I am what I am: A meta-analysis of the association between substance user identities and substance use-related outcomes

Related metacognitions, desire thinking and identity differentially predict compulsion and withdrawal symptoms in problematic Instagram use

Work has identified that metacognitive thought results in desire-based thinking and perpetuates the magnitude and severity of maladaptive behaviour including problematic social media use, and also that one's ingroup identity is related to increasing problematic behaviour. No evidence has ascertained the relative contribution of these as related differential factors in the experience of problematic social media use. The current study explored the comparative importance of components of desire thinking, positive and negative metacognitions and dimensions of ingroup identity on degree of problematic use among 147 current Instagram users. Results showed that for predicting general problematic Instagram use negative metacognitive beliefs and the verbal perseverance component of desire-based thinking were significant. Importantly, however, different factors appeared to be important for predicting distinct aspects of problematic Instagram. For compulsivity indicators, negative metacognitions and verbal perseveration were essential, whereas for the withdrawal component identity centrality (and no other dimensions of identity) and imaginal prefiguration emerge as the sole independent predictors.

Does identity as a drinker predict problem recognition motivation in harmful drinkers?

Harmful drinking is associated with significant negative health and social outcomes, but drinkers are reticent to recognise personal drinking problems, hindering natural recovery or help-seeking. Recent evidence suggests that social identity as a drinker is associated with various drinking-related factors but has not been examined in relation to likelihood of problem recognition. In a group of ninety-six harmful drinkers (61 females, M age = 34 years) we explored how identity components associated with ingroup self-investment and ingroup self-definition in combination with implicit identity as a drinker accounted for degrees of problem recognition. In addition to demographic information, addiction experience and drinking behaviour (AUDIT), respondents completed measures of ingroup self-investment (identity centrality, solidarity, and satisfaction), ingroup self-definition (ingroup homogeneity and self-stereotyping), a "self as drinker" identity implicit association test and problem recognition (four items from the Stages of Change Readiness and Treatment Eagerness Scale). After controlling for possible covariates (age, gender and alcohol addiction experience) increased problem recognition was accounted for by explicit and not implicit identity components. More specifically, increasing perceived chronic saliency of one's drinker identity (self-investment in the drinker ingroup) and not an implicit association between the self and being a drinker was related to increased likelihood of problem recognition. This suggests that how chronically and explicitly accessible the identity of the drinker is for individuals might operate to stimulate the willingness or motivation to recognise potential drinking related harm.

Investigating cognitive and motivational proximal outcomes in a randomized clinical trial of writing about the future self to reduce drinking

BACKGROUND

Drinking identity (the extent to which one links the self with drinking alcohol) is a unique risk factor for college students' hazardous drinking that is not directly targeted by existing interventions. We conducted a study that aimed to decrease drinking identity among college students with hazardous drinking. We adapted a writing task about the future self and tested whether three writing sessions could decrease drinking identity and change drinking. We also investigated whether two additional factors (writing perspective and inclusion of participants' social networks) would enhance task impact. The present study evaluated whether posited proximal cognitive and motivational outcomes (drinking identity, self-efficacy, readiness to change, and drinking intentions) changed immediately after each writing session.

METHOD

The study is a randomized clinical trial in which hypotheses and analyses were pre-registered. Participants were 328 college students who met hazardous drinking criteria. The study had a 2 (narrative writing topic: low-risk drinker vs. reduced smartphone use) × 2 (writing perspective: first-person vs. non-first-person) × 2 (social network instruction: instructed to include vs. not) factorial design. Proximal outcomes were drinking identity, self-efficacy, readiness to change, and drinking intentions. The clinical outcome was alcohol consumption. Participants completed three laboratory sessions at weekly intervals that included the writing task and pre- and post-task assessments.

RESULTS

Results were largely null, except that readiness to reduce drinking was higher in the low-risk drinker condition and increased over the lab sessions. Time effects indicated that reductions in drinking identity, drinking intentions, and alcohol consumption, and increases in self-efficacy were observed but did not change above and beyond control conditions.

CONCLUSIONS

Findings indicate the need to strengthen the writing task and select a more appropriate control task to target proposed proximal outcomes. Future studies might try personalizing the task, evaluating its efficacy with individuals motivated to change their drinking, and using a control task that does not involve imagining a future self.

