This blog post is taken from part of a chapter in my recent eBook Our Recovery Stories: Journeys from Drug and Alcohol Addiction.
Research I conducted with Lucie James back in 2008 provided important insights into factors that facilitate behavioural change and a person’s path to recovery from addiction. This study involved a qualitative analysis of the views and experiences of clients on the RAPt treatment programme [1] in one male and one female prison.
Transcripts of the semi-structured interviews with 15 males and 15 females were analysed with Grounded Theory in order to reveal identified concepts and themes. Four inter-related themes were derived from the analysis that were labelled: ‘Belonging’, ‘Socialisation’, ‘Learning’, and ‘Support’. Each of these themes impacted on a fifth theme, ‘Personal Change’, which had two key components, motivation to change and self-esteem.
Our sample of prison inmates had a long history of substance use problems and criminal offending. Our interviews revealed that their problems prior to treatment went much further, in that interviewees had difficulty in trusting others, feeling accepted, being honest (with themselves and others), and in talking about their thoughts, feelings and problems. They often blocked out issues related to substance use, felt very isolated in their addiction, and believed that they were ‘weak’ and ‘evil’ people and ‘the only one to have done bad things’.
A summary of the key themes identified in our research provides insights into the changes that occurred during the RAPt treatment programme:
‘Belonging’: On entering the RAPt programme, the participants met other people with similar experiences and they realised that they were not alone. This sense of belonging helped them to open up and share their thoughts and experiences. It enabled them to build trusting relationships, which led them to feel more able to be honest with themselves and others. The sense of belonging also resulted in an increase in self-esteem and confidence that played a role in them coming to believe that they were capable of changing their problematic behaviours.
Belonging to a group of people who had similar experiences and problems, but who were successfully addressing their substance use, also enhanced the participants’ motivation and self-belief in overcoming addiction. Belonging to a group also facilitated the learning of new skills revolving around improved communication and better-quality interpersonal relationships.
The importance of belonging was evident in all aspects of the RAPt programme.
‘Socialisation’: A person who has been isolated in their addiction can only truly ‘belong’ to a group when they have started to interact with other groups members, which may require the learning and use of appropriate social skills.
A strong theme that permeated our analysis centered around the idea of a socialisation process, whereby participants learned to interact with others to a mutual benefit. They first got to know and relate to other people in the early stages of the programme, both within and outside formal therapy sessions, which helped to reduce their isolation. They started to share thoughts and experiences—learning they were not the only one to have certain experiences and beliefs—ask for and give help, and listen to and provide feedback. The interviewees described becoming more able to trust, be honest, respect others, and learn about themselves. They began to feel they could talk to the peer supporters and counsellors.
Participants described how their self-esteem and confidence increased as they learnt more social skills and became more adept at interacting with other people. The development of social skills contributed to an increased self-awareness, an understanding that they needed to change their previous destructive thought and behavioural patterns, and a belief that they could leave their old lifestyles behind and work towards a more positive future.
Many of these positive changes occurred before the 12-Step part of the treatment programme was introduced. However, once the 12-Step Primary Treatment programme commenced, the interviewees further developed their social skills during group therapy sessions, Fellowship meetings, family conferences, and in the general living environment.
Interviewees’ use of these new skills was constantly being reinforced by the positive changes they were experiencing within themselves, and the praise that was being offered by others. The development of social skills also enhanced the sense of belonging as participants became more comfortable, and more capable of offering a valuable input, in group situations.
‘Learning’ – about addiction and themselves: Learning about the disease model of addiction and admitting to being addicted helped to change self-image, as participants no longer blamed themselves for their destructive behaviours. Understanding that they would have to abstain from all substances if they were to attain the goal of recovery led to significant changes in the participants’ thinking.
During the Step-work, participants began to see how out-of-control their lives had become and how their substance use had impacted negatively on others. They were helped to come to terms with, and let go, of their pasts and focus on a positive future free of substance use, a process which was facilitated by understanding and utilising the concept of a Higher Power.
As they learnt about addiction, themselves and their capabilities, the participants became more motivated and determined to change and abstain from substance use. Meeting other people who had gone through the same stages also helped to motivate and give hope that recovery was attainable.
The RAPt programme took the participants on a journey of self-discovery. By looking at their past actions, they began to understand the relationships between their drug use and their thoughts and behaviours. They learnt a great deal about recognising certain thoughts, feelings and behaviours and they became better armed to deal with any potentially destructive thought or behavioural patterns.
Although the process of learning about themselves was very difficult, the participants came out stronger and feeling better able to cope with life and their futures in a positive manner. Having entered the programme with little self-esteem and hope for their futures, the increase in confidence led the participants to view a happy, drug-free future as more of a reality.
‘Support’: Support, from day one to completion, was a key factor in the perceived success of the RAPt programme and in the changes that the participants saw in their thinking and behaviours. This support came from various sources (staff, peers and peer supporters), from different aspects of the programme (e.g. group therapy, one-to-one counselling, family conferences), and focused on a wide variety of different issues. In addition, the participants developed the ability to offer support to others, which helped boost their confidence and made them feel like a valued member of the group.
Support from the staff and peers was paramount in enabling and encouraging the participants to open up about their thoughts and experiences, and was therefore essential in the cleansing process that enabled letting go of the past and focusing on the future. The participants received positive feedback at every step they made towards developing their new lives, and this reinforcement helped to boost self-esteem and confidence.
As the participants developed deep relationships with their peers and staff, they began to open up more and learn that they could trust others with their thoughts, experiences and emotions. Learning to trust, and knowing that they had support around them, enabled them to become more honest with themselves and with others.
‘Personal Change’: The personal changes that occurred on the RAPt programme are described in the four preceding themes. Several sub-themes related to ‘Personal Change’ resonated throughout the interviews. The participants frequently referred to their self-esteem and confidence, and to their motivation to change.
A variety of elements in the programme enhanced self-esteem and increased the participants’ confidence in their ability to change, which are key components required for recovery. These elements included aspects related to the socialisation process and belonging, the education programme, and the feedback and support available from various sources. Seeing others doing well in the programme and in Fellowship meetings also played a significant role in enhancing hope and motivation to change.
The interviewees emphasised that a critical element of the success of the programme was that attention paid to all aspects of the participants’ lives, not just their substance use issues. The programme showed participants that their problematic substance use stemmed from issues that had occurred in their lives. This completely changed the way that many viewed themselves, as they had previously thought that it was their own fault that they couldn’t stop taking drugs/alcohol.
Participants also obtained a better understanding of themselves, and the relationship between their thoughts and behaviours, and were taught how to divert potentially destructive behaviours. This all enhanced self-esteem and helped them become more confident in their ability to abstain from substances.
As they implemented what they had been taught during the Step-work, they saw the positive changes that this made, and this acted as a further reinforcement to change. Many of the participants described beginning to like themselves and understand who they really were. Seeing oneself differently (in a positive sense), and liking oneself, are powerful facilitators of recovery.
One final aspect of personal change emphasised by interviewees is that programme participants must want to change, and must work hard if change is to occur. Many of the clients described periods of emotional distress occurring during the programme, which they considered an important part of the change process.
1 RAPt is now part of the Forward Trust.
