three children. He currently lives with his girlfriend Trisha and is employed as a power engineer. Sean attended 66 Sunshine Coast five years prior to being interviewed. At the time of interview, he had been abstinent for seven months.  Sean’s hitting bottom moment. Sean was a married father of three with a solid career when he experienced hitting bottom. At the time, he was working long hours as a power engineer to support his young family, all the while taking additional certification courses to secure a better position with his employer. Sean’s busy life as an engineer, husband, parent, and student masked a growing sense of despair. He turned to bingeing on alcohol to cope: “[My] drinking would lead into cocaine . . . drinking and driving, poor decision-making, blacking out.” After his binges, Sean would try to make amends by taking the family to Disneyland: “My daughter was six, and she had been to Disneyland six times.” Vacations provided brief respites but, eventually, Sean and his wife Megan’s “disconnect” meant that the same “vicious cycle” would repeat itself every couple of months.  Over time, Sean’s binges developed into a more regular pattern of heavy drinking. A typical day for him involved riding his bike down to the liquor store as soon as it opened, drinking for a couple of hours, going to work, and then returning home for more drinking. He rarely missed work, even at the peak of his substance use. Sean “went to every counsellor on the Coast” for help with his marriage. His parents flew in from out of province to help, but he pushed them away. When Megan moved back to Ontario to be closer to her parents, Sean’s drinking increased: “I was in the house by myself, running out of money, running out of everything.” Desperate, he was about to hang himself in his living room but had a last-minute change of heart: “I realized I was sick. I got down. I called work.” A neighbour came over. An ambulance was called. After spending a week at the hospital, Sean checked himself into Sunshine Coast.  67 Sean’s turning point moment. Sean recalled feeling scared prior to being admitted to Sunshine Coast: “I didn’t know what [I was] expecting . . . [if I was] going into a prison-like setting.” He credited a counsellor for helping him connect with his love for music. During a group therapy session, the counsellor asked the peer group to share any meaningful activity they thought they could “do on [their] own and that only [they] could control.” When it was Sean’s turn to speak, he mentioned his love of music. Sensing Sean’s passion, the counsellor stopped the group and asked, “Did you guys feel that?” Sean remembers that “they all said yes.” Several commented on how “the room lit up when [Sean] spoke about music.” That night, Sean went back to his room and wrote a song that he performed the next day in front of a small group of his peers. He could not recall much from his performance, but he did remember feeling nervous and awkward. Sean had never performed in front of an audience before, but he thought that the guys who showed up “really liked it.”  Sean’s life since completing treatment. Sean’s abstinence from drugs following treatment was short-lived: “I used the first day that I left. I made a drug deal in the parking lot on my way out.” Fortunately, his relapse was brief. On the bus home from Sunshine Coast, Megan called Sean to advise him that she was returning with the kids: “[I remember thinking], ‘Okay, now the family is coming back. I am out of treatment. I’m going to stay sober.’” He then abstained from drugs and alcohol for two years. During that time, as he resumed his busy life, he wrote and recorded 50 songs. Word spread about his music, and soon he was “getting interviews with radio stations.” Then Sean’s marriage to Megan ended. It was a messy split. She left town with the kids and wanted full custody. He started drinking again. Then new ownership at work cut Sean’s salary. Sean fought the cut by trying to unionize his fellow managers.  68 At the time of interview, Sean continued to work as an engineer while negotiations on union certification continued. He and Megan are now on good terms and share custody of the children. Sean realized his tendency to be a “people pleaser,” going back to his childhood: “The relationship between [my mom] and my dad weren’t [sic] so great. So she needed somebody—then I carried that burden and then continued to carry that burden.” After treatment, Sean realized that “you can’t fix everybody’s problem. You can’t carry all their burdens that way. You can only be there for them and protect your own health.” At the time of interview, Sean was living with his girlfriend Trisha, who was also in recovery. For a while, he was writing songs with a fellow Sunshine Coast alumnus, Josh, but stopped after Josh relapsed: “I’m really watching my boundaries with him.” Unlike before, Sean was no longer turning to alcohol to help him relax during social gatherings: “[When] I am starting to feel those things, I just remove myself from it and then I go to where my comfort zone is.” His arrangement with his girlfriend was that both agreed to end the relationship if the other relapsed to drugs or alcohol: “We need to have boundaries.”  Contextual factors Sean identified as part of his personal transformation. Sean identified a sense of safety and the diversity and solidarity of the peer group as important sociocultural contextual factors at Sunshine Coast. His decision to perform music to an audience for the first time was made possible by a sense of safety. I have already discussed this event as his turning point. Sean also acknowledged the comfort of knowing “that there are more people like you.” Elsewhere, he referred to his peer group as “like-minded people.” At the time of interview, he reported continuing to draw strength from his peer group and the “knowledge that there is a group out there.”  69 The main identity-related theme of Sean’s story: Discovering oneself through music. Sean’s recovery can be understood as a search for his authentic and spiritual selves and meaningful connection with others. Dirkx (2007) described transformation as the realization of a “true, real, or authentic self” (p. 112). Prior to treatment, Sean reported a lack of identity: “I felt lost. . . . I didn’t know who I was, myself, my place in the world. I just felt like I was lost, for sure.” He described his love for music and sharing it with others as “just real. It’s very real.” When he described his performance at Sunshine Coast as “truthful” and “honest,” he was not referring to honesty in a moral sense but in terms of his sense of connection with others. According to Sean, “I like to use [music] as my main purpose because I truly feel like . . . there’s something magical about it.” Since leaving treatment, he has continued to write music and use it to help others who have similarly struggled with addiction and other mental health issues.  Ian’s story (#3). Ian grew up in Atlantic Canada but moved to Vancouver with his parents when he was 17. He spent the next 10 years away from his parents, touring North America as a musician. In his late 20s, he stopped touring and became a successful business manager in Vancouver’s hospitality industry and director for several nonprofit agencies. Ian’s career, however, was sidetracked by frequent partying, drinking, and drug use. It was then that he decided to attend Sunshine Coast. At the time of interview, Ian was single, 35 years of age, and back in Atlantic Canada working as an operations manager.  Ian’s hitting bottom moments. Ian recalled hitting bottom twice. Three years prior to his treatment at Sunshine Coast, he experienced a “mental health breakdown.” According to him, “I didn’t have the coping skills developed to deal with the realness of doing business in [the Downtown Eastside]”—a neighbourhood known for its high incidence of drug addiction. 70 Ian changed jobs and cut back on volunteering, but continued to work and reside in the Downtown Eastside : “You become a part of that fabric when you live in it.” Complicating matters at the time was getting “involved in a relationship with a woman who was also [opioid] dependent.” Ian continued in a “kind of slow decline that happened over [a] period of two years or so.” His second experience of hitting bottom occurred while attending a party thrown in recognition of his 33rd birthday. Ian remembered arriving and “look[ing] around the little special room that we had and [asking himself], ‘You know, are any of these people really my friends?’” He described the party as the “icing on the cake.” Ian met with his parents and asked for their help. A few weeks later, he began treatment at Sunshine Coast.  Ian’s turning point moment. While talking about his Sunshine Coast experience, Ian did not point to one single event that was transformative. Instead, he described three contextual factors of residential treatment that facilitated his personal transformation, which I discuss below. In many ways, these were Ian’s turning points, but because they connect more to contextual factors, I save the analysis for below. Ian’s life since completing treatment. Ian’s struggles did not end when he completed treatment. With no job, no money, and no place of his own, he relapsed: “Living back with my mother and father like at that age was kind of emasculating.” He was angry at himself for “having developed this addiction, . . . having wasted 15 years of my life, [and having] nothing to show for [my]self.” Ian’s dependence on his parents was demoralizing to the point that he found it difficult to look for work. Four months later, his parents gave him an ultimatum: Move back to Atlantic Canada and live with your uncle or “go to the streets.” For Ian, moving back to Atlantic Canada was the “right decision to make.” Living there meant less exposure to the lifestyle that had contributed to his addiction: “[the 71 Downtown Eastside] was just full of triggers.” At the time of interview, he was coming up on two years of sobriety, was back working in operations management, had started training to be a SMART Recovery meeting facilitator, was seeing a counsellor, and was volunteering at a street outreach program.12 Ian’s relationship to drugs has changed. He told the story of when his personal belongings arrived from the city. While retrieving his clothes from one of the boxes, a small bag of heroin fell to the floor: “There was no inclination to be like, ‘Yeah, I’m going to use this.’” He remembers his days spent at the Vancouver detox, talking to people in their 60s who were still addicted to heroin. “I’m, like, lucky to be out of this at my age.” Contextual factors Ian identified as part of his personal transformation. Ian credited several contextual factors at Sunshine Coast for his personal transformation.  Sociocultural factors. At Sunshine Coast, Ian benefited from having a sense of safety, the diversity and solidarity of the peer group, and time to engage in reflective discourse with his peers. He described Sunshine Coast as a place that allows “people to show a certain level of vulnerability that they may not otherwise be able to achieve.” According to Ian, evening and weekend art classes in crocheting, quilting, and making bracelets gave the men “permission to be vulnerable.” He commented on how rare it is for men “to do those kinds of creative activities.” He laughed while recalling making art with his fellow peers: “You want to see a bunch of tough army guys hanging out around a loom.”  Ian also reported benefiting from meeting men of different ages, backgrounds, drugs of choice, and life experiences. He allowed himself to become more vulnerable in the presence of others and “take in what they had to share about their personal experiences.” He did not let their differences become “something that sort of prevented you from relating to  12 See Anderson (2010) for a study of SMART Recovery participants and their recovery experiences. 72 those guys.” Ian referred to the “knowledge shared between the younger and older generations.” Meeting men who shared his problems with drugs and alcohol was an eye-opening experience for him: “No matter who you are or where you’re at, when you’re in that environment, you’re all at the same batting level, right? Everybody is playing the same game.” Ian also benefitted from the more senior peers: “So there’s a rotational cast13 [at Sunshine Coast], but so you’re catching the wisdom of guys in your early recovery.” Finally, Ian used his time outside of the therapy room to have “informal conversations” with his peers: “You go to group [therapy] and, you know, a three-hour session that’s mediated by your counsellor, but then you go to lunch and you can debrief.”  Material factors. For Ian, time for critical self-reflection and Sunshine Coast’s peaceful environment were two important material factors. The beach was his favourite place to engage in “personal moments of reflection.” Being on the beach reminded him of spending time with his grandfather on the beaches of Atlantic Canada. Elsewhere, Ian described Sunshine Coast as “homey-like [and] . . . comfortable.” The main identity-related theme of Ian’s story: “I’m going to be cool with sharing my emotions.” Ian’s story is an example of a man coming to terms with his investment in an idealized sense of masculinity which includes the need to be in control and self-reliant. During treatment, he explored other forms of masculinity by reconnecting with his emotions and allowing a more vulnerable self to emerge, something he had not done since he was a child growing up in Atlantic Canada. Ian explained that, prior to treatment, he had developed a certain arrogance from years of living and working in Vancouver’s Downtown Eastside: “I  13 Sunshine Coast has a continuous intake policy, meaning that attendees do not start and finish together but, instead, are at various stages of treatment completion.  73 wouldn’t want to be told anything, really, by anybody.” Being with friendly, caring people at Sunshine Coast “made me drop a chip on my shoulder and made me more apt to take in what they had to share about their personal experiences.” He decided during treatment that “I’m going to be cool with sharing my emotions.” Now that he’s back in Atlantic Canada, Ian finds himself “doing a lot more listening than talking. . . . Just taking a break from doing your thing all the time.” He shared a story about his friend Tommy, who is proud of having Ian as his friend. Tommy likes to smoke cigarettes and go on long drives with Ian. One day, Tommy brought Ian to the soup kitchen to meet his friends. Reflecting on his day with Tommy, Ian said it was about “taking time out of my day. . . to just go do something for a guy that, you know, has been through similar things.” For Ian, spending the day with Tommy was a chance to be vulnerable again, “man to man.” Nick’s story (#4). Nick is a 52-year-old man who took early retirement due to early onset dementia caused by multiple traumatic brain injuries sustained playing amateur sports. For the past few years, he has been on numerous medications to slow the progression of his short-term memory loss and treat other symptoms of early onset dementia, including mania, anxiety, and depression. He is married and a father to a 10-year-old boy.  