Recovery from alcoholism: a spiritual journey

A Critical Review of Qualitative Interview Studies with Alcoholics Anonymous Members

Background: Alcoholics Anonymous (AA) is a community-based NGO that supports people with alcohol misuse concerns to achieve and maintain abstinence. Qualitative methods are best suited to investigate individual experiences of recovery in AA, since this typically involves not only abstinence from alcohol but also the global psychological growth of the whole person. Despite this, the growing body of qualitative research exploring individual experiences in AA has yet to be collated. Objectives: The aims of this paper were to systematically search for and critically review qualitative interview studies with AA members. Methods: A systematic database and citation search identified 21 articles published between 1977 and 2014. Two independent reviewers assessed each research report and extracted data pertaining to the findings and the methodological quality of the studies. Results: Major themes across the reviewed articles included 'rock-bottom' experiences and powerlessness, and identity and change processes in AA. Findings related to the methodological quality of the papers were both general to qualitative research and more specific to AA. Conclusions/Importance: Research in this field has been characterized by a relatively uncritical discovery of AA narratives among AA members and by a lack of methodological rigor, which is likely to perpetuate its negative standing in the context of academia, and therefore in public and political discourse. Overall, findings demonstrated a pressing need for high quality qualitative research on AA.

An Integrative Review of the Concept of Spirituality in the Health Sciences

Spirituality is a universal human phenomenon, yet confusion and incomprehension of the concept is ever-present. The purpose of this study was to explore how research on the concept of spirituality has been reported in the health literature in the past decade and develop an ontological and theoretical understanding of spirituality. The examination was based on quantitative and qualitative integrative review approaches, which integrated empirical research on spirituality. The sample included 73 spirituality research articles, which were published in English between January 1990 and September 2000. An electronic data-collection tool was designed for use in this project and formatted using Excel software for transfer of codeddata into the NVivo software for the data analysis. The results identified essential elements of spirituality, current use of operational definitions and instruments, conceptual frameworks used in spirituality research, and cultural aspects of spirituality. Historical comparison among decades and barriers in researching spirituality are discussed.

Narrative and attachment in the process of recovery from substance misuse

OBJECTIVES

The aim of this study was to illustrate the individual accounts of a small group of substance misusers who had found psychological therapy helpful in their recovery from substance misuse. The study also aimed to highlight the roles that the psychologists played within these narratives.

DESIGN

Narrative analysis, a qualitative design, was used to capture the unique recovery narratives of substance users who had received psychological therapy.

METHODS

Seven participants (three males and four females, age range 40-54 years, six White British, one White European) were recruited via clinical psychologists from an addictions psychology department and participated in 60-90 min interviews.

RESULTS

Analysis of the recovery narratives resulted in an overarching theme; role of the psychologists as a secure attachment figure leading to the development of surrogate internal working models, and the following subthemes which developed and maintained the attachments: closeness and proximity leading to positive expectations about the relationship, safe haven leading to increasing capacities for affect regulation, secure base leading to the experience of being able to mentalize regarding ones mental states and associated actions, and separation distress leading to internalizing the psychologists.

CONCLUSIONS

The study analysed the personal accounts of seven substance misusers regarding their use of psychological therapy in their recovery. The relationship between the therapists and the clients developed as a result of the psychologists serving as secure attachment figures, and providing closeness and proximity, a safe haven and a secure base to the clients. Clients' separation distress also led to the internalizing of the psychologists. Future studies are needed to tease out which substance user clients would most be suited to the above approach. Measures of newer more adaptive internal working models could then be applied to relationships outside of therapy to see in what way the newer, more flexible, and transferable IWMs were truly internalized and influential in the recovering minds of substance misusers.

PRACTITIONER POINTS

Clinical Psychologists can play a vital role in the recovery of substance misusers who are ready to work through their psychological recovery. Forming a positive therapeutic relationship is dependent on the psychologists fulfilling the role of positive attachment figures for the clients.

The Religious and Spiritual Dimensions of Cutting Down and Stopping Cocaine Use: A Qualitative Exploration Among African Americans in the South

This study qualitatively examines the religious and spiritual dimensions of cutting down and stopping cocaine use among African Americans in rural and urban areas of Arkansas. The analyses compare and contrast the narrative data of 28 current cocaine users living in communities where the Black church plays a fundamental role in the social and cultural lives of many African Americans, highlighting the ways that participants used religious symbols, idiomatic expression, and Biblical scriptures to interpret and make sense of their substance-use experiences. Participants drew on diverse religious and spiritual beliefs and practices, including participation in organized religion, reliance on a personal relationship with God, and God's will to cut down and stop cocaine use. Our findings suggest that culturally sensitive interventions addressing the influence of religion and spirituality in substance use are needed to reduce cocaine use and promote recovery in this at-risk, minority population.

