The Impact Of Group Membership 2
Table of Contents
Impact Of Group Membership
Use your textbook, Sue and Sue’s Counseling the Culturally Diverse: Theory and Practice, to complete the following:
- Read Chapter 2, “The Superordinate Nature of Multicultural Counseling and Therapy,” pages 37–65.
- Read Chapter 9, “Multicultural Evidence-Based Practice,” pages 283–314.
- Read Chapter 13, “Culturally Competent Assessment,” pages 429–451.
Remember, your e-books are available for reading via VitalSource Bookshelf. You can access Bookshelf from the left Course Tools menu or via the optional downloaded application.
Use the Capella University Library to complete the following readings:
- Buckingham, Frings, and Albery’s 2013 article, “Group Membership and Social Identity in Addiction Recovery” in Psychology of Addictive Behaviors, volume 27, issue 4, pages 1132–1140.
- Pedersen’s 1991 article, “Multiculturalism as a Generic Approach to Counseling,” in Journal of Counseling & Development, volume 70, issue 1, pages 6–12.
- Sacks and Peled’s 2008 article, “The Self-Perception of Women Who Live With an Alcoholic Partner: Dialoging With Deviance, Strength, and Self-Fulfillment,” in Family Relations, volume 57, issue 3, pages 390–403.
The Impact of Group Membership
Sue and Sue (2016) illustrated similarities and differences among people, and the powerful influence of perceived group membership on how we view others and how we view ourselves. Read the Buckingham, Frings, and Albery article provided in the Resources section, and discuss the impact of group membership or memberships as they relate to the treatment of addiction.
Group Membership and Social Identity in Addiction Recovery
Sarah A. Buckingham, Daniel Frings, and Ian P. Albery London South Bank University
Despite a growing interest in how group membership can positively impact health, little research has addressed directly the role social identity processes can have on recovery from addiction. Drawing on social identity theory and self-categorization theory, the present study investigated how recovery group membership can introduce a new social identity associated with recovery, compared to the social identity associated with addiction. We hypothesized that two processes— evaluative differentiation and identity preference—would be linked with higher self-efficacy and positive health outcomes (i.e., reduced relapse, lower levels of appetitive behavior, and elevated feelings of social connectedness [Study 2]). Study 1 recruited members (N � 61) from United Kingdom based mutual aid groups of Alcoholics Anonymous and Narcotics Anonymous. Study 2 recruited ex-smokers (N � 81) from online sources. In Study 1, evaluative differentiation was significantly related to lowered relapse and reduced appetitive behavior. Identity preference was related to higher levels of self-efficacy, which was related to months drug-free and reduced levels of appetitive behaviors. In Study 2, evaluative differentiation was related to identity preference. Identity preference was also related to higher self-efficacy, which in turn was related to lower relapse. Although exploratory, these results suggest that developing a social identity as a “recovering addict” or an “ex-smoker” and subsequently highlighting the difference between such identities may be a useful strategy for reducing relapse among people with problems associated with addictive behaviors.
Keywords: group, social identity, self-efficacy, addiction, recovery, relapse
To feel part of and socially connected to other group members has positive implications for both physical and mental health (Jetten, Haslam, & Haslam, 2012; Simon, 2004; Tice & Baumeis- ter, 2001; James, 1890/2007). Positive psychological effects have been found to be associated with group membership in a variety of social contexts. For example, stroke patients who maintained their group memberships posttrauma have reported a greater feeling of well-being (Haslam et al., 2008). Similarly, social support has been shown to act as a buffer against stress-related psychological and physical health in a prospective study of Swedish business men (Rosengren, Orth-Gomér, Wedel, & Wilhelmsen, 1993; as cited in Sani, 2012).
