Researching with Women in Recovery: How midlife women with alcohol use disorder maintain

771 Pages·2013·5.12 MB·English

UNIVERSITY OF WESTERN SYDNEY
SCHOOL OF EDUCATION

Researching with Women in Recovery:
How midlife women with alcohol use disorder
maintain quality abstinent recovery
and wellbeing

Janice Withnall

2013

This thesis is submitted in fulfilment of the requirements for the degree
of Doctor of Philosophy, University of Western Sydney
DEDICATION
To the women who shared the richness and darkness of their recovery.
For the women and practitioners who bring compassion and expertise to enable
more midlife women to become abstinent and well.
To the living recoveries that contribute to the greater whole.

Flowers represented the women's lived experiences of recovery throughout the
'Researching with Women in Recovery' study.

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ACKNOWLEDGEMENTS
How can I express my gratitude to the people who have supported me throughout
my candidature and those that have contributed over a sustained period to the
Researching with Women in Recovery study. This I express here through the
learning they have shared with me.
Firstly, I acknowledge the willingness of those persons who have enabled my
research practice to expand through principled, creative and thorough methods; and
secondly to persist with and to support my completion of a demanding
transdisciplinary action research project, cognisant of the need for ethical care of the
vulnerable and wise participants, to improve midlife women’s addiction healthcare.
The women in recovery and healthcare practitioners who volunteered for the study
were dedicated to bringing the best of nurturing healthcare, developing partnerships
in continuing care and ongoing community support. I learned how false stereotypes,
and ongoing stigma and shame so often prevent an achievable whole-person
recovery. The contributors to the study wanted to move beyond harm reduction
treatment and name and resolve societal discrimination. The women and their
supporters provided the means for more women to celebrate abstinence and live
well in recovery.
My supervisors, Professor Stuart Hill, Associate Professor Sharon Bourgeois and my
early supervisor Dr John Cameron, helped me to understand the importance of
engaging with people’s lived experiences in a natural setting, along with academic
protocols to develop an original study (exploring the personal, sociocultural,
environmental and spiritual factors), implement and evaluate evidence-based
research from multiple disciplines to contribute to knowledge and to support
people’s mental health and wellbeing.
I wish also to acknowledge my medical team with whom I learned about how to
continue to plan and to achieve my research objectives as a mature woman
contributing to society whilst also in ongoing healthcare.
Members of my School and University have provided me with experiences and a
learning-research environment with professional support and resources to explore,
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innovate and share new research knowledge. An exceptional ‘proof in practice’ at the
University of Western Sydney is their commitment to support innovative studies and
individual student’ needs. The staff of Disability Support Services and their
assistants made the physical demands of the study achievable. School staff
encouraged and advocated for this significant study and for my candidature to
progress whilst providing compassion and optimism; with special thanks to Steve
Wilson, Mary Moody, Nikki Pearson, David Wright, Linda Lamond and to Markie
Lugton who, with great goodwill, always helped with the seemingly daunting
administration tasks.
The University Library staff and IT staff (Sarah Fearnley and Peter Wilcockson),
who by their ongoing training and expertise, made continuing with a complex study
that contained multiple software versions and equipment changes, possible. There
are memories of extraordinary technology-based events that have been addressed,
such support has always been provided with an affirmative attitude.
I acknowledge the many inspiring people who contributed their energy, passion,
expertise and good humour to the mental health and alcohol and drug fields.
Studying in a changing ‘live’ research environment challenged my thinking whilst
experiencing anger, trust, fear, joy and peace of mind. I was surprised by the
connections that were made possible through the research processes and how this
has strengthened my beliefs and continued practice.
Finally to acknowledge the contribution of those I hold dear, my adult children and
friends; friends who provided the advice below. My children and I have learned and
matured together; the study has contributed to lowering their and my anxieties
around physical health. The unexpected benefit was our greater understanding of
the value of mental health and the power of people working together.
I believe I can now answer their concerned and jovial question asked many times –
“are we there yet?” Today, my answer is yes, and let’s enjoy the moment.
Inner peace
Be on the lookout for symptoms of Inner Peace. The hearts of a great many have
already been exposed to Inner Peace, and it is possible that people everywhere could
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come down with it in epidemic proportions. This could pose a serious threat to what
has, up to now, been a fairly stable condition of conflict in the world.
Some signs and symptoms of Inner Peace
A tendency to think and act spontaneously, rather than on fears based on past
experiences:
 An unmistakable ability to enjoy each moment.
 A loss of interest in judging other people.
 A loss of interest in interpreting the actions of others.
 A loss of interest in conflict.
 A loss of the ability to worry. (This is a very serious symptom.)
 Frequent, overwhelming episodes of appreciation and gratitude.
 Contented feelings of connectedness with others and nature.
 An increasing tendency to let things happen – rather than make them happen.
 An increased susceptibility to the love extended by others, as well as the
uncontrollable urge to extend it!
If you have some or all of the above symptoms – please be advised that your
condition of Inner Peace may be so far advanced as to not be curable. If you are
exposed to anyone exhibiting any of these symptoms, remain exposed only at your
own risk (source unknown).

