The overall objective of this study is to develop and evaluate a social group work empowerment programme which is aimed at alcohol dependent elderly people's needs and strengths. The thesis consists of four sections: Section A refers to the problem statement, research objectives and procedures which were followed. Furthermore the limitations of this study, the definition of key words as well as the composition of the research report are discussed. The problem statement can be condensed as follows: o Journals all over the world have been pleading for decades that alcohol dependent clients should be exposed to special developed treatment programmes. Opposed to this, it was found that treatment centres in South Africa use one programme for all their clients, irrespective of age. This entails an unfair and unjust service delivery model. From these findings a need for a specialized treatment programme for alcohol dependant clients was identified. o The strengths perspective has been successfully implemented in various service areas of social work. Unfortunately it has not yet been implemented in a controlled study with alcohol dependent elderly through group work services. The problem statement leads to four research aims. Developmental and Utilization Research (DR & U-model) was used as the overall research model. This model was implemented within a mixed methodological design model. Interviews and experimental research were used as quantitative approaches, although some qualitative data were also reported. A case study, as a qualitative approach, was also used. Literature studies were conducted on the themes of alcoholism, social group work, as well as the strengths perspective. Section B consists of the four articles that form the report about the research outcomes. Each article is a report about a particular sub-project of the research and each has, as a self-contained unit, an own research aim, research method and report. Each of these is linked with the central aim, objectives and content of the umbrella research project. The four articles are: Article 1: Profile of alcohol dependent elderly people A comprehensive profile of alcohol dependent elderly is drafted based on the results of interviews and case studies with 56 aged participants. Various strengths, such as a spouse, of alcohol dependent elderly were identified. On the other hand needs, such as effective communication skills, were also identified. Article 2: The nature and practice of a strengths perspective with alcohol dependent elderly people The history of the strengths perspective is outlined within a South African and international context. From the literature study as well as interviews with the aged participants (N=56) and social work practitioners (N=27) various strengths and qualities group work services with alcohol dependent elderly people. Opposed to this, it was found that although this perspective holds many advantages for the alcohol dependent elderly person, it is presently not practised at registered treatment centres in South Africa that were involved in this investigation. Advantages, disadvantages and principles of this perspective are also discussed. Article 3: A social group work empowerment programme with alcohol dependent elderly people A social group work empowerment programme was developed for alcohol dependent elderly, aimed at their special needs, strengths and challenges. The programme was developed in the spirit of empowerment, a strengths perspective, healing and wholeness, as well as music therapy. Thirteen group meetings, such as communication, conflict management, handling of mild depression, managing of loss, HIV/Aids and the aged person, as well as religion and spirituality in old age, were developed and presented to the client group. Special concerns for group work with the aged, such as to use a loud voice and to speak clearly, were identified from the literature and empirical research, and was taken into account during the programme presentation. Article 4: The effect of a social group work empowerment programme on the social functioning of alcohol dependent elderly people The programme was implemented with eight (N=8) aged participants in an experimental group. Eight (N=8) aged participants was in a comparative group and they received the current group work programme offered by the targeted treatment centre. The shortened Affectometer 2 (Kammann & Nett) and Personal Multi-Screening Inventory (Perspective College) were used as quantitative measuring tools at four occasions with both groups. Added to that, the experimental group completed a self-developed qualitative questionnaire once after intervention. According to the quantitative data neither the empowerment programme, nor the current group work programme improved the social function of the alcohol dependent elderly people The qualitative data showed exactly the opposite findings for the experimental group. In Section C a summary of the findings and conclusions of the full research project is provided. Furthermore some recommendations are provided, followed by a discussion on the contribution of the study. Section D consists of various addenda, such as the interview schedules that were used for data collection purposes. The thesis is concluded with a compound bibliography. / Thesis (Ph.D. (Social Work))--North-West University, Potchefstroom Campus, 2006

Thesis (Ph.D. (Social Work))--North-West University, Potchefstroom Campus, 2006.