This interest in the social benefits of groups has recently led to a number of studies which have attempted to understand the relationship between group membership and recovery from alco- hol and drug addiction. Being a member of a social group has generally been shown to be beneficial. Attendance at the mutual- aid fellowship of Alcoholics Anonymous (AA) has been associ- ated with “protective and positive social influence” (Kelly, Hoe- ppner, Stout, & Pagano, 2012, p. 297), and increased psychological well-being, reduced depression, reduced impulsiv- ity, and reduced alcohol use (Kelly, Stout, Magill, Tonigan, &
Pagano, 2010; Blonigen, Timko, Finney, Moos, & Moos, 2011). Despite this interest, little is known about the social identity processes that may underlie these benefits or how they may be applicable in other recovery group membership categories, such as ex-smokers.
Social Identities of Addiction and Recovery
Social psychology has recognized the importance of social identities in shaping beliefs and behavior, including health behav- iors (Jetten et al., 2012; Haslam et al., 2008). Social identity theory (SIT; Tajfel & Turner, 1979) proposes that becoming a member of a group is both emotionally and psychologically relevant for one’s own and one’s group’s decision-making and behavior. Self- categorization theory (SCT; Turner, Hogg, Oakes, Reicher, & Wetherell, 1987) argues that people internalize qualities of their group membership, which then contributes to how they perceive themselves as individuals and how they are perceived by members of their own group or other groups. In essence, people can become part of a group and the group part of the person (Abrams & Hogg, 2004). SIT contends that individuals strive toward having a posi- tive self-construct (Tajfel & Turner, 1979). When group members categorize themselves as being part of a particular group (the ingroup), they also identify a comparison group (the outgroup) against which the ingroup’s value or worth can be measured and assessed (Tajfel & Turner, 1979; Turner et al., 1987). These categorizations become cognitively amplified by group members to maximize both the similarities within the ingroup and the differences between the outgroup (see Turner, 1987, for the meta- contrast principle). Therefore, how people self-define who they are socially (e.g., understand their ingroup as being) is often against a
This article was published Online First April 15, 2013. Sarah A. Buckingham, Daniel Frings, and Ian P. Albery, Department of
Psychology, London South Bank University, London, England. Correspondence concerning this article should be addressed to: Sarah
Buckingham, Department of Psychology, London South Bank University, Borough Road, London, SE1 OAA, England. E-mail: buckins2@ lsbu.ac.uk
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Psychology of Addictive Behaviors © 2013 American Psychological Association 2013, Vol. 27, No. 4, 1132–1140 0893-164X/13/$12.00 DOI: 10.1037/a0032480
1132
http://dx.doi.org/10.1037/a0032480
backdrop of who they are not (e.g., their perceived outgroup comparator) at any given time. The more distinctive a category membership, the greater chance there is of this becoming salient when cued by environmental triggers (see Oakes, 1987; Rosch, 1978).
Developing or making salient social identities with different behavioral norms can significantly influence perceptions of both self-efficacy and related health behaviors. Self-efficacy is a per- ception or expectation that one can (or cannot) achieve one’s goals and aims. These can be specific (e.g., related to particular behav- ior) or more generic (see Bandura, 1977). Tarrant and Butler (2011) showed that participants, whose student identities (associ- ated with negative health behaviors such as binge drinking) were primed before an attitudinal survey, indicated that they intended to engage in risky drinking behaviors. By contrast, students who had a different social identity primed (i.e., their nationality) indicated lower intentions to drink in a risky way. These findings suggest that, in the context of addiction, preference for the identity asso- ciated with recovery, compared to the identity associated with addiction, may elevate specific self-efficacy beliefs and be asso- ciated with new behaviors.
The different social identities that people hold are more or less relevant to them in different contexts (Jetten & Pachana, 2012; Sani & Bennett, 2009; Oakes, 1987). Before people who have problems with addictive behaviors engage in treatment, they are likely to perceive themselves as unable to control these behaviors and view their associated identity ambivalently. In other words, they might have little or no identity associated with recovery. Among people with negative identities, creating a psychological distance by disidentifying from their existing membership is a possible response to reduce negative self-worth (Kreiner & Ash- forth, 2004). However, it is also likely that such individuals (par- ticularly those with stigmatized identities) are restricted to which other groups will accept them as legitimate members (e.g., social mobility into many other groups is difficult or impossible; see St. Claire & Clucas, 2012; Tajfel & Turner, 1979). In such cases, affiliation with an identity such as “recovery” or similar may offer group members the chance to be affiliated with a positively va- lenced group and also the opportunity to create psychological distance from previous social connections and associated behav- iors. Such identities are also likely to have relatively permeable boundaries (e.g., social mobility into the group will be possible; see Haslam, Ellmeres, Reicher, Reynolds, & Schmitt, 2010; Tajfel, 1975).
