Recovery from addiction and the potential role of sport: Using a life-course theory to study change

Introduction: ‘recovery’ as located in the community

People with chronic alcohol and other drug use problems (AOD) ¹ are some of British society’s most socially excluded groups (Home Office, 2010). Due to their circumstances and lifestyles many are faced with a range of complex, interrelated handicaps such as homelessness, unemployment, poor health, offending and addiction (Bradshaw et al., 2004). These factors ostracise the individual from his or her community and from effective contact with the services they need to help them find the safety, stability and physical and mental health necessary to recover from addiction. Subject to wide discrimination, they are routinely excluded from mainstream services and frequently estranged from families and non-substance misusing friends (Laudet and White, 2008). As such they experience low self-esteem, poor health and under-achievement (De Leon, 2000). A lack of appropriate support and engagement in the community fuels a lack of motivation, loneliness and stress, which are among the most commonly cited reasons for relapse (Laudet and White, 2008). Drug and alcohol treatment interventions, and corresponding research, have tended to focus on immediate treatment outcomes and cohort studies, based on retrospective accounts of people at the height of their addiction (Groshkova and Best, 2011). As a result, the factors which predict how successful changes are sustained have been understudied. Issues which are critical to the individual, such as healthy eating, being physically active and feeling like an equal member of the community, have been given less attention (Laudet and White, 2008). A focus on what happens to people at the height of their addiction, and while in treatment, is important. However, recovery from AOD is a lengthy, sometimes lifelong process, often likened to a journey. As addiction impacts across social, psychological and occupational dimensions, so recovery from addiction consists of more than merely the absence of the drug.

Although its history is substantial, ‘recovery’ is a concept which has recently had a new surge of interest from policy makers and practitioners in the UK and US, notably in the UK’s most recent National Drug Strategy (Home Office, 2010). While ‘recovery’ is individual, and means different things to different people in recovery and at different times in their lives, it will involve some degree of abstinence, physical and mental health and wellbeing, hope and self-efficacy, personal empowerment and citizenship (Center for Substance Abuse Treatment (CSAT), 2009). Recovery’s ‘social and political movement’ has emerged from a relatively small number of empirical studies which identified the longer-term approach necessary to support addicts in desisting (Groshkova and Best, 2011) and indicated that recovery takes place at least as much in the community as it does in treatment settings (for example detox units and residential rehabilitation centres). The key predictors of successful recovery include supportive social networks and meaningful activities which are grounded in community settings (Best et al., 2008).

For researchers, the shifting nature and variety of recovery journeys highlight the value of methodologies which are prospective and longitudinal, and which de-emphasise generalisations. Empirical research which examines factors related to sustaining recovery is small in comparison to those which focus on the harms associated with alcohol and drug addiction (Granfield and Cloud, 2001). To address this gap in the research, this article explores how meanings come to be attached to a community-based sport programme – Second Chance – in the wider circumstances of participants’ lives. To do this we explore the biographies of two respondents specifically, John and Paul, and consider how they developed meanings towards Second Chance in the context of their recovery from addiction in their day-to-day lives over a period of 12 months.

Sports programmes and recovery from AOD

Despite the well-established health benefits of physical exercise (Department of Health, 2010) and the knowledge that many people with AOD problems are, and want to be, physically active (Neale et al., 2007), sport has played relatively little part in adult alcohol and drug treatment programmes. Limited research examines the contribution sporting programmes may make to people’s recovery from addiction (Crabbe, 2000). However, natural recovery research identifies that meaningful activities are a key part of resolving alcohol and drug problems (Granfield and Cloud, 2001). For example, the Positive Futures (n.d.) programme (www.catch-22.org.uk/Service/Positive-Futures) has helped to demonstrate the value that sport can have in engaging hard-to-reach groups such as young offenders, but to date it has played little part in adult alcohol and drug rehabilitation programmes. Calton Athletic Recovery Group has been one of the few UK-based programmes to use sport as a change agent. However, despite this programme’s apparent success (Malloch, 2011), there has remained a reluctance to use sport and physical exercise as an alternative or adjunct to established psychological and pharmacological interventions. Indeed, Calton Athletic Recovery Group ceased to formally exist, due to a lack of funding, in 2013. The appeal of sport and exercise can be seen at different stages for people with AOD problems. For instance, many prisoners engage in organised physical exercise and sport while in prison and gain related qualifications, but few continue with sporting activities, or use their qualifications, on release because of the problems associated with social exclusion (Meek and Lewis, 2012). Acknowledging debates around the often assumed benefits of sport, there is, in principle, much which could be gained by supporting people with AOD problems to do more exercise.

