The mechanisms of treatment – client and treatment staff perspectives on change during treatment for alcohol problems

The role of mindfulness, meditation, and peer support in recovery capital among Recovery Dharma members

INTRODUCTION

Recovery Dharma (RD) is a Buddhist-based peer support program for the treatment of addiction that incorporates mindfulness and meditation into meetings, program literature, and the recovery process, creating the opportunity to study these variables in a peer-support program context. Mindfulness and meditation are beneficial for people in recovery, yet we know little about their relationship to recovery capital, a positive indicator of recovery outcomes. We explored mindfulness and meditation (average length of sessions and average frequency per week) as predictors of recovery capital and examined perceived support in relation to recovery capital.

METHODS

The study recruited participants (N = 209) through the RD website, newsletter and social media pages for an online survey that included measures of recovery capital, mindfulness, perceived support, and questions about meditation practices (e.g., frequency, duration). Participants' mean age was 46.68 years (SD = 12.21), with 45 % female (5.7 % non-binary), and 26.8 % from the LGBTQ2S+ community. The mean time in recovery was 7.45 years (SD = 10.37). The study fitted univariate and multivariate linear regression models to determine significant predictors of recovery capital.

RESULTS

As anticipated, multivariate linear regressions indicated that mindfulness (β = 0.31, p < .001), meditation frequency (β = 0.26, p < .001), and perceived support from RD (β = 0.50, p < .001) were all significant predictors of recovery capital when controlling for age and spirituality. However, longer time in recovery and the average duration of meditation sessions did not predict recovery capital as anticipated.

CONCLUSIONS

Results indicate the importance of a regular meditation practice for recovery capital rather than engaging in prolonged sessions infrequently. The results also support previous findings, which point to the influence of mindfulness and meditation on positive outcomes for people in recovery. Further, peer support is associated with higher recovery capital in RD members. This study is the first examination of the relationship between mindfulness, meditation, peer support, and recovery capital in recovering people. The findings lay the groundwork for the continued exploration of these variables as they relate to positive outcomes both within the RD program and in other recovery pathways.

Cultural Safety as an Outcome of a Dynamic Relational Process: The Experience of Inuit in a Mainstream Residential Addiction Rehabilitation Centre in Southern Canada

Few addiction treatment options are available in Arctic Canada, leading many Inuit to seek treatment programs in southern cities. We conducted a case study to understand what contributes to a culturally safe experience for Inuit in a mainstream addiction rehabilitation centre in Southern Canada. We carried out more than 700 hours of participant observation, in addition to semi-structured interviews and member-checking activities with 20 Inuit residents, 18 staff and four managers. Data were analysed using an inductive interpretative process. Throughout their journey in the program, Inuit navigated through contrasting situations and feelings that we grouped under six broad themes: having Inuit peers, having limitations imposed on one's ways of being and doing, facing ignorance and misperceptions, having conversations and dialogue, facing language barriers and being in a supportive and caring environment. This study highlights how cultural safety varies according to people, context and time, and relates to developing trustful relationships.

Trust and collaboration between patients and staff in SUD treatment: A qualitative study of patients’ reflections on inpatient SUD treatment four years after discharge

Background and aim: Substance use disorder (SUD) is multifactorial, complex, and involves the severe problematic use of alcohol, prescription drugs, and other substances. People with SUD have long histories of perceived stigma, marginalisation, exclusion, social isolation, and shame. Moreover, patients with SUD are often treated as untrustworthy and incapable of actively participating in their treatment planning, even by healthcare and social services workers. Methods: Through in-depth interviews with former patients who have undergone SUD treatment, we explored their reflections on the treatment content. Interpretative phenomenological analysis revealed that some informants experienced aspects of the treatment as valuable, whereas others considered the same treatment useless or harmful. Results: Essential aspects of treatment were developing self-esteem and optimism about the future, developing strategies for coping with stress and challenging emotions and situations, developing relationships with family and friends, and preparing for life after inpatient treatment. Relationships with staff were described as crucial in all parts of the treatment. Conclusion: In conclusion, we suggest that a transition to a more collaborative treatment philosophy would be ethically and professionally valuable for providing support and treatment and enhancing patients’ perceptions of empowerment, inclusion, participation, and well-being on their terms, in cooperation with supportive others.

Recovery processes among young adults treated for alcohol and other drug problems: A five-year follow-up

Aim

Studies on recovery from alcohol and other drugs (AOD) among young adults are scarce. In the present study, young adults, previously interviewed with a focus on their recovery process shortly after they completed treatment, were re-interviewed five years later focusing on their recovery process during the last five years in relation to their former AOD problems, other problems and processes of change.

Methods

Twenty-one young adults were interviewed: 16 women and five men aged between 25 and 33 years. After transcribing the interviews, the material was analysed thematically.

Results

Three overall themes emerged: previous problems, mental illness and the search for identity. The results were discussed in relation to recovery capital, primarily focusing on human and social capital. The results indicate that the group in focus often needs professional support for mental health issues in order to reach a stable recovery.

Conclusions

Since the problems described were heterogeneous, this client group might benefit from individual treatment and extended support after treatment. Further, the results indicate that the established period of five years for a stable recovery might need to be extended for young adults.

