Place matters for health. We know that features of the natural, built, and social environment can be either health promoting or health damaging. From previous research we know that the environment is likely to be significant in shaping health-related behaviours, including alcohol consumption (here and here) and smoking patterns (here and here). In a new paper we have explored individuals’ experience and perceptions of the role of place in recovery from alcohol dependence. We wanted to gain a better understanding of the influence of the environment on the everyday experiences of those in recovery.
In order to do this we worked alongside a group of individuals who attend a recovery café in Central Scotland. We used photovoice, a participatory research method that enabled the participants to capture images of their recovery. Individuals at various stages of recovery, but all at least one year sober, were able to document features of the environment that enable and/or hinder their journey. Nine participants captured a total of 468 photographs. During focus group discussions participants identified features of the environment that were therapeutic and risky.
Almost all of the participants made references to natural, wide-open spaces, such as hills, the sea, green spaces, in which they found calm and healing. Participants associated such spaces with escape, meditation, clearing a busy mind, calm and support (Figure 1).
Figure 1: ‘I’ve took a, a picture at the top of the Braids. Eh, one that looks onto Arthur’s seat. Really green Arthur’s seat. And to the right a bit looks as far doon, I think you can see Bass Rock. Eh, and all that beauty and scenery and it’s on our doorstep. And I use it for a bit of my meditation and clearing my mind and that’.
Aside from vast open spaces, participants also found support in more everyday spaces, including the recovery café itself or in their homes. The café provides a space where the participants could see that they are ‘not the only one’, other café users understand their behaviour and the café itself was seen as a place of refuge following difficult moments.
All of the participants highlighted places of risk within their everyday environments, for most the single biggest element of risk was the retail environment, including both the sale and marketing of alcohol. For one participant the constant presence of alcohol was summed up with a photograph of the view from his window that included the local shop (Figure 2).
Figure 2: ‘it’s just there right on my doorstep and the first sign is beers and ciders’.
The same participant noted that, before recovery, he was able to navigate the city to buy alcohol 24 hours a day, the challenge for him now is to try to avoid it in an environment where it is so readily available. Participants spoke of the difficulty of avoiding such triggers in the everyday.
Further themes discussed in this paper include the transitory nature of place (places moving from supportive to risky and vice versa) and shame and stigma. This paper demonstrates that the journey of recovery from alcohol dependence is embedded in place, with place both supporting and hindering recovery. The findings confirm that people in recovery experience a particular set of challenges on a day-to-day basis. Of particular note here was the ubiquitous sale of alcohol and presence of alcohol marketing and promotions. By viewing recovery as a journey we can begin to frame alcohol dependence as a process of change; change in both the individual and in the way in which the individual sees and interacts with the environment. According to Banonis ‘recovering from addiction is a daily choice’ (Banonis 1989, p.37), however such choices are not made in a vacuum. This paper extends previous work by the CRESH team that argues that such health-related choices can be made more or less difficult by the environment in which one lives.