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

尽管最近在英国当前的药物政策中强调“康复”药物和酒精依赖(Best，de Alwis和Burdert，2017)，但大约75%的吸毒者在完成有组织的治疗后的前12个月内复发(英国药物滥用统计，2017)。然而，关于吸毒者的生活经历以及他们如何使康复有意义的文献很少，特别是在复发之后(Koester，Anderson，&Hoffer，1999；Lancaster等人，2015)。此外，在成瘾研究中，服务提供者对客户复发经验的看法被广泛忽视，尽管这些观点已被认为在整个治疗过程中影响服务使用者的身份(McIntosh&McKeganey，2000)。因此，本项目将探讨吸毒者和相关毒品服务提供者之间对复吸的看法的异同，总体目的是对复吸，从而从药物滥用中康复产生新的理解。因此，该项目试图解决以下研究问题：*服务用户从康复中反复复发的生活经历是什么，以及这些经验如何影响服务用户对康复的意义？*服务提供商对复发的看法是什么，这些观点如何影响他们对待和支持服务用户的方式？*服务用户和提供商对复发的看法如何匹配/不同？通过回答上述研究问题，本研究的目的和目的如下：(1)从服务使用者和服务提供者的角度对复发和康复有新的认识(2)确定服务使用者和提供者对治疗和复发风险的看法(3)确定当前康复政策的有益/不利因素(4)为决策者提供更有效的应对复发/康复的战略。拟议的研究将采用定性设计，并与最多15名服务使用者和最多20名服务提供者参与者进行个人深入访谈。参与者将通过使用有目的的抽样策略进行招募。潜在的毒品服务参与者必须确认年龄在18岁和之间的鸦片和/或强效可卡因服务使用者，他们a)自我认为“康复”；b)已经出院/完成治疗；c)将在访谈时已经戒烟至少6个月(根据英国药物滥用和依赖临床指南2017，定义为“不接触任何呈现物质”)，以及d)在过去经历过至少两次复发(广义定义为“在试图戒毒后重新吸毒”(国家药物滥用研究所，2018)。潜在的毒品服务提供者必须以前曾作为使用者参与者的“关键工作人员”工作过，在此期间，这些参与者必须至少经历过一次反复复发。所有面谈将安排在招募参与者的治疗服务机构的前提下进行，以最大限度地提高感受到的舒适度和安全性。对服务用户的访谈数据将使用解释性现象学分析进行分析，对服务提供者的访谈将使用专题分析进行分析。参与者将通过英格兰的一家成瘾机构进行抽样。为了与ESRC鼓励合作和公众参与保持一致，研究设计将包括一个指导小组，成员包括同行导师、主要工作人员和一名经理，我将在整个项目期间与他们会面。由于尚未考虑和/或利用关于复发的内部观点来为实践和政策提供信息(Best等人，2017年)，该项目将产生有价值的新证据，使我们能够更好地理解“复发”现象，以及随后从毒瘾中“康复”的现象。

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.