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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 R O M A S U S A N P A L M E R B . A . , The Un ive r s i t y o f B r i t i s h C o l u m b i a , 1991 A T H E S I S S U B M I T T E D I N P A R T I A L F U L F I L L M E N T O F T H E R E Q U I R E M E N T S F O R T H E D E G R E E O F M A S T E R O F A R T S i n T H E F A C U L T Y O F G R A D U A T E S T U D I E S (Counse l l ing Psycho logy ) T H E U N I V E R S I T Y O F B R I T I S H C O L U M B I A A p r i l 2005 © R o m a Susan Palmer , 2005 Abstract 11 T h e purpose o f this study was to examine the subjective experience o f interactions w i t h others that were either faci l i ta t ive or i m p e d i n g for ind iv idua l s w h o have m o v e d f rom substance addict ion to health. A quali tat ive, phenomenologica l methodology was used for data co l lec t ion and analysis. T h e study i n v o l v e d one in-depth, data co l lec t ion in terv iew wi th each o f s ix volunteer participants. Interviewees inc luded f ive men and one w o m a n , va ry ing i n ages f rom 35 to 55. T h e y a l l had extensive histories w i th substance abuse and were a l l connected to some 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 Narco t ics A n o n y m o u s programs. Interviews were transcribed verbat im and analyzed us ing C o l a i z z i ' s (1978) method o f phenomenologica l data analysis as a guide. Seven themes c o m m o n to a l l participants were extracted f rom the data. These inc luded : a sense o f isola t ion and loss, a sense o f support or discouragement, a sense o f understanding or misunderstanding, a sense o f be long ing or not be longing, a sense o f meaning or meaninglessness, a sense o f hope o r hopelessness, and a sense o f shif t ing identities. The f indings l ed to impl ica t ions for counse l l ing as w e l l as suggestions for future research. i i i TABLE OF CONTENTS Abstract - i i Tab le o f Contents i i i Acknowledgemen t s v i CHAPTER ONE: INTRODUCTION 1 Statement o f the P r o b l e m 1 Rat ionale for the Study 2 Research Quest ion : 5 S igni f icance o f the Study 6 De f in i t i on o f Terms .6 CHAPTER TWO: LITERATURE REVIEW 8 Introduction 8 H i s to ry 9 Theory 10 R e v i e w of the Literature 13 Professionals W h o W o r k wi th Individuals wi th A d d i c t i o n s 13 S o c i a l Support o f Individuals w i t h A d d i c t i o n s 27 E thn ic and Gender Issues 34 S u m m a r y and Synthesis 39 CHAPTER THREE: METHODOLOGY 40 M e t h o d Select ion 40 R o l e o f the Researcher .41 Selec t ion o f Participants 44 i v Recrui tment o f Participants 46 D a t a C o l l e c t i o n 47 D a t a A n a l y s i s 49 Trustworthiness 50 CHAPTER FOUR: RESULTS 55 Introduction 55 Participants 55 Identified Themes 58 A Sense o f Isolation or L o s s 58 A Sense o f Support or Discouragement 68 A Sense o f Unders tanding or Misunders tand ing .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 Meaninglessness 95 A Sense o f H o p e or Hopelessness 104 A Sense o f Shif t ing Identities I l l C o n c l u s i o n 119 CHAPTER FIVE: DISCUSSION 121 Introduction • 121 C o m p a r i s o n to the Literature 121 Impl ica t ions for C o u n s e l l i n g 127 Suggestions for Future Research 130 L imi t a t i ons o f the Study 132 C o n c l u s i o n • 133 REFERENCES 135 APPENDICES 141 A p p e n d i x A : Recrui tment Poster 141 A p p e n d i x B : Informed Consent F o r m 1 142 A p p e n d i x C : Or ien t ing Statement 144 A p p e n d i x D : Interview Questions 145 v i Acknowledgemen t s So many people have supported me throughout the process o f wr i t i ng this thesis; I hope I do not forget anyone. F i r s t l y I w o u l d l i ke to thank m y thesis commit tee . I have felt their support dur ing this whole process and that has been invaluable to me. In part icular I w o u l d l i ke to thank D r . Judi th D a n i l u k who , through her expertise, and excellent feedback has made this experience much more fu l f i l l i ng than I ever c o u l d have anticipated. H e r encouragement and ava i lab i l i ty have been unfa i l ing . I feel fortunate and grateful to have had her as m y supervisor. T o the numerous friends and f ami ly w h o have l is tened to me muse on m y question, the paper, and the process, I thank you . T o those w h o p rov ided chi ldcare t ime and again for me to be able to work , I am most appreciative. I must also remember everyone who has assisted me by reading over m y w o r k and he lp ing me shape the end result. M y f a m i l y have been a source o f constant strength and encouragement throughout m y thesis experience. M y parents have guided me and l istened to me endlessly. M y chi ldren have endured hours and days away f rom their mother so she can do "her homework . " T h e y have been remarkably patient and, i n their o w n way , have p layed an integral part i n he lp ing me complete this project. L a s t l y , I w o u l d l i ke to thank m y husband. H e has he ld me through the rol ler coaster o f this process and read every w o r d I have writ ten. M y constant cheerleader, he has supported me and g iven me the space and t ime I have needed for this project and this degree. F o r his constant be l ie f i n me and m y abil i t ies I am forever grateful. 1 C H A P T E R O N E Introduction E v e r y interaction between people involves the exercise o f some degree o f socia l influence. E v e n the most superficial encounter leaves its mark, however minor , on the participants. S t r ic t ly speaking, every op in ion we utter, every request w e make, and every behaviour we undertake towards another person w i l l in one way or another influence that person. (Forgas, 1985, p. 267) Statement o f the P r o b l e m Soc ia l interactions invo lve influence between ind iv idua l s o f a verbal , emot ional or phys ica l nature (Sears, Peplau , & T a y l o r , 1991). Individuals interact w i th friends, f ami ly members , coworkers , therapists, and others i n their l ives a l l o f w h o m may be perceived by the ind iv idua l to influence their behaviours, attitudes, and beliefs. In the area o f substance addict ion, researchers continue to explore the reasons ind iv idua l s develop substance abuse problems as w e l l as the reasons for the cessation o f addict ive behaviours. Whether ind iv idua ls disentangle themselves f rom their addictions wi th or without professional help, they are necessari ly and inevi tably inf luenced to vary ing degrees by their interactions wi th others on their journey. A l t h o u g h the literature suggests that social interaction is part o f the process o f hea l ing f rom addict ion ( A k i n & Gregoire , 1997; R e i d , M a r i n i , Sales & K a m p f e , 2001), it is unclear what role these interactions play. The specific interactions this study was interested i n were interactions that the i nd iv idua l h im/hersel f experienced as be ing either faci l i ta t ive of, or h inder ing to, their process o f heal ing f rom addict ion. 2 It is important to learn about what ind iv idua l s heal ing f rom addictions experience as helpful and h inder ing socia l interactions because o f the potential for counsel lors to use this informat ion i n the counse l l ing process. K n o w i n g what types o f interactions ind iv idua ls perceive to have the greatest influence on their heal ing f rom substance addic t ion, and understanding how these interactions have made a difference, pos i t ive ly or negat ively, m a y be helpful in teaching counsel lors h o w to interact i n a faci l i tat ive way wi th clients facing their substance addict ion issues. A d d i t i o n a l l y , increasing counsel lors ' awareness o f what interactions facilitate or impede a c l ient ' s recovery, may help the counsel lor to encourage faci l i tat ive interactions i n the c l ient ' s l i fe . Ra t iona le for the Study It is apparent f rom the addictions treatment and counse l l ing process literature (Egan, 1994; H a c k n e y & Cormie r , 1996; Rotgers , K e l l e r , & Mortgenstern , 1996) that interactions wi th others can potential ly have an influence on ind iv idua l s and that certain behaviours, beliefs and attitudes on the part o f others, i nc lud ing c l in ic ians , appear to be helpful to clients i n faci l i ta t ing and mainta in ing change. H o w e v e r , very l i t t le 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 rom substance addict ion to health. The attitudes that professionals have toward ind iv idua ls w i th addictions and the influence o f socia l support on the i n d i v i d u a l heal ing f rom addict ion have been examined most ly i n quantitative studies ( A m o d e o , 2000, Mat thews et a l . , 2002; Wes t & M i l l e r , 1999). Qual i ta t ive studies have begun to explore the experiences o f ind iv idua ls w h o have addict ion issues i n their relationships w i th professionals ( A k i n & Gregoi re , 1997; A s h e r y , Ca r l son , F a l c k , & S iega l , 1995). 3 B i e r n a c k i (1986), i n his book descr ibing the process o f natural recovery (without therapeutic intervention) f rom heroin addict ion, suggests that research into addict ion recovery needs to inc lude studies that focus on the problems ind iv idua l s wi th addictions face when they attempt to abstain and h o w these problems are, or are not, overcome. " E s p e c i a l l y important here w o u l d be observations o f how the various reactions o f noriaddicts either facilitate or s tymie the recovery process" (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 s t i l l appears to be very li t t le literature relat ing to what is experienced as faci l i tat ive or imped ing to ind iv idua ls who have addressed their addict ion issues. The l im i t ed avai lable literature tends to focus on the role o f health professionals i n the heal ing process. T h e exis t ing research that examines interactions between clients and addict ion and health professionals includes several studies that address the attitudes of health professionals i n their interactions wi th substance addicted ind iv idua l s ( A m o d e o , 2000, Mat thews et a l . , 2002; Wes t & M i l l e r , 1999). T h i s research suggests that negative attitudes are c o m m o n among professionals who w o r k wi th ind iv idua l s w i t h addictions. T y p i c a l l y , however , such negative attitudes are tempered when spec ia l ized t raining i n w o r k i n g wi th substance users is provided. Cer ta in ly the attitudes o f health care professionals have the potential to be helpful or to hinder clients i n their efforts to overcome addict ion. H o w e v e r , the extent to w h i c h the attitudes o f professionals are perceived by clients as be ing significant i n faci l i ta t ing or i m p e d i n g their heal ing process remains to be examined . In terms o f studies that explore c l ients ' perspectives on their interactions wi th professionals, the experiences o f drug users i n their interactions wi th people i n various 4 support services are described by Ashe ry , Ca r l son , F a l c k , and Siega l (1995) i n their quali tat ive study o f human services u t i l iza t ion by 44 injection drug users and crack-cocaine users. The experiences o f drug users i n their interactions wi th service providers were examined , but the study by A s h e r y et a l . was not concerned wi th the perce ived influence o f the c l ients ' interactions on their journey out o f addict ion. In another quali tat ive study, A k i n and Gregoi re (1997) also explored the experience o f substance abusing clients i n their interactions wi th service providers . T h e study ident i f ied posi t ive aspects o f interactions that helped the parents reunite w i th their ch i ldren as w e l l as frustrating components o f interactions they felt impeded their progress. T h i s study provides valuable informat ion about the subjective experience o f clients i n document ing the experiences they felt were faci l i ta t ive or h inder ing i n their process o f heal ing. Other interactions o f potential influence i n the process o f heal ing f rom addictions inc lude those wi th ind iv idua ls f rom a c l ient ' s socia l support network. The avai lable literature seems to suggest that a broader, stronger social network has faci l i tat ive properties for ind iv idua l s s t ruggling wi th addict ion ( A m e s & R o i t z s c h , 2000; D o b k i n , D e C i v i t a , Paraherakis, & G i l l , 2002; R e i d et a l . , 2001). In general, these studies indicate that ind iv idua l s who have strong social connections stay i n treatment longer, and mainta in treatment effects longer than those who do not have many socia l connections. W h a t remains unclear is what it is about their interactions wi th others that facilitates the heal ing process o f ind iv idua ls wi th addict ion. T h e literature described above gives a picture o f some o f the different people who , through their interactions, may be perceived by ind iv idua l s w i t h substance 5 addictions to influence their heal ing process. The literature on ly begins to address the interactions that ind iv idua l s who are s t ruggling wi th addictions perceive as faci l i tat ive or h inder ing to their progress. T o address this gap i n the literature, i n this study I exp lored how ind iv idua ls wi th addict ion issues experience their interactions wi th others as be ing helpful to, or imped ing o f their heal ing process. Research Quest ion T h e question that guided 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 lack o f research on how social interactions facilitate or impede the process o f heal ing f rom substance addictions prompted this question. F r o m the results o f this study I hoped to gain some insight into the experience o f ind iv idua ls who have healed f rom substance addict ions. T h i s research invest igat ion sought to establish c o m m o n themes o f what interactions wi th others were perceived to have helped or hindered participants i n m o v i n g away f rom addict ion toward a healthier l ifestyle. "Others" i n this study was kept intent ional ly vague because we d i d not k n o w who the ind iv idua l s were w h o w o u l d be perceived by the participants to have p layed key roles (pos i t ive ly or negatively) i n their heal ing journey f rom addict ion. Ideal ly, this was one o f the things that I hoped to uncover i n this invest igat ion. 6 Signi f icance o f the Study The themes that emerged through this study may help increase the knowledge and shape the behaviours o f professionals who w o r k wi th clients w h o have substance addict ion issues. A d d i t i o n a l l y , the results o f this study m a y raise counsel lors ' awareness o f what interactions are perceived by clients as be ing instrumental i n their progress. T h i s new awareness m a y help counsel lors to w o r k wi th significant others i n their c l ients ' l ives to encourage interactions that help to support the heal ing process. T h e data f rom this study m a y also assist i n the t raining o f professionals w h o w o r k w i t h ind iv idua l s w h o have substance addict ion issues, by p rov id ing examples o f faci l i tat ive interactions to help clients heal f rom addict ion. The study w i l l also potential ly provide important informat ion for friends and f ami ly members o f what behaviours and attitudes are perceived as helpful i n terms o f supporting ind iv idua l s w i th addictions through the heal ing process. Ideal ly this study w i l l also contribute to both theoretical and addict ion treatment literature. De f in i t i on o f Te rms The terms "addic t ion ," or "substance addic t ion ," "problematic drug or a lcohol use," and "substance abuse" w i l l be used interchangeably i n this study. T h e D S M I V - T R (2000) defines substance abuse as a "maladapt ive pattern o f substance use manifested by recurrent and significant adverse consequences related to the repeated use o f substances" (p. 198). I w i l l f o l l o w the convent ion i n the literature that tends to group substance addict ion separately f rom nicot ine addict ion and other addict ions. The terms "hea l ing ," "heal ing journey ," "heal ing process," or "progress" w i l l be used i n this study i n place o f recovery wherever possible. D e n n i n g (2000) states that the 7 term " i n recovery" identifies an ind iv idua l as w o r k i n g through a 12-step program. T h e term impl i e s that no one can every fu l ly recover f rom addic t ion and impl ies a process o f l i fe - long recovery. D e n n i n g also states that there is no term to describe ind iv idua ls s truggling wi th addictions who are not a part o f the 12-step movement . A s a result, the terms described above w i l l be used i n this study whenever possible to indicate ind iv idua l s w h o are no longer act ively abusing a substance. T h i s m a y mean the i nd iv idua l is abstinent or is us ing drugs or a lcohol i n moderat ion. T h e heal ing journey, i n m y m i n d and as described by participants i n this study, begins when an ind iv idua l decides they are unhappy wi th their current addict ive l i festyle and starts to th ink about changing those behaviours. T h e road on this journey is very rarely straight, as the ind iv idua ls i n this study out l ined. E v e r y interviewee relapsed at least once on their journey to free themselves f rom addict ion. Consequent ly the descriptions o f heal ing i nvo lve both posi t ive and negative elements. The def ini t ion o f interaction has been taken f rom socia l psychologis ts Sears, Pep lau and T a y l o r (1991) w h o define socia l interaction as occur r ing "when two or more people influence each other - verbal ly , phys ica l ly , or emot iona l ly" (p. 207). B a s e d on the results f rom this study I w i l l expand on this def ini t ion s l ight ly . A l o n g wi th interactions i n v o l v i n g people I w i l l inc lude interactions wi th a "higher power , " " G o d , " or "god o f one 's understanding" as w e l l as interactions wi th the personif ied substance o f abuse that were described i n by participants i n this study. 8 C H A P T E R T W O 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 experience o f ind iv idua l s w i th substance addictions i n their interactions wi th others i n terms o f the theoretical and his tor ical context o f addict ion and the pertinent literature relat ing to m y question. In order to contextual ize the research question, I w i l l begin by g i v i n g some background on the history o f addict ion and theoretical perspectives on soc ia l interaction as w e l l as that o f counse l l ing literature pertinent to addict ion. The remainder o f the chapter w i l l inc lude a rev iew o f the relevant studies relating to the topic o f interactions ind iv idua l s wi th substance addictions have wi th various people i n their l ives . In r ev i ewing the relevant literature related to the experience o f ind iv idua l s w i th addic t ion issues i n their interactions wi th others, two major areas w i l l be highl ighted: literature on the professionals w h o interact w i th ind iv idua l s who have addict ions, as w e l l as literature on the social support o f ind iv idua l s wi th addict ions. Literature focus ing on the relat ionship o f professionals wi th ind iv idua ls w i th addict ions, f rom both the professional and cl ient perspective w i l l be addressed. The reason for inc lus ion o f these studies is that many ind iv idua ls come into contact w i th professionals over the course o f their heal ing journey and there is great potential for clients to feel these ind iv idua l s have inf luenced their progress i n some way . T h e literature examin ing the role o f soc ia l support w i l l be discussed because it appears that the relationships ind iv idua l s have wi th their friends and f ami ly members p lay a role in i nd iv idua l heal ing f rom addict ion. Therefore, it is important to examine both the literature relat ing to socia l support as w e l l 9 as h o w professionals interact w i th their clients and h o w these interactions are perce ived by clients. In addi t ion to these two major areas, I w i l l also discuss the l im i t ed research addressing the ethnici ty and gender literature and its relevance i n the area o f substance addic t ion. There appears to be evidence that ind iv idua l s o f different ethnicities and/or gender may br ing different perspectives to the issue o f the ut i l i ty o f interactions wi th others based on their unique experience o f addict ion. I was, therefore, mindfu l o f ethnici ty and gender i n recrui t ing participants and i n ana lyz ing data. T h e chapter w i l l conclude wi th a summary and synthesis o f the exis t ing literature leading to the statement of the p rob lem. H i s to ry O v e r the last hundred years, attitudes toward addict ion and toward ind iv idua l s w i th addictions have evo lved i n N o r t h A m e r i c a ( B o y d , 1991; D e n n i n g , 2000; G r a y , 1998): starting as a racial issue then becoming a mora l issue. F r o m here, the v i e w o f addict ion as a disease developed. T h e use o f i l l ega l drugs has meant that addict ion has also been interpreted as a c r im ina l just ice matter. Presently, i n Canada , addict ion is be ing seen more and more as a publ ic health issue. L a w s prohib i t ing substances l ike o p i u m and mari juana were o r ig ina l ly based on racia l prejudice. These laws carr ied over to a lcohol dur ing prohib i t ion i n the U n i t e d States f rom the years 1920-1933. H o w e v e r , the laws developed around a lcohol came f rom the re l ig ious v i e w o f a lcohol and a lcohol ics as e v i l and mora l ly wrong . S ince then, the A l c o h o l i c s A n o n y m o u s organizat ion has construed a l coho l i sm and drug use as a disease rather than a mora l issue. In the 1970's the " W a r on D r u g s " was int roduced as a 10 w a y to rid society o f the harm of drugs. T h i s "war" has turned the issue o f addict ion into a c r im ina l jus t ice p rob lem rather than v i e w i n g it as a pub l i c health concern. Consequent ly , ind iv iduals w i th drug addictions are often seen as c r imina l s rather than people w i t h a health p rob lem, and are treated accordingly . T h e his tory o f Nor th A m e r i c a n socie ty 's attitudes and approaches to a lcohol and drug issues is relevant because the culture around an ind iv idua l imparts the lens through w h i c h they see people w i t h addictions and influences the w ay ind iv idua ls w i th addictions see themselves. Curren t ly there is a shift happening i n Canada toward a ph i losophy o f harm reduction that v iews the p rob lem of addict ion as a b iopsychosoc ia l issue (Denning , 2000), rather than a disease or c r im ina l phenomenon. T h e harm reduction approach advocates reducing harm to the i nd iv idua l and promot ing their health. Abs t inence is not the on ly goal o f treatment wi th in the paradigm of harm reduction. In v i e w i n g addict ion as a b iopsychosoc ia l phenomenon, the harm reduction mode l looks not on ly at the b io log i ca l effects o f drugs on the i nd iv idua l , but also the psycho log ica l effects and the interaction between the i nd iv idua l and society and addresses both commun i ty and i nd iv idua l interventions. It appears that the ha rm reduction mode l m a y provide a more constructive w a y o f v i e w i n g addic t ion and ind iv idua l s w i th addictions than some o f the his tor ical alternatives. T h e nature o f socia l interactions and faci l i ta t ive counse l l ing interventions f rom different theoretical orientations w i l l be descr ibed i n the next section. Theory In his book, 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 socia l psychologis t spec ia l iz ing i n socia l interaction, identifies several mot iva t ing factors to exp la in w h y ind iv idua ls seek social interaction. These drives inc lude 1 b io log i ca l needs, dependency, aff i l iat ion, dominance, sex, aggression, self-esteem and ego-identity, and other motivat ions w h i c h affect socia l behaviour (achievement, money, interests, values). Individuals seek to satisfy goals relat ing to these drives through their interactions wi th others. The nature o f a socia l interaction comprises verbal and non-verbal elements ( A r g y l e , 1994). Non-ve rba l elements communica te attitudes, emotions and supplement the verbal exchange. Non-ve rba l communica t ion is compr i sed o f facia l expression, gaze voice , gestures, posture, touch / bod i ly contact, spatial behaviour, and appearance. V e r b a l communica t ion and conversat ion convey meaning and are intended to influence the hearer i n some way (Aus t in , i n A r g y l e ) . A r g y l e breaks verbal communica t ion into utterances and describes these different types o f utterances: orders and instructions, questions, informat ion, in formal speech, expression o f emotions and interpersonal attitudes, performative utterances (e.g., vo t ing , judging) , social routines (e.g., thanking), and latent messages. V e r b a l and non-verbal communica t ion can influence ind iv idua l s verbal ly , phys i ca l l y and emot ional ly . The specific interactions this study is interested i n are interactions that are either faci l i tat ive or h inder ing i n an i nd iv idua l ' s process o f heal ing f rom addict ion. W h e n counsel lors work wi th clients, their interactions are intended to facilitate the heal ing process. The counsel lor facilitates beneficial interactions wi th clients by d i sp lay ing accurate empathy, genuineness, and an uncondi t ional posi t ive regard for the cl ient (Hackney & Cormie r , 1996). Cer ta in behaviours are exhib i ted i n order to demonstrate these he lp ing characteristics. Behav iours associated wi th empathy include "verbal and non verbal attending, paraphrasing content o f c l ient communica t ion , 12 reflect ing cl ient feelings and i m p l i c i t cl ient message, and pac ing or synchrony o f cl ient experience" (Hackney & Cormie r , p. 53). Behav iours that convey genuineness are "congruence, openness and discrete self-disclosure and i m m e d i a c y " (p. 61). Pos i t ive regard is expressed through supporting nonverbal behaviours and enhancing verbal responses. The presence o f these factors does not necessari ly guarantee that the cl ient w i l l respond favourably to the counsel lor ; but the literature suggests these interactions are faci l i tat ive i n nature (Egan, 1994; H a c k n e y & C o r m i e r , 1996). The addict ion counse l l ing literature supports the eff icacy o f counsel lor behaviours s imi la r to the general counse l l ing mode l discussed above, when w o r k i n g wi th clients w h o have addict ion issues. Different theories discuss elements o f the helper 's role i n faci l i ta t ing the hea l ing process o f ind iv idua ls w i th addict ions. T h e A l c o h o l i c s A n o n y m o u s mode l suggests that a facil i tator ( N o w i n s k i , 1996) should provide an environment o f safety and acceptance for clients, reinforce the c l ient ' s posi t ive efforts, and w o r k co l labora t ive ly w i th the client. T h e behavioural mode l (Rotgers, 1996) outlines a col laborat ive, empower ing process that encourages the c l ient ' s involvement i n treatment p lann ing and goal setting. M o t i v a t i o n a l in te rv iewing ( B e l l & R o l l n i c k , 1996) and psychoanalyt ic (Ke l l e r , 1996) approaches advocate the use o f empathy by therapists and mot iva t ional in te rv iewing also stresses cl ient choice i n goal setting. H a r m reduction literature refers (Denning , 1998; M c C a n n & R o y - B y r n e , 1998; Tatarsky, 1998), as the general counse l l ing literature does, to the importance o f establishing a therapeutic al l iance i n effecting change wi th a cl ient . Studies us ing the ha rm reduct ion approach to addict ion treatment (Denning , 1998; M c C a n n & R o y - B y r n e , 1998; Ro thsch i l d , 1998; Tatarsky, 1998) suggest that interacting wi th the cl ient f rom "where they are" and 13 w o r k i n g wi th the c l ient ' s goals i n a col laborat ive w a y rather than impos ing a prescribed treatment strategy is the key to faci l i ta t ing the heal ing process. " H a r m reduct ion psychotherapy rests on the be l ief that the interactions w i t h i n a relat ionship between the drug user and the c l i n i c i a n help create the environment w i t h i n w h i c h change takes p lace" (Denning , 2000, p. 93). H o w e v e r we do not k n o w what it is about these interactions that facilitates change for the cl ient . In the next section I review the literature pertaining to interactions between professionals and clients w i th addict ion issues. T h e literature addresses studies that describe the result ing behavioural and attitudinal changes that occur among professionals w h o have rece ived specia l ized t raining about addict ion and w o r k i n g wi th ind iv idua ls w i th addictions. In addi t ion, the qualitative literature document ing the experiences o f ind iv idua l s w i th addictions wi th certain professionals w i l l be described. These studies begin to g ive some idea o f the types o f interactions that may be perceived as faci l i tat ive or imped ing i n an i nd iv idua l ' s recovery f rom addict ion. Professionals W h o W o r k wi th Individuals w i th A d d i c t i o n s A m o d e o (2000) conducted a study to examine the influence o f substance abuse training on S o c i a l W o r k e r s i n terms o f their attitudes, sk i l l s and c l i n i c a l behaviour w i t h respect to clients w i th substance addict ion issues. The sample o f 81 Masters l eve l S o c i a l Worke r s w h o comple ted a nine month, 84 hour t raining program between 1986 and 1995 was compared w i t h a matched sample o f 78 Masters l eve l S o c i a l W o r k e r s w h o d i d not enrol l i n the t raining program. T h e sample was mos t ly female (87%) and W h i t e (96%). Participants w i th the training who had substance abuse experience pr ior to the t raining per iod were exc luded f rom the study i n order to m i n i m i z e the poss ib i l i ty that outcomes 14 predated training. Telephone interviews i n this long-term fo l low-up design i n v o l v e d a questionnaire developed for this study compr i sed o f both c losed and open-ended questions. T h e questionnaire inc luded measures o f behaviour , c l i n i c a l sk i l l s and self-rated attitudes o f interest, commitment , op t imi sm, competence and confidence i n w o r k i n g wi th substance-abusing clients. Part ic ipants ' supervisors were in te rv iewed i n order to substantiate the c la ims o f participants. In terms o f attitudes toward clients w i th substance addic t ion issues, the f indings indicated that the trainees' scores and supervisor ratings o f trainees were s ignif icant ly more posi t ive than those o f compar ison subjects. Trainees and their supervisors rated themselves higher on the extent to w h i c h they ident i f ied and intervened wi th clients who had substance abuse issues. Trainees had s ignif icant