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Sibley AL, Baker R, Levander XA, Rains A, Walters SM, Nolte K, Colston DC, Piscalko HM, Schalkoff CA, Bianchet E, Chen S, Dowd P, Jaeb M, Friedmann PD, Fredericksen RJ, Seal DW, Go VF. "I am not a junkie": Social categorization and differentiation among people who use drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 114:103999. [PMID: 36905779 PMCID: PMC10066877 DOI: 10.1016/j.drugpo.2023.103999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Substance use stigma is a form of group-based exclusion, and delineating pathways from stigma to poor health requires a deeper understanding of the social dynamics of people who use drugs (PWUD). Outside of recovery, scant research has examined the role of social identity in addiction. Framed by Social Identity Theory/Self-Categorization Theory, this qualitative study investigated strategies of within-group categorization and differentiation among PWUD and the roles these social categories may play in shaping intragroup attitudes, perceptions, and behaviors. METHODS Data come from the Rural Opioid Initiative, a multi-site study of the overdose epidemic in rural United States. We conducted in-depth interviews with people who reported using opioids or injecting any drug (n=355) living in 65 counties across 10 states. Interviews focused on participants' biographical histories, past and current drug use, risk behaviors, and experiences with healthcare providers and law enforcement. Social categories and dimensions along which categories were evaluated were inductively identified using reflexive thematic analysis. RESULTS We identified seven social categories that were commonly appraised by participants along eight evaluative dimensions. Categories included drug of choice, route of administration, method of attainment, gender, age, genesis of use, and recovery approach. Categories were evaluated by participants based on ascribed characteristics of morality, destructiveness, aversiveness, control, functionality, victimhood, recklessness, and determination. Participants performed nuanced identity work during interviews, including reifying social categories, defining 'addict' prototypicality, reflexively comparing self to other, and disidentifying from the PWUD supra-category. CONCLUSION We identify several facets of identity, both behavioral and demographic, along which people who use drugs perceive salient social boundaries. Beyond an addiction-recovery binary, identity is shaped by multiple aspects of the social self in substance use. Patterns of categorization and differentiation revealed negative intragroup attitudes, including stigma, that may hinder solidary-building and collective action in this marginalized group.
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Affiliation(s)
- Adams L Sibley
- Department of Health Behavior, UNC Gillings School of Global Public Health, 170 Rosenau Hall CB #7400, 135 Dauer Dr., Chapel Hill, NC, 27599, USA.
| | - Robin Baker
- OHSU-PSU School of Public Health, Oregon Health & Science University, 1805 SW 4th Ave, Suite 510, Portland, OR, 97201, USA
| | - Ximena A Levander
- Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Alex Rains
- University of Chicago Pritzker School of Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Suzan M Walters
- Department of Epidemiology, School of Global Public Health, New York University, 708 Broadway, New York, NY 10003, USA
| | - Kerry Nolte
- Department of Nursing, College of Health and Human Services, University of New Hampshire, Hewitt Hall, 4 Library Way, Durham, NH, 03824, USA
| | - David C Colston
- Department of Health Behavior, UNC Gillings School of Global Public Health, 170 Rosenau Hall CB #7400, 135 Dauer Dr., Chapel Hill, NC, 27599, USA
| | - Hannah M Piscalko
- Division of Epidemiology, The Ohio State University College of Public Health, Cunz Hall 1841 Neil Ave, Columbus, OH, 43210, USA
| | - Christine A Schalkoff
- Department of Health Behavior, UNC Gillings School of Global Public Health, 170 Rosenau Hall CB #7400, 135 Dauer Dr., Chapel Hill, NC, 27599, USA
| | - Elyse Bianchet
- Baystate Medical Center, University of Massachusetts, Office of Research, UMass Chan Medical School-Baystate, 3601 Main Street, 3rd Floor, Springfield, MA, 01199, USA
| | - Samuel Chen
- University of Chicago Pritzker School of Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Patrick Dowd
- Baystate Medical Center, University of Massachusetts, Office of Research, UMass Chan Medical School-Baystate, 3601 Main Street, 3rd Floor, Springfield, MA, 01199, USA
| | - Michael Jaeb
- School of Nursing, University of Wisconsin-Madison, 4244 #4 Signe Skott Cooper Hall, 701 Highland Avenue, Madison, WI, 53705, USA
| | - Peter D Friedmann
- Baystate Medical Center, University of Massachusetts, Office of Research, UMass Chan Medical School-Baystate, 3601 Main Street, 3rd Floor, Springfield, MA, 01199, USA
| | - Rob J Fredericksen
- University of Washington Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA
| | - David W Seal
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2210, New Orleans, LA, 70112, USA
| | - Vivian F Go
- Department of Health Behavior, UNC Gillings School of Global Public Health, 170 Rosenau Hall CB #7400, 135 Dauer Dr., Chapel Hill, NC, 27599, USA
