Social identity differentiation predicts commitment to sobriety and wellbeing in residents of therapeutic communities

Components of identity expression in problem and non-problem gamblers

Few studies have examined whether specific aspects of group identification predict problematic and non-problematic addictive behaviours and none have focused on gambling. Applying Leach et al.'s (2008) hierarchical model of in-group identification, we tested the associations between components of self-investment (satisfaction, solidarity, and centrality) and components of self-definition (individual self-stereotyping, in-group homogeneity) on distinguishing between problem and non-problem gambling (n = 10,157) and on the severity of problematic gambling behaviour (n = 2,568). Results showed that (i) in-group-based identities are important in predicting problematic vs. non-problematic gambling behaviours; (ii) in-group-based identities are important in predicting the severity of problematic gambling; (iii) how self-invested an individual is with their in-group and aspects associated with self-definition processes are both important predictors; (iv) perceptions related to how chronically salient one's group membership is for the self (centrality) are essential features of the self-investment mechanism; and (v) self-stereotypical beliefs about one's essential similarities to the prototypical gambling group member norm are fundamental for the defining oneself as a gambler.

Discrimination and social identity processes predict impairment and dysfunction among heavy drinkers

BACKGROUND

Previous research has linked discrimination to poorer health. Yet health risk behaviours such as heavy alcohol consumption are often targeted with stigmatising public health campaigns. The current study sought to establish the link between experiencing discrimination and health outcomes among heavy drinkers, with a focus on exploring the multiple social identity processes that might underpin this relationship.

METHODS

A survey was conducted with 282 people who self-reported consuming alcohol above recommended guidelines. We measured discrimination experienced as a drinker, components of social identification as a drinker (centrality, satisfaction, solidarity, homogeneity, and self-stereotyping), and two health outcomes: psychological distress and severity of alcohol use disorder symptomatology.

RESULTS

Discrimination was a moderate-large predictor of psychological distress and alcohol use disorder symptoms. Three social identity constructs were implicated in the link between discrimination and ill-health: identity centrality and homogeneity positively mediated this relationship while identity satisfaction was a negative mediator. The model explained a large proportion of the variance (39-47%) in health outcomes.

DISCUSSION

Results are interpreted with an emphasis on the need to avoid stigmatising messaging and to prioritise social identity processes to prevent and treat substance use disorders. We further highlight the need for social identity researchers to consider the multidimensional nature of social identities, especially in the context of stigmatised groups.

Understanding the Process of Drug Addiction Recovery Through First-Hand Experiences: A Qualitative Study in the Netherlands Using Lifeline Interviews

Understandings of drug addiction recovery are still being debated. Research on perspectives from first-hand experiences with recovery is rare and often contains short-term experiences in the context of a treatment setting. We aim to gain further understanding of recovery by analyzing autobiographical data from persons in different stages of drug addiction recovery who are not linked to any specific treatment service. We conducted 30 in-depth qualitative interviews with participants from various parts of the Netherlands. Participants self-identified as being "in recovery" or "recovered" from drug addiction for at least 3 months. Men and women are equally represented, and the sample consists of an equal number of participants in early (<1 year, n = 10), sustained (1-5 years, n = 10), and stable (>5 years, n = 10) recovery. We undertook a data-driven thematic analysis. Participants described that recovery is a broad process of change because addiction is interwoven with everything (theme 1); that recovery is reconsidering identity, seeing things in a new light (theme 2); that recovery is a staged long-term process (theme 3); and that universal life processes are part of recovery (theme 4). Thus, Drug addiction recovery is experienced as an interwoven long-term process, including identity change and common or universal life processes. Policy and clinical practice should therefore be aimed at supporting long-term tailored recovery goals and disseminating first-hand recovery experiences to enhance long-term outcomes and reduce stigmatization.

Factors associated with problematic substance use before and during the COVID-19 pandemic among a drug addiction recovery cohort: A prospective study in the Netherlands, Belgium, and UK

BACKGROUND

The COVID-19 pandemic and measures have placed various burdens on societies and individuals. Emerging evidence suggests that people in drug addiction recovery were negatively affected. This study investigates whether risk and protective factors associated with return to problematic substance use differed between the periods before and during the pandemic for those in recovery.

