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How individuals who have moved from substance addiction to health, experience interactions with others… Palmer, Roma Susan 2005

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HOW INDIVIDUALS WHO HAVE MOVED FROM SUBSTANCE ADDICTION TO HEALTH, EXPERIENCE INTERACTIONS WITH OTHERS IN TERMS OF FACILITATING OR IMPEDING THEIR HEALING JOURNEY  by  ROMA SUSAN PALMER  B . A . , The University of British Columbia,  1991  A THESIS S U B M I T T E D IN P A R T I A L F U L F I L L M E N T OF T H E R E Q U I R E M E N T S  FOR THE D E G R E E OF  MASTER OF ARTS  in T H E F A C U L T Y OF G R A D U A T E STUDIES (Counselling Psychology)  THE UNIVERSITY OF BRITISH C O L U M B I A A p r i l 2005  © R o m a Susan Palmer, 2005  11 Abstract  T h e purpose o f this study was to e x a m i n e the subjective experience o f interactions w i t h others that were either f a c i l i t a t i v e or i m p e d i n g f o r i n d i v i d u a l s w h o h a v e m o v e d f r o m substance a d d i c t i o n to health. A qualitative, p h e n o m e n o l o g i c a l m e t h o d o l o g y was u s e d for data c o l l e c t i o n and analysis. T h e study i n v o l v e d one i n - d e p t h , data c o l l e c t i o n i n t e r v i e w w i t h e a c h o f s i x volunteer participants. Interviewees i n c l u d e d f i v e m e n a n d one w o m a n , v a r y i n g i n ages f r o m 35 to 5 5 . T h e y a l l h a d extensive histories w i t h substance abuse and were a l l c o n n e c t e d to s o m e extent w i t h the A l c o h o l i c s A n o n y m o u s o r N a r c o t i c s A n o n y m o u s programs. Interviews were transcribed v e r b a t i m and a n a l y z e d u s i n g C o l a i z z i ' s (1978) m e t h o d o f p h e n o m e n o l o g i c a l data analysis as a guide. S e v e n themes c o m m o n to a l l participants were extracted f r o m the data. T h e s e i n c l u d e d : a sense o f i s o l a t i o n a n d loss, a sense o f support or discouragement, a sense o f understanding o r m i s u n d e r s t a n d i n g , a sense o f b e l o n g i n g or not b e l o n g i n g , a sense o f m e a n i n g or meaninglessness, a sense o f hope o r hopelessness, a n d a sense o f s h i f t i n g identities. T h e f i n d i n g s l e d to i m p l i c a t i o n s for c o u n s e l l i n g as w e l l as suggestions for future research.  iii  TABLE OF CONTENTS Abstract  -ii  T a b l e o f Contents  iii  Acknowledgements  vi  CHAPTER ONE: INTRODUCTION  1  Statement o f the P r o b l e m  1  R a t i o n a l e for the S t u d y  2  Research Question  :  S i g n i f i c a n c e o f the S t u d y Definition of Terms  CHAPTER TWO: LITERATURE REVIEW  5 6 .6  8  Introduction  8  History  9  Theory  10  R e v i e w o f the Literature  13  Professionals W h o W o r k w i t h I n d i v i d u a l s w i t h A d d i c t i o n s  13  S o c i a l Support o f I n d i v i d u a l s w i t h A d d i c t i o n s  27  E t h n i c a n d G e n d e r Issues  34  S u m m a r y a n d Synthesis  CHAPTER THREE: METHODOLOGY M e t h o d Selection R o l e o f the R e s e a r c h e r S e l e c t i o n o f Participants  39  40 40 .41 44  iv  R e c r u i t m e n t o f Participants  46  Data Collection  47  Data Analysis  49  Trustworthiness  50  CHAPTER FOUR: RESULTS  55  Introduction  55  Participants  55  Identified T h e m e s  58  A Sense o f Isolation or L o s s  58  A Sense o f Support or D i s c o u r a g e m e n t  68  A Sense o f U n d e r s t a n d i n g or M i s u n d e r s t a n d i n g  .81  A Sense o f B e l o n g i n g or N o t B e l o n g i n g  87  A Sense o f M e a n i n g or M e a n i n g l e s s n e s s  95  A Sense o f H o p e or H o p e l e s s n e s s  104  A Sense o f S h i f t i n g Identities  Ill  Conclusion  119  CHAPTER FIVE: DISCUSSION Introduction  121 •  121  C o m p a r i s o n to the Literature  121  I m p l i c a t i o n s for C o u n s e l l i n g  127  Suggestions for Future R e s e a r c h  130  L i m i t a t i o n s o f the S t u d y  132  Conclusion  •  133  REFERENCES  135  APPENDICES  141  A p p e n d i x A : R e c r u i t m e n t Poster A p p e n d i x B : Informed Consent F o r m  141 1  142  A p p e n d i x C : O r i e n t i n g Statement  144  A p p e n d i x D : Interview Questions  145  vi  Acknowledgements S o m a n y p e o p l e have supported m e throughout the process o f w r i t i n g this thesis; I hope I do not forget anyone. F i r s t l y I w o u l d l i k e to thank m y thesis c o m m i t t e e . I have felt their support d u r i n g this w h o l e process a n d that has been i n v a l u a b l e to m e . In particular I w o u l d l i k e to thank D r . J u d i t h D a n i l u k w h o , through her expertise, a n d e x c e l l e n t feedback has m a d e this experience m u c h m o r e f u l f i l l i n g than I ever c o u l d have anticipated. H e r encouragement a n d a v a i l a b i l i t y have been u n f a i l i n g . I feel fortunate a n d grateful to have h a d her as m y supervisor. T o the n u m e r o u s friends a n d f a m i l y w h o have l i s t e n e d to m e m u s e o n m y question, the paper, a n d the process, I thank y o u . T o those w h o p r o v i d e d c h i l d c a r e t i m e and again f o r m e to be able to w o r k , I a m most appreciative. I must also r e m e m b e r e v e r y o n e w h o has assisted m e b y r e a d i n g o v e r m y w o r k a n d h e l p i n g m e shape the e n d result. M y f a m i l y have been a source o f constant strength a n d encouragement throughout m y thesis e x p e r i e n c e . M y parents have g u i d e d m e a n d l i s t e n e d to m e e n d l e s s l y . M y c h i l d r e n have e n d u r e d hours a n d days a w a y f r o m their m o t h e r so she c a n d o "her h o m e w o r k . " T h e y have been r e m a r k a b l y patient and, i n their o w n w a y , have p l a y e d an integral part i n h e l p i n g m e c o m p l e t e this project. L a s t l y , I w o u l d l i k e to thank m y husband. H e has h e l d m e through the r o l l e r coaster o f this process a n d read e v e r y w o r d I have w r i t t e n . M y constant cheerleader, he has supported m e a n d g i v e n m e the space a n d t i m e I have n e e d e d f o r this project and this degree. F o r his constant b e l i e f i n m e a n d m y abilities I a m forever grateful.  1 CHAPTER ONE Introduction  E v e r y interaction between people i n v o l v e s the exercise o f some degree o f s o c i a l influence. E v e n the most superficial encounter leaves its m a r k , h o w e v e r m i n o r , o n the participants. S t r i c t l y s p e a k i n g , e v e r y o p i n i o n w e utter, every request w e m a k e , and e v e r y b e h a v i o u r w e undertake towards another person w i l l i n one w a y or another i n f l u e n c e that person. (Forgas, 1985, p. 2 6 7 )  Statement o f the P r o b l e m S o c i a l interactions i n v o l v e i n f l u e n c e between i n d i v i d u a l s o f a v e r b a l , e m o t i o n a l or p h y s i c a l nature (Sears, P e p l a u , & T a y l o r , 1991). I n d i v i d u a l s interact w i t h friends, f a m i l y m e m b e r s , c o w o r k e r s , therapists, and others i n their l i v e s a l l o f w h o m m a y be p e r c e i v e d b y the i n d i v i d u a l to influence their b e h a v i o u r s , attitudes, a n d beliefs. In the area o f substance a d d i c t i o n , researchers c o n t i n u e to e x p l o r e the reasons i n d i v i d u a l s d e v e l o p substance abuse p r o b l e m s as w e l l as the reasons for the cessation o f a d d i c t i v e b e h a v i o u r s . W h e t h e r i n d i v i d u a l s disentangle themselves f r o m their addictions w i t h or w i t h o u t p r o f e s s i o n a l help, they are necessarily and i n e v i t a b l y i n f l u e n c e d to v a r y i n g degrees b y their interactions w i t h others o n their j o u r n e y . A l t h o u g h the literature suggests that s o c i a l interaction is part o f the process o f h e a l i n g f r o m a d d i c t i o n ( A k i n & G r e g o i r e , 1997; R e i d , M a r i n i , Sales & K a m p f e , 2 0 0 1 ) , it is unclear what role these interactions p l a y . T h e s p e c i f i c interactions this study was interested i n were interactions that the i n d i v i d u a l h i m / h e r s e l f e x p e r i e n c e d as b e i n g either f a c i l i t a t i v e of, or h i n d e r i n g to, their process o f h e a l i n g f r o m a d d i c t i o n .  2  It is important to learn about what i n d i v i d u a l s h e a l i n g f r o m addictions experience as h e l p f u l a n d h i n d e r i n g s o c i a l interactions because o f the potential for c o u n s e l l o r s to use this i n f o r m a t i o n i n the c o u n s e l l i n g process. K n o w i n g what types o f  interactions  i n d i v i d u a l s perceive to have the greatest i n f l u e n c e o n their h e a l i n g f r o m substance a d d i c t i o n , and understanding h o w these interactions have m a d e a difference, p o s i t i v e l y or n e g a t i v e l y , m a y be helpful i n teaching c o u n s e l l o r s h o w to interact i n a f a c i l i t a t i v e w a y w i t h clients f a c i n g their substance a d d i c t i o n issues. A d d i t i o n a l l y , i n c r e a s i n g c o u n s e l l o r s ' awareness o f what interactions facilitate or i m p e d e a c l i e n t ' s r e c o v e r y , m a y help the c o u n s e l l o r to encourage facilitative interactions i n the c l i e n t ' s life. R a t i o n a l e for the S t u d y It is apparent f r o m the addictions treatment a n d c o u n s e l l i n g process literature ( E g a n , 1994; H a c k n e y & C o r m i e r , 1996; R o t g e r s , K e l l e r , & M o r t g e n s t e r n , 1996) that interactions w i t h others c a n potentially have an i n f l u e n c e on i n d i v i d u a l s and that certain behaviours, beliefs and attitudes o n the part o f others, i n c l u d i n g c l i n i c i a n s , appear to be helpful to clients i n f a c i l i t a t i n g and m a i n t a i n i n g change.  H o w e v e r , v e r y little is k n o w n  about what specific interpersonal interactions facilitate or hinder an i n d i v i d u a l ' s progress f r o m substance a d d i c t i o n to health. T h e attitudes that professionals have t o w a r d i n d i v i d u a l s w i t h addictions and the influence o f s o c i a l support o n the i n d i v i d u a l h e a l i n g f r o m a d d i c t i o n have been e x a m i n e d m o s t l y i n quantitative studies ( A m o d e o , 2 0 0 0 , M a t t h e w s et a l . , 2 0 0 2 ; W e s t & M i l l e r , 1999). Q u a l i t a t i v e studies have begun to e x p l o r e the experiences o f i n d i v i d u a l s w h o have a d d i c t i o n issues i n their relationships w i t h professionals ( A k i n & G r e g o i r e , 1997; A s h e r y , C a r l s o n , F a l c k , & S i e g a l , 1995).  3  B i e r n a c k i (1986), i n his b o o k d e s c r i b i n g the process o f natural r e c o v e r y (without therapeutic intervention) f r o m h e r o i n a d d i c t i o n , suggests that research into a d d i c t i o n r e c o v e r y needs to i n c l u d e studies that focus o n the p r o b l e m s i n d i v i d u a l s w i t h addictions face w h e n they attempt to abstain and h o w these p r o b l e m s are, or are not, o v e r c o m e . " E s p e c i a l l y important here w o u l d be observations o f h o w the v a r i o u s reactions o f noriaddicts either facilitate or s t y m i e the r e c o v e r y p r o c e s s " (p. 197). A l t h o u g h B i e r n a c k i ' s research was written i n 1986, there still appears to be v e r y little literature r e l a t i n g to what is e x p e r i e n c e d as f a c i l i t a t i v e or i m p e d i n g to i n d i v i d u a l s w h o have addressed their a d d i c t i o n issues. T h e l i m i t e d a v a i l a b l e literature tends to focus o n the role o f health professionals i n the h e a l i n g process. T h e e x i s t i n g research that e x a m i n e s interactions b e t w e e n clients and a d d i c t i o n a n d health professionals i n c l u d e s several studies that address the attitudes o f health professionals i n their interactions w i t h substance a d d i c t e d i n d i v i d u a l s ( A m o d e o , 2 0 0 0 , M a t t h e w s et a l . , 2 0 0 2 ; W e s t & M i l l e r , 1999). T h i s research suggests that negative attitudes are c o m m o n a m o n g professionals w h o w o r k w i t h i n d i v i d u a l s w i t h addictions. T y p i c a l l y , h o w e v e r , s u c h negative attitudes are tempered w h e n s p e c i a l i z e d t r a i n i n g i n w o r k i n g w i t h substance users is p r o v i d e d . C e r t a i n l y the attitudes o f health care professionals have the potential to be h e l p f u l or to h i n d e r clients i n their efforts to o v e r c o m e a d d i c t i o n . H o w e v e r , the extent to w h i c h the attitudes o f professionals are p e r c e i v e d b y clients as b e i n g significant i n f a c i l i t a t i n g o r i m p e d i n g their h e a l i n g process remains to be e x a m i n e d . In terms o f studies that e x p l o r e c l i e n t s ' perspectives o n their interactions w i t h professionals, the experiences o f d r u g users i n their interactions w i t h p e o p l e i n v a r i o u s  4  support services are d e s c r i b e d b y A s h e r y , C a r l s o n , F a l c k , and S i e g a l (1995) i n their qualitative study o f h u m a n services u t i l i z a t i o n b y 4 4 i n j e c t i o n d r u g users and c r a c k c o c a i n e users. T h e experiences o f d r u g users i n their interactions w i t h service p r o v i d e r s were e x a m i n e d , but the study b y A s h e r y et a l . was not c o n c e r n e d w i t h the p e r c e i v e d influence o f the c l i e n t s ' interactions o n their j o u r n e y out o f a d d i c t i o n . In another qualitative study, A k i n and G r e g o i r e (1997) also e x p l o r e d the experience o f substance a b u s i n g clients i n their interactions w i t h service p r o v i d e r s . T h e study i d e n t i f i e d p o s i t i v e aspects o f interactions that h e l p e d the parents reunite w i t h their c h i l d r e n as w e l l as frustrating c o m p o n e n t s o f interactions they felt i m p e d e d their progress. T h i s study p r o v i d e s v a l u a b l e i n f o r m a t i o n about the subjective e x p e r i e n c e o f clients i n d o c u m e n t i n g the experiences they felt were f a c i l i t a t i v e or h i n d e r i n g i n their process o f h e a l i n g . O t h e r interactions o f potential i n f l u e n c e i n the process o f h e a l i n g f r o m addictions i n c l u d e those w i t h i n d i v i d u a l s f r o m a c l i e n t ' s s o c i a l support n e t w o r k . T h e a v a i l a b l e literature seems to suggest that a broader, stronger s o c i a l n e t w o r k has f a c i l i t a t i v e properties for i n d i v i d u a l s s t r u g g l i n g w i t h a d d i c t i o n ( A m e s & R o i t z s c h , 2 0 0 0 ; D o b k i n , D e C i v i t a , P a r a h e r a k i s , & G i l l , 2 0 0 2 ; R e i d et a l . , 2 0 0 1 ) . In general, these studies indicate that i n d i v i d u a l s w h o have strong s o c i a l c o n n e c t i o n s stay i n treatment longer, and m a i n t a i n treatment effects l o n g e r than those w h o d o not have m a n y s o c i a l c o n n e c t i o n s . W h a t remains unclear is what it is about their interactions w i t h others that facilitates the h e a l i n g process o f i n d i v i d u a l s w i t h a d d i c t i o n . T h e literature d e s c r i b e d above g i v e s a picture o f some o f the different p e o p l e w h o , through their interactions, m a y be p e r c e i v e d b y i n d i v i d u a l s w i t h substance  5 a d d i c t i o n s to i n f l u e n c e their h e a l i n g process. T h e literature o n l y begins to address the interactions that i n d i v i d u a l s w h o are s t r u g g l i n g w i t h a d d i c t i o n s p e r c e i v e as f a c i l i t a t i v e o r h i n d e r i n g to their progress. T o address this gap i n the literature, i n this study I e x p l o r e d h o w i n d i v i d u a l s w i t h a d d i c t i o n issues experience their interactions w i t h others as b e i n g helpful to, or i m p e d i n g o f their h e a l i n g process. Research Question T h e question that g u i d e d this study was  "How do individuals who have moved  from substance addiction to health experience their interactions with others in terms of facilitating or impeding their healing journey?" T h e l a c k o f research on h o w s o c i a l interactions facilitate or i m p e d e the process o f h e a l i n g f r o m substance addictions p r o m p t e d this question. F r o m the results o f this study I h o p e d to gain s o m e i n s i g h t into the experience o f i n d i v i d u a l s w h o have h e a l e d f r o m substance a d d i c t i o n s . T h i s research i n v e s t i g a t i o n sought to establish c o m m o n themes o f what interactions w i t h others were p e r c e i v e d to have h e l p e d or h i n d e r e d participants i n m o v i n g a w a y f r o m a d d i c t i o n t o w a r d a healthier lifestyle. " O t h e r s " i n this study was kept i n t e n t i o n a l l y vague because w e d i d not k n o w w h o the i n d i v i d u a l s were w h o w o u l d be p e r c e i v e d b y the participants to have p l a y e d k e y roles ( p o s i t i v e l y or n e g a t i v e l y ) i n their h e a l i n g j o u r n e y f r o m a d d i c t i o n . I d e a l l y , this was one o f the things that I h o p e d to u n c o v e r i n this i n v e s t i g a t i o n .  6  S i g n i f i c a n c e o f the S t u d y T h e themes that e m e r g e d through this study m a y h e l p increase the k n o w l e d g e and shape the b e h a v i o u r s o f professionals w h o w o r k w i t h clients w h o have substance a d d i c t i o n issues. A d d i t i o n a l l y , the results o f this study m a y raise c o u n s e l l o r s ' awareness o f what interactions are p e r c e i v e d b y clients as b e i n g i n s t r u m e n t a l i n their progress.  This  n e w awareness m a y help c o u n s e l l o r s to w o r k w i t h s i g n i f i c a n t others i n their c l i e n t s ' l i v e s to encourage interactions that h e l p to support the h e a l i n g process. T h e data f r o m this study m a y also assist i n the t r a i n i n g o f professionals w h o w o r k w i t h i n d i v i d u a l s w h o have substance a d d i c t i o n issues, b y p r o v i d i n g e x a m p l e s o f f a c i l i t a t i v e interactions to help clients heal f r o m a d d i c t i o n . T h e study w i l l also p o t e n t i a l l y p r o v i d e i m p o r t a n t i n f o r m a t i o n for friends and f a m i l y m e m b e r s o f what b e h a v i o u r s and attitudes are p e r c e i v e d as helpful i n terms o f s u p p o r t i n g i n d i v i d u a l s w i t h a d d i c t i o n s through the h e a l i n g process. I d e a l l y this study w i l l also contribute to both theoretical and a d d i c t i o n treatment literature. Definition of Terms T h e terms " a d d i c t i o n , " or "substance a d d i c t i o n , " " p r o b l e m a t i c d r u g or a l c o h o l use," and "substance abuse" w i l l be used i n t e r c h a n g e a b l y i n this study. T h e D S M I V - T R (2000) defines substance abuse as a " m a l a d a p t i v e pattern o f substance use m a n i f e s t e d b y recurrent and s i g n i f i c a n t adverse consequences related to the repeated use o f substances" (p. 198). I w i l l f o l l o w the c o n v e n t i o n i n the literature that tends to group substance a d d i c t i o n separately f r o m n i c o t i n e a d d i c t i o n a n d other a d d i c t i o n s . T h e terms " h e a l i n g , " " h e a l i n g j o u r n e y , " " h e a l i n g p r o c e s s , " or "progress" w i l l be used i n this study i n p l a c e o f r e c o v e r y w h e r e v e r p o s s i b l e . D e n n i n g (2000) states that the  7  t e r m " i n r e c o v e r y " identifies an i n d i v i d u a l as w o r k i n g t h r o u g h a 12-step p r o g r a m . T h e t e r m i m p l i e s that n o one c a n e v e r y f u l l y r e c o v e r f r o m a d d i c t i o n and i m p l i e s a process o f l i f e - l o n g r e c o v e r y . D e n n i n g also states that there is n o t e r m to describe i n d i v i d u a l s s t r u g g l i n g w i t h addictions w h o are not a part o f the 12-step m o v e m e n t . A s a result, the terms d e s c r i b e d above w i l l be used i n this study w h e n e v e r p o s s i b l e to i n d i c a t e i n d i v i d u a l s w h o are n o l o n g e r a c t i v e l y a b u s i n g a substance. T h i s m a y m e a n the i n d i v i d u a l is abstinent or is u s i n g drugs or a l c o h o l i n m o d e r a t i o n . T h e h e a l i n g j o u r n e y , i n m y m i n d and as d e s c r i b e d b y participants i n this study, begins w h e n an i n d i v i d u a l decides they are u n h a p p y w i t h their current a d d i c t i v e l i f e s t y l e and starts to t h i n k about c h a n g i n g those b e h a v i o u r s . T h e r o a d o n this j o u r n e y is v e r y rarely straight, as the i n d i v i d u a l s i n this study o u t l i n e d . E v e r y i n t e r v i e w e e relapsed at least once o n their j o u r n e y to free themselves f r o m a d d i c t i o n . C o n s e q u e n t l y the descriptions o f h e a l i n g i n v o l v e both p o s i t i v e and negative elements. T h e d e f i n i t i o n o f interaction has been taken f r o m s o c i a l p s y c h o l o g i s t s Sears, P e p l a u a n d T a y l o r (1991) w h o define s o c i a l interaction as o c c u r r i n g " w h e n t w o or m o r e p e o p l e i n f l u e n c e each other - v e r b a l l y , p h y s i c a l l y , or e m o t i o n a l l y " (p. 207). B a s e d o n the results f r o m this study I w i l l e x p a n d o n this d e f i n i t i o n s l i g h t l y . A l o n g w i t h interactions i n v o l v i n g people I w i l l i n c l u d e interactions w i t h a " h i g h e r p o w e r , " " G o d , " or " g o d o f o n e ' s u n d e r s t a n d i n g " as w e l l as interactions w i t h the p e r s o n i f i e d substance o f abuse that were d e s c r i b e d i n b y participants i n this study.  8  CHAPTER TWO Literature R e v i e w Introduction In this chapter I w i l l set the stage for this study o f the e x p e r i e n c e o f i n d i v i d u a l s w i t h substance a d d i c t i o n s i n their interactions w i t h others i n terms o f the theoretical a n d h i s t o r i c a l context o f a d d i c t i o n and the pertinent literature r e l a t i n g to m y question. In order to c o n t e x t u a l i z e the research question, I w i l l b e g i n b y g i v i n g s o m e b a c k g r o u n d o n the h i s t o r y o f a d d i c t i o n and theoretical perspectives o n s o c i a l interaction as w e l l as that o f c o u n s e l l i n g literature pertinent to a d d i c t i o n .  T h e r e m a i n d e r o f the chapter w i l l i n c l u d e a  r e v i e w o f the relevant studies relating to the topic o f interactions i n d i v i d u a l s w i t h substance addictions have w i t h various p e o p l e i n their l i v e s . In r e v i e w i n g the relevant literature related to the e x p e r i e n c e o f i n d i v i d u a l s w i t h a d d i c t i o n issues i n their interactions w i t h others, t w o major areas w i l l be h i g h l i g h t e d : literature o n the professionals w h o interact w i t h i n d i v i d u a l s w h o have a d d i c t i o n s , as w e l l as literature o n the s o c i a l support o f i n d i v i d u a l s w i t h a d d i c t i o n s . L i t e r a t u r e f o c u s i n g o n the r e l a t i o n s h i p o f professionals w i t h i n d i v i d u a l s w i t h a d d i c t i o n s , f r o m both the p r o f e s s i o n a l and c l i e n t perspective w i l l be addressed. T h e reason for i n c l u s i o n o f these studies is that m a n y i n d i v i d u a l s c o m e into contact w i t h professionals o v e r the course o f their h e a l i n g j o u r n e y and there is great potential for clients to feel these i n d i v i d u a l s have i n f l u e n c e d their progress i n some w a y . T h e literature e x a m i n i n g the r o l e o f s o c i a l support w i l l be d i s c u s s e d because it appears that the relationships i n d i v i d u a l s have w i t h their friends a n d f a m i l y m e m b e r s p l a y a r o l e i n i n d i v i d u a l h e a l i n g f r o m a d d i c t i o n . Therefore, it is important to e x a m i n e both the literature r e l a t i n g to s o c i a l support as w e l l  9  as h o w professionals interact w i t h their clients a n d h o w these interactions are p e r c e i v e d b y clients. In a d d i t i o n to these t w o major areas, I w i l l also discuss the l i m i t e d research addressing the e t h n i c i t y and gender literature and its relevance i n the area o f substance a d d i c t i o n . T h e r e appears to be e v i d e n c e that i n d i v i d u a l s o f different ethnicities and/or gender m a y b r i n g different perspectives to the issue o f the u t i l i t y o f interactions w i t h others based o n their u n i q u e experience o f a d d i c t i o n . I w a s , therefore, m i n d f u l o f e t h n i c i t y and gender i n r e c r u i t i n g participants and i n a n a l y z i n g data. T h e chapter w i l l c o n c l u d e w i t h a s u m m a r y and synthesis o f the e x i s t i n g literature l e a d i n g to the statement o f the p r o b l e m . History O v e r the last h u n d r e d years, attitudes t o w a r d a d d i c t i o n and t o w a r d i n d i v i d u a l s w i t h a d d i c t i o n s have e v o l v e d i n N o r t h A m e r i c a ( B o y d , 1 9 9 1 ; D e n n i n g , 2 0 0 0 ; G r a y , 1998): starting as a r a c i a l issue then b e c o m i n g a m o r a l issue. F r o m here, the v i e w o f a d d i c t i o n as a disease d e v e l o p e d . T h e use o f i l l e g a l drugs has meant that a d d i c t i o n has also been interpreted as a c r i m i n a l j u s t i c e matter. P r e s e n t l y , i n C a n a d a , a d d i c t i o n is b e i n g seen m o r e and m o r e as a p u b l i c health issue. L a w s p r o h i b i t i n g substances l i k e o p i u m and m a r i j u a n a were o r i g i n a l l y based o n r a c i a l prejudice. T h e s e l a w s c a r r i e d o v e r to a l c o h o l d u r i n g p r o h i b i t i o n i n the U n i t e d States f r o m the years 1 9 2 0 - 1 9 3 3 . H o w e v e r , the l a w s d e v e l o p e d a r o u n d a l c o h o l c a m e f r o m the r e l i g i o u s v i e w o f a l c o h o l and a l c o h o l i c s as e v i l and m o r a l l y w r o n g . S i n c e then, the A l c o h o l i c s A n o n y m o u s o r g a n i z a t i o n has construed a l c o h o l i s m and d r u g use as a disease rather than a m o r a l issue. In the 1 9 7 0 ' s the " W a r o n D r u g s " was i n t r o d u c e d as a  10  w a y to rid society o f the h a r m o f drugs. T h i s " w a r " has turned the issue o f a d d i c t i o n into a c r i m i n a l j u s t i c e p r o b l e m rather than v i e w i n g it as a p u b l i c health c o n c e r n . C o n s e q u e n t l y , i n d i v i d u a l s w i t h d r u g addictions are often seen as c r i m i n a l s rather than people w i t h a health p r o b l e m , and are treated a c c o r d i n g l y . T h e h i s t o r y o f N o r t h A m e r i c a n s o c i e t y ' s attitudes and approaches to a l c o h o l and d r u g issues is relevant because the culture a r o u n d an i n d i v i d u a l imparts the lens through w h i c h they see people w i t h addictions and influences the w a y i n d i v i d u a l s w i t h addictions see themselves. C u r r e n t l y there is a shift h a p p e n i n g i n C a n a d a t o w a r d a p h i l o s o p h y o f h a r m r e d u c t i o n that v i e w s the p r o b l e m o f a d d i c t i o n as a b i o p s y c h o s o c i a l issue ( D e n n i n g , 2 0 0 0 ) , rather than a disease or c r i m i n a l p h e n o m e n o n . T h e h a r m r e d u c t i o n approach advocates r e d u c i n g h a r m to the i n d i v i d u a l and p r o m o t i n g their health. A b s t i n e n c e is not the o n l y g o a l o f treatment w i t h i n the p a r a d i g m o f h a r m r e d u c t i o n . In v i e w i n g a d d i c t i o n as a b i o p s y c h o s o c i a l p h e n o m e n o n , the h a r m reduction m o d e l l o o k s not o n l y at the b i o l o g i c a l effects o f drugs o n the i n d i v i d u a l , but also the p s y c h o l o g i c a l effects and the interaction between the i n d i v i d u a l and society a n d addresses b o t h c o m m u n i t y and i n d i v i d u a l interventions. It appears that the h a r m r e d u c t i o n m o d e l m a y p r o v i d e a m o r e constructive w a y o f v i e w i n g a d d i c t i o n and i n d i v i d u a l s w i t h addictions than some o f the h i s t o r i c a l alternatives. T h e nature o f s o c i a l interactions a n d f a c i l i t a t i v e c o u n s e l l i n g interventions f r o m different theoretical orientations w i l l be d e s c r i b e d i n the next section. Theory In his b o o k , T h e P s y c h o l o g y o f Interpersonal B e h a v i o u r (1994), M i c h a e l A r g y l e , a s o c i a l p s y c h o l o g i s t s p e c i a l i z i n g i n s o c i a l interaction, identifies several m o t i v a t i n g factors to e x p l a i n w h y i n d i v i d u a l s seek s o c i a l interaction. T h e s e drives i n c l u d e  1  b i o l o g i c a l needs, dependency, affiliation, d o m i n a n c e , sex, aggression, self-esteem and ego-identity, and other m o t i v a t i o n s w h i c h affect s o c i a l b e h a v i o u r (achievement, m o n e y , interests, values). I n d i v i d u a l s seek to satisfy goals r e l a t i n g to these d r i v e s through their interactions w i t h others. T h e nature o f a s o c i a l interaction c o m p r i s e s v e r b a l and n o n - v e r b a l elements ( A r g y l e , 1994). N o n - v e r b a l elements c o m m u n i c a t e attitudes, e m o t i o n s and supplement the v e r b a l exchange. N o n - v e r b a l c o m m u n i c a t i o n is c o m p r i s e d o f f a c i a l e x p r e s s i o n , gaze v o i c e , gestures, posture, touch / b o d i l y contact, spatial b e h a v i o u r , and appearance. V e r b a l c o m m u n i c a t i o n and c o n v e r s a t i o n c o n v e y m e a n i n g and are i n t e n d e d to i n f l u e n c e the hearer i n some w a y ( A u s t i n , i n A r g y l e ) . A r g y l e breaks v e r b a l c o m m u n i c a t i o n into utterances a n d describes these different types o f utterances: orders and instructions, questions, i n f o r m a t i o n , i n f o r m a l speech, e x p r e s s i o n o f e m o t i o n s a n d interpersonal attitudes, performative utterances (e.g., v o t i n g , j u d g i n g ) , s o c i a l routines (e.g., t h a n k i n g ) , and latent messages.  V e r b a l and n o n - v e r b a l c o m m u n i c a t i o n c a n i n f l u e n c e i n d i v i d u a l s  v e r b a l l y , p h y s i c a l l y a n d e m o t i o n a l l y . T h e specific interactions this study is interested i n are interactions that are either f a c i l i t a t i v e or h i n d e r i n g i n an i n d i v i d u a l ' s process o f healing from addiction. W h e n c o u n s e l l o r s w o r k w i t h clients, their interactions are intended to facilitate the h e a l i n g process. T h e c o u n s e l l o r facilitates b e n e f i c i a l interactions w i t h clients b y d i s p l a y i n g accurate empathy, genuineness, a n d an u n c o n d i t i o n a l p o s i t i v e regard for the client ( H a c k n e y & C o r m i e r , 1996). C e r t a i n b e h a v i o u r s are e x h i b i t e d i n order to demonstrate these h e l p i n g characteristics. B e h a v i o u r s associated w i t h e m p a t h y i n c l u d e " v e r b a l and n o n v e r b a l attending, paraphrasing content o f c l i e n t c o m m u n i c a t i o n ,  12  reflecting client feelings and i m p l i c i t client message, and p a c i n g or s y n c h r o n y o f client e x p e r i e n c e " ( H a c k n e y & C o r m i e r , p . 53). B e h a v i o u r s that c o n v e y genuineness are "congruence, openness and discrete self-disclosure and i m m e d i a c y " (p. 61). P o s i t i v e regard is expressed through supporting n o n v e r b a l behaviours a n d e n h a n c i n g verbal responses. T h e presence o f these factors does not necessarily guarantee that the client w i l l r e s p o n d f a v o u r a b l y to the c o u n s e l l o r ; but the literature suggests these interactions are facilitative i n nature ( E g a n , 1994; H a c k n e y & C o r m i e r , 1996). T h e a d d i c t i o n c o u n s e l l i n g literature supports the e f f i c a c y o f c o u n s e l l o r behaviours s i m i l a r to the general c o u n s e l l i n g m o d e l discussed above, w h e n w o r k i n g w i t h clients w h o have a d d i c t i o n issues. Different theories discuss elements o f the h e l p e r ' s role i n f a c i l i t a t i n g the h e a l i n g process o f i n d i v i d u a l s w i t h addictions. T h e A l c o h o l i c s A n o n y m o u s m o d e l suggests that a facilitator ( N o w i n s k i , 1996) s h o u l d p r o v i d e an e n v i r o n m e n t o f safety and acceptance for clients, reinforce the c l i e n t ' s p o s i t i v e efforts, and w o r k c o l l a b o r a t i v e l y w i t h the client. T h e b e h a v i o u r a l m o d e l (Rotgers, 1996) outlines a c o l l a b o r a t i v e , e m p o w e r i n g process that encourages the c l i e n t ' s i n v o l v e m e n t i n treatment p l a n n i n g a n d g o a l setting. M o t i v a t i o n a l i n t e r v i e w i n g ( B e l l & R o l l n i c k , 1996) and p s y c h o a n a l y t i c ( K e l l e r , 1996) approaches advocate the use o f e m p a t h y b y therapists and m o t i v a t i o n a l i n t e r v i e w i n g also stresses client c h o i c e i n g o a l setting. H a r m r e d u c t i o n literature refers ( D e n n i n g , 1998; M c C a n n & R o y - B y r n e , 1998; T a t a r s k y , 1998), as the general c o u n s e l l i n g literature does, to the importance o f establishing a therapeutic a l l i a n c e i n effecting change w i t h a client. Studies u s i n g the h a r m r e d u c t i o n approach to a d d i c t i o n treatment ( D e n n i n g , 1998; M c C a n n & R o y - B y r n e , 1998; R o t h s c h i l d , 1998; T a t a r s k y , 1998) suggest that interacting w i t h the client f r o m " w h e r e they are" a n d  13  w o r k i n g w i t h the c l i e n t ' s goals i n a c o l l a b o r a t i v e w a y rather than i m p o s i n g a p r e s c r i b e d treatment strategy is the k e y to f a c i l i t a t i n g the h e a l i n g process. " H a r m r e d u c t i o n p s y c h o t h e r a p y rests o n the b e l i e f that the interactions w i t h i n a relationship between the d r u g user and the c l i n i c i a n help create the e n v i r o n m e n t w i t h i n w h i c h change takes p l a c e " ( D e n n i n g , 2 0 0 0 , p. 93). H o w e v e r w e d o not k n o w what it is about these interactions that facilitates c h a n g e for the client. In the next section I r e v i e w the literature p e r t a i n i n g to interactions between professionals and clients w i t h a d d i c t i o n issues. T h e literature addresses studies that describe the r e s u l t i n g b e h a v i o u r a l and attitudinal changes that o c c u r a m o n g professionals w h o have r e c e i v e d s p e c i a l i z e d t r a i n i n g about a d d i c t i o n and w o r k i n g w i t h i n d i v i d u a l s w i t h addictions. In a d d i t i o n , the qualitative literature d o c u m e n t i n g the experiences o f i n d i v i d u a l s w i t h addictions w i t h certain professionals w i l l be described. T h e s e studies b e g i n to g i v e some i d e a o f the types o f interactions that m a y be p e r c e i v e d as f a c i l i t a t i v e or i m p e d i n g i n an i n d i v i d u a l ' s r e c o v e r y f r o m a d d i c t i o n . Professionals W h o W o r k with Individuals with A d d i c t i o n s A m o d e o (2000) c o n d u c t e d a study to e x a m i n e the i n f l u e n c e o f substance abuse t r a i n i n g o n S o c i a l W o r k e r s i n terms o f their attitudes, s k i l l s and c l i n i c a l b e h a v i o u r w i t h respect to clients w i t h substance a d d i c t i o n issues. T h e s a m p l e o f 81 M a s t e r s l e v e l S o c i a l W o r k e r s w h o c o m p l e t e d a n i n e m o n t h , 84 h o u r t r a i n i n g p r o g r a m between 1986 and 1995 was c o m p a r e d w i t h a m a t c h e d sample o f 78 M a s t e r s l e v e l S o c i a l W o r k e r s w h o d i d not e n r o l l i n the t r a i n i n g p r o g r a m . T h e sample was m o s t l y female ( 8 7 % ) a n d W h i t e ( 9 6 % ) . Participants w i t h the t r a i n i n g w h o h a d substance abuse experience p r i o r to the t r a i n i n g p e r i o d were e x c l u d e d f r o m the study i n order to m i n i m i z e the p o s s i b i l i t y that outcomes  14 predated t r a i n i n g . T e l e p h o n e i n t e r v i e w s i n this l o n g - t e r m f o l l o w - u p d e s i g n i n v o l v e d a questionnaire d e v e l o p e d for this study c o m p r i s e d o f b o t h c l o s e d a n d open-ended questions. T h e questionnaire i n c l u d e d measures o f b e h a v i o u r , c l i n i c a l s k i l l s a n d selfrated attitudes o f interest, c o m m i t m e n t , o p t i m i s m , c o m p e t e n c e a n d c o n f i d e n c e i n w o r k i n g w i t h substance-abusing clients. P a r t i c i p a n t s ' supervisors w e r e i n t e r v i e w e d i n order to substantiate the c l a i m s o f participants. In terms o f attitudes t o w a r d clients w i t h substance a d d i c t i o n issues, the f i n d i n g s i n d i c a t e d that the trainees' scores a n d s u p e r v i s o r ratings o f trainees w e r e s i g n i f i c a n t l y m o r e p o s i t i v e than those o f c o m p a r i s o n subjects. T r a i n e e s a n d their supervisors rated themselves h i g h e r o n the extent to w h i c h they i d e n t i f i e d a n d i n t e r v e n e d w i t h clients w h o h a d substance abuse issues. T r a i n e e s h a d s i g n i f i c a n t l y m o r e substance-abusing clients i n their c a s e l o a d i n their p r i m a r y w o r k setting than c o m p a r i s o n subjects.  