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Exploring the phenomenon of recovery for chemically dependent women survivors of childhood sexual abuse Oxner, Katherine B. 1993

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EXPLORING THE PHENOMENON OF RECOVERY FOR CHEMICALLYDEPENDENT WOMEN SURVIVORS OF CHILDHOOD SEXUAL ABUSEbyKATHERINE B. OXNERB.S.W., The University of British Columbia, 1992A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THEREQUIREMENTS FOR THE DEGREE OFMASTER OF SOCIAL WORKinTHE FACULTY OF GRADUATE STUDIES(School of Social Work)We accept this thesis as conforming to the required standardTHE UNIVERSITY OF BRITISH COLUMBIAAugust 1993© Katherine B. Oxner, 1993In presenting this thesis in partial fulfilment of the requirements for an advanceddegree at the University of British Columbia, I agree that the Library shall make itfreely available for reference and study. I further agree that permission for extensivecopying of this thesis for scholarly purposes may be granted by the head of mydepartment or by his or her representatives. It is understood that copying orpublication of this thesis for financial gain shall not be allowed without my writtenpermission.(Signature) Department ofThe University of British ColumbiaVancouver, CanadaDate Olit i" 3 0 ) DE-6 (2/88)ABSTRACTThis study explores the influence of childhood sexual abuse on the recoveryprocess from chemical dependence for women. A feminist perspective is utilizedin the qualitative design which elicited rich information from the interviews heldwith eight women The participants who volunteered, were referred by theircounsellors from a Drug and Alcohol residential treatment program and out-patient clinic. The recovery stories as shared by these women were audio tapedand the interpretation of their responses was directed by the grounded theorymethod of data analysis. Two themes emerged from the analysis: 1) Self-Discovery Through Story Sharing and, 2) Symptomatic Relapse, whichcaptured the complex intertwining nature of recovery from chemical dependencewhere the process is compounded by the aftereffects of childhood sexual abusetrauma. All eight women reported a desire to maintain a drug and alcohol freelifestyle but repeatedly found themselves abusing substances until theyunderstood the connection between their addiction patterns and the aftereffectsof being survivors of childhood sexual abuse. Chemical dependence andchildhood sexual abuse have been viewed as distinct "treatment" issues, however,these findings suggest the issues be addressed simultaneously if chemicalabstinence is to be a realized goal in recovery.TABLE OF CONTENTSABSTRACT^ iiTABLE OF CONTENTS^ iiiLIST OF TABLES vLIST OF FIGURES^ viACKNOWLEDGEMENT viiCHAPTER ONE: INTRODUCTION^ 1Historical Aftermath^ 6Women Survivors & Addiction Research^13Oppressive Power Relationships^ 17Summary^ 21CHAPTER TWO: LITERATURE REVIEW^23Models of Recovery^ 23Theories on Addiction 30A. Biological Theories^ 30B. Social Learning Theories 31C. Psychological Theories 33Theories of Sexual Abuse:^ 33Recovery from Chemical DependenceSummary^ 37CHAPTER THREE: METHODOLOGY^ 39Design^ 39The Participants^ 40Interview Process 43Exploring Her-Story 45Her-Story Unfolded^ 47iiiCHAPTER FOUR: RESULTS/DISCUSSION^51Categories^ 53Themes 61Recovery in Motion^ 72CHAPTER FIVE: CONCLUSIONS AND IMPLICATIONS^75Bibliography^ 80Appendix A: The Twelve Steps of Alcoholics Anonymous^87Appendix B: Sixteen Steps for Discovery and Empowerment^88Appendix C: The Thirteen Statements^ 90Appendix D: Interview Guide 91Appendix E. 1: Research Approval(N.B. Alcohol & Drug Counselling Services)^93Appendix E.2: Research Approval (Alcohol & Drug Programs)^94Appendix E.3: Research Approval (Aurora House)^95Appendix F: U.B.C. - Certificate of Approval 96Appendix G: Contact Letter^ 97Appendix H: Interview Consent Form^ 98Appendix I: Consent Form Copy Receipt 99Appendix J: Interview Transcript^ 100ivLIST OF TABLESTABLE 1: The Evolving Recovery Framework- Recovery Enhancers^ 49TABLE 1A: The Evolving Recovery Framework- Recovery Barriers^ 50TABLE 2: The Evolving Recovery Process^ 52vLIST OF FIGURESFIGURE 1: The Recovery Process Flow Chart^72viACKNOWLEDGEMENTI would especially like to thank the eight women who participated in this study.Their contribution enriched this study as they individually shared their recoverystory and their hope for other women on this healing path. Many thanks go toDr. Mary Russell, Dr. Betty Carter, and Dr. Kathryn McCannell for theirguidance and support throughout my studies and particularly for their insightand encouragement for this project.In appreciation to the team members of Aurora House and the North BurnabyAlcohol and Drug Counselling Service for their interest in this study, for theirsupport to me personally, and for their dedication to the women whose lives theytouch in a special healing way. Much love and thanks go out to my family andfriends who believed in me. Lastly, I would like to thank the most importantperson in my life, my partner Mary. Her love and gentle patience has helped methrough these many years and most importantly, through my own healingjourney.viiCHAPTER ONEINTRODUCTIONRecovery from chemical dependence for women is a complex issue wherelittle is yet known because few research studies have focused directly on womenand their issues specific to recovery. Three primary recovery models have beenutilized to assist people with chemical dependence: 1) the controlled drinkingmodel; 2) the medical [disease] model and 3) the biopsychosocial dysfunctionalmodel (Gorski, 1986) but these models were developed from research based onmen's experiences. A critique of the research will be outlined later in this chapteralong with a description of the three recovery models in chapter two. Recoveryas a term explains the process of healing from chemical dependence and is oftencharacterized as abstinence from drugs and alcohol with a full return to optimalbiopsychosocial functioning (biopsychosocial dysfunctional model). Suchfunctioning includes the ability to cope with day to day stressors, reestablishhealthy relationships with others, and eliminate drugs and alcohol as anintervening method of dealing with life's problems through complete abstinence.A feeling of "wholeness" and balance in ones' life is a recovery goal. Thisrecovery model, however, does not examine the influence of the culturalsocialization that shapes the lives of men and women. Thus, a feeling of1wholeness may have a different meaning dependent upon gender, ethnic or racialbackground, class, sexual orientation, or disability because "meaning" isculturally and socially determined. In this century alone, women were notaccorded the same rights and liberties as men. For instance, women did notbecome persons in Canada until 1929, up to that time, they could not beappointed to the senate. Emancipation for women occurred slightly before 1929but at different times depending on which province the women lived and whitewomen were allowed to vote much earlier than First Nations' women or otherminority women. If a woman is native, lesbian, from a minority group, disabledor poor, she suffers additional jeopardy. Historically, it appears most societieshave condoned physical violence towards women in intimate relationships(Dobash & Dobash, 1979, 1992; Clark & Lewis, 1977; Pagelow, 1984; Schecter,1982) and today women are still fighting for the legal sanctions to have a sayover their own bodies (Pro Choice - Abortion Laws). Thus, what does it meanfor a woman to feel whole with such societal pressure to conform? Thesesocially constructed conditions, from a feminist perspective, are believed toinfluence women's choices and experiences. Such socialization and its influenceis apparent in the addiction field once an exploration of women's experiences inrecovery from chemical dependence is undertaken. One aspect of women'sexperiences that has received little attention is the impact of childhood sexual2abuse on the recovery process for chemically dependent women even though ahigh incidence of childhood sexual abuse among chemically dependent womenhas been documented.This study, guided by a feminist framework, explores the impact ofchildhood sexual abuse issues on women's recovery process from chemicaldependence. This topic area was purposively chosen because of the numerousconcerns voiced to me by women with whom I have worked professionally. Asa drug and alcohol counsellor for more than twelve years, I have heard womenshare over and over again the struggles they have had in trying to maintain adrug-free lifestyle, explaining that the traumatic memories of abuse theyexperienced as children overwhelm and bombard them in their adult life wherebyreturning to active addiction seems like the only plausible solution to eliminatingthe pain. Such statements as "I'd rather be drunk then remember" were echoedrepeatedly. Along with the influence of my professional experience to pursuethis topic, I was also personally motivated. As a survivor of childhood sexualabuse, I also battled with a drug and alcohol problem for years. Doctorsprescribed drugs for me starting at the age of ten, never enquiring why a childso young could be in so much distress. I learned at the age of twelve, at a partymy parents were having, that alcohol made me feel better and enabled me tosleep without nightmares, and thus the rollercoaster began. Numerous attempts3at "sobriety" ended in failure perpetuating the spiral disintegration of my self-esteem and self-worth. I fmally reached the doors of Alcoholics Anonymous andmanaged to stay "clean and sober" (drug-free) for two years. However, as myfeelings surfaced, no longer masked and subdued by chemical suppression, I feltI was in an emotional crisis and desperate, losing the desire to live. Lookingback, I felt isolated and alone because the unwritten rule in AA is that you keepthe discussions focused on your problems with alcohol. Although helpful, theprogram did not meet my need to understand my experiences. At one meeting,a woman shared about her drinking and its association to having been sexuallyabused as a child. I clung to her every word, but later heard comments by othermembers that she should not have shared that "stuff'. I recall one person saying,"pretty soon we won't know what kind of meeting we are at because they'll betalking about eating problems, work problems and other addictions." "Youhave to deal with being an alcoholic first and then look at all that other stuff'.There may be some merit in the perspective of staying singly focused, however,it presented a barrier for me in my healing. When my emotional decline landedme in a treatment centre, because I was considered at high risk for relapse, theanswers finally started to surface. I was one of the lucky ones because thetreatment centre for chemically dependent women that I attended focused on allareas that impact women's lives, including childhood sexual abuse.4As a result of my personal and professional involvement in this area ofchemical dependence and sexual abuse, I wanted to know more about otherwomen's experiences in the hopes that exposing information publicly mightassist women with these dual issues in the future.Many Alcohol and Drug treatment centres focus on addiction as itinterferes in a person's present life circumstance such as health problems, jobimpairment, problems in interpersonal relationships and so forth, with recoveryaimed at changed behaviours and attitudes in order to attain and maintain"sobriety". This approach ignores past life-experiences as an influencing factortoward the onset of a chemically dependent life-style thus omitting the possibleinfluence of these issues, i.e. childhood sexual abuse, on the recovery processfrom chemical dependence. Although most drug and alcohol counsellors doacknowledge that underlying issues from child abuse to battering relationshipscan affect a woman's ability to stay drug free, many program mandates do notallow for the extensive intervention that would be required to assist women toresolve their issues in conjunction with dealing with their substance abuseproblems.Women's recovery issues differ from men's in numerous ways, with somebeing directly related to their status in society and some due to the division oflabour along gender lines. This study focuses on childhood sexual abuse as one5possible factor influencing recovery from chemical dependence, however, it isimportant to understand the variety of issues faced by women in recovery whichhave already been researched to some extent. This chapter will provide anoverview of the various issues that have compounded the understanding ofwomen's experiences of chemical dependency and recovery.Historical AftermathResearch, policies and practice in the addiction field from the 1940's tothe present have been responsible in many ways for the ineffective serviceshistorically provided for women who are chemically dependent. Theethnocentric and androcentric biases of research methodologies, are particularlyblatant in the fields of mental health and medicine (Forth-Finnegan, 1990). Thetwo fields that have been instrumental in research on addiction and women'spsychological health, are only one part of a larger picture which has been shapedby the patriarchal, hierarchical, capitalist Western societal structures.Feminist scholars and the women's health movement have confronted thenorms set by androcentric research. They also have challenged mainstreammedicine, arguing that scientific knowledge has been constructed around a male-centred cultural view of women's place in our society (Zimmerman, 1987). Anhistorical account of the research on chemical dependence will exemplify theandrocentric biases that have left a legacy of marginalization of women's6experiences.Efforts to help alcoholics by the professional community during the mid-1940's were almost non-existent (Straus, 1976). This followed the period of thetemperance movement where alcohol problems were viewed as a moral deviancethat required spiritual or religious intervention. However, the "alcoholismmovement" did begin during the 40's and the medical model of alcoholism wasdeveloped to help combat the stigma and prejudice created by the temperanceera so that people with alcohol problems would seek help (Ames, 1985). Alsoduring this time, Bill Wilson, the co-founder of Alcoholics Anonymous, soberedup in 1935 and was a key figure in the future of alcoholism treatment.The AA program has been a very successful self-help recovery programfor alcoholics and helped Bill Wilson and thousands like him over the years toget sober and maintain a sober lifestyle. It is important to note though, that BillWilson was influenced by white, male, middle-class Christian values of the1930's when he began to develop the twelve step program. As Kasl (1992) pointsout, "most of the men who were instrumental in putting together the AAprogram and whose experiences were to be recorded in Alcoholics Anonymous, the AA "Big Book", came from similar backgrounds" (p. 3). The experienceswere drawn from the stories of one hundred white men but only one woman.Bill Wilson had a law degree and was an experienced stockbroker, such7credentials are held in esteem in Western culture, which aided his cause inrecruiting support from the medical profession in assisting alcoholics to "getsober" in the United States during this time period.The disease concept of alcoholism gained recognition from the WorldHealth Organization (1952) and the American Medical Association (1961). Thismodel depicts alcoholism as a progressive disease process that, if not arrested,leads to death. Commonly used definitions are:Alcoholism is a disease in which the person's use ofalcohol continues despite problems it causes in anarea of life (Kinney & Leaton. 1982, p. 41).Alcoholism is a chronic disease manifested byrepeated implicative drinking so as to cause injuryto the drinker's health or to his social or economicfunctioning (Keller. 1960).As a result of the acceptance of the disease concept, and the work done byJellinek (1946) outlining the phases of alcoholism, research began to flourish.The research was conducted by men about men's experiences of alcoholism.Documentation of women's experiences concerning chemical dependence wasvirtually non-existent as only a handful of research on women and substanceabuse was published before 1970 (Harrison and Belille, 1987).Many of the articles and studies that are available today concerningwomen and chemical dependence begin by highlighting the lack of research8specific to women. Most of the literature dealing with alcoholism/drugdependence have viewed women as a subgroup or "special population" (Fellios,1989). Since white anglo-saxon males have primarily been the populationstudied, women and other minority groups have been compared to the standardsset by white men, both as subjects and as researchers, thereby viewing everyoneelse as deviant from this norm. As a result, many issues relevant to a person'sgender, race, sexual orientation and culture have virtually been ignored orminimized. Although some shifts in addiction research have occurred, these"special populations" continue to be marginalized. Harrison and Belille (1987)point out that it is essential "to recognize that substance abusing women are nota homogenous population and that socio-cultural transitions may profoundlyimpact the context of women's chemical dependency" (p. 578). One suchtransition cited by the study was the influence of the acceptance of marijuana useduring the seventies which showed up in the responses made by women whowere in their twenties during that time period (70's) versus the women whowould have been much older and did not use marijuana.Chemical dependency is known to cross all gender, ethnic, class, and culturallines but differences can impact recovery. A critical component of recovery isthe risk of relapse which often means a return to active addiction. One study byWeiner, Wallen and Zankowski (1990) reflects the all encompassing difficulties9encountered by women from low socio-economic backgrounds:Poverty and social disorganization do not directlycause relapse, but problems related to daily lifeunder such conditions represent significant riskfactors. The temporary pleasure of a "quick fix"may be more difficult to resist if one is forced toreside in a blighted inner-city community,surrounded by poverty, illiteracy, dilapidatedhousing, unemployment, broken families, highcrime rates, random violence, rampant drugdealing and use, inadequate schools, high infantmortality rates, filth, poor health care, andinadequate public services. The commonly foundassociation between despair, demoralization, andrelapse is further compounded in thesecommunities by feelings of helplessness,hopelessness, and impotence - a breakdown of thespirit caused by the inability to realisticallyvisualize a brighter future for one's self or one'schildren (p. 240).Many chemically dependent women are abandoned by their husbands, and aretherefore often solely responsible for the care of their children (Weiner et al,1990), which complicates their efforts at recovery.In 1982, the ,Journal of Studies on Alcoholism  abstracted forty-ninestudies of drinking, problem drinking, and alcoholism related to women. Theseforty-nine studies constituted more than the total number of English publishedstudies between 1929 and 1970 (Wilsnack and Beckman, 1984) with earlierstudies maligned with myths and stereotypes, portraying women alcoholics assexually promiscuous (Lisansky, 1957).10The lack of female centred research and the negative attitudes generatedby previous research i.e. the myth about sexual promiscuity, has sustained thestigmatization of women with drinking problems Wilsnack, Wilsnack &Klassen (1986) discovered that women are not more promiscuous but thelingering societal beliefs have "promoted sexual victimization of women byconsidering women who drink as acceptable targets for male aggression" (Blume,1990, p. 18). One study, by William George and colleagues (1988), exploredattitudes towards men's and women's drinking College students were shownvideos or written scripts of women and men dating. The scenes depicted thecharacters drinking either soft drinks or alcoholic beverages. Women were ratedto be more sexually available and more likely to have intercourse when showndrinking alcoholic beverages (George, Gournic & McAfee, 1988). Such stigmahas been regarded as a frequent barrier to treatment encountered by women(Blume 1990).Today, there is still less acceptance for a woman alcoholic than for a man(Hunter, 1990). Studies have shown that only 1 out of 10 men stay with theiralcoholic wives/partners compared to 9 out of 10 women who stay with theiralcoholic husbands/partners (Kinney & Leaton, 1982). This stems fromwomen's role in society as the nurturer and caregiver, who cannot fulfil herduties in child rearing and as a homemaker or provide for the needs of her11husband when in a state of chemical intoxication. Such deviance from her roleis seriously frowned upon and words such as "disgusting" are often used whenreferring to an intoxicated woman, especially when in a public place, with suchcomments as "she probably has