Nick’s hitting bottom moment. Nick was motivated to attend Sunshine Coast after a string of broken relationships. He divorced his wife Helen to be with his girlfriend Tara. Nick and Tara would often spend their weekends “doing a lot of coke.” The relationship was turbulent but progressed to the point that they were making wedding plans. That all changed one holiday weekend. Nick recalled Tara saying, “[I’m] done. . . . That’s it. I’m leaving you.” He pushed her to the ground. Even though he was “higher than a kite,” the incident was 74 “kind of an epiphany . . . [a realization that] I can’t keep on doing this.” When Nick returned home, he booked an appointment with a counsellor who recommended he attend Sunshine Coast. He checked in later that week. Nick’s turning point moments. Nick experienced two turning points during his stay at Sunshine Coast. Initially, his attention was on how he could salvage his relationship with Tara, so he wrote to her. Tara wrote back two weeks later stating, in no uncertain terms, that the relationship was over. Sitting around a bonfire with a group of his peers one night, Nick told them about the letter: “Look, she wrote me back, guys. She doesn’t want anything to do with me. So you know what? I am going to cleanse myself.” Nick then dropped the letter into the bonfire. For him, it was an emotional moment: “A load had been lifted off my shoulders. . . . [It was] cathartic.” After that night, he felt a sense of freedom to focus on himself. Nick summed up the burning of the letter as “throwing out the old . . . [and] open[ing] myself up to something new.” The event also brought him closer to his treatment friends. At the time of interview, he was still in daily contact with several of the men who were there that day. Nick’s second turning point involved a spiritual encounter with nature which I describe further below.  Nick’s life since completing treatment. Life changed quite dramatically after Nick returned home from treatment. He met another woman and married two years later. They have a 10-year-old son. Nick’s early onset dementia progressed to the point that, four years after completing Sunshine Coast, he went on permanent disability from work. At the time of interview, he was exercising on a daily basis and golfing with his son on the weekends. He used to coach his son in hockey and baseball but, due to his medical condition, eventually had to be content cheering from the stands. Nick and his ex-wife Helen are now on good 75 terms. A 25-year member of AA, Helen helped him find a sponsor. He credited his sponsor with helping him maintain recovery since completing treatment. Nick’s current wife drinks, and when I was interviewing him in his home, there was a wine rack in the living room. For Nick, being in recovery means that you “don’t flake out just because there’s alcohol [in the room].” He continues to have the occasional urge to drink alcohol or snort cocaine, but he said, “It’s fleeting. It’s there and then it’s gone.” Contextual factors Nick identified as part of his personal transformation. Nick talked about needing to sort out the abrupt end to his engagement to Tara. At the same time, he realized that he needed to make a change in his life, with or without her. He credited both sociocultural and material contextual factors in helping him move forward. Nick’s letter burning story illustrated taking time to engage in reflective discourse and having a sense of community as important sociocultural factors. In terms of material contextual factors, his deer encounter, which I now describe, illustrates the importance of Sunshine Coast’s peaceful environment and time to engage in critical self-reflection.  The main identity-related theme of Nick’s story: “Something was guiding me.” Nick’s emergent sense of spirituality was an important theme in his recovery. He identified the importance of signs: “Signs of something like—signs that there is something bigger than me.” He had encountered numerous signs before but had never thought much about them. Often the signs came in the form of close calls or brushes with death: “Something bad [that] should have happened.” For example, 10 years before he went to Sunshine Coast, Nick had a stroke “purely because of cocaine use.” Doctors said he was lucky to be alive. Somehow, he made a complete recovery. His brush with death did not change anything: “Second or third call I made [out of the hospital] was, ‘Okay, I’m out. I need an eight ball [an eighth of an 76 ounce of cocaine].’” During his treatment at Sunshine Coast, a counsellor pointed out all of Nick’s close calls: “She just showed me that if I went back in my life to certain events that happened that there was something there . . . guiding me and keeping me safe.” For him, the very fact that he is alive today is “empirical data” for the existence of a guardian spirit.  Nick experienced a sign a few weeks into his stay at Sunshine Coast. Sitting alone one night at a spot looking out at Malaspina Strait, he found himself “doing a prayer to myself and asking for a sign.” When he opened his eyes, a deer slowly emerged out of the darkness: “[It] looked at me. Looked down, looked at me again, [and then] just walked away.” Nick had already seen humpback whales, bears, and deer during his stay at Sunshine Coast: “There was nature all around.” But this was different: “It was just me and the deer. . . . It was personalized.” The deer’s mysterious appearance was proof that “something was guiding me towards finding a more—just a different lifestyle.” Ten years later, Nick’s sense of spirituality continues to play a big part in his recovery from addiction: “I still believe there’s something bigger than me. That keeps me sober to this day.” Scott’s story (#5). Scott, 43, owns a consulting business, is married, and has no children. He had been abstinent from gambling six months before attending Sunshine Coast and from alcohol since the beginning of his treatment stay. Prior to treatment, he was formally diagnosed with bipolar disorder.  Scott’s hitting bottom moment. Scott was formerly a lawyer and practiced for seven years until he “kind of burned out.” Law was simply too stressful and not good for his bipolar disorder. Scott requested a lump-sum payment from his employer. Flush with cash, he went on an online gambling spree: “I was getting up in the middle of the night gambling and doing it while [my wife Naomi] was at work.” Scott described his life at the time as being “riddled 77 with guilt and shame.” He finally admitted to Naomi the extent of his online gambling problem: “I didn’t have any [savings] left, and I had to explain why.” Scott started seeing a counsellor for his gambling and attending Gamblers Anonymous meetings, but his drinking and financial problems continued. His physical health started to decline: “I was heavy and gaining a lot of weight. I was using food and alcohol as a means of escaping.” This behaviour went on for years. Scott found full-time work as a car salesman, but his sales were disappointing. The pressure of meeting his sales quota triggered his bipolar disorder. He started to feel “very hopeless . . . a complete waste of space.” He reasoned that if he killed himself, Naomi “would at least get some money” from their insurance policy. Perhaps she would forgive him for gambling away their savings. Scott attempted suicide, survived, and spent a week in a psychiatric ward. The following week he flew to Powell River to begin his treatment at Sunshine Coast.  Scott’s turning point moments. Several significant events happened during Scott’s first week at Sunshine Coast. First, he found immediate relief after being taken off an antipsychotic medication for his bipolar disorder. One of the drug’s side effects is lowered inhibition, resulting in pleasure-seeking: “[I] could see how my pattern [of online gambling] escalated once I was on this [drug].” Second, Scott’s negative, work-defined sense of self was transformed after being warmly welcomed into the peer group: “I knew at that moment I had worth as a human being.” Third, Scott credited two counsellors for helping in his recovery. One counsellor helped him become aware of his negative self-talk: “[She told me,] ‘You don’t recognize that you’re doing it, but it is very destructive.’” Another counsellor introduced him to visualization and mindful breathing techniques to help him with his 78 anxiety. The same counsellor gave him a simple way to understand stress—as an activation of the primitive reptilian part of his brain.  Scott used his time in treatment to repair his relationship with Naomi. For him, this was the beginning of his “journey of self-discovery . . . where I had to be honest with myself.” In the evenings over the course of his treatment, Scott would call Naomi and talk about his past, including the online gambling and his visits to the pub. There had been little omissions, too. For example, Scott would get invited to a party and then tell Naomi only the night before. She would then get upset for not being told sooner. Scott agreed to be more forthcoming with her in the future.  Scott’s life since completing treatment. Since completing treatment, Scott has made many changes in his life. When he was at Sunshine Coast, he did not exercise: “I felt so tired when I was at Sunshine Coast. . . . I think I needed a lot of rest.” He noticed a lot of the other guys in treatment worked out: “[I] saw the benefits of it, and I knew how important it was to have that as a priority.” At the time of his interview, Scott was attending group fitness classes—he liked “the energy and the camaraderie and doing things together.” He also found that fitness had a positive effect on his bipolar condition. After treatment, he practised visualization and mindful breathing techniques. At the time of interview, however, Scott found such techniques less important: “I don’t need it as much; I have a stronger tool kit to deal with my mental state.” Scott’s employment situation has changed dramatically, too. At first, he was thinking of returning to practise law: “I applied to get my law license back. . . . I was eager to do things, and I felt like I had the power to do things.” But something else happened in treatment: “I realized I had value, and the value is really being a good person.” He did not 79 just want to be “chasing material things” but actually make a difference in the world. Furthermore, Scott “didn’t like having somebody tell [me] to do things in a certain way that [didn’t] coincide with the way I ethically view the situation.” So, instead, he started his own data security consulting firm where he could “be a good person and do good, good things. . . . That’s what gives me meaning.” His business has grown enough that he no longer needs side jobs to pay the bills. Scott acknowledged that it is has been hard to balance his relationship with Naomi, look after his body, and grow his start-up business: “But, you know, I’m not going home going, ‘Ah, I wish I had a beer.’” His mental health has improved, too: “[I] can stop and recognize the way I’m thinking and talking to myself and I can turn that around.” Now Scott’s “funks” last only a few hours or a day, not weeks like before.   Contextual factors Scott identified as part of his personal transformation. Scott’s identity transformation involved both sociocultural and material contextual factors.  Sociocultural factors. Scott identified three important sociocultural contextual factors that contributed to his personal transformation. First, he referred to having a sense of safety during his stay at Sunshine Coast. He believed that staff were “genuinely looking after my care.” He was initially shy with his peer group but that changed a week into treatment: “[I] started finding people and talking to people and feeling really comfortable.” Second, Scott identified the diversity and solidarity of the peer group. He recognized that he was in treatment with “people from all walks of life.” At the same time, he appreciated getting “peer perspective from people who have been through similar struggles.” Scott came to realize that he was “certainly not the only one who has experienced this [issue], and that was eye-opening.” Third, Scott benefited from having time for reflective discourse. He recalled discussing his tendency to engage in negative self-talk with his peers after his counsellor first 80 brought it to his attention in an individual counselling session. For the most part, however, he preferred engaging in reflective discourse with his wife Naomi.  Material factors. Scott benefited from several material contextual factors, including time for reflection, time for implementing lifestyle changes, and the peaceful environment at Sunshine Coast. He described his time at Sunshine Coast as “the only time in my life that I’ve been able to focus in an unselfish way on myself.” He also reported visits to the lookout point as his “introspective time.” The main identity-related theme of Scott’s story: We all have our struggles; our mistakes do not define who we are. Scott’s identity transformation involved a positive, more expansive, view of self. Prior to treatment, Scott’s sense of self suffered from being too narrowly focused on his breadwinner role, further problematized by the end of his career in law:  I was working in a job selling cars. I was not a good car salesman. . . . I didn’t believe in myself. . . . I just sort of lost hope. . . . I tried to kill myself. . . . I literally thought my only worth, like my only value to my wife, [was my] insurance policy if I died. During treatment at Sunshine Coast, Scott also realized the extent to which he had internalized the shame associated with being addicted to gambling and alcohol. As mentioned above, he had been attending Gamblers Anonymous meetings. However, the meetings further contributed to his negative sense of self:  The night before I committed suicide [sic]—I think it was one of the reasons why I was feeling so bad the next morning was because—I attended this bloody meeting and you don’t move forward. . . . Everybody tells their crappy story, and you just feel like you’re [in] a room full of losers.  