Data Coding and Analysis

Interviews were transcribed verbatim, first by Ms. Stringfellow and research assistants from the Social System Design Lab, and then using an online professional service. They were imported into MaxQDA v12 for coding. Coding proceeded in two stages, initial and focused, following constructivist grounded theory principles, in which there are no a priori codes (Charmaz, 2014). Initial coding is a line-by-line analysis of the data, which breaks up the story told by participants and ensures that as many concepts and ideas can emerge as possible. The goal is not to describe participants’ stories but to find latent patterns across events, occurrences, or interactions described by participants through constant comparison. Thus, the stories as conceived by participants cannot be taken in whole; they are “fractured,” and the resulting codes are later reconstructed through theoretical coding.

The goal of open coding is to identify the core code or codes, which are the problems central to resolving the participants’ main concerns and thus relate to most other categories. They

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should recur frequently in the data, represent stable patterns, and account for most variation in behavior. Once the core code was identified, focused coding began, with the goal of making theoretical connections across codes (Charmaz, 2014). Patterns and connections in the data were identified through constant comparison, abductive reasoning (M. Agar, 2006; Bendassolli, 2013; Bryant, 2009; Charmaz, 2014; Haig, 1995; Nathaniel, 2011; Timmermans & Tavory, 2012), and memo-writing. Constant comparative analysis facilitates rising codes above specific people and incidents to identify patterns and generate concepts, i.e., conceptualization or naming the emerging pattern (Glaser, 2002). These strategies are standard best practices for qualitative coding and analysis techniques in constructivist (Charmaz, 2014) and classic (Glaser, 1998; Glaser & Strauss, 1967) grounded theory, as well as ethnographic research (M. Agar, 2013; M. H. Agar, 1996).

Consistent with these techniques, Ms. Stringfellow was the sole coder (M. Agar, 2013; Glaser, 1978, 1998). However, to ensure that no major codes were missed at the initial stages of open coding, a second coder, trained in qualitative analysis, coded three interview transcripts independently for major codes and connections across codes. Overall, Ms. Stringfellow

identified more codes, and the second coder did not identify any codes that Ms. Stringfellow had missed. Codes that Ms. Stringfellow had identified that the second coder had not were discussed and the second coder agreed these were present. The differences were primarily in emphasis. Ms. Stringfellow completed all subsequent coding, consistent with grounded theory technique.

As noted, this study used a feedback-based approach within the framework of complex adaptive systems. Thus, principles from control theory were used as theoretical codes. Control theory makes explicit that people have goals, which they compare to their current perceived state. The difference between these goals and current states are the gaps that spur people to

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action, though their actions do not always have the intended consequences. In addition to goals and gaps, the principle of self-reinforcing behavior also guided theoretical coding.

Once the basic theory was developed, the core concepts emerging from the theory were further refined by consulting extant literature. Previous research helped to differentiate and operationalize concepts as well as clarify the nature of mechanisms that had emerged from the grounded theory.

To aid in theory development, tools and visual heuristics from the field of system dynamics were used during coding and in later interviews. Two main heuristics were used: behavior over time graphs (BOTGs) to reflect how people talk about change over time, and causal loop diagrams (CLDs) to reflect relationships between concepts. CLDs are the visual representation of people’s mental models. A single CLD was built that synthesized the multiple perspectives of participants into a collective mental model. The goal was to create a causal loop diagram that was parsimonious. Thus, variables and the links between them were chosen based on their ability to reflect a wide a range of experiences. Building the CLD proceeded iteratively with a simplified simulating model. Together, the qualitative CLD and simulating model were used to identify feedback processes that may be contributing to relapse.

The reinforcing and balancing feedback loops identified and refined for this study are based on explicit participant narratives, inference when connecting participants’ narratives together, and narratives that were incomplete but similar to those found in extant research on addiction remission, recovery, and relapse. Results, therefore, are different from traditional results in that they inherently relate the concepts of the present study to those of previous studies. This triangulation of data sources is a key strength of grounded theory (Glaser & Strauss, 1967) and systems science modeling (Roux, 2015).

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Triangulation of multiple sources of data and perspectives form as holistic a view as possible. This is especially true for theorizing the role of loved ones, given that loved ones who participate in studies are different from those who do not. Thus, in order to theorize the role of loved ones, sources of data included: how the participant loved ones talked about the person with addiction in their lives; how the participants who had used drugs talked about their loved ones; how the participants who had used drugs talked about others who were addicted; prior qualitative research on family members; and correlational studies indicating a link between social support and outcomes.

The most difficult perspectives to represent are that of non-supportive family members as described by the person with addiction. Participants who had been addicted described their most non-supportive loved ones as the most abusive, leaving little reason to doubt that their support for recovery was nonexistent. Even if these family members would claim they were supportive of recovery, the experience of abuse is enough to negate such support. Regarding loved ones, none claimed to be fully supportive without reservation; all had at least purported lines that their addicted loved ones should not cross. Moreover, the descriptions of the support they provided were consistent with descriptions of support by the participants who had been addicted.