Addiction Recovery Through Photovoice Qualitative Study
Addiction Recovery Through Photovoice Qualitative Study
Addiction Recovery Through Photovoice Qualitative Study
© Under License of Creative Commons Attribution 3.0 License | This article is available from: ${articleDOI} 1
Journal of Addictive Behaviors and Therapy 2017
Vol.1 No.2:7
has also been described in stages (Darbo, 2005); a continuous Its philosophical orientation has its origins in critical
process of lessons learned [18]; or a dynamic fluid state [19-21]. consciousness, feminism, documentary photography and Paolo
Freire’s empowerment education [37-39].
Others suggest, recovery is an opportunity to begin
abstinence, change both dysfunctional thinking and behavior, It provides the ability to shift the power of research from the
regain health and in general reduce chaos of substance abuse in researcher to the participants [20,38,40], providing voice to
their lives [10,17,20]. Recovery chances are improved by those marginalized populations [35-36,41], while embodying a
understanding the person and their relationships, problems and thematic framework.
struggles. It is often four to six years before recovering addicts
It provides a sense of ownership and empowerment that can
show return to acceptable responsibilities or stable lifestyles
stimulate social action [38-39,42], assisting development of
[2,10,22].
personal and social identities of the participants.
Recovery Initiation
Reasons cited for recovery include motivation to change,
positive influences of family, strength of religion and spirituality
and help from drug treatment [3,22-23]. Conventional lifestyles,
better psychological support, relocating to different area with
limited drug availability, developing meaningful relationships,
replacing the addiction self-motivators also contributes to long-
term success.
Mindfulness, compassion, observing fears and anxiety must
happen before recovery begins [22]. Using the Drug Abuse
Reporting Program (DARP) and Drug Abuse Treatment Outcome
Study (DATOS) information, Joe, Simpson and Broome (1998)
found indicators of intrinsic motivation especially readiness for
treatment were not only significant predictors of engagement
and retention, but were more important than socio- Figure 1: Schematic of Photovoice and SHOWED Questions.
demographic, drug use and other background variables.
Ethical concerns included privacy, confidentiality/stigma, photographs and the potential for voyeurism [25,35,48]. These
consent, misrepresentation, safety, access of computer/online, are listed in following table (Table 1).
fatigue, vulnerable population, ownership of the actual
Ownership of Once logged in, each participant is given his/her own blog thread to choose six photographs describing what recovery is to
them.
Photographs/ Privacy
Each participant owns their photographs.
With each photograph the participant described the photograph using SHOWED questions.
This level of blogging is only visible to the participant and the researcher.
The researcher evaluated the photographs for common themes and divided into two groups based on themes combining into
18 photographs per group
Only visible to researcher and the particular group. The photographs are mixed and numbered.
The participants are advised to discuss through blogging about the photographs and their meaning as pertained to recovery.
Over the next 10 months, each group narrows down the photographs to a group consensus of six photographs that
represented their experiences with the recovery process.
The two groups are reunited into a single blog group with a total of twelve photographs which are re-numbered and mixed.
This blog can be seen by all participants and the researcher.
Further discussion continued as they choose the final six photographs that best illuminate recovery to the group.
Themes are derived from comments.
Safety/ Stigma/ The online environment provides the opportunity for flexibility of the participants to work at different times to gather the same
information and comment in their words at their convenience.
Potential for Voyeurism/Fatigue
Minimize participant risk:
Data Analysis
Data were collected in various forms including interviews,
documents, and reflection journaling guided by preprocessing
questions via blogging, and field notes, while building coherent
justification for the themes, through the presentation of the
participant’s voices under each stage and providing detailed
descriptions obtained through the preprocessing questions and
photographs chosen. Notes were taken throughout the process
in all stages.
Data were analyzed by two researchers over four months,
following independent coding of 95 blog post through reflection,
judging relevance and meaning to develop themes that depict Figure 3: Group Photographs (36 photographs divided into 2
the experience and noted observations through 100 hours of groups).
review individually and eight hours jointly until consensus was
reached.
slates, ups and downs, emptiness, regret, shame, acceptance Each of the final 6 photographs were then grouped into a
and appreciation. combined or reunited group, resulting in the photographs noted
in Figure 8: Final 12 Photographs (6 photographs from each
group, chosen by participants) Recovery is a journey recognizing
the addictive nature and need for change.