In the UK considerably more provision is provided for sporting activities for young marginalised groups, such as youth offenders (Crabbe, 2013). ² For example, examining sports-based interventions for young socially excluded people, Kelly (2011) found that despite the benefits (such as enabling people who would otherwise not have been able to access sporting facilities), projects often did not meet the aims they predicated themselves on, such as tackling social exclusion. There was also little impact made by the projects in addressing the socio-structural foundations from which young people became excluded in the first place. Kelly’s (2011) study brings further salience to the point that sports programmes on their own are most unlikely to cure social problems, including that of addiction. While Second Chance was established on the assumption that it would never be a panacea for alcohol and drug treatment (Batchelor et al., 2005), that point is still important to this study, which found marked differences in the outcomes for respondents attending the same programme during the fieldwork. Where research does exist it is largely in relation to young people (Coalter, 2001). With this in mind, much of the evidence in relation to sports-based interventions and young people relates to the ways in which sports programmes are delivered (and by whom), rather than the sports themselves (Coalter, 2007). Qualitative evidence suggests that the greatest gains from involvement in activity relate to psychological health and increased feelings of wellbeing and a sense of being included (Coalter, 2001). There appear to be relatively few systematic attempts to assemble qualitative evidence among most sports programmes (Crabbe, 2013).

Despite the benefits which programmes of exercise potentially offer, mainstream funding has favoured pharmacological and psychological interventions which have focused on reducing the harms associated with alcohol and drug misuse. Correspondingly there is little research, and even less prospective research, into how sport and exercise may help people resolve alcohol and other drug use issues and help maintain sobriety. This paper sought to address this lacuna by examining how respondents attached meaning to a sports programme (Second Chance) during the course of one year ³ in the context of their recovery, and located in their other routine activities over the course of 12 months.

Theory: life-course perspective

This study employed a life-course theory of informal social controls (Laub and Sampson, 2003). In the field of alcohol and drug research, social capital and symbolic interactionism dominate the sociological approaches used by researchers. The findings at certain points in this research reflected elements of both. The concept of recovery capital for example, which has its roots in social capital, was important: participants who had higher levels of recovery capital were better able to desist (Best and Laudet, 2010). In relation to symbolic interactionism, and the emphasis placed on the role of identity (re)construction and how individuals attach meaning to their lives, the wider aims of this research set out to examine those aspects specifically (McKintosh and McKeganey, 2002). However, while both approaches provided useful insights for interpreting data, neither approach alone could fully account for the findings which emerged. Social capital overstated the structural aspects of what moves people to behave in certain ways, while symbolic interactionism placed too much emphasis on identity and agency aspects of behavioural change. A life-course theory, which integrates elements of structure and agency, was thus most appropriate.