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STATEMENT OF AUTHENTICATION
I certify that the work presented in this thesis is, to the best of my knowledge and
belief, original except as acknowledged in the text. The thesis has been written by me
and any help that I have received in the writing process, in preparing it, and all
sources used, have been acknowledged in the thesis. I hereby declare that the
material contained in this thesis has not already been submitted and is not being
submitted, either in full or in part for a degree at this or any other institution.
Janice Withnall

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TABLE OF CONTENTS
DEDICATION .....................................................................................I
ACKNOWLEDGEMENTS ..................................................................... II
Inner peace.............................................................................................iii
Some signs and symptoms of Inner Peace.........................................iv
STATEMENT OF AUTHENTICATION......................................................V
TABLE OF CONTENTS...................................................................... VI
LIST OF APPENDICES .....................................................................XIII
LIST OF TABLES.............................................................................XV
LIST OF FIGURES .......................................................................... XVI
DVD TABLE OF CONTENTS...........................................................XVIII
GLOSSARY................................................................................... XIX
ABBREVIATIONS...........................................................................XXIV
ABSTRACT .................................................................................XXVII
PREFACE ....................................................................................XXXI
Women’s ways of recovery work for women...................................xxxi
How the research began...............................................................................xxxi
The need for relevant research evidence on women’s recovery...............xxxiii
Research focus refined...............................................................................xxxiv
I, the researcher and, we, the participants.................................................xxxv
RWR documents: Presentation information................................xxxviii
Print meta-document and e-book...........................................................xxxviii
Evidence-based content for a variety of readers.......................................xxxix
Extensive footnotes........................................................................................xxxix
Boxed information.........................................................................................xxxix
Terminology...........................................................................................xl
CHAPTER 1: WOMEN’S RECOVERY AND WELLBEING WITH AUDS.......1
Structure of this chapter...................................................................................1
RWR questions and working descriptions of the critical concepts.................2
Midlife a life-stage................................................................................................3
The meanings of recovery in RWR.......................................................................3
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Health, wellness and wellbeing............................................................................5
Why ‘abstinent recovery’ for women with AUDs................................................5
The need for the study and the need for action in Australia...........................8
The phenomenon investigated through secondary research
questions.........................................................................................11
Meeting women’s AUDs healthcare needs.....................................................12
Developing good practice for women’s AUDs healthcare..............................13
Working with healthcare providers to engage in healthcare
partnerships..............................................................................................15
Decreasing public misinformation to limit societal discrimination..............17
Improving educational content and accessing training and
professional development........................................................................19
Advocating for the inclusion of a midlife women’s recovery strategy...........21
Significance of the RWR study and its outcomes..............................23
Overview of chapter content................................................................27
CHAPTER 2: A DYNAMIC PARTICIPATORY FIVE-STAGE LITERATURE
SEARCH...................................................................................34
Literature exploration as communicative action................................36
Six substantial areas of influence on women’s abstinent
recovery...........................................................................................41
1. Understanding some of the causes and consequences of women’s
AUDs.........................................................................................................43
Emotional pain and memory.............................................................................43
Effects on the immune system and the brain....................................................48
2. The importance of peers...........................................................................49
3. Attention and role change........................................................................51
4. Identity and individuation.......................................................................54
5. Theories and models suitable for midlife women’s healthcare..............57
6. Health systems for recovery.....................................................................61
New recovery......................................................................................................63
Health service providers.....................................................................................64
Abstinence and therapies....................................................................................66
Explorations during the final evaluation processes of RWR............68
CHAPTER 3: RESEARCH DESIGN....................................................70
Introduction: Transactive participation...............................................70
Researching with Women in Recovery...............................................71
Transdisciplinary studies with praxis outcomes...............................74
Developing ‘How to begin and continue in recovery’ as cooperative
research.....................................................................................................76
Combining transactive and participatory elements.........................................78
Designing a robust and flexible Transactive Participation Research
Process......................................................................................................79
Field work in natural settings assisting robust and flexible research............80
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Participants........................................................................................................82
Recruiting participants......................................................................................85
Mapping the study..............................................................................................91
Recognising participant objectives....................................................................94
Ethics, research safety, confidentiality and equity...........................................95
RWR Transactive Participation Research Process (RWR TPRP)....................98
