PH.D CONCEPT PAPER

  

Proposed Title:

‘Routes to recovery from drug addiction: An oral history account of addicts in recovery on the KZN South Coast’  

Through my  experience with long-term drug addiction and recovery, and extensive reading on the subject I have come to believe that the present model  of addiction treatment is limited in three crucial respects.

Addiction is still by and large treated as an acute ailment which can and should be cured after a short stay in a treatment centre.  Increasingly research is showing that that is not viable. While providing short term  therapy might provide a structure for ongoing recovery, in and of itself it is inadequate. Recovery is increasingly been revealed though experience and research as a long term process which requires finding ways  in assisting drug users  to feel connected and purposive. 

Secondly, present treatment models focus on the individual,  overlooking the community and social aspects of the problem. If we are to truly understand addiction as a long term illness, it is critical to understand the role that community plays in contributing to the illness and in remedying it.

Thirdly, treatment is expensive and the vast majority of addicts will never be able to afford the costs involved. Though efforts are being made to make treatment affordable and available resources simply do not exist  to meet the need. In the meantime, addiction numbers are rising and the longer this is left untreated, the more endemic this social and public health problem is likely to become.

These limitations are the research problem to be addressed in the dissertation. The objective is to explore alternative pathways to recovery which address these. It is for this reason that it is important to gain a deep understanding of how those who are in long term recovery came to the point they are at. This dissertation therefore will focus on the pathways to recovery of a group of addicts, some of whom have been clean for a sustained period of time, some still struggling, but with a desire to find recovery.

The focus of the study will be a group of recovering addicts in Umzinto on the Natal South Coast, mainly , but not exclusively from Riverside Park, a poor community particularly hard hit by drug addiction, especially whoonga. This group has been chosen purposively as it comprises of addicts who are actively seeking, and involved in recovery through participation in Narcotics Anonymous.   This group has grown from two regular attendees at NA a year ago to a core of eight members now clean between 3 weeks and 1 year, plus a growing group of between 6-10 addicts still in active who regularly attend meetings expressing the desire to get and stay clean. This will be a longitudinal study using qualitative research techniques . I plan is to collect life stories (Oral Histories) from these addicts and follow their progress over the next few years.. not only for the three years of my doctoral studies but beyond. Further I plan to hold focus groups to discuss various aspects of addiction and recovery.  I will also interview family members and other members of the community as to the effect addiction has had in the community and, as the study progresses the effect a group of recovering addicts has on the community as they begin to reintegrate. I would also be drawing on aspects of applied research through describing and evaluating  of  community initiatives as they develop. There are a number of initiatives planned in the area (greater Umdoni) which these addicts would be part of, and which the study would cover. These would be aimed at addressing the above limitations and modelled on the initiatives of the American recovery movement.

The following objectives guide the study:

• ·         To explore and document the experiences, through addiction and recovery, of a group of recovering addicts, involved in active recovery programs as a means of gaining greater understanding of the pathways in and out of addiction. 
• ·         To explore and document the experiences of members of families and communities of these addicts as a means to gain greater  understanding of the link between individual addiction and  family and community trauma and vulnerability, as well as between individual and community recovery.
• ·         To  document   and assess the progress of a Community Recovery  program which is being developed in this community  as it unfolds  with the intention of investigating, and ultimately contributing toward designing a new and effective model for treating drug addiction that ‘fits’ with the localised South African context, taking account of the afore-mentioned limitations.
• ·         To critically engage with the various debates about addiction recovery in the existing literature, particularly that emerging from the Recovery  movement,  and to contribute to theoretical and evidential debates

The Recovery movement which has come to the fore in America has addressed these issues. This movement  locates both addiction and recovery firmly within the community. The focus of this movement is on  involving recovering addicts and those affected by addiction (families and communities) in the healing process and the reintegration of addicts back into their communities. It is strongly rooted in the ideas, drawn from the 12 step program of the Narcotics and Alcoholics Anonymous movements,  of one addict helping another and of recovery being dependent on service to others. A strong network of Community Recovery organisations has emerged. These are embedded in communities through establishing Recovery Community Centres. The movement is also engaged in advocacy, education and research and a strong body of academic writing is emerging.

William White and other writers in the recovery tradition have claimed that communities that have been victims of  what they call “historical trauma” become particularly vulnerable to a wide spectrum of personal and social problems. Such trauma erodes indigenous sources of cultural and personal resilience leaving communities, community institutions, neighbourhoods, families, and individuals  particularly vulnerable to drug and alcohol related  problems.  I believe this to be particularly relevant  the South African context. Through my own experience and through contact with other addicts I have realised that the one thing we have in common is a sense of alienation, of not being fully part of one’s family, one’ s community,  and disconnected from one’s peers. This is backed up in the literature. It seems to me that this experience is paralleled  at a community level and the communities most at risk of drug and alcohol related problems  are those most alienated from  economic and cultural processes.  White also draws from Native American culture with its concepts of the “wounded healer” and the “healing forest” (the “healthy” community.)

