Navigating the chaos: A grounded theory study of seeking psychological therapy amongst people who use alcohol

Background: People who use alcohol (PWUA) experience a higher rate of psychological problems including depression, anxiety and post-traumatic stress disorder (PTSD). Despite clinical recommendations for psychological therapy as first-line treatment, psychological support for PWUA in the United Kingdom (UK) remains fragmented and inconsistent. Provision is often split between specialist community substance use services and National Health Service (NHS) mental health services. Broader research into the UK healthcare system has shown PWUA struggle to access appropriate services for support with both general health and alcohol addiction. More specific research into PWUA’s experience of pathways into psychological therapy is limited. Aim: This study addresses this gap in the literature and explores the experiences of attempts to access psychological therapies from the perspective of PWUA. Method: 15 PWUA were recruited mainly from community substance use services and addiction support groups across South East England. Semi-structured interviews were conducted with participants who identified as trying to negotiate both alcohol addiction and a mental health problem. A Constructivist Grounded Theory approach guided the data collection and analysis with a focus on the principles of constant comparison. Findings: A theoretical model was constructed, integrating the themes of chaos, negative self-image, embodied experiences such as relapse, and an increasing sense of self-reliance. The process by which PWUA remain stuck in a chaotic system, as well as the alternative pathways sought out of chaos, are presented in the model. Conclusion: This study draws attention to the difficulties PWUA experience when attempting to navigate routes into mental health treatment as well as the need for integrated, consistent and accommodating pathways to support chronically excluded PWUA into appropriate psychological treatment. Findings are discussed in relation to existing research; implications for clinical practice are considered, especially regarding the provision of NHS services as opposed to third sector organisations.