ly more substance-abusing clients i n their caseload i n their pr imary w o r k setting than compar ison subjects. A d d i t i o n a l l y , s ignif icant ly more trainees had made j o b changes to increase the focus on substance abuse related work . Subjects who comple ted t ra ining i n the first f ive years scored s ignif icant ly higher on the attitudinal components than those w h o comple ted the t raining i n the latter f ive years. The authors interpreted this result as suggesting that attitudes m a y improve i n t ime wi th more exposure to clients w i t h addict ion issues. T h e study's strengths include the matching o f the sample. Subjects were matched professional ly and were also very s imi la r on relevant background variables. T h e long -term fo l low-up nature o f the study is rare and i n this case seems to indicate that t raining effects stand the test o f t ime and may improve over t ime. Supervisor corroborat ion o f subjects' responses gives greater c red ib i l i ty to the results. T h e study is l im i t ed by the fact that the t raining program was voluntary and it is possible that ind iv idua l s who took part 15 i n the t ra ining program were already more interested i n the area o f addict ion and c o u l d have had more posi t ive attitudes about addict ion and clients w i th addictions than the compar i son group regardless o f t raining. The general izabi l i ty o f the study is l im i t ed because it relates to o n l y one t raining program. A d d i t i o n a l l y , other than a focus group used to hone the questions for the interviews, no va l id i ty or re l iab i l i ty data were g iven for the scale developed for this study. The f indings o f A m o d e o ' s study (2000) converge wi th those o f Ma t thews et a l . (2002) w h o also found that a substance abuse training interclerkship assisted i n i m p r o v i n g knowledge , attitudes and sk i l l s o f third year med ica l students i n w o r k i n g w i t h patients w i th substance addictions issues. In their study, Mat thews et a l . (2002) assessed the immediate and delayed impact o f a one or two day intensive substance abuse t ra ining session (interclerkship) on the knowledge , sk i l l s and attitudes o f 396 th i rd year med ica l students f rom 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 2001 . T h e purpose o f the interclerkship was to enhance knowledge and competence wi th substance abuse assessment and br ief intervention. T h e interclerkship format i n v o l v e d in terdisc ipl inary instructors (medical and commun i ty professionals) integrating teaching formats, emphas iz ing smal l group teaching and s k i l l development. Students comple ted an in i t i a l questionnaire, a pre-interclerkship test, a f inal course evaluat ion and a post-interclerkship test. T h e in i t i a l questionnaire gathered demographic data i nc lud ing past w o r k or personal experience wi th substance abuse disorders. Pre- and post-interclerkship tests asked questions related to attitudes and knowledge regarding substance abuse disorders and treatment. T h e attitude assessment instrument was adapted f rom the Substance A b u s e At t i tude Survey and the knowledge 16 assessment instrument was developed by this s tudy's authors. Students were also asked two questions about their confidence i n assessing substance abuse problems and p rov id ing br ie f intervention. A d d i t i o n a l l y , i n 1998-99 each thi rd year medica l student participated i n an Object ive Standardized 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, measured students' substance abuse assessment and intervention c l i n i c a l sk i l l s . T h e O S C E may have occurred up to s ix months after the substance abuse interclerkship for some students, and others m a y not yet have taken part i n the interclerkship. Students ' performances on the O S C E were compared based on whether the O S C E was comple ted before or after their substance abuse interclerkship. F ind ings were assessed in the f o l l o w i n g way . Pre- and post- interclerkship test scores for knowledge , attitudes and confidence were compared us ing non-direct ional paired sample t-tests and the authors found significant posi t ive changes immedia te ly after the interclerkship. Spearman correlations were calculated to examine the relationships among attitudes, knowledge , and confidence and self-reported past experience wi th substance abuse and to evaluate the relat ionship between students' performance on the O S C E and their responses on the pre and post interclerkship assessments. N o correlat ion was apparent between past personal experience wi th substance abuse and knowledge , attitudes or confidence regarding substance abuse issues. H o w e v e r , pr ior w o r k knowledge seemed to predict more posi t ive students' attitudes and greater confidence levels at the beg inn ing o f the interclerkship. C h i square tests were used to compare the frequencies o f O S C E performance ratings fa l l ing above and be low expected levels for students comple t ing the O S C E before and after the interclerkship. O S C E performance data showed significant improvement i n the students' ab i l i ty to assess and intervene w i t h 1 7 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 compr i sed o f verbal , emot ional or phys ica l influence between two people. Therefore, i f the attitudes and behaviours o f professionals interacting wi th their substance abusing patients are more opt imis t ic , there may 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 faci l i tat ive rather than hinder ing. Wes t and M i l l e r (1999) carr ied out a survey o f 90 vocat ional rehabil i tat ion counsel lors to determine i f differences exis ted i n the attitudes o f vocat ional rehabil i tat ion counsel lors toward serving substance abusing clients depending on the counsel lors ' t raining and education. Participants were employed by the Tennessee D i v i s i o n o f Rehabi l i ta t ion Services and the Tennessee Department o f Hea l th and H u m a n Services . O f the respondents, 5 7 % had been employed as vocat ional rehabil i ta t ion counsel lors f ive years or less. T h e Substance A b u s e At t i tude Survey ( S A A S ) was administered to participants to gain informat ion about rehabil i tat ion counsel lors ' attitudes and beliefs about the e t io logy, course and treatment o f addictions. Subjects were grouped according to their substance use and abuse training history. T-tests were conducted on the S A A S as a who le and its subscales o f nonmora l i sm, 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 found between the t ra ining and non-t ra ining groups on the S A A S as a who le although the results were approaching s ignif icance i n the predicted direct ion. O f the f ive subscales o f the S A A S , on ly two indicated a difference between groups based on their t raining. The subscales o f nonmora l i sm and treatment intervention showed s ignif icant ly more posi t ive attitudes on the part o f counsel lors w h o had training compared wi th those who had none. T h i s f ind ing suggests that counsel lors wi th substance abuse t ra ining were less l i k e l y to see substance abuse as a mora l f a i l ing and he ld more posi t ive expectations o f treatment intervention. O n the whole , however , the attitudes o f a l l counsellors i n this study were found to be somewhat negative, perhaps because the type o f substance abuse training received was not standard across a l l participants. Issues specific to rehabil i tat ion counsel lors such as their be l ief that rehabil i tat ion clients wi th substance abuse issues cannot be helped, or that the care and rehabil i tat ion o f substance abusing clients w i l l be more t ime consuming , may not have been addressed i n the t raining the rehabil i tat ion counsel lors received. T h e rehabil i tat ion counsellors i n this study met the cr i ter ion scores for ind iv idua l s satisfied wi th w o r k i n g wi th a substance abusing populat ion on on ly one subscale o f the S A A S , suggesting that this group is unsatisfied on the who le i n w o r k i n g wi th a substance abusing popula t ion. In the sample o f the study, very li t t le informat ion was g iven as to how the 52 ind iv idua ls were chosen for the t raining group. T h e authors also ment ioned that a l l reported t ra ining was accepted without categorizat ion so participants ' t raining c o u l d vary f rom a one day workshop to graduate coursework. In contrast to A m o d e o (2000) and Mat thews et a l . (2002) the attitudes o f the vocat ional rehabil i tat ion counsellors towards ind iv idua l s w i t h addictions were largely negative even after t raining. H o w e v e r , most o f the respondents i n this study had f ive years or less experience as a rehabil i tat ion counsel lor . Perhaps, as A m o d e o indicated i n her study, greater experience leads to greater satisfaction or better attitudes i n w o r k i n g wi th a substance abusing populat ion. Al te rna t ive ly , the difference m a y s i m p l y indicate that socia l workers and physicians respond differently to substance abuse training than vocat ional rehabil i tat ion counsel lors . T h e survey nature o f this study is a general data 20 co l lec t ion method result ing i n the inab i l i ty to comment on the reasons w h y these vocat ional rehabil i tat ion counsellors were unsatisfied w o r k i n g wi th ind iv idua l s w i th addict ion issues. T h e strengths o f the Wes t and M i l l e r study (1999) inc lude the sample size and the use o f an established instrument for measur ing attitudes toward substance abuse. In a descript ive pi lo t study o f former drug, tobacco and former or moderate a lcohol users, C u n n i n g h a m , Kosk i - Jannes and Toneatto (1999) examined the reasons for s topping or reducing consumpt ion o f a lcohol , drugs, and/or tobacco p rov ided by these ind iv idua ls . T h e data for this study were extracted f rom the results o f a random digi t d i a l ing telephone survey conducted by the Centre for A d d i c t i o n and M e n t a l Hea l th ( C A M H ) ca l led the Ontar io D r u g M o n i t o r . T h i s organizat ion collects data relevant to a lcohol and drug use i n a representative sample o f 200 adults once a month . Separate questions for each drug were asked about present and past use o f cannabis, cocaine/crack, tobacco, and a lcohol . Summaries that had been generated b y the interviewers f rom the C A M H study were p rov ided to the first author o f this study w h o coded statements f rom these summaries. T w e l v e categories o f reasons for change were der ived f rom separating the coded statements into groups. O f the people who used drugs relevant to this study, cannabis users, cocaine/crack users and moderate drinkers indicated int rapsychic reasons for changes such as g rowing up or personal decisions. Si tuat ional changes or new responsibi l i t ies were also c i ted by cannabis users and abstinent and moderate drinkers as reasons for change. Abst inent drinkers also noted health concerns as a reason for changing their us ing behaviour. F o r cocaine users both finances and not l i k i n g the effect 21 o f the drug p layed more significant roles than situational changes. T h e most notable data gathered i n this study were that on ly eight respondents o f 200 ment ioned treatment or doctor 's advice as relevant to changing their drug us ing act ivi ty . A d d i t i o n a l l y , treatment was not ment ioned by participants as a reason for changing us ing behaviour. T h e strength o f this study by C u n n i n g h a m et a l . (1999) is that the sampl ing method was random m a k i n g it closer to a representative sample than convenience sampl ing . H o w e v e r , smal l sample sizes o f some drug groups means that the results may not define the drug class as a whole . The informat ion avai lable to the authors o f this study was l i m i t e d because the study was based on a popula t ion study that had already been completed. 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 accuracy. T h e authors o f the study were unable to ascertain the p r imary reason for behaviour change among participants when participants offered several reasons. T h e questions were not randomly presented, therefore users o f mul t ip le drugs m a y have been inf luenced i n their responses to later questions by earlier responses i n the survey. In relat ion to m y study, the results o f C u n n i n g h a m et a l . (1999) suggested that ind iv idua ls recover ing f rom addict ion d i d not f ind professionals to be as inf luent ia l as we might expect i n their recovery process. Exper iences wi th doctors or treatment d i d not seem to play a significant role wi th many o f the ind iv idua ls po l l ed i n this study. H o w e v e r , this result may be due to the fact that these participants had less severe addict ion problems than those i n other studies. The nature and extent o f drug abusers' interactions wi th the social services system was examined i n the study by A s h e r y et a l . (1995). T h e study sample o f 44 participants . 22 inc luded 29 injection drug users and 15 crack cocaine users w h o were not i n treatment at the t ime o f the study. T h e participants were recruited i n D a y t o n and C o l u m b u s , O h i o b y indigenous A I D S project outreach workers . T h e mean age o f the men was 41 years and the mean age o f the w o m e n was 35. The sample inc luded 10 white men, 10 white w o m e n , 13 A f r i c a n A m e r i c a n men, and 11 A f r i c a n A m e r i c a n w o m e n . Focus group methodology was used for the purpose o f this study. E i g h t focus groups were conducted: 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 ranged i n size f rom four to nine people and were organized by ethnici ty and gender. T h e team moderator approach was used for the focus groups. T h e moderators took turns leading the group us ing a structured focus group protocol . T o analyze the data f rom the focus groups, each in terview was transcribed and edited b y the moderators. T h e authors then analyzed the interviews for themes by reading through the transcripts numerous times and m a k i n g notes on general themes that emerged. Themes were cross-checked wi th observations and interpretations among the authors. T h e researchers found two major themes, regardless o f type o f participant drug use, ethnici ty, or gender. F i r s t ly , participants were very fami l ia r w i t h social services, especia l ly f inancia l programs, housing, food pantries, and drug treatment. Secondly , participants felt that they received demeaning treatment f rom staff at pub l ic f inancia l programs i n compar i son wi th treatment by staff o f private programs. T h e treatment that was perceived b y participants as demeaning inc luded the condescending attitude o f workers , and through workers ' tone o f vo ice be ing made to feel inadequate and degraded. Participants also reported some instances o f ethnic and gender overtones. 23 F o o d and shelter programs were more easi ly accessed by participants than f inancia l programs and drug treatment programs. Participants felt there were many barriers when seeking f inancia l assistance. P roduc ing the documentat ion required was perceived as demeaning and arduous. A d d i t i o n a l l y , the h igh rate o f turnover among publ ic assistance workers was perceived by participants as an obstacle i n acqui r ing services. Participants felt they and their needs s l ipped through the cracks because they had not formed a relat ionship wi th a worker . T h e long wai t for their cheques l ed some ind iv idua l s to turn to i l l ega l activities i n order to obtain funds. A s w e l l , one w o m a n felt that her dire situation gave her no recourse but to return to drug use. W h e n seeking assistance f rom socia l services, participants generally d i d not reveal their drug use because o f their perception that knowledge o f their drug us ing behaviour c o u l d negat ively affect their acquis i t ion o f services, or worse, that their chi ldren w o u l d be taken f rom them. Perce ived barriers to drug treatment inc luded long wa i t ing lists and the cost o f treatment. H o w e v e r , when treatment was obtained, the experience was described by participants as educational and meaningful . Se l f -mot iva t ion was addressed as essential for treatment success. T h e posi t ive effects o f treatment were l i m i t e d by the short duration o f treatment programs and lack o f aftercare. The study has some strengths but requires some caut ion i n interpretation. S tudy ing soc ia l service u t i l iza t ion might attract people w h o have specif ic issues wi th social services, thereby rais ing issues that are not relevant for others. O n the posi t ive side, the focus group method seemed to be an effective w a y to capture themes among this group o f participants. There is very li t t le research on the phenomenon explored i n this study. T h e researchers stated that there was next to no research on the use o f socia l 24 services b y users o f i l l ega l drugs w h o were not i n treatment. T h e inc lus ion o f both whi te and A f r i c a n A m e r i c a n men and w o m e n is a strength o f the study because it provides a good sample i n terms o f size and diversi ty. In terms o f its relat ionship to m y study, A s h e r y et a l . (1995) discussed the experience o f participants i n their use o f various services. T h i s informat ion provides indicat ions that certain workers and situations were perce ived by participants to have inf luenced their actions, but this perceived influence was on ly touched upon i n A s h e r y et al . 's study. One o f m y goals was to explore further i n m y study the perceived influence interactions had on part icipants ' pathways out o f addict ion. In a quali tat ive study us ing extreme cases o f parents w h o had successfully addressed their drug or a lcohol addict ion p rob lem and regained their ch i ld ren f rom c h i l d welfare, A k i n and Grego i re (1997) sought to describe the impediments and contributions o f c h i l d welfare workers to the progress o f these ind iv idua l s . F i v e white w o m e n and s ix 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 ch i ldren were in te rv iewed i n d i v i d u a l l y us ing semistructured interviews to col lect data. Constant comparat ive analysis o f the data ident i f ied themes that fe l l into the categories o f addic t ion experience, system shortcomings, and system successes. In terms o f system shortcomings and system successes, some experiences were described by participants that were negative or posi t ive i n terms o f their recovery. Feel ings o f powerlessness and hopelessness were sometimes reinforced b y socia l workers ' who seemed more interested i n paperwork than the cl ient , w h o on ly vis i ted twice i n one year, and w h o the w o m e n felt treated them l i ke a statistic. Al te rna t ive ly , experiences that were posi t ive for participants inc luded trusting relationships wi th 25 workers , soc ia l worker ava i lab i l i ty and persistence, and demonstrations o f care for and patience wi th the cl ient . A d d i t i o n a l l y participants felt supported when socia l workers were able to share power wi th their clients by offering them choices and authority i n m a k i n g decisions. K n o w l e d g e o f addict ion by workers was also ident i f ied as a posi t ive factor i n part icipants ' heal ing experiences. T h e strengths o f this study are numerous. F i r s t l y the study provides an alternative v i e w to tradit ional research i n terms o f a quali tat ive approach descr ib ing the experiences o f cl ients, treating these clients as people wi th valuable and v a l i d insights and experiences, and i n document ing participants ' success. In terms o f gathering data and accurately reflect ing participants ' experience, both informal and formal member checks were used, by c la r i fy ing and paraphrasing throughout the in terv iew and i n seeking the feedback o f participants on the pre l iminary data analysis. A s far as cautions w i t h respect to the study, this study was based on a very specific sample. Different results m a y be found wi th ind iv idua l s w h o re l inquished custody o f their ch i ld ren or, w h o cont inued to struggle wi th addic t ion. F ind ings m a y also have differed i f the participants inc luded men. T h e d iscuss ion o f the system shortcomings i n this study appears to reflect the negative attitudes o f professionals ment ioned i n A m o d e o (2000), Mat thews et a l . (2002), and Wes 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 and Grego i re ' s study (1997) the frustrations o f participants w i th services and service providers reflect the barriers to accessing services described i n A s h e r y et a l . (1995). T h e barriers and system shortcomings out l ined inc luded services that were not user f r iendly and service workers whose attitudes and behaviours were perceived as demeaning, degrading and uncaring. 26 H o w e v e r , it d i d appear f rom the data i n A k i n and Grego i re ' s study that a posi t ive worker -cl ient relat ionship made a difference i n the participants ' l ives . A l t h o u g h it was not addressed di rect ly i n the literature, it appeared that the attitudes and behaviours o f professionals i n the l ives o f ind iv idua ls w h o have addic t ion issues c o u l d be perce ived as harmful or helpful i n the ind iv idua l s ' journey out o f addict ion. O n the whole , the research described above suggests that professionals w h o had received t ra ining i n substance addict ion issues reported posi t ive changes f o l l o w i n g their t raining i n terms o f their attitudes and behaviours toward ind iv idua l s w h o had substance addict ion issues. A d d i t i o n a l l y , research ou t l in ing cl ient perspectives described both posi t ive and negative cl ient experiences in deal ing wi th 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 lay a significant role i n the recovery o f ind iv idua l s f rom addict ion, f indings o f the study by A k i n and Gregoi re (1997) m a y point i n the other direct ion, suggesting that interactions wi th socia l service workers seemed to p lay an important role i n he lp ing clients manage their addict ion i n order to be reunited wi th their ch i ldren . T h e quali tat ive studies described above begin to explore the experiences o f ind iv idua ls w i th addict ion issues i n their interactions w i t h services and service workers . The research alludes to the poss ib i l i ty that ind iv idua ls i n soc ia l service roles m a y be perceived b y their clients w i th substance abuse issues as faci l i ta t ing or imped ing their progress out o f addict ion: an aspect o f the literature I hoped to expand i n the current study. Furthermore, the literature to date does not d i rect ly examine whether ind iv idua l s perceive their interactions wi th professionals to have any influence on their success i n addressing their addic t ion issues. A n area I explored i n m y study was whether the 27 attitudes, knowledge and sk i l l s o f practitioners were perceived by the cl ient , and i n fact, whether these interactions were significant to clients i n their heal ing process. S o c i a l Support o f Individuals wi th A d d i c t i o n s Ano the r subset o f the literature examines the possible role o f socia l support i n heal ing f rom addic t ion and i n the maintenance o f healthy choices i n an i nd iv idua l ' s l i fe . Th rough their interactions, the ind iv idua l addressing their addict ion may perceive their friends or f a m i l y members to be instrumental i n faci l i ta t ing or h inder ing their heal ing process. It is therefore important to review the literature pertaining to the role socia l support may p lay i n the journey f rom addict ion and the maintenance o f a healthy lifestyle. In a study o f inpatients i n a substance dependence treatment program, A m e s and R o i t z s c h (2000) examined the relationship between stress and drug cravings and whether socia l support mediated this relat ionship. Th i r ty nine o f the 52 inpatients chosen for the study comple ted enough informat ion to be inc luded i n the study. T h e sample was composed largely o f men (59%) who were Caucas ian (74.4%), emp loyed (53.8%), the largest percentage were single (38.5%) wi th a mean 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 Inventory (DSI ) to assess mino r stress, the Interpersonal Support Eva lua t ion L i s t ( I S E L ) to measure socia 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 cravings. A demographic questionnaire developed for this study was used to gather background data. T h e demographic questionnaire and the I S E L were comple ted at the t ime when participants were recruited. Participants were asked to complete one D U R S sheet each t ime they experienced a c rav ing and to keep track o f m i n o r stressful events and record them each 28 night on the D S L Participants met wi th an experimenter each day to hand i n forms and ensure accurate and t imely comple t ion o f forms. W h e n the mean number o f stressful events and their perce ived influence were compared wi th a normat ive sample o f adults l i v i n g i n the communi ty , the participants i n the study reported a s imi la r number o f m i n o r stressful events but rated these events somewhat, but not s ignif icant ly , more stressful than the normat ive sample. W i t h i n the t ime enrol led i n the study (average 4 days) 64 .10% (n=25) o f participants d i d not experience any cravings. Consequent ly , participants were grouped into c rav ing and no-c rav ing groups. T h e number o f mino r stressful events and perceived impact o f stress appeared to predict cravings. Perce ived socia l support was found to moderate the association between the impact o f stressful events and cravings. T h e study begins to address the potential inf luence soc ia l support m a y have i n media t ing the stress-craving relationship. Ano the r strength o f the study is the v ig i lance o f the experimenters i n meet ing wi th participants da i ly to ensure forms were comple ted correct ly. H o w e v e r , the l o w leve l o f cravings dur ing this experiment means that more research is necessary to f i rmly establish patterns o f stress and cravings. Perhaps ind iv idua ls were not enrol led long enough in the study to obtain an accurate impress ion o f cravings, or perhaps the rate o f cravings post treatment m a y have been a better measure. D o b k i n et a l . (2002) carr ied out a study o f ind iv idua ls at treatment intake and again s ix months later i n order to compare them at the two stages i n terms o f h igh and l o w functional social support and the relat ionship between this variable and various r i sk factors that may interfere wi th the early stages o f recovery. T h e researchers examined 29 the stress-buffering role o f functional socia l support on treatment outcomes and whether leve l o f functional socia l support at intake predicted treatment outcomes. Func t iona l socia l support was defined by D o b k i n et a l . as "actual or perceived emot ional and instrumental support" (p. 348). T h e sample inc luded 206 ind iv idua l s at intake and 172 at s ix months. There were 100 ind iv idua ls i n the high social support group and 106 i n the l o w socia l support group. The l o w and h igh socia l support groups were not s ignif icant ly different on the demographic variables, legal status, or p r imary drug o f abuse. M o s t participants were Caucas ian (92.3%) and male (65.5%). Drugs o f abuse by participants i n this study inc luded a lcoho l , cocaine, sedatives and "other." T h e h igh and l o w socia l support groups in this study were compared across several variables considered to be risk factors for early recovery success inc lud ing : depressive symptomatology, negative l ife events, and severity o f substance abuse. T h e Interpersonal Support Eva lua t ion L i s t ( I S E L ) was used to assess patients' perception o f funct ional socia l support. The L i f e Exper iences Survey ( L E S ) was used to assess l i fe events i n the s ix months pr ior to treatment intake and again i n the intervening months between the in i t i a l and fo l low-up interviews. T h e B e c k Depress ion Inventory ( B D I ) was used to assess depressive symptoms and the S y m p t o m C h e c k l i s t - 9 0 - R was used to assess psycho log ica l distress. The A d d i c t i o n Severi ty Index ( A S I ) was administered to gather informat ion on the number o f days abstinent and the severity o f drug and a lcohol abuse. T w o - w a y A N O V A w i t h repeated measures was used to analyze the above data across the h igh and l o w soc ia l support groups and over t ime (intake versus s ix month fo l low-up) . 