alcoholism

Recovery as a process of identity change

Part 2

 

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The social identity model of recovery (SIMOR) applies the Social Identity Approach to the process of recovery from addiction. This model frames the mechanism of recovery as a process of social identity change in which a person’s most salient identity shifts from being defined by membership of a group whose norms and values revolve around substance abuse to being defined by membership of a group whose norms and values encourage recovery (1) .

“This emerging sense of self is shared with others in recovery, thus strengthening the individual’s sense of belongingness within recoveryoriented groups. This emerging social identity is gradually internalised, so that the individual comes to embody the norms, values, beliefs and language of recovery-oriented groups. This, in turn, helps the individual shape and makes sense of changes in substance-related behaviour, and reinforces the new social identity.

As groups are strong determinants of self-definition (Turner, 1991), strong affiliation with a group that is discriminated against and socially excluded due to involvement in deviant norms and activities (e.g. groups of injecting drug users) may also increase group members’ health vulnerability and reduce subjective wellbeing and selfesteem (Schofield, Pattison, Hill, & Borland, 2001). Social exclusion and stigma around addictive behaviours may also lead using group members to identify more strongly with one another, seeing themselves as different from any other social group and thereby reinforcing membership.

However, as SIMOR highlights, this need not prevent recovery, provided there is a basis from which to develop or strengthen other group memberships that support recovery. In particular, if a person self-categorizes as a member of a recovery-oriented group comprising former users, they will internalise the shared characteristics of the group as part of the self, and this new selfcategorisation will typically involve distancing themselves from, and diminishing identification with, using groups due to their inconsistency with the characteristics of the recovery group. This means that when (and to the extent that) people come to define themselves in terms of a recovery-based social identity (i.e. as ‘‘us in recovery’’), their behaviour will be informed by the normative expectations associated with that identity (e.g. avoiding environments and people associated with substance abuse).

Their identification with a recovery group will shape their understanding of substance-related events (e.g. an offer to go to the pub with friends) and their response to it (rejection on the grounds that it would put their recovery at risk). In sum, group memberships exert influence on individuals through the transmission of social norms, which are internalised and thus shape subsequent attitudes and behaviour. Identification with the group increases exposure to its norms and values, as well as receptivity to them. This increases the likelihood the group’s norms will be integrated into one’s own sense of self (who I am).

… groups provide a basis for a sense of belonging, meaning, support and efficacy (Cruwys, Haslam, Dingle, Haslam, & Jetten, 2014; Haslam, Jetten, Postmes, & Haslam, 2009), and social identities provide a reservoir of social resources that the individual can draw on in their recovery journey. An emerging recovery-based social identity can also help to make sense of new decisions around situations and groups associated with the previous using lifestyle and may also contribute to a sense of self-efficacy that reinforces the utility of the recovery-based identity and increases the perceived desirability of recovery group membership.

…recovery can be conceptualised as involving the emergence of a new sense of self, encompassing a history of substance abuse, yet embedded within new, health-promoting social groups. Here, recovery is seen not as a personal attribute that can be observed and measured (Best & Lubman, 2012), but rather as a socially mediated process, facilitated and structured by changes in group membership and resulting in the internalisation of a new social identity.

This social identity exerts influence on individual values, beliefs and action and is reinforced and made more salient by successful use in challenging situations. Factors that maintain recovery are primarily social; recovery involves moving away from the using social network and actively engaging with an alternative social network that includes other people in recovery. However, it is important to note that the factors that initiate recovery often relate to becoming tired with one’s lifestyle, and these can often be brought to a head by a crisis event (Best et al., 2008).

…there is also the possibility that changes in social identity may in turn accelerate the process of becoming ‘‘tired of the lifestyle’’. Clearly, there are challenges in initiating this transition. In part, these can arise from a lack of awareness of, or wariness of, pro-social or recovery groups, something that can be exacerbated by the social exclusion that results from a heavy substance-using lifestyle. Nevertheless, there is evidence that even a single positive group experience, in the face of multiple negative ones, can provide the necessary scaffolding to help vulnerable and excluded individuals seek out meaningful groups and supportive networks (Cruwys, Dingle, et al. 2014; Cruwys, Haslam, et al. 2014). This suggests that even deep-seated experiences of isolation can be challenged in the process of initiating the recovery transition.

Setting the scene for initial contact with recovery-oriented groups is one of the primary motives of an ‘‘assertive linkage’’ approach that supports individuals to engage with various groups. Testing this approach, both Timko, DeBenedetti, and Billow (2006) and Manning et al. (2012) have demonstrated the benefits of using peers to support active engagement in groups. In each of these trials, peers linked to specialist treatment providers acted as ‘‘connectors’’ between socially isolated clients and pro-social groups, resulting in both increased engagement in group activity and better substance use outcomes. Similarly, Litt et al. (2009) reported a 27% reduction in the likelihood of alcohol relapse in the year following residential detoxification amongst members of a trial group assigned to a ‘‘network support’’ condition that involved adding one person to their social network who neither drank alcohol nor used other substances.

