Transformation of identity in substance use as a pathway to recovery and the potential of treatment for hepatitis C: a systematic review

BACKGROUND AND AIM

People who inject drugs are at high risk of contracting hepatitis C (HCV). The introduction of direct acting antiviral (DAA) drugs to treat HCV has the potential to transform care; however, uptake of DAAs has been slower than anticipated. The strong link between HCV and injecting drug use frames HCV as a shameful, stigmatising disease, reinforcing an 'addict' identity. Linking HCV care to a recovery journey, 'clean' identity and social redemption may provide compelling encouragement for people to engage with treatment and re-evaluate risk and behaviours, reducing the incidence of HCV re-infection. The aim of this review was to identify actions, interventions and treatments that provide an opportunity for a change in identity and support a recovery journey and the implications for HCV care.

METHODS

Databases (MEDLINE, EMBASE, PsycINFO, ProQuest Public Health, ProQuest Sociological Abstracts, CINAHL and Web of Science) were searched following our published strategy and a grey literature search conducted. A narrative synthesis was undertaken to collate themes and identify common threads and provide an explanation of the findings.

RESULTS

Thirty-two studies fulfilled the inclusion criteria. The narrative synthesis of the studies identified five over-arching analytical themes: social factors in substance use and recovery, therapeutic communities, community treatment, online communities, and finally women and youth subsets. The change from an 'addict' identity to a 'recovery' identity is described as a key aspect of a recovery journey, and this process can be supported through social support and turning point opportunities.

CONCLUSIONS

Recovery from addiction is a socially mediated process. Actions, interventions and treatments that support a recovery journey provide social connections, a recovery identity and citizenship (reclaiming a place in society). There is a gap in current literature describing how pathways of care with direct acting antivirals can be designed to promote recovery, as part of hepatitis C care.

The communicative power of metaphors: an analysis and interpretation of metaphors in accounts of the experience of addiction

OBJECTIVES

The aim of this study was to explore how participants use metaphors to express and communicate experiences and emotions that may have been previously unexpressed or unexplored, and perhaps too painful to address directly. In addition, this study investigates the potential of using interpretative phenomenological analysis (IPA) in metaphor research.

DESIGN

Data were collected in semi-structured interviews, designed to capture a rich and detailed description of participants' experiences of addiction and what the experiences means to them.

METHODS

Six participants took part in the study. The data were analysed using IPA.

RESULTS

The results capture the abundance and vividness of metaphorical expressions embedded in participants' accounts and produce insights and a richer picture of the participants' experiences.

CONCLUSIONS

The study highlights the power of metaphors as tools for communicating and sharing experience, as well as the particular ways in which metaphors make sense as part of individual lives. We believe that IPA can make a valuable contribution to metaphor analysis as it attends both to the experiential dimension of metaphors through phenomenological analysis, as well as to the hermeneutic possibilities opening up through the capacity of metaphors to make connections between disparate ideas and concepts.

Women's Early Recovery: Managing the Dilemma of Substance Abuse and Intimate Partner Relationships

Numerous studies have shown that women's patterns of substance use are strongly impacted by social relationships. Using a hermeneutic phenomenological method, this study examined the interplay between intimate partner relationships and substance abuse recovery through in-depth interviews with 17 women in a treatment program. Six essential themes about the dilemmas posed by recovery and relationships emerged from analysis: (a) experiencing themselves as damaged goods; (b) paying the price for both recovery and relationship choices made; (c) trading parts of self for relationships and drugs; (d) waking from the nightmare and realizing the impact of abuse; (e) hoping, but not always quite believing, in the possibility of recovery; (f) asking themselves “who's in charge of my life?” This study expands on previous findings by examining critical similarities in the dynamics of interpersonal relationships and recovery for women and the meanings they assign to each.