Recovery and the 12 steps

I believe that there are many pathways to recovery from addiction and that we all have to find our own path.  For myself I found I could get off heroin easily enough, but I never found a way to stay off it.  I tried many different ways: rehab, medication, iboga, amino acid supplements, different spiritual pathways, psychology, psychiatry, supposedly less harmful drugs, psychedelics etc. All of these things worked to varying degrees to alleviate my withdrawals, and to help me put down the drugs. But they could not keep me clean.  I am not saying these things don’t work or are ineffective: they can no doubt help in the early phases of recovery. And I have seen them work as long-term solutions for some people. Personally I always found that no matter how badly I tried or wanted to stay away, I always found myself back on heroin. The only thing that helps me stay off it in the long term is participation in the fellowship and the program of the 12 steps.

I do believe that there are certain essential necessary for recovery, whichever path we follow. I think connection is the most important of these. We learn to reconnect with friends, family, life, nature. I believe some kind of spiritual experience and reconnection with a higher power is essential. A change in attitude from blaming others for one’s problems and accepting responsibility for one’s faults. Practising gratitude for what one has. Nurturing the ability to really listen to others and to learn lessons from others experience has been essential in my recovery. I always thought that I could only learn from my own experience. Awareness, honesty, open mindedness, willingness are all essential.  A desire not just to put down the drugs, but to be a better person. Service towards the still suffering addict, and a general willingness to reach out and help other helps overcome the selfishness we learn in active addiction and our morbid obsession with ourselves and our own problems.  Another crucial point for me Is fellowship with like minded people. It reminds me where I come from and I can share my problems with people who truly understand me. Make myself vulnerable, and reaching out to others for help was something I could never to which is why I always felt alone and different.

The 12 step program has many critics and it seems the biggest problems they have with the fellowship is around the concept of powerlessness and the perception of the 12 step program as a religious one. Also there is the idea that NA because teaches abstinence it is against the use of all drugs. All of these stem, I believe,  from misconceptions and misunderstandings. For me powerlessness means firstly the recognition that I cannot use any mind or mood  altering substances with putting myself at risk of relapse. But also it means in a more general sense that I cannot be attached to any particular outcome of any kind. If I engage in any activity with a particular outcome in mind I will always be disappointed. Life or god, call it what you will, always gets in the way, things always turn out differently to the way we expect. I have found that all the fret and worry that come from expectations not being met and situations not turning out as we would like is unhelpful and unnecessary. We can only put in the action and leave the outcome to god/fate/the universe, call it what you will. I have found in most cases when we stop having expectation and leave the outcome to a higher power the results actually exceed anything we can possibly imagine.

The 12 step program also has nothing to do with religion. We encourage people to connect with a higher power of their own understanding. This, as I understand it, draws the individuals focus away from himself as the centre of the universe, and the selfishness of active addiction, with the realization that there is something bigger than oneself. A higher power can be as simple the group consciousness of the fellowship. It does not have to be God. I myself believe in the power of nature and the life energy of the universe. There are atheist and agnostics in the rooms alongside Christians, Muslims, Hindus and Jews. The program itself does not teach religion, but rather a spirituality which focusses on connection.

 The 12 step fellowship does not teach that all drugs are bad, or try and get everyone off drugs. Plenty of people use drugs and have no problem. In fact many in the fellowship, including myself, support the unbanning of all drugs, because it then makes greater regulation possible. What it does teach  is that my life became crazy and unmanageable because of drugs. The problem does not actually lie in the drugs, they were in fact my solution. Initially  drugs do make life more fun, enable us to handle the problems life throws at us, feel less alienated, angry, anxious and frustrated.  Some people are able to continue taking drugs in a moderate way throughout their lives without it becoming a problem.  The problem then, for me, the addict, is that I came to rely on this solution, and that I  needed to keep taking more and more drugs to get the same feeling. The drugs stopped working and I needed to find another solution. For me the program and the fellowship of the 12 steps is that solution. I know from years of trying that if I use any mind or mood altering substance I get reminded of the solution I found in drugs, and I want more.

As for being always being an addict, I believe I was an addict long before I discovered drugs. I always want more of everything, never satisfied with what I have.  Nearly four years  into my recovery I still attend meetings nearly  everyday. Not because I have to but because I want to and because I  owe my life to the fellowship. I give back by giving an hour of my time everyday to meet with other people like me, and to carry the message to those still suffering that, yes,  recovery is possible.  So  I am still a junky, but now I have a healthy addiction, one that is not going to kill me or destroy my life.