30 Func t iona l socia l support was a modest predictor o f reductions i n the severity o f a l coho l abuse at fo l low-up but d i d not predict reductions i n drug abuse. H i g h e r levels o f perce ived functional social support were related to more days spent i n treatment and to higher rates o f treatment comple t ion . B o t h h igh and l o w soc ia l support groups showed marked declines i n negative affect and severity o f substance abuse over t ime. Symptoms of depression and psycho log ica l distress were higher among patients w i t h l o w social support at intake and at s ix months. Patients w i th l o w soc ia l support at intake reported higher severity o f a lcohol and drug abuse at s ix months. N u m b e r o f days i n treatment was also s ignif icant ly related to number o f days abstinent, improvement i n severity o f a l coho l abuse, and improvement i n severity o f drug abuse. Hie ra rch ica l regression analyses were used to determine the m a i n effects o f stress and examine days abstinent f rom pr imary drug, severity o f a lcohol abuse, and severity o f drug abuse. T h e number o f days i n treatment was used as a var iable i n a l l regression analyses to examine the independent and interactive effects o f soc ia l support and stress on outcomes. Patients i n the l o w socia l support group exper ienced a greater number o f stressful l i fe events than those i n the h igh soc ia l support group at fo l low-up . B o t h stress and socia l support were found to have modest effects on treatment outcome. H o w e v e r , their interaction effect was not significant. Therefore the results fa i led to support a stress-buffering role o f soc ia l support on the number o f days abstinent and 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 by taking measures at both intake and again six months later to document changes i n risk factors that c o u l d interfere wi th early hea l ing f rom substance addict ion. Caut ions o f the study inc lude the 31 demographics o f the largely white, male sample as w e l l as the appropriateness o f the I S E L wi th a substance abusing populat ion. T h e study by D o b k i n et a l . (2002) and that o f A m e s and R o i t z s c h (1997) point to the possible benefits o f increased socia l support to ind iv idua l s i n treatment for addict ion. S o c i a l support seemed to be related to more days i n treatment and higher rates o f treatment comple t ion i n A m e s and Ro i t s ch ' s study. A d d i t i o n a l l y , D o b k i n et a l . found that ind iv idua l s w i th h igh socia l support had l ower symptoms o f depression and psycho log ica l distress and l ower severity o f a lcohol and drug abuse at s ix months than ind iv idua l s w i th l o w socia l support. A l t h o u g h the results differ, they seem to complement each other i n that socia l support m a y p lay a role i n he lp ing ind iv idua ls cope i n treatment situations. If social support does provide a cop ing mechan i sm for ind iv idua ls heal ing f rom addict ion, it is possible that the heal ing ind iv idua l s m a y perceive people w i th in their socia l support network as he lp ing to facilitate their hea l ing process. I a imed to explore i n m y research interactions wi th various people i n part icipants ' l ives that were perceived as influential i n their journeys. In a descript ive, quali tat ive study by R e i d et a l . (2001) the authors explored the meaning and perce ived influence o f cocaine use i n the l ives o f ind iv idua l s w h o used cocaine i n moderat ion. The authors hoped to identify factors the participants associated wi th their abi l i ty to function at an acceptable leve l wh i l e us ing cocaine. T h e sample inc luded ten ind iv idua l s : one Wes t Indian male , one A f r i c a n A m e r i c a n female, one Y a q u i Indian female, two white males, and f ive white females a l l f rom 21 to 46 years o f age. L e v e l o f funct ioning o f each participant was determined us ing the A d d i c t i o n Severi ty Index as w e l l as a subjective assessment by a person w h o was fami l ia r w i th that 32 participant. A screening interview was then conducted wi th ind iv idua l s chosen for the study. F o l l o w i n g the in terview, a researcher-designed questionnaire was administered to participants to obtain informat ion on participants ' history, evolu t ion o f their drug use and the role it cont inued to p lay i n their l ives . F o l l o w - u p interviews were conducted w i t h the participants to c lar i fy any discrepancies between the A S I data and the data obtained f rom the researcher-designed instrument. Th rough descriptions o f their thoughts and behaviours, participants ident i f ied socia l factors, personal factors, and cocaine use factors that assisted them i n their abi l i ty to mainta in their cocaine use at a level that d i d not compromise their everyday l ives . S o c i a l factors ident i f ied by participants inc luded w o r k ethic, invo lvement i n soc ia l ly oriented activit ies, f ami ly considerations, compass ion for others, strong interpersonal relat ionships, and faith i n G o d . Personal factors perce ived as in f luenc ing the cocaine use o f participants inc luded posi t ive self-image, sel f -discipl ine, and self-confidence. Me thods to control cocaine use or cocaine use factors inc luded m i n i m i z i n g the amount o f cocaine used, choos ing the times to use, and us ing when their attitudes and moods were posi t ive . O lde r participants used less freely than younger participants who were not as concerned about consequences o f their drug use and w h o also used i n pub l ic more often and used larger amounts o f cocaine. W o m e n i n this study used more conservat ively than men wi th their reason be ing the need to care for, and set an example for their chi ldren. Participants f rom cultural minori t ies rejected the not ion that cocaine use was "bad," and ident i f ied their culture as a reason for hav ing posi t ive attitudes about cocaine use. The 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 unusual sample. A d d i t i o n a l l y , the study 33-sample is a strength i n terms o f its d ivers i ty o f gender, e thnici ty and economic status. Ano the r strength o f this study is that it focuses on the idea that a l l drug use is not abuse; whereas most research highlights the negative aspects o f drug use. Qual i f ica t ions i n the interpretation o f the study's results inc lude that the sample was one o f convenience us ing the snowba l l ing method. A l s o general izat ion is not possible because o f the smal l sample size. W h e n asked about what factors keep their cocaine use i n check, participants i n this study s ingled out social factors, i nc lud ing interpersonal and f ami ly relationships as part o f that component. T h i s evidence, combined wi th results f rom A m e s and R o i t z s c h (1997) and D o b k i n et a l . (2002) that social support seems to p lay some role i n he lp ing ind iv idua l s i n treatment settings, underscores the possible formative role o f socia l support i n the process o f heal ing f rom addict ion and i n mainta in ing ind iv idua l s ' posi t ive l i festyle changes. The research on the effects o f social support i n media t ing stress and faci l i ta t ing treatment outcomes as w e l l as i n mainta in ing moderate levels o f cocaine use seemed to suggest that socia l support m a y p lay some role i n he lp ing an i nd iv idua l m o v e away f rom addict ion and mainta in their new lifestyle. H o w e v e r , none o f these studies addressed what it was about these socia l connections that may be faci l i tat ive i n the context o f recovery. In m y study I tried to explore what ind iv idua l s heal ing f rom addict ion experienced i n their interactions wi th their social support network i n terms o f faci l i ta t ing or imped ing their process o f heal ing. 34 E thn ic and Gender Issues T h e l im i t ed literature avai lable on gender and ethnic issues i n the area o f addic t ion research seems to suggest that men and w o m e n as w e l l as ind iv idua ls o f different ethnic or igins may have different needs throughout their heal ing journey. G i v e n this considerat ion I t r ied to include ind iv idua ls i n m y study who represented different ethnicities and both genders in order to compare their experiences. In their summary and cri t ique o f the literature descr ib ing the ways w o m e n experience addict ion and how this differs f rom men, N e l s o n - Z l u p k o , K a u f f m a n and D o r e (1995) suggest that w o m e n wi th chemica l dependencies differ f rom men w i t h s imi la r issues i n terms o f patterns o f drug use, psychosoc ia l characteristics and phys io log i ca l consequences o f drug use. It appears, f rom their expl ica t ion o f the research, that w o m e n were more l i k e l y to use legal drugs (tranquilizers, sedatives, psychoact ive drugs, hypnotics , stimulants) and men to use i l l i c i t ones. T h e onset o f drug use for w o m e n was described as sudden and heavy, typ ica l ly after a traumatic event i n their l ives . In contrast, men often described a gradual, increasing pattern o f drug use. W o m e n were described as more often i n v o l v e d in mul t ip le drug use than men. P h y s i c a l l y , w o m e n experienced more harmful consequences o f drug use at l ower dosages and i n a shorter amount o f t ime than men. The research indicated that women had fewer socia l supports to draw on than men wi th addictions. W o m e n appeared more l i k e l y than men to use i n isola t ion and i n private places rather than publ ic places. W o m e n were more l i k e l y than men to be i n relationships wi th drug-using partners or spouses. A d d i t i o n a l l y , w o m e n tended to have . less education, fewer marketable sk i l l s , fewer w o r k experiences and fewer f inancia l 3 5 ' resources than men wi th chemica l dependencies. It seemed f rom the research that, i n treatment, w o m e n were less l i k e l y than their male counterparts to have someone support ing them. W o m e n were even typ ica l ly discouraged f rom part ic ipat ing i n treatment by f ami ly members. T h e discouragement f rom f a m i l y members was not the o n l y barrier to treatment for w o m e n that was described in N e l s o n - Z l u p k o et a l . (1995). T h e lack o f c h i l d care was ment ioned frequently as a barrier to treatment. Mothe r s were either u n w i l l i n g to give up their role as p r imary caregiver or c o u l d not afford c h i l d care w h i l e i n treatment. Mothe r s also tended to distrust socia l services and were reluctant to admit their addict ion issues. W o m e n were also more l i k e l y to experience sexual harassment i n treatment settings than men. A d d i t i o n a l l y , most treatment programs were designed for men, by men and based on research conducted wi th male participants. N e l s o n - Z l u p k o et a l . suggested that as a result, the typ ica l treatment format m a y not be ideal for w o m e n . F i n a l l y , there were more men i n treatment than w o m e n and more male staff that dissuaded w o m e n f rom entering treatment depending on the issues they were facing. F r o m the summary o f the research on w o m e n and chemica l dependence by 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 addic t ion and recovery than men. T h e onset o f addic t ion for w o m e n m a y differ f rom that o f men. The socia l network o f w o m e n fac ing addic t ion issues may be non existent or certainly less extensive and not as supportive i n compar i son to men wi th addiction.issues. A d d i t i o n a l l y , w o m e n may not get into and stay i n treatment; thus main ta in ing the social i sola t ion these w o m e n appear to experience. I f differences 36 between men and w o m e n wi th addict ion issues do 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 examine the differences i n longi tudinal patterns o f narcotics use, other substance use, c r i m i n a l status, treatment experience, and morb id i ty and mortal i ty among H i span i c and white ind iv idua l s w i th addict ions. The sample compr i sed 323 H i span i c and 212 white male narcotics addicts who were admitted to a court-mandated treatment program ca l l ed the C a l i f o r n i a C i v i l A d d i c t P rogram ( C C A P ) between the years o f 1962 and 1964. T h e two groups d i d not differ s ignif icant ly i n terms o f mari ta l status, age at admiss ion to the treatment program, or age o f first opiate use. H o w e v e r , H i span ic s had s ignif icant ly less education than whites and age o f first arrest was s ignif icant ly l ower for Hi span ics than whites. T h i s study is a secondary analysis o f data that were obtained f rom admiss ion records o f the C C A P as w e l l as interviews conducted i n 1974/75 and 1985/86. P r i o r to the 1985/86 interviews, 95 Hispan ics and 58 whites d ied , so data is avai lable for 203 Hispan ics and 123 whites for both the 1974/75 and 1985/86 interviews. T h e in i t i a l intake interview was l imi t ed , compr i s ing several demographic variables. T h e in terview instrument used in the two subsequent interviews was adapted f rom another, p rev ious ly designed in terview. Information on demographic characteristics, f a m i l y history, drug-use history, treatment experience, employment , c r im ina l behaviour , and legal status was gathered dur ing a two to three hour in terview us ing the researcher-developed in terview protocol . In order to corroborate respondents' reports, researchers had access to c r im ina l records and urine samples were col lected after in te rv iewing participants w h o were not 37 incarcerated. Agreement between respondent reports and ur inalysis was 73 .7% at the first in terview and 85 .8% at the second interview. E igh ty -n ine point three percent o f the sample agreed to provide urine samples at first in terv iew and 8 9 . 1 % o f participants agreed to ur inalysis at the second in terview. Narco t i c use was determined by urine test or incarcerat ion: not self-report, and d i d not inc lude the narcotic use status i n the intervening years. In terms o f test-retest re l iab i l i ty determined by compar ing data f rom the two interviews, the test-retest correlat ion range was 0.63 to 0.71. H i span i c addicts showed a progression o f more persistent and severe narcotics addic t ion compared wi th whi te addicts. A t each in terview, Hi span ics were more l i k e l y than whites to be us ing opiates or to be incarcerated. H i span ics were less l i k e l y than whites to remain abstinent and were more l i k e l y to relapse to opiate use. H i span ics had greater invo lvement i n the c r im ina l just ice system, higher rates o f cocaine use, and a higher proport ion o f deaths due to v io lence and accidents. H o w e v e r , rates o f hepatitis and cigarette s m o k i n g were part icular ly h igh among white addicts. In treatment, H i span i c participants d i d not l i ke sharing personal thoughts and feelings i n a group situation wi th ind iv idua l s o f other ethnicities. Treatment part icipat ion was l o w for each group and there were no differences between the two groups for treatment part icipat ion. T h e m a i n strengths o f the study are the longi tudinal nature and the var ied data gathered on drug behaviour. A d d i t i o n a l l y , the abi l i ty o f the researchers to corroborate most respondents' answers by urine sample and b y c r i m i n a l records lends c red ib i l i ty to the data gathered. The relevance o f this research to m y study is that it appears that ind iv idua ls f rom a H i span i c background m a y have a different experience o f addic t ion and treatment than 38 white ind iv idua l s . Prendergrast, H s e r and G i l - R i v a s ' (1998) study indicated that H i span i c ind iv idua l s showed more severe addic t ion and c r i m i n a l just ice issues than whi te participants. A d d i t i o n a l l y , H i span ic ind iv idua ls d i d not l i ke sharing i n a group treatment format w i t h ind iv idua l s o f different ethnicities. These results suggest that the experience of addict ion m a y be different for ind iv idua ls o f differ ing ethnicities or cul tural backgrounds. I was mindfu l o f this when selecting m y participants and i n l i s tening to their experiences. The l im i t ed literature on ind iv idua ls o f different genders and f rom different ethnic and cul tural backgrounds who have substance addictions seems to suggest that the experiences o f these ind iv idua ls may be inf luenced by their culture or gender. In R e i d et a l . (2001) ind iv idua l s f rom cul tural minori t ies tended not to see cocaine use as "bad" i n the way the p reva i l ing culture does. T h e study by Prendergast et a l . (1998) reported that H i span ic participants d i d not l i ke the group format o f treatment that requires personal disclosures w i t h people o f other ethnic groups. A s h e r y et a l . (1995) noted that " i n some instances ethnic and gender overtones were ment ioned by the part icipants" (p. 79) suggesting that ind iv idua ls may be treated differently because o f their background or gender. T h e summary and cri t ique o f the experiences o f w o m e n wi th addict ion issues b y N e l s o n - Z l u p k o et a l . (1995) lists a variety o f ways i n w h i c h w o m e n m a y differ f rom men throughout the heal ing process. T h e above research suggests that ind iv idua ls o f different cultures and different genders m a y have different needs and different experiences throughout their heal ing f rom substance addict ion. I was able to inc lude i n m y study ind iv idua ls o f different ethnicities and genders and I tr ied to gain insights into the experiences o f these ind iv idua ls i nc lud ing interactions based on these factors. 39 S u m m a r y and Synthesis F r o m a rev iew of the literature addressing the role o f professionals, socia l support and ethnic and gender issues i n the area o f addic t ion, it is apparent that a gap exists i n our understanding o f the experience o f ind iv idua ls w i th addictions i n terms o f their experiences and perceptions o f their interactions wi th others i n their process o f heal ing. It w o u l d be beneficial to gain insights into these interactions i n order to be faci l i ta t ive i n the heal ing process o f ind iv idua l s w i t h addict ion issues. T h e soc ia l support literature ( A m e s & R o i t z s c h , 2000; D o b k i n et a l . , 2002; R e i d et a l . , 2001) suggests the poss ib i l i ty o f socia l relationships be ing experienced as beneficial by ind iv idua l s w i th addict ion issues i n their heal ing process. H o w e v e r , i f indeed a relat ionship does exist between an extensive social support network and facil i tated heal ing, the nature o f the interactions between the recover ing i nd iv idua l and their supports remains to be explored. The literature suggests that the training o f professionals i n substance addict ion issues may be helpful i n addressing the negative attitudes that may exist among professionals. W h a t remains uncertain is whether these more posi t ive attitudes are translated to the cl ient and, moreover , whether interactions wi th professionals are among the perceived significant interactions o f clients on their road to a healthy l ifestyle. It was m y hope that through a phenomenologica l study o f ind iv idua ls w i th addict ion issues that I w o u l d be able to contribute to the literature by exp lor ing the interactions wi th others that were experienced by participants as faci l i tat ive or imped ing i n their heal ing path away f rom an addict ive l ifestyle. 40 C H A P T E R T H R E E M e t h o d o l o g y M e t h o d Select ion In spite o f m u c h literature i n the area o f addict ion, researchers are s t i l l s t ruggling to understand the road out o f the l ifestyle characterized by addict ion. Studies have investigated the role o f addict ion professionals ' attitudes toward clients and the influence of a broad soc ia l network on cl ient recovery. H o w e v e r , very l im i t ed research exists that examines faci l i tat ive or imped ing interactions wi th others i n the l ives o f ind iv idua l s w h o have m o v e d f rom substance addict ion to health. It seemed fi t t ing at this t ime to address the gap that exists i n this area o f research. I f w e can learn about the perceived faci l i tat ive and hinder ing interactions ind iv idua ls have w i t h others throughout their heal ing process, we can provide important informat ion for counsel lors and other professionals who are intended to p lay a he lp ing role i n the heal ing journey o f ind iv idua ls w i th addict ion issues. B a s e d upon a rev iew of 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? The purpose o f this study was to examine how ind iv idua l s who have m o v e d f rom substance addict ion to health experienced their interactions wi th others i n terms o f faci l i ta t ing or i m p e d i n g their heal ing journey. T h i s study was exploratory i n nature because very l i t t le is k n o w n about the l i v e d experience o f this phenomenon. Exp lo ra to ry research is undertaken i n order to provide a better understanding or i l l umina t ion o f a process or a p rob lem (Hart, 1998). Qual i ta t ive invest igat ion is most appropriate for this 41 study because the purpose o f quali tat ive research is "to identify the characteristics o f phenomena" (Beck , 1993, p. 263). T h e quali tat ive method that was chosen to investigate this phenomenon was phenomenology. T h e nature o f phenomenology is descript ive rather than experimental . T h e purpose is to describe and understand experience instead o f predict and control behaviour. T h e " a i m o f the research is to achieve perspectival understanding o f a phenomenon and identify its structure" (Osborne, 1990, p. 82). Genera l ly this understanding is sought through interviews wi th ind iv idua l s w h o have experienced the phenomenon i n question i n order to gain a detai led descr ipt ion o f the l i v e d experience o f the phenomenon ( C o l a i z z i , 1978). The descript ion is then analyzed for themes that fo rm the structure o f the phenomenon w h i l e attempting to accurately represent the l i v e d experience o f the participants. In-depth, phenomenologica l interviews were used i n this study to capture the c o m m o n themes i n the experiences o f the participants. Phenomenolog ica l inqu i ry assumes that meaning is der ived f rom the commona l i t y o f shared experience (Patton, 1990). R o l e o f the Researcher In quali tat ive research the researcher's process, presupposit ions and possible influence on the research project are made exp l i c i t so the researcher's biases and assumptions can be d i s t i l l ed f rom the data. Qual i ta t ive research does not assume that the researcher is unbiased ( C o l a i z z i , 1978) as i n quantitative research, where it is assumed that the researcher is objective or has no influence on the research process. The presupposit ions and biases o f the researcher are articulated pr ior to and dur ing the . 42 quali tat ive research process so the reader can take this perspective into account when reading the research report. D e s c r i b i n g the researcher's presupposit ions 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 (Osborne, 1990). H o w I came to this research question and what I expected to f ind w i l l be out l ined i n the f o l l o w i n g paragraphs. M y or ig ina l interest in the area o f addic t ion is der ived f rom the history o f a l coho l i sm i n m y fami ly . L i v i n g around ind iv idua ls w h o have addictions has made me curious about the phenomenon o f substance abuse and the process o f ove rcoming this aff l ic t ion. I feel that m y personal experience i n this area has helped me to understand m y clients i n counse l l ing situations and I feel this was beneficial i n the research process as w e l l . Af te r counse l l ing ind iv idua ls w h o have substance abuse issues, m y compass ion for those w h o suffer w i t h addictions grew. M y bel ief is that the pl ight o f people who suffer f rom addic t ion is worsened by society 's and certain ind iv idua l s ' attitudes. I suspected that these attitudes w o u l d be communica ted i n their interactions wi th addicted ind iv idua l s . Aspects o f interactions that I thought might be experienced by participants as negative inc luded impat ience on the part o f others, dismissiveness , unrealist ic expectations, and expect ing that addict ive behaviours c o u l d change without addressing an i nd iv idua l ' s entire l i festyle. If an ind iv idua l w i t h addict ion issues was treated as a c r im ina l rather than an ind iv idua l w i th a health p rob lem I be l ieved this might also be construed by ind iv idua l s as hinder ing i n their recovery. I also thought that impar t ing the 43 be l ie f "once an addict, a lways an addict" to an ind iv idua l i n the recovery process might also be perceived as l i m i t i n g by these ind iv idua ls who are t ry ing to change their l i festyle. I assumed that ind iv idua l s who were m o v i n g toward a healthier l ifestyle w o u l d be aided i f they have more people around them: fami ly , friends or professionals, who had posi t ive attitudes about the i nd iv idua l ' s struggles to overcome their addic t ion, and therefore more faci l i tat ive interactions wi th these ind iv idua l s . I imag ined that some o f the attitudes and behaviours that might be perceived by participants as faci l i tat ive w o u l d inc lude patience, encouragement, convey ing o p t i m i s m about the i n d i v i d u a l ' s progress and potential , acceptance and respect. In a professional relat ionship, I imag ined that w o r k i n g co l labora t ive ly wi th clients, treating each person as a unique i nd iv idua l rather than as "an addict ," being patient and accepting 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, empath iz ing wi th the d i f f icul ty o f qui t t ing or cut t ing d o w n , encouraging persistence i n reinvent ing cl ients ' l ives , and w o r k i n g toward reducing harm to the i n d i v i d u a l and promot ing healthful behaviours c o u l d be perce ived by participants to be faci l i tat ive i n their heal ing journey. M y reasons for choos ing m y specific quest ion emerged f rom m y addic t ion counse l l ing background. H i s to r i c a l l y ( B o y d , 1991; G r a y , 1998) ind iv idua l s w i t h addictions have been treated as outcasts rather than as ind iv idua l s w h o need help. T h e harm reduct ion mode l (Denning , 2000) is t ry ing to change this practice b y treating ind iv idua ls w i t h addictions wi th respect, and by encouraging health p romot ion and harm reduction as the goals o f treatment rather than abstinence. In-keeping w i t h this mode l o f approaching ind iv idua l s wi th addictions wi th respect, I chose a quali tat ive thesis question that a l lows the data to come f rom the experts: those ind iv idua l s w i th substance addic t ion 44 histories w h o have healed f rom their addict ion and who are n o w leading healthy l ives . I w o u l d l i ke to add to the literature that exists that treats ind iv idua l s w i th addictions as wor thwhi le , contr ibut ing people who have expertise to offer the academic, research and professional communi t ies . I was aware that m y be l ie f that those w h o suffer f rom addict ion are marg ina l i zed i n society might have l ed to biases when I was ana lyz ing data; whether I was l o o k i n g for conf i rmatory evidence or t ry ing to counter m y preconceived notions. T o address m y assumptions, I engaged i n a process o f "r igorous self-ref lect ion" (Osborne, 1990, p. 81) throughout the duration o f the research that was documented i n a journa l . I was also prepared to consult w i th m y supervisor when necessary to address any o f m y assumptions and the influence they may have p layed i n data analysis and interpretation. A s a he lp ing professional I hoped to f ind throughout the data co l lec t ion interviews that counsel lors and others i n he lp ing roles p layed a significant part i n faci l i ta t ing heal ing f rom addict ion. I was prepared, however , for the poss ib i l i ty that this w o u l d not be the case. I hoped to be open enough i n m y th ink ing to a l l ow for responses and opinions that differed f rom m y expectations and to be able to reflect the part icipants ' experiences accurately i n the data analysis. Selec t ion o f Participants A l t h o u g h there are no strict guidelines for the number o f required participants i n a phenomenologica l study, Osborne (1990) and K v a l e (1996) suggest that sufficient participants are needed to i l luminate the phenomenon o f interest. T o explore the phenomenon i n this study the sample was compr i sed o f the first 6 ind iv idua l s who met the research cri teria. O n l y 6 participants were chosen because at this point the themes 45 appeared to be saturated. Participants appropriate for this study had not been abusing substances for at least the last s ix months but had experienced their substance addic t ion w i t h i n the past f ive years. S i x months without relapse is the t ime required for an ind iv idua l to be considered to be i n the "maintenance" stage o f change wi th respect to their addic t ion (Denning , 2000; Prochaska, D i C l e m e n t e , & Norc ross , 1992). Relapse occurs when ind iv idua l s revert to an earlier stage o f change (Prochaska, D i C l e m e n t e & Norcross ) , characterized by addict ive behaviours. S i x months without relapse hopeful ly gave participants enough t ime to reflect on their experiences i n order to g ive a retrospective account. H o w e v e r , i n order to i l luminate the phenomenon wi th reasonable accuracy, participants were required to have experienced their substance abuse w i t h i n the last f ive years. E l i g i b l e ind iv idua ls for this study had adequate fami l ia r i ty w i th the phenomenon i n question i n order to give a r i ch descript ion o f their experience i n an i n -depth interview. F a m i l i a r i t y w i th substance addict ion refers to the problematic substance use participants exper ienced wi th in the last f ive years. F o r the purposes o f this study, the sample was restricted to adult participants. Deve lopmenta l literature (Berk , 1996; Ca r l son & L e w i s , 1998) suggests that adolescents differ cogn i t ive ly , emot iona l ly and soc ia l ly f rom adults and therefore adolescents were not inc luded i n the sample for this study. Individuals interested i n part ic ipat ing i n the study also agreed to an audio-taped interview, a t ime commitment o f two to three hours, and agreed to discuss their experience o f interactions that they perce ived to facilitate and impede their heal ing f rom addict ion. Participants d i d not have any impai rment that rendered them unable to g ive informed consent or respond coherent ly i n the in terview. 46 A d d i t i o n a l l y , participants were able to communica te effect ively i n E n g l i s h for the interviews. The avai lable literature suggests that interactions may be shaped b y an i nd iv idua l ' s ethnici ty or gender (B ie rnack i , 1986; D e n n i n g , 2000; 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, Hser , & G i l - R i v a s , 1998). W i t h this i n m i n d , I t r ied to include i n m y sample ind iv idua ls o f different ethnici ty as w e l l as w o m e n and men, i n an attempt to capture any differences i n experiences based on these factors. Included i n the participants were one man wi th South A s i a n and Swed i sh heritage, and one w o m a n w h o was A f r i c a n Canadian . Recrui tment o f Participants Participants were recruited us ing posters p laced i n various locat ions around the c i ty o f V a n c o u v e r i nc lud ing the A l a n o C l u b , A V a l o n W o m e n ' s Centre , D a y t o x at V a n c o u v e r De tox , Dunba r C o m m u n i t y Centre, F a m i l y Services o f Greater Vancouver : V a n c o u v e r East Off ice , H e y - W a y - N o q u , Pac i f i c Spi r i t C o m m u n i t y Hea l th Centre, R a v e n Song C o m m u n i t y Hea l th Centre, St. M a r y ' s Ker r i sda le : A n g l i c a n C h u r c h , T u r n i n g Poin t R e c o v e r y House , U B C C o u n s e l l i n g P s y c h o l o g y Department, 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 conducted in i t i a l telephone interviews to give participants an ove rv iew of the study's nature and purpose and establish participant sui tabi l i ty for the study (Osborne, 1990). Once sui tabi l i ty and wi l l ingness were established, an appointment was set up to meet for the data co l lec t ion in terview. 