METHODS

A convenience sample of persons in drug addiction recovery for at least three months completed an assessment at baseline before the pandemic (T0, N = 367) and at two consecutive follow-ups 12 months apart (T1, N = 311; T2, N = 246). The final follow-up took place during the pandemic (2020-2021). We analyzed rates and predictors of problematic substance use in both periods, and whether relations between predictors and problematic use differed between the periods.

RESULTS

Rates of problematic use did not differ significantly before and during the pandemic for those who were followed-up. However, the relationship between problematic use and commitment to sobriety differed between both periods (OR = 3.24, P = 0.010), as higher commitment was only associated with lower odds of problematic use during (OR = 0.27, P < 0.001), but not before, the pandemic (OR = 0.93, P = 0.762). In both periods, persons who were engaged in psychosocial support had lower odds of problematic use.

CONCLUSIONS

The COVID-19 pandemic was not followed by significant return to problematic substance use in a cohort of people who were already in drug addiction recovery for some time before the pandemic. However, with restricted access to environmental resources, they may have been more dependent on internal motivations. Targeting personal recovery resources with interventions could therefore reduce the chances of return to problematic substance use during a pandemic.

Transformation of identity in substance use as a pathway to recovery and the potential of treatment for hepatitis C: a systematic review

BACKGROUND AND AIM

People who inject drugs are at high risk of contracting hepatitis C (HCV). The introduction of direct acting antiviral (DAA) drugs to treat HCV has the potential to transform care; however, uptake of DAAs has been slower than anticipated. The strong link between HCV and injecting drug use frames HCV as a shameful, stigmatising disease, reinforcing an 'addict' identity. Linking HCV care to a recovery journey, 'clean' identity and social redemption may provide compelling encouragement for people to engage with treatment and re-evaluate risk and behaviours, reducing the incidence of HCV re-infection. The aim of this review was to identify actions, interventions and treatments that provide an opportunity for a change in identity and support a recovery journey and the implications for HCV care.

METHODS

Databases (MEDLINE, EMBASE, PsycINFO, ProQuest Public Health, ProQuest Sociological Abstracts, CINAHL and Web of Science) were searched following our published strategy and a grey literature search conducted. A narrative synthesis was undertaken to collate themes and identify common threads and provide an explanation of the findings.

RESULTS

Thirty-two studies fulfilled the inclusion criteria. The narrative synthesis of the studies identified five over-arching analytical themes: social factors in substance use and recovery, therapeutic communities, community treatment, online communities, and finally women and youth subsets. The change from an 'addict' identity to a 'recovery' identity is described as a key aspect of a recovery journey, and this process can be supported through social support and turning point opportunities.

CONCLUSIONS

Recovery from addiction is a socially mediated process. Actions, interventions and treatments that support a recovery journey provide social connections, a recovery identity and citizenship (reclaiming a place in society). There is a gap in current literature describing how pathways of care with direct acting antivirals can be designed to promote recovery, as part of hepatitis C care.

Exploring the Impacts of Urban Community Leisure on Subjective Well-Being during COVID-19: A Mixed Methods Case Study

Participating in community leisure activities has become an important way for the public to pursue good health and a high quality of life. However, few studies have focused on the health and welfare effects of participating in urban leisure activities during the COVID-19 pandemic. In response to this gap in the literature, this study drew on the stimulus–organism–response (SOR) theory to examine the effects of community leisure on subjective well-being during the pandemic from the perspective of urban residents. A sample of 1041 urban residents in Beijing, China, was empirically analyzed by applying partial least squares structural equation modeling (PLS-SEM) and fuzzy set qualitative comparative analysis (fsQCA). The PLS-SEM results revealed the net effects of the pandemic influence, leisure satisfaction, leisure environment, and community identity on subjective well-being. The fsQCA provided causal methods for realizing subjective well-being and a necessary condition analysis supplemented the necessary antecedents. The results showed that (1) higher levels of pandemic influence and leisure environment increased leisure satisfaction; (2) pandemic influence, leisure environment, and leisure satisfaction had a positive effect on community identity; (3) pandemic influence, leisure satisfaction, and community identity also combined with leisure environment and leisure time to positively influence subjective well-being; and (4) leisure satisfaction and community identity mediated the impacts of pandemic influence and leisure environment on subjective well-being. This paper contributes not only to empirical evidence but also to theory by constructing and enriching the research models of community leisure and subjective well-being. The practical implications for the public, community managers, and policymakers are also discussed.