Harm Reduction and Recovery; Two sides of a coin.

The focus of the Drug Policy week, held in Cape Town was on a call for harm reduction interventions to be increased in South Africa.   There is a view, held by both many practitioners of harm reduction and recovery that the two views are hostile and antagonistic. This was initially my view, coming as I do from a recovery background. I have come to understand that this is not the case and in fact the two approaches  actually have far more in common than what divides them.

The first and most important area in which I found agreement  is the need for legalisation/ decriminalisation  of drugs and the adoption of rational policies towards drugs and drug use. I know this is a contentious issue and one many recovery proponents would argue against, but I feel equally strongly that this is a conversation we need to have, and that people need to take a stand on this issue. We know that the war on drugs is not working, or rather it is working --as a political exercise to criminalise and control large sections of the population through violent militarisation and terror. This was highlighted in the opening address by Ethan Nadelmann. (http://www.sadrugpolicyweek.com/31-july-2017.html ).

The end result of the war on drugs is that the power and profit from the sale of drugs ends up in the hands of competing gangs (the most powerful of whom are not even seen as gangs but comprise so-called respectable people  within our political and corporate structures of power), and escalating warfare for control of these profits. While the legalisation and decriminalization of drugs, undoubtedly, will present us with a new set of  challenges and social issues, these will certainly not  (judging by the examples of countries which have gone down this road….Portugal, Holland, Uruguay and even the USA amongst others) compare to problems created by the war on drugs.

The following is controversial. Please read this as  my opinion given  with the stated aim of stimulating debate.

I believe the war on drugs forms part of a deliberate strategy by those in power to benefit themselves and  to establish a world order of individual survival and disconnection from community.  A world where violence and military power hold sway and the weak and powerless are victimised and blamed for the state of the world. A world, in short that feeds addiction.

I believe this is a political issue. We have come to see the political sphere as somehow separate from our everyday life—something done by politicians. In reality politics permeates every area of our lives. All the choices we face everyday- what we eat, how we treat people, the language we use-are political by nature. We have been made, deliberately, to forget this. We need to reclaim politics as a normal sphere of everyday life and make a stand as active citizens to rectify the  wrongs in our society.

I am not challenging the traditions of the 12 step fellowship. I remain committed to these. I feel deeply that the fellowship does and should continue to provide a space free from the divisive nature of these and other issues. I do feel however that those who care about these issues should find other spaces, channels and organisations, alongside the fellowship, to take these up.

To be continued….

‘Pathways to recovery from heroin addiction: An oral history account of addicted heroin users in recovery.’

Thesis Proposal pt1: Context of the Research

This is the final version of my proposal as accepted by the Durban University of Technology, to undertake a research project leading to a PhD degree in Health Science.