small children at home" even though she may besingle and without children. In contrast, if the husband/man is seen drunk,comments such as "oh, Joe's had a bit too much to drink again" may be madewithout reference to his family obligations.Blume (1990) points out that most of the research conducted to evaluatetreatment effectiveness have either ignored women completely or have includedwomen with men in the same treatment program, assuming that men's andwomen's needs are similar. Some of the possible reasons that current resourcesare more geared toward men are captured by Reed:Many of the reasons are related to the socialacceptability of various drugs at different times inhistory, and the types of social and personal coststhat society wants to reduce or control. Others arerelated to stereotypical views of women and men,as well as general knowledge about women withinsocial sciences and human services...women havehistorically been more likely than men to usesocially acceptable drugs and to perceive their useof psychoactive substances as a form ofcoping...men are more likely to engage in rule-breaking behaviour and illicit drug use, and toperceive their use as serving social and recreationalpurposes. ...drinking - and especially drunkenness -is more permissable for men, and may even be an12expected component of the male role in manysubcultures. Strong societal disapproval of suchbehaviours in women has led to more shame andsecrecy for women, and less recognition ofwomen's alcoholism (1987, p. 152).Reed's summation places women's experiences within a social andcultural context that must be understood if effective policies and resources areto be made available and geared towards women's needs in healing fromchemical dependence.Women Survivors & Addiction ResearchThe Women's Movement during the seventies extricated women's issuesinto public view with a resultant increase in focus on women's issues generallyand alcohol and drug problems specifically. Still, women received very littleattention from researchers in the addiction field until recently. Althoughresearch on women and alcoholism/chemical dependency was increasing duringthe seventies, the research on women and their specific issues or needs inrecovery from chemical dependence has continued to lag behind.For the purposes of this study, I will use the terms "alcoholism", "drugaddiction" and "chemical dependency" interchangeably. Most of the literatureavailable on women's addiction problems has concentrated on alcoholism,therefore, interchanging the terms of chemical dependency, alcoholism, and drugaddiction broadens the base of knowledge for exploring women's issues as they13relate to addiction. Another reason for grouping the terms, has to do with thefact that very few people are addicted and/or abusing only one particularsubstance but more commonly combine various drugs and/or alcohol. The term"chemical dependency" is commonly used as a catch-all name to include anydrug that is mood or mind altering regardless of the form the drug may take i.e.liquid - alcohol; pill - tranquilizers; powder - cocaine and so forth.While examining the literature, it was apparent to me that a lack ofunderstanding or the omission of women's life experiences exists and reflects theinstitutional forms of oppression women repeatedly encounter. The followingtwo examples (sexual dysfunction and depression) outline some of the biases andmethodological discrepancies I have found.Women alcoholics are frequently reported to experience sexualdysfunction (Wasnick, Schaffer & Bencivegno, 1980) and speak of self-medicating for sexual problems and needing a drink in order to feel comfortableenough to engage in sexual activity (Romand, 1988). A causal relationshipbetween sexual dysfunction and alcohol consumption was established due to thepositive correlation of the data. Many studies, however, have not even queriedif sexual abuse was a contributing factor to sexual problems and just linkedalcohol consumption to the presenting problems of sexual dysfunction. Yet,many studies show that sexual dysfunction, or, as I prefer to call it, sexual14discomfort is directly related to the boundary violations experienced by survivorsof childhood incest/sexual abuse (Meiselman, 1978; Herman, 1981; Finkelhor,1979).A second major symptom commonly cited for alcoholic women has beendepression. Some studies have found depression to be the primary diagnosiswith alcoholism secondary (Hezler and Pryzbeck, 1988; Hesselbrock, Meyer, andKeener, 1985) with both studies indicating that depression was primary inapproximately two thirds of alcoholic women suffering from depression.Depression is also a common denominator for survivors of childhood sexualabuse. However, asking the type of questions that may uncover a history ofsexual abuse is missing from the studies, therfore, information on thatrelationship has been largely absent from the literature.Such research results, as cited above, have the potential to lead people todraw the wrong conclusions. This risk is even higher with a history that hasroutinely victimized women and relegated women's problems to some kind ofintrinsic and intrapsychic defect. The mental health and medical field have leftwomen a legacy of encouraged self-blame, guilt, and responsibility for "others"(Gottlieb, 1987; Berlin, 1987; Caplan, 1987). The feminist movement hasassisted women in challenging the male world view of women's experiences."Women began to discover that the experts' answer to the Woman Question was15not science after all, but only the ideology of a masculinist society, dressed up asobjective truth" (Ehrenreich & English, 1979, p. 5).Over the past two decades more research has begun to focus on theconnection between sexual abuse and chemical dependency for women.Covington (1986) provides a summary of the data on sexual abuse and alcoholicwomen stating that these women were subjected to "a wider variety of sexualabuse perpetrators, experienced more instances of abuse, had more multipleincidents, and were subjected to longer durations of sexual abuse than thenonalcoholic women. The alcoholic women also reported more incidents ofincest and rape." (p. 37).Even with such startling statistics, the research to date is limited withregards to recovery for chemically dependent women who were victims of incestor childhood sexual abuse.Social worker Barbara Ball and colleagues formed the Women's PostTreatment Centre in Winnipeg, Manitoba in 1985 in response to theoverwhelming needs expressed by their clients who best understood the linkbetween sexual abuse and chemical dependency. Ball (1990) succinctlysummarizes the dilemma of addiction treatment for women:Chemical dependency was understood as a"disease" and only a disease. This definition led tolooking for a solution within a woman's16psychology and physiology without reference to awoman's current and past experience and how shewas perceiving and interpreting it. Because of thismindset, what "addicted" women were beginning todescribe about abuse experiences (to those whowould listen) was being largely ignored by policymakers and in treatment programs (p 15).Covington (1986) also stresses the importance of dealing with sexualabuse issues in alcoholism treatment centres if recovery is to be a reality. Yet,in 1993 little progress has been made in changing policies or treatment mandates.What little progress has been made is a result of more and more helpingprofessionals, like Barbara Ball, speaking out about the common denominatorof sexual abuse as it relates to chemical dependency and substance abuse forwomen.Oppressive Power RelationshipsA feminist analysis routinely examines the relations of power and theinequalities of power relationships within systems providing a framework forunderstanding the context of human experiences, and especially the experiencesof women. Kasl provides such a feminist perspective when she looks at theinfluences of patriarchy, hierarchy and capitalism as social constructs thatinfluence women's chemical dependence.The dominant group determines the "culture" in any society andpatriarchy is one such manifestation. Kasl (1992) states:17... patriarchy, hierarchy, and capitalism create,encourage, maintain, and perpetuate addiction anddependency. Patriarchy and hierarchy are basedon domination and subordination, which result infear. This fear is expressed by the dominatorsthrough control and violence, and in thesubordinated people through passivity andrepression of anger. The external conflict ofhierarchy between dominants and subordinatesbecomes internalized in individuals, creatingpersonal inner chaos, anxiety, and duality. Toquell the inner conflict people resort to addictivesubstances and behaviour (p 53).A glaring example of maintaining the "status quo" through the oppression ofanother person is heard in the words of one woman Km] interviewed, "I'maddicted because I was born into a culture that allowed me to be a victim ofincest, abuse, violence, poverty, and sexism. There was never care andprotection for me" (Kasl, 1992, p. 65). This woman's experience is a clearindication of the victimization women encounter in societies that value one sexover another. "Because patriarchy assigns a secondary position to women, itcreates a hierarchy, in which human value is determined by gender, race, class,position, religion, age, appearance, ethnic background, and physical ability" (p.55).The media is also a powerful means of communicating the dominantagenda because it infiltrates every area of people's lives from billboard ads totelevision newscasts, from newspaper articles to sex-typed children's toys. The18public is bombarded daily with ads for drugs, alcohol, and food espousing quickfixes to our every ills, from helping people to relax, to sleep better, and to feelbetter, ignoring the realities of many people's lives. "Instead of affirming life, weare taught to medicate ourselves in order to cope with it." (Kasl, 1992, p. 55).Advertising and the media further define femininity and masculinity and sexroles in our society. Such advertising creates a climate in which certain attitudesand images are presented as normal and therefore acceptable. The image of the"superwoman" of the 90's, of the Mom nurturing her children and husbandwhile holding down a full-time job, dressed in an executive suit with that neverending smile, is enough to lead to hospitalization exhaustion. McConville(1983) points out that: "women have talked about how the resulting negativefeelings about themselves can lead into the spiral of problem drinking -adevastating illustration of what happens when we internalise images of ourselvesand judge our 'success' or 'failure' in relation to them." ( p. 60). Thus, if awoman does not feel happy in her role as "superwoman" than the inadequacy issomehow an inherent reflection of herself and interpreted as a failure.Historically, childhood sexual abuse has not been directly addressed inalcohol and drug treatment services and this is not surprising since thephenomenon has only been part of public discourse for the past decade. Recentresearch has indicated that three out of four chemically dependent women are19survivors of childhood sexual abuse (Rohsenow, Corbett, & Devine, 1988;Covington, 1986). Aurora House, a treatment centre for chemically dependentwomen in Vancouver, British Columbia, estimates that ninety-five percent of thewomen seen report a history of childhood sexual abuse. Aurora's statistics maybe higher because it is one of the few treatment facilities that addresses the issueof sexual abuse concurrently with the issue of addiction. Considering the highincidence of sexual abuse among chemically dependent women, a need toacknowledge the interrelatedness of addiction and childhood sexual abuse isparamount if women are to be protected from this vulnerability in their recoveryprocess.Drugs and alcohol have the perceived effect of repressing painful stimuliand memories. As a result, mood and mind altering substances may provide acoping mechanism for women with histories of childhood sexual abuse. Thus,during the recovery process, where complete abstinence of mood and mindaltering substances is required, feelings and memories begin to surface becausethe repressing effects of drugs and alcohol are no longer present. The painassociated with the surfacing abuse memories and feelings may be too great,resulting in a return to established coping patterns, and a return to activeaddiction. Dolan (1991) points out the necessity of resolving sexual abuse ifpreventing symptomatic relapses is to occur. Recent research has purported that20childhood sexual abuse is a strong predictor of future chemical dependence forwomen and relapse may result if it is not addressed (Rohsenow et al. 1988;Young, 1990). Thus, it appears that a reciprocal relationship exists betweenunresolved sexual abuse and active addiction for many women.SummaryThe limited research focus on women's experiences in recovery fromchemical dependency has left women vulnerable to ineffective policies whichinfluence program mandates, treatment facilities, and healing models.Due to the general marginalization of women in most research studies, afeminist perspective is used in this study so that women's voices will be heard.The women who participated in this study shared their recovery stories from aplace of personal healing which I incorporated in the interpretations of the data.In keeping with a feminist stance, the essence of the womens' healing, from theirown words, is apparent in the analysis.A clear understanding of womens' experiences of the recovery process is essentialif social workers and other helping professionals are to provide effective servicesthat enhance the recovery process for this population.This study, "Exploring The Phenomenon of Recovery For ChemicallyDependent Women Survivors of Childhood Sexual Abuse" was conducted in thehopes that some light could be shed on the issues encountered by women in21recovery from chemical dependence and how their healing has been impacted bythe sexual victimization experienced in childhood.The next chapter examines three models of recovery and previousresearch findings that have been influenced by various theoretical perspectives.Chapter three discusses methodology, chapter four deals with the results of thestudy while chapter five concludes with implications for the social workprofession and other helping professions.22CHAPTER TWOLITERATURE REVIEWModels of RecoveryNumerous recovery models and treatment program designs have beendeveloped from the perspective of relapse prevention. Relapse is commonlyreferred to as a return to using alcohol and drugs. Most of the research to date,in the drug and alcohol field, has focused on relapse rather than on recovery.Difficulty in operationalizing and reaching consensus on the term recoverycontributes to the lack of research on the phenomena of recovery (Maddux andDesmond, 1986). As a result, a combination of recovery and relapse issues willbe examined in the literature.Three main models of recovery have influenced the addiction field andtreatment programs over the years. These are referred to as the ControlledDrinking Model, the Abstinence Model, and the Biopsycho social DysfunctionalModel (Gorski, 1986).The controlled drinking model's emphasis is on establishing healthydrinking patterns in which a person takes responsibility for their alcohol intake,does not over consume and lose control. This model has not proven to be veryeffective for people who have become physically dependent on alcohol. The23Sixth Special Report to the IT S. Congress on Alcohol and Health stated that:In general, the bulk of the clinical and scientificevidence appears to support the interpretation thatonce significant physical dependence has occurred,the alcoholic no longer has the option of returningto social drinking ; hence, abstinence is the mostappropriate goal for alcoholic persons (NationalInstitute on Alcohol Abuse and Alcoholism, 1987,p. 136).This model, however, has proven to be a viable solution for people consideredto be alcohol "abusers" where no physical dependence is exhibited (Pendery,Maltzman, and West, 1982).The Abstinence Model promotes complete abstinence of drugs andalcohol with abstinence used as the measure of successful recovery. The diseasemodel programs have traditionally utilized the abstinence model and basedtreatment outcomes on recovery being complete abstinence, and a return tousing drugs and/or alcohol viewed as a relapse. One of the limitations of thismodel is "that it fails to measure a variety of factors other than alcohol and druguse that significantly affect recovery and relapse" (Gorski, 1986, p. 8).The biopsychosocial dysfunction model on the other hand, defines abroad base of factors that are commonly associated with recovery and relapse,incorporating the complex interaction among the physical, psychological, andsocial levels (Gorski, 1986). This model, which emerged from clinical practice24during the 1970's to the present time, is defined in the recent literature(Donovan, 1986; Gorski and Miller, 1986), and identifies high risk situationsand stresses the need for individual treatment planning in order to reverse suchfactors that create risks of relapse. This model considers underlying issues foreach individual which may impede recovery. Gorski (1986) argues that peoplewho are raised in "dysfunctional families", for instance, often develop "self-defeating personality styles" that may interfere with their ability to cope andachieve recovery. The labelling and ideological jargon in this statement iscommon throughout traditional research studies. As a feminist, I would preferto say that some people develop ways of coping which prove beneficial in gettingthem through unhappy family situations but later interfere with their ability toachieve recovery.The most commonly used model of recovery is that presented byAlcoholics Anonymous (AA) which is based on the disease concept ofalcoholism. AA views alcoholism as an incurable disease which involves alifelong recovery process. Many treatment services are either based on AA'stwelve-step model of recovery or utilize it as an adjunct to treatment. This modeluses both the Abstinence Model and aspects of the BiopsychosocialDysfunctional Model of recovery. This model stresses abstinence from alldrugs and alcohol, with any substance use called a relapse. The recovery process25entails a holistic approach of healing the physical, spiritual, mental, andemotional self through working the twelve steps. For example, step 2 "Came tobelieve that a power greater than ourselves could restore us to sanity."