Category Group 1 1 1 2 2 2
Getting to
Journey Process Plan for future Turning point Path
the plate,
Don’t want to go
Tree sprouting from Footprints in
back down that Journey
same foundation sand
road
Rebirth
Hardest thing
to do
Addictive
Nature
Didn’t seem to
No compass High Legal trouble Committing crimes High in life
care
Nothing to
Mundane Jail In & out jail Violating parole Struggles
show for it
Thinking was
Aggressive Something bad Tough time Good & Bad days Death
all clouded
Always
Skeletons in closet Bad news Bad path Up & down
reacting
Destructive
Behavior Hurting other Everything like a
Loneliness Solitude Running
people joke
Physical
Throwing
Up & down Telling a fib effects of
everything down
body
Skeleton of
Death Lifestyle of lies Flushed away
self
Serious
Failure Roller coaster health Where I should be
problems
Lying
Crutch Things to snort Dependent Highs & lows Downhill spiral ROCKY
Impaired
Control Couldn’t Bumps on
Not able to cope Life in shambles Rock bottom “I was great”
understand track
Daughter
End of road Trouble Chase the high Struggle Not enough
taken away
Passion
Missing life Do together replaced by Complacency Tolerance
drug
Multiple
Next rush One became three Terrible cycle Ups & downs
relapse
Looking for
Chase Broken promise bathrrom for Roller coaster Out of control
pills
Relapse Relapse
Addiction took
everything
Not want
My past has bad
Minority Outcasts Terrible anything to Fit in
stuff in it
do with me
Druggie vs
Stigma Bad one Alone
disappointment
Stigma
Judgement of
Prejudice Peer pressure
others
Cancer vs
Alone
sickness
Peer pressure
Wanted to fit in
Out of the
grave
World keeps
turning
Surviving not
living
Emotions
frozen
Change Emotions
Positive Give meaning to life Happy Truth Happiness Trust Happy ending
Comfort in
Happiness Honest Supportive Small steps Passion Accepting
abilities
Learn from
Strong individual Potential
past
Mistakes
Share/flexible
cleansed
Hope Thankful
Self actualized
Leap of faith
Peace
Embrace
Sound mind
Forgiveness
Success
Humility
Taxing mental,
Ups & Downs physically & Feelings Empty Hurt Fear Hurting
spirituality
Afraid of
Shame Disappointments Mad Ashamed Depression
change
Meaninglessne
Empty Angry All the effort Ashamed
ss
Bargain for
Powerlessness Still hate me Hopeless Fear of dying
survival
Mistakes Fight
Tired
Worry
Realizations
Missed daughters
Moving forward Compass Challenge Dependable Think clearly Fresh day
life
Comfortable in own Face own Fail before Valuable Face & handle Don’t want to lose
Finality
skin reality success lessons them it again
Only person
Stand Continue to
Outcomes Allow mistakes can make it Washing away Landed on my feet
ground blossom
better
Fight for
Work out fears Envision future Recover differently what you Comes in waves Fought like crazy
believe
Place could
Keeping things
Accept faults Change have ended I’ve ever done
simple
up
Hold onto
Find something
Enjoy time important Moved away Death
good
things
Brightness
Lesser carbon Thinking
behind the Cemetery
footprint through
darkness
Worth
Uncomplicated Cemetery
fighting
World of color
behind the Take time
darkness
Involvement
Journey needs
to be with God,
Extend to others like the
footprints in the
sand
Empowered to
others
Connections
Self worth
Love ourselves
Family/
Experience
relationship Shame
with addiction
changes
Concerned how
Regret perceived by
others
Allow addiction to
Shame
define them
Acceptance
Appreciation
Hope
Repair
mistakes
Category: Addictive Nature causing physical effects on her body and living with serious
health problems.