Additionally,  s i g n i f i c a n t l y m o r e trainees h a d made j o b changes to increase the focus o n substance abuse related w o r k . Subjects w h o c o m p l e t e d t r a i n i n g i n the first f i v e years s c o r e d s i g n i f i c a n t l y h i g h e r o n the attitudinal c o m p o n e n t s than those w h o c o m p l e t e d the t r a i n i n g i n the latter f i v e years. T h e authors interpreted this result as suggesting that attitudes m a y i m p r o v e i n t i m e w i t h m o r e exposure to clients w i t h a d d i c t i o n issues. T h e s t u d y ' s strengths i n c l u d e the m a t c h i n g o f the sample. Subjects w e r e m a t c h e d p r o f e s s i o n a l l y a n d w e r e also v e r y s i m i l a r o n relevant b a c k g r o u n d v a r i a b l e s . T h e l o n g t e r m f o l l o w - u p nature o f the study is rare a n d i n this case seems to i n d i c a t e that t r a i n i n g effects stand the test o f t i m e a n d m a y i m p r o v e o v e r t i m e . S u p e r v i s o r c o r r o b o r a t i o n o f subjects' responses g i v e s greater c r e d i b i l i t y to the results. T h e study is l i m i t e d b y the fact that the t r a i n i n g p r o g r a m w a s v o l u n t a r y a n d it is p o s s i b l e that i n d i v i d u a l s w h o t o o k part  15  i n the t r a i n i n g p r o g r a m were already m o r e interested i n the area o f a d d i c t i o n and c o u l d have h a d m o r e p o s i t i v e attitudes about a d d i c t i o n and clients w i t h a d d i c t i o n s than the c o m p a r i s o n group regardless o f t r a i n i n g . T h e g e n e r a l i z a b i l i t y o f the study is l i m i t e d because it relates to o n l y one t r a i n i n g p r o g r a m . A d d i t i o n a l l y , other than a focus group u s e d to hone the questions for the i n t e r v i e w s , n o v a l i d i t y or r e l i a b i l i t y data were g i v e n f o r the scale d e v e l o p e d for this study. T h e f i n d i n g s o f A m o d e o ' s study (2000) c o n v e r g e w i t h those o f M a t t h e w s et a l . (2002) w h o also f o u n d that a substance abuse t r a i n i n g i n t e r c l e r k s h i p assisted i n i m p r o v i n g k n o w l e d g e , attitudes and s k i l l s o f t h i r d year m e d i c a l students i n w o r k i n g w i t h patients w i t h substance addictions issues. In their study, M a t t h e w s et a l . (2002) assessed the i m m e d i a t e a n d d e l a y e d i m p a c t o f a one or t w o d a y i n t e n s i v e substance abuse t r a i n i n g session (interclerkship) o n the k n o w l e d g e , s k i l l s and attitudes o f 396 t h i r d year m e d i c a l students f r o m the U n i v e r s i t y o f Massachusetts M e d i c a l S c h o o l between the years 1997 and 2 0 0 1 . T h e purpose o f the i n t e r c l e r k s h i p was to enhance k n o w l e d g e and competence w i t h substance abuse assessment and b r i e f i n t e r v e n t i o n . T h e i n t e r c l e r k s h i p format i n v o l v e d i n t e r d i s c i p l i n a r y instructors ( m e d i c a l and c o m m u n i t y professionals) integrating t e a c h i n g formats, e m p h a s i z i n g s m a l l group t e a c h i n g and s k i l l d e v e l o p m e n t . Students c o m p l e t e d an i n i t i a l questionnaire, a p r e - i n t e r c l e r k s h i p test, a f i n a l course e v a l u a t i o n a n d a post-interclerkship test. T h e i n i t i a l questionnaire gathered d e m o g r a p h i c data i n c l u d i n g past w o r k or p e r s o n a l e x p e r i e n c e w i t h substance abuse disorders. P r e - a n d p o s t - i n t e r c l e r k s h i p tests a s k e d questions related to attitudes and k n o w l e d g e r e g a r d i n g substance abuse disorders and treatment. T h e attitude assessment instrument was adapted f r o m the Substance A b u s e A t t i t u d e S u r v e y and the k n o w l e d g e  16  assessment instrument w a s d e v e l o p e d b y this s t u d y ' s authors. Students w e r e also a s k e d t w o questions about their c o n f i d e n c e i n assessing substance abuse p r o b l e m s a n d p r o v i d i n g b r i e f i n t e r v e n t i o n . A d d i t i o n a l l y , i n 1998-99 each t h i r d year m e d i c a l student participated i n an O b j e c t i v e S t a n d a r d i z e d C l i n i c a l E x a m i n a t i o n ( O S C E ) that, i n part, m e a s u r e d students' substance abuse assessment a n d i n t e r v e n t i o n c l i n i c a l s k i l l s . T h e O S C E m a y have o c c u r r e d up to s i x months after the substance abuse i n t e r c l e r k s h i p for s o m e students, a n d others m a y not yet have taken part i n the i n t e r c l e r k s h i p . Students' performances o n the O S C E were c o m p a r e d based o n whether the O S C E was c o m p l e t e d before o r after their substance abuse i n t e r c l e r k s h i p . F i n d i n g s w e r e assessed i n the f o l l o w i n g w a y . P r e - a n d p o s t - i n t e r c l e r k s h i p test scores for k n o w l e d g e , attitudes and c o n f i d e n c e w e r e c o m p a r e d u s i n g n o n - d i r e c t i o n a l p a i r e d s a m p l e t-tests a n d the authors f o u n d s i g n i f i c a n t p o s i t i v e changes i m m e d i a t e l y after the i n t e r c l e r k s h i p . S p e a r m a n correlations were c a l c u l a t e d to e x a m i n e the relationships a m o n g attitudes, k n o w l e d g e , a n d c o n f i d e n c e a n d self-reported past experience w i t h substance abuse a n d to evaluate the r e l a t i o n s h i p between students' p e r f o r m a n c e on the O S C E a n d their responses on the pre a n d post i n t e r c l e r k s h i p assessments.  N o correlation  w a s apparent between past personal e x p e r i e n c e w i t h substance abuse a n d k n o w l e d g e , attitudes o r c o n f i d e n c e r e g a r d i n g substance abuse issues. H o w e v e r , p r i o r w o r k k n o w l e d g e s e e m e d to predict m o r e p o s i t i v e students' attitudes a n d greater c o n f i d e n c e l e v e l s at the b e g i n n i n g o f the i n t e r c l e r k s h i p . C h i square tests w e r e u s e d to c o m p a r e the frequencies o f O S C E performance ratings f a l l i n g above a n d b e l o w e x p e c t e d l e v e l s for students c o m p l e t i n g the O S C E before a n d after the i n t e r c l e r k s h i p . O S C E performance data s h o w e d s i g n i f i c a n t i m p r o v e m e n t i n the students' a b i l i t y to assess a n d intervene w i t h  17  substance abuse issues immediately following and up to six months after the interclerkship. Stepwise multiple regression was used to examine the contributions of the substance abuse interclerkship and the internal medicine and family medicine to the students' OSCE performance. Completing the family medicine or internal medicine components were not shown to demonstrate an effect on the substance abuse measures of the OSCE. The interclerkship remained the only positive predictor of performance on the OSCE. Positive strengths were comparable given both the one and two day format of the interclerkship. The strengths of this study include addressing the issue of attitudes, knowledge and skills of medical students relating to patients with substance abuse issues as substance abuse appears to be an area without a great deal of training for medical students. In addition, the sample size and repetition of the study in successive years for comparison lends itself to the credibility of the study. However, the reliability and validity of the pre- and post-interclerkship tests was not sufficiently addressed in the study. Questions on the tests were modified from an existing substance abuse attitude survey. The authors also added and developed questions for this study. It is unclear whether these instruments were appropriate for use in this study. Matthews et al. (2002) found an improvement in the attitudes, knowledge and confidence of students who completed a substance abuse interclerkship. This finding seems to support the idea that specific training in substance abuse can positively influence beliefs and behaviours of physicians who may interact with individuals struggling with addiction issues. The attitudes and behaviours of physicians have the potential to influence individuals in their interactions with them. Interactions are  18  c o m p r i s e d o f v e r b a l , e m o t i o n a l or p h y s i c a l influence between t w o people. Therefore, i f the attitudes and b e h a v i o u r s o f professionals interacting w i t h their substance a b u s i n g patients are m o r e o p t i m i s t i c , there m a y be a greater l i k e l i h o o d that their interactions w i t h these patients c o u l d be f a c i l i t a t i v e rather than h i n d e r i n g . W e s t and M i l l e r (1999) c a r r i e d out a survey o f 9 0 v o c a t i o n a l r e h a b i l i t a t i o n c o u n s e l l o r s to determine i f differences e x i s t e d i n the attitudes o f v o c a t i o n a l r e h a b i l i t a t i o n c o u n s e l l o r s t o w a r d s e r v i n g substance a b u s i n g clients d e p e n d i n g o n the c o u n s e l l o r s ' t r a i n i n g a n d education. Participants were e m p l o y e d b y the T e n n e s s e e D i v i s i o n o f R e h a b i l i t a t i o n S e r v i c e s a n d the Tennessee D e p a r t m e n t o f H e a l t h and H u m a n S e r v i c e s . O f the respondents, 5 7 % h a d been e m p l o y e d as v o c a t i o n a l r e h a b i l i t a t i o n c o u n s e l l o r s f i v e years or less. T h e Substance A b u s e A t t i t u d e S u r v e y ( S A A S ) w a s a d m i n i s t e r e d to participants to g a i n i n f o r m a t i o n about r e h a b i l i t a t i o n c o u n s e l l o r s ' attitudes and beliefs about the e t i o l o g y , course and treatment o f addictions. Subjects were g r o u p e d a c c o r d i n g to their substance use a n d abuse training history. T-tests were c o n d u c t e d o n the S A A S as a w h o l e a n d its subscales o f n o n m o r a l i s m , treatment intervention, nonstereotypy, permissiveness and treatment o p t i m i s m to determine the existence o f attitude differences between groups. N o significant difference was f o u n d between the t r a i n i n g and n o n - t r a i n i n g groups o n the S A A S as a w h o l e although the results were a p p r o a c h i n g s i g n i f i c a n c e i n the predicted d i r e c t i o n . O f the five subscales o f the S A A S , o n l y t w o i n d i c a t e d a difference between groups based o n their t r a i n i n g . T h e subscales o f n o n m o r a l i s m and treatment intervention s h o w e d s i g n i f i c a n t l y m o r e p o s i t i v e attitudes o n the part o f c o u n s e l l o r s w h o h a d t r a i n i n g c o m p a r e d w i t h those w h o h a d none. T h i s f i n d i n g suggests that c o u n s e l l o r s  w i t h substance abuse t r a i n i n g were less l i k e l y to see substance abuse as a m o r a l f a i l i n g and h e l d m o r e p o s i t i v e expectations o f treatment i n t e r v e n t i o n . O n the w h o l e , h o w e v e r , the attitudes o f a l l c o u n s e l l o r s i n this study were f o u n d to be s o m e w h a t negative, perhaps because the type o f substance abuse t r a i n i n g r e c e i v e d was not standard across a l l participants. Issues specific to r e h a b i l i t a t i o n c o u n s e l l o r s such as their b e l i e f that r e h a b i l i t a t i o n clients w i t h substance abuse issues cannot be h e l p e d , or that the care and r e h a b i l i t a t i o n o f substance abusing clients w i l l be m o r e t i m e c o n s u m i n g , m a y not have been addressed i n the t r a i n i n g the r e h a b i l i t a t i o n c o u n s e l l o r s r e c e i v e d . T h e r e h a b i l i t a t i o n c o u n s e l l o r s i n this study met the c r i t e r i o n scores for i n d i v i d u a l s satisfied w i t h w o r k i n g w i t h a substance a b u s i n g p o p u l a t i o n o n o n l y one subscale o f the S A A S , suggesting that this group is unsatisfied o n the w h o l e i n w o r k i n g w i t h a substance a b u s i n g p o p u l a t i o n . In the sample o f the study, v e r y little i n f o r m a t i o n was g i v e n as to h o w the 52 i n d i v i d u a l s were c h o s e n for the t r a i n i n g group. T h e authors also m e n t i o n e d that a l l reported t r a i n i n g was accepted w i t h o u t c a t e g o r i z a t i o n so participants' t r a i n i n g c o u l d v a r y f r o m a one day w o r k s h o p to graduate c o u r s e w o r k . In contrast to A m o d e o (2000) and M a t t h e w s et a l . (2002) the attitudes o f the v o c a t i o n a l r e h a b i l i t a t i o n c o u n s e l l o r s towards i n d i v i d u a l s w i t h addictions were l a r g e l y negative e v e n after t r a i n i n g . H o w e v e r , most o f the respondents i n this study h a d f i v e years or less experience as a r e h a b i l i t a t i o n c o u n s e l l o r . Perhaps, as A m o d e o i n d i c a t e d i n her study, greater experience leads to greater satisfaction or better attitudes i n w o r k i n g w i t h a substance a b u s i n g p o p u l a t i o n . A l t e r n a t i v e l y , the difference m a y s i m p l y indicate that s o c i a l w o r k e r s and p h y s i c i a n s r e s p o n d differently to substance abuse t r a i n i n g than v o c a t i o n a l r e h a b i l i t a t i o n c o u n s e l l o r s . T h e survey nature o f this study is a general data  20  c o l l e c t i o n m e t h o d r e s u l t i n g i n the i n a b i l i t y to c o m m e n t o n the reasons w h y these v o c a t i o n a l r e h a b i l i t a t i o n c o u n s e l l o r s w e r e unsatisfied w o r k i n g w i t h i n d i v i d u a l s w i t h a d d i c t i o n issues. T h e strengths o f the W e s t a n d M i l l e r study (1999) i n c l u d e the s a m p l e s i z e a n d the use o f an established instrument for m e a s u r i n g attitudes t o w a r d substance abuse. In a d e s c r i p t i v e p i l o t study o f f o r m e r d r u g , t o b a c c o a n d f o r m e r o r moderate a l c o h o l users, C u n n i n g h a m , K o s k i - J a n n e s a n d Toneatto (1999) e x a m i n e d the reasons for s t o p p i n g o r r e d u c i n g c o n s u m p t i o n o f a l c o h o l , drugs, and/or t o b a c c o p r o v i d e d b y these i n d i v i d u a l s . T h e data for this study w e r e extracted f r o m the results o f a r a n d o m d i g i t d i a l i n g telephone s u r v e y c o n d u c t e d b y the C e n t r e for A d d i c t i o n a n d M e n t a l H e a l t h ( C A M H ) c a l l e d the O n t a r i o D r u g M o n i t o r . T h i s o r g a n i z a t i o n c o l l e c t s data relevant to a l c o h o l a n d d r u g use i n a representative s a m p l e o f 2 0 0 adults once a m o n t h .  Separate  questions for each d r u g w e r e asked about present a n d past use o f cannabis, c o c a i n e / c r a c k , tobacco, a n d a l c o h o l . S u m m a r i e s that h a d been generated b y the i n t e r v i e w e r s f r o m the C A M H study were p r o v i d e d to the first author o f this study w h o c o d e d statements f r o m these s u m m a r i e s . T w e l v e categories o f reasons for change w e r e d e r i v e d f r o m separating the c o d e d statements into groups. O f the p e o p l e w h o u s e d drugs relevant to this study, cannabis users, c o c a i n e / c r a c k users a n d moderate d r i n k e r s i n d i c a t e d i n t r a p s y c h i c reasons f o r changes such as g r o w i n g up or personal d e c i s i o n s . S i t u a t i o n a l changes o r n e w r e s p o n s i b i l i t i e s w e r e also c i t e d b y cannabis users a n d abstinent a n d moderate drinkers as reasons for change. A b s t i n e n t drinkers also n o t e d health concerns as a reason for c h a n g i n g their u s i n g b e h a v i o u r . F o r c o c a i n e users both finances a n d not l i k i n g the effect  21  o f the d r u g p l a y e d m o r e significant roles than situational changes. T h e most notable data gathered i n this study were that o n l y eight respondents o f 2 0 0 m e n t i o n e d treatment or d o c t o r ' s a d v i c e as relevant to c h a n g i n g their d r u g u s i n g a c t i v i t y . A d d i t i o n a l l y , treatment was not m e n t i o n e d b y participants as a reason for c h a n g i n g u s i n g b e h a v i o u r . T h e strength o f this study b y C u n n i n g h a m et a l . (1999) is that the s a m p l i n g m e t h o d was r a n d o m m a k i n g it c l o s e r to a representative s a m p l e than c o n v e n i e n c e s a m p l i n g . H o w e v e r , s m a l l sample sizes o f s o m e d r u g groups means that the results m a y not define the d r u g class as a w h o l e . T h e i n f o r m a t i o n a v a i l a b l e to the authors o f this study was l i m i t e d because the study was based o n a p o p u l a t i o n study that h a d already been c o m p l e t e d . A d d i t i o n a l l y the retrospective nature o f the responses to the survey m a y have affected their a c c u r a c y . T h e authors o f the study were unable to ascertain the p r i m a r y reason for b e h a v i o u r change a m o n g participants w h e n participants offered several reasons. T h e questions were not r a n d o m l y presented, therefore users o f m u l t i p l e drugs m a y have been i n f l u e n c e d i n their responses to later questions b y earlier responses i n the survey. In r e l a t i o n to m y study, the results o f C u n n i n g h a m et a l . (1999) suggested that i n d i v i d u a l s r e c o v e r i n g f r o m a d d i c t i o n d i d not f i n d professionals to be as i n f l u e n t i a l as w e m i g h t expect i n their r e c o v e r y process. E x p e r i e n c e s w i t h doctors or treatment d i d not seem to p l a y a significant r o l e w i t h m a n y o f the i n d i v i d u a l s p o l l e d i n this study. H o w e v e r , this result m a y be due to the fact that these participants h a d less severe a d d i c t i o n p r o b l e m s than those i n other studies. T h e nature and extent o f d r u g abusers' interactions w i t h the s o c i a l services s y s t e m was e x a m i n e d i n the study b y A s h e r y et a l . (1995). T h e study s a m p l e o f 4 4 participants  .  22  i n c l u d e d 29 i n j e c t i o n d r u g users and 15 c r a c k c o c a i n e users w h o were not i n treatment at the t i m e o f the study. T h e participants were r e c r u i t e d i n D a y t o n and C o l u m b u s , O h i o b y i n d i g e n o u s A I D S project outreach w o r k e r s . T h e m e a n age o f the m e n was 41 years and the m e a n age o f the w o m e n was 3 5 . T h e s a m p l e i n c l u d e d 10 w h i t e m e n , 10 w h i t e w o m e n , 13 A f r i c a n A m e r i c a n m e n , a n d 11 A f r i c a n A m e r i c a n w o m e n . F o c u s group m e t h o d o l o g y was used for the purpose o f this study. E i g h t focus groups were c o n d u c t e d : four i n D a y t o n and four i n C o l u m b u s . T h e groups r a n g e d i n size f r o m four to n i n e p e o p l e and were o r g a n i z e d b y e t h n i c i t y and gender. T h e team moderator approach was used for the focus groups. T h e moderators t o o k turns l e a d i n g the group u s i n g a structured focus group p r o t o c o l . T o a n a l y z e the data f r o m the focus groups, each i n t e r v i e w was transcribed and e d i t e d b y the moderators. T h e authors then a n a l y z e d the i n t e r v i e w s f o r themes b y r e a d i n g through the transcripts n u m e r o u s times and m a k i n g notes o n general themes that emerged. T h e m e s were c r o s s - c h e c k e d w i t h observations a n d interpretations a m o n g the authors. T h e researchers f o u n d t w o major themes, regardless o f type o f participant d r u g use, e t h n i c i t y , or gender. F i r s t l y , participants were v e r y f a m i l i a r w i t h s o c i a l services, e s p e c i a l l y f i n a n c i a l p r o g r a m s , h o u s i n g , f o o d pantries, a n d d r u g treatment. S e c o n d l y , participants felt that they r e c e i v e d d e m e a n i n g treatment f r o m staff at p u b l i c f i n a n c i a l programs i n c o m p a r i s o n w i t h treatment b y staff o f private p r o g r a m s . T h e treatment that was p e r c e i v e d b y participants as d e m e a n i n g i n c l u d e d the c o n d e s c e n d i n g attitude o f w o r k e r s , and t h r o u g h w o r k e r s ' tone o f v o i c e b e i n g m a d e to feel inadequate a n d degraded. Participants also reported s o m e instances o f ethnic a n d gender overtones.  23  F o o d and shelter p r o g r a m s were m o r e e a s i l y accessed b y participants than f i n a n c i a l p r o g r a m s and d r u g treatment p r o g r a m s . Participants felt there were m a n y barriers w h e n s e e k i n g f i n a n c i a l assistance. P r o d u c i n g the d o c u m e n t a t i o n r e q u i r e d was p e r c e i v e d as d e m e a n i n g a n d arduous. A d d i t i o n a l l y , the h i g h rate o f turnover a m o n g p u b l i c assistance w o r k e r s was p e r c e i v e d b y participants as an obstacle i n a c q u i r i n g services. Participants felt they and their needs s l i p p e d through the c r a c k s because they h a d not f o r m e d a r e l a t i o n s h i p w i t h a w o r k e r . T h e l o n g w a i t for their cheques l e d some i n d i v i d u a l s to turn to i l l e g a l activities i n order to o b t a i n funds. A s w e l l , one w o m a n felt that her dire situation gave her n o recourse but to return to d r u g use. W h e n s e e k i n g assistance f r o m s o c i a l services, participants g e n e r a l l y d i d not r e v e a l their d r u g use because o f their p e r c e p t i o n that k n o w l e d g e o f their d r u g u s i n g b e h a v i o u r c o u l d n e g a t i v e l y affect their a c q u i s i t i o n o f services, or w o r s e , that their c h i l d r e n w o u l d be taken f r o m t h e m . P e r c e i v e d barriers to d r u g treatment i n c l u d e d l o n g w a i t i n g lists a n d the cost o f treatment. H o w e v e r , w h e n treatment was obtained, the experience was d e s c r i b e d b y participants as e d u c a t i o n a l and m e a n i n g f u l . S e l f - m o t i v a t i o n was addressed as essential for treatment success. T h e p o s i t i v e effects o f treatment were l i m i t e d b y the short duration o f treatment p r o g r a m s and l a c k o f aftercare. T h e study has s o m e strengths but requires s o m e c a u t i o n i n interpretation. S t u d y i n g s o c i a l service u t i l i z a t i o n m i g h t attract p e o p l e w h o have s p e c i f i c issues w i t h s o c i a l services, thereby r a i s i n g issues that are not relevant for others. O n the p o s i t i v e side, the focus group m e t h o d seemed to be an effective w a y to capture themes a m o n g this group o f participants. T h e r e is v e r y little research o n the p h e n o m e n o n e x p l o r e d i n this study. T h e researchers stated that there was next to n o research o n the use o f s o c i a l  24  services b y users o f i l l e g a l drugs w h o were not i n treatment. T h e i n c l u s i o n o f b o t h w h i t e a n d A f r i c a n A m e r i c a n m e n and w o m e n is a strength o f the study because it p r o v i d e s a g o o d s a m p l e i n terms o f size and d i v e r s i t y . I n terms o f its r e l a t i o n s h i p to m y study, A s h e r y et a l . (1995) d i s c u s s e d the experience o f participants i n their use o f v a r i o u s services. T h i s i n f o r m a t i o n p r o v i d e s i n d i c a t i o n s that certain w o r k e r s a n d situations were p e r c e i v e d b y participants to have i n f l u e n c e d their actions, but this p e r c e i v e d i n f l u e n c e was o n l y t o u c h e d u p o n i n A s h e r y et a l . ' s study. O n e o f m y goals was to e x p l o r e further i n m y study the p e r c e i v e d i n f l u e n c e interactions h a d o n p a r t i c i p a n t s ' pathways out o f addiction. In a qualitative study u s i n g extreme cases o f parents w h o h a d s u c c e s s f u l l y addressed their d r u g or a l c o h o l a d d i c t i o n p r o b l e m and r e g a i n e d their c h i l d r e n f r o m c h i l d welfare, A k i n and G r e g o i r e (1997) sought to describe the i m p e d i m e n t s a n d c o n t r i b u t i o n s o f c h i l d welfare w o r k e r s to the progress o f these i n d i v i d u a l s . F i v e w h i t e w o m e n and s i x A f r i c a n A m e r i c a n w o m e n i n their twenties and thirties w i t h an average o f three c h i l d r e n were i n t e r v i e w e d i n d i v i d u a l l y u s i n g semistructured i n t e r v i e w s to c o l l e c t data. C o n s t a n t c o m p a r a t i v e analysis o f the data i d e n t i f i e d themes that f e l l into the categories o f a d d i c t i o n experience, s y s t e m s h o r t c o m i n g s , and s y s t e m successes. In terms o f s y s t e m s h o r t c o m i n g s a n d s y s t e m successes, s o m e experiences were d e s c r i b e d b y participants that were negative or p o s i t i v e i n terms o f their r e c o v e r y . F e e l i n g s o f powerlessness and hopelessness were sometimes r e i n f o r c e d b y s o c i a l w o r k e r s ' w h o s e e m e d m o r e interested i n p a p e r w o r k than the c l i e n t , w h o o n l y v i s i t e d t w i c e i n one year, and w h o the w o m e n felt treated t h e m l i k e a statistic. A l t e r n a t i v e l y , experiences that were p o s i t i v e for participants i n c l u d e d trusting relationships w i t h  25  w o r k e r s , s o c i a l w o r k e r a v a i l a b i l i t y a n d persistence, and demonstrations o f care for a n d patience w i t h the c l i e n t . A d d i t i o n a l l y participants felt supported w h e n s o c i a l w o r k e r s were able to share p o w e r w i t h their clients b y o f f e r i n g t h e m c h o i c e s a n d authority i n m a k i n g d e c i s i o n s . K n o w l e d g e o f a d d i c t i o n b y w o r k e r s was also i d e n t i f i e d as a p o s i t i v e factor i n p a r t i c i p a n t s ' h e a l i n g experiences. T h e strengths o f this study are n u m e r o u s . F i r s t l y the study p r o v i d e s an alternative v i e w to t r a d i t i o n a l research i n terms o f a qualitative a p p r o a c h d e s c r i b i n g the experiences o f c l i e n t s , treating these clients as p e o p l e w i t h v a l u a b l e and v a l i d insights and experiences, a n d i n d o c u m e n t i n g participants' success. In terms o f gathering data and accurately r e f l e c t i n g participants' experience, both i n f o r m a l and f o r m a l m e m b e r c h e c k s were used, b y c l a r i f y i n g a n d paraphrasing throughout the i n t e r v i e w a n d i n s e e k i n g the feedback o f participants o n the p r e l i m i n a r y data analysis. A s far as cautions w i t h respect to the study, this study was based o n a v e r y s p e c i f i c sample. D i f f e r e n t results m a y be f o u n d w i t h i n d i v i d u a l s w h o r e l i n q u i s h e d c u s t o d y o f their c h i l d r e n or, w h o c o n t i n u e d to struggle w i t h a d d i c t i o n . F i n d i n g s m a y also have differed i f the participants i n c l u d e d men. T h e d i s c u s s i o n o f the s y s t e m s h o r t c o m i n g s i n this study appears to reflect the negative attitudes o f professionals m e n t i o n e d i n A m o d e o (2000), M a t t h e w s et a l . (2002), and W e s t and M i l l e r (1999). A d d i t i o n a l l y i n A k i n a n d G r e g o i r e ' s study (1997) the frustrations o f participants w i t h services and service p r o v i d e r s reflect the barriers to a c c e s s i n g services d e s c r i b e d i n A s h e r y et a l . (1995). T h e barriers and s y s t e m s h o r t c o m i n g s o u t l i n e d i n c l u d e d services that were not user f r i e n d l y a n d service w o r k e r s w h o s e attitudes a n d b e h a v i o u r s were p e r c e i v e d as d e m e a n i n g , d e g r a d i n g a n d u n c a r i n g .  26 H o w e v e r , it d i d appear f r o m the data i n A k i n and G r e g o i r e ' s study that a p o s i t i v e w o r k e r client r e l a t i o n s h i p m a d e a difference i n the participants' l i v e s . A l t h o u g h it was not addressed d i r e c t l y i n the literature, it appeared that the attitudes a n d b e h a v i o u r s o f professionals i n the l i v e s o f i n d i v i d u a l s w h o have a d d i c t i o n issues c o u l d be p e r c e i v e d as h a r m f u l or h e l p f u l i n the i n d i v i d u a l s ' j o u r n e y out o f a d d i c t i o n . O n the w h o l e , the research d e s c r i b e d above suggests that professionals w h o h a d r e c e i v e d t r a i n i n g i n substance a d d i c t i o n issues reported p o s i t i v e changes f o l l o w i n g their t r a i n i n g i n terms o f their attitudes and b e h a v i o u r s t o w a r d i n d i v i d u a l s w h o h a d substance a d d i c t i o n issues. A d d i t i o n a l l y , research o u t l i n i n g c l i e n t perspectives d e s c r i b e d both p o s i t i v e and negative c l i e n t experiences i n d e a l i n g w i t h professionals. A l t h o u g h C u n n i n g h a m et a l . (1999) suggested that professionals m a y not p l a y a s i g n i f i c a n t role i n the r e c o v e r y o f i n d i v i d u a l s f r o m a d d i c t i o n , f i n d i n g s o f the study b y A k i n and G r e g o i r e (1997) m a y p o i n t i n the other d i r e c t i o n , suggesting that interactions w i t h s o c i a l service w o r k e r s s e e m e d to p l a y an important role i n h e l p i n g clients m a n a g e their a d d i c t i o n i n order to be reunited w i t h their c h i l d r e n . T h e q u a l i t a t i v e studies d e s c r i b e d above b e g i n to e x p l o r e the experiences o f i n d i v i d u a l s w i t h a d d i c t i o n issues i n their interactions w i t h services a n d service w o r k e r s . T h e research alludes to the p o s s i b i l i t y that i n d i v i d u a l s i n s o c i a l service roles m a y be p e r c e i v e d b y their clients w i t h substance abuse issues as f a c i l i t a t i n g or i m p e d i n g their progress out o f a d d i c t i o n : an aspect o f the literature I h o p e d to e x p a n d i n the current study. F u r t h e r m o r e , the literature to date does not d i r e c t l y e x a m i n e whether i n d i v i d u a l s p e r c e i v e their interactions w i t h professionals to have any i n f l u e n c e o n their success i n addressing their a d d i c t i o n issues. A n area I e x p l o r e d i n m y study was whether the  27  attitudes, k n o w l e d g e and s k i l l s o f practitioners were p e r c e i v e d b y the c l i e n t , and i n fact, whether these interactions were s i g n i f i c a n t to clients i n their h e a l i n g process. Social Support of Individuals with Addictions A n o t h e r subset o f the literature e x a m i n e s the p o s s i b l e r o l e o f s o c i a l support i n h e a l i n g f r o m a d d i c t i o n and i n the maintenance o f healthy c h o i c e s i n an i n d i v i d u a l ' s life. T h r o u g h their interactions, the i n d i v i d u a l addressing their a d d i c t i o n m a y p e r c e i v e their friends or f a m i l y m e m b e r s to be instrumental i n f a c i l i t a t i n g or h i n d e r i n g their h e a l i n g process. It is therefore important to r e v i e w the literature p e r t a i n i n g to the r o l e s o c i a l support m a y p l a y i n the j o u r n e y f r o m a d d i c t i o n a n d the maintenance o f a healthy lifestyle. In a study o f inpatients i n a substance dependence treatment p r o g r a m , A m e s a n d R o i t z s c h (2000) e x a m i n e d the relationship between stress and d r u g c r a v i n g s a n d whether s o c i a l support m e d i a t e d this r e l a t i o n s h i p . T h i r t y n i n e o f the 52 inpatients c h o s e n for the study c o m p l e t e d e n o u g h i n f o r m a t i o n to be i n c l u d e d i n the study. T h e s a m p l e was c o m p o s e d l a r g e l y o f m e n (59%) w h o were C a u c a s i a n ( 7 4 . 4 % ) , e m p l o y e d (53.8%), the largest percentage were single (38.5%) w i t h a m e a n age o f 36.47 years. T h e instruments used to gather the data i n the study were the D a i l y Stress I n v e n t o r y ( D S I ) to assess m i n o r stress, the Interpersonal S u p p o r t E v a l u a t i o n L i s t ( I S E L ) to measure s o c i a l support, the self-report D a i l y U r g e R e c o r d Sheet ( D U R S ) to measure c r a v i n g s . A d e m o g r a p h i c questionnaire d e v e l o p e d for this study was u s e d to gather b a c k g r o u n d data. T h e d e m o g r a p h i c questionnaire and the I S E L were c o m p l e t e d at the t i m e w h e n participants were recruited. Participants were asked to c o m p l e t e one D U R S sheet each t i m e they e x p e r i e n c e d a c r a v i n g and to keep track o f m i n o r stressful events and r e c o r d t h e m each  28  night o n the D S L Participants met w i t h an e x p e r i m e n t e r each d a y to h a n d i n forms a n d ensure accurate a n d t i m e l y c o m p l e t i o n o f f o r m s . W h e n the m e a n n u m b e r o f stressful events a n d their p e r c e i v e d i n f l u e n c e were c o m p a r e d w i t h a n o r m a t i v e sample o f adults l i v i n g i n the c o m m u n i t y , the participants i n the study reported a s i m i l a r n u m b e r o f m i n o r stressful events but rated these events somewhat, but not s i g n i f i c a n t l y , m o r e stressful than the n o r m a t i v e sample. W i t h i n the t i m e e n r o l l e d i n the study (average 4 days) 6 4 . 1 0 % (n=25) o f participants d i d not experience any c r a v i n g s . C o n s e q u e n t l y , participants were g r o u p e d into c r a v i n g a n d n o c r a v i n g groups. T h e n u m b e r o f m i n o r stressful events a n d p e r c e i v e d i m p a c t o f stress appeared to p r e d i c t c r a v i n g s . P e r c e i v e d s o c i a l support was f o u n d to moderate the association between the i m p a c t o f stressful events a n d c r a v i n g s . T h e study begins to address the potential i n f l u e n c e s o c i a l support m a y have i n m e d i a t i n g the stress-craving r e l a t i o n s h i p . A n o t h e r strength o f the study is the v i g i l a n c e o f the experimenters i n m e e t i n g w i t h participants d a i l y to ensure f o r m s w e r e c o m p l e t e d c o r r e c t l y . H o w e v e r , the l o w l e v e l o f c r a v i n g s d u r i n g this e x p e r i m e n t means that m o r e research is necessary to f i r m l y establish patterns o f stress a n d c r a v i n g s . Perhaps i n d i v i d u a l s w e r e not e n r o l l e d l o n g e n o u g h i n the study to obtain an accurate i m p r e s s i o n o f c r a v i n g s , o r perhaps the rate o f c r a v i n g s post treatment m a y have been a better measure. D o b k i n et a l . (2002) c a r r i e d out a study o f i n d i v i d u a l s at treatment intake a n d again s i x months later i n order to c o m p a r e t h e m at the t w o stages i n terms o f h i g h a n d l o w f u n c t i o n a l s o c i a l support a n d the r e l a t i o n s h i p b e t w e e n this v a r i a b l e a n d various r i s k factors that m a y interfere w i t h the early stages o f r e c o v e r y . T h e researchers e x a m i n e d  29  the stress-buffering r o l e o f functional s o c i a l support o n treatment o u t c o m e s a n d whether l e v e l o f f u n c t i o n a l s o c i a l support at intake p r e d i c t e d treatment outcomes. F u n c t i o n a l s o c i a l support was d e f i n e d b y D o b k i n et a l . as "actual o r p e r c e i v e d e m o t i o n a l a n d i n s t r u m e n t a l support" (p. 348). T h e s a m p l e i n c l u d e d 2 0 6 i n d i v i d u a l s at intake a n d 172 at s i x months. T h e r e w e r e 100 i n d i v i d u a l s i n the h i g h s o c i a l support group a n d 106 i n the l o w s o c i a l support g r o u p . T h e l o w a n d h i g h s o c i a l support groups w e r e not s i g n i f i c a n t l y different o n the d e m o g r a p h i c v a r i a b l e s , l e g a l status, o r p r i m a r y d r u g o f abuse. M o s t participants w e r e C a u c a s i a n (92.3%) a n d m a l e ( 6 5 . 5 % ) . D r u g s o f abuse b y participants i n this study i n c l u d e d a l c o h o l , c o c a i n e , sedatives a n d "other." T h e h i g h a n d l o w s o c i a l support groups i n this study w e r e c o m p a r e d across several variables c o n s i d e r e d to be risk factors for early r e c o v e r y success i n c l u d i n g : depressive s y m p t o m a t o l o g y , negative life events, a n d severity o f substance abuse. T h e Interpersonal S u p p o r t E v a l u a t i o n L i s t ( I S E L ) was u s e d to assess patients' p e r c e p t i o n o f f u n c t i o n a l s o c i a l support. T h e L i f e E x p e r i e n c e s S u r v e y ( L E S ) w a s used to assess life events i n the s i x months p r i o r to treatment intake a n d again i n the i n t e r v e n i n g months between the i n i t i a l a n d f o l l o w - u p i n t e r v i e w s . T h e B e c k D e p r e s s i o n I n v e n t o r y ( B D I ) was used to assess depressive s y m p t o m s a n d the S y m p t o m C h e c k l i s t - 9 0 - R was used to assess p s y c h o l o g i c a l distress. T h e A d d i c t i o n S e v e r i t y Index ( A S I ) w a s a d m i n i s t e r e d to gather i n f o r m a t i o n o n the n u m b e r o f days abstinent a n d the severity o f d r u g a n d a l c o h o l abuse. T w o - w a y A N O V A w i t h repeated measures w a s used to a n a l y z e the above data across the h i g h a n d l o w s o c i a l support groups a n d o v e r t i m e (intake versus s i x m o n t h f o l l o w - u p ) .  30  F u n c t i o n a l s o c i a l support w a s a modest p r e d i c t o r o f reductions i n the severity o f a l c o h o l abuse at f o l l o w - u p but d i d not predict reductions i n d r u g abuse. H i g h e r l e v e l s o f p e r c e i v e d f u n c t i o n a l s o c i a l support w e r e related to m o r e days spent i n treatment a n d to h i g h e r rates o f treatment c o m p l e t i o n . B o t h h i g h a n d l o w s o c i a l support groups s h o w e d m a r k e d d e c l i n e s i n negative affect a n d severity o f substance abuse o v e r t i m e . S y m p t o m s o f depression a n d p s y c h o l o g i c a l distress were h i g h e r a m o n g patients w i t h l o w s o c i a l support at intake a n d at s i x months. Patients w i t h l o w s o c i a l support at intake reported h i g h e r severity o f a l c o h o l a n d d r u g abuse at s i x months. N u m b e r o f days i n treatment was also s i g n i f i c a n t l y related to n u m b e r o f days abstinent, i m p r o v e m e n t i n severity o f a l c o h o l abuse, a n d i m p r o v e m e n t i n severity o f d r u g abuse. H i e r a r c h i c a l regression analyses w e r e used to determine the m a i n effects o f stress a n d e x a m i n e days abstinent f r o m p r i m a r y d r u g , severity o f a l c o h o l abuse, a n d severity o f d r u g abuse. T h e n u m b e r o f days i n treatment w a s u s e d as a v a r i a b l e i n a l l regression analyses to e x a m i n e the independent a n d interactive effects o f s o c i a l support a n d stress o n outcomes. Patients i n the l o w s o c i a l support group e x p e r i e n c e d a greater n u m b e r o f stressful life events than those i n the h i g h s o c i a l support g r o u p at f o l l o w - u p . B o t h stress and s o c i a l support w e r e f o u n d to have modest effects o n treatment o u t c o m e .  