The autobiography of addiction: autobiographical reasoning and psychological adjustment in abstinent alcoholics

A study on the social contract conditional reasoning of male substance abusers during detoxification

Previous studies on social contract reasoning of male substance abusers only examined individuals who are using drugs, and most of them compared social contract and nonsocial contract reasoning, and paid less attention to the characteristics of social contract reasoning of substance abusers during withdrawal. In addition, there is little research on the difference between the standard social contract rules and the switched social contract rules. To further explore this issue, experiment 1 examined the differences between 110 male substance abusers' conditional reasoning for descriptive and social contract rules; Experiment 2 examined the differences between 110 other male substance abusers' conditional reasoning for standard and switched social contracts. Results: (1) for male substance abusers, the performance of social contract conditional reasoning is significantly better than descriptive conditional reasoning; (2) the performance of standard social contract rules is significantly better than that of switched social contract rules.

Characteristics of alcohol recovery narratives: Systematic review and narrative synthesis

BACKGROUND AND AIMS

Narratives of recovery from alcohol misuse have been analysed in a range of research studies. This paper aims to produce a conceptual framework describing the characteristics of alcohol misuse recovery narratives that are in the research literature, to inform the development of research, policy, and practice.

METHODS

Systematic review was conducted following PRISMA guidelines. Electronic searches of databases (Ovid MEDLINE, EMBASE, CINHAL, PsychInfo, AMED and SCOPUS), grey literature, and citation searches for included studies were conducted. Alcohol recovery narratives were defined as "first-person lived experience accounts, which includes elements of adversity, struggle, strength, success, and survival related to alcohol misuse, and refer to events or actions over a period of time". Frameworks were synthesised using a three-stage process. Sub-group analyses were conducted on studies presenting analyses of narratives with specific genders, ages, sexualities, ethnicities, and dual diagnosis. The review was prospectively registered (PROSPERO CRD42021235176).

RESULTS

32 studies were included (29 qualitative, 3 mixed-methods, 1055 participants, age range 17-82years, 52.6% male, 46.4% female). Most were conducted in the United States (n = 15) and Europe (n = 11). No included studies analysed recovery narratives from lower income countries. Treatment settings included Alcoholic Anonymous (n = 12 studies), other formal treatment, and 'natural recovery'. Eight principle narrative dimensions were identified (genre, identity, recovery setting, drinking trajectory, drinking behaviours, stages, spirituality and religion, and recovery experience) each with types and subtypes. All dimensions were present in most subgroups. Shame was a prominent theme for female narrators, lack of sense of belonging and spirituality were prominent for LGBTQ+ narrators, and alienation and inequality were prominent for indigenous narrators.

CONCLUSIONS

Review provides characteristics of alcohol recovery narratives, with implications for both research and healthcare practice. It demonstrated knowledge gaps in relation to alcohol recovery narratives of people living in lower income countries, or those who recovered outside of mainstream services.

PROTOCOL REGISTRATION

Prospero registration number: CRD42020164185.

A Temporal Profile of pro-abstinence-oriented Constructs from The Modified Theory of Planed Behavior in a Slovenian Clinical Sample of Treated Alcoholics - an 18-year Follow-up

Introduction

Using the modified Theory of Planned Behaviour (mTPB), different indicators of therapeutic success were studied to understand pro-abstinence behavioural orientation during an 18-year after-care period following a 3-month intensive alcoholism treatment. The indicators were: perceived needs satisfaction (NS), normative differential (ND), perceived alcohol utility (UT), beliefs about treatment programme benefits (BE) and behavioural intentions (BI).

Methods

The sample of 167 patients who consecutively started an intensive alcoholism treatment programme has been followed-up for 18 years, using standardised ailed instruments at the end of the treatment, and in the years 4-5, 9 and 18 of follow-up. The last data collection was completed by 32 subjects in 2010. The analysis followed the standard explore-analyse-explore approach. After the initial descriptive exploration of data, multivariate analysis of variance (MANOVA) in SPSS statistical package was set to explore between-groups and within-groups differences over time.