Laub and Sampson’s (2003) life-course theory of informal social controls developed from an empirically based longitudinal study. The framework uses three mechanisms to meaningfully understand persistence and desistance. Those three mechanisms were (a) ‘routine activities’, (b) ‘informal social controls’ and (c) purposeful ‘agency’. The authors stated that the concept which best describes the interaction of the three variables was ‘situated choice’. What this means is that behaviour is the result of both the context in which people with chronic substance misuse problems live (the ‘social environment’) and their own personal agency. While Laub and Sampson (2003) described agency as ‘choice’, stating that this was equally as important as routine activities and social controls when examining persistence and desistance across the life course, they also drew a distinction between their use of choice and rational choice theories, stating: ‘Choice alone without structures of support, or the offering of support alone absent of a decision to desist, however inchoate, seems destined to fail’ (Sampson and Laub, 2005: 43). Specifically, agency in this study was defined as ‘choice’, but differentiated from rational choice and situated in the social and environmental circumstances which were experienced at any given point in time. Thus choice is determined by a complex and dynamic set of interrelated variables which include a person’s past and present experiences (e.g. addiction, homelessness), while at the same time constantly needing to move forward. The acts of doing things (routines, habits and practices; Nettleton et al., 2011), as well as the cognitive processes involved in choosing to desist (Biernacki, 1986), also influence choice, even when an individual cannot easily account for their actions or does not want to (Gadd, 2006). The interaction of routine activities, informal social controls and agency was described as ‘situated choice’. Applying the life-course perspective to drug abuse, Hser et al. (2007) noted that turning points vary: the same event can trigger a change in one person’s drug use but not another’s, and this will depend on the individual and the context.

From this perspective it is only through in-depth, theoretically selected case studies that are ‘sensitive to the latent or unconscious meanings of respondents’ narratives, including all the absences, contradictions and avoidances intrinsic to them’ (Gadd and Farrall, 2004: 132) that agency can be most accurately captured and understood. This article focused on a small number of respondents, which allowed an in-depth examination of their cognitive processes as they attached meaning to Second Chance, in the context of their day-to-day lives in their recovery, during the fieldwork.

Discussing the use of life-course perspective in relation to alcohol and drug abuse and turning points, Groshkova and Best (2011: 37) state that ‘within a life-course model, there are “windows of opportunity for change” that represent the turning points [out of addiction] in a developmental trajectory. The challenge for science is to identify when and why these occur and what makes the changes sustainable’. This is a key statement in the context of this article, which suggests that Second Chance was a ‘window of opportunity for change’ (Groshkova and Best, 2011: 11) within which one respondent was experiencing a turning point, while the other was not. This turning point was conceptualised as an identity change, and was dependent upon the respondent’s other routine activities, social networks and personal agency (choice) both within and outside Second Chance. Thus for desistance to happen, respondents needed other networks of support in addition to Second Chance. The life-course perspective thus offers a useful approach to explain and understand AOD problems, and how these interrelate with social systems which structure people’s lives (Groshkova and Best, 2011).

Approaching recovery biographically

The findings discussed in this article relate specifically to two adults taking part in Second Chance as part of their recovery from AOD problems. ⁴ These two men form a subset of a larger group of 19 who constituted the sample for a prospective research study, the fieldwork for which was conducted during 2008 and 2009. These 19 Second Chance clients were followed over the course of a year and interviewed individually three times, at six-month intervals. As a group they had been desisting from AOD for one year on average when they were first interviewed. Following the fieldwork they were divided into two broad groupings on the basis of two distinctive patterns of behaviour which emerged from the interpretive analysis: individuals in group one were successfully desisting, while those in group two were not and were ‘trapped’ and unable to move forward in their recovery. Importantly, we argue that members of group one and group two are not inherently ‘different’ people; they were similarly matched in terms of average age, substance misuse, length of time since last use (at research outset) and length of time attending Second Chance. Instead, what set the groups apart were the handicaps which hindered group two’s successful attempts at recovery. This article is based on the biographical accounts of two respondents – Paul as ‘desister’ and John as ‘trapped’ – who attended Second Chance.

