Table Of Content1
The cycle of relapse and recovery of substance misusing offenders on a community
based rehabilitation programme: The impact of childhoods, family, relationships,
significant life events and psychological wellbeing
An Interpretative Phenomenological Analysis and Approach
Beverly Love, BSc (Joint Hons.) Psychology and Criminology,
MSc (Forensic Psychology)
Thesis submitted in fulfilment of the requirements for the award of
Doctor of Philosophy
Department of Psychology
Faculty of Health and Medical Sciences
University of Surrey
August 2017
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ABSTRACT
Background and aims
There is a paucity of research into the relapse and recovery of Class A drug misusing
offenders who are part of the Drug Interventions Programme (DIP). The key aims of
the DIP, a UK Government criminal justice strategy, are to reduce Class A drug misuse
and the [perceived] associated offending behaviour. This group have entrenched and
long lasting addictions, with many ‘failed’ attempts at recovery. There is no published
research about DIP clients, using a qualitative methodology, which explores
childhoods, relationships, psychological health and significant life events and how
these might impact on drug use, relapse and recovery from their perspective. The aim
of the research was to ask community based DIP clients what they considered to be
important factors in their relapse and recovery and to explore how they understand and
make sense of these. Theories within the developmental psychology field, some of
which have not been extensively applied within the addiction field, have helped to
inform the research.
Method and participants
To address a gap in the field, an Interpretative Phenomenological Analysis (IPA) was
adapted for use with a focus group design (four Focus Groups, total N= 10), to explore
the value and merit of the research question. These findings helped to inform semi-
structured interviews (N= 17) using IPA. Participants were adult men and women who
were either current or past DIP clients recruited through the DIP teams in England.
Findings
The following themes were developed from the semi-structured interview study: 1)
Experiences of abusive childhoods – links to emotions that were experienced as
damaging/harmful and problem behaviours; 2) The divergent and damaged selves –
links to substance misuse; and 3) Drug use to cope and survive dangerous events and
trauma/responses. Recovery was about managing these in a healthier way. A fourth
theme showed how participants’ experiences changed during transitions into and out
of recovery, for example the presence or absence of supportive networks.
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Conclusion
The research has implications for theory, policy, practice and future research. This
includes the provision of trauma based therapy and supporting clients to manage their
emotions as well as their wider mental health problems. The importance of an
integrated framework of theories from a developmental attachment, trauma and family
systems approach to inform training and practice are highlighted from the findings.
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DECLARATION OF ORIGINALITY
This thesis and the work to which it refers are the results of my own efforts. Any ideas,
data, images or text resulting from the work of others (whether published or
unpublished) are fully identified as such within the work and attributed to their
originator in the text, bibliography or in footnotes. This thesis has not been submitted
in whole or in part for any other academic degree or professional qualification. I agree
that the University has the right to submit my work to the plagiarism detection service
Turnitin UK for originality checks. Whether or not drafts have been so assessed, the
University reserves the right to require an electronic version of the final document (as
submitted) for assessment as above.
Beverly Love
© Beverly Love 2017
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ACKNOWLEDGEMENTS
I would like to thank my supervisors Professor Arlene Vetere and Dr. Paul Davis for
their advice, support and guidance. I am fully appreciative of their dedication and
encouragement which helped me to complete the thesis.
I am extremely grateful to the DIP teams for trusting me with their client group. I am
immensely grateful to the participants for having the courage to talk to me so openly
about their lives, which I appreciate could not have been an easy task at times. I hope
I have done your stories justice.
I am grateful to Professor Jan Keene for starting me on this journey at the University
of Reading and to the University of Reading for providing me with a bursary to
continue my PhD at the University of Surrey.
I would like to thank the Society for the Study of Addiction for awarding me their
studentship in 2015 to support the remaining stages of my PhD. It was a great honour
to receive the award.
I would like to thank the Home Office for permitting me to conduct this research. I
will always be grateful for the support from my colleagues at the Home Office during
my research endeavours. I fully appreciate that it was new territory through which both
parties had to navigate their way. My intention with this research is to help to improve
policy and practice and to therefore improve peoples’ lives – aims and values which I
held during my time as a civil servant for the UK Government. I hope that the findings
in this research go some way to achieving those shared aims and values.
I would like to thank my family for their support and perseverance, in particular my
husband and children. I would like to thank Arlene Faris, my mother-in-law, for her
enthusiasm, proof reading abilities and babysitting duties. I would further like to thank
my Mum for her faith in my academic abilities and for reminding me of my
determination, focus and resilience during the tough times.
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I would also like to acknowledge those family members who sadly passed away during
the course of my PhD. I know you would both be very proud of me.
In loving memory of
Andrew Love, my dear twin brother
and
Edmund Faris, the best father-in-law I could have ever wished for.
