Guest Blog from “Inside the alcoholic brain”
Guest Blog from “Inside the alcoholic brain”
Narratives of Self-Redemption Predict Behavioral Change and Improved Health Among Recovering Alcoholics
In our previous blog “Shame keeps you ill” we looked at how shame about addictive behaviors interferes with addicts’ recovery by increasing their propensity to engage in the shame-inducing behaviors. Specifically, the more shame behaviors individuals displayed, the more likely they were to relapse and decline in health within the next 4 months. These findings indicate that responding to past problematic drinking with pronounced behavioral displays of shame is a strong predictor of future drinking, and that shame about one’s addiction may be a cause of relapse.
The 12 steps ultimately deals with feelings of shame about previous behaviour by acceptance of your disease of addiction and by processing these shameful emotions by working the steps, particularly steps 4-7 and by making amends to those affected by our behaviour in steps 8-9.
This sense of self redemption brought via the 12 step program of recovery is also reinforced by “sharing” our stories at 12 step meetings. We share with others what it was like drinking, what happened for us to come into recovery and what it is like now for us in recovery (often referred to as one’s experience, strength and hope). These three part shares are ultimately stories of self redemption. They are also part of the formation of recovering self schema.
Here in this blog we look at an academic study (1) which addresses the positive behavioural changes brought about by these self redemptive stories. The authors are the same as in our previous blog.
“The present research (1) examined whether the production of a narrative containing self-redemption (wherein the narrator describes a positive personality change following a negative experience) predicts positive behavioral change. In Study 1, we compared the narratives of alcoholics who had maintained their sobriety for over 4 years with those of alcoholics who had been sober 6 months or less. When describing their last drink, the former were significantly more likely to produce a narrative containing self-redemption than the latter. In Study 2, we examined the relation between the profession of self-redemption and behavioral change using a longitudinal design, by following the newly sober alcoholics from Study 1 over time.
Newly sober alcoholics whose narratives included self-redemption were substantially more likely to maintain sobriety in the following months, compared to newly sober alcoholics who produced nonredemptive narratives; 83% of the redemptive group maintained sobriety between assessments, compared to 44% of nonredemptive participants.
Redemptive participants in Study 2 also demonstrated improved health relative to the nonredemptive group.
Collectively, these results suggest that the production of a self-redemptive narrative may stimulate prolonged behavioral change and thus indicate a potentially modifiable psychological process that exhibits a major influence on recovery from addiction.
Humans are natural storytellers (Bruner, 1990). They construct stories to bring a sense of comprehension and coherence to the events around them. In the same vein, they construct life stories to bring comprehension and coherence to their lives (McAdams, 2001).
In recent years, there has been a shift in narrative research, toward the examination of how life stories influence certain life outcomes, most notably psychological adjustment (Adler, 2012). This transition is consistent with McAdams’s (1985, 1993) original conception of the life story as functional, serving, in essence, as the “story we live by” (McAdams, 1985, 1993). From this perspective, once a narrative about one’s past is constructed, an individual feels compelled to maintain congruence with this self-defining story or, in Giddens’s (1991) words, to “keep a particular narrative going” (p. 54).
Interestingly, if this is the case—that personal narratives are developed for the purpose of providing direction to one’s life—then for those who create a story that professes positive or adaptive self-change following a negative or harrowing experience (i.e., redemption), the life story may function to promote not consistency in one’s behaviors but, rather, change. In other words, those who construct redemptive stories may be motivated to change their behaviors to align with the bettered self-image that is described.
As a result, upon constructing a story in which a bettered self emerges following adversity, narrators may actually become better, in part by reducing their engagement in problematic behaviors.
We investigated the relation between the narration of a positive self-transformation following a difficult experience and behavioral change, and we did so by examining stories and behaviors among a unique sample of individuals for whom these issues are likely to be particularly relevant, as they are seeking (or have sought) to dramatically change and improve their lives: recovering alcoholics.
These individuals represent an ideal population within which to test this relation, both because they are, by definition, actively seeking to change their lives and behaviors in a fundamental way, and because many self-help addiction recovery programs (e.g., Alcoholics Anonymous [AA]) encourage recovering addicts to develop coherent personal narratives about their addiction that climax with a positive personal transformation and successful recovery (Denzin, 2009; O’Reilly, 1997)…. that addicts’ behaviors will come to align with the narrative plot of the personal stories they create; that once a story detailing personal growth following abstinence is constructed, the story will come to influence the narrator, thereby stimulating the recovery process.