Social identity research has suggested that, during group therapy or through the course of meetings, a new identity associated with “recovery” will be constructed compared to the existing identity associated with addiction (Oakes, 1987). For instance, where the “addict” identity includes alcohol or drug use or excessive appet- itive behavior (see Orford, 2001), the “recovering addict identity” may normatively include abstinence or controlled use. Appetitive behaviors are defined as “objects and activities” that have the potential to become addictive (Orford, 2001, p. 2). The exact nature and nomenclature of “recovery” and “addiction” identities are context-dependent, and there are possibilities of other nonstig- matized identities that may provide comparison with that of the identity associated with addiction (i.e., Biernacki, 1986).
Although people with difficulties associated with addictive be- haviors may not be able leave their social identity of “addict”
behind, they can use it as part of a favorable downward compar- ison with their recovery identity. When the identity associated with addiction includes having low self-efficacy, the identity associated with recovery may normatively define as more self-efficacious. Similarly, the extent to which identities associated with recovery have behavioral norms of abstinence, pressures to remain abstinent (and resources to achieve this) may increase. In line with these changes, the identity associated with addiction may be derogated, enabling an even more positive evaluation of the recovery identity (a process we refer to as evaluative differentiation). Alongside changes in evaluation, we would also expect individuals to identify themselves more with the recovery identity, and less with the addiction identity, in order to attain a positive sense of self (Tar- rant, Hagger, & Farrow, 2012). We refer to this second process as identity preference change.
To the extent that normative identity content predicts behavior (e.g., see Tarrant & Butler, 2011), more positive related health outcomes should be associated with greater evaluative differenti- ation and identity preference change in favor of the recovery identity. For instance, both identities of addiction and of recovery are likely to be associated with differing behavioral norms (e.g., nonabstinence and lack of control vs. abstinence and control). When presented with an opportunity to lapse, an individual with an identity of recovery can behave in a way that is normative to addiction (e.g., lapse) or recovery (e.g., abstain). We predict that the greater the difference in valence between identities, the greater the likelihood that the individual may conform to the normative behavior of the preferred (presumably “recovery”) group, in order to maintain legitimate membership of a valued group identity. The comparable identities of recovery and addiction are context- dependent, and we recognize that there are possibilities of other nonstigmatized identities that may provide comparison with that of the identity associated with addiction (i.e., Biernacki, 1986).
The present studies begin to investigate the underlying social identity processes that may explain success (and failure) when individuals are in recovery from addiction. Such recovery is de- fined for the current article as decreased relapse, lower levels of appetitive behavior, and increased feelings of recovery-related self-efficacy (see Bandura, 1977), which has previously been linked with reduced posttreatment relapse (Gwaltney, Metrik, Kahler, & Shiffman, 2009; Allsop, Saunders, & Phillips, 2000). Specifically, we tested how two underlying processes—identity preference and evaluative differentiation—relate to recovery. These processes were explored using a sample of recovering addicts (Study 1) and ex-smokers (Study 2). In developing our work, Study 2 also explored the role of social connectedness (perceived links with social others; see Lee & Robbins, 1995) to ascertain how a general sense of belonging in ones’ social envi- ronment affects identity and behavior.
