Month: January 2015

Interpersonal Factors in Relapse – Part 1

“Living life on life’s terms” essentially means living with others.

The majority of relapses I have witnessed have been due to interpersonal factors, e.g. arguments at home with family and loved ones, not being able to cope with relationship breakdowns, perceived rejection by loved ones.

Research itself shows that the majority of relapses are caused by an inability to deal with distress (negative emotions) especially in the context of interpersonal relationship.

While neurobiological accounts of addiction suggest the main cause of relapse is due to responding to alcohol or drug cues, an effect heightened in the presence of stress, it does not allow for the main arena in which this stress/distress occurs i.e. with loved ones or people we are having relationships with, or thwarted relationships . Living with others can be difficult for alcoholics and addicts especially as we often found ourselves living in social isolation from others at the endpoint of our addictions.  Especially as many of us, if not the majority, have insecure attachment styles.

So why do addicts and alcoholics and others suffering from a range of addictive behaviours from sex to eating disorders have difficulties with coping with relationships with others?

This point certainly needs addressing as it appears to be a major determinant of relapse!

I do not know about you but there are certain parts of my “personality” that I do not like.

I believe these are mainly do to my insecure attachment – these include the tendency at times to be dismissive, to be needy, look at “me, me me!”, to be wary of others and their motives and to be very rejection sensitive. I have major issues with rejection from others and guard against it. I am also taking action in my personal life to deal with these issues more adaptively, more healthily.

It appears to me increasingly that part of my alcoholism is rooted not only in the genes I inherited from both my parents but in the fertile ground of insecure attachment and childhood maltreatment.

So have any researchers considered these factors? Not many it has to be said but this study (1) certainly did an it is one o the best and most comprehensive studies I have read in relation to these issues.

So in short, is there a sequelae between insecure attachment, rejection issues, low self esteem, interpersonal relationship difficulties and relapse?

“In this article, we review the literature on interpersonal stress and rejection sensitivity and examine how these factors increase the risk of relapse in individuals with alcohol or drug dependence…(to) provide insight into the role of interpersonal stress as a powerful and oftentimes destructive factor that affects individuals in recovery from substance dependence.

Relapse following treatment for alcohol or drug use disorders is a common problem. Studies indicate that 50–70% of patients are unable to remain abstinent during the first year following addiction treatment (1)…(we)  review the constructs of rejection sensitivity, insecure attachment, and low self-esteem, integrating these traits and considering how they influence relapse vulnerability…

Next (blog 2), we review the constructs of expressed emotion, perceived criticism, and marital distress, examining how these negative social contexts can contribute to unfavorable outcomes among individuals recovering from substance dependence.

We conclude with the testable hypothesis that there exists a subgroup of substance-dependent individuals with high trait rejection sensitivity that is particularly vulnerable to relapse in the context of a harsh and critical interpersonal milieu. We propose that high trait rejection sensitivity is a unique risk factor for relapse that can inform research in this area.

rejection images (40)

Intrapersonal Vulnerabilities to Addiction and Relapse

Interpersonal stressors are regarded by many as the one of the most severe forms of stress and can affect an individual’s cognition and behavior. Interpersonal stress is a well-known precipitant of maladaptive drug and alcohol use…we will review the extant literature on the related constructs of rejection sensitivity, insecure adult attachment style, and low implicit and explicit self-esteem. Although not identical, all of these constructs contribute to an individual’s compromised sense of self and an inability to interact comfortably and effectively with others. Further, they all share a propensity to increase an individual’s vulnerability to addiction.

Rejection Sensitivity

Rejection sensitivity (RS) is defined as the disposition to anxiously expect, readily perceive and react intensely to rejection. High-RS individuals interpret ambiguous social cues as indicative of rejection (22,23,24). Individuals entering into a romantic relationship with expectations of rejection attribute insensitive behavior by their partners to hurtful intent. RS also causes people to be dissatisfied in relationships and to anticipate that their partners are dissatisfied and want to end the relationship. High-RS individuals react in ways that undermine their relationships, ultimately serving as “self-fulfilling prophecies” (22,23). High-RS people have lower self-esteem and coping skills than those with low RS…and have higher levels of drug use than low-RS individuals (24).

High-RS individuals may quickly activate a defensive motivational system (DMS), which acts automatically and at a nonverbal level (22). The DMS results in rapid execution of automatic behavior aimed at self-protection, whether the threat is physical or social (22). Although the DMS is adaptive when a quick automatic defense to threat is required, it is maladaptive when a response requires higher reflective cognition (22)….

…thwarting a person’s fundamental need to belong produces cognitive dissonance, leading to a failure to self-regulate effectively, which is manifested in self-defeating behaviors (25).

Insecure Adult Attachment Style

Anxiously attached adults lack self-confidence, are extremely sensitive to interpersonal rejection and lack effective emotion regulation skills, while securely attached adults have high self-worth, perceive that other people are accepting and engage in healthy coping skills (28,29,30). The ability to regulate distressing emotional experiences is theorized to develop during infancy in the context of a responsive and available caregiver (27,28,30). A primary function of attachment, therefore, is the interpersonal regulation of distressing emotional states (27,31). Insecure attachment is marked by deficient mood regulation skills and a propensity to use maladaptive coping methods, such as drugs and alcohol, to modulate distressing affect (27,29,30,31,32).

Anxious attachment, therefore, predisposes individuals to heightened interpersonal conflicts due both to their diminished self-worth and their deficits in regulating emotion.

rejection

Insecure adult attachment is associated with addictive disorders (27,28,29,31,32). Thorberg and Lyvers (30) found that, compared with control subjects, individuals with a substance use disorder scored lower on the “attachment dimension of close” and the “attachment dimension of depend” and higher on the “anxiety dimension” of the Revised Adult Attachment Scale. These measures reflect the extent to which a person feels comfortable with closeness and intimacy, how much they feel they can depend on others, and how anxious they are of being abandoned or unloved. Those with substance use disorders were also more emotionally reactive than controls (30). Another study by these investigators (31) used the Negative Mood Regulation (NMR) expectancies scale to examine the association between anxious attachment and mood regulation. The NMR measures an individual’s ability to regulate and successfully cope with negative affective states. They found an association between anxious attachment and a diminished ability to regulate negative moods and postulated that substance use represents a “mood regulating coping mechanism” (30).