Initiation into recovery
Dman and Heatherg11 describes loosing family and her
Basil stated, “When I finally started my recovery process and daughter. She states “I would find myself looking in their
having a compass of who I am and what I want to be, it became bathroom for pills.” Taxidriver 3 stated, “No matter how long the
clear to me that this was the missing place that helped me.” line was, it was never enough.” All participants describe feeling
“The only thing that would give meaning to my life would be the empty and difficulty controlling their impulses.
giving of love to others.” These comments indicate direction and
purpose for recovery. Heatherg11 states, “You get many times at Stigma
the plate. I may have struck out a few times, but I am still in the Ckunkle21 describes the stigma of addiction with his
game. It is up to me if I want to swing or not.” Ckunkle21 states statement, “If I had cancer, people would feel bad for me but
“Everyone recovers differently, but I think the stages are the because I have this sickness, I am garbage.” Taxidriver3 also
same.” CAH describes, “The choices I make, make me.” makes mention to the stigma of addiction, “Did I become a
Heatherg11, Ckunkle21 and CAH’s comments elicit ideas of druggie because I was a disappointment or did I become a
repeat intentions and purposeful direction to change. CAH also disappointment because I was a druggie?” Basil states, “I know
states, “Recovery is one of the hardest things I have ever had to that everyone has skeletons in their closet. I keep mine out
go through.” This was also expressed by Dman, Heatherg11, because I can look at them squarely.
Ckunkle21 and Taxidriver3. CAH states “I can make a plan for my
future. Instead of always reacting to the mess I have made for This is my cross to bear.” Dman states, “One of my biggest
my life, I can envision my future the way I want it to turn out. I challenges has been dealing with the shame. My past has some
need to figure out what makes me happy.” Heatherg11 states, bad stuff in it.” Taxidriver3 states, “If they don’t want me, then
“It’s up to me and only me to do the right thing.” A description it’s because I would not be in a place where I would be happy. I
of the difficulties of recovery and accepting change is developed use their prejudice to my benefit.” Shame and stigma are a
from these comments, creating an understanding of the need to constant throughout this research. Some are affected by others
change but the conflict involved with change. perceptions of them and seem to live on past events, whereas
others (those in recovery longer) use it as a way to evaluate
Self destructive behaviors where they came from and plan for the future.
Basil describes a “very aggressive and emotionally difficult Change Dysfunctional thinking
experience” and issues with racism and inability coping. CAH,
Heatherg11, Taxidriver3 and Ckunkle21 note feelings of being an Basil states, “The definition of humility is not to think LESS of
outcast and not accepted, constant challenges, parental strain yourself, but to think of yourself LESS.” “Keeping things simple
and loneliness. Ckunkle21, Dman and Heatherg11 also describe leads to an uncomplicated life.” “We can grow to love others by
issues with criminal activity, lying, cheating and downhill spirals. being there and knowing that we are not alone.” “It’s about
These are common issues in recovery as evidenced in previous personal growth.” Ckunkle21 states, “It is because of my past
research making recovery difficult. that I am now who I am. Unlike some of the others, I do not hate
my past. I just don’t want to go back.” “I need to learn from our
These behaviors and emotions are constant fall backs with mistakes but can’t focus on the negatives.” Taxidriver3 also
failure. CAH states “I don’t plan on hurting other people, states a similar concept in stating, “I use their prejudice to my
especially someone I love so much. It just happens. When I get benefit. We can be honest with who we are and not hide in
the selfish feeling to do something I know is bad, I try so hard to turmoil of being false.”
resist.” Chunkle21, Heatherg11, Taxidriver3, and Dman describe
similar feelings. Taxidriver3 describes a lifestyle of lies. These These comments indicate the understanding for the need to
comments indicate the non-purposeful actions within addiction change and what was, was not healthy. Ckunkle21 also states
that may be related to the brain function destruction of the “Just as water evaporates to the sky and then rains to support
frontal brain or executive function of the brain, supported in the the plants. We need others to support and guide us. We need to
literature. ask for help. We must trust that each day will be anew.” “We
need to take each day at a time and learn from our past.” Dman
Impaired Control states, “Drugs are not the problem, I am the problem.” “I have
Dman describes relapsing multiple times, anger and hurting been lucky enough that another day gave me another chance.
others, a rocky road and drugs being a constant in his life. He The sunset offers me hope.” Heatherg11, “Each new beginning
states, “Addiction took everything from me. Drugs are not the gives increased confidence even if it is just a ripple.” “The
problem, I am the problem.” Heatherg11 describes the drugs passion is lost and my light is dim, but as the earth rotates and
process as recognizing you are not alone on this journey and Dman notes “I feel lucky enough that another day has given me
require the support of others. It suggests that the past has the another chance; the sunset offers me hope.” Heatherg11 states
opportunity to change with recognition and effort. “Each new beginning gives increased confidence even if it is only
a ripple.” These quotes indicate a journey, hope and change.