Study 1
The aim of Study 1 was to examine the relationships between evaluative differentiation, identity preference, self-efficacy, and health outcomes, such as relapse, and the frequency of appetitive behavior. We explored these relationships in a sample of individ- uals attending the mutual aid “fellowship” groups of AA and Narcotics Anonymous (NA). Both AA and NA share a common recovery culture based on abstinence and group support. We used
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1133GROUP MEMBERSHIP AND SOCIAL IDENTITY IN ADDICTION
the terms addict and recovering addict to identify the pre- and postrecovery identities for both groups. Although the terms addict and recovering addict are generic, they are collectively understood in AA and NA ideology as tools for ritual identification (Kellogg, 1993). In line with SIT and SCT, it was predicted that increased identity preference for a “recovering addict” identity and evalua- tive differentiation of this identity from “addict identity” would be related to increased self-efficacy, decreased relapse rates, and less appetitive behavior.
Method
Design. A cross-sectional correlational design was used to examine the relationships between recovering addict identity, ad- dict identity, self-efficacy, number of months drug-free, appetitive behavior, relapse, and the evaluation of the favorability of both identities (addict and recovering addict). Identity preference and evaluative differentiation were calculated as a function of identi- fication and evaluations, respectively (see Measures subsection below).
Participants. Sixty-one participants (34 men, 27 women), be- tween ages 19 and 77 years (M � 46.66, SD � 11.32), were recruited from AA and NA groups in the United Kingdom. Eligibility for recruitment was membership in AA or NA and meeting attendance. The number of meetings attended in the past 2 months ranged from 3�70 (M � 22.15, SD � 14.53). The number of months participants had been drug-free ranged from less than 1 month to 360 months (M � 93.57, SD � 89.73). Forty participants had been in residential treatment one or more times (Mnumber of treatments � 1.62, SD � 2.15). Nine participants had attended day care treatment one or more times (Mnumber of treatments � 0.93, SD � 4.44). Sixteen participants attended one or more other mutual aid fellowship groups, such as Codepen- dency Anonymous and Al-Anon (Mnumber of groups attended � 1.70, SD � 0.49).
Measures. The following measures were used. Relapse. The term relapse was defined to participants as a
return (however brief) to using alcohol, drugs, or both. This conservative definition reflects the social norm of the fellowships, which encourages a clear dichotomy restricted to either abstinence or relapse. Frequency of relapse was measured by asking partici- pants to indicate how many times they had relapsed over the past month, past year, and past 2 years. Participants were also asked to state how many months they had been alcohol- or drug-free.
Self-efficacy. Statements were adopted from Bandura (1977) to address addiction- and recovery-specific aspects. Self-efficacy was measured using four statements: “I can remain abstinent,” “I can manage my addiction,” “It is unlikely that I will remain drug-free,” and “I think I can achieve recovery.” Participants rated each statement on a 7-point Likert-type scale, anchored at 1 (strongly disagree) and 7 (strongly agree). Once scores for any negatively framed items were reverse-coded and a mean calcu- lated, higher scores indicated higher levels of self-efficacy (Cron- bach’s alpha � .82).
Recovering addict identity. Statements for social identifica- tion were adapted from Doosje, Ellemers, and Spears (1995). Four items were used to measure recovering addict identity: “Being an AA(NA) member is a central part of who I am,” “I would describe myself as an AA(NA) member,” “I identify with other AA(NA) members,” and “Even when I am not in a meeting, I think of
myself as an AA(NA) member.” Participants rated each statement on a 7-point Likert-type scale, anchored at 1 (strongly disagree), 4 (neither agree nor disagree), and 7 (strongly agree) (Cronbach’s alpha � .80).
Addict identity. Identification with being an addict was mea- sured using the same four items, except that the term AA(NA) member was replaced with addict (Cronbach’s alpha � .70).
Identity preference. Identity preference was calculated by subtracting addict identity from recovering addict identity such that positive values indicated higher levels of identification with the recovery identity (relative to addict identity) and negative scores the reverse. Means ranged from �1.75 to 4.00.
Appetitive behavior. The list of items to measure appetitive behavior was drawn from excessive appetitive activities described by Orford (2001) alongside other behaviors suggested by AA and NA members. Measurement for appetitive behavior followed the introductory question “Addiction can take many forms, do you feel your behavior in any of the following areas is currently problem- atic for you?” Participants rated how problematic each of 15 appetitive behaviors (acting out, alcohol, disruptive or abusive behavior, exercise, food, gambling, gaming, illegal drugs, Internet, nicotine, other people, prescription drugs, sex, shopping, work) were for them using a 7-point Likert-type scale (0 � not at all problematic to 7 � very problematic). Higher scores indicated higher levels of appetitive behavior (Cronbach’s alpha � .72).