McNally et al. (27) examined the relations between alcohol-related consequences and adult attachment dimensions. They used the adult attachment style conceptualization of Bartholomew and Horowitz, which is similar to that of Hazan and Shaver except that they differentiated avoidant attachment into “dismissive” and “fearful” attachment. Two dimensions exist in this model: view of self and view of others. Securely attached individuals have a positive view of self and others; anxiously attached (renamed “preoccupied”) individuals have a positive view of others but a negative view of self; dismissive individuals have a positive view of self but a negative view of others; and fearful individuals have a negative view of both self and others. These investigators found that individuals with a negative view of self (i.e., those with preoccupied and fearful attachment styles) reported greater alcohol-related consequences, which were mediated by the individual’s desire to alleviate negative affect. The investigators noted that the “individuals’ global feelings of insecurity in relationships and interpersonal interaction, and in particular, their sense of themselves as both inadequate and undeserving (negative model of self) appear to have a direct effect on the motivated use of alcohol to cope with negative affect, and an indirect effect (mediated by coping motives) on drinking-related problems” (p. 1124).”

Negative reinforcement of social rejection is not the only mechanism increasing high-rejection-sensitivity individuals’ risk for addiction and relapse. Because rejection activates the defensive motivational system, these individuals frequently respond with automatic aggressive behaviors, sometimes assuming a passive form of “going out and getting wasted” to “punish” the person who rejected them. Social rejection also impairs self-regulation, further diminishing the high- rejection-sensitivity individual’s ability to employ the strategies and cognitions necessary to avoid relapse.

I call this a “to Hell With It!” relapse! You reject me and I will reject you back! Again this ties in with the emotional immature reactions that we blogged on before, and the direct consequence, again, of insecure attachment.

In Part 2 we will look at low self esteem and interpersonal vulnerabilities to relapse (particularly in family settings).

To be continued.

 

References

1. Leach, David, and Henry R. Kranzler. “An Interpersonal Model of Addiction Relapse.” Addictive disorders & their treatment 12.4 (2013): 183–192. PMC. Web. 30 Jan. 2015.

The Scream often starts closer to Home!

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Why have I decided to review this!?
On first viewing superficial, flighty and poorly written….I am not sure why The Huffington Post in reviewing this book has stated that “the likely cause of addiction has been discovered” when the author’s understanding of addiction and the addicts in his own life is so limited and lacking any depth or intellectual rigor.

How it can be called “rigorous” by Glenn Greenwald beggars belief while Chomsky, one of personal intellectual heroes calls it “wonderful”. It is depressing when there is so much bluster over a work which then disappoints so profoundly! I was really looking forward to getting my teeth into this….

At times the book seems more about the author than the subject matter. 

If the author had stuck to his need for an end to the “War on drugs” argument instead of straying in territory he obviously knew very little about, i.e. theories of addiction, this book would have been more convincing. He did meet some fascinating characters along the way although he refers to them quite glibly at times.

When he discusses addiction it is through the lens and academic work of Bruce Alexander who in his “Rat Park” series of experiments in the late 1970s came to the conclusion that addiction is primarily a social disease, caused by the wider environment, that society (particularly capitalist society) creates addiction, via social  disconnection.  He seeks to extrapolate the finding that rats who have been deprived of maternal deprivation and who appeared to then become more addicted to drugs than others who were not deprived to wider human society in all it’s complexity.

 

Some have also viewed Alexander’s ideas as overly naive and simplistic.

Some studies have failed to reproduce the original experiment’s results, but in at least one of these studies (1) both caged and “park” rats showed a decreased preference for morphine, suggesting a genetic difference.

 

I disagree that it is addiction is caused solely by societal or cultural means although each has a part to play as a part of a wider environmental influence which would also include family  environment, particularly as the majority of addicts appear to have suffered some form of childhood maltreatment, some form of abuse, sexual, emotional or mental, and some form of insecure attachment.

I believe these environmental issues also shape neurobiological and psychological aspects such as altering stress systems in the brain which effects the ability to process and regulate emotion which in turns drives a pathomechanism which results in eventual compulsive addictive behaviour.

Only by addressing a bio-psycho-social approach can we never hope to gain insight into this disorder of addiction. Addiction is a complicated matter and implicates everything from genes to environment and everything in between so “a likely cause” of addiction seems fanciful to say the least.

In a bio-psycho-social approach every strata effects the other and at all times, they are continually reciprocal. They are inseparable so any theory of addiction needs to account for everything or be more circumspect in it’s claims.

We look for simple answers while dismissing factors just as important or seen as opposing when we should always look for synthesis. 

Addicts need our help now! Not by overturning the capitalist system but by identifying the causes of addiction closer to home, in inherited genetic make up, in abusive family backgrounds, in social deprivation in their communities, in a legal system that criminalizes those with mental disorders for the manifestation of their disorder, i.e. the procuring and taking of drugs, in a society that actively encourages binge drinking, excessive gambling etc and social isolation via an increasingly disconnected society.

Even within a capitalistic system we can surely work greatly to address many of these issues without complete and quite unrealistic overhaul.

If I find anything else in this book worth further debating I”ll blog on it another time.

Here’s some excerpts from The Guardian’s review of this book

“But what Chasing the Scream betrays is a little more complicated than the zero-sum stuff of truth and fiction. He took the very modern career path of becoming a high-profile polemicist before he had done much reporting, and perhaps as a result his writing is too melodramatic, a little naive, and reluctant to give a fair shout to the other side of the argument – things reflected in a tone that too often falls into being either shrill, or over-emotional.”

“His biggest problems, though, are a tendency to insert himself into the cracks between his stories, and his often histrionic turn of phrase. No one, it seems, has explained to him the strengths of the show-don’t-tell school of non-fiction writing. He tells the grim story of a cop’s rape of a heroin-addicted woman and the resultant birth of a child who went on to be a dealer, but then ends it with a real clunker: “a child of the drug war in the purest sense – he was conceived on one of its battlefields”.

“Later, when he compares the compulsion to gamble with drug addiction, he superfluously points out that “you don’t inject a deck of cards into veins; you don’t snort a roulette wheel”.

“Chasing the Scream is a powerful contribution to an urgent debate, but this is its central problem: in contrast to the often brutal realities it describes, it uses the gauche journalistic equivalent of the narrative voice found in Mills & Boon novels. Amid Mexican sand dunes, he tells us, Hari thought about the drug wars’ endless downsides as he “ran my fingers through the prickly hot white sand” and crassly imagined the joyous lives of local teenagers in a world free of gangsters (“Juan, stripped of his angel wings, is chatting with Rosalio about World of Warcraft”).