Results

At the between-group level, BI remained stable at the same level as at the end of the treatment programme, whereas BE and UT robustly changed over time and levelled off after 10 years of follow-up. NS and ND show a trend of pro-abstinent orientation and level off after 10 years of follow-up, although the trend is not significant. The same results were confirmed by the within-subject level.

Conclusions

Studied constructs stabilised after ten years of follow-up, apart from BI. The latter suggests that BI level needed for completion of an intensive treatment programme suffices for the maintenance of abstinence when accompanied by the change in perception of alcohol usefulness.

A temporal profile of pro-abstinence-oriented constructs from the modified theory of planed behavior in a Slovenian clinical sample of treated alcoholics – an 18-year follow-up

Introduction

Using the modified Theory of Planned Behaviour (mTPB), different indicators of therapeutic success were studied to understand pro-abstinence behavioural orientation during an 18-year after-care period following a 3-month intensive alcoholism treatment. The indicators were: perceived needs satisfaction (NS), normative differential (ND), perceived alcohol utility (UT), beliefs about treatment programme benefits (BE) and behavioural intentions (BI).

Methods

The sample of 167 patients who consecutively started an intensive alcoholism treatment programme has been followed-up for 18 years, using standardised ailed instruments at the end of the treatment, and in the years 4-5, 9 and 18 of follow-up. The last data collection was completed by 32 subjects in 2010. The analysis followed the standard explore-analyse-explore approach. After the initial descriptive exploration of data, multivariate analysis of variance (MANOVA) in SPSS statistical package was set to explore between-groups and within-groups differences over time.

Results

At the between-group level, BI remained stable at the same level as at the end of the treatment programme, whereas BE and UT robustly changed over time and levelled off after 10 years of follow-up. NS and ND show a trend of pro-abstinent orientation and level off after 10 years of follow-up, although the trend is not significant. The same results were confirmed by the within-subject level.

Conclusions

Studied constructs stabilised after ten years of follow-up, apart from BI. The latter suggests that BI level needed for completion of an intensive treatment programme suffices for the maintenance of abstinence when accompanied by the change in perception of alcohol usefulness.

Addictive behaviors: Why and how impaired mental time matters?

Mental time travel (MTT) allows navigation into the past, the future, and the minds of others, and it subserves future-oriented decision-making. Impaired MTT has been associated with a tendency to over-rely on the present, which is a characteristic of addictive behaviors. We here discuss the possible relationship between impaired autographical memory, future-oriented MTT, shortened time horizons, suboptimal social cognition, and poor decision-making in individuals with drug and gambling use disorders. We elaborate on how impaired MTT could compromise the process of change in addiction recovery and the effectiveness of psychotherapy. We argue that facilitating MTT represents, for individuals with addictive behaviors, an important process to enhance readiness to change, and to improve the quality and the efficiency of psychosocial interventions that focus on "emotional correction."

Autobiographical memory compromise in individuals with alcohol use disorders: Towards implications for psychotherapy research

It has been found that Autobiographical memory (i.e., memory for personal experiences and facts about the self) are not properly maintained in people with alcohol-use disorders (AUD). The present paper offers a comprehensive overview of findings regarding the consequences of AUD on autobiographical memory. More specifically, we offer a theoretical model (the AMAUD Autobiographical Memory and Alcohol Use Disorders model) according to which chronic alcohol consumption compromises emotion regulation as well as executive control, which maintains the construction of autobiographical memory. Compromises in emotional regulation and executive functioning can be linked to a weak aspiration to construct detailed memories (i.e., autobiographical overgenerality), compromises of subjective reliving, anterograde amnesia, negative self-defining memories, and a difficulty to mentally project oneself forward in time to generate complex autobiographical representations and self-images. By gathering cognitive and clinical aspects of autobiographical decline in AUD, this model constitutes a theoretical foundation that may lead to a better understanding of this decline. Different clinical perspectives are proposed for developing personalized autobiographical memory rehabilitation programs for individuals with AUD.