(Alcoholics Anonymous, 1976, p. 59) reflects the spiritual connection to anoutside power which will relieve the mental anguish - "restore us to sanity". Allof the steps focus on a group process of growth where you are not alone in yourstruggle, step 1 "We admitted..., step 2 "...a power greater than ourselves.. " (seeAppendix A - the 12 Steps) thus giving rise to new social networks, a new socialidentity, and new interests as a result of working these steps and being involvedin the twelve step program.Although AA has helped many women in their recovery from alcoholism,just as many have reported their experience as oppressive due to its masculinistmodel (mackinnon, 1991; Kasl, 1992; Berenson, 1991). Berenson (1991)outlines the feminist critique of the recovery movement stressing that thismovement has incorporated and reinforced the following characteristics:1. An emphasis upon the private and personal atthe expense of the public and political - While theexperience of powerlessness [AA's first step " Weadmitted we were powerless...] may be liberatingfor some women is some respects, it does nothingto address the very real social, political, andeconomic power inequalities that exist. Focusingon their private growth may distract many women,and men, from questioning and changing26oppressive power arrangements based on gender.2. A denigration and pathologizing of traitsassociated with femininity- The very developmentof terms like codependence and "women who lovetoo much," the labelling of behaviours andrelationship patterns as diseases, combined withthe focus upon powerlessness as a key componentfor healing, have all served to increasestigmatization and to reinforce women's socialconditioning. Women wind up blaming themselvesfor personal and relationship problems instead ofgetting angry and taking assertive action to changetheir situation.3. A tendency toward self-abnegation and theunquestioning acceptance of authority - WhileAlcoholics Anonymous and its Twelve Stepoffshoots give theoretical lip-service to spiritualityas non-dogmatic and non-hierarchical, in practicethey wind up asking women to be subservient tomale authority. The AA Twelve Steps refer to"God as we understood Him," [my emphasisadded] and women who are working the steps arecalled upon to make amends for damage done tothem. (p 78).It is important to add here that many AA group members recommend that youtranslate the program in any way that fits for the individual person using theslogan "take what you need and leave the rest behind" in an attempt to be allinclusive of the membership. However, the use of the term "God" denotes achristian god who is male (Him) alienating those who may relate to a Goddess,spiritual guide, or other religious or spiritual powers.27Charlotte Kasl (1992) offers women an alternative to the "Twelve StepModel" in her Sixteen Steps for Discovery and Empowerment. (See AppendixB) and invites women to use these steps in any way that suits their individualneeds and also to change them if they so desired.Jean Kirkpatrick founded the recovery program, Women For Sobriety(WFS), in 1976 during her personal struggle to recover from alcoholism.Kirkpatrick (1986) attended AA but felt it did not meet her needs. Kirkpatrickbelieves that women have different reasons for drinking than men and thereforewomen also have differing needs in recovery. Her thirteen "step" program isdesigned "to build up women's fragile egos and battered self-esteem through self-discovery, and to release the shame and guilt through the sharing of experiences,hopes, and mutual encouragement" (Kasl, 1992, p. 166). (See Appendix C forKirkpatrick's 13 - Statements)There are hundreds of Women for Sobriety groups established across theUnited States but fewer exist here in Canada. Although one group did exist inVancouver, British Columbia for many years, it folded and to my knowledge hasnot been restarted. Thus alternatives to the AA self-help recovery program arevery limited for women.The recovery process as described by AA, refutes the notion that relapseoccurs as a single isolated event but instead sees relapse as evolving over time28with altered attitudes and behaviours, called "stinking thinking" This meansthat someone does not just return to using drugs and alcohol by consciouslymaking a choice to do so but instead, over a period of time, begins to rationalizethe use of drugs and alcohol and denies previous problems directly related totheir substance abuse and a change in attitude is evident. These altered attitudesare self-defeating and destructive in nature. During recovery, the focus is onchanging these negative attitudes into positive self-loving ones in order toprevent relapse. "Until the alcoholic is ready to let go absolutely of their oldideas, the chances of staying sober are nil" (Alcoholics Anonymous, 1976, p. 58).One such "old idea" may be the belief that the person can control their drinkingagain. This notion of controlling one's drinking is in direct contrast to AA'smodel, but, forms the basis of the Controlled Drinking Model, as describedearlier in this chapter.Relapse prevention is commonly viewed as a recovery tool. The variousrelapse prevention strategies provide the impetus for different treatment modelswhich are geared toward maintaining abstinence from mood and mind alteringdrugs and enhancing the recovery process. Thus, it is necessary to understandthe numerous theories that exist to explain the phenomenon of relapse. Someof the major theories are discussed in the remainder of this chapter under theheadings of Biological, Social Learning, and Psychological Theories. The final29section of this chapter focuses on a brief discussion of the various sexual abusetheories to set the context of this study.Theories on AddictionA Biological Theories Genetic theories focus on altered metabolism which predispose theindividual to becoming an alcoholic (Schuckit et al., 1985). The risk ofdeveloping alcoholism increases where a history of alcoholism is present in thefamily of origin. As a result of this genetic link and change in metabolism,abstinence is advocated as the treatment choice if relapse is to be prevented(Schuckit and Duby, 1982). Conditioning theory incorporates the withdrawalsyndrome and the concept of craving in explaining relapse. When the abstinentalcoholic, once conditioned, is faced with environmental "triggers", i.e. sitting ina bar with friends, and emotional stimuli, i.e. drink to relieve stress, the sensationof withdrawal may be percieved by the person, increasing the likelihood ofrelapse in order to alleviate the withdrawal symptoms. (Wesson et al, 1986).These biological theories have been popular in advancing the "disease"concept of alcoholism. Thus, a person is not responsiblie for causing theiraddiction and requires treatment in order to get "well".Genetic and Conditioning theories do not address whether or not womenare affected differently from men in recovery yet studies have shown that alcohol30affects women differently than men physiologically. Women reach higher peakblood alcohol levels per dose of alcohol per pound of body weight (Greenblatt& Schuckit, 1976). Women are more vulnerable than men in developing late-stage physical complications such as fatty liver and hepatic cirrhosis,hypertension, and gastrointestinal hemorrhage (Blume, 1990). Special concernsspecific to women are the affects of drugs and alcohol on the unborn fetusduring pregnancy with complications of Fetal Alcohol Syndrome and otheralcohol/drug related complications such as low birth weight.B. Social Learning TheoriesMarlatt (1978) points out that craving is defined as the anticipation of thereinforcing effects of alcohol, when viewed from the context of social learningtheory. The relapse model from a social learning framework explores therelevance of high risk situations, the person's expectations about handling thesesituations without drugs, and the person's coping abilities in high risk situations(Wesson et al., 1986). Relapse will ensue if these high risk situations are notdealt with or anticipated during treatment. Cognitive and behavioral techniquesare commonly used during treatment and recovery to prevent relapse. In thecase of sexual abuse, a flashback would be an example of a high risk situation,"causing the survivor to temporarily associate powerfully to the reexperiencingof emotions and sensations associated with the sexual abuse trauma" (Dolan,311991, p. 106). Dolan (1991) points out that "traumatic associational cues" maybe triggered by an event that literally or symbolically resembles some aspect ofthe earlier trauma. This places the recovering person in a vulnerable situationin which a return to previous coping patterns, drinking, compulsive eating, self-mutilation and so forth, may result.Traditional learning theory and social learning theory did not includehuman emotions and ideas because of the difficulty in operationalizing andmeasuring the variables and have been criticized for the lack of cognitiveinclusion. However, with operant conditioning, "reinforcement" has proven tobe a powerful avenue for increasing the likelihood of a particular behaviour(Berger, 1988). These traditional theories would not have addressed sexualabuse and the response to aftereffects as I have done in the example cited above.Yet, if you examine the operant conditioning and social learning theories,alcohol and drugs would provide the "positive" reinforcer of repressing painfulstimuli. Considering the high risk of developing alcoholism if one or bothparents are alcoholics, children from this type of background are influenced bytheir environment and learn that alcohol provides a means of coping with dailyproblems. Zimmerman (1983) claims that it is crucial for social learningtheorists to look at the overall context of the learning process ie. environmentrather than at the specific details of reinforcement.32C. Psychological TheoriesSome studies have explored the relationship of stress (Moos & Finney,1983) and negative life events as precursors to relapse (Moos et al., 1981; Marlatt& Gordon, 1980). However, the stressors outlined in these studies focusedprimarily on present negative life events i.e. divorce after treatment, and ignoredthe ramifications of past negative life events i.e. childhood sexual abuse, in thelives of chemically dependent women.Psychodynamic theory, assumes that past experiences shape currentbehaviours (Maddux & Desmond, 1986). This theory could be useful inunderstanding sexual abuse as a high risk precursor to developing chemicaldependence because it suggests a causal relationship exists between pastexperiences and current behaviour. As a result, this theory has the potential tosupport the idea that sexual abuse trauma experienced in childhood, if nottreated, may result in behaviours conducive to the person's survival ie. escapingthe pain and trauma through the use of drugs/alcohol.Theories of Sexual Abuse:Recovery from Chemical DependenceThis study explores the impact of childhood sexual abuse on thephenomenon of recovery from chemical dependence. An overview of the varioustheories on sexual abuse aftereffects and the literature that examines the issues33of sexual abuse and chemical dependency concurrently is needed in order tounderstand women's experience of recovery.One case study examined shame and relapse issues for the chemicallydependent person concluding that "with a greater attention and focus on treatingshame-based issues during recovery then potentially the percentage of clientswho relapse could be reduced" (Brown, 1991, p. 82). The limitation of Brown'scase study was that he used a male subject, using the term "clients", which leadsto the assumption that these generalities are applicalble to women as well asmen. Gender is not addressed specifically but generalities are made based onclinical experience of working with "clients" who struggle with the issues of"shame" and "relapse". Brown's focus on the dynamics of shame do however,assist in addressing womens' experiences of sexual abuse and chemicaldependence. Sexual abuse survivors are wrought with shame-based conflictwhich, according to Brown, would need to be addressed in recovery programsif recovery is to be maintained.Many studies have observed that childhood sexual abuse may be apredictor of future chemical dependence in women. Recent studies have foundthat over 75% of chemically dependent women in inpatient settings reporthistories of childhood sexual abuse (Rohsenow, Corbett & Devine, 1988;Covington, 1986). Blake-White and Kline (1985) point out that "the adult victim34of incest wants to avoid the anxiety of remembering; she wishes to forget thetrauma and push it into the past. Methods used are total denial, abuse ofalcohol, and excessive use of prescription and non-prescription drugs" (p. 396).Children who experience prolonged, violent, intrusive trauma such assexual abuse, and, especially where such abuse is instigated by a primarycaretaker, create stressors "beyond the adaptive capacities of all but the mostexceptional children and that will regularly produce a long-lasting traumaticsyndrome" (Hermen et al., 1986, p. 1296).This "traumatic syndrome" manifests itself in aftereffects which meet theDiagnostic and Statistical Manual-III-R  (American Psychiatric Association,1987) criteria in diagnosing Post-Traumatic Stress Disorder. Professionals whowork in the field of addiction with sexual abuse survivors, have informed me thatmany of their clients display post-traumatic stress responses, from dissociating,nightmares and flashbacks of their experiences, to avoidance of these memoriesthrough the use of drugs and alcohol.Courtois (1988) utilizes the Traumatic Stress/Victimization theory indirecting her assessment of the aftereffects of sexual abuse and therapeuticapproaches in which "trauma must be treated directly in conjunction with itssymptoms and secondary problems." (p. 123). Drawing from Courtois' theory,chemical dependence could be viewed as the secondary problem, with craving35and potential relapse as the symptoms, along with any feelings and stress beingexperienced by the client herself. I support Young's (1990) contention that self-impairment underlies secondary symptoms, such as addictive behaviours.Young argues that with the emergence of memories during abstinence, recoverywill not be maintained if the reparation of self is not initiated, by addressingchildhood memories of abuse.The traumatic stress/victimization theory affords the counsellor therecognition that the client's responses to traumatic stress are natural rather thanpathological, acknowledging that the aftereffects and secondary elaborationsmay be maladaptive. Although maladaptive, feminist's would argue that thestress responses have been functional. The "recovery enhancers" described bythe women in my study support the notion of functionality wheredrinking/drugging provides a means of coping with painful circumstances andrecurrent memories.Loss theory recognizes the paradox faced by many victims, "accepting theloss means admitting the inability to control the circumstances" (Courtois, 1988,p. 127). However, it is through grieving the losses encountered by incest/sexualabuse survivors that healing can begin. Belinger and Fleming (1992), inexploring chronic grief reactions for sexual abuse survivors, suggest that "ratherthan treating survivors as a homogeneous group, as is often the case which can36mask important differences, researchers might well consider the various tasksparticipants are struggling with" (p. 16). One such task, for the population inthis study, would be to maintain drug and alcohol abstinence.Feminist theory provides another framework from which anunderstanding of the sexual abuse/incest experience can be understood. Due tothe high prevalence and secrecy of abuse of female children by fathers andtrusted males, feminists have concluded that sexual abuse is an endemic societalmanifestation of the power imbalance between the sexes (Russell, 1986).Moreover, feminist theorists have suggested that the sexual abuse of childrenand women serves a political function since it preserves the system of maledominance through terror, thus, benefitting all men whether or not theypersonally commit the sexual abuse (Herman, 1985; Griffin, 1986; Brownmiller,1975).SummaryThe various models and theories outlined in this chapter provide thebackground information necessary for understanding the impact of traditionaladdiction treatment resources and the research that perpetuates use of maletherapeutic models when responding to womens' experiences of chemicaldependence.The feminist ideology expressed in the research on sexual abuse and37treatment affords a new way of addressing childhood sexual abuse issues withan inclusion of chemical dependence as a coping skill developed for survival.Feminist scholarship also points to the need for including women's voices if theirexperiences are to be fully understood.A feminist perspective validates womens' experiences and sees women asauthorities of their own experience. The relationship between childhood sexualabuse and chemical dependence in women has been researched in terms of theformer being a predictor of the latter, but little is known about the impact ofsexual abuse experiences during the recovery period from chemical dependence.The literature raises a number of important questions. For example,Does being a survivor of childhood sexual abuse influence the recovery processfor chemically dependent women? Do unresolved sexual abuse experiencesmanifest as an internally generated precursor to relapse?Due to the limited research in this area, I have chosen to adopt aqualitative design for this study which allows for a more in-depth exploration ofthe question: How does the impact of childhood sexual abuse influence therecovery process for chemically dependent women?I shall now turn to my methodology chapter which explains in detail thethe research process and provides the reader with an introduction to the eightwomen I interviewed.38CHAPTER THREEMETHODOLOGYDesign: A qualitative exploratory design is utilized because such methods enableone to "uncover and understand what lies behind any phenomenon about whichlittle is yet known" (Strauss and Corbin, 1990, p. 19). The literature reviewrevealed that research on chemical dependence for women is limited.Information which explores the impact of childhood sexual abuse on therecovery process is also extremely limited. Due to the invisibility of women'sexperience in recovery, a qualitative approach enables the research to be data-driven whereby themes evolve directly from the data and thus directly from thewomen's experience who participated in this study. Patton (1990) suggests that:The strategy of inductive designs is to allow theimportant dimensions to emerge from patternsfound in the cases under study withoutpresupposing in advance what the importantdimensions will be (p. 44).As a feminist, I have selected a qualitative design from a feministperspective as the method of inquiry because I believe it provides the best arenafor women's voices to be heard and their lived experiences honoured. Aqualitative design enables and encourages the researcher to "find out what39people's lives, experiences, and interactions mean to them in their own terms"(Patton, 1990, p. 22).The Participants: Two agencies in the drug and alcohol system of care in British Columbiaassisted me in contacting women who might be interested in participating in astudy that explored the impact of childhood sexual abuse on the recoveryprocess from chemical dependency. Eight women volunteered to participatetheir time and shared their pain and recovery stories with me.My selection of participants was purposive due to the nature of thesubject matter. The eight women in this study were referred by their counsellorsbased on the following criteria:1) women eighteen years of age or older2) women who have been drug free for at least three months;3)women who have disclosed a history of childhood sexual abuseto at least one other person;4) Each participant's ability to partake in such an interviewprocess was determined by each woman in consultation with hercounsellor, to ensure that the interview material would notcontribute to overstimulation of painful events/memoriesbeyond the individuals ability/readiness to cope.The criteria was set in the above manner due to the possibility that elicitingpainful memories was high, thus the participants needed to be stable in theiraddiction recovery so as not to jeopardize them in any way.I would like to introduce the reader to the women who shared their40experiences with me. Some of the participants requested that their first namesbe used, others chose alias names to protect their identity and to ensureconfidentiality. All of them preferred to be mentioned by a name rather than anumber or other differentiating code. Thus, I respect their request.The eight women who shared their stories openly with me were Ann,Susan, Wendy, Kate, Tina, Lyn, Beth, and Lydia. As the women revealed theirstories, I was deeply touched by their honesty and integrity and their courageand willingness to risk themselves in the hopes that sharing their experiencesmight help other women who struggle with the issues of chemical dependencyand childhood sexual abuse.General background information will provide an introduction to thesewomen as a group without revealing their identities. The eight women in thisstudy ranged in age from 22 to 40; two were employed full-time and the other sixwere unemployed; one woman was Mêtis, one was from an European/Spanishbackground, and the other six were of English descent, one of whom had nativeancestry. One woman was a single mother with one child, two women werecurrently living with a partner (one male, and one female) and the other fivewere living either on their own or in a recovery house setting. The length ofcontinuous sobriety ranged from three months to seven years. Two of thewomen had university degrees, five had taken courses or attended a college41program after high school and one woman had not completed high school.Six women were raised in alcoholic homes where there was physical,sexual, and/or emotional abuse experienced. One woman described her familyas caring and felt guilty, wondering how she could have become chemicallydependent, until she recognized, in therapy, that her substance abuse was relatedto her having been sexually abused as a child. One woman described herchildhood as chaotic in a home where her parents were non-demonstrative butnot necessarily abusive.All eight women had experienced physical and/or sexual abuse duringtheir adult lives in their intimate relationships and two had been raped whileintoxicated by acquaintenances with one woman having been raped three times,once by a stranger and twice by men she knew and had no reason not to trust.The victimization and violence experienced by these women wasrepeatedly reported from childhood to the present, and included furthervictimization at the hands of those in counselling and positions of authority andtrust during this period when two of the women sought help. Even afterexperiencing such adverse living conditions and abusive relationships, all eightwomen were hopeful about their futures and committed to healing their pain.I had contact with all eight women two to three months after the initial interviewand all eight were still on a recovery path.42Interview Process: In-depth interviews were held with each of the participants. From afeminist perspective, such interviews offer "access to people's ideas, thoughts,and memories in their own words" (Reinharz, 1992, p. 19).An interview guide which consists mostly of open-ended questions (seeAppendix D - interview guide) was used to assist the dialogue process. Theguide