Mechanisms of Behavior Change in Substance Use Disorder With and Without Formal Treatment

This article provides a narrative review of studies that examined mechanisms of behavior change in substance use disorder. Several mechanisms have some support, including self-efficacy, craving, protective behavioral strategies, and increasing substance-free rewards, whereas others have minimal support (e.g., motivation, identity). The review provides recommendations for expanding the research agenda for studying mechanisms of change, including designs to manipulate putative change mechanisms, measurement approaches that expand the temporal units of analysis during change efforts, more studies of change outside of treatment, and analytic approaches that move beyond mediation tests. The dominant causal inference approach that focuses on treatment and individuals as change agents could be expanded to include a molar behavioral approach that focuses on patterns of behavior in temporally extended environmental contexts. Molar behavioral approaches may advance understanding of how recovery from substance use disorder is influenced by broader contextual features, community-level variables, and social determinants of health. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Eigenvector centrality defines hierarchy and predicts graduation in therapeutic community units

INTRODUCTION

Therapeutic communities (TCs) are mutual aid based residential programs for the treatment of substance abuse and criminal behavior. While it is expected that residents will provide feedback to peers, there has been no social network study of the hierarchy through which feedback flows.

METHODS

Data for this study was drawn from clinical records of peer corrections exchanged between TC residents in six units kept over periods of less than two to over eight years. Four of the units served men while two served women. Hierarchy position was measured using eigenvector centrality, on the assumption that residents who were more central in the network of corrections were lower in the hierarchy. It was hypothesized that residents would rise in the hierarchy over time. This was tested using Wilcoxon paired samples tests comparing the mean and maximum eigenvector centrality for time in treatment with those in the last month of treatment. It was also hypothesized that residents who rose higher in the hierarchy were more likely to graduate, the outcome of primary interest. Logistic regression was used to test hierarchy position as a predictor of graduation, controlling for age, race, risk of recidivism as measured by the Level of Services Inventory-Revised (LSI-R) and days spent in the program.

RESULTS

Residents averaged a statistically significantly lower eigenvector centrality in the last month in all units, indicating a rise in the hierarchy over time. Residents with lower maximum and average eigenvector centrality both over the length of treatment and in the last month of treatment were more likely to graduate in four of the six units, those with lower maximum and average eigenvector centrality in the last month but not over the length of treatment were more likely to graduate in one of the six units, while eigenvector centrality did not predict graduation in one unit. However, this last unit was much smaller than the others, which may have influenced the results.

CONCLUSION

These results suggest that TC residents move through a social network hierarchy and that movement through the hierarchy predicts successful graduation.

"It's like a Brotherhood": Thematic analysis of veterans' identity processes in substance abuse recovery homes

This exploratory study aimed to understand how veterans' social identity influenced their experiences living in Oxford Houses (OH)-the largest network of substance use recovery homes in the United States. We conducted three focus groups, with 20 veterans who were current or former OH residents. Thematic analysis revealed several ways in which participants' veteran identity influenced their experiences living in OH, including: (1) thriving through OH organizational similarities with the military, (2) relationships with other OH residents, and (3) and growth and reintegration. The themes were interpreted using the Social Identity Theory and the Social Identity Model of Identity Change perspectives. Social identity processes were found to play an influential role in veterans' experiences in their recovery homes and reintegration into civilian life. Findings highlight the importance of veterans developing a community within a culturally congruent setting to facilitate their recovery from substance use disorders and adjustment to life post-military service.

