Breaking Bad: How Breaking Old Social Ties Can be Good for Recovery

Social factors play a significant role in both the onset and offset of substance use disorder (SUD). Research has taught us that, irrespective of the combination of pathways by which individuals achieve remission (e.g., treatment, mutual-help, “natural” recovery), those who increase recovery-supportive social connections and decrease SUD-supportive ones substantially raise their chances of entering and sustaining recovery.

Social identity has been studied far less often in clinical circles, due in part, to our bias toward simplified and reductionistic models with which we use science to understand the human experience. Augmenting our existing models by taking social and interpersonal change processes into account could increase our understanding of substance use disorder recovery and enhance treatment or community supports.

Prior research suggests this might be a difficult question to answer for several reasons:

1. there has not been a clear relationship between markers of alcohol severity, like age of onset for dependence, and smaller hippocampal volume
2. important factors that typically co-occur with alcohol use disorder, such as cigarette smoking, are also associated with a smaller hippocampus and could impact recovery of this memory-related brain structure
3. a substance called brain derived neurotrophic factor (BDNF) – which affects brain cell maintenance and production – could impact how the brain recovers from alcohol use disorder. From a genetic perspective, some individuals are born with a variant in the BDNF gene, called “Met carriers” (specifically, the “Val66Met” polymorphism), and prior work shows the brains of Met carriers may not recover as quickly as those without that variation, called Val homozygotes.

Dingle and her co-authors examined how substance use disorder (SUD)-relevant social identities change during treatment and how this change is related to substance use and life satisfaction over time.

The sample included 132 individuals residing in a therapeutic community, a substance-free intensive treatment setting typically hosting members for approximately 3 to 6 months that emphasizes not only abstinence-based SUD recovery but also social skills and activities of daily living. These individuals were primarily male (62%), Caucasian (87%), single (64%), and modest levels of education (11^th grade, on average).

They had been using their substance of choice (alcohol, 38%; amphetamines, 32%; opiates, 14%; and cannabis, 8%) for 15 years and entered the therapeutic community with more than 5 prior treatment episodes, on average, indicative of relatively severe substance use histories. The sample was assessed at intake and 2, 4, and 6 weeks after-intake as well as at treatment exit and 7 months after treatment exit.

Of note, the sample of 132 decreased steadily with each follow-up, resulting in only 27 by treatment exit, though authors were able to capture data from 60 of the original 132 at the end of treatment (6-months). That said, apart from slightly higher levels of education, the participants that the authors were able to re-assess measure at the 7-month follow-up did not differ from those with whom they could not reach for follow-up. Social identity was measured by self-reported identification with the therapeutic community and with substance using peers, and SUD-related social identity was measured by subtracting self-reported “user” identity score from recovery identity score.

Data results showed, over and above age and substance use history as well as recovery and user identities at treatment entry:

• substance use disorder social identity (= recovery – user identity) predicted percentage of days abstinent from alcohol, accounting for 41% of its effect
• substance use disorder social identity (= recovery – user identity) predicted days abstinent from other drugs to a lesser degree, accounting for only 6% of its effect.
• substance use disorder social identity (= recovery – user identity) predicted life satisfaction, accounting for 49% of its effect.
• Additionally, participants’ identity as a therapeutic community member increased over time while living in the therapeutic community, while identity as member of a substance using peer group simultaneously decreased over time.

IN CONTEXT

Given that SUD recovery is often conceptualized as social, and interpersonal in nature, studies of the role of social identity in recovery are conceptually a good fit. Given that much of the work on social network changes in the field has occurred in context of mutual-help research, it is interesting that when the impact of specific mutual-help recovery activities are examined simultaneously, sponsorship (i.e., having a recovering person as a personal mentor) and a regular “home group” membership – activities with clear interpersonal and social threads – are among the strongest predictors of positive outcomes.

This study is a notable example of how we can use models of group membership and social identity to help understand substance use disorder recovery.

LIMITATIONS

That said, it remains unclear whether changes in identity result from treatment engagement and subsequently influence positive outcomes, and whether social identity changes help explain outcomes over and above other well-articulated, empirically-supported mechanisms of change (e.g., abstinence self-efficacy).

NEXT STEPS

1. research in other treatment settings since TC’s are rather unique in their approach
2. larger treatment sample with better follow-up rates
3. measuring identity at a time point prior to the outcomes its purported to influence in order to better support a causal interpretation
4. measuring and controlling for well-articulated, empirically-supported mechanisms of substance use disorder treatment and recovery, such as abstinence self-efficacy and motivation

 CITATIONS

Dingle, G. A., Stark, C., Cruwys, T., & Best, D. (2015). Breaking good: Breaking ties with social groups may be good for recovery from substance misuse. British journal of social psychology, 54(2), 236-254.