The overall objective of this study is to develop and evaluate a social group work empowerment programme which is aimed at alcohol dependent elderly people's needs and strengths. The thesis consists of four sections: Section A refers to the problem statement, research objectives and procedures which were followed. Furthermore the limitations of this study, the definition of key words as well as the composition of the research report are discussed. The problem statement can be condensed as follows: o Journals all over the world have been pleading for decades that alcohol dependent clients should be exposed to special developed treatment programmes. Opposed to this, it was found that treatment centres in South Africa use one programme for all their clients, irrespective of age. This entails an unfair and unjust service delivery model. From these findings a need for a specialized treatment programme for alcohol dependant clients was identified. o The strengths perspective has been successfully implemented in various service areas of social work. Unfortunately it has not yet been implemented in a controlled study with alcohol dependent elderly through group work services. The problem statement leads to four research aims. Developmental and Utilization Research (DR & U-model) was used as the overall research model. This model was implemented within a mixed methodological design model. Interviews and experimental research were used as quantitative approaches, although some qualitative data were also reported. A case study, as a qualitative approach, was also used. Literature studies were conducted on the themes of alcoholism, social group work, as well as the strengths perspective. Section B consists of the four articles that form the report about the research outcomes. Each article is a report about a particular sub-project of the research and each has, as a self-contained unit, an own research aim, research method and report. Each of these is linked with the central aim, objectives and content of the umbrella research project. The four articles are: Article 1: Profile of alcohol dependent elderly people A comprehensive profile of alcohol dependent elderly is drafted based on the results of interviews and case studies with 56 aged participants. Various strengths, such as a spouse, of alcohol dependent elderly were identified. On the other hand needs, such as effective communication skills, were also identified. Article 2: The nature and practice of a strengths perspective with alcohol dependent elderly people The history of the strengths perspective is outlined within a South African and international context. From the literature study as well as interviews with the aged participants (N=56) and social work practitioners (N=27) various strengths and qualities group work services with alcohol dependent elderly people. Opposed to this, it was found that although this perspective holds many advantages for the alcohol dependent elderly person, it is presently not practised at registered treatment centres in South Africa that were involved in this investigation. Advantages, disadvantages and principles of this perspective are also discussed. Article 3: A social group work empowerment programme with alcohol dependent elderly people A social group work empowerment programme was developed for alcohol dependent elderly, aimed at their special needs, strengths and challenges. The programme was developed in the spirit of empowerment, a strengths perspective, healing and wholeness, as well as music therapy. Thirteen group meetings, such as communication, conflict management, handling of mild depression, managing of loss, HIV/Aids and the aged person, as well as religion and spirituality in old age, were developed and presented to the client group. Special concerns for group work with the aged, such as to use a loud voice and to speak clearly, were identified from the literature and empirical research, and was taken into account during the programme presentation. Article 4: The effect of a social group work empowerment programme on the social functioning of alcohol dependent elderly people The programme was implemented with eight (N=8) aged participants in an experimental group. Eight (N=8) aged participants was in a comparative group and they received the current group work programme offered by the targeted treatment centre. The shortened Affectometer 2 (Kammann & Nett) and Personal Multi-Screening Inventory (Perspective College) were used as quantitative measuring tools at four occasions with both groups. Added to that, the experimental group completed a self-developed qualitative questionnaire once after intervention. According to the quantitative data neither the empowerment programme, nor the current group work programme improved the social function of the alcohol dependent elderly people The qualitative data showed exactly the opposite findings for the experimental group. In Section C a summary of the findings and conclusions of the full research project is provided. Furthermore some recommendations are provided, followed by a discussion on the contribution of the study. Section D consists of various addenda, such as the interview schedules that were used for data collection purposes. The thesis is concluded with a compound bibliography. / Thesis (Ph.D. (Social Work))--North-West University, Potchefstroom Campus, 2006