The prospective study was based on in-depth, semi-structured interviews conducted with 19 respondents at three points, with six-month intervals. Criteria for inclusion in the research study were that they were on the Second Chance programme and registered in some form of treatment for alcohol or drug use problems. The 19 respondents were male, resident in the North East of England and had an average age of 29 years old (range 19–46 years). At the height of their addiction, the majority were poly drug abusers, in that they used a range of illicit and licit (including alcohol) drugs. Care was taken to make certain that interviewees understood the ethical arrangements in relation to their testimonies. Interview one examined respondents’ backgrounds, including education, employment and alcohol and drug-using careers. Interviews two and three explored how participants had spent their time over the past six months, including any changes, problems or successes they had experienced. Participants were also asked to describe their social situations, focusing on certain life circumstances thought to be associated with recidivism: housing, employment, finances, relationships (family, friends and partners), alcohol and drugs (LeBel et al., 2008). The interview schedules included questions on the trajectories of substance misuse (onset, course, cessation, desistance); the social and structural contexts in which those trajectories were set; and, significantly, where Second Chance fitted into these journeys as their lives unfolded. Paul and John’s life stories, which are examined here, detail the cognitive processes which emerged during the follow-up interviews, and describe some of the ways in which they coped with challenges and setbacks encountered in their daily lives.

This article therefore takes a biographical case study approach because we argue that comprehending the psychosocial interface of recovery requires a form of in-depth case analysis that is sensitive to the latent and unconscious meanings of respondents’ narratives, including all the absences, contradictions and avoidances intrinsic to them (Gadd and Farrall, 2004). Large-scale studies that disaggregate data about individuals into variables that can be used to make generalisations about the ‘typical case’ are of limited value when one is aiming to make sense of phenomena that are partly biographically contingent. Arranging data biographically makes sense in terms of comprehending processes of recovery, since respondents seldom maintain one subjective stance over time and context (Gadd, 2006). In the following section we seek to illustrate the kind of in-depth case analysis we are advocating. So, although there are shades of recovery, Paul and John are identified as relevant luminous case studies principally on the basis that they are theoretically interesting, but also because they:

The case studies have been selected from the sample not because they are cherry-picked illustrations of good or poor practice, but rather because John’s narrative of recovery emphasised the social connections which developed over time at Second Chance, while Paul’s narrative depicted loneliness, stress and lack of meaning, indicative of ‘trapped’ respondents. Focusing on John and Paul enables a deeper insight into the lives of two people, rather than a larger cohort, and enables the complexity of each individual’s life to be comprehended. This is also emphasised in recovery literature which suggests that ‘recovery is heterogeneous’ (Gagne et al., 2007): people have different pathways to recovery.

Discussion

A total of 11 respondents were identified as ‘recovering’ and desisting during the fieldwork, and John’s biography exemplifies the key findings from this group. He implicitly emphasised the social connections which developed over time at Second Chance, both with other players and coaches; a strong therapeutic alliance ⁵ emerged between John and his coach, who challenged his negative behaviour while encouraging the values of teamwork and discipline. These attributes were meaningful. The informal social controls found in Second Chance were evident directly via these specific social relations, indirectly through the value John placed on going to the programme and internally as he learned about new ways of thinking and behaving through teamwork.

Outside Second Chance, John’s life had structure and routine, and he was involved in important activities which necessitated responsibility. John’s narrative laid stress on his improving relationships with his family, specifically his children, which also absorbed time. When asked about the meaning John attached to these areas, volunteering for Second Chance was related to developing new skill sets, acquiring new social networks, a positive use of time, a sense of purpose and feelings of restoration. Second Chance and volunteering provided John with something positive to talk about and simultaneously offered his family a visible sign of recovery. John appeared to be growing in hope and self-efficacy. This was evident in his belief that he could stay alcohol- and drug-free, and in the tangible plans he described beyond Second Chance.

John was in the process of transforming his former addict identity such that new identities as sportsman and team-mate developed. Yet his activities outside Second Chance developed other identities also. These non-addict identities were reinforced by players and coaches and, importantly, by other networks of support outside Second Chance. John described shame about past wrong-doings; however, he now described a new and developing set of skills through which to process these emotions: Second Chance, volunteering and family were key parts of this.