Other quotes indicate faith, higher power and acceptance. Basil
advises, “By knowing that the world revolves around more then
just the addict/alcoholic, it effects the entire family (Figure 14).
We can grow into being more then just ourselves.
We have to offer up our powerlessness and embrace the
things in life we can control, love and support.” CAH states, “I’m
not sure if they find God or if God finds them, but I know that
God has something to the journey.” Faith hope, second chances,
growing confidence in one’s ability to stay on the recovery
journey were all important to all participants in the study. These
indicate a moving away from addiction into recovery, that
Figure 12: Fortune Cookie. change is possible.
· Quality of monitor
Initiation into recovery is becoming more difficult as addiction intensity can be matched through the continuum by allowing
treatment centers are coming under the same scrutiny as patients to “step-up” or “step-down” based on recovery needs.
hospitals, for example, in being denied payment if a heart failure In viewing recovery as a continuum of care, persons with
patient if readmitted to the hospital in less then 30 days. substance abuse disorders can remain in recovery, with
Treatment for drug addiction requires minimal thirty days but individuals need to be tracked in an ongoing manner.
funding is being limited to 11-15 days and then funding is not
The American Society of Addiction Medicine has established
being supported if relapse occurs as drug addiction is not
five main levels for substance abuse continuum of care. These
considered a life threatening disease. This makes successful
levels include: early intervention services, outpatient services,
recovery difficult and does not support addiction as a chronic
intensive outpatient/partial hospitalization services, residential/
illness.
inpatient services and medically managed [9,53-54].
Chronic Illness
These levels are further divided into stages: treatment
This study lends support to research findings that drug engagement, early recovery, maintenance and community
addiction is a chronic relapsing illness that impacts all racial, support. Treatment should include a plan of ongoing care but
cultural and economic groups, where the addict engages in self also the transition through one stage to the next. It involves a
destructive and criminal behaviors to get his or her fix movement through the continuum back and forth depending on
[7,9-10,50-51]. In understanding that addiction is a chronic the need of the addict.
disease, it cannot be cured but must be managed. Treatment for
The participants in the study discuss their flowing life
addiction, similar to those chronic, incurable diseases requiring
between sobriety and addiction as well have the description of
lifestyle changes, works as well, or better than,most other
different levels of recovery. One, Ckunkle, is still early in
therapies [52].
recovery whereas, Basil is involved in the community support
Effective treatment in a continuum of care includes ongoing, less
stage. Goals of care include achieving abstinence, fostering
intensive, and tapered contact with treatment systems, much
behavioral change, facilitating active participation in community
like other chronic disease [53]. The chronic relapsing nature of
support activities, identifying and addressing psychological
substance use disorders often means that individuals may
problems, developing a positive network and improving
remain in this level of care for many months or years, relapse,
problem-solving skills and coping strategies.
return to outpatient treatment, regain abstinence and return to
continuing community care [54]. All of the participants describe these goals using their own
language. This method allows complex information to be broken
“When managing and treating a long term, chronic illness the
into small increments and modified to the appropriateness to
patient is often involved in varying levels of care for an extended
client’s cognitive and psychological functioning and stage of
period of time in order to give them the highest possibility of
readiness. All participants describe the idea of feeling
success, defined as an effective management of symptoms that
overwhelmed and taking it in small increments more tolerable.
recur and remit over the course of a person’s lifetime”.