In the present research, we asked alcoholics who were members of AA to construct and narrate a story regarding a (potentially) critical moment in their lives—their last drink. In the minds of some, this drink represents the turning point at which commitment to sobriety is renewed and and recovery is stimulated. In the minds of others, however, this drink simply represents the most recent lapse, one soon to be followed by a long line of others. Drawing on the theoretical work outlined above (e.g., Giddens, 1991; McAdams, 1985), we predicted that individuals who narrated stories depicting personal improvement following their last drink would exhibit a change in behavior consistent with this description (i.e., extended sobriety, improved general health), relative to those whose narratives did not reflect a sense of positive self-change.
Alcohol addiction is one domain in which the construction of a story containing self-redemption has been deemed particularly relevant (Diamond, 2001). Surveying the personal stories of a group of alcoholics who had repeatedly failed to maintain sobriety, Singer (1997) observed that these individuals tended to struggle when tasked with authoring a redemptive personal story. Similarly, in his psychobiography of George W. Bush, McAdams (2011) proposed that the formation of a redemptive life story may have played a role in Bush’s recovery from alcohol addiction.
Furthermore, in small-scale qualitative investigations of alcohol recovery programs such as AA, researchers have noted an emphasis on the construction of stories that are redemptive, in which the self and one’s life improve following sobriety (e.g., Denzin, 2009; O’Reilly, 1997). Indeed, the emphasis on striving for self-redemption is particularly apparent within AA, a self-help alcohol recovery organization boasting over 2 million members worldwide. This focus on positive transformation in the wake of alcohol addiction is manifest in the organization’s official guidebook (Alcoholics Anonymous World Services, 2004), which includes a collection of transformative life stories written by its members. This emphasis is also manifest in AA’s regularly held speaker meetings, at which members are encouraged to share their experiences pertaining to alcohol and addiction, and professions of self-redemption from consistently abstinent members tend to be particularly well received (Denzin, 2009). Indeed, it has been proposed that the purpose of these meetings is to reward and foster such stories, leading O’Reilly (1997) to assert that “there is really only one story in AA” (p. 24).
The present research demonstrated that (a) there is a strong association between the tendency to perceive past traumatic life events as resulting in positive personality change and corresponding behavioral change, and (b) the perception of positive personality change predicts subsequent positive behavioral change.
…alcoholics who had maintained sobriety for 4 years or longer were significantly more likely to describe their most recent drinking experience (prior to sobriety) as stimulating a positive development in the self, compared to alcoholics who had maintained sobriety for 6 months or less...newly sober alcoholics who perceived a sense of self-redemption in the wake of their recent sobriety demonstrated improved health months later, and were over twice as likely to have maintained sobriety across the two waves of assessment than those who did not evince any sense of self-redemption in their stories during the initial wave.
These results are suggestive of the possibility that developing a story of self-redemption about one’s addiction may be a causal factor underlying long-term behavioral change.
1. Dunlop, W. L., & Tracy, J. L. (2013). Sobering stories: Narratives of self-redemption predict behavioral change and improved health among recovering alcoholics. Journal of personality and social psychology, 104(3), 576.
Following on from Ernie Kurtz’s great video on the role of shame in alcoholism and how the 12 steps help alcoholics in recovery address this shame via the 12 steps, we cite and use the findings of a study (1) which demonstrates how shame about the consequences of one’s alcoholism can prevent recovery and prompt relapse.