Self-defining memories in recently detoxified alcohol-dependent patients

Patients with alcohol dependence have been shown to be impaired in recalling specific autobiographical events, yet little is known on how changes in the memory of these events may impact their self-representation. In this study, we examined Self-Defining Memories (SDMs), a specific type of autobiographical memory that plays a key role in the construction of personal identity, in 25 patients with alcohol dependence, abstinent from alcohol from 10 days to 6 months, compared to 28 control subjects. We observed that SDMs in patients were significantly less specific and included more reference to alcohol than those of controls. Patients also reported more SDMs with negative emotional valence and higher emotional intensity. These results suggest that recently abstinent alcohol-dependent patients may be prone to define themselves by negative events referring to alcohol consumption, which may contribute to an unfavorable perception of their self and subsequently of their ability to remain abstinent. These findings should be taken into account to optimize psychological approaches in the treatment of alcohol-dependence.

Down on the upside: redemption, contamination, and agency in the lives of adult children of alcoholics

We investigated differences in the nature and implications of Adult Children of Alcoholics (ACOAs; n = 53) and non-ACOAs' (n = 80) narrative identities. Participants described six autobiographical narratives and completed measures of emotional functioning. Narratives were coded for redemptive (bad things turning good), contaminated (good things turning bad), and agentic (perceived control) imagery. ACOAs exhibited similar levels of redemptive and contaminated imagery, and lower levels of agency in their narratives, relative to non-ACOAs. In addition, themes of redemption, contamination, and agency corresponded divergently with emotional functioning. Among ACOAs, narrative redemption and agency were related to poorer emotional functioning whereas, among non-ACOAs, narrative contamination predicted poorer emotional functioning. These findings provide indication of the manner in which ACOAs story their lives. They also align with the emerging area of research noting that, among certain vulnerable populations, redemptive and agentic imagery serve as predictors of maladaptive functioning.

The Autobiographical Author Through Time

We examined continuity and change in the tendencies to construct a life story (i.e., narrative identity) that was redemptive or contaminated in nature. In Study 1, college freshmen and seniors wrote accounts of several autobiographical key scenes pertinent to narrative identity twice over a 3-year period. In Study 2, midlife adults provided, via a semistructured interview, key scenes twice over a 5-year period and also indicated whether their employment status had changed between assessments. Across studies, the rank-order consistency of redemptive and contaminated stories was moderate and low to moderate, respectively. In Study 1, the frequency of redemptive and contaminated stories increased throughout college. Furthermore, the frequency of contaminated stories decreased following graduation. In Study 2, changes in employment status corresponded with reduced redemptive imagery. These results suggest a possible narrative acculturation of young adults as well as a correspondence between changes in life circumstances and narrative identity.

The Incremental Validity of Narrative Identity in Predicting Well-Being

Grounded in four theoretical positions—structural, cognitive, phenomenological, and ethical—the present review demonstrates the empirical evidence for the incremental validity of narrative identity as a cross-sectional indicator and prospective predictor of well-being, compared with other individual difference and situational variables. In doing so, we develop an organizational framework of four categories of narrative variables: (a) motivational themes, (b) affective themes, (c) themes of integrative meaning, and (d) structural elements. Using this framework, we detail empirical evidence supporting the incremental association between narrative identity and well-being, a case that is strongest for motivational, affective, and integrative meaning themes. These categories of themes serve as vital complimentary correlates and predictors of well-being, alongside commonly assessed variables such as dispositional personality traits. We then use the theoretically grounded review of the empirical literature to develop concrete areas of future research for the field.

Meaning making, adversity, and regulatory flexibility

Despite the widely accepted belief that meaning making is essential for mental health following adversity, the available research continues to provide mixed findings: meaning making is sometimes evident, sometimes not, and more frequently than we would expect associated with poor health outcomes. The papers that comprise this special issue of Memory put flesh to those bones by approaching the question from a narrative memory perspective. Meaning making, these studies demonstrate, is a multi-faceted phenomenon and whether it is necessary or adaptive depends on which particular form of meaning making is considered and on the context and timing in which it occurs. To situate these insights in a broader framework I consider parallels with the emergent literature on regulatory flexibility and briefly review recent research and theory on that construct as it has been applied in the literatures on coping and emotion regulation. Finally, I close by suggesting a basic framework, informed by the flexibility construct, that might guide future research on meaning making.