was left open and flexible so that questions could be asked spontaneouslyand applicable to the direction the women took as they uncovered theirexperiences of the recovery process. The guide was presented to each participantwith an explanation of the purpose of the study.The questions were generated through discussions about this subject withpeople with experiences similar to the sample population, from my ownexperience working in the drug and alcohol field with women survivors ofchildhood sexual abuse, with other professionals' input, and was shaped partlyby the literature review. Some of these questions were refined as the interviewsessions progressed.Initially, I had more questions, but found that richer information couldbe obtained by having the women in the last few interviews basically tell their"recovery story" and focus my questions from the content of the informationthey presented.43Validating the findings in qualitative research is particularly crucialbecause the researcher is often "working alone, without any standardized orvalidated instruments [running] the risk of overgeneralizing" (Miles &Huberman, 1984, p. 230) or drawing false conclusions based on researcher bias.Verifying the findings through follow-up interviews adds to the validityof a measure (Miles & Huberman, 1984). I conducted follow-up interviews withseven of the eight participants to ascertain that my interpretations accuratelyreflected their experiences. In keeping with a feminist stance, follow-upinterviews, for the purpose of verifying findings, also honours women'sexperiences by not imposing external perceptions/interpretations of thoseexperiences. All seven women agreed with the categories that conceptualizedtheir experiences and they felt the themes accurately depicted their ongoingprocess of recovery.The face validity was checked by consulting other professionals as towhether or not the questions in the interviews were adequately addressing theresearch question being explored and they appeared to be on target. One personsaid "I'm just so glad you are doing this kind of research and asking these kindsof questions as this has been a greatly ignored research area. I believe thequestions posed in your guide will get at women's experiences at a deeper levelconerning the recovery process and the impact on recovery as a survivor of44sexual abuse."The information generated by the interview questions was found to besimilar across participants, this strongly supports the accuracy of the measure.In order to reduce "researcher effects on site" as Miles and Huberman(1984) discuss, two of the interviews took place in the women's homes and theinformation obtained was still consistent with the other six women. Onewoman, whose experience was different from the others, in that she rejected self-help groups, provided an outlier as she did not use the same language to describeher experiences whereas the other seven women used AA language, apparent ifyou are familiar with these meetings. However, her experiences were also similarto those of the other women in terms of the recovery process itself.Exploring Her-Story: I met with the staff and directors of the two agencies, Aurora House andNorth Burnaby Alcohol and Drug Counselling Services, involved in the studyand presented my research proposal. Upon acceptance by them, with writtenpermission obtained (see Appendices, E.1, E.2, & E.3), I submitted the researchproposal to the University of British Columbia Office of Research Services forethical review to conduct this study. The study was approved (see Appendix, F)by U.B.C. and the referring counsellors were contacted. An introductory letter(see Appendix G) was provided to the referring counsellors to give to their45clients, who then contacted me to set up interview appointments.Private office space was provided by the two referring agencies and mostof the interviews were conducted there but the option to meet elsewhere was leftopen to the individual women; one chose to meet in her home and another choseto meet off-site at a location convenient for her. The interviews were audiotaped with permission in which each woman signed a consent form (seeAppendices H & I) specific to taping the sessions. An explanation of the consentform and the purpose of using audio tapes was provided as well as anopportunity to refuse to be audio taped. The interviews ranged in length fromone to one and a half hours, followed by a debriefmg period that varied witheach person from fifteen minutes to one hour. The debriefing with two of thewomen continued outside the formal setting as well, by going for a coffee at anearby restaurant. This relaxed atmosphere seemed to generate even furtherdiscussion of some of the issues and is in keeping with feminist research methodswhich encourage involvement and interaction between the participant asopposed to more conventional research methods which emphasize detachmentand value-free objectivity. Like many feminist researchers, I struggled with thenotions of "objectivity" and "subjectivity". In order to remain honest to thewomen who participated in this exploration of personal discovery, I decided todisclose my personal connection, of being on my own recovery path of healing46from childhood sexual abuse and chemical dependency, to the topic of inquiry.As feminist researcher Reinharz (1992) reports, "starting from one's ownexperience is an idea that developed in reaction to androcentric social science"(p 261) and using self-disclosure creates a more egalitarian relationship with thehopes of providing safety and ease of participation. This comfort level wasverified by each of the women, who told me after the interviews, that theyappreciated knowing I was also a survivor and felt safe sharing with me. Onewoman commented "I shared more with you than I have with anyone else, butI knew you would understand and not judge me because you have been there".The women also expressed feelings of empowerment and elation for theopportunity to contribute something to other women as participants in thisproject. The comments from the debriefmgs were written down shortlyafterwards in the field journal.Her-Story Unfolded: The interviews provided rich information about the eight womens'experiences. Grounded theory was used to assist me in drawing out, comparingand summarizing the main categories and themes which arose. Grounded theoryuses an inductive approach to analyzing data, this inductive approach generateshypotheses as opposed to testing them as in deductive research (Glaser & Straus,1967). Although a form of deduction is used in this method, deduction is solely47used for expanding and for elaborating concepts and themes.All eight audio tapes were transcribed and coded. Open coding, aprocess of "breaking down, examining, comparing, conceptualizing, andcategorizing data" (Strauss & Corbin, 1990), was used, for complete interviewsee Appendix J. The coding was done line by line when appropriate, butsometimes, an entire sentence was used in order to capture the essence of whatwas being said. The transcripts were read and emerging concepts were coded onthe right hand side (of the rough draft) of the transcript. The eight transcriptswere compared and eight categories consolidated the concepts coded (see Tables1 & 1 a), which were also noted on the left hand margins of the rough transcripts.Utilizing the constant comparative method of analyzing and abstracting thedata, two primary themes arose which reflect the overall experiences of therecovery process for these eight women (see Table 2, Ch. 4). An in-depthexploration of the categories and themes will be explored in chapter four whichdiscusses the results of the analysis.48`NUMBING' BEHAVIOUR II IDENTIFYING SEXUALSEXUAL TRIGGERSIII SELF-CONNECTINGHOLISTIC HEALINGCOGNITIVE LINKSSELF-SEARCHING "who am I"SELF-LOVEACKNOWLEDGE/EXPRESS^feelingsEMOTIONSPIRITUALITYTABLE I - THE EVOLVING RECOVERY FRAMEWORKRECOVERY ENHANCERSOPEN CODES PROPERTIES CATEGORIES PROBLEM RECOGNITIONHELP SEEKING BEHAVIOUREXTERNAL CONTACT (+)^hopefulness^I EXTERNAL SEARCHCONNECTING WITH OTHERSINTIMATE RELATIONSHIPSDELIBERATE^ ABUSE/ADDICTION LINKSPATTERN AWARENESSESTABLISH BOUNDARIESSELF-DISCLOSURE (SA)^• behavioursD/A ABSTINENCEINTIMACY COMFORTABLESEXUAL IDENTITYTRUST^ exploration^IV RECLAIMING SEXUALITYSAFETYBODY-IMAGE49NEGATIVE SELF-TALKSILENCED BY OTHERSALONENESSPERSONALIZATION OF TRAUMAENTRENCHED BELIEF SYSTEMDENIALOTHER FOCUSEDSECRET KEEPINGOBLITERATE REALITYISOLATIONVII SELF-DETACHMENTTABLE IA - THE EVOLVING RECOVERY FRAMEWORKRECOVERY BARRIERSOPEN CODES PROPERTIES CATEGORIES AUTHORITATIVE VICTIMIZATIONBETRAYAL/LABELLINGSEXUAL EXPLOITATIONsystems V OPPRESSIVE POWERIMPOSED NEGATION OFEXPERIENCESDICHOTOMIZED TREATMENTNO SAFE PLACESITUATIONAVUSING"TRIGGERSEMOTIONAL "USING" TRIGGERS hopelessnessUNSUPPORTIVE FEEDBACKVI INWARD RETREATESCAPISMMEMORIES/FLASHBACKS despair^VIII SUICIDALOVERWHELMING^THOUGHTS/ATTEMPTSRELIEVE EMOTIONAL PAINKEY: ID/A = Drug/Akohol "Using" = consuming drugs/akohol SA = Sexual Abuse (+) = positive50CHAPTER FOURRESULTS/DISCUSSIONAnalysis of the eight transcripts revealed that the recovery process is acomplex intertwining experience of events depicted by the two overall themes:1.) Self-Discovery Through Story Sharing and 2.) Symptomatic Relapse.Self-Discovery Through Story Sharing captures the overall importanceexpressed by the women of healing being generated not only by having theability to share, but more importantly, by having the safety to share theirstories. The women describe recovery as an ongoing process of life-longdiscovery, reaching ascending levels of awareness and understanding. Thefollowing categories: I. External Search, II. Identifying Sexual Abuse/AddictionLinks, III. Self-Connecting and IV. Reclaiming Sexuality gave rise to theme one.Symptomatic Relapse describes a phenomenon of events that createvulnerability in maintaining abstinence from using drugs and/or alcohol or afeeling of wellness and control of one's life. Symptomatic relapse can occur ona physical level with the ingestion of chemicals or on an emotional level with theonset of feeling defeated and suicidal. The categories: I. Oppressive Powers, II.Inward Retreat, III. Self-Detachment, and IV. Suicidal Thoughts/Attemptsunderlie the theme of symptomatic relapse (Table 2).51Subitance Abuse : VI INWARD RETREATOut of Body ExperiencesVoicelessLack of BoundariesAlternative to Substance AbusePunishmentStop Sexual Abase MemoriesVII SELF-DETACHMENTVIII SUICIDALTHOUGHTSVATTEMPTSSUB-CATEGORIES I CATEGORIES THEMESUnderstanding ExperiencesEstablishing Support NetwOrk I EXTERNAL SEARCHSeW-Rnowledge in Relation to OthersResponsirllity AllocationPhysical, Emotional, Mental, & Dpititual- Holistic Healingblcin-Abueive RelationshipsHonouring the *Mull SelfAccepting Sexuality/Sexual OrientationjIII SELFONNECrINGIV RECLAIMING SEXHALITY .<Behaviour in Context^H IDENTIFYING SEXUALABUSE/ADDICTION LINKSAwareness Of issues ExpandingSELF-DISCOVERYTHROUGH STORYSHARINGV OPPRESSIVE POWERtow Self-Esteem• SYMPTOMATICRELAPSE .•^•TABLE 2 - THE EVOLVING RECOVERY PROCESS52CATEGORIESEach category reflects a set of common experiences encountered by theeight women in this study. Exploring these categories will enable the reader tofollow the journey these women have undertaken, and continue with, in theirrecovery process from chemical dependence and childhood sexual abuse. Thedescriptions of their experiences, quoted directly from the transcripts, providean overview of the process of recovery which illuminates the themes generatedfrom these womens' responses.Each woman consistently sought answers to why she felt and acted theas she did, which gave rise to the category, external search. At the onset oftrying to understand their experiences, these women often sought help throughvarious avenues, from attending AA meetings to seeing professional counsellors:Ann - I tried a treatment centre for drugs andalcohol, I was really messed up.Lyn - My recovery began the day I called AA. Thewoman I spoke to was instrumental in my gettinghelp.Prior to reaching out for help, each woman had struggled in her own way toidentify that either a chemical dependency problem existed or that the long-termeffects of being sexually abused were interfering somehow in their lives.However, seven of the eight women sought help first through various drug and53alcohol resources. Upon making the initial contact, they all were able tomaintain a period of abstinence from drugs/alcohol, but soon found themselveseither "using" again or feeling depressed and suicidal. If they were able to stayconnected with some kind of support system, AA, friends, or family, patterns of"using" drugs/alcohol became apparent and were connected to the hauntingissues of sexual abuse.The second category, Identifying Sexual Abuse/Addiction Links, resultedfrom the numerous responses by the eight participants which included arealization and identification of a connection between the issues of sexual abuseaftereffects and substance abuse. Often, the women described a situation thatwould 'trigger' the desire to 'use' drugs and/or alcohol to alleviate the feelingsthey were having. Wendy and Tina commented that:Wendy - I mapped out the sexual thing andrealized I had never been sexual without beingunder the influence [of drugs and alcohol].Tina - It was easier to be sexual when I was drunkbecause there were less memories and flashbacks.On the other hand, it subjected me to a lot moreabuse by lowering my guard and my boundaries,what I had left of them.Throughout the interviews the women kept referring to feelings of notknowing who they were but appeared to keep searching out answers andexplanations for why they felt as they did and why they found themselves in54particular situations. As they began to identify triggers, an awareness of aconnection between the long term consequences of being sexually abused anddrinking and drugging behaviours appeared to emerge. One woman said, "Inever made the connection between my using (drinking/drug use) until I wassexual once while sober and the flashbacks were unbearable and all I wanted todo was drink"Once the linkage between sexual abuse and addiction was made by thewomen, a feeling of relief and understanding ensued:Beth - I felt I opened a can of worms [as she spokeabout being sexually abused as a child] but therewas this big relief. I was able to see the commonground. I was able to see the connection betweenmy childhood and why I am the way I am now.Lydia - I went to a treatment centre that looked atboth sexual abuse issues and addiction. In thepast, I stayed sober but never felt happy because Ididn't get to the underlying stuff, the sexual abuse.Barrett and Trepper (1991) discuss the apparent inter-connectednessbetween childhood sexual abuse and adult chemical dependence and argue that"it is important that clinicians working with either population understand theorigins of both, and how they relate to and amplify one another" (p. 128).Feelings of Self-Connecting, the third category, arose as the women wereable to talk about their feelings around their experiences. Kate said:55coping with my anger [in therapy] enabled me to uhto get on with my life and basically to discover thatI had more deeply rooted problems than I wasaware of in other therapy sessions, so I startedworking on those.As the women continued to explore their individual issues, they were ableto reclaim their sexuality by understanding the effects the abuse had on theirsexuality. Wendy reflects this movement toward reclaiming sexuality, the fourthcategory, when she says, "he was the first person I ever took a chance with andslept with without the use of alcohol and drugs and it was ok." Wendy, who isa lesbian, said that coming to terms with her sexuality/sexual orientation was notdifficult because of rejecting societal attitudes but was more troublesome becauseshe had been abused by women. Once again, the more relevant issue was tiedto being abused as a child.Although these categories appear to fall into a linear order, quite thecontrary was true. The intertwining aspects of the recovery process as describedby the women in this study will be considered in more detail at the end of thischapter.The following categories exemplify the barriers these women encounteredin their recovery process. The most exasperating category for me as aninterviewer and witness to the pain in some of these womens' eyes as theyrecalled their experiences, was what I call Oppressive Power. The eight women56reported various forms of oppression from feeling invalidated to outright abuse.The oppressors ranged from family members to professionals abusing theirpower as helpers. For example, some of the women were either told directly thattheir addiction had nothing to do with their sexual abuse, or that this is not thetime and place to deal with these issues. This led to a questioning of their ownreality because they intuitively knew that a connection between their childhoodabuse and their "using" patterns existed. A clear example of this externaloppression was profoundly experienced by Wendy when she was given anassignment by a drug and alcohol counsellor to write down the triggers she wasaware of that precipitated drinking episodes. She wrote about the sexual abusetriggers, flashbacks, painful memories, and the need to be under the influenceduring sexual contact. Wendy recalls the following response from her counsellor:He just sat bolt upright in his chair saying 'this hasnothing to do with your drug and alcoholaddiction. These aren't the triggers I'm talkingabout. These aren't triggers!' I was just floored.This response may have reflected the attitudes at that time as Wendy'streatment experience occurred in 1979. However, Kate was also referred tosomeone who specialized in sexual abuse but who did not address her addictionissues as recently as two and a half years ago (1991). Now she is seeing acounsellor who works with both issues together and she feels this person has57"helped me the most"."Beth" also experienced similar barriers in her recovery both in a recoveryhouse and at meetings she was attending for addiction problems during the pastyear:I felt AA was too limited for where I have to go inmy recovery and the issues I have to deal with.Right now I am not involved in any AA supportgroup. I would rather talk about my sexual abuseissues and other important issues in my life ratherthan just alcohol. At the recovery house, I felt Icould not talk about the sexual abuse issues either.It was based on AA and focused strictly on alcoholproblems. This helped me too, but, one of thecounsellors said some damaging stuff about thesexual abuse when I told her about the connectionsI was making [because of the counsellors' personalexperience] so I didn't feel I could talk to herbecause she wasn't neutral and I didn't feel safe.Whenever the women encountered a negative situation or were unable to securea feeling of safety, an Inward Retreat would occur:Ann - [after going to see a counsellor] I rememberjust crying hysterically and she didn't seemsympathetic but she didn't seem to not understandbut she was very distant and just wrote everythingdown and that was it. I didn't tell anyone again fora long time.Lydia - I asked to be referred to a treatment centrefor help but the counsellor wanted to send me to aplace that advocated controlled drinking I didn'tfeel heard. So, I just continued on. [drinking andusing].58Lyn - when I used drugs and stuff, it was an escapething. I wanted to get away from myself and tomake the pain go away and not think about it.Numerous methods of coping with the memories of the abuse wereutilized by these women with the most common being the use of drugs andalcohol. The unresolved trauma seemed to create a sense of Self-detachment;Wendy - I really thought I had a multiplepersonality problem for a long time. I was reallyappalled with myself and I'd get loaded.Tina - If somebody sat too close to me I'd flip, ifsomebody touched me I'd flip, if somebody saidthe wrong word that triggered off something Iwouldn't necessarily have a picture of it, but Iwould just freak out...I had never felt that waybefore...looking back, I connect it [sexual abusememories] to why I drank more and more. As Istarted drinking more and more, I turned fromsomeone who never slept around at all to someonewho some would call a slut.SuicidtA=21As/altempts were a continuous theme the women shared.Repeated attempts and/or thoughts were frequent throughout the recovery andusing periods:Kate - I realized that in the past I had used alcoholas a way of hoping somebody would kill me. Iwould get incredibly drunk, put myself in verydangerous situations and hope that someone wouldkill me.59Wendy - actually throughout the whole time I feltvery suicidal.Tina - I had attempted suicide on numerousoccasions because of the flashbacks. I just couldn'thandle them!Ann - I was pretty well at the end of my rope, I wassuicidal and uh, my whole life was just one bigstruggle and it kept going backwards, it wasn'tgoing forwards at all.Often, the women experienced numerous aspects of both the recoverybarriers and the recovery enhancers as they sought answers and change in theirlives. The entwined nature of the recovery process