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    Traumatic brain injury and substance use disorder in Aotearoa New Zealand : characteristics, correlates, and the role of social cognition in an inpatient addictions treatment sample : a thesis presented in partial fulfilment of the requirements for the qualification of Doctor of Clinical Psychology at Massey University, Wellington, New Zealand
    (Massey University, 2025-11-25) Marshall, Hannah L. M.
    Traumatic Brain Injuries (TBIs) and Substance Use Disorder (SUD) often cooccur, yet the underlying mechanisms linking these conditions remain unclear. One potential explanation is that TBI disrupts neuropsychological functioning, particularly Social Cognition, thereby increasing the risk of SUD. The overall objective of this thesis is to explore these relationships in depth. To achieve this, the first study aimed to gather a detailed history of head-injury characteristics among individuals with SUD in Aotearoa, including TBI with loss of consciousness (LOC). By ascertaining these characteristics, the second study aimed to examine their association with neuropsychological outcomes. Third, our final study aimed to explore the potential role of Social Cognition in explaining the relationship between TBI and SUD. A total of 77 adults (aged 18-64) engaged in residential treatment for SUD, participated in the current research. During their residential treatment program, participants completed self-report questionnaires to ascertain head-injury, TBI and SUD history, mental health, and TBI-related symptom severity. Of this sample, 70 went on to complete neuropsychological tasks. Study 1 revealed that one hundred percent of the sample endorsed one or more lifetime head-injury events. 81.8% of the sample had experienced a self-reported TBI featuring LOC, with the remaining 18.2% having a history of a ‘possible TBI’ where they sustained a head-injury event without LOC. Overall, 91% sustained multiple lifetime head-injuries (either with or without LOC). Compared to the general New Zealand population, this sample featured a higher rate of TBIs of moderate severity, and most events were untreated. Many individuals sustained head-injuries at a young age and sustained repeated injuries into adulthood. Study 2 found that individuals who had a high number of lifetime head-injuries showed significantly lower scores on executive functioning and self-reported experiencing more cognitive difficulties. Study 3 found that within Social Cognition, the interpretation of complex social cues, particularly those involving deception and subtle social intentions, may mediate the relationship between TBI and SUD. This research contributes to identifying unique rates, patterns, and outcomes of head-injury including TBI among treatment-seeking substance users and highlights factors which may increase individuals’ vulnerability. Social Cognition appears to be a mechanism worthy of future exploration as it may explain the relationship between TBI and SUD. Implications of these results for treatment and rehabilitation and directions for future research are discussed.
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    What contributes to alcohol and substance misuse recovery while parenting in integrated residential rehabilitation? : thesis submitted in partial completion of the requirements for the degree of Doctor of Clinical Psychology, Massey University, Auckland, New Zealand
    (Massey University, 2023) Stanley, Laura
    Alcohol and substance use recovery while parenting is a complicated endeavour. People in alcohol and substance misuse recovery while parenting have unique and complex needs, which mainstream treatment approaches cannot always meet. Treatment often focuses solely on substance misuse and fails to pay attention to parenting, and most often, parents and their children are separated during residential treatment. Parents often face the tough decision to either take care of themselves or take care of their children. Integrated treatment services, which include both drug and alcohol treatment and parenting support, have been developed to break the often intergenerational cycle of substance use and troubled parenting. These programmes have rendered successful outcomes in participants achieving and maintaining abstinence, improving their mental health, and supporting responsive parenting. However, little is known about what particular factors in integrated services support these positive changes made in recovery while parenting. The current research explores the unique factors that have contributed to parents’ recovery at the Family Centre, an integrated parent-child rehabilitation facility. The research additionally illustrates the needs of these individuals in recovery. Experiences of recovery and parenting were explored in semi-structured interviews and case studies with mothers undertaking a recovery programme. Through a reflexive thematic analysis, three themes were constructed: ‘The Construction of Self’ ‘The Therapeutic Milieu’, and ‘Relational Recovery’. The complex histories and recovery journeys of research participants were given context through the use of case vignettes. The findings highlight the complex and multifaceted nature of recovery while parenting, particularly the role that parenting plays in driving recovery-orientated change. The relational nature of recovery was a prevalent factor in recovery, providing a developing perspective on how recovery is viewed in research and practice.
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    A cognitive behavioural intervention for problematic substance use in adolescence : a pilot study : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
    (Massey University, 2006) Morrison, Cara
    Experimentation with substance use in adolescence is common, yet there is often concern when it appears to become more than experimentation. New Zealand youth, in particular, have some of the highest rates of substance abuse in the Western world. The main goal of this study was to determine if a brief manualised integration of cognitive behavioural therapy and motivational interviewing for adolescents was effective in reducing the harm caused by problematic substance use. The aim of the intervention was to reduce current and future difficulties with AOD use for adolescents. Four individual case studies and within subject comparisons were used to measure the effectiveness of this intervention in an educational setting. A battery of psychometric measures were used, including a structured diagnostic interview. Results indicated improvements in motivation and coping skills, and some short term reduction in substance use. Research issues are discussed, including the applicability of the DSM-IV criteria for substance use disorders in adolescence, and our understanding of 'risk'. The current study highlights the need for adolescent substance use interventions to be holistic and systemic in nature to successfully reduce substance related harm. The limitations of the current study are also discussed.