My contention is that our society suffers from a dis-ease, rooted in alienation,  of which the individual addict is but  the symptom and carries the burden of suffering. Perhaps through the healing and reintegration of  individuals a greater healing can begin and the lessons of addiction and recovery at an individual level could  hold some solutions for  our broken communities and for society at large.

Concept note for Doctoral studies

Proposed title:

‘Routes to recovery from drug addiction: An oral history account of addicts in recovery on the KZN South Coast’

Personal Background:

As a result of my own personal history I have chosen to do a dissertation that focuses on drug use and recovery instead. I have become interested in this field of addiction recovery  through my own experience of addiction and realised that with my experience I can make a contribution.  I have  suffered a long term battle with drug addiction and came into treatment early last year at  a rehabilitation centre in Scottburgh on the South Coast. On leaving treatment 18 months ago I decided to stay in Umdoni where there is a very strong fellowship of recovering addicts and have immersed myself into the program and activities of Narcotics Anonymous.  I have also used this time to do research, on my own volition, on addiction and recovery with a particular interest in the Recovery Movement in the USA and other treatment and recovery models around the world.

I am also a member of the Harm Reduction Advocacy Group which is co-ordinated by the UFC@DUT. I believe that my meeting up with Prof. Monique Marks has been very fortuitous. I am keen to combine my social science training with my deep interest in health sciences. The project focus of the UFC@DUT on street level drug addiction resonates with my personal and academic interests.

 While I have no formal training in the Health Sciences, I do believe that this is the correct      Faculty for me to conduct my doctoral research on pathways to recovery for drug addiction, which I view as a chronic illness. Not only do I hope that my doctoral work will assist in understandings pathways to recovery further, but I am also keen to use this doctoral programme to assist in establishing a community based organisation that centres on community recovery and makes use of alternative models of therapy and treatment. I have already began my research journey by reading extensively on the recovery movement, but also through conducting in-depth oral histories of a wide range of individuals who are currently in recovery.

It is my view that studying in the field of Health Science will enable me to be able to work more effectively, and with greater credibility, in the broad health sector. But most importantly, I view this doctoral degree as an opportunity to learn more about drug addiction recovery, and to contribute to this body of knowledge in significant ways, and within the context of KwaZulu-Natal.

Background to the dissertation:

As a recovering drug addict, and someone who has read extensively about both addiction and recovery, I have come to believe that existing models of addiction treatment are very limited. Addiction is by and large treated as an acute illness that can and should be cured after a short stay (one to three months)  in a treatment centre. Increasingly research is showing that that is not viable or effective, and that simply weaning off or detoxifying users is inadequate in the medium to long term. It is for this reason that most rehabilitation programmes fail to ‘cure’ addicts of their illness in the longer term, and instead what is most evident is repeat relapse and wasted expenditure.

Short term medical and even psychological interventions are without doubt ineffective. What is required is a real understanding not simply of the biological factors that contribute to addiction, but the more deep level motivation for getting into drug use in the first place. Much of this has to do with feelings of social disconnect and dissociation, as well as ways of coping with traumatic and stress. While providing short term  therapy might establish a structure for ongoing recovery, in and of itself it is inadequate. Staying clean is a long term process and extended recovery  requires finding ways  in assisting drug users  to feel connected and purposive. What is evident from the latest research on recovery is that that long term addicts often have little or no life-skills or resources to stay clean. What is required, then, is sustained help with reintegrating into society, and developing alternative ways to deal with the personal and social problems that led them into addiction in the first place.

Another limitation with existing addiction treatment models is that they are by and large focused on the individual. The community context from which the individual comes and the social dynamics that feed addiction habits are largely overlooked. What is required then  is more community based approach that addresses  social dynamics in much the same way as is now happening with other chronic illnesses such as diabetes and obesity. If we are to truly understand addiction as a long term illness, it is critical to understand the role that community plays in contributing to the illness and in remedying it. William White and others have claimed that communities where addiction levels are high have been victims of what they call “historical trauma”. Such trauma erodes indigenous sources of cultural and personal resilience leaving communities, community institutions, neighbourhoods, families, and individuals particularly vulnerable to drug and alcohol related problems. This, I believe is crucial to the rise in drug addiction in the South African context where whole communities have experienced and continue to experience collective trauma, and where individuals have become disconnected and alienated from family and community. It is therefore important in the South African context to gain a deeper understanding of how individual vulnerability to drug addiction is mirrored with broader community vulnerability and risk.

A third and critical problem with existing rehabilitation treatment is that it is extremely costly. The majority of addicts are unable to afford the cost of the existing treatment centres, even those that are short term in their services. And in resource poor countries like South Africa, the chances of having long term holistic intervention in the public sector is unlikely in the short to medium term. In the meantime, addiction numbers are rising and the longer this is left untreated, the more endemic this social and public health problem is likely to become.