47 D a t a C o l l e c t i o n W h e n I met w i th each participant for the data co l l ec t ion in terview, I in t roduced myse l f and endeavoured, through casual conversat ion, to establish rapport. Rapport is important i n encouraging accurate descriptions f rom participants o f their experience (Osborne, 1990). Informed consent was discussed next. T h i s d iscuss ion inc luded the purpose o f the study, the use o f a tape recorder to record the in terviews, and addressed any questions the participant had about the study. A n in formed consent f o r m was comple ted ou t l in ing the purpose o f the study, requirements o f participants, issues o f confident ial i ty , freedom o f participants to wi thdraw from the study at any point, and storage o f data (see A p p e n d i x B ) . T h e participant and I both signed the consent f o r m and a copy was g iven to the participant. Once the consent fo rm was completed, I read the participant an or ient ing statement to give the participant a context for the in terview ( K v a l e , 1996)(see A p p e n d i x C ) . T h e orient ing statement p rov ided a consistent introduct ion to the interview for each participant. T h e duration o f each data co l lec t ion interview was between IV2 hours and 3 hours. A n unstructured, open-ended style o f in te rv iewing was used i n order to gain insights into h o w participants exper ienced the phenomenon o f their interactions wi th others that they felt facil i tated or impeded their heal ing journey f rom substance addic t ion to health. In-depth interviews are appropriate for this study because the in terview process enables the researcher to uncover part icipants ' v iews through their eyes and f rom their unique perspectives (Mar sha l l & Rossman , 1999). T h e p r imary in terv iew question was " W o u l d y o u please te l l me about your experiences o f faci l i tat ive or imped ing interactions that y o u felt were significant to your process o f heal ing f rom addic t ion?" I used paraphrasing and 48 reflection to help prompt the participant. F o l l o w - u p and c la r i fy ing questions were also asked about the part icular nature o f the interactions i n order to gather a r i ch descr ipt ion o f the phenomenon (Osborne, 1990; K v a l e , 1996). Some examples o f these fo l low-up questions include: "can you tel l me more about what y o u were feel ing or what went through your m i n d when that happened?", "how d i d the interaction affect you?" , " w o u l d y o u l i ke to say any more about that?". I responded to statements us ing the techniques ment ioned above, as w e l l as us ing the counse l l ing sk i l l s o f active l is tening and empathy i n order to facilitate a more in-depth explorat ion o f each part icipant 's experiences. Quest ions i n the interview schedule ( A p p e n d i x D ) were avai lable for me i n order to move the process along, draw out expl icat ions f rom participants, help to facilitate a we l l - rounded descript ion o f each part icipant 's experience, and to help focus the interviews. 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 on the participants, a l ist o f counsel lors ' names were avai lable i f the participant felt they w o u l d l i ke to fo l low-up . T h e interviews were tape-recorded i n order to transcribe the data for analysis. I col lec ted and analyzed a l l data i n the study. F o l l o w i n g each in terview I wrote d o w n detai led notes about the in terview, i nc lud ing informat ion about the part icipant 's verbal and non-verbal behaviour, the in terview content, and m y impressions o f the in terview proceedings i nc lud ing any personal feelings that arose for me i n the interview. T h i s informat ion helped i n contextual iz ing the analysis o f the interviews. Once the data were analyzed, I conducted va l ida t ion interviews wi th 4 o f the 6 participants. T h e summary data analysis and their o w n b iographica l informat ion were 49 presented to each participant for them to examine pr ior to our second in terv iew i n order to conf i rm that the informat ion and analysis were consistent w i th their experience. D u r i n g a fo l low-up in terview, participants were asked for their feedback about the data analysis and to relate how w e l l the themes reflected their experience. T h e interviews lasted an average o f one hour. Participants were able to offer any addi t ional insights dur ing the va l ida t ion interview based on the themes that emerged through data analysis. A n y feedback or comments were taken into considerat ion i n the f ina l analysis. Participants were pleased wi th the results and felt accurately represented. Interviewees felt they c o u l d relate to most o f the f indings, whether f rom their o w n experiences, or the experiences o f others they knew w h o had a history o f addic t ion. D a t a A n a l y s i s F o l l o w i n g m y first in terview m y supervisor checked m y in terv iew procedure to ensure that I d i d not inadvertently influence the in terview process. A t that t ime she also gave feedback and suggestions about m y interview style pr ior to subsequent interviews. I then comple ted the remain ing data co l lec t ion interviews. Once the data co l lec t ion interviews were f in ished and transcribed verbat im f rom the audio-tapes, the data were analyzed for c o m m o n themes according to C o l a i z z i ' s (1978) method o f data analysis. The transcript took into considerat ion verbal and nonverbal behaviour wherever possible (i.e., pauses, c ry ing , laughter, tone o f voice) . T h e f i e ld notes I kept, deta i l ing m y experience o f the in terview, complemented the transcript informat ion. F i rs t I read over the transcripts to "get a feel for the data" (Osborne, 1990, p. 85). I then read and re-read the transcriptions i n order to become intimate wi th the data and seek out further insights (Smi th , Jarman, & Osborn , 1999). Signif icant 50 sentences and paraphrases that pertained to the phenomenon be ing examined were extracted f rom each part icipant 's transcript. T h e resultant paraphrases were then examined wi th the a i m of formulat ing the meaning o f the or ig ina l statement. T h i s process is not interpretation o f the part icipant 's intention so m u c h as the i l l umina t ion o f the meaning or experience o f the participant ( C o l a i z z i ) . I l lumina t ion o f meaning was focused on extracting the "deep structures w h i c h characterize the phenomenon" (Osborne, 1990, p. 85) rather than s i m p l y per forming a l i teral content analysis o f the data. T h i s process differs f rom interpretation w h i c h looks for meaning based on a preconceived theory whereas i l l umina t ion seeks meaning di rect ly f rom the data (Osborne). S i m i l a r formulated meaning statements were clustered into themes. T h e themes that emerged were then clustered and the clusters were grouped into higher-order themes. The clusters o f themes were referred back to the or ig ina l transcripts for va l ida t ion . The purpose o f this referral was to ensure the themes accurately reflected the or ig ina l protocols . The result ing themes compr i sed the structure o f the phenomenon. Clus te r ing o f themes was conducted for each participant as w e l l as across participants to determine a shared thematic structure. In terv iewing and data analysis cont inued unt i l no new informat ion or themes emerged f rom the data. Trustworthiness T h e rigor o f the f indings i n a quali tat ive w o r k is an ind ica t ion o f whether the results can be trusted - whether the phenomenon exists and whether I have measured what I have said I w o u l d measure (Marsha l l & Rossman , 1999). T h e k e y i n t ry ing to ensure the re l iab i l i ty and va l id i ty o f quali tat ive research is not to detract f rom its contr ibut ion by do ing so. W h a t makes quali tat ive research so rich is the abi l i ty to 51 examine i n great depth and detail the experience o f ind iv idua l s and through this explorat ion come to some agreement on the structure o f the experience. That the same results m a y not be achieved by another researcher or w i th different participants does not necessari ly render the w o r k i n v a l i d (Sande lowski , 1993). Different results s i m p l y serve to deepen our understanding o f the breadth o f the phenomenon. H o w e v e r , it remains necessary to establish cri ter ia for evaluat ing the worth o f quali tat ive research. B e c k (1993) addresses the need for evaluat ing quali tat ive research on its o w n terms rather than t ry ing to fit quantitative terms and ideas around quali tat ive methodologies . F o r the purposes o f phenomenologica l inqui ry , re l iab i l i ty , termed auditabi l i ty (Beck , 1993), is measured by consistency (Beck) or dependabil i ty ( M a r s h a l l & R o s s m a n , 1999). A s wi th re l iab i l i ty , the purpose o f auditabi l i ty is to ensure that the results can be repeated by another researcher. In order to ensure auditabi l i ty i n this study I audio-taped a l l interviews and kept detailed f i e ld notes about the interviews i n c l u d i n g contextual details about the in terview situation. I also detai led m y process o f dec is ion-m a k i n g i n determining m y thematic analysis. M a k i n g m y "audit t r a i l " (Beck) exp l i c i t i n these ways w i l l help the reader and other researchers f o l l o w the path I took i n obtaining m y results. The corresponding qualitative measure o f internal va l id i ty is c red ib i l i ty w h i c h is a measure o f the "truth va lue" (Beck , 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 descr ipt ion o f the phenomenon i s " (Beck , p. 264). T h e ways that c red ib i l i ty were addressed i n this study were by i nc lud ing i n m y f i e ld notes informat ion about m y relationships wi th the participants and m y personal feelings and reactions throughout the research process, cons ider ing and account ing for the influence o f m y 52 presence on the data col lected, remain ing open to the poss ib i l i ty o f negative or conf l i c t ing themes ( C o l a i z z i , 1978) i n the data analysis, and hav ing m y supervisor rev iew m y first in terview to substantiate that I was not leading the participants i n the in terview situation. I t r ied to uncover meanings f rom the data, g iven the context o f the part icipants ' comments . T h i s hopeful ly l ed to a more accurate reflection o f the part icipants ' intentions. I also conducted val idat ion interviews wi th the participants to ensure that the emergent themes accurately represented their experience ( C o l a i z z i , 1978; Osborne, 1990). Ex te rna l va l id i ty or general izabi l i ty is described i n quali tat ive research by the term fittingness. Fit t ingness measures the appl icab i l i ty (Beck , 1993) or transferability (Marsha l l & R o s s m a n , 1999) o f the f indings. The issue o f fittingness was addressed i n this study by sampl ing f rom a range o f participants where possible and b y t ry ing to be true to the o r ig ina l data by detai l ing differences as w e l l as c o m m o n themes. In addi t ion I conf i rmed the results w i th two ind iv idua ls w h o had substance addic t ion histories but w h o d i d not participate i n the study. These independent ind iv idua 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 phenomenon o f faci l i ta t ing and imped ing interactions wi th others throughout their heal ing journey f rom substance addict ion. One ind iv idua l d i d suggest, however , that I inc lude i n m y paper a def ini t ion o f the term heal ing journey. H e was unclear on m y meaning because I described i n m y themes both times o f substance abuse or relapse and t imes when ind iv idua ls were not abusing substances. One feel ing I discussed i n the role o f the researcher section that I perhaps d i d not make exp l i c i t is m y be l ie f that the heal ing journey involves both progression and regression. That is to say, relapse is a part o f 53 heal ing. Relapse m a y be a setback, but contemplat ing change and the cont inued efforts to m o v e away f rom an addict ive l ifestyle constitute a heal ing journey i n m y eyes. W h e n I described it as such, the interviewee said he felt it was important to state this orientation because th ink ing o f these s tumbl ing b locks as mere ly a necessary part o f a heal ing journey is a helpful orientation for ind iv idua ls s t ruggling to overcome addict ion. T h e quantitative ideal o f object ivi ty is replaced i n quali tat ive research wi th the concept o f conf i rmabi l i ty (Beck , 1993). U n l i k e quantitative research, the quali tat ive approaches do not deny the existence o f researcher influence but try to expose this influence i n order to tease it apart f rom the experience o f the participants. ( C o l a i z z i , 1978). Neut ra l i ty o f the researcher i n quali tat ive research is more concerned wi th be ing true to, or accurately reflect ing the phenomenon ( C o l a i z z i ) , than t ry ing to remove the researcher influence f rom the equation. The influence o f the researcher is what a l lows for rich, in-depth data co l lec t ion . Neut ra l i ty is achieved b y staying true to the data and not impos ing presupposit ions and biases on the data analysis. In order to expose the potential for researcher influence several steps were taken. T o begin wi th , m y role as the researcher was documented. T h i s process gave me an awareness o f the assumptions and biases I had that c o u l d influence the research process. T h i s awareness a l l owed me to set aside m y presupposit ions i n order to uncover accurately the part icipants ' experiences. T h e process o f reflection and main ta in ing o f f i e ld notes about the interviews cont inued throughout the research. These reflections were then summar ized i n the research report so the reader c o u l d determine whether the phenomenon o f interest was accurately captured f rom the participants ' perspective. The procedures ment ioned above hopeful ly helped reduce the contaminat ion o f data b y 54 researcher influence. A detai led descript ion o f m y procedure and data analysis was inc luded i n the report to help the reader determine neutrality. 55 C H A P T E R F O U R Resul ts Introduction T h i s chapter includes b iographical sketches o f the s ix ind iv idua l s who participated i n this study as w e l l as the descr ipt ion o f the f ive themes that emerged f rom analysis o f their in-depth interviews. T h e b iographica l summaries provide demographic and drug and a lcohol information 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 wi th others that they feel have inf luenced their heal ing process f rom addict ion i n imped ing or faci l i tat ive ways . Descr ip t ions i nvo lve interactions dur ing times o f active substance abuse dur ing relapse as w e l l t imes o f sobriety, g iven that heal ing journeys are not l inear. The themes described w i l l be supported by quotations f rom the participants that seem to capture, most accurately, the experience o f participants. Participants The participants i n this study inc luded f ive men and one w o m a n between the ages of 35 and 55 w h o are to some degree connected wi th the A l c o h o l i c s A n o n y m o u s or Narco t ics A n o n y m o u s program. Three o f the men have been marr ied and two o f the three are n o w d ivorced and one is estranged f rom his wi fe . These three men are also parents o f ch i ldren ranging i n age f rom 7 to mid -30 ' s . T h e substance abuse histories o f the participants are varied, a l l but one i n v o l v i n g drugs as w e l l as a lcohol . Robert Rober t is i n his late 40 ' s , Caucas ian , has never been marr ied and has no chi ldren . H e was former ly a journal is t who considered h imse l f a communis t . H e n o w works i n 56 construction. H e is f rom 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 Toron to throughout his l i fe . H i s years o f substance abuse problems i n v o l v e d a l coho l , c rack cocaine and to a m u c h lesser extent, marijuana. A t his lowest point he m o v e d f rom l i v i n g i n his single occupancy r o o m i n the D o w n t o w n Easts ide to l i v i n g i n the park. S ince go ing to detox i n Augus t , 2003, he has been through the support recovery program at Together W e C a n and is now l i v i n g i n a transition house and is i n v o l v e d i n the Narco t ics A n o n y m o u s Program. A t the t ime o f our in terview Rober t had been clean and sober eight months. Phillip P h i l l i p is 35 years o ld , and d ivorced wi th two chi ldren , ages seven and eight. H i s father is South A s i a n and his mother Swedi sh . O r i g i n a l l y f rom 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 Vancouve r . H e is a logger b y trade, al though an accident i n w h i c h he broke his back has meant that he is on d isabi l i ty at the moment . In addit ion to logg ing , P h i l l i p has also been i n v o l v e d i n drug deal ing and has spent some t ime i n pr ison. H e has been through the Together W e C a n program and is l i v i n g i n a group home. 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 had been abstaining f rom heroin and a lcohol use for seven months at the t ime o f our in terview. Stan Stan was born and raised i n Vancouver . H e is 55 years o ld , Caucas ian , and has a wi fe and three ch i ld ren i n their 20 's and 30 ' s . H e was a successful businessman w h o hit his "bo t tom" as a result o f crack cocaine use. P r io r to his cocaine use, he had been a binge dr inker and dabbled i n drugs i n his late teens and twenties. H e is now w o r k i n g , l i v i n g i n an apartment on his o w n after starting his journey toward health i n a recovery house. O u r in terview took place when Stan had been clean for almost one year. 57 Curren t ly Stan 's daughter is very supportive o f the efforts Stan has made to address his addict ion, however his wife and two boys do not want to associate w i th h i m . Mark F o r m e r l y a journal is t , M a r k makes his l i v i n g as an artist. H e was born and raised i n Vancouve r , is Caucas ian , and has recently m o v e d back to V a n c o u v e r f rom W h i t e R o c k . M a r k is 4 1 , has never been marr ied and has no chi ldren. M a r k ' s p r imary substance o f addic t ion has been a lcohol . H i s d r i n k i n g became a p rob lem for h i m as early as his teens. H e d i d not attend any residential treatment program as part o f his heal ing process. A t the t ime o f our in terview M a r k had been sober almost f ive years and has been supported greatly i n his journey by 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 rom M o n t r e a l , George n o w l ives in Vancouve r . H e has been i n various management posit ions i n the restaurant industry over the years and has also been i n v o l v e d i n organized c r ime. H e has struggled wi th cocaine and a lcohol addic t ion over the last 18 years. O u r interview took place when George had been clean and sober for seven months. George is d ivorced wi th two boys (ages 17 and 21) both o f w h o m are also in recovery. H e also has a daughter f rom another relat ionship w h o he sees regular ly. H e is currently w o r k i n g i n the a lcohol and drug recovery f ie ld . George is 47 years o l d and Caucas ian . Elise E l i s e is a 39 year o l d A f r i c a n Canad ian who is o r ig ina l l y f rom M o n t r e a l . She is a social worker by profession. She has a long-standing addict ion to a lcohol . She has been diagnosed wi th b ipolar disorder and also has mul t ip le sclerosis. She has not been marr ied 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 became angry, and his anger became a motivator. " W h y am I accepting this? W h y ? H o w can I accept this? A n d I couldn ' t , I cou ldn ' t accept it, r ight? .. .So something changed inside me at that point ." H i s "pass ion" and "desire" to stop d r ink ing and us ing drugs " l ed to his courage to change." H e said: T h i s is enough. I can ' t take this anymore . . . . I had to k i n d o f run out o f gas but m y heart had changed. . . . S o m e h o w it was no longer fun . . . . I had to g r ind m y s e l f d o w n . I had to run out o f gas. . . . I got fed up. M y life got smal ler and smaller and smaller . So i n terms o f I guess that's exper iencing interaction wi th others. T h e y died. I d idn ' t . I wanted to go on. I felt a deep sense o f loss. W i t h respect to the influence he perceived the deaths to have had on his process o f heal ing he said: T h e i r deaths facil i tated, but wh i l e they were a l ive they were an impediment . . . . T h e y ' r e s t i l l i n m y heart. B u t maybe i f t hey 'd l i v e d we w o u l d n ' t have been friends by now. W h o knows . Ano the r type o f loss experienced by al l participants that appeared to influence their heal ing processes was loss o f intimate relationships. Three participants described los ing relationships wi th spouses and three described the break-ups o f other romant ic relationships they felt were instrumental i n both posi t ive and negative ways dur ing their heal ing journeys . One o f the participants felt "abandoned" by his wife when he was " thrown out o f the house" after she found out about his crack cocaine use. 61 I a lways thought we w o u l d be there for each other, through thick and thin, no matter what happened. B u t anyway it d idn ' t happen that way . I found m y s e l f alone, w i th no place to go, l i v e d i n a hotel , things that just created more chaos, more addict ion. S i m i l a r painful feelings were echoed b y another interviewee after l o s ing his wife when he admitted his inf idel i ty . " L o s i n g her at that point i n m y l i fe was just devastating. A n d I think there's a b i g part o f me that s t i l l hasn't gotten over that." One participant ta lked about h o w he "just went c razy" when his wife and k ids left h i m because o f his invo lvement w i th drugs. H e "d idn ' t want to feel they were gone." H e expressed his feelings o f loneliness and hurt by becoming angrier. "I was angry before m y wife left but it just got worse ." "The on ly way to escape those feelings was by getting h i g h . " Ano the r part icipant 's fiancee left h i m when he was s t i l l d r ink ing . H e was desperate to h o l d onto the relat ionship and was afraid that los ing her w o u l d devastate h i m . H e described his thoughts and feelings about w h y his relat ionship wi th his fiancee fa i led: . . .deal ing w i t h m y problems is the most important th ing i n the w o r l d , right. M o r e important than anybody else, r ight . . . . I felt l i ke m y p rob lem was more important than the relat ionship. I put myse l f ahead o f the relat ionship, you k n o w . A n d I w o u l d rather escape f rom m y feelings and escape f rom m y issues rather than deal w i th them i n a healthy way because I d idn ' t k n o w any better at the t ime, r igh t . . . L o s i n g her was l ike a very very tough b l o w for me, right. A n d I was l i ke comple te ly bewi ldered by it. I d idn ' t have a c l u e . . . . W h y can ' t I be happy? I d i d not have a c lue what was wrong wi th me. W h y do I feel miserable? E v e r y b o d y else - other people don ' t seem to feel miserable. Other people don ' t seem to have 62 this longing . Other people don ' t seem to have to dr ink l i ke I do. H o w come, r ight? I d idn ' t k n o w . A l l I knew was, I a m miserable. H e be l ieved the end o f this relat ionship worsened his d r ink ing p rob lem and impeded his heal ing. H o w e v e r , after a more recent break-up wi th another g i r l f r iend this participant reacted very differently. H e managed to mainta in his sobriety and rea l ized that he c o u l d lose her and s t i l l survive. The funny thing is l i ke - she's gone, right, but sobriety is way better. T h i s is a way better wa y o f l i fe . In the end I knew that it was right to let her go and I learned such an important lesson. The loss o f significant romantic relationships i n the interviewees ' l ives , al though largely imped ing i n the experience o f participants, was also a marker o f progress for another. Individuals i n this study also reported that separation f rom f a m i l y members or friends was inf luent ia l for them. These losses, par t icular ly o f f a m i l y support, were perceived by the interviewees as imped ing to their heal ing journeys . F o r example , f o l l o w i n g the news that his ex-gir l f r iend and daughter might m o v e away f rom Vancouve r , one participant became very discouraged. H e felt "s lapped i n the face" by the news o f their pending move when a l l he had been t ry ing to do was to prove his commitment and abi l i ty to be responsible and dependable wi th his daughter. H e described his feelings o f frustration, anger and pain: I show her [his daughter 's mother] a l l the stuff I ' ve been do ing and n o w they're m o v i n g . So I l ook at it l i ke - what 's the message n o w ? I might as w e l l be a drug dealer. I was happier. R e a l l y . That ' 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 you ' re put on a different l eve l , y o u k n o w . " T h e y reflected on h o w their feelings o f authority have been replaced by feelings o f inadequacy through their drug use and the reactions o f others to their addict ion. B e g i n n i n g again has been diff icul t for some o f the participants. M o s t reported a deep sense o f failure and loss at their inab i l i ty to h o l d onto their previous l ifestyles. Inc luded i n the loss o f l ifestyle o f interviewees was a sense o f loss o f control and power i i i their interactions. One ind iv idua l described h imse l f as "con t ro l l ing and addicted to power . . .and money and drugs." Ano the r participant described his loss o f control : "cont ro l o f other people, control o f myself , control o f m y addic t ion ." S o m e interviewees descr ibed feelings o f anger because o f the changes i n power and control i n their l ives . T h e y be l ieved the interactions they experienced have changed f rom ones re inforc ing their power or authority to those h igh l igh t ing their l ack o f status and prestige. M a n y reported feel ing the change i n status and the perceptions and judgments o f others have l ed them 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 rom being autonomous in their dec i s ion-making , some participants expressed di f f icul ty i n reconc i l ing that aspects o f their l ives and decisions are n o w subject to others' authority. O n a more accepting note, one ind iv idua l said "most o f m y l ife I have run m y affairs pretty w e l l . I can ' t do that anymore. I ' ve got a brother w h o helps me wi th m y finances. I f he wasn ' t there to help me I ' d screw up." O n the whole , the loss o f interactions around status, control and power were largely h inder ing for participants i n their heal ing journeys. Interviewees described the diff icult ies they had adjusting to their new l ifestyle and their reluctance to do so. 66 A f inal aspect o f the experience o f loss and soc ia l isolat ion was the awareness on the part o f participants that in many cases these losses were self- induced by their wi thdrawal o f attention, affection and car ing for others, or by their choice to continue on the soc ia l ly unacceptable and destructive path o f addict ion. O n several occasions participants described addict ion as "a selfish disease" that led them to isolate themselves f rom others. Isolat ion was perceived as imped ing and the interactions i n v o l v e d expressly avo id ing contact w i th other people, pushing others away and responding negat ively to others' attempts to engage them. O n e interviewee was very aware that he was "not attracting anyone by be ing i n the mode" he was i n . " I ' m not a happy camper." People were not responding to his pleas for help and he felt l i ke he was "be ing neglected." A s a result o f his frustrations he was "gonna scare everyone away." H e was ready to "real ly raise ho ly h e l l " or "just p lay si lent" to unsettle people and wor ry them. "E i the r I ' m gonna snap, or I ' m gonna get drunk." Other cases o f i sola t ion i n v o l v e d four o f the participants who described times when they ac t ive ly tr ied to resist acceptance by ind iv idua ls in the A A movement . S o m e ta lked about be ing "put o f f by the spiri tual language." Others were afraid o f feel ing l i ke they w o u l d be w a l k i n g "naked" i f they revealed themselves. A l t h o u g h they had a desire "to be heal thy" they d i d not want "to accept that pathway." These interviewees attended A A meetings, but said they s t i l l felt they were "deal ing wi th it alone." One participant described t ry ing to get w e l l on his o w n i n the f o l l o w i n g words: "It was l i ke dragging a sled over gravel . It was horrible. W h o the heck w o u l d want to be sober? T h i s sucks." A sense o f isola t ion was also experienced by one o f the men w h o described feel ing "afraid o f w o m e n " and be ing "afraid o f any relat ionship, especia l ly wi th 67 w o m e n . . .People scared me and i n order to overcome that, I became something I wasn ' t . . .brash, loudmouth and pushy." Ano the r participant sought escape. H e said he w o u l d "rather escape f rom m y feelings and escape f rom m y issues rather than deal w i th them i n a healthy wa y because I d idn ' t k n o w any better at the t ime ." T w o of the interviewees imposed isola t ion on themselves by choos ing to use their substance in the p r ivacy o f their homes. One participant described a l c o h o l i s m as " a very lone ly disease" that he d i d a lot on his o w n : "just alone wi th m y twisted thoughts and not real ly anything I wanted to go out i n pub l ic and do ." Ano the r ta lked about how she isolated herself i n her home p l a y i n g Scrabble on her computer. She also spent a lot o f t ime sleeping. She described the isolated w o r l d she created for herself: It was a very dark - when I think - it was a very dark place to be. A n d a very lone ly place to be. L i k e it got so bad that I just had m y phone disconnected. I d idn ' t want to talk to people . . . J u s t totally total i so la t ion . A n d when I had m y phone hooked up I had it turned off. Y o u k n o w - d idn ' t return cal ls . Y o u k n o w what I mean? I was just exis t ing to exist. Participants felt that i sola t ing f rom others impeded their heal ing. T o summarize , ind iv idua ls i n this study experienced various personal losses as w e l l as a sense o f isola t ion that p layed an important role i n either faci l i ta t ing or i m p e d i n g their progress toward a healthier l i festyle. Somet imes these losses, al though they appeared negative, such as the death o f friends, p rov ided the necessary wake up ca l l i n order for participants to cease their us ing behaviour. O n the other hand, los ing relationships wi th a spouse, partner, chi ldren and f a m i l y members , or los ing prestige and status i n business and social l i fe was experienced as setting ind iv idua l s back i n their 68 progress. Isolat ion appeared to exist for participants i n this study as a result o f them either pushing people away or feel ing and fostering a sense o f separateness and choos ing not to connect w i th others around them. Whether self or other imposed , the i so la t ion was perceived by the ind iv idua l s in this study as h inder ing their progress toward a healthier l ifestyle. A Sense o f Support or Discouragement Several factors were described 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 specif ic ind iv idua l s i n v o l v e d i n these interactions as w e l l as the posi t ive or negative experience o f the interactions were described as important by participants i n this theme. A l s o , ask ing for help surfaced as important i n rece iv ing the support interviewees needed.