Writing about the future self to shift drinking identity: An experimental investigation

College student drinking is prevalent and costly to public and personal health, leading to calls to identify and target novel mechanisms of behavior change. We aimed to manipulate drinking identity (a cognitive risk factor for hazardous drinking) via three sessions of narrative writing about a future self. We tested whether writing could shift drinking identity and would be accompanied by changes in alcohol consumption and problems. Participants were college students meeting hazardous drinking criteria (N = 328; Mage = 20.15; 59% women, 40% men, 1% gender-diverse; 60% white; 23% Asian; 12% multiple races; 2% other racial groups; 8% identified as Hispanic/Latino/a/x). The study had a 2 [narrative writing topic: low-risk drinker vs. reduced smartphone use] × 2 [writing perspective: first person vs. non-first-person] × 2 [social network instruction: instructed to include vs. not] factorial design. Outcomes were drinking identity, drinking refusal self-efficacy, alcohol consumption, alcohol-related problems, and craving. Participants completed three writing sessions and online follow-up assessments at 2, 4, and 12 weeks. The study is a registered clinical trial; hypotheses and analyses were preregistered (https://osf.io/vy2ep/). Contrary to predictions, narrative writing about a future self as a low-risk drinker did not significantly impact outcomes. Null results extended to expected interactions with writing perspective and social network instructions. The narrative writing task did not shift drinking or alcohol-related outcomes. Future experimental work may benefit from greater flexibility in conceptualizing a future self, recruiting individuals interested in behavior change, and more sensitive measures of drinking identity.

Components of identity expression in problem and non-problem gamblers

Few studies have examined whether specific aspects of group identification predict problematic and non-problematic addictive behaviours and none have focused on gambling. Applying Leach et al.'s (2008) hierarchical model of in-group identification, we tested the associations between components of self-investment (satisfaction, solidarity, and centrality) and components of self-definition (individual self-stereotyping, in-group homogeneity) on distinguishing between problem and non-problem gambling (n = 10,157) and on the severity of problematic gambling behaviour (n = 2,568). Results showed that (i) in-group-based identities are important in predicting problematic vs. non-problematic gambling behaviours; (ii) in-group-based identities are important in predicting the severity of problematic gambling; (iii) how self-invested an individual is with their in-group and aspects associated with self-definition processes are both important predictors; (iv) perceptions related to how chronically salient one's group membership is for the self (centrality) are essential features of the self-investment mechanism; and (v) self-stereotypical beliefs about one's essential similarities to the prototypical gambling group member norm are fundamental for the defining oneself as a gambler.

Associations of childhood poly-adversity with alcohol problems among undergraduates: adolescent alcohol use trajectories and drinker self-schema

OBJECTIVE

Undergraduate drinking is associated with childhood adversity, early alcohol experience, and drinker self-schema. However, the pathway linking childhood adversity to undergraduate drinking problems remains undefined. This study aimed to identify the effects of childhood poly-adversity on the sequelae of adolescent alcohol-use trajectory, drinker self-schema, and alcohol problems among undergraduates. We also examined whether adolescent alcohol-use trajectory and drinker self-schema mediated the effects of childhood poly-adversity on undergraduate alcohol problems.

METHODS

Baseline data from an ongoing prospective study, which included 851 first- and second-year full-time college students in Taiwan, were used. An anonymous online questionnaire was administered.

RESULTS

The results showed that low poly-adversity and high poly-adversity were associated with the mean of initial alcohol use frequency during adolescence and further alcohol problems at college than those with no adversity. High poly-adversity was also associated with the increase in alcohol use frequency during adolescence. Both initial and increase in alcohol use frequency were associated with higher drinker self-schema scores and further alcohol problems. The indirect effects of high poly-adversity on undergraduate alcohol problems were mediated through adolescent alcohol-use trajectories and drinker self-schema.

CONCLUSION

Findings suggest that early identification of childhood poly-adversity and interventions to decrease adolescent drinking may prevent the formation of drinker self-schema and reduce undergraduate drinking problems.

Normative Perceptions of Sexual Behavior and Alcohol Use among Bisexual Women

Background: As compared to heterosexual and lesbian women, bisexual women report higher rates of alcohol, other substance use, and risky sexual behavior, and they experience more negative outcomes from these behaviors. Descriptive norms (i.e., perceptions of others' behavior) are an important predictor of risky behaviors, but scant research has examined whether bisexual women's perceptions of other bisexual women's alcohol use and sexual behavior are associated with their own alcohol or drug use during sex. Objectives: Consequently, the present study examined (1) whether perceived sex norms were related to engagement in sex and (2) the relative influence of drinking and sex norms on engaging in sex while drinking among bisexual women. Method: Data were collected from 225 self-identified bisexual women who completed an online survey about their typical weekly alcohol use, engagement in alcohol or drug use during sex in the past 30 days, and normative perceptions of drinking and sexual behavior. Results: Regression models demonstrated both sexual norms and drinking frequency norms were positively associated with alcohol or drug use during sex. In addition, only perceived norms of other bisexual women, compared to perceived norms of lesbian and heterosexual women, predicted engagement in sex. Conclusions: Bisexual women may be susceptible to normative perceptions, given their connectedness to a marginalized social group. Thus, alcohol prevention and intervention efforts aimed at reducing risky consequences among bisexual women should specifically consider drinking and sexual norms of other bisexual women.

