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On the road to Damascus? A qualitative study of life events and decreased drinking.

Article Excerpt
Many heavy drinkers stop or significantly reduce their alcohol intake without receiving treatment, through processes often referred to as "natural recovery" (Burman 1997; Cunningham et al. 2000; Humphreys et al. 1997; Klingemann 1991; 2001; Weisner et al. 2003). Reduction in heavy drinking is often considered to be primarily due to a process of cognitive decision-making (e.g. Armor et al. 1978; Sobell et al. 1993). However, this decision-making process can also be considered to rely on a complex interplay of psychological, social, and cultural factors (Humphreys et al. 1997; Klingemann 1991; O'Doherty & Davies 1988; Orford 2001).

One aspect of social processes that may be relevant in studying "natural recovery" is that of significant life events. Life events can be classified in several different ways: in terms of whether they are perceived to be positive or negative; the sphere of the person's life that is affected (i.e. health or relationships); the suddenness and level of impact of the event; or in terms of social roles and identities. Thus, the term "life event" covers a wide range of occurrences, and this article adopts a broad definition of this term in order to capture the diversity of events which heavy drinkers may consider to have impacted upon their lives and their drinking.

Previous research indicates that life events and individuals' responses to them are not predictable in any straightforward way. As Blomqvist & Cameron (2002:115) note, "routes both into and out of destructive habitual repetitive behaviors are diverse and many layered, and [...] our responses to people who find themselves in such difficulties should be similar." While there is now a substantial body of quantitative research suggesting an association between significant life events and drinking change, there is less work which qualitatively describes and explains the experience from the perspective of the heavy drinker. Qualitative research may be particularly useful in examining the diverse and complex responses individuals have to life events.

Previous research by the authors indicates that around a third of heavy drinkers who reduce their alcohol consumption describe an event that they believe triggered this reduction (Dalton & Orford 2002:44). The role of such events in triggering change can be said to be an underexplored area in research terms. The current article, therefore, uses data from qualitative interviews with heavy drinkers, in order to explore the many and various ways in which participants talk about change in drinking, and how they consider such change to relate to a recent life event.

Method

Data presented in this article are taken from qualitative interviews with 17 heavy drinkers, carried out as part of the Birmingham Untreated Heavy Drinkers Project. This is a ten year longitudinal interview study of heavy drinkers in the English West Midlands, which commenced in 1997. Inclusion criteria at recruitment were that men had been drinking over 50 British units (1) and women over 35 units per week for at least 27 weeks during the last 12 months, and that they had received no treatment for drinking in the past ten years. All participants take part in a two-hour interview every two years. Data presented here were collected in 2003.

The interview includes forced choice questions and the completion of a "changes chart," where drinking levels, changes, and life events over the previous two years are recorded in diagrammatic form. It also includes a qualitative interview section, lasting around 40 minutes, focusing on one of a number of subtopics of particular interest. During the third wave of interviews in 2003, one of the qualitative topics chosen was that of the experience of a significant life event and its impact on drinking. (2) This topic was employed with a subsample selected from those participants who, by their own definition, had experienced a significant external event or change in their life over the previous two years, as recorded on the "changes chart." (3) The 17 participants had a mean age of 45 years old. They had consumed between and 116 units of alcohol in the week before interview. Interviews were audio-recorded and reports written by interviewers on the basis of these recordings. Thematic analysis of the data was conducted, assisted by Nvivo qualitative analysis software. Analysis was theoretically informed by a critical realist approach, which takes as its premise that people talk about "real" experiences in interviews, but that the meaning of such...