How are offenders’ subjective feelings about participating in treatment for their drug-related offending behaviour linked to their experiences of the recovery process?
Thematic Analysis
The purpose of this study is to analyze how the treatment indicated by authorities can influence the recovery process and what are the expectations for the drug rehabilitation program.
Qualitative methods are suitable for intricate topics, providing „unique and valuable insights” (Barbour, 2008). Therefore, I have chosen a social constructionist ontology and a critical relativist epistemological position to present participants’ opinions regarding experiences being part of a rehabilitation program.
Participants were interviewed and the dialog was transcribed. Each transcript ( see Appendix A) was analysed using thematic analysis as proposed by King & Horrocks (2010). The objective is to expose patterns in the data that provide a profound comprehension of the participants’ stories. Clarke & Braun (2013) affirm that the researcher’s task is to analyze the data in a selective manner, „it’s about telling a particular story about the data, a story that answers your research question”. For that reason, the analysis begun by identifying any piece of the data that was helpful in addressing my research question, continuing by defining descriptive codes and organize them to create interpretative codes, capturing a common meaning. Lastly, overarching themes were based on interpretative codes. ( see thematic map).
Overarching themes:
Self-motivation: every human has the capacity to change but only if he/she is confident and motivated enough, the change will happen
The programme is efficient only if you work hard : being present is not enough, you must be active, establishing a connection with other participants and offering support and empathy
Unhappy living : having no independence, no healthy relationships, life can take a downturn; frequently considered a starting point to the changing process
Strength is all you need: finding the freedom is tough from a captive environment, therefore the participant must use every source to fight addiction.
Thematic map
Self-motivation
Interpretative
codes
The most effective motivation has its source within the individual
Descriptive codes
Willingness to stop using
Participant 4 : “Yes I wanted to do it. I was ready for it.”
“I actually did want to stop taking them, I’d had enough”
Participant 6: “I would have got myself rehabilitated anyway.”
“It made me recognise this dependency and I didn’t want it anymore”
“My rehabilitation was all me”
“that’s my sheer hard work and strong will”
Participant 11:” I knew it would help me to stop my substance use”
Overarching theme
The programme is efficient only if you work hard
Interpretative codes
Reestablish the confidence
Compassion
Gratitude
Mercy
Descriptive codes
Positive aspects of the programme
Participant 4 : “ I think the programme just gave me a push”
“I can do stuff in my future. I have goals for my life”
Participant 15: “ it was a second chance. I had hope.”
Positive aspects of the programme
Participant 4 : “Overall everyone was dead helpful and treated me properly.”
Participant 15 : “The support you get was striking to me.”
Feelings about the programme
Participant 4 : “ I can do stuff in my future. I have goals for my life”.
Participant 11: “ It’s good to complete something, I feel like I’ve achieved and I feel like I can now take it forward”
Participant 15 : “ I’m thankful for it.”
Sadness and regret
Participant 15: “It’s mixed up with feelings about my dad – so sadness as well that it was right at the end and he doesn’t get to spend time with me like this – clean, sober, back to the person I was supposed to be”
Programme not needed
Participant 6 : “suppose I maybe wasn’t as enthusiastic as other people because I didn’t feel as if I needed to be there.”
“ I didn’t need it really. I didn’t require feedback or support or any of the provisions it offers. My rehabilitation was all me, the programme was decoration.”
Overarching theme
Unhappy living
Interpretative codes
Downturn
Descriptive codes
Factors leading to desire to stop using
Participant 4: “where I actually did want to stop taking them, I’d had enough”
“ I’d just turned 30 and my mates, who used to do the same sort of stuff as me when we left school, it was like they’d grown up and left me behind. “
“I couldn’t keep a job”
“ I felt rubbish about myself “
Participant 6 : “ I had no independence, no autonomy. Getting convicted was humiliating to me. “
Participant 11 : “. Firstly being in and out of prison is no way to live”
“ I was living hour to hour and it was lonely. There were people around me but they weren’t friends they were using me and I was using them. It was chaos.”
Participant 15 : “ my dad had a terminal illness and I was devastated that this meant I’d never get to see him. “
Overarching theme
Strength is all you need
Interpretative codes
Finding the way out
Independence
Descriptive codes
Consequences of substance misuse
Participant 6 :” For years I’d been depending on substances. Like a kid depends on their parents. I had no independence, no autonomy. Getting convicted was humiliating to me. „
Imprisonment failing
Participant 4 : „This sentence is my third for drugs (I’ve got convictions for other theft offenses as well) and although I had orders to attend programmes in the past I never did them. One time I think I started one but I got breached and went back to prison.”
Negative aspects of the programme
Participant 4 : „— The testing is a pain and getting there all the time is difficult with the buses and stuff. „
Participant 6 : „. I didn’t require feedback or support or any of the provisions it
offers.”