Our shameful secrets do keep us ill. We are ill people getting better and dealing with the shame and guilt of the past is essential to long term recovery. “…Several researchers have argued that shame rather than promoting positive change can also motivate hiding, escape, and general avoidance of the problem
….Supporting this account, those who are prone to shame tend to show a range of dysfunctional dispositions and biological outcomes, including depression, anxiety, eating disorders, chronic anger, heightened cortisol reactivity….Shame typically occurs when individuals blame themselves for negative events, and, in particular, aspects of themselves that are stable, uncontrollable, and not amenable to change…Thus, though seemingly counterintuitive, the impact of shame on one’s global self-image (i.e., the feeling, “I’m a bad person”) may lead individuals to believe they have no choice but to be that person, even if it is someone who hurts others…engages in substance abuse…
As a result, shame may lead to an increase, rather than decrease, of problematic behaviors, making shame a risk factor rather than a deterrent…researchers have suspected that shame promotes self-injurious behaviors, and that dispositional shame is a cause of alcoholism and a barrier to recovery…
We tested whether shame about addictive behaviors (i.e., one’s most recent alcoholic drink, among self-identified recovering alcoholics) interferes with addicts’ recovery by increasing their propensity to engage in the shame-inducing behaviors…
Alcoholics, like all addicts, are known to be dispositionally prone to shame…Additionally, alcohol consumption may provide a unique means of coping with painful shame feelings, because alcohol induces a form of disrupted cognition in which self-awareness—an essential pre-requisite for the experience of shame… is decreased or prevented. Thus, some alcoholics may have initially turned to binge drinking as a way to regulate the onslaught of chronic shame. If shame is a risk factor for alcoholism, it may be part of a vicious cycle in which it promotes addictive drinking and is experienced in response to addictive drinking, leading to a cycle of abuse.
If this is the case, then shame may perpetuate addiction and have a negative impact on health. When recovering alcoholics publically discuss their past drinking, the degree to which they demonstrate behavioral displays of shame significantly and substantially predicts changes in their … mental health, their likelihood of relapsing over time, and the severity of that relapse.
Specifically, the more shame behaviors individuals displayed, the more likely they were to relapse and decline in health within the next 4 months. These findings indicate that responding to past problematic drinking with pronounced behavioral displays of shame is a strong predictor of future drinking, and that shame about one’s addiction may be a cause of relapse, chronic drinking, and health declines in recovering alcoholics.
In conclusion, this research suggests that shame about past addictive behaviors not only fails to help alcoholics avoid these behaviors, but also indicates that they are likely to continue engaging in them.”
In later blogs we will address how accepting one has an illness called alcoholism and that one was indeed powerless over past behaviours leads to a transforming power in processing and dissipating these shame based feelings concerning past behaviours.
We become free from this past as it is the non-processing of these negative emotions which keep us tied to the past via the evident negative emotions it reactivates. Negative emotions which in turn activate negative addictive behaviours to cope with these feelings.
This processing of the past or “clearing way the wreckage of the past” leads to an increased ability in emotion regulation and a narrowing focus on dealing with such feelings and emotions in present, every day recovery. Step 4 and 5 inventory helps illuminate which particular negative emotions and their dysregulation trip us up in our every day lives.
I believe the so-called “defects of character” I continually exhibit when distressed are distinct patterns of emotions expressed due to emotion dysregulation. A still ever present in these dysregulated negative emotions are shame which often leads to self pity. This shame-self pity axis could lead to “poor me, pour me, pour me a drink” if I am not vigilant, even if I never want to drink again.
It is my emotional dysregulation that I need to be constantly aware of, my underlying condition.
I suffer from alcoholism not alcohowasm.
As a result I need constant regulation (or inventory) of these continually occurring negative emotions so that I can identify, label and process (often by/through sharing with another recovering person). In other words, the 12 steps leads to a greater ability to manage our emotions one day at time by becoming aware of the damage this emotional dysregulation has caused in the past and has the potential to do so again.
This manageability of our condition leads to an emotional sobriety. A living of life on life’s terms.
1. Randles, D., & Tracy, J. L. (2013). Nonverbal displays of shame predict relapse and declining health in recovering alcoholics. Clinical Psychological Science,1(2), 149-155.
INTERNET ADDICTION has become a prevailing problem in the modern wired society. One important line of research has examined the relationships among Internet abuse, social anxiety, and interpersonal relationships. Several studies have identified that people who are shy, have poor social skills, or experience a high level of interpersonal anxiety may be drawn to cyberspace relationships.
The social anxiety this study describes seems very similar to the “not being part of” or “not belonging to” that alcoholics and addicts frequently talk about. Many addicts say they never had the manual to know how to deal with other people hence it seems they had some form of social anxiety as the result of insecure relationships with primary care givers. Hence they found “friends” via the mediation of alcohol and drugs and these substances suddenly seem to endow them with the “chemical keys” to unlock the ability to act socially with other people, to be part of or “to act extemporaneously” to quote Bill Wilson, to act spontaneously, to act as if we had shed our anxiety straight jacket. We all felt more social, wittier, etc even if we were not in reality.
I felt I was “more me” when I started drinking initially, that this was the “real me” not the grey version of me when sober!
