Living with, and moving beyond, a problematic relationship with alcohol

Abstract

Most individuals with alcohol use disorders (AUD) never seek or receive specialist treatment. However, much of what is known about addiction and recovery is based on pre- and postintervention studies with patients in specialist treatment settings who tend to have severe dependence. These studies often fail to capture the complex and circuitous nature of recovery, and findings might not be generalisable to most people with AUD. The work described within this thesis therefore aimed to: 1) gain an in-depth understanding of how those with a range of drinking patterns and treatment experiences, whose narratives are largely absent in the literature, conceptualise their relationship with alcohol, and 2) generate theory about processes and determinants of recovery.

A mixed-methods constructivist grounded theory approach, comprising two separate but related studies, was employed. Study 1 involved in-depth telephone interviews with 31 members and browsers of a previously unresearched online mutual aid group (Soberistas.com) which resulted in the development of a theoretical framework of recovery entitled: ‘managing multiple facets of self’. This analysis highlighted important personal and social identity processes that appeared to underpin change. To advance the framework, a further two-phased study with a more heterogeneous population was conducted. During the first phase, an observational follow-up cohort study recruited 141 patients with AUD during their unscheduled attendance at a general hospital, and gained quantitative estimates of alcohol use, and related measures such as psychological dependence and readiness to change. Participants were re-interviewed six months later, and variables examined for change (or lack thereof). The second phase employed face-toface in-depth qualitative interviews with a sub-sample of the hospital cohort, purposively selected to be a maximum variation sample using quantitative data collected previously.

Quantitative and qualitative data were synthesised to develop the final theoretical framework, ‘alcohol and recovery self-concept fluidity’, which illustrates the dynamic, fluid, and complex nature of living with, and moving beyond, a problematic relationship with alcohol. The theory posits that conceptualisations of problematic alcohol use and recovery are diverse and subject to constant (re)negotiation; individuals navigate numerous, and at times conflicting, explanatory frameworks, in order to make sense of their experiences and align themselves to an approach most suited to their needs at the time. This thesis contributes new understanding of how problematic alcohol use and recovery can be conceptualised, addressed, and researched, by gaining the perspectives of individuals whose voices are largely absent in the literature.

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Identifiers

ORCID for Julia Sinclair: orcid.org/0000-0002-1905-2025

ORCID for David Baldwin: orcid.org/0000-0003-3343-0907

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