Living and Caring for a Loved One Suffering from Addiction

Literature Review

There has been lots of research done to study addiction. There are many faces of addiction, there is alcohol dependency, drug addiction, and even a combination of both. Any form of addiction like the ones listed will have an effect on loved ones; “The health of family and friends affected by another person’s substance use and/or gambling is an undervalued health issue” (Wood & Tirone, 2013). Their lives will be affected by addiction, even if they are not the ones with the addiction themselves. There has been a lot of qualitative research done on those with addiction. There is a lack of research being done on those who love and care for people with addictions. We have seen how love plays a role in nurses who work with those being treated for their addictions, we can see how parenthood changes when a child suffers from addiction. We can see how families change; “Addiction can devastate the lives of people and their families” (Owens, 2015). It changes family dynamics and can ruin family relations. What is not known, however, is how these carers particularly significant others cope in everyday life and the strain that loving and caring for someone with an addiction places on them. There has been documentation and research done in the past over the burden of being a caregiver, but most of this research is on caring for someone with a chronic health condition. As it is not often documented that those who love and care for someone with addiction are aware and label what their loved one has as an addiction, it is important to note what makes addiction and how it can be ignored for fear of the connotation of that label.

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There is a core of love that the nurses can give to patients that helps in their treatment process. To be able to give such love to strangers is one thing; to see someone you know and love in that situation is different, and we do not know much about it (Thorkildsen, Eriksson, & Råholm, 2015). A similar style of study was done about how peer mentorship affects those hospitalised for substance use disorders.  Having peer mentorship allowed patients to form meaningful connections that they can rely on during a time when they are in a dark place, and often feel misunderstood (Collins, et al., 2019). There has also been research done regarding the caring needs that those with addiction desire and need. There are many themes that come across when they speak of care, meaning, life, connectedness (Wiklund, et al., 2008). Many of the themes need to be bolstered by someone else, from someone who cares about the individual which is who research in the past has not focused on. There has been research in the past on “concerned significant others”, but not a lot has been said about the impact that their significant others addiction has for them (Wood & Tirone, 2013). In fact, most of the time their needs are not even considered; “Most research and treatment focuses on the concerned significant others ability to support the persons recovery who is harmfully involved, prioritizing the health of the person harmfully involved over the concerned significant others” (Csiernik, 2002).

Research Question

What is it like to love and care for a loved one suffering from addiction?

The aim of the study is to shed light on what it is like for someone tasked with caring for a loved one suffering from addiction, and how that influences their own lives and their choices.

Method

The method that makes the most sense for this project is IPA or Interpretative Phenomenological Analysis. This is because the IPA method is used to explore the participants own experiences (Willig, 1964; 2013). This makes the most sense to understand the lives of people who love and care for those with an addiction, it gives the researcher a glimpse in their own words to their lives. It is based more in lived experiences rather than a thematic analysis which qualifies and organises data (Smith, 2019). Using IPA allows the participant to explain in their own words their experiences and to be heard by the researcher. 

Sampling

Participants for this study should be currently caring for someone with an addiction. These participants would have to be willing to keep a written record of their thoughts, in the form of a diary or journal. They would have to be willing to share this with the researcher and if necessary, be willing to speak about the contents of the journal with the researcher in the format of a semi-structured interview. These participants would be chosen once they have discussed with the researcher the situation they are in, as well as if they are healthy and mentally prepared to discuss and write down how they are feeling in detail, and what their life is like in detail. This project will have to be a longitudinal study and participants would have to currently be in the situation. To find these participants, the researcher would have to reach out to shelters, social services, as well as support groups to invite people who fit the criteria of living and caring for a loved one suffering from addiction to participate in this project. There would have to be a clear arrangement with the interviewer over the contents of the diary and be clear about the anonymity of their writing (Woll, 2013). To be able to use the contents of a diary, it would have to be kept consistently over the period of the study, and they would have to be comfortable sharing their thoughts. The only resources needed for this project would be the diaries that the participants will be using to record their thoughts.

This could be a positive way to study the participants because it allows them to write their thoughts first and then let researchers read it, it could make them more comfortable expressing their thoughts. There can be issues with using a diary, especially if the diary had been kept before the study, it would not be monitored and lack the structure necessary to find compelling information (Woll, 2013). It should be noted that it is likely that the contents of the diary would drop off over time, most of the information that could be used in the analysis would come from earlier stages of the diary due to the “first day’s effect” (Woll, 2013). However, diaries can reduce bias from the researcher as well as limit the invasiveness of the study (Morell-Scott, 2018). The diary can be used to find patterns of behaviour that will emerge as themes from the project. The researcher will know that they have enough participants when they analyse the data and common themes and experiences begin to emerge. The possible number of participants for this study would be around 4-6, being able to compare the possible patterns and themes from these diaries will support the aim of the study. With only a few diaries, there is hope that comparable themes will begin to emerge.

Analysing the Data

To start, the researcher would have to take the contents of the dairy, find the commonalities in behaviours and beliefs that emerge: how were they feeling, what was their daily experience like? (Morell-Scott, 2018). And begin to hopefully find patterns across the diaries. These patterns will then become themes which the researcher discusses towards the end of the project. This can be a very long process, as the diaries will have been kept over a long period of time, there will be quite a lot of data to go through. The researcher should take the time to read through and find commonalities in behaviour before identifying them as themes. These themes should emerge from the readings of the diaries from the selected participants and if necessary, the interviews with the participants (Smith, 2008). A semi-structured interview would only occur if the contents of the diary could not be understood and there is a belief that important information could be overlooked. To properly analyse the data, a comparison would be done following the diaries and finding commonalities that will then emerge as themes.  

