Self-determination meanings in concurrent disorders treatment and recovery experiences: a qualitative study

Ostrander, John Francis (2009) Self-determination meanings in concurrent disorders treatment and recovery experiences: a qualitative study. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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Abstract

Growing attention is being paid to co-occurring mental health and substance use disorders or concurrent disorders (CDs) in relation to treatment services and supports. A related theme is the mental health self-advocate vision of recovery that includes respecting peoples' subjective self-determination (SD) in treatment. Client SD is an important social work concept but its meaning and purpose remains unclear and it is typically defined from the professional perspective. Understanding SD meanings of people with CDs in relation to recovery may help social workers better assist people with CDs to achieve their recovery goals. This study explored the meanings of SD in CDs treatment and recovery experiences among five female and three male participants. Interview transcripts were analyzed using a qualitative grounded theory approach. -- SD meanings hinged on the subjective “sense of self” of participants within their ecosystem. Three interrelated SD meaning components were identified: key standpoint elements (beliefs and values, attitudes towards self and ecosystem, sense of control, and aspirations), a power or force (associated with being determined) and determining processes (knowledge building and decision making). A primary sense of self and a later more “nuanced” sense of self in CDs recovery were distinguishable within participants' descriptions and meanings. The more nuanced sense of self reflected more situationally relative, compatible, and discerning meanings of the self, SD, the ecosystem, mental health, addiction, and CDs recovery. Hermeneutic knowledge building is interpreted as facilitating the trend towards a more nuanced sense of self over time. One practice implication involves the role and importance of SD in relation to regulating the relative stability of the sense of self simultaneously with growth and change associated with CDs recovery.

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