Favorability. Favorability toward each identity was measured using traits discussed in the main texts of AA and NA and confirmed by five active members. Participants were asked; “How much do the following traits represent your life today as an AA(NA) member?” followed by 34 traits (17 positive, 17 nega- tive) listed in the following order: altruistic, angry, arrogant, blam- ing, despairing, dishonest, disturbed, envious, faithful, fearful, forgiving, grandiose, grateful, harmful, honest, hopeful, humble, imaginative, impulsive, isolated, joyful, less than, miserable, nur- turing, part of, peaceful, resentful, respectful, responsible, selfish, self-nurturing, survivor, thoughtful, and trapped. Participants rated each trait on a Likert-type scale (1 � not at all representative to 6 � very representative; Cronbach’s alpha � .67). The same list of traits was repeated to measure favorability toward addicts, but prefaced with the following question: “Taking your mind back to your days of active addiction, how much did the following traits represent you?” (Cronbach’s alpha � .76).
Evaluative differentiation. Evaluative differentiation was cal- culated by first reverse-scoring the negative traits and, second, aggregating with scores on the positive traits to give an overall score for each identity (score range: �1.51 to 9.50; n � 58). The addict identity score was then subtracted from the recovering addict identity score to calculate the difference between evalua- tions of each favorability scale. Positive scores reflected a prefer- ence for the recovering addict.
Procedure. One hundred and fifty numbered questionnaires were distributed to participants who regularly attended AA or NA meetings. To detect a medium size effect (� � .40) at an alpha of .05, power analysis using G�Power 3 software (Faul, Erdfelder, Buchner, & Lang, 2009) indicated an end sample size of 59 participants. Given our experience of questionnaire return rates among samples of this nature, we assumed a conservative return rate of 40% (i.e., requiring 150 questions to ensure sufficient sample size).
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1134 BUCKINGHAM, FRINGS, AND ALBERY
Data collection took place over a 6-month period. To retain anonymity and confidentiality, research information and informed consent agreements were presented verbally to the participants and subsequently endorsed by the researcher, with a signature and date. Participants were asked to complete the questionnaire alone, in the order presented, and in a single sitting. They were asked to answer the questions as honestly as they could, and to return the ques- tionnaire via a stamped, addressed envelope. The response rate was 40%. After collecting demographic information (sex, age, first AA or NA meeting, alcohol- or drug-free since, AA or NA meetings attended in past 2 months, attended residential treatment, attended day care treatment, other fellowship groups, and, if so, which ones), measures were collected in the same order as pre- sented in the materials section. All participants were debriefed at the conclusion of the study. They were not compensated for their time. Ethics approval for the study was in accordance with London South Bank University Research Ethics codes of conduct and British Psychological Society guidelines. Ethics approval for this research was provided by London South Bank University Research Ethics Committee.
Results
To examine the associations between identity preference, eval- uative differentiation alongside self-efficacy and measures of out- comes (i.e., months drug-free; relapse rates at 1 month, 1 year, and 2 years; and levels of appetitive behavior), Pearson’s correlations were used (see Table 1). Evaluative differentiation and identity preference correlated with marginal statistical significance, r(58), � .26, p � .06, with greater levels of identity preference being linked to greater evaluative differentiation. This suggests that the two constructs are related, but, given the moderate size of
this correlation (sharing 7% of their variance), also distinct. Re- sults showed that evaluative differentiation correlated negatively with relapse over the past month, r(58) � �.31, p � .02, past year, r(58) � �.39, p � .01, and past 2 years, r(58) � �.27, p � .04, and with appetitive behavior, r(58) � �.26, p � .05. Identity preference was significantly related to self-efficacy, r(54) � .32, p � .02. Self-efficacy was significantly positively correlated with months drugs-free, r(59) � .34, p � .01. Finally, there was a significant negative correlation between self-efficacy and appeti- tive behavior, r(59) � �.28, p � .03. In addition to these statis- tically significant effects, there were relationships of statistically marginal significance between identity preference and evaluative differentiation (see Table 1).