Alcohol had boosted my neurobiology in some way, my blood flowed better around my veins, my stress chemicals reduced, the neurotransmitters that were reduced seem to be repleted. I seemed to grow more into my body, be more alert, be more loving to my fellow human beings. I liked me more when drinking just as others seemed to.
I preferred this me, more than my sober me. Fact. Alcohol gave me something I could get by myself. This was my first “spirit awakening” in a sense. I could transform my self in minutes via substances and via certain behaviours. Spirit transformation.
Wears out. Drastically. Leaving me chronically addicted to everything.
I often wondered if I would be an internet addict myself if an adolescent now? The answer would be yes as I am an internet addict now!!
I use the internet so much it would be considered, by diagnostics, as internet addiction. I use it to write blogs, research, run my own business rather than to find cyber “love” but…I use it 7 hours or more every day! Is this internet addiction to add to my alcoholism, substance addiction, behavioural addictions, insecure attachment issues , PTSD etc.
When I engage in any behaviour I have to be aware of doing that behaviour way too much. If I want to do something, there is a sure fire guarantee that I will really, really want to do it more and more and….
This study (1) suggests “that the quality of parent–child relationship is indeed positively correlated to the quality of our participants’ interpersonal relationships and that frustrating interpersonal relationships may raise the level of social anxiety. In addition, interpersonal relationships, the parent–child relationship, and social anxiety all influence Internet addiction… Finally, the more social anxiety and discontent with their peer interactions the participants experienced, the more addicted they were to the Internet.
Other studies have explored whether the cyber-relationship substitutes for an unmet need in an actual relationship.3–5 Together, these studies indicate that cyber-relationships can provide a sense of belonging, warmth, and well-being.
A study by Bell et al. revealed that the parent–child relationship was a primary experience of the child, as parents retained a substantial influence on the development of adolescent social relationships outside the family (8).
Feldman and Wentzel also found that parental child-rearing style and social support from the family were positively associated with whether the adolescent was trusted or liked by his or her peers (9). These studies collectively suggested that warmth, support, acceptance, and love in the parent–child relationship are directly related to the child’s closeness to peers, satisfaction with peer relations, and acceptance by peers.
In this study, we identify predictors of Internet addiction by constructing a model from elucidating the linkages among Internet addiction, parent–child relationship, interpersonal relationships, and social anxiety. This finding is consistent with the positions of Suler and Young, who have said that addiction to the Internet is a reaction to poor adaptation in the real world (5,14).
Most individuals who are addicted to the Internet experience more social anxiety because of bad social skills and frustrated personal companionship, which in turn may be shaped by qualities of the parent–child relationship. Anxiety picked up from caregivers or parents in the early stages of development, however, can be overcome and social skills can be improved if people develop good relationships during adolescence(6).
1. Liu, C. Y., & Kuo, F. Y. (2007). A study of Internet addiction through the lens of the interpersonal theory. CyberPsychology & Behavior, 10(6), 799-804.
Following on from our recent blogs on who interpersonal factors (e.g. family and love relationships conflict and distress) can interact with intrapersonal factors (e.g. insecure attachment based rejection sensitivity, low self esteem) can prompt relapse.
Today we look at both a detailed video on the concept of the interpersonal neurobiology (INPB) of addiction. Our next blog will look at how this interpersonal model of addiction appears to effectively model internet addiction.
In this video author, professor and clinician Jon Daily illustrates how attunement and secure attachment affect one’s emotional, psychological and neurological development and, concomitantly, one’s regulatory systems and result in affect (emotion) regulation or dysregulation.
He makes the valid point that people regulate our emotions and behaviour and do so in every day life and have done so since we were babies and infants.
Just as caregivers contribute to insecure attachment and this leads to an impaired ability to regulate emotions, people in our adult lives can give us a secure attachment and help us greatly improve our ability to regulate our emotions and behaviour.
This for me is one of the reasons for “How it Works” in recovery. Fellow recovering people, reconstructed relationships with our loved ones and our relationship with a Higher Power allow us to gain secure attachments and higher self esteem, less rejection sensitivity and great emotional regulation. Hence the chances of relapse are greatly reduced.
Living with emotions, not running away from them.