Brain Chemistry and Impaired Control Conclusions
The study findings identified the challenges and difficulties
Recovery from drug addiction was a journey for these
encountered along the recovery process such as impaired
participants involving understanding their addictive nature and
control, stigma, self destructive behaviors and the risk of
need to change. Through the methodology of photovoice, they
relapse. The participants also described impaired control
were able to reflect on prior negative and positive times, while
overdrug use, compulsive use, continued use despite harm and
describing the ”toughest” journey in life they’ve encountered
cravings [3,10,51]. These aspects can be correlated to the
thus far.
dysfunctional brain activity also supported in the literature. The
Dopamine release in the brain is a critical mediator towards Participants were able to envision a different future and
reinforcing effects of stimuli [3,9-11]. Kalivsas (2004) suggests looked forward with both trepidation and hope towards the
that dopamine underlines the development of addiction but future. They also described factors that motivated them towards
permeant changes result from sensitization and reinstatement this journey, times when they relapsed, struggled, (i.e. a series
with protein changes regulating glutamate transmission. By of ups and downs), destroyed and re-built relationships, and
further understanding the drug’s effect on the brain to cause discovered trust/love in self and others. Clear throughout this
dysfunctional thinking processes and behaviors and the journey was the recognition of the need for honesty, change,
utilization of medications on the dopamine effects of the brain, and ability to accept support for self and from others.
further progress can be made to the continuum of care for the
They were able to recognize their emotional journey away
chronic disease of addiction.
from the characteristics of addictive nature and over time. The
Recovery Models of Care journey required personal insight and self-support, the support
of others, God, faith and or a spiritual nature that assisted in
Today’s treatment has graduated steps designed to meet the
changing their behaviors and thought processes to a healthier
differing needs of each patient and each phase of addiction or
future.
recovery. The subjects of this study support a continuum of care
with descriptions of their process or journey. Treatment Nursing Impact
Services offered within a continuum of care model suggests: 2. Lui Y, Han M, Liu X, Ding Y, Li Y (2013) Dopamine transporter availability in
sponsorship of alumni meeting, providing checkup counseling, heroin-dependent subjects & controls: Longitudinal changes during abstinence
periodic contact through telephone contacts and involvement in & the effects of Jitai tablets treatment. Psychopharmacology (Berl) 230:
therapy, family therapy or medical care [53,55]. Further research Tai B, Volkow ND (2013) Treatment for substance use disorder: Opportunities
3.
is needed as well as social action to encourage the chronic and challenges under the Affordable Care Act. Soc Work Public Health 28:
illness aspect of addiction and appropriate length of treatment 165-174.
to decrease relapse potential and increase healthy lifestyles.
4. Ciero TJ, Surratt H, Kurtz S, Ellis Ms, Inciardi JA (2012) Patterns of prescription
Research continues to yield new information on biological opioid abuse and comorbidity in an aging treatment population. Journal of
predisposition, brain chemistry and behaviors. Treatment will Substance Abuse Treatment 42: 87-94.
need to continue to change and improve. Treatment providers
5. Price AM, Ilgen MA, Bohnert ASB (2011) Prevalence and correlates of non
must create trusting, open and caring relationships with the
medical use of prescription opioids in patients seen in a residential and alcohol
person struggling with substance use disorder.
treatment program. J Subst Abuse Treat 41: 208-214.
Further research is recommended for both photovoice as a Substance Abuse & Mental Health Services Administration (SAMHSA). (2008).
research methodology in order to identify triggers that might 6.
Results from the 2007 National Survey on Drug Use & Health: National Findings,
potentiate relapse and more importantly how to prevent relapse Substance Abuse & Mental Health Services Administration (SAMHSA)
and maintain sobriety. Based on such research newer
interventions based on such evidence can be implemented to 7. NIDA.
assist clients in maintaining sobriety. Smyth B, Fan J, Hser Y (2006) Life expectancy and productivity loss among
8.
The use of Photovoice and technology can contribute to the narcotics addicts thirty three years after index treatment. Journal of Addictive
care of individuals in the recovery process. Photovoice can help Diseases 25: 37-47.
the individual on pattern recognition and problem avoidance, by Mee-Lee D, Shulman GD (2003) The ASAM placement criteria and matching
9.
asking the individual to record what (s)he perceives as important patients to treatment. In: Graham AW, Schultz TK, Mayo-Smith MF, Ries RK,
in his or her personal recovery process. Wilford BB, Principles of Addiction Medicine Chevy Chase, MD: American
Society of Addiction Medicine 453-465.