Scott had a similarly negative opinion of addicts: “My notion of people addicted to substances was what I’d see on the Downtown Eastside of Vancouver. . . . I thought I was going to encounter 40 other men like that.” He recalled feeling terrified while travelling to 81 Powell River: “I didn’t know what to expect. I didn’t know how I was going to relate to addicts.” Reflecting on his treatment experience, Scott realized something about himself: “I had a lot of judgment towards addicts and my own. I loathed myself because of my own addictive pattern.” Part of his transformation was recognizing that he was not the only one with problems: “Most of what I was seeing [were] people who [were] just struggling with something in their life.” Whether they were paramedics or veterans who were witnesses to human suffering or people like himself who had made some bad decisions in life, he understood that “we just didn’t know how to deal with it ourselves, so we turned to things that are not healthy, like substances.” Going forward, Scott concluded, “I made mistakes [but] that’s not going to define me. . . . I’m not a bad person.”  Ed’s story (#6). Ed was a successful 48-year-old married businessman and father to two boys in their 20s. He described himself as a “functional” husband and father: “I was kind of there. But I was never there.” For years, he was able to limit his drinking to Thursday nights, Fridays, and weekends: “Twice a week, I’d probably be finishing off three quarters of a 40 [ounce bottle] of rum.” On vacations with the family, Ed would start drinking at 10:00 each morning and stay drunk until he passed out. When asked how he balanced his many obligations with his heavy drinking, he explained that he “was able to kind of manage around it.”  Ed’s hitting bottom moment. In the weeks leading up to treatment, however, Ed’s life had become untenable: “I was in a mass existential crisis, you could say.” His drinking was getting “progressively worse.” He sold his business. His weight had ballooned to 275 pounds. During a trip out of town for his son’s hockey, Ed got “black-out drunk” during a night out at a restaurant with all the players and their families. He ended up in jail after getting into an 82 altercation with a police officer. The humiliation of that evening was too much for him. Out of jail and back home, he cancelled a planned dinner party with friends. A friend told him about Sunshine Coast. Three days later, Ed was on his way to Powell River.  Ed’s turning point moments. Ed’s first turning point occurred while waiting at the Powell River airport for the shuttle bus to take him to Sunshine Coast. He noticed a haggard, nervous-looking man sitting across from him in the waiting room. Ed guessed correctly that he, too, was going to Sunshine Coast: “I remember a comfort in finding someone else there, . . . understanding that this may not be just me.” In the early days of his treatment at Sunshine Coast, he recalled thinking, “‘[I] don’t belong here.’ . . . I remember being scared.” Over the next few weeks of treatment, Ed came to realize that “other people are going through this. You’re not alone; it’s not just me.” That realization was “where the transformation started happening. . . . Before I was thinking, ‘I am isolated.’ That it [was] just me. My problem. My shit.” It was also at this point that Ed started to think, “You can do this.”  Other turning points would follow. Ed credited a Sunshine Coast counsellor for introducing him to the concept of “‘Little Ed’—that’s [the] Ed that’s hiding inside, that’s terrified of letting other people know who he is.” He also found psychoeducation classes transformative, particularly the talks on neurobiology. For him, the idea that the brain can heal itself, according to research on neuroplasticity, engendered Ed with a sense of hope and helped reinforce the importance of a healthy diet and exercise. Ed became a voracious reader and identified Viktor Frankl’s (1946/1985) Man’s Search for Meaning and musician Eric Clapton’s (2007) autobiography as particularly important books that facilitated his recovery. He remembered thinking after reading Clapton’s book that addiction “doesn’t have to be a sickness that people look down at you upon. . . . This can be your triumph.” Reading and 83 attending Sunshine Coast psychoeducation sessions “help[ed] make sense of things—that [I was not] necessarily doomed in any way.”  Ed’s life since completing treatment. Ed’s transformation continued unabated after completing treatment. At the time of interview, he was avoiding caffeine, refined sugar, and artificial sweeteners—“any kind of influences that could have an impact on my neurobiology from a physical standpoint.” Since leaving treatment, Ed has lost 65 pounds. He nourishes his spiritual self by studying Buddhist teachings and following a daily meditative practice. He went back to school and completed a master’s degree in business administration. He described his relationship with his wife Keli as excellent and with his boys as improving: “[Keli and I] live a quieter life. We grow vegetables, and I’m not as focused on things anymore. I don’t work as much.” Ed’s interest in helping others was also evident—after treatment, he became a certified professional coach and volunteered to manage the Sunshine Coast peer group in his home city. He described his approach to recovery as “scaffolding”—a process he described, metaphorically, as something to stand on “so that when you’re ready to jump through the next threshold you can.” Coincidentally, Rossiter (2007) also used the term scaffolding to represent how “an adult student is able to grow, change, cast off constraints, and take on new challenges” (p. 93).  Contextual factors Ed identified as part of his personal transformation. Ed reported benefiting from both sociocultural and material contextual factors at Sunshine Coast. He identified the diversity and solidarity of the peer group as an important sociocultural factor in his personal transformation. Ed discovered that Sunshine Coast was a “super interesting place. You’ve got guys that are, you know, coming in off the street to famous musicians and stuff.” After a week in treatment, he described a “feeling of togetherness, that feeling of 84 sharing, that feeling of not being alone.” This was particularly important for Ed given that his friends and family were not supportive of his decision to go to treatment. He also appreciated having time for critical self-reflection and time to implement lifestyle changes as important material factors. He acknowledged that, prior to treatment, “alcohol was an excuse not to spend time with myself.” At Sunshine Coast, Ed found that he had time to read and “think about this stuff. . . . I didn’t have any work to do.” Ed used his time in treatment to implement numerous lifestyle changes, preferring exercise, playing team sports, mindful meditation, and reading to “idle chit chat” and “gossip.”  The main identity-related theme of Ed’s story: A new yet evolving sense of self—“I’m still working on that social aspect.” Ed’s personal transformation involved an acceptance of his former, negative self and a willingness to reveal his “true” self. Ed found a creative way to work on his negative sense of self while exercising in the gym. Before jumping on the treadmill, he would create a song loop on his smartphone. He would listen to the song “No Love” by Eminem and change the lyrics, e.g., changing the line from “no love for myself” to “no love for that old self.” The song became a mantra for Ed that had the effect of changing his “negative self-talk.”  During our interview, Ed identified his struggles with social anxiety as being partly responsible for his drinking. As an adolescent, he recalled being a “very anxious young man, very socially awkward. . . . [When I found alcohol, my] brain said, ‘Bang! Here’s your solution.’” Ed attributed a fear of rejection as being what kept him from reaching his full potential: “I still had a huge mask on. . . . I was scared still of letting people in. . . . I was part of a multinational company—I could have been the CEO of the entire organization.” At the time of interview, Ed was “still working on that social aspect” of his life. Fortunately, Ed’s 85 struggles with how he relates to others is no longer handicapped by a negative sense of self: “I just love life—I love myself.” James’s story (#7). At the time of interview, James was a 39-year-old Indigenous man, divorced, with two young children. His marriage to wife Cindy was an unhappy one, marred by frequent arguments. After his marriage ended in divorce, he relocated to be closer to the Nation of his birthplace: “[I] wanted to be with my culture.” After his relocation, however, James’s life spiralled into a personal crisis.  James’s hitting bottom moment. James changed jobs after relocating to his birthplace Nation. His new career as a family support worker became a daily reminder of his own past history of abuse and growing up in foster homes: “My mom used to beat me. . . . I was molested [by a teacher] when I was 12.” James turned to alcohol to “shut it off,” but it took a toll on his work: “I was showing up to work hung over, or I’d be an hour late.” His drinking was no secret among his many relatives in the community. One night, he crashed his car into a ditch. Thinking that the Nation’s remoteness was contributing to his drinking, his employer suggested James relocate to a larger community and commute to work. He moved, but the traumatic memories and heavy drinking persisted. He decided he needed treatment but did not want to attend a facility funded by the National Native Alcohol and Drug Abuse Program due to its focus on Indigenous culture: “[Sunshine Coast’s program] was more focused on me and what was really behind my drinking.” After two months of negotiations, James’s Nation agreed to cover his expenses to attend Sunshine Coast.  James’s turning point moments. James recalled having a lot of anxiety on his way to Sunshine Coast: “I was real nervous. I was sweating the whole time.” In spite of his anxiety, James took full advantage of peer group discussions: “The guys there made the biggest 86 difference.” Once a week, newly arrived clients at Sunshine Coast are invited to share their life stories with the peer group. It took James two and a half hours to tell his story—a full 90 minutes longer than scheduled. The experience was very emotional: “I was crying. . . . There was a time when I didn’t talk for 10 minutes.” He thanked his peers for not leaving early. Initially, James was afraid that eye movement desensitization and reprocessing (EMDR) therapy and hypnotherapy would bring back painful traumatic injuries: “I had self-confidence issues,” he recalled.14 Ultimately, he was glad he went ahead with the therapies: “I had real breakthroughs. . . . At about the 40-day mark I was like, ‘Oh, this is what [my counsellor] was talking about.’ . . . [It was] like an awakening.”15 In the evenings following EMDR and hypnotherapy sessions, James would talk about the experience with his peers: “That’s where the aha moments came in—where I just talked about it and [came to realize that] I didn’t die. . . . I was able to still process it and still be in a good mood at the end of the day.” James’s life since completing treatment. James has made significant changes to his life since completing treatment. At the time of interview, he reported no longer physically reacting to stress: “I know what to do afterwards if something does come up.” James has created several strategies to help self-regulate from stress. For example, he likes to go for long drives after particularly difficult days at work. He also reaches out to his support network, which included his former counsellor at Sunshine Coast, several of his treatment  14 EMDR is a treatment for trauma developed by Francine Shapiro. It involves a therapist directing a client to recall a distressing image while engaging in side-to-side eye movements. This process is repeated until the client feels more comfortable when asked to recall a distressing memory (Feske, 1998). 15 I incorporated James’s experience of “like an awakening” into this study’s title. I chose this quote based on how it captured the transformative experience of residential addiction treatment for many of the study’s participants.  87 friends from Sunshine Coast, and a counsellor arranged through work. James has transformed into a supportive father to his children and friend to his ex-wife Cindy.  When asked about his kids, James recalled how one of them said, “I have my dad back.” Before, James would drink beer and watch television on the days he had custody of the kids. Now he has fun with his them. In the year since completing treatment, he had taken his kids camping on four separate occasions. James recalled how one of his kids recently said it would be okay if he had a beer. He explained that “Daddy doesn’t drink anymore,” to which his child replied, “I like you better when you don’t drink.” Following treatment, James took responsibility for the divorce—the fights, the name calling. One day, he said to Cindy, “You are the mother of my children. I want you to be happy because if you are happy, they are happy.” James’s relationship with her has progressed to the point that “she’s now calling me to confide in me and asking me for advice.” Cindy has since remarried, and James has become friends with the stepfather of his children: “We are friends now.” Cindy even has James over for dinner when he is in town.  