Personal autonomy in group-based interventions

Marginalized individuals are often caught in a vicious cycle of economic or health problems, a lack of social connection and disempowerment. The present research examines interventions that provide opportunities for social inclusion to break this cycle. Specifically, in two longitudinal field studies, we examined the effect of social inclusion on self-efficacy and hope in two vulnerable groups, namely, 68 residents in a drug and alcohol rehabilitation centre (Study 1) and 48 marginalized adults taking part in activities organized by a community organization (Study 2). Although somewhat counterintuitive, we hypothesized that social inclusion would affect self-efficacy by fostering feelings of personal autonomy. The hypothesis was supported by results from both studies revealing an indirect effect from social inclusion via personal autonomy on self-efficacy and hope. The findings are discussed in relation to how group inclusion may stimulate the development of personal autonomy in disadvantaged adults, an important factor in their recovery and mental health.</p

Predictors of flexibility in social identity among people entering a therapeutic community for substance abuse

One of the key aspects of recovery from substance dependence is making a transition from a social network supportive of substance use to one that supports recovery. This study assessed this transition in social identity in an adult therapeutic community (TC) at baseline and 2 weeks into treatment. Where residents increased identification with the TC, and reduced social identification with using groups, retention in treatment improved. As retention is a proxy measure of positive outcomes, this pilot suggests that facilitating residents’ positive identification with the community in the first weeks of treatment may be central to retaining residents and improving treatment outcomes

Social identity mapping in addiction recovery (SIM-AR): extension and application of a visual method

Background: The Social Identity approach offers a unifying framework for understanding recovery from addiction as a process of identity change, associated with change in social network composition. This paper introduces Social Identity Mapping in Addiction Recovery (SIM-AR) — a visual method for capturing social group memberships, extended to integrate the substance use ‘status’ of group members as an indicator of group substance use norms. The aim here is to test theory-derived predictions focused on the relationship between changes in social identity and network composition reflected in substance use norms in early recovery. Method: 155 therapeutic community (TC) residents in Victoria, Australia, completed the SIM-AR plus measures of substance-using and recovery identities and substance use shortly after admission, and 65% (N=101) again 6 months later. Results: As predicted, substance use severity at follow up was associated with changes in both social identity and network composition. Furthermore, reduced strength of substance-using identity was associated with a decrease in the proportion of groups with heavy substance use norms, while increased strength of ‘recovery’ identity was associated with an increased proportion of non-using groups. Conclusion: SIM-AR proved useful in testing predictions about social identity and network changes in a residential treatment context. It captured key social identity constructs in recovery using a visual technique with value to both research and applied contexts. Findings highlight the clinical importance of assessing a person’s group-based relationships in treatment and early recovery, especially the influence of social group norms in relation to substance use

Feeling connected again: interventions that increase social identification reduce depression symptoms in community and clinical settings

Background: Clinical depression is often preceded by social withdrawal, however, limited research has examined whether depressive symptoms are alleviated by interventions that increase social contact. In particular, no research has investigated whether social identification (the sense of being part of a group) moderates the impact of social interventions

Craving mediates the effect of impulsivity on lapse-risk during alcohol use disorder treatment

Rash impulsiveness, the propensity for approach behaviour despite potential negative consequences, is associated with stronger alcohol craving in patients with Alcohol Use Disorder (AUD). This relationship is poorly understood and implications for treatment response are unexamined. This study explored the relationship between rash impulsiveness, craving, and treatment response among 304 outpatients enrolled in a 12-week abstinence-based Cognitive-Behavioural Therapy (CBT) program for AUD. Assessments were completed pre-and-post treatment, with craving and alcohol consumption monitored at each treatment session. Higher rash impulsiveness predicted more frequent craving over treatment (b = 0.95, 95% CI = 0.40, 1.50). Higher craving was associated with greater lapse-risk (b = 0.04, 95% CI = 0.03, 0.05), with the association between craving and lapse-risk increasing as treatment progressed (b = 0.01, 95% CI = 0.01, 0.02). Craving positively mediated the relationship between rash impulsiveness and lapse-risk (µ = 0.38, 95% CI = 0.10, 0.70). Contrary to hypotheses, the risk of lapse in response to craving was not moderated by rash-impulsiveness. These results suggest that AUD patients with a predisposition for rash impulsiveness are more vulnerable to alcohol craving, and subsequently, poorer treatment outcomes

Social group membership before treatment for substance dependence predicts early identification and engagement with treatment communities

Social relationships play a major role in recovery from substance dependence. To date, greater attention has been paid to the role of important individuals in a person’s life and their contribution to recovery following treatment. This study is the first to examine both individual and wider group-based social connections in the lead up to residential treatment for substance misuse in a therapeutic community (TC), and their influence both on a person’s readiness to engage with the treatment community and with a recovery pathway. Participants were 307 adults interviewed early in treatment about their individual- and group-based social relationships prior to treatment entry, their social identification with the TC, as ‘a user’ and a person ‘in recovery’, their current recovery capital and quality of life. Correlational analysis showed that only pre-treatment group-based, and not individual, relationships, were significantly associated with developing social identification with the TC early in treatment. Moreover, results of hierarchical regression analyses indicated that identification with the TC was best predicted by the extent to which people saw themselves as being in recovery. Finally, mediation analysis indicated that TC identification was the mechanism through which social group memberships prior to treatment commencement protected quality of life in the early phases of treatment. These findings highlight the protective role that group memberships play in building early identification with the TC and supporting well-being in a critical period of transitioning to treatment