Mechanisms and processes involved in women's pathways into alcohol dependence and towards recovery: a qualitative meta-synthesis

Women's heavy drinking is often rooted in trauma and histories of abuse, while socio-cultural factors affect both the initiation of use as well as pathways to recovery. Research has largely focused on the epidemiology of alcohol use, and considerably fewer studies have examined the elements that facilitate recovery and the socio-cultural specificities that affect women's lives. To address this gap, we conducted a qualitative meta-synthesis in which we employed a holistic approach to exploring women's pathways into alcohol dependence and towards recovery. Twenty-three qualitative studies from 1998 to 2018 were identified from relevant databases and synthesized to delineate the mechanisms that led to dependence and how these affected recovery processes. Results highlight the complex interplay between adverse childhood experiences, sense of 'self', and wider dynamics of power. Alcohol was initially used as a corrective agent and as a tool of temporary empowerment, regulating structural and familial imbalances. However, drinking became progressively compulsive and overpowered every aspect of life. Initiation of recovery was often hindered by shame and stigma and facilitated by belonging to and being accepted by recovery groups and a revision of ‘the self' within wider social structures. Implications for treatment, policy, and practice are discussed