The lack of research of the identity phenomenon in Lithuania that open up the opportunities to look into the problem of physical, social, psychological and spiritual nature from a holistic perspective, the problem being alcohol dependence and convalescence, hinders the identification of the preconditions of the identity (re)construction processes. The aim of this thesis is to devise a grounded theory on the peculiarities of (re)construction of identity of alcohol-dependent individuals during a period of abstinence. To this effect, the version of the grounded theory method by K. Charmaz employed in the thesis is combined with the following theoretical research preconditions: the fundamentals of the theory of social constructionism by P. Berger and T. Luckmann, A. Giddens’ concept of the reflexive self, E. Goffman’s concept of stigma and H. Hermans’ concept of the dialogical identity. Two underlying components of the identity construct of alcohol-dependant individuals who live in abstinence emerge in the devised grounded theory: (a) the dual axis of the identity reconstructed in the story and (b) the dimensions that describe it: temporality, self-image, embodiment, value/spiritual dimension, social dimension and dilemma of free will. In the stories the duality of identity, which marks the social dimension of identity construction and which is an important precondition for the (re)construction of identity in abstinence, manifests itself in the dialogue of dependent “self” and... [to full text] / Tapatumo fenomeno tyrimų, atveriančių galimybes iš holistinės perspektyvos pažvelgti į fizinio, socialinio, psichologinio ir dvasinio pobūdžio problemą – priklausomybės nuo alkoholio vystymąsi ir sveikimą – stoka Lietuvoje apsunkina prielaidų apie šių asmenų tapatumo (at)kūrimo procesus identifikavimą. Disertacijos tikslas – sukurti grindžiamąją teoriją apie priklausomų nuo alkoholio asmenų tapatumo (re)konstravimo ypatumus blaivybės periodu. Tam pasitelkta K. Charmaz grindžiamosios metodologijos versija derinama su teorinėmis darbo prielaidomis – P. Berger ir T. Luckmann socialinio konstrukcionizmo teorijos nuostatomis, A. Giddens refleksyvaus tapatumo E. Goffman stigmos ir H. Hermans dialoginio tapatumo koncepcijomis. Sukurtoje grindžiamojoje teorijoje išryškėja du pamatiniai nuo alkoholio priklausomų, bet blaivybėje gyvenančių asmenų, tapatumo konstrukto komponentai: (a) duali pasakojime rekonstruojamo tapatumo ašis ir (b) ją apibūdinantys matmenys: laikiškumas, savivaizdis, įkūnytumas, vertybių/dvasinis matmuo, socialinis matmuo ir laisvos valios dilema. Pasakojimuose tapatumo dualumas, kuris žymi tapatumo konstravimo socialinį matmenį ir yra svarbi prielaida tapatumui (at)kurti blaivybėje, reiškiasi priklausomo „aš“ ir blaiviojo „aš“ dialogu, taip integruojant gyvenimo pokyčius iki blaivybės periodo ir po jo. Siekiant tapatumo vientisumo ir integralumo, dualiam tapatumo konstruktui suteikiamos vertybinės gairės ir iškeliami socialiai pageidaujami tikslai, kompensuojamas... [toliau žr. visą tekstą]

Background: Alcohol misuse and dependency are major health problems worldwide. Despite the availability of a number of evidence-based treatments for alcohol-dependency, a large proportion of people relapse following detoxification. The costs to society and the individual are vast, not only economically but in terms of social and interpersonal functioning also. There is a recognised need to understand the factors that contribute to poorer outcomes in this population. Cognitive impairment is one factor that has demonstrated considerable associations with poor outcomes in the wider substance-misuse population. Aims: This thesis has two sections. The first comprises a systematic review which aimed to present the objective evidence for emotional decision-making deficits in the alcohol dependent population. The second is an empirical study which aimed to establish whether or not relapse can be predicted in a severely alcohol dependent population in the early stages following inpatient detoxification. In addition, a normative dataset for this clinical population using the ACE-III is presented. Methods: For the systematic review, a structured search of the literature relating to emotional decision-making in alcohol dependent samples was conducted. Iterative application of pre-defined inclusion and exclusion criteria identified eighteen studies for critical review. Quality assessment of these studies was undertaken and validated by means of calculating inter-rater reliability. For the empirical study, two sub-samples of a cross-sectional group of patients being treated for severe alcohol-dependence were examined; one to collate normative data for the ACE-III (N=73) and one to investigate associations between the ACE-III and relapse (N=20), including covariates of age, mood, anxiety and motivation. Results: The systematic review demonstrated substantial support for a deficit in emotional decision-making ability in alcohol-dependence. Methodological quality of the reviewed papers was moderate to high. Deficits in performance on a task of emotional decision-making compared to healthy controls indicated a reduced learning curve in alcohol dependent samples. Limitations of the studies included failure to report power analyses and effect sizes, insufficient detail regarding methodology and exclusion of common comorbidities in alcohol-dependence. The empirical study demonstrated clinically significant cognitive impairment in a sample of severely alcohol dependent individuals in the early stages following detoxification. In a smaller sample, cognitive functioning was not found to be predictive