The future
Participant 4 : „Like I can do stuff in my future. I have goals for my life. „
Participant 6 : . I’m thinking about my independence constantly. I can live with myself now.
Thematic Narrative: Unhappy living
I have chosen to analyse the overarching theme „Unhappy living” because represents the climax of the rehabilitation process and is connected with other themes. We will explore how participants experience awareness of their substance dependence and how they found the desire to change their lives.
Participants realize at some point in their life that all the suffering was enough and that they are about to lose more important things, starting to consider rehabilitation program as a solution, or at least a „push”( Participant 4 ) to their situation. Although, there are always exceptions, participants that are conscious about their circumstances, admitting that they are addicted but don’t believe that a rehabilitation program is relevant for them.
„I complied with all the programme requirements but I suppose I maybe wasn’t as enthusiastic as other people because I didn’t feel as if I needed to be there” – Participant 6
Similar findings are present in other research studies such as De Leon & Jainchill (1986), Kinght et all. (1994); explaining that some substance abusers are not ready for treatment because of long-term commitment.
Dependency is seen as a constraint from the rest of the world, being incapacitated to have healthy social relationships and financial and mental independence.
„There wasn’t one thing either. I’d just turned 30 and my mates, who used to do the same sort of stuff as me when we left school, it was like they’d grown up and left me behind. I was pissing them off with my antics, I couldn’t keep a job, and I felt rubbish about myself. So it really wasn’t one thing.”- Participant 4
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Being addicted to anything is described as „chaos” ( Participant 11 ), a lonely world dominated by low self-esteem, shame, guilt; struggling to find a balance, always feeling that the world is moving forward without you. All these negative factors seizing personal authority are able to create a powerful desire for change, having the courage to fight for the lost independence.
„I’d reached this point though this time where I actually did want to stop taking them, I’d had enough. „ – Participant 4
Moreover, in some cases the motivation to change a lifestyle is generated by external factors such as legal obligations or loss of someone. Examples are Participant 6 and Participant 15, they started a rehabilitation programme despite their will, they were forced by the environment to change their lives, to become humans with new hopes and dreams.
Another important aspect of this condition is the fear of recidivism. There are some studies examining the relapse stage and the most common influence it seems to be stress. Sinha, Rajita. (2002) presented valuable evidence suggesting that high-stress levels are the main cause for „ drug use, and are associated with craving and relapse in addicts”. Recidivism is exposed by two different perspectives: rejection and acceptance as a possibility.
„ I also know I’m never going back to it and I refuse to embrace this notion that you should think about relapse constantly. I’m thinking about my independence constantly” – Participant 6
„ there’s a possibility I might relapse, but I know how to cope if I do and the programme helped me with that.” – Participant 11
Accordingly, yet there is still a chance to relapse, participants are becoming responsible after the rehabilitation, they have their lives in control and are able to take the right choices.
In summary, one of the most important parts of the whole process of rehabilitation is the time when people are becoming aware of their situation, how lonely and how discouraged they are and how can they change everything with just a thought. It’s a reborning process, trying to adapt to the new environment and having no fear of relapse.
References:
Barbour R: Introducing Qualitative Research: A Student Guide to the Craft of Doing Qualitative Research. 2008, Los Angeles. London. New Delhi: Sage Publications
Clarke, V. and Braun, V. (2013) Successful qualitative research: A practical guide for beginners. London: Sage. ISBN 9781847875815
De Leon G, Jainchill N (1986) Circumstance, motivation, readiness and suitability as correlates of treatment tenure. J Psychoactive Drugs 18:203–208.
King, N., & Horrocks, C. (2010). Chapter 9: An introduction to Interview Data Analysis. In N. King, & C. Horrocks, Interviews in Qualitative Research (pp. 144-174). Los Angeles: SAGE.
Knight, K, Holcom, M, Simpson, DD ( 1994) TCU Psychosocial Functioning and Motivation Scales. Texas Christian University, Fort Worth, TX
Sinha, Rajita. (2002). Sinha R. How does stress increase risk of drug abuse and relapse? Psychopharmacology (Berl) 158: 343-359. Psychopharmacology. 158. 343-59. 10.1007/s002130100917.
The Questionnaire: Participants were asked the following questions:
Appendix A
How did you feel about taking a drug rehabilitation programme? Please give
examples of how this influenced your participation on the programme.
What made you want to stop using?
How did you find the programme?
How do you feel now you have completed the programme?