‘Ernest Kurtz, who made landmark contributions to the study of addiction recovery, died January 19, 2015 of pancreatic cancer. Following publication of Not-God: A History of Alcoholics Anonymous in 1979, Kurtz focused his studies on the growing varieties of recovery experience, the healing of shame and guilt, and the role of spirituality in addiction recovery.
see William White’s personal tribute here – http://www.recoverystories.info/a-personal-tribute-ernie-kurtz-1935-2015-by-bill-white/
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.
In this two part blog we have considered evidence that shows intrapersonal traits (e.g. rejection sensitivity and low self esteem) and interpersonal environments (e.g. the family environment) can interact to increase an addict’s risk of relapse.
This study (1) concludes by proposing that substance-dependent individuals with high trait rejection sensitivity and a critical interpersonal environment are particularly vulnerable to relapse.
In the first part of this blog we looked mainly at intrapersonal (i.e. within the self) traits now we consider how these factors interact with interpersonal (relationships between individuals ) factors to often prompt relapse situations.
“Interpersonal Vulnerabilities to Addiction and Relapse
Perceived criticism (PC) and expressed emotion (EE) are related constructs that are used to measure criticism by family members directed toward the patient (36,37). EE—measured with a semi-structured interview—reflects the degree to which relatives refer to the patient in critical, hostile or over-involved ways (36).
O’Farrell et al. (36) found that alcoholic patients with high EE spouses are also more likely to relapse than their low EE counterparts. They proposed the development of a vicious cycle in which increased criticism leads to increased drinking, which leads to escalating criticism. They also found that behavioral marital therapy that aims to improve communication and decrease criticism reduced relapse in patients with high EE spouses (36).
The perceived criticism (PC) measure is operationalized using the single question “How critical is your spouse of you?” Similar to high EE, high PC—a far simpler measure that is less expensive to obtain than EE—significantly predicted relapse to substance use in a sample of alcohol dependent individuals (37).
Marital distress and spousal criticism are frequently associated with worse outcomes in treatment-seeking addicts (40,41). Family cohesion has been shown to significantly predict the severity of a person’s dysfunction resulting from drug use (42), and one study reported that spousal conflict was most frequently identified by male alcoholics as the cause of their relapse (43).
Booth et al. (40) showed that support from family and friends, specifically “reassurance of worth,” significantly predicted improved treatment outcomes even in patients with high rates of prior recidivism.
They argued that enhancing an alcoholic’s sense of self-worth would increase the individual’s likelihood of recovery and called for treatment interventions that focus on enhancing social support (40). Consistent with this approach, numerous studies have shown a positive association between supportive family and friends and improved drug and alcohol treatment outcomes and enhanced psychological functioning (44,45,46,47).
Individuals who are unable effectively to regulate the negative affective states elicited by interpersonal conflict are at greater risk of becoming substance dependent and to persist in their use of alcohol and drugs despite adverse consequences (48,49). For instance, fMRI studies have repeatedly shown that threatening social cues elicit increased amygdala reactivity. Sripada et al. (48) showed that alcohol attenuates this reactivity and hypothesized that alcohol’s ability to reduce stress and anxiety is mediated by its attenuation of threat processing in the amygdala (48).
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.”
As the Big Book suggests “All members of the family should meet upon the common ground of tolerance, understanding and love…Cessation of drinking is but the first step away from a highly strained, abnormal condition…”Years of living with an alcoholic is almost sure to make any wife or child neurotic. The entire family is, to some extent, ill.” Let families realize, as they start their journey, that all will not be fair weather….”
Indeed, the family needs to recover not just the obvious candidate of the alcoholic/addict. This is a family illness and everyone in the family needs to support each other in their recovery. This hard earned wisdom often seems the profound and most profitable to all.
The NCADD state the notion of family disease clearly …
“Alcoholism and drug addiction affects the whole family – young, teenage, or grown-up children; wives or husbands; brothers or sisters; parents or other relatives and friends. One family member addicted to alcohol and drugs means the whole family suffers. Addiction is a family disease that stresses the family to the breaking point, impacts the stability of the home, the family’s unity, mental health, physical health, finances, and overall family dynamics.
Without help, active addiction can totally disrupt family life and cause harmful effects that can last a lifetime.
Regrettably, no family is born with the knowledge of how to deal effectively with addiction. It is a skill that must be learned and practiced daily.
But, with the proper help and support, family recovery has become a reality for millions!”
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.
2. Alcoholics Anonymous. (2001). Alcoholics Anonymous, 4th Edition. New York: A.A. World Services.
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