It is for this reason that it is important to gain a deep understanding of how those who are in long term recovery came to the point they are at. This dissertation therefore will focus on the pathways to recovery of a group of addicts, some of whom have been clean for a sustained period of time, some still struggling to find recovery , but with a strong desire to do so. There are various possible paths to recovery and the point of this dissertation is to uncover what they are and to see which ones are thought to be most effective.

The thinking behind this dissertation is largely based on literature on the recovery movement. The recovery movement locates both addiction and recovery firmly within the community. The focus of this movement is on involving recovering addicts, and those affected by addiction (families and communities) in the healing process, and the reintegration of addicts back into their communities. It is strongly rooted in the ideas, drawn from the 12 step program of the Narcotics and Alcoholics Anonymous movements, of one addict helping another and of recovery being dependent on service to others. While the movement primarily started in America  where there is a strong network of Community Recovery organisations has emerged, and is spreading around the world. In South Africa though this movement is in its infancy.

 These organisations are embedded in communities through establishing Recovery Community Centres, which host a range of activities from out-patient therapy, to life-skill and job training, to providing a venue for creative and recreational activities. They also operate as a resource centre for families and social and health care workers to learn about addiction. The movement is also engaged in advocacy, education and research and a strong body of academic writing is emerging. In places like the US and Northern Ireland, the recovery movement is now gaining increasing support from both those in the health care professions and from police who are confronted with the back end of addiction consistently.

Johan Hari has also drawn attention to the importance  social context plays in driving addiction through elaborating on the famous  “Rat Park” experiment. For Hari the prime drive of addiction is disconnection and the focus of recovery should be reconnection.

Anne Wilson Schaeff argues that our society is driven by addictive behaviour. The obsession with extracting fossils fuels with no regard to the environmental damage  and our fixation with material wealth and possessions as a measure of success and happiness  certainly mirror the behaviour of an addict..

My contention is that our society suffers from a dis-ease of which the individual addict is but the symptom and carries the burden of suffering. Perhaps through the healing and reintegration of individuals a greater healing can begin and the lessons of addiction and recovery at an individual level could hold some solutions for our broken communities and for society at large.

Objectives of the study are:

·         To  discover, through Oral histories  the most effective routes out of drug addiction

·         To document the stories of users who are part of a recovery community on the KZN South Coast

·         To follow and assess the progress of a Community Recovery program which is being introduced in this community as it unfolds

·         To document the processes and the structure of the Umdoni Recovery Programme with the intention of investigating new model for drug addiction treatment

·         To understand the link between individual addiction and community trauma and vulnerability.

·         To critically engage with the various debates about addiction recovery in the existing literature and to contribute to theoretical and evidential debates

·         To ultimately contribute toward designing an effective model for treating drug addiction that ‘fits’ with the localised South African context.

Key questions to be answered:

Given the above, the following questions are viewed as central to this dissertation:

·         What are the most effective and sustainable pathways out of long term drug addiction?

·         What are the pathways into drug addiction?

·         In what way do family and community factors contribute to individual addiction?

·         What impact does addiction have on communities?

·         In what ways can families and communities be involved in individual recovery?

·         In what ways can individuals be involved in community recovery?

·         What alternatives to the mainstream rehabilitation programmes should be developed in a South African context?

Research methodology

This study will focus on a group of recovering addicts that are living in the broad Umzinto district on the Natal South Coast. The majority, but not all of these addicts are from Riverside Park, a poor community particularly hard hit by drug addiction, especially whoonga. This group has been chosen purposively as it comprises of addicts who are actively seeking, and involved in recovery through participation in a Narcotics Anonymous group of which I am a part.   This group has grown from two regular attendees at NA a year ago to a core of eight members now clean between 3 weeks and 1 year, plus a growing group of between 6-10 addicts still in active who regularly attend meetings expressing the desire to get and stay clean.

This study will mainly comprise of oral histories which will allow those in recovery to tell their stories in a manner that is not constrained nor overly directed. The oral histories will be taken over two different periods of time allowing for some evaluation of the effectiveness of the pathways that the recovering addicts that are part of the study have opted for. The two points of conducting oral histories will be 12-18 months apart.

I  plan to hold focus groups with recovering addicts in Umzinto to deliberate various aspects of addiction and recovery. I will also interview family members and other members of the community as to the effect addiction has had in the community and, as the study progresses the effect a group of recovering addicts has on the community as they begin to reintegrate.

Further a number of  initiatives are being planned in this community. An NGO is being put together to raise funding to start a community centre. This will obviously be  a long term process. In the meantime creative and innovative ways of  implementing some of the ideas of community recovery will be pursued.  Throughout this research process, I will be drawing on aspects of applied research through the describing and evaluating of these initiatives as they develop.