James’s recovery from addiction has provided an additional benefit: “Having my sobriety has given me my culture back.” As he explained, when he was drinking, he was too ashamed to show up at dance practice, potlatches, or powwows. With recovery, he gave himself permission to attend “many cultural events, and that has been huge.” After returning to his Nation, James took a new position as a family ties and preservation worker. His employer agreed that there were just too many triggers being a family support worker. James’s new work involves travelling thousands of kilometres every week to First Nations communities across his home province. For him, “It’s very empowering to be able to go in front of a large group.” James occasionally brings his kids with him so that they can learn to 88 appreciate their First Nations heritage. They also get to see him drum and sing while he performs cultural dances. An exception to the many positive changes James has experienced after completing treatment has been his relationship with his family of origin. His sister has struggled with drugs and an abusive relationship. James recognized the importance of maintaining boundaries for his own well-being. He told his sister he loves her, but hearing about her continued drug use and on-again, off-again marriage was not good for his own recovery. James had long been estranged from his physically abusive mother. After receiving the news that her death was imminent, he travelled great lengths to be at her bedside: “I made my peace with her. [I] said, ‘Look, Mom, I don’t hate you. I don’t want you to die thinking I hate you.’” James did not want to repeat the mistake he made with his father, who passed away when James was still a teenager. The last thing James said to his father was, “I don’t fucking need you” before hanging up the phone. James’s father died that night. It was important for James to bring closure to that chapter in his life: “I gave her that peace; a peace for myself, too. It helped me [get] past it.” Contextual factors James identified as part of his personal transformation. James’s transformation was facilitated by contextual factors that were both sociocultural and material in nature. Sociocultural factors. An important sociocultural factor for James was time for reflective discourse. He credited his peer group with his personal transformation: “Those guys . . . probably helped me more than the [psychotherapy] groups did.” He “clicked” with a group of five peers, and they became friends: “We all just hung out every single day after our groups and played cards, [watched] movies together, talked, and we started knitting and 89 [making] crafts.” Oftentimes, James and his group would “laugh and talk about something that came up after the small group [counselling] was over.”16 He preferred talking to the peer group without having a counsellor present: “[My peer group] didn’t really talk about it in small group but amongst themselves. They shared with me what happened to them when they were young.” James also identified the importance of being with a peer group to whom he could relate: “We just clicked because of similar interests . . . hockey and Marvel movies, things like that.” He found these informal talks with friends a significant aspect of treatment: “It was really helpful to have the debrief afterwards.” Material factors. James reported benefiting from having time for critical self-reflection and mentioned that he rarely called home while he was in treatment: “My philosophy was, I am here for me, right. I need to just focus on me. This is my time to be selfish.” Having time to critically reflect was consistent with his Indigenous spirituality: “There was something you were supposed to see, but it required you slowing down to get there. I liked that aspect of [Sunshine Coast]. It worked [hand] in hand with my cultural beliefs.” James also took advantage of Sunshine Coast’s peaceful environment. He recalled having deep conversations with his peers down on the beach or at the “smoke shack,” which is the designated smoking area at Sunshine Coast. He described his busy life back home: “Working back home was—you had a pretty hectic schedule. . . . I was on call for seven days [a week].” The main identity-related theme of James’s story: “I can take control over the story rather than [let] it control me.” James alluded to a storied self and a transcendent self as part  16 At Sunshine Coast, “small group” refers to group psychotherapy involving 8 to 12 attendees, as opposed to “big group” psychoeducation sessions involving all program attendees.  90 of his recovery experience. Prior to treatment, James perceived a lack of control over past traumas; he would either suffer in silence—“[I] never told anybody”—or be overwhelmed by emotion—“[I would] just shut down. . . . My jaw would start clenching.” Part of his transformation was the recognition that “I can’t change what happened to me, [but] I can take control over the story rather than [let] it control me.” Recall Dirkx’s (2007) transformative learning research on the “storied self” (p. 110). After sharing his story, James continued to talk to peers and counsellors about his childhood trauma. The more he shared his story, the more he noticed that it was “possible to talk about [his trauma] without being retriggered every single time.” Within two weeks of returning to his Nation after completing treatment, he shared his story with his work colleagues. They all knew he had gone to treatment, and he wanted to explain “what was affecting me and what led me to choosing to go to treatment.” After telling his story, James recalled how many of his work colleagues opened up about their own experiences of childhood abuse. He also felt it was important to explain to his ex-girlfriend that his problems with sexual intimacy were due to being molested as a child. According to James, “The more times I’ve been sharing [my story], the easier it has been.” Telling his story gave him a sense of control over his life: “I’m getting my ownership back.” During treatment, James was also able to reconnect with his Indigenous-informed spirituality which, in turn, helped him make sense of his childhood trauma experience and subsequent recovery. A village elder taught him three important spiritual lessons. The first lesson was, “Everything that you experience is a lesson.” Meaning is behind every experience, although sometimes one has to slow down to find it. Second, “Everything happens for a reason.” James believed that there was a reason why he went to treatment. All of the struggles he endured happened for a reason, but “you have to sit down and analyze it, 91 think about it.” He came to realize that addressing his unresolved trauma issues could, in turn, make it possible to help others who still struggled with the same condition. Third, “Everyone you meet is a teacher.” James believed that his peers helped him learn to live more slowly and bring meaningful conversations back into his life. He credited his friends at treatment with showing him how to slow down, so he was better able to “see something I was supposed to see” and learn from it. Part II: Synthesizing the Stories Participant narrative revealed several common themes and differences that are relevant to my research questions. They also demonstrated the utility of combining transformative learning and addiction treatment and recovery frameworks to illuminate how some men undergo meaningful change in some adult learning contexts, particularly residential addiction treatment. In this section I summarize the results of participant data presented in the individual stories above.  Findings related to Research Question 1. “What are some of the processes involved in personal transformation as reported by men recovering from addiction?” Participants engaged in rational and extrarational processes that culminated in one or more turning points. The data revealed important differences between hitting bottom and turning points. For many of the participants, hitting bottom was a period of increasing isolation and emotional suffering to the point that suicide became a viable option. Participants described how negative consequences associated with problematic substance use contributed to their experience of hitting bottom. Participants also identified deeper emotional and relational issues that existed prior to, or coincided with, their problematic substance use. Turning points, on the other hand, involved both negative and positive emotions and the successful 92 employment of other psychological processes. I summarize each participant’s turning points and related processes in Table 3.  Table 3 Summary of Turning Points by Participant Name Turning point Rational processes Extrarational processes Relational Emotional Spiritual Imaginative Unconscious Eric Group therapy session  ✓ ✓    Hypnotherapy, nontraditional therapies ✓ ✓ ✓   ✓ Group meditation  ✓ ✓ ✓   Sean Group therapy session  ✓ ✓    Performing for group  ✓ ✓  ✓  Ian Group therapy sessions & informal talks ✓ ✓ ✓    Creating art with peers  ✓ ✓  ✓  Sitting at beach ✓  ✓ ✓   Nick Campfire incident  ✓ ✓    Encounter w/ deer ✓  ✓ ✓   Counselling session ✓ ✓  ✓   Scott Group therapy session  ✓ ✓    “Negative self-talk” session ✓ ✓     Sitting at beach ✓  ✓ ✓   Ed Encounter at the airport  ✓ ✓    Group therapy session  ✓ ✓    Running on the treadmill ✓  ✓  ✓  Reading ✓  ✓    James Group therapy session  ✓ ✓    Individual trauma therapies ✓ ✓ ✓    93 Participant data revealed two types of turning points: an initial turning point and one or more facilitating turning points. Initial turning points typically involved the experience of fear or shame, soon followed by positive emotions such as a sense of relief, love, hope, and awe. With the exception of Nick, whose initial turning point occurred during an informal peer group gathering, participants identified their first group therapy session as an initial turning point. Some participants identified group therapy in tandem with other activities or events as their initial turning points. Sean’s initial turning point was a group therapy session that inspired a musical performance the next day. Ian’s and James’s turning points involved group therapy sessions coupled with informal evening discussions with peers.17 Ed’s initial turning point was an airport encounter with a fellow client followed by a group therapy session.  Participants identified additional turning points that occurred after an initial turning point (facilitating turning points), which typically involved positive emotions and a variety of psychological processes. Nick’s facilitating turning point involved a deer and is reminiscent of Maslow’s (1964) research on awe, defined as brief but intense emotional experiences that often accompany peak experiences. The majority of participants’ facilitating turning points, however, occurred during individual counselling sessions. Eric experienced a sense of relief after hypnotherapy. Nick’s, Scott’s, and James’s transformative counselling sessions were mostly cognitive and rational in nature. In the evenings, James discussed these counselling sessions with his peers (reflective discourse). Participants also reported profound gratitude (Nick and Scott), even love (Eric), for the counsellors involved in these facilitating turning  17 Unlike other participants, Ian did not identify separate initiating and facilitating turning points. Instead, all of Ian’s turning points included informal discussions with his peers. I treated Ian’s multiple turning points as an initial turning point due to their similarity with other participants’ initial turning points. 94 points. Other facilitating turning points included group meditation (Eric and Ed), quietly reflecting alone at the beach (Ian and Scott), exercise (Ed), group psychoeducation (Scott and Ed), and reading (Eric, Sean, and Ed).  Findings related to Research Question 2. “What are the contextual factors that facilitate, delay, or inhibit personal transformation as reported by these men in the context of residential addiction treatment?” Data collected from participants identified numerous references to facilitating contextual factors, and a few potentially delaying or inhibiting contextual factors, that occurred during their stays at Sunshine Coast. Mezirow (2006) identified critical self-reflection and reflective discourse as the two main mechanisms by which transformation occurs. I considered the provision of time to engage in reflective discourse as a sociocultural contextual factor and the provision of time to engage in critical self-reflection as a material context (see Table 4).  Table 4 Summary of Residential Treatment Contextual Factors by Participant Contextual factors Participant name Eric Sean Ian Nick Scott Ed James Sociocultural contextual factors Sense of safety ✓ ✓ ✓  ✓   Diversity and solidarity of peers ✓ ✓ ✓  ✓ ✓ ✓ Time for reflective discourse   ✓ ✓ ✓  ✓ Chance to address idealized masculinity ✓  ✓  ✓ ✓ ✓ Material contextual factors Time for critical self-reflection ✓  ✓ ✓ ✓ ✓ ✓ Time to implement lifestyle changes   ✓   ✓  Peaceful environment ✓  ✓ ✓ ✓  ✓ Privacy ✓       Program philosophy and policies ✓       95 Sociocultural contextual factors. Participant data illustrated the importance having a sense of safety, the diversity and solidarity of the peer group, time for reflective discourse, and the opportunity to explore shared experiences of being men struggling with addiction as important sociocultural factors that facilitated the turning points summarized in Table 3. Staff and the peer group both contributed to participants’ sense of safety. Scott commented on how Sunshine Coast staff were “genuinely looking after my care.” Ian described Sunshine Coast as a place that allows “people to show a certain level of vulnerability that they may not otherwise be able to achieve.” Ian was one of the few participants who made a direct reference to the importance of having a safe space for men to explore alternative masculinities and participate in stereotypically “feminine” activities that might expose them to criticism in other settings.  Other participants did, however, comment on the importance of being with other men, with all their similarities and differences. Sean took solace from knowing “that there are more people like you.” Ian referred to the “knowledge shared between the younger and older generations [who are all] playing the same game.” Scott appreciated getting “peer perspective from people who have been through similar struggles.” Ed described Sunshine Coast as a “super interesting place.” Ed also described a “feeling of togetherness, that feeling of sharing, that feeling of not being alone.”  Some participants took significant risks during treatment that they may otherwise have avoided. Sean wrote and performed a song for his peer group for the very first time. Ian and his peers would often spend their evenings crocheting and making bracelets together. Scott overcame painful shyness to be a part of the peer group: “I was spending a lot of time outside trying to relate to the guys.” Eric and James shared their stories of being raped—a 96 secret they had kept even from their intimate partners. A willingness to be vulnerable was behind Ed’s sudden devotion to exercise, a healthy diet, and learning, although he acknowledged that, during his treatment stay, “I still had a huge mask on. . . . I was scared of letting people in.”  At the same time, Eric and Scott identified the all-male peer group as a potentially delaying sociocultural contextual factor. Eric criticized Sunshine Coast for having a “hetero-normative straight” environment. Towards the end of his stay, Scott became increasingly annoyed by his all-male peer group: “[I got tired of the] swearing, the burping, the man behaviour that sort of comes out in that environment.”  Material contextual factors. Participants identified time to engage in critical self-reflection and being situated in a peaceful environment as important material contextual factors. They identified the beach or the lookout point as their favourite spots to engage in critical self-reflection. Ed recognized the value of having time to implement lifestyle changes, and Ian mentioned how valuable it was for him and his peers to have the opportunity to work on their art projects during nonprogramming hours. Ed preferred reading and exercising to spending time with his peer group after concluding they were not interested in meaningful conversation. Eric identified the value of Sunshine Coast’s remote location and his need for privacy. He endorsed Sunshine Coast’s strengths-based, non–Twelve Step, secular harm reduction approach but was critical of its policies, such as charging extra for a private room and requiring newly admitted patients to undergo “dehumanizing” urine tests and disclose “hyperpersonal information.” Findings related to Research Question 3. “How do the lives of these men, and their sense of identity as men, change as a result of their self-reported learning?” Participants 97 demonstrated a change in their sense of self and a change in lifestyle as a result of their self-reported learning while attending residential addiction treatment (see Table 5). Participant data also showed evidence of Illeris’s (2014) progressive and restoring transformations but not for regressive transformations, which is to be expected given the nature of this study.  