Planting the seeds of change: Directionality in the narrative construction of recovery from addiction

Abstract

Objective: The dominant theoretical perspective that guides treatment evaluations in addiction assumes linearity in the relationship between treatment and outcomes, viewing behaviour change as a ‘before and after event’. In this study we aim to examine how the direction of the trajectory of the process from addiction to recovery is constructed in personal narratives of active and recovering users.

Design: 21 life stories from individuals at different stages of recovery and active use were collected and analysed following the principles of narrative analysis.

Results: Personal trajectories were constructed in discontinuous, non-linear and long lasting patterns of repeated, and interchangeable, episodes of relapse and abstinence. Relapse appeared to be described as an integral part of a learning process through which knowledge leading to recovery was gradually obtained.

Conclusion: The findings show that long-term recovery is represented as being preceded by periods of discontinuity before change is stabilised. Such periods are presented to be lasting longer than most short-term pre-post intervention designs can capture and suggest the need to rethink how change is defined and measured.

Keywords:

• addiction/substance use
• behaviour change
• narratives
• recovery
• processes of change

Acknowledgements

We owe many thanks to Andrea Verenini for his valuable assistance in designing the graphs, Laura McGrath and Serena Wright for their insightful comments and support. Thanks also due to the anonymous reviewers and the editor for their helpful feedback on earlier drafts of this paper. Finally, we are immensely grateful to the participants who shared their life stories with the research team.

Notes

1. Metaphysics is the term applied when questioning issues related to the definition of reality that go beyond those that can be addressed by scientific methods (for example being, causation, categories of things that exist). Ontology is closely related to and can be considered as a branch of metaphysics (Blackburn, 2008, pp. 232, 260). Ontology is mostly concerned with what exists, etymologically deriving from the Greek word οντολογία whereby the ὄν refers to something which is/exists (authors’ translation).

2. the phrase ‘πάντα χωρεῖ καὶ οὐδὲν μένει’ is attributed to Heraclitus translated into ‘everything is moving and nothing stays the same’, found in Plato’s Cratylus (402a). (Campbell, O’Rourke, & Silverstein, 2010; Kahn, 2013).

3. It is useful to note the misconceptions surrounding the use of the term ‘chaos’ which result in the associations of the term with randomness and unpredictability. These misconceptions originate usually from the unscientific use of the term or its use as a metaphor. However, the main element of chaotic systems is their sensitive dependence on initial conditions with big changes in future states, occurring after only minor errors in measurement of the initial conditions (Kincanon & Powel, 1995). In this context, although Hager implies non-linear motions in human behaviour, he does not clearly define the term ‘chaos’. Although non-linearity is inherent in chaotic states it can be found in other systems too. In this case, it is not clear if treatment is perceived as change in initial conditions that could cause chaotic behaviour and it can be assumed that the term ‘chaos’ is used as a metaphor of random and unpredictable behaviour.

4. Drug maintenance, substitution or replacement therapy involves the substitution of an illegal drug, such as heroin, with a legal one such as methadone or buprenorphine (usually found under the trade name Subutex).

5. Pomerantz (1986) discusses the conversational uses of Extreme Case Formulations, extreme expressions such as all, none, best, least, as good as it gets, always, absolutely, perfectly used as rhetoric devices to illustrate activities such as complaining, justifying, accusing, legitimising, defending.