Factors affecting substance abuse treatment in Greece and their course during therapy

The effective therapy of substance abuse is attributed to a wide range of factors. A relevant bibliography review has highlighted those factors, which are most commonly employed by mental health professionals: Readiness (recognition, taking steps, and ambivalence), Self-efficacy, Expectation about the therapy outcome, Satisfaction by the therapy treatment, Perceived Social Support, Depression/Anxiety/Stress levels of the client (clinical profile), Positive and Negative Emotions and the way in which clients realize the Meaning of Life. These factors have been thoroughly researched for the purposes of the current study during the different treatment stages of a residential treatment program. The sample included 157 clients. In total, four measurements of the factors have been conducted in the three basic stages of treatment (Counseling Centre, Residential Phase, and Social Re-integration). The analysis of the Repeated Measures Design revealed a statistically significant increase in factors, such as Taking Steps, Self-efficacy, Perceived Social Support, Positive Emotions and Meaning of Life, while it showed an important decrease in factors, such as Problem Recognition, Ambivalence, Depression and Stress. The findings of the study both confirm the important role already recognized factors play in treatment and present the impact new factors can have on the therapeutic outcome.

The notion of self in the journey back from addiction

In this study we explored how those recovering from addiction negotiated self, and the role supported accommodation played in the journey back from addiction. Transcripts from 11 in-depth interviews were analyzed by 2 coders who identified the most salient themes relevant to the self in recovery within the personal contexts of participants. The participants noted that reclaiming the self that had been lost to addiction was of primary importance to them. The recovery journey exposed a self that had reached the lowest point in life; one that was hardly recognizable; one that was undesirable. Engaging with supported accommodation provided participants with a sanctuary within which to reclaim the self, and was seen as central to their recovery.

Recovering from Alcohol Addiction: A Transformation to Promote Health

Se presenta una metasíntesis cuyo objetivo es establecer las características del proceso de recuperación en las personas que tienen adicción al alcohol. La metodología metasintética se fundamenta en la integración e interpretación de los hallazgos de algunos estudios cualitativos que permiten reconocer elementos sustanciales en la creación de nuevas interpretaciones en el fenómeno de recuperación de la adicción al alcohol. Para ubicar las fuentes se realizó una búsqueda en las bases de datos Ovid, Medline, Cinalh, Psych Info, Lilacs y Scielo, que comprendió el periodo 1988 a 2008, y en el que se ubicaron once artículos mediante las palabras clave: abuso de alcohol, adicción, dependencia, recuperación, experiencia e investigación cualitativa; de estos únicamente seis cumplieron con los criterios de calidad para ser incluidos en la metasíntesis. Los hallazgos permiten señalar que la recuperación es concebida como una trasformación con movimiento ascendente, conceptualización que implica reconocer la potencialidad de los aspectos positivos de las personas, alcanzar la madurez psicológica y espiritual, y lograr la paz y la libertad para actuar. En conclusión, este proceso de transformación inmerso en la recuperación debe ser reconocido por el profesional de enfermería para establecer, entre ese otro y ella, una fructífera interacción que permita el desarrollo del cuidado.

The lived experiences of alcohol addiction: men of alcoholics anonymous

Alcohol addiction is one of the most prevalent and debilitating psychiatric disorders among the general population. Yet, little has been published on what it is like for men to actually experience this disorder. The purpose of this study was to identify commonalities in the experience of alcohol addiction among seven male members of Alcoholics Anonymous. Using a phenomenological approach, the participants completed an audio taped, unstructured, nondirective interview in which they were asked to describe their experience of alcohol addiction. The interviews were then transcribed and read by a phenomenological research team. Four themes were discovered: Emotions, Control, Awareness of Others, and The Turning Point, as well as a temporal ground. The authors conclude that mental health professionals should encourage alcohol addicted persons to talk about their experiences and to help them identify feelings and develop new coping skills.

Spiritual-care process and content: lessons learned from the ECHO Project

PURPOSE

To describe the process and content of spiritual caregiving delivered by a minister to 18 homeless male addicts in recovery and to determine whether and how advanced practice nurses can integrate similar counseling into practice.

DATA SOURCES

Notes from the minister's clinical sessions with individuals in the study sample were analyzed to identify the procedures used in spiritual counseling and the overall content of the interactions. Results were then reviewed in light of the literature on the nurse's role in spiritual caregiving to determine realistic implications for practice.

IMPLICATIONS FOR PRACTICE

Advanced practice nurses are currently mandated to integrate spiritual care into clinical practice as part of their holistic-practice model. Although theoretically sound, in practice, the time-dependent and specialized nature of spiritual caregiving may be more appropriately and effectively delivered by ministers as part of the primary care team when time, personal, and other constraints exist.