Women's Discourses About Secretive Alcohol Dependence and Experiences of Accessing Treatment by Liezille Jean Pretorius Decem
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CORE Metadata, citation and similar papers at core.ac.uk Provided by Stellenbosch University SUNScholar Repository Women’s discourses about secretive alcohol dependence and experiences of accessing treatment by Liezille Jean Pretorius Dissertation presented for the degree of Doctor of Philosophy in the Department of Psychology at the University of Stellenbosch Promoter: Prof Anthony Naidoo Faculty of Arts and Social Sciences Department of Psychology December 2010 DECLARATION By submitting this dissertation electronically, I declare that the entirety of the work contained therein is my own, original work, that I am the owner of the copyright thereof and that I have not previously in its entirety or in part submitted it for obtaining any qualification. ……………………………. …………………… Signature Date Copyright © 2010 Stellenbosch University All rights reserved ii ABSTRACT There is a paucity of research documenting women’s undisclosed drinking. This study explored the discursive accounts of women’s alcohol dependence, treatment history and barriers in accessing alcohol dependence treatment. The goals of this dissertation were to explore women’s alcohol dependence history; explore women’s treatment history (or lack thereof); identify barriers and nature of barriers that limit women’s access to alcohol dependence treatment; identify the reasons for women not accessing treatment, and to interpret women’s experiences of treatment per se. A Human Scientific Approach was adopted to examine and interpret how women’s drinking is socially constructed. A social constructionist approach was utilised to access and construct meaning from the discourses emanating from the women’s narratives of their experience with alcohol and their attempts at rehabilitation. Ten women were interviewed using the life story (narrative) interview method. The findings illustrate two major discourses namely, secret drinking and inaccessibility of appropriate treatment facilities for women alcohol dependents. This means that participants feel forced to conceal their drinking and to drink secretively because of the stigma associated with women drinking heavily. The stigma they experience translates into barriers (mostly internal barriers) to seeking institutionalised treatment. This makes it easier for them to seek alternative treatment such as an anonymous fellowship, like Alcoholics Anonymous. Other discourses signify the importance of problem identification and treatment readiness. This means that if the alcohol dependent woman realises what the real problem is causing her to use alcohol as an escape or as a coping strategy, she will be more willing to address the underlying problem. Recommendations are made focusing on micro and macro-level intervention strategies such as access to treatment, public health campaigns and policies to improve the quality of life of women recovering from alcohol dependence. iii OPSOMMING Daar is min inligting beskikbaar oor die dokumentering van vroue wat in-die-geheim alkohol gebruik. Hierdie studie het die diskursiewe weergawe van vroue se alkohol- gebruik, behandelingsgeskiedenis en hindernisse tot die behandeling van alkohol-misbruik verken. Die doelstellings van hierdie verhandeling is om die volgende te verken: Vroue se afhanklikheidsgeskiedenis; vroue se rehabiliteringsgeskiedenis (of die gebrek daaraan); die identifisering van hindernisse en die aard van die probleme wat vroue se toegang tot die behandeling van alkohol-misbruik beperk; die identifisering van redes waarom vroue rehabilitering weier; en die interpretasie van vroue se belewings van behandeling per se. ‘n Humanisties-wetenskaplike benadering is gebruik om die sosiale konstruksie van vroue se drinkgewoontes te ondersoek en te interpreteer. Die verstaan van en die skep van betekenis van die diskoerse van die vroue, en die temas wat na vore gekom het vanuit hul vertellings/narratiewe van hul alkohol-ervarings en hul pogings tot rehabilitering, is binne die raamwerk van die sosiaal-konstruksionistiese uitgangspunt aangepak. Onderhoude is met tien vroue gevoer en die narratiewe metode is gebruik. Die bevindings toon twee hoof- diskoerse naamlik, drinkery in-die-geheim en die ontoeganklikheid van gepaste behandelingsfasiliteite vir vroue met afhanklikheidsprobleme. Dit beteken dat vroue ondervind dat hulle gedwing word om in-die-geheim te drink, as gevolg van die stigmatisering van vroue en oormatige alkohol-gebruik. Hierdie stigmatisering kan herlei word tot hindernisse (meestal interne hindernisse) te make met ge-institutionaliseerde behandeling. Om die rede is dit makliker vir vroue om alternatiewe behandeling soos anonieme gemeenskappe, byvoorbeeld Alkoholiste Anoniem te