By the end, as he discusses the details of taxing marijuana with a civil servant from Colorado, he says that he is “bored at last, and I realise a tear of relief is running down my cheek”. Thanks to such melodrama, and the book’s slightly excitable tone, one conclusion is all but inescapable. The title of Chasing the Scream is a reference to the young Harry Anslinger’s experience of hearing a drug-addicted woman howl for a fix, but it might easily apply to the sensibility of the author himself.”

http://www.theguardian.com/books/2015/jan/09/chasing-the-scream-johann-hari-war-on-drugs

References

  1. Petrie, B.F., Psychol Rep. 1996, 78, 391–400. PMID 9148292

 

In dreams…an illness that never sleeps!

It is often said that we have an illness of addiction that never rests, when you are in a meeting it is outside doing press ups, when you awake it is at the foot of the bed waiting, “hey ready to go!”

In the early weeks and months (years) of recovery I often had “drinking” dreams  in which I would dreaming about drinking alcohol. In early recovery these used to scare the life out of me and confuse me greatly. Did I still want to drink?

The study (1) we cite today shows the opposite that “that alcoholics would have more drinking dreams if they wanted to stay sober and that to dream of drinking was a good indicator of continued abstinence.” 

The drinking dreams, I later realised,  would normally occur when I was fearful of anxious. They were fear based dreams not appetitive, i.e. they were not about wanting to drink but about being afraid of drinking again. That would appear to my greatest fear so when I was anxious about something in my daily life, at night I would have dreams about drinking alcohol.

In these early days, fortunately, in the drinking dreams the drinking would have dire consequences and I would get out of control drunk or dissolve like the Wicked Witch of the West from the movie “Wizard of Oz”.

Unfortunately in later years I have had dreams were I drank and could handle a few without dire results!  My illness had apparently infiltrated by dreams and starting manipulating them.

Now if I have the odd drinking dream I simply use it as a prompt to look at what is going on emotionally in my life. I have to say that my dreams have increasingly used other symbols of fear and anxiety in recent years, like buildings collapsing, having to save people’s lives etc etc.

I must also be rigorously honest here and state that many of my fear based and drinking dreams occur when I have not done my step 10 properly or thoroughly. A way to a sound sleep is a sound step 10!

Anyway I came across this study (1)  from a few years ago which looked at the dreams of alcoholics. It showed that the self esteem issues that sometimes plague alcoholics in revcovery are also present in their dreams lathough these lessen as time in recovery increases.

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“This study focused on people who had self-labelled themselves as ‘Alcoholics.’ They all had a previously previous history of severe alcohol use, but were currently abstinent and recovering in Alcoholics Anonymous.

People who have been diagnosed as ‘alcoholic’ have been described as over sensitive, anxious, to have low self esteem (Fields, 1992; Christo & Stutton, 1994) and to be emotionally immature (Dayton, 2007).

Recovery form addiction has been described as a process (Larsen; 1985; Nixon, 2005; Nixon & Solowoniuk, 2008). Stage I recovery is characterised by the priority of learning how to be abstinent. Stage II recovery has different goals which emerge after initial withdrawal from active addiction. Larson states that Stage II includes the following goals: improving self-esteem, changing negative thinking, and discovering emotional sobriety. So if dreams do “cut through the pretensions and deceits of waking life, and lay bare the true feelings of the individual” (p229, Hall & Norby, 1972), dream content in Stage II recovery may explicate where in the recovery process abstinent alcoholics are compared to non alcoholic controls.

Moore (1962) predicted that there would be a difference in the dreams of hospitalized alcoholics compared to nonalcoholics. He found that alcoholics often dreamt of themselves as victims.

Scott (1968) compared the dream reports of male and female alcoholics and identified several differences. Both sexes dreamt less about joy, happiness, or their children, and were more likely to describe themselves as victims. Alcoholics reported significantly more dreams about drinking, often associated with guilt, than the control group.

Theme identification in male and female alcoholic’s dreams showed male alcoholics dreamt more about death, whilst female alcoholics had more colourful dreams. Scott concluded that alcoholic’s dreams depicted problems, conflicts, insecurity, and sadness…alcoholics were “unable to use their dreams therapeutically as do controls … alcoholics incorporate their feelings of helplessness whilst controls are able to integrate strength into their dreams” (Scott, 1968, p.1317). This idea that dreams provide a therapeutic function has recently been supported by Hartmann (2001).

Cartwright (1974) predicted that the ‘psychologically healthy’ would have greater continuity between their waking and dreaming life. This is due, in part, to the assumed internal emotional and mental equilibrium that exists in individuals with assumed psychological balance. This early literature suggests that alcoholics in early abstinence, or during hospitalization, may report dream content which is more unpleasant in terms of emotion and themes.

Studies have begun to focus on the reason why drinking dreams appear in alcoholism (or other substance misuse disorders). Choi (1973) compared those who experienced drinking dreams at 3 months, with those who did not and found that 80% of those who had drinking dreams were still abstinent compared to 18% of those who did not. He concluded that alcoholics would have more drinking dreams if they wanted to stay sober and that to dream of drinking was a good indicator of continued abstinence.

Denzin (1988) points out, using anecdotal reports from AA members, that drinking dreams are usually fearful, and this may reflect waking preoccupation with the fear of returning to active alcoholism, rather than a desire to return to drinking.

This study showed that abstinent alcoholics did experience more unpleasant emotion, make more negative attributes about the self and generally have a less pleasant dream experiences than nonalcoholics…one explanation is that these findings may describe permanent damage to brain function caused by severe alcohol use, and that abstinent alcoholics may experience more unpleasant dreams as a consequence, another is that rebound during REM sleep when executive commands are off-line (Maquet et al, 1996). More specifically, abstinent alcoholics may spend time during waking suppressing negative feelings, thoughts, and actions.  Suppressing thoughts during waking has been found to cause them to rebound in dream content (Wegner, Wenzlaff & Kozak, 2004).

…(this has generally been the case with me) a longer period of abstinence may be needed before dream emotionality settles into a pattern reflecting non-alcoholic dream-life.

Abstinent alcoholics in Stage II recovery constantly strive to change, and observe their emotional life in order to make positive changes. They may therefore be predisposed to paying more attention to dream emotion as well as waking emotion…

The 12 steps of Alcoholics Anonymous provide a program of self-help where addiction is ‘accepted’ rather than ‘abstained’ from. The difference between ‘acceptance’ and ‘abstinence’ is the same as the difference between being highly motivated to not drink and being highly unmotivated to not pick up the first drink or drug (Colace, 2004; Berridge, 2001). This difference would be clearly observed in the self-construal of the ‘recovering’ alcoholics who took part in this study. If drinking dreams are indicative of where the person is in their recovery process, then wanting to drink intermittently is arguably the most natural of states that an alcoholic may find themselves in. Drinking dreams are not predetermine indicators of relapse: how they act on may be. Rather, the occasional presence of drinking dreams which are accompanied by unpleasant emotional affect, including guilt and remorse are a common part of the recovery process (Marshall, 1995). Knudson (2003) suggests dreams are seen as indicators of either the past (retrospective), or the present moment (concurrent), but includes a further prospective function used to make positive change. Using this model, drinking dreams can be seen as indicators of needing to take prospective action, such as increased access to support, talking about these dreams in AA meetings, or with sponsors and therapists (McEwing, 1991; Marshall, 1995).

