“I owe my recovery to the group”: how addicts learn to recover: a case study of an addiction aftercare group.
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Date
2019
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Abstract
This study explores how addicts learned to recover in an addiction aftercare group by identifying the pedagogic and group mechanisms of recovery, and revealing the knowledge and competencies that assisted participants. Part One outlines the ongoing, critical problem of addiction, both internationally and locally, and group approaches to recovery. Part Two analyses the findings, locating each category of findings in its own literature review.
The interdisciplinary study was informed by communities of practice theory (1991, 1998) and elements of attachment-based psychology theory, focusing on identity. Psychological challenges for the addicted population were highlighted and linked to Khantzian’s self-medication hypothesis (1975) and to research on the attachment aspect of groups. This work provided conceptual tools that broadened understanding of the aetiology of addiction being formed by, and redressed through, relationship. Research on two relevant group models - the psychological approach and the twelve-step model - was used to guide the approach to the case study.
Case study and bricolage methodologies were employed in the qualitative study. The nineteen participants were from a clinic addiction aftercare group in a city in KwaZulu-Natal, South Africa. Each had achieved over a year of unbroken recovery. The group was co-facilitated by three consecutive addiction counsellors and the author. Data was collected from eight individual interviews and five focus groups. The emergent themes were analysed using a hybrid method of thematic analysis and interpretive phenomenological analysis.
The findings revealed that group recovery transformed key aspects of the person with addiction: spiritual and religious; psychological (including emotional regulation — specifically of shame, anger and honesty, working with empathy and the development of self-esteem); and physical. These were termed ‘Mechanisms of Transformation’. Mechanisms that emerged as critical to addiction group recovery were Mechanisms of Transformation; Membership; Regime of Competence; and the Competency Framework. Membership is crucial as it overcomes the alienating aspects of shame and creates opportunity for acceptance, belonging and participation. The Regime of Competence — the authority aspect of the group — allows participants to call errant members to order on key issues such as honesty. This is essential as relapse begins in thought and other behaviour and can be identified in transgressions of the Regime of Competence. The Competency Framework is an evolving repertoire of essential recovery skills and knowledge. From these mechanisms, I developed an interactional model that suggests how the mechanisms work as components of the recovery practice and highlights their possible effects on participants’ recoveries.
This model could prove beneficial to addiction recovery groups in varied contexts. Limitations are that a single case was used in a particular context, making generalisation tentative until followed up empirically. This study makes a methodological contribution in terms of ‘insider’ research. It also makes an interdisciplinary contribution to the advancement of knowledge in terms of the understanding of group recovery from addiction, particularly in South Africa.
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Doctoral degree. University of KwaZulu-Natal, Pietermaritzburg.