However,  their i n t e r a c t i o n effect w a s not significant. T h e r e f o r e the results f a i l e d to support a stress-buffering r o l e o f s o c i a l support o n the n u m b e r o f days abstinent a n d the severity o f substance abuse. T h e m a i n strength o f this study is that it adds to the research b y t a k i n g measures at both intake a n d again six months later to d o c u m e n t changes i n risk factors that c o u l d interfere w i t h early h e a l i n g f r o m substance a d d i c t i o n . C a u t i o n s o f the study i n c l u d e the  31  d e m o g r a p h i c s o f the l a r g e l y w h i t e , m a l e s a m p l e as w e l l as the appropriateness o f the I S E L w i t h a substance a b u s i n g p o p u l a t i o n . T h e study b y D o b k i n et a l . (2002) a n d that o f A m e s a n d R o i t z s c h (1997) p o i n t to the p o s s i b l e benefits o f increased s o c i a l support to i n d i v i d u a l s i n treatment for a d d i c t i o n . S o c i a l support seemed to be related to m o r e days i n treatment a n d h i g h e r rates o f treatment c o m p l e t i o n i n A m e s and R o i t s c h ' s study. A d d i t i o n a l l y , D o b k i n et a l . f o u n d that i n d i v i d u a l s w i t h h i g h s o c i a l support h a d l o w e r s y m p t o m s o f depression a n d p s y c h o l o g i c a l distress and l o w e r severity o f a l c o h o l a n d d r u g abuse at s i x months than i n d i v i d u a l s w i t h l o w s o c i a l support. A l t h o u g h the results differ, they s e e m to c o m p l e m e n t each other i n that s o c i a l support m a y p l a y a r o l e i n h e l p i n g i n d i v i d u a l s cope i n treatment situations. I f s o c i a l support does p r o v i d e a c o p i n g m e c h a n i s m for i n d i v i d u a l s h e a l i n g f r o m a d d i c t i o n , it is p o s s i b l e that the h e a l i n g i n d i v i d u a l s m a y p e r c e i v e p e o p l e w i t h i n their s o c i a l support n e t w o r k as h e l p i n g to facilitate their h e a l i n g process. I a i m e d to e x p l o r e i n m y research interactions w i t h v a r i o u s p e o p l e i n p a r t i c i p a n t s ' l i v e s that were p e r c e i v e d as influential i n their j o u r n e y s . In a d e s c r i p t i v e , qualitative study b y R e i d et a l . (2001) the authors e x p l o r e d the m e a n i n g and p e r c e i v e d i n f l u e n c e o f c o c a i n e use i n the l i v e s o f i n d i v i d u a l s w h o used c o c a i n e i n m o d e r a t i o n . T h e authors h o p e d to i d e n t i f y factors the participants associated w i t h their a b i l i t y to f u n c t i o n at an acceptable l e v e l w h i l e u s i n g c o c a i n e . T h e s a m p l e i n c l u d e d ten i n d i v i d u a l s : one W e s t I n d i a n m a l e , one A f r i c a n A m e r i c a n female, one Y a q u i I n d i a n female, t w o w h i t e males, and f i v e w h i t e females a l l f r o m 21 to 4 6 years o f age. L e v e l o f f u n c t i o n i n g o f each participant was d e t e r m i n e d u s i n g the A d d i c t i o n S e v e r i t y Index as w e l l as a subjective assessment b y a person w h o was f a m i l i a r w i t h that  32  participant. A screening i n t e r v i e w was then c o n d u c t e d w i t h i n d i v i d u a l s chosen for the study. F o l l o w i n g the i n t e r v i e w , a researcher-designed questionnaire was a d m i n i s t e r e d to participants to o b t a i n i n f o r m a t i o n o n participants' history, e v o l u t i o n o f their d r u g use and the r o l e it c o n t i n u e d to p l a y i n their l i v e s . F o l l o w - u p i n t e r v i e w s were c o n d u c t e d w i t h the participants to c l a r i f y any discrepancies between the A S I data and the data o b t a i n e d f r o m the researcher-designed instrument. T h r o u g h descriptions o f their thoughts and b e h a v i o u r s , participants i d e n t i f i e d s o c i a l factors, personal factors, and c o c a i n e use factors that assisted t h e m i n their a b i l i t y to m a i n t a i n their c o c a i n e use at a l e v e l that d i d not c o m p r o m i s e their e v e r y d a y l i v e s . S o c i a l factors i d e n t i f i e d b y participants i n c l u d e d w o r k ethic, i n v o l v e m e n t i n s o c i a l l y oriented a c t i v i t i e s , f a m i l y considerations, c o m p a s s i o n for others, strong interpersonal relationships, a n d faith i n G o d . P e r s o n a l factors p e r c e i v e d as i n f l u e n c i n g the c o c a i n e use o f participants i n c l u d e d p o s i t i v e self-image, s e l f - d i s c i p l i n e , a n d self-confidence. M e t h o d s to c o n t r o l c o c a i n e use or c o c a i n e use factors i n c l u d e d m i n i m i z i n g the amount o f c o c a i n e used, c h o o s i n g the times to use, and u s i n g w h e n their attitudes a n d m o o d s were p o s i t i v e . O l d e r participants used less freely than y o u n g e r participants w h o were not as c o n c e r n e d about consequences o f their d r u g use and w h o also u s e d i n p u b l i c m o r e often and u s e d larger amounts o f c o c a i n e . W o m e n i n this study u s e d m o r e c o n s e r v a t i v e l y than m e n w i t h their reason b e i n g the need to care for, a n d set an e x a m p l e for their c h i l d r e n . Participants f r o m c u l t u r a l m i n o r i t i e s rejected the n o t i o n that c o c a i n e use was " b a d , " and i d e n t i f i e d their culture as a reason for h a v i n g p o s i t i v e attitudes about c o c a i n e use. T h e major strength o f this study is that the participants i n this study were not incarcerated or i n treatment, m a k i n g this an u n u s u a l s a m p l e . A d d i t i o n a l l y , the study  33-  s a m p l e is a strength i n terms o f its d i v e r s i t y o f gender, e t h n i c i t y and e c o n o m i c status. A n o t h e r strength o f this study is that it focuses o n the i d e a that a l l d r u g use is not abuse; whereas most research h i g h l i g h t s the negative aspects o f d r u g use. Q u a l i f i c a t i o n s i n the interpretation o f the s t u d y ' s results i n c l u d e that the s a m p l e was one o f c o n v e n i e n c e u s i n g the s n o w b a l l i n g m e t h o d . A l s o g e n e r a l i z a t i o n is not p o s s i b l e because o f the s m a l l s a m p l e size. W h e n a s k e d about what factors keep their c o c a i n e use i n c h e c k , participants i n this study s i n g l e d out s o c i a l factors, i n c l u d i n g interpersonal a n d f a m i l y relationships as part o f that c o m p o n e n t . T h i s e v i d e n c e , c o m b i n e d w i t h results f r o m A m e s a n d R o i t z s c h (1997) and D o b k i n et a l . (2002) that s o c i a l support seems to p l a y s o m e r o l e i n h e l p i n g i n d i v i d u a l s i n treatment settings, underscores the p o s s i b l e f o r m a t i v e r o l e o f s o c i a l support i n the process o f h e a l i n g f r o m a d d i c t i o n and i n m a i n t a i n i n g i n d i v i d u a l s ' p o s i t i v e l i f e s t y l e changes. T h e research o n the effects o f s o c i a l support i n m e d i a t i n g stress and f a c i l i t a t i n g treatment o u t c o m e s as w e l l as i n m a i n t a i n i n g moderate l e v e l s o f c o c a i n e use seemed to suggest that s o c i a l support m a y p l a y s o m e r o l e i n h e l p i n g an i n d i v i d u a l m o v e a w a y f r o m a d d i c t i o n and m a i n t a i n their n e w lifestyle. H o w e v e r , none o f these studies addressed what it was about these s o c i a l c o n n e c t i o n s that m a y be f a c i l i t a t i v e i n the context o f r e c o v e r y . In m y study I tried to e x p l o r e what i n d i v i d u a l s h e a l i n g f r o m a d d i c t i o n e x p e r i e n c e d i n their interactions w i t h their s o c i a l support n e t w o r k i n terms o f f a c i l i t a t i n g or i m p e d i n g their process o f h e a l i n g .  34  E t h n i c and G e n d e r Issues T h e l i m i t e d literature a v a i l a b l e o n gender and ethnic issues i n the area o f a d d i c t i o n research seems to suggest that m e n and w o m e n as w e l l as i n d i v i d u a l s o f different ethnic o r i g i n s m a y have different needs throughout their h e a l i n g j o u r n e y .  Given  this c o n s i d e r a t i o n I t r i e d to i n c l u d e i n d i v i d u a l s i n m y study w h o represented different ethnicities and both genders i n order to c o m p a r e their experiences. In their s u m m a r y and c r i t i q u e o f the literature d e s c r i b i n g the w a y s w o m e n experience a d d i c t i o n and h o w this differs f r o m m e n , N e l s o n - Z l u p k o , K a u f f m a n a n d D o r e (1995) suggest that w o m e n w i t h c h e m i c a l dependencies differ f r o m m e n w i t h s i m i l a r issues i n terms o f patterns o f d r u g use, p s y c h o s o c i a l characteristics a n d p h y s i o l o g i c a l consequences o f d r u g use. It appears, f r o m their e x p l i c a t i o n o f the research, that w o m e n were m o r e l i k e l y to use l e g a l drugs (tranquilizers, sedatives, p s y c h o a c t i v e drugs, h y p n o t i c s , stimulants) and m e n to use i l l i c i t ones. T h e onset o f d r u g use for w o m e n w a s d e s c r i b e d as sudden a n d heavy, t y p i c a l l y after a traumatic event i n their l i v e s . In contrast, m e n often d e s c r i b e d a gradual, i n c r e a s i n g pattern o f d r u g use. W o m e n were d e s c r i b e d as m o r e often i n v o l v e d i n m u l t i p l e d r u g use than m e n . P h y s i c a l l y , w o m e n e x p e r i e n c e d m o r e h a r m f u l consequences o f d r u g use at l o w e r dosages and i n a shorter amount o f t i m e than m e n . T h e research i n d i c a t e d that w o m e n h a d fewer s o c i a l supports to d r a w o n than m e n w i t h addictions. W o m e n appeared m o r e l i k e l y than m e n to use i n i s o l a t i o n and i n private places rather than p u b l i c places. W o m e n were m o r e l i k e l y than m e n to be i n relationships w i t h d r u g - u s i n g partners o r spouses. A d d i t i o n a l l y , w o m e n tended to have . less education, f e w e r marketable s k i l l s , fewer w o r k experiences a n d f e w e r f i n a n c i a l  35'  resources than m e n w i t h c h e m i c a l dependencies. It seemed f r o m the research that, i n treatment, w o m e n were less l i k e l y than their m a l e counterparts to have s o m e o n e s u p p o r t i n g them. W o m e n w e r e e v e n t y p i c a l l y d i s c o u r a g e d f r o m p a r t i c i p a t i n g i n treatment b y f a m i l y m e m b e r s . T h e d i s c o u r a g e m e n t f r o m f a m i l y m e m b e r s w a s not the o n l y barrier to treatment for w o m e n that w a s d e s c r i b e d i n N e l s o n - Z l u p k o et a l . (1995). T h e l a c k o f c h i l d care w a s m e n t i o n e d frequently as a barrier to treatment. M o t h e r s w e r e either u n w i l l i n g to g i v e up their r o l e as p r i m a r y c a r e g i v e r o r c o u l d not afford c h i l d care w h i l e i n treatment. M o t h e r s also tended to distrust s o c i a l services a n d were reluctant to a d m i t their a d d i c t i o n issues. W o m e n were also m o r e l i k e l y to e x p e r i e n c e sexual harassment i n treatment settings than m e n . A d d i t i o n a l l y , most treatment p r o g r a m s w e r e d e s i g n e d for m e n , b y m e n a n d b a s e d o n research c o n d u c t e d w i t h m a l e participants. N e l s o n - Z l u p k o et a l . suggested that as a result, the t y p i c a l treatment format m a y not be i d e a l for w o m e n . F i n a l l y , there w e r e m o r e m e n i n treatment than w o m e n a n d m o r e m a l e staff that d i s s u a d e d w o m e n f r o m entering treatment d e p e n d i n g o n the issues they w e r e f a c i n g . F r o m the s u m m a r y o f the research o n w o m e n a n d c h e m i c a l dependence b y N e l s o n - Z l u p k o et al.(1995), it appears that w o m e n m a y face different issues throughout their a d d i c t i o n a n d r e c o v e r y than m e n . T h e onset o f a d d i c t i o n f o r w o m e n m a y differ f r o m that o f m e n . T h e s o c i a l n e t w o r k o f w o m e n f a c i n g a d d i c t i o n issues m a y be n o n existent o r c e r t a i n l y less e x t e n s i v e a n d not as s u p p o r t i v e i n c o m p a r i s o n to m e n w i t h addiction.issues. A d d i t i o n a l l y , w o m e n m a y not get i n t o a n d stay i n treatment; thus m a i n t a i n i n g the s o c i a l i s o l a t i o n these w o m e n appear to e x p e r i e n c e . I f differences  36  between m e n and w o m e n w i t h a d d i c t i o n issues d o exist, it is important to try and address these differences i n the current study. T h e purpose o f Prendergrast, H s e r and G i l - R i v a s ' (1998) study was to e x a m i n e the differences i n l o n g i t u d i n a l patterns o f narcotics use, other substance use, c r i m i n a l status, treatment experience, and m o r b i d i t y a n d m o r t a l i t y a m o n g H i s p a n i c and w h i t e i n d i v i d u a l s w i t h a d d i c t i o n s . T h e sample c o m p r i s e d 323 H i s p a n i c and 2 1 2 w h i t e m a l e narcotics addicts w h o were admitted to a court-mandated treatment p r o g r a m c a l l e d the C a l i f o r n i a C i v i l A d d i c t P r o g r a m ( C C A P ) between the years o f 1962 and 1964. T h e t w o groups d i d not differ s i g n i f i c a n t l y i n terms o f m a r i t a l status, age at a d m i s s i o n to the treatment p r o g r a m , or age o f first opiate use. H o w e v e r , H i s p a n i c s h a d s i g n i f i c a n t l y less education than whites a n d age o f first arrest was s i g n i f i c a n t l y l o w e r for H i s p a n i c s than whites. T h i s study is a secondary analysis o f data that were o b t a i n e d f r o m a d m i s s i o n records o f the C C A P as w e l l as i n t e r v i e w s c o n d u c t e d i n 1974/75 and 1985/86. P r i o r to the 1985/86 i n t e r v i e w s , 95 H i s p a n i c s and 58 whites d i e d , so data is a v a i l a b l e for 203 H i s p a n i c s and 123 whites for both the 1974/75 a n d 1985/86 i n t e r v i e w s . T h e i n i t i a l intake i n t e r v i e w was l i m i t e d , c o m p r i s i n g several d e m o g r a p h i c variables. T h e i n t e r v i e w instrument u s e d i n the t w o subsequent i n t e r v i e w s was adapted f r o m another, p r e v i o u s l y d e s i g n e d i n t e r v i e w . I n f o r m a t i o n o n d e m o g r a p h i c characteristics, f a m i l y h i s t o r y , drug-use history, treatment experience, e m p l o y m e n t , c r i m i n a l b e h a v i o u r , a n d l e g a l status was gathered d u r i n g a t w o to three h o u r i n t e r v i e w u s i n g the researcher-developed i n t e r v i e w p r o t o c o l . In order to corroborate respondents' reports, researchers h a d access to c r i m i n a l records and urine samples were c o l l e c t e d after i n t e r v i e w i n g participants w h o were not  37  incarcerated. A g r e e m e n t between respondent reports a n d u r i n a l y s i s was 7 3 . 7 % at the first i n t e r v i e w a n d 8 5 . 8 % at the s e c o n d i n t e r v i e w . E i g h t y - n i n e p o i n t three percent o f the s a m p l e agreed to p r o v i d e urine samples at first i n t e r v i e w and 8 9 . 1 % o f participants agreed to u r i n a l y s i s at the s e c o n d i n t e r v i e w . N a r c o t i c use was d e t e r m i n e d b y urine test or i n c a r c e r a t i o n : not self-report, and d i d not i n c l u d e the narcotic use status i n the i n t e r v e n i n g years. In terms o f test-retest r e l i a b i l i t y d e t e r m i n e d b y c o m p a r i n g data f r o m the t w o i n t e r v i e w s , the test-retest c o r r e l a t i o n range was 0.63 to 0 . 7 1 . H i s p a n i c addicts s h o w e d a p r o g r e s s i o n o f m o r e persistent and severe narcotics a d d i c t i o n c o m p a r e d w i t h w h i t e addicts. A t each i n t e r v i e w , H i s p a n i c s were m o r e l i k e l y than whites to be u s i n g opiates or to be incarcerated. H i s p a n i c s were less l i k e l y than whites to r e m a i n abstinent and were m o r e l i k e l y to relapse to opiate use. H i s p a n i c s h a d greater i n v o l v e m e n t i n the c r i m i n a l j u s t i c e s y s t e m , h i g h e r rates o f c o c a i n e use, and a h i g h e r p r o p o r t i o n o f deaths due to v i o l e n c e and accidents. H o w e v e r , rates o f hepatitis and cigarette s m o k i n g were p a r t i c u l a r l y h i g h a m o n g w h i t e addicts. In treatment, H i s p a n i c participants d i d not l i k e sharing p e r s o n a l thoughts a n d feelings i n a group situation w i t h i n d i v i d u a l s o f other ethnicities. Treatment p a r t i c i p a t i o n was l o w for each group a n d there were n o differences between the t w o groups for treatment p a r t i c i p a t i o n . T h e m a i n strengths o f the study are the l o n g i t u d i n a l nature a n d the v a r i e d data gathered o n d r u g b e h a v i o u r . A d d i t i o n a l l y , the a b i l i t y o f the researchers to corroborate most respondents' answers b y urine s a m p l e a n d b y c r i m i n a l records lends c r e d i b i l i t y to the data gathered. T h e r e l e v a n c e o f this research to m y study is that it appears that i n d i v i d u a l s f r o m a H i s p a n i c b a c k g r o u n d m a y have a different e x p e r i e n c e o f a d d i c t i o n a n d treatment than  38  w h i t e i n d i v i d u a l s . Prendergrast, H s e r a n d G i l - R i v a s ' (1998) study i n d i c a t e d that H i s p a n i c i n d i v i d u a l s s h o w e d m o r e severe a d d i c t i o n a n d c r i m i n a l j u s t i c e issues than w h i t e participants. A d d i t i o n a l l y , H i s p a n i c i n d i v i d u a l s d i d not l i k e sharing i n a g r o u p treatment format w i t h i n d i v i d u a l s o f different ethnicities. T h e s e results suggest that the e x p e r i e n c e o f a d d i c t i o n m a y be different for i n d i v i d u a l s o f d i f f e r i n g ethnicities o r c u l t u r a l b a c k g r o u n d s . I w a s m i n d f u l o f this w h e n selecting m y participants a n d i n l i s t e n i n g to their experiences. T h e l i m i t e d literature o n i n d i v i d u a l s o f different genders a n d f r o m different ethnic and c u l t u r a l b a c k g r o u n d s w h o have substance a d d i c t i o n s seems to suggest that the experiences o f these i n d i v i d u a l s m a y be i n f l u e n c e d b y their culture o r gender. In R e i d et a l . (2001) i n d i v i d u a l s f r o m c u l t u r a l m i n o r i t i e s tended not to see c o c a i n e use as " b a d " i n the w a y the p r e v a i l i n g culture does. T h e study b y Prendergast et a l . (1998) reported that H i s p a n i c participants d i d not l i k e the group format o f treatment that requires personal disclosures w i t h p e o p l e o f other ethnic groups. A s h e r y et a l . (1995) n o t e d that " i n s o m e instances ethnic a n d gender overtones w e r e m e n t i o n e d b y the p a r t i c i p a n t s " (p. 79) suggesting that i n d i v i d u a l s m a y be treated differently because o f their b a c k g r o u n d o r gender. T h e s u m m a r y a n d c r i t i q u e o f the experiences o f w o m e n w i t h a d d i c t i o n issues b y N e l s o n - Z l u p k o et a l . (1995) lists a variety o f w a y s i n w h i c h w o m e n m a y differ f r o m m e n throughout the h e a l i n g process. T h e above research suggests that i n d i v i d u a l s o f different cultures a n d different genders m a y have different needs a n d different experiences throughout their h e a l i n g f r o m substance a d d i c t i o n . I w a s able to i n c l u d e i n m y study i n d i v i d u a l s o f different ethnicities a n d genders a n d I t r i e d to g a i n insights into the experiences o f these i n d i v i d u a l s i n c l u d i n g interactions based o n these factors.  39  S u m m a r y and S y n t h e s i s F r o m a r e v i e w o f the literature addressing the r o l e o f professionals, s o c i a l support and ethnic and gender issues i n the area o f a d d i c t i o n , it is apparent that a gap exists i n o u r understanding o f the experience o f i n d i v i d u a l s w i t h addictions i n terms o f their experiences and perceptions o f their interactions w i t h others i n their process o f h e a l i n g . It w o u l d be b e n e f i c i a l to g a i n insights into these interactions i n order to be f a c i l i t a t i v e i n the h e a l i n g process o f i n d i v i d u a l s w i t h a d d i c t i o n issues. T h e s o c i a l support literature ( A m e s & R o i t z s c h , 2 0 0 0 ; D o b k i n et a l . , 2 0 0 2 ; R e i d et a l . , 2 0 0 1 ) suggests the p o s s i b i l i t y o f s o c i a l relationships b e i n g e x p e r i e n c e d as b e n e f i c i a l b y i n d i v i d u a l s w i t h a d d i c t i o n issues i n their h e a l i n g process. H o w e v e r , i f i n d e e d a r e l a t i o n s h i p does exist between an extensive s o c i a l support n e t w o r k and f a c i l i t a t e d h e a l i n g , the nature o f the interactions between the r e c o v e r i n g i n d i v i d u a l and their supports r e m a i n s to be e x p l o r e d . T h e literature suggests that the t r a i n i n g o f professionals i n substance a d d i c t i o n issues m a y be h e l p f u l i n addressing the negative attitudes that m a y e x i s t a m o n g professionals. W h a t remains uncertain is whether these m o r e p o s i t i v e attitudes are translated to the c l i e n t and, m o r e o v e r , whether interactions w i t h professionals are a m o n g the p e r c e i v e d s i g n i f i c a n t interactions o f clients o n their r o a d to a healthy lifestyle. It was m y hope that through a p h e n o m e n o l o g i c a l study o f i n d i v i d u a l s w i t h a d d i c t i o n issues that I w o u l d be able to contribute to the literature b y e x p l o r i n g the interactions w i t h others that were e x p e r i e n c e d b y participants as f a c i l i t a t i v e or i m p e d i n g i n their h e a l i n g path a w a y f r o m an a d d i c t i v e lifestyle.  40  CHAPTER THREE Methodology M e t h o d Selection In spite o f m u c h literature i n the area o f a d d i c t i o n , researchers are s t i l l s t r u g g l i n g to understand the r o a d out o f the l i f e s t y l e c h a r a c t e r i z e d b y a d d i c t i o n . Studies have investigated the r o l e o f a d d i c t i o n p r o f e s s i o n a l s ' attitudes t o w a r d clients and the i n f l u e n c e o f a b r o a d s o c i a l n e t w o r k on c l i e n t r e c o v e r y . H o w e v e r , v e r y l i m i t e d research exists that e x a m i n e s f a c i l i t a t i v e or i m p e d i n g interactions w i t h others i n the l i v e s o f i n d i v i d u a l s w h o have m o v e d f r o m substance a d d i c t i o n to health. It seemed fitting at this t i m e to address the gap that exists i n this area o f research. I f w e c a n learn about the p e r c e i v e d f a c i l i t a t i v e a n d h i n d e r i n g interactions i n d i v i d u a l s have w i t h others throughout their h e a l i n g process, w e c a n p r o v i d e important i n f o r m a t i o n f o r c o u n s e l l o r s and other professionals w h o are i n t e n d e d to p l a y a h e l p i n g r o l e i n the h e a l i n g j o u r n e y o f i n d i v i d u a l s w i t h a d d i c t i o n issues. B a s e d u p o n a r e v i e w o f the relevant literature, the f o l l o w i n g question was generated:  How do individuals who have moved from substance addiction to health, experience interactions with others in terms of facilitating or impeding their healing journey? T h e purpose o f this study was to e x a m i n e h o w i n d i v i d u a l s w h o have m o v e d f r o m substance a d d i c t i o n to health e x p e r i e n c e d their interactions w i t h others i n terms o f f a c i l i t a t i n g or i m p e d i n g their h e a l i n g j o u r n e y . T h i s study was e x p l o r a t o r y i n nature because v e r y little is k n o w n about the l i v e d experience o f this p h e n o m e n o n . E x p l o r a t o r y research is undertaken i n order to p r o v i d e a better understanding or i l l u m i n a t i o n o f a process or a p r o b l e m (Hart, 1998). Q u a l i t a t i v e i n v e s t i g a t i o n is most appropriate for this  41  study because the purpose o f qualitative research is "to identify the characteristics o f p h e n o m e n a " ( B e c k , 1993, p. 263). T h e qualitative m e t h o d that was c h o s e n to investigate this p h e n o m e n o n was p h e n o m e n o l o g y . T h e nature o f p h e n o m e n o l o g y is d e s c r i p t i v e rather than e x p e r i m e n t a l . T h e purpose is to describe and understand experience instead o f predict and c o n t r o l b e h a v i o u r . T h e " a i m o f the research is to a c h i e v e p e r s p e c t i v a l understanding o f a p h e n o m e n o n and identify its structure" ( O s b o r n e , 1990, p. 82). G e n e r a l l y this understanding is sought t h r o u g h i n t e r v i e w s w i t h i n d i v i d u a l s w h o have e x p e r i e n c e d the p h e n o m e n o n i n question i n order to g a i n a d e t a i l e d d e s c r i p t i o n o f the l i v e d e x p e r i e n c e o f the p h e n o m e n o n ( C o l a i z z i , 1978). T h e d e s c r i p t i o n is then a n a l y z e d for themes that f o r m the structure o f the p h e n o m e n o n w h i l e attempting to accurately represent the l i v e d experience o f the participants. In-depth, p h e n o m e n o l o g i c a l i n t e r v i e w s were u s e d i n this study to capture the c o m m o n themes i n the experiences o f the participants. P h e n o m e n o l o g i c a l i n q u i r y assumes that m e a n i n g is d e r i v e d f r o m the c o m m o n a l i t y o f shared e x p e r i e n c e (Patton, 1990). R o l e o f the R e s e a r c h e r In q u a l i t a t i v e research the researcher's process, p r e s u p p o s i t i o n s and p o s s i b l e influence o n the research project are m a d e e x p l i c i t so the researcher's biases and assumptions can be d i s t i l l e d f r o m the data.  Q u a l i t a t i v e research does not assume that the  researcher is u n b i a s e d ( C o l a i z z i , 1978) as i n quantitative research, w h e r e it is a s s u m e d that the researcher is objective or has n o i n f l u e n c e o n the research process. T h e presuppositions a n d biases o f the researcher are articulated p r i o r to a n d d u r i n g the  . 42  qualitative research process so the reader c a n take this perspective into account w h e n r e a d i n g the research report. D e s c r i b i n g the researcher's p r e s u p p o s i t i o n s helps the reader determine whether the researcher has been true to the data or whether the assumptions o f the researcher have affected the results o f the study ( O s b o r n e , 1990). H o w I c a m e to this research question and what I e x p e c t e d to f i n d w i l l be o u t l i n e d i n the f o l l o w i n g paragraphs. M y o r i g i n a l interest i n the area o f a d d i c t i o n is d e r i v e d f r o m the h i s t o r y o f a l c o h o l i s m i n m y f a m i l y . L i v i n g around i n d i v i d u a l s w h o have a d d i c t i o n s has m a d e m e c u r i o u s about the p h e n o m e n o n o f substance abuse a n d the process o f o v e r c o m i n g this affliction. I feel that m y personal experience i n this area has h e l p e d m e to understand m y clients i n c o u n s e l l i n g situations and I feel this was b e n e f i c i a l i n the research process as well. A f t e r c o u n s e l l i n g i n d i v i d u a l s w h o have substance abuse issues, m y c o m p a s s i o n for those w h o suffer w i t h a d d i c t i o n s grew. M y b e l i e f is that the p l i g h t o f p e o p l e w h o suffer f r o m a d d i c t i o n is w o r s e n e d b y s o c i e t y ' s and certain i n d i v i d u a l s ' attitudes.  I  suspected that these attitudes w o u l d be c o m m u n i c a t e d i n their interactions w i t h a d d i c t e d i n d i v i d u a l s . A s p e c t s o f interactions that I thought m i g h t be e x p e r i e n c e d b y participants as negative i n c l u d e d i m p a t i e n c e on the part o f others, d i s m i s s i v e n e s s , unrealistic expectations, and e x p e c t i n g that a d d i c t i v e b e h a v i o u r s c o u l d change w i t h o u t addressing an i n d i v i d u a l ' s entire lifestyle. I f an i n d i v i d u a l w i t h a d d i c t i o n issues was treated as a c r i m i n a l rather than an i n d i v i d u a l w i t h a health p r o b l e m I b e l i e v e d this m i g h t also be construed b y i n d i v i d u a l s as h i n d e r i n g i n their r e c o v e r y . I also thought that i m p a r t i n g the  43  b e l i e f " o n c e an addict, a l w a y s an a d d i c t " to an i n d i v i d u a l i n the r e c o v e r y process m i g h t also be p e r c e i v e d as l i m i t i n g b y these i n d i v i d u a l s w h o are t r y i n g to change their l i f e s t y l e . I a s s u m e d that i n d i v i d u a l s w h o were m o v i n g t o w a r d a healthier lifestyle w o u l d be a i d e d i f they have m o r e p e o p l e a r o u n d them: f a m i l y , friends or professionals, w h o h a d p o s i t i v e attitudes about the i n d i v i d u a l ' s struggles to o v e r c o m e their a d d i c t i o n , and therefore m o r e f a c i l i t a t i v e interactions w i t h these i n d i v i d u a l s . I i m a g i n e d that s o m e o f the attitudes a n d b e h a v i o u r s that m i g h t be p e r c e i v e d b y participants as f a c i l i t a t i v e w o u l d i n c l u d e patience, encouragement, c o n v e y i n g o p t i m i s m about the i n d i v i d u a l ' s progress a n d potential, acceptance and respect. In a p r o f e s s i o n a l r e l a t i o n s h i p , I i m a g i n e d that w o r k i n g c o l l a b o r a t i v e l y w i t h clients, treating each person as a u n i q u e i n d i v i d u a l rather than as "an a d d i c t , " b e i n g patient and a c c e p t i n g o f the c y c l i c a l nature o f change i n v o l v i n g relapse as part o f the process, e m p a t h i z i n g w i t h the d i f f i c u l t y o f q u i t t i n g or c u t t i n g d o w n , e n c o u r a g i n g persistence i n r e i n v e n t i n g c l i e n t s ' l i v e s , a n d w o r k i n g t o w a r d r e d u c i n g h a r m to the i n d i v i d u a l and p r o m o t i n g healthful b e h a v i o u r s c o u l d be p e r c e i v e d b y participants to be f a c i l i t a t i v e i n their h e a l i n g j o u r n e y . M y reasons for c h o o s i n g m y s p e c i f i c q u e s t i o n e m e r g e d f r o m m y a d d i c t i o n c o u n s e l l i n g b a c k g r o u n d . H i s t o r i c a l l y ( B o y d , 1 9 9 1 ; G r a y , 1998) i n d i v i d u a l s w i t h addictions have been treated as outcasts rather than as i n d i v i d u a l s w h o need h e l p . T h e h a r m r e d u c t i o n m o d e l ( D e n n i n g , 2000) is t r y i n g to change this practice b y treating i n d i v i d u a l s w i t h addictions w i t h respect, and b y e n c o u r a g i n g health p r o m o t i o n and h a r m r e d u c t i o n as the goals o f treatment rather than abstinence. I n - k e e p i n g w i t h this m o d e l o f a p p r o a c h i n g i n d i v i d u a l s w i t h addictions w i t h respect, I chose a qualitative thesis question that a l l o w s the data to c o m e f r o m the experts: those i n d i v i d u a l s w i t h substance a d d i c t i o n  44  histories w h o have h e a l e d f r o m their a d d i c t i o n and w h o are n o w l e a d i n g healthy l i v e s . I w o u l d l i k e to a d d to the literature that exists that treats i n d i v i d u a l s w i t h a d d i c t i o n s as w o r t h w h i l e , c o n t r i b u t i n g p e o p l e w h o have expertise to offer the a c a d e m i c , research a n d professional communities. I was aware that m y b e l i e f that those w h o suffer f r o m a d d i c t i o n are m a r g i n a l i z e d i n society m i g h t have l e d to biases w h e n I was a n a l y z i n g data; whether I was l o o k i n g for c o n f i r m a t o r y e v i d e n c e or t r y i n g to counter m y p r e c o n c e i v e d n o t i o n s . T o address m y assumptions, I e n g a g e d i n a process o f " r i g o r o u s s e l f - r e f l e c t i o n " ( O s b o r n e , 1990, p. 81) throughout the d u r a t i o n o f the research that was d o c u m e n t e d i n a j o u r n a l . I was also prepared to c o n s u l t w i t h m y s u p e r v i s o r w h e n necessary to address any o f m y assumptions and the i n f l u e n c e they m a y have p l a y e d i n data analysis and interpretation. A s a h e l p i n g p r o f e s s i o n a l I h o p e d to f i n d throughout the data c o l l e c t i o n i n t e r v i e w s that c o u n s e l l o r s a n d others i n h e l p i n g roles p l a y e d a s i g n i f i c a n t part i n f a c i l i t a t i n g h e a l i n g f r o m a d d i c t i o n . I was prepared, h o w e v e r , for the p o s s i b i l i t y that this w o u l d not be the case. I h o p e d to be open e n o u g h i n m y t h i n k i n g to a l l o w for responses a n d o p i n i o n s that differed f r o m m y expectations and to be able to reflect the participants' experiences accurately i n the data analysis. S e l e c t i o n o f Participants A l t h o u g h there are n o strict g u i d e l i n e s for the n u m b e r o f r e q u i r e d participants i n a p h e n o m e n o l o g i c a l study, O s b o r n e (1990) and K v a l e (1996) suggest that sufficient participants are needed to i l l u m i n a t e the p h e n o m e n o n o f interest. T o e x p l o r e the p h e n o m e n o n i n this study the sample was c o m p r i s e d o f the first 6 i n d i v i d u a l s w h o met the research criteria. O n l y 6 participants were chosen because at this p o i n t the themes  45 appeared to be saturated. Participants appropriate for this study h a d not been a b u s i n g substances for at least the last s i x months but h a d e x p e r i e n c e d their substance a d d i c t i o n w i t h i n the past f i v e years. S i x months w i t h o u t relapse is the t i m e r e q u i r e d for an i n d i v i d u a l to be c o n s i d e r e d to be i n the " m a i n t e n a n c e " stage o f change w i t h respect to their a d d i c t i o n ( D e n n i n g , 2 0 0 0 ; P r o c h a s k a , D i C l e m e n t e , & N o r c r o s s , 1992). R e l a p s e o c c u r s w h e n i n d i v i d u a l s revert to an earlier stage o f change ( P r o c h a s k a , D i C l e m e n t e & N o r c r o s s ) , c h a r a c t e r i z e d b y a d d i c t i v e b e h a v i o u r s . S i x months w i t h o u t relapse h o p e f u l l y gave participants e n o u g h t i m e to reflect o n their experiences i n order to g i v e a retrospective account. H o w e v e r , i n order to i l l u m i n a t e the p h e n o m e n o n w i t h reasonable accuracy, participants were r e q u i r e d to have e x p e r i e n c e d their substance abuse w i t h i n the last f i v e years. E l i g i b l e i n d i v i d u a l s for this study h a d adequate f a m i l i a r i t y w i t h the p h e n o m e n o n i n question i n order to g i v e a r i c h d e s c r i p t i o n o f their e x p e r i e n c e i n an i n depth i n t e r v i e w . F a m i l i a r i t y w i t h substance a d d i c t i o n refers to the p r o b l e m a t i c substance use participants e x p e r i e n c e d w i t h i n the last f i v e years. F o r the purposes o f this study, the s a m p l e was restricted to adult participants. D e v e l o p m e n t a l literature ( B e r k , 1996; C a r l s o n & L e w i s , 1998) suggests that adolescents differ c o g n i t i v e l y , e m o t i o n a l l y and s o c i a l l y f r o m adults and therefore adolescents were not i n c l u d e d i n the s a m p l e for this study. I n d i v i d u a l s interested i n p a r t i c i p a t i n g i n the study also agreed to an audio-taped i n t e r v i e w , a t i m e c o m m i t m e n t o f t w o to three hours, and agreed to discuss their experience o f interactions that they p e r c e i v e d to facilitate and i m p e d e their h e a l i n g f r o m a d d i c t i o n . Participants d i d not have any i m p a i r m e n t that rendered t h e m unable to g i v e i n f o r m e d consent or r e s p o n d c o h e r e n t l y i n the i n t e r v i e w .  46  A d d i t i o n a l l y , participants were able to c o m m u n i c a t e e f f e c t i v e l y i n E n g l i s h for the interviews. T h e a v a i l a b l e literature suggests that interactions m a y be shaped b y an i n d i v i d u a l ' s e t h n i c i t y or gender ( B i e r n a c k i , 1986; D e n n i n g , 2 0 0 0 ; N e l s o n - Z l u p k o , K a u f m a n , & D o r e , 1995; Prendergast, H s e r , & G i l - R i v a s , 1998). W i t h this i n m i n d , I tried to i n c l u d e i n m y sample i n d i v i d u a l s o f different e t h n i c i t y as w e l l as w o m e n and m e n , i n an attempt to capture any differences i n experiences based o n these factors. I n c l u d e d i n the participants were one m a n w i t h S o u t h A s i a n a n d S w e d i s h heritage, a n d one w o m a n w h o was A f r i c a n C a n a d i a n . R e c r u i t m e n t o f Participants Participants were recruited u s i n g posters p l a c e d i n v a r i o u s l o c a t i o n s a r o u n d the c i t y o f V a n c o u v e r i n c l u d i n g the A l a n o C l u b , A V a l o n W o m e n ' s C e n t r e , D a y t o x at V a n c o u v e r D e t o x , D u n b a r C o m m u n i t y Centre, F a m i l y S e r v i c e s o f G r e a t e r V a n c o u v e r : V a n c o u v e r E a s t O f f i c e , H e y - W a y - N o q u , P a c i f i c S p i r i t C o m m u n i t y H e a l t h Centre, R a v e n S o n g C o m m u n i t y H e a l t h Centre, St. M a r y ' s K e r r i s d a l e : A n g l i c a n C h u r c h , T u r n i n g P o i n t R e c o v e r y H o u s e , U B C C o u n s e l l i n g P s y c h o l o g y D e p a r t m e n t , and V a n c o u v e r R e c o v e r y C l u b (see A p p e n d i x A ) . I c o n d u c t e d i n i t i a l telephone i n t e r v i e w s to g i v e participants an o v e r v i e w o f the s t u d y ' s nature a n d purpose and establish participant s u i t a b i l i t y for the study ( O s b o r n e , 1990). O n c e s u i t a b i l i t y and w i l l i n g n e s s were established, an appointment was set up to meet for the data c o l l e c t i o n i n t e r v i e w .  47  Data Collection W h e n I met w i t h each participant for the data c o l l e c t i o n i n t e r v i e w , I i n t r o d u c e d m y s e l f a n d endeavoured, through c a s u a l c o n v e r s a t i o n , to establish rapport. R a p p o r t is important i n e n c o u r a g i n g accurate descriptions f r o m participants o f their e x p e r i e n c e ( O s b o r n e , 1990). I n f o r m e d consent was d i s c u s s e d next. T h i s d i s c u s s i o n i n c l u d e d the purpose o f the study, the use o f a tape recorder to r e c o r d the i n t e r v i e w s , and addressed any questions the participant had about the study. A n i n f o r m e d consent f o r m was c o m p l e t e d o u t l i n i n g the purpose o f the study, requirements o f participants, issues o f c o n f i d e n t i a l i t y , f r e e d o m o f participants to w i t h d r a w f r o m the study at any point, and storage o f data (see A p p e n d i x B ) . T h e participant a n d I both s i g n e d the consent f o r m and a c o p y was g i v e n to the participant. O n c e the consent f o r m was c o m p l e t e d , I read the participant an o r i e n t i n g statement to g i v e the participant a context for the i n t e r v i e w ( K v a l e , 1996)(see A p p e n d i x C ) . T h e o r i e n t i n g statement p r o v i d e d a consistent i n t r o d u c t i o n to the i n t e r v i e w for each participant. T h e d u r a t i o n o f each data c o l l e c t i o n i n t e r v i e w was between IV2 hours and 3 hours. A n unstructured, open-ended style o f i n t e r v i e w i n g was used i n order to g a i n insights i n t o h o w participants e x p e r i e n c e d the p h e n o m e n o n o f their interactions w i t h others that they felt facilitated or i m p e d e d their h e a l i n g j o u r n e y f r o m substance a d d i c t i o n to health. I n depth i n t e r v i e w s are appropriate for this study because the i n t e r v i e w process enables the researcher to u n c o v e r participants' v i e w s through their eyes a n d f r o m their u n i q u e perspectives ( M a r s h a l l & R o s s m a n , 1999). T h e p r i m a r y i n t e r v i e w question was " W o u l d y o u please t e l l m e about y o u r experiences o f f a c i l i t a t i v e or i m p e d i n g interactions that y o u felt were s i g n i f i c a n t to y o u r process o f h e a l i n g f r o m a d d i c t i o n ? " I used paraphrasing a n d  48  reflection to h e l p p r o m p t the participant. F o l l o w - u p and c l a r i f y i n g questions were also a s k e d about the p a r t i c u l a r nature o f the interactions i n order to gather a r i c h d e s c r i p t i o n o f the p h e n o m e n o n ( O s b o r n e , 1990; K v a l e , 1996). S o m e e x a m p l e s o f these f o l l o w - u p questions i n c l u d e : " c a n y o u tell m e m o r e about what y o u were f e e l i n g or what went t h r o u g h y o u r m i n d w h e n that happened?", " h o w d i d the i n t e r a c t i o n affect y o u ? " , " w o u l d y o u l i k e to say any m o r e about that?". I r e s p o n d e d to statements u s i n g the techniques m e n t i o n e d above, as w e l l as u s i n g the c o u n s e l l i n g s k i l l s o f active l i s t e n i n g and e m p a t h y i n order to facilitate a m o r e in-depth e x p l o r a t i o n o f each p a r t i c i p a n t ' s experiences. Q u e s t i o n s i n the i n t e r v i e w schedule ( A p p e n d i x D ) were a v a i l a b l e for m e i n order to m o v e the process a l o n g , d r a w out e x p l i c a t i o n s f r o m participants, help to facilitate a w e l l - r o u n d e d d e s c r i p t i o n o f each p a r t i c i p a n t ' s experience, and to h e l p focus the i n t e r v i e w s . A l t h o u g h it was not anticipated that this research process w o u l d cause any undue stress o n the participants, a list o f c o u n s e l l o r s ' names were a v a i l a b l e i f the participant felt they w o u l d l i k e to f o l l o w - u p . T h e i n t e r v i e w s were tape-recorded i n order to transcribe the data for analysis. I c o l l e c t e d and a n a l y z e d a l l data i n the study. F o l l o w i n g each i n t e r v i e w I wrote d o w n d e t a i l e d notes about the i n t e r v i e w , i n c l u d i n g i n f o r m a t i o n about the p a r t i c i p a n t ' s v e r b a l and n o n - v e r b a l b e h a v i o u r , the i n t e r v i e w content, and m y i m p r e s s i o n s o f the i n t e r v i e w proceedings i n c l u d i n g any personal feelings that arose for m e i n the i n t e r v i e w . T h i s i n f o r m a t i o n h e l p e d i n c o n t e x t u a l i z i n g the analysis o f the i n t e r v i e w s . O n c e the data were a n a l y z e d , I c o n d u c t e d v a l i d a t i o n i n t e r v i e w s w i t h 4 o f the 6 participants. T h e s u m m a r y data analysis and their o w n b i o g r a p h i c a l i n f o r m a t i o n were  49  presented to each participant for t h e m to e x a m i n e p r i o r to o u r s e c o n d i n t e r v i e w i n order to c o n f i r m that the i n f o r m a t i o n and analysis w e r e consistent w i t h their experience. D u r i n g a f o l l o w - u p i n t e r v i e w , participants were a s k e d for their feedback about the data analysis a n d to relate h o w w e l l the themes reflected their experience. T h e i n t e r v i e w s lasted an average o f one hour. Participants were able to offer any a d d i t i o n a l insights d u r i n g the v a l i d a t i o n i n t e r v i e w based o n the themes that e m e r g e d t h r o u g h data analysis. A n y feedback or c o m m e n t s were taken into c o n s i d e r a t i o n i n the f i n a l analysis. Participants were p l e a s e d w i t h the results and felt accurately represented.  