Social Identity: Transitioning from Addiction to Recovery

Social factors play an important role in the development of, and recovery from, addiction. Peer influence may either encourage or discourage use of substances depending on the group.

In terms of recovery, for those with a substance use disorder (SUD), increasing recovery-supportive social connections can have a profound benefit for achieving and maintaining abstinence.

WHAT PROBLEM DOES THIS STUDY ADDRESS?

Since social groups can influence self-concept and how people define their place in the world, the idea of social identity is particularly important for addiction research.

Research on the social identity model of recovery, however, is still in early stages. Therefore, in this study, Dingle, Cruwys & Frings used qualitative interviews with adults residing in drug and alcohol therapeutic communities to explore how social identities changed during the course of their addiction and during early recovery.

HOW WAS THIS STUDY CONDUCTED?

Twenty-one volunteers from a drug and alcohol therapeutic community volunteered to participate in these interviews. A majority of participants were male and single with an average age of 36 (ranging from 26 to 58). Most did not have children residing with them and had an average of 4 close friends. The interview was designed to ensure that participants did not know that the topic of interest was social relationships and social identity.

Three open ended questions were used:

What was your life like before you came into the therapeutic community?
What has been your experience here?
What have you learned at the therapeutic community that you think will help you when you leave?

The authors then read and coded the interview transcripts and conducted a thematic analysis to identify primary themes and subthemes.

WHAT DID THIS STUDY FIND?

The interviews yielded two major identity-related pathways into addiction:

In the first, participants had a positive social identity prior to developing an substance use disorder (SUD) and felt that they lost it as a result of their addiction. The development of SUD created an identity that was stigmatized due to substance use or one that was “spoiled” by criminal activity.
The second pathway was characterized by negative social identity prior to addiction and development of addiction, with individuals forming a new identity as someone who used substances with a sense of acceptance and belonging in a social network.

These pathways described by four stages—before addiction, during addiction, in the therapeutic community, and after leaving the therapeutic community—are depicted in the figure.

Before addiction, participants on the first pathway described experiences such as happy childhoods, achievements in school or sports, and being a good parent while participants in the second pathway noted social isolation despite living with family or a significant other. Substance use was viewed as problematic and stigmatized for the first group while the second group associated it with a sense of belonging.

During addiction, for the second group, this sense of belonging eventually shifted to a point where some experienced rejection which precipitated their entering treatment. Other participants cited conversations with family members or loss of friends as reasons for entering treatment.

After leaving the therapeutic community, participants in the first pathway desired to renew the positive identity they held before experiencing addiction while those in the second pathway mentioned goals consistent with an aspirational identity (e.g., becoming a student or parent for the first time).

Regarding development of a recovery identity, important factors included positive relationships with staff and the proximity to, and support from, other residents with shared experiences. The therapeutic community also provided participants with a sense of meaning and purpose. However, some participants did note that these relationships were only temporary and may not extend beyond the therapeutic community.

This study identified two main identity-related pathways into addiction and recovery:

The first, marked by loss of a positive identity and regaining of it after treatment, is consistent with prior research.
The second offers an alternative explanation for individuals who may experience this process differently. This pathway described by participants initially lacking in social support was characterized by gaining a new identity as a result of recovery.

WHY IS THIS STUDY IMPORTANT

The social identity model of recovery suggests that changing one’s identity from someone actively addicted/using substances to an identity as someone in recovery is important for achieving successful outcomes, and that this identity change is more likely to occur if the person is engaged with a network or social group of other recovering individuals. As people begin to develop an substance use disorder (SUD), they experience a loss of their existing social identity (e.g., as a good spouse, parent, or employee/employer); restoring or regaining this lost identity may provide motivation for people to transition into recovery.

However, this idea may not apply to all individuals who recover from substance use disorder (SUD). Using qualitative methods, the authors sought to uncover other social identities among people living in therapeutic communities, and how their social identities and relationships changed from before addiction onset to after receiving treatment. Rich qualitative data from individuals in early recovery can help build the social identity model of recovery and offer hypotheses for future research.

Development of clinical interventions could benefit from understanding social identity history and pathways experienced by patients, but it is unlikely that a one-size-fits-all approach is possible. However, assessment of a patient’s social network and identity may be a helpful part of the treatment process and can be used to help motivate and sustain change.

LIMITATIONS

The results of this study are specific to the group of individuals involved in the interviews since definitions of addiction and recovery—and the associated stigma—are likely to vary geographically and culturally and across levels of addiction severity and related impairments.
Additionally, the interview asked individuals to recall past experiences which can be difficult to do accurately and without bias.

NEXT STEPS

Understanding how social and cognitive factors impact the pathway from addiction to recovery with naturalistic, longitudinal studies can be helpful for developing prevention and intervention strategies. For example, although there are several studies showing associations between developing (or re-establishing) a recovery identity and more abstinence, these have been mostly cross-sectional (where constructs are measured at one point in time). So at this point it is difficult to answer “To what extent is increased identity as a person in recovery a cause, result, or simply a correlate of abstinence?”

Future research can use qualitative studies like this to build the social identity model of recovery, and test empirical questions like these. In addition, it is also important to replicate the study in other populations and settings (e.g., emerging adults in residential treatment in the United States) to see if similar themes emerge.

BOTTOM LINE

For individuals & families seeking recovery: This study uncovered two social identities as they relate to developing an addiction and entering recovery which may or may not describe your own social identity. The first is marked by a loss of a positive identity in active addiction followed by a renewal of this identity in recovery, and the second describes gaining a “user” identity in addiction and creation of a recovery identity characterized by aspirations. In both cases, it may be helpful to think about desired social roles, personal goals, and values when entering recovery, as potential motivators to help begin and maintain change.
For scientists: This qualitative study supports the potential significance of social identity theory for addiction research. More qualitative and quantitative studies are needed to investigate further what the precipitants, correlates, and consequences are of shifts in social identity.
For policy makers: Addiction and recovery is not an individual process but rather relies heavily on environment and social support. This may have implications for how addiction treatment and recovery services are created and funded. Consider funding Recovery Community Centers as they may help create abstinence supportive networks for people in recovery and help shift individuals’ self-concepts to positive recovering ones that may facilitate and reinforce ongoing remission and recovery.
For treatment professionals and treatment systems: Your patient’s social identity may be an important motivator for change in a treatment setting. If a patient views themselves as a person in recovery, it may help them stay motivated to maintain this identify. Exploring your patients self-concepts and having them exposed to, and engaged with, recovery-supportive social networks could help shift their social identity that ultimately bolsters their chances of long-term recovery.

CITATIONS

Dingle, G. A., Cruwys, T., & Frings, D. (2015). Social Identities as Pathways into and out of Addiction. Frontiers in Psychology, 6, 1795. doi:10.3389/fpsyg.2015.01795