is complex and seemed to beinfluenced by both external influences, such as negative contact when theyreached out for help, and internal convictions of self-loathing and feelings ofunworthiness, which appeared to be a consequence of the trauma of beingsexually abused in childhood.The intricacies of the recovery process, although different in somerespects for each individual woman, are generally portrayed by the categoriesoutlined. These categories show the commonalities encountered by all eightwomen in this study and provide the background information which led to theformation of the two overriding themes that depict the overall process ofrecovery and healing.60THEMESThe two themes encompass the essence of the recovery process asexperienced by these eight women as revealed in the interviews. The sub-categories, as outlined in Table 2 (p. 52), depict the circumstances that underliethe meanings inherent in the categories from which the themes emerged. Eachtheme will be examined with excerpts from the interviews that support thesefindings.The first theme, Self-Discovery Through Story Sharing, was anevolving process that was generated by increased awareness through exploringand sharing in a safe place about their issues of sexual abuse and chemicaldependence. Such sharing enabled the women to place their experiences withinthe context of their entire lives rather than simply focusing on the "self' assomehow damaged and therefore defective.Each woman was at a different place in her healing, but had anawareness, none the less, of reaching a wholeness not felt before. The holisticintegration of the physical, emotional, mental, and spiritual being seemed acritical aspect in the recovery process. As the women speak about theirexperiences and desires the notion of healing and self-discovery through storysharing becomes apparent:61Kate - Recovery starts as very functional and at theend of my natural life it will be more of a spiritualprogression. Very much like a child. A child startsoff with, what you initially teach them, gross motorskills, and as an adult what you are looking at isrequiring more philosophical skills. At the end ofthe recovery process, I see it as being at that morespiritual level.Ann - My connection to my higher power, which Igot by going to meetings and sharing, was thecatalyst to my cleaning up.Wendy - Recovery for me is just my whole being,spiritual, emotional, physical. It didn't happenuntil I was willing to open up, until I foundsomeone safe to talk about the issues that weremost important to me. The ones that I felt worseabout myself, and that was my sexual abuse.Recovery affected my whole life. I mean recoveryto me was getting past all those things.The women talked about running and hiding from their lives for yearsbecause they felt either there was no safe place to share their stories, or the painof sharing their stories would be too overwhelming This desire for integration,as an ongoing process, is again supported by Kate's experience:When I was being sexually abused I had to blockmy feelings so I would go into a trance, leave mybody, and so it was happening to my body but notto me. So it's very very easy for me to walk out ofmy body. To me it's still the issue and that's whyI'm still in counselling because I can just walkaway. I'd like to see a full body integration.Young (1990) advocates that holistic healing must be a goal of treatment if62relapse is to be prevented and Miller (1991) promotes the healing aspects of"story-telling" when she says:We may not be completely comfortable with thesimplifications offered in "Twelve-Step" problemformulations and interventions, but we need towork with what we can accept and value in thisform of collective story-telling and spiritualempowerment.Both authors lend credence to this theme of self-discovery through story sharingand I support Young's argument that "creative and healthful living becomespossible as the self, which was impaired and thereby dependent on addictivebehaviours, is reconstructed and restored" (1990, p. 256).The theme of Self-Discovery Through Story Sharing appears to fall ona continuum that reflects the challenges these women faced in gaining a sense ofthemselves. The following excerpts from the transcripts exemplify this journey:Wendy - I couldn't recover from my drug andalcohol abuse until I looked at my whole life. Mywhole life.Kate - Recovery fits in with a philosophy of lifethat I have, recovery is not a destination, but likelife, it is a journey. I would go to therapy sessionsand then stop and integrate what I had learned,and then when things fell apart again, I would goback.Ann - Recovery is a life long process. It's like atotal reversal of my entire lifestyle, everything haschanged. I don't think I'm the same person. I63don't do the same things and don't enjoy the sameactivities. Every aspect of my life has beenaffected.Recovery appears to be an evolving process where experiences begin tobe understood and self-awareness increases. This integration of knowledge isreflected in Kate's statement:I look at my present behaviours and understandwhere they came from and what's nice is it gave mean opportunity to stop beating up on myself... SoI've learned about boundaries, I've learned aboutbeing co-dependent, I've learned about appropriateand inappropriate behaviours. I have learnedenormously. I see recovery as an ongoing processthat I personally took in chunks So recovery isongoing but it's also escalating.An awareness of the sexual abuse/addiction linkage enhanced this process of self-discovery and enhanced their ability to maintain their recovery from drugs andalcohol. Wendy talks about being able to recognize the connection between herabuse and "using" patterns and expressed the following:Recovery is not one piece, it's not like I drank, takeaway the booze, it was just impossible, that's whatI had done and just kept drinking. I don't know ifit's like that for everybody, but I certainly knowwhat it took for me to get to a place where I nowknow I can stay sober. I had to deal with all myissues.Gorski (1986) describes a recovery model that moves along a continuumwhich he calls stages, going from a "stabilization period" through to the64"maintenance period of recovery" where a focus on improving the quality ofones' life and living a productive lifestyle are maintained if sobriety-centredvalues are cardinal within the newly achieved lifestyle. This movement towardself-discovery apparent in Gorski's model would support the theme justdescribed here.The second theme, Symptomatic Relapse, depicts situations that havecreated a vulnerability to relapse for these women.Throughout the recovery process, the women found themselvesvulnerable to relapse when faced with a variety of new situations orcircumstances that triggered the original trauma or addiction patterns. Thefollowing excerpts reflect these high risk circumstances of symptomatic relapse,each reflecting a different experience, yet, common to all of the womeninterviewed:Kate - I was looking for relief from my life whichis why I continued to put myself in vulnerablesituations [talking about the past when she wasdrinking] But, I wanted someone else to takeresponsibility and to a degree that is still what I amhoping for in the counselling situation. As asexually abused child and living in an alcoholichome, I felt burdened by responsibility and I'm stilllooking to unload that responsibility either throughcounselling or through death.Ann - Relationships are the hardest for me. WhenI have a lot of conflict in my relationships, my65natural reaction is to use. It's like I can't deal withthe heavy emotional stress. Recently I was withsomeone who started rolling a joint in front of meand just the thought of knowing that this personwas going to get high kicked up a craving in me. Ijust had to leave and get out of there, even thoughI don't really want to use, the feelings to use wereso strong.Susan - There is a tone in the program that's likethe worst of the disease in action. Like thecontrolling, abusive, totalitarian, rigid thinking,male table thumping, you know, 'take the cottonout of your ears and put it in your mouth' stuff. Ineeded to talk about my experiences.Gorski (1986) claims that "placing the phenomenon of relapse in itsproper perspective within the recovery process, planning for the likelihood ofrelapse, and providing patients with skills to cope with the stresses that typicallylead to the resumption of alcohol and other drug use" is critical (p. 6). Rose,Peabody, and Stratigeas (1991) found in their study that "nonrecognition [ofabuse] by mental health professionals and the failure to intervene appropriatelyand early create devastating outcomes for clients who have been abused" (p. 411)such as relapse.Relapse is a common phenomenon of recovery, as pointed out in theliterature, and studies have shown that mortality rates for alcoholic womenrange from more than three (Schmidt & DeLint, 1972) to nine times (Gorwitz,Bahn, Warthen, & Cooper, 1970) that expected for women in the general66population. The alcoholic woman's life span is also shortened by fifteen years(Smith, 1983). Although you cannot draw causal relationships of sexual abusecausing relapse that will shorten women's lives there are strong indications thata relationship may exist. Relapse indicates a return to a previous state ie.drug/alcohol abuse.A clear picture can be visualized about the symptomatic relapsephenomenon that repeatedly occurred for these women as their stories unfolded.Wendy first attempted to quit drugs and alcohol at the age of twenty-three. She is now thirty-six and has two and a half years of continuous sobriety.Her description of her recovery suggests the need to look at the entire picture ofthe recovery process:At some point I grasped another year and a half ofsobriety, it seems a year or a year and a half was areal milestone for me...It seems like for a long time,it was like chunks of years, then almost to themonth I would have a year of sobriety and then useagain.Relapse episodes were also experienced at one level or another, whether that bephysical or emotional, during continuous abstinence as reflected by the followingcommentsAnn - I did a step four while I was in a recoveryhouse. I felt overwhelmed by the guilt, shame, andremorse and deep down I felt like a rotten person.I couldn't face the things that I had done as a result67of my drinking and it didn't even occur to me toconsider the things that had been done to me. Ispent two weeks crying and thought of over-dosingevery day, I just wanted to kill the pain.Wendy - I would start talking about something andthen go drink. I started drinking again just a littlebit [after 1 1/2 years of sobriety], controlled, I justneeded something to get me through the eveningand I'd leave it at that.Kate claimed that she did not experience a relapse during recovery because thepast two years is the first time she acknowledged that an addiction problemexisted. However, she did state that "quitting was easy for me because I thinkI just switched my addiction to nicotine". Kate also stated that in the past twoyears she had been drinking on two separate occasions but did not consider thesea problem because she did not lose control.Kate first sought help by contacting a psychiatrist when she was in herlate teens because she was experiencing difficulties coping with her homeenvironment but was unable to articulate what her issues were. The doctor didnot question her about addiction or the possibility of being abused but ratherfocused on her speech. "The advice I had from the psychiatrist set me back quitesubstantially...his main concern was that I spoke too quickly and that was hismain concern, to get me to slow down my speech." After two sessions she didnot return to see this doctor. Kate's drinking and drug use continued, until two68years ago, with periodic abstinent periods which she says she did for herhusband. She was able to quit for months at a time and thought this proved shedid not have an addiction problem.The prevalence of relapse, whether in an emotional sense or in an actualphysical return to active addiction, points to the need to uncover hidden relapsepredictors. Young (1990) believes that "one of the greatest unacknowledgedcontributors to recidivism in alcoholism and other addictions may be the failureto identify and treat underlying childhood sexual abuse issues" (p. 249)Seven of the women relapsed several times before attaining continuousabstinence from drugs and alcohol which placed them at risk for further physicaland sexual abuse, life-threatening health problems, and suicide. Hansen (1987)reported that "some therapists hold that one addresses the addiction and thenrefers the woman in order to deal with her sexual abuse experiences" (p. 9).Hansen (1987) argues that "separating sexual abuse treatment from addictionstreatment assumes that these two issues are mutually exclusive and that sexualabuse is not an antecedent to addiction involvement" (p 9). I strongly agree withHansen, and believe that such attitudes and policies only perpetuate barriers forwomen in recovery and serve to aggravate the struggles women already have intheir recovery from chemical dependence which is reflected in the stories sharedby the women in this study:69Tina - I popped back all these pills. I don't think Iwanted to commit suicide, [pause] I just wanted thepain to stop and the feelings to go away. I didn'twant to remember all the sexual abuse.Lyn - In light of my recent suicide attempt I waswilling to share whatever I needed to, to stay alive.For the first time, I realized I wanted to live. I sawthis counsellor because of my attempted suicideand for the first time, I told somebody about theabuse, I broke my silence. It was quite a momentfor me [smile], but unfortunately he really didn'thelp me. There was no follow-up from himbecause I wasn't an ongoing client of his.Susan - If I don't deal with this stuff, anotherabusive relationship will come along, or somethingelse and I just can't take it anymore. I don't everwant to be used and abused again. I don't want touse or abuse myself. This stuff won't go away. Ifit would, I wouldn't have to be here [treatmentcentre for chemically dependent women]. If I couldclose a door on it and run, I would. I tried withdrugs and alcohol but I couldn't drink enough tomake it go away. If I drink again then they win. Igo out there and end up in an institution or dead,those bastards [abusers] win!One of the most horrendous aspects of the realties experienced by Tina,Lyn and Susan (quoted above), is that this additional trauma in their lives mighthave been prevented if adequate resources and knowledgeable support peoplehad been available to them.An illustration of the recovery process is depicted in Figure 1. It will beexamined and explained by using the descriptions provided by Lyn, Tina, Lydia,70Wendy, Susan, Ann, Beth and Kate, to afford the reader a sense of the processin action. Perhaps using such a diagram will assist in looking for interventionpoints that might reduce the pain in women's lives who have been affected bychemical dependence and childhood sexual abuse.71Recovery in MotionThe complexity of the recovery process is exemplified in Figure 1, whichprovides a schematic view of the experiences described by the women.THE RECOVERY PROCESS FLOW CHARTThe motion within the chart reflects contstant movement, in various directions,capturing the "random chaos", as described by Wendy, of the recovery process.Dependent on positive or negative contact, one might spin off the spiral into one72of the various categories. The semi-permeable boundaries surrounding the twocategories, External search and Oppressive power, and the two themes, Self-discovery through story sharing and Symptomatic relapse, shows the fluidity ofin-and-out movement. For instance, as a woman searches for answers, externalsearch, she may proceed to identifying abuse related triggers, or if contact andfeedback is negative, she may feel torn and confused by the influences ofoppressive power relations and may stay on the bottom circular track for aperiod of time where she may resort to an inward retreat. This may lead to asense of self-detachment. This pattern may be interrupted, however, at anypoint where she would return to the upper track. Some of the precipitatingfactors that influence a change in direction might be a crisis, supportive contactwith someone, a new insight and so forth.Once a change has occurred, for instance, she may proceed to self-connecting and move on to reclaiming sexuality. If the "recovery enhancers"persist over time, then she will begin to shift to the upper right side of the chartwhere self-discovery through story sharing begins to become moreestablished. A back and forth flow of events seems to occur, once again,dependent on the experiences encountered. If the experiences and changes incoping patterns are positive, she will tend to stay in the healing portion of thechart. However, if negative circumstances persist and identifying sexual73abuse/addiction links are not made, she may shift to the relapse circle.The flow of the recovery process is very individualized. Although thewomen in this study had distinct commonalities as described by the variouscategories and themes, each woman's journey would be pictorially different onthe chart described above.This diagrammatic view of the recovery process for chemically dependentwomen survivors of childhood sexual abuse highlights the complexity of theprocess encountered by women. The chart also emphasizes several implicationsin which positive change can be implemented. Chapter five concludes the thesiswith a discussion of implications for professional social workers, helpingprofessionals from other disciplines, and others involved in program/policies forwomen recovering from chemical dependence who have also been victims ofchildhood sexual abuse.74CHAPTER FIVECONCLUSIONS AND IMPLICATIONSThe intent of this study was to conceptualize the impact of childhoodsexual abuse on women's experiences of recovery from chemical dependence.The results indicate that issues of sexual abuse add to the complexity of therecovery process in such a way that if unrecognized may contribute tosymptomatic relapse which could cost the woman her life as discussed in chapterfour.Although the data obtained in these eight interviews have been rich inextricating some of the influences which impact the recovery process forchemically dependent women survivors of sexual abuse, the results must beconsidered cautiously due to the small sample size. The generality of conceptsdelineated from these womens' experiences, however, may be applied over a widevariety of situations where similar histories exist (Glaser & Strauss, 1967).A possible controversial point in the study might arise from the fact thatI have worked in this area for many years and have ideas about the recoveryprocess based on my own personal journey of healing. Thus it might be arguedthat I come to this research project with preconceived ideas influencing thenature of the questions and the outcome of the research topic. However, many75feminist researchers utilize the strenghts inherent in personal experience. Still,another researcher looking at the same data may have derived different themesand categories based on their valuing of statements differently than I have.I believe that the most important aspect of exploring a relatively new isto generate dialogue and increase understanding. In this study, I wanted toengage with the participants in order to co-create knowledge. By contactingeach woman to verify my interpretations of their experiences, ownership of thisstudy is shared and the womens' stories are honoured.Further research will strengthen the arguments posed in this study. Alarger sample population would also make possible the generalizability of causalrelationships which cannot be done in a qualitative study of this size. Thus thepreliminary findings in this study will require further investigation but thepresent results certainly point to several implications necessary to explore forhelping professionals working in this area.Most of the research to date, based on male subjects, has guided theformation of policies and programs in place for addiction recovery. Since 1972,some studies have focused on chemically dependent women, but have only begunto explore the relationship between substance abuse and childhood sexual abuse.Considering the findings in this study, which are corroborated byprofessional accounts of working with women in this population, intervention76and prevention strategies need to be examined and revised for this group. Forinstance, in the Alcohol and Drug programs in B.C., there is no mandate to treatsexual abuse issues nor is there a requirement that professionals working intreatment centres be trained in sexual abuse. Presently it is left to individualcounsellor preference as to whether or not the issues of addiction and sexualabuse are being treated concurrently as reported by Hansen in chapter four.Studies strongly corroborate that sexual abuse experienced in childhoodis a predictor of future substance abuse (Rohsenow et al., 1988, Coleman, 1987).Thus, intervention