Limited research has been conducted with people with SUDs through surveys, focus groups and interviews in order to better understand and define the meaning of recovery from those who are living through it. Little research has been done to examine views of patients with SUDs through anonymous online forums which may yield different results that those conducted through other forms of research. The purpose of the study is to gain an understanding of the experience of recovery from anonymous online postings in recovery support forums. The study was conducted using a qualitative descriptive approach through a thematic content analysis.
The setting of this study is an online forum called Bluelight which can be found at www.bluelight.org. Data were collected from the recovery section of the site, specifically through a forum titled Sober Living. Bluelight proclaims itself as an international, online harm-reduction community, committed to reducing the harm associated with drug use. Harm reduction includes the concept of accepting people where they are in recovery which may include ongoing substance use. Users of the site are anonymous and set up a username and password to access the site and participate in discussions. The forums are categorized by the main topics of discussion within. Forums topics include addiction, sobriety, mental health, media, and pharmacology to name a few. Within the forums, users create threads which further narrow the discussion topic. Each forum has moderators. According to the website statistics there are usually about 2,000 to 3,000 active users of the site.
Description of the Study: An Institutional Review Board exemption was obtained prior to starting the study. A convenience sample of all 1,230 posts made between February 1, 2017 to February 28, 2017 on the recovery forum titled Sober Living was used. All posts were copied from the website as a guest user (no registration required) and no posts were made within any of the forum threads. Users post under non-identifying user IDs which do not include names. The copied posts were uploaded into Dedoose which is an online software program for qualitative and mixed methods study. The content of the posts was then coded and subsequently analysed as described below.
To code the content of the posts, each post was reviewed in its entirety and meaningful excerpts were highlighted and assigned a code based on the idea conveyed within. For an excerpt to be selected for coding, it had to convey an idea about the user's lived experience of recovery. In line with thematic analysis, the codes were allowed to emerge from the text versus the researchers looking for certain ideas to appear within. Initial coding of all posts was completed by one researcher. Secondary coding of meaningful excerpts only was completed independently by the second researcher to ensure inter-rater reliability of the assigned codes. Discrepancies were discussed between the researchers until consensus was reached on the most appropriate code. This coding process was the first step in the identification of trends, patterns, and categories within the posts. Once all meaningful content assigned a code, the researchers then met several times to analyze the coded text for the presence of interrelationships between codes and to begin determining common themes. If clear relationships were noticed between codes, they were then lumped together and organized into themes and subthemes. Global themes emerged quantitatively when looking at the number of coded excerpts contained in each theme. Those themes with the most coded excerpts by unique users were considered significant and served as the global themes of this thematic content analysis. These themes were then shared with a PhD researcher with experience in content analysis to ensure that the findings were consistent and to prevent researcher bias.
Findings: Themes identified from the online posts were that the experience of recovery included (a) the agony of physical distress and self-medicating during withdrawals, (b) a psychological roller coaster during recovery, and (c) identification of common coping skills and strategies that help in recovery. Additionally, it was noted that users on the forum sought and gave support and advice to each other and engaged in discussions about providers and treatment modalities.
Implications: The findings from this study are significant because they can be used to inform treatment during recovery. It is noted that many people who posted on this forum attempt to withdraw and enter recovery on their own without medical help. The findings indicate that patients struggle with physical and emotional distress, including pain and anxiety as well as problems sleeping during withdrawal. Users of the forum often reported using over the counter or prescription medications to self-medicate and there were many discussions between users of the best way to taper off of recreational drugs. Medications that were commonly used were trazodone for sleep, gabapentin for anxiety and pain, and the herb kratom for general withdrawal support. Indications for nursing include that in some cases it may be advantageous for health care providers to discuss these options and possibly prescribe the medications in a harm reduction effort to assist patients in their recovery process. Education about over the counter herbs such as kratom which has some health risks should also be included when patients leave treatment or are considering recovery.
Furthermore, findings from this study showed that users often reported and recommended a variety of coping skills and self-help strategies which were helpful during recovery including the practice of mindfulness, developing healthy support networks, and engaging in hobbies and exercise. This validates the current practice of healthcare providers encouraging coping skills and self-help strategies for patients entering recovery. The discussion of positive and negative interactions and experiences with healthcare providers indicates that healthcare providers do play a vital role in the recovery process. Implications for healthcare providers includes that their relationship with patients in recovery has value and there should be an emphasis on supporting patients through understanding of their experience and to spend adequate time with them in order to prevent the appearance of services being rendered for profit.
Limitations: Limitations of the study include that the participants from this study are those that post on an online forum during a one month period and may not be generalizable to other populations. Demographic data of the forum users was not known. Additionally, the users on this forum post anonymously which may impact what information is shared.
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