exiting an alcohol career and maintaining change

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EXITING AN ALCOHOL CAREER AND MAINTAINING CHANGE

Justyna Klingemann

Department of Studies on Alcohol and Drug Dependence

Institute of Psychiatry and Neurology,

Warsaw, Poland

STEG FOR STEG-KONFERANSEN, LITTERATURHUSET OSLO 2013, MARCH 14

ME

DIA

RE

CR

UIT

ME

NT

2

Study design

recruitment data collection analysis & interpretation

media recruitment

standardised

phone interview

with respondent and collateral

information sheet and

life history chart

in-depth personal interview

qualitative analysis Problem- Centered Interview

+ CAQDA (Atlas.ti)

Justyna Klingemann, Institute of Psychiatry & Neurology, Warsaw, Poland

Research sample

Use of treatment Sex Age

(mean)

Average time of being addicted

(in years)

Average time of recovery (in years)

Consumption pattern (respondents’ no)

M F Abstinence Moderation

non -treated

Self-changers (SC, n=9)

8 1 53 12 12 7 2

treated

Consumers (CR, n=4) 3 1 55 9 15 3 1

AA believers (AA, n=4)

4 0 52 15 9 3 1

Outpatients (OP, n=6) 5 1 49 9 10 5 1

Inpatients (IP, n=6)

4 2 56 18 9 6 0

TOTAL (N=29)

24 5 53 13 11 24 5


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PL103:M45

„till I was 20-21 everything was all right, so up“

„I went to the army and my first marriage broke, so down“

„I found a job, so it went up but just a little bit because I started drinking“

„I lost a friendship of important person in my life and I kept on drinking, so down and then that person died, and I inherited the money, and I drank even more, it was a real downslide, tragedy”

“the time of my marriage with A. was the best time in my life, even though I was drinking… if I could go back to those times, I would … we lived in France, we had a home, work, good money, friends, parties, alcohol…”

“I had an apartment in Poland, so I went back there, and I kept on drinking, till I had no money and no apartment … and that was bottom and the seaweeds”

“I told to myself: you have to bounce back, I found a job, so at least I had money to buy alcohol… then in 1996 I found a job I still have … having a stable job makes the line go up, I also found a woman and moved into her apartment, and I had money … so the line was going up but I kept on drinking … a lot … much too much”

“but I drank more and more, started to be aggressive, so the line goes down … I loved A. a lot, and I was so jealous, started to be violent against her, I did not know what I was doing … my marriage was in serious crisis … she told me she does not want such a life … it was a nightmare”

then that woman moved to Ukraine and I had nowhere to live again … and I kept on drinking … so the line goes little down”

“then I met my present wife and there was no more downs… since 1999 I do not drink and I do not smoke”

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PL108:M59

BEGINNING: “there were no problems at first (…) my life was on a right truck: I had a good job, good salary, I married, my son was born… every man wants a son”

RED SIGNS: “then the first warning signals appeared and alcohol was present and was lowering the line (…) I realised my close ones do not care about me anymore and their indifference was painful (…) My business was suffering – I do not know how many clients I have lost”

BLUE LINE: “some life pleasures: travelling, building a house, buying a car … when I look back I am satisfied”

RECOVERY: “it went smoothly, I did not change much, except I stopped drinking”

„U know that U-shape… that is how my line of life looks like. Falling falling falling. Hitting the bottom and going up. I will mark here my treatments… I went to treatment so many times… It kept me from drinking … sometimes for few moths sometimes just for few days. My treatment looks like steps when you look at it that way. It is more then 40 years of drinking…. First treatment in 1959, the last one in 1997. And we are in 2007 now” (M73, IP-A)

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Help-seeking history: 5 paths to recovery


Using professional support

Factors influencing the choice of type of professional help:   Knowledge of the individual regarding treatment offer   Level of marginalisation of the individual   Severity of dependence   Physical and financial availability of professional support

1967 1970 1975 1980 1985 1990 1995 2000 2005

aversive therapy psycho-education psychotherapy

self-help movements

legal reform treatment reform


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Self-changers

Ability to maintain resources (recovery capital) despite the occurrence of dependence, and building on them when changing addictive behaviour

Strategies:

  Taking the chance in favourable circumstances

  Experimenting with sobriety till succeeded

  Keeping attempts to quit in secret OR intentionally making them public

  Double resolutions

  Prayers for divine assistance


TYPES OF REACTION ON DEPENDENCE

NU

ISA

NC

E

INTIMACY

PRESSURE

CLOSE FAMILY (parents, partner, children)

REJECTION - STIGMATISATION

ACQUAINTANCES, NEIGHBOURS, CO-WORKERS

PERMISSIVISM, PASSIVITY

ACQUAINTANCES, NEIGHBOURS, CO-WORKERS

SUPPORT

FRIENDS & RELATIVES


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Exiting the addiction

  Addiction can be stopped at any point of its development   The acceptance of the alcohol dependent role is not equal to

the acceptance of patient role

  Stability of alcohol dependent status – the social audience expects further development of addiction

