Journeys of recovery following a hospital based alcohol detoxification programme: a mixed methods study

Within the last two decades, there has been a shift towards incorporating the recovery model within statutory services delivered for people with alcohol dependence in the UK. Nevertheless there is little consensus about what type of process recovery is, how services can facilitate recovery, or how to determine the effectiveness of recovery oriented services.This study aims to contribute to understanding the process of recovery from alcohol dependence, to identify factors that can support and hinder recovery, and to compare two recovery pathways following detoxification in a general hospital setting.A pragmatic mixed methods approach was used, integrating two different types of analysis. Firstly, a thematic analysis of up to four semi-structured interviews with patient participants over the course of a year (N=24); principles from contextual behavioural science were applied to the findings. Secondly, a retrospective analysis of routinely collected data (N=742) in which the following outcomes were explored: survival, further detoxification events, readmissions to hospital and Emergency Department attendances.Active change often followed a crisis event, and this involved changes in awareness, behaviour and decision making. Professional, family and peer-group relationships were central to this process, providing opportunities to open up, validation of expressions of vulnerability, and experiences of commonality with others. New `rules’ were adopted in order to initiate abstinence, which initially involved avoiding alcohol and triggers; avoidance based rules were gradually replaced by those that led to engagement with valued aspects of living.Interventions from an Alcohol Specialist Nurse Service in hospital supported a significant number of people to orient to recovery during the first few weeks after detoxification, and a wider network of support was employed as recovery got underway. Traditional alcohol specialist services were underutilised after detoxification, and participants often experienced barriers to accessing community alcohol and mental health services when seeking help. Those with more `recovery capital’ (in terms of potential for health, mental health, social networks and employment) reported more progress in recovery, and had fewer negative outcomes.Traditional models of community treatment are not serving this group of patients, and alternative pathways to support ongoing recovery could be more widely developed; these would ideally be informed by an understanding of the process of change.