The United Nations recently convened a special assembly recently in response to the growing criticism of present international drug policy. In particular the so-called “War on Drugs” is coming under increasing attack as, at its best,  a costly and futile exercise, (Gray 2001; Rolles et al. 2012) and, at its worst, a sinister machination of bio-political control (Bobo and Thompson 2006). Internationally and locally experts are baffled by the growth of what is perceived as a “drug problem”. An increasing number of countries, institutions and individuals are exploring and debating a range of alternatives in reducing the harm that drugs cause, from legalization to policies that are aimed at harm reduction rather than punishment (GCOD 2011; UKDPC 2012).  In South Africa the National Drug Master Plan commits to a multi-disciplinary and community-based oriented in what it refers to as a “bio-psycho-social” model (South Africa 2012: 30). However according to Howell and Couzyn (2015: 1) the plan is “riddled with internal inconsistencies and impractical resolutions” and will be extremely difficult to implement due to lack of government resources and co-ordination on one hand, and the lack of non-government facilities on the other. Furthermore content analysis by Geyer and Lombard (2014: 342) reveal that the master plan is still stuck with using the language of criminalisation and individual pathology, which, they conclude, has the result of absolving the government of any responsibility. There is a growing perception that present treatment and policy models in regard  to drug addiction are inadequate to deal with the multitude of psycho-social, family and community issues emanating from, and leading to, the ever-increasing abuse of drugs. They tend to pathologise the individual and overlook the structural and social aspects of the problem (Chetty 2015; Prinsloo and Ovens 2015) . Further there is little agreement as to what the outcome of the recovery process should be. Dos Santos claims too that “the pathways to recovery tend to be complicated and the variety of possible outcomes is extremely great”  (Dos Santos 2012: 54) .   Practically treatment is inaccessible to the majority of addicted user (Myers and Parry 2005; Dos Santos, Rataemane and Rataemane 2013). This is available either through private residential treatment centres, which are prohibitively expensive and inaccessible to the majority of addicted users, or available, largely as out-patient treatment centres through non-profit state or NGO organisations. Access to these centres is limited, due to lack of funding and resources, and there is usually a three to six month waiting list. In both private institutions and the NGO/state sector there is a poor record in achieving sustained recovery. (Jeewa and Kasiram 2008) . Largely missing from this debate is the voice of addicted user themselves. As a recovering addicted heroin user myself, I have come to believe that it is critical to have such voices heard if a decent model for dealing with drug use disorders is to be developed and implemented. Drug users are a highly stigmatised and marginalised community. Their voices are seldom heard when it comes to policy making and practice models that are directed at them. Yet their own experiences and journeys into and out of problematic drug use could provide invaluable insights into the development of more effective treatment models.

Thesis Proposal pt 2: Aims and Objectives.

The use of drugs is as old as humankind. For the most part drugs have been used for healing, spiritual purposes and recreation with very little negative consequences (Hoffmann 1990). However there has always been a  small minority of people who have become problematic drug users.  Drug use becomes problematic when it becomes the sole focus of one’s life and when their use harms the user, their family and the community they live in. This small percentage of problematic drug users from within the drug use community could best be described as “addicts”. .(Alexander and Schweighofer 1988).

This study will attempt to understand how and why certain people, at certain points in their lives, turn to drugs for relief, become addicted, and how and why they recover.  It will do this by exploring the oral histories of previously addicted heroin users, now in recovery.

 Both ‘addiction’ and ‘recovery’ are contested terms. The meaning we give to these terms has profound implications for our approach to policy and treatment. Different models have different measures and diverse underlying concepts and normative outcomes. It could be said, however, that all treatment models aim towards what can be broadly called ‘recovery’. [1] An essential part of this study is to explore what these terms mean to the recovering addicted user, to begin to understand these from lived experiences.

The aim of the study is to allow the subject free rein to tell their life stories in their own words, to construct it in ways that are meaningful to them. Through analyzing these stories the aim is to gain a greater understanding into the pathways of addiction and recovery.  This information can then be used to inform debates around the nature and the lived realities of addiction, but also the effectiveness of different treatment and policy models.

The objectives are as follows:

1                          to record the oral histories of a group of addicted heroin users in recovery.

2                         to analyse the narratives to extract common themes relating to pathways in and out of addiction.

3                         to assess the emergent themes in relation to the various theoretical and evidential debates about addiction and recovery in the existing literature, particularly relating to current treatment models.

4                         to use the insight gained to begin to identify the strengths and address the limitations in the current treatment models by engaging with current policy and the various agents involved in treatment of drug addiction.

 The primary question that will be asked is: What insight can we gain from the oral histories of recovering addicted heroin users that might assist in identifying the strengths and addressing the limitations of present treatment models in South Africa?

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[1]              The meaning of these terms is explored in the literature section below.

Thesis Proposal pt 3: Literature Review

 The traditional discourse on the subject of drug addiction focuses on two models: the judicial and the medical. The first has led to the War on Drugs and conceptualises the addicted user as a criminal who needs to be punished and removed from society.  Addiction in this model is viewed as a moral failing, or a lack of willpower (Gray 2001). Treatment is seen as punitive, with jails or militaristic “boot camp” type institutions being the preferred destination not only of addicted users, but of all who have fallen foul of the drug laws. The UN Global Commission on Drug Policy, made up of imminent persons, including former heads of state, business leaders and renowned artists states quite plainly : “The global war on drugs has failed… policy makers believed that harsh law enforcement action against those involved in drug production, distribution and  use would lead to an ever-diminishing market in controlled drugs such as heroin, cocaine and cannabis, and the eventual achievement of a “drug-free world”. In practice the global scale of illegal drug markets- largely controlled by organized crime- has grown dramatically over this period.” (2011:4).  Rolles et al (2018:8) estimate the annual cost of the War on Drugs exceeded 100 billion dollars, while profits from the annual trade in illicit drugs exceeded 330 billion dollars. It is, however, still the dominant model for dealing with addiction at a global level.