oorweeg. Ander diskoerse beklemtoon die identifisering van probleme en die instemming tot rehabilitering. Dit beteken dat wanneer die alkoholis die werklike probleem vir alkohol-gebruik verstaan as ‘n ontsnapping of as ‘n hanteringsstrategie, sy meer gewillig sal wees om die onderliggende probleem aan te spreek. Aanbevelings is gemaak met die fokus op mikro- en makro- intervensiestrategieë, soos die toegang tot rehabilitering, openbare gesondheidsveldtogte en beleide ten einde die leef-kwaliteit van vroue in die herstelproses van alkohol- afhanklikheid te verbeter. iv ACKNOWLDGEMENTS It took me a long time to complete this thesis. It was very challenging and demanding for various reasons, not all academic. Finally, it’s finished and this gives me the opportunity to thank those who motivated and supported me throughout the research process. I would like to extend my sincere gratitude to: • The participants of this study. Without their honest life stories this research project would not have been possible. • Professor Anthony Naidoo, my thesis director, who diligently assisted me, even when I was living in the United States and warm heartedly coached me throughout the research process. • The Research and Capacity Development Department, Medical Research Council staff for facilitating and funding this doctoral thesis through the MRC Internship programme. • Professor Priscilla Reddy, my MRC mentor, for accepting me into her Unit and guiding me towards ethical and rigorous research. I would like to give a genuine thank you to her and the entire Health Promotion Research and Development Unit staff component who housed my Doctoral Internship. • Dr. Vanessa Thompson, I would like to extend an earnest thank you for the effortless, expert Human Scientific consultation. • Anthea Coller and her MRC IT department co-workers for help with formatting the document. • Uncle Tyrone (Prof. Pretorius) for your inspiration; tough love and whipping me into shape ever so gently. • Mommy and Daddy, thank you for believing in me and giving me this opportunity. • Lesley and Nathan for babysitting and Meagan for your support. • Julian for your encouragement, support and for effortlessly taking care of the little ones when mommy was working. • Reginold Simmons for your help editing the document and your friendship. • I am grateful that I still have friends, thank you all for understanding why I had to cancel and postpone social gatherings to meet thesis deadlines. • My Cassidy and Isaiah, who contribute to my purpose, I did this for us. • Heavenly Father who undoubtedly carried me through the difficult and frustrating times, my gratitude and faith will never perish. v DEDICATION This thesis is dedicated to Dean. vi TABLE OF CONTENTS Page Declaration ii Abstract iii Opsomming iv Acknowledgements v List of Tables x List of Figures xi CHAPTER 1 ............................................................................................................... 1 INTRODUCTION ............................................................................................................. 1 1.1 Basic Concepts .................................................................................................. 1 1.2 Why Do Women Drink? ...................................................................................... 3 1.3 Why Study Women And Alcohol Dependence? ................................................. 4 1.4 Psychology’s Response to Substance Dependence .......................................... 5 1.5 An Overview of the Problem Statement.............................................................. 6 1.6 Theoretical Points of Departure .......................................................................... 6 1.6.1 Alcoholics Anonymous (AA)………………………………………………...7 1.6.2 Transtheoretical Model (TTM)……………………………………………….9 1.7 Methodology ....................................................................................................... 9 1.8 Goals of the Study ............................................................................................ 10 1.9 Outline of the Thesis ........................................................................................ 10 CHAPTER TWO A REVIEW OF WOMEN’S ALCOHOL DEPENDENCE ...................... 11 2.1 In context: Alcohol Dependence in South Africa ............................................... 11 2.1.1 Alcohol Dependence and Age, Race, Geographic Location ................. 13 2.2 Women and Alcohol Dependence ..................................................................... 14 2.3 Understanding the Stigma of Alcohol Dependency through a Gender Lens ..... 15 2.4 Exploring and Interpreting Women’s Treatment History .................................... 16 2.5 Alcohol Dependency Treatment ........................................................................ 20 2.5.1 Alcoholics Anonymous