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    Attachment type and cognitive status of people in treatment for substance use and abuse : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts at Massey University
    (Massey University, 2002) Murch, Lesley Barbara
    This study demonstrates the importance of examining attachment issues, and the cognitive status of people in treatment for substance abuse. The participants were seven clients aged between 20 and 45 years of age, in treatment for substance abuse, and six of their counsellors. The Adult Attachment Interview (AAI: George, Kaplan & Main, 1996) was used as a therapeutic tool to uncover forgotten trauma and unresolved grief. Each of these participants was interviewed and portions of the transcripts are used to demonstrate the effectiveness of the instrument in use. These findings give examples of the richness of the client AAI transcripts which are then used in the counselling process. The second measure used was Loevinger's Sentence Completion Test (1976,1998) which was thought to show promise for indicating where people are 'stuck' in their thinking. In this study rather than being 'stuck' in an immature way of thinking participants show evidence of mature thinking. Classification of the AAI gave support to findings in attachment research that reflect a substantial and enduring connection between attachment organisation and psychopathology, and was linked to a wide array of indices of psychosocial functioning. Intergenerational transmission of severe insecure attachment behaviours was evident with all clients, as expected, which suggests that further investigation of the use of the AAI in therapy is important.
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    Dialectical Behaviour Therapy skills use in a Substance Use Disorder and Borderline Personality Trait population : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology
    (Massey University, 2012) Howard, Victoria,
    This study examined the skills used within a Dialectical Behaviour Therapy programme for 13 clients presenting with comorbid Substance Use Disorders and Borderline Personality Disorder traits at the Community Alcohol and Drugs Service North. This was the first known study to evaluate skills use within a 12-month Dialectical Behaviour Therapy programme for this client population in an outpatient alcohol and drug community based treatment service in New Zealand. Dialectical Behaviour Therapy is an evidence-based treatment comprised of four components, one being the training and practice of behavioural skills. Skills training has been suggested as an important element in attaining positive treatment outcomes. This study was designed to explore the frequency and variety of skills used by clients in this population. Skills use was recorded on the daily diary cards completed by clients over the course of treatment. The findings indicated that the clients made statistically significant increases in their rate of skills use as treatment progresses. Increases in all skills modules were observed, with the skills module of Core Mindfulness being used the most frequently, followed by Emotion Regulation, Distress Tolerance, and Interpersonal Effectiveness. In addition, findings also indicated reductions in substance use and substance use urges. These findings suggest tentative support for the use of Dialectical Behaviour Therapy skills training with Substance Use Disorder and Borderline Personality Disorder trait clients in an alcohol and drug community based setting.
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    Sober houses : the role of the environment in aiding recovering from addiction : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University, Wellington, New Zealand
    (Massey University, 2013) Van Es, Michael James
    There is a need for a deeper understanding of the role that the environment plays in an individual’s addiction to substances and in aiding recovery from addiction. The aim of the present study is to investigate the impacts the environment has on individual attempts at recovering from substance addiction, by learning from residents of sober-houses. Sober-houses are substance-free living environments for persons attempting to abstain from alcohol or drugs. Qualitative methodologies were employed, with an Interpretative Phenomenological Analysis (IPA) approach, to take into account the subjective individual differences between residents. A sample of five participants was drawn from residents of a sober-house to participate in semi-structured interviews. The results showed that the most significant impacts on addiction recovery occur with the domain of the social and physical environments. Participants were shown to be able to benefit from physically distancing themselves from destructive environments, and that positive social influences play important roles in the promotion of a sober life-style.
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    Stories of addiction : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology [at Massey University, Palmerston North, New Zealand]
    (Massey University, 2011) Ashton, Peter Robert
    This thesis examines lay understandings of addiction in the context of academic and clinical understandings and how these discourses are encapsulated in the treatment modalities available to persons experiencing addictive behaviour. It examines the tensions that exist in the treatment sector due to diverse ‘expert’ understandings of the addictive process and the very ‘construct’ of addiction. Participants’ narratives exposed the mutually constitutive nature of lay and professional discourses but also suggested that such use of narratives in clinical settings may have utility in the alleviation of addictive behaviours. However, the predominance of the medical model of addiction within the New Zealand treatment sector, and an increasing focus on highly manualised brief treatment modalities, may not be conducive to solutions that are deemed ‘creative’ rather than ‘corrective’ and give ‘voice’ and credence to the understandings of clients.