 

References

1. Parker, J., & Alford, C. (2009). The dreams of male and female abstinent alcoholic’s in stage II recovery compared to non-alcholic controls: are the differences significant?. International Journal of Dream Research, 2(2), 73-84.

 

Do we have to Hit Rock Bottom to Recover?

There has been much recent debate about whether a person has to hit rock bottom in under to surrender and start recovering, whether one has to go to the bitter end before surrendering to the recover process.

My own experience shows  that we have to concede to our inner selves that we are alcoholic and that we need help from others.

For me it was a “last gasper” rock bottom for many it was a low bottom, I had lost practically everything and for some they had lost little compared to me but they had seen the road ahead and realised it was not going to get any better without accepting help.

This shows there is more to alcoholism than alcohol, that these people realised their negative behaviours and their consequences were causing them as much distress as their drinking. They did not like who they were becoming or the effect it was having on others around them , their loved ones, families and friends and employers.

I maintain also that there are also many different variables that contribute not only to one’s alcoholism and it s severity but also in one’s chances of getting into recovery sooner rather than later. Environmental factors such  as ethnicity, income, place in society, class can often play a role and social and therapeutic support networks. One of the most startling parts of this study was the lingering question that given that 85.1% of AA members in the US are White shouldn’t AA members be reaching out to non-white communities? 

Environment  is a factor in the progression of addiction but should it play such a huge role in the starting and progression of recovery too!? I have also noticed that many AAs in the groups I have intended are White and middle class. It always bugs me that there is not more non white and working class or blue collar alcoholics in recovery,  in my part of the world anyway.

In fact, the working class, and sometimes non-white alcoholics I know have come to AA via Treatment facilities.  Do cultural issues get in the way of access to recovery? The other startling point is that many more alcoholics who seem to have stopped drinking before losing what was important to them are motivated to pursue recovery than those who lost nearly everything, including health, family, friends, and jobs.

Individuals are accessing treatment via support networks much earlier in their drinking and may not have to experience the multitude of physiological, mental, emotional, financial, legal relationship and other problems low bottom alcoholics frequently do. This for me begs the question of whether AA is doing enough for the low bottom alcoholic who still suffers?

Anyway check this study (1) out – it signals the start of many blogs on why and how AA and other 12 works. Also this study shows a very interesting statistic which is that a majority of recovering alcoholics in this study have sought additional professional help. This shows that Bill Wilson’s “Lets be friendly with our friends” appears to be becoming a reality for many. It is our intention, via our research blogs, to continue this desire, to demonstrate how 12 step and other recovery models can work together and even compliment each other.

“The concept of hitting bottom persists within Alcoholics Anonymous (AA) even though the backgrounds, addiction experiences, and therapeutic options of AA members are now radically different than they were at the group’s founding. Understanding what AA members now mean by hitting bottom is important because the experience describes the point at which they become willing to seek help—professional treatment, AA, or both.

The concept of the alcoholic bottom evolved from the illness model of addiction. By popularizing the illness model (later reconceptualized as a disease model), AA revolutionized addiction treatment, and its 12-step approach remains the most popular and accessible route to recovery (Gross, 2010; Kurtz, 2002).

Among the most controversial aspects of AA is the idea that alcoholics will seek help only when their “illness” has led to “pitiful and incomprehensible demoralization” (AA, 2001, p. 30). Those words originally appeared in the 1939 first edition of Alcoholics Anonymous, but by the time of the publication of the 1953 commentary, Twelve Steps and Twelve Traditions (AA, 1953), the idea had changed in contradictory ways. The instance of help seeking received a name (“hitting bottom”) that suggested an objectively fixed point.

On the other hand, the experiences of those entering AA demonstrated that such a point is relative, and not fixed. AA was helping “people who were scarcely more than potential alcoholics” so it was “necessary to raise the bottom” (AA, 1953, p. 23). The meaning of “hitting bottom” remains problematic (for some). Denzin (1987) provided the succinct definition used in this article: “Bottom: Confronting one’s alcoholic situation, finding it intolerable and surrendering to alcoholism. Accompanied by collapse and sincerely reaching out for help; may be high or low” (p. 134).

The hitting bottom concept originally reflected the experience and outlook of AA’s founders and pioneers in the 1930s. They shared a common background (professional White men), the common “low-bottom” experience of institutionalization for their alcoholism, and commitment to peer-facilitated spiritual growth (Kurtz, 1988). In refining the disease concept of alcoholism,Jellinek (1946) surveyed these early AA members and identified the bottoming-out phenomenon, which he subsequently developed into the Jellinek curve (Jellinek, 1960). jellinek_lg   Since the founding of AA, the membership has become much more diverse and the rise of professional treatment has provided multiple alternatives to institutionalization of alcoholics (Robertson, 1988; Stolberg, 2006). Yet despite the variable backgrounds and experiences of AA members today, they continue to rely on the hitting bottom concept and terminology. Although hitting bottom entails the crucial decision to seek help, no research has been conducted to determine any commonality among AA members regarding the meaning and implications of the term. The purpose of this exploratory study, therefore, is to determine how AA members perceive their alcoholic bottom (high, middle, or low)…

Participants were asked, “Which description best fits the ‘bottom’ you hit as an alcoholic?” This categorical variable had three potential values: high, middle, or low. Although Denzin (1987) reported a bottom could be high or low, the middle category was added so that participants would not be forced to select a more extreme option if they believed their bottom was neither high nor low. AA literature represents bottom levels in terms of loss, such that high-bottom alcoholics, “still had their health, their families, their jobs, and even two cars in the garage” (AA, 1953, p. 23). In keeping with this understanding, loose definitions were provided to participants in their answer choices:
•
High bottom: I stopped drinking before I lost what was important to me.
•
Middle bottom: I suffered serious consequences but did not lose everything.
•
Low bottom: I lost nearly everything, including health, family, friends, and jobs.

The study found that Whites, religious people, and episodic drinkers were less likely to be low bottoms when they began recovering. Alcohol-related problems were most clearly associated with level of bottom, supporting recent findings that problems increase the odds that an alcoholic will perceive the need for help and will seek help (Grella et al., 2009). Findings were – high bottom (36.1%), middle bottom (44.5%), and low bottom (19.4%).

