Abstract
Background: Addiction is a major public health concern, with risk of significant relapse.
Traditional treatment modes look at correcting deficit, not developing positive personal utility.
Understanding addiction recovery as a process of change and growth, as well as how positive interventions can improve recovery outcomes are vital to addressing this health concern.
Aims: Contribute valuable and original knowledge to what constitutes successful addiction recovery. Specifically, in how it can be understood through a positive lens, how this knowledge can be used to support its efficacy, and how positive interventions can be used to safeguard its future. The overarching aim is to empirically improve addiction recovery, through a series of complementary and reinforcing studies that endorse and facilitate it as a state of improved wellbeing, where recovery is strengthened, and a foundation for future flourishing established.
Method: The conceptualisation of a new recovery model, G-CHIME, which considers growth, connectedness, hope, identity, meaning in life and empowerment as central to addiction recovery. This is used with apposite contributions from positive psychology (PP) to study addiction recovery using a mixed-methods approach. This benefits from the methodological pluralism advocated in third wave PP, and the philosophical backing of second wave PP, which recognises growth as a facilitator for positive outcome from a negative life event. To this effect, a qualitative study comprising (n=15) individual narrative analysis studies aggregated using G-CHIME as a connecting theory, explores the phenomenon of addiction recovery through accounts of lived experience. A case study investigates how the Values in Action (VIA) character strengths model, an important contribution from PP to positive functioning, can be used to identify and explain (subjectively and objectively) positive traits and capacities that support recovery. A complementary group study (n=100) analyses the VIA character strengths of people in addiction recovery, which are most and least represented, how this differs from normative data and why this may be important. From this, G-CHIME and the VIA character strengths model are used as inputs to the design of a new treatment programme called Positive Addiction Recovery Therapy (PART). To study the efficacy of PART, two studies using a within-subjects design assess its effect on wellbeing, recovery capital, and flourishing.
Inherently this includes the quantitative study of G-CHIME, complementing the qualitative narrative analysis study using this model. The first is a pilot study (n=30) field testing the programme, and the second, a replication and follow-up study (n=35), substantiating its findings. PART is then engineered for eHealth using a novel implementation framework, so it may reach a wider audience via a website. A user evaluation study (n=20) assesses its perceived impact and reported quality in comparison to other eHealth solutions using independent summary data, to gauge its success. To complete the digital branch of this work, the use of chatbots in addiction is systematically reviewed, the output of which is employed in a user-led design showcasing a novel addiction recovery chatbot, which is not subject to the prevalent concerns raised in the review. Criterion-based purposeful sampling was used to recruit participants in addiction recovery for all qualitative and quantitative investigations in this research. Results: The narrative analysis studies showed the G-CHIME model is helpful for understanding addiction recovery, and that the important elements of growth, connectedness, hope, identity, meaning in life and empowerment were identifiable in each of the accounts. The VIA character strengths model was found to be effective in identifying personal assets that benefit recovery, and that these could be subjectively explored and objectively measured. The character strengths profile of people in addiction recovery was seen to have two characteristics unique to this population, humour, and teamwork. Both the PART pilot, and replication and follow-up studies yielded statistically significant results affirming the positive effect that PART has on wellbeing, recovery capital and flourishing. The PART website was well received by representative users, who reported higher scores than seen in other studies evaluating eHealth implementation. A perceived impact on health-related change was also reported. Chatbots were found to be a poorly used resources with serious ethical concerns, requiring better design. Discussion: The findings from a methodologically diverse set of studies, including both quantitative and qualitative investigations, support a positive approach to addiction recovery. G-CHIME has been shown as an effective model for understanding addiction recovery and the components important to its success, providing evidence that addiction recovery is the positive outcome of a negative experience. G-CHIME has been found helpful in intervention design, where it provided theoretical input to a comprehensive treatment programme that was seen to improve the wellbeing and recovery of the participants who engaged with it, as well as establishing a foundation for them to flourish.
The pluralistic approach advocated in third wave PP, led to the inclusion of the VIA character strengths, providing further evidence and direction on how PP can be used with effect to aid positive function in addiction recovery. The eHealth interventions highlighted the need for new and efficacious design approaches, cognisant of the target population, which can disseminate positive interventions to a wider group than achievable through face-to-face intervention. A methodological limitation in this work means a control group has not been considered. Future study, using a control group design would advance the credibility of the conclusions drawn in the quantitative aspects of this work. Implications: This work generated several contributions to knowledge with implications for practice, policy, and research. PART has been operationalised in a manual, and funding decisions that support its accessibility for future service users have been made. It is envisioned this could extend to community referrals from outside of the service where it is currently delivered. The G-CHIME model and the analytical approach used in the narrative analysis studies continues to be employed in a curated series of addiction recovery stories in a peer reviewed journal, further developing its evidence base as an effective model for studying addiction recovery. The opening studies on the VIA character strengths model in addiction recovery, sets a foundation for further research on how it may benefit people in addiction recovery. Similarly, the systematic review offered a starting study on chatbots in the field of addiction, which could help advance their applied use in addiction and recovery, so that it does not fall behind other areas of healthcare, as is currently the case.