  Evolving reaction of the close environment & role of social support

  Developing negative attitude towards substance

  Normalisation – internalisation of new social roles & finding meaning in life


PERCEPTION OF SELF-HELP

  simple easy-to-follow rules   everybody equal   you can take your time in the

process of recovery – you have as much time as you need

  high availability of groups   chance to get support after

relapse   chance to help others

  every story feels similar which makes those who are different feel uncomfortable

  concentration on negative experiences and events

  connection to church

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Maintenance resources & strategies – literature review


  changes in general life style or changes in living arrangements or work-related changes

  engagement in new, improved, or more meaningful interpersonal relationships or a spiritual life

  becoming more involved or renewing their involvement in:   meaningful work   non-substance-related activities   volunteer work   artistic and creative endeavours

  avoidance temptations or former company & remembering of negative consequences of alcohol use

  positive thinking & future orientation & rewarding oneself   socializing with non- or social drinkers & focusing on their own

responsibilities and society’s role expectations   participation in self-help groups

Maintenance factors and strategies – literature review

WHAT & HOW MANY resources or strategies

are available to the individual in the process of recovery ?

  subjective relevance of specific factors & strategies

  the individual ability of making adequate & flexible

choices from the available repertoire of strategies &

resources to cope with problems


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Multidimensionality of change

change of environment

new country (transformation 1989)

new school

new work

new apartment new furniture

new values & goals

remembering the past thinking of future

regaining dignity and respect becoming new (better) person

becoming beautiful

becoming balanced

becoming joyful

becoming stronger regaining control

gaining self-awareness

effective problem coping having time & managing

time need to help others volunteering

developing hobby

& trying new th

ighs

poems writing reading

hiking

biking fishing

flying

new quality of social relationships

romantic relationship

parenthood friendship

spiritual community membership

cooking

Multidimensionality of change

“Change of house, new job.

Completely new people

who didn’t know about the problem.

This was more than just quitting drinking.

Everything, my whole life began anew”

(M36, CR-A)


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 Start  Start

„my life is a constant up-ward line … I am growing, I started to believe in myself.“

“alcohol destroyed many things in my life … there are still things, unpleasant things, that last”

PL101:34

RELIGIOUS COMMUNITY SUPPORT

  „At some point I have stopped attending AA meetings and started to pray and spend time in my religious community. I quickly realized, that more I asked for in my prayers, more I received” (M50, OP-A)

  „Whole my life I was an atheist, but few years ago I found faith. It helped me. My daughters brought me to church. First they were going to church to pray for my recovery, then they brought me there” (W56, IP-A)

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PL104:M60 “if I could evaluate my present life I would say it is a good one, it feels better then ever”

Impact of time Having time & managing time:   “I don’t go to work just for the money, I go to meet people, dress in the

morning, shave, have some responsibility” (M60, SC-A)   “Rest and relax is very important. You have to have time for yourself. I’m

making my family accustomed to the fact that I sometimes take my little radio to the bathroom and have a bath or sit at my computer and play cards” (W43, OP-A)

Looking into the future while remembering about the past:   “To recall the problems – it was terrible, indescribable … I felt completely

stripped of self-respect … The thought of being in such a position once again definitely motivates you not to drink” (M52, OP-M)

Consolidation of life changes:   “Every year accumulates… Bit by bit, becoming reconciled with your

losses, stabilization, organizing your life anew” (M48, OP-A)


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Summary   independent from help seeking status, more commonalities than

differences exist within successful recoveries from alcohol dependence

  some recovering addicts meet “professional” criteria of stable recovery , whereas others resolve dependence without any significant changes of identity or values

  the multidimensionality of change emerges as the most important characteristic of maintaining recovery

  time management is one of the crucial skills to be developed as well as one’s ability to invest available resources and strengths in shaping and actuating personal goals


Final conclusions

  Heterogeneous phenomenon

  Many ways to overcome dependence   Choice of strategy of changing addictive behaviour depends

on both, the individual & socio-cultural context

  The role of treatment: enhancing naturally occurring processes of change of the addictive behaviour and compensating the lack of crucial resources in the environment of the recovering individual


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(Self-) change friendly society?

ALCOHOL

ADDICTS

PROFESSIONAL REFERRAL

SYSTEM

LAY REFERRAL

SYSTEM

compensation of ‘recovery resources’ lacking in lay networks

lay network support


[email protected] [email protected]

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Klingemann, J.I. (2012) Mapping the Maintenance Stage of Recovery: A Qualitative Study Former Alcohol Dependents in Poland. Alcohol and Alcoholism, pp.1–8, doi: 10.1093/alcalc/agr163

exiting an alcohol career and maintaining change

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