Substance misuse services and the self. Version 1.
Research type
Research Study
Full title
An exploration of users of addiction services, the salient identities held, and the relationship between these identities, the individual, and the wider system.
IRAS ID
304044
Contact name
L. Cunningham-Amos
Contact email
Sponsor organisation
Canterbury Christ Church University
Duration of Study in the UK
2 years, 0 months, 1 days
Research summary
Summary of Research
People who engage with substance misuse services have likely experienced changes in their relationship with themselves, other people and their substance by the time they come to engage with services.This study wants to understand the important aspects of identity and sense of self that are held by those who engage with substance misuse services to consider whether including these aspects of identity and self in treatment could help with recovery and with improved self-esteem and wellbeing for people engaging with services.
Substance misuse services place people in treatment groups depending on their primary substance. This may neglect to consider other aspects of identity and self that may be vital for a sense of community in these groups and for a more effective recovery from substance misuse difficulties. My hypothesis is that this may contribute to the negative consequences of stigma and labelling.
Most research does not include or involve those who are engaged in substance misuse services, and when it does, it is usually testing out the efficacy of an already decided treatment plan.The research will consist of narrative interviews with 10-12 participants. Narrative interviews ask limited questions and allow the interviewee to share their own story. Participants will be asked to share the story of their journey Participants will be interviewed twice – once for an initial interview and then a potential follow-up interview to discuss interpretations and expand narratives if needed.
They will be recruited from the three substance misuse services within the NHS trust of the lead clinical supervisor, Dr Derek Tracy.
Summary of Results
This paper aimed to explore the life story narratives of people using addiction services. People have a long and complicated life history not defined only by their addiction. Nevertheless, in order to ask for help from addiction services and engage with them, the addiction may seem to overshadow everything else. Services may not appear to give enough consideration to the other aspects of identity that are important, such as race, gender, values, and belief systems. This study aimed to highlight these important aspects of identity with the hope that it could have useful implications for services and clinicians.After receiving ethical approval from the university and NHS ethics board, the researcher contacted two West London services to confirm recruitment was ready to begin. It passed ethical approval with their local research and development teams. Service sponsors at each site managed recruitment and provided participants with the information sheet and consent forms. Interviews took place between September and October 2022. Nine participants (seven men, two women) were interviewed using a narrative interview schedule. At the end of the interview, participants were given further information about the study if they asked. All participants were given pseudonyms and all names and places were changed or removed.
Narrative analysis was used to understand and interpret interview data. Summary narratives for each participant were created. An overarching narrative was developed which combined participant narratives. This overarching narrative was separated into life chapters.
The first chapter describes childhood. A common thread among participants was feeling disconnected to others and struggling to fit in. For all participants, drugs were a way to mask physical or emotional pain. Eventually, drug use spiralled out of control. This could be because their use escalated, they started experiencing withdrawals, or bad things kept happening as a consequence of their drug use but use continued. After reaching “rock bottom”, people entered services. Difficulties with funding and with the help offered meant that maintaining engagement and sobriety was not always easy.
Crucially, positive aspects of the narrative involved participants being able to see themselves as more than their drug use. They were able to identify positive traits and be proud of themselves for living by their values. The researcher discussed how this was portrayed during interviews.
Finally, the researcher shared lessons from the research. It discussed the role of stigma in perpetuating a negative narrative about people with addictions. It considered how services could improve, such as creating abstinent groups, offering service users responsibilities within groups, and working with the concept of shame. It also discussed future research directions, including further purposive sampling of hard-to-reach or marginalised groups, such as the homeless population. It highlighted the low number of women sampled and suggested purposively sampling more women in the future. It also suggested focusing on specific intersections, such as race and poverty or race and the criminal justice system and the impact on identity and addiction outcomes among service users.
REC name
London - Brighton & Sussex Research Ethics Committee
REC reference
22/LO/0334
Date of REC Opinion
20 Jul 2022
REC opinion
Further Information Favourable Opinion