Interviewees  felt they c o u l d relate to most o f the f i n d i n g s , whether f r o m their o w n experiences, or the experiences o f others they k n e w w h o h a d a h i s t o r y o f a d d i c t i o n . Data Analysis F o l l o w i n g m y first i n t e r v i e w m y s u p e r v i s o r c h e c k e d m y i n t e r v i e w procedure to ensure that I d i d not inadvertently i n f l u e n c e the i n t e r v i e w process. A t that t i m e she also gave feedback and suggestions about m y i n t e r v i e w style p r i o r to subsequent i n t e r v i e w s . I then c o m p l e t e d the r e m a i n i n g data c o l l e c t i o n i n t e r v i e w s . O n c e the data c o l l e c t i o n i n t e r v i e w s were f i n i s h e d and transcribed v e r b a t i m f r o m the audio-tapes, the data were a n a l y z e d for c o m m o n themes a c c o r d i n g to C o l a i z z i ' s (1978) m e t h o d o f data analysis. T h e transcript t o o k into c o n s i d e r a t i o n v e r b a l and n o n v e r b a l b e h a v i o u r w h e r e v e r p o s s i b l e (i.e., pauses, c r y i n g , laughter, tone o f v o i c e ) . T h e f i e l d notes I kept, d e t a i l i n g m y experience o f the i n t e r v i e w , c o m p l e m e n t e d the transcript i n f o r m a t i o n . F i r s t I read o v e r the transcripts to "get a feel for the data" ( O s b o r n e , 1990, p. 85). I then read and re-read the transcriptions i n order to b e c o m e intimate w i t h the data and seek out further insights ( S m i t h , J a r m a n , & O s b o r n , 1999). S i g n i f i c a n t  50  sentences and paraphrases that pertained to the p h e n o m e n o n b e i n g e x a m i n e d were extracted f r o m each p a r t i c i p a n t ' s transcript. T h e resultant paraphrases were then e x a m i n e d w i t h the a i m o f f o r m u l a t i n g the m e a n i n g o f the o r i g i n a l statement. T h i s process is not interpretation o f the p a r t i c i p a n t ' s intention so m u c h as the i l l u m i n a t i o n o f the m e a n i n g or experience o f the participant ( C o l a i z z i ) . I l l u m i n a t i o n o f m e a n i n g was f o c u s e d on e x t r a c t i n g the "deep structures w h i c h characterize the p h e n o m e n o n " ( O s b o r n e , 1990, p. 85) rather than s i m p l y p e r f o r m i n g a literal content analysis o f the data. T h i s process differs f r o m interpretation w h i c h l o o k s for m e a n i n g based o n a p r e c o n c e i v e d theory whereas i l l u m i n a t i o n seeks m e a n i n g d i r e c t l y f r o m the data ( O s b o r n e ) . S i m i l a r f o r m u l a t e d m e a n i n g statements were c l u s t e r e d into themes. T h e themes that e m e r g e d were then c l u s t e r e d a n d the clusters were g r o u p e d i n t o higher-order themes. T h e clusters o f themes were referred b a c k to the o r i g i n a l transcripts for v a l i d a t i o n . T h e purpose o f this referral was to ensure the themes accurately reflected the o r i g i n a l p r o t o c o l s . T h e r e s u l t i n g themes c o m p r i s e d the structure o f the p h e n o m e n o n . C l u s t e r i n g o f themes was c o n d u c t e d for each participant as w e l l as across participants to determine a shared thematic structure. I n t e r v i e w i n g a n d data analysis c o n t i n u e d u n t i l n o n e w i n f o r m a t i o n or themes e m e r g e d f r o m the data. Trustworthiness T h e rigor o f the f i n d i n g s i n a qualitative w o r k is an i n d i c a t i o n o f whether the results can be trusted - whether the p h e n o m e n o n exists and whether I have m e a s u r e d what I have s a i d I w o u l d measure ( M a r s h a l l & R o s s m a n , 1999). T h e k e y i n t r y i n g to ensure the r e l i a b i l i t y a n d v a l i d i t y o f qualitative research is not to detract f r o m its c o n t r i b u t i o n b y d o i n g so. W h a t makes qualitative research so rich is the a b i l i t y to  51  e x a m i n e i n great depth a n d detail the experience o f i n d i v i d u a l s a n d through this e x p l o r a t i o n c o m e to some agreement o n the structure o f the e x p e r i e n c e . T h a t the same results m a y not be a c h i e v e d b y another researcher o r w i t h different participants does not n e c e s s a r i l y render the w o r k i n v a l i d ( S a n d e l o w s k i , 1993). D i f f e r e n t results s i m p l y serve to deepen o u r understanding o f the breadth o f the p h e n o m e n o n . H o w e v e r , it remains necessary to establish c r i t e r i a f o r e v a l u a t i n g the w o r t h o f qualitative research. B e c k (1993) addresses the n e e d for e v a l u a t i n g q u a l i t a t i v e research o n its o w n terms rather than t r y i n g to fit quantitative terms a n d ideas a r o u n d q u a l i t a t i v e m e t h o d o l o g i e s . F o r the purposes o f p h e n o m e n o l o g i c a l i n q u i r y , r e l i a b i l i t y , t e r m e d a u d i t a b i l i t y ( B e c k , 1993), is m e a s u r e d b y c o n s i s t e n c y ( B e c k ) o r d e p e n d a b i l i t y ( M a r s h a l l & R o s s m a n , 1999). A s w i t h r e l i a b i l i t y , the purpose o f a u d i t a b i l i t y is to ensure that the results c a n be repeated b y another researcher. In order to ensure a u d i t a b i l i t y i n this study I audio-taped a l l i n t e r v i e w s a n d kept detailed f i e l d notes about the i n t e r v i e w s i n c l u d i n g c o n t e x t u a l details about the i n t e r v i e w situation. I also d e t a i l e d m y process o f d e c i s i o n m a k i n g i n d e t e r m i n i n g m y thematic analysis. M a k i n g m y "audit t r a i l " ( B e c k ) e x p l i c i t i n these w a y s w i l l h e l p the reader a n d other researchers f o l l o w the path I t o o k i n o b t a i n i n g m y results. T h e c o r r e s p o n d i n g qualitative measure o f internal v a l i d i t y is c r e d i b i l i t y w h i c h is a measure o f the "truth v a l u e " ( B e c k , 1993) o f the results o f a study. T h i s is " h o w v i v i d and faithful the d e s c r i p t i o n o f the p h e n o m e n o n i s " ( B e c k , p . 2 6 4 ) . T h e w a y s that c r e d i b i l i t y w e r e addressed i n this study w e r e b y i n c l u d i n g i n m y f i e l d notes i n f o r m a t i o n about m y relationships w i t h the participants a n d m y personal feelings a n d reactions throughout the research process, c o n s i d e r i n g a n d a c c o u n t i n g for the i n f l u e n c e o f m y  52  presence o n the data c o l l e c t e d , r e m a i n i n g open to the p o s s i b i l i t y o f negative or c o n f l i c t i n g themes ( C o l a i z z i , 1978) i n the data a n a l y s i s , a n d h a v i n g m y s u p e r v i s o r r e v i e w m y first i n t e r v i e w to substantiate that I was not l e a d i n g the participants i n the i n t e r v i e w situation. I t r i e d to u n c o v e r m e a n i n g s f r o m the data, g i v e n the context o f the participants' c o m m e n t s . T h i s h o p e f u l l y l e d to a m o r e accurate r e f l e c t i o n o f the participants' intentions. I also c o n d u c t e d v a l i d a t i o n i n t e r v i e w s w i t h the participants to ensure that the emergent themes accurately represented their experience ( C o l a i z z i , 1978; O s b o r n e , 1990). E x t e r n a l v a l i d i t y or g e n e r a l i z a b i l i t y is d e s c r i b e d i n q u a l i t a t i v e research b y the t e r m fittingness. F i t t i n g n e s s measures the a p p l i c a b i l i t y ( B e c k , 1993) o r transferability ( M a r s h a l l & R o s s m a n , 1999) o f the f i n d i n g s . T h e issue o f fittingness was addressed i n this study b y s a m p l i n g f r o m a range o f participants w h e r e p o s s i b l e and b y t r y i n g to be true to the o r i g i n a l data b y d e t a i l i n g differences as w e l l as c o m m o n themes. In a d d i t i o n I c o n f i r m e d the results w i t h t w o i n d i v i d u a l s w h o h a d substance a d d i c t i o n histories but w h o d i d not participate i n the study. T h e s e independent i n d i v i d u a l s were able to verify that the themes were a v a l i d and accurate reflection o f their experiences o f the p h e n o m e n o n o f f a c i l i t a t i n g a n d i m p e d i n g interactions w i t h others throughout their h e a l i n g j o u r n e y f r o m substance a d d i c t i o n . O n e i n d i v i d u a l d i d suggest, h o w e v e r , that I i n c l u d e i n m y paper a d e f i n i t i o n o f the t e r m h e a l i n g j o u r n e y . H e was u n c l e a r o n m y m e a n i n g because I d e s c r i b e d i n m y themes both times o f substance abuse or relapse a n d times w h e n i n d i v i d u a l s were not a b u s i n g substances.  O n e f e e l i n g I d i s c u s s e d i n the r o l e o f the  researcher section that I perhaps d i d not m a k e e x p l i c i t is m y b e l i e f that the h e a l i n g j o u r n e y i n v o l v e s both p r o g r e s s i o n and regression. T h a t is to say, relapse is a part o f  53  h e a l i n g . R e l a p s e m a y be a setback, but c o n t e m p l a t i n g change and the c o n t i n u e d efforts to m o v e a w a y f r o m an a d d i c t i v e l i f e s t y l e constitute a h e a l i n g j o u r n e y i n m y eyes. W h e n I d e s c r i b e d it as s u c h , the i n t e r v i e w e e s a i d he felt it was important to state this orientation because t h i n k i n g o f these s t u m b l i n g b l o c k s as m e r e l y a necessary part o f a h e a l i n g j o u r n e y is a helpful orientation for i n d i v i d u a l s s t r u g g l i n g to o v e r c o m e a d d i c t i o n . T h e quantitative i d e a l o f o b j e c t i v i t y is r e p l a c e d i n q u a l i t a t i v e research w i t h the concept o f c o n f i r m a b i l i t y ( B e c k , 1993). U n l i k e quantitative research, the qualitative approaches d o not deny the existence o f researcher i n f l u e n c e but try to e x p o s e this i n f l u e n c e i n order to tease it apart f r o m the experience o f the participants. ( C o l a i z z i , 1978). N e u t r a l i t y o f the researcher i n qualitative research is m o r e c o n c e r n e d w i t h b e i n g true to, or accurately r e f l e c t i n g the p h e n o m e n o n ( C o l a i z z i ) , than t r y i n g to r e m o v e the researcher i n f l u e n c e f r o m the equation. T h e i n f l u e n c e o f the researcher is what a l l o w s for rich, i n - d e p t h data c o l l e c t i o n . N e u t r a l i t y is a c h i e v e d b y s t a y i n g true to the data and not i m p o s i n g presuppositions and biases on the data analysis. In order to e x p o s e the potential for researcher i n f l u e n c e several steps were taken. T o b e g i n w i t h , m y r o l e as the researcher was d o c u m e n t e d . T h i s process gave m e an awareness o f the assumptions and biases I h a d that c o u l d i n f l u e n c e the research process. T h i s awareness a l l o w e d m e to set aside m y presuppositions i n order to u n c o v e r accurately the participants' experiences. T h e process o f r e f l e c t i o n and m a i n t a i n i n g o f f i e l d notes about the i n t e r v i e w s c o n t i n u e d throughout the research. T h e s e reflections were then s u m m a r i z e d i n the research report so the reader c o u l d determine whether the p h e n o m e n o n o f interest was accurately captured f r o m the participants' perspective. procedures m e n t i o n e d above h o p e f u l l y h e l p e d reduce the c o n t a m i n a t i o n o f data b y  The  54  researcher i n f l u e n c e . A d e t a i l e d d e s c r i p t i o n o f m y procedure a n d data analysis was i n c l u d e d i n the report to help the reader determine neutrality.  55  CHAPTER FOUR Results Introduction T h i s chapter i n c l u d e s b i o g r a p h i c a l sketches o f the s i x i n d i v i d u a l s w h o participated i n this study as w e l l as the d e s c r i p t i o n o f the f i v e themes that e m e r g e d f r o m analysis o f their in-depth i n t e r v i e w s . T h e b i o g r a p h i c a l s u m m a r i e s p r o v i d e d e m o g r a p h i c a n d d r u g and a l c o h o l i n f o r m a t i o n about the participants. T h e themes f o l l o w i n g these b i o synopses describe the participants' experiences o f interactions w i t h others that they feel have i n f l u e n c e d their h e a l i n g process f r o m a d d i c t i o n i n i m p e d i n g or f a c i l i t a t i v e w a y s . D e s c r i p t i o n s i n v o l v e interactions d u r i n g times o f active substance abuse d u r i n g relapse as w e l l times o f sobriety, g i v e n that h e a l i n g j o u r n e y s are not linear. T h e themes d e s c r i b e d w i l l be supported b y quotations f r o m the participants that seem to capture, most accurately, the e x p e r i e n c e o f participants. Participants T h e participants i n this study i n c l u d e d f i v e m e n and one w o m a n between the ages o f 35 and 55 w h o are to some degree c o n n e c t e d w i t h the A l c o h o l i c s A n o n y m o u s or N a r c o t i c s A n o n y m o u s p r o g r a m . T h r e e o f the m e n have been m a r r i e d a n d t w o o f the three are n o w d i v o r c e d and one is estranged f r o m his w i f e . T h e s e three m e n are also parents o f c h i l d r e n r a n g i n g i n age f r o m 7 to m i d - 3 0 ' s . T h e substance abuse histories o f the participants are v a r i e d , a l l but one i n v o l v i n g drugs as w e l l as a l c o h o l .  Robert R o b e r t is i n his late 4 0 ' s , C a u c a s i a n , has n e v e r been m a r r i e d a n d has n o c h i l d r e n . H e was f o r m e r l y a j o u r n a l i s t w h o c o n s i d e r e d h i m s e l f a c o m m u n i s t . H e n o w w o r k s i n  56  c o n s t r u c t i o n . H e is f r o m V a n c o u v e r and has l i v e d i n V a n c o u v e r and T o r o n t o throughout his life. H i s years o f substance abuse p r o b l e m s i n v o l v e d a l c o h o l , c r a c k c o c a i n e a n d to a m u c h lesser extent, marijuana. A t his l o w e s t p o i n t he m o v e d f r o m l i v i n g i n his single o c c u p a n c y r o o m i n the D o w n t o w n E a s t s i d e to l i v i n g i n the park. S i n c e g o i n g to detox i n A u g u s t , 2 0 0 3 , he has been through the support r e c o v e r y p r o g r a m at T o g e t h e r W e C a n a n d is n o w l i v i n g i n a transition house a n d is i n v o l v e d i n the N a r c o t i c s A n o n y m o u s P r o g r a m . A t the t i m e o f o u r i n t e r v i e w R o b e r t h a d been c l e a n and sober eight months.  Phillip P h i l l i p is 35 years o l d , and d i v o r c e d w i t h t w o c h i l d r e n , ages seven and eight. H i s father is S o u t h A s i a n a n d his mother S w e d i s h . O r i g i n a l l y f r o m V a n c o u v e r Island, P h i l l i p is n o w l i v i n g i n V a n c o u v e r . H e is a l o g g e r b y trade, although an accident i n w h i c h he b r o k e his b a c k has meant that he is on d i s a b i l i t y at the m o m e n t . In a d d i t i o n to l o g g i n g , P h i l l i p has also been i n v o l v e d i n d r u g d e a l i n g and has spent s o m e t i m e i n p r i s o n . H e has been through the T o g e t h e r W e C a n p r o g r a m and is l i v i n g i n a g r o u p h o m e . H e is i n v o l v e d w i t h A l c o h o l i c s A n o n y m o u s and h a d been abstaining f r o m h e r o i n and a l c o h o l use for seven m o n t h s at the t i m e o f o u r i n t e r v i e w . Stan Stan was b o r n a n d r a i s e d i n V a n c o u v e r . H e is 55 years o l d , C a u c a s i a n , and has a w i f e and three c h i l d r e n i n their 2 0 ' s and 3 0 ' s . H e was a successful b u s i n e s s m a n w h o hit his " b o t t o m " as a result o f c r a c k c o c a i n e use. P r i o r to his c o c a i n e use, he h a d been a b i n g e d r i n k e r and d a b b l e d i n drugs i n his late teens and twenties. H e is n o w w o r k i n g , l i v i n g i n an apartment o n his o w n after starting his j o u r n e y t o w a r d health i n a r e c o v e r y house. O u r i n t e r v i e w t o o k p l a c e w h e n Stan h a d been c l e a n for almost one year.  57  C u r r e n t l y S t a n ' s daughter is v e r y supportive o f the efforts Stan has made to address his a d d i c t i o n , h o w e v e r his w i f e and t w o b o y s do not want to associate w i t h h i m .  Mark F o r m e r l y a j o u r n a l i s t , M a r k makes his l i v i n g as an artist. H e was b o r n and r a i s e d i n V a n c o u v e r , is C a u c a s i a n , and has recently m o v e d b a c k to V a n c o u v e r f r o m W h i t e R o c k . M a r k is 4 1 , has never been m a r r i e d and has no c h i l d r e n . M a r k ' s p r i m a r y substance o f a d d i c t i o n has been a l c o h o l . H i s d r i n k i n g became a p r o b l e m for h i m as e a r l y as his teens. H e d i d not attend any residential treatment p r o g r a m as part o f his h e a l i n g process. A t the t i m e o f our i n t e r v i e w M a r k h a d been sober almost f i v e years and has been supported greatly i n his j o u r n e y b y A l c o h o l i c s A n o n y m o u s .  George O r i g i n a l l y f r o m M o n t r e a l , G e o r g e n o w l i v e s i n V a n c o u v e r . H e has been i n v a r i o u s management p o s i t i o n s i n the restaurant i n d u s t r y o v e r the years and has also been i n v o l v e d i n o r g a n i z e d c r i m e . H e has struggled w i t h c o c a i n e a n d a l c o h o l a d d i c t i o n o v e r the last 18 years. O u r i n t e r v i e w t o o k place w h e n G e o r g e h a d been c l e a n a n d sober for seven months. G e o r g e is d i v o r c e d w i t h t w o b o y s (ages 17 a n d 21) both o f w h o m are also i n r e c o v e r y . H e also has a daughter f r o m another r e l a t i o n s h i p w h o he sees r e g u l a r l y . H e is c u r r e n t l y w o r k i n g i n the a l c o h o l and d r u g r e c o v e r y f i e l d . G e o r g e is 47 years o l d and Caucasian.  Elise E l i s e i s a 3 9 year o l d A f r i c a n C a n a d i a n w h o i s o r i g i n a l l y f r o m M o n t r e a l . S h e is a s o c i a l w o r k e r b y p r o f e s s i o n . She has a l o n g - s t a n d i n g a d d i c t i o n to a l c o h o l . She has been d i a g n o s e d w i t h b i p o l a r disorder and also has m u l t i p l e sclerosis. S h e has not been m a r r i e d  58 and does not have any children. At the time of her interview she had been sober for seven months. She is currently on disability and living in a supportive living situation for individuals with substance addiction issues. Identified Themes Detailed phenomenological analysis of the in-depth interviews revealed seven themes common to all participants in the study. The themes are presented below in random order, not reflecting the importance of the theme in participants' experience: 1. A sense of isolation or loss 2. A sense of support or discouragement 3. A sense of understanding or misunderstanding 4. A sense of belonging or not belonging 5. A sense of meaning or meaninglessness 6. A sense of hope or hopelessness 7. A sense of shifting identities Aspects of the themes overlapped with each other. Certain themes were more significant to some participants than others. However all themes were reflected in each participant's experience. The themes that emerged seem to encompass the interactions participants felt were facilitative or impeding in their healing. A Sense of Isolation or Loss Each of the participants in this study described interactions influential to them in facilitative or impeding ways that involved either loss or isolation during the course of their healing process. The various losses described included deaths of people that they had been close to, loss of significant relationships, and loss of interactions around status,  59  power or money. Other losses included loss of control, and loss of self esteem or identity. Sometimes these losses left the individuals in this study feeling isolated, but isolation was also experienced as a result of participants separating themselves from others. Loss and isolation were experienced by interviewees as negative, positive or sometimes both, in terms of their healing journeys, depending on the individuals and situations involved. Three of the participants described the deaths of individuals that they felt motivated their choice to change their addictive lifestyle. Two of these interviewees indicated that the deaths of friends or acquaintances who were users provided a "wake up call" for them, their fear prompting them to realize that they could have been the ones who died. The deaths reinforced a feeling of "being sick and tired of being sick and tired" as well as feeling "all used up." They described the feelings of guilt and disappointment in themselves as a result of these deaths. One participant expressed his disappointment in his behaviour after his friend died: He dies and I uh -1 kept using drugs. Like right after the ambulance came and hauled his body away -1 just kept using drugs.. .it made me think... what am I doing? .. .What kind of a human am I? I didn't even care. Another interviewee reflected on how he felt "shocked, stunned, just going through the motions" in the face of the deaths of three people he "had been close to" and who were fellow users. His sense of despair was compounded by his frustration at his powerlessness and inaction to address the deaths of his friends. He said that the deaths of his friends "were bad deaths. This was not a good way to go. Too soon and wrong." One individual had been murdered, one drank himself to death and the other overdosed.  60  H o w e v e r , out o f his feelings o f powerlessness this participant reported that he b e c a m e angry, and his anger became a m o t i v a t o r . " W h y a m I a c c e p t i n g this? W h y ? H o w can I accept this? A n d I c o u l d n ' t , I c o u l d n ' t accept it, r i g h t ? .. . S o s o m e t h i n g c h a n g e d i n s i d e m e at that p o i n t . " H i s " p a s s i o n " and " d e s i r e " to stop d r i n k i n g and u s i n g drugs " l e d to his courage to change." H e said: T h i s is enough. I c a n ' t take this a n y m o r e . . . . I h a d to k i n d o f r u n out o f gas but m y heart h a d c h a n g e d . . . . S o m e h o w it was n o l o n g e r f u n . . . . I h a d to g r i n d m y s e l f d o w n . I h a d to r u n out o f g a s . . . . I got fed up. M y life got s m a l l e r and s m a l l e r and smaller. S o i n terms o f I guess that's e x p e r i e n c i n g interaction w i t h others. T h e y d i e d . I d i d n ' t . I w a n t e d to go o n . I felt a deep sense o f loss. W i t h respect to the i n f l u e n c e he p e r c e i v e d the deaths to have h a d o n his process o f h e a l i n g he said: T h e i r deaths facilitated, but w h i l e they were a l i v e they were an i m p e d i m e n t . . . . T h e y ' r e s t i l l i n m y heart. B u t m a y b e i f t h e y ' d l i v e d w e w o u l d n ' t have been friends b y n o w . W h o k n o w s . A n o t h e r type o f loss e x p e r i e n c e d b y a l l participants that appeared to i n f l u e n c e their h e a l i n g processes was loss o f intimate relationships. T h r e e participants d e s c r i b e d l o s i n g relationships w i t h spouses and three d e s c r i b e d the break-ups o f other r o m a n t i c relationships they felt were instrumental i n both p o s i t i v e and negative w a y s d u r i n g their healing journeys. O n e o f the participants felt " a b a n d o n e d " b y his w i f e w h e n he was " t h r o w n out o f the h o u s e " after she f o u n d out about his c r a c k c o c a i n e use.  61  I a l w a y s thought w e w o u l d be there for each other, through t h i c k and t h i n , n o matter what happened. B u t a n y w a y it d i d n ' t happen that w a y . I f o u n d m y s e l f alone, w i t h n o p l a c e to go, l i v e d i n a hotel, things that just created m o r e chaos, more addiction. S i m i l a r p a i n f u l feelings were e c h o e d b y another i n t e r v i e w e e after l o s i n g his w i f e w h e n he a d m i t t e d his i n f i d e l i t y . " L o s i n g her at that p o i n t i n m y life was just devastating. A n d I t h i n k there's a b i g part o f m e that s t i l l h a s n ' t gotten o v e r that." O n e participant t a l k e d about h o w he "just went c r a z y " w h e n his w i f e and k i d s left h i m because o f his i n v o l v e m e n t w i t h drugs. H e " d i d n ' t want to feel they were g o n e . " H e expressed his feelings o f l o n e l i n e s s and hurt b y b e c o m i n g angrier. " I was angry before m y w i f e left but it just got w o r s e . " " T h e o n l y w a y to escape those feelings was b y getting h i g h . " A n o t h e r p a r t i c i p a n t ' s fiancee left h i m w h e n he was s t i l l d r i n k i n g . H e was desperate to h o l d onto the r e l a t i o n s h i p and was afraid that l o s i n g her w o u l d devastate h i m . H e d e s c r i b e d h i s thoughts a n d feelings about w h y his r e l a t i o n s h i p w i t h his fiancee f a i l e d : .. . d e a l i n g w i t h m y p r o b l e m s is the most important t h i n g i n the w o r l d , right. M o r e important than a n y b o d y else, r i g h t . . . . I felt l i k e m y p r o b l e m was m o r e i m p o r t a n t than the relationship. I put m y s e l f ahead o f the r e l a t i o n s h i p , y o u k n o w . A n d I w o u l d rather escape f r o m m y feelings and escape f r o m m y issues rather than deal w i t h t h e m i n a healthy w a y because I d i d n ' t k n o w any better at the t i m e , r i g h t . . . L o s i n g her was l i k e a very v e r y tough b l o w for m e , right. A n d I was l i k e c o m p l e t e l y b e w i l d e r e d b y it. I d i d n ' t have a c l u e . . . . W h y c a n ' t I be h a p p y ? I d i d not have a c l u e what was w r o n g w i t h me. W h y d o I feel m i s e r a b l e ? E v e r y b o d y else - other p e o p l e d o n ' t seem to feel m i s e r a b l e . O t h e r p e o p l e d o n ' t s e e m to have  62  this l o n g i n g . O t h e r people d o n ' t seem to have to d r i n k l i k e I do. H o w c o m e , right? I didn't k n o w . A l l I knew was, I a m miserable. H e b e l i e v e d the e n d o f this r e l a t i o n s h i p w o r s e n e d his d r i n k i n g p r o b l e m and i m p e d e d his h e a l i n g . H o w e v e r , after a m o r e recent break-up w i t h another g i r l f r i e n d this participant reacted v e r y differently. H e m a n a g e d to m a i n t a i n his sobriety a n d r e a l i z e d that he c o u l d lose her and still s u r v i v e . T h e f u n n y t h i n g is l i k e - she's gone, right, but sobriety is w a y better. T h i s is a w a y better w a y o f life. In the e n d I k n e w that it was right to let her go and I learned s u c h an important lesson. T h e loss o f s i g n i f i c a n t r o m a n t i c relationships i n the i n t e r v i e w e e s ' l i v e s , although l a r g e l y i m p e d i n g i n the experience o f participants, was also a m a r k e r o f progress for another. I n d i v i d u a l s i n this study also reported that separation f r o m f a m i l y m e m b e r s o r friends was i n f l u e n t i a l for them. T h e s e losses, p a r t i c u l a r l y o f f a m i l y support, were p e r c e i v e d b y the interviewees as i m p e d i n g to their h e a l i n g j o u r n e y s . F o r e x a m p l e , f o l l o w i n g the n e w s that his e x - g i r l f r i e n d and daughter m i g h t m o v e a w a y f r o m V a n c o u v e r , one participant became v e r y d i s c o u r a g e d . H e felt " s l a p p e d i n the face" b y the n e w s o f their p e n d i n g m o v e w h e n a l l he h a d been t r y i n g to do was to p r o v e his c o m m i t m e n t a n d a b i l i t y to be responsible a n d dependable w i t h his daughter.  He  d e s c r i b e d his feelings o f frustration, anger and p a i n : I s h o w her [his daughter's mother] a l l the stuff I ' v e been d o i n g a n d n o w t h e y ' r e m o v i n g . S o I l o o k at it l i k e - w h a t ' s the message n o w ? I m i g h t as w e l l be a d r u g dealer. I was happier. R e a l l y . T h a t ' s where I go.  63  Another participant also talked about feeling abandoned by his sons, daughter, and brother when he initially admitted his drug problem. His brother and daughter have since come back into his life but others in his family have not. This disconnected family continued to be difficult for him to accept, particularly given his perception that most addicts regain their family and friends once they're clean. He struggled to understand why this was not the case in his life: The one thing I see, quickly happening to most people is their families come back in their life very quickly.... An addict seems to, or an alcoholic seems to make the move to get better and their families seem to rally around them. And um - it's extremely rare when that doesn't happen. Feelings of abandonment, lost love, and longing were perceived by most participants as significant impairments to their healing. As one participant noted: "The biggest hindrance to my recovery is my feelings for my family. The fact that I basically can't.. .go back and see them." "That's the reason I relapsed. I crashed because I missed my family." The inability to repair their relationships with certain family members and past failings with respect to family have resulted in feelings of regret, as well as "shame and guilt" for several of the individuals in this study. As one stated: "I still punish myself for what I've done to my kids. I still feel bad about that.. .1 mean I swore that I wouldn't do what I did." Aside from losing family members, participants also reflected on their sense of loss at having grown away from friends they used with; although it was a necessary part of their healing. As captured in the words of one interviewee:  64  You grow attached to people, to a certain lifestyle and it's harder to break free... .the attachments to the drug and using together. It becomes part of your routine. So that if you stop using, you pretty well lose the relationship too. He stated that fear of the emptiness from losing his friends kept him in the addictive lifestyle longer. "Several people I think just slowed me down." Another aspect of loss mentioned expressly by five participants was the loss of interactions based on their social or economic position. These individuals perceived a sense of failure as a result of their loss of status and success, power and control, as well as their loss money. These losses dealt hindering blows in most cases. Five of the participants talked about losses of relationships, possessions, careers and money. Some individuals lost their businesses, their homes, and their vehicles. Along with the loss of material items, it was the interactions involved in their previous lifestyles that three of the participants mourned. As one participant explained: "I really miss the limelight.. .best years of my life. And that's what I miss.. .1 miss the wheeling and dealing, the setting up deals, the setting up people." This interviewee and others referred repeatedly to the loss of their reputations and the respect they held in the eyes of others. The impeding nature of these losses was expressed by participants in their reluctance to accept their new way of life without alcohol or drugs. Some of the participants talked about having moved from being respected in their previous lives to starting from scratch, building an identity for themselves in an unfamiliar world. This change in status reportedly has meant a change in the interactions in which these individuals engage. One individual described it this way: "it's not fun being an alcoholic or a drug addict. 'Cuz all of a sudden you're an outcast - not an  65  outcast - yeah an outcast. Y o u k n o w y o u ' r e put o n a different l e v e l , y o u k n o w . " T h e y reflected o n h o w their feelings o f authority have been r e p l a c e d b y feelings o f i n a d e q u a c y through their d r u g use and the reactions o f others to their a d d i c t i o n . B e g i n n i n g again has been d i f f i c u l t for s o m e o f the participants.  M o s t reported a deep sense o f failure and loss  at their i n a b i l i t y to h o l d onto their p r e v i o u s lifestyles. I n c l u d e d i n the loss o f lifestyle o f interviewees was a sense o f loss o f c o n t r o l a n d p o w e r i i i their interactions. O n e i n d i v i d u a l d e s c r i b e d h i m s e l f as " c o n t r o l l i n g a n d a d d i c t e d to p o w e r . . .and m o n e y and d r u g s . " A n o t h e r participant d e s c r i b e d his loss o f c o n t r o l : " c o n t r o l o f other people, c o n t r o l o f m y s e l f , c o n t r o l o f m y a d d i c t i o n . " S o m e interviewees d e s c r i b e d feelings o f anger because o f the changes i n p o w e r and c o n t r o l i n their l i v e s . T h e y b e l i e v e d the interactions they e x p e r i e n c e d have c h a n g e d f r o m ones r e i n f o r c i n g their p o w e r or authority to those h i g h l i g h t i n g their l a c k o f status and prestige. M a n y reported f e e l i n g the change i n status and the perceptions and j u d g m e n t s o f others have l e d t h e m to behave differently i n their interpersonal interactions because o f their sense o f shame and guilt. A s w e l l , f r o m b e i n g autonomous i n their d e c i s i o n - m a k i n g , s o m e participants expressed d i f f i c u l t y i n r e c o n c i l i n g that aspects o f their l i v e s and d e c i s i o n s are n o w subject to others' authority. O n a m o r e a c c e p t i n g note, one i n d i v i d u a l said "most o f m y life I have run m y affairs pretty w e l l . I c a n ' t d o that a n y m o r e . I ' v e got a brother w h o helps m e w i t h m y finances. I f he w a s n ' t there to help m e I ' d screw u p . " O n the w h o l e , the loss o f interactions around status, c o n t r o l a n d p o w e r were l a r g e l y h i n d e r i n g for participants i n their h e a l i n g j o u r n e y s . Interviewees d e s c r i b e d the difficulties they h a d adjusting to their n e w l i f e s t y l e and their reluctance to do so.  66  A f i n a l aspect o f the experience o f loss and s o c i a l i s o l a t i o n was the awareness o n the part o f participants that i n m a n y cases these losses were s e l f - i n d u c e d b y their w i t h d r a w a l o f attention, affection and c a r i n g for others, or b y their c h o i c e to c o n t i n u e o n the s o c i a l l y unacceptable and destructive path o f a d d i c t i o n . O n several o c c a s i o n s participants d e s c r i b e d a d d i c t i o n as " a selfish disease" that l e d t h e m to isolate themselves f r o m others. I s o l a t i o n was p e r c e i v e d as i m p e d i n g and the interactions i n v o l v e d e x p r e s s l y a v o i d i n g contact w i t h other people, p u s h i n g others a w a y and r e s p o n d i n g n e g a t i v e l y to others' attempts to engage them. O n e i n t e r v i e w e e was v e r y aware that he was "not attracting anyone b y b e i n g i n the m o d e " he was i n . " I ' m not a h a p p y c a m p e r . " P e o p l e were not r e s p o n d i n g to his pleas for help and he felt l i k e he was " b e i n g n e g l e c t e d . " A s a result o f his frustrations he was " g o n n a scare e v e r y o n e a w a y . " H e was ready to " r e a l l y raise h o l y h e l l " or "just p l a y s i l e n t " to unsettle p e o p l e and w o r r y t h e m . " E i t h e r I ' m g o n n a snap, or I ' m g o n n a get d r u n k . " O t h e r cases o f i s o l a t i o n i n v o l v e d four o f the participants w h o d e s c r i b e d times w h e n they a c t i v e l y t r i e d to resist acceptance b y i n d i v i d u a l s i n the A A m o v e m e n t .  