A Mixed-Methods Examination of Language Used by College Students to Describe Alcohol Recovery

Given that approximately 5% of the U.S. population is currently attending college, research is needed to better understand the language that college students use to describe alcohol recovery regardless of their current drinking behavior. College student perceptions of alcohol recovery are important, given that students may experience an alcohol use disorder themselves or may encounter others with an alcohol use disorder. Research on college student perceptions of alcohol recovery in the literature is scarce but is needed to better understand the alcohol recovery process. The current mixed-methods study examines language that college students use to describe alcohol recovery based on findings from two focus group interviews. The focus groups were conducted with college students who reported using alcohol at least once in their lifetime. All participants (N = 18) were asked questions regarding language perceived to be associated with alcohol recovery. Data were examined within a thematic analysis framework. The three central themes related to alcohol recovery that emerged in the study were harm reduction-based recovery, abstinence-based recovery, and social correlates of recovery. College students rated the terms "recovered," "drinking reduction," and "sobriety" as being highly representative of being in recovery, whereas the terms "bars" and "light drinker" were identified as not being representative of recovery. A better understanding of these themes will help the field understand the language that college students use to describe alcohol recovery.

Predictors of changes in running and smoking identity among individuals in the Run to Quit smoking cessation program

OBJECTIVES

Multiple health behaviour change is a viable strategy to promote health outcomes. An example is the use of running behaviour to support smoking cessation in the group-mediated Run to Quit program. On the basis that changes in running and smoking identity were related to changes in running and smoking behaviour among individuals in the Run to Quit program, the purpose of this study was to extend these findings by examining key predictors of change in both running and smoking identity.

METHODS

We analyzed data collected from 450 adult individuals (70.67% female, and 92.44% white) during the program evaluation of Run to Quit from 2016 to 2018. Participants completed assessments at week 1 (baseline), week 3 (mid-program), and week 10 (follow-up) of the program. Relevant predictor variables for change in identity were identified by drawing from theory (identity theory, identity control theory, physical activity self-definition model, social identity theory) and past research regarding exercise and smoking identity. Potential predictors of changes in running and smoking identity included changes in behaviour, self-efficacy, perceptions of the social environment (task and social cohesion, descriptive norms), as well as smoking identity and running identity, respectively. Two regression models, using residualized change scores (for each variable) and relative Pratt indices, were constructed for both running and smoking identity.

RESULTS

Changes in running self-efficacy, running frequency, and individual attractions to the group exercise tasks were significant and meaningful predictors of change in running identity, whereas changes in objectively measured smoking behaviour and running identity were significant and meaningful predictors of change in smoking identity.

CONCLUSION

Consistent with identity theories and past research, ensuring individuals develop a sense of efficacy and enjoy group exercise tasks both represent viable strategies to enhance exercise identity. Including an exercise component within smoking cessation programs may help individuals replace their existing smoking identity with a healthier exercise identity.

The nomological network of drinker identity: A scoping review

BACKGROUND

Despite the growing interest in the construct of drinker identity and empirical evidence for its role in drinking behavior, there is a paucity of papers that evaluate and integrate the results of studies on drinker identity, leaving a gap in our knowledge of the importance of the drinker identity construct. The current paper addresses this gap by reviewing and integrating the results of the studies of drinker identity.

METHODS

The scoping review identified, retrieved, and evaluated the existing literature regarding drinker identity. English language studies from EBSCOHost, PubMed, ScienceDirect, and Scopus databases were reviewed. Studies were included in the review if they were data-based studies or theoretical publications with drinker identity as the primary topic published in peer-reviewed journals. Studies were reviewed and coded based on their reported methodology and findings and codes were used to integrate and present findings.

RESULTS

This review advances this line of research in four ways. First, the operationalization of drinker identity is evaluated by examining the theoretical frameworks defining the construct. Second, the conceptualization and measurement of drinker identity is assessed, with suggestions for future measurement research. Third, an integrated framework of predictors, outcomes, moderators, and mediators is presented. Finally, the research gaps, future recommendations, and clinical implications are discussed.

CONCLUSIONS

There is a need for continued research, specifically research which aims to standardize and improve measurement of drinker identity, considers longitudinal and developmental processes, and broadens the research samples and settings.