The second approach conceptualises the addicted user as a patient in need of medical intervention and has led to the rise of the treatment industry.   There is a growing awareness of the limitations of current approaches to treatment (Borkman 1998; White 2007a; Keen, Sathiparsad and Taylor 2015). I have stated some of these limitations in section 2 (The Context), others will be explored below.

In South Africa this has been the dominant model of treatment. Jeewa and Kasiram (2008: 44) found, that in this country, “there is no “best treatment option” and “there are too many variations and complexities in reaching the goal of freedom from dependence.” They also found that the approach to treatment was founded on a “unidimensional philosophy”  and that there was a need for more comprehensive and creative approaches.  Dos Santos, a practicing psychiatrist and head of the South African Foundation for Professional Development, found that successful treatment programs needed to be holistic, long term and focus on all aspects of life (Dos Santos et al. 2009).  At present, however, treatment usually involves a short stay in a private institution. In South Africa medical aids only pay for one month treatment, so this is the usual duration, but this may be extended to three months. During this time the addicted user is the passive recipient of a bio-medical or psychological treatment program, after which they are sent on their way with little, if any follow up.

Further only about 16% of South Africans are on medical aid schemes (Myers 2013). The remaining 84% are dependent on public service, and for the most part can’t afford private care, where treatment is still largely based on expensive, in-patient, rehabilitation models . Treatment for heroin addicts in the public sector is virtually non-existent, and while government rehabilitation centres have opened, they offer no detoxification or substitution treatment and have a long term waiting period to get in. In both public and private sector, the “expert hierarchical model” is applied, relying on doctors, psychiatrists, nurses and other professional who are assumed to have expert knowledge of addiction. (Borkman 1998: 41). The “gatekeeper myth” keeps us believing that professionals have a better understanding of the workings of addiction than those who have been addicts, when in reality  treatment by professionals is no more (or less) successful than programs run by recovering addicted users (Humphreys 2015). Many too recover without any intervention (McIntosh and McKeganey 2000).

Perhaps the biggest deficit with the medical model is that little attention is paid to social factors which may be involved in causing addiction, and the circumstances to which people  return when they leave in-patient based treatment centres. (Borkmann 1998: 42; Jeewa and Kasiram 2008).

These deficits are now well documented  and have given rise to a rethinking  of the treatment of drug dependence and addiction. Since the latter half of the 20^th Century newer methods of dealing with addiction are coming to the fore. Predominant among these is the social model which places addiction firmly in a community context and conceptualises the addicted user as a vulnerable and alienated member of society in need of re-integration into their community. The two main approaches using this model are the harm reduction and recovery schools of thought. These approaches are often portrayed as being in conflict, but in reality have much common ground and can complement one another (Roberts 2009; Evans, White and Lamb 2013). Both are geared towards the normalization of life for the addicted user. The harm reduction model looks to reducing the harms done by drugs, both to society and the individual using pragmatic, non-judgmental interventions. (Public Awareness Task Group 2007: 4)  Among these are needle exchange programs, controlled drug using spaces, and Opioid Substitution Therapy. Abstention is not the necessary outcome. While in the recovery model, abstention is seen as the ultimate goal, other measures of success are seen as equally important. The Betty Ford Clinic, one of the oldest and most respected recovery based centres in the USA, holds up personal health, citizenship and social integration along with sobriety (abstention) as measures of recovery (Panel 2007: 222).

Writers within the growing social model discourse encompassing both harm reduction and recovery, place the causes of both addiction and recovery firmly in the community.  (Bamber 2010; Alexander 2012; Evans, Lamb and White 2013). Alexander attributes addiction to what he calls “inadequate social integration” or “dislocation”. Those suffering from dislocation construct “substitute lifestyles” which may focus on dangerous and excessive drug use (Alexander 2000: 502). The famous Rat Park experiment (Alexander et al1980) is a powerful demonstration of this effect. Addiction is viewed as a disorder of society rather than the individual, rooted in the alienation and dislocation so prevalent in the modern world. (Alexander 2000, Bourgois 2003, White 2007b). The solution then to problematic drug use is re-connection.