SIMOR argues that motivation to change can be initiated through two processes. The first involves increasing exposure to recovery-oriented groups that are perceived to be attractive to the individual. Second, motivation to change may also be precipitated by a crisis event (e.g. loss of a relationship or of a job), which may enhance the desire to change through increasing tiredness with a substance-using lifestyle. This may also occur through engagement with a recovery-oriented group as part of specialist treatment programmes (e.g. participation in 12-step meetings), or through encouragement and enthusiasm from friends. Thus, the initial drive may be to escape the adverse and stigmatised consequences of a substance-using lifestyle, but the catalyst and mechanism for change lies in the changing social dynamics that an individual experiences as they transition between using and recovery-oriented groups. This causes the person to move away from the using groups and to engage more actively with recovery-oriented groups.

The journey towards recovery proceeds alongside initial exposure to recovery groups in the context of ambivalence towards an existing social identity linked to active substance use. This transitioning occurs as a recovery-based social identity becomes more accessible and increasingly salient and as the using identity, while still salient and accessible, starts to diminish. As the sense of identity associated with recovery-oriented groups stabilises, becoming highly accessible and salient, the using identity diminishes in salience and relevance.

The new recovery-oriented social identity may take time to develop as this requires a fundamental shift in group memberships, values and goals that occurs alongside growing recognition of the incompatibility of this identity with the values of the using group. Indeed, this may explain why rates of relapse are so high early in recovery. Nevertheless, if factors prompting initial attraction to a recovery group can overcome its perceived incompatibility, participation in the recovery group may offer new values and norms that ‘‘fit’’ with the individual’s recovery aims.

The transition to a maintained state of stable recovery involves ongoing involvement with recovery-oriented groups whose mechanisms of impact include social learning and social control thereby shaping social identity. Here, the salience and stability of a recovery-focused identity will grow as the individual becomes actively engaged in recovery groups. Moreover, as this identity becomes internalised the influence of using group values and norms significantly diminishes. In response, the recovery-focused identity becomes the more accessible and meaningful social identity, thus supporting recovery maintenance. The result of this entire process is a transition in social identity – from one that is predominantly using based to one that is recovery-focused. The latter is then sustained and maintained through active participation in recoveryoriented group activities. While the identity associated with substance use is not altogether lost or discarded, its salience diminishes as the ‘‘fit’’ of the new recoverybased identity increases and that of the substance usebased identity diminishes. Over time, this reduces the likelihood of the using-based identity providing a basis for behaviour.

A similar process of social transition has been highlighted by Longabaugh et al. (2010) in predicting increased abstinent days from alcohol. SIMOR is also consistent with evidence reported by Buckingham et al. (2013) that both substance users and smokers are more likely to remain abstinent if they identify strongly with a recovery group. In other words, as former users come to identify more strongly with recovery-oriented groups, and less strongly with using groups, their likelihood of sustained recovery increases.

More recently, Frings and Albery (2015) have developed a Social Identity Model of Cessation Maintenance (SIMCM), which draws on previous research showing that therapeutic group interventions that create a sense of shared identification are the basis for cure or, in the present context, recovery (Haslam et al., 2010, 2014; Jetten et al., 2012a). Like SIMOR, this model highlights the importance of social identity processes in recovery maintenance, but approaches this from a social cognitive perspective, positing that attending group therapy generates a recovery identity for each individual within the group and, through this group identification process, that an individual increases their self-efficacy to maintain recovery. The model assesses this in the context of group therapy for addiction, seeing this as a vehicle through which to promote a positive recovery-based identity that individual members can draw on in negotiating their current lifestyle.

SIMOR highlights multiple phases within the recovery process, recognising that group memberships are continually being negotiated and proposing that shifts in social identity may well be initiated prior to a conscious investment in recovery. Consequently, SIMOR suggests a transition in social identity is being negotiated throughout the recovery process and is consolidated during recovery maintenance.

 

 

 

Reference

  1. Overcoming alcohol and other drug addiction as a process of social identity transition: the Social Identity Model Of Recovery (SIMOR). Available from:https://www.researchgate.net/publication/281643200_Overcoming_alcohol_and_other_drug_addiction_as_a_process_of_social_identity_transition_the_Social_Identity_Model_Of_Recovery_%28SIMOR%29[accessed Sep 14, 2015].
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