In this two part blog I will look at how positive (as opposed to negative) views of self (self schema) lie at the heart of successful recovery and how negative self schema keep addicts in active addiction.

I cite this study for much of these blogs (1)…

“Psycho-social and environmental factors may also influence the expression of genetic and other biologic factors, serve as important mediators of genetic and other biologic risk, and increase risk load in an additive way (Heath & Nelson, 2003). Because they may also be more amenable to change than genetic and other biologic factors, it is important to identify modifiable psychosocial and environmental factors that motivate maladaptive alcohol use to develop more effective prevention and treatment strategies.

One potentially modifiable psychosocial factor that has been implicated as a determinant of alcohol dependence as well as a factor in recovery from alcohol dependence is the self-concept. For decades, theorists and clinicians have suggested that vulnerabilities in the knowledge about the self may contribute to the development and progression of alcohol problems. The self-concept is also viewed by some theorists as a key determinant in recovery  and  n the incidence of relapse.

For several decades, theorists and researchers have argued that alcohol dependence results in part from inadequate development of the self. Support for this view was noted in an early empirical study that showed that the number of self-descriptive adjectives endorsed was negatively associated with the severity of alcohol dependence in persons in inpatient treatment for alcohol dependence, providing suggestive evidence that the degree of elaboration or richness of thoughts about the self is associated with the severity of the disorder.

More recently, two qualitative studies of persons in recovery from alcohol dependence also provide some suggestion that drinking may be motivated by an empty self. Klingemann (1992) interviewed spontaneous remitters who reported that they used alcohol to fill a hole of inner emptiness.

Based on observations of more than 2,000 Alcoholics Anonymous meetings, Denzin (1993) concluded that alcohol was used to escape an inner emptiness of self. As such, he argues that an empty self is at the core of alcohol dependence.

There is also some suggestion in the literature that with recovery, the self-concept is more well-developed and includes a more extensive and diverse collection of beliefs about the self. Theorists suggest that with continued abstinence, a new self is “built,” that is, new identities and domains of self-definition are formed . Connor (1962) found that among groups of alcoholics who had stopped drinking, the total number of self-descriptive adjectives endorsed was positively associated with the length of sobriety.”

“Studies have found that persons with alcohol dependence have lower global self-esteem than controls , and furthermore, that low global self-esteem prospectively predicts the development of alcohol use disorders. The findings are consistent with having either few positive and/or many negative beliefs about the self. A second group of studies focused on the number of positive and negative self descriptive adjective endorsements and found that persons with alcohol dependence endorsed fewer positive and more negative adjectives as self-descriptive compared to controls.

The literature also suggests that self-evaluation may improve with recovery. Bennett (1988) found that among alcoholics in recovery, the length of sobriety was positively associated with self-esteem. Earlier work using adjective endorsements also showed that as the length of sobriety increases, the relative proportion of positive self-descriptive adjective endorsements increases (Connor, 1962). The most compelling evidence comes from the Tarquinio et al. (2001) study noted earlier. They found that persons with alcohol dependence described themselves more positively and
less negatively 4 months after treatment, but no such change was noted in controls after 4 months.

The pattern of findings suggests that the lack of positivity and the high proportion of negativity in the self-concept may normalize with recovery.

Those at risk for alcohol dependence may have unstable or uncertain self-concepts.

Connor (1962) found that persons with alcohol dependence used more contradictory terms to describe themselves compared to controls.

Drozd and Dalenberg (1994) found that adult female children of alcoholics were less consistent in their self-descriptive adjective endorsements during a 1- week time span than controls and were more uncertain about their self-descriptions compared to controls.
Drozd and Dalenberg also found that the level of uncertainty predicted scores on an alcoholism screening test. Based on a qualitative study noted earlier, Denzin (1993) concluded that persons with alcohol dependence who are actively drinking have a “divided” self-concept with two simultaneous modes of existence: sober and intoxicated. He argues that these opposing modes of existence leave the individual emotionally divided with two separate and distinct senses of self.

Very recently, Knauth, Skowron, and Escobar (2006) found that adolescents who had an unclear sense of self were more likely to have difficulty with problem solving, which in turn influenced alcohol and other drug use.

An unclear sense of self, two distinctly different senses of self, and inconsistency, lack of certainty, and use of opposing terms to describe the self suggest that the self-definitions may be transient and poorly formed rather than stable, internal knowledge structures.

The “alcoholic self”

Taking on an “alcoholic” identity is a strategy used to cope with the lack of a clear and focused self (Blume, 1967; Denzin, 1993).

Denzin (1993) argues that an alcohol-related self-concept becomes a “master identity that overrides all other [self] conceptions the
alcoholic has” (p. 97).

An alternative model of the self in alcohol dependence is that the “alcoholic” identity must be adopted for recovery to occur. According to this view, recovery is a reconstruction project involving the self.”

” Specifically, it involves building a new self, one that is rooted in an identity as an alcoholic.   From this perspective, radical transformations of the self occur once the alcoholic identity is adopted.

An example of a model based on this premise is Alcoholics Anonymous (AA). AA is explicit about fostering an identity as an alcoholic Alcoholics Anonymous World Services, Inc., 2001).

In fact, it is customary for members to identify themselves at group meetings by their first name and the label “alcoholic” and to share stories about “what it used to be like,” “what happened,” and “what it is like now.”

Participating in a recovery program that focuses exclusively on living with and recovering from alcoholism contributes to the development of a “recovering alcoholic” identity.

However it should be noted, in terms of treatment,  that alternative
treatment approaches to alcohol dependence, such as motivational interviewing and cognitive behavioral skills training , focus on drinking as a problematic behavior pattern, not as a central part of “who one is.” As such, these different treatment perspectives would have different implications in terms of a recovery self-schema. More specifically, whereas a recovery-related identity is viewed as a critical component of recovery from the AA perspective, it is inconsistent with the motivational interviewing and cognitive behavioral skills training perspectives.”

How these therapy regimes deal with persons  with alcohol dependence who have an underdeveloped, negative, and unstable self-concept and a conception of the self is unclear and I am not in a position to comment as I have not used either in my own recovery.

What we can conclude perhaps that people with alcohol dependence have an underdeveloped, negative, and unstable self-concept and a conception of the self in terms of drinking that motivates alcohol use, and persons in recovery often have a more well-developed, positive self-concept and a conception of the self in terms of recovery.

to be continued…

References

Corte, C. (2007). Schema model of the self-concept to examine the role of the self-concept in alcohol dependence and recovery.Journal of the American Psychiatric Nurses Association, 13(1), 31-41.