of relapse at one-month post-detoxification. Associations were identified between age and ACE-III score and between age and relapse status. Age was not predictive of outcome. Conclusions: The available evidence points towards the existence of emotional decision-making deficits in alcohol dependent individuals. These are likely to impact on the ability of individuals make the health behaviour changes required to recover from alcohol dependence. Further research may be helpful in identifying factors associated with increased decision-making deficit in this specific population and investigating the processes underlying such difficulties. The clinical normative dataset presented in the empirical study points towards generalised cognitive impairment during the early stages of abstinence which may negatively impact on ability to engage meaningfully with psychosocial interventions. Performance on the ACE-III was not found to predict relapse in the current sample. Previous research would suggest that the links between cognitive functioning and relapse are less well defined in alcohol-misusing samples than in the wider substance-misuse population. Therefore future research may help to clarify this association in alcohol dependent samples. It is acknowledged that the ACE-III is yet to be validated for use in the alcohol dependent population and is limited in its ability to assess executive functions. Given the high prevalence of executive functioning deficits in the alcohol dependent population, it seems of importance to use cognitive screening tools which place appropriate emphasis on these abilities. Service providers are encouraged to incorporate routine cognitive screening into clinical practice and consider the implications of cognitive impairment at both individual and service delivery levels.

In the UK there has been growing concern about the relationship between levels of alcohol consumption and offending behaviour. The Alcohol Treatment Requirement (ATR) was introduced to the UK in 2007 and was piloted in a District in the north of England in July 2007. The ATR is a coercive form of treatment delivered jointly by the probation service and the National Health Service (NHS) and was funded by the NHS. The ATR centres on supporting offenders to cease their offending behaviour and reduce or end their alcohol misuse. Two female alcohol treatment workers have been appointed to specifically deliver the ATR. Therefore this study aimed to investigate the delivery of the ATR, and more specifically, aimed to explore what impact the ATR might have in relation to positive behaviour change and rehabilitation for offenders with alcohol problems. In order to meet the expectations of producing 'outcome' data for the NHS funders, and indepth theoretical data worthy of an academic PhD, this research took a pragmatic methodological approach which enabled different social realities of the ATR to be explored. To this end, a mixed methods design was employed involving quantitative and qualitative data collection methods. The data for this research was generated in three phases with Phase One aiming to explore quantitatively the characteristics, impacts and outcomes of those sentenced to the ATR. This phase revealed that the ATR is being delivered to predominantly young, male, alcohol dependent, violent, persistent offenders. This analysis further revealed that the ATR was effective in bringing about positive treatment outcomes and in reducing reoffending. In order to explore further how this positive change was occurring, Phase Two consisted of qualitative participant observations of the treatment interaction involving the female alcohol treatment workers and the male offenders. By drawing on positioning theory, the analysis considered the complexity of the gendered interactions that occurred during these encounters. It was found that the two female alcohol treatment workers resisted positions of 'feminine carer' offered up by these young men in order to occupy positions of control. Indeed this analysis provided great insight into the constant flow of negotiations and manoeuvring of positions that occurred between the alcohol treatment worker and the offender, argued to be vitally important in working towards positive behaviour change. During Phase Three ten offenders were interviewed in order to explore through a dialogical lens (Bakhtin, 1982) how they constructed and experienced treatment on the ATR. In exploring the offenders' stories dialogically, the analysis highlighted how the ATR was enabling, in that it offered a 'space' for these offenders to engage and internalise a dialogue that draws on the authoritative voice of therapy. Therefore it was revealed that through dialogue with the 'other', offenders were able to re-author a more 'moral' and 'worthy' self. Moreover, the ATR has been found to be successful in enabling the offenders' hegemonic masculine identities to be both challenged and protected as a result of the multilayered interactions that occurred during these treatment encounters. This research therefore concludes that coercive treatment, rather than being a concern, should be embraced as a way of enabling change for offenders with alcohol problems. Furthermore, this research has highlighted the value of the relational aspect of treatment in bringing about positive behaviour changes. Finally this research has shown that community sentences offer a more constructive way of engaging with offenders than those who receive a custodial sentence.