Abstinence or controlled drinking – a five-year follow-up on Swedish clients reporting positive change after treatment for substance use disorders

Purpose

The purpose of this paper is to investigate how clients – five years after completing treatment interventions endorsing abstinence – view abstinence and the role of Alcoholics Anonymous (AA) in their recovery process.

Design/methodology/approach

Interviews with 40 clients were conducted shortly after them finishing treatment and five years later. All the interviewees had attended treatment programmes based on the 12-step philosophy, and they all described abstinence as crucial to their recovery process in an initial interview.

Findings

At follow-up, the majority remained abstinent. For many, attending AA meetings was still important – some described attending as a routine, whereas others stressed that the meetings were crucial for remaining abstinent. For those who reported controlled drinking (CD), this was described either as a natural step in their recovery process or as associated with worries and self-doubts.

Research limitations/implications

The results suggest the importance of offering interventions with various treatment goals and that clients choosing CD as part of their sustained recovery would benefit from support in this process, both from peers and professionals.

Originality/value

There are heterogeneous views on the possibilities of CD after recovery from substance use disorder both in research and in treatment systems. This study on client views on abstinence versus CD after treatment advocating total abstinence can contribute with perspectives on this ongoing discussion.

Into the unknown: Treatment as a social arena for drug users' transition into a non-using life

Background and aims:

For people trying to stop using alcohol or other drugs (AOD), the process is often characterised by periods of abstinence followed by relapse into their previous drug-related way of life and subsequent re-entry into the treatment system. There is a call for greater attention to the how of these transitions, with a special focus on the phase of leaving treatment. The aim of this article was to get a better understanding of the transformation of practice when moving from a drug-using to a non-using lifestyle by exploring the experience of (1) the involvement in treatment settings, (2) the process of leaving treatment, and finally, (3) the early phase of changing everyday practice into a drug-free way of living.

Method:

The article takes on a social practice approach, in particular Bourdieu’s concepts of habitus, “doxa” and field to analyse 17 in-depth interviews with Norwegian men and women seeking treatment for problems resulting from the use of drugs and/or alcohol.

Results:

The study shows that the support of professionals operates as transitional relations that can bridge the transformation from a drug-using to a drug-free life, by providing a social web of relations, positions, settings and activities. However, leaving treatment and establishing AOD-free practice involves moving into something unknown in the sense that there is no embodied, taken-for-granted knowledge about how to relate to a world where drug use is not the focal point of existence.

Conclusions:

The process of change, then, involves being exposed to an existential feeling of maladjustment. To get beyond the feeling of maladjustment, and get into the doxic mode takes time, and involves reconfiguration of habitus through reorientation of social settings, relations and networks. The treatment system could potentially develop a continuum of support during these transformations.

Building trust and recovery capital: the professionals’ helpful practice

Purpose

The possibility of recovery for persons with co-occurring addiction and mental health problems has been contested. Though, recent studies show that recovery might happen, but without connection to specific treatment interventions. The purpose of this paper is to analyse professionals’ perceptions of their contribution to improvement.

Design/methodology/approach

In all, 15 experienced professionals were interviewed. The interviews were analysed using thematic analysis.

Findings

Recovery processes were dependent of the persons’ access to different forms of recovery capital (RC). Lack of RC was often associated with lack of trust in one’s self and others (identity and personal capital). Professionals had to be accepted as trustful agents through co-creating changes in the person’s life. Trusting a professional might be a basis for trusting one’s self as an agent in one’s recovery process and develop a social network (identity and relationship capital). Other aspects stressed by the professionals were to manage their own fragmentized organisations and societal shortcomings (economic capital).

Practical implications

Recovery has been described as a profoundly individual journey. However, it is also deeply social, involving other persons and contextual factors. Focusing on just one level might counteract the complex work behind double recovery.

Originality/value

Improvement was described as dependent on the presence of personal, inter-personal, organisational and societal factors. The findings give a deep and concrete understanding of the process constituting the development of a working alliance and its dependence on factors outside the direct relation between the staff member and the person.

Patient satisfaction with treatments and outcomes in residential addiction institutions

Aim:

The objective of the present study was to investigate associations between patients’ satisfaction with different domains of inpatient substance use treatment and their perceived treatment outcome. The primary purpose was to identify domains of treatment satisfaction most strongly associated with a positive treatment outcome.

Design:

Data were based on a survey among 188 patients with alcohol and/or illicit substance use disorders completing a three–six-month inpatient stay at one of two public clinics in Central Norway. The survey was carried out shortly before discharge. The 15-item questionnaire covered ratings of staff and programme factors, and services received for medical and mental problems and ancillary services. The outcome score was based on items measuring perceived substance use improvements and benefit of treatment.

Results:

A significant proportion of patients were dissatisfied with the support provided for housing, financial issues and employment. Confidence in staff competence was the domain of treatment satisfaction most strongly associated with the outcome score. Furthermore, patients were more likely to report a positive outcome when they were actively involved in the treatment, as indicated by satisfaction with opportunities to affect treatment plans.

Conclusion:

Our results suggest that patient-experienced improvements are connected to confidence in staff competence and user involvement. The findings may be interpreted as supporting a collaborative relationship between patients and counsellors.