Table 5 Summary of Identity and Lifestyle Changes by Participant Change categories Participant name Eric Sean Ian Nick Scott Ed James Identity changes Authentic self ✓ ✓ ✓  ✓ ✓ ✓ Storied self       ✓ Transcendent self ✓ ✓  ✓  ✓ ✓ Lifestyle changes Meaningful relationships ✓ ✓ ✓ ✓ ✓ ✓ ✓ Helping others  ✓ ✓ ✓ ✓ ✓ ✓ Meaningful work   ✓  ✓ ✓ ✓ Improved self-care ✓   ✓ ✓ ✓  Type of transformation Progressive ✓   ✓ ✓ ✓ ✓ Restoring  ✓ ✓     Note. A third type of transformation is regressive, but no participants experienced it. Identity changes. Participants made implicit and explicit references to having experienced identity change and the development of a more authentic sense of self, a storied self, and a transcendent self. I organize this section by type of identity change. With the exception of Nick, participants described an authentic self. Eric and James were able to connect with their authentic selves after addressing repressed traumatic memories. James also described his sense of self metaphorically as a story and his personal transformation as taking control of his story. Finally, with the exception of Ian and Scott, participants described the 98 emergence of a transcendent self as part of their personal transformations. In Chapter 5, I examine each participant’s experience of identity change in greater detail.  Lifestyle changes. All participants reported significant lifestyle changes after experiencing a transformation in their sense of self, their relationships with others, and their communities. Participants reported enhanced, more personally meaningful, relationships after returning home from treatment. Participants whose relationships were not conducive to their recoveries were able to maintain recovery by imposing healthy boundaries. Sean and Ian both experienced periods during which relationship struggles led to relapse. At the time of interview, however, both had secured “restoring” (Illeris, 2014, p. 110) transformations after developing alternate supportive relationships.  Several participants reported helping others in the community as important lifestyle changes. Sean used his music to help his online followers who shared his struggles with addiction and loneliness. Ian worked with medical and public health stakeholders in Atlantic Canada to address the growing opioid overdose crisis. Nick was an active member of the Twelve Step community. Scott was helping others with his new security company. Ed became a personal coach and ran a Sunshine Coast alumni support group.  Sean, Scott, Ed, and James found meaningful work that better reflected their values, including their desire to help others. Part of Sean’s struggles after treatment involved his ongoing challenges at work. I interpreted Sean’s attempt to unionize his department as a way to preserve a job that he found meaningful, while recognizing that Sean still struggled to find meaningful connection with management and his coworkers. James’s new employment involved travelling across his province, telling his story of recovery and raising cultural 99 awareness with various First Nations groups. I have already described how Eric, Nick, Scott, and Ed improved self-care through diet, exercise, and/or mindfulness practice.  Type of transformation (progressive, restoring, or regressive). Participants experienced significant changes in identity and lifestyle during treatment that continued after returning to their home communities. Participant data were also consistent with Illeris’s (2014) transformative learning research that distinguishes between progressive, restoring, and regressive transformations. Five of the seven participants experienced progressive transformations; Sean and Ian experienced restoring transformations. I return to this topic in the next chapter.  In summary, this chapter presented the findings of this study. Part I examined the results and main theme of each participant story (holistic analysis), and Part II summarized the results and themes across participant stories (categorical analysis). The next chapter concludes this study with a discussion of its findings.   100 Chapter 5: Discussion and Concluding Remarks Chapter 5 is divided into three parts. Part I examines the main findings of the present study. Part II considers its implications. The chapter closes with a few concluding remarks.  Part I: Putting the Research Findings in Context Findings from the present study support the idea that recovery from addiction involves a change in how we see ourselves, relate to others and the world, and how we live (lifestyles); rational and extrarational processes that are facilitated, delayed, or inhibited by sociocultural and material contextual factors in treatment settings; and progressive, restoring, or regressive transformations. Part I discusses identity change as the emergence of an authentic, storied and transcendent self; phases of personal transformation; and types of personal transformation (transformative outcomes). I credit Cranton’s (2016) distinction between processes and outcomes for helping me distinguish between phases and types of transformation. Cranton (2016) argued that separating transformative learning outcomes from transformative learning processes “may be helpful in understanding how an integrative theory can be developed” (p. 41).  Identity change. Participants made explicit or implicit references to identity change, which is aligned with the writings of Mezirow (1991) and other contributors who view transformative learning through a psychologically oriented theoretical framework, as opposed to the socially oriented theoretical framework exemplified by Freire (1970) and others.18 These findings are not surprising, given the psychological focus of residential  18 Taylor (2008) identified two main theoretical frameworks in transformative learning research: personal transformation and social change. With a personal transformation orientation, the focus is on the individual with less focus on context. A social change orientation, by contrast, understands personal transformation as being inherently linked to culture and relations of power within society: “where the individual and society are seen as one and the same” (p. 10).  101 addiction treatment. This psychological framework shaped how my participants experienced and articulated the transformations they made during and after treatment. With the exception of Nick’s deer encounter and Ed’s negative self-talk sessions, participants’ reported experiences of identity change (turning points) occurred in social settings. These findings are consistent with Dirkx’s (2007) conclusion that “psychologically-minded transformative learning theories . . . recognize that the nature of the self is deeply intertwined with its social and cultural contexts” (p. 111). The majority of participant references to identity change involved group encounters or one-on-one counselling sessions. Individuals who described a transcendent self also demonstrated that their sense of self and how they related to the world were overlapping experiences. As summarized in Table 5, participants made implicit or explicit references to identity change as a process through which an authentic self, a storied self, or a transcendent self emerged. I examine these three selves separately in the remainder of this section.  Authentic self. Study participants made references to developing a more authentic sense of self or way of being in the world. Eric, Ed, and James alluded to an “inauthentic self” (Tennant, 2005, p. 104) that they addressed during treatment. Their experiences support transformative learning research which posited the emergence of a truer self after addressing “unwarranted anxiety that impede[d] taking action” (Mezirow, 1990, p. 16). The transformative learning research has described two kinds of distorted thinking relevant to this study. The first is what Gould (1988, as cited in Mezirow, 1990) referred to as “psychic distortions” (p. 16). These distortions arise due to traumatic events in childhood . . . that though submerged from consciousness continue to inhibit adult action by generating anxiety feelings when there is a risk of breaching them. This dynamic results in a lost function—such as the ability to 102 confront, to feel sexual, or take risks—that must be regained if one is to become a fully functioning adult. (Mezirow, 1990, p. 16) Eric and James both experienced childhood trauma in the form of physical and sexual abuse. Eric managed to work, go to school, and be in a relationship by blocking off his childhood trauma: “I have to compartmentalize because of my upbringing I have never had anyone to depend on but myself.” However, once Eric experienced being retraumatized, he found himself unable to feel sexual. James described a similar inability to feel sexual after work served to activate childhood traumatic memories:  I was dating a girl and we were getting—we were fooling around, and she went to go give me oral and I just—I stopped. . . . And from within two weeks from that, I found myself heavily drinking.   Ed found himself unable to take risks that arose from his inability to access his authentic sense of self prior to treatment. Tennant (2005) described how “social roles and aspirations” (p. 104) can serve to block authenticity. Tennant (2005) gave the example of the “relentless pursuit of material gain accompanied by long hours of debilitating and ultimately alienating work” (p. 104), which is similar to how Ed managed to avoid addressing his inauthentic sense of self for so many years: “I was a pretty successful guy, right? I had the cash, had all this stuff and—from the outside I was the guy who had it all.” Despite external appearances of success, however, Ed’s private life told a different story; while describing his relationship with his family, he explained, “I was kind of there, but I was never there. A vacation [with my family] was an extended binge.”  Ed and Scott also underwent changes in how they related to their former selves, which suggests the emergence of a more authentic self. Both men described a similar overidentification with work and money and emotional struggles associated with the shame of alcohol and gambling addiction. Initially, their change in how they related to themselves 103 was initially marked by a rejection of their former selves. Gradually, both men developed greater self-compassion. Working with a counsellor later in his treatment, Ed learned to embrace his “‘Little Ed’—that’s [the] Ed that’s hiding inside, that’s terrified of letting other people know who he is.” Scott learned to embrace his former self rather than simply reject it: “I had a lot of judgment towards addicts and my own [addiction]. I loathed myself because of my own addictive pattern.”  Finally, the inability of Sean, Ian, Scott, and Ed to share their thoughts and feelings with others suggests that they struggled with navigating culturally idealized norms of masculinity, or “hegemonic masculinities” (Donaldson, 1993, p. 645) and the importance of meaningful work as a “socially valued masculinity” (Hanlon, 2012, p. 109). In a previous section, I have already described how Sunshine Coast’s safe space allowed the men in this study to explore multiple masculinities beyond hegemonic forms. Here I only suggest that these men were better able to access their authentic selves after exploring more expansive experiences of being men during treatment.    Storied self. Tennant (2005) identified two types of storied selves in the transformative learning literature: a psychosocial construction and a postmodern construction. Dirkx (2007) distinguished a unitary positing of the storied self from the “multiplicity” (p. 110) of storied selves as understood by the postmodern perspective. My analysis of James’s reference to his identity change as a storied self reflects a psychosocial understanding. Castel et al. (1998, cited in Taïeb et al., 2008) described addiction recovery as a “form of mastery over the autobiographical discourse” (p. 56). After realizing that the jaw-clenching and sweating had disappeared after he shared his childhood trauma experience with his peer group, James concluded, “I can take control over the story rather than [let] it 104 control me.” Here James’s description of his sense of self appears to be more unitary in nature.  Participants also described a postmodern understanding of storied self, as multiple senses of self. Eric, for example, described how he was able to “compartmentalize” his personal life from his life as a student and mental health case manager. Participant transformations appeared to coincide with an emerging spiritual (Eric, Sean, Nick, and James) or creative (Sean) self, a rejection of their former “addict” selves (Scott and Ed), and a newfound appreciation for their societal roles as husbands (Nick, Scott, Ed, and James) and caring community members (Sean, Ian, Nick, Scott, Ed, and James). Recall that Stall and Biernacki’s (1986) spontaneous recovery research concluded that many individuals in recovery from addiction defined themselves based on societal roles and a subjectively more “ordinary” identity (p. 11) while repudiating the label of alcoholic or addict. Both Eric and Scott explicitly rejected AA’s notion of the addict identity. Arguably, participant transformations were facilitated by their adoption of a multiple sense of self to replace their sense of isolation experienced prior to treatment. With each new sense of self, participants appeared to find a new pathway of relatedness to others.    