A fundamental tenet of AA is that alcoholism is progressive, so that alcoholics “get worse, never better” (AA, 2001, p. 30). Supportive of this progressive framework is the finding that problems distinguish high bottoms from low bottoms. The difference was most clear in the categories of social and physical problems, indicating that early identification of these problems could signal a need for intervention, particularly if the individual drinks constantly or uses drugs other than alcohol.

The finding that hitting bottom remains salient for AA members holds implications for addiction professionals treating those members. Professionals have struggled with the idea that addiction must render an individual demoralized before treatment can be initiated. Some reject the bottom concept outright, whereas others have attempted to integrate hitting bottom into standard practice.

Nearly 50 years ago, the family intervention was developed to “raise the bottom” by confronting alcoholics with ultimatums to guide them into treatment (Jay & Jay, 2000; Johnson, 1986; Liepman, Nirenberg, & Begin, 1989). In recent decades, the legal system likewise has coerced offenders into treatment initiation and compliance (Sullivan et al., 2008). Although such confrontational and coercive strategies ostensibly are in the alcoholic’s best interest, they have drawn criticism for their manipulative tactics and for inconclusive reports of effectiveness (Broadstock, Brinson, & Weston, 2008;Loneck, Garrett, & Banks, 1996; W. R. Miller, Meyers, & Tonigan, 1999; Perry et al., 2006).

Researchers and practitioners have expressed concerns about the alcoholic’s loss of agency when the only options are hitting bottom or being manipulated into perceiving that the bottom is immanent. Their concerns include both the ethics and efficacy of the alcoholic bottom (Smith, 1999; White & Miller, 2007). Effective alternatives designed to facilitate treatment entry without an alcoholic bottom include motivational interviewing and harm reduction (Logan & Marlatt, 2010; Lundahl & Burke, 2009). With these approaches, which are now widely used by professional therapists, the alcoholic is encouraged to determine whether treatment is desirable and, if so, how intensive that treatment should be.
Although the concept of surrendering at the alcoholic bottom seems incompatible with the more agentive therapeutic frameworks now popular in professional counseling, the evidence suggests that many recovering alcoholics rely on a combination of professional treatment and mutual-help groups to sustain their abstinence (Patterson & Nochaski, 2010;VanderWaal et al., 2008).
AA estimates a third of its members enter AA through a treatment center, and 63% of its members receive some form of treatment or counseling before entering AA and the same proportion do so after entering the fellowship (AA, 2001). Evidence suggests combining AA with professional services is associated with significantly greater abstinence over time (Gossop, Stewart, & Marsden, 2008; Kelly, Stout, Zywiak, & Schneider, 2006; McKellar, Stewart, & Humphreys, 2003;Moos & Moos, 2005).
Given that the majority of AA members (a) understand their addiction in terms of hitting bottom, and (b) are helped by a combination of both AA and professional treatment, professionals treating AA members should therefore understand the bottom concept and be prepared to address it during patient interactions.
Whites and those introduced to AA by an AA member were significantly less likely to hit a low bottom. Given that 85.1% of AA members are White, it is possible that non-White alcoholics are less likely to enter AA at a high-bottom stage because their social network includes fewer AA members who could take them to a meeting (AA, 2008).
The finding that alcoholics who enter AA via court order are far less likely to be high bottoms indicates that mandated referral can work, but it seems to be more of a last resort than other modes of entry. This finding supports the research that endorses the effectiveness of coercion, for at least some alcoholics (Gregoire & Burke, 2004; N. S. Miller & Flaherty, 2000). A recent study by Field, Duncan, Washington, and Adinoff (2007) reported an inverse relationship between motivation to change and alcoholic problem severity, suggesting low-bottom alcoholics might be less motivated than high-bottom alcoholics to pursue recovery.”
The salutatory lesson from this for me from this study is that we should never pronounce when another addict or alcoholic has had enough! That quite clearly is for them to decide not us!  It appears almost counter intuitive for some, if not many,  that many more alcoholics, who seem to have stopped drinking before losing what was important to them, are motivated to pursue recovery than those who lost nearly everything, including health, family, friends, and jobs. This is very noteworthy as it runs contrary to AA experience in the early days when most alcoholics seeking recovery were low bottom.
This would suggest that widespread societal awareness that there is a solution has had a profound effect on alcoholics seeking help for their illness much earlier than in the early decades of AA.
This has profound effects on earlier intervention as these individuals can access treatment via support networks and may not have to experience the multitude of physiological, mental, emotional, financial, legal, relationship, family and other problems low bottom alcoholics frequently do.
If we can alleviate suffering we should also seek to do so and help others to do so as early as possible.
You do not appear to have lost everything in order to surrender to 12 step programs of recovery. For me there is  a real message of hope in this study, that alcoholics can seek help earlier without having to experience the various hardships of low bottom.
Obviously this also begs another very important and pertinent question. Why do so many low bottom people not seek recovery or treatment? Why do I sit in AA rooms and rarely see a beat up low bottom alcoholic walk into the room like I did a number of years ago?
Is AA doing enough for the low bottom alcoholic who still suffers? 
The type of alcoholic who co-founded AA in the first place?
References
1. Young, L. B. (2011). Hitting bottom: Help seeking among Alcoholics Anonymous members. Journal of Social Work Practice in the Addictions, 11(4), 321-335.
Quote

Shame and Addiction

In the next few weeks we will be looking at Shame and Addiction – shame leads to the self pity and depression that can drive drinking and relapse – nicely summed up here in this quote from  The Little Prince.

“- Why are you drinking? – the little prince asked.
– In order to forget – replied the drunkard.
– To forget what? – enquired the little prince, who was already feeling sorry for him.
– To forget that I am ashamed – the drunkard confessed, hanging his head.
– Ashamed of what? – asked the little prince who wanted to help him.
– Ashamed of drinking! – concluded the drunkard, withdrawing into total silence.
And the little prince went away, puzzled.
‘Grown-ups really are very, very odd’, he said to himself as he continued his journey.”

― Antoine de Saint-Exupéry, The Little Prince

 

little prince download

Filling the Empty Self

In the first part of this two part blog – we looked at how addicts in recovery move from a more negative (perhaps chronically negative) self schema to a more positive recovering self schema and how this now sense of self and the new interrelatedness with others which develops in recovery drives recovery and an increased self empowerment.

The self, via schema, is increasingly positive in outlook, attitude and action. In other words recovery does for the self schema, sense of self, what we could not do for our own selves, our own self schemas. The self and the self schema becomes a vehicle for increasing well being and not further disease and disorder.