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Conneely M, McNamee P, Gupta V, Richardson J, Priebe S, Jones JM, Giacco D. Understanding Identity Changes in Psychosis: A Systematic Review and Narrative Synthesis. Schizophr Bull 2020; 47:309-322. [PMID: 32989443 PMCID: PMC7965068 DOI: 10.1093/schbul/sbaa124] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Experiencing psychosis can be associated with changes in how people see themselves as individuals and in relation to others (ie, changes in their identity). However, identity changes receive little attention in treatment, possibly due to a lack of clarity or consensus around what identity change means in people with psychosis. We aimed to create a conceptual framework synthesizing how identity changes are understood in the psychosis literature. METHODS Electronic databases were searched up to April 2020. Studies about identity changes among people with psychotic disorders were analyzed using narrative synthesis by a collaborative review team, including researchers from different disciplines, clinicians, and people who have experienced psychosis. RESULTS Of 10 389 studies screened, 59 were eligible. Identity changes are understood in 5 ways as (1) characteristics of psychosis, (2) consequences of altered cognitive functioning, (3) consequences of internalized stigma, (4) consequences of lost roles and relationships, and (5) reflections of personal growth. These 5 understandings are not mutually exclusive. Across a heterogeneous literature, identity changes were mostly framed in terms of loss. CONCLUSIONS Our conceptual framework, comprising 5 understandings, highlights the complexity of studying identity changes and suggests important implications for practice and research. For clinicians, this framework can inform new therapeutic approaches where the experience and impact of identity changes are acknowledged and addressed as part of treatment. For researchers, the conceptual framework offers a way of locating their understandings of identity changes when undertaking research in this area.
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Affiliation(s)
- Maev Conneely
- Unit for Social and Community Psychiatry, WHO Collaboration Centre, Queen Mary University of London, London, UK,To whom correspondence should be addressed; Unit for Social and Community Psychiatry, Newham Centre for Mental Health, London E13 8SP, UK; tel: +44 020 7540 4380 (ext.: 2308), fax: +44 020 7540 4380, e-mail:
| | - Philip McNamee
- Unit for Social and Community Psychiatry, WHO Collaboration Centre, Queen Mary University of London, London, UK
| | - Veenu Gupta
- Department of Primary Care and Mental health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - John Richardson
- Unit for Social and Community Psychiatry, WHO Collaboration Centre, Queen Mary University of London, London, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaboration Centre, Queen Mary University of London, London, UK
| | - Janelle M Jones
- Department of Biological and Experimental Psychology, School of Biological and Chemical Sciences, Queen Mary University of London, London, UK
| | - Domenico Giacco
- Unit for Social and Community Psychiatry, WHO Collaboration Centre, Queen Mary University of London, London, UK,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Jones JM, Schönherr DM, Zaitsoff S, Pullmer R. Changing from the inside out? Examining relationships between overweight identification, dieting behaviours, and body measurements over time. Br J Health Psychol 2019; 24:460-476. [PMID: 30924253 DOI: 10.1111/bjhp.12363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 02/23/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate whether changes in overweight identification were associated with dieting behaviours and body measurements over time. DESIGN Longitudinal study with assessments at three time points: before and twice during (i.e., baseline, 6 months, 12 months) a 1-year self-directed weight loss attempt. METHOD Eighty individuals with overweight or obesity (classified by BMI ≥ 25) reported their personal (i.e., I see myself as overweight), social (i.e., I identify/feel strong ties with other overweight people), and affective (i.e., I am pleased to be overweight) overweight identification; dieting behaviours (e.g., eat less, exercise, eat more fruit and vegetables); and had their body measurements taken (i.e., weight, height, body fat, waist circumference). RESULTS Linear mixed modelling was used to examine between-person differences and within-person changes in overweight identification on dieting behaviours and body measurements over time. Between-person differences mattered for measurements: Higher personal overweight identification was associated with higher BMI, body fat, and waist circumference over time. Higher social overweight identification was associated with higher BMI over time. Within-person changes mattered for behaviours over time: At 12 months, decreases in social overweight identification were associated with increases in a subset of 'Eat Less, Move More' dieting behaviours, but not a subset of 'Healthy' dieting behaviours. At 12 months, decreases in affective overweight identification were also associated with increases in 'Eat Less, Move More' dieting behaviours. CONCLUSION Addressing different aspects of overweight identification and how they change over time, may harness an important psychological pathway to support behavioural change and health irrespective of weight loss. Statement of contribution What is already known on this subject? Psychological factors, such as self-concept clarity and weight stigma, are associated with dieting behaviours and body measurements. Qualitative data suggest that identity change may be tied to dieting behaviours and weight loss. What does this study add? New insights into the nature of another psychological factor, overweight identification, among individuals with overweight and obesity attempting to lose weight. The first quantitative evidence that different aspects of overweight identification, and changes in these aspects of overweight identification over time, influence body measurements and dieting behaviours.
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