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CONTENTS
Abstract 2
Background and aims 2
Method and participants 2
Findings 2
Conclusion 3
Declaration of originality 4
Acknowledgements 5
Contents 7
List of Appendices 12
List of Tables 14
List of Figures 15
Chapter 1: Orientation to the Thesis 16
1.1 Political influences and terminology 16
1.2 Background to the research question - my role as a policy adviser on the
Drug Interventions Programme 16
1.3 Developing the rationale for the theoretical and qualitative approaches
used in this research 18
1.4 Overarching research question and structure of the PhD 20
1.5 Chapter structure and summary 20
Chapter 2: Introduction 24
2.1 Chapter overview 24
2.2 Introduction 24
2.3 The historical political context and background to the DIP 25
2.4 Published research about the DIP clients – gaps in the literature and
knowledge base 29
2.5 What else was known about substance misusing offenders - psychological
health and co-morbidity? 29
2.6 Situating the ‘drug misusing offender’ within the wider addiction and
recovery field 30
2.7 Interpretative Phenomenological Approach (includes self-reflexivity) 34
2.8 Psychological theories informing the research 35
2.9 Aims and purpose of the research 36
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Chapter 3: Literature review and theoretical framework 37
3.1 Chapter overview 37
3.2 Introduction 37
3.3 Review of the empirical literature on the relapse and recovery of substance
misusing offenders and substance misusers 38
3.4 Theories informing the research scope, direction and questions 49
3.4.1 Introduction 49
3.4.2 Overview of the Developmental Psychological theories 50
3.4.3 Attachment theory and addiction – introduction and overview 51
3.4.4 Affect regulation theory and attachment theory - application to addiction 53
3.4.5 The influence of self psychology theory in advancing attachment theory
to understand addiction 55
3.4.6 Khantzian’s Self Medication Hypothesis - an affect regulation theory of
addiction? 59
3.4.7 Modern affect regulation theory – a theory of self-regulation 62
3.4.8 Developmental trauma theory 63
3.4.9 Family systems theory 67
3.5 Summary of the theoretical framework and gaps in the field 71
3.6 Research questions 72
Chapter 4: Methodological approach, rationale and criticisms 73
4.1 Chapter overview 73
4.2 Introduction 73
4.3 Further reasons for using a qualitative approach in the research 74
4.4 Subjectivity, generalisability and small sample sizes – value, merit and
scope of qualitative methodologies 77
4.5 Interpretative Phenomenological Analysis (includes self-reflexivity) 78
4.6 IPA and the addiction/substance misuse field 80
4.7.1 Epistemological position in this research and rationale for using IPA
rather than other phenomenological methodologies (includes self-reflexivity) 81
4.7.2 Why not a discourse analysis or grounded theory approach? 83
4.8 IPA ‘approach’ in Focus Groups – adaptions, applications and theoretical
considerations (includes self-reflexivity) 86
4.9 Criticisms and limitations of IPA 89
4.10 Research questions 90
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4.11 Ethic approval and permissions 91
4.12 Ensuring quality and standards in qualitative research 94
Chapter 5.1: Part One Focus Group Study: Methodology and method 95
5.1.1 Chapter overview 95
5.1.2 Rationale for using focus groups 95
5.1.3 Criticisms of focus groups – overcoming challenges 97
5.1.4 Focus group size and the number of focus groups 98
5.1.5 The card sort task in a qualitative phenomenological approach and in a
focus group design 99
5.1.6 Design and materials 103
5.1.7 Participants 110
5.1.8 Procedure 121
Chapter 5.2: Part One Focus Group Study: Findings 136
5.2.1 Chapter overview 136
5.2.2 Introduction and overview of the findings 136
5.2.3 Superordinate Theme 1: Difficult and/or traumatic childhood experiences 140
5.2.4 Superordinate Theme 2: Struggles with complex and tense relationships 145
5.2.5 Superordinate Theme 3: Challenges and struggles with mental and
psychological health 155
5.2.6 Superordinate Theme 4: Criminality – pathways, turning points and
U-turns 160
5.2.7 Superordiante Theme 5: Reasons to use drugs, to lapse or relapse – a
coping mechanism 161
5.2.8 Superordinate Theme 6: Ways of coping with life ‘the mundane to the
extreme’ 165
5.2.9. Superordinate Theme 7: What helps in recovery and to prevent
lapses/relapses 170
5.2.10 Summary and next steps 173
Chapter 5.3: Part One Focus Group study: Discussion 174
5.3.1 Chapter overview 174
5.3.2 Summary of findings 174
5.3.3 Developing the findings from the Focus Group Study (Part One) into a
semi-structured interview schedule for Part Two 176
5.3.4 Credibility checks 176
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5.3.5 Considerations, challenges and benefits of adapting IPA for focus groups 183
Chapter 6.1: Part Two Semi-structured Interview Study: Methodology and
method 185
6.1.1 Chapter overview 185
6.1.2 Research questions 185
6.1.3 Design and materials 186
6.1.4 Participants 190
6.1.5 Procedure 197
6.1.6 Ensuring high quality and standards in the research 203
6.1.7 The interview method – value, merit and critique 203
Chapter 6.2: Part Two Semi-structured Interview Study: Results section 206
6.2.1 Chapter overview 206
6.2.2 Introduction 206
6.2.3 Overview of the main findings: 208
6.2.4 Superordinate Theme 1: Experiences of abusive childhoods – links to
emotions that were experienced as damaging/harmful and problem behaviours 208
6.2.5 Superordinate Theme 2: The divergent and damaged selves – links to
substance use 219
6.2.6 Superordinate Theme 3: Drug use to cope and survive trauma/responses 229
6.2.7 Superordinate Theme 4: Managing trauma – transitions into and out of
recovery (internalised will, relational connecting, processing capabilities) 237
Chapter 6.3: Part Two Semi-structured Interview Study: Discussion 249
6.3.1 Chapter overview 249
6.3.2 Superordinate Theme 1: Experiences of abusive childhoods – links to
emotions that were experienced as damaging/harmful and problem behaviours 249
6.3.3 Superordinate Theme 2: The divergent and damaged selves – links to
substance use 256
6.3.4 Superordinate Theme 3: Drug use to cope and survive trauma/responses 261
6.3.5 Superordinate Theme 4: Managing trauma – transitions into and out of
recovery (internalised will, relational connecting, processing capabilities) 268
Chapter 7: Ethical, legal and safeguarding considerations and challenges in
the thesis 280
7.1 Chapter overview 280
7.2 Incentives to take part 280
7.3 Criminal disclosure 281