It is a vehicle by which we recover.  For me it helped recover the person who I was meant to be, the person who had become so lost to alcoholism for so long. It in some ways introduced me to a person I did not really know and in many ways am still getting to know.

The fascinating thing also is that negative self perception, as we know from previous blogs, generates a brain frequency very similar to thinking about drinking and not similar to drinking itself. We presume a positive self perception does not and this not only does not lead one back to drinking but very much in the opposite direction.

We again cite from the same article as before (1) to demonstrate perhaps how self schema, especially, the recovering self schema, is so vital to recovery for alcoholism.

“….From this perspective, specific disturbances in the underlying structure of the self-concept are considered intermediary factors that serve as important mechanisms that link more distal factors (e.g., genetic factors, family history of alcohol problems) to alcohol
use. A person with a self-concept composed of few positive and many negative and highly interrelated self-schemas would not have the internal motivation necessary to facilitate adaptive behavior. The negative affect stemming from such a self-concept configuration
would be likely to motivate maladaptive
behavior in an attempt to escape the negative self views
(Baumeister, 1990) and “fill up” the empty self (Cushman, 1990).

Persons with a family history of alcohol problems or other risk factors for alcohol problems would be likely to turn to alcohol (versus other types of maladaptive behavior) as a means to escape the negative emotions. A core belief about the self in relation
to alcohol (drinker self-schema) would be likely to form as drinking experience accumulates and similarities across drinking-related incidents are abstracted. Such a drinking-related self-schema
would serve to motivate schema-consistent (drinking)
behavior.
According to the hypothesized model, a person in sustained recovery (long-term abstinence) would have a more well-developed self-concept—one that consists of newly developed positive self-schemas and a recoveryrelated
self-schema. The recovery self-schema is conceptualized
as central to the recovery process as it would serve to motivate schema-consistent (recovery) behaviors.

During the process of recovery, new positive self-schemas are likely to form as a result of new relationships, activities, and involvements. The development of new positive self-schemas would diminish the proportion of negative self-schemas and the overall level of interrelatedness among the self-schemas.

 

How-To-Fill-The-Inner-Emptiness-Of-Addiction-PhysicianHealthProgram

 

TESTING THE THEORETICAL MODEL

… findings provide empirical evidence that (a) young adults with early-onset alcohol dependence have impaired self-concepts that are characterized by many negative self-schemas, a tendency toward few positive self-schemas, and an elaborated self-schema related to alcohol; and (b) young adults in recovery have healthier self-concepts characterized by few negative self-schemas, a tendency toward many positive self-schemas, and an elaborated recovery related self-schema.

If further longitudinal research studies demonstrate that the self-concept configuration that we found in persons with early-onset alcohol dependence contributes to the development of the disorder,
then prevention strategies aimed at children and adolescents
could be beneficial, particularly for those children who are at risk for alcohol problems based on the presence of other risk factors (e.g., familial alcohol problems, conduct problems). More specifically, interventions designed to build a healthy self-concept (by
fostering the development of a diverse collection of positive self-schemas, thereby decreasing the relative proportion of negative self-schemas) may serve as a protective factor that buffers the effects of the more distal risk factors.

 

At the other end of the spectrum, the data from our study suggest that interventions may also profitably focus on fostering the development of a recovery self schema in persons with alcohol dependence. 

…the nature of any recovery related intervention would depend on how ready the person is to change. For a person who does not yet recognize that alcohol is a problem, the goal would not be
to foster the development of a recovery schema but to help him or her identify that drinking is a problem.

One possible way to do this is to assist the person to make associative links across the multitude of negative alcohol-related outcomes so that rather than a series of unrelated incidents, the individual begins to see a pattern of repeated, enduring, and pervasive alcohol-related problems.

…when the individual is able to pull unpleasant alcohol related episodic memories together to identify that he or she indeed has a problem with alcohol. So whereas
assisting the person to increase his or her awareness
of problems with alcohol is consistent with the basic
tenets of motivational interviewing (Miller & Rollnick,
2002), fostering the development of a recovery self schema
is not.

For people who recognize that they have a problem with alcohol or people who are seeking treatment for alcohol problems, one strategy may be to foster the idea that they can be recovering persons— that is, that recovery is possible for them. Fostering communication with other recovering persons and encouraging involvement in recovery-related activities may help to form a recovery-related “possible self”—a future-oriented conception of the self one “hopes to be,” that is, a recovering person.

Imagining the self in the future by developing detailed images of what one would be like in recovery is an important part of this process. Participation in 12-step recovery programs such as Alcoholics Anonymous that explicitly foster the development of a recovery related identity may also be helpful…

In fact, one plausible explanation…for an emerging recovery related self-schema is that the alcohol dependent participants were in a treatment  facility based on such a 12-step recovery program.

 

 

Reference

1. 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.

Reconstructing the Hole in the Soul – part 1

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.”

Although the Big Book of AA suggests that self centredness is the root of our troubles, paradoxically it may seem, that  the process of recovery, may be a process of “reinvesting” in the self, a process of renewing oneself. Although this may be realignment of self may obviously be aided via support of AA members and a higher power.

Ultimately we may become more ourselves in a sense, or real selves, the self we were born to be. Not the self lost in a fog of active addiction.

Egomaniacs with low self esteem?

“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.”

I know which view I support!

” 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.

 

Recovering the Real Self

It is often said that alcoholics and addict fear nothing more than rejection. Little did I know this is based on a maladaptive self schema many addicts carry, even in recovery.

It has always been an “achilles heel” of mine and I often thought people were rejecting me when they were doing nothing of the sort. They were either just disagreeing with me, having a different viewpoint.

So why such a heightened sensitivity to perceived feeling of rejection from others.?

I came across this study which was fairly revealing on the subject (1).

“The aim of this study was to compare early maladaptive schemas and attributional styles in addicts and non-addicts to recognize their role in addiction.

In this causal-comparative study, 200 addicted and non-addicted men were randomly selected. Young early maladaptive schema and attributional styles questionnaires were used.

Early maladaptive schemas (EMSs) are chronically self-defecting emotional and cognitive patterns that develop early in life. They are the causes of many psychological disorders. Maladaptive schemas and inefficient ways the patient learns to adapt with others often lead to chronic symptoms of anxiety, depression and substance abuse.5

Based on the revised model of learned helplessness theory, another factor that increases a person’s vulnerability is attributional style which means how individuals explain different events.

If a person attributes a bad event to a stable, internal, and global cause, it can result in learned helplessness (LH).6

Some researchers showed that LH is the core of psychopathology and a predictor of successful treatment for substance abuse.