In his more recent work, Alexander (2012), goes further than this. Elaborating on his Rat Park experiment, he sees drug addiction as the manifestation of a greater problem in our society. The problem he sees is that addiction, in all its forms, not just drug addiction, is a way of adapting to the sustained dislocation of globalisation. The only way we can tackle this problem in the long run, he believes, is through large scale social and political changes. This is not in contrast to the social model, but rather can be seen as the extreme, but logical outcome of its premises.

Treatment, in the social model requires long-term intervention of re-integration back into society. Both social model schools view recovery as a long term, active process of re-connection and learning, rather than as an event (Du Pont and Humphreys 2011).

The harm reductionists believe this can be achieved by ensuring that addicted users who opt to stop using illicit drugs have access to Opioid Substitution Therapy. OST is viewed as a platform for re-integration and normalisation and provides the user with a degree of stability in their lives, unattainable while using heroin. OST is controversial within the recovery movement. Recovery supporters are concerned about the addictive nature of opiate substitutes and speak of “methadone madness”. (Neale, Nettleton and Pickering 2012 : 33). Opiate substitution therapy  has however been endorsed by William White, a leading figure in the recovery movement, among others (White and Mojer-Torres 2010).

Recovery proponents believe that an addictive lifestyle exacerbates the initial disconnection that causes it. Thus long- term process of re-connection, and learning to live a drug free lifestyle is necessary to address all the issues involved which initially led the individual, and may  lead them back, to using drugs (White 2007: 231). The previously addicted user is encouraged to participate in a program which may include personal or family counselling, attending support groups, vocational and life skills training workshops, participating in community service, access to resources (transportation, housing, employment) and clean-living social, creative and sporting events among other activities.

In South Africa the best known proponent of recovery ideas are the 12-step fellowships of Narcotics and Alcoholics Anonymous. These groups can claim some success based on international membership running into the millions. Self-conducted surveys of these groups show that AA comprised of 120 00 weekly meetings, while NA in 2013 held over 63 000 meetings a week in 132 countries (NA 2013; AA 2014). While these groups form an important historical role in the formation of the recovery movement, many in the movement are critical of these organisations for various reasons. Among these are the focus on abstinence and the insistence on anonymity (other reasons will be explored in the study) and they are not representative of the movement as a whole.

Another important element the recovery and harm reduction movements have in common is the emphasis on peer based support.  White and Evans, among others have emphasized the significant role that non-professional recovering addicted users can play (White and Evans 2014). Contact with recovering addicted users is important as it provides a sense of hope to the using addict, and access to a new circle of friends. According to White and Mojer- Torres (2010:99), one of the key indicators of long term recovery is the extent to which the previously addicted user makes changes in their lives, moving away from old friends, places, habits and finding healthier, drug-free alternatives. A “culture of recovery” can be built to replace the drug filled lifestyle in which the addicted user becomes enmeshed.

Other writers influenced by the social model conceptualise addiction as a learning or developmental disorder, rather than a medical condition (Di Chiarra 1999;  Matto 2008; Levy 2013) and argue it should be treated as a community health issue (Mudavahnu and Schenk 2014: Jagganath 2015) rather than a medical or criminal one.

The social model, both in the form of  harm reduction and recovery, is prevalent in Europe and the Americas, but is practically unknown in South Africa. A search on the Sabinet SA e publications website revealed no single article that used the words “social model recovery” or any combination of these words in relation to recovery from addiction, as opposed to international sites which turned up over a hundred. There is however a small but growing body of literature on harm reduction, with the National Drug Master Plan making reference to it.

The rationale of the social model in terms of the underlying causes of problematic drug use (and how to deal with it) is of great relevance in the South African context where individual and community trauma and disconnection, both current and historical, is deeply embedded. Evans etal use the term “historical trauma” to describe a unique form of distress brought about by sustained assault on a community’s values, through colonisation and dispossession which could result in increased vulnerability to drug related problems. (2013). Recovery of individuals can further be the starting point for recovery of affected communities.