must address these issues as dual recovery issues.Professional awareness is necessary in both fields of work because sexualabuse counsellors if not aware of the addiction recovery process mayinadvertently trigger a relapse if the client is not yet aware of her "using" triggersrelated to her sexual abuse.Aurora House, one of the few treatment centres in Vancouver, thataddresses sexual abuse issues, has an average wait list of five months whichpoints to the need for addressing these issues together. It is estimated that 90-95% of the women who come to Aurora have been sexually abused as children.Many have sought treatment with two or more years of sobriety because theyfelt they were on the verge of relapse because of the surfacing abuse memories.As stated in chapter two, Brown (1991) argues that counsellors need to77understand the dynamics between shame and relapse, stressing that, "shame-based conflict needs to be addressed directly" (p. 80).In Gorski's (1986) model, most relapses that occur during the "laterecovery period" are attributed "either to the inability to cope with the stress ofunresolved childhood issues or evasion of the need to develop a functional, low-stress personality style" (p. 9). I would argue that developing a functional low-stress lifestyle is not possible where unresolved sexual abuse issues exist.More services need to be made available to this population. Manywomen with whom I have worked were turned away from drug and alcoholservices because they had long term sobriety and were told that their problemswere emotional and thus, they needed to seek services elsewhere. For many, thiswas not financially feasible or they feared that seeing someone who did notunderstand their addiction issues could jeopardize that aspect of their healing.Research and resources are scarce when it comes to understanding andproviding for the additional difficulties faced by the following groups: FirstNation's women, other minority group women, Lesbians, or women withdisabilities, to name only a few. Some of the difficulties faced by these womenare institutional and societal racism, homophobia, limited wheelchair accessiblefacilities, and simply because of their gender, sexism, all of which place womenin vulnerable positions in their recovery process from chemical dependency.78Women-centred research that addresses all aspects of every woman's lifeis critical if women are to be empowered in their healing. This study is abeginning step in understanding the relationship between chemical dependencyand sexual abuse and its effects on the recovery process. The study reflects amore personal inward-looking process in examining revoery from chemicaldependece and childhood sexual abuse. Future research examining morestructural influences, such as quality of housing, poverty, access to employmenttraining, childcare, etc. would benefit women by incorporating a more systemicanalysis in the move toward holistic healing.Another recommendation would be directed at including all children inPrevention Programs (drug and alcohol) because of the high prevalence ofchildhood sexual abuse and the potential for future chemical dependence asoutlined in chapter two. Early treatment of sexual abuse could possibly preventthe development of future substance abuse.I have only begun to scratch the surface of avenues to be explored and/orchanged. Advocacy for clients in this population is a large area that requiresmuch consideration. I hope that this study will spur interest in further, muchneeded, research.79BIBLIOGRAPHYAlcoholics Anonymous (1976). New York: Alcoholics Anonymous WorldServices, Inc.American Psychiatric Association. (1980). Diagnostic andof Mental Disorders JII-R. 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Newbury Park, CA: Sage.86APPENDIX AThe Twelve Steps of Alcoholics Anonymous1^We admitted we were powerless over alcohol - that our lives had becomeunmanageable.2. Came to believe that a power greater than ourselves could restore us tosanity.3. Made a decision to turn our will and our lives over to the care of God, aswe understood him.4. Made a searching and fearless moral inventory of ourselves.5. Admitted to God, to ourselves, and to another human being the exactnature of our wrongs.6. Were entirely ready to have God remove all these defects of character.7. Humbly asked Him to remove our short-comings.8. Made a list of all persons we had harmed, and became willing to makeamends to them all.9. Made direct amends to such people wherever possible, except when to doso would injure them or others.10. Continued to take personal inventory and when we were wrong promptlyadmitted it.11. Sought through prayer and meditation to improve our conscious contactwith God as we understood him, praying only for knowledge of His willfor us and the power to carry that out.12.^Having had a spiritual awaking as a result of these steps, we tried to carrythis message to alcoholics and to practice these principles in all ouraffairs.(Alcoholics Anonymous, 1976)87APPENDIX BSixteen Steps For Discovery and Empowerment1. We affirm we have the power to take charge of our lives and stop beingdependant on substances or other people for our self-esteem and security.Alternative: We admit we were out of control with/powerlessover , but have the power to take charge of our livesand stop being dependant on substances or other people for ourself-esteem and security.2. We come to believe that God/the Goddess/Universe/Great Spirit/HigherPower/ awakens the healing wisdom within us when we open ourselvesto that power.3. We made a decision to become our authentic Selves and trust in thehealing power of the truth.4. We examine our beliefs, addictions, and dependant behaviour in thecontext of living in a hierarchal, patriarchal culture.5. We share with another person and the Universe all those things inside ofus for which we feel shame and guilt.6. We affirm and enjoy our strengths, talents, and creativity, striving not tohide these qualities to protect others' egos.7. We become willing to let go of shame, guilt, and any behaviour thatkeeps us from loving ourSelves and others.8. We make a list of people we have harmed and people who have harmedus, and take steps to clear out negative energy by making amends andsharing our grievances in a respectful way.9.^We express love and gratitude to others, and increasingly appreciate thewonder of life and the blessings we do have.8810. We continue to trust our reality and daily affirm that we see what we see,we know what we know, and we feel what we feel.11. We promptly acknowledge our mistakes and make amends whenappropriate, but we do not say we are sorry for things we have not doneand we do not cover up, analyze, or take responsibility for theshortcomings of others.12. We seek out situations, jobs, and people that affirm our intelligence,perceptions , and self-worth and avoid situations or people who arehurtful, harmful, or demeaning to us.13. We take steps to heal our physical bodies, organize our lives,reduce stress,and have fun.14. We seek to find our inward calling, and develop the will and wisdom tofollow it.15. We accept the ups and downs of life as natural events that can be used aslessons for our growth.16.^We grow in awareness that we are interrelated with all living things, andwe contribute to restoring peace and balance on the planet.(Kasl, 1992)89APPENDIX CThe Thirteen Statements1. I have a drinking problem that once had me.2. Negative emotions destroy only myself.3. Happiness is a habit I will develop.4. Problems bother me only to the degree I permit them to.5. I am what I think6. Life can be ordinary or it can be great.7. Love can change the course of my world.8. The fundamental objective of life is emotional and spiritual growth.9. The past is gone forever.10. All love given returns.11. Enthusiasm is my daily exercise.12. I am a competent woman and have much to give others.13.^I am responsible for myself and my actions.(This was formerly, "I amresponsible for myself and my sisters.")(Kirkpatrick, 1976)90APPENDIX DINTERVIEW GUIDEThe purpose of this study is to explore the recovery process for women,who are in recovery from substance abuse and who are survivors of childhoodsexual abuse. I believe that it is essential to explore the area of recovery withwomen who have first-hand knowledge of what the experience of healing hasbeen like for them.1.^Women view recovery in many different ways, could you describe whatrecovery means to you?a. drugs and alcohol - recovery?b. sexual abuse recovery?This next question is very open, on purpose, because I think it is important forwomen to have an opportunity to share whatever they feel is important to themabout the recovery process. If you feel stuck along the way, I can help by askingsome questions about what you have already shared or explore new areas.2.^Could you describe your recovery to me from the beginning until now?It is kind of like telling your recovery story.- for example, from the first time you attempted to quit "using" orthe first time you talked about the abuse with someone?3. Children often find numerous ways to cope when they have gone throughtraumatic experiences. Can you describe what you did that helped youto cope after being abused?4. Did your ways of coping change at anytime, from childhood untilpresent?5. Looking back over your recovery experiences, does anything/s inparticular stand out that helped?ie. any particular situation, person, treatment centres etc.6. Has there been anything in particular that has created a block for youduring your recovery?91[some areas will be further explored as the woman shares her recoverystory. Look for any problem areas she may have had. Any relapses?Length of sobriety? How does sexual abuse relate to her addictionrecovery?]92NORTH BURNABYALCOHOL & DRUGCOUNSELLINGSERVICES285 - 9600 Cameron St.Burnaby, B.C.V3J 7N3Tel. (604) 421-2228Fax (604) 421-2291APPENDIX E.1FAMILY SERVICES OF GREATER VANCOUVERDecember 3rd, 1992To WHOM IT MAY CONCERN:This letter is to confirm the willingness of North Burnaby Alcohol &Drug Counselling (Family Services of Greater Vancouver) to partici-pate in the attached study "Exploring the Phenomenon of Recovery ForChemically Dependent Women Survivors of Childhood Sexual Abuse" tobe conducted by Kathy Oxner.This approval is dependent upon review by the UBC Ethics ReviewCommittee.If you have any questions, do not hesitate to contact me.Yours truly,Myrna Driol, M.A.Clinic Co-Ordinatorcc:^Kathy OxnerAPPENDIX E.293Province of^Ministry of Health and^Alcohol and Drug ProgramsBritish Columbia^Ministry Responsible for Seniors^Lower Mainland Regional Office509, 4980 KingswayAPPENDIX E.2^Burnaby, British ColumbiaV5H 4K7December 21, 1992Ms. Gail Malmo,Executive DirectorAurora House2036 West 13th AvenueVancouver, B.C.V6J 2H7Dear Gail,Re:^Exploring The Phenomenon of Recovery for Chemically Dependent WomenSurvivors of Childhood Sexual AbuseThankyou for your information package faxed December 6, 1992 concerning the aboveresearch proposal.I trust that the proposal has been approved from an ethical perspective by the Universityof British Columbia Behaviourial Science Screening Committee for Research and OtherStudies Involving Human Subjects.The Regional Office would look forward to learning of insights and recommendationswhich may arise from this research.Yours truly,Ted MitchellArea Managercc. Karen Abrahamson, Regional DirectorMIT/MIT/j f/160-2094Thecituroa Society'INCORPORATED UNDER THE SOCIETIES ACT APPENDIX E.32036 West 13th Avenue, Vancouver, British Columbia V6J 2H7 Telephone 733-9191Fax 733-8957November 30, 1992U.B.C. School of Social Work6201 Cecil Green Park RoadVancouver, B.C., V6T 1Z1ATTENTION: Katherine OxnerDear Katherine:I am pleased to inform you that the Aurora Society hasgranted you approval to conduct your research study atour facility.We look forward to meeting with you in the new year IfI can be of any further assistance to you, please do nothesitate to contact me.Sincerely yours,Gail Malmo MEWExecutive Director95Funded by Ministry of Health — Alcohol & Drug Programs, Province of B.C.TITLE :Exploring the phenomena of recovery for chemically dependent women survivors of childhoodsexual abuseAPPROVAL DATEMAR 11 1993TERM (YEARS)3CERTIFICATION:Dr. I. Franks, Associate ChairsDr. R. Corteen or^ Dr. D.Spratley41 Director, Research ServicesThe University of British ColumbAPPENDIX FOffice of Research ServicesBehavioural Sciences Screening Committee forResearch Involving Human SubjectsCertificate of ApprovalINSTITUTION(S) WHERE RESEARCH WILL BE CARRIED OUTCO-INVESTIGATORS:Oxner, K., Social WorkSPONSORING AGENCIESThe protocol describing the above-named project has been reviewed by theCommittee and the experimental procedures were found to be acceptable on ethicalgrounds for research involving human subjects.PRINCIPAL INVESTIGATORRussell, M.DEPARTMENTSocial WorkThis Certificate of Approval is valid for three years provided there is no change in theexperimental procedures96APPENDIX GCONTACT LETTERDear Participant:^ [On Letterhead]I am currently a graduate student at the University of British Columbia, completing mymasters degree in social work. I am doing a study to explore women's experiences of therecovery process. My interest in this area has grown out of my work with women in theaddiction field over the past twelve years.I believe that women who are encountering addiction issues and have been sexuallyabused as children may have different needs during the healing process of recovery. Thus, Iwould be very interested in meeting with you to explore these issues together.The study would involve two audio taped interview sessions lasting approximately oneand a half hours each. The purpose of the second interview is to verify with you the accuracyof my interpretations of the experiences you shared with me in the first interview.The interview questions are fairly open, for example, "Could you describe what the termrecovery means to you?" but, some questions may stir up painful incidents concerning the sexualabuse you experienced during childhood. Your decision to not answer particular questions willbe totally honoured.Your participation is completely voluntary and you can withdraw at any time. Yourright to agency service will not be compromised at any time throughout this study.All information you share with me will be strictly confidential with no personalidentifying information attached. The audio tapes will be destroyed after transcribing them intowritten form, no later than two months after the interviews. A copy of the final report will bea public document given to this agency and available at the University of British Columbia.Your participation in this study will provide valuable information about the recoveryprocess which I hope can assist you on your journey, and will provide much needed informationto counsellors working in this area. If you are interested in participating in this study, please feelfree to contact me through your counsellor or by calling: 876-0766, or 822-2255.Sincerely yours,Katherine Oxner97APPENDIX HINTERVIEW CONSENT FORM[On Letterhead]PROJECT TITLE: Exploring the Phenomenon of Recovery forChemically Dependent Women Survivors of Childhood SexualAbuse.INVESTIGATORS: Katherine Oxner BSW, MSW (candidate) - 876-0766Supervisor: Dr. Mary Russell - 822-2795The purpose of this study is to explore women's experiences of the recovery processfrom chemical dependence and how being survivors of childhood sexual abuse may influence thisprocess.As a participant, the study would involve two audio taped interview sessions lastingapproximately one and a half hours each. There will be time available at the end of each meetingto discuss any feelings or concerns that may have come up as a result of the interviews.A personal journal will be kept by me, containing your first name and telephonenumber only for purposes of contacting you. No personal identifying information will be on thedocument developed from the interviews and the audio tapes will be destroyed within twomonths of the interviews. Thus, strict confidentiality will be maintained.A compensatory travel expense of $5.00 will be given to you at the beginning of eachmeeting.Your participation is completely voluntary and if you chose to participate, you maywithdraw from this study at any time, your decision to withdraw will in no way affect yourtreatment with this agency. If you have any questions concerning this study or yourinvolvement, please feel free to contact me or my supervisor at any time (telephone numberslisted above).I ^  understand the above statements and agree toparticipate in this research study conducted by Katherine Oxner.Participant signature^DateInvestigator signature^Date98APPENDIX ICONSENT FORM COPY RECEIPTT[On Letterhead]I  have received a copy of the consentform I signed granting permission to be interviewed by audio tape as aparticipant in the research project being conducted by Katherine Oxner.Participant signature^DateInvestigator signature^DateCONSENT FORM(optional)I^ authorize Katherine Oxner to share with mycounsellor  information that was shared during ourinterviewsession. Participant signature^DateInvestigator signature^Date99APPENDIX JINTERVIEW - TRANSCRIPTInterview with WendyKO: When you think back to the first time you tried toquit alcohol and drugs or the first time you sought helpfor the issues of childhood sexual abuse, could you justgo from there and describe what the recovery processhas been like up until the present time?Wendy: Uh .. the first time I probably tried to quit^Problem Recognitionalcohol and drugs I was 23 and I had actually started^Help Seeking Behaviourgoing to Al-anon because my mother was alcoholicand .. uh .. I went to that off and on. I left home whenI was 14 and she came to live with me when I was 17 so No Safe PlaceI could take care of her and I went through a lot ofstuff and she ended up in AA. When I started Al-anon^Other Directedit was really bizarre as I wasn't hardly able to attendsober and I didn't really see that as a problem at the^Obliterate Realitytime until someone pointed it out that I might need to^Denialgo to AA. So I thought yeah right so I started going to100Help Seeking BehaviourAA and uh I really just stumbled through it. I wouldonly go for a month, drink, go for a week, drink, gofor a couple of days, drink, and not really getting afirm grasp on my own problem. I kept on getting hungup on "oh it's my mother's problem" you know andnot really believing [pause] and people alwayscommenting on how young I was that perhaps thatwasn't the right place for me anyway.KO: the message was virtually you are too young tohave a drinking problem.Wendy: oh yeah I can't remember how many times Iheard "I spilt more on my tie than you ever drank. Soit was hard.KO: What made you decide at that point in time thatdrinking was causing you trouble or getting to be toomuch?Wendy: oh I recognized that locking my doors andclosing all my curtains with a bottle of CaptainMorgon and seeing how much I could drink might bea problem, [laughter] you know, without passing out.Note: Motivation to quitapparent but continuesto "use" - patterns ofrelapse?Imposed Negation ofExperienceUnsupportive FeedbackAlonenessProblem RecognitionAwareness of PatternsDenial101I would isolate to the maximum and hide and uh I also^Isolationhad a lot of memories of things that I had done orbeen told that I had done over the years since I starteddrinking and drugging^ Memory ImpairmentKO: How old were you when you started?Wendy: I started drugging when I was around 12 andstarted drinking even before that [pause] I uh reallydon't know. I go back as far as my mother giving mean ounce of booze, brandy, in my bottle when I was^[family history andaround a year to keep me quiet and stuff because I had^childhood perspective]bronchitis and stuff so I look at that as giving a babyan ounce of alcohol as a lot of alcohol for their system.When I got a little older I would steal drinks andremember being rude.Wendy: So from the time I can remember ... also beingaround aunts and uncles and they were all alcoholics... so I drank forever, and ah, I did drugs since at least12 and the first drugs were prescribed.KO: Why were drugs being prescribed for you?Wendy: uh according to them or according to me102[laughter].KO: According to the doctors and you.Wendy: Well, according to the doctors it was becauseI was hystrung like my mother, and according to mewhy I was sent to them was because I had no desire to Labellingstay at home so the school counsellors brought my^Note:^stereotyping:Dad in. The worse thing to do, and they said so what's^sexism - institutionalthe problem here and my Dad said oh you know a^oppressionyoung girl, her mother is very hystrung, and she is just^No Safe Place/Betrayallike her and uh so with his permission they sent me off^Secret Keepingto the doctor to try and normalize me and that's thewords they used, to make you normal, some people^Labellingneed insulin, some people need thyroid medication,^Silenced by Othersand some people need tranquilizers you know to makethem normal and so at 12 years old I was put on themand realized immediately that would just numb my^Numbing Behaviourawareness of what was going on and that was ok.