Transcendent self. James, Nick, and Eric described the emergence of a transcendent self during treatment. Cook’s (2013) distinction between theological transcendence and self-transcendence is helpful to understand their experiences. Theological transcendence requires a belief in a supernatural power, e.g., AA’s higher power, whereas self-transcendence works 105 within intrapersonal and interpersonal realms, not the transpersonal realm. After addressing his childhood trauma, James was able to reconnect to his Indigenous spirituality:19  I found my First Nations culture. Before I went to treatment, I wasn’t active in it at all, right? But now I know my cultural songs, my cultural dance. I know my ancestors and knowing your ancestors helps you know who you are. James believed that his trauma and addiction and eventual recovery were all part of a greater purpose based on three important lessons he once learned from a village elder: “Everything that you experience is a lesson. . . everything happens for a reason. . . . [and] everyone you meet is a teacher.” Nick’s spiritual self emerged during treatment: “[Something was] guiding me and keeping me safe.” For Nick, surviving so many close calls with death was “empirical data” of God’s existence. Nick description of an emerging spiritual self is more consistent with the Twelve Step’s notion of spirituality. Craigie (2008) identified various forms of therapy and concepts that help clients achieve self-transcendence such as acceptance, meditation, mindfulness, gratitude, and forgiveness (cited in Cook, 2013). Eric found ways to connect to spirituality through group meditation during treatment and club dancing and spin classes after treatment: “It’s very hypnotic. . . . You’re in a dark room with blasting beats that kind of put you into a meditative state.” Sean’s discovery of music during treatment also suggests the emergence of a transcendent self: “I like to use [music] as my main purpose because I truly feel like . . . there’s something magical about it.” Prior to treatment, Sean described a lack of connection to self: “I felt lost, I didn’t know who I was, myself, my place in the world.” Reflecting on his newfound love for music and sharing it with others, he said: “[It’s] just real. It’s very real.”  19 At the same time, James reported liking SMART Recovery meetings because “there was no surrender to a Higher Power. There’s no God in it. There’s no Oh! You slipped, you’re back at day one.”  106 Phases of personal transformation. The study’s findings were consistent with The Big Book (AA, 2001) and the addiction treatment and recovery literature (Barton et al., 2007; Burman, 2003) that posited recovery as being tripartite. I have created a graph to illustrate the relationship between my proposed phases of personal transformation and treatment stages (see Figure 1).   Figure 1. The three phases of personal transformation. Data support the notion that experiencing hitting bottom and turning points are both necessary for personal transformation. Recall that I define hitting bottom as the point at which individuals initiate critical self-reflection and turning points as the points at which individuals initiate identity transformation. Furthermore, data suggest that critical self-reflection and reflective discourse do not adequately encapsulate participants’ transformative experiences. For example, Ed’s initial turning point—which occurred at the Powell River airport waiting for the shuttle bus to Sunshine Coast—did not involve an exchange of dialogue. It was, however, highly emotional and relational. Several participants’ group 107 encounters were similarly emotional and relational, and similarly lacking in meaningful dialogue. Participant experiences suggest that rational processes may play a secondary role in the occurrence of turning points.  Participant data also indicate that the hitting bottom, turning point, and maintenance phases could roughly coincide with the lives of participants before, during, and after treatment, respectively. Participant data from Ed, Sean, and Ian were the exception. Ed was the only participant whose initial turning point occurred before he arrived at Sunshine Coast. Sean and Ian’s struggles after treatment suggest that their respective turning point phases extended into post-treatment.  Types of personal transformation (transformative outcomes). Participant data lend support for Illeris’s (2014) identification of three types of personal transformation, or transformative outcomes, and Lawrence and Cranton’s (2015) facilitating, delaying, and inhibiting influences. Illeris (2014) equated Mezirow’s (2006) epochal and incremental transformations as two forms of progressive transformations. In Figure 2, I distinguish between delaying and inhibiting influences, rather than combining them as Lawrence and Cranton did in their illustration. Another difference in my approach is that I only considered facilitating or delaying influences after participants experienced a turning point which, again, marks the initiation of identity transformation and taking action. Lawrence and Cranton, by contrast, included influences that occurred long before participants experienced disorienting dilemmas (or hitting bottom), e.g., negative childhood messages.  108  Figure 2. Progressive, restoring, and regressive transformations. Adapted from A novel idea: Researching transformative learning in fiction (p. 62), by R. L. Lawrence and P. Cranton, 2015, Rotterdam, NL: Sense Turning to participant data, working from left to right in Figure 2, all participants reported experiencing an initiating turning point and one or more facilitating turning points during their treatment stay. Most participants continued to experience primarily facilitating influences after returning home. When they did experience potentially delaying or inhibiting influences, such as interpersonal conflict with family members, they were able to minimize their impact by establishing boundaries or engaging in stress reduction techniques. Implementing positive lifestyle changes helped reduce the frequency of potentially delaying or inhibiting influences. Sean and Ian both struggled with inhibiting influences that resulted in relapse. After treatment, Sean struggled to find meaningful connection with his family, friends, and co-workers. His marriage ended in divorce. Joining a baseball team for companionship was complicated by social anxiety and trips to the bar after games. A dispute 109 over a cut in pay and his subsequent push to unionize his department complicated Sean’s relationships at work. Ian’s recovery was quickly put to the test as soon as he left treatment: “Living back with my mother and father like at that age was kind of emasculating.” Being a man without meaningful work and being financially dependent on his parents served as an inhibiting influence on Ian’s personal transformation. Their eventual recoveries lend support to Illeris’s (2014) claim that, even in the midst of a personal crisis,  something of importance has happened, things are not as they were before, there is a new feeling, a difference that cannot be neglected, the person or part of the identity has changed, a withdrawal has been unavoidable, some regressive transformative learning has taken place. (p. 95)  Illeris (2014) claimed that adult learners who experienced regressive transformations could potentially achieve restoring transformations after replacing desired but, ultimately, unattainable life changes with acceptable and achievable alternatives. Both Sean and Ian experienced restoring transformations. Sean experienced a restoring transformation after establishing a new group of people to relate to in place of his family and friends, first with girlfriend Trisha and then with an online community who found his music healing. Ian had a restoring transformation after returning to Atlantic Canada where he was able to find meaningful work, be part of the solution in local efforts to address the growing problem of opioid misuse, and connect with other men struggling with addiction.20 For Ian, returning to Atlantic Canada was a necessary compromise: “[Vancouver] was just full of triggers. . . I could be making such a difference if I was back [there but I would probably] be in the tents smoking down (heroin).”  20 Ian’s recovery is consistent with research by Robbins (1993), who found that many returning American servicemen who had significant heroin addiction during the Vietnam war were able to end or significantly reduce their drug use once they returned to the United States.  110 Part II: Implications of Research Findings This study has important implications for transformative learning theory and for adult learning in residential addiction treatment and recovery settings. In Part II, I examine these implications separately. I conclude Part II with an examination of this study’s limitations.  Implications for transformative learning theory. The findings of this study support the idea that viewing personal transformation as a change in identity is one potential way to fix what Cranton (2016) described as the fragmented state of current transformative learning theory. Transformative change as identity change also has implications for the therapy room and the classroom. Tennant (2000) argued that “theorizations about the self and its capacity for change are clearly critical to the way we conceive of therapeutic and educational interventions” (para. 5). This study has three specific implications for concepts associated with Mezirow’s (1990) transformative learning theory and his 10 phases of perspective transformation. First, data was consistent with Mezirow’s (1990) research on disorienting dilemmas as following an “externally imposed event” (p. 13), and as a trigger for critical self-reflection and perspective transformation. Study participants experienced significant personal crises prior to treatment (“hitting bottom”) similar to those described by Taylor (2008), e.g., relationship struggles, and failing health. However, besides a disorienting dilemma (Phase 1) and maintenance phase (Phase 10), findings from this study were not consistent with Mezirow’s (1991) 10 phases of perspective transformation. Unlike Mezirow’s (1991) Phase 2—a self-examination with feelings of guilt and shame—data showed that participants frequently experienced powerful, negative emotions throughout their self-reported personal transformations, not just during one phase. In addition, participants also experienced positive emotions as part of their turning point phase. 111 Mezirow’s (1991) 10-phase model does not appear to account for positive emotions. Mezirow’s (1991) Phase 4—recognition that one’s discontent and the process of personal transformation are shared and that others have negotiated a similar change—is also inconsistent with participant data. Similar to my comment on Mezirow’s Phase 2, participants frequently engaged in reflective discourse throughout their transformation, not just during one phase. Furthermore, participants also reported the importance of the diversity of peer group members. Mezirow (1991) overlooked diversity as a group characteristic in his Phase 4 of perspective transformation. Finally, participant data suggest that, akin to Mezirow’s (1990) trigger event, a second “externally imposed event” (p. 13) is necessary before adult learners take action, as reflected by Phases 7 to 9 in Mezirow’s (1991) model. I referred to this second trigger event as a turning point, and it appears that Mezirow (1991) failed to account for it in his 10-phase model.  Second, participant data suggests there are pros and cons to the terms critical self-reflection and reflective discourse. I found the terms to be a useful way to organize data along individual/relational lines, e.g., psychological/relational processes or sociocultural/material contextual factors. The weakness of these terms is in their overemphasis on cognition and rationality. For example, with the exception of cognitive therapy sessions and informal evening conversations between peers, most turning points in the study involved at least one additional psychological process other than cognitive and relational processes. Powerful emotions were a particularly important aspect of most participants’ turning points. Taylor (2009) cited research revealing that emotions are instrumental in how people “prioritize experience and identify. . . what is personally most significant in the process of reflection” (p. 4). Future transformative learning researchers may 112 want to consider alternative terms to critical self-reflection and reflective discourse that better reflect their extrarational nature. Third, the present study has important implications for the transformative learning research on epochal and incremental transformations. According to Illeris (2014) , transformative learning theory research is dominated by positive transformations which can be either epochal or incremental in nature. With few exceptions (e.g., Brooks & Clark, 2001; Sandoval et al., 2016), researchers have overlooked adult learners whose experiences resembled regressive or restoring transformations. I was initially apprehensive about including Sean and Ian in this study because their transformations were not consistent with what I was reading in the transformative learning research. In retrospect, however, I am grateful for their willingness to share their stories, knowing that their relapses might disqualify their accounts. The transformative learning research community could benefit from hearing from more adult learners who have experienced non-traditional transformations.  Implications for research on adult learning in residential addiction treatment and recovery settings. I have identified three implications for research on residential addiction treatment and recovery settings. The first implication is based on participants’ descriptions of how their sense of self and lifestyles changed as part of their self-reported personal transformations. Although I distinguished between identity and lifestyle change, participant accounts revealed the overlapping nature of these changes. Research by McIntosh and McKeganey (2000) described identity and lifestyle change as “different parts of the same process” (p. 1509). Participants in this study described a newfound appreciation for their societal roles as partners, fathers, and community members which, in turn, resulted in 113 important lifestyle changes. Therefore, there may be merit in training residential addiction treatment educators and therapists to address, as McIntosh and McKeganey (2000) similarly concluded, “issues of identity and narrative construction in their work with clients” (p. 1509).  Second, the findings of this study have implications for how providers allocate scarce treatment resources. Data suggest that facilitating adult learners’ turning points may be an effective way to improve treatment outcomes. Data indicate that once participants experienced turning points, they were sufficiently motivated to do what was necessary to abstain from their drugs of choice and implement meaningful lifestyle changes. Residential treatment providers may, therefore, consider allocating more resources to enhancing the contextual factors identified by this study as facilitating participant turning points (see Table 4).  