White and Evans write that “clinical and social interventions can be substantially enriched by drawing lessons from the lived solutions to these problems at personal, family, neighbourhood, and community levels.” (2014: 2). If we wish to begin to utilize this resource, the experience of addicted drug users in various stages of recovery may be the most appropriate place to begin. Through listening to their stories we can begin  to make sense, not only of the reasons that people become addicted, but more importantly how and why they recover. The insight gained from the lived experience of  people surviving addiction  can then applied to present policy and treatment models,  leading to a greater understanding of the best practices for promoting recovery and the reduction of harms that addiction creates to individuals, their families their community and society at large.

In this proposal I have addressed only some of the issues involved in the debate around treatment and recovery, drawing on those which are prevalent in the literature, and my own experience as a recovering addicted user. Through the oral histories of recovering addicted users others issues are expected to emerge, revealing further the strengths and weaknesses of present policy and treatment models, and will be explored.

In terms of a theoretical approach, this study draws on the social model, and more particularly the recovery paradigm in its understanding both of addiction and recovery. This will lay the theoretical groundwork for analysing the oral histories and in engaging with existing and future policy and treatment models. However, serious consideration will be given in this study to the harm reduction approach given its centrality in the global discourse on drug use disorders and its treatment. Differences and commonalities between the two approaches will be explored in some detail in the literature review in the study, and will frame the conversations that will be held with participants in this study.

Thesis Proposal pt 4: Research Methodology

Research Paradigm
This study will employ a qualitative technique of data collection and analysis. Qualitative methodology has been chosen as it allows the researcher directaccess to the lived realities and experience of the subject in a way that quantitative data cannot (Silverman 2008: 57).

According to Polkinghorne, quoted here in Holloway and Jefferson, narrative is the "primary form
by which human experience is made meaningful" (2000: 32). Through narrative the researcher can gain understanding of events and processes in the life of the subject, and the meaning attached to them. Oral histories allow the subject to construct the narrative of their life story, in a free flowing
way according to the themes that are important to them and seen as being a factor in , or having relevance to their subsequent addiction.

Oral history originated in the humanities as a means of introducing the voice of ordinary people into the study of history, as well as giving voice to marginalised and oppressed groups (Fontana and James 1994; Dahl and Malin 2009). Thus it is suited to the task of telling the stories of drug users, who fall within this category. It is also useful for locating for locating individual experience within broader cultural and historical contexts (Sangster 1994; Green 2004; Batty 2009), and for revealing processes and agency (Abrams 2010). This makes it an appropriate approach for uncovering the causes and effects of addiction and recovery, which may may play out in unsuspecting ways. Oral histories have more recently been widely used in the social and health sciences (Kerr 2003, Miller-Rosser et al. 2009)

Sampling Process

Sampling will be purposive, with particular criteria in mind. Subjects will be chosen according to severity of their addiction  and all will have spent time on the streets, in institutions or jail as a result of their addiction to heroin. For purposes of recovery, emphasis will be placed on the candidates level  of reintegration into the community, healthy social functioning and financial independence, rather than "clean" time. The ideal candidate will have remained free of using heroin, but not necessarily other drugs, for a minimum of one year period, but allowances will be made for minor relapses, or "slips".

I have done extensive work with addicted users at a community level. I am a member of a 12-step fellowship support group in my local area and play a role as a peer support person for other addicts who are in recovery or who are aiming for recovery. Being a recovering  addicted user myself will help with locating subjects and with the bonding required to gain their trust. I will make use of my own membership in these groups, and my active participation in them as a gateway to recruiting participants in this study. However I will not limit my respondents to 12 step group members in my locality. I will also actively be seeking out stories of recovery as told by those who are not, and have not been, members of 12 step fellowship groups. To facilitate this I will also draw on a circle of friends and acquaintances, from my time in active addiction, of previously addicted users who have found other pathways to recovery. Further my colleagues at the Urban Futures Centre are involved in a large scale harm-reduction based research and intervention project from which participants will be drawn. David Silverman has established the use of existing relationships and contacts as acceptable practice within qualitative research (2008: 34). I also intend to approach other addiction treatment centres who can recommend further participants for the study. In this way a diversity of recovery pathways can be represented.

The number of interviewees will be determined by data saturation,with a tentative figure of 15 (this represents one sample) bearing in mind that the interviews will be extensive, covering the life story of the subject in detail.

Procedure for the collection of data.