Some  t a l k e d about b e i n g "put o f f b y the s p i r i t u a l language." Others were afraid o f f e e l i n g l i k e they w o u l d be w a l k i n g " n a k e d " i f they r e v e a l e d themselves. A l t h o u g h they had a desire "to be h e a l t h y " they d i d not want "to accept that p a t h w a y . " T h e s e i n t e r v i e w e e s attended A A meetings, but s a i d they still felt they were " d e a l i n g w i t h it a l o n e . " O n e participant d e s c r i b e d t r y i n g to get w e l l on his o w n i n the f o l l o w i n g w o r d s : "It was l i k e d r a g g i n g a sled o v e r g r a v e l . It was h o r r i b l e . W h o the heck w o u l d want to be sober? T h i s s u c k s . " A sense o f i s o l a t i o n was also e x p e r i e n c e d b y one o f the m e n w h o d e s c r i b e d f e e l i n g " a f r a i d o f w o m e n " and b e i n g " a f r a i d o f any r e l a t i o n s h i p , e s p e c i a l l y w i t h  67  w o m e n . . . P e o p l e scared m e and i n order to o v e r c o m e that, I b e c a m e s o m e t h i n g I w a s n ' t . . .brash, l o u d m o u t h and p u s h y . " A n o t h e r participant sought escape. H e s a i d he w o u l d "rather escape f r o m m y feelings and escape f r o m m y issues rather than deal w i t h t h e m i n a healthy w a y because I d i d n ' t k n o w any better at the t i m e . " T w o o f the interviewees i m p o s e d i s o l a t i o n o n themselves b y c h o o s i n g to use their substance i n the p r i v a c y o f their h o m e s . O n e participant d e s c r i b e d a l c o h o l i s m as " a v e r y l o n e l y disease" that he d i d a lot o n his o w n : "just alone w i t h m y t w i s t e d thoughts and not r e a l l y a n y t h i n g I w a n t e d to go out i n p u b l i c and d o . " A n o t h e r t a l k e d about h o w she i s o l a t e d herself i n her h o m e p l a y i n g S c r a b b l e o n her computer. She also spent a lot o f t i m e s l e e p i n g . S h e d e s c r i b e d the i s o l a t e d w o r l d she created for herself: It was a v e r y dark - w h e n I t h i n k - it was a v e r y d a r k p l a c e to be. A n d a very l o n e l y p l a c e to be. L i k e it got so b a d that I just h a d m y phone d i s c o n n e c t e d . I d i d n ' t want to talk to p e o p l e . . . J u s t totally total i s o l a t i o n . A n d w h e n I h a d m y phone h o o k e d up I h a d it turned off. Y o u k n o w - d i d n ' t return c a l l s . Y o u k n o w what I m e a n ? I was just e x i s t i n g to exist. Participants felt that i s o l a t i n g f r o m others i m p e d e d their h e a l i n g . T o s u m m a r i z e , i n d i v i d u a l s i n this study e x p e r i e n c e d v a r i o u s personal losses as w e l l as a sense o f i s o l a t i o n that p l a y e d an important r o l e i n either f a c i l i t a t i n g or i m p e d i n g their progress t o w a r d a healthier l i f e s t y l e . S o m e t i m e s these losses, although they appeared negative, such as the death o f friends, p r o v i d e d the necessary w a k e up c a l l i n order for participants to cease their u s i n g b e h a v i o u r . O n the other hand, l o s i n g relationships w i t h a spouse, partner, c h i l d r e n and f a m i l y m e m b e r s , or l o s i n g prestige and status i n business a n d s o c i a l life was e x p e r i e n c e d as setting i n d i v i d u a l s b a c k i n their  68  progress. I s o l a t i o n appeared to exist for participants i n this study as a result o f t h e m either p u s h i n g p e o p l e a w a y or f e e l i n g and fostering a sense o f separateness a n d c h o o s i n g not to connect w i t h others a r o u n d them. W h e t h e r self or other i m p o s e d , the i s o l a t i o n was p e r c e i v e d b y the i n d i v i d u a l s i n this study as h i n d e r i n g their progress t o w a r d a healthier lifestyle. A Sense o f S u p p o r t or D i s c o u r a g e m e n t S e v e r a l factors were d e s c r i b e d as important i n the interactions o f the theme o f a sense o f support or a sense o f discouragement. B o t h the s p e c i f i c i n d i v i d u a l s i n v o l v e d i n these interactions as w e l l as the p o s i t i v e or negative experience o f the interactions were d e s c r i b e d as important b y participants i n this theme. A l s o , a s k i n g for h e l p surfaced as i m p o r t a n t i n r e c e i v i n g the support interviewees needed.- T h e i n d i v i d u a l s w h o were m e n t i o n e d frequently i n interactions b y participants that affected t h e m i n terms o f a c k n o w l e d g e m e n t , support, or discouragement were other i n d i v i d u a l s w i t h a d d i c t i o n issues, as w e l l as friends, f a m i l y m e m b e r s and the g o d o f their understanding. In a d d i t i o n , i n f l u e n t i a l health and a d d i c t i o n s professionals appeared to f a l l into t w o categories i n the experience o f the i n d i v i d u a l s i n t e r v i e w e d : those interactions w h e r e p r o f e s s i o n a l s ' p e r s o n a l a d d i c t i o n histories were relevant to participants and those interactions w h e r e the p r o f e s s i o n a l s ' a d d i c t i o n histories were not felt to be significant to the interaction. O t h e r i n d i v i d u a l s o f p e r c e i v e d i n f l u e n c e i n the l i v e s o f participants were those f r o m their p r e v i o u s lifestyle, c h a r a c t e r i z e d b y substance abuse, w h o participants b e l i e v e d at the t i m e to be supportive but w h o a c t u a l l y kept the participants i n their destructive lifestyles.  69  P a r t i c u l a r l y f a c i l i t a t i v e to the i n d i v i d u a l s i n this study were their supportive interactions w i t h others w h o shared a.history o f a d d i c t i o n . I n d i v i d u a l s w i t h a p e r s o n a l h i s t o r y o f a d d i c t i o n h a d i m m e d i a t e c r e d i b i l i t y w i t h the participants because o f their c o m m o n experience. W i t h i n this category, three participants d e s c r i b e d important, p o s i t i v e relationships w i t h their sponsors. O n e i n d i v i d u a l d e s c r i b e d his sponsor as " m e n t o r , " " g u i d e , " "tutor," " c o a c h , " and "teacher." H e felt his sponsor was supportive i n terms o f g i v i n g his " t i m e " as w e l l as b e i n g " d e m a n d i n g " o f h i m . H e d e s c r i b e d his sponsor as " c r i t i c a l , " "respectful," " t r u s t i n g " and "honest." T h i s participant d e s c r i b e d feelings o f trust t o w a r d his sponsor a n d a sense o f " f e l l o w s h i p " and " s o l i d a r i t y " w i t h h i m i n a r e l a t i o n s h i p that he felt was c o n t i n u a l l y g r o w i n g . T w o i n t e r v i e w e e s m e n t i o n e d the i n d i v i d u a l s at A A w h o were w a r m and w e l c o m i n g and h e l p e d to p r o v i d e t h e m w i t h a sense o f c o n n e c t i o n and c o m m u n i t y . A s i m p l e , yet important aspect o f the support f r o m i n d i v i d u a l s i n A A was expressed b y one participant i n the f o l l o w i n g w a y : " b a s i c a l l y t h e y ' v e just been n i c e to m e . " A n o t h e r participant noted o n his t h i r d try at A A it was important for h i m to k n o w he " w o u l d be accepted." O n e participant m e n t i o n e d that he went to a m e e t i n g e v e r y d a y just "to have that interaction w i t h p e o p l e . " H e s a i d the interaction itself was an important support m e c h a n i s m i n his life. H e also went o n to say, " y o u c a n ' t do it a l o n e . . . .There has to be interaction w i t h a h u m a n b e i n g . " O n e participant d e s c r i b e d his step group, a s m a l l group o f A A m e m b e r s w h o meet to w o r k through the t w e l v e steps and traditions, as an important source o f support for h i m because it was a safe p l a c e o f " h o n e s t y " and " e m p a t h y " w h e r e they " s t r u g g l e d together o v e r some things that were d i f f i c u l t . " T h e s i m i l a r experiences o f group m e m b e r s a l l o w e d t h e m to  70  relate to a n d support each other. T h i s i n t e r v i e w e e also t a l k e d about h o w " i m p o r t a n t a n d quite v a l u a b l e " it was to b e l o n g to a group w h e r e he felt free to disagree w i t h others. O n e aspect o f the support f r o m i n d i v i d u a l s i n A A that seemed to be p a r t i c u l a r l y m e a n i n g f u l to participants i n their h e a l i n g j o u r n e y w a s that " n o b o d y e v e r tells y o u what to d o . " O n e i n t e r v i e w e e a s k e d someone f r o m A A whether he thought the i n t e r v i e w e e w a s an a l c o h o l i c . T h e i n d i v i d u a l r e p l i e d " o n l y y o u can say i f y o u ' r e an a l c o h o l i c . " H i s response m a d e the participant feel "that r e c o v e r y c o u l d be safe" because n o one w a s g o i n g to m a k e h i m d o a n y t h i n g he d i d not want to do. T h i s i n t e r v i e w e e felt that b y not i n f l i c t i n g o p i n i o n s a n d a d v i c e on someone it "encourages the person to take o w n e r s h i p . . . . ' C u z i f s o m e b o d y tells y o u what to d o , i t ' s not l i k e y o u ' r e o w n i n g the solution." T h e s i g n i f i c a n c e o f trust i n f a c i l i t a t i n g h e a l i n g f o r participants was apparent i n interactions w i t h p e o p l e w h o shared a h i s t o r y o f a d d i c t i o n . P e o p l e i n A A w e r e d e s c r i b e d b y s o m e participants as people w h o w e r e " d o i n g it. T h e y have n o m o t i v e to l i e . " O n e i n t e r v i e w e e d e s c r i b e d his feelings about his r o o m m a t e i n the r e c o v e r y house w h e r e he l i v e d w h e n he first stopped u s i n g drugs. H e " w a s v e r y s u p p o r t i v e , v e r y w i s e because he had been there f o r t w o months a n d straightened h i m s e l f out." A n o t h e r w a y i n d i v i d u a l s were p e r c e i v e d to p r o v i d e support for the participants i n the study w a s t h r o u g h s h a r i n g their stories a n d g i v i n g out i n f o r m a t i o n about resources f o r p e o p l e w i t h a d d i c t i o n s . Participants felt supported w h e n p r o v i d e d w i t h a safe, trusting p l a c e to share experiences a n d stories at meetings. " M o s t l y w e talk m o r e about these u n d e r l y i n g feelings c o n n e c t e d w i t h the hopelessness before a n d the feelings of, n o w . " A f t e r one i n t e r v i e w e e d e s c r i b e d his misdeeds to an i n d i v i d u a l i n the p r o g r a m , the i n d i v i d u a l  71 s h o w e d support b y l i s t e n i n g to h i m and m a k i n g h i m feel " a c c e p t e d " a n d " l o v e d . "  When  t a l k i n g about his sponsors, another participant m e n t i o n e d his sense that they were " g e n u i n e , " they d i d "care" and they h a d " f a i t h " i n h i m . H e s a i d he d i d not require a n y t h i n g m o r e than l i s t e n i n g f r o m his sponsors at times: " T h e y d o n ' t n e e d to tell m e what to do, just b y sharing, b y t a l k i n g about it, it feels better." T h e support garnered f r o m i n d i v i d u a l s i n A A was instrumental i n f a c i l i t a t i n g the h e a l i n g process for participants i n this study. O t h e r i n d i v i d u a l s w h o seemed to p l a y a l a r g e l y f a c i l i t a t i v e r o l e i n p r o v i d i n g a c k n o w l e d g e m e n t a n d support for participants i n this study were a d d i c t i o n s and health professionals, p a r t i c u l a r l y those w i t h their o w n a d d i c t i o n histories. T h e e x p e r i e n c e o f a d d i c t i o n o n the part o f addictions and health professionals appeared to h e l p i n e s t a b l i s h i n g a b o n d o f trust and c r e d i b i l i t y w i t h participants. T w o o f the i n d i v i d u a l s i n this study e x p r e s s l y m e n t i o n e d that it was important for t h e m that the a d d i c t i o n s professionals they dealt w i t h h a d their o w n h i s t o r y w i t h a d d i c t i o n . F o r one participant, k n o w i n g his c o u n s e l l o r was " i n the p r o g r a m " gave h i m the trust to express his "fear about c o u n s e l l o r s and s h r i n k s . " H i s fears i n c l u d e d "that y o u w o u l d have m e c o m m i t t e d i f I t o l d y o u w h a t I r e a l l y t h i n k and stuff. A n d the s e c o n d one, that y o u ' r e gonna, sort of, y o u k n o w , keep m e s i c k , so that y o u can b i l l m e . " T h i s c o u n s e l l o r reassured h i m b y s a y i n g "these s e s s i o n s . . . w i l l o n l y continue as l o n g as y o u feel y o u ' r e getting s o m e t h i n g out o f t h e m . " T h e d i s c u s s i o n reportedly put the participant "at ease" because he felt he was " i n c h a r g e " o f the process. T h e trust established b y virtue o f the c o u n s e l l o r b e i n g i n A l c o h o l i c s A n o n y m o u s a l l o w e d the participant to be v u l n e r a b l e and honestly confront his fears.  72  H o w e v e r , for other i n d i v i d u a l s i n this study, the a d d i c t i o n h i s t o r y o f the health a n d a d d i c t i o n s professionals assisting t h e m d i d not s e e m to h o l d i m p o r t a n c e . It appeared to be the nature o f the exchange that was significant f o r these i n d i v i d u a l s . S e v e r a l times participants m e n t i o n e d interactions w h e r e professionals h a d gone the extra m i l e for t h e m a n d h o w m e a n i n g f u l that was for t h e m . S o m e e x a m p l e s o f this f r o m one participant i n c l u d e d a d o c t o r w h o has a l w a y s treated h i m " v e r y decently, v e r y r e s p e c t f u l l y , " a welfare w o r k e r w h o " j u m p e d through h o o p s " to m a k e sure he r e c e i v e d the f i n a n c i a l assistance he needed, and a support r e c o v e r y house that p r o v i d e d "safe" l i v i n g c o n d i t i o n s i n c l u d i n g "heat, l i g h t , phone. I d i d n ' t have to w o r k . In fact I w a s n ' t a l l o w e d to w o r k . S o y o u just have to concentrate on y o u r h e a l t h " A d d i t i o n a l l y , the i n d i v i d u a l s i n his dental c l i n i c were " w e l c o m i n g " and went out o f their w a y to h e l p h i m restore his "self-esteem" and " h e a l t h . " P r o f e s s i o n a l s demonstrated to the participants g o o d w i l l , and gave freely o f their t i m e a n d space to attend to participants' health. A l t h o u g h b e i n g t o l d what to do was not seen as helpful b y m o s t interviewees, e d u c a t i o n apparently was an important part o f the r o l e o f s o m e health professionals i n f a c i l i t a t i n g the h e a l i n g o f i n d i v i d u a l s i n this study. O n e participant d e s c r i b e d his expectations o f an effective c o u n s e l l o r : A s k i l l e d c o u n s e l l o r w o n ' t tell y o u what to do. T h e y sort o f ask questions.. .to d r a w it out o f y o u so that y o u c a n k i n d o f d i s c o v e r it for y o u r s e l f . . . . T h e n y o u c a n k i n d o f o w n i t . . . . A n d i t ' s not l i k e a f o r e i g n substance i n y o u r b o d y . . . . It m a k e s sense because y o u k i n d o f h e l p e d create it. It s e e m e d f r o m the i n t e r v i e w s that education i n the area o f a p r o f e s s i o n a l ' s expertise w a s w e l c o m e d b y most participants. F o r e x a m p l e , one participant w h o h a d been s t r u g g l i n g  73  w i t h f a m i l y o f o r i g i n issues f o u n d the k n o w l e d g e g a i n e d f r o m a c o u n s e l l o r " h e l p f u l " to h i m about this matter. " T h e fact he was a p r o f e s s i o n a l gave his w o r d s o m e w e i g h t . " T h e interactions this i n d i v i d u a l f o u n d h e l p f u l i n c l u d e d h e l p i n g h i m "understand the i s s u e s " i n v o l v e d i n his f a m i l y situation and his part i n their p r o b l e m s . T h e c o u n s e l l o r " g u i d e d " h i m and " e x p l a i n e d " to the participant. T h e c o u n s e l l o r " d i d n ' t g i v e a d v i c e " a n d he " h e l p e d . . .establish b o u n d a r i e s " and h e l p e d h i m "get i n s i g h t " into the issues. A n o t h e r i n t e r v i e w e e t a l k e d about her experience o f her doctor w h o was c l e a r and straightforward w i t h i n f o r m a t i o n about the steps she needed to take i n her h e a l i n g process. " M y b i g p l a n was - I ' m g o n n a get m y stuff. G e t an apartment. G e t m y stuff out o f storage. A n d m y doctor s a i d ' w e l l no. T h a t ' s not part o f the p l a n . . . . I f y o u want d i s a b i l i t y , ' he said, 'this is what y o u have to do. A n d i f y o u choose not to, that's y o u r c h o i c e . ' " H e r doctor also t o l d her she needed to "be i n r e c o v e r y " and stay i n a support r e c o v e r y f a c i l i t y " f o r at least a year." A t V a n c o u v e r G e n e r a l H o s p i t a l the staff were also v e r y clear about her situation. " T h e y ' r e the ones w h o t o l d m e y o u ' r e an a l c o h o l i c a n d . . .this is what w e ' r e d o i n g . " A n o t h e r d o c t o r g a i n e d one participant's trust because he was a " w e l l respected and learned p r o f e s s i o n a l . "  A d d i t i o n a l l y he h a d c r e d i b i l i t y because "he was an M D .  He  k n e w about b r a i n c h e m i s t r y . " P a r t i c i p a n t s d e s c r i b e d supportive reactions o n the part o f addictions and health professionals that stood out as f a c i l i t a t i v e i n their h e a l i n g j o u r n e y s . O n e i n t e r v i e w e e returned to his r e c o v e r y house after a relapse a n d staff there were supportive. T h e i r support h e l p e d h i m to get b a c k o n track. A n o t h e r i n d i v i d u a l w h o a s k e d to stay l o n g e r at his r e c o v e r y house after his allotted t i m e , was g i v e n p e r m i s s i o n to stay longer. A s o c i a l w o r k e r i n detox l i s t e n e d to one participant, and u s i n g his expertise and experience, was  74  able to m a k e suggestions to h i m for a course o f action to h e l p h i m navigate his first steps w i t h o u t substances.  H e s h o w e d a b e l i e f i n the participant as w e l l as support o f h i m  through his actions. F o r another i n t e r v i e w e e , b e i n g g i v e n t i m e and space i n a safe p l a c e and f e e l i n g l i s t e n e d to b y her s o c i a l w o r k e r was v e r y important. S h e d e s c r i b e d her experience i n the f o l l o w i n g w a y : T h e y saw m e right a w a y . S u r p r i s i n g l y . . . .1 h a d a w o n d e r f u l w o r k e r . A n d I just sat there and c r i e d and c r i e d . I s a i d 'what a m I g o i n g to .. .do? L i k e I ' m homeless. I have n o apartment. I have n o w h e r e to g o . ' A n d u h I was there f r o m 11:30 i n the m o r n i n g . I left there at f o u r o ' c l o c k i n the afternoon. T h i s participant also d i s c u s s e d the support and a v a i l a b i l i t y o f the staff i n the r e c o v e r y house where she l i v e d : " T h e staff are o v e r the t o p . . . . Y o u can just talk to them.  Anytime.  T h e y have an o p e n d o o r p o l i c y . . ..It's just so n i c e that they have this open d o o r p o l i c y . " In one c o n v e r s a t i o n w i t h the director o f the f a c i l i t y where she l i v e d , she t o l d h i m she w o u l d be l i v i n g there a l o n g t i m e because her "needs were b e i n g met." T h e same i n t e r v i e w e e p r a i s e d a staff m e m b e r at V a n c o u v e r G e n e r a l H o s p i t a l : " S h e ' s just the neatest w o m a n . I gotta c a l l her and tell her where I a m at. C u z I m e a n , they, V G H s a v e d m y l i f e . " T h e participant also d e s c r i b e d this staff m e m b e r i n the f o l l o w i n g w a y : " s h e ' s a w o n d e r f u l w o m a n . " " S h e was v e r y i n s p i r a t i o n a l . " E v e n t h o u g h this w o m a n was a h o s p i t a l administrator, this i n t e r v i e w e e appreciated the genuine c o n c e r n and t i m e she t o o k w i t h patients. T h e e m o t i o n s e x p e r i e n c e d b y i n d i v i d u a l s i n this study i n their relationships w i t h health and addictions professionals were k e y to d e t e r m i n i n g whether interactions were p e r c e i v e d as f a c i l i t a t i v e . Participants d e s c r i b e d the i m p o r t a n c e o f f e e l i n g c o m f o r t a b l e  75  w i t h the professionals i n question, as w e l l as trusting t h e m . T h i s trust was e x p e r i e n c e d b y i n t e r v i e w e e s w h e n the professionals l i s t e n e d to t h e m , put i n effort w i t h them, s h o w e d faith i n t h e m and supported t h e m . Interactions w i t h friends and f a m i l y were expressed as significant to participants i n their h e a l i n g j o u r n e y i n both f a c i l i t a t i v e and i m p e d i n g w a y s . Participants e x p e r i e n c e d support i n terms o f others' a c k n o w l e d g e m e n t o f their experience, l i s t e n i n g w i t h an openness and l a c k o f j u d g m e n t , s y m p a t h y to their situation, and a s h o w o f faith i n t h e m . F o r three i n d i v i d u a l s i n this study support was garnered f r o m their f a m i l i e s .  One  participant felt a sense o f a c k n o w l e d g e m e n t w h e n his sons c a m e to h i m , to h e l p them w i t h their d r u g p r o b l e m s . H e was " a m a z e d " that they a s k e d for his help and was p l e a s e d he " w a s i n a p o s i t i o n to h e l p t h e m . " F o r another, his f a m i l y was d i v i d e d . H e d e s c r i b e d his f a m i l y situation i n this w a y : " M y f a m i l y ' s n o w split i n t w o . T h o s e that r e m a i n a n g r y a n d those that understand and support m e . " T h i s participant felt supported not o n l y b y the f a m i l y m e m b e r s w h o learned about a d d i c t i o n but also f r o m their desire to h e l p h i m o n his path. " T h e y have been able to support m e - not just v o l u n t a r i l y - but be there. W a n t to be there. M a k e m e t h i n k that they want to be there. K n o w that they want to be a part o f m y l i f e . " F o r another i n t e r v i e w e e , a c k n o w l e d g e m e n t o f both his current health and o f past experiences b y his grandmother was p a r t i c u l a r l y m e a n i n g f u l for h i m . H e d e s c r i b e d a v i s i t to his grandmother i n h o s p i t a l : M e and m y g i r l f r i e n d . . . w e went to v i s i t h e r . . . . S h e started c r y i n ' . S h e says ' I ' m so h a p p y that y o u ' r e d o i n g so w e l l , ' she said. T r e m e m b e r w h e n y o u were s i x years o l d a n d y o u r D a d s m a s h i n g y o u r . . . h e a d o f f the .. .cement'.  76  H a v i n g someone important to h i m a d m i t to w i t n e s s i n g the v i o l e n c e he e x p e r i e n c e d a n d a c k n o w l e d g e his progress h e l p e d to keep h i m on track i n his h e a l i n g j o u r n e y . F r i e n d s , sponsors a n d partners, as w e l l as c o m p l e t e strangers, p r o v i d e d support and a c k n o w l e d g e m e n t for participants that they felt f a c i l i t a t e d their h e a l i n g . O n e participant m e n t i o n e d the a c k n o w l e d g e m e n t b y his g i r l f r i e n d o f h o w w e l l he was d o i n g both i n c e a s i n g his a d d i c t i v e b e h a v i o u r s and t a k i n g r e s p o n s i b i l i t y i n his life. H e felt as though he h a d r e a l l y a c c o m p l i s h e d s o m e t h i n g because she h a d g i v e n h i m her encouragement.  A s he noted: " S h e ' s v e r y p r o u d o f w h e r e I ' m at right n o w . " W h e n times  were t o u g h f o r another i n t e r v i e w e e she said, "the o n l y t h i n g that was h o l d i n g m e together was m y v i s i t s w i t h m y f r i e n d . " N o w that things have i m p r o v e d i n her life she continues to f i n d support a m o n g her friends and her sponsor. S u p p o r t has sometimes meant b e i n g c h a l l e n g e d o n her b e h a v i o u r b y her friends. A n u m b e r o f participants m e n t i o n e d f i n d i n g it d i f f i c u l t to b u i l d trust i n relationships and suggested trust is not e a s i l y r e g a i n e d after a breach. O n e i n t e r v i e w e e said he f o u n d it easier to talk w i t h strangers about his experience at times. A f t e r one such c o n v e r s a t i o n he r e c e i v e d the encouragement he needed. T h e stranger t o l d h i m , " Y o u ' r e a p o w e r f u l , l o v i n g , c a r i n g i n d i v i d u a l . . . . G o after what y o u r heart's t e l l i n g y o u to d o . " T h i s message h e l p e d h i m to stay on his path and refrain f r o m d r u g use.  T h e encouragement  f r o m friends, f a m i l y , professionals as w e l l as strangers was expressed as h e l p f u l i n k e e p i n g participants o n their path t o w a r d health. F o u r o f the participants c i t e d s p i r i t u a l support as an important f a c i l i t a t i v e factor i n their h e a l i n g j o u r n e y s . O n e i n d i v i d u a l d e s c r i b e d his s p i r i t u a l c o n n e c t i o n as a b e l i e f that " s o m e t h i n g greater t h a n " h i m s e l f was h e l p i n g h i m . T h e s p i r i t u a l r e l a t i o n s h i p these  77  i n d i v i d u a l s d e s c r i b e d e m e r g e d l a r g e l y f r o m the A A m o v e m e n t . In e x p l a i n i n g his rationale for b e i n g open to a h i g h e r p o w e r , one participant d e s c r i b e d h o w the i n d i v i d u a l s i n A A h a d f r a m e d the idea: A l l y o u r best t h i n k i n g got y o u here, right. S o d o n ' t y o u t h i n k i t ' s t i m e y o u thought about s o m e t h i n g . . .some other s o l u t i o n other that y o u c a n c o m e up w i t h . . . . S o that k i n d o f opens the d o o r a little b i t that s o m e t h i n g other than m e is gonna help me. T h i s same i n d i v i d u a l d e s c r i b e d his feelings o f trust towards his h i g h e r p o w e r : I p r a y to m y h i g h e r p o w e r , m y G o d , w h i c h , I d o n ' t k n o w what it i s , but I b e l i e v e i n it. I b e l i e v e that it cares about m e and c a n h e l p m e w h e n e v e r I ask. I f I trust, right.  A n d I b e l i e v e that y o u k n o w it w o n ' t g i v e m e what I a l w a y s want. B u t I d o  b e l i e v e it w i l l g i v e m e what I n e e d . . ..It's l i k e a partnership, a team. I ' m d o i n g m y part, I n e e d G o d ' s help. W h e n t a l k i n g about his b e l i e f i n G o d he said, "I b e l i e v e it, right. A n d I b e l i e v e it because I ' v e felt i t . . . . I t ' s l i k e the most e p h e m e r a l t h i n g has b e c o m e the most p o w e r f u l t h i n g . " H e also e x p l a i n e d that his experience o f G o d c a m e i n m a n y guises: W e say G o d is so m a n y things. I m e a n I b e l i e v e i n s o m e d i v i n e b e i n g that I p r a y to, right. B u t also, y o u k n o w , G r o u p O f D r u n k s . G - O - D . S i t t i n g i n a m e e t i n g - these p e o p l e t h e y ' r e sharing their truth a n d their c a r i n g - for their benefit and for m y benefit. T h a t ' s k i n d o f l i k e G o d i n a w a y . T h e r e ' s l o v e there,  right.  A s k i n g G o d for h e l p was instrumental i n the h e a l i n g process o f t w o participants i n particular. A s one i n t e r v i e w e e articulated, a s k i n g G o d for h e l p " b a s i c a l l y reinforces that  78  I c a n ' t d o it b y m y s e l f . " H e c o n t i n u e d , "I n e e d faith. W i t h o u t m e r e a c h i n g out to G o d , H e ' s not g o n n a h e l p m e . " T h r e e participants d e s c r i b e d interactions w i t h others that felt supportive at the t i m e but they n o w r e a l i z e these interactions actually i m p e d e d their h e a l i n g j o u r n e y s . O n e participant felt a strong sense o f l o y a l t y to m e m b e r s o f a b i k e g a n g to w h i c h he b e l o n g e d . T h e y h a d been a s o l i d source o f support and security throughout the m a n y years was i n v o l v e d w i t h them. T h e y were there for h i m no matter what. H e said, " a n y g i v e n t i m e that I want to be i n v o l v e d i n any i l l e g a l c r i m e , whether it be d r u g d e a l i n g - d r u g d e a l i n g I w o u l d say put at the top o f the list that I can get i n v o l v e d a n y t i m e . " T h a t sense o f c o n n e c t i o n was v e r y important to h i m and p r o v i d e d a strong p u l l b a c k to that life at times. F o r another participant, his connections to p e o p l e f r o m M a i n and H a s t i n g s were a negative i n f l u e n c e on h i m . " M y relations w i t h t h e m c e r t a i n l y i m p e d e d , they h a r m e d m e . " T h i s c o m m u n i t y o f friends p r o v i d e d the i l l u s i o n o f support. "It seems that it can support y o u and the outside - outside that w a r m c i r c l e - c a n s e e m so scary. T c a n ' t leave m y friends b e h i n d . ' Y o u c a n t h i n k that. B u t I tell y o u , y o u get desperate e n o u g h to." A n o t h e r participant spoke o f his peer group s u p p o r t i n g his habit. T h e y supported his f e e l i n g that, " I r e a l l y n e e d this stuff. I l i k e it and I need it a n d I want i t . . .to feel o k a y i n s i d e . " T h e e m o t i o n a l interactions d e s c r i b e d d e p i c t e d situations that were h i n d e r i n g for participants i n their h e a l i n g j o u r n e y . T h e l a c k o f support d e s c r i b e d b y i n d i v i d u a l s i n this study d i d not appear to s i m p l y reflect abandonment.  T h e other e n d o f the s p e c t r u m f r o m support, c h a r a c t e r i z e d b y  discouragement o n the part o f participants, seemed to be related to f e e l i n g u n d e r m i n e d ,  79  j u d g e d , not trusted, betrayed, abused, as w e l l as s i m p l y the absence o f a c k n o w l e d g e m e n t and support. A l l o f the participants d e s c r i b e d some form o f d i s c o u r a g i n g interactions throughout their h e a l i n g j o u r n e y . O n e participant d e s c r i b e d not f e e l i n g " a p p r e c i a t e d " or "trusted" b y certain p e o p l e i n his life. H e also d e s c r i b e d f e e l i n g " n e g l e c t e d " and " d e g r a d e d " although he was " c r y i n g out for h e l p . " " N o t getting m u c h support" left h i m f e e l i n g frustrated, hurt and as t h o u g h "they d o n ' t care." H i s sense o f betrayal and b r o k e n trust reportedly m a d e h i m feel l i k e g i v i n g up o n his progress. " I ' d rather be a d r u g dealer." A n o t h e r participant d e s c r i b e d f e e l i n g betrayed b y c o w o r k e r s w h o h a d been " c o n c e r n e d " about h i m and " c o e r c e d " h i m into g o i n g to A A meetings. H e t o o k A A o n as a " d i s c i p l i n e " but was not r e a l l y interested at that t i m e . H e f o u n d a lot to get " a n n o y e d at." T h i s same i n d i v i d u a l m e n t i o n e d "frustrating t i m e s " l i v i n g i n a r e c o v e r y house w i t h " a n n o y i n g i d i o t s " w h o "get o n y o u r nerves." H e was able to describe t h e m as " c h a l l e n g e s " and r e a l i z e d that he, " h a d to learn h o w to cope w i t h a n n o y i n g p e o p l e . " L a c k o f f a m i l y support was e s p e c i a l l y difficult for one participant. H e s a i d his w i f e , "stopped s u p p o r t i n g h i m or h a v i n g a n y t h i n g to d o w i t h h i m . " W h e n they were together he d e s c r i b e d his experience o f v e r b a l abuse that r e i n f o r c e d his feelings that he b e l o n g e d i n a c r a c k house. O f his f a m i l y he s a i d , "they d o n ' t want m e i n their l i v e s . T h e y d o n ' t want any trace o f m e i n their l i v e s . " H e d e s c r i b e d that the reason for his relapse was m i s s i n g his f a m i l y . " T h e biggest h i n d r a n c e to m y r e c o v e r y is m y feelings for m y f a m i l y . T h e fact that I b a s i c a l l y c a n ' t . . .go b a c k a n d see t h e m . " A n o t h e r i n d i v i d u a l d e s c r i b e d her p a i n f u l experience i n one support r e c o v e r y f a c i l i t y : " I ' v e w a t c h e d t h e m tear p e o p l e d o w n but t h e y ' r e not p u t t i n g p e o p l e b a c k together a g a i n . " A s a result, she  80 reported feeling unsafe in this environment. "I felt I had nothing -1 had no control over anything in my life there." This participant felt the staff at this facility were not approachable either. She described her experience of talking with the program director at this recovery house: "You know when you'd speak to him.. .you'd sit in his office and you'd speak to him and then he'd start wiggling his keys. It's like 'I'm done'." This professional's nonverbal behaviour was experienced as "demeaning" and "unprofessional" by this participant. Interviewees described a lack of support from various individuals in their lives as a hindrance in their pathway toward health. In conclusion, interactions that participants perceived as supportive and facilitative in their healing journeys included feeling as though others had faith in them, feeling welcomed, and being treated with kindness by others. Participants described the importance of individuals giving their time and providing a safe space to explore their newfound sobriety. Teaching, information sharing, and going the extra mile were also mentioned as instrumental in aiding the healing process of participants. The shared past experience of addiction provided an immediate connection with others and established other people's credibility with the individuals in this study. This connection allowed participants to freely give those individuals their trust. Hindering interactions for interviewees involved not only a lack of support but open rejection, disrespect or betrayal on the part of others. Individuals in this study described the importance of feeling they were setting the pace of their healing journeys. They learned rather than being taught. They asked for and accepted help. Interviewees acknowledged and stressed that supportive interactions with healthy individuals were essential to the process of healing. In the words of one participant, "you can't do it alone."  81  A Sense o f U n d e r s t a n d i n g or M i s u n d e r s t a n d i n g A n o t h e r set o f interactions that were i n f l u e n t i a l i n both p o s i t i v e and negative w a y s for participants were those i n v o l v i n g feelings o f understanding or m i s u n d e r s t a n d i n g . Interactions d e s c r i b e d b y i n d i v i d u a l s i n this study often i n v o l v e d situations where they felt either understood o r m i s u n d e r s t o o d b y others. Participants felt that others w h o d i d not understand their d r u g or a l c o h o l abuse h a d not m a d e the t i m e o r effort to acquire the appropriate k n o w l e d g e . H e a l t h professionals were sometimes regarded as h a v i n g a c a d e m i c k n o w l e d g e but not e x p e r i e n t i a l k n o w l e d g e o f a d d i c t i o n , furthering participants' feelings o f b e i n g m i s u n d e r s t o o d a n d i m p e d i n g their h e a l i n g . Interactions w i t h others also seemed to expose the l a c k o f understanding participants h a d o f themselves and others w i t h addictions. I n d i v i d u a l s i n this study reported that they felt their c i r c u m s t a n c e s a n d feelings were best understood b y i n d i v i d u a l s w h o also h a d a h i s t o r y o f a d d i c t i o n . In a s i m i l a r v e i n , n o w that they h a d s o m e k n o w l e d g e o f their o w n a d d i c t i o n p r o b l e m s , interviewees felt that they c o u l d better understand the situation o f other i n d i v i d u a l s w i t h a d d i c t i o n s . Interactions that participants p e r c e i v e d as h e l p i n g t h e m understand a d d i c t i o n as w e l l as those w h e r e they felt understood were d e s c r i b e d as f a c i l i t a t i v e i n their h e a l i n g . Interactions where participants felt m i s u n d e r s t o o d or where they l a c k e d understanding o f themselves or other addicts were p e r c e i v e d b y participants as i m p e d i n g their h e a l i n g journeys. T h r e e participants referred to interactions where they felt m i s u n d e r s t o o d b y others. T h e interactions i n v o l v e d f a m i l y , colleagues f r o m w o r k , and health professionals. O n e i n t e r v i e w e e d e s c r i b e d f e e l i n g m i s u n d e r s t o o d at w o r k . H e s a i d this p a r t i c u l a r f e e l i n g  82  m a d e h i m want to " g o and get d r u n k . " H e felt h e ' d " h a d e n o u g h " hassles i n his w o r k a n d personal life. A n o t h e r i n d i v i d u a l felt his w i f e had "not been v e r y helpful at a l l " because she " d i d n ' t want to understand what was g o i n g o n " a n d chose to see his b e h a v i o u r as " w r o n g . " H e c o m m e n t e d o n their r e l a t i o n s h i p : " T h e o n l y w a y m y w i f e and I w i l l ever be together i n the same r o o m again is i f she starts to understand." T w o out o f three o f this p a r t i c i p a n t ' s c h i l d r e n were not s p e a k i n g to h i m . H e felt that "they d i d n ' t understand. T h a t ' s the difference between - understanding the sickness or t h i n k i n g someone is an e v i l person. I c a n ' t c o n v i n c e p e o p l e I ' m not an e v i l person. I c a n just try to c h a n g e . " H e d e s c r i b e d the steps s o m e o f his f a m i l y t o o k i n order to understand h i m : T h o s e that understand and want to support m e are the ones that t o o k the t i m e to get the k n o w l e d g e , to get the understanding, to read the b o o k s , to talk to experts. T o f i n d out what was w r o n g w i t h m e . L a c k o f understanding o n the part o f s o m e f a m i l y m e m b e r s was e x p e r i e n c e d as i m p e d i n g for this participant whereas he felt the attempts made b y others to understand his situation facilitated his h e a l i n g j o u r n e y . I n d i v i d u a l s i n this study felt that health professionals d i d not a l w a y s understand their situation. F o r e x a m p l e , one participant mistrusted his p s y c h i a t r i s t ' s m o t i v e s : "there was a l w a y s this little itty bitty thought i n the b a c k o f m y m i n d that I bet h e ' d just l o v e to have m e c o m i n g b a c k for m a n y , m a n y , m a n y sessions so that he c a n m a k e m o r e m o n e y . " T h i s i n d i v i d u a l d e s c r i b e d his concerns about his p s y c h i a t r i s t ' s understanding o f a d d i c t i o n : " I sort o f felt l i k e y o u ' v e got that degree o n y o u r w a l l , right, and y o u ' v e p r o b a b l y read a lot o f b o o k s and stuff but what d o y o u r e a l l y k n o w about it f r o m . . . p e r s o n a l e x p e r i e n c e . " T h i s c o n c e r n about health professionals was e c h o e d b y  83  another participant: " W i t h a l l due respect to a c a d e m i c s et cetera, they d o n ' t n e c e s s a r i l y understand a n y t h i n g . Y o u have to w a l k w i t h it, be i n v o l v e d w i t h it, meet people i n it to b e g i n to understand." T h e s e feelings o f m i s u n d e r s t a n d i n g were e x p e r i e n c e d as i m p e d i n g participants i n their h e a l i n g j o u r n e y s . S o m e interactions d e s c r i b e d b y participants h i g h l i g h t e d their l a c k o f selfunderstanding that kept them i s o l a t e d and stuck i n their a d d i c t i v e patterns. A s one participant noted: U p u n t i l the t i m e I went into r e c o v e r y w h i c h was I guess a year ago I felt i s o l a t e d a n d I felt I h a d an e v i l n e s s i n s i d e m e and I d i d n ' t k n o w what I was g o i n g to do about it. M y thoughts were bizarre, w e i r d - centered o n self-gratification, selfcentered et cetera. I k n o w today that I ' m not that w a y . I can accept it. I w o u l d w a l k into a r o o m and I w o u l d t h i n k e v e r y b o d y was l o o k i n g at me. I c a n w a l k into a r o o m n o w and p e o p l e accept m e for w h o I a m . A n o t h e r participant tried to understand and c o m e to terms w i t h s o m e o f his past actions. H e d e s c r i b e d h i m s e l f as " t w i s t e d " and " a n t i s o c i a l . " W h e n he was y o u n g he s a i d he just w a n t e d to be " n o r m a l . Just l i v e a n o r m a l , m e d i o c r e l i f e . " H i s fear m o t i v a t e d h i m to ask a psychiatrist i f he " w a s a h e a d case." H e expressed his fear o f others k n o w i n g his thoughts. A b o u t A A meetings he said, " I n e v e r share there. I never say a w o r d . N e v e r . I h a v e n ' t o n c e . " H e s a i d that the i d e a o f s h a r i n g " m a k e s m e feel l i k e p r o b a b l y I ' d be n a k e d . " A n o t h e r participant admitted his fear o f e x p o s i n g his thoughts to others.  