^Cognitive LinksKO: were you aware at the time what you wanted tonumb out?Wendy: Uh, I was aware of what was going on a lot103but sometimes I wasn't. I just was aware that I neededto escape and it was really important for me to escape.KO: Can I ask what it was you wanted to escapefrom?Wendy: oh my home life, the abuse. From age 4 I wassexually abused, and my Dad was a batterer, and uhthe sexual abuse and the physical abuse. The firstsexual abuse I ever encountered was by a baby-sitter,a girl a bit older than my sister, and she sexually abuseme for years and later it was my uncle. And I wouldjust go to sleep. It was like a joke in my family, everytime anything got stressful I would just knock off andgo to sleep. And uh I still do that. So uh at home Iwas always falling asleep.Pattern AwarenessObliterate RealityCognitive LinksPattern AwarenessSexual ExploitationAuth. VictimizationSexual ExploitationObliterate RealityObliterate RealityWith both my parents there was sexual abuse, with myfather it was fondling. Something I haven't beentalking about much until recently was the sexual abuseby my mother. A lot of feeling bad, about that andthat I was quote 'bad' and uh it made a lot of thingsSexual ExploitationAuth. VictimizationSecret KeepingNegative Self-talk104complicated about what's mine And uh so there's avery strong code of morale beliefs in the church thatwe didn't seem to adhere to at all and I just thought Iwas the bad person, I had heard about hell and Ithought I was going there and things like that. And Iwould be told that too.KO: Do you think it was used as a threat to keep yousilent?Wendy: Uh no, I would be threatened with hell, likegoing to hell for not eating my porridge so for sure.The hardest thing I have had to deal with was the firstabuse being with a female. [Discussed lesbian issues,feeling bad when she came to terms with knowing shewas a lesbian later in her adult life and equating thiswith the first abuse experience.]KO: Did you have anyone to turn to talk about whatwas happening to you?Wendy: No but I'd beg people to take me homethough and I never said anything out loud. Just reallyasking someone to save me without saying from what.Entrenched Belief SystemPersonalization ofTraumaAuth. VictimizationNote: InstitutionalOppressionAuth. VictimizationSexual IdentityIsolationNote: boundaries weak-self-detachment105Save me .. it is too much and I can't handle it... and^Help Seeking Behaviourthem never really wanting to go into what it was. Theyreally didn't want to deal with that.^Secret KeepingKO: In terms of recovery and your own healing^Unsupportive Feedbackaround your childhood experience of sexual abuse,^(non-verbal)seeking help at 17, what happened after that in termsof your recovery?Wendy: uh at 17 I was still feeling really bad aboutmyself uh that I was, very suicidal, actually throughout^Negative Self-Talkthat whole time I felt very suicidal. When I was 17 I^Personalization ofmoved out of a relationship I had had since age 15 and^Trauma/ Relievereally hadn't had much time to think about myself I^Emotional Painwas always thinking about what he was going to do^Other Directednext. It was a very dangerous situation for me and uh^Other DirectedI started taking Sundays off and make myself go do^No Safe Placesomething by myself. The first step I made was trying^Self-Loveto hook up with someone, I was going in to^, and I went past a church and I went up to^Help Seeking Behaviourthe church and I had never been in a catholic church inmy life and anyways I went in and sat there and just106cried. I rarely cried, I don't remember crying very^Express Emotionmuch. Just tears and nobody knew. I was just sitting^Isolationthere crying and somebody came up to me and startingtalking to me and uh I was feeling so worthlessthrough all that abuse and everything I felt so^Entrenched Belief Systemdisconnected spiritually and to myself. I really thought^Negative Self-TalkI had a multiple personality problem for a long time.^Silenced by othersI was really appalled with myself and I'd get loaded.^Obliterate RealitySo I met this priest and uh said some of the things that^Emotional (E) "Using"happened at home and some of the things that^Triggerhappened and uh .. this person, I really, .. he showed^Self-Disclosuresigns of empathy to me. And uh .. it was really neat.^Connecting with OthersNot long after that he would hold me in his lap andstart kissing me and it was just like, again I just felt^Auth. Victimizationthere was something wrong with me. That was my^Sexual Exploitationfirst, try to get some help.^ Personalization ofKO: That was when you were 17.^ Trauma/ BetrayalWendy: yeah that was the first part of it and thesecond was when I started going to meetings. There Italked about resentment towards my mother and^Help Seeking Behaviour107found out that she and her siblings were abused by the^Self-Disclosuresame uncle and yet she [mother] used to send me there^Betrayalfor summer holidays.KO: That information must have been very painfulfor you.Wendy: yeahKO: What happened with your recovery during thistime?Wendy: I just kept stumbling, yeah well I didn'trecover, I just kept escaping. I ran away to^and ah I ah helped set up an AA program. I went to a^S & E "Using" TriggersDr. and asked if there was anyone who would go to^Obliterate RealityAA and she gave me a list of people with names and^Connecting with Othersnumbers of people who might need the program so Iphoned them all. I didn't know any better. [laughter]^Other Directedand that was the beginning of AA in the^. Iran into more of this "I spilt more on my tie than youever drank" and also still feeling really bad aboutmyself. The thing that kept on running through my Imposed Negation ofmind no matter how sober I got, no matter how much^Experiences108Negative Self-TalkI was taking care of myself was what a worthlesshuman being I was. Absolutely worthless, hopeless,right! I think, people would see the outside of me andpeople admired me and liked me but my thought wasif you ever knew, or got to know me you wouldn't likeme. And it wasn't just sort of, it was a really strongbelief system that I had and me knowing how bad Iwas and how evil I was how immoral I was you know,from all this stuff, from the past. It was just, it mademe crazy. Uh .. it was like always staring at the edgeof life and that black down there and that was just allof me. I'm not being dramatic, I would visualize thatit was just very powerful and every time I got into thatI would use again. It wouldn't take much to get me tothat place. Simple things would send me to that place.Not being able to do my job well. uh loss of arelationship, I didn't, .. I couldn't even maintain arelationship with any nice people that came around, Iwould barely look at them. So, I ah .. finally when Igot to be 19, I really felt that like I had to get a clearerEntrenched Belief SystemNote: incongruence ofself and image presentedto others - self-detachmentEntrenched Belief SystemPersonalization ofTraumaCognitive LinksE "Using" TriggerNumbing BehaviourS "Using" TriggersAlonenessObliterate Reality109picture on things, I had chunks of sobriety, what it was^Self-Searchinglike to be sober, and something would happen. Plus^Note: desire for change -that, trigger, there was always that thing in the back of^Self-Discoverymy mind that I wasn't normal. That I needed drugs tofeel normal. I was always going back and using drugs.^E "Using" TriggerKO: So you used drugs in order to feel ok.Wendy: No, Not ok, I just didn't care. No I never did^Entrenched Belief Systemfeel ok.KO: I guess I mean that you used to get that sense ofnormal.Wendy: No, ah I guess I believed that is what wouldmake me normal but I never reached normal.^Denial ?KO: OH I see,Wendy: Yeah I was looking for it but it was never^Self Searchingthere, it wasn't in a bottle, it wasn't in a bottle of pills,it wasn't anywhere. Normal! It just didn't happen. I^Entrenched Belief Systemdidn't know what they were talking about but at leastI felt numb. You know, if I took enough I felt numb^Numbing Behaviourand uh .. I could cope. By this point my mother had^Cognitive Links110gone into a treatment centre and I knew about it and^Self Searchinghad been around it. So I went to a treatment centreand I quit my job.One of the things that use to happen to me wasthat I ended up having zero memory around my body.^Memory impairmentAnd uh I really didn't know how to say to somebody,^IsolationI don't feel anything and I just ended up^Secret Keepingfeeling...whenever that happened, whenever I would^E & S "Using" Triggershave sex, It seemed like, that only reinforced that^Sexual Triggerfeeling of the abuse. The sex act would trigger that^Sexual Triggerwhatever, .. I could be sober for a long time, and have^D/A Abstinencesex, and there was a real connection there.^Cognitive LinksKO: So it would kick up all the feelings and memories^Note: identifying SA/of the abuse?^ addiction linksWendy: It was, move into a relationship and before wehad sex, I would use. In order to get into that intimatepart of the relationship. I might being seeing Situational "U" Triggersomebody, but if I thought we might sleep together I^Sexual Triggerwould use. Afterwards, it would be worse using. I^Acknowledges Emotionswould also feel suicidal. So I went into treatment at^Help Seeking Behaviour11119, but I was so angry, I went in there really angry witheverything, and angry that I had to do this. I went toone of the counsellors there, for the first time, and wetalked, and they had male counsellors there at thattime, and it was a test [sigh]. He was a minister, and hewanted to know and said I want you to think aboutthis, what is it that triggers you. You talk about beingtriggered all the time, what is it that triggers you. Ihad never verbalized that so I had to go away andthink about it. I came back and I wanted to talk aboutthe abuse and the abuse in my family, throughout mylife. He just sat bolt upright in his chair and said thishas nothing to do with anything to do with drug andalcohol addiction. These aren't the triggers I'm talkingabout. These aren't triggers. I was just flooredbecause I thought ok what is it that I do and mappedout the sexual thing and realized I had never beensexual without being under the influence even with aman I had been with for over 2 years.KO: So you were very clear about what the triggersHelp Seeking Behaviour/acknowledges EmotionsHelp Seeking BehaviourSelf SearchingSecret KeepingSelf DisclosureUnsupportive FeedbackDichotomized TreatmentImposed Negation ofExperiencesSilenced by OthersPattern AwarenessCognitive LinksNote: Identifying SA/Addiction Links112were for you. Again, somebody couldn't or wouldn'thear what you were saying?Wendy: No, No he wouldn't hear it. So him being^Silenced by Othersstraight and sober and a counsellor, my god, I must be^Auth. Victimizationreally off the fucking wall if that's what I thought a^Negative Self-Talktrigger was and there must be something else out thereif that can't be it. And I believed him. I didn't^Silenced by Othersquestion him at that time. I just thought I'm really^Alonenessscrewed. I really don't know what it is then. I justwent into myself even more with anger so the next^Personalization ofthree months they threatened to throw me out of^Traumatreatment because I wouldn't open up. The director at^Silenced by Othersthis point, who was a friend of my mothers, said she^External Contact (+)ain't going anywhere. I got really angry and quiteaggressive and people were really nervous around me.^Express EmotionsKO: Did you have any other support?Wendy: No, when I left there I went to quite a few AA^Help Seeking Behaviourmeetings and I met a woman who was in treatment^Connecting with Otherswith me and we hung around a lot. I got involved inhelping set up a house. There was no place safe for me^No Safe Place113to live. So I helped set up this house for women^Connecting with Othersleaving treatment. This counsellor got involved and^External Contact (+)helped get this house ready for people to move in andto uh so I kept busy.KO: So, did being involved help keep you sober?Wendy: Keeping busy? yeah, yeah it did. I took thestaying sober really seriously. If nothing else that'sone thing I grabbed and held onto, again I recognized^D/A AbstinenceI had a real problem. I uh .. then one day I got aphone call to work at ^ and .. uh from the^Problem Recognitiondirector who really liked me and I guess she saw what^External Contact (+)I was doing and what I represented at^KO: What kind of Job was it?Wendy: Working as a House Attendant. That reallykept me going if nothing else. I was probably 21.Wendy: by this point I had started seeing an ADPcounsellor and we started talking about the abuse .^Self SearchingI walked in and the only counsellor available was^Self Disclosureanother man and I ended up just going this is really^Note: Lack of choice &bad and I recognized it as being really bad and if there^resources - Oppressive114is any way I can get a woman...but there just wasn't^Power (community)any available. I was beginning to sense boundaries just^Establish Boundarieson my own it was not that anybody had told me inparticular but I read a book and I was going down thestreet and it really affected me. It was just sort of, Oh,..it's clear to me. Like we talked about it briefly at^Cognitive Links[treatment ctre] but it was a different program back^Self Disclosurethen. I made up my mind I don't want to be touched,^Establish Boundariesyou have one strike against you, you're a man, Ill giveyou 6 sessions and I'll see how it goes from there. Andah this person was really respectable, and veryrespectful of me. I told him there is a whole bunch^External Contact (+)going wrong here and I don't see any salvageable parts^Negative Self-Talkof it. The only problem with him was that he was sonice that again I couldn't tell him the truth about^Secret Keepingmyself. I knew how badly I looked at myself.^Entrenched Belief SystemKO: When you talked about the abuse, you did talk tohim about the abuse, was it in a general way?Wendy: Yeah it was in very general terms.KO: What was his reaction?115Wendy: He would uh just, he recognized I guess howbad I felt about myself, I'd say that outloud, and hewould always try to take the responsibility away fromme. He was the first person to point out to me that Iwasn't responsible for everything that ever happenedto me. The other thing was, is that I didn't believehim. I'd hear it and feel good but in the end I'd say`well he gets paid to say this'. Like my belief systemwas so entrenched and I thought it was very nice ofhim to say that, and felt cared for, but I didn't reallytrust that that was the truth. I knew it wasn't thetruth. It was the first time I talked about it, well notthe first because the priest was the first person I talkedto. I think that priest saw me as some moral, a littlesexual object, because that's how I looked at myself.KO: It sounds like he took advantage of you whenyou were very vulnerable.Wendy: yeah extremely so. But this person didn't.This person looked at me and said Wendy you are avaluable person. I think he may have been the firstExpress emotionNote:^Allocation ofresponsibility for abuse -Identifying SA/Addiction LinksEntrenched Belief SystemNegative Self-TalkEntrenched Belief SystemExternal Contact (+)Personalization ofTrauma/Self DisclosureSexual Exploitation/Personalization ofTraumaAuth. Victimization/External Contact (+)116person that I ever impressed upon how close I was tokilling myself all the time. Kathy there were years that^Relieve Emotional Painall I thought about was committing suicide. And I^Escapismtried to do it also. Anyway, .. ah, .. after we met Istarted, I got into a situation, I was probably a year^Intimate Relationshipand a half past treatment and celibacy. I got involved^D/A Abstinencewith this woman I had been in treatment with and shestarted using [drugs] and got involved in a relationshipwith another woman. We were close and inseparable.^Connecting with OthersShe kept putting alcohol right in front of me when she^Situational "U" Triggerwas using. She would always have my favouritealcohol around and knew what I liked to use. I t wasimportant to her that I use with her and I started using^E & S "Using" Triggersagain. Her part in it was that she set it up but my partin it was that I did use. I wasn't taking care of myself^Denialand I didn't know how. Here was this person that^Isolationreally cared about me and I just didn't know how tocare about myself. And as soon as I drank again, she^Emotional "U" Triggerlooked at me and smiled and said "I knew you were no^E & S "Using" Triggersbetter than me" and I just reinforced it.117KO: How long did your drinking continue?Wendy: I don't know how many months, but anotherthing that happened was as soon as I used, we got intoa situation, her drug of choice was heroine and sheknew I had used it in the past and things I was goingthrough, she knew a lot about me, and uh she got someheroine and by that point it , what was the use? Andbasically that's what she told me. I was also, aroundthat time, was in a car accident and was put onbarbiturates and codeine and barbiturates was myhook [medical details]. I was in a lot of pain and I lostthe job at^ over it because they couldn't hold thejob open for me for that length of time and uh so sheended up getting some heroine and we ended up usingit together. Over the course of the evening she endedup initiating a sexual situation that I didn't want tohappen and I kept voicing that, in my state, and wejust ended up getting involved and it just triggered allsorts of stuff. I was a whore again. It was reallydevastating for me because I didn't want to have sexSituational "U" TriggerDichotomized TreatmentE & S "Using" TriggersSexual ExploitationSexual TriggerNegative Self-TalkNo Safe Place118with this person, and again I used because at that timeI had a lot of attractions for women but not her. Ididn't find her attractive in that way at all, in fact Ifound her quite mean in the way she treated people.She got up in the morning and said well I'm out ofhere, I"m meeting some people for breakfast and Iphoned My counsellor and said I'm going to killmyself.KO: Throughout this period of using had you beenstaying in contact with your counsellor regularly?Wendy: yeahKO: And he didn't know you were using?Wendy: I don't think he knew I was using, I didn't tellhim. And I didn't tell him the truth about whathappened that night. I told him I used but I didn't tellhim about ... the attack, it really was abuse. So I tookresponsibility as "why did I let this happen". We hadtalked about having no boundaries at great length andshe knew about my abuse to a degree and my fear anduh [pause] and so after that I went and talked to some119Emotional "U" TriggerNote: Sexual IdentityHelp Seeking BehaviourRelieve Emotional PainSecret KeepingCognitive LinksNegative Self-TalkBetrayalEmotional "U" Triggerfriends of hers and got really stoned. And within daysI was sleeping with her best friend who was a guy. Itwas like save me get me out of here. He looked at meand said when I look at you I don't see your heartbeing in this life. Which, he was really drunk andstoned, and I said I don't know what the fuck I amdoing here, this is not where I want to be and he saidthis is not where I want to be either. He didn't use likeus. He drank a bit and used but it was like take it orleave it. He said I'll save you and I went andstraightened up again. We went up to and I was on my prescription medication for mymedical stuff. And then I started abusing that. Hewas the first person I ever took a chance with and sleptwith without the use of alcohol and drugs and uh itwas ok. I was surprised it was so ok. And it was thefirst time I didn't feel suicidal after sex but I still feltunclean. I really couldn't get over that hump of notfeeling somehow unclean about the whole situationand I told him about my feelings about women andPersonalization ofTraumaIntimate Relationships/Pattern AwarenessConnecting with OthersD/A AbstinenceSituational "U" TriggerTrustIntimacy ComfortableCognitive LinksEntrenched Belief SystemSelf Disclosure120that I probably wouldn't be with him very long but I^Self Searchinghad a lot of stuff to sort out. He was very open to meand said I will enjoy you as long as I have you. He was^Intimate Relationship (+)a great person. I had to figure it out though.^Self SearchingDuring all this time, the relationship with the priestwas still occurring. It was a thread that went through^Sexual Exploitationthis whole time^ Auth. VictimizationWendy: Meeting B_ helped me escape my fear of^Safetywomen for awhile, my fear of a relationship. He is^Denialtotally a non-threatening person. Helped me escape^Safetythis priest. I had a reason not to do these things^Connecting with Othersanymore. Just safe.