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

尽管最近英国现行的药物政策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（英国药物滥用统计，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，文献很少（Koester, Anderson, & Hoffer, 1999; Lancaster et al., 2015）。此外，在成瘾研究中，服务提供者对客户复发经历的看法被广泛忽视，尽管这些观点在整个治疗过程中被认为会影响服务使用者的身份（McIntosh & McKeganey, 2000）。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发观点的异同，总体目标是对复发产生新的理解，从而从药物滥用中恢复过来。因此，该项目寻求解决以下研究问题：*服务使用者在康复后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建构？*服务提供者对复吸有何看法？这些看法如何影响他们对待和支持服务使用者的方式？*服务使用者和服务提供者对复吸的看法有何相同/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对复发治疗和复发风险的看法(3)确定当前康复政策中有益/无益的因素(4)为政策制定者提供更有效的策略来解决复发/康复问题。拟议的研究将采用定性设计，并涉及个人，与多达15个服务用户和多达20个服务提供商参与者进行深入访谈。参与者将通过使用有目的的抽样策略来招募。潜在的药物服务使用者参与者必须确定为年龄在18至64岁之间的阿片剂和/或快克可卡因（OCU）服务使用者，并且a)自认为“已康复”；B)已退役/完成治疗；c)在面谈时至少有6个月的戒断（根据2017年英国药物滥用和依赖临床指南定义为“无任何呈现物质”），并且d)在过去至少经历过两次复发（广义定义为“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以前必须是使用者参与者的“关键工作人员”，在此期间，必须至少经历过一次反复复发。所有访谈将安排在招募参与者的治疗服务的前提下进行，以最大限度地提高感知舒适度和安全性。对服务使用者的访谈所得的数据将采用解释性现象学分析加以分析，对服务提供者的访谈将采用专题分析加以分析。参与者将通过英国一家戒毒机构进行抽样调查。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，包括同行导师、关键工作人员和一名经理，我将在整个项目中与他们会面。由于内部人士对复发的看法尚未被考虑和/或用于实践和政策（Best et al., 2017），该项目将产生有价值的新证据，使我们能够更好地理解吸毒成瘾的“复发”现象，以及随后的“恢复”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.