According to findings, addicted and non-addicted men are significantly different in all 15 EMSs, i.e. addicts suffer from higher levels of EMSs. Kirsch5 made similar conclusions.

Ball and Young, as well as Cullum, suggested that schemas have an important role in successful treatment of addiction.13,14 Young et al. also found many schemas related to substance abuse.15

Among schemas domains, the first domain (rejection/disconnection) obtained the highest scores.

Bosmans et al.16 indicated that psychopathology is perfectly related to this domain. Likewise, Brummett found rejection/disconnection domain linked to more problems and also positively related with psychopathology indicators such as substance abuse.

Aimee suggested this domain to be more sever in substance abusers.4

These findings are consistent with Iranian researchers such as Haghighat manesh and Lotfi.18,19 Compared to normal people, sex offenders had higher EMS scores.18

Comparing means of attributional styles of addicts and non-addicts showed significant differences between optimistic and pessimistic attributional styles, i.e. addicts were more pessimistic and developed LH more. These findings are consistent with studies conducted by Haj Hosseini, and also Garcia et al.,20,21

Other findings show pessimistic addicts were more likely to return to substance abuse.6 We also found a direct relationship between LH and successful addiction treatment. Therefore, addicts who suffered more from LH were less successful in treatment and more likely to relapse to substance abuse.

Correlation between EMS and pessimistic attributional style in addicts revealed positive relationships between pessimism and defect/shame, dependence/incompetence, and emotional inhibition schemas. Therefore, more pessimistic addicts had more sever schemas. In addition, Pearson correlation between LH and EMS in addicts indicated direct relationships between LH and entitlement, emotional inhibition, dependence/incompetence, failure, defect/shame, social isolation, abandonment, and emotional deprivation. These findings are consistent with Aimee’s research which found dependence/incompetence schema related to LH.4 Similarly, Hoffart and Sexton, and Tarquinio also suggested that since emotional deprivation, mistrust/abuse, social isolation vulnerability to harm and compliance were related to pessimism.22,23”

 

This study certainly highlights a number of desriptions of many addicts and alcoholics I have seen and been, especially in early recovery (and still on a bad day!).

It may be not so much an alcoholic personality that drives addiction but maladaptive self schemas, which act to propel self fulfilling prophesies of further addictive behaviour.

It is how we feel about about ourselves that seems to determine who we will act in relation to ourselves. Again feelings feed our addiction or our recovery.

We can alter these schemas fundamentally however and profoundly via among other things the 12 steps and other treatments such as schema therapy.

Recovery in simple terms is a change is schema for addicted self schema to recovery self schema. From feeling helpless, vulnerable, dependent,  pessimistic to  the opposite of these feelings.

This is why an addict needs to  fundamentally change in recovery.

References

1. Shaghaghy F, Saffarinia M, Iranpoor M, Soltanynejad A. The Relationship of Early Maladaptive Schemas, Attributional Styles and Learned Helplessness among Addicted and Non-Addicted Men. Addiction & Health 2011;3(1-2):45-52.

 

 

Recovering from Stigma

New post on The Alcoholics Guide to Alcoholism

Recovering from Stigma

by alcoholicsguide

Our last blog “Addicts continue to Face Widespread Stigma”looked at the stigma towards addicts that still prevails in much of society.

As addiction can often seem to be fuelled at times by negative emotions such as guilt and shame, societal  stigma towards addicts and alcoholics may have a negative effect on seeking treatment and on recovery itself.

It stops addicts accepting their condition and in seeking help for it, in other words.

I came across an article from a couple of years ago that looks at how addicts even in initial stages of treatment, in detox and assessment, begin to recover from maladaptive self schemata, the type of negative self schema that societal views help perpetuate.

These schemata are partly shaped by how society reflects them. Hence in recovery it is essential to move from a maladaptive negative self perception and self schema to a more accepting, positive and realistic self schema of being a person in recovery. That of an ill person getting better.

This is often called a recovering self schema or sometimes called a spiritual self schema.

Thus it is essential for those addicts who do recover to move from a negative sense of self to a more positive sense of self – from an ill self schema to a recovering self schema. From being a negative using to a positive recovering self schema.

In fact this can also be translated into memory associations of the past too with positive memory associations of drug use being transformed into more realistic negative memory associations. These memory networks along with schemata play a huge role in recovery. In fact one feeds of the other. I feel good about myself and negative about the effects alcohol and drugs had on me, my family and wider society. This is useful to my recovery. Accepting me and the wreckage alcohol and drugs played on my life.

Self schemata are the vehicles by which we drive our lives, they are how we regulate our selves, our attitudes and behaviours.

Unless we develop a positive recovering self schema it will be very difficult to remain in recovery.

We have to have some emotional self catharsis, some spiritual awakening, some realigning of how we feel and think about ourselves and those around us, the society around us (regardless of how it feels about us).

It does not matter what the society thinks about us, their views are often based on ignorance and not having to live with or around addiction. As communities of recovering people we help with this catharsis, this chrysalis effect, this transformation from what we thought we were to what we think we are now.

This study (1)  ” The Self Schema and Addictive Behaviours; Studies on Alcoholic Patients.” shows how people with alcoholism in the initial stages of treatment move from a negative to a positive view of themselves.

The subjects had to perform three tasks that required manipulating personality traits with positive and negative connotations (a self-description task in which decision time was measured, an autobiographical task, and a recall task). The results of the first interview showed that (1) in their self-descriptions, alcoholics took more time than control subjects both to accept positive traits and to reject negative ones, (2) unlike control subjects, alcoholics considered more negative traits to be self-descriptive than positive traits, and (3) unlike controls, alcoholics recalled more negative traits than positive ones.

By the second interview, the results for the alcoholic subjects on the autobiographical and recall tasks had changed: (1) they now described themselves more positively and less negatively than on the first meeting, (2) they recalled a marginally greater number of positive traits and a significantly smaller number of negative traits, and (3) the differences between the alcoholics and controls indicated an improvement in the alcoholics’ self-perceptions.

“Persons who are perceived negatively by society, especially ones who belong to social minorities, may be influenced by those perceptions and thereby generate negative perceptions of themselves.

In other words, the value judgments individuals make about themselves are in effect partially based on the judgments others direct at them (Crocker, Major, & Steele, 1998).

The social and occupational consequences of addictions also play a part in identity building by modifying and structuring the addicted individual’s self-schema. According to Markus (1977), as people accumulate personal experiences of a given type (addictive behaviors, for example), their self-schema becomes more and more resistant to inconsistent or contradictory information.