A multi-site study of emerging adults in collegiate recovery programs at public institutions

BACKGROUND

Collegiate Recovery Programs (CRPs) are campus-based support programs for substance use and recovery needs among college students. These CRPs utilize a variety of program activities and components aimed at promoting healthy development and sobriety while encouraging college retention among participants.

OBJECTIVES

Describe the types of activities and administrative structures used in CRPs, examine the characteristics of students involved in this sample, and explore changes in students' outcomes after they have enrolled in a CRP.

METHODS

This multi-site study collected de-identified data from six CRPs on participating students' sociodemographic characteristics, academic performance, substance use, and socioemotional well-being. One CRP administrator from each participating site completed a survey on CRP programming. Data were harmonized across sites and descriptively summarized.

RESULTS

Participating CRPs had been in operation since 2007 to 2012. Five of the six sites provided individual-level student data for a total of 861 students (56% male, 89% White, 91% undergraduate). Student histories indicated the majority had received treatment for a substance use disorder (82%) or mental health concern (77%), 56% had criminal justice involvement, and the majority were in recovery less than five years. Student GPA improved in three of the four sites that provided student GPA data.

CONCLUSIONS

CRPs collect diverse types of data on participating students, but more effort is needed to focus on systematic data collection. Findings from this study suggest that CRPs play an important role in providing needed services for this vulnerable population of college students.

Effective factors of addiction treatment communities in Peru, Nicaragua and Czechia

Purpose

This paper aims to explore the effective factors that influence the treatment of drug addiction in therapeutic communities (TCs) and to determine its essential elements in the Peruvian, Nicaraguan and Czech context.

Design/methodology/approach

The qualitative data were collected during semi-structured interviews with inpatients/clients of seven TCs based in Peru (Takiwasi), Nicaragua (Centro de Especialiades en Adicciones, Centro de Rehabilitación del Alcohólico y Adicto a Otras Drogas and Albergue de Miembros Adictos en Recuperación) and the Czech Republic (Renarkon, Sejrek and Kladno-Dubi). All 90 interviews were manually transcribed, and content analysis was performed. Codes were created using the grounded theory method.

Findings

The effective factors of TC, treatment in Peru, Nicaragua and Czechia are identical in conditions such as the presence of a personal therapist, the use of psychotherapy and the importance of group cohesion. In Peru, the administration of medicinal plants and diet was perceived as a principal part of the treatment. Nicaraguan TCs were specific for practicing 12 steps. In Czechia, an emphasis is put on the therapeutic program, workshops and leisure activities. Spirituality and religion play a main role in the Peruvian and Nicaraguan TCs only.

Originality/value

The current study presents a unique insight into the factors considered effective by inpatients/clients of TCs in different socio-cultural contexts.

Mass meets mosh: Exploring healthcare professionals' perspectives on social identity processes and health risks at a religious pilgrimage and music festivals

RATIONALE

The field of mass gathering medicine has tended to focus on physical factors in the aggravation and mitigation of health risks in mass gatherings to the neglect of psychosocial factors.

OBJECTIVES

This study sought to explore perspectives of healthcare professionals (HCPs) on (1) implications of social identity processes for mass gathering-associated health risks; and (2) how social identity processes can be drawn on to inform and improve healthcare practices and interventions targeted at mitigating health risks in mass gatherings.

METHODS

Semi-structured interviews, complemented by a brief survey, were conducted with 17 HCPs in the United Kingdom operating at a religious pilgrimage and music festivals.

RESULTS

The findings from a thematic analysis suggest that HCPs recognise that social identity processes involved in identity enactment in mass gatherings are implicated in health risks. HCPs also perceive value in drawing on social identity processes to inform and improve healthcare practices and interventions in mass gatherings. The findings from the survey corroborate the findings from the interviews.

CONCLUSION

Taken together, the research highlights avenues for future research and collaboration aimed at developing healthcare practices and interventions informed by the social identity approach for the management of health risks in mass gatherings.