Quality and Rigour

Because this project would rely heavily on the openness of the participants, sensitivity to context will be really important. By showing sensitivity to the context of the situation for the participants it would show the quality and rigour of the experiment (Yardley, 2000). To do this, it requires the research to create a clear understanding with the participants about what the project is about, alerting them beforehand of what can come from the project and preparing them as to what is to be expected of them. The participants need to know that if it becomes too much for them, they are able to stop participating in the project at any time and counselling will be made available to them. This also relates to transparency and coherence. To have clarity in the project on both the participants and the researcher’s end will lead to more clear data and better analysis can be done. Commitment and rigour would be shown in the continued keeping of the diary following the guidelines laid out before the project and agreed upon by the participants and the researcher (Yardley, 2000). Consistent dialogue with the researcher checking in on the effect that the diary is having on the participants also contributes to rigour and commitment.

Ethics

There are some ethical considerations to be aware of when looking to do this project. The main ethical concern would be the possible invasiveness of the study and the negative mental effect this could have on the participants. The reason that researchers would be looking at diaries is to mitigate this potentially negative effect. The thought is that by avoiding a face to face discussion that this would lessen the invasiveness (Morell-Scott, 2018). It could also affect their relationships with the people that they care for with an addiction.  Another ethical issue to consider would be the effect of keeping the diary and using it as the data since the diary would be started and kept over the course of the experiment would the participants be able to have the diary back? Would they want the diary back? The agreement with the researcher would have to include what would happen to the diary and they would have to consent to whatever is decided before the start of the project (Woll, 2013). The main ethical concern would be to minimise the effect of what writing the diary could have on the beliefs and thoughts of the participant (Yardley, 2000). This would include getting informed consent from the participants about the matter of the study as discussed, what the diary will consist of, making sure the participants know that they can withdraw from the project at any time, and providing a full debrief at the end with the offer of counselling for the participants and possible treatment options for the loved one.

Reflexivity

This topic is necessary because there are thousands of people who spend the majority of their time loving and caring for someone with a disability, this is most often significant others, but can be children or parents. The emotional toll this takes on them is not well understood or often talked about. To be able to shed some light on the experiences of loved ones caring for people with an addiction, it could help those who are going through the same things but feel alone. Over the years I have seen people have to care for people they love that have an addiction, I have seen how it changes them. Their lives stop being about them, their sole focus is following a partner through the ups and downs of addiction. I would like for them to be able to share their experiences and hopefully, this project would be able to show them that they can. This project would hopefully use the data to show how there are many common themes in the experiences of those caring for a loved one suffering from addiction.

Dissemination of Themes and Outcomes

The data from this project could be disseminated to clinics and shelters where loved ones could be living. It could be an example of what people are going through that they could possibly relate to, and maybe help them realise they are in a similar situation, hopefully women, men, and children will be able to see that they are not alone. There are others in similar situations and that it is possible to survive and get help if they feel they need it. Possible dissemination could aid in future research about how they have changed and how being able to identify their feelings could have helped in the future. The use of IPA allows for the participants own words to form the themes that emerge, it would allow anyone reading the project to see the true effect of living with and caring for someone suffering from addiction (Smith, 2019). The dissemination can also help people reading possibly realise that they are in a similar position that they were not aware of before. There are many positive possibilities that can come from the dissemination of the data and emergent themes from this project.

References

• Collins, D., Alla, J., Nicolaidis, C., Gregg, J., Gullickson, D. J., Patten, A., & Englander, H. (2019). “If it Wasn’t for him, I Wouldn’t have talked to them”: Qualitative study of addiction peer mentorship in the hospital. Journal of General Internal Medicine, doi:10.1007/s11606-019-05311-0
• Csiernik, R. (2002). Counseling for the family: The neglected aspect of addiction treatment in canada. Journal of Social Work Practice in the Addictions, 2(1), 79-92. doi:10.1300/J160v02n01_05
• Morrell-Scott, N. (2018). Using diaries to collect data in phenomenological research. Nurse Researcher, 25(4), 26-29. doi:10.7748/nr.2018.e1527
• Owens, B. (2015). addiction. Nature, 522(7557), S45-S45. doi:10.1038/522S45a
• Smith, J. A. (2019). Participants and researchers searching for meaning: Conceptual developments for interpretative phenomenological analysis. Qualitative Research in Psychology, 16(2), 166-181. doi:10.1080/14780887.2018.1540648
• Smith, J. A. (2008). Qualitative psychology: A practical guide to research methods (2nd ed.). London;Los Angeles, Calif;: SAGE.
• Thorkildsen, K. M., Eriksson, K., & Råholm, M. (2015). The core of love when caring for patients suffering from addiction. Scandinavian Journal of Caring Sciences, 29(2), 353-360. doi:10.1111/scs.12171
• Wiklund, L., Mälardalens högskola, & Akademin för hälsa, vård och välfärd. (2008). Existential aspects of living with addiction – part II: Caring needs. A hermeneutic expansion of qualitative findings. Journal of Clinical Nursing, 17(18), 2435-2443. doi:10.1111/j.1365-2702.2008.02357.x
• Willig, C., 1964. (2013). Introducing qualitative research in psychology (3rd ed.). Maidenhead:McGraw-Hill Education.
• Woll, H. (2013). Process diary as methodological approach in longitudinal phenomenological research. Indo-Pacific Journal of Phenomenology, 13(2), 1-11. doi:10.2989/IPJP.2013.13.2.2.1176A
• Wood, S., & Tirone, S. (2013). The leisure of women caring for people harmfully involved with alcohol, drugs, and gambling. Journal of Leisure Research, 45(5), 583-601. doi:10.18666/jlr-2013-v45-i5-4364
• Yardley, L. (2000). Dilemmas in qualitative health research. Psychology & Health, 15(2), 215-228. doi:10.1080/08870440008400302