- The ind iv idua l s w h o were ment ioned frequently i n interactions by participants that affected them i n terms o f acknowledgement , support, or discouragement were other ind iv idua l s w i th addict ion issues, as w e l l as friends, f ami ly members and the god o f their understanding. In addi t ion, inf luent ia l health and addictions professionals appeared to fa l l into two categories i n the experience o f the ind iv idua ls in terviewed: those interactions where professionals ' personal addict ion histories were relevant to participants and those interactions where the professionals ' addict ion histories were not felt to be significant to the interaction. Other ind iv idua ls o f perceived influence i n the l ives o f participants were those f rom their previous l ifestyle, characterized by substance abuse, w h o participants be l ieved at the t ime to be supportive but who actual ly kept the participants i n their destructive l ifestyles. 69 Par t icu lar ly faci l i tat ive to the ind iv idua ls i n this study were their supportive interactions wi th others who shared a.history o f addict ion. Individuals w i th a personal history o f addict ion had immediate c red ib i l i ty w i th the participants because o f their c o m m o n experience. W i t h i n this category, three participants descr ibed important, posi t ive relationships wi th their sponsors. One ind iv idua l described his sponsor as "mentor," "guide ," "tutor," "coach ," and "teacher." H e felt his sponsor was supportive i n terms o f g i v i n g his " t ime" as w e l l as be ing "demanding" o f h i m . H e described his sponsor as " c r i t i c a l , " "respectful ," " trust ing" and "honest." T h i s participant described feelings o f trust toward his sponsor and a sense o f " f e l l o w s h i p " and "so l ida r i ty" wi th h i m i n a relat ionship that he felt was cont inual ly g rowing . T w o interviewees ment ioned the ind iv idua l s at A A who were w a r m and w e l c o m i n g and helped to provide them wi th a sense o f connect ion and communi ty . A s imple , yet important aspect o f the support f rom ind iv idua l s i n A A was expressed by one participant i n the f o l l o w i n g way: "bas ica l ly they 've just been nice to me." Ano the r participant noted on his th i rd try at A A it was important for h i m to k n o w he " w o u l d be accepted." One participant ment ioned that he went to a meet ing everyday just "to have that interaction wi th people ." H e said the interaction i tself was an important support mechanism i n his l i fe . H e also went on to say, " y o u can' t do it a lone . . . .There has to be interaction wi th a human be ing . " One participant described his step group, a smal l group o f A A members w h o meet to w o r k through the twelve steps and traditions, as an important source o f support for h i m because it was a safe place o f "honesty" and "empathy" where they "struggled together over some things that were d i f f icu l t . " T h e s imi la r experiences o f group members a l l owed them to 70 relate to and support each other. T h i s interviewee also ta lked about h o w "important and quite va luable" it was to be long to a group where he felt free to disagree wi th others. O n e aspect o f the support f rom ind iv idua ls i n A A that seemed to be par t icular ly meaningful to participants i n their heal ing journey was that "nobody ever tells y o u what to do ." One interviewee asked someone f rom A A whether he thought the interviewee was an a lcohol ic . The ind iv idua l repl ied "on ly you can say i f you ' re an a l coho l i c . " H i s response made the participant feel "that recovery c o u l d be safe" because no one was go ing to make h i m do anything he d i d not want to do. T h i s interviewee felt that by not in f l i c t ing opinions and advice on someone it "encourages the person to take ownersh ip . . . . ' C u z i f somebody tells you what to do, i t ' s not l i ke you ' re o w n i n g the so lu t ion ." T h e s ignif icance o f trust i n faci l i ta t ing heal ing for participants was apparent i n interactions w i t h people who shared a history o f addic t ion. People i n A A were described by some participants as people who were "do ing it. T h e y have no mot ive to l i e . " One interviewee described his feelings about his roommate i n the recovery house where he l i v e d when he first stopped us ing drugs. H e "was very supportive, very wise because he had been there for two months and straightened h imse l f out." Ano the r w a y ind iv idua l s were perceived to provide support for the participants i n the study was through sharing their stories and g i v i n g out informat ion about resources for people wi th addict ions. Participants felt supported when p rov ided wi th a safe, trusting place to share experiences and stories at meetings. " M o s t l y we talk more about these under ly ing feelings connected wi th the hopelessness before and the feelings of, n o w . " Af te r one interviewee described his misdeeds to an ind iv idua l i n the program, the ind iv idua l 71 showed support by l is tening to h i m and m a k i n g h i m feel "accepted" and " l o v e d . " W h e n ta lk ing about his sponsors, another participant ment ioned his sense that they were "genuine," they d i d "care" and they had "fa i th" i n h i m . H e said he d i d not require anything more than l is tening f rom his sponsors at t imes: " T h e y don ' t need to tel l me what to do, just by sharing, by ta lk ing about it, it feels better." T h e support garnered f rom ind iv idua l s i n A A was instrumental i n faci l i ta t ing the heal ing process for participants i n this study. Other ind iv idua l s who seemed to p lay a largely faci l i tat ive role i n p rov id ing acknowledgement and support for participants i n this study were addict ions and health professionals, par t icular ly those wi th their o w n addict ion histories. T h e experience o f addic t ion on the part o f addictions and health professionals appeared to help i n establishing a bond o f trust and c red ib i l i ty w i th participants. T w o of the ind iv idua l s i n this study expressly ment ioned that it was important for them that the addictions professionals they dealt w i th had their o w n history wi th addict ion. F o r one participant, k n o w i n g his counsel lor was " i n the p rogram" gave h i m the trust to express his "fear about counsel lors and shr inks ." H i s fears inc luded "that you w o u l d have me commi t ted i f I to ld y o u what I rea l ly think and stuff. A n d the second one, that you ' re gonna, sort of, y o u k n o w , keep me sick, so that y o u can b i l l me ." T h i s counsel lor reassured h i m by saying "these se s s ions . . .w i l l on ly continue as l ong as y o u feel you ' re getting something out o f them." T h e discuss ion reportedly put the participant "at ease" because he felt he was " i n charge" o f the process. The trust established by virtue o f the counsel lor be ing i n A l c o h o l i c s A n o n y m o u s a l l owed the participant to be vulnerable and honestly confront his fears. 72 H o w e v e r , for other ind iv iduals i n this study, the addic t ion history o f the health and addictions professionals assisting them d i d not seem to h o l d importance. It appeared to be the nature o f the exchange that was significant for these ind iv idua l s . Several t imes participants ment ioned interactions where professionals had gone the extra m i l e for them and how meaningful that was for them. S o m e examples o f this f rom one participant inc luded a doctor w h o has a lways treated h i m "very decently, very respectful ly," a welfare worke r w h o " jumped through hoops" to make sure he received the f inancia l assistance he needed, and a support recovery house that p rov ided "safe" l i v i n g condi t ions i nc lud ing "heat, l ight , phone. I d idn ' t have to work . In fact I wasn ' t a l l owed to work . So y o u just have to concentrate on your health" A d d i t i o n a l l y , the ind iv idua 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 way to help h i m restore his "self-esteem" and "health." Professionals demonstrated to the participants good w i l l , and gave freely o f their t ime and space to attend to participants ' health. A l t h o u g h be ing to ld what to do was not seen as helpful by most interviewees, education apparently was an important part o f the role o f some health professionals i n faci l i ta t ing the hea l ing o f ind iv idua ls i n this study. One participant described his expectations o f an effective counsel lor: A s k i l l e d counsel lor w o n ' t tel l y o u what to do. T h e y sort o f ask questions. . .to draw it out o f you so that you can k i n d o f d iscover it for yoursel f . . . .Then y o u can k i n d o f o w n i t . . . . A n d i t ' s not l i ke a foreign substance i n your b o d y . . . . It makes sense because you k i n d o f helped create it. It seemed f rom the interviews that education i n the area o f a professional 's expertise was w e l c o m e d b y most participants. F o r example , one participant w h o had been s truggling 73 w i t h f ami ly o f o r ig in issues found the knowledge gained f rom a counsel lor "he lp fu l " to h i m about this matter. "The fact he was a professional gave his w o r d some weight ." T h e interactions this i nd iv idua l found helpful inc luded he lp ing h i m "understand the issues" i n v o l v e d i n his f ami ly situation and his part i n their problems. T h e counsel lor "gu ided" h i m and "exp la ined" to the participant. The counsel lor "d idn ' t g ive adv ice" and he "helped. . .establish boundaries" and helped h i m "get ins ight" into the issues. Ano the r interviewee ta lked about her experience o f her doctor w h o was clear and straightforward wi th informat ion about the steps she needed to take i n her heal ing process. " M y b i g plan was - I ' m gonna get m y stuff. Ge t an apartment. Ge t m y stuff out o f storage. A n d m y doctor said ' w e l l no. That ' s not part o f the p l an . . . . I f y o u want d isab i l i ty , ' he said, 'this is what you have to do. A n d i f y o u choose not to, that's your c h o i c e . ' " H e r doctor also to ld her she needed to "be i n recovery" and stay i n a support recovery fac i l i ty "for at least a year." A t V a n c o u v e r Genera l Hosp i t a l the staff were also very clear about her situation. " T h e y ' r e the ones w h o to ld me you ' re an a lcohol ic and. . .this is what we ' r e do ing . " Ano the r doctor gained one participant 's trust because he was a " w e l l respected and learned professional ." A d d i t i o n a l l y he had c red ib i l i ty because "he was an M D . H e knew about bra in chemist ry ." Part icipants described supportive reactions on the part o f addictions and health professionals that stood out as faci l i tat ive i n their heal ing journeys . One interviewee returned to his recovery house after a relapse and staff there were supportive. T h e i r support helped h i m to get back on track. An o t h e r i nd iv idua l w h o asked to stay longer at his recovery house after his allotted t ime, was g iven permiss ion to stay longer. A social worker i n detox l is tened to one participant, and us ing his expertise and experience, was 74 able to make suggestions to h i m for a course o f action to help h i m navigate his first steps wi thout substances. H e showed a be l ie f i n the participant as w e l l as support o f h i m through his actions. F o r another interviewee, be ing g iven t ime and space i n a safe place and feel ing l is tened to by her socia l worker was very important. She described her experience i n the f o l l o w i n g way: T h e y saw me right away. Su rp r i s ing ly . . . .1 had a wonderful worker . A n d I just sat there and c r ied and cr ied . I sa id 'what am I go ing to .. .do? L i k e I ' m homeless. I have no apartment. I have nowhere to go. ' A n d uh I was there f rom 11:30 i n the morn ing . I left there at four o ' c l o c k i n the afternoon. T h i s participant also discussed the support and ava i lab i l i ty o f the staff i n the recovery house where she l i ved : "The staff are over the top. . . . Y o u can just talk to them. A n y t i m e . T h e y have an open door p o l i c y . . ..It's just so nice that they have this open door p o l i c y . " In one conversat ion wi th the director o f the fac i l i ty where she l i v e d , she to ld h i m she w o u l d be l i v i n g there a l ong t ime because her "needs were be ing met." T h e same interviewee praised a staff member at V a n c o u v e r Genera l Hosp i t a l : "She ' s just the neatest w o m a n . I gotta ca l l her and tel l her where I a m at. C u z I mean, they, V G H saved m y l i f e . " T h e participant also described this staff member i n the f o l l o w i n g way: "she's a wonderful w o m a n . " "She was very inspi ra t ional ." E v e n though this w o m a n was a hospital administrator, this interviewee appreciated the genuine concern and t ime she took w i t h patients. The emotions experienced by ind iv idua ls i n this study i n their relationships wi th health and addictions professionals were key to determining whether interactions were perceived as faci l i ta t ive. Participants described the importance o f feel ing comfortable 75 w i t h the professionals i n question, as w e l l as trusting them. T h i s trust was experienced by interviewees when the professionals l is tened to them, put i n effort w i t h them, showed faith i n them and supported them. Interactions wi th friends and f a m i l y were expressed as significant to participants i n their heal ing journey i n both faci l i tat ive and imped ing ways . Participants exper ienced support i n terms o f others' acknowledgement o f their experience, l i s tening wi th an openness and l ack o f judgment , sympathy to their situation, and a show o f faith i n them. F o r three ind iv idua l s i n this study support was garnered f rom their famil ies . One participant felt a sense o f acknowledgement when his sons came to h i m , to help them w i t h their drug problems. H e was "amazed" that they asked for his help and was pleased he "was i n a pos i t ion to help them." F o r another, his f a m i l y was d iv ided . H e described his f a m i l y situation i n this way: " M y f a m i l y ' s now split i n two. Those that remain angry and those that understand and support me." T h i s participant felt supported not on ly by the f ami ly members w h o learned about addict ion but also f rom their desire to help h i m on his path. " T h e y have been able to support me - not just vo luntar i ly - but be there. W a n t to be there. M a k e me think 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 interviewee, acknowledgement o f both his current health and o f past experiences by his grandmother was par t icular ly meaningful for h i m . H e described a v is i t to his grandmother i n hospital : M e and m y g i r l f r i end . . .we went to v is i t her . . . .She started c r y i n ' . She says ' I ' m so happy that you ' re do ing so w e l l , ' she said. T remember when you were s ix years o l d and your D a d smashing your . . . head off the .. .cement ' . 76 H a v i n g someone important to h i m admit to wi tness ing the v io lence he experienced and acknowledge his progress helped to keep h i m on track i n his hea l ing journey. Fr iends , sponsors and partners, as w e l l as complete strangers, p rov ided support and acknowledgement for participants that they felt faci l i tated their heal ing. One participant ment ioned the acknowledgement b y his g i r l f r iend o f h o w w e l l he was do ing both i n ceasing his addict ive behaviours and taking responsibi l i ty i n his l i fe . H e felt as though he had real ly accompl i shed something because she had g iven h i m her encouragement. A s he noted: "She ' s very proud o f where I ' m at right n o w . " W h e n times were tough for another interviewee she said, "the on ly thing that was ho ld ing me together was m y visi ts w i t h m y fr iend." N o w that things have i m p r o v e d i n her l ife she continues to f ind support among her friends and her sponsor. Support has sometimes meant be ing chal lenged on her behaviour by her friends. A number o f participants ment ioned f ind ing it dif f icul t to b u i l d trust i n relationships and suggested trust is not easi ly regained after a breach. One interviewee said he found it easier to talk wi th strangers about his experience at t imes. Af te r one such conversat ion he received the encouragement he needed. T h e stranger to ld h i m , " Y o u ' r e a powerful , l o v i n g , car ing i n d i v i d u a l . . . . G o after what your heart's t e l l ing you to do ." T h i s message helped h i m to stay on his path and refrain f rom drug use. The encouragement f rom friends, f ami ly , professionals as w e l l as strangers was expressed as helpful i n keeping participants on their path toward health. F o u r o f the participants c i ted spiri tual support as an important faci l i tat ive factor i n their heal ing journeys. One ind iv idua l described his spir i tual connect ion as a be l i e f that "something greater than" h imse l f was he lp ing h i m . The spir i tual relat ionship these 77 ind iv idua l s described emerged largely f rom the A A movement . In exp la in ing his rationale for be ing open to a higher power , one participant described how the ind iv idua l s i n A A had framed the idea: A l l your best th ink ing got you here, right. So don ' t y o u think i t ' s t ime you thought about something. . .some other solut ion other that you can come up w i t h . . . .So that k i n d o f opens the door a l i t t le bi t that something other than me is gonna help me. T h i s same ind iv idua l described his feelings o f trust towards his higher power: I pray to m y higher power , m y G o d , w h i c h , I don ' t k n o w what it i s , but I bel ieve i n it. I bel ieve that it cares about me and can help me whenever I ask. If I trust, right. A n d I bel ieve that y o u k n o w it w o n ' t g ive me what I a lways want. B u t I do bel ieve it w i l l g ive me what I need. . ..It's l i ke a partnership, a team. I ' m do ing m y part, I need G o d ' s help. W h e n ta lk ing about his be l ief in G o d he said, "I bel ieve it, right. A n d I bel ieve it because I 've felt i t . . . . I t ' s l i ke the most ephemeral th ing has become the most powerful th ing ." H e also expla ined that his experience o f G o d came i n many guises: W e say G o d is so many things. I mean I bel ieve i n some d iv ine be ing that I pray to, right. B u t also, y o u k n o w , G r o u p O f Drunks . G - O - D . Si t t ing in a meet ing - these people they're sharing their truth and their car ing - for their benefit and for m y benefit. That ' s k i n d o f l i ke G o d i n a way . There ' s love there, right. A s k i n g G o d for help was instrumental i n the heal ing process o f two participants i n particular. A s one interviewee articulated, asking G o d for help "bas ica l ly reinforces that 78 I can ' t do it by mysel f . " H e continued, "I need faith. W i t h o u t me reaching out to G o d , H e ' s not gonna help me." Three participants described interactions wi th others that felt supportive at the t ime but they now real ize these interactions actually impeded their hea l ing journeys. O n e participant felt a strong sense o f loya l ty to members o f a b ike gang to w h i c h he belonged. T h e y had been a so l id source o f support and security throughout the many years was i n v o l v e d wi th them. T h e y were there for h i m no matter what. H e said, "any g iven t ime that I want to be i n v o l v e d i n any i l l ega l c r ime, whether it be drug deal ing - drug deal ing I w o u l d say put at the top o f the l ist that I can get i n v o l v e d any t ime ." That sense o f connect ion was very important to h i m and p rov ided a strong p u l l back to that l i fe at t imes. F o r another participant, his connections to people f rom M a i n and Hast ings were a negative influence on h i m . " M y relations wi th them certainly impeded , they harmed me." T h i s c o m m u n i t y o f friends provided the i l l u s ion o f support. "It seems that it can support y o u and the outside - outside that w a r m c i rc le - can seem so scary. T can ' t leave m y friends behind . ' Y o u can think that. B u t I tel l you , y o u get desperate enough to." Ano the r participant spoke o f his peer group support ing his habit. T h e y supported his feel ing that, "I rea l ly need this stuff. I l i ke it and I need it and I want i t . . .to feel okay ins ide ." T h e emot ional interactions described depicted situations that were h inder ing for participants i n their heal ing journey. T h e lack o f support described by ind iv idua ls i n this study d i d not appear to s i m p l y reflect abandonment. T h e other end o f the spectrum from support, characterized by discouragement on the part o f participants, seemed to be related to feel ing undermined, 79 judged, not trusted, betrayed, abused, as w e l l as s i m p l y the absence o f acknowledgement and support. A l l o f the participants described some form of d iscouraging interactions throughout their heal ing journey. One participant described not feel ing "appreciated" or "trusted" by certain people in his l i fe . H e also described feel ing "neglected" and "degraded" although he was " c r y i n g out for help ." " N o t getting much support" left h i m feel ing frustrated, hurt and as though "they don ' t care." H i s sense o f betrayal and broken trust reportedly made h i m feel l ike g i v i n g up on his progress. " I ' d rather be a drug dealer." Ano the r participant described feel ing betrayed by coworkers who had been "concerned" about h i m and "coerced" h i m into go ing to A A meetings. H e took A A on as a "d i s c ip l i ne" but was not rea l ly interested at that t ime. H e found a lot to get "annoyed at." T h i s same ind iv idua l ment ioned "frustrating t imes" l i v i n g i n a recovery house wi th "annoying id io t s" w h o "get on your nerves." H e was able to describe them as "chal lenges" and real ized that he, "had to learn h o w to cope wi th annoying people ." L a c k o f f a m i l y support was especia l ly diff icul t for one participant. H e said his wife , "stopped support ing h i m or hav ing anything to do wi th h i m . " W h e n they were together he described his experience o f verbal abuse that reinforced his feelings that he be longed i n a crack house. O f his f a m i l y he said, "they don ' t want me i n their l ives . T h e y don ' t want any trace o f me i n their l i ves . " H e described that the reason for his relapse was mis s ing his f ami ly . "The biggest hindrance to m y recovery is m y feelings for m y fami ly . T h e fact that I bas ica l ly can ' t . . .go back and see them." Ano the r ind iv idua l described her painful experience i n one support recovery fac i l i ty : " I 've watched them tear people d o w n but they're not putt ing people back together again ." 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 Unders tanding or Misunders tanding Ano the r set o f interactions that were inf luent ial i n both posi t ive and negative ways for participants were those i n v o l v i n g feelings o f understanding or misunderstanding. Interactions described by ind iv idua l s i n this study often i n v o l v e d situations where they felt either understood or misunders tood by others. Participants felt that others w h o d i d not understand their drug or a lcohol abuse had not made the t ime or effort to acquire the appropriate knowledge . Hea l th professionals were sometimes regarded as hav ing academic knowledge but not experient ial knowledge o f addict ion, furthering participants ' feelings o f be ing misunders tood and imped ing their heal ing. Interactions wi th others also seemed to expose the lack o f understanding participants had o f themselves and others wi th addictions. Individuals i n this study reported that they felt their circumstances and feelings were best understood by ind iv idua ls who also had a history o f addic t ion. In a s imi la r ve in , n o w that they had some knowledge o f their o w n addict ion problems, interviewees felt that they c o u l d better understand the situation o f other ind iv idua l s w i th addict ions. Interactions that participants perceived as he lp ing them understand addict ion as w e l l as those where they felt understood were described as faci l i tat ive i n their heal ing. Interactions where participants felt misunderstood or where they lacked understanding o f themselves or other addicts were perceived by participants as imped ing their heal ing journeys. Three participants referred to interactions where they felt misunders tood by others. T h e interactions i n v o l v e d fami ly , colleagues f rom work , and health professionals. One interviewee described feel ing misunderstood at work . H e said this part icular feel ing 82 made h i m want to "go and get drunk." H e felt h e ' d "had enough" hassles i n his w o r k and personal l i fe . Ano the r i nd iv idua l felt his wife had "not been very helpful at a l l " because she "d idn ' t want to understand what was go ing o n " and chose to see his behaviour as " w r o n g . " H e commented on their relat ionship: "The on ly w a y m y wife 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 part icipant 's ch i ld ren were not speaking to h i m . H e felt that "they d idn ' t understand. That ' s the difference between - understanding the sickness or th ink ing someone is an e v i l person. I can ' t conv ince people I ' m not an e v i l person. I can just try to change." H e described the steps some o f his f ami ly took i n order to understand h i m : Those that understand and want to support me are the ones that took the t ime to get the knowledge , to get the understanding, to read the books, to talk to experts. T o f ind out what was wrong wi th me. L a c k o f understanding on the part o f some f a m i l y members was experienced as i m p e d i n g for this participant whereas he felt the attempts made by others to understand his situation facil i tated his heal ing journey. Individuals i n this study felt that health professionals d i d not a lways understand their situation. F o r example , one participant mistrusted his psychiatr is t ' s motives: "there was a lways this litt le itty bitty thought i n the back o f m y m i n d that I bet h e ' d just love to have me c o m i n g back for many, many, many sessions so that he can make more money ." T h i s i nd iv idua l described his concerns about his psychiatr is t ' s understanding o f addict ion: " I sort o f felt l ike y o u ' v e got that degree on your w a l l , right, and y o u ' v e probably read a lot o f books and stuff but what do y o u real ly k n o w about it f rom. . .personal experience." T h i s concern about health professionals was echoed by 83 another participant: " W i t h a l l due respect to academics et cetera, they don ' t necessari ly understand anything. Y o u have to w a l k wi th it , be i n v o l v e d wi th it , meet people i n it to begin to understand." These feelings o f misunderstanding were experienced as imped ing participants i n their heal ing journeys. Some interactions described by participants h ighl ighted their l ack o f self-understanding that kept them isolated and stuck i n their addict ive patterns. A s one participant noted: U p unt i l the t ime I went into recovery w h i c h was I guess a year ago I felt isolated and I felt I had an evilness inside me and I d idn ' t k n o w what I was go ing to do about it. M y thoughts were bizarre, w e i r d - centered on self-gratification, self-centered et cetera. I k n o w today that I ' m not that way . 