He  o n l y saw his psychiatrist once because he was "terrified that i f I r e a l l y t a l k e d about m y real feelings that I w o u l d get l o c k e d u p . " Interactions w i t h others h i g h l i g h t e d  84  i n t e r v i e w e e s ' fears. T h e fear o f e x p o s i n g their thoughts and feelings to others was e x p e r i e n c e d as i m p e d i n g participants' h e a l i n g j o u r n e y s . Interactions w i t h others also e m p h a s i z e d s o m e p r e c o n c e i v e d notions participants h a d about i n d i v i d u a l s w i t h addictions. O n e i n t e r v i e w e e felt he needed to separate h i m s e l f m e n t a l l y f r o m the p e o p l e i n his transition house. H e d e s c r i b e d t h e m as " a b u n c h o f losers." H e m a d e it clear that he p a i d his o w n rent; the g o v e r n m e n t d i d not. H e also gave an i n d i c a t i o n that he d i d not want to identify w i t h other addicts. H e d e s c r i b e d the i n d i v i d u a l s he met i n v a r i o u s r e c o v e r y settings as "freaks," " l o s e r s " and " s k i d s . " In his refusal to m a k e c o n n e c t i o n s w i t h i n d i v i d u a l s i n the A A p r o g r a m , he d e s c r i b e d f e e l i n g p u l l e d between his o l d w o r l d and the n e w one o f h e a l i n g . T h e p r e c o n c e i v e d notions h e l d b y participants were e x p e r i e n c e d as h i n d e r i n g their h e a l i n g process. A s a result o f c h a n g i n g their lifestyles and e d u c a t i n g themselves about a d d i c t i o n , a n u m b e r o f p a r t i c i p a n t s ' feelings t o w a r d other addicts shifted. O n e participant c o m m e n t e d o n h o w the rewards o f v i s i t i n g w i t h addicts i n detox benefitted his understanding o f a d d i c t i o n : W e a l l understand what w e ' r e g o i n g through. B a c k i n the o l d days I used to t h i n k those p e o p l e were just degenerates, b a d , b a d h u m a n beings. Y o u k n o w , i f t h e y ' d just clean up their act, get a j o b , t h e y ' d be o k a y . I d i d n ' t have the understanding. T h a t ' s the w a y I understood t h e m . . . .The biggest r o a d b l o c k to m e to the w h o l e process is that understanding. U n d e r s t a n d i n g w h y that u h that d r u n k is f a l l i n g d o w n i n the gutter, w h y that g i r l is standing o n that street c o r n e r s e l l i n g her b o d y . U m - i t ' s not because t h e y ' r e b a d people. It's because t h e y ' r e s i c k people. I feel i f I c o u l d get m y - i f I c o u l d - i f m y w i f e and t w o k i d s w o u l d understand that,  85 they w o u l d p r o b a b l y not have the desire to have m e out o f their life. T h e y ' d want to have m e b a c k i n their life. O f m e e t i n g up w i t h addicts f r o m his past, this i n d i v i d u a l noted: I ' v e met s o m e p e o p l e . . . w h o ' v e stolen f r o m m e . . . a n d r i p p e d m e off. B u t I have n o a n i m o s i t y . I f I saw t h e m o n the street t o m o r r o w , I ' d g i v e t h e m a h u g . B e c a u s e I k n o w what t h e y ' r e g o i n g through is is - is p a i n . A s participants began to understand other i n d i v i d u a l s w i t h a d d i c t i o n s , so d i d they c o m e to feel understood. Often these interactions i n v o l v e d i n d i v i d u a l s i n the A A p r o g r a m or i n d i v i d u a l s w i t h addictions.  O n e i n t e r v i e w e e m a d e c l e a r the i m p o r t a n c e o f  the a d d i c t i o n h i s t o r y o f i n d i v i d u a l s he dealt w i t h : T h e p e o p l e i n the r e c o v e r y house h a d a huge effect o n m e . T h e y ' r e a l l f o r m e r addicts or a l c o h o l i c s . I c o u l d n ' t - w h e n I spoke about m y p r o b l e m w i t h drugs -1 c a n ' t d e a l w i t h p e o p l e w h o h a v e n ' t used drugs. W e l l - not that I c a n ' t d e a l w i t h t h e m - they d o n ' t understand. A n o t h e r participant also endorsed this i d e a b y d e s c r i b i n g i n d i v i d u a l s f r o m A A : "these p e o p l e understand that i t ' s o k a y to have s u i c i d a l thoughts a n d that i t ' s o k a y - s o m e o f the c r a z y shit w e ' v e done w h i l e w e were, y o u k n o w , i n t o x i c a t e d . " T w o i n t e r v i e w e e s d i s c u s s e d the i m p o r t a n c e o f the understanding they r e c e i v e d f r o m their sponsors. O n e i n d i v i d u a l c o m m e n t e d about his sponsors: I have faith i n them. It's l i k e faith, y o u k n o w . I j u s t k n o w i t . I k n o w that I c o u l d u h - y o u k n o w I c o u l d talk to t h e m about stuff that I c o u l d not t a l k to, for e x a m p l e , m y brother or m y mother, y o u k n o w , or m y friends that I ' v e k n o w n since grade t w o . B e c a u s e those p e o p l e are, y o u k n o w , not a l c o h o l i c . R i g h t , l i k e  86  they d o n ' t have the same e m o t i o n a l , m e n t a l w i r i n g that I do, right. B u t m y t w o a l c o h o l i c friends do. O n e p a r t i c i p a n t ' s e m p l o y e r was also i n the p r o g r a m . H e felt an acceptance a n d understanding f r o m h i m . H e said, " W e can talk about the p r o g r a m . I n s t a n t l y . . . . S o - i f I have a n y difficulties at a l l , as l o n g as y o u put it o n a s p i r i t u a l l e v e l , I can ask h i m for help. H e k n o w s e x a c t l y what a s k i n g for h e l p i s . " H i s felt his step group also understood his situation. H e c o m m e n t e d that the i n d i v i d u a l s i n his step group were i n a p o s i t i o n to say to h i m , " y e a h , I ' v e been there. Y e a h , I understand." Interactions that h i g h l i g h t e d participants' g r o w t h i n understanding o f self a n d others were e x p e r i e n c e d as f a c i l i t a t i v e i n their h e a l i n g j o u r n e y s . A negative side o f understanding c a m e f r o m interactions w h e r e users supported each other. O n e participant d e s c r i b e d that his g i r l f r i e n d was sensitive to his situation w h i l e he was u s i n g drugs. H e c o m m e n t e d : "I felt that she u n d e r s t o o d m e . S h e was a f e l l o w - a d d i c t . W e used together."  A n o t h e r i n t e r v i e w e e reflected o n the nature o f  interactions between users: T h e y c o u l d even seem - i n a m o m e n t a r y w a y - h e l p f u l . Y o u ' r e i n a j a m , y o u need a j o b or a p l a c e to stay or y o u want to b o r r o w s o m e m o n e y or s o m e t h i n g l i k e that, then p e o p l e w i l l - there is a sense o f c o m m u n i t y there. T h e y can be helpful i n a short t e r m k i n d o f w a y . U n d e r s t a n d i n g that o r i g i n a t e d i n relationships a m o n g users was e x p e r i e n c e d b y participants as i m p e d i n g their h e a l i n g j o u r n e y although they felt helpful at the t i m e . In c o n c l u s i o n , i n d i v i d u a l s i n this study felt that interactions i n v o l v i n g understanding or m i s u n d e r s t a n d i n g were i n f l u e n t i a l to t h e m i n their h e a l i n g j o u r n e y s .  87  Participants felt that interactions w h e r e they were understood b y others w h o were not addicts were f a c i l i t a t i n g i n their h e a l i n g . A s w e l l , w h e n they understood themselves a n d other addicts these interactions were p e r c e i v e d as f a c i l i t a t i v e o f h e a l i n g . H o w e v e r , interactions i n v o l v i n g m i s u n d e r s t a n d i n g were e x p e r i e n c e d as i m p e d i n g o f health as were those understanding interactions that i n v o l v e d other users. A Sense o f B e l o n g i n g or N o t B e l o n g i n g A n o t h e r theme that was significant for i n d i v i d u a l s i n this study was that o f b e l o n g i n g or not b e l o n g i n g . S h a r i n g their stories and l i v e s i n a supportive context w i t h other addicts or w i t h i n A A gave interviewees the sense, sometimes for the first t i m e i n their l i v e s , o f b e l o n g i n g to a group. S o m e participants h a d p r e v i o u s l y felt a sense o f b e l o n g i n g and c o n n e c t i o n w i t h other users or a m o n g d r u g dealers. Others felt trapped between their u p s t a n d i n g life and their life o f drugs and a l c o h o l . Interviewees reported that f e e l i n g a sense o f b e l o n g i n g a m o n g i n d i v i d u a l s they felt were healthy influences was helpful to t h e m on their path o f h e a l i n g f r o m a d d i c t i o n . A l t e r n a t e l y , participants expressed that feelings o f e x c l u s i o n or b e l o n g i n g i n c i r c l e s i n v o l v i n g drugs or a l c o h o l use were i m p e d i n g i n their h e a l i n g j o u r n e y s . O n e participant expressed his feelings o f p a i n and anger after his f r i e n d d i e d and his w i f e left h i m . H e d i d not b e l i e v e he h a d anyone to c o n f i d e i n about his p r o b l e m s or his feelings because the i n d i v i d u a l s he was surrounded b y were other d r u g dealers. H e noted: Y o u d o n ' t go p o u r y o u r heart out to these d r u g dealers a n d c r i m i n a l s , r i g h t . . . .So it just - y o u just b u r y it and b u r y it and b u r y it and c o v e r , c o v e r , c o v e r , c o v e r , right. S o the o n l y w a y to escape those feelings is b y getting h i g h .  88  T h i s participant also e x c l u d e d h i m s e l f f r o m the category o f r e c o v e r i n g addicts. H e d e s c r i b e d his sentiments about them: T h o s e p e o p l e are perfect strangers. I c a n ' t - the o n l y t h i n g that I have i n c o m m o n w i t h t h e m is that I used to use drugs. A n d that's the o n l y t h i n g . O t h e r than that m a y b e I ' d get s o m e b o d y to sell t h e m drugs. I w o u l d n e v e r associate w i t h t h e m . A n o t h e r i n t e r v i e w e e chose to c l a s s i f y h i m s e l f a c c o r d i n g to his a d d i c t i o n status. H e separated h i m s e l f f r o m " n o r m y s " or ' n o r m a l ' p e o p l e w h o d i d not struggle w i t h a d d i c t i o n issues. A s he stated: I put m y s e l f i n a different class because o f the a l c o h o l i s m a n d d r u g a d d i c t i o n s o m e p e o p l e l o o k at it as t h e y ' r e b l e s s e d because t h e y ' v e got this p r o b l e m . T h i s disease. I d o n ' t l o o k at it that w a y . I ' m not too p r o u d o f b e i n g an a l c o h o l i c or d r u g addict. I w o u l d have rather l i v e d m y life as a n o r m y . W h e n one participant felt his d r i n k i n g and d r u g use was getting out o f c o n t r o l he was reluctant to talk to anyone about it. H e was c o n c e r n e d w i t h h o w his friends or brothers w o u l d r e s p o n d . H e w a n t e d to m a i n t a i n an o u t w a r d appearance o f b e i n g "able to go w i t h the f l o w . " A t the t i m e he felt " i t w o u l d be u n c o o l to not be able to handle it, r i g h t . " O n e i n t e r v i e w e e reported e n d u r i n g v e r b a l abuse f r o m his spouse i n order to c o n t i n u e his c o n n e c t i o n w i t h her. H e d e s c r i b e d his feelings: I m i s s e d her so m u c h I w o u l d n ' t m i n d b e i n g c a l l e d an asshole, a loser and an asshole b y her right n o w because that w o u l d be better than not h a v i n g her around. T h a t ' s the sort o f c r a z i n e s s . . .that's the a d d i c t i o n - that y o u w o u l d accept the abuse because i t ' s better than n o t h i n g .  89  Interviewees d e s c r i b e d a v o i d i n g interactions where they c o u l d discuss their p a i n and concerns. A s w e l l , they recounted interactions i n v o l v i n g s t a y i n g i n u n h e a l t h y r e l a t i o n s h i p s for fear o f b e i n g aione. T h e r e s u l t i n g e x p e r i e n c e b y participants o f not b e l o n g i n g or b e l o n g i n g to a group w h e r e the i n f l u e n c e was negative, r e p o r t e d l y h a d a i m p e d i n g effect o n t h e i r h e a l i n g . Participants d e s c r i b e d their life w i t h drugs as a p l a c e w h e r e they felt they b e l o n g e d , e v e n t h o u g h it i m p e d e d their h e a l i n g j o u r n e y s . O n e participant n o t e d the p u l l he felt to the w o r l d o f drugs: " I a l w a y s felt some affinity for that w o r l d . I felt I b e l o n g e d . " D r i v i n g to a n d f r o m w o r k he w o u l d d r i v e b y M a i n and H a s t i n g s . O f this he said, " I a l w a y s felt that s o m e day I ' d e n d up there a n d I d i d . I d o n ' t k n o w w h y . M a y b e I thought that's w h e r e I b e l o n g e d . " A n o t h e r i n t e r v i e w e e d e s c r i b e d s i m i l a r feelings about h i s h i s t o r y as a d r u g dealer: It's w h o I a m . . . . T h a t ' s w h o I w a s . H o w d o y o u change that? I ' m 4 7 years o l d . B e e n d e a l i n g drugs a l l m y life. I ' v e a l w a y s been i n a management, c o n t r o l l e d situation. N o w y o u ' r e s a y i n g I have to g i v e it a l l up. F o r w h a t ? A l t h o u g h m a i n t a i n i n g unhealthy m a r i t a l interactions a n d interactions w i t h i n d i v i d u a l s i n the d r u g culture h e l p e d participants m a i n t a i n a f e e l i n g o f b e l o n g i n g , they r e a l i z e n o w that these interactions h i n d e r e d t h e m o n their p a t h w a y out o f a d d i c t i o n . T h e sense o f b e l o n g i n g s t e m m i n g f r o m relationships w i t h other users and their substance o f c h o i c e also i n v o l v e d i m p e d i n g interactions for participants i n this study. O n e participant d e s c r i b e d the d r a w o f other addicts f o r h i m : " c e r t a i n l y p e o p l e y o u use w i t h , the p e o p l e y o u d r i n k w i t h e n d up b e i n g an i m p e d i m e n t . B e c a u s e y o u get attached to t h e m . It b e c o m e s y o u r c o m m u n i t y . " H e further d e s c r i b e d this i l l u s i o n o f b e l o n g i n g  90  a n d c o m m u n i t y i n the f o l l o w i n g w a y : " w h e n y o u d r i n k - y o u go to the same bars and y o u have the same pals and y o u get into this routine. It seems to support y o u . " A n o t h e r i n t e r v i e w e e t a l k e d about a d d i c t i o n a l l o w i n g a person to push certain boundaries. A s he noted, " y o u e n d up d o i n g things and b e i n g i n v o l v e d w i t h p e o p l e y o u w o u l d not be i n v o l v e d w i t h " i f a d d i c t i o n was not part o f the equation. In d e s c r i b i n g his g i r l f r i e n d , he reported that their c o n n e c t i o n was l a r g e l y based on u s i n g together. She was f r o m a " t o t a l l y different s o c i o - e c o n o m i c b a c k g r o u n d . " T h i s same participant r e m a r k e d that he needed to separate h i m s e l f f r o m his g i r l f r i e n d w h e n she started u s i n g drugs again. H o w e v e r , he s a i d to some extent he felt he b e l o n g e d i n that w o r l d . "Part o f m y b r a i n says do it, do it, d o it y o u ' v e got to go b a c k there. Y o u ' r e a l o s e r . . . y o u ' r e a loser, she's a loser." A l t h o u g h some participants felt they b e l o n g e d i n the d r u g w o r l d , a n u m b e r o f t h e m also expressed a sense o f never quite f e e l i n g as though they fit i n t o that w o r l d . A t one p o i n t o n his h e a l i n g j o u r n e y , one participant q u e s t i o n e d his alternatives. H e was t h i n k i n g "Is that it? Is that m y o p t i o n , hopeless addict o r Jesus freak? W a s I c o n d e m n e d to t h i s ? " T h i s same i n d i v i d u a l c o m m e n t e d o n his sense o f not b e l o n g i n g : I t h i n k at the heart o f d r u g a d d i c t i o n is some k i n d o f d i s l o c a t i o n w i t h life, some fear a n d l o n e l i n e s s at the heart. A n d i t ' s d i f f i c u l t to get a l o n g w i t h other people, to fit i n w i t h the w o r l d and feel g o o d about y o u r s e l f . . . .The a d d i c t i o n is a n s w e r i n g that u n d e r l y i n g p r o b l e m . A "feature o f a l l a d d i c t s " he c o n t i n u e d , was that: T h e y a l l have that p r o b l e m - o f n e e d i n g l o v e , n e e d i n g to l o v e and to be l o v e a b l e a n d they d o n ' t get it. T h e y d o n ' t t h i n k t h e y ' r e getting it and they t h i n k drugs w i l l  91  be the s o l u t i o n . M a k e s them feel g o o d . Y o u take drugs or y o u d r i n k because it m a k e s y o u feel g o o d . A day later y o u c a n ' t stop. T h r e e i n d i v i d u a l s i n this study d i s c u s s e d f e e l i n g as t h o u g h they were l i v i n g t w o l i v e s , the u p s t a n d i n g c i t i z e n and the d r u g addict or dealer, yet not r e a l l y b e l o n g i n g c o m p l e t e l y to either w o r l d . O n e i n t e r v i e w e e felt his d o u b l e life was d i s c o v e r e d w h e n he was " c o e r c e d into g o i n g to m e e t i n g s " b y colleagues at w o r k . H e felt he needed to " c l e a n u p " his act. T h e d o u b l e life for another participant i n v o l v e d h a v i n g a j o b w h e r e he " d i d a l l the right t h i n g s , " but he also dealt drugs o n the side. S t i l l another i n d i v i d u a l d e s c r i b e d the d o u b l e life he was l i v i n g . A t age 25 he was m a r r i e d , h a d three c h i l d r e n , a mortgage as w e l l as a " w o n d e r f u l career." H e sat on the " b o a r d o f directors for a c o u p l e f o u n d a t i o n s " and was the "president o f the h o c k e y a s s o c i a t i o n . " H e e v e n " w a l k e d a w a y f r o m drugs and a l c o h o l w h e n he first got m a r r i e d . " H o w e v e r the a l c o h o l crept b a c k i n to his life a n d then he started u s i n g c r a c k . H e d e s c r i b e d his feelings.about d o i n g crack: It was just l i k e g o i n g to a p l a c e I s h o u l d n ' t have been at and I k n e w i t . . .1 s h o u l d n ' t have been there. B u t it was the p l a c e I f i g u r e d I b e l o n g e d . . . . 1 was c o m f o r t a b l e there. I was c o m f o r t a b l e s m o k i n g c r a c k w i t h other c r a c k addicts. I was v e r y , v e r y c o m f o r t a b l e sitting i n a c r a c k house w i t h a b u n c h o f other c r a c k addicts. R a t s r u n n i n g around. N e e d l e s o n the floor. I h a d n o q u a l m s about that and I thought this was the place that I b e l o n g e d . I felt that's w h e r e I s h o u l d be. H e expressed the attraction the d r u g w o r l d h a d to h i m : " I ' d d r i v e b y M a i n and H a s t i n g s and i t ' s not a pretty sight at the best o f times i t ' s not a pretty s i g h t . . . . B u t I still have the f e e l i n g there's a party g o i n g on and I w a s n ' t i n v i t e d . " A l t h o u g h this participant kept up  92  the appearance o f the upstanding b u s i n e s s m a n , he was u n c o m f o r t a b l e i n that r o l e and felt he was m o r e suited to the d r u g w o r l d . A t the height o f his career, he was r e q u i r e d to g o to m a n y receptions a n d parties where he s a i d he, " a l w a y s felt u n c o m f o r t a b l e , a l w a y s drunk, a l w a y s at the bar, a l w a y s fearful." N o w he acted out his sense o f b e l o n g i n g to the w o r l d o f a d d i c t i o n i n a m o r e p o s i t i v e w a y . H e e x p l a i n e d , " I g o to a detox centre and I k n o w that i n that r o o m are d r u g addicts, thieves, p o s s i b l y a m u r d e r e r o r t w o but I feel v e r y safe." H e s a i d he n o w feels l i k e he is "part o f s o m e t h i n g - b i g g e r than m e . " T h e u n f u l f i l l i n g interactions i n v o l v e d i n b e l o n g i n g to the d r u g w o r l d or f e e l i n g trapped between a life o f substance abuse and ' n o r m a l c y ' w e r e e x p e r i e n c e d b y participants as i m p e d i n g o n their j o u r n e y s t o w a r d health. H o w e v e r , the i n v o l v e m e n t i n r e h a b i l i t a t i o n o f addicts gave one i n t e r v i e w e e a constructive sense o f b e l o n g i n g that he felt facilitated his healing. F i v e participants d e s c r i b e d interactions i n v o l v i n g other f o r m e r a l c o h o l i c s and addicts, f a m i l y m e m b e r s , and friends that fostered their sense o f b e l o n g i n g a n d f a c i l i t a t e d their h e a l i n g . F o r m e r addicts and a l c o h o l i c s were d e s c r i b e d b y one participant i n the f o l l o w i n g w a y : " W e ' r e a l l the same. Sort o f l i k e y o u go into a c l u b . . ..I never b e l o n g e d up to then. A sense o f b e l o n g i n g . " H e elaborated on what gave h i m this sense o f i n c l u s i o n : " W e have s o m e t h i n g i n c o m m o n . T h e t h i n g w e h a d i n c o m m o n was not necessarily o u r d r u g and a l c o h o l abuse....It was the feelings that m a d e us use drugs and a l c o h o l . . . . I s o l a t i o n , fear, l o n e l i n e s s . " A n o t h e r i n t e r v i e w e e i n d i c a t e d he was w i l l i n g to invest m o r e i n his f a m i l y i n order to m a i n t a i n his sense o f b e l o n g i n g . H e said, " T h a t ' s f a m i l y . T h a t ' s b l o o d . It's a little bit t h i c k e r than water." L i v i n g i n a house where she felt at ease i n s t i l l e d a sense o f b e l o n g i n g for s t i l l another participant. She d e s c r i b e d the  93  r e c o v e r y house w h e r e she was l i v i n g as b e i n g " a p l a c e I c a l l h o m e . . . .1 feel v e r y c o m f o r t a b l e there." S h e t a l k e d about her r o o m m a t e : " S h e r o c k s . L i k e w e sit up to one, one thirty just l a u g h i n g . Y o u k n o w . A n d just t a l k i n g . A n d g e l l i n g . Y o u k n o w , i t ' s so n i c e . T h a t ' s what r e c o v e r y s h o u l d be about." S h e also reported b e i n g v e r y h a p p y w i t h the other p e o p l e l i v i n g i n the r e c o v e r y house: L i k e at ten o ' c l o c k at night d u r i n g the w e e k w e have snack. T h a t ' s w h e r e - y o u can just sit d o w n and just talk w i t h people. L i k e i t ' s so n i c e , y o u k n o w . U h m e a l t i m e s . Is a t i m e to talk w i t h people, y o u k n o w . It's, i t ' s a great group. It's a r e a l l y n i c e group. S h e d e s c r i b e d the staff w h e r e she l i v e s as v e r y open a n d supportive so that she feels her "needs are b e i n g met." S h e contrasted this experience w i t h her encounters at the p r e v i o u s f a c i l i t y w h e r e she l i v e d . S h e d e s c r i b e d the staff there as v e r y " u n a p p r o a c h a b l e " and " d e m e a n i n g " t o w a r d her. T h i s p a r t i c i p a n t ' s n e w f o u n d stability a l l o w e d her to appreciate and take part m o r e f u l l y i n life. S h e e n j o y e d " s o c i a l i z i n g " w i t h her sponsor a n d friends. S h e has p l a y e d "tourist" w i t h her friends. S h e was " r e c o n n e c t i n g " w i t h other p e o p l e i n her life and m e e t i n g n e w p e o p l e . T h e acceptance and c o m m o n experience o f a d d i c t i o n a m o n g i n d i v i d u a l s i n A A has p r o v i d e d a sense o f b e l o n g i n g for several participants. W h e n one i n t e r v i e w e e first went to A A he s a i d : T h e first t h i n g I r e m e m b e r was the s m i l i n g face this g u y - m i d d l e aged m a n s m i l i n g face, h a n d out, ' w e l c o m e ' y o u k n o w . . . . S o that was l i k e a h u m a n b e i n g , right. W i t h a s m i l e , right, l o o k i n g m e i n the eye, w e l c o m i n g m e . . . .That was so important.  94 H e a c k n o w l e d g e d the v a l u e and i m p o r t a n c e o f f e e l i n g w e l c o m e d and accepted, as he put it, " b y his k i n d . " A n o t h e r i n t e r v i e w e e had been to A A before. O f his sense o f b e l o n g i n g he m e n t i o n e d that this t i m e " I k n e w I w o u l d be accepted. T h e question was whether I accepted t h e m . " T h i s participant s a i d o f his n e w life i n A A : It's f i l l e d w i t h other people. N e w associations. N e w associations that are also w a r m a n d - 1 w e l c o m e them. I w a n t e d t h e m and they were there. P e o p l e were n i c e to m e so y o u w e l c o m e t h e m . Y o u l o o k f o r w a r d to seeing p e o p l e . A lot o f the reason I g o to meetings n o w is s o c i a l . T h i s p a r t i c i p a n t ' s step group was "quite i m p o r t a n t " to h i m . H e c o n s i d e r e d t h e m his "friends." T h e " h o n e s t y " and " e m p a t h y " o f the group gave h i m the o p p o r t u n i t y to share what was g o i n g o n i n his life.  T h i s participant also n o t e d the " e m p a t h y " and  " u n d e r s t a n d i n g " o f his sponsor through the personal stories he w o u l d share w i t h h i m . T h e transition house, where this participant l i v e d at the t i m e o f the i n t e r v i e w , also p r o v i d e d h i m w i t h a sense o f c o m m u n i t y . A s he noted, " T h e r e ' s a l w a y s p e o p l e a r o u n d to talk to. Y o u ' r e always i n a c o m m u n i t y of some similarity, some unity, some solidarity."  The  i n d i v i d u a l s l i v i n g i n the house shared a " c o m m o n v o c a b u l a r y " so that this participant felt " w h e n I go h o m e I k n o w I ' m safe... .and y o u get s o m e sense o f feedback. A n d often good-natured." Participants felt their experiences w i t h f o r m e r a l c o h o l i c s and addicts, supportive and understanding f a m i l y and friends, as w e l l as supportive staff w h e r e one participant l i v e d were l a r g e l y p o s i t i v e : f a c i l i t a t i n g their h e a l i n g process. In c l o s i n g , i n d i v i d u a l s i n this study a l l d e s c r i b e d experiences w h e r e they felt either a sense o f b e l o n g i n g or not b e l o n g i n g . O n the w h o l e , w h e n associations were i n c l u s i v e and w e l c o m i n g a n d c a m e f r o m a source not i n v o l v i n g drugs or a l c o h o l , the  95  interactions d e s c r i b e d were reported as f a c i l i t a t i v e i n the participants' h e a l i n g j o u r n e y . O n the other hand, participants d e s c r i b e d interactions w i t h i n d i v i d u a l s w h o were s t i l l i n v o l v e d w i t h drugs or a l c o h o l that fostered a sense o f b e l o n g i n g or c o m m o n a l i t y at the t i m e b y s t e m m i n g their fear and l o n e l i n e s s . H o w e v e r , these interactions were e x p e r i e n c e d as i m p e d i n g their h e a l i n g progress. F i n a l l y , interactions w h e r e i n t e r v i e w e e s felt e x c l u d e d were e x p e r i e n c e d as h i n d e r i n g i n their h e a l i n g j o u r n e y . A Sense o f M e a n i n g or M e a n i n g l e s s n e s s T h e theme o f a sense o f m e a n i n g or meaninglessness i n c l u d e s descriptions b y participants o f interactions that h e l p e d to p r o v i d e m e a n i n g or f a i l e d to b r i n g m e a n i n g to their l i v e s . Interactions d e s c r i b e d b y participants as m e a n i n g f u l to t h e m i n c l u d e d those where there were opportunities for t h e m to m a k e p o s i t i v e c o n t r i b u t i o n s or leave f a v o u r a b l e legacies. I n d i v i d u a l s i n this study d e s c r i b e d t u r n i n g points as situations where they struggled to f i n d or m a k e m e a n i n g o f their life c i r c u m s t a n c e s . Participants o u t l i n e d m a n y instances w h e r e c o n n e c t i n g w i t h a s p i r i t u a l force was important for t h e m i n b r i n g i n g m e a n i n g to their l i v e s . Interviewees expressed the n e e d for m e a n i n g as c r u c i a l to t h e m i n their d e c i s i o n s about c h a n g i n g their a d d i c t i v e patterns a n d i n m a i n t a i n i n g the changes they h a d m a d e i n their l i v e s . T h r e e i n t e r v i e w e e s expressed i m p e d i n g interactions that u n d e r s c o r e d times w h e n life felt m e a n i n g l e s s and w i t h o u t purpose. O n e o f these situations o c c u r r e d w h e n a participant, as part o f his j o b , was h e l p i n g a y o u n g w o m a n f i n d space i n a r e c o v e r y house. S h e h a d been s l e e p i n g on the beach and he went to h e l p her. S h e d i d not want his h e l p and c o n s e q u e n t l y he felt "frustrated" and " o n edge." H e was " e x h a u s t e d " f r o m t r y i n g to h e l p and not b e i n g appreciated. A n o t h e r participant d e s c r i b e d her despair at the  96  depth o f her depression at the height o f her d r i n k i n g p r o b l e m . S h e s a i d she felt she h a d " n o p u r p o s e " and she " d i d want to d i e . " S h e c o m m e n t e d o n her feelings o f apathy w h e n p s y c h i a t r i c services h a d d e c i d e d to g i v e up her apartment and put her b e l o n g i n g s i n storage: " I d o n ' t t h i n k I r e a l l y c a r e d . " S h e s a i d at that t i m e she was " d e t a c h i n g f r o m everything." T w o i n d i v i d u a l s i n this study d e s c r i b e d c i r c u m s t a n c e s w h e r e they were s e e k i n g m e a n i n g and t r y i n g to sort out the messages that life was h a n d i n g t h e m i n terms o f their a d d i c t i o n . In his prayers, one participant asked, " W h a t does G o d want m e to d o ? W h a t w o u l d G o d d o ? Y o u k n o w the answer I c o m e up w i t h ? B e n i c e . B u t I get t i r e d o f b e i n g n i c e . " T h i s same i n d i v i d u a l d e s c r i b e d l o o k i n g for rules and guarantees i n his n e w life that c o m p a r e d w i t h the v e r y e x p l i c i t rules o f his o l d w a y o f life d e a l i n g drugs. H e s a i d it felt scary j u m p i n g into a life w i t h o u t drugs. H e was t r y i n g to figure out w h y he w o u l d g i v e up his d r u g - i n v o l v e d life that i n v o l v e d his p r e v i o u s s o c i a l n e t w o r k . " W h a t do y o u d o ? W e l l , w h a t ' s right? D o e s it get better? I d o n ' t k n o w . " T h e results o f past interactions returned to haunt h i m , m a k i n g it d i f f i c u l t to step w i t h both feet into a n e w w a y o f life. H e c o m m e n t e d o n his current c i r c u m s t a n c e s : "the hurt a n d the p a i n and the shame and g u i l t I ' m f e e l i n g today is a direct result o f what I have done i n the past." A n o t h e r participant d e s c r i b e d his o l d w a y s o f s e e k i n g m e a n i n g and c o n n e c t i o n w i t h others: If I c a n ' t relate to p e o p l e o n a s o c i a l i s t l e v e l - through c a m p a i g n s or projects, or whatever w e ' r e w o r k i n g o n , w e l l there's a l w a y s the camaraderie o f the bar, the tavern. E m p t y i n a w a y . B u t it answers that same k i n d o f n e e d f o r purpose. O r tries to answer that need that is b e h i n d -1 s a i d d r i n k i n g is a s y m p t o m and there is  97  s o m e t h i n g b e h i n d there - a sense o f l o n e l i n e s s . W e a l l want to l o v e a n d be l o v e d and to be l o v e a b l e . T h e times o f uncertainty were d e s c r i b e d b y i n t e r v i e w e e s as "frustrating." T h e anger a n d uncertainty felt b y participants i n their interactions at these times tended to be e x p e r i e n c e d as i m p e d i n g i n their j o u r n e y s t o w a r d health. T h e m e a n i n g or l a c k o f m e a n i n g i n f o u r i n t e r v i e w e e s ' l i v e s was h i g h l i g h t e d b y instances o f near-misses or t u r n i n g points where it b e c a m e apparent to t h e m that their chances to change their w a y s were r u n n i n g out. F o r t w o participants the deaths o f friends m a d e t h e m question the m e a n i n g o f their l i v e s , and u l t i m a t e l y , they felt, f a c i l i t a t e d their h e a l i n g j o u r n e y s . S e v e r a l interactions h a d o c c u r r e d w i t h one o f the participants that m a d e h i m v e r y aware that his chances were r u n n i n g out to change his w a y s . H e h a d escaped c o n v i c t i o n o n c o c a i n e and h e r o i n t r a f f i c k i n g charges. W h e n w e met he still h a d m a r i j u a n a g r o w i n g charges he was h o p i n g his l a w y e r w o u l d have d i s m i s s e d . H e also t a l k e d about the s i g n i f i c a n c e o f his age to h i m i n terms o f c h a n g i n g his lifestyle: " M y l i f e ' s h a l f o v e r , m a n . . ..freaks m e out. It's, I d o n ' t k n o w , i t ' s l i k e , m a n , i t ' s too late." T h e w a k e up c a l l for another participant c a m e i n the f o r m o f a car accident. H e expressed his realizations at the t i m e o f the accident: T h e r e but f o r the grace o f G o d I c o u l d have k i l l e d that person. O r c r i p p l e d that person for life, right. A n d gone to j a i l for l i k e a l o n g t i m e . O r just the g u i l t , or hurt m y s e l f . . . I thought w e l l n o w i t ' s up. T h e j i g is up. A l t h o u g h the w a k e - u p c a l l s recounted b y i n d i v i d u a l s i n this study s o u n d e d p o t e n t i a l l y negative i n i n f l u e n c e , they were e x p e r i e n c e d b y these participants as t u r n i n g points that  98  m a d e t h e m question the m e a n i n g o f their l i v e s and resulted i n h e a d i n g their l i v e s i n healthier directions. T h r e e participants articulated interactions that seemed to p e r s o n i f y their substance o f abuse, a n d painted a r e l a t i o n s h i p w i t h this 'other' that f o r m e d the purpose for their existence. O n e i n t e r v i e w e e d e s c r i b e d the nature o f this r e l a t i o n s h i p and the m e a n i n g it h e l d for h i m and continues to h o l d i n his life. H e expressed his " p o w e r f u l " r e l a t i o n s h i p with alcohol: M y life t o t a l l y pertains to a l c o h o l . E v e n today. E v e n though I.haven't h a d a d r i n k for almost f i v e years, right. B e c a u s e , y o u k n o w , I ' m i n r e c o v e r y l i k e I n e e d t o . . . h a v e to treat this disease o n a d a i l y basis, right....So m y life still has a lot to d o w i t h a l c o h o l . In fact y o u c o u l d say that m y life still r e v o l v e s a r o u n d a l c o h o l even though I d o n ' t d r i n k it a n y m o r e . H e went o n to describe his l o v e - l u s t r e l a t i o n s h i p w i t h a l c o h o l : I adore a l c o h o l . I m e a n I still t h i n k about it almost l i k e one w o u l d t h i n k about that relationship y o u h a d a l o n g t i m e ago that was - so m a g i c a l and even i n h i n d s i g h t it sometimes seems even m o r e w o n d e r f u l , y o u k n o w . A n d y o u start to t h i n k ' i f o n l y ' a n d 'what i f . ' " T h e p o w e r f u l interactions w i t h drugs or a l c o h o l were d e s c r i b e d as c o n s u m i n g b y participants, to the e x c l u s i o n o f m u c h else i n their l i v e s . T h e c o n t i n u a t i o n o f this r e l a t i o n s h i p i n the f o r m o f u s i n g was e x p e r i e n c e d as detrimental to participants' h e a l i n g j o u r n e y s . T h o s e participants w h o were able to c h a n n e l this focus i n t o a spiritual r e a l m expressed h o w their r e l a t i o n s h i p w i t h a higher p o w e r , " f i l l e d the h o l e " that their d r u g o f c h o i c e h a d p r e v i o u s l y o c c u p i e d a n d greatly facilitated their h e a l i n g .  99 A m e a n i n g f u l s p i r i t u a l c o n n e c t i o n w i t h G o d or a h i g h e r p o w e r was expressed as i n f l u e n t i a l for three interviewees. O n e participant d e s c r i b e d his desire for a s p i r i t u a l c o n n e c t i o n : " A l c o h o l i c s are s p i r i t u a l l y bankrupt k i n d o f p e o p l e . . . . S p i r i t u a l l y thirsty. Just s p i r i t u a l l y starving. L i k e I ' m d y i n g for some - s p i r i t u a l s o l u t i o n . " H e d e f i n e d a l c o h o l i s m i n terms o f his s p i r i t u a l j o u r n e y : " O u r disease is o u r distance f r o m o u r h i g h e r p o w e r . T h e fact w e ' r e not w a l k i n g a s p i r i t u a l path."  T h i s i n d i v i d u a l e x p l a i n e d h o w his  s p i r i t u a l i t y f i l l s the h o l e that the a l c o h o l used to f i l l for h i m : T h a t same l o n g i n g that used to m a k e m e d r i n k is n o w the l o n g i n g that drives m y s p i r i t u a l i t y . . . . P l e a s e G o d . . . d o n ' t let m y life be a waste. Please let m e f i n d s o m e w a y to let m e m a k e a p o s i t i v e c o n t r i b u t i o n . H e l p m e be a g o o d person, a l o v i n g person. H e l p m e to stay sober... .1 so want to k n o w G o d . It's sort o f l i k e a spiritual release for me. I want to have G o d i n m y heart. It's l i k e the same w a y that I w a n t e d that a l c o h o l i n s i d e m e . F o u r participants t a l k e d about prayer b e i n g an important part o f their l i v e s n o w . F o r t w o i n t e r v i e w e e s i n particular, prayer has b e c o m e " r o u t i n e , " or " a habit," and e v e n " a w a y o f l i f e . " O n e i n d i v i d u a l e m p h a s i z e d his f e e l i n g o f c o n n e c t i o n w i t h G o d through prayer: " w h e n I ' m p r a y i n g and m e d i t a t i n g and m a k i n g a c o n n e c t i o n w i t h w h a t e v e r G o d I b e l i e v e i n , I ' m not i n self. I ' m i n a r e l a t i o n s h i p . " A s i d e f r o m prayer, another w a y o f f o l l o w i n g a s p i r i t u a l path that participants d e s c r i b e d i n c l u d e d h e l p i n g others: W h e n people ask us for help i n this p r o g r a m w e ' r e s u p p o s e d to h e l p i f w e ' r e able to. T h a t ' s p a r t l y w h y I a n s w e r e d y o u r flyer. I thought ' y e a h , that's l i k e a request for h e l p . ' I thought - I read it - I thought T fit.' T h e r e ' s s p i r i t u a l things there,  100 right.  