Once contact has been made, an interview will be set up. This will take place either in the home of the candidate, or in a neutral venue. Community centres or church halls are available as venues through Narcotics Anonymous and other support groups.

At the outset, the participant will be asked to read and sign the letter of consent, agreeing to the terms of the interview. Ethical questions, such as the sensitivity of the subject matter will then be discussed. Issues of confidentiality, access to data as well as any other questions the participants may have will be addressed. The participant will then be briefed as to the nature and intent of the study. They will be made aware that if they wish to discontinue the interview at any stage, due to discomfort or distress they may do so. They will also be informed that a drug addiction counsellor is available for them to talk to, if  necessary. Arrangements for this have been made in advance.

My own experience as an addicted drug user will be drawn on to create a sense of identification and trust with the interviewee. Where necessary I will share my own story with the participant.The aim is that the interviewer will be seen as an accomplice and fellow journeyer, with whom they can share openly and honestly, rather than an authority figure collecting information for processing.  This will convey an interest in their story for it's own sake rather than as merely subjects. In this way issues of power can be addressed and the temptation of the subject to elaborate or downplay aspects of their story will be avoided.

At the beginning of the interview itself, the participants attention will be directed to a list of questions
(Appendix 2). These are aimed at focusing the life story narrative on issues pertinent to addiction and recovery. Attention will be drawn to these during the interview, but interruptions will be kept to a minimum. This will allow the participant to direct and construct their own story, according to what they see as relevant to their addiction and recovery.

Four trial interviews were conducted in preparation for this study. Interviews lasted between 90 and 150 minutes. They have also shown that when a list of questions is presented in advance, minimal intervention is needed to keep the oral history on track.The participants were found to follow the script in keeping with the subject of the narrative.

I will be conducting interviews personally, as well as writing up the transcripts myself.

Provision will be made for the participants to view and respond to the narratives once they have been transcribed to ensure their authenticity and that participants are still willing to have them used in the study. This is in line with good protocol for doing oral history research (Abrams 2010).

Procedure for analysis of data.

Becoming intimately familiar with the data is seen by Silverman as vitally important before any thematic breakdown begins. (Silverman 2008: 55).  Listening to the initial recordings would be an important initial stage,as this can give one verbal cues often missed in the transcript. These could be tone of voice, breaks, laughter and other noises which may indicate emotional states. This will be followed by a close reading of the transcripts, to begin to identify themes and topics within the subject's histories.

The NVIVO program will then be used to assist in the process of organising the data thematically. Focus will be on the subjects personal understanding of life events in relation to their subsequent addiction and recovery, and on relations with family and community. Factors and events that may have contributed to addiction, and subsequent recovery, in the understanding of the subject, no matter how small or seemingly irrelevant will be sought out. Common themes that emerge will then be analysed in relation to the literature around existing treatment models and theories of addiction with the aim of identifying the strengths and addressing the limitations of these in light of the data that emerges.

Hopefully this study can make some contribution to a better understanding of addiction, informed as it is by the life experience of people who have survived active addiction in its most severe form, and lead to the designing of better programs and models of treatment for those that are excluded or do not benefit, for whatever reason, from present models.

Thesis Proposal pt 5; References

REFERENCES

Abrams, L. 2010. Introduction: Turning practice into theory. In: Abrams, L. ed. Oral History Theory. New York: Routledge, 1-17.

Alcoholics Anonymous. 2014. Membership Survey. New York. AA World Services.

Alexander, B. 2000. The globalisation of addiction. Addiction Research, 8 (6): 501-526.

Alexander, B. 2012. Addiction; The urgent need of a paradigm shift. Substance Use and Misuse,  (47): 1475-1482.

Alexander, B., Beyerstein, B., Hadaway, P. and Coambs, R. 1980. Effect of early and later colony housing on oral ingestion of morphine in rats. Pharmacology  Biochemistry & Behaviour, 15: 571-576.

Alexander, B. and Schweighofer, A. 1988. Defining "addiction". Canadian Psychology, 29 (2): 151-162.

Bamber, S. 2010. Rethinking community: Addiction, recovery and globalisation. In: Recovery Writing: Volume 1, 2009-2010. Manchester: The Art of Life Itself.

Batty, E. 2009. Reflections on the use of oral history techniques in social research. People, Places and Policy, 3 (2): 109-121.

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