Difference in Response to Feedback and Gender in Three Therapeutic Community Units

Therapeutic communities (TCs) for substance abuse incorporate a system of peer feedback through written affirmations and corrections. Previous research has found that TC residents show a response to affirmations that is detectable for roughly 8 weeks, with response to corrections being of shorter duration and weaker overall. It is not clear whether and to what extent response to feedback in TCs varies between men and women. Previous research in other settings suggests that women should be more responsive to feedback than men. In order to test this hypothesis we draw on a large dataset of affirmations and corrections sent and received in three 80 bed TC units, two of which house men and one of which houses women. The analysis uses a multilevel negative binomial model, treating affirmations and corrections that TC residents receive as predictors of affirmations that they send over a 9 week period (week 0, the week during which affirmations and corrections are actually sent, and eight subsequent weeks). The model controls for gender, age, race, unit and scores on the Level of Service Inventory-Revised (LSI-R). The relationship between affirmations received and those sent is stronger for women during the initial week and on lags 1-2 and 5-8. The relationship between corrections received and affirmations sent is stronger for women on lags 2 and 8. Graphs suggest that response to affirmations falls off in an exponential curve, while that to corrections appears to include a periodic element. These results indicate that both men and women respond to feedback, but that the strength of the women's response is somewhat greater. These results suggest that any difference in suitability by gender to the feedback approach that characterizes TCs may favor women.

Life Change, Social Identity, and Health

Life change affects health. Research aimed at understanding the consequences of life change has primarily focused on the important roles played by stress, social support, individual differences, and broader socioeconomic factors in shaping health outcomes, most notably mental health decline. In this review we extend these accounts by exploring social identity-based determinants of adjustment to life change. We do so by drawing on social identity theorizing and, in particular, the Social Identity Model of Identity Change (SIMIC). This points to the importance of multiple, maintained, new, and compatible group memberships as determinants of people's responses and adjustment to life change. We apply this model to understand the health consequences of adjustment to life change in four diverse areas: pursuit of higher education, migration, trauma and resilience, and recovery from illness and injury. Finally, we provide direction for future research on SIMIC and the health consequences of life change.

Perceptions of loneliness among people accessing treatment for substance use disorders

INTRODUCTION AND AIMS

Guided by cognitive theory of loneliness, this study sought to explore the experience of loneliness among people accessing treatment for substance use disorders. Specifically, contributors to, consequences and alleviators of loneliness were explored.

DESIGN AND METHODS

Individual semi-structured interviews were conducted with 20 participants. Interviews were conducted onsite at two residential treatment facilities in New South Wales, Australia. Interviews were audio recorded and transcribed and an iterative categorisation approach was used to guide data analysis and reporting.

RESULTS

Four key themes emerged as contributors to and consequences of loneliness: cognitions (mistrust, perceived support from others, low self-worth and fear of negative evaluation), quality and authenticity of relationships, unhelpful interpersonal behaviours and the role of substance use. Participants indicated that overcoming the cognitive and behavioural perpetuators helped to alleviate loneliness and also described the utility of support groups, pursuit of authentic relationships and activities that provide a sense of purpose as helpful.

DISCUSSION AND CONCLUSIONS

Cognitions related to mistrust, lack of perceived support, low self-worth, fear of negative evaluation and identification and pursuit of meaningful relationships supportive of recovery should be key treatment targets for this population.

Reducing loneliness among people with substance use disorders: Feasibility of 'Groups for Belonging'

INTRODUCTION AND AIMS

Although loneliness is common among people with substance use disorders, few interventions to reduce loneliness have been developed for this population. This study aimed to determine the feasibility of delivering a six-session group-based intervention, 'Groups for Belonging', that builds social group connectedness.

DESIGN AND METHODS

Participants were 41 individuals accessing residential substance use treatment services. The primary aims of the present study were to determine indicators of feasibility of Groups for Belonging; namely, demand (recruitment, attendance and retention) for and acceptability (program adherence and participant satisfaction) of the Groups for Belonging program in residential substance use treatment settings.

RESULTS

Over half of the people attending the services were interested in participating in Groups for Belonging. Of 41 participants who commenced the program, 20 participants completed the program per protocol. In terms of acceptability, the average number of sessions attended was 3.7 (SD = 1.76, range 1-6). Program adherence was 99.3% and overall satisfaction with the program was high, with 95% of participants reporting they enjoyed Groups for Belonging.