Given the near significant correlation between identity prefer- ence and evaluative differentiation, it was desirable also to test for their unique effects. Partial correlations were conducted between identity preference (controlling for evaluative differentiation) and both self-efficacy and outcome measures, and also between eval- uative differentiation (controlling for identity preference) and those measures. The pattern of significant relationships between variables were identical, with the exception that the relationship between self-efficacy and evaluative differentiation was signifi- cant, rp(50) � �.27, p � .05.
Discussion
Study 1 aimed to investigate the role of the social identities of “recovering addicts” and “addicts” among those in treatment for problems associated with addictive behaviors. Specifically, we explored the relationship between two identity processes—identity preference and evaluative differentiation— on self-efficacy and outcomes such as relapse rates and levels of appetitive behavior.
Table 1 Study 1: Means, (Standards Deviations), and Pearson’s Correlations for Measured Variables Among Participant Group Members of Alcoholics Anonymous and Narcotics Anonymous
Variable M (SD) Identity
preference Evaluative
differentiation Self-
efficacy Months
drug-free Relapse 1 month
Relapse 1 year
Relapse 2 years
Appetitive behavior
Recovery addict identity
Addict identity
Identity preference 0.17 (0.84) (n � 55)
Evaluative differentiation 2.20 (1.10) .26���
(n � 59) Self-efficacy 5.31 (1.62) .32� �.02
(n � 61) Months drug-free 93.58 (89.73) �.06 .14 .34��
(n � 61) Relapse 1 month 0.26 (1.55) �.01 �.31� .01 �.02
(n � 61) Relapse 1 year 0.80 (2.60) .01 �.39�� �.11 �.17 .61��
(n � 61) Relapse 2 years 0.65 (2.15) .02 �.27� �.15 �.21 .08 .83��
(n � 61) Appetitive behavior 1.54 (1.13) �.15 �.26� �.28� �.44�� .52�� .52�� .32�
(n � 61) Recovery addict identity 6.21 (1.00) .12 .25��� �.07 .11 �.01 .10 .15 .03
(n � 61) Addict identity 6.00 (1.24) �.58�� �.03 �.32� .07 .01 .09 .13 .16 .74��
(n � 55)
Note. Coefficients in boldface represent statistically significant relationships. � p � .05. �� p � .01. ��� p � .10.
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1135GROUP MEMBERSHIP AND SOCIAL IDENTITY IN ADDICTION
The extent to which participants identified as being either an “addict” or a “recovering addict” separately was not associated with self-efficacy or relapse rates. However, as predicted, identity preference was related positively to self-efficacy, and evaluative differentiation was negatively related to all levels of relapse and appetitive behavior. Specifically, the greater the preference for “recovering addict” identity compared to the “addict” identity, the higher the level of reported self-efficacy. The greater the perceived difference between evaluations of “addict” and “recovering ad- dict” identities, the less likely an individual was to retrospectively report relapse in the last month, year, and 2 years. In addition, increased evaluative differentiation was associated with decreased frequency of appetitive behavior. In line with previous findings (Gwaltney et al., 2009; Allsop et al., 2000), more months drug-free was linked to increased self-efficacy. Higher self-efficacy had, in turn, a relationship with decreased appetitive behavior. Taken together, these results complement previous research that has suggested that one’s perception of being part of a group promotes identification with similar others (Brewer, 1991) and allows for peer support and learning vicariously from other group members’ experiences (Kelly et al., 2012; Conyne & Harpine, 2010). In line with SIT and SCT, it also suggests that it is not simply identifi- cation with a particular identity that can impact self-efficacy and behavior change. In this study, it was the preference for an identity, compared to a previously known identity, and the evaluative differentiation between identities that were related to self-efficacy and positive health outcomes.