Data set
Participant 004
1. Yes I wanted to do it. —- motivation ——I was ready for it. This sentence is my third for drugs (I’ve got convictions for other theft offences as well) and although I had orders to attend programmes in the past I never did them —-irresponsibility—-One time I think I started one but I got breached and went back to prison. I’d reached this point though this time where I actually did want to stop taking them, I’d had enough.—–motivation—–
2. It came from me.—-self motivation—- I think this time I was ready to stop. I think the programme just gave me a push —the starting point—but importantly it was me that wanted to do it.—self motivation— There wasn’t one thing either. I’d just turned 30 and my mates, who used to do the same sort of stuff as me when we left school, it was like they’d grown up and left me behind. —loneliness, social issues, —- I was pissing them off with my antics, I couldn’t keep a job,—profesionnal failure—- and I felt rubbish about myself.—-low self esteem—- So it really wasn’t one thing.
3. Good.—–positive experiences—- I liked doing some of the group stuff.—-partnership, cooperation— The testing is a pain and getting there all the time is difficult with the buses and stuff.—-negative external factors—- Overall everyone was dead helpful and treated me properly. —gratitude—
4. Like I can do stuff in my future. I have goals for my life.—confidence,— I think that’s important though I think you have to do the programme for you. No-one can make you want to change. —self motivation—
Participant 006
1. I would have got myself rehabilitated anyway. —–concerned—- You sort of have to do the programme, you are coerced into it —controled by authority—- really but I would have done it myself anyway.—concerned—- I complied with all the programme requirements but I suppose I maybe wasn’t as enthusiastic as other people because I didn’t feel as if I needed to be there.—–uncertainly—
2. For years I’d been depending on substances. Like a kid depends on their parents. I had no independence, no autonomy.—–limitations— Getting convicted was humiliating to me.—low-self esteem— It made me recognise this dependency and I didn’t want it anymore.—starting point of changing—
3. I didn’t need it really. I didn’t require feedback or support or any of the provisions it offers. My rehabilitation was all me, the programme was decoration. —confidence, self-motivation—
4. I am not using anymore and I have been able to gain employment again,–stability— so that’s positive and I have that independence that I so clearly needed—-stability, confidence—. That’s not as a result of my compliance with the programme though, that’s my sheer hard work and strong will.—self motivation— I also know I’m never going back to it and I refuse to embrace this notion that you should think about relapse constantly. I’m thinking about my independence constantly. I can live with myself now. —-confidence—
Participant 011
1. They [Probation] prepared me for it in our one-to-ones so I knew what was involved. I knew it would help me to stop my substance use –self awareness —-and what the knock-on effects of that can be.
2. Usual stuff. Firstly being in and out of prison is no way to live. —self awareness–I’d been doing it for years, since I was in my late teens. I’d either get done for drugs or get done for doing shit in order to buy drugs. I’ve hurt people and not even remembered doing it properly. I assaulted someone I didn’t even know; she could have been my mum or my baby sister. I was living hour to hour and it was lonely.—lonelyness, social issues— There were people around me but they weren’t friends they were using me and I was using them. It was chaos. —-negative external factors—
3. Tough. It’s totally different. I didn’t really ever properly go to school, I used to wag [truant] a lot and then they kicked me into this ‘special’ programme and that was even easier to avoid. So going to some of the sessions on the programme was a bit weird to start with, a bit like school where people are talking to you and you have to do exercises and stuff. But eventually I got into the habit and then it became a routine after a few months and that’s what I’d needed a routine, structure.—-stability—
4. It’s good to complete something, —confidence—I feel like I’ve achieved and I feel like I can now take it forward.—confidence—I know it isn’t going to be easy and that there’s a possibility I might relapse, but I know how to cope if I do and the programme helped me with that. It was hard work but you feel like you earned it at the end. —self motivation—
Participant 015
1. I was actually happy! I was remanded for two months in prison – this was the first time ever for me and I’d been doing heroin for years and years – but my dad had a terminal illness and I was devastated that this meant I’d never get to see him. So, when they offered me a community order in court I was happy, it meant I could be with him when I died and the drug rehabilitation element was just there you know. I’m grateful.—gratitude—
2. For me.—self motivation– With everything that happened with my dad, I hated the thought of what I was when he found out he was dying. That I’d screwed my entire life up and ended up in prison. They helped me when I was on remand – CARAT workers I think they call them. That help and knowing then that I had a few months with my dad and my mum, it was a second chance. I had hope. —confidence—
3. The support you get was striking to me.—impressed— I thought it might have been about punishing me and making me feel ashamed about my behaviour. It wasn’t. Yes, you get to recognise your issues and everything, —self –aware—but I found it really positive that I was getting to build on what I do well and drugs were just a part of that bigger picture.
4. I’m glad I did it, I am thankful for it.—gratitude— It’s mixed up with feelings about my dad – so sadness as well that it was right at the end and he doesn’t get to spend time with me like this – clean, sober, back to the person I was supposed to be,—confidence— but all in all I’m thankful for it. —-gratitude—-
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