Y o u can say G o d puts opportunities i n y o u r path, y o u k n o w , l i k e -  opportunities to be o f service to others. Y o u ' r e s u p p o s e d to say yes. Y o u ' r e supposed to. It's s u p p o s e d to be g o o d for m e . T w o i n t e r v i e w e e s d e s c r i b e d A A as h e l p i n g to shift their focus to a s p i r i t u a l path. Interactions w i t h others have p l a y e d a k e y r o l e for t h e m , but they d e s c r i b e d the o v e r a r c h i n g r o l e o f other people was h o w they fit into G o d ' s p l a n . O n e participant defined G o d as, " w h o e v e r listens to and responds to m y p r a y e r s . " G o d "speaks to m e through p e o p l e . " A n o t h e r i n d i v i d u a l c o m m e n t e d about his e x p e r i e n c e o f the A A program: T h i s is about G o d . It's not just about the 12 steps and i t ' s not just about meetings and sharing. I m e a n those - the steps a n d the p e o p l e s h a r i n g - the interactions have been c r u c i a l to help m e c o m e to understand about a G o d o f m y understanding. H a v e h e l p e d m e c o m e to understand about l o v e and - h e l p e d m e understand about courage a n d about f a c i n g r e a l i t y a n d about b e i n g a h u m a n b e i n g w h o m a k e s m i s t a k e s and that i t ' s o k a y . Participants d e s c r i b e d the experience o f a h i g h e r p o w e r as h e l p i n g to g i v e m e a n i n g a n d a p o s i t i v e d i r e c t i o n to their l i v e s . I n d i v i d u a l s i n this study d e s c r i b e d that a sense o f m e a n i n g or purpose i n their interactions served as a r e m i n d e r o f h o w their l i v e s were e v o l v i n g c o n s t r u c t i v e l y and h e l p e d t h e m c o n t i n u e o n their h e a l i n g paths. O n e i n t e r v i e w e e reflected o n the experience o f o u r i n t e r v i e w : " B e i n g here today and t e l l i n g y o u this stuff is r e a l l y g o o d for m e . It, r e m i n d s m e - to share w i t h s o m e b o d y else w i t h a reasonable amount o f honesty. T h a t  101  feels g o o d . " O n e participant reported that m a k i n g amends to others h e l p e d to p r o v i d e m e a n i n g for h i m : S o m e people have b a s i c a l l y not been too h a p p y to see m e or hear f r o m m e a g a i n . B u t it was for m y benefit. I take r e s p o n s i b i l i t y b y o f f e r i n g - a d m i t t i n g to that person I h u r t . . . .1 a c k n o w l e d g e that I hurt y o u and here's w h y . T h a t d o e s n ' t e x c u s e it but I just want y o u to k n o w I ' m v e r y sorry and I ' m t r y i n g to be a better person. A n o t h e r i n d i v i d u a l strengthened her r e s o l v e to stay o n her current h e a l i n g path w h e n she c o m p a r e d her situation w i t h a w o m a n she k n e w . S h e d e s c r i b e d her e x p e r i e n c e w i t h the w o m a n w h o h a d been l i v i n g i n the same f a c i l i t y but had not c h o s e n a healthy path: T h e r e was a w o m a n here. A n d it just reinforces y o u r sobriety or whatever, that was d r i n k i n g i n her car. T h a t was b a s i c a l l y l i v i n g - that l i v e d i n the house but spent m o s t o f her t i m e i n her car, because she l i v e d i n her car for the last year and a h a l f . . ..It just reinforces that I c a n have this or I c a n be l i k e that. In her descriptions o f several interactions this participant expressed her gratitude for the chance she has been g i v e n to experience life anew. In r e c o u n t i n g v i s i t s w i t h her sponsor she m a r v e l l e d , " I ' m able to d o these things. A n d i f I was d r i n k i n g I w o u l d not be d o i n g t h e m . " Interactions that a l l o w e d participants to e x a m i n e their progress i n h e a l i n g were m e a n i n g f u l for t h e m a n d were e x p e r i e n c e d as f a c i l i t a t i v e . A l o n g w i t h e x p e r i e n c i n g a n e w sense o f m e a n i n g i n their l i v e s , some participants d e s c r i b e d t r y i n g to create m e a n i n g for themselves out o f situations that arose for t h e m . O n e i n t e r v i e w e e was i n the process o f m a k i n g c h o i c e s about what was m e a n i n g f u l for her. O f the A A meetings she attended she said, " I d o n ' t n e c e s s a r i l y listen to e v e r y t h i n g  102 that's g o i n g o n . I take what I want. O r what interests m e out o f the m e e t i n g . " S h e also reflected o n c h o o s i n g the p e o p l e w i t h w h o m she spends t i m e : It d o e s n ' t m e a n e v e r y b o d y y o u meet i n r e c o v e r y y o u ' r e g o n n a be friends w i t h . Y o u k n o w l i k e i n life, y o u gotta p i c k and c h o o s e w h o y o u want i n y o u r life. A n d I ' m i n that process and I ' m o k a y w i t h that. F o r another participant, the w o r k he d i d w i t h others throughout his h e a l i n g process a l l o w e d h i m to gain some perspective o n his experience. H e recounted: R e c o v e r y ' s funny. A s y o u start p u l l i n g o f f these m a s k s , p u l l i n g b a c k the layers, things start p o p p i n g up at y o u . . . . S o n o w one t h i n g r e c o v e r y has a l l o w e d m e to do is put a lot o f the pieces o f the p u z z l e together. H e reported that r e c o v e r y has g i v e n h i m an a p p r e c i a t i o n o f " w h a t got h i m to w h e r e he is t o d a y . " T h r o u g h o u t the experiences recounted b y i n t e r v i e w e e s , the interactions that they felt p r o v i d e d a sense o f m e a n i n g or purpose whether t h r o u g h a s p i r i t u a l c o n n e c t i o n , t u r n i n g points, r e f l e c t i o n on life c i r c u m s t a n c e s , or m a k i n g healthy c h o i c e s , were e x p e r i e n c e d as h e l p f u l i n k e e p i n g participants o n track i n their h e a l i n g j o u r n e y s . F i v e i n d i v i d u a l s i n this study gave e x a m p l e s o f situations w h e r e they were t r y i n g to m a k e a p o s i t i v e c o n t r i b u t i o n to others or d e s i r e d to leave a f a v o u r a b l e l e g a c y . T h e o p p o r t u n i t y to " g i v e b a c k " was important for the h e a l i n g o f participants i n h e l p i n g t h e m feel their life h a d not been a waste and that they were able to m a k e amends for past b e h a v i o u r s . O n e i n t e r v i e w e e had v o l u n t e e r e d to b e c o m e an E S L tutor. A n o t h e r said, " m y g o a l i n life n o w is n o l o n g e r to d o for m e , i t ' s to do for others." S t i l l another participant m e n t i o n e d , " I ' m t a k i n g care o f m y s e l f and I ' m h e l p i n g others."  One  i n t e r v i e w e e was quite distressed at the l e g a c y he p e r c e i v e d he w o u l d leave i f he were to  103  die at the t i m e o f the i n t e r v i e w . H e said: " W h e n I die I d o n ' t want p e o p l e to r e m e m b e r m e as b e i n g ' h o l y f u c k that g u y was f u c k i n ' c r a z y . ' That. A n d as it stands right n o w that's p r o b a b l y h o w they w i l l . " T w o participants c o n s i d e r e d h o w their past actions h a d affected their c h i l d r e n a n d what they c o u l d d o to assist t h e m i n their futures.  One  i n d i v i d u a l was t r y i n g to h e l p his daughter deal w i t h the " i s s u e s " that she had f r o m g r o w i n g up i n an a l c o h o l i c h o m e . A t t e m p t s to leave a p o s i t i v e l e g a c y or m a k e a p o s i t i v e c o n t r i b u t i o n to society gave participants a sense o f m e a n i n g a n d this was p e r c e i v e d as facilitative i n their h e a l i n g j o u r n e y s . F o u r participants expressed the i m p o r t a n c e to t h e m o f g i v i n g b a c k to the a d d i c t i o n s c o m m u n i t y . P r i o r to his o w n struggles, one i n t e r v i e w e e h e l d negative v i e w s about i n d i v i d u a l s w i t h addictions. H e c o m m e n t e d o n his c h a n g i n g v i e w s : " I guess I ' m t r y i n g to r e c o v e r f r o m those years o f t h i n k i n g those p e o p l e w e r e n ' t better people. It's not a g u i l t y f e e l i n g , i t ' s just that I was so w r o n g . " H e v o l u n t e e r e d r e g u l a r l y at detox and felt his c o n t r i b u t i o n there h e l p e d alleviate his g u i l t and also assisted others. H e noted,  "Even  i f I g o b a c k out a n d b e c o m e a d r u g a d d i c t t o m o r r o w I w i l l have d o n e s o m e t h i n g right. T h a t m a k e s m e feel g o o d t o d a y . " H e and another i n t e r v i e w e e also m e n t i o n e d w a n t i n g to contribute i n a m o r e g l o b a l w a y to others w i t h a d d i c t i o n s . A s this participant stated: " I ' m not w e l l e n o u g h to do it. B u t i f there's a n y t h i n g I c a n d o w h e n I get better.. .1 desperately w a n t . . .to see what I c a n d o to help other addicts i n a b i g g e r w a y . " S t i l l another participant c o m m e n t e d o n his reason f o r t a k i n g part i n this research project: " T h a t ' s w h y I rode m y b i k e up here. I feel so g o o d that I c a n h e l p m a y b e s o m e b o d y else d o w n the r o a d through y o u r research." C o n t r i b u t i n g i n p o s i t i v e w a y s gave participants a sense o f m e a n i n g a n d they expressed that this h e l p e d to facilitate their h e a l i n g j o u r n e y s .  104  T o s u m m a r i z e , participants d e s c r i b e d v a r i o u s interactions that were helpful and h i n d e r i n g i n their search for m e a n i n g . A l a c k o f m e a n i n g was e x p e r i e n c e d w h e n i n t e r v i e w e e s were i n v o l v e d i n d i s c o u r a g i n g interactions i n their l i v e s . I n d i v i d u a l s i n this study also d e s c r i b e d interactions w h e r e they sought m e a n i n g and expressed frustration at not getting answers. T u r n i n g points were recounted as constructive experiences, although s o m e t i m e s difficult. F a c i l i t a t i v e interactions were reported w h e n participants felt a sense o f m e a n i n g and purpose i n their l i v e s a n d were o p e n to experiences w i t h a h i g h e r p o w e r or w a n t i n g to contribute to others through their interactions. A Sense o f H o p e o r H o p e l e s s n e s s I n d i v i d u a l s i n this study recounted interactions i n v o l v i n g hope a n d hopelessness that they felt were i n f l u e n t i a l i n their h e a l i n g j o u r n e y s . F e e l i n g hopeful was reported to be an integral f a c i l i t a t i v e experience for participants i n their j o u r n e y t o w a r d health. Situations w h e r e hopelessness p r e v a i l e d generated feelings o f futility, frustration, powerlessness, and failure. A l t e r n a t e l y , w h e n they were h o p e f u l , participants d e s c r i b e d f e e l i n g openness to change, and w i t h that, a w i l l i n g n e s s to f o l l o w the g o o d e x a m p l e s o f others. I n c l u d e d i n interactions that p r o v i d e d hope, i n t e r v i e w e e s also d e s c r i b e d the o p t i m i s m that a c o n n e c t i o n w i t h the s p i r i t u a l r e a l m gave them. A sense o f hopelessness e m e r g e d throughout the i n t e r v i e w s i n descriptions b y interviewees o f their feelings o f depression, s u i c i d e , futility, frustration and p a i n that i m p e d e d their h e a l i n g . O n e participant d i s c u s s e d his d o w n w a r d s p i r a l after the deaths o f his friends: I c h a n g e d and I b e c a m e m o r e depressed. M y life b e c a m e m o r e l i m i t e d . . . . I t seemed hopeless. I was angry a n d then the anger h a d n o w h e r e to go. S o the  105  reaction for m e is to get depressed.  Y o u k n o w y o u have this p a s s i o n and i t ' s k i n d  o f useless. It's just d i s r u p t i v e . . ..I get these strong feelings, r i g h t ? A n d then n o t h i n g to do w i t h them. I c a n ' t stop the traffic l i k e I suggested. F o r this i n d i v i d u a l , d r i n k i n g and s o c i a l i z i n g w i t h other drinkers h e l p e d h i m to face the " l o n e l i n e s s " a n d " e m p t i n e s s " he was f e e l i n g . T w o other i n t e r v i e w e e s d e s c r i b e d s u i c i d a l feelings d u r i n g their j o u r n e y through their a d d i c t i o n . O n e participant expressed h o w his s u i c i d a l feelings l e d h i m to c r a c k c o c a i n e : M y m o s t s u i c i d a l I was, was w h e n I stopped d r i n k i n g . I was sober for f i v e years. T h a t ' s w h e n I was most s u i c i d a l . B e c a u s e I d i d n ' t have a p l a c e to go and h i d e . . . . S o I was a l w a y s t h i n k i n ' about g o i n ' o f f the b r i d g e or - 1 felt l i k e I was trapped into s o m e t h i n g . A n d that's w h e n I d i s c o v e r e d c r a c k . C r a c k t o o k a w a y a l l that shit. T o o k a w a y the s u i c i d e . T o o k a w a y a l l those desires to hurt m y s e l f et cetera. F e e l i n g s o f p a i n a n d frustration were also d e s c r i b e d b y t w o participants w r a p p e d up i n feelings o f futility i n their l i v e s . A f t e r e x p e r i e n c i n g a n u m b e r o f p a i n f u l b l o w s to his life i n c l u d i n g his daughter m o v i n g a w a y , not b e i n g trusted at w o r k , a n d not f e e l i n g appreciated, one participant d e s c r i b e d f e e l i n g a l a c k o f p o w e r to change those events. H i s powerlessness left h i m f e e l i n g "hurt," " p u n i s h e d , " " a n g r y , " and i n terms o f his daughter, as t h o u g h his heart h a d been b r o k e n . H e felt l i k e he " d i d n ' t k n o w w h o to trust a n y m o r e " and expressed c o n f u s i o n about a l l the events that were h a p p e n i n g i n his life. H i s feelings translated into h i m i s o l a t i n g h i m s e l f f r o m p e o p l e a n d p u s h i n g others a w a y . A n o t h e r i n t e r v i e w e e expressed his distress o v e r his i n a b i l i t y to help his f a m i l y i n the f o l l o w i n g w a y : " T h e o n l y w a y m y c h i l d r e n are g o i n g to get help is i f there is a  106  crash....So I ' m powerless and helpless and i t ' s frustrating." T h e p a i n f u l feelings were expressed b y participants as i m p e d i n g their h e a l i n g process. D e s c r i p t i o n s o f failure pervaded three participants' i n t e r v i e w s . O n e i n t e r v i e w e e felt he was an e x a m p l e o f failure to his sons, h a v i n g been i n and out o f r e c o v e r y for 18 years. H i s uncertainty about h o w to change was clear f r o m his c o m m e n t s about his r e l a t i o n s h i p w i t h his o l d e r son: I used to treat h i m l i k e m y D a d used to treat m e . A n d w h y d i d I do that? B e c a u s e I d i d n ' t k n o w any better. N o one ever taught m e any different. S o - w e are w h o w e attract a n d w e act l i k e w h o w e ' v e been brought up b y . P e r i o d . W h a t is that? B e h a v i o u r . H o w d o y o u unlearn that? W e l l break the c y c l e . W e l l h o w d o y o u break the c y c l e w h e n y o u ' r e 47 years o l d . H o w d o y o u change? W e l l - 1 d o n ' t know. Participants expressed feelings o f " s h a m e " and " g u i l t " as a result o f their sense o f failure. Interactions reflecting this f e e l i n g o f failure fostered a sense o f hopelessness and futility for participants that they felt i m p e d e d their progress towards a healthier lifestyle. A sense o f hope was discussed b y a l l the i n d i v i d u a l s i n this study as facilitative i n their h e a l i n g j o u r n e y s . Participants e x p e r i e n c e d hope i n their c o n n e c t i o n s w i t h other people, i n f o l l o w i n g or b e i n g i n s p i r e d b y the e x a m p l e s o f others, and also as a result o f their c o n n e c t i o n w i t h things s p i r i t u a l . F o r one i n d i v i d u a l , h a v i n g welfare top up his e m p l o y m e n t insurance h e l p e d h i m take his first steps o n his j o u r n e y t o w a r d health: "I was grateful towards m y welfare f i n a n c i a l e l i g i b i l i t y o f f i c e r w h o j u m p e d through hoops to m a k e sure this w o u l d happen." A t A A meetings he said he l o o k e d for signs o f hope:  107  "I listen for a d v i c e and strength. H o p e and w a y s o f p e o p l e c o n t i n u i n g - are just part o f m y d a i l y life n o w . " O n e i n t e r v i e w e e garnered a sense o f hope f r o m the support a n d encouragement she r e c e i v e d at the R e c o v e r y H o u s e where she was l i v i n g . She also felt hopeful after resisting v e r y strong c r a v i n g s for a l c o h o l she felt just before she got into the r e c o v e r y house where she was l i v i n g . She was accepted to the house because she h a d " m o r e sobriety t i m e " than others o n the w a i t i n g list. She felt this was a sign that she "was o n the right track." S p e n d i n g t i m e w i t h friends also h e l p e d her to f i n d hope and enjoyment i n life again. O n e v i s i t to S p a n i s h B a n k s w i t h a friend brought this reaction: B e a u t i f u l b e a c h ! . . . A n d w e w a l k e d out.. .one S u n d a y . W e h a d to w a l k out 45 minutes to get to the water because that's h o w far out it was. A n d I w a s l i k e this is the life. Y o u k n o w - this is w h y I ' m here. She d e s c r i b e d g o i n g s w i m m i n g on this visit: " w e were just s w i m m i n g i n the Ocean and l a u g h i n g and just h a v i n g fun and I ' m t h i n k i n g this is the life. T h i s is a l l a part o f r e c o v e r y . " S h e s a i d her w o r l d was "brighter. It's a m a z i n g . L i k e the grass was a l w a y s green. I just d i d n ' t see i t . " She was e n j o y i n g r e c o v e r y and her n e w lease o n life, f u e l l e d b y the i n d i v i d u a l s s u r r o u n d i n g her and the sense o f hope and o p t i m i s m that interactions w i t h others gave her. She was r o m a n t i c a l l y interested i n s o m e o n e at the t i m e o f o u r i n t e r v i e w a n d she was r e c o n n e c t i n g w i t h friends. Participants also e x p e r i e n c e d the e x a m p l e s set b y other i n d i v i d u a l s as h e l p f u l i n their h e a l i n g j o u r n e y s . T h e i n d i v i d u a l s p r o v i d i n g p o s i t i v e e x a m p l e s i n c l u d e d sponsors, others i n A A , and p e o p l e i n general. T h r e e interviewees m e n t i o n e d experiences w i t h their sponsors that h e l p e d t h e m to achieve and m a i n t a i n a p o s i t i v e o u t l o o k and approach  108  to life. F o r one i n d i v i d u a l this experience c a m e i n the f o r m o f a r o a d trip, for another it was the p r e v i o u s shared experience o f w o r k i n g together, and for another one important interaction i n v o l v e d e n c o u r a g i n g h i m to go b a c k to meetings w h e n he was f e e l i n g disheartened. O n e sponsor was d e s c r i b e d as " a g o o d g u y , " " a r e l i a b l e f e l l o w and peer," "considerate, courteous, h e l p f u l , and k n o w l e d g e a b l e , " " a person I trusted, person I respected. I k n e w he w o u l d n ' t b u l l s h i t m e . " T h i s p a r t i c i p a n t ' s sponsor h e l p e d m a k e it safe f o r h i m to take the next step i n his h e a l i n g j o u r n e y . A n o t h e r i n t e r v i e w e e m e n t i o n e d that his sponsor was important to h i m as a r o l e m o d e l a n d has h e l p e d h i m out i n difficult times. H e d e s c r i b e d his sponsor i n the following way: H e ' s not a g u r u o r whatever. H e ' s not a c l i n i c a l p s y c h o l o g i s t or whatever.  He's  just an a l c o h o l i c w h o ' s been sober o v e r 28 years and h e ' s a h u m a n b e i n g . H e ' s got faults and he uses the p r o g r a m and sometimes he gets a l l t w i s t e d . Y o u k n o w he's just - 1 want what he has. H e has an a b i l i t y - he just - he c a n deal w i t h life and he seems to r e a l l y - l i k e a pretty h a p p y g u y , right. Others i n the A A p r o g r a m were also e x a m p l e s o f hope for participants. O n e participant noted: " y o u see p e o p l e w h o are g o o d people. I c a n r e c o g n i z e i d e a l i s m . I c a n r e c o g n i z e zeal and I c o u l d see that p e o p l e were sincere and I c o u l d see they were healthy." O f his step group, this i n d i v i d u a l m e n t i o n e d he " l i k e d their stories." H e was i m p r e s s e d b y the fact that "they s t i l l f i n d the patience. A n d the c o m p a s s i o n . B u t the toughness t o o " to h e l p others w i t h their addictions. A n o t h e r participant thought he w o u l d "get r e c o v e r y for a c o u p l e three w e e k s . Straighten his life out. O v e r n i g h t . G e t b a c k o n the street." It d i d n ' t happen that w a y . H e was "affected p r o f o u n d l y b y the p e o p l e i n the r e c o v e r y  109 house." H i s openness to suggestion a n d change was evident i n the i n f l u e n c e that the staff a n d the residents at his r e c o v e r y house h a d o n h i m . H i s r o o m m a t e was an important r o l e m o d e l for h i m . H e h a d "been there for t w o m o n t h s and straightened h i m s e l f out." T h i s i n d i v i d u a l was " v e r y s u p p o r t i v e " and " v e r y w i s e " because o f his e x p e r i e n c e and h a d c r e d i b i l i t y f o r this participant because o f his a d d i c t i o n experience. O t h e r p o s i t i v e e x a m p l e s for participants c a m e i n v a r i o u s forms. A character o n a T V s h o w was a " p o s i t i v e f i g u r e " for one i n t e r v i e w e e . T h i s character h a d a substance abuse p r o b l e m and he got h e l p and was sober i n the s h o w . T h e character was "not a basket case. H e ' s l i k e this i n - c o m m a n d , take charge g u y w i t h the beautiful w i f e . "  This  a l l o w e d the participant to feel that substance a d d i c t i o n was s o m e t h i n g he c o u l d face i f he h a d to: "It was o k a y because it was o k a y for h i m . " F o r one i n t e r v i e w e e , the i n d i v i d u a l s i n his dental c l i n i c were " a picture to m e o f p e o p l e i n v o l v e d i n service. It's detail, i t ' s scientific, i t ' s t e c h n i c a l . It's almost l i k e j e w e l l e r y , f i x i n g teeth. A t the same t i m e i t ' s i n c r e d i b l y s o c i a l . " T h e p e o p l e i n the c l i n i c h e l p e d to restore his " s e l f esteem" a n d " h e a l t h . " F o r this participant, he felt: " E v e r y b o d y I b u m p into i n a w a y facilitates m y h e a l i n g j o u r n e y . ' C u z t h e y ' r e there. I learn s o m e t h i n g . M a y b e I just n o t i c e that t h e y ' r e c h e e r f u l . " I n t e r v i e w e e s ' felt their h e a l i n g j o u r n e y s w e r e f a c i l i t a t e d b y the h o p e f u l , p o s i t i v e e x a m p l e s set b y other i n d i v i d u a l s i n their l i v e s . H o p e was also evident for participants t h r o u g h their s p i r i t u a l c o n n e c t i o n s . M a i n t a i n i n g a p o s i t i v e o u t l o o k was assisted b y prayer and gratitude for a l l that they had. O n e i n t e r v i e w e e felt he was o n the u p s w i n g o f a rollercoaster r i d e and h o p e d the trend w o u l d continue. In order to keep his focus p o s i t i v e he s a i d " I ' m not the m o s t r e l i g i o u s person i n the w h o l e w o r l d or a n y t h i n g but I d o pray to G o d . A n d I ask h i m for h e l p and  110 s o m e strength." A n o t h e r participant felt that "the purpose o f p r a y i n g is the effect o n the person w h o p r a y s . " S t i l l another expressed gratitude for the e x a m p l e o f others and f o r a l l that he h a d i n his life. T h i s c o n n e c t i o n was m a d e f o r h i m through his b e l i e f i n a h i g h e r power. H e explained: W h e n I take m y t i m e to get to k n o w that person, i n the end, I ' m so h a p p y I d i d . T h e ones that are r e a l l y w o r t h w h i l e k e e p i n g are the ones that have it. T h a t have sobriety. O r have life. A g o o d life. T h a t have the message that I b e l i e v e what G o d wants us to be, or Creator, or w h a t e v e r y o u w a n n a c a l l H i m . T h a t gift o f the gift o f g i v i n g , to be so c h i l d l i k e , to be f o r g i v i n g , to be f o r g i v e n and g i v e and g i v e and g i v e . A n d that's what I do. A n d d o n ' t expect a n y t h i n g i n return. T h e r e ' s a lot o f times where i f I d o n ' t expect a n y t h i n g i n return a n d I tell y o u , b o y , i t ' s turned o v e r ten f o l d . L i k e m y daughter, b a c k i n m y life. M y sons c o m i n g into r e c o v e r y . T h a t I ' m not u s i n g dope or d r i n k i n g today. T h a t I have a j o b to c o m p l a i n about. P a r t i c i p a n t s ' s p i r i t u a l connections gave t h e m hope; and they e x p e r i e n c e d this f e e l i n g as facilitative i n their h e a l i n g . T o c o n c l u d e , i n d i v i d u a l s i n this study e x p e r i e n c e d interactions i n v o l v i n g hope and hopelessness as i n s t r u m e n t a l i n both f a c i l i t a t i v e a n d i m p e d i n g w a y s i n their h e a l i n g journeys.  Interactions that were e x p e r i e n c e d as h o p e f u l b y participants were d e s c r i b e d  as helpful i n their h e a l i n g j o u r n e y . Participants d e s c r i b e d situations w h e r e hope was absent as h i n d e r i n g t h e m i n their h e a l i n g process. H o p e was d e s c r i b e d b y participants i n spiritual interactions, interactions w i t h professionals, f a m i l y , friends and i n d i v i d u a l s i n the A A p r o g r a m . H o p e l e s s n e s s was e x p e r i e n c e d i n interactions w i t h other users as w e l l  111  as i n d i s c o u r a g i n g interactions w h e r e participants felt a l a c k o f c o n t r o l o v e r the o u t c o m e o f the interactions. A Sense o f S h i f t i n g Identities T h e f i n a l theme that e m e r g e d d u r i n g this study was a sense o f shifting identities for participants. T h e interactions i n this theme i n v o l v e d p o s i t i v e changes i n b e h a v i o u r a l response or perspective o n the part o f interviewees f r o m h o w they w o u l d have reacted before c e a s i n g their a d d i c t i v e b e h a v i o u r s . Participants p e r c e i v e d these shifts as facilitative i n their h e a l i n g j o u r n e y s . T h e interactions that h i g h l i g h t e d these shifts i n v o l v e d t u r n i n g points, or m a k i n g c o n n e c t i o n s w i t h others or G o d . Interviewees also d e s c r i b e d interactions that h e l p e d t h e m r e a l i z e they c o u l d m a k e m o r e p o s i t i v e c h o i c e s i n their l i v e s . S o m e other interactions expressed i n this theme i n c l u d e d instances w h e r e participants r e a l i z e d that it was acceptable to experience unpleasant e m o t i o n s , w h e n they w o u l d have t r i e d to a v o i d these e m o t i o n s i n the past. A d d i t i o n a l l y , i n d i v i d u a l s i n this study b e c a m e aware through interactions that they c o u l d choose to a v o i d encounters they p e r c e i v e d as negative or h a r m f u l . K e y for t w o participants i n c h a n g i n g their b e h a v i o u r was their part i n a s k i n g f o r help and a c c e p t i n g the h e l p that was g i v e n . T h e interactions reported b y i n t e r v i e w e e s i n this theme e x e m p l i f i e d p o s i t i v e b e h a v i o u r s a n d attitudes that differed greatly f r o m h o w they w o u l d have r e s p o n d e d w h e n they were a c t i v e l y a b u s i n g substances. E v e r y participant reported interactions where they b e h a v e d i n m o r e c o n s t r u c t i v e w a y s than they h a d w h e n f a c e d w i t h s i m i l a r situations i n the past. F o r one i n t e r v i e w e e , an e x a m p l e o f a m o r e favourable response i n v o l v e d his r e a c t i o n to his e x - g i r l f r i e n d ' s n e w s that she was m o v i n g out o f t o w n w i t h his daughter. R a t h e r than s h o w i n g his  112 distress, he responded to his ex-girlfriend more constructively: "I tried to be understanding with her and she - and I didn't have to yell at her and I didn't have to scream, which is really good progress for me." Another instance of behaving differently for this participant was trying to feel secure in his sobriety before he tried to help his grown children with their addiction problems. In the past he would "always jump to the kids 'cuz of shame and guilt." He was aware this time, however, that if he could not save himself, he could not help his children. Another participant felt that during his active addiction he "led two lives": one of businessman and father, the other of drug addict. • Now, he says his "relationships are built on honesty. They never were before." After engaging in activities that were "centered on self-gratification" and "self-centeredness," this participant described going to A A meetings where "being around a room full of alcoholics makes me forget about myself and start thinking about other people." From the "self-centered, secretive" activities of his previous lifestyle, this participant appreciated the difference between how he was then and how he is now. " Y o u don't become a monster overnight. It takes time and it's not taking me long to discover that. I'm not a monster nowadays but I was a monster." The changes in behaviour and acknowledging these changes were experienced as facilitative by participants in their healing journeys. For two interviewees, asking for help was key to facilitating their healing journeys. One participant stated: "What was really important for me was asking for help. A n d somehow accepting the help that I was given." "So you have to ask for help. A n d people are there. I was amazed....I was amazed at how much help was there....if I have  113 the right k i n d o f attitude it w i l l p r o b a b l y c o m e . " A s k i n g for h e l p kept this participant o n track i n his h e a l i n g j o u r n e y . H e noted: I have to ask for h e l p e v e r y d a y . S o m e h o w . E v e n i f I just ask G o d for help. B u t i t ' s helpful i f I ask a person. Puts m e i n a p o s i t i o n o f h u m i l i t y . Puts m e i n a p o s i t i o n o f service. O r d e a l i n g w i t h service. I d o n ' t k n o w . E v e r y b o d y , e v e r y b o d y I b u m p into i n a w a y facilitates m y h e a l i n g j o u r n e y . ' C u z t h e y ' r e there. . F o u r i n d i v i d u a l s i n this study d e s c r i b e d interactions that were t u r n i n g points for t h e m . F o r one participant, b e i n g w e l c o m e d b y someone at an A A m e e t i n g s e e m e d to s o l i d i f y his d e c i s i o n not to return to d r i n k i n g . " I guess for what ever reason I d e c i d e d , I ' m done. I ' v e h a d e n o u g h . " F o r t w o other i n t e r v i e w e e s their t u r n i n g points c a m e after the death o f friends. A s one participant noted, " S o m e t h i n g c h a n g e d i n s i d e m e at that p o i n t . " " I ' v e seen a few p e o p l e that have d i e d . B u t u h - (this death) was different. It was different. I d o n ' t k n o w h o w it was but it was just different." S t i l l another e x p e r i e n c e d e s c r i b e d as a t u r n i n g p o i n t was w h e n one p a r t i c i p a n t ' s g i r l f r i e n d began " s e l l i n g h e r s e l f so that the t w o o f t h e m c o u l d pay for their drugs. A t this p o i n t he s a i d "this is e n o u g h . " " I d o n ' t want to be c a u s i n g s o m e b o d y to d o that." T h e s e t u r n i n g points p r o v i d e d important interactions for these participants i n their d e c i s i o n to l e a d healthier l i v e s . T h e s p i r i t u a l aspect o f the A A p r o g r a m was m e n t i o n e d b y a l l o f the participants but seemed to be v e r y significant i n e s t a b l i s h i n g the n e w f o u n d lifestyles o f t w o interviewees i n particular. T h e s e t w o m e n t i o n e d that they p r a y r e g u l a r l y n o w . O n e i n d i v i d u a l s a i d that i n his p r e v i o u s life he " w o u l d not have sought s p i r i t u a l s o l u t i o n s . " O f his current s p i r i t u a l life, he c o m m e n t e d : " I c e r t a i n l y d o n e e d to pray. T h e effect o f prayer  114  is often about the pray-er.. . . T h e purpose o f p r a y i n g is the effect o n the person w h o p r a y s . " A n o t h e r participant d e s c r i b e d the 12 steps as b e i n g : A l l about sort o f t r y i n g to connect and m a i n t a i n a r e l a t i o n s h i p w i t h a G o d o f y o u r o w n understanding. H i g h e r p o w e r , whatever that is, right. A n d I b e l i e v e that's because that's what a l c o h o l was. A l c o h o l was y o u k n o w - 1 w i l l w o r s h i p y o u , I g i v e it a l l to y o u , y o u k n o w , d o w i t h m e as y o u w i l l , right. I c o m p l e t e l y s u b m i t to you. T h i s participant o u t l i n e d h o w he saw interactions w i t h p e o p l e fitting i n to his s p i r i t u a l life: T h e 12 steps and the interactions w i t h people - is a l l - part o f - m e h a v i n g a r e l a t i o n s h i p w i t h G o d , right, U m - but u l t i m a t e l y G o d is w i t h m e 2 4 / 7 . Y o u k n o w i n m y heart, right, and I n e e d to talk to p e o p l e and stuff, right, but p e o p l e are not a l w a y s there and people sometimes m a k e m i s t a k e s . B u t G o d , o f m y understanding, is a l w a y s there and has u n c o n d i t i o n a l l o v e and w i s d o m . A n d i f I d o n ' t understand, I just b e l i e v e . T h e s p i r i t u a l aspect o f their l i v e s was n e w to both o f these participants but p l a y e d a k e y role i n e s t a b l i s h i n g their n e w , healthier identities. T h r e e i n d i v i d u a l s i n this study m e n t i o n e d the s i g n i f i c a n c e to t h e m o f c o n n e c t i n g w i t h other p e o p l e instead o f i s o l a t i n g themselves, i n terms o f h e l p i n g t h e m to m a i n t a i n their l i f e s t y l e free f r o m a d d i c t i o n . T h e perspective other i n d i v i d u a l s were able to g i v e to i n t e r v i e w e e s i n d i f f i c u l t times seemed to be v a l u e d . In the w o r d s o f one participant: T h e r e have been times w h e n I r e a l l y w a n t e d to d r i n k and I was p i s s e d off, right, and I d i d n ' t p r a y or a n y t h i n g , right. I d i d n ' t pray. U m - 1 was p i s s e d off, y o u  115  k n o w , but I just thought w e l l I ' m just not g o n n a take that d r i n k just for t o d a y . . . . T h e next day o r m a y b e later that n i g h t I ' d speak to one o f m y friends a n d say this is h o w I ' m feeling, y o u k n o w and I w o u l d get s o m e perspective f r o m a sane m i n d . . . . S o again, y o u k n o w , I connect w i t h s o m e other a l c o h o l i c that's l i k e a p o w e r b i g g e r than m y s e l f . S o m e t i m e s I p r a y - i f I ' m f e e l i n g - w e a k o r t r o u b l e d or whatever. I ' l l p r a y and that's also m a k i n g a c o n n e c t i o n . F o r another participant, " r e c o n n e c t i n g " w i t h p e o p l e i n her life has h e l p e d her m a i n t a i n her health. S h e s a i d s o m e o f the i n d i v i d u a l s she contacted have p r e v i o u s l y o n l y heard f r o m her was w h e n they " w e r e b a i l i n g her out." T h i s i n d i v i d u a l also d e s c r i b e d the i m p o r t a n c e o f the staff at V a n c o u v e r G e n e r a l H o s p i t a l to her h e a l i n g process: " V G H s a v e d m y life. I m e a n w h e n I was i n there they s a v e d m y life. T h e y o b v i o u s l y d i d s o m e t h i n g right. E v e n though m a y b e at the t i m e I d i d n ' t t h i n k it was right. U m but they saved m y life." A v o i d i n g negative interactions was important to three o f the i n t e r v i e w e e s i n terms o f rejecting a d d i c t i v e b e h a v i o u r s . O n e participant m e n t i o n e d a v o i d i n g d o w n t o w n because he w o u l d b u m p into people he k n e w and he w o u l d not k n o w what to say to t h e m . H e d i d not want to be a "poster b o y " o f r e c o v e r y for them. H e also m e n t i o n e d "there were other p e o p l e I used w i t h . It w o u l d be h a r d for m e to hang a r o u n d w i t h them today w i t h o u t u s i n g . I ' m not sure what w e ' d have i n c o m m o n a n y w a y . " A n o t h e r i n t e r v i e w e e r e a l i z e d he needed to stay a w a y f r o m his f a m i l y u n t i l he had m o r e t i m e to establish his n e w lifestyle. P r e v i o u s l y he h a d " c r a s h e d " a n d relapsed because he m i s s e d his f a m i l y . H e q u i c k l y p u l l e d out o f his relapse but he noted: " I c a n ' t go b a c k and see t h e m . . . .1 k n o w i f I went b a c k into that I ' m i n v i t i n g trouble for m y s e l f .  116  I ' l l start u s i n g drugs a g a i n . " H e also r e c o g n i z e d that he " c a n ' t e v e n speak o n the p h o n e " to his g i r l f r i e n d because w i l l e n d up u s i n g again. T h i s was a sad r e a l i z a t i o n for h i m because his r e l a t i o n s h i p w i t h his g i r l f r i e n d was the " o n l y l o v i n g r e l a t i o n s h i p " i n his life. H e was aware, h o w e v e r , that he needed to a v o i d that r e l a t i o n s h i p i n order to m a i n t a i n his health. F o r another participant, staying c o n n e c t e d w i t h G o d a n d c h o o s i n g to focus his attention o n p o s i t i v e things c o n t i n u e d to keep h i m a w a y f r o m n e g a t i v i t y . P r i o r to this turn a r o u n d i n his life, w h e n f a c e d w i t h t r y i n g times his response was " f e e l i n g h a r d done b y " and " s e l f p i t y " as w e l l as " p o o r m e , " "things aren't g o i n g m y w a y , " a n d " w h a t ' s w r o n g w i t h m e ? " H e d e s c r i b e d his current e x p e r i e n c e i n the f o l l o w i n g w a y : " T h a t ' s part o f what r e c o v e r y i s . It's c u l t i v a t i n g and e n c o u r a g i n g a p o s i t i v e s p i r i t u a l p o i n t o f v i e w and, d i s c a r d i n g n e g a t i v i t y , negative points o f v i e w . " O n e participant d e s c r i b e d n e g a t i v i t y as "part o f the i s o l a t i o n " o f a d d i c t i o n . T h i s i n d i v i d u a l r e a l i z e d that she can c h o o s e the p e o p l e w i t h w h o m she spends t i m e . "In l i f e y o u gotta p i c k a n d choose. Y o u k n o w , w h o y o u want i n y o u r l i f e . " S h e chose to a v o i d p e o p l e w h o e x h i b i t a negative i n f l u e n c e o n her. S h e s a i d : " I f i n d I have to stay a w a y f r o m n e g a t i v i t y . I f i n d that that just r e a l l y d o e s n ' t w o r k for m e . " P a r t i c i p a n t s r e a l i z e d that a v o i d i n g negative or u n h e l p f u l interactions was important i n s t a y i n g o n the path o f abstinence they have c h o s e n . L e a r n i n g to manage unpleasant e m o t i o n s that arose d u r i n g interactions constituted a different category f o r participants f r o m steering c l e a r o f negative interactions. F o u r i n d i v i d u a l s i n this study d i s c u s s e d b e i n g able to experience u n c o m f o r t a b l e e m o t i o n s i n interactions n o w w i t h o u t t u r n i n g to substance use. O n e i n t e r v i e w e e expressed h o w  117 d i s a g r e e i n g w i t h m e m b e r s o f his step group was "quite i m p o r t a n t and quite v a l u a b l e " to h i m . H e also m e n t i o n e d an a w k w a r d altercation w i t h an i n d i v i d u a l where he felt "frightened and i n t i m i d a t e d " but he was able to react n o n - d e f e n s i v e l y . A n o t h e r participant stated " I ' m getting g o o d at d e a l i n g w i t h p e o p l e that are h u r t i n ' m e w i t h o u t p h y s i c a l l y h u r t i n g t h e m or a n y t h i n g l i k e that." O n e situation that put this to the test was w h e n he reported that his g i r l f r i e n d h a d cheated o n h i m . In this instance, this participant d i d not turn to v i o l e n c e or drugs. Instead, he p r a y e d about the situation a n d he sought support f r o m friends. A n o t h e r a w k w a r d c i r c u m s t a n c e m e n t i o n e d b y one i n t e r v i e w e e i n v o l v e d l e a r n i n g to cope w i t h the " a n n o y i n g i d i o t s " i n his r e c o v e r y house. L i f e is - y o u d o n ' t a l w a y s get w h a t ' s pleasant. I have to learn h o w to c o p e w i t h a n n o y i n g - people. W i t h p e o p l e w h o aren't at the same p o i n t o n the path, say. I have to f i n d s o m e w h e r e i n m e the patience, the strength, or the a b i l i t y to just w a l k a w a y f r o m t h e m . I have to s o m e h o w f i n d that - i n s i d e me. I have to accept the situation. L e s s o n s for one participant i n this study i n c l u d e d e n d i n g a r e l a t i o n s h i p w i t h o u t resorting to d r i n k i n g and g i v i n g h i m s e l f p e r m i s s i o n to feel sad. A f t e r p r a y i n g about whether to e n d the r e l a t i o n s h i p he had a " f e e l i n g i n his heart" that he was g o i n g to have to let the r e l a t i o n s h i p go. H e d e s c r i b e d the " a w a k e n i n g " he h a d : I a l w a y s thought i f y o u felt sad about s o m e t h i n g then - w r o n g d e c i s i o n . D o n ' t d o that. M u s t a v o i d f e e l i n g sad. D o n ' t want to ever feel sad, right. T h a t was another reason to d r i n k , right. A n d I learned at that m o m e n t , y o u k n o w w h a t ? S o m e t i m e s y o u feel sad about s o m e t h i n g even i f i t ' s the right d e c i s i o n .  118  H e s a i d he felt "stronger n o w " because he h a d "been t h r o u g h stuff." T h i s courage, strength a n d " f a i t h " i n a " p o w e r greater t h a n " h i m s e l f h e l p e d h i m i n d i f f i c u l t situations such as m o v i n g house, a w a y f r o m his "support s y s t e m . " H e s a i d it w a s "stressful" a n d he was " a bit l o n e l y . " H e c o m m e n t e d further: I ' v e learned to deal w i t h stuff l i k e that. I ' v e learned that stuff l i k e that is part o f life a n d I ' v e learned an alternative to m y o l d c o p i n g s k i l l w h i c h was o b l i v i o n , right. A n d u h - it w o r k s f o r m e - a n d I ' v e p r o v e n that it w o r k s because I ' v e been i n this space before. A n o t h e r instance where this i n d i v i d u a l reported that he h o n e s t l y expressed unpleasant e m o t i o n s w h e r e he w o u l d p r e v i o u s l y not have a d m i t t e d t h e m w a s t e l l i n g his c o u n s e l l o r that he w a s fearful about b e i n g p l a c e d i n a p s y c h i a t r i c i n s t i t u t i o n a n d that the c o u n s e l l o r w o u l d keep h i m s i c k so that he c o u l d c o n t i n u e b i l l i n g h i m . O f this, the participant s a i d , "that's the t h i n g the p r o g r a m has taught m e about is to be honest about m y fears." B y c o n f r o n t i n g his fears a n d b e i n g honest about t h e m , "then it w a s dealt w i t h . B e f o r e it w a s l i k e a l l these fears a n d stuff a n d they a l l b e c a m e a b i g mass, right. D i d n ' t k n o w what I w a s afraid of,  right."  