^ SafetyKO: Did you quit drinking the whole time you werewith B when you were in the^?Wendy: No, no I didn't. At some point I grasped^Obliterate Realityanother 11/2 years of sobriety, it seems a year and a^Note: Relapse patternshalf was a real milestone for me. Then I used againand I don't really remember it. Until pretty much thetime when B had a heart attack. Close to then.121B^had a heart attack, I was leaving him. I don'tremember when I started using again, it was prior toleaving him.KO: Nothing stands out for you during that time orwhat may have triggered that time.Wendy: NO [pause] It seems like for a long time it waslike chunks of years then almost to the month I wouldhave a year of sobriety and then use again. I couldn'tgo to AA. I knew what I needed to deal with Icouldn't really get there. I tried going to a femalecounsellor who dealt with sexual abuse and I justwould panic. Just absolute shear terror and I couldn'tget to the point to where I could talk to her about thisI didn't feel safe with her at all. B and I would talkabout the abuse, I never told him about my family inparticular, oh the sexual abuse was also with my sister.My only sister. She would set it up also, she set it upthat her boyfriend would come into my room and havesex with me. I was 13 and we had been drinking Iwas absolutely freaked out. She knew about the baby-Memory ImpairmentObliterate RealityDichotomized TreatmentHelp Seeking BehaviourMemories/FlashbacksOverwhelmingSilenced by OthersNo Safe Place (to share)Self DisclosureNote: important to sharestory - would jump backand forth from childhoodexperiences to present122sitter sexually assaulting me too. So I couldn't talk to^recovery processmy sister who was like the closest person in my life to^Betrayalme. And she lived up in the^ . Then mymother, oh my mother, there, that's a trigger. Mymother moved back to the^and that's when^Emotional "U" TriggerI started using again at one point. All of a suddenshe's in my face. I really had a hard time coping withher. I wouldn't let her touch me. I'd be nauseated if Obliterate Realityshe touched me. Anyways I used in that time.KO: So how old are you know, for what you have^Emotional "U" Triggershared with me up to this point?Wendy: Probably, there's that gap I can't remember,it's just a sort of blur. Early 30's.^Memory ImpairmentKO: So you have left B ,Wendy: We went to Mexico, and we had never takena trip together and damn it we were going to even if wewere splitting up. So we went to Mexico and uh Idrank a lot in mexico and I had to get Valium to calmmyself in between drinking. We got back. I had all Note: Relapsekinds of reasons to leave him. I thought I was dying in123the relationship. I wasn't treating myself well and Iwasn't treating him well. Nothing! That's when a realmajor shift happened. I came back from there. He Self Searchinghad a heart attack within about two weeks and theydidn't expect him to live. I didn't drink but I used, I^E & S "Using" Triggerwasn't sleeping, I was staying up all night, the doctorlooked at me and I just looked like shit and the doctorsaid what's wrong and I went to talk to him and I saidI can't handle this, I'm not coping very well. I'm notsleeping at all and from the time I was a little girl Icould put myself to sleep. That's a tool I have and I^Numbing Behaviourcan't fmd it, I was hysterical because I can't find it and^DeliberateI couldn't escape from how I was feeling. He says^EscapismWendy has there ever been any, were you ever sexuallyabused? And this wall came down. I could feel it, it^Safetywas almost like you could hear it. I said that has^Pattern Awarenessnothing to do with anything And it was just echoing^Negative Self-Talkwhat I had been told, what I was told in the 70's by thecounsellor, it has nothing to do with it, it has nothing^Silenced by Othersto do with it. I really believed that, I mean I knew how^Entrenched Belief System124bad it made me feel but I had already been told in no^Cognitive Linksuncertain terms that that was something else, keep thatsomewhere else because that has nothing to do withwhat your life has been. So I uh. He started askingmore questions. He said I think what you are going Imposed Negation ofthrough right now has a lot more, than what you are^Experiencesgoing through with B_. "It seems like there is a lotof stuff surfacing for you." And I just like, shit, I can't^External Contact (+)deal with this. You know, and I uh anyways we^Escapismstarted talking and he finally started telling me that itwas ok just to talk about it if I had to talk about it. He^Self Disclosurewas really cool, he had no experience with sexual abusebut he told me that he may not be the person to talk to^Safetybut he would like my permission to find someone for^Trustme to talk to. I went home and I was shaking,absolutely shaking and I [pause] . The first thing that^External Contact (+)welled up was intense anger. I finally got really really^Express Emotionsangry. Almost uncontrollable. And I really pridedmyself in being controlled. All the feelings were^Express Emotionsuncontrollable. I think I was just so vulnerable and125open because of all this other stuff going on. No^Cognitive Linksstrength left to keep the lid on it. So I just startedtalking. He and I would talk and when I couldn't talkabout something, at that point I had never verbalized^Self Disclosurewhat had happened with my mother, that was the^Secret Keepinghardest part for me. He says if you can't saysomething you could write it down for me. He gaveme a lot of leeway. So I wrote it out. It was really^Safetybizarre but it gave me a lot of insight into myself^Self Disclosurebecause it was really little writing and I felt really little^Cognitive Linkswhen I was writing it. It was on a little tiny piece ofpaper, the whole story. Things I thought about myself,at that point in my life, I'm a business woman, I havestrength, I have a position in the community, I had^Note: Story Sharingbeen involved with politics all this stuff and here wasthis little tiny writing, and this little tiny person and Ijust felt so little. And, uh, uh, I was terrified. And Imet T . I knew this man through my business and he^Cognitive Linksphoned me at home one day just out of the blue and^Connecting with Otherssaid hi. I said T___ you can't believe what's going on126for me and I knew he was great to talk to, what he wasworking on [ book on sexual abuse]. Anyhow it wasjust those feelings of, there would be one step forwardand then this ton of shit land on me again. Allthrough that no matter how good I would feel aboutsome little insight I might get, what became morepowerful was the feelings of my worthlessness. And Ihad a really hard time getting past the fact that mybeing worthless. Spending money if I wanted to go totherapy, just anything that I was worth it. And in thattime my doctor suggested I go to a woman's sexualabuse workshop. I went reluctantly. When B andI were together, 9 1/2 years, we only slept together thefirst three years. I always felt there was somethingwrong with my body. I use to do things to alter myappearance. To make myself unattractive. I would gofrom wearing very good clothes to wearing baggyclothes. Cut my hair, quit wearing make-up and justalways do something to alter my appearance.KO: Do you understand now why you would try andTrustNote: notion ofintertwining processCognitive LinksEntrenched Belief SystemNegative Self-TalkConnecting with OthersPersonalization ofTraumaBody Image (-)127alter your appearance?Wendy: No I don't actually. Well, yeah I get reallypanicked even now at times. I just want to be leftalone. Even gaining weight this past year, I had asituation develop that made me very uncomfortable.I felt unattractive in my personality, you know, beinga human being and physically too.KO: When you started talking to T____ and your doctorabout your sexual abuse experiences, how was that interms of your recovery process for drugs and alcohol?Wendy: My recovery process, like, Kathy, it was sochopped up. I would start talking about somethingand then go drink. I started drinking again just a littlebit, controlled, I just needed something to get methrough the evening and I'd leave it at that. I wasn'tdrinking a lot. Then one day two and a half years agoI, [remembered earlier comments and jumped back]I didn't use anyone for support beyond them, I wouldjust white knuckle it until I saw them again. Ratherthen turn to anybody---I would not call anybody from128Personalization ofTraumaNegative Self-TalkObliterate RealityEntrenched Belief SystemNo Safe Place - beforeNote: establishingsupport networkNo Safe PlaceAA, I had no support system, I could not talk toanybody about this My doctor also introduced me tothis woman who was suppose to be a sexual abusecounsellor from , and every time I told herabout my abuse, every session she cried, she wouldburst into tears and fall apart and I would be sittingthere trying to rescue her for the rest of the session.She use to say "that is so awful," and that is the wordshe use to use, awful. I would just cave in on myself.So I used during that time. It was that maintenanceusing. It was like every two days, whatever.Self DisclosureDichotomized TreatmentOther DirectedSilenced by OthersEmotional "U" TriggerThe last time I ever drank was two and a half years agoand I don't remember anything. I came out of itdesperate and suicidal. I realized I needed treatmentagain. Also, because I had worked in the system, itwhat kept me from going to treatment the second time.I needed it, but if I ever ran into anyone I knew or ifthey found out the truth... It was all that thing aboutthe truth and the secrets. That was just my whole life.D/A AbstinenceMemory ImpairmentMemories OverwhelmingHelp Seeking BehaviourSecret Keeping129To maintain that secret. So I went to ADP and said Iwant treatment. I went to a place that didn't deal withlong term issues, but that was ok. It was a co-ed livingsituation but we had women's groups for the first time.So I was really lucky in that and we talked surfaceabout sexual abuse. By that point in my life, I reallyneeded the AA Part of that whole thing, I was workingon that other stuff. But I had never come to termswith God, My spirituality, ever. I never believed I wassalvageable because of the abuse. And for the firsttime I talked and thought about it. I think for the firsttime, I had 34 years of processing under my belt, andI just needed some place calm and peaceful so that Icould move through that. I was able to sort out the"exact nature of my wrongs" [AA: step 4] vs the natureof the wrongs done to me. And I was able to unload90% of what I had been carrying. And sort out whatsomebody else had done to me and what I wasresponsible for. That was just freedom, absolutefreedom for me. Because I took the "exact nature ofSecret KeepingHelp Seeking BehaviourDichotomized TreatmentSafetyNote: Need to sharestoryHolistic HealingSpiritualityEntrenched Belief SystemNote: Shares StoryPattern AwarenessSafe placeSelf SearchingProblem RecognitionNote: ResponsibilityallocationAcknowledge Emotion130my wrongs" to mean my sexual abuse. When I did my^Cognitive Linksfourth step, my sexual abuse was in there, I was sexualat four, I was sexual at and that was so much of ahook.KO: So who helped you sort this out and understandthe difference between your responsibility fromsomeone else?Wendy: I had a female counsellor for a week and thenSexual Triggerthey gave me another male. But this guy nameddid the lectures there on the 4th and 5th steps, and it'sreally funny, he's a born again christian, a realdifferent view of spirituality but what he was able topoint out ah, I felt he was talking to me even though^Connecting with Othersthere was a room full of people because that's what Iwas struggling with. and my belief system was so^Entrenched Belief Systementrenched. I don't know how to tell you this, butseriously it was the most important thing I had ever^Pattern Awarenessheard. I was able to look at people in AA, fear, the^External Contact (+)fear went out the window. I cried for 24 hrs off and^Express Emotionson, sobbing, just absolute relief to figure that out.^Cognitive Links131Even yet, with what I'm going through right now Iwant to keep taking it back. It's not a conscious thing,all of a sudden I start taking back responsibility forthat [abuse]. I have this fear that I'm going to be heldresponsible and then I start feeling responsible and it'sjust a constant process. Oh that's fixed let's move on.I realize that was an important thing that happened forme.KO: Have you been sober since that treatment? Andwhat has helped during this time?Wendy: yeah. I started going to a counsellor when Imoved back to Vancouver. I kept seeing my doctor upin and when I moved I immediately hooked upwith a counsellor down here and have switchedcounsellors since. She wasn't able to do any more forme and I was able to see that. And that was a bigchange for me, well this isn't quite where I am at, Ihave moved beyond this To think I was beyondsomething, not that I was so good, it was just I hadworked out so much and gained so much strength. ICognitive LinksEntrenched Belief SystemPersonalization ofTraumaLabellingCognitive LinksHelp Seeking BehaviourConnecting with OthersProblem RecognitionEstablish BoundariesSelf-LoveHolistic Healing132also started going to AA regularly for the first time.^External Contact (+)T introduced me to another counsellor and she wasstronger. I needed a stronger counsellor. I did more in^External Contact (+)the first two sessions than I've done in the last 15years, [laughter]. It's just that I was ready, to say^Self Disclosurethings outloud, and my fear of saying things outloud,I always had this thing that if you said something^Entrenched Belief Systemoutloud then it made it real if you didn't say it outloud^Secret Keepingthen it didn't have to be real.^ EscapismKO: As you have been working with her and talkingabout your childhood sexual abuse, have there beenany times in the past five months that you felt likeusing drugs or alcohol? You have talked aboutwanting to use in the past whenever you started to talkoutloud about these issues.Wendy: All the time.KO: Is there anything that is different this time fromthe past that has influenced you to decide not to use.Wendy: ah [long pause]Kathy: Because that has been one way of coping,133something that has helped you get through all theseyears. Even if it caused you it's own set of pain.Wendy: There's a place I came to, that God had mademe special, and I feel really special. The spiritualconnection, even my self-esteem. My presentrelationship is negative towards my self-esteem, butwhen I'm away from that, my self-esteem, my sobriety,where I am in my growth, as a human being I'm ableto feel real positive. Sometimes it's really hard And Iwant to isolate still but I'm finally able to recognizewhat I want and what I need is two different things. Inever recognized that before. So I force myself to dothings that is against my ingrained belief system. So Igo to AA, Call up my counsellor, I tell people how Ifeel, how bad I,m feeling. I can do that sometimes. Inever use to do that I just isolated before. No secrets,I'm really out about my abuse, I'm really out about mysexuality, who I am and what I am. That gives mestrength, there is no hiding anymore. I think that's alot of what it is, I don't have to hide anymore.SpiritualitySpiritualityIntimate RelationshipHolistic HealingCognitive LinksEntrenched Belief SystemConnecting with OthersSelf DisclosureSexual IdentityTrust (self)Safety134KO: Do you think, now that you've had all thisexperience, uh, is there anything that comes to mindthat would have made a difference for you when youfirst sought help?Wendy: Oh God yes. I grieve that all the time. Justmore training uh, uh a willingness to talk about abuse.It would have made a real big difference if I hadn't meta priest that wanted to take me to bed. I realize nowhow much this has affected me. Talked about this withmy counsellor, [pause] and it's just grieving that losttime.KO: So you felt worse when you came up against thatsituation when you first reached out for help, to keepthe secret.Wendy: It just reinforced how I felt, not evenreinforced, it added on to it. A sexual relationshipwith a priest was like the worst. But I didn't think theworst of him it was the worst of me. He's a wonderfulperson, if you had talked to me back then or even afew years ago. I could have done a speech for him atNote: Need for trainedprofessionals and safeplace to share storyCognitive LinksExpress EmotionEntrenched Belief SystemAuth. VictimizationPersonalization ofTrauma/Cognitive Links135a friar's convention [laughter] or something and then^Entrenched Belief Systemhe'd take me out of the depths, and then I thought ,^Auth. Victimizationwait a fucking minute save me from what? That'swhat he told me he did. I just couldn't believe it. So^Personalization ofyeah if there had been somebody there. And the^Trauma/second time after him, sorry, I'm going back a bit^Cognitive LinksKO: that's okWendy: Somebody told me about someone whoworked a lot with sexual abuse in the nativecommunity and my family being native on my mothersside, my uncle who abused me, I felt that maybe it was Self Searchingsomething in the native social system that I don'tunderstand or that I need to know more about. Ithought there was a higher prevalence of sexual abusein native communities. So I went to this sexuality^Help Seeking Behaviourworkshop so here is this person I had been told about,he was just great, and this guy was God as far as thisperson was concerned so I thought well, I'd like to^Connecting with [safe]meet this person. So it was really my second foray into^Othersmeeting someone who is experienced in working with136sexual abuse. [early 30"s of age, 4-5 years ago]. So Imet this man, and said we have a mutual friend. Heasked what my interest was in this area, and so I told^Connecting with Othershim, it was mostly personal, that I hadn't worked out^Self Disclosurea lot of my own stuff yet. So he invited me up to hishotel room later to pick him up for supper and I wentto go get him. I didn't think anything of it. Heshowed up to the door with nothing on but his shorts Betrayaland he said oh you just caught me getting out of theshower, come on in. We had talked earlier aboutboundaries, all these things. I really had told him a lot^Self-Disclosure/Betrayalabout myself so it was like he had all this informationabout me. Ammunition. Within seconds this man was^Auth. Victimizationundoing my blouse and telling me how beautiful I was^Sexual Exploitationand telling me how attracted he was to me the minutehe saw me. You know, all that shit. I'm standingthere going, I could hardly breath, and could hardlytalk. I think about it now and I just want to throw up.^Note: voiceless - self-it was really devastating.^ detachmentKO: Yeah especially since you were told he was137someone out there helping people.Wendy: Yeah, shit that was his workshop. It was^No Safe Placeabout sexual abuse and about people in power abusing^Auth. Victimizationit. I finally was able to find my voice and stop him.^Establish BoundariesThen he said I really didn't want to go for supperanyway. It was really hard and again I felt^Betrayalresponsible. I felt like hell.^ Personalization ofKo: Although we have been talking about this for the^Traumapast hour and a half, do you have any particulardefinition of recovery?Wendy: Yeah, I think it's holistic. I couldn't recover^Holistic Healingfrom my drug and alcohol abuse until I looked at my^Note: Identifying Sexuallife. My whole life. Recovery for me is just my whole^Abuse/Addiction Linksbeing, spiritual ,emotional, physical. It didn't happen^Holistic Healinguntil I was willing to open up, until I found someone^Spiritualitysafe to talk about the issues that were most important^Safety - Share Storyfor me. The ones that I felt worse about myself andthat was my sexual abuse. No doubt about itabsolutely no doubt about it. When I look at how I^Note: Identifying Sexualbehaved, how I drank whenever I had sex. After^Abuse/Addiction Links138Note: Self Discoveryunderstandingexperiences in contextHolistic Healinghaving sex with someone I would stand in the showerwith cold water. There was such a connection there.Recovery affected my whole life. I mean recovery tome was getting past all those things. I still haveflashbacks sometimes uh during sex, and I'm able tolook at it. There need not be the fear. I can deal withit at another time. I have some place safe to go to talkabout that. Recovery is not one piece, it's not like Idrank, take away the booze, it was just impossible,that's what I did and I kept drinking. I don't know ifit's like that for everybody but I certainly know whatit took for me to get to a place where I know I can staysober. And even then, in the last couple of days, I'mmoving towards a complaint and laying chargesagainst someone. I'm going to a meeting the day aftertomorrow about that. Something in the back of mymind goes medicate me. Something is there that, thepain gets so intense, that its really subliminal and itends up screaming. [laugh] Huh! it's time to go to ameeting.SafetyPattern AwarenessD/A AbstinenceConnecting with OthersNegative Self-TalkConnecting with Others139KO: So that's helping you right now.Wendy: Yeah and talking to friends. Reach out. Me^Trustbeing vulnerable has always meant time to be taken^Connecting with Othersadvantage of but now I'm vulnerable and I trust for^Trustthe most part the type of people that I surround myselfwith. IT IS getting better!^ Self-Love!140

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