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Parker, Phil (2019) Evaluating the rediscovery process as a treatment programme for a range of substance use disorders. Doctoral thesis, London Metropolitan University.
Poor outcomes for many of those in treatment for substance use disorders (SUD) has raised interest in recovery-based approaches, positive psychology and the importance of flourishing, a quality defined as functioning positively in all realms of life. However, there is little research into approaches that focus on flourishing in SUD.
This study evaluates The Rediscovery Process (TRP), a brief, recovery focussed approach for SUD. It teaches self-coaching techniques designed to increase flourishing and recovery capital (psychological health, physical health, quality of life, days at work, college, volunteering and housing status) and to reduce impulsivity. A mixed-methods approach was used, comprising of three studies.
First, to evaluate the effect of the TRP on substance use, flourishing, impulsivity and recovery capital, a preliminary pilot study using a randomised wait-list controlled structure was conducted. 72 participants who had been formally diagnosed with single and poly-drug use issues, including, alcohol, opiate, cocaine, crack, cannabis and amphetamine were assigned to either immediately receive the intervention or to wait for the treatment, providing a wait-list control arm. Validated measures of substance use, flourishing, impulsivity and recovery capital were assessed pre- and 1 month post intervention. The results of the study showed that, compared to the wait-list control group, the TRP provided a significant decrease in alcohol use (the most commonly used substance in the study) and impulsivity, and an increase in flourishing and recovery capital. Due to the low numbers of those using other substances in the study, no other significant changes in use were identified. Associations between flourishing, impulsivity and alcohol usage were also evaluated and a significant moderate negative association between impulsivity and flourishing was found, an association which has not been previously reported. Second, once the intervention and wait-list groups had both received the intervention, a cohort study (n = 69) evaluated the sustainability of this combined group’s changes. Validated measures of substance use, flourishing, impulsivity and recovery capital were assessed pre-, 1 and 3 months post-intervention. Impulsivity and alcohol use decreased significantly at 1 and 3 months post-intervention, compared to pre-intervention measurements. Flourishing and psychological health increased significantly at 1 and 3 months post-intervention, compared to pre-intervention measurements. No effect on outcomes was seen in the different referral routes for all analysed measures, at all time points, with the exception of impulsivity at 1month and QOL at 3-month. Associations between flourishing, impulsivity and alcohol usage were also evaluated and a highly significant strong association between a decrease in impulsivity and an increase in flourishing was found, however, no other significant associations were found. Third, a thematic analysis evaluation of participants’ experience of the TRP identified two main themes (1) control and (2) flourishing. These themes reflected the value participants found in applying the approach to controlling substance use, emotional regulation, personal growth, empowerment and their sense of self. Many participants noted differences between this approach and those previously tried and the majority found the intervention effective. However, some did not find it of use and there was evidence of issues of a conflict between the concepts of this and other previously used models, which made adopting the new ideas difficult for some.
These studies show that, compared to TAU, the TRP approach significantly reduced alcohol use and impulsivity and increased flourishing and elements of recovery capital and this was maintained over the 3 month period. This supports its place as an approach for those with SUD and opens the possibility of its inclusion within the range of positive psychology interventions for SUD. These results help bridge the gap between the more traditional focus of addressing the psycho-pathology in SUD and the newer interest in increasing flourishing. It is hoped that this study will encourage further research and a wider adoption of the flourishing concept and this new approach, in SUD.
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