The aim of the thesis is
to investigate pathways into addiction and subsequent recovery through the
experience of problematic drug users engaging in a process of recovery.
The stories of these individuals’ experience will be told through a series of
oral histories. A secondary aim is to
critically engage with the various debates about addiction and recovery in the existing
literature, particularly relating to current treatment models, and to
contribute to theoretical and evidential debates. This study will be guided by a qualitative research design. The primary
research tool that will be used is oral histories, which will be analysed, through
narrative analysis, to uncover common themes in the stories of the problematic drug
users.
The focus of the study will be a
group of addicted heroin users living in Umdoni on the Natal South
Coast, mainly , but not exclusively from Umzinto. This is a poor community that
has in recent years been particularly hard hit by problematic drug use,
particularly heroin use. This group has been chosen purposively as it comprises
of addicted drug users who are actively seeking, and involved in recovery
through participation the twelve step program of Narcotics Anonymous. Some members
of this selected group have been ‘clean’ (abstinent from all drugs and alcohol) for
varying a mounts of time, while others are still using drugs , but engaging
with the program and expressing a desire to get ‘clean’. The interviewees will come
from a wide range of socio-economic backgrounds, many reduced to homelessness,
others in more affluent conditions where they are dependent on family, or even
self-supporting. The oral history
stories of 15 of these individuals will be conducted over a period of 12
months. Each participant will be interviewed twice, allowing them to tell their
stories, as a continuum at two points in time. This is important because the
process of recover from problematic drug use is precarious, and the aim of the
study is to find out what pathways and interventions appear to be most
successful in leading to longer and more sustainable recovery outcomes.
My motivation for doing this
research stem from my own long-term experience as an addicted drug user. It is also driven by a
more academic interest in the literature on the recovery of problematic drug users and on the various academic and
practical debates about ‘rehabilitation’ and how one understands the reasons
for problematic drug use in the first place.
Worldwide there is growing criticism of the present approach to the
international drug problem. This is best demonstrated by the recent Special UN
Assembly which was called to look at alternative ways to address this problem.
The traditional discourse on the subject focuses on two models; the judicial and the medical. The first
conceptualises the addicted drug user as
a criminal who needs to be punished or even removed from society. The second
conceptualises the user as a patient in need of medical intervention.
A third way, the social model, as conceived by writers in the recovery
movement, view addicts as vulnerable and alienated members of society in need
of re-integration into the community. The proponents of this model are split into two camps, labelled harm
reduction and recovery, often seen as
hostile and mutually exclusive. My personal interest is in the recovery movement which locates the causes and resolution of
problematic drug use firmly within a community context. I will also, however be
exploring commonality between the harm reduction and recovery camps, which I
believe is greater than the differences between them, and hope to identify and
draw on the strengths of both approaches. The
recovery movement focuses on involving
recovering addicted drug users, and those affected by addiction (families and
communities) in the healing process and the reintegration of problematic drug
users back into their communities. William White and other writers in the
recovery tradition have claimed that entire communities have been victims of what they call “historical
trauma”. Such communities, where disconnection and disadvantage is predominant,
become particularly vulnerable to a wide spectrum of personal and social
problems. 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. Anne
Wilson Schaeff puts it slightly differently when she argues that problematic
drug use is rooted in a society that
suffers from a state of dis-ease, rooted
in alienation, in which the individual addicted drug user is but
the symptom and carries the burden of suffering.
This movement has come to the fore in the USA where 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. It is however not widely
acknowledged in this country, where the predominant approaches are still
located within the judicial and medical paradigms. In my view, the rationale of
the recovery movement 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 community trauma – both current and historical – is deeply embedded.
Through my own experience, contact with other
recovering drug users, and reviewing the literature I have tentatively
identified the three main limitations of the current treatment approach that
are most apparent. These are the inaccessibility of treatment to the
vast majority of problematic drug users; the discord between the perception
that problematic drug users can and should be cured by a single intervention
and the reality of the chronic and recurring nature of the disease; and thirdly
the focus on the individual which overlooks the community and social aspects of
the problem.
The voices of problematic drug users in various stages of recovery are
without doubt the most appropriate place to begin in making sense of best
practice models for promoting recovery and the reduction of harms that
problematic drug use creates to individuals, their families and the community.
Through the oral history stories told by drug users at various stages of
recovery, as well as through a thorough investigation of the recovery movement
and its relationship with other ‘treatment’ models, I hope to feed into policy
debates and discussions around treatment of addiction, all of which are in a
very transient stage in South Africa.
The purpose of the study
is that the insight gained may be used
to identify and begin to address limitations within the present treatment
models. The primary question I
will be asking is : “What insight can we gain from the life experience of addicted heroin users, as
revealed through their oral histories, that might assist in identifying and
addressing the limitations of present treatment models in South Africa and internationally?” The secondary questions I will focus on
include: What is the
connection between community vulnerability and what White calls historical
trauma and individual addiction? What role does time in formal treatment (rehab) play
in recovery? What role
does spirituality (or connectedness ) play in recovery? What role can recovering addicts (wounded
healers) play in recover?
Researching problematic drug users is not always easy to
do, particularly those who have been victimised by police and marginalised by
their own families and communities. The possibilities for gaining access to,
and the trust of these participants, and
to uncovering the stories that lie behind their drug use and their routes to
recovery will, I believe, be greatly facilitated by my own personal history as
a long term addicted drug user, as well as my ongoing work
with homeless addicts. The shared experience of problematic drug use, combined with a growing
academic interest in recovery processes will, I believe, allow for research
outcomes that have depth and validity.