In the UK there has been growing concern about the relationship between levels of alcohol consumption and offending behaviour. The Alcohol Treatment Requirement (ATR) was introduced to the UK in 2007 and was piloted in a District in the north of England in July 2007. The ATR is a coercive form of treatment delivered jointly by the probation service and the National Health Service (NHS) and was funded by the NHS. The ATR centres on supporting offenders to cease their offending behaviour and reduce or end their alcohol misuse. Two female alcohol treatment workers have been appointed to specifically deliver the ATR. Therefore this study aimed to investigate the delivery of the ATR, and more specifically, aimed to explore what impact the ATR might have in relation to positive behaviour change and rehabilitation for offenders with alcohol problems. In order to meet the expectations of producing ¿outcome¿ data for the NHS funders, and indepth theoretical data worthy of an academic PhD, this research took a pragmatic methodological approach which enabled different social realities of the ATR to be explored. To this end, a mixed methods design was employed involving quantitative and qualitative data collection methods. The data for this research was generated in three phases with Phase One aiming to explore quantitatively the characteristics, impacts and outcomes of those sentenced to the ATR. This phase revealed that the ATR is being delivered to predominantly young, male, alcohol dependent, violent, persistent offenders. This analysis further revealed that the ATR was effective in bringing about positive treatment outcomes and in reducing reoffending. In order to explore further how this positive change was occurring, Phase Two consisted of qualitative participant observations of the treatment interaction involving the female alcohol treatment workers and the male offenders. By drawing on positioning theory, the analysis considered the complexity of the gendered interactions that occurred during these encounters. It was found that the two female alcohol treatment workers resisted positions of ¿feminine carer¿ offered up by these young men in order to occupy positions of control. Indeed this analysis provided great insight into the constant flow of negotiations and manoeuvring of positions that occurred between the alcohol treatment worker and the offender, argued to be vitally important in working towards positive behaviour change. During Phase Three ten offenders were interviewed in order to explore through a dialogical lens (Bakhtin, 1982) how they constructed and experienced treatment on the ATR. In exploring the offenders¿ stories dialogically, the analysis highlighted how the ATR was enabling, in that it offered a ¿space¿ for these offenders to engage and internalise a dialogue that draws on the authoritative voice of therapy. Therefore it was revealed that through dialogue with the ¿other¿, offenders were able to re-author a more ¿moral¿ and ¿worthy¿ self. Moreover, the ATR has been found to be successful in enabling the offenders¿ hegemonic masculine identities to be both challenged and protected as a result of the multilayered interactions that occurred during these treatment encounters. This research therefore concludes that coercive treatment, rather than being a concern, should be embraced as a way of enabling change for offenders with alcohol problems. Furthermore, this research has highlighted the value of the relational aspect of treatment in bringing about positive behaviour changes. Finally this research has shown that community sentences offer a more constructive way of engaging with offenders than those who receive a custodial sentence.