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 think everybody was l o o k i n g at me. I can w a l k into a r o o m n o w and people accept me for w h o I am. Ano the r participant tried to understand and come to terms w i t h some o f his past actions. H e descr ibed h imse l f as " twis ted" and "ant i soc ia l . " W h e n he was young he said he just wanted to be "normal . Just l i ve a normal , mediocre l i f e . " H i s fear mot ivated h i m to ask a psychiatrist i f he "was a head 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 never share there. I never say a word . Neve r . I haven ' t once." H e said that the idea o f sharing "makes me feel l i ke probably I ' d be naked." Ano the r participant admitted his fear o f expos ing his thoughts to others. H e on ly saw his psychiatrist once because he was "terrif ied that i f I rea l ly ta lked about m y real feelings that I w o u l d get l o c k e d up." Interactions wi th others h ighl ighted 84 interviewees ' fears. The fear o f expos ing their thoughts and feelings to others was experienced as imped ing participants ' heal ing journeys . Interactions wi th others also emphasized some preconceived notions participants had about ind iv idua l s w i th addictions. One interviewee felt he needed to separate h imse l f menta l ly f rom the people i n his transition house. H e described them as "a bunch o f losers." H e made it clear that he pa id his o w n rent; the government d i d not. H e also gave an indica t ion that he d i d not want to identify wi th other addicts. H e described the ind iv idua l s he met i n various recovery settings as "freaks," " losers" and " sk ids . " In his refusal to make connections wi th ind iv idua ls i n the A A program, he described feel ing pu l l ed between his o l d w o r l d and the new one o f heal ing. T h e preconceived notions he ld by participants were experienced as h inder ing their heal ing process. A s a result o f changing their l ifestyles and educating themselves about addic t ion, a number o f part icipants ' feelings toward other addicts shifted. One participant commented on how the rewards o f v i s i t ing wi th addicts i n detox benefitted his understanding o f addict ion: W e a l l understand what we ' re go ing through. B a c k i n the o l d days I used to think those people were just degenerates, bad, bad human beings. Y o u k n o w , i f t h e y ' d just clean up their act, get a j ob , t hey 'd be okay. I d idn ' t have the understanding. That ' s the way I understood them. . . .The biggest road b l o c k to me to the who le process is that understanding. Unders tanding w h y that uh that drunk is fa l l ing d o w n i n the gutter, w h y that g i r l is standing on that street corner se l l ing her body. U m - i t ' s not because they're bad people. It's because they're s ick 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 wi fe and two k ids w o u l d understand that, 85 they w o u l d probably not have the desire to have me out o f their l i fe . T h e y ' d want to have me back i n their l i fe . O f meet ing up wi th addicts f rom his past, this i nd iv idua l noted: I ' ve met some people . . . w h o ' v e stolen f rom me . . .and r ipped me off. B u t I have no animosi ty . If I saw them on the street tomorrow, I ' d g ive them a hug. Because I k n o w what they're go ing through is is - is pain . A s participants began to understand other ind iv idua l s w i th addict ions, so d i d they come to feel understood. Often these interactions i n v o l v e d ind iv idua l s i n the A A program or ind iv idua ls wi th addictions. One interviewee made clear the importance o f the addict ion history o f ind iv idua ls he dealt wi th : T h e people i n the recovery house had a huge effect on me. T h e y ' r e a l l former addicts or a lcohol ics . I cou ldn ' t - when I spoke about m y p rob lem w i t h drugs -1 can ' t deal w i th people who haven' t used drugs. W e l l - not that I can ' t deal w i th them - they don ' t understand. Ano the r participant also endorsed this idea by descr ib ing ind iv idua l s f rom A A : "these people understand that i t ' s okay to have suic idal thoughts and that i t ' s okay - some o f the crazy shit w e ' v e done w h i l e we were, y o u k n o w , in toxica ted ." T w o interviewees discussed the importance o f the understanding they received f rom their sponsors. One ind iv idua l commented about his sponsors: I have faith i n them. It 's l i ke 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 uh - y o u k n o w I c o u l d talk to them about stuff that I c o u l d not talk to, for example , m y brother or m y mother, you k n o w , or m y friends that I 've k n o w n since grade two. Because those people are, y o u k n o w , not a lcohol ic . R igh t , l i ke 86 they don ' t have the same emot ional , mental w i r i n g that I do, right. B u t m y two a lcohol ic friends do. O n e part icipant 's employer was also i n the program. H e felt an acceptance and understanding f rom h i m . H e said, " W e can talk about the program. Instantly. . . .So - i f I have any diff icul t ies at a l l , as l ong as you put it on a spir i tual l eve l , I can ask h i m for help. H e k n o w s exact ly what asking for help i s . " H i s felt his step group also understood his situation. H e commented that the ind iv idua ls in his step group were i n a posi t ion to say to h i m , "yeah, I ' ve been there. Y e a h , I understand." Interactions that h ighl ighted participants ' growth i n understanding o f self and others were experienced as faci l i ta t ive i n their heal ing journeys . A negative side o f understanding came f rom interactions where users supported each other. One participant described that his gi r l f r iend was sensitive to his situation w h i l e he was us ing drugs. H e commented: "I felt that she understood me. She was a fe l low-addict . W e used together." Ano the r interviewee reflected on the nature o f interactions between users: T h e y c o u l d even seem - i n a momentary way - helpful . Y o u ' r e i n a j a m , you need a j o b or a place to stay or y o u want to borrow some money or something l i ke that, then people w i l l - there is a sense o f commun i ty there. T h e y can be helpful i n a short term k i n d o f way. Unders tanding that or iginated i n relationships among users was experienced by participants as imped ing their heal ing journey although they felt helpful at the t ime. In conc lus ion , ind iv idua ls i n this study felt that interactions i n v o l v i n g understanding or misunderstanding were inf luent ial to them i n their heal ing journeys . 87 Participants felt that interactions where they were understood b y others who were not addicts were faci l i ta t ing i n their heal ing. A s w e l l , when they understood themselves and other addicts these interactions were perceived as faci l i tat ive o f heal ing. H o w e v e r , interactions i n v o l v i n g misunderstanding were experienced as imped ing 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 Ano the r theme that was significant for ind iv idua ls i n this study was that o f be longing or not be longing . Shar ing their stories and l ives i n a supportive context w i th other addicts or w i th in A A gave interviewees the sense, sometimes for the first t ime i n their l ives , o f be longing to a group. S o m e participants had prev ious ly felt a sense o f be longing and connect ion wi th other users or among drug dealers. Others felt trapped between their upstanding l i fe and their l i fe o f drugs and a lcohol . Interviewees reported that feel ing a sense o f be longing among ind iv idua ls they felt were healthy influences was helpful to them on their path o f heal ing f rom addict ion. Al ternate ly , participants expressed that feelings o f exc lus ion or be longing i n circles i n v o l v i n g drugs or a lcohol use were i m p e d i n g i n their heal ing journeys. One participant expressed his feelings o f pain and anger after his fr iend d ied and his wife left h i m . H e d i d not bel ieve he had anyone to confide i n about his problems or his feelings because the ind iv idua ls he was surrounded by were other drug dealers. H e noted: Y o u don ' t go pour your heart out to these drug dealers and c r imina l s , r ight . . . .So it just - y o u just bury it and bury it and bury it and cover , cover , cover , cover, right. So the on ly w a y to escape those feelings is by getting h igh . 88 T h i s participant also exc luded h imse l f f rom the category o f recover ing addicts. H e described his sentiments about them: Those people are perfect strangers. I can ' t - the on ly th ing that I have i n c o m m o n wi th them is that I used to use drugs. A n d that's the on ly thing. Other than that -maybe I ' d get somebody to sel l them drugs. I w o u l d never associate w i th them. Ano the r interviewee chose to classify h imse l f according to his addict ion status. H e separated h imse l f f rom "normys" or ' no rma l ' people who d i d not struggle wi th addict ion 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 and drug addict ion -some people l ook at it as they're blessed because they 've got this p rob lem. T h i s disease. I don ' t l ook at it that way . I ' m not too p roud o f be ing an a lcohol ic or drug addict. I w o u l d have rather l i v e d m y l i fe as a normy. W h e n one participant felt his d r ink ing and drug use was getting out o f control he was reluctant to talk to anyone about it. H e was concerned wi th h o w his friends or brothers w o u l d respond. H e wanted to mainta in an outward appearance o f be ing "able to go wi th the f l o w . " A t the t ime he felt "i t w o u l d be uncoo l to not be able to handle it , r ight ." One interviewee reported enduring verbal abuse f rom his spouse i n order to continue his connect ion wi th her. H e described his feelings: I missed her so much I wou ldn ' t m i n d be ing ca l led an asshole, a loser and an asshole by her right n o w because that w o u l d be better than not hav ing her around. That ' s the sort o f craziness . . .that's the addict ion - that you w o u l d accept the abuse because i t ' s better than nothing. 89 Interviewees described avo id ing interactions where they c o u l d discuss their pa in and concerns. A s w e l l , they recounted interactions i n v o l v i n g staying i n unhealthy relat ionships for fear o f be ing aione. T h e result ing experience by participants o f not be longing or be long ing to a group where the influence was negative, reportedly had a i m p e d i n g effect on their heal ing. Participants described their l i fe w i t h drugs as a place where they felt they belonged, even though it impeded their heal ing journeys . One participant noted the p u l l he felt to the w o r l d o f drugs: "I a lways felt some affinity for that w o r l d . I felt I be longed." D r i v i n g to and f rom w o r k he w o u l d dr ive by M a i n and Hast ings . O f this he said, "I a lways felt that some day I ' d end up there and I d id . I don ' t k n o w w h y . M a y b e -I thought that's where I be longed." Ano the r interviewee described s imi la r feelings about his history as a drug dealer: It 's w h o I am. . . .Tha t ' s who I was. H o w do y o u change that? I ' m 47 years o ld . B e e n dea l ing drugs a l l m y l ife . I ' ve a lways been i n a management, cont ro l led situation. N o w you ' re saying I have to give it a l l up. F o r what? A l t h o u g h main ta in ing unhealthy mari ta l interactions and interactions wi th ind iv idua l s i n the drug culture he lped participants mainta in a feel ing o f be longing , they real ize n o w that these interactions hindered them on their pathway out o f addict ion. T h e sense o f be long ing s temming f rom relationships w i t h other users and their substance o f choice also i n v o l v e d imped ing interactions for participants i n this study. One participant described the draw o f other addicts for h i m : "certainly people y o u use w i t h , the people y o u dr ink wi th end up be ing an impediment . Because you get attached to them. It becomes your c o m m u n i t y . " H e further descr ibed this i l l u s i o n o f be long ing 90 and commun i ty i n the f o l l o w i n g way: "when you dr ink - y o u go to the same bars and you have the same pals and you get into this routine. It seems to support y o u . " Ano the r interviewee ta lked about addict ion a l l o w i n g a person to push certain boundaries. A s he noted, " y o u end up do ing things and be ing i n v o l v e d wi th people y o u w o u l d not be i n v o l v e d w i t h " i f addict ion was not part o f the equation. In descr ib ing his gir l f r iend, he reported that their connect ion was largely based on us ing together. She was f rom a "total ly different soc io-economic background ." T h i s same participant remarked that he needed to separate h imse l f f rom his gi r l f r iend when she started us ing drugs again. H o w e v e r , he said to some extent he felt he be longed i n that w o r l d . "Part o f m y brain says do it, do it , do it y o u ' v e got to go back there. Y o u ' r e a loser . . .you ' re a loser, she's a loser." A l t h o u g h some participants felt they belonged i n the drug w o r l d , a number o f them also expressed a sense o f never quite feel ing as though they fit into that w o r l d . A t one point on his heal ing journey, one participant questioned his alternatives. H e was th ink ing "Is that i t? Is that m y opt ion, hopeless addict or Jesus freak? W a s I condemned to th is?" T h i s same ind iv idua l commented on his sense o f not be longing: I th ink at the heart o f drug addict ion is some k i n d o f d is locat ion wi th l i fe , some fear and loneliness at the heart. A n d i t ' s diff icul t to get a long wi th other people, to fit i n w i th the w o r l d and feel good about yourse l f . . . .The addic t ion is answering that under ly ing prob lem. A "feature o f a l l addicts" he continued, was that: T h e y a l l have that p rob lem - o f needing love , needing to love and to be loveable and they don ' t get it. T h e y don ' t th ink they're getting it and they think drugs w i l l 91 be the solut ion. M a k e s them feel good. Y o u take drugs or y o u dr ink because it makes y o u feel good. A day later you can ' t stop. Three ind iv idua ls i n this study discussed feel ing as though they were l i v i n g two l ives , the upstanding c i t i zen and the drug addict or dealer, yet not rea l ly be long ing comple te ly to either w o r l d . One interviewee felt his double l i fe was d iscovered when he was "coerced into go ing to meetings" by colleagues at work . H e felt he needed to "clean up" his act. The double l i fe for another participant i n v o l v e d hav ing a j o b where he " d i d a l l the right things," but he also dealt drugs on the side. S t i l l another i nd iv idua l described the double l ife he was l i v i n g . A t age 25 he was marr ied, had three ch i ldren , a mortgage as w e l l as a "wonderfu l career." H e sat on the "board o f directors for a couple foundations" and was the "president o f the hockey associat ion." H e even " w a l k e d away f rom drugs and a lcohol when he first got marr ied ." H o w e v e r the a lcohol crept back in to his l i fe and then he started us ing crack. H e described his feelings.about do ing crack: It was just l i ke go ing to a place I shouldn ' t have been at and I knew i t . . .1 shouldn ' t have been there. B u t it was the place I f igured I belonged. . . .1 was comfortable there. I was comfortable s m o k i n g crack wi th other crack addicts. I was very, very comfortable sitt ing i n a crack house wi th a bunch o f other crack addicts. Rats running around. Needles on the f loor. I had no qualms about that and I thought this was the place that I belonged. I felt that's where I should be. H e expressed the attraction the drug w o r l d had to h i m : " I ' d dr ive b y M a i n and Hast ings and i t ' s not a pretty sight at the best o f times i t ' s not a pretty sight . . . .But I s t i l l have the feel ing there's a party go ing on and I wasn ' t i nv i t ed . " A l t h o u g h this participant kept up 92 the appearance o f the upstanding businessman, he was uncomfortable i n that role and felt he was more suited to the drug w o r l d . A t the height o f his career, he was required to go to many receptions and parties where he said he, "a lways felt uncomfortable, a lways drunk, a lways at the bar, a lways fearful ." N o w he acted out his sense o f be long ing to the w o r l d o f addict ion i n a more posi t ive way . H e expla ined, "I go to a detox centre and I k n o w that i n that r o o m are drug addicts, thieves, poss ib ly a murderer or two but I feel very safe." H e said he n o w feels l i ke he is "part o f something - b igger than me." T h e unfu l f i l l ing interactions i n v o l v e d i n be longing to the drug w o r l d or feel ing trapped between a l i fe o f substance abuse and ' no rma lcy ' were exper ienced by participants as imped ing on their journeys toward health. H o w e v e r , the invo lvement i n rehabil i ta t ion o f addicts gave one interviewee a constructive sense o f be long ing that he felt facil i tated his heal ing. F i v e participants described interactions i n v o l v i n g other former a lcohol ics and addicts, f ami ly members , and friends that fostered their sense o f be long ing and faci l i tated their heal ing. F o r m e r addicts and a lcohol ics were described by one participant i n the f o l l o w i n g way: " W e ' r e a l l the same. Sort o f l i ke you go into a c l u b . . ..I never belonged up to then. A sense o f be long ing . " H e elaborated on what gave h i m this sense o f inc lus ion : " W e have something i n c o m m o n . The th ing we had i n c o m m o n was not necessari ly our drug and a lcohol abuse....It was the feelings that made us use drugs and a lcohol . . . . I so la t ion , fear, lonel iness ." Ano the r interviewee indicated he was w i l l i n g to invest more i n his f ami ly in order to mainta in his sense o f be longing . H e said, "That ' s f ami ly . Tha t ' s b lood . It 's a l i t t le bit thicker than water." L i v i n g i n a house where she felt at ease ins t i l l ed a sense o f be longing for s t i l l another participant. She descr ibed the 93 recovery house where she was l i v i n g as be ing "a place I ca l l home . . . .1 feel very comfortable there." She ta lked about her roommate: "She rocks. L i k e we sit up to one, one thirty just laughing. Y o u k n o w . A n d just ta lk ing . A n d ge l l ing . Y o u k n o w , i t ' s so nice. That ' s what recovery should be about." She also reported be ing very happy wi th the other people l i v i n g i n the recovery house: L i k e at ten o ' c l o c k at night dur ing the week we have snack. That ' s where - y o u can just sit d o w n and just talk wi th people. L i k e i t ' s so nice, you k n o w . U h -mealt imes. Is a t ime to talk wi th people, y o u k n o w . It 's, i t ' s a great group. It 's a rea l ly nice group. She described the staff where she l ives as very open and supportive so that she feels her "needs are be ing met." She contrasted this experience wi th her encounters at the previous fac i l i ty where she l i ved . She described the staff there as very "unapproachable" and "demeaning" toward her. T h i s part icipant 's newfound stabil i ty a l l owed her to appreciate and take part more fu l ly i n l i fe . She enjoyed " s o c i a l i z i n g " w i th her sponsor and friends. She has p layed "tourist" w i th her friends. She was "reconnect ing" wi th other people i n her l ife and meeting new people. T h e acceptance and c o m m o n experience o f addict ion among ind iv idua l s i n A A has p rov ided a sense o f be longing for several participants. W h e n one interviewee first went to A A he said: The first th ing I remember was the s m i l i n g face this guy - midd le aged man -s m i l i n g face, hand out, ' w e l c o m e ' you k n o w . . . .So that was l i ke a human being, right. W i t h a smi le , right, l o o k i n g me i n the eye, w e l c o m i n g m e . . . .That was so important. 94 H e acknowledged the value and importance o f feel ing w e l c o m e d and accepted, as he put it , "by his k i n d . " Ano the r interviewee had been to A A before. O f his sense o f be long ing he ment ioned that this t ime "I knew I w o u l d be accepted. T h e question was whether I accepted them." T h i s participant said o f his new l i fe i n A A : It 's f i l l ed w i th other people. N e w associations. N e w associations that are also w a r m and -1 we lcome them. I wanted them and they were there. People were nice to me so y o u we lcome them. Y o u look forward to seeing people. A lot o f the reason I go to meetings n o w is soc ia l . T h i s part icipant 's step group was "quite important" to h i m . H e considered them his "friends." The "honesty" and "empathy" o f the group gave h i m the opportunity to share what was go ing on i n his l i fe . T h i s participant also noted the "empathy" and "understanding" o f his sponsor through the personal stories he w o u l d share wi th h i m . The transition house, where this participant l i v e d at the t ime o f the in terview, also p rov ided h i m w i t h a sense o f communi ty . A s he noted, "There ' s a lways people around to talk to. Y o u ' r e a lways i n a commun i ty o f some s imi lar i ty , some unity, some sol idar i ty ." T h e ind iv idua l s l i v i n g i n the house shared a " c o m m o n vocabula ry" so that this participant felt "when I go home I k n o w I ' m safe.. . .and you get some sense o f feedback. A n d often good-natured." Participants felt their experiences wi th former a lcohol ics and addicts, supportive and understanding fami ly and friends, as w e l l as supportive staff where one participant l i v e d were largely posi t ive: faci l i ta t ing their heal ing process. In c los ing , ind iv idua ls i n this study a l l described experiences where they felt either a sense o f be longing or not be longing . O n the whole , when associations were inc lus ive and w e l c o m i n g and came f rom a source not i n v o l v i n g drugs or a lcohol , the 95 interactions described were reported as faci l i tat ive i n the part icipants ' heal ing journey. O n the other hand, participants described interactions wi th ind iv idua 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 lcohol that fostered a sense o f be long ing or commona l i t y at the t ime by s temming their fear and loneliness. H o w e v e r , these interactions were experienced as imped ing their heal ing progress. F i n a l l y , interactions where interviewees felt exc luded were experienced as h inder ing i n their heal ing journey. A Sense o f M e a n i n g or Meaninglessness T h e theme o f a sense o f meaning or meaninglessness includes descriptions by participants o f interactions that helped to provide meaning or fa i led to b r ing meaning to their l ives . Interactions described by participants as meaningful to them inc luded those where there were opportunities for them to make posi t ive contributions or leave favourable legacies. Individuals in this study described turning points as situations where they struggled to f ind or make meaning o f their l i fe circumstances. Participants out l ined many instances where connect ing wi th a spir i tual force was important for them in br ing ing meaning to their l ives . Interviewees expressed the need for meaning as c ruc ia l to them i n their decisions about changing their addict ive patterns and i n main ta in ing the changes they had made i n their l ives . Three interviewees expressed imped ing interactions that underscored times when l ife felt meaningless and without purpose. One o f these situations occurred when a participant, as part o f his j ob , was he lp ing a young w o m a n f i n d space i n a recovery house. She had been sleeping on the beach and he went to help her. She d i d not want his help and consequently he felt "frustrated" and "on edge." H e was "exhausted" f rom t ry ing to help and not be ing appreciated. Ano the r participant descr ibed her despair at the 96 depth o f her depression at the height o f her d r ink ing prob lem. She said she felt she had "no purpose" and she " d i d want to d ie . " She commented on her feelings o f apathy when psychiatr ic services had decided to give up her apartment and put her belongings i n storage: " I don ' t th ink I real ly cared." She said at that t ime she was "detaching f rom everyth ing ." T w o ind iv idua l s i n this study described circumstances where they were seeking meaning and t ry ing to sort out the messages that l i fe was handing them i n terms o f their addict ion. In his prayers, one participant asked, "Wha t does G o d want me to do? W h a t w o u l d G o d do? Y o u k n o w the answer I come up wi th? B e nice. B u t I get t i red o f be ing n ice ." T h i s same ind iv idua l described l o o k i n g for rules and guarantees i n his new l i fe that compared wi th the very expl ic i t rules o f his o l d way o f l i fe deal ing drugs. H e said it felt scary j u m p i n g into a life without drugs. H e was t ry ing to figure out w h y he w o u l d give up his d rug- invo lved l ife that i n v o l v e d his previous social network. "Wha t do y o u do? W e l l , what ' s right? Does it get better? I don ' 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 diff icul t to step wi th both feet into a new w ay o f l i fe . H e commented on his current circumstances: "the hurt and the pain and the shame and guil t I ' m feel ing today is a direct result o f what I have done i n the past." Ano the r participant described his o l d ways o f seeking meaning and connect ion wi th others: If I can ' t relate to people on a social ist level - through campaigns or projects, or whatever we ' r e w o r k i n g on, w e l l there's a lways the camaraderie o f the bar, the tavern. E m p t y i n a way . B u t it answers that same k i n d o f need for purpose. O r tries to answer that need that is behind -1 said d r ink ing is a symptom and there is 97 something behind there - a sense o f loneliness. W e a l l want to love and be l o v e d and to be loveable . T h e t imes o f uncertainty were described by interviewees as "frustrating." The anger and uncertainty felt by participants i n their interactions at these times tended to be experienced as imped ing i n their journeys toward health. T h e meaning or lack o f meaning i n four interviewees ' l ives was h ighl ighted by instances o f near-misses or turning points where it became apparent to them that their chances to change their ways were running out. F o r two participants the deaths o f friends made them question the meaning o f their l ives , and ul t imately, they felt, facil i tated their heal ing journeys . Several interactions had occurred wi th one o f the participants that made h i m very aware that his chances were running out to change his ways. H e had escaped conv ic t ion on cocaine and heroin t raff icking charges. W h e n we met he s t i l l had marijuana g r o w i n g charges he was hop ing his l awyer w o u l d have dismissed. H e also ta lked about the s ignif icance o f his age to h i m i n terms o f changing his l ifestyle: " M y l i fe ' s ha l f over, m a n . . ..freaks me out. It 's, I don ' t k n o w , i t ' s l i ke , man , i t ' s too late." The wake up c a l l for another participant came i n the fo rm o f a car accident. H e expressed his realizations at the t ime o f the accident: There but for 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 ipp led that person for l i fe , right. A n d gone to j a i l for l ike a l ong t ime. O r just the guil 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 wake-up cal ls recounted by ind iv idua l s i n this study sounded potential ly negative i n influence, they were experienced by these participants as turning points that 98 made them question the meaning o f their l ives and resulted i n heading their l ives i n healthier directions. Three participants articulated interactions that seemed to personify their substance of abuse, and painted a relat ionship wi th this 'other' that formed the purpose for their existence. One interviewee described the nature o f this relat ionship and the meaning it he ld for h i m and continues to h o l d i n his l i fe . H e expressed his "power fu l " relat ionship wi th a lcohol : M y l ife total ly pertains to a lcohol . E v e n today. E v e n though I.haven't had a dr ink for almost f ive years, right. Because , you k n o w , I ' m in recovery l i ke I need to . . .have to treat this disease on a da i ly basis, right....So m y l i fe s t i l l has a lot to do wi th a lcohol . In fact y o u c o u l d say that m y l i fe s t i l l revolves around a lcohol even though I don ' t d r ink it anymore. H e went on to describe his love-lust relat ionship wi th a lcohol : I adore a lcohol . I mean I s t i l l think about it almost l i ke one w o u l d think about that relat ionship y o u had a l o n g t ime ago that was - so mag ica l and even i n hindsight it sometimes seems even more wonderful , you k n o w . A n d you start to think ' i f o n l y ' and 'what i f . ' " T h e powerful interactions wi th drugs or a lcohol were described as consuming by participants, to the exc lus ion o f m u c h else i n their l ives . T h e cont inuat ion o f this relat ionship i n the fo rm of us ing was experienced as detrimental to part icipants ' heal ing journeys. Those participants who were able to channel this focus into a spiri tual r ea lm expressed h o w their relat ionship wi th a higher power , " f i l l e d the ho le" that their drug o f choice had prev ious ly occup ied and greatly facil i tated their heal ing. 99 A meaningful spiri tual connect ion w i t h G o d or a higher power was expressed as inf luent ia l for three interviewees. One participant described his desire for a spiri tual connect ion: " A l c o h o l i c s are spir i tual ly bankrupt k i n d o f peop le . . . .Sp i r i tua l ly thirsty. Just spi r i tual ly starving. L i k e I ' m d y i n g for some - spiri tual so lu t ion ." H e defined a l coho l i sm i n terms o f his spiri tual journey: " O u r disease is our distance f rom our higher power. T h e fact we ' re not w a l k i n g a spiri tual path." T h i s i n d i v i d u a l expla ined how his spir i tual i ty f i l l s the hole that the a lcohol used to f i l l for h i m : That same long ing that used to make me dr ink is now the l ong ing that drives m y spi r i tua l i ty . . . .P lease G o d . . . d o n ' t let m y l ife be a waste. Please let me f ind some way to let me make a posi t ive contr ibut ion. H e l p me be a good person, a l o v i n g person. H e l p me to stay sober. . . .1 so want to k n o w G o d . It 's sort o f l i ke a spiri tual release for me. I want to have G o d i n m y heart. It 's l i ke the same w a y that I wanted that a lcohol inside me. F o u r participants ta lked about prayer be ing an important part o f their l ives now. F o r two interviewees i n particular, prayer has become "routine," or "a habit ," and even "a way o f l i f e . " One i nd iv idua l emphasized his feel ing o f connect ion wi th G o d through prayer: "when I ' m pray ing and meditat ing and m a k i n g a connect ion wi th whatever G o d I bel ieve i n , I ' m not i n self. I ' m i n a relat ionship." A s i d e f rom prayer, another w a y o f f o l l o w i n g a spiri tual path that participants described inc luded he lp ing others: W h e n people ask us for help i n this program we ' r e supposed to help i f we ' re able to. That ' s part ly w h y I answered your f lyer. I thought 'yeah, that's l i ke a request for help. ' I thought - I read it - I thought T fi t . ' There ' s spiri tual things there, 100 right. Y o u can say G o d puts opportunities i n your path, y o u k n o w , l i ke -opportunities to be o f service to others. Y o u ' r e supposed to say yes. Y o u ' r e supposed to. It's supposed to be good for me. T w o interviewees described A A as he lp ing to shift their focus to a spir i tual path. Interactions wi th others have p layed a key role for them, but they descr ibed the overarching role o f other people was how they fit into G o d ' s p lan. One participant defined G o d as, "whoever listens to and responds to m y prayers." G o d "speaks to me through people ." Ano the r i nd iv idua l commented about his experience 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 mean those - the steps and the people sharing - the interactions have been cruc ia l to help me come to understand about a G o d o f m y understanding. H a v e helped me come to understand about love and - helped me understand about courage and about fac ing reali ty and about be ing a human be ing w h o makes mistakes and that i t ' s okay. Participants described the experience o f a higher power as he lp ing to give meaning and a posi t ive direct ion to their l ives . Individuals in this study described that a sense o f meaning or purpose i n their interactions served as a reminder o f how their l ives were e v o l v i n g construct ively and helped them continue on their heal ing paths. One interviewee reflected on the experience of our in terview: " B e i n g here today and te l l ing you this stuff is rea l ly good for me. It , reminds me - to share wi th somebody else wi th a reasonable amount o f honesty. That 101 feels good ." O n e participant reported that m a k i n g amends to others he lped to provide meaning for h i m : Some people have bas ica l ly not been too happy to see me or hear f rom me again. B u t it was for m y benefit. I take responsibi l i ty by offering - admit t ing to that