As predicted, there was a significant relationship between iden- tity preference and self-efficacy— higher levels of identification with recovery (relative to addiction) were related to higher levels of self-efficacy. However, there were no significant associations between identity preference and health outcomes (although there was a trend in the data toward a link between identity preference toward recovering addicts and evaluative differentiation). This lack of a clear effect could be due to the finding that higher levels of identity as a “recovering addict” were linked to higher levels of identification as an “addict.” The similarity between levels of identification may be due to the normative values explicitly ad- opted by the AA and NA groups. Members are encouraged to use the category alcoholic/addict for their common identity. In our sample, the “addict” and “recovering addict” identities may be seen as relatively indistinct or possibly separate components of the broader, superordinate, category of an “AA or NA member.” In other words, membership in AA or NA and attendance at related meetings consistently encourages identification with being an “ad- dict” while simultaneously encouraging identification with “recov- ery.” This could also explain the finding that, once levels of identity preference were controlled for, lower levels of evaluative differentiation were linked to higher self-efficacy. For example, AA or NA members who do not differentiate the valence of these identities may also see themselves as behaving normatively and hence being “effective.” This is especially the case among those who affiliate more strongly with being in recovery (i.e., those with higher identity preference).
Among samples for which these pre- and postquit identities are more distinctive, it is more likely that identity preference will be associated not only with higher levels of self-efficacy but also with lower levels of relapse and appetitive behaviors. Such reinforce- ment is not necessarily emphasized and apparent among people
attempting to change other types of behaviors. One possible way to test this would be to sample a group of people for whom there is less potential overlap in identities—that is, a group for whom being an “addict” is not an explicit part of being a “recovering addict,” as in contrast to AA or NA. Thus, for Study 2, a sample of ex-smokers, for whom pre- and postquit identities may be separated with greater clarity, were tested.
Study 2
The aim of Study 2 was to replicate Study 1 with a different population whose identities were more likely to be distinctive from one another. Ex-smokers were recruited from online network sites, with the categories “smoker” and “ex-smoker” used to define pre- (“addict”) and postquit (“recovering addict”) identities. The role of a second underlying factor, social connectedness, was also tested (Lee & Robbins, 1995). Social connectedness is defined as a component of the self that includes representations of links and connections between the self and others within ones’ social milieu (Lee & Robbins, 1995). Individuals with beliefs of high social connectedness therefore have a subjective sense of belonging and feel integrated with the social world. To feel psychologically connected to others has positive implications for both physical and psychological well-being (Kelly et al., 2012; Jetten et al., 2012; Haslam et al., 2008; Kelly, Stout, Magill, & Tonigan, 2011). Affiliation with the new ingroup of recovery (recovering addict or ex-smoker) may be indicative of increased perceived social con- nectedness. By examining an individual’s perceived social con- nectedness, we will be able to identify how psychologically significant the feeling of connectedness becomes in terms of self-efficacy and health outcomes. It was predicted that both iden- tity preference and evaluative differentiation would significantly relate to self-efficacy, reduced levels of relapse, reported lower levels of appetitive behavior, and greater perceived social connect- edness.
Method
Design. A cross-sectional correlational design was used to examine the relationships between evaluative differentiation, iden- tity preference, self-efficacy, months since smoke-free, appetitive behavior, lapse rate, and social connectedness. Identity preference (score range: �.75 to 6.00; n � 79) and evaluative differentiation (score range: �2.89 to 7.47; n � 72) were calculated as functions of identification and evaluation, respectively, using the method reported in Study 1.
Participants. Eighty-two participants (29 men, 53 women), between ages 18 and 66 years (M � 44.40, SD � 11.73), were recruited from the networking site of WhyQuit.com and a social networking site (Facebook). A recruitment advertisement was placed on the advertisement bar of both sites for 1 month. For WhyQuit.com, the advertisement appeared to all users of the website. For Facebook, it was placed alongside some users pro- files. Which Facebook users were exposed to it was determined using Facebook’s automated advertising systems to ensure a max- imum number of hits over a broad demographic. The number of months participants had been smoke-free ranged from less than 1 month to 469 months (M � 69.33, SD � 102.88).