Individual differences in selective attentional bias for healthy and unhealthy food-related stimuli and social identity as a vegan/vegetarian dissociate "healthy" and "unhealthy" orthorexia nervosa

Previous work identified the operation of an attentional bias (AB) towards healthy food related stimuli among those with increasing tendencies towards orthorexia nervosa (ON) using a modified Stroop task. The current work aimed to replicate and extend our understanding of this effect by incorporating alternative measures of AB (i.e., the dot probe task) and ON (i.e., the Teruel Orthorexia Scale [ToS]) in a sample of self-defined vegans/vegetarians. The theoretical assertion of the ToS is the conceptual broadening of orthorexia with differentiable dimensions - one characterised as a "healthy" preoccupation with healthy food/eating patterns (HeOr) and the other by a more underlying pathology (OrNe). This study also aimed to examine the pattern of responding across these two dimensions according to factors known to predict ON. Eighty-six participants (mean age = 33.0 years; 20 males, 66 females) completed measures of obsessive compulsivity, perfectionism, state/trait anxiety and ToS as well as a dot probe designed to measure AB for healthy and unhealthy-related food stimuli, threat ratings of each of words utilised and perceived identity centrality as a vegan/vegetarianism. Results showed a dissociation of predicted determinants for "healthy" ON (HeOr) and pathological ON (OrNe). HeOr was predicted by increasing identity centrality whereas OrNe was predicted by increased OCD and perfectionism, and increased interference for healthy-related food words (in particular slowed disengagement) and not unhealthy related food words. Threat-related ratings of unhealthy food words was shown to be common across both dimensions. This pattern highlights cognitive and individual differences-based correlates of pathological and non-pathological ON.

Mapping the evidence on identity processes and identity-related interventions in the smoking and physical activity domains: a scoping review protocol

INTRODUCTION

Smoking and insufficient physical activity (PA), independently but especially in conjunction, often lead to disease and (premature) death. For this reason, there is need for effective smoking cessation and PA-increasing interventions. Identity-related interventions which aim to influence how people view themselves offer promising prospects, but an overview of the existing evidence is needed first. This is the protocol for a scoping review aiming to aggregate the evidence on identity processes and identity-related interventions in the smoking and physical activity domains.

METHODS

The scoping review will be guided by an adaption by Levac et al of the 2005 Arksey and O'Malley methodological framework, the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses: Extension for Scoping Review (PRISMA-ScR) and the 2017 Joanna Briggs Institute guidelines. It will include scientific publications discussing identity (processes) and/or identity-related interventions in the context of smoking (cessation) and/or physical (in)activity, in individuals aged 12 and over. A systematic search will be carried out in multiple databases (eg, PubMed, Web of Science). Records will be independently screened against prepiloted inclusion/exclusion criteria by two reviewers, using the Active Learning for Systematic Reviews machine learning artificial intelligence and Rayyan QCRI, a screening assistant. A prepiloted charting table will be used to extract data from included full-text articles. Findings will be reported according to the PRISMA-ScR guidelines and include study quality assessment.

ETHICS AND DISSEMINATION

Ethical approval is not required for scoping reviews. Findings will aid the development of future identity-related interventions targeting smoking and physical inactivity.

Mechanisms of Behavior Change in Substance Use Disorder With and Without Formal Treatment

This article provides a narrative review of studies that examined mechanisms of behavior change in substance use disorder. Several mechanisms have some support, including self-efficacy, craving, protective behavioral strategies, and increasing substance-free rewards, whereas others have minimal support (e.g., motivation, identity). The review provides recommendations for expanding the research agenda for studying mechanisms of change, including designs to manipulate putative change mechanisms, measurement approaches that expand the temporal units of analysis during change efforts, more studies of change outside of treatment, and analytic approaches that move beyond mediation tests. The dominant causal inference approach that focuses on treatment and individuals as change agents could be expanded to include a molar behavioral approach that focuses on patterns of behavior in temporally extended environmental contexts. Molar behavioral approaches may advance understanding of how recovery from substance use disorder is influenced by broader contextual features, community-level variables, and social determinants of health. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Investigating Healthcare Provider Bias Toward Patients Who Use Drugs Using a Survey-based Implicit Association Test: Pilot Study

OBJECTIVES

Negative bias against people who use illicit drugs adversely affects the care that they receive throughout the hospital. We hypothesized that emergency providers would display stronger negative bias toward these patients due to life-threatening contexts in which they treat this population. We also hypothesized that negative implicit bias would be associated with negative explicit bias.

METHODS

Faculty, nurses, and trainees at a midwestern tertiary care academic hospital were invited (June 26, 2019-September 5, 2019) to complete an online implicit association test and explicit bias survey.

RESULTS

Mean implicit association test results did not vary across demographics (n = 79). There were significant differences in explicit bias scores between departments regarding whether patients who use drugs deserve quality healthcare access (P = 0.017). We saw no significant associations between implicit and explicit bias scores.

CONCLUSION

Though limited by sample size, the results indicate that emergency and obstetrics/gynecology providers display more negative explicit bias toward this patient population than other providers.