Reconceptualization of Relapse: An Interpretative Phenomenological Analysis of Lived Experiences of Repeated Relapse from Drug Misuse in the UK

Despite a recent emphasis on 'recovery' from drug and alcohol dependency within the UK's current drug policies (Best, De Alwis, & Burdett, 2017) approximately 75% of drug service users relapse within the first twelve months of completing structured treatment (Statistics of Drug Misuse England, 2017). However, literature about the lived experiences of drug service users and how they make meaning of recovery, particularly after having relapsed, is scarce (Koester, Anderson, & Hoffer, 1999; Lancaster et al., 2015). Additionally, views of service providers on clients' experiences of relapse have been widely disregarded in addiction scholarship, although these have been recognized as impacting the service user's identity throughout treatment (McIntosh & McKeganey, 2000). Therefore, this project will explore the differences and similarities of perspectives on relapse between drug service users and relevant drug service providers, with the overall aim to generate novel understanding of relapse, and, consequently, recovery from drug misuse. As such, the project seeks to address the following research questions:
* What are service users' lived experiences of repeated relapse from recovery and the ways in which these impact the service users' meaning-making of recovery?
* What are service providers' perspectives on relapse and how do these inform the ways they treat and support service users?
* How do service users' and providers' views on relapse match/differ?
By addressing the above research questions, the study's aims, and objectives are as follows:
(1) To provide new understanding of relapse and recovery from a service user and provider perspective
(2) To identify the ways in which service users and providers perceive treatment and risk for relapse
(3) To identify helpful/unhelpful elements of current recovery policies
(4) To inform policy-makers of more effective strategies to address relapse/recovery
The proposed study will employ a qualitative design and involve individual, in-depth interviews with up to 15 service user-, and with up to 20 service provider participants. Participants will be recruited through the use of a purposive sampling strategy. Potential drug service user participants must identify as opiate and/or crack cocaine (OCU) service users within the age range of 18 and 64 who a) self-identify as 'recovered'; b) have been discharged from the service/completed their treatment; c) will have been abstinent (defined as 'free from any presenting substance' by the UK clinical guidelines for substance misuse and dependence 2017) for at least 6 months at the time of the interview and who d) have experienced at least two relapses (defined broadly as the 'return to drug use after an attempt to stop' (National Institute on Drug Abuse, 2018)) in the past. Potential drug service providers must have previously worked as 'key worker' of user participants who, during that time, must have experienced at least one of their repeated relapses. All interviews will be arranged to take place at the premise of the treatment service from which the participant was recruited, as to maximize levels of perceived comfort and security.
Data derived from interviews with service users will be analysed using interpretative phenomenological analysis and interviews with service providers will be analysed using thematic analysis. Participants will be sampled through an addictions agency in England. In alignment with the ESRC's encouragement for collaboration and public engagement, the study design will include a steering group, including peer-mentors, key workers and a manager, with whom I will meet throughout the project. As insider-perspectives on relapse have not yet been considered and/or utilized to inform practice and policy (Best et al., 2017), this project will generate valuable novel evidence which will allow us to better understand the phenomenon of 'relapse', and subsequently that of 'recovery', from drug addiction.