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    Alcohol, drug, well-being and recovery in New Zealand : a thesis presented in partial fulfilment of the requirements of the Master of Philosophy, Massey University, Palmerston North, New Zealand
    (Massey University, 2012) Smith, Dale
    Addressing dependence on alcohol or drugs involves much more than merely stopping heavy drinking or drug use. National and international literature shows that there are many dimensions to recovering from alcohol or other drug dependence (AOD). Though some of these aspects have previously been explored in detail there is still insight to be gained about what makes recovery from alcohol or other drug dependence possible. One of the fundamental questions that warrants exploration is: what enables people with AOD dependence to achieve and maintain abstinence and improve their well-being, in the first two years, within the New Zealand context? This thesis explored, in detail, the lifestyle changes of 11 New Zealanders with two years or more of abstinence-based recovery from alcohol and/or other drug dependence. In particular, it examined what they perceived were the necessary lifestyle ingredients to maintaining abstinence and improving their quality of life. These lifestyle changes happened within a recovery community context that supported their need to have belonging, relating, meaning and purpose. More specifically, the key recovery ingredients for this recovery population were found to be: identifying with other people with AOD, following a structured recovery programme (12-steps), processing challenging emotions, developing high levels of self-honesty, building relationships with other recovering people, serving others, managing alcohol and drug saturated environments, experiencing higher power encounters, and establishing hobbies, interests, and fitness routines. Involvement in these dynamic recovery communities resulted in a number of behavioural changes and shifts in participants’ outlook on life that could otherwise take years of counselling or therapy to achieve. The treatment field has a lot to learn from these rich community-based alcohol and other drug recovery fellowships; a number of implications and recommendations for alcohol and other drug treatment professionals have been identified.
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    The Janus influence and discovering a life : a study of people living with coexisting mental health and substance use disorders : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Sociology at Massey University, Albany, New Zealand
    (Massey University, 2001) Warren, Helen Barbara
    This grounded study examines how people who are dually diagnosed with a major mental illness and substance use disorder 'recover' their lives from a past of 'intemperate insanity' and discover a world in a rich and productive present. Thirty participants, including consumers, staff and families, took part in the study. Additional slices of data were retrieved from the analysis of six 'policy' documents and 72 hours of participant observation. All data were constantly compared and analysed using Glaser's emergent approach to grounded theory. Research and literature on those with coexisting disorders has been dominated by the 'medical model' with a focus on assessment, diagnosis, treatment and rehabilitation both in addiction and mental health settings. Whilst these aspects of 'management' of coexisting disorders are important, this acute phase of intervention represents only a small fragment of a person's life. These people are not their disease, and the coexisting disorders are not the totality of their being. 'Discovering a life' was an emergent theme that formed the basic core category. Intemperate insanity, naked in Woolworths (the crisis), shedding the armour (recovery) and living without the armour (maintaining the change) and Janus' temple (service provision) formed the theoretical codes which made up the entity discovering a life. There also emerged a further 'natural division', a critical juncture essential to discovering a life - sobriety. Without sobriety, participants' lives took a different path which linked them back to a past of intemperate insanity. Literary images of the Roman God Janus are used as a metaphor throughout the thesis to elucidate aspects of the participants' lives. Janus was the God of endings and new beginnings, of youth and age, and is portrayed in historical texts with a double head, one looking backwards and the other forwards. It is this need to remind themselves of the past in order to imagine the future, a need to track the metaphorical trajectory from youth to age that informs the basis of 'wellness' in the present for my participants. Service provision in the mental health and alcohol and drug fields is aimed at early intervention, the acutely ill and early phase rehabilitation. There are clearly ways of analysing and approaching the 'illness' at this initial point of the continuum that are efficacious and cardinal to the ultimate well-being of the individual. What I am proposing here is not an alternative to this bio-psycho-social explication, but a second-level, substantive theory that offers an insight into the way a diversity of people with coexisting mental health and substance dependence disorders integrate their human imperfections into their lives. They have found a way of accepting, rather than transcending, the human condition. At the same time, this new paradigm has implications for the way we provide a service to people with coexisting disorders. Service providers are invited to participate in a way that shifts the emphasis of intervention from 'doing' (tasks and skills-related activities), to 'being' (with a focus on integrating coexisting disorders into identity of 'self'). A therapeutic emphasis on 'caring', not 'curing', creates an environment that allows consumers to realistically live rich and meaningful lives.
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    Striking a balance : improving practice as a student doing group music therapy with adults with substance abuse and dependence : a research thesis presented in partial fulfilment of the requirements for the Master of Music Therapy at the New Zealand School of Music, Wellington, New Zealand
    (Massey University, 2010) Yearsley, Sharon
    An action research project was devised to help a music therapy student improve her practice in a group alcohol and drug treatment setting. The project initially focussed on improving practice by delivering more creative, sustained and holistic experiences. Four action cycles of one week each were carried out, each cycle comprising planning, action and reflection stages. Data sources were gathered in the form of clinical notes, a reflective journal and supervision notes from meetings and session de-briefs with counselling staff at the facility. The data was then woven into narrative accounts of each cycle, and key learning points for each cycle were identified. Cycles were also examined for common themes, and nine themes were identified. Findings show the student developing a deeper understanding of practice through the examination of structure and flexibility in facilitation style and musical interactions, and how and when to find balance between structure and freedom. Other key factors relevant to improving practice such as building confidence and working with the interdisciplinary team, are explored. Findings are discussed, along with ideas about the value of carrying out an Action Research project, and suggestions for future projects focussed on improving practice with this client group.