person I hurt . . . .1 acknowledge that I hurt y o u and here's w h y . That doesn' t excuse it but I just want y o u to k n o w I ' m very sorry and I ' m t ry ing to be a better person. Ano the r i nd iv idua l strengthened her resolve to stay on her current heal ing path when she compared her situation wi th a w o m a n she knew. She descr ibed her experience wi th the w o m a n w h o had been l i v i n g i n the same fac i l i ty but had not chosen a healthy path: There was a w o m a n here. A n d it just reinforces your sobriety or whatever, that was d r ink ing i n her car. That was bas ica l ly l i v i n g - that l i v e d i n the house but spent most o f her t ime i n her car, because she l i v e d i n her car for the last year and a half . . ..It just reinforces that I can have this or I can be l i ke that. In her descriptions o f several interactions this participant expressed her gratitude for the chance she has been g iven to experience l ife anew. In recount ing visi ts w i th her sponsor she marve l led , " I ' m able to do these things. A n d i f I was d r ink ing I w o u l d not be do ing them." Interactions that a l l owed participants to examine their progress i n heal ing were meaningful for them and were experienced as faci l i ta t ive. A l o n g wi th exper iencing a new sense o f meaning i n their l ives , some participants described t ry ing to create meaning for themselves out o f situations that arose for them. One interviewee was i n the process o f m a k i n g choices about what was meaningful for her. O f the A A meetings she attended she said, "I don ' t necessari ly l isten to everything 102 that's go ing on. I take what I want. O r what interests me out o f the meet ing." She also reflected on choos ing the people wi th w h o m she spends t ime: It doesn' t mean everybody y o u meet i n recovery you ' re gonna be friends wi th . Y o u k n o w l i ke i n l i fe , you gotta p i c k and choose who y o u want i n your l i fe . A n d I ' m i n that process and I ' m okay w i t h that. F o r another participant, the work he d i d w i t h others throughout his heal ing process a l l owed h i m to gain some perspective on his experience. H e recounted: R e c o v e r y ' s funny. A s you start p u l l i n g off these masks, p u l l i n g back the layers, things start popp ing up at y o u . . . . S o n o w one th ing recovery has a l l owed me to do is put a lot o f the pieces o f the puzz le together. H e reported that recovery has g iven h i m an appreciation o f "what got h i m to where he is today." Throughout the experiences recounted by interviewees, the interactions that they felt p rov ided a sense o f meaning or purpose whether through a spir i tual connect ion, turning points, ref lect ion on l ife circumstances, or m a k i n g healthy choices , were experienced as helpful i n keeping participants on track i n their hea l ing journeys . F i v e ind iv idua l s i n this study gave examples o f situations where they were t ry ing to make a posi t ive contr ibut ion to others or desired to leave a favourable legacy. T h e opportunity to "g ive back" was important for the heal ing o f participants i n he lp ing them feel their l i fe had not been a waste and that they were able to make amends for past behaviours. One interviewee had volunteered to become an E S L tutor. Ano the r said, " m y goal i n l i fe n o w is no longer to do for me, i t ' s to do for others." S t i l l another participant mentioned, " I ' m taking care o f m y s e l f and I ' m he lp ing others." One interviewee was quite distressed at the legacy he perce ived he w o u l d leave i f he were to 103 die at the t ime o f the in terview. H e said: " W h e n I die I don ' t want people to remember me as be ing ' h o l y fuck that guy was f u c k i n ' c razy . ' That. A n d as it stands right n o w that's probably how they w i l l . " T w o participants considered h o w their past actions had affected their ch i ld ren and what they c o u l d do to assist them i n their futures. O n e ind iv idua l was t ry ing to help his daughter deal w i th the "issues" that she had f rom g r o w i n g up i n an a lcohol ic home. Attempts to leave a posi t ive legacy or make a posi t ive contr ibut ion to society gave participants a sense o f meaning and this was perce ived as faci l i tat ive i n their heal ing journeys. F o u r participants expressed the importance to them of g i v i n g back to the addictions communi ty . P r io r to his o w n struggles, one interviewee he ld negative v iews about ind iv idua l s w i th addictions. H e commented on his changing v iews : "I guess I ' m t ry ing to recover f rom those years o f th ink ing those people weren ' t better people. It 's not a gui l ty feel ing, i t ' s just that I was so w r o n g . " H e volunteered regular ly at detox and felt his contr ibut ion there helped alleviate his guil t and also assisted others. H e noted, " E v e n i f I go back out and become a drug addict tomorrow I w i l l have done something right. That makes me feel good today." H e and another interviewee also ment ioned want ing to contribute i n a more g lobal way to others wi th addict ions. A s this participant stated: " I ' m not w e l l enough to do it. B u t i f there's anything I can do when I get better.. .1 desperately want . . .to see what I can do to help other addicts i n a bigger w a y . " S t i l l another participant commented on his reason for taking part i n this research project: "That ' s w h y I rode m y b ike up here. I feel so good that I can help maybe somebody else d o w n the road through your research." Cont r ibu t ing i n posi t ive ways gave participants a sense o f meaning and they expressed that this helped to facilitate their hea l ing journeys. 104 T o summarize , participants described various interactions that were helpful and h inder ing i n their search for meaning. A lack o f meaning was experienced when interviewees were i n v o l v e d i n discouraging interactions i n their l ives . Individuals i n this study also described interactions where they sought meaning and expressed frustration at not getting answers. T u r n i n g points were recounted as constructive experiences, although sometimes diff icul t . Fac i l i t a t ive interactions were reported when participants felt a sense o f meaning and purpose i n their l ives and were open to experiences wi th a higher power or want ing to contribute to others through their interactions. A Sense o f H o p e or Hopelessness Individuals i n this study recounted interactions i n v o l v i n g hope and hopelessness that they felt were inf luent ial i n their heal ing journeys . F e e l i n g hopeful was reported to be an integral faci l i tat ive experience for participants i n their journey toward health. Situations where hopelessness prevai led generated feelings o f fut i l i ty, frustration, powerlessness, and failure. Al ternate ly , when they were hopeful , participants described feel ing openness to change, and wi th that, a wi l l ingness to f o l l o w the good examples o f others. Inc luded i n interactions that p rov ided hope, interviewees also described the o p t i m i s m that a connect ion wi th the spir i tual rea lm gave them. A sense o f hopelessness emerged throughout the interviews i n descriptions by interviewees o f their feelings o f depression, suicide, fut i l i ty, frustration and pain that impeded their heal ing. One participant discussed his d o w n w a r d spiral after the deaths o f his friends: I changed and I became more depressed. M y l i fe became more l imi ted . . . . I t seemed hopeless. I was angry and then the anger had nowhere to go. So the 105 reaction for me is to get depressed. Y o u k n o w y o u have this passion and i t ' s k i n d o f useless. It 's just d isrupt ive . . ..I get these strong feelings, r ight? A n d then nothing to do wi th them. I can ' t stop the traffic l i ke I suggested. F o r this i n d i v i d u a l , d r ink ing and soc ia l i z ing wi th other drinkers helped h i m to face the " lonel iness" and "emptiness" he was feel ing. T w o other interviewees described su ic ida l feelings dur ing their journey through their addict ion. One participant expressed how his su ic ida l feelings led h i m to crack cocaine: M y most su ic ida l I was, was when I stopped d r ink ing . I was sober for f ive years. That ' s when I was most su ic ida l . Because I d idn ' t have a place to go and h ide . . . .So I was a lways t h i n k i n ' about g o i n ' off the bridge or - 1 felt l i ke I was trapped into something. A n d that's when I d iscovered crack. C r a c k took away a l l that shit. T o o k away the suicide. T o o k away a l l those desires to hurt m y s e l f et cetera. Feel ings o f pa in and frustration were also described by two participants wrapped up i n feelings o f fut i l i ty i n their l ives . Af te r exper iencing a number o f painful b lows to his l i fe i nc lud ing his daughter m o v i n g away, not be ing trusted at work , and not feel ing appreciated, one participant described feel ing a lack o f power to change those events. H i s powerlessness left h i m feel ing "hurt," "punished," "angry," and i n terms o f his daughter, as though his heart had been broken. H e felt l i ke he "d idn ' t k n o w who to trust anymore" and expressed confusion about a l l the events that were happening i n his l i fe . H i s feelings translated into h i m isolat ing h imse l f f rom people and pushing others away. Ano the r interviewee expressed his distress over his inab i l i ty to help his f a m i l y i n the f o l l o w i n g way: "The on ly wa y m y chi ldren are go ing 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 painful feelings were expressed by participants as imped ing their heal ing process. Descr ip t ions o f failure pervaded three participants ' in terviews. One interviewee felt he was an example o f failure to his sons, hav ing been i n and out o f recovery for 18 years. H i s uncertainty about how to change was clear f rom his comments about his relat ionship wi th his older son: I used to treat h i m l ike m y D a d used to treat me. A n d w h y d i d I do that? Because I d idn ' t k n o w any better. N o one ever taught me any different. So - we are w h o we attract and we act l i ke who w e ' v e been brought up by . Pe r iod . W h a t is that? Behav iour . H o w do you unlearn that? W e l l break the cyc le . W e l l how do you break the cyc l e when you ' re 47 years o ld . H o w do y o u change? W e l l - 1 don ' t k n o w . Participants expressed feelings o f "shame" and "gu i l t " as a result o f their sense o f failure. Interactions reflect ing this feel ing o f failure fostered a sense o f hopelessness and fut i l i ty for participants that they felt impeded their progress towards a healthier l i festyle. A sense o f hope was discussed by al l the ind iv idua ls i n this study as faci l i tat ive i n their heal ing journeys. Participants experienced hope i n their connections wi th other people, i n f o l l o w i n g or be ing inspi red b y the examples o f others, and also as a result o f their connect ion wi th things spir i tual . F o r one i nd iv idua l , hav ing welfare top up his employment insurance helped h i m take his first steps on his journey toward health: "I was grateful towards m y welfare f inancial e l i g ib i l i t y off icer who j u m p e d through hoops to make 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 l isten for advice and strength. H o p e and ways o f people cont inu ing - are just part o f m y da i ly l i fe n o w . " One interviewee garnered a sense o f hope f rom the support and encouragement she rece ived at the R e c o v e r y House where she was l i v i n g . She also felt hopeful after resist ing very strong cravings for a lcohol she felt just before she got into the recovery house where she was l i v i n g . She was accepted to the house because she had "more sobriety t ime" than others on the wa i t ing list . She felt this was a sign that she "was on the right track." Spending t ime wi th friends also helped her to f ind hope and enjoyment i n l i fe again. O n e vis i t to Spanish B a n k s wi th a fr iend brought this reaction: Beaut i fu l beach! . . .And we w a l k e d out. . .one Sunday. W e had 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 was l i ke -this is the l i fe . Y o u k n o w - this is w h y I ' m here. She described go ing s w i m m i n g on this visi t : "we were just s w i m m i n g i n the Ocean and laughing and just hav ing fun and I ' m th ink ing this is the l i fe . T h i s is a l l a part o f recovery ." She said her w o r l d was "brighter. It 's amazing . L i k e the grass was a lways green. I just d idn ' t see i t ." She was enjoying recovery and her new lease on l i fe , fuel led by the ind iv idua l s surrounding her and the sense o f hope and o p t i m i s m that interactions wi th others gave her. She was romant ica l ly interested i n someone at the t ime o f our in terview and she was reconnecting wi th friends. Participants also experienced the examples set by other ind iv idua ls as helpful i n their heal ing journeys . T h e ind iv idua ls p rov id ing posi t ive examples inc luded sponsors, others i n A A , and people i n general. Three interviewees ment ioned experiences wi th their sponsors that helped them to achieve and mainta in a posi t ive out look and approach 108 to l i fe . F o r one ind iv idua l this experience came i n the fo rm of a road trip, for another it was the previous 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 encouraging h i m to go back to meetings when he was feel ing disheartened. One sponsor was described as "a good guy ," " a re l iable f e l low and peer," "considerate, courteous, helpful , and knowledgeable , " "a person I trusted, person I respected. I knew he wou ldn ' t bul lshi t me ." T h i s part icipant 's sponsor helped make it safe for h i m to take the next step i n his heal ing journey. Ano the r interviewee ment ioned that his sponsor was important to h i m as a role mode l and has helped h i m out in diff icul t t imes. H e described his sponsor i n the f o l l o w i n g way: H e ' s not a guru or whatever. H e ' s not a c l i n i c a l psychologis t or whatever. H e ' s just an a lcohol ic w h o ' s been sober over 28 years and he 's a human being. H e ' s got faults and he uses the program and sometimes he gets a l l twisted. Y o u k n o w he's just - 1 want what he has. H e has an abi l i ty - he just - he can deal w i th l ife and he seems to real ly - l i ke a pretty happy guy, right. Others i n the A A program were also examples o f hope for participants. One participant noted: " y o u see people who are good people. I can recognize idea l i sm. I can recognize zeal and I c o u l d see that people 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 ment ioned he " l i k e d their stories." H e was impressed by the fact that "they s t i l l f i nd the patience. A n d the compass ion . B u t the toughness too" to help others wi th their addictions. Ano the r participant thought he w o u l d "get recovery for a couple three weeks. Straighten his l i fe out. Overnight . Ge t back on the street." It d idn ' t happen that way . H e was "affected profoundly by the people i n the recovery 109 house." H i s openness to suggestion and change was evident i n the influence that the staff and the residents at his recovery house had on h i m . H i s roommate was an important role m o d e l for h i m . H e had "been there for two months and straightened h i m s e l f out." T h i s i nd iv idua l was "very support ive" and "very w i s e " because o f his experience and had c red ib i l i ty for this participant because o f his addict ion experience. Other posi t ive examples for participants came i n various forms. A character on a T V show was a "posi t ive f igure" for one interviewee. T h i s character had a substance abuse p rob lem and he got help and was sober i n the show. T h e character was "not a basket case. H e ' s l ike this in -command , take charge guy w i t h the beautiful w i f e . " T h i s a l l owed the participant to feel that substance addict ion was something he c o u l d face i f he had to: "It was okay because it was okay for h i m . " F o r one interviewee, the ind iv idua ls i n his dental c l i n i c were "a picture to me o f people i n v o l v e d i n service. It 's detail , i t ' s scient if ic , i t ' s technical . It 's almost l ike j ewel le ry , f i x i n g teeth. A t the same t ime i t ' s inc red ib ly soc i a l . " T h e people i n the c l i n i c helped to restore his "se l f esteem" and "health." F o r this participant, he felt: " E v e r y b o d y I bump into i n a w a y facilitates m y heal ing journey. ' C u z they're there. I learn something. M a y b e I just notice that they're cheerful ." Interviewees ' felt their heal ing journeys were faci l i tated by the hopeful , posi t ive examples set by other ind iv idua ls i n their l ives . H o p e was also evident for participants through their spir i tual connections. M a i n t a i n i n g a posi t ive out look was assisted by prayer and gratitude for a l l that they had. One interviewee felt he was on the upswing o f a rollercoaster r ide and hoped the trend w o u l d continue. In order to keep his focus posi t ive he said " I ' m not the most re l igious person i n the who le w o r l d or anything but I do pray to G o d . A n d I ask h i m for help and 110 some strength." Ano the r participant felt that "the purpose o f pray ing is the effect on the person who prays." S t i l l another expressed gratitude for the example o f others and for a l l that he had i n his l i fe . T h i s connect ion was made for h i m through his be l ie f i n a higher power. H e expla ined: W h e n I take m y t ime to get to k n o w that person, in the end, I ' m so happy I d i d . T h e ones that are rea l ly wor thwhi le keeping are the ones that have it. That have sobriety. O r have l i fe . A good l i fe . That have the message that I bel ieve what G o d wants us to be, or Creator, or whatever you wanna ca l l H i m . That 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 fo rg iv ing , to be forgiven and give and give and give. A n d that's what I do. A n d don ' t expect anything i n return. There ' s a lot o f times where i f I don ' t expect anything i n return and I tel l you , boy , i t ' s turned over ten fo ld . L i k e m y daughter, back i n m y l ife . M y sons c o m i n g into recovery. That I ' m not us ing dope or d r ink ing today. That I have a j o b to c o m p l a i n about. Part ic ipants ' spir i tual connections gave them hope; and they experienced this feel ing as faci l i tat ive i n their heal ing. T o conclude, ind iv idua l s i n this study experienced interactions i n v o l v i n g hope and hopelessness as instrumental i n both faci l i tat ive and imped ing ways i n their heal ing journeys. Interactions that were experienced as hopeful by participants were descr ibed as helpful i n their heal ing journey. Participants described situations where hope was absent as h inder ing them i n their heal ing process. H o p e was described by participants i n spir i tual interactions, interactions wi th professionals, f ami ly , friends and ind iv idua l s i n the A A program. Hopelessness was experienced i n interactions wi th other users as w e l l 111 as i n d iscouraging interactions where participants felt a lack o f control over the outcome o f the interactions. A Sense o f Shi f t ing Identities T h e f ina l theme that emerged dur ing this study was a sense o f shift ing identities for participants. T h e interactions i n this theme i n v o l v e d posi t ive changes i n behavioural response or perspective on the part o f interviewees f rom h o w they w o u l d have reacted before ceasing their addict ive behaviours. Participants perce ived these shifts as faci l i tat ive i n their heal ing journeys. T h e interactions that h igh l igh ted these shifts i n v o l v e d turning points, or m a k i n g connections w i t h others or G o d . Interviewees also described interactions that helped them real ize they c o u l d make more posi t ive choices i n their l ives . S o m e other interactions expressed i n this theme inc luded instances where participants rea l ized that it was acceptable to experience unpleasant emotions, when they w o u l d have t r ied to a v o i d these emotions i n the past. A d d i t i o n a l l y , ind iv idua l s i n this study became aware through interactions that they c o u l d choose to a v o i d encounters they perce ived as negative or harmful . K e y for two participants i n changing their behaviour was their part i n ask ing for help and accepting the help that was g iven . The interactions reported b y interviewees i n this theme exempl i f i ed posi t ive behaviours and attitudes that differed greatly f rom h o w they w o u l d have responded when they were act ively abusing substances. E v e r y participant reported interactions where they behaved i n more constructive ways than they had when faced w i t h s imi la r situations i n the past. F o r one interviewee, an example o f a more favourable response i n v o l v e d his reaction to his ex-gir l f r iend 's news that she was m o v i n g out o f town wi th his daughter. Rather than showing 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. "You 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. And somehow accepting the help that I was given." "So you have to ask for help. And 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 probably come ." A s k i n g for help kept this participant on track i n his heal ing journey. H e noted: I have to ask for help everyday. Somehow. 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 me i n a posi t ion o f humi l i ty . Puts me i n a pos i t ion o f service. O r deal ing wi th service. I don ' t k n o w . E v e r y b o d y , everybody I bump into i n a way facilitates m y hea l ing journey. ' C u z they're there. . F o u r ind iv idua l s i n this study described interactions that were turning points for them. F o r one participant, be ing w e l c o m e d by someone at an A A meet ing seemed to so l id i fy his decis ion not to return to d r ink ing . "I guess for what ever reason I decided, I ' m done. I ' ve had enough." F o r two other interviewees their turning points came after the death o f friends. A s one participant noted, "Someth ing changed inside me at that point ." " I ' ve seen a few people that have died. B u t uh - (this death) was different. It was different. I don ' t k n o w how it was but it was just different." S t i l l another experience described as a turning point was when one part icipant 's g i r l f r iend began "se l l ing h e r s e l f so that the two o f them c o u l d pay for their drugs. A t this point he said "this is enough." " I don ' t want to be causing somebody to do that." These turning points p rov ided important interactions for these participants i n their dec is ion to lead healthier l ives . The spir i tual aspect o f the A A program was ment ioned by a l l o f the participants but seemed to be very significant in establishing the newfound lifestyles o f two interviewees i n particular. These two ment ioned that they pray regular ly now. One ind iv idua l said that i n his previous l ife he " w o u l d not have sought spir i tual solut ions." O f his current spiri tual l i fe , he commented: "I certainly do need to pray. The effect o f prayer 114 is often about the pray-er. . . .The purpose o f p ray ing is the effect on the person who prays." Ano the r participant described the 12 steps as being: A l l about sort o f t ry ing to connect and mainta in a relat ionship wi th a G o d o f your o w n understanding. H i g h e r power, whatever that is , right. A n d I bel ieve that's because that's what a lcohol was. A l c o h o l was you k n o w - 1 w i l l worsh ip you , I g ive it a l l to you , y o u k n o w , do wi th me as y o u w i l l , right. I comple te ly submit to you . T h i s participant out l ined how he saw interactions wi th people fi t t ing i n to his spiri tual l i fe : The 12 steps and the interactions wi th people - is a l l - part o f - me hav ing a relat ionship wi th G o d , right, U m - but u l t imately G o d is wi th me 24/7. Y o u k n o w i n m y heart, right, and I need to talk to people and stuff, right, but people are not a lways there and people sometimes make mistakes. B u t G o d , o f m y understanding, is a lways there and has uncondi t ional love and w i s d o m . A n d i f I don ' t understand, I just bel ieve. T h e spiri tual aspect o f their l ives was new to both o f these participants but p layed a key role i n establ ishing their new, healthier identities. Three ind iv idua l s i n this study ment ioned the s ignif icance to them of connect ing wi th other people instead o f i sola t ing themselves, i n terms o f he lp ing them to maintain their l i festyle free f rom addict ion. T h e perspective other ind iv idua ls were able to give to interviewees i n di f f icul t t imes seemed to be valued. In the words o f one participant: There have been times when I rea l ly wanted to dr ink and I was pissed off, right, and I d idn ' t pray or anything, right. I d idn ' t pray. U m - 1 was pissed off, y o u 115 k n o w , but I just thought w e l l I ' m just not gonna take that d r ink just for today. . . .The next day or maybe later that night I ' d speak to one o f m y friends and say this is h o w I ' m feel ing, you k n o w and I w o u l d get some perspective f rom a sane m i n d . . . . S o again, you k n o w , I connect w i th some other a lcohol ic that's l i ke a power bigger than myself . Somet imes I pray - i f I ' m feel ing - weak or t roubled or whatever. I ' l l pray and that's also m a k i n g a connect ion. F o r another participant, " reconnect ing" wi th people i n her l ife has helped her mainta in her health. She said some o f the ind iv idua ls she contacted have prev ious ly on ly heard f rom her was when they "were ba i l ing her out." T h i s i nd iv idua l also described the importance o f the staff at V a n c o u v e r Genera l Hosp i t a l to her heal ing process: " V G H saved m y l i fe . I mean when I was i n there they saved m y l i fe . T h e y obv ious ly d i d something right. E v e n though maybe at the t ime I d idn ' t th ink it was right. U m but they saved m y l i f e . " A v o i d i n g negative interactions was important to three o f the interviewees i n terms of rejecting addict ive behaviours. One participant ment ioned avo id ing down town because he w o u l d bump into people he knew and he w o u l d not k n o w what to say to them. H e d i d not want to be a "poster b o y " o f recovery for them. H e also ment ioned "there were other people I used wi th . It w o u l d be hard for me to hang around wi th them today without us ing. I ' m not sure what w e ' d have i n c o m m o n anyway . " Ano the r interviewee rea l ized he needed to stay away f rom his f ami ly unt i l he had more t ime to establish his new lifestyle. P rev ious ly he had "crashed" and relapsed because he missed his f ami ly . H e q u i c k l y pu l l ed out o f his relapse but he noted: "I can ' t go back and see them. . . .1 k n o w i f I went back into that I ' m inv i t i ng trouble for myself . 116 I ' l l start us ing drugs again." H e also recognized that he "can ' t even speak on the phone" to his gi r l f r iend because w i l l end up us ing again. T h i s was a sad real izat ion for h i m because his relat ionship wi th his gi r l f r iend was the " o n l y l o v i n g re la t ionship" i n his l i fe . H e was aware, however , that he needed to a v o i d that relat ionship i n order to mainta in his health. F o r another participant, staying connected wi th G o d and choos ing to focus his attention on posi t ive things cont inued to keep h i m away f rom negativi ty. P r i o r to this turn around i n his l i fe , when faced wi th t ry ing times his response was "feel ing hard done b y " and "se l f p i t y " as w e l l as "poor me," "things aren't go ing m y w a y , " and "what ' s w r o n g w i t h m e ? " H e described his current experience i n the f o l l o w i n g way: "That ' s part o f what recovery is . It 's cul t iva t ing and encouraging a posi t ive spir i tual point o f v i e w and, d iscarding negativi ty, negative points o f v i e w . " One participant described negativi ty as "part o f the i so la t ion" o f addict ion. T h i s i nd iv idua l rea l ized that she can choose the people wi th w h o m she spends t ime. "In l i fe y o u gotta p i c k and choose. Y o u k n o w , who y o u want i n your l i f e . " She chose to a v o i d people w h o exhibi t a negative influence on her. She said: "I f i n d I have to stay away f rom negativi ty. I f ind that that just real ly doesn' t w o r k for me . " Part icipants rea l ized that avo id ing negative or unhelpful interactions was important i n s taying on the path o f abstinence they have chosen. L e a r n i n g to manage unpleasant emotions that arose dur ing interactions constituted a different category for participants f rom steering clear o f negative interactions. F o u r ind iv idua l s i n this study discussed be ing able to experience uncomfortable emotions i n interactions n o w without turning to substance use. One interviewee expressed how 117 disagreeing wi th members o f his step group was "quite important and quite va luable" to h i m . H e also ment ioned an a w k w a r d altercation wi th an i nd iv idua l where he felt "frightened and in t imida ted" but he was able to react non-defensively. Ano the r participant stated " I ' m getting good at deal ing wi th people that are hur t in ' me without phys i ca l ly hurt ing them or anything l i ke that." One situation that put this to the test was when he reported that his gi r l f r iend had cheated on h i m . In this instance, this participant d i d not turn to v io lence or drugs. Instead, he prayed about the situation and he sought support f rom friends. Ano the r a w k w a r d circumstance ment ioned by one interviewee i n v o l v e d learning to cope wi th the "annoying id io ts" i n his recovery house. L i f e is - y o u don ' t a lways get what ' s pleasant. I have to learn h o w to cope wi th annoying - people. W i t h people w h o aren't at the same point on the path, say. I have to f ind somewhere i n me the patience, the strength, or the abi l i ty to just w a l k away f rom them. I have to somehow f ind that - ins ide me. I have to accept the situation. Lessons for one participant i n this study inc luded ending a relat ionship without resorting to d r ink ing and g i v i n g h imse l f permiss ion to feel sad. Af te r p ray ing about whether to end the relat ionship he had a "fee l ing i n his heart" that he was go ing to have to let the relat ionship go. H e described the " awaken ing" he had: I a lways thought i f y o u felt sad about something then - w r o n g dec is ion . D o n ' t do that. M u s t a v o i d feel ing sad. D o n ' t want to ever feel sad, right. That was another reason to drink, right. A n d I learned at that moment , y o u k n o w what? Somet imes you feel sad about something even i f i t ' s the right dec is ion . 