S t i l l another i n t e r v i e w e e d e s c r i b e d a test o f his n e w f o u n d honest approach to life. H e h a d to go to R e v e n u e C a n a d a to r e s o l v e s o m e issues about his taxes. H e s a i d he w a s "so f r i g h t e n e d " he "just about started to c r y . " H e s a i d "that was g o o d " because: In the o l d days I w o u l d go there a n d p i c k a fight w i t h the g u y . . ..That w a s j u s t a l l because - 1 d i d n ' t r e a l i z e it at the t i m e - 1 w a s scared. N o w I went there a n d I k n e w I w a s scared a n d uh - petrified a n d I can get o v e r that. I d o n ' t have to use drugs o r a l c o h o l .  119 L e a r n i n g to accept that negative e m o t i o n s are part o f life a n d to p e r m i t themselves to experience d i f f i c u l t e m o t i o n s w i t h o u t the consequent u s i n g b e h a v i o u r was a step f o r w a r d for these participants i n terms o f e s t a b l i s h i n g a n e w identity. In s u m m a r y , interactions that reflected a change i n the participants' response or perspective f r o m h o w they w o u l d have r e s p o n d e d w h e n they were u s i n g appeared to c o m p r i s e a theme o f shifting identities. T h e categories o f interactions that seemed significant f o r participants i n c l u d e d : those where participants a c t i v e l y a s k e d for h e l p and accepted the h e l p that was g i v e n , and instances w h e r e i n t e r v i e w e e s chose to a v o i d unnecessary n e g a t i v i t y . A d d i t i o n a l l y , i n d i v i d u a l s i n this study d e s c r i b e d the s i g n i f i c a n c e o f c h o o s i n g to connect w i t h people or G o d instead o f i s o l a t i n g .  A l s o o f consequence to  participants was k e e p i n g their perspective, and r e c o g n i z i n g c h o i c e s instead o f f e e l i n g m i s e r a b l e and r e s o r t i n g to u s i n g b e h a v i o u r s . F i n a l l y , i n this theme were situations w h e r e i n t e r v i e w e e s a c k n o w l e d g e d their feelings and gave themselves p e r m i s s i o n to experience negative e m o t i o n s . I n c l u d e d i n these interactions were situations that s e e m e d to test p a r t i c i p a n t s ' responses. T h e interactions i n this theme a l l h i g h l i g h t e d a change i n i n t e r v i e w e e s ' response that was m o r e constructive than before they began their h e a l i n g j o u r n e y s . R e c o g n i z i n g these interactions as i n d i c a t i v e o f a n e w w a y o f life was facilitative for participants i n their h e a l i n g j o u r n e y s . Conclusion T h e data c o l l e c t i o n i n t e r v i e w s i n this study were u s e d to extract f i v e themes that reflected the c o m m o n e x p e r i e n c e o f both f a c i l i t a t i v e a n d i m p e d i n g interactions o f the participants i n their h e a l i n g j o u r n e y s a w a y f r o m substance a d d i c t i o n . T h e descriptions o f the participants y i e l d e d experiences o f f e e l i n g supported or d i s c o u r a g e d , i s o l a t e d or at a  120  loss, and feeling understood or misunderstood through their interactions. Additionally participants reported experiencing in their interactions a sense of belonging, meaning and hope or the lack thereof, and a shift in their identities now that they were on healing paths.  121  CHAPTER  FIVE  Discussion Introduction T h i s study was d e s i g n e d to e x p l o r e the interactions i n d i v i d u a l s e x p e r i e n c e d as facilitative or h i n d e r i n g i n their process o f h e a l i n g f r o m a d d i c t i o n . T h e research question that g u i d e d this study was:  How do individuals who have moved from substance  addiction to health, experience interactions with others in terms of facilitating or impeding their healing journey.  T h i s chapter w i l l i n c l u d e a c o m p a r i s o n o f the f i n d i n g s  in this study w i t h those f r o m the e x i s t i n g literature. F o l l o w i n g this c o m p a r i s o n , i m p l i c a t i o n s for c o u n s e l l i n g , l i m i t a t i o n s o f the study a n d thoughts about future directions for research w i l l be discussed. C o m p a r i s o n to the L i t e r a t u r e T h e literature r e v i e w e d for this study ( A k i n & G r e g o i r e , 1997; A m e s & R o i t z s c h , 2 0 0 0 ; A s h e r y et a l . , 1995; D o b k i n et a l . , 2 0 0 2 ; R e i d et a l . , 2 0 0 1 ) gives the i m p r e s s i o n that i n d i v i d u a l s h e a l i n g f r o m a d d i c t i o n c o u l d p o s s i b l y be i n f l u e n c e d p o s i t i v e l y or n e g a t i v e l y i n their interactions w i t h professionals and others i n their s o c i a l support n e t w o r k ; h o w e v e r , the p e r c e i v e d i n f l u e n c e o n their h e a l i n g j o u r n e y s is not addressed i n this literature. T h i s study, although o n l y d e s c r i b i n g the e x p e r i e n c e o f s i x i n d i v i d u a l s o n their h e a l i n g paths f r o m a d d i c t i o n , contributes to the literature i n d e s c r i b i n g what was helpful or h i n d e r i n g to participants i n terms o f interactions i n v o l v e d i n their h e a l i n g . T h e i n depth i n t e r v i e w process d e t a i l i n g interactions f r o m the p a r t i c i p a n t s ' o w n e x p e r i e n c e a l l o w e d m e to u n c o v e r a n u m b e r o f f i n d i n g s that were not apparent i n the literature r e v i e w e d for this study.  122  F i r s t l y , this study supports the idea that i n d i v i d u a l s h e a l i n g f r o m a d d i c t i o n do p e r c e i v e others to have an i n f l u e n c e o n that process. Participants reported interactions w i t h others as f a c i l i t a t i v e or h i n d e r i n g i n their h e a l i n g f r o m a d d i c t i o n . O f t e n the interactions that were e x p e r i e n c e d as negative b y participants such as a v o i d i n g others out o f embarrassment Or e m o t i o n a l p a i n , or d i s c o u r a g e m e n t f r o m v e r b a l abuse or betrayal, reflected a h i n d e r i n g i n f l u e n c e . Interactions e x p e r i e n c e d as p o s i t i v e such as support o r e m p a t h y were reported to be facilitative. H o w e v e r , this was not a l w a y s the case. O n e interesting f i n d i n g o f this study was that i n certain situations, s e e m i n g l y negative or p a i n f u l interactions l e d to p o s i t i v e change. Participants d e s c r i b e d the deaths o f friends that p r o m p t e d cessation o f their d r u g and a l c o h o l abuse, the hopelessness o f l o s i n g relationships, or a car accident that p r o v o k e d one participant to change his d r i n k i n g habits. A l t h o u g h i n i t i a l l y participants often e x p e r i e n c e d these interactions as setbacks, they frequently p r o v i d e d the impetus for t h e m to change their a d d i c t i v e b e h a v i o u r s . T h e i n f l u e n c e o f interactions i n this w a y appears to be a f i n d i n g unique to this study. A n o t h e r f i n d i n g that is not reflected i n the literature r e v i e w e d for this study but reflects other a v a i l a b l e studies ( N e a l o n - W o o d s , F e r r a r i , & J a s o n , 1995; R a t l i f f , 2 0 0 3 ; S w o r a , 2002) is the i m p o r t a n c e for participants o f a sense o f i n c l u s i o n i n a c o m m u n i t y w i t h a n o t i o n o f c o m m o n g r o u n d . In the current study, feelings o f b e l o n g i n g appeared m o s t often for participants w i t h i n the A A m o v e m e n t . Interviewees expressed that elements o f the A A p r o g r a m addressed their n e e d for c o n n e c t i o n w i t h other p e o p l e , and they also p r o v i d e d a c o n n e c t i o n w i t h the s p i r i t u a l . P r i o r to c e a s i n g the use o f their a d d i c t i v e substance, some participants d e s c r i b e d their substance o f c h o i c e as the 'other'  123  i n their l i v e s that gave to t h e m a sense o f b e l o n g i n g a n d c o n n e c t i o n . T h e s e results reflect that for participants i n this study, s o m e c o n n e c t i o n s w e r e p e r c e i v e d as healthier than others. O t h e r participants reported f e e l i n g as t h o u g h they w e r e l i v i n g a d o u b l e l i f e : one side trapped i n c i v i l i t y , the other c o m p r i s i n g a f e e l i n g o f e v i l n e s s . P a r t i c i p a n t s e x p e r i e n c e d the p u l l o f t w o w o r l d s yet felt as t h o u g h they b e l o n g e d to neither one n o r the other. O n c e participants stopped a b u s i n g substances, several m e n t i o n e d f e e l i n g a loss o f c o n t r o l a n d p o w e r . H o w e v e r , these feelings appeared to dissipate o n c e n e w , healthy b o n d s w e r e m a d e w i t h other people. Interactions w i t h G o d or a h i g h e r p o w e r also gave participants a sense o f b e l o n g i n g i n a c o n s t r u c t i v e w a y . T h e sense o f s p i r i t u a l c o n n e c t i o n is reflected i n the a d d i c t i o n r e c o v e r y literature ( G r e e n , F u l l i l o v e , & F u l l i l o v e , 1998; S h e r m a n & F i s c h e r , 2 0 0 2 ; W h i t e , W a m p l e r , & F i s c h e r , 2 0 0 1 ) . C o n n e c t i o n s w i t h others, as w e l l as w i t h G o d , w e r e reported to h a v e g i v e n participants n e w m e a n i n g , a sense o f support a n d hope i n their l i v e s a n d resulted i n a change i n their identity a n d w a y o f t h i n k i n g about themselves. O n e p a r t i c u l a r l y salient finding i n this study w a s the d e s c r i p t i o n o f p e r s o n a l g r o w t h a m o n g participants, i n terms o f the changes i n their response to v a r i o u s interactions. A s participants shifted their identities a w a y f r o m that o f ' a d d i c t , ' they b e g a n to ask for a n d accept the h e l p o f others, a n d chose m o r e constructive b e h a v i o u r s i n interactions. These b e h a v i o u r s i n c l u d e d l e a r n i n g to accept a n d experience unpleasant e m o t i o n s a n d m a k e the c h o i c e to a v o i d negative o r u n h e a l t h y encounters w i t h others. A d d i t i o n a l l y , participants d e s c r i b e d c h o o s i n g h o w to spend their t i m e a n d focus their energy, p a r t i c u l a r l y i n w a n t i n g to m a k e a p o s i t i v e c o n t r i b u t i o n i n the w o r l d .  Similar  124  descriptions o f g r o w t h and change were not apparent i n the literature r e v i e w e d for this study. T h e r e were, h o w e v e r a n u m b e r o f f i n d i n g s i n this study that were consistent w i t h the p r e v a i l i n g literature. T h e results f r o m this study reflected the a d d i c t i o n s and c o u n s e l l i n g literature ( B e l l & R o l l n i c k , 1996; E g a n , 1994; D e n n i n g , 1998; H a c k n e y & C o r m i e r , 1996; K e l l e r , 1996; M c C a n n & R o y - B y r n e , 1998; N o w i n s k i , 1996; T a t a r s k y , 1998) suggesting the e f f i c a c y o f empathy, genuineness and u n c o n d i t i o n a l p o s i t i v e regard w i t h c l i e n t s . C r e a t i n g an e n v i r o n m e n t o f safety a n d acceptance was e x p e r i e n c e d b y participants as f a c i l i t a t i v e i n their h e a l i n g process. A d d i t i o n a l l y , the a d d i c t i o n s c o u n s e l l i n g literature ( D e n n i n g , 1998; M c C a n n & R o y - B y r n e , 1998; R o t g e r s , 1996; R o t h s c h i l d , 1998; T a t a r s k y , 1998) suggests the effectiveness o f e n c o u r a g i n g c l i e n t s ' i n v o l v e m e n t i n treatment p l a n n i n g , g o a l setting and a l l o w i n g clients to set the pace o f therapy sessions. In this study the sense o f i n v o l v e m e n t and c o n t r o l a c h i e v e d b y a c t i v e l y p a r t i c i p a t i n g i n the d i r e c t i o n o f therapy was e x p e r i e n c e d as f a c i l i t a t i v e for participants. F i n d i n g s o f this study i n c l u d e d both helpful a n d h i n d e r i n g experiences w i t h addictions and health professionals. T h i s is consistent w i t h the f i n d i n g s o f A s h e r y et a l . (1995) that i l l u s t r a t e d both p o s i t i v e and negative experiences o f d r u g abusers w i t h s o c i a l service p r o g r a m s and A k i n and G r e g o i r e (1997) that d e s c r i b e d v a r i o u s experiences w i t h c h i l d welfare w o r k e r s o f i n d i v i d u a l s w h o h a d s u c c e s s f u l l y addressed their a d d i c t i o n issues. C e r t a i n l y attitudes o f addictions and health professionals were p e r c e i v e d b y participants i n the current study as i n f l u e n t i a l i n their interactions a n d i n their h e a l i n g process. V e r b a l and n o n v e r b a l b e h a v i o u r was e x p e r i e n c e d b y participants i n both p o s i t i v e and negative w a y s . C r e a t i n g an e n v i r o n m e n t o f safety, g i v i n g o f t i m e a n d space,  125 responding with kindness, and empathy were all emphasized by participants as facilitative i n their healing. Alternatively, feeling demeaned, not listening and not being generous with time were impeding influences on participants' healing. Findings i n this study did not reflect the results o f Cunningham et al. (1999). Individuals i n Cunningham et al.'s study reported that addiction treatment and doctors' advice were not influential for them i n their decision to reduce their using habits. In the current study, both the staff at various treatment or supportive living residences as well as doctors' advice were seen as facilitative by participants i n terms o f their healing from addiction. Perhaps the focus o f Cunningham et al.'s study on the reasons for changing using behaviour patterns is sufficiently different from facilitative or impeding interactions in an individual's healing journey to warrant the difference i n result. In the current study participants expressed the critical role o f healthy social support i n facilitating their healing journey. Interviewees described healthy social support as including individuals within the A A movement, whether i n groups, or individually. Additionally, for some participants, family and friends who did not abuse drugs or alcohol of deal drugs, were important i n facilitating their healing from addiction. These findings are consistent with the results o f D o b k i n et al. (2002) and A m e s and Riotzsch (2000) that suggested beneficial effects o f social support on healing from addiction. Family, i n particular, were influential for participants i n this study i n both facilitative and impeding ways. Facilitative interactions included acknowledging the interviewees' efforts, making efforts to understand substance abuse and the addicted individual, and helping participants manage their affairs. Individuals i n this study also  126  recounted interactions w i t h f a m i l y that i m p e d e d their h e a l i n g progress.  Interviewees  d e s c r i b e d u n s u p p o r t i v e a n d v e r b a l l y a b u s i v e spouses, partners w h o they felt abandoned t h e m , a n d c h i l d r e n w h o d i d not understand their substance abuse a n d c o n s e q u e n t l y a v o i d e d the i n t e r v i e w e e . A l t h o u g h not addressed i n the literature, b o t h the healthy s o c i a l support o f f a m i l y m e m b e r s a n d the i m p e d i n g interactions w i t h f a m i l y d e s c r i b e d b y participants speaks to the p o t e n t i a l l y strong i n f l u e n c e f a m i l y m a y have o n i n d i v i d u a l s h e a l i n g f r o m a d d i c t i o n i n b o t h p o s i t i v e a n d negative w a y s . W i t h respect to e t h n i c i t y a n d gender s o m e aspects o f this study w e r e consistent w i t h the literature a n d others were not. Participants d i d not report that either their gender or e t h n i c i t y w a s s i g n i f i c a n t i n their h e a l i n g . T h i s m a y h a v e b e e n a f a i l i n g o n m y part i n g l e a n i n g this data o r these factors were s i m p l y not relevant for the participants i n this study. F r o m the one w o m a n i n v o l v e d i n the current study, her situation at the depth o f her a d d i c t i o n w a s congruent w i t h the research ( N e l s o n - Z l u p k o et a l . , 1995) o n w o m e n w h o tended to use i n i s o l a t i o n and h a d fewer s o c i a l supports. H o w e v e r , the f i n d i n g s o f this study differed f r o m the literature i n that the female participant i n this study w a s single, w i t h o u t c h i l d r e n , a n d h a d marketable s k i l l s . It i s h a r d to say w h e t h e r the f i n d i n g s f r o m the current study support the research o n e t h n i c i t y (Prendergrast et a l . , 1998) because o f the l i m i t e d n u m b e r s . H o w e v e r , the one i n d i v i d u a l i n the study o f S o u t h A s i a n a n d S w e d i s h descent w h o w a s i n v o l v e d i n the c r i m i n a l j u s t i c e s y s t e m a l l u d e d to a great deal o f v i o l e n c e i n h i s life. H e also d i s c u s s e d h i s reluctance to d i s c l o s e p e r s o n a l i n f o r m a t i o n i n group settings. T h e s e factors are consistent w i t h the e v i d e n c e for H i s p a n i c participants i n the study b y Prendergrast et a l . .  127  I m p l i c a t i o n s for C o u n s e l l i n g T h e results o f this study p r o v i d e s o m e i n s i g h t into the experience o f the participants i n their interactions w i t h professionals i n terms o f w h a t w a s h e l p f u l to t h e m i n their h e a l i n g process. F i n d i n g s are f r o m the p a r t i c i p a n t s ' perspectives so w e c a n l e a r n w h a t they f o u n d h e l p f u l or u n h e l p f u l i n terms o f their interactions w i t h h e a l t h a n d a d d i c t i o n s professionals a n d c a n a p p l y this i n f o r m a t i o n to c o u n s e l l i n g . A n u m b e r o f the interactions d e s c r i b e d b y participants i n this study d i r e c t l y i n v o l v e d i n d i v i d u a l s i n c o u n s e l l i n g roles, i f not c o u n s e l l o r s themselves. T h e s e f i n d i n g s m a y be useful to c o u n s e l l o r s w h o w o r k w i t h clients w h o have a d d i c t i o n issues. Participants d e s c r i b e d the necessity for t h e m o f trust a n d faith i n the r e l a t i o n s h i p w i t h the h e a l t h a n d a d d i c t i o n s professionals w i t h w h o m they w e r e w o r k i n g , i n order for t h e m to share their experience. B e l i e v i n g i n the c r e d i b i l i t y o f the p r o f e s s i o n a l w a s essential to the c o u n s e l l i n g r e l a t i o n s h i p . A p e r s o n a l a d d i c t i o n h i s t o r y o n the part o f the p r o f e s s i o n a l h e l p e d establish trustworthiness a m o n g participants. H o w e v e r , other factors w e r e i m p o r t a n t i n e s t a b l i s h i n g rapport i n the interactions discussed. C r e a t i n g a safe space for clients to share, g i v i n g o f a c o u n s e l l o r ' s t i m e a n d a l i s t e n i n g ear w e r e instrumental i n facilitating p a r t i c i p a n t s ' h e a l i n g . C o n s i s t e n t w i t h the c o u n s e l l i n g a n d a d d i c t i o n s c o u n s e l l i n g literature ( B e l l & R o l l n i c k , 1996; E g a n , 1994; D e n n i n g , 1998; H a c k n e y & C o r m i e r , 1996; K e l l e r , 1996; M c C a n n & R o y - B y r n e , 1998; N o w i n s k i , 1996; T a t a r s k y , 1998), these f i n d i n g s c o n f i r m that e s t a b l i s h i n g the r e l a t i o n s h i p w i t h c l i e n t s i s important for c o u n s e l l o r s w o r k i n g i n the a d d i c t i o n s f i e l d . O n a n u m b e r o f different o c c a s i o n s participants reported d i f f i c u l t y i n e s t a b l i s h i n g trust w i t h others, i n c l u d i n g h e a l t h a n d a d d i c t i o n s professionals. A t t i m e s p r o f e s s i o n a l s '  128  m o t i v e s for c o n t i n u i n g c o u n s e l l i n g w e r e questioned, a l o n g w i t h their u n d e r s t a n d i n g o f a d d i c t i o n . Participants feared the p r o f e s s i o n a l s ' k n o w l e d g e w a s m e r e l y a c a d e m i c rather than e x p e r i e n t i a l . S o m e t i m e s fear i n c o u n s e l l i n g situations s t e m m e d f r o m insecurities o v e r p a r t i c i p a n t s ' o w n thoughts, feelings a n d fears o f b e i n g l o c k e d u p o r k e p t s i c k . Reassurance f r o m the professionals m a d e a n important difference i n a l l e v i a t i n g a n x i e t y a n d a l l o w i n g participants to share their p r o b l e m s a n d get the h e l p they needed. U n c o n d i t i o n a l p o s i t i v e regard is w e l l d o c u m e n t e d i n the literature ( H a c k n e y & C o r m i e r , 1996; N o w i n s k i , 1996) as is e s t a b l i s h i n g rapport ( D e n n i n g , 1998; M c C a n n & R o y - B y r n e , 1998; T a t a r s k y , 1998). A l l a y i n g participants fears about the c o u n s e l l i n g r e l a t i o n s h i p a n d process, as w e l l as a n y fears about f e e l i n g j u d g e d , w o u l d be a d v i s a b l e for a d d i c t i o n s counsellors. A l o n g the lines o f e s t a b l i s h i n g rapport a n d d e f i n i n g the c o u n s e l l i n g r e l a t i o n s h i p , participants expressed that f e e l i n g i n c o n t r o l o f their h e a l i n g process w a s important to t h e m . A l l o w i n g the clients to set the pace i n the c o u n s e l l i n g sessions a n d reassuring t h e m that their c o u n s e l l i n g sessions w i l l o n l y c o n t i n u e as l o n g as the c l i e n t feels they are w a r r a n t e d w a s expressed b y one c l i e n t as g i v i n g h i m a sense o f safety a n d c o n t r o l . T h i s p o i n t w a s e m p h a s i z e d b y the fact that p a r t i c i p a n t s ' responses to c e r t a i n interactions appeared to be related to a l e v e l o f readiness to accept the support b e i n g offered. T h e i d e a o f w o r k i n g c o l l a b o r a t i v e l y w i t h clients is supported i n the e x i s t i n g a d d i c t i o n s literature ( D e n n i n g , 1998; M c C a n n & R o y - B y r n e , 1998; P r o c h a s k a et a l . , 1992; R o t g e r s , 1996; R o t h s c h i l d , 1998; T a t a r s k y , 1998) It w o u l d , therefore, be prudent for a d d i c t i o n s c o u n s e l l o r s to w o r k f r o m the c l i e n t ' s l e v e l o f readiness i n their sessions.  129  A d d i t i o n a l l y c o u n s e l l o r s w o u l d benefit f r o m c o n s i d e r i n g that the c l i e n t i s the expert o n their a d d i c t i o n and the c o u n s e l l o r the expert o n p s y c h o l o g y o r c o u n s e l l i n g . A l t h o u g h participants d i d not appreciate a d v i c e or b e i n g g i v e n instructions, e d u c a t i o n w a s w e l c o m e d . Participants accepted that professionals m a y h a v e expertise i n certain areas s u c h as b e h a v i o u r patterns or b r a i n c h e m i s t r y a n d i m p a r t i n g this k n o w l e d g e to the c l i e n t w a s h e l p f u l to t h e m i n understanding their a d d i c t i o n better. A d d i c t i o n s c o u n s e l l i n g literature ( D e n n i n g , 1998; M c C a n n & R o y - B y r n e , 1998; R o t g e r s , 1996; R o t h s c h i l d , 1998; T a t a r s k y , 1998) supports the i d e a o f c o l l a b o r a t i n g w i t h clients i n the therapeutic process a n d w o r k i n g w i t h the c l i e n t s ' goals. C o u n s e l l o r s w o r k i n g w i t h clients w h o have a d d i c t i o n issues w o u l d p r o b a b l y benefit f r o m the k n o w l e d g e that their h e l p m a y be best offered to clients i n the p s y c h o l o g i c a l aspects o f their a d d i c t i o n , the relationships they h o l d a n d n a v i g a t i n g w o r k situations that are affected a n d entangled w i t h their a d d i c t i v e patterns. A n interesting f i n d i n g i n this study w a s that t w o participants d e s c r i b e d their a d d i c t i v e substance o f c h o i c e as the " o t h e r " i n some o f their interactions.  The  r e l a t i o n s h i p d e s c r i b e d b y these participants w a s one o f the substance b e i n g the l o v e r , the c o m m u n i t y , the understanding, g i v i n g a f e e l i n g o f b e l o n g i n g , a n d the one w h o w i l l a l w a y s take y o u b a c k . E x i s t i n g c o u n s e l l i n g literature that relates to this i d e a is that o f the e m p t y - c h a i r technique f r o m Gestalt therapy ( C o r e y , 1996). It c o u l d be useful for c o u n s e l l o r s w o r k i n g w i t h i n d i v i d u a l s w h o have a d d i c t i o n issues to be m i n d f u l o f this p e r s o n i f i e d r e l a t i o n s h i p a n d w o r k w i t h it as s u c h , rather than v i e w i n g the substance m e r e l y as a n object.  130  A l t h o u g h the actual i n d i v i d u a l s w h o m a y m a k e an i m p r e s s i o n o n a c l i e n t ' s life m a y differ f r o m c l i e n t to c l i e n t , k n o w i n g that others are i n f l u e n t i a l f o r clients i n their h e a l i n g process f r o m a d d i c t i o n opens the d o o r for c o u n s e l l o r s to f i n d out w h o are the k e y p e o p l e i n their c l i e n t s ' l i v e s and w o r k w i t h their clients i n fostering o r s e e k i n g supportive relationships w h e r e v e r p o s s i b l e . H e a l t h y interactions that were p e r c e i v e d as f a c i l i t a t i v e were felt to be supportive, gave participants a sense o f hope or m e a n i n g i n their l i v e s or h e l p e d encourage a f e e l i n g o f m u t u a l understanding and b e l o n g i n g . C o u n s e l l o r s c o u l d assist their clients i n e s t a b l i s h i n g a n d m a i n t a i n i n g these types o f f a c i l i t a t i v e relationships i n their l i v e s . W h e n appropriate, c o u n s e l l o r s m a y suggest that clients get i n v o l v e d i n a group or groups that c o u l d p r o v i d e p o s i t i v e s o c i a l support. A d d i t i o n a l l y , c o u n s e l l o r s m i g h t ask clients w h o i n their l i v e s g i v e s t h e m the k i n d o f support they need. C o u n s e l l o r s are i n a p o s i t i o n to help clients d i s c o v e r what k i n d s o f support they require to assist t h e m i n their h e a l i n g . F i n a l l y , c o u n s e l l o r s c o u l d encourage clients to be clear w i t h i n d i v i d u a l s i n their l i v e s about h o w they c a n support t h e m d u r i n g their h e a l i n g process. S u g g e s t i o n s for F u t u r e R e s e a r c h T h e f i n d i n g s o f this research are the result o f an e x p l o r a t o r y study i n w h i c h s i x i n d i v i d u a l s w i t h substance a d d i c t i o n histories shared their experiences o f interactions that they p e r c e i v e d to help or h i n d e r their h e a l i n g process f r o m a d d i c t i o n . A s an e x p l o r a t o r y study d e s c r i b i n g the experiences o f o n l y s i x participants, the results cannot be g e n e r a l i z e d b e y o n d the i n d i v i d u a l s i n this study. In order to b r o a d e n o u r understanding o f the p h e n o m e n o n i n question, it w o u l d be b e n e f i c i a l to e x p l o r e this p h e n o m e n o n further. I n t e r v i e w i n g m o r e i n d i v i d u a l s c o u l d refine themes or reflect n e w themes that m i g h t emerge.  F o l l o w i n g participants o v e r a p e r i o d o f t i m e w i t h several i n t e r v i e w s  131 m i g h t h e l p to further e x p l i c a t e the shape o f the p h e n o m e n o n . I f a l o n g i t u d i n a l study were undertaken it m i g h t be p o s s i b l e to identify factors that d i s t i n g u i s h e d one p a r t i c i p a n t ' s experience f r o m another. A d d i t i o n a l l y , a m o r e i n depth study m i g h t u n c o v e r whether different aspects o f the themes were h i g h l i g h t e d at different stages o f the h e a l i n g process. Participants i n this study d e s c r i b e d instances that were helpful or h i n d e r i n g and the i m p o r t a n c e to t h e m o f a s k i n g for help. It w o u l d be interesting to tease out whether s i m i l a r interactions are p e r c e i v e d differently g i v e n the p a r t i c i p a n t s ' stage o f h e a l i n g . A n o t h e r factor that w o u l d be o f interest to investigate i n further studies o f this nature, is whether i n d i v i d u a l s h e a l i n g f r o m a d d i c t i o n w i t h o u t the support o f A A reflected the same themes as the participants i n this study. A l l o f the i n t e r v i e w e e s i n the current study were c o n n e c t e d i n s o m e w a y w i t h A A .  M o s t participants d r e w a great deal o f  support, life m e a n i n g and hope f r o m their interactions w i t h i n d i v i d u a l s i n the A A o r g a n i z a t i o n . Perhaps for i n d i v i d u a l s l a c k i n g this experience, f i n d i n g s w o u l d reflect different themes. A d d i t i o n a l l y , most o f the participants i n this study also went t h r o u g h s o m e sort o f residential p r o g r a m as part o f their h e a l i n g process. I n d i v i d u a l s w h o d i d not have this e x p e r i e n c e m a y report different influential events f o r t h e m i n their h e a l i n g process. A study i n c l u d i n g i n d i v i d u a l s w h o were not abstinent but s t i l l u s e d i n m o d e r a t i o n m a y y i e l d different results also. T h i s study i n c l u d e d i n d i v i d u a l s o f different ethnicities and genders. H o w e v e r , i n the descriptions o f participants these factors were not expressed as relevant to t h e m i n their h e a l i n g j o u r n e y s . A n o t h e r study w i t h different participants m a y report different findings.  132 G i v e n the experience o f this research project ! w o u l d also suggest that i n future studies, the l e n g t h o f t i m e since participants h a d ceased their a d d i c t i v e b e h a v i o u r s p r i o r to the study be lengthened to c l o s e r to one year. I w a s unable to contact t w o o f the participants i n this study w h o h a d the shortest p e r i o d s o f abstinence (7 m o n t h s ) for their f o l l o w - u p i n t e r v i e w s . I h a d several different n u m b e r s for o n e participant, i n c l u d i n g a c e l l u l a r p h o n e n u m b e r . N o n e o f h i s p e r s o n a l phone n u m b e r s w e r e w o r k i n g . T h e p e r s o n w h o a n s w e r e d the telephone n u m b e r o f h i s p r e v i o u s A A g r o u p s a i d she h a d not seen h i m for m o n t h s . T h e staff at the f a c i l i t y w h e r e the other participant l i v e d at the t i m e o f o u r i n t e r v i e w d i d not have a f o r w a r d i n g n u m b e r for her. M y best guess f r o m the i n f o r m a t i o n I r e c e i v e d is that they are b o t h b a c k out u s i n g a g a i n . T h e e x p l o r a t o r y nature o f this study a n d its l i m i t e d s a m p l e size a n d s i n g l e data c o l l e c t i o n i n t e r v i e w m a d e it i m p o s s i b l e to d r a w c o n c l u s i o n s about the f i n d i n g s that describe the substance o f abuse as "other" b y participants. A s w e l l , the issues o f f e e l i n g trapped i n a d o u b l e life w e r e not e x p l o r e d to their potential. It w o u l d be interesting a n d useful to c o u n s e l l i n g professionals to further e x p l o r e the r e l a t i o n s h i p b e t w e e n a d d i c t i o n s professionals a n d their clients i n terms o f c l i e n t s ' perspectives o n trust, c r e d i b i l i t y a n d c o m f o r t . T h i s study p r o v i d e s a first step i n v i e w i n g w h a t i s p e r c e i v e d b y i n d i v i d u a l s w i t h a d d i c t i o n s as f a c i l i t a t i v e or i m p e d i n g to t h e m i n their h e a l i n g j o u r n e y s . L i m i t a t i o n s o f the S t u d y T h i s study h a d a n u m b e r o f l i m i t a t i o n s . F i r s t l y , the study w a s l i m i t e d i n terms o f recruitment. N o t e v e r y o n e e l i g i b l e w a s i n f o r m e d o f the study. T h e s a m p l e w a s gathered f r o m i n d i v i d u a l s l i v i n g i n the V a n c o u v e r area w h o speak a n d read E n g l i s h . I i n t e r v i e w e d the first s i x respondents w h o w e r e interested a n d w h o met the c r i t e r i a for the study;  133  therefore, they were not n e c e s s a r i l y representative o f the p o p u l a t i o n o f i n d i v i d u a l s w i t h a d d i c t i o n issues. T h e s m a l l s a m p l e size i n this study also m a k e s it i m p o s s i b l e to generalize the results. Participants were volunteers so there m a y have been s o m e t h i n g i n the research ' question that p a r t i c u l a r l y appealed to them. T h e participants o f this study m a y have felt they h a d s o m e t h i n g to offer. T h o s e i n d i v i d u a l s f o r w h o m interactions were not felt to be i n f l u e n t i a l i n f a c i l i t a t i v e or i m p e d i n g w a y s w o u l d p r o b a b l y not have v o l u n t e e r e d f o r the study. I n d i v i d u a l s o f v a r i e d ethnic b a c k g r o u n d s a n d both genders were i n c l u d e d i n the study. H o w e v e r , the results d i d not suggest that these factors were relevant f o r participants i n their h e a l i n g process. W h e t h e r this was, i n fact, the case or whether a s h o r t c o m i n g o n m y part i n i n t e r v i e w i n g was r e s p o n s i b l e for that o v e r s i g h t is uncertain. F i n a l l y the q u a l i t y o f the results m a y be l i m i t e d b y a n u m b e r o f p r o c e d u r a l issues. M y i n t e r v i e w i n g a b i l i t y , c a p a c i t y to establish trust, the p a r t i c i p a n t s ' a b i l i t y to describe their experience, a l l m a y affect the c r e d i b i l i t y o f the f i n a l results. A d d i t i o n a l l y m y s k i l l i n e n g a g i n g i n the p h e n o m e n o l o g i c a l process and accurately e x t r a c t i n g the emergent themes f r o m the data c o l l e c t i o n i n t e r v i e w s m a y have l i m i t e d the f i n d i n g s o f the study. Conclusion In c o n c l u s i o n I w o u l d l i k e to share m y personal e x p e r i e n c e o f d o i n g this research. I c a m e to this research f r o m both personal and p r o f e s s i o n a l avenues. T h e h i s t o r y o f a d d i c t i o n i n m y f a m i l y gave m e a certain v i e w o f the w o r l d o f a d d i c t i o n . W o r k i n g w i t h i n d i v i d u a l s w h o have a d d i c t i o n issues h e l p e d to broaden m y understanding and e m p a t h y for their struggles. T h i s research has, once again, e x p a n d e d m y understanding of, a n d  134 appreciation for, the w i n d i n g p a t h w a y out o f a d d i c t i o n . I b e g a n this research h o p i n g to address issues o f i n d i v i d u a l s w h o were not part o f the A A p r o g r a m because I felt they w e r e underrepresented i n the literature. A d d i t i o n a l l y , I b e l i e v e I h a d a p e r s o n a l bias against the A A p r o g r a m . I have t r a d i t i o n a l l y reacted n e g a t i v e l y to i n d i v i d u a l s i n v o l v e d i n the p r o g r a m because o f m y experience o f f e e l i n g a barrier b e t w e e n m y s e l f a n d i n d i v i d u a l s w i t h i n the A A o r g a n i z a t i o n . H o w e v e r , as a result o f the s a m p l e i n this study, m y understanding o f the p r o g r a m a n d an a p p r e c i a t i o n for w h a t it g i v e s those w h o n e e d the support offered b y A A has g r o w n s i g n i f i c a n t l y . A s w e l l , I have a greater understanding o f the barrier that I have felt between m y s e l f a n d i n d i v i d u a l s i n A A ; I a m so grateful to the participants i n this study for s h a r i n g their stories so o p e n l y w i t h m e , an outsider.  135  References A k i n , B . A . , & G r e g o i r e , T . K . (1997). Parents' v i e w s o n c h i l d w e l f a r e ' s response to a d d i c t i o n . 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C o m p a r i s o n s o f v o c a t i o n a l r e h a b i l i t a t i o n c o u n s e l o r s ' attitudes t o w a r d substance abusers. J o u r n a l o f A p p l i e d R e h a b i l i t a t i o n C o u n s e l i n g , 3 0 , (4), 3 3 - 3 7 . W h i t e , J . M . , W a m p l e r , R . S., & F i s c h e r , J . L . (2001). Indicators o f spiritual d e v e l o p m e n t i n r e c o v e r y f r o m a l c o h o l and other drug p r o b l e m s . A l c o h o l i s m Treatment Q u a r t e r l y , 19, (1), 19-35.  144  APPENDIX C Orienting Statement The following statement will be read by the investigator to all participants at the beginning of the first interview: I am interested in learning about your experiences of interactions which you feel have been influential in your healing process from addiction in both positive and negative ways. I want to be sure that I understand your feelings and experiences as fully as possible. So, during the interview I may ask you for more information or clarification about something that you have said. You do not have to answer any questions or discuss anything you do not feel comfortable with. Please describe your experiences as completely as possible until you feel understood. There may be many different interactions that you feel have influenced you, both positively and negatively, during your healing from substance addiction. These interactions may be as impersonal as a comment from a stranger, or as personal as a conversation or experience with a professional. The interactions could also be experiences with someone very close to you, such as a friend, partner or family member. I would like to hear about as many of these interactions as you feel are relevant. Take some time to reflect on your experiences, and when you are ready, please start by describing the first example that comes to your mind.  145  APPENDIX D I n t e r v i e w questions General Research Question H o w d o i n d i v i d u a l s w h o have m o v e d f r o m substance a d d i c t i o n to health experience their interactions w i t h others i n terms o f f a c i l i t a t i n g or i m p e d i n g their h e a l i n g j o u r n e y ? M a i n Interview Q u e s t i o n A s k e d o f Participants W o u l d y o u please tell me about y o u r experiences o f f a c i l i t a t i v e or i m p e d i n g interactions w h i c h y o u felt were significant to y o u r process o f h e a l i n g f r o m a d d i c t i o n ? B a c k u p questions  Who •  W h a t was y o u r relationship w i t h this person? ( w i t h w h o m y o u h a d the interaction)  How •  H o w d i d the interaction affect y o u ?  •  W h a t was it about this interaction that either facilitated or i m p e d e d y o u r h e a l i n g from addiction?  •  C a n y o u tell m e m o r e about what y o u were f e e l i n g or what went through y o u r m i n d w h e n that happened?  •  W h a t went o n for y o u d u r i n g this interaction?  •  W h a t i n f l u e n c e do y o u t h i n k this interaction had: o n y o u r h e a l i n g process?: o n y o u r self perceptions?  •  W o u l d y o u l i k e to say any m o r e about that?  When •  In what w a y was the t i m i n g o f the interaction significant i n terms o f b e i n g i n f l u e n t i a l to y o u r r e c o v e r y process?  •  C o u l d y o u describe a t u r n i n g point for y o u i n y o u r h e a l i n g process?  

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