Everything an individual does in an attempt to organize or explain his or her own behavior in a given domain thus contributes to the formation of cognitive structures about the self, which Markus called self-schemata (Markus, Crane, Bernstein, & Siladi, 1982; Markus & Nurius, 1986 ; Stein, Roeser & Markus, 1998). The self-schema can thus be conceived of as a structure that enables generalizations and theorizations about the self based on the categorization of one’s own recurring behaviors and those of others. It gives each person a clearly defined idea of the type of person he or she is in a particular domain. For a given facet or aspect of life, subjects may possess a self-schema of a certain type (masculinity, academic achievement, successful career, independence).

Markus and her collaborators (1977; Markus & Smith, 1981; Markus, Smith, & Moreland, 1985) defined the essential properties and functions of a self-schema: (1) evaluate new information, (2) process information about the self (judgments and decision making) with greater ease or certainty, (3) retrieve behavioral proofs, (4) predict future behavior on the dimension in question, and (5) resist information that goes against the dominant schema.

The present study on alcoholic patients sees the self-schema of these individuals (partly) as being determined instead by psychosocial variables rooted in the stigmatization they bear. In this view, the personality traits of alcoholics are expressions of their self-schema and are determined by the social context in which they live, not just by the characteristics of the cognitive processes at play.

Because of the particular category to which alcoholic patients belong, they are subjected to stigmatizing social evaluations. Stigmatization here means ascribing negative attributes to certain persons which discredit them and give them a negative self-image. The term stigma is a very old one, formerly used to refer to a mark made on the body, generally by a hot iron, for the purposes of exposing what was “uncustomary and detestable” in the moral character of the branded person (Goffman, 1975).

Addictive behaviors are a form of social disqualification that prevents the addicted individual’s full acceptance in society. One of the consequences for the addicted is withdrawal, which necessarily leads to awareness of their socially-marked status. Such marking tends to reinforce negative self-perceptions and self-images which, in time, may lead to the emergence of a highly discredited and degraded “self”, especially if the heavy drinker recognizes the need for therapeutic treatment.

The results of this study opens some new doors for investigation by pointing out the dynamic nature of the self-schema. The self-schema can hereafter be understood as an adaptive process, not a mere cognitive structure.”

This study’s although limited in some ways – it would  be more interesting to track subjects all the way through a treatment program based on the Minnesota Model for instance – shows how being among others like oneself, also in recovery can help change how the subjects though and felt about themselves. They were no longer alone.

There was a society of people like themselves, in the “same boat” and this help change their self schema, they shared aspects of personality with others, they had found the group they belonged too. This is a good point as it points to the social isolation that addicts feel prior to coming into recovery. It also helps in terms of self worth via a newly found “secure” attachment.

It points out that recovery is often best done in the company of others like yourself. One has a societal self as well as a personal, individual self. The need to belong is huge and healthy ultimately. We are social animals.

We generally change how we think, feel about and act in life via the help of others who have made the same, essential changes to their own self schemata.

The study also mentions that the self-schema is affected by various life events (particularly ones involving self-questioning). I would add that the 12 steps changed my self schema profoundly via the self examination required.

I went from a fanciful,  distorted, negative view of self to a more realistic, accepting and empowering sense of self, a self that could others find their true selves  too.

We need the help of each other.

 

Reference

1. Tarquinio, C., Fischer, G. N., Gauchet, A., & Perarnaud, J. (2001). The self-schema and addictive behaviors: Studies of alcoholic patients. Swiss Journal of Psychology/Schweizerische Zeitschrift für Psychologie/Revue Suisse de Psychologie, 60(2), 73.

Addicts Continue to Face Widespread Stigma

Addiction seen as a moral failing!?

I came across this article from a few months ago which shows we as a collective have not come very far in understanding addiction and that society continues to stigmatize those suffering from addiction.

It makes depressing reading considering the advances in neuroscientific evidence which demonstrates that addiction is clearly a psychiatric disorder, involve chronic neuroplasticity of the brain which has a permanent influence on behaviour. The brain of the addict is changed irrevocably during the addiction cycle, hence once an alcoholic/addicts always an alcoholic/addict.

It has nothing to do with weak will – it is about a impaired and compromised self will.

If any thing we have too much will power sometimes not lacking in it.

The University study below states that many of the public still see addiction as a vice and not a medical condition. Unfortunately there are also many academics who feel the same way.

Read for yourselves (1)

“People with drug addiction are much more likely to face stigma than those with mental illness because they’re seen as having a “moral failing,” according to a new survey.

The poll of more than 700 people across the United States also found that the public is less likely to approve of insurance, housing and employment policies meant to help people with drug addiction.

 The study results suggest that many people consider drug addiction a personal vice rather than a treatable medical condition, according to the Johns Hopkins Bloomberg School of Public Health researchers.

“While drug addiction and mental illness are both chronic, treatable health conditions, the American public is more likely to think of addiction as a moral failing than a medical condition,” study leader Colleen Barry, an associate professor in the department of health policy and management, said in a Hopkins news release.

“In recent years, it has become more socially acceptable to talk publicly about one’s struggles with mental illness. But with addiction, the feeling is that the addict is a bad or weak person, especially because much drug use is illegal,” she added.

The survey revealed that only 22 percent of people would be willing to work closely on a job with someone with a drug addiction, while 62 percent said they would do so with a person with a mental illness.

Sixty-four percent of respondents said employers should be able to refuse to employ people with a drug addiction, while 25 percent said the same about people with a mental illness. Forty-three percent of respondents said people with drug addiction should not be given the same health insurance benefits as the general public, while 21 percent felt the same about those with mental illness.

About 30 percent of respondents believed that recovery from either drug addiction or mental illness is impossible, according to the study in the October issue of the journal Psychiatric Services.

“The more shame associated with drug addiction, the less likely we as a community will be in a position to change attitudes and get people the help they need,” study co-author Beth McGinty, an assistant professor in the department of health policy and management at Hopkins, said in the news release.

“If you can educate the public that these are treatable conditions, we will see higher levels of support for policy changes that benefit people with mental illness and drug addiction,” she added.”

This is depressing because in doesn’t help addicts get help. I did not want to go to AA because I did not want to be stigmatised so this sort of ignorance does have a profound effect. I did not want to go to AA although I have been in alcoholic psychosis for months and was certifiable but AA, well….?

If they only knew how profound this illness is? I would not wish it on my worst enemy, if I had one. Although sometimes I feel that some could do with a temporary dose of it.

Anyway we trudge on…

References

from this link –  http://health.usnews.com/health-news/articles/2014/10/03/drug-addiction-seen-as-moral-failing-survey-finds