Here I highlight two contextual factors; namely, a sense of safety and building nonformal learning into program scheduling (“free” time). First, participant findings from this study highlighted the importance of a sense of safety, which extended to the peer group; staff; facility location and design; and programs, policies, and procedures. Second, participants reported benefiting from having time to engage in critical self-reflection and reflective discourse outside of the therapy room or psychoeducation classroom. Participant data suggest that having too many scheduled activities may result in a peer group that is too busy, and too exhausted, to engage in reflection or dialogue. Illeris’s (2014) comments about the importance of time as a contextual factor for adult learners bear repeating: “The democratic process, the possibility of taking up all relevant issues, endeavours of coming to agreement, critical reflection and dialogue are all time-consuming processes” (p. 9). Art expression appeared to have the right balance of structure (an art therapist was there to get 114 new attendees started on their art projects) and informality (attendance was optional and instruction was kept to a minimum). Such occasions were in contrast to the typical rational or cognitive focus of scheduled psychoeducation or therapy sessions.  The third and final implication for this study’s findings is for how educators and therapists engage with adult learners who are struggling emotionally as a result of personal adversity. I quote with approval Clark and Dirkx (2008), who said, “Allowing students to give voice to powerful affect is not getting it off their chests and getting it out of the way, but encouraging them to own and integrate these feelings and emotions within their sense of being” (p. 92). Encouraging adult learners to be emotionally vulnerable is “part of the practice and study of helping adults learn” (Clark & Dirkx, 2000, p. 103). Illeris (2014) similarly argued that “transformative learning is often initiated when learners come up against their limitations, go beyond the habitual, experience the unaccustomed, meet, split or break down, face dilemmas, feel insecure, or make incalculable decisions” (p. 11). Illeris referred to this process as “leading learners to the edge” (2014, p. 11; see also Mälkki, 2010; Taylor & Jarecke, 2009). That being said, results from this study again underscore the importance of having a therapeutic or learning setting that adult learners perceive as safe. Creating a challenging learning environment that is, at the same time, perceived as safe is not easy, but findings from this study suggest that the payoff for adult learners is worth the effort.  Limitations. There are several limitations to the present study. The first concerns generalizability. The study cannot be generalized due to its small sample size (N = 7), lack of adequate heterogeneity in terms of socioeconomic status, gender, age, and ethnicity, and the particularities of Sunshine Coast as a residential addiction treatment centre. The relatively privileged lives, at least socioeconomically, of study participants compared to the vast 115 majority of people struggling with addictions further problematizes efforts to generalize this study’s findings; it is important to acknowledge the financial barriers many people face in accessing the type of residential addiction treatment that is offered by Sunshine Coast. It is also true that residential addiction treatment and recovery programs vary widely in terms of location, program amenities, staff qualifications, program philosophies, etc. Yet it is important to note that generalizability was not the aim here—especially not beyond residential addiction treatment and learning for men. This was a study of people’s experiences in relation to only one residential addiction treatment centre. Its findings on the contextual factors at play in residential addiction treatment was also limited by its exclusion of personal and socioeconomic/structural factors.21 Furthermore, the study’s focus on residential addiction treatment also meant that I gave secondary consideration to otherwise important contextual pre- and post-treatment contextual factors.  Second, this study did not incorporate triangulation, which Creswell (2008) defined as a strategy to enhance study accuracy that uses secondary sources of data to confirm qualitative research findings. I did not corroborate participant data collected from interviews with archival data or interviews with staff at Sunshine Coast, friends, family members, co-workers, etc. As Riessman (2008) stated, “Interviews, though important and the most widely used method of data collection in the human sciences, represent only one source of knowledge about a phenomenon or group” (p. 26). Archival data in the form of admission records or treatment files or interviews with individuals familiar with study participants may have confirmed or refuted aspects of the interview data. However, as stated earlier,  21 I recommend research by Cloud and Granfield (2008) on recovery capital for those interested in the impact of personal factors on residential addiction treatment outcomes. 116 participants were not required to prove that they had undergone personal transformation; self-report was the focus of this study. Its aim was to access the truth as recounted by these men, not to ascertain facts which could be proven or disproven. As narrative inquiry, I was most interested in the stories and what they meant to these men.  Third, and interrelated, the present study relied upon the ability of participants to accurately recall events, thoughts, feelings, and actions. To the best of my ability, I attempted to foster trust and rapport to facilitate more accurate accounts (Morrow, 2005). Regardless, it is quite possible that respondents may have reported beliefs and behaviours that they felt I wanted to hear as a researcher and someone who works in the addiction treatment and recovery field (participant bias). Participants’ retrospective self-reports may have also been confounded by their inability to accurately recall past events (recall bias). Participants for this study—all of whom self-selected—may have also shared characteristics that distinguish them from non-participants (self-selection bias). Yet, even here, the stories one tells about oneself are what I was ultimately interested in, and the particular slant they gave to their stories may be crucial to understanding the transformative processes they underwent.  It is, however, important to reiterate that none of these men’s descriptions of their experiences ‘prove’ the benefits of residential addiction treatments beyond themselves. I recognise that these were a small subset of men who have attended Sunshine Coast. Former program attendees with less positive post-treatment experiences likely would have decided not to participate as they did not see themselves as having experienced a positive transformation through and following addiction treatment at Sunshine Coast. Finally, the criterion that required participants to have completed treatment meant that there was no representation of individuals who had achieved recovery without attending treatment 117 (spontaneous recovery), who simply chose not to attend treatment, or could not access this form of treatment due to an inability to pay. This was a study of a small subset of men who had participated in a particular type of residential addiction treatment at one centre and who self-reported as having undergone a transformation as a result of the recovery processes.  Part III: Concluding Remarks This study sought to learn more about the experience of men who self-reported experiencing personal transformation while undergoing residential addiction treatment at a private centre in BC. Combining the literature from the transformative learning and addiction treatment and recovery fields provided an important context for making sense of their stories as adult learners in recovery from addiction. It is my hope that the knowledge gained from this study leads to meaningful change in transformative learning theory and in residential addiction treatment and recovery programs. The findings of this study have affirmed my belief that retrospective accounts of personal transformation are an effective way to understand how men make meaning as adult learners in their recovery from addiction. I intend to use the results of this study to increase the likelihood that participating in the program at Sunshine Coast will be a transformative experience. As the addiction historian William L. White (2017) put it, “we can own neither the addiction nor the recovery, only the clarity of the presented choice, the best clinical technology we can muster, and our faith in the potential for human rebirth” (p. 470).  I close with a personal reflection. In the introduction I indicated that part of my motivation for this study was to better understand my own transformation. I may not be in recovery, and I acknowledge that my hitting bottom moment—dropping out of university—perhaps cannot compare to what the men in this study have endured. What I do think I shared 118 with them was a sense of desperation and loneliness and an inability to make sense of my circumstances. I, like them, allowed myself a brief moment of vulnerability, opening my heart to friends and family and heeding their advice. Then I set aside my daily routine to explore and share my life with a group of strangers. During my transformative experience, I remember having a profound sense of relief: I was okay, and I sensed that my life going forward was going to be okay, too. Under normal circumstances, this message of self-acceptance was not getting through. Perhaps I was too busy making a living, too afraid, to reflect and engage with others in such a personally meaningful way. It has been 35 years since my transformative experience. Like the participants in this study, I am certainly in the maintenance phase of my transformation. Like them, I continue to make important changes in my life, some significant, some less so. Every once in a while, I catch my “old” self emerging, like a friend from high school. When he shows up, I hear what he has to say and get on with my life. I wish the participants in my story a similar peace with their past selves. Above all, I offer my heartfelt gratitude to them for having shared their stories.    119 References Aguilar, J. L. (1981). Insider research: An ethnography of a debate. In D. A. Messerschmidt (ed.), Anthropologists at home in North America (pp. 15–26). Cambridge, UK: Cambridge University Press. Alcoholics Anonymous. (1985). Alcoholics anonymous comes of age: A brief history of A.A. New York, NY: Alcoholics Anonymous World Series. (Original work published 1957) Alcoholics Anonymous. (2001). Alcoholics anonymous: The big book (4th ed.). New York, NY: Alcoholics Anonymous World Services. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Anderson, D. (2010). 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Yousaf, O., Popat, A., & Hunter, M. S. (2015). An investigation of masculinity attitudes, gender, and attitudes toward psychological help-seeking. Psychology of Men & Masculinities, 16, 234–237.   140 Appendices Appendix A: Recruitment Ad  Recovery as a Transformative Experience: How Men With Addictions Experience Perspective Change in Response to Significant Life Events  Perspectives, also known as worldviews, shape our underlying assumptions—thoughts, feelings, and attitudes—and how we see ourselves, others, and the world. We often inherit our perspectives from society, our parents, or other authority figures without deliberate effort. When we experience perspective transformation, we adopt a perspective that is more open to other viewpoints, more willing to reflect on our underlying assumptions, and more emotionally capable of change. Are you an alumni of Sunshine Coast Health Centre who has experienced a perspective transformation?  ● Did you complete at least 30 days of treatment at Sunshine Coast?  ● Did you complete treatment at Sunshine Coast at least 90 days ago?  ● Are you willing to share your experience of personal transformation?  The purpose of this study is to understand the experiences of individuals with addictions who self-identify as having experienced perspective transformation. The proposed research will contribute to the design of effective treatment interventions and supportive learning environments that facilitate perspective transformation. Participants will be interviewed in a narrative technique to elicit their stories of perspective transformation and these stories will be analyzed for themes. All participants will also have the opportunity to review and comment on the study’s emergent themes before publication. All participant identities will be kept strictly confidential.  If you are interested in participating in this study or in obtaining additional information, please contact: Daniel Jordan (Co-Investigator), Graduate Student, Department of Educational Studies, UBC Phone: [phone number] or E-mail: [email address]   This research is being conducted as part of Daniel Jordan’s thesis requirement for a master’s degree in Adult Learning Education.     141 Appendix B: List of Counselling Services Community Counselling Services (No-cost or low-cost)  Abbotsford Addictions Centre Phone: (604) 850-5106  Website: Abbotsford  SHARE Family and Community Services Phone: (604) 540-9161  Website: Coquitlam  Family Services of the North Shore Phone: (604) 988-5281  Website: North Vancouver  BC Mental Health and Addictions Phone: (604) 953-4900  Website: no website Surrey  Family Services of Greater Vancouver Phone: (604) 731-4951  Website: Vancouver  Oak Counselling Services Phone: (604) 266-5611  Website: Vancouver  Private Counselling Services  Peter White, MA, RCC Phone: (778) 551-2896  Website: Abbotsford 142  Sears Taylor, MA, LMHC Phone: (604) 670-3107  Website: Langley   Larry Green, Ph.D. Phone: (778) 233-0377  Website: Vancouver  Paul Murray, Ph.D. Phone: (604) 925-1950 Website: Vancouver   143 Appendix C: Consent Form Recovery as a Transformative Experience: How Men With Addictions Experience Perspective Change in Response to Significant Life Events  Principal Investigator Dr. Jude Walker, Ph.D., Assistant Professor, Department of Educational Studies, Faculty of Education, University of British Columbia. E-mail: [email address]  Co-Investigators Dr. Robinder Bedi, Ph.D., Associate Professor, University of British Columbia. E-mail: [email address]   Dr. Danya Fast, Ph.D., Associate Professor, University of British Columbia; Research Scientist, British Columbia Centre on Substance Use. E-mail: [email address]   Daniel Jordan, Graduate Student, Department of Educational Studies, University of British Columbia. Phone: [phone number], E-mail: [email address]  This research is being conducted as part of Daniel Jordan’s thesis requirement for completing a Master of Arts (M.A.) degree in the University of British Columbia’s (UBC) Adult Learning Education program.  Why are we doing this study? The purpose of this study is to understand the experiences of men with addictions who self-identify as having experienced personal transformation and have undergone residential addictions treatment. You have been invited to participate in this study because a) you are someone who has attended, and completed, a residential addictions treatment program, and b) you previously disclosed having undergone some kind of personal transformation. The results of this study contribute to the knowledge base of adult education and addictions research and the design of effective educational interventions and supportive learning environments. What happens to you in the study?  