Facilitation.....................................................................................................100
RWR Knowledge Production Framework.........................................102
RWR Transactive Meaning Making of Action Cycle data................104
1. Data collection methods providing categories and topics....................104
2. Participants.............................................................................................104
Methods of analysis..........................................................................................105
Coding and cooperative analysis.....................................................................106
3. Outcomes of data analysis processes and interpretation techniques...106
Detail of the review methods............................................................................107
Example of theme checking..............................................................................109
Last element of the review.............................................................................112
CHAPTER 4: TRANSACTIVE METHODOLOGY, ANALYSIS
AND RESULTS.........................................................................114
The Dynamic Lines of Inquiry: Diamonds and Pearls......................115
Selection of research methods..........................................................119
Mixed methods..............................................................................................120
Collecting credible data..................................................................................121
Questionnaires...............................................................................................121
Researcher immersed in participant interactions.......................................124
Data categories and coding..............................................................................130
TMAR Pearls analysis and interpretation.........................................131
The six phases of the Recovery Continuum.....................................139
Distressed Recovery......................................................................................139
ENACT Recovery............................................................................................141
Enable Recovery............................................................................................152
‘I’m in recovery’.............................................................................................155
Complex Recovery..........................................................................................161
Valued Recovery............................................................................................166
Women sustaining their recovery.................................................................168
The Meta-study..............................................................................................211
Integrating and exploring RWR data as a comprehensive dataset.............212
Preparing for meta-analysis............................................................................214
The Meta-study and RWR findings..................................................................215
CHAPTER 5: FINDINGS.................................................................217
Women’s recovery change enabled in a Recovery Triad................217
A Meta-study process....................................................................................219
Section Content Summary.................................................................223
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Section 1 Discussion overview......................................................................224
Recovery Change and a Recovery Triad as an effective nexus of
women’s AUDs care...................................................................................224
Section 2 Discussion overview......................................................................225
Recovery Care constructs.................................................................................225
Recovery Development concepts......................................................................225
Recovery Development clusters.......................................................................225
Recovery Support subjects...............................................................................226
Section 3 Discussion overview......................................................................226
Meta-themes: Non-recovery............................................................................226
Analytical themes: Enabling support for further self-discovery....................227
Section 4 Discussion overview......................................................................227
Wise Recovery: Living well with others..........................................................227
Section 1 Discussion..........................................................................228
Midlife women’s recovery: Self-discovery and mental health.....................228
Self-stigma and stigma replaced by self-discovery, understanding and
acceptance...............................................................................................229
Recovery Change: Women no longer acting on AUDs misperceptions.....230
A process of abstaining to be ‘in recovery’...................................................232
Control and intense activity.............................................................................233
Experiencing and learning in recovery...........................................................236
Recovery Triad and Recovery Care, Development with Support (RCDs)...237
Recovery Triad and Wise Recovery opportunities.......................................239
In recovery identity exploration......................................................................239
Section 2 Discussion..........................................................................243
Recovery Care, Development with Support (RCDs)....................................243
Recovery approaches improving rehabilitation for AUDs.............................245
Healthcare team management for women’s continuing recovery care.......248
Change in the health and welfare system.....................................................249
Politics of recovery and abstinent AUDs care................................................250
Women’s recovery treatment details............................................................250
Cooperative change: Healthcare relationships............................................251
Painful experiences and transposition.............................................................253
Psychological disquiet with others...................................................................254
Midlife women in collective relationship: For the greater good....................255
An integrated healthcare team.....................................................................257
The practitioners...........................................................................................258
The women as members of the healthcare team..........................................259
Expert Volunteers.........................................................................................259
Participation and roles for significant others as supporters......................260
Practitioners and Expert Volunteers benefitting from the Recovery
Triad for wellbeing.................................................................................261
Women–oriented Chronic illness Recovery management plans
(CiRmp)..................................................................................................262
Coalitions of holistic care..............................................................................264
A health alliance............................................................................................266
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