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Making Sense of Alcohol Dependence: Exploring the Beliefs of Adult Children of Problem Alcohol Users

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Making Sense of Alcohol Dependence: Exploring the Beliefs of Adult Children of Problem Alcohol Users MAKING SENSE OF ALCOHOL DEPENDENCE: EXPLORING THE BELIEFS OF ADULT CHILDREN OF PROBLEM ALCOHOL USERS Jessica Ingrid Munafò (née Zetteler) July 2009 Dissertation submitted in partial fulfilment of the requirement for the degree of D.Clin.Psy. at Cardiff University and the South Wales Doctoral Course in Clinical Psychology DECLARATIONS This work has not previously been accepted in substance for any degree and is not concurrently submitted in candidature for any degree. Signed: __________________________ (Candidate) Date: __________________________ (Candidate) STATEMENT 1 This thesis is being submitted in partial fulfilment of the requirements for the degree of D.Clin.Psy. Signed: __________________________ (Candidate) Date: __________________________ (Candidate) STATEMENT 2 The thesis is the result of my own independent work/investigation, except where otherwise stated. Other sources are acknowledged by explicit references. Signed: __________________________ (Candidate) Date: __________________________ (Candidate) STATEMENT 3 I hereby give consent for my thesis, if accepted, to be available for photocopying and for inter‐library loan, and for the title and summary to be made available to outside organisations. Signed: __________________________ (Candidate) Date: __________________________ (Candidate) STATEMENT 4 I hereby give consent for my thesis, if accepted, to be available for photocopying and for inter‐library loan after expiry of a bar on access previously approved by the Graduate Development Committee. Signed: __________________________ (Candidate) Date: __________________________ (Candidate) i ACKNOWLEDGEMENTS Firstly, I would like to thank the people who gave their time to participate in this study and share their thoughts and ideas with me. I really appreciate their willingness to think about issues that may have been difficult and offer me the insights that they have developed over many years. They have taught me so much. I am also very grateful for the support I received from my supervisors, Professor Neil Frude and Dr Alyson Smith. I really appreciate the time and energy that they have generously given to help me take this research study from a simple idea to a piece of work that I can be proud of. My thanks go to Hilary Henriques, Director of the National Association for Children of Alcohol‐dependent Parents (NACOA) who has supported this research from the start and made the recruitment process go so smoothly. I hope the study findings can be useful to the charity in some way. Thank you to the 2006 cohort for their kindness, encouragement and, above all, humour which has kept me going when my motivation and confidence has been low. They have been a great source of inspiration and fun! Finally, I would like to say a huge thank you to my family and friends for believing in me and tolerating my frequent mood swings! Special thanks go to Mama and Marcus. ii ABSTRACT The research literature concerning individuals who have experienced parental alcohol dependence during childhood has primarily focused on the harmful psychological and social consequences arising from such an experience. Relatively little research has focused on positive outcomes, or the various psychological factors that might mediate the relationship between the experience of growing up with an alcohol‐dependent parent and outcomes in adulthood. In addition, very few studies have used qualitative methods to explore the significance and meanings that children of alcohol‐dependent parents attach to their experiences. The current study employed a qualitative methodology to explore the beliefs held by individuals affected by parental alcohol dependence regarding the nature of, and responsibility for, alcohol dependence. Data was collected and analysed using a Grounded Theory framework, based on interviews with ten individuals. The findings revealed that through an active sense‐making process, participants had developed a wide range of interrelated beliefs regarding alcohol dependence and its development. They also held a number of attitudes towards the responsibility for alcohol dependence and experienced a variety of dilemmas and ambivalent emotions relating to these. The findings are reviewed in relation to the wider literature regarding children of alcohol‐ dependent parents, attribution theory and the diagnostic criteria for alcohol dependence. Implications for clinical practice and service delivery are considered in terms of individual and family interventions, and training. iii CONTENTS List of Boxes, Tables and Figures .......................................................................................... vii CHAPTER 1: INTRODUCTION .................................................................................................. 1 1.1 OVERVIEW OF CHAPTER ............................................................................................. 1 1.2 ALCOHOL DEPENDENCE .............................................................................................. 2 1.2.1 Definitions and diagnostic criteria ............................................................................. 2 1.2.2. Consequences of alcohol dependence for the individual and wider society ............ 4 1.2.3. Popular discourses regarding the nature of alcohol use and dependence ............... 5 1.3 ALCOHOL DEPENDENCE AND THE FAMILY ................................................................. 8 1.4 CHILDREN OF ALCOHOL‐DEPENDENT PARENTS ....................................................... 14 1.4.1. Psychosocial characteristics of children of alcohol‐dependent parents (COAs) ..... 15 1.4.2 Developmental trajectories, risk and resilience ...................................................... 18 1.4.3 Qualitative accounts of growing up with an alcohol‐dependent parent ................ 22 1.5 SOCIAL COGNITION ................................................................................................... 25 1.5.1. Attribution theory ..................................................................................................... 26 1.5.2. Brickman model of helping and coping .................................................................... 29 1.5.3. Further research examining attributions regarding alcohol use and misuse ......... 31 1.6 RATIONALE FOR THE STUDY AIMS AND CLINICAL RELEVANCE ............................... 34 CHAPTER TWO: METHODOLOGY .......................................................................................... 36 2.1 DESIGN ...................................................................................................................... 36 iv 2.2 GROUNDED THEORY ................................................................................................. 36 2.2.1 Philosophy and rationale .......................................................................................... 36 2.2.2 Process ...................................................................................................................... 38 2.2.2.1 Categories and coding .............................................................................................. 39 2.2.2.2 Further strategies guiding data analysis .................................................................. 40 2.3 RELIABILITY AND VALIDITY ....................................................................................... 41 2.4 PROCEDURE .............................................................................................................. 43 2.4.1 Development of the interview materials ................................................................. 43 2.4.2 Ethical considerations ............................................................................................... 44 2.4.3 Recruitment .............................................................................................................. 45 2.4.4 Data collection and analysis ..................................................................................... 46 2.5 REFLEXIVITY AND PARTICIPANT DESCRIPTIONS ...................................................... 49 2.5.1 Researcher reflexivity ............................................................................................... 49 2.5.2 Group demographics ................................................................................................ 50 2.5.3 Participant profiles ................................................................................................... 51 CHAPTER THREE: RESULTS .................................................................................................... 56 3.1 OUTLINE OF CORE CATEGORIES ............................................................................... 56 3.1.1 CONCEPTUALISING ALCOHOL DEPENDENCE [1] ...................................................... 58 3.1.2 DEVELOPMENT OF ALCOHOL DEPENDENCE [2] ....................................................... 63 3.1.3 ATTITUDES TOWARDS RESPONSIBILITY FOR ALCOHOL DEPENDENCE [3] .............. 71 3.1.4 AFFECTIVE RESPONSES TO ALCOHOL DEPENDENCE [4] ........................................... 78 3.1.5 ACTIVE SENSE‐MAKING PROCESS [5] ....................................................................... 85 v 3.1.6 EXPERIENCE OF GROWING UP WITH ALCOHOL‐DEPENDENT PARENT/S [6] ........... 86 3.2 MAKING SENSE OF ALCOHOL DEPENDENCE: A GROUNDED THEORY ..................... 88 CHAPTER 4: DISCUSSION ...................................................................................................... 91 4.1 REVIEW OF RESEARCH FINDINGS ............................................................................
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