Qualitative exploration of relationships between peers in residential addiction treatment

Abstract

Relationships between peers are often considered central to the therapeutic process, yet there is relatively little empirical research either on the nature of peer-to-peer relationships within residential treatment or on how those relationships generate positive behaviour change or facilitate recovery. In this paper, we explore relationships between peers in residential addiction treatment, drawing upon the concept of social capital to frame our analyses. Our study was undertaken during 2015 and 2016 in two English residential treatment services using the same therapeutic community-informed model of treatment. We conducted 22 in-depth interviews with 13 current and 9 former service residents. All interviews were audio-recorded, transcribed verbatim, coded in MAXQDA, and analysed using Iterative Categorisation. Residents reported difficult relationship histories and limited social networks on entry into treatment. Once in treatment, few residents described bonding with their peers on the basis of shared experiences and lifestyles. Instead, interpersonal differences polarised residents in ways that undermined their social capital further. Some senior peers who had been in residential treatment longer acted as positive role models, but many modelled negative behaviours that undermined others' commitment to treatment. Relationships between peers could generate feelings of comfort and connectedness, and friendships developed when residents found things in common with each other. However, residents more often reported isolation, loneliness, wariness, bullying, manipulation, intimidation, social distancing, tensions and conflict. Overall, relationships between peers within residential treatment seemed to generate some positive but more negative social capital; undermining the notion of the community as a method of positive behaviour change. With the caveat that our data have limitations and further research is needed, we suggest that residential treatment providers should more routinely open the "black box" of "community as method" to consider the complex and dynamic nature of the relationships and social capital inside.

Do women with complex alcohol and other drug use histories want women‐only residential treatment?

“…Also, we would probably have found some similar treatment experiences if we had conducted interviews in a mixed‐sex residential setting. Indeed, bonding, forming friendships, sharing personal stories but also tensions, arguments, conflict, mistrust, loneliness and social distancing have all been reported in the literature on mixed‐sex residential treatment . Lastly, we interviewed women cross‐sectionally, at different stages of treatment.…”

The practitioners’ perspective on the upside and downside of applying social capital concept in therapeutic settings

“…McPherson, Smith‐Lovin, and Cook () explain that homophily dictates the formation of most social networks and relationships among individuals leading to creation of homogenous social networks. In the case of recovery groups, homogeneity is with regard to type of substance one is addicted to, age, life experiences and personal characteristics (Neale, Tompkins, & Strang, ). In contrast with recovery gains associated with strong social ties and peer‐peer relationships (Best et al, ; Knight, Logan, & Simpson, ), highly homogenous groups may limit resources available to individuals leading to a more negative than positive social capital (McPherson et al, ; Neale et al, ).…”

Experiences of sharing, learning and caring: Peer support in a Finnish group of mothers

“…The mothers involved in the study recounted that they gained experiential knowledge and opportunities for learning from each other. In this regard, the findings support previous research reporting on the learning effects of peer support (Borkman, ; Mead et al, ; Neale et al, ). Furthermore, the findings deepen the current understanding by concentrating on learning among mothers.…”

“…As shown in a range of studies on peer support, receiving knowledge has many positive effects. Gaining experiential knowledge can help to alleviate emotional drain, can help in learning practical skills and ways of coping, and can facilitate appropriate support outside of the peer relation (e.g., Borkman, ; Mead et al, ; Neale, Tompkins, & Strang, ).…”