self schema and addiction

Filling the Empty Self

Posted on by alcoholicsguide

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

Posted on by alcoholicsguide

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.