Although Photovoice was used as a methodology in this study,
it was found to express many emotions, growth and healing and 10. Bowler JL, Bowler MC, James LR (2011) The cognitive underpinnings of
create a supportive network and should be considered for an addiction. Substance Use & Misuse 46: 1060-1071.
interventional study or a potential supportive recovery
11. Canadian Associates of Neuroscience (2014) Investigating the pleasure centers
intervention for this type of population.
of the brain: How reward signals are transmitted. Science Daily.
In addition, due to the creativity of photovoice, future studies Winters KC, Arria A (2011) Adolescent brain development and drugs. Prev Res
should consider incorporating the Creative Arts Therapies, as art 12.
18: 21-24.
therapy has been a long standing intervention in addiction, the
component of photovoice can be future impacted with their 13. Robles E, Huang BE, Simpson PM, McMillan (2011) Delay discounting,
understanding of spacial design and unconscious impact of the impulsiveness, and addiction severity in opioid-dependantdependent patients.
art. Journal of Substance Abuse Treatment 41: 354-362.
Although there were issues secondary to follow through 14. DeLeon G (1996) Integrative recovery: A stage paradigm. Substance Abuse 17:
remain on task, the opportunity of utilizing social media and Center for Substance Abuse Treatment (2005) Medication-Assisted Treatment
15.
telemedicine can create increased access of care within a safe for opioid Addiction in Opioid treatment Programs. Pharmology of Medications
security encrypted server cyberspace environment for Used To Treat Opioid Addiction.
communication and openness. Individuals with addiction
16. Betty Ford Institute Consensus Panel (2007) J Subst Abuse Treat 33: 221-228.
experienced shame and have concerns around trust, memory
and following-up on appointments. 17. Kirby M, Keon W (2006) Out of the shadows at last. Transforming mental
health, mental illness and addiction in Canada. Final report of the standing
Telemedicine can provide a venue for reaching individuals
committee on social affairs, science and technology.
with addiction. Future research can include computer
technology to increase access and awareness to the needs of 18. Flynn PM, Joe GW, Broome KM, Simpson D, Brown BS (2003) Looking back on
recovering addicts and the ability to connect with others to cocaine dependence: Reasons for recovery. Am J Addict 12: 398-411.
envision future change allowing for reflection and observation. Boyarsky BK, McCance-Katz EF (2000) Improving the quality of substance
19.
dependency treatment with pharmacotherapy. Subst Use Misuse 35:
Reference 2095-2125.
1. Denisco RA, Chandler RK, Compton WM (2008) Addressing the intersecting 20. Clements K (2012) Participatory action research and Photovoice in psychiatric
problems of opioid misuse and chronic pain treatment. Exp Clin nursing clubhouse collaboration exploring the recovery narrative. J Psychiatr
Psychopharmacol 16: 417-428. Ment Health Nurs 19: 785-791.
21. Davstad I, Stenbacka MA, Leifman A, Beck O, Karkmaz S, Et al. (2007) Patterns 40. Gaventa J, Cornwall A (2006) Power & knowledge. Ina: Handbook of Action
of illicit drug use & retention in methadone program: A longitudinal study. Research. Sage Publications: Thousand Oaks 72-82.
Journal of opioid management 3: 27-34.
41. Marinas BA, Strickland MJ, Keat JB (2010) Using photo-narration to support all
22. Nordfjaern T, Rundmo T, Hole R (2010) Treatment and recovery as perceived by learners. Young Children 65: 32-36,38.
patients with substance addiction. J Psychiatr Ment Health Nurs 17: 46-64.
42. Goodhart FW, Hsu J, Baek JH, Coleman AL, Maresca FM, Et al. (2006) A view
23. Vakili S, Currie S, el-Guebaly N (2009) Evaluating the utility of drug testing in an through a different lens: Photovoice as a tool for student advocacy. J Am Coll
outpatient addiction program. Addictive Disorders & Their Treatment 8: 22-32. Health 55: 53-56.
