The Lived Experiences of Relapse into Opiate and Crack Cocaine Misuse among Recovering Drug Service Users and Addiction Therapists: A Multi-Perspectival Interpretative Phenomenological Analysis

: (Alternative Format Thesis)

Abstract

Multiple relapses from illicit substance misuse after periods of abstinence can significantly exacerbate drug poisoning and subsequent overdose death. The United Kingdom (UK) experienced a steep rise in opiate and crack cocaine consumption in 2019 and recorded its highest numbers of heroin-related overdose deaths in 2020. Between 60-70 percent of drug service users who work towards recovery from opiate and cocaine misuse are reported to experience a relapse within 12 months of exiting structured treatment. Despite this, little is known about how relapse is experienced and made sense of, either by recovering drug service users or addiction therapists, which this study addresses. Beginning with a scoping review, this study examines the current evidence base on opiate and crack relapse and finds that qualitative explorations into relapse in the addiction literature are lacking. A review of UK drug policies and clinical guidelines also highlights a failure to acknowledge and address relapse. The empirical part of this study addresses these limitations in two ways. First, by exploring the lived experiences of opiate and crack relapse among recovering service users and among addiction therapists. Second, by investigating how users’ and therapists’ experiences co-exist in a therapeutic practice context. Guided by recovery-informed theory and hermeneutic phenomenology, data were gathered through semi-structured interviews with seven recovering drug service users and seven addiction therapists. Data were subsequently analysed using a multi-perspectival approach to interpretative phenomenological analysis. Findings from the service user interviews identify two superordinate themes, highlighting that multiple relapses foster self-mistrust and a sense of powerlessness in service users, which subsequently shapes their view of themselves and of recovery. Findings from the therapist interviews identify three superordinate themes, revealing that therapists perceive relapse as complex and difficult to account for, which, over time, disempowers their therapeutic abilities. A subsequent cross-group analysis found a further three superordinate themes. These illuminate that users and therapists mirror feelings of powerlessness over relapse in a therapeutic relationship context; that long-term recovery provides a relapse risk environment; and that relapse shapes users’ and therapists’ perception of themselves in recovery. This study provides a novel understanding of opiate and crack cocaine relapse and highlights the need for clinical practice and policy to acknowledge and address the impact of relapse on those who are directly affected.

Date of Award	25 May 2022
Original language	English
Awarding Institution	University of Bath
Supervisor	Jeremy Dixon (Supervisor), Catherine Butler (Supervisor) & Cathy Randle-Phillips (Supervisor)