Reconceptualization of Relapse: An Interpretative Phenomenological Analysis of Lived Experiences of Repeated Relapse from Drug Misuse in the UK

复发的重新概念化：对英国药物滥用反复复发的生活经历的解释性现象学分析

• 批准号: 1931196
• 金额: --
• 依托单位: University of Bath
• 依托单位国家: 英国
• 项目类别: Studentship
• 财政年份: 2017
• 资助国家: 英国
• 起止时间: 2017 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=studentship-1931196
• 关键词: Reconceptualization; Relapse; Interpretative; Phenomenological; Analysis

Despite a recent emphasis on 'recovery' from drug and alcohol dependency within the UK's current drug policies (Best, De Alwis, & Burdett, 2017) approximately 75% of drug service users relapse within the first twelve months of completing structured treatment (Statistics of Drug Misuse England, 2017). However, literature about the lived experiences of drug service users and how they make meaning of recovery, particularly after having relapsed, is scarce (Koester, Anderson, & Hoffer, 1999; Lancaster et al., 2015). Additionally, views of service providers on clients' experiences of relapse have been widely disregarded in addiction scholarship, although these have been recognized as impacting the service user's identity throughout treatment (McIntosh & McKeganey, 2000). Therefore, this project will explore the differences and similarities of perspectives on relapse between drug service users and relevant drug service providers, with the overall aim to generate novel understanding of relapse, and, consequently, recovery from drug misuse. As such, the project seeks to address the following research questions: * What are service users' lived experiences of repeated relapse from recovery and the ways in which these impact the service users' meaning-making of recovery? * What are service providers' perspectives on relapse and how do these inform the ways they treat and support service users? * How do service users' and providers' views on relapse match/differ? By addressing the above research questions, the study's aims, and objectives are as follows:(1) To provide new understanding of relapse and recovery from a service user and provider perspective (2) To identify the ways in which service users and providers perceive treatment and risk for relapse (3) To identify helpful/unhelpful elements of current recovery policies (4) To inform policy-makers of more effective strategies to address relapse/recovery The proposed study will employ a qualitative design and involve individual, in-depth interviews with up to 15 service user-, and with up to 20 service provider participants. Participants will be recruited through the use of a purposive sampling strategy. Potential drug service user participants must identify as opiate and/or crack cocaine (OCU) service users within the age range of 18 and 64 who a) self-identify as 'recovered'; b) have been discharged from the service/completed their treatment; c) will have been abstinent (defined as 'free from any presenting substance' by the UK clinical guidelines for substance misuse and dependence 2017) for at least 6 months at the time of the interview and who d) have experienced at least two relapses (defined broadly as the 'return to drug use after an attempt to stop' (National Institute on Drug Abuse, 2018)) in the past. Potential drug service providers must have previously worked as 'key worker' of user participants who, during that time, must have experienced at least one of their repeated relapses. All interviews will be arranged to take place at the premise of the treatment service from which the participant was recruited, as to maximize levels of perceived comfort and security. Data derived from interviews with service users will be analysed using interpretative phenomenological analysis and interviews with service providers will be analysed using thematic analysis. Participants will be sampled through an addictions agency in England. In alignment with the ESRC's encouragement for collaboration and public engagement, the study design will include a steering group, including peer-mentors, key workers and a manager, with whom I will meet throughout the project. As insider-perspectives on relapse have not yet been considered and/or utilized to inform practice and policy (Best et al., 2017), this project will generate valuable novel evidence which will allow us to better understand the phenomenon of 'relapse', and subsequently that of 'recovery', from drug addiction.

尽管最近在英国现行药物政策中强调从药物和酒精依赖中“恢复”（Best，De Alwis，& Burdett，2017），但大约75%的药物服务使用者在完成结构化治疗的前12个月内复发（药物滥用统计英格兰，2017）。然而，关于药物服务使用者的生活经历以及他们如何理解康复的意义，特别是在复发后的文献很少（Koester，安德森和Hoffer，1999年;兰开斯特等人，2015年）的报告。此外，服务提供者对客户的复发经验的看法在成瘾奖学金中被广泛忽视，尽管这些已被公认为在整个治疗过程中影响服务用户的身份（McIntosh和McKeganey，2000年）。因此，本项目将探讨药物服务使用者和相关药物服务提供者对复吸的不同和相似之处，总体目标是对复吸产生新的理解，从而从药物滥用中恢复。因此，该项目旨在解决以下研究问题：* 服务使用者从康复中反复复发的生活经历是什么，以及这些经历如何影响服务使用者对康复的意义？* 服务提供者对复发的看法是什么？这些看法如何影响他们治疗和支持服务使用者的方式？* 服务使用者和提供者对复发的看法如何匹配/不同？通过解决上述研究问题，本研究的目的和目标如下：（1）从服务使用者和提供者的角度提供对复发和康复的新理解（2）确定服务使用者和提供者如何看待治疗和复发风险（3）确定当前康复政策中有用/无用的元素（4）告知政策制定者更有效的策略来解决复发/康复拟议的研究将采用定性设计，并涉及多达15个服务使用者和多达20个服务提供者参与者的个人深入访谈。将通过使用有目的的抽样策略招募参与者。潜在的药物服务使用者参与者必须确定为年龄在18至64岁之间的阿片类药物和/或快克可卡因（奥库）服务使用者，并且a）自我确定为“已康复”; B）已从服务中出院/完成治疗; C.将被禁止（2017年英国药物滥用和依赖临床指南定义为“不含任何存在的物质”）在访谈时至少6个月，并且d）过去经历过至少两次复发（广义上定义为“尝试停止后重新使用药物”（国家药物滥用研究所，2018））。潜在的药物服务提供者必须以前曾担任用户参与者的“关键工作人员”，在此期间，必须经历至少一次重复复发。所有面谈都将安排在招募参与者的治疗服务场所进行，以尽可能提高舒适度和安全感。将使用解释性现象学分析法分析与服务用户访谈所得的数据，并使用专题分析法分析与服务提供者访谈所得的数据。参与者将通过英国的一家成瘾机构进行抽样调查。为了与ESRC对合作和公众参与的鼓励保持一致，研究设计将包括一个指导小组，包括同行导师，主要工作人员和经理，我将在整个项目中与他们会面。由于关于复发的内部观点尚未被考虑和/或用于告知实践和政策（Best等人，2017年），该项目将产生有价值的新证据，使我们能够更好地了解“复发”现象，以及随后的“康复”，从吸毒成瘾。