24. Stewart J (2004) Pathways to relapse: Factors controlling the re initiation of 43. Gandhi D, Welsh C, Bennett M, Carreño J, Himelhoch S (2009) Acceptability of
drug seeking after abstinence. Nebr Symp Motiv 50: 197-234. technology-based methods substance abuse counseling in office based
buprenorphine maintenance of opioid dependence. Am J Addict 18: 182-183.
25. Castleden H, Garvin T, Nation HF (2008) Modifying photovoice for community
based participatory indigenous research. Social Science and Medicine 66: 44. Moore BA, Fazzino T, Garnet B, Cutter CJ, Barry DT (2011) Computer-based
1393-1405. interventions for drug use disorders: A systematic review. J Subst Abuse Treat
40: 215–223.
26. Killion C, Wang CC (2000) Linking African-American mothers across life stage
and station through photovoice. J Health Care Poor Underserved 11: 310-325. 45. Carroll KM, Ball SA, Martino S, Babuscio TA, Et. al. (2008) Computer-assisted
delivery of cognitive-behavioral therapy for addiction: A randomized trial of
27. Killion C (2001) Understanding cultural aspects of health through photography.
CBT4CBT. Am J Psychiatry 165: 881-888.
Nurs Outlook 1: 50-54.
46. Kruger LG, Gilroy AA (2013) Broadband internet access and the digital divide:
28. LeClerc CM, Wells DL, Craig D, Wilson JL (2002) Falling short of the mark: tales
Federal assistance programs. Journal of Current Issues in Media and
of life after discharge. Clin Nurs Res 11: 242-266.
Telecommunications 5: 303-329.
29. Lorenz LS, Kolb B (2009) Involving the public through participatory visual
47. Davidson J, Dottin J, James W, Robertson SP (2009). Visual sources and the
research methods. Health Expect 12: 262-274.
qualitative research dissertation: Ethics, evidence and the politics of academia
30. Riley RG, Manias E (2004) The uses of photography in clinical nursing practice – Moving innovation in higher education from the center to the margins.
and research: A literature review. J Adv Nurs 48: 397-405. International Journal of Educational & the Arts 10:
31. Strack RW, Magill C, McDonagh K (2004) Engaging youth through photovoice. Cook K, Buck G (2010) Photovoice: A community-based socioscientific
48.
Health Promot Pract 5: 49-58. pedagogical tool. Science Scope 33: 35-39.
32. Wang CC, Burris M (1994) Empowerment through photonovella: Portraits of Van den Brink W, Haasen C (2006) Evidence based treatment of opioid
49.
participantion. Health Educ Q 21: 171-186. dependent patients. Can J Psychiatry 51: 635-646.
33. Wang CC (1999) Photovoice: A participatory action research strategy applied to Cicero TJ, Kuehn BM (2014) Driven by prescription drug abuse: Heroin use
50.
women’s health. J Womens Health 8: 185-192. increases among suburban and rural whites. JAMA 312: 118-119.
34. Chilton M, Rabinowich J, Council C, Breaux J (2009) Witnesses to hunger: Weisner C, Hinman A, Lu Y, Chi FW, Martens J (2010) Addiction treatment
51.
Participation through photovoice to ensure the right to food. Health Hum ultimatums and U.S. health reform: A case study. Nordisk Alkohol Nark 27:
Rights 11: 73-85. 685-698.
35. Ozanne JL, Moscato EM, Kunkel DR (2013) Transformative photography: McLellan AT, Meyers K (2004) Contemporary addiction treatment: A review of
52.
Evaluation & best practices for eliciting social and policy changes. Journal of systems problems for adults and adolescents. Biol Psychiatry 56: 764-770.
Public Policy & Marketing. 32: 45-65.
53. Center for Substance Abuse Treatment (2006) Intensive Outpatient Treatment
36. Sharma M (2010) Photovoice in alcohol and drug education. Journal of Alcohol and the Continuum of Care. Substance Abuse: Clinical Issues in Intensive
& Drug Education 54: 3-6. Outpatient Treatment. Substance Abuse and Mental Health Services
Pearson S, Ralph S (2007) The identity of SENCos: Insights through images. month outcomes. Arch Gen Psychiatry 62: 199-207.
39.
Journal of Research in Special Educational Needs 7: 36-45.