If you accept the invitation to participate in this study, you will first be asked to share some background information. This information will help the researcher understand your situation and treatment experience. You will then take part in an interview. During the interview, you will be asked questions about your ongoing recovery from addictions and any transformative experiences you have had prior, during, and after your residency at Sunshine Coast. The researcher may ask you to provide more details about certain aspects of your experience, and you get to choose what to share. If you do not feel comfortable answering a question, you can refuse to answer without any penalty. The interview will happen face-to-144 face and audio-recorded or via Skype and video-recorded. Four weeks after the interview you will be contacted by e-mail and the researcher will provide you with a transcript of the interview. At this time you will be able to share your thoughts, add more detail, or ask for changes to be made within two weeks of the interview transcript being sent to you. The total time involved for participation in this project will be 60 to 90 minutes.  Study Results The interview will be analyzed and written up for Co-Investigator Daniel Jordan’s M.A. thesis. Upon completion, the findings of this research will be published in a graduate thesis, which is a public document that can be viewed through the UBC library. The findings may also be shared at conferences and may be published in academic journals. Once the findings are made publicly available, you will not be able to withdraw your data. Your name or any other identifying information will not be shared in the thesis, nor in any presentation or publication.  Is there any way being in this study could be bad for you?  The risks for participating in this study are small. Please be aware of the following potential implications of this study that may pose certain risks: (1) new understandings about your relationships; and (2) remembering difficult or unpleasant experiences during the interview process. You may find that when you share parts of your story, you may experience strong emotions; these are expected to be brief. You can tell the researcher if you do not want to answer a question, if you need to take a break, or if you want to end the interview at any time. To help with anything that comes up during the interview, the researcher will provide you with a list of counselling referrals at the end of the interview. Please note that your decision to participate or opt out of this research will not jeopardize your future re-entry into treatment.  What are the benefits of participating?  Participants may gain a better understanding of their thought processes involved in their self-identified perspective transformation. The interview may spark further reflection which may lead to further personal growth or transformation. How will your identity be protected?  Your confidentiality is a priority. You will not be identified by name in any reports of the completed study. A pseudonym or assigned client number will be used in reference to you in all transcripts, the M.A. thesis, and future publications and presentations. Information that discloses your identity will not be released without your consent unless required by law. Interviews will be audio-recorded and transcribed, unless you are interviewed via Skype video-conferencing, in which case the interview will be video-recorded and transcribed. Audio-recordings, consent forms, and notes referring to your data will be secured in a locked filing cabinet in the Principal Investigator’s office at the University of British Columbia (UBC). Electronic files related to your data will be encrypted and password protected. UBC’s policy is to destroy all research data five years after the completion of the study: paper 145 materials will be shredded, and electronic files will be erased. The only people with access to the data will be Dr. Jude Walker (Principal Investigator) and Daniel Jordan (Co-Investigator). Researchers will do everything possible to maintain your confidentiality. Due to the use of video-conferencing, there is a possibility that the company providing the technology, Skype, is tracking, recording, and storing conversations. For more information about the security policies of Skype video-conferencing software please ask Co-Investigator Daniel Jordan. Who can you contact if you have questions about the study?  This study is being conducted by the study’s Co-Investigator Daniel Jordan and Principal Investigator. If you have any questions or concerns about what we are asking of you, please contact the Co-Investigator Daniel Jordan or Principal Investigator. Their names and telephone numbers are listed at the top of the first page of this form.  Who can you contact if you have complaints or concerns about the study?  If you have any concerns or complaints about your rights as a research participant and/or your experiences while participating in this study, contact the Research Participant Complaint Line in the UBC Office of Research Ethics at (604) 822-8598 or if long distance e-mail or call toll free 1(877) 822-8598. Participant Consent and Signature  Taking part in this study is entirely up to you. You have the right to refuse to participate in this study. If you decide to take part, you may choose to pull out of the study at any time without giving a reason and without any negative impact on your standing at Sunshine Coast Health Centre, including your future re-entry.  ● Your signature below indicates that you have received a copy of this consent form for your records ● Your signature indicates that you consent to participate in this study.  ● Your signature indicates your consent to be audio-recorded (if participating in a face-to-face interview). ● Your signature indicates your consent to be video-recorded (if participating via Skype). ● Your signature indicates your awareness that once data findings are made publicly available, you will not be able to withdraw your data.  ______________________________________________ Participant Signature     Date ______________________________________________  Printed Name of the Participant    146 Appendix D: Research Interview Guide Recovery as a Transformative Experience: How Men With Addictions Experience Perspective Change in Response to Significant Life Events   PART 1 OF INTERVIEW GUIDE Preliminary Administrative Section 1. Initial greeting a. Hello, ______, my name is Daniel Jordan and I want to thank you for agreeing to be interviewed for this study.  b. Today’s interview has three parts. First, I will ask you about your recollection of the events which led to your admission to Sunshine Coast Health Centre (“Sunshine Coast”). Second, I will ask you about the events that initiated your personal transformation during treatment. For the purposes of this research, personal transformation refers to fundamental changes in your perceptions, thoughts, and feelings about yourself, others, and the world at large. Third, I will ask you to recall your experience—your thoughts, feelings, and behaviours—of personal transformation since completing treatment.   2. Overview - before we get started with the interview, I want to ensure that you understand and give consent to being interviewed for this study. a. Consent form i. Interview will be approximately 90 minutes in duration. ii. You can change your mind about being interviewed at any point in the interview. iii. I am planning on audio-recording our interview in order to create an accurate record of our conversation. If we are conducting this interview online, I will also be video-recording our interview.  iv. Only me and my research supervisor Dr. Jude Walker will have access to the audio-recording and video-recording. I will record our conversation on my smartphone and then upload it to my password-protected laptop. Once uploaded, the audio-recording will be deleted from my smartphone.  v. I will keep a typed copy of the interview transcript in Dropbox. The posting will be removed at the end of the study.  vi. I will email you a copy of the transcript and you will have an opportunity to comment and correct it.  147 vii. (Confidentiality section) You have the option of using a pseudonym if you prefer. The pseudonym will appear in the transcript. Would you prefer to use a pseudonym? If so, what pseudonym do you prefer?  viii. (Risk section). I do not foresee any harm that could arise out of this study but if you have any questions or concerns you can email Dr. Walker at the address provided on this consent form. You can also contact the UBC Research Participant Complaint Line. b. Signature page i. Your participation is voluntary and you can refuse to participate in this study. ii. Once the interview begins, you can withdraw at any time. iii. I will provide you with a copy of this consent form for your own records.  iv. I will keep a signed copy of your consent form in my locked briefcase for six months after the end of the study, after which time I will shred the form.  v. Do you have any questions about the consent form?   PART 2 OF INTERVIEW GUIDE  Demographic Survey and Interview  Again, ________, thank you for agreeing to be interviewed for this project.  As I mentioned earlier, our interview today will be focusing on the events that led to your admission at Sunshine Coast and the events that led to your personal transformation as well as the thoughts and feelings you experienced at Sunshine Coast that make up your experience of personal transformation.   Demographic Survey Follow-Up 1. Thank you. Now I want to confirm the information you provided in a previous conversation. What year were you born? Are you currently working or attending school? If so, what is your occupation or what education are you pursuing? What is your marital status? Do you have children? When did you attend Sunshine Coast? How long was your stay? What is your drug of choice? How long have you been abstinent from your drug of choice? Are you currently using any mood-altering substances? Is there any other general information about you that you would like me to know? 2. So with that aside, do you have any questions or concerns before we get started with the interview?  148 Interview Questions about Trigger Events Leading to Disorienting Dilemmas 3. Thank you. Now I want to have you think back to the weeks leading up to your stay at Sunshine Coast. To the best of your ability, please describe the events that happened to you that led to your decision to attend Sunshine Coast (Possible probing questions: Where did these events happen? Who was involved? What did you do after you decided to enrol at Sunshine Coast?). 4. Great. Thank you. For this next question, please think back to your stay at Sunshine Coast. To the best of your ability, please describe the events that happened to you or any environmental aspects of Sunshine Coast that you believe started you on the path to personal transformation. a. Where did these events happen?  b. Who was involved?  c. What did you do after experiencing these events?  d. Did any of these events involve conversations with staff or other clients?  e. What were some of the environmental aspects of your stay at Sunshine Coast that contributed to your personal transformation?   Interview Questions About the Experience of Personal Transformation 5. Okay, great. Thanks. I now want to ask you about your experience of personal transformation while attending Sunshine Coast. To the best of your ability, please describe your thoughts and feelings at the time.  a. Where were you when you experienced these thoughts and feelings?  b. What time of day was it?  c. Who was with you?  d. Was there more than one time when you engaged deeply about your thoughts and feelings?  e. What was special about these thoughts and feelings?  f. How do you know that these thoughts and feelings were responsible for your personal transformation?  g. What was that experience like?  h. How did you feel? What emotions were you experiencing?  i. How did the workshops impact you during your stay, if at all? j. How did the group and individual counselling impact you during your stay, if at all?  6. Okay, great. Thanks. I now want to ask you about your experience—your thoughts, feelings, and behaviours—of personal transformation after completing the program at Sunshine Coast.  a. In what ways have your thoughts, feelings, and behaviours changed since completing the program at Sunshine Coast? 149 b. Can you think of any incidents that suggested that you have undergone significant personal change, meaning that you would have responded differently to the same incident before treatment?  c. How have your relationships changed since completing treatment? d. What role, if any, has helping others had in your recovery? e. How have your daily activities changed since completing treatment—e.g., physical-, psychological-, social-based activities?  f. Have you been engaged in spiritual pursuits since completing treatment?   Cool Down Questions.  1. Is there anything else you would like to add about the events that led to your admission at Sunshine Coast, the events at treatment that led to your personal transformation, or your experience of personal transformation?  2. Okay, I want to thank you for your time and participation in this interview.  3. How was your experience of talking with me today?  4. Do you have any other questions or comments before we wrap up this interview?  5. As for the next steps of this study, first I will transcribe our interview. If I find there is any identifying information in the transcript, I will delete this information to protect your confidentiality. My recording of our interview will be downloaded onto my password-protected laptop and then deleted from this recording device. Secondly, I will synthesize your story into a narrative story and explore what important themes or concepts came up in your story. I will be doing this for everyone I interview. Third, I will be comparing the content from everyone’s stories for similar and dissimilar themes. After this I will contact you again to send you my findings, including a copy of our con-constructed narrative of your experience, and to schedule a half hour interview where I would like to review with you the study findings and to ensure they resonate and reflect your personal experiences. How does this sound?  6. Okay, thanks again. Remember, if you have any questions about this study please contact Dr. Walker or the Research Participant Complaint Line if you have concerns about your rights as a research participant and/or any comments about your experiences as a study participant. You can find the contact information on your copy of the consent form.   


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