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Downloaded From: Usage Rights: Creative Commons: Attribution-Noncommercial-No Deriva- Tive Works 4.0 Fox, Sarah (2018)“They said if you come you can’t drink. I thought, I can’t stop.” Exploring the journeys to support among women who experience co- occurring substance use and domestic abuse. Doctoral thesis (PhD), Manch- ester Metropolitan University. Downloaded from: http://e-space.mmu.ac.uk/622567/ Usage rights: Creative Commons: Attribution-Noncommercial-No Deriva- tive Works 4.0 Please cite the published version https://e-space.mmu.ac.uk “They said if you come you can’t drink. I thought, I can’t stop.” Exploring the journeys to support among women who experience co-occurring substance use and domestic abuse. Sarah Fox February 2018 A thesis submitted in partial fulfilment of the requirements of Manchester Metropolitan University for the degree of Doctor of Philosophy Department of Social Care and Social Work Manchester Metropolitan University This research is funded by the Society for the Study of Addiction (SSA). The views expressed in this thesis do not reflect the views of the SSA. ii Research abstract Although 30-40 percent of people in England seeking treatment for substance use are women, little research explores their experiences of support when domestic abuse is also present. There is also a gap in service provision for women with multiple and complex issues such as problematic substance use and domestic abuse. Ongoing austerity measures continue to impact health and social care services in the UK, which in turn, has an impact on the support options available to women. What women do to seek help, how they feel about the support they receive (or lack thereof), and information about the type of support available to them, is a missing conversation in both substance use and domestic abuse research and other related literature. As such, this research seeks to understand women’s journeys to support, when they experience co-occurring substance use and domestic abuse. The research aims to take an in-depth look at women’s motivations for support seeking, explore the barriers and/or enablers to accessing support, determine the wider influences on women's decision to seek help, and, identify the practice of substance use services and domestic abuse agencies in supporting women with dual needs. Influenced by feminist research theory and hermeneutic phenomenology, this thesis will present data from 12 interviews with women who have experienced co-occurring substance use and domestic abuse. Using interpretative phenomenological analysis (IPA) to analyse the interviews, a sample profile, 12 pen portraits and five superordinate themes will be presented. A discussion of the findings focuses on the complexity of support seeking among women with co-occurring’s substance use and domestic abuse. In particular, this research shows that the women in this study experienced multiple complex histories of abuse and substance use. The relationship between motivations and barriers of support seeking, the impact of systematic barriers and, a discussion of trauma informed approaches to support are also key themes discussed in this thesis. Overall, this research presents the journey to support, and the experiences of support, for women with histories of substance use and domestic abuse. This research creates a new knowledge, because it is the first-time women’s voices have been heard in terms of their own support journey. By listening to the voices of women, this research presents the lived realities of accessing support in a climate where support is reducing. iii Acknowledgements To the 12 women for generously giving me your time and trusting me with their words. To the Society for the Study of Addiction for supporting a study all about women. To my supervisory team, Prof. Hugh McLaughlin and Dr. Marian Foley at Manchester Metropolitan University for your sound advice and input. To my Director of Studies, Prof. Sarah Galvani for inspiring me, calming me, and getting me to the finish line. To Joyce Nicholson, former lecturer and current friend, for introducing me to hegemonic masculinity, we will continue to fight the fight. To Sharon Greenwood, my DAWF co-organiser and friend, for your sound advice and support. To my previous Women’s Aid colleagues and current friends Debbie Daly, Irene Campbell and Kerry Cook, for being there for me, and always making me laugh. To Aoife Begley, Emma Ozenbrook and Aisling Connell for being great friends no matter where we are in the world. To Zoe Clarke, Emilie Kristensen and Alex Campbell, for introducing me to feminism in a big way and changing how I see the world. To my family at Emmeline’s Pantry, especially to Karen Wilson for inspiring me with your self-lessness, your passion and your dedication to women in need of support. To my PhD friends who are friends for life, Sophia Chambers, Amuda Agneswaran, Daniela Di Basilio, Jessica Beck and Gemma Meek, you are strong, fabulous, academic women. To Chris Fox and Atish Sircar, you are strong, fabulous men. To the Jay family for your encouragement and for excusing my absence at family events. To my siblings, Claire, Donal, Sinéad, Bernard, Thomas, Erica, Philip, James, Lily-May and Martin, for being great people. A special shout out to my sister Maria, for making me laugh, a lot. To my brother Séan, for all your support, encouragement and funny texts, you helped me get here #getswole. To my mum Trish, for being a living example of strength. To my friend Selena, for your motivation, your patience as I complained (a lot), and your supply of food. To Paul, for remaining (very) patient and kind, for excusing my absence at family gatherings, for loving me when I was an ass. Thank You iv (Rupi Kaur, The Sun and Her Flowers, 2017) This thesis is dedicated to all of the strong women in my life. v Table of Contents Part One Introduction to the Research ................................................................................ 1 Chapter 1: Introduction to the Research .......................................................... 2 1.1 Why Women, Substance Use and Domestic Abuse? ................................... 3 1.2 Thesis Outline ............................................................................................... 6 1.3 Definitions ..................................................................................................... 8 Part Two A Review of the Literature Relating to Substance Use and Domestic Abuse ......... 10 Chapter 2: Conducting the Literature Review ................................................. 11 2.1 Finding the Literature ................................................................................. 11 Chapter 3: Co-occurring Substance Use and Domestic Abuse – Understanding Prevalence .................................................................................................... 13 3.1 Co-occurring Substance Use and Domestic Abuse – Understanding Prevalence Using International Research ......................................................... 16 3.2 Co-occurring Substance Use and Domestic Abuse - Understanding Prevalence Using Qualitative Literature ........................................................... 21 3.3 Co-occurring Substance Use and Domestic Abuse – Understanding Prevalence Using Women’s Voices ................................................................... 23 3.4 Summary of Chapter 3 ................................................................................ 26 Chapter 4: Service Response to Co-occurring Substance Use and Domestic Abuse ............................................................................................................ 27 4.1 Service Provision for Women Affected by Co-occurring Issues ................. 28 4.2 Collaboration Between Substance Use and Domestic Abuse Services ...... 32 4.3 Women as Research Participants – Their Views on Services ..................... 34 4.4 Summary of Chapter 4 ................................................................................ 38 Chapter 5: The Policy Context ........................................................................ 39 5.1 The Ending Violence against Women and Girls Strategy (2016) ................ 39 5.2 The 2012 Government’s Alcohol Strategy .................................................. 40 5.3 The 2017 Drug Strategy .............................................................................. 41 5.4 NICE ‘Domestic Violence and Abuse: Multi-agency Working’ (2014) ........ 43 5.5 Summary of Chapter 5 ................................................................................ 44 5.6 Summary of Part 2 ...................................................................................... 44 Part Three: Methodology and Methods ................................................................................ 45 Chapter 6: The Research Aims ....................................................................... 46 i Chapter 7: Epistemological and Methodological Understanding – Feminism and Phenomenology ............................................................................................ 48 7.1 Focusing on Women’s Experiences ............................................................ 48 7.2 Navigating Feminist Research ..................................................................... 49 7.3 Feminist Standpoint Theory........................................................................ 51 7.4 Including Phenomenology .......................................................................... 54 7.5 Using Hermeneutic Phenomenology .......................................................... 56
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