118 H e said he felt "stronger n o w " because he had "been through stuff." T h i s courage, strength and " fa i th" i n a "power greater than" h imse l f helped h i m i n diff icul t situations such as m o v i n g house, away f rom his "support system." H e said it was "stressful" and he was "a bit l one ly . " H e commented further: I ' ve learned to deal wi th stuff l i ke that. I 've learned that stuff l i ke that is part o f l ife and I 've learned an alternative to m y o l d cop ing s k i l l w h i c h was o b l i v i o n , right. A n d uh - it works for me - and I 've proven that it works because I 've been i n this space before. Ano the r instance where this i nd iv idua l reported that he honestly expressed unpleasant emotions where he w o u l d prev ious ly not have admitted them was te l l ing his counsel lor that he was fearful about be ing p laced i n a psychiatr ic inst i tut ion and that the counsel lor w o u l d keep h i m s ick so that he c o u l d continue b i l l i n g h i m . O f this, the participant said, "that's the thing the program has taught me about is to be honest about m y fears." B y confront ing his fears and be ing honest about them, "then it was dealt w i th . Before it was l i ke a l l these fears and stuff and they a l l became a b i g mass, right. D i d n ' t k n o w what I was afraid of, right." S t i l l another interviewee described a test o f his newfound honest approach to l i fe . H e had to go to Revenue Canada to resolve some issues about his taxes. H e said he was "so fr ightened" he "just about started to c ry . " H e said "that was g o o d " because: In the o l d days I w o u l d go there and p i ck a fight w i t h the guy . . . .That was just a l l because - 1 d idn ' t real ize it at the t ime - 1 was scared. N o w I went there and I knew I was scared and uh - petrified and I can get over that. I don ' t have to use drugs or a lcohol . 119 L e a r n i n g to accept that negative emotions are part o f l i fe and to permit themselves to experience diff icul t emotions without the consequent us ing behaviour was a step forward for these participants i n terms o f establishing a new identi ty. In summary, interactions that reflected a change i n the part icipants ' response or perspective f rom how they w o u l d have responded when they were us ing appeared to comprise a theme o f shift ing identities. The categories o f interactions that seemed significant for participants inc luded: those where participants ac t ive ly asked for help and accepted the help that was g iven , and instances where interviewees chose to a v o i d unnecessary negativi ty. A d d i t i o n a l l y , ind iv idua l s i n this study descr ibed the s ignif icance of choos ing to connect w i th people or G o d instead o f isola t ing. A l s o o f consequence to participants was keeping their perspective, and recogn iz ing choices instead o f feel ing miserable and resort ing to us ing behaviours. F i n a l l y , i n this theme were situations where interviewees acknowledged their feelings and gave themselves permiss ion to experience negative emotions. Included i n these interactions were situations that seemed to test part icipants ' responses. The interactions i n this theme a l l h ighl ighted a change i n interviewees ' response that was more constructive than before they began their heal ing journeys . R e c o g n i z i n g these interactions as indica t ive o f a new w a y o f l i fe was faci l i tat ive for participants i n their heal ing journeys . C o n c l u s i o n T h e data co l lec t ion interviews i n this study were used to extract f ive themes that reflected the c o m m o n experience o f both faci l i tat ive and imped ing interactions o f the participants i n their heal ing journeys away f rom substance addict ion. T h e descriptions o f the participants y ie lded experiences o f feel ing supported or discouraged, isolated or at a 1 2 0 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 C H A P T E R F I V E D i s c u s s i o n Introduction T h i s study was designed to explore the interactions ind iv idua l s experienced as faci l i tat ive or h inder ing i n their process o f hea l ing f rom addict ion. T h e research question that guided 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 inc lude a compar i son of the f indings in this study wi th those f rom the exis t ing literature. F o l l o w i n g this compar ison , impl ica t ions for counse l l ing , l imita t ions o f the study and thoughts about future directions for research w i l l be discussed. C o m p a r i s o n to the Literature T h e literature rev iewed for this study ( A k i n & Gregoi re , 1997; A m e s & R o i t z s c h , 2000; A s h e r y et a l . , 1995; D o b k i n et a l . , 2002; R e i d et a l . , 2001) gives the impress ion that ind iv idua l s heal ing f rom addict ion c o u l d poss ib ly be inf luenced pos i t ive ly or negat ively i n their interactions wi th professionals and others i n their social support network; however , the perce ived influence on their heal ing journeys is not addressed i n this literature. T h i s study, al though on ly descr ib ing the experience o f s ix ind iv idua l s on their heal ing paths f rom addict ion, contributes to the literature i n descr ib ing what was helpful or h inder ing to participants i n terms o f interactions i n v o l v e d i n their heal ing. The i n -depth in terview process deta i l ing interactions f rom the part icipants ' o w n experience a l l owed me to uncover a number o f f indings that were not apparent i n the literature rev iewed for this study. 122 F i r s t ly , this study supports the idea that ind iv idua l s heal ing f rom addict ion do perceive others to have an influence on that process. Participants reported interactions wi th others as faci l i tat ive or hinder ing i n their heal ing f rom addict ion. Often the interactions that were experienced as negative by participants such as avo id ing others out o f embarrassment Or emot ional pain, or discouragement f rom verbal abuse or betrayal, reflected a h inder ing influence. Interactions experienced as posi t ive such as support or empathy were reported to be faci l i tat ive. H o w e v e r , this was not a lways the case. One interesting f ind ing o f this study was that i n certain situations, seemingly negative or painful interactions led to posi t ive change. Participants described the deaths of friends that prompted cessation o f their drug and a lcohol abuse, the hopelessness o f lo s ing relationships, or a car accident that p rovoked one participant to change his d r ink ing habits. A l t h o u g h in i t i a l ly participants often experienced these interactions as setbacks, they frequently p rov ided the impetus for them to change their addict ive behaviours. T h e influence o f interactions i n this way appears to be a f ind ing unique to this study. Ano the r f ind ing that is not reflected in the literature rev iewed for this study but reflects other avai lable studies (Nea lon -Woods , Fer rar i , & Jason, 1995; Rat l i f f , 2003; Swora , 2002) is the importance for participants o f a sense o f inc lus ion i n a communi ty wi th a not ion o f c o m m o n ground. In the current study, feelings o f be long ing appeared most often for participants w i th in the A A movement . Interviewees expressed that elements o f the A A program addressed their need for connect ion wi th other people, and they also p rov ided a connect ion wi th the spir i tual . P r i o r to ceasing the use o f their addict ive substance, some participants described their substance o f choice as the 'other ' 123 i n their l ives that gave to them a sense o f be long ing and connect ion. These results reflect that for participants i n this study, some connect ions were perce ived as healthier than others. Other participants reported feel ing as though they were l i v i n g a double l i fe : one side trapped i n c i v i l i t y , the other compr i s ing a feel ing o f evilness. Part icipants experienced the p u l l o f t w o wor lds yet felt as though they be longed to neither one nor the other. Once participants stopped abusing substances, several ment ioned fee l ing a loss o f control and power . H o w e v e r , these feelings appeared to dissipate once new, healthy bonds were made w i t h other people. Interactions w i t h G o d or a higher power also gave participants a sense o f be long ing i n a constructive way . The sense o f spir i tual connect ion is reflected i n the addic t ion recovery literature (Green, F u l l i l o v e , & F u l l i l o v e , 1998; Sherman & Fischer , 2002 ; W h i t e , W a m p l e r , & Fischer , 2001) . Connect ions w i t h others, as w e l l as w i t h G o d , were reported to have g i v e n participants new meaning , a sense o f support and hope i n their l ives and resulted i n a change i n their identity and w a y o f th ink ing about themselves. One par t icular ly salient finding i n this study was the descr ipt ion o f personal g rowth among participants, i n terms o f the changes i n their response to var ious interactions. A s participants shifted their identities away f rom that o f 'addict , ' they began to ask for and accept the help o f others, and chose more constructive behaviours i n interactions. These behaviours inc luded learning to accept and experience unpleasant emotions and make the choice to a v o i d negative or unhealthy encounters w i t h others. A d d i t i o n a l l y , participants described choos ing h o w to spend their t ime and focus their energy, par t icular ly i n want ing to make a pos i t ive contr ibut ion i n the w o r l d . S i m i l a r 124 descriptions o f growth and change were not apparent i n the literature r ev iewed for this study. There were, however a number o f f indings in this study that were consistent w i th the p reva i l ing literature. T h e results f rom this study reflected the addictions and counse l l ing 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 & Cormie 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; Tatarsky, 1998) suggesting the eff icacy o f empathy, genuineness and uncondi t ional posi t ive regard wi th cl ients. Crea t ing an environment o f safety and acceptance was experienced by participants as faci l i tat ive i n their heal ing process. A d d i t i o n a l l y , the addictions counse l l ing literature (Denning , 1998; M c C a n n & R o y - B y r n e , 1998; Rotgers , 1996; Ro thsch i l d , 1998; Tatarsky, 1998) suggests the effectiveness o f encouraging c l ients ' invo lvement i n treatment p lanning, goal 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 invo lvement and control achieved by ac t ive ly part icipat ing i n the direct ion o f therapy was experienced as faci l i tat ive for participants. F ind ings o f this study inc luded both helpful and h inder ing experiences wi th addictions and health professionals. T h i s is consistent wi th the f indings o f A s h e r y et a l . (1995) that i l lustrated both posi t ive and negative experiences o f drug abusers w i t h socia l service programs and A k i n and Gregoi re (1997) that described various experiences wi th c h i l d welfare workers o f ind iv idua ls who had successfully addressed their addict ion issues. Cer ta in ly attitudes o f addictions and health professionals were perce ived by participants i n the current study as inf luent ial i n their interactions and i n their heal ing process. V e r b a l and non verbal behaviour was experienced by participants i n both posi t ive and negative ways . Crea t ing an environment o f safety, g i v i n g o f t ime and space, 125 responding with kindness, and empathy were all emphasized by participants as facilitative in their healing. Alternatively, feeling demeaned, not listening and not being generous with time were impeding influences on participants' healing. Findings in this study did not reflect the results of Cunningham et al. (1999). Individuals in Cunningham et al.'s study reported that addiction treatment and doctors' advice were not influential for them in 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 in terms of their healing from addiction. Perhaps the focus of 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 in result. In the current study participants expressed the critical role of healthy social support in facilitating their healing journey. Interviewees described healthy social support as including individuals within the A A movement, whether in groups, or individually. Additionally, for some participants, family and friends who did not abuse drugs or alcohol of deal drugs, were important in facilitating their healing from addiction. These findings are consistent with the results of Dobkin et al. (2002) and Ames and Riotzsch (2000) that suggested beneficial effects of social support on healing from addiction. Family, in particular, were influential for participants in this study in 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 in this study also 126 recounted interactions w i t h f ami ly that impeded their hea l ing progress. Interviewees described unsupport ive and verba l ly abusive spouses, partners w h o they felt abandoned them, and ch i ld ren w h o d i d not understand their substance abuse and consequently avoided the interviewee. A l t h o u g h not addressed i n the literature, bo th the healthy soc ia l support o f f ami ly members and the imped ing interactions w i t h f ami ly descr ibed by participants speaks to the potential ly strong influence f a m i l y m a y have o n ind iv idua l s heal ing f rom addic t ion i n both posi t ive and negative ways . W i t h respect to ethnici ty and gender some aspects o f this study were consistent w i t h the literature and others were not. Participants d i d not report that either their gender or ethnici ty was significant i n their heal ing. T h i s m a y have been a fa i l ing o n m y part i n gleaning this data or 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 si tuation at the depth o f her addic t ion was congruent w i t h the research (Ne l son -Z lupko et a l . , 1995) o n w o m e n w h o tended to use i n i so la t ion and had fewer soc ia l supports. H o w e v e r , the f indings o f this study differed f rom the literature i n that the female participant i n this study was single, wi thout chi ldren , and had marketable sk i l l s . It is hard to say whether the f indings f rom the current study support the research o n ethnici ty (Prendergrast et a l . , 1998) because o f the l im i t ed numbers. H o w e v e r , the one i nd iv idua l i n the study o f South A s i a n and S w e d i s h descent w h o was i n v o l v e d i n the c r i m i n a l just ice system a l luded to a great deal o f v io lence i n his l i fe . H e also discussed his reluctance to disclose personal informat ion i n group settings. These factors are consistent w i t h the evidence for H i span i c participants i n the study b y Prendergrast et a l . . 127 Implicat ions for C o u n s e l l i n g The results o f this study provide some insight into the experience o f the participants i n their interactions w i t h professionals i n terms o f what was helpful to them i n their heal ing process. F ind ings are f rom the part icipants ' perspectives so w e can learn what they found helpful or unhelpful i n terms o f their interactions w i t h health and addict ions professionals and can apply this informat ion to counse l l ing . A number o f the interactions described by participants i n this study di rect ly i n v o l v e d ind iv idua l s i n counse l l ing roles, i f not counsel lors themselves. These f indings m a y be useful to counsel lors w h o w o r k w i t h clients w h o have addic t ion issues. Participants described the necessity for them o f trust and faith i n the relat ionship w i t h the health and addict ions professionals w i t h w h o m they were w o r k i n g , i n order for them to share their experience. B e l i e v i n g i n the c red ib i l i ty o f the professional was essential to the counse l l ing relat ionship. A personal addic t ion history o n the part o f the professional helped establish trustworthiness among participants. H o w e v e r , other factors were important i n establ ishing rapport i n the interactions discussed. Crea t ing a safe space for clients to share, g i v i n g o f a counse l lor ' s t ime and a l is tening ear were instrumental i n faci l i tat ing part icipants ' heal ing. Consistent w i t h the counse l l ing and addict ions counse l l ing literature ( B e l l & R o l l n i c k , 1996; Egan , 1994; D e n n i n g , 1998; H a c k n e y & Cormie 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; Tatarsky, 1998), these f indings con f i rm that establishing the relat ionship w i t h cl ients is important for counsel lors w o r k i n g i n the addict ions f ie ld . O n a number o f different occasions participants reported d i f f icul ty i n establ ishing trust w i t h others, i nc lud ing health and addict ions professionals. A t t imes professionals ' 128 mot ives for cont inuing counse l l ing were questioned, a long w i t h their understanding o f addic t ion. Participants feared the professionals ' knowledge was mere ly academic rather than experient ial . Somet imes fear i n counse l l ing situations s temmed f rom insecurit ies over part icipants ' o w n thoughts, feelings and fears o f be ing l o c k e d up or kept s ick . Reassurance f rom the professionals made an important difference i n a l lev ia t ing anxiety and a l l o w i n g participants to share their problems and get the help they needed. U n c o n d i t i o n a l posi t ive regard is w e l l documented i n the literature (Hackney & Cormie r , 1996; N o w i n s k i , 1996) as is establishing rapport (Denn ing , 1998; M c C a n n & R o y - B y r n e , 1998; Tatarsky, 1998). A l l a y i n g participants fears about the counse l l ing relat ionship and process, as w e l l as any fears about feel ing judged , w o u l d be advisable for addict ions counsellors . A l o n g the l ines o f establishing rapport and def ining the counse l l ing relat ionship, participants expressed that feel ing i n control o f their hea l ing process was important to them. A l l o w i n g the clients to set the pace i n the counse l l ing sessions and reassuring them that their counse l l ing sessions w i l l on ly continue as l ong as the cl ient feels they are warranted was expressed by one cl ient as g i v i n g h i m a sense o f safety and control . T h i s point was emphasized by the fact that part icipants ' responses to certain interactions appeared to be related to a leve l o f readiness to accept the support be ing offered. The idea o f w o r k i n g col labora t ive ly w i t h clients is supported i n the exis t ing addict ions literature (Denning , 1998; M c C a n n & R o y - B y r n e , 1998; Prochaska et a l . , 1992; Rotgers , 1996; Ro thsch i ld , 1998; Tatarsky, 1998) It w o u l d , therefore, be prudent for addict ions counsel lors to w o r k f rom the c l ien t ' s l eve l o f readiness i n their sessions. 129 A d d i t i o n a l l y counsel lors w o u l d benefit f rom consider ing that the cl ient is the expert o n their addic t ion and the counsel lor the expert o n psycho logy or counse l l ing . A l t h o u g h participants d i d not appreciate advice or be ing g iven instructions, educat ion was we l comed . Part icipants accepted that professionals m a y have expertise i n certain areas such as behaviour patterns or bra in chemistry and impar t ing this knowledge to the cl ient was helpful to them i n understanding their addic t ion better. A d d i c t i o n s counse l l ing literature (Denning , 1998; M c C a n n & R o y - B y r n e , 1998; Rotgers, 1996; Ro thsch i l d , 1998; Tatarsky, 1998) supports the idea o f col laborat ing w i t h clients i n the therapeutic process and w o r k i n g w i t h the c l ients ' goals. Counse l lo rs w o r k i n g w i t h clients w h o have addic t ion issues w o u l d probably benefit f rom the knowledge that their help m a y be best offered to clients i n the psycho log ica l aspects o f their addic t ion , the relationships they h o l d and navigat ing w o r k situations that are affected and entangled w i t h their addict ive patterns. A n interesting f ind ing i n this study was that two participants described their addict ive substance o f choice as the "other" i n some o f their interactions. The relat ionship described b y these participants was one o f the substance be ing the lover , the communi ty , the understanding, g i v i n g a feel ing o f be longing , and the one w h o w i l l a lways take y o u back. E x i s t i n g counse l l ing literature that relates to this idea is that o f the empty-chair technique f rom Gestalt therapy (Corey , 1996). It c o u l d be useful for counsel lors w o r k i n g w i t h ind iv idua l s w h o have addic t ion issues to be mindfu l o f this personif ied relat ionship and w o r k w i t h it as such, rather than v i e w i n g the substance mere ly as an object. 130 A l t h o u g h the actual ind iv idua ls who m a y make an impress ion on a c l ient ' s l i fe m a y differ f rom cl ient to cl ient , k n o w i n g that others are inf luent ia l for clients i n their heal ing process f rom addict ion opens the door for counsel lors to f ind out who are the key people i n their c l ients ' l ives and w o r k wi th their clients in fostering or seeking supportive relationships wherever possible. Hea l thy interactions that were perceived as faci l i tat ive were felt to be supportive, gave participants a sense o f hope or meaning i n their l ives or helped encourage a feel ing o f mutual understanding and be longing . Counse l lo rs c o u l d assist their clients i n establishing and main ta in ing these types o f faci l i tat ive relationships i n their l ives . W h e n appropriate, counsel lors may suggest that clients get i n v o l v e d in a group or groups that c o u l d provide posi t ive social support. A d d i t i o n a l l y , counsel lors might ask clients w h o i n their l ives gives them the k i n d o f support they need. Counse l lo rs are i n a posi t ion to help clients d iscover what k inds o f support they require to assist them i n their heal ing. F i n a l l y , counsellors c o u l d encourage clients to be clear w i th ind iv idua l s i n their l ives about how they can support them dur ing their hea l ing process. Suggestions for Future Research The f indings o f this research are the result o f an exploratory study i n w h i c h s ix ind iv idua l s w i th substance addict ion histories shared their experiences o f interactions that they perce ived to help or hinder their heal ing process f rom addict ion. A s an exploratory study descr ib ing the experiences o f on ly s ix participants, the results cannot be general ized beyond the ind iv idua l s i n this study. In order to broaden our understanding o f the phenomenon i n question, it w o u l d be benef ic ia l to explore this phenomenon further. In terv iewing more ind iv idua ls c o u l d refine themes or reflect new themes that might emerge. F o l l o w i n g participants over a per iod o f t ime wi th several interviews 131 might help to further explicate the shape o f the phenomenon. If a longi tudina l study were undertaken it might be possible to identify factors that dis t inguished one part icipant 's experience f rom another. A d d i t i o n a l l y , a more i n depth study might uncover whether different aspects o f the themes were h ighl ighted at different stages o f the heal ing process. Participants i n this study described instances that were helpful or h inder ing and the importance to them of ask ing for help. It w o u l d be interesting to tease out whether s imi la r interactions are perce ived differently g iven the part icipants ' stage o f heal ing. Ano the r factor that w o u l d be o f interest to investigate i n further studies o f this nature, is whether ind iv idua ls heal ing f rom addict ion without the support o f A A reflected the same themes as the participants i n this study. A l l o f the interviewees i n the current study were connected i n some way wi th A A . M o s t participants drew a great deal o f support, l i fe meaning and hope f rom their interactions wi th ind iv idua l s i n the A A organizat ion. Perhaps for ind iv idua ls l a c k i n g this experience, f indings 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 through some sort o f residential p rogram as part o f their heal ing process. Individuals who d i d not have this experience m a y report different influential events for them i n their heal ing process. A study i nc lud ing ind iv idua l s who were not abstinent but s t i l l used i n moderat ion m a y y i e l d different results also. T h i s study inc luded ind iv idua ls 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 them i n their heal ing journeys . Ano the r study wi th different participants m a y report different f indings. 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 length o f t ime since participants had ceased their addict ive behaviours pr ior to the study be lengthened to closer to one year. I was unable to contact t w o o f the participants i n this study w h o had the shortest periods o f abstinence (7 months) for their fo l low-up interviews. I had several different numbers for one participant, i nc lud ing a cel lu lar phone number. N o n e o f h is personal phone numbers were w o r k i n g . The person w h o answered the telephone number o f his previous A A group said she had not seen h i m for months. The staff at the fac i l i ty where the other participant l i v e d at the t ime o f our in te rv iew d i d not have a forwarding number for her. M y best guess f rom the informat ion I received is that they are both back out us ing again. The exploratory nature o f this study and its l im i t ed sample size and single data co l l ec t ion in terv iew made it imposs ib le to draw conclus ions about the f indings that describe the substance o f abuse as "other" b y participants. A s w e l l , the issues o f feel ing trapped i n a double l i fe were not explored to their potential . It w o u l d be interesting and useful to counse l l ing professionals to further explore the relat ionship between addict ions professionals and their clients i n terms o f c l ients ' perspectives o n trust, c red ib i l i ty and comfort . T h i s study provides a first step i n v i e w i n g what is perceived b y ind iv idua l s w i t h addict ions as faci l i tat ive or imped ing to them i n their hea l ing journeys . L imi ta t ions o f the Study T h i s study had a number o f l imita t ions . F i r s t ly , the study was l im i t ed i n terms o f recruitment. N o t everyone e l ig ib le was in formed o f the study. The sample was gathered f rom ind iv idua 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 and read E n g l i s h . I in terv iewed the first s ix respondents w h o were interested and w h o met the cr i ter ia for the study; 133 therefore, they were not necessari ly representative o f the popula t ion o f ind iv idua l s w i th addict ion issues. T h e smal l sample size i n this study also makes it imposs ib le to generalize the results. Participants were volunteers so there may have been something i n the research ' question that par t icular ly appealed to them. T h e participants o f this study m a y have felt they had something to offer. Those ind iv idua ls for w h o m interactions were not felt to be inf luent ia l i n faci l i tat ive or imped ing ways w o u l d probably not have volunteered for the study. Individuals o f var ied ethnic backgrounds and both genders were inc luded i n the study. H o w e v e r , the results d i d not suggest that these factors were relevant for participants i n their heal ing process. Whether this was, i n fact, the case or whether a shor tcoming on m y part i n in te rv iewing was responsible for that oversight is uncertain. F i n a l l y the qual i ty o f the results m a y be l im i t ed by a number o f procedural issues. M y in te rv iewing abi l i ty , capacity to establish trust, the part icipants ' abi l i ty to describe their experience, a l l may affect the c red ib i l i ty o f the f ina l results. A d d i t i o n a l l y m y s k i l l i n engaging i n the phenomenologica l process and accurately extracting the emergent themes f rom the data co l lec t ion interviews m a y have l im i t ed the f indings o f the study. C o n c l u s i o n In conc lus ion I w o u l d l ike to share m y personal experience o f do ing this research. I came to this research f rom both personal and professional avenues. The history o f addic t ion i n m y fami ly gave me a certain v i e w o f the w o r l d o f addic t ion. W o r k i n g wi th ind iv idua l s who have addict ion issues helped to broaden m y understanding and empathy for their struggles. T h i s research has, once again, expanded m y understanding of, and 134 appreciation for, the w i n d i n g pathway out o f addict ion. I began this research hop ing to address issues o f ind iv idua l s who were not part o f the A A program because I felt they were underrepresented i n the literature. A d d i t i o n a l l y , I bel ieve I had a personal bias against the A A program. I have t radi t ional ly reacted negat ively to ind iv idua l s i n v o l v e d i n the program because o f m y experience o f feel ing a barrier between m y s e l f and ind iv idua l s w i t h i n the A A organizat ion. 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A l c o h o l i s m Treatment Quarter ly, 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 A P P E N D I X D Interview questions Genera l Research Quest ion H o w do ind iv idua l s w h o have m o v e d f rom substance addict ion to health experience their interactions w i th others i n terms o f faci l i ta t ing or imped ing their heal ing journey? M a i n Interview Quest ion A s k e d of Participants W o u l d you please tel l me about your experiences o f faci l i tat ive or imped ing interactions w h i c h you felt were significant to your process o f heal ing f rom addict ion? B a c k u p questions Who • W h a t was your relat ionship wi th this person? (wi th w h o m you had the interaction) How • H o w d i d the interaction affect you? • W h a t was it about this interaction that either facil i tated or impeded your hea l ing f rom addict ion? • C a n y o u tel l me more about what you were feel ing or what went through your m i n d when that happened? • W h a t went on for you dur ing this interaction? • W h a t influence do you think this interaction had: on your heal ing process?: on your self perceptions? • W o u l d you l i ke to say any more about that? When • In what w a y was the t iming o f the interaction significant i n terms o f be ing inf luent ial to your recovery process? • C o u l d y o u describe a turning point for y o u i n your hea l ing process? 

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