DISCUSSION AND CONCLUSIONS

The Groups for Belonging program may be feasible for delivery in residential substance use treatment services. Findings from this study suggest that an adequately powered replication study is warranted.

Dynamic characteristics of groups and individuals that amplify adherence to perceived drinking norms in college club sport teams: A longitudinal multilevel investigation

Social norms positively predict college students' alcohol use, but it is critical to explore heterogeneity in these patterns to identify which students are most susceptible to normative influences. The current study explored the nature of drinking norms within college student peer sport clubs. We examined the association between self-reported alcohol use (i.e., number of drinks in a typical week) and perceived descriptive/injunctive norms as an indicator of norm adherence and then tested moderating effects of social constructs related to the group: Social identification with one's team, along with social network-derived indices of indegree centrality and network density. We sampled members of 35 intact college club sport teams at 3 timepoints across the school year (N = 1,054; 61% female). Multilevel modeling was employed to estimate moderating effects at within-person, between-person, and between-groups levels. Initial analyses revealed that perceived group norms predicted self-reported alcohol use, and that teams approached consensus on the groups' drinking norms over time. Several significant time-varying moderation patterns were uncovered. At timepoints when students identified more strongly with their team (relative to person-mean levels), they more readily adhered to perceived descriptive and injunctive team drinking norms. Students also adhered more closely to these perceived team drinking norms at timepoints when students were nominated as having relatively lower indegree centrality. Cross-level interactions revealed that neither network density nor team sex moderated these associations. Taken together, the current findings advance our understanding of group processes that may produce more salient social influences on students' alcohol use behaviors within proximal peer groups. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Connectivity as a Mediating Mechanism in the Cybervictimization Process

This paper explores the relationship between social connectivity and cybervictimization as it is mediated by psychosocial variables such as social identity and self-esteem. Likewise, it analyses the moderating role in that relationship played by adolescents’ perception of cyberbullying. The sample consisted of 2072 adolescents (48.7% girls) aged between 14 and 18 (Mean = 15.78, Standard Deviation = 1.02) years. Through the use of five questionnaires, an explanatory model is constructed that shows the direct and indirect relationships between the factors analysed, the predictive values that social connectivity can reach when applied to the virtual environment, and the perception of cyberbullying in the victimization processes. The results indicate that self-esteem and social identity are protective factors in the establishment of healthy virtual relationships and avoidance of cybervictimization situations. Moreover, the equation of cyberbullying with aggressive or maladaptive styles of humour has an indirect influence on the link between connectivity and cybervictimization.

Longitudinal Substance Use and Biopsychosocial Outcomes Following Therapeutic Community Treatment for Substance Dependence

The Therapeutic Community (TC) model is considered an effective treatment for substance dependence, particularly for individuals with complex presentations. While a popular approach for this cohort across a number of countries, few studies have focussed on biopsychosocial and longer-term outcomes for this treatment modality. This study reports on substance use, dependence, and biopsychosocial outcomes up to 9 months post-exit from two TC sites.

METHODS

A longitudinal cohort study (n = 166) with two follow-up time points. Measures included substance use, dependence, subjective well-being, social functioning, and mental and physical health. Generalized Linear Models were employed to assess change over time.

RESULTS

At 9 months, 68% of participants reported complete 90-day drug abstinence. Alcohol frequency and quantity were reduced by over 50% at 9 months, with 32% of the sample recording 90-day abstinence at 9 months. Both alcohol and drug dependence scores were reduced by over 60%, and small to medium effect sizes were found for a range of psychosocial outcomes at 9 months follow-up, including a doubling of wellbeing scores, and a halving of psychiatric severity scores. Residents who remained in the TC for at least 9 months reported substantially better outcomes.

CONCLUSIONS

With notably high study follow-up rates (over 90% at 9 months post-exit), these data demonstrate the value of the TC model in achieving substantial and sustained improvements in substance use and psychosocial outcomes for a cohort with severe substance dependence and complex presentations. Implications for optimal length of stay are discussed.