Paul was one of eight participants in the larger study who were ‘trapped’ and unable to move successfully forward in recovery. Like John, the reasons Paul gave for starting Second Chance were filling time and playing sport. Paul reported that Second Chance was a place where he could evade the difficulties experienced outside the programme, specifically the influence of other people who were still using. With little structure and routine, and few meaningful activities, Second Chance was somewhere Paul went to stay alcohol- and drug-free, and which offered him the chance to have ‘a laugh’ doing an activity unrelated to his substance-use problems. The programme was clearly important to him. Outside Second Chance, Paul’s family barely referenced his engagement with the programme; indeed, they appeared to voice disbelief in his ability to desist. This was in stark contrast to John. Thus, the turning points experienced by desisters such as John simply could not develop to the same extent among trapped respondents such as Paul. Any identity transformations which may have been taking place through Second Chance were largely restricted to the programme, but this should not detract from what the programme may have offered him.

Outside Second Chance Paul rarely engaged in meaningful activities; those which were accessible tended to be short-lived. His only routine activities were alcohol and drug treatment appointments. Important as those were, in the absence of few other meaningful activities, such appointments merely reinforced his addict and offending identities. Consequently, trapped respondents such as Paul experienced boredom and stress, feelings which have strong associations with relapse (Best et al., 2008). Paul wanted to be alcohol- and drug-free, but when asked how he managed problems such as cravings, he offered few strategies. His narrative reflected low levels of self-efficacy and hope, as well as depression, anxiety, stress, isolation and a lack of purpose. Paul clearly lacked the stability, confidence, self-belief and support structures necessary to create and sustain an identity other than that of an addict. Thus, while he did experience many periods of abstinence, sustaining these efforts was ultimately futile.

Situational contingencies, and routine activities, can either lure people towards or away from addiction (Sampson and Laub, 2005). In one of criminology’s largest empirical desistance studies, it was found that persisters in crime had chaotic and unstructured lives across a range of areas, such as housing, employment and relationships, and routine activities were ‘loaded with opportunities for crime and extensive associations with like-minded offenders’ (Sampson and Laub, 2005: 275). Paul’s ‘trapped’ narrative was similarly loaded with opportunities to relapse, and his limited meaningful activities outside Second Chance reflected this. By contrast, John had several meaningful activities, including Second Chance, such as volunteering and developing family relations. John’s success was not about having ‘nice things to do’ but, while each were distinct domains, his routine activities shared commonalities which supported his recovery and desistance. This included not simply a new social network but also informal social controls – such as values, customs and behaviours through the activity and its related social networks. These conscious and unconscious mechanisms provided John with the necessary ‘tools’ with which to begin to change his way of thinking and help him to live without alcohol and drugs. By contrast, Paul’s situated choice was based around a lack of opportunities to further himself and a lack of belief in his ability to succeed. Paul’s informal social controls were largely found through other people who were in comparable situations. Paul had frequent drug and alcohol counselling appointments but in the absence of non-addict related things to do, this appeared to reinforce his problems rather than creating alternative identities and hope for desisting.

Conclusion

Reviewing the role of sports-based interventions in relation to social inclusion, Coalter (2007) asserts that some programmes help some people only some of the time. He goes on to state that one of the tasks for future research is to examine the mechanisms within programmes to account for why this is this the case. This prospective study explored this by examining the meanings which participants attached to Second Chance in the wider context of their lives. According to both interviewees, sport was something with which they had positive associations. Overcoming addiction requires some degree of self-change, and for this process to happen, facilitating opportunities are required. The findings articulated here suggest that Second Chance was a ‘window of opportunity for change’ (Groshkova and Best, 2011: 11). The degree to which change was experienced varied, and depended on factors both within and outside of Second Chance. These factors included participants’ routine activities, informal social control (influences found through social networks) and agency (personal choice).

In this study, recovering respondents assumed identities such as sportsmen, students, fathers and volunteers. This process of transforming identities was theorised as a turning point, made possible via routine activities, informal social controls and agency (personal choice). While only time will tell if this was indeed a ‘true’ turning point in their lives, the findings are positively indicative. Although the Second Chance window of opportunity was an important part of this process, it was not the complete picture. For participants to move forward and recover, Second Chance had to be delivered in tandem with sources of stability and support outside the programme. By prospectively examining the experiences of John and Paul, it is hoped that this research has added knowledge to this area.