Measures. The measures used followed a similar format to those of Study 1 and comprised the following: self-efficacy
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(Cronbach’s alpha � .73), ex-smoker identity (Cronbach’s al- pha � .83), smoker identity (Cronbach’s alpha � .85), appet- itive behavior (Cronbach’s alpha � .89), favorability toward ex-smoker identity (Cronbach’s alpha � .94), and favorability toward smoker identity (Cronbach’s alpha � .94). Favorability scales and identity scales were again used to calculate identity preference and evaluative differentiation, respectively. Along- side the measures taken in Study 1, Study 2 also measured social connectedness. In addition, the measure of relapse rates was altered to measure lapses to reflect differences in nomen- clature used by this sample.
Lapse rates. The term lapse was defined to participants as a return (however brief) to smoking. Lapse rates were measured by asking participants to indicate how many times they had lapsed over the past 2 years. This time frame for lapse was selected as the least likely to be affected unduly by temporal events (e.g., short periods of particular vulnerability).
Social connectedness. Six items measured social connected- ness: “I feel disconnected from the people around me,” “Even around people I know, I don’t feel that I really belong,” “I feel so distant from most people,” “I don’t feel related to others,” “I catch myself losing all sense of connectedness from society,” and “Even among my friends, there is no sense of brotherhood/sisterhood” (see Lee & Robbins, 1995). Participants rated each item on a 7-point Likert-type scale (Cronbach’s alpha � .89), anchored at 1 (strongly disagree), 4 (neither agree nor disagree), and 7 (strongly agree). Higher scores on this scale indicated less social connect- edness (i.e., greater social isolation).
Procedure. Ex-smokers were recruited by advertisements placed on WhyQuit.com and Facebook containing a URL to online questionnaires. The settings were configured to allow one response per computer. An analysis of key demographics suggested no
commonalities between participants. After reading the study in- formation sheet, participants gave consent to take part in the study by clicking on a response box. Participants were unable to access the survey without giving consent. Participants were asked to complete the questionnaire alone, in the order presented, and in a single sitting. Of those who had initially opened the study site and clicked the endorsement of consent, 41% continued and completed the study measures.
After collecting demographic information (i.e., sex, age, number of quit attempts, and date since smoke-free), participants com- pleted the self-efficacy, ex-smoker identity, smoker identity, ap- petitive behavior, social connectedness, and favorability scales. All participants were debriefed at the conclusion of the study. This occurred automatically if participants ceased participation prema- turely. The order in which self-efficacy, recovering addict identity, and addict identity scales appeared was counterbalanced across participants. The resulting versions of the questionnaire set were rotated on a weekly basis against four age-range categories (18 – 30, 31– 45, 46 – 60, over 60 years) until data collection was com- pleted.
Results
To examine the association between ex-smoker and smoker identities, identity preference, evaluative differentiation, self- efficacy, and measures of outcome (i.e., months drug-free, lapse rates at 2 years, appetitive behavior, and social connectedness), Pearson’s correlations were used (see Table 2).
In support of the idea that evaluative differentiation and identity preference are related but distinct constructs, evaluative differen- tiation correlated positively with identity preference, r(72) � .36, p � .01. In support of the hypothesis that differences in identifi-
Table 2 Study 2: Means, (Standards Deviations), and Pearson’s Correlations for Measured Variables Among Participant Group of Ex-Smokers
Variable M (SD) Identity
preference Evaluative
differentiation Self-efficacy Months
drug-free Relapse 2 years
Appetitive behavior
Social connectedness
(isolation) Ex-smoker
identity Smoker identity
Identity preference 2.96 (1.82) (n � 79)
Evaluative differentiation 0.75 (1.11) .36��
(n � 74) Self-efficacy 6.21 (0.74) .46�� 06
(n � 81) Months drug-free 69.37 (102.88) �.12 �.01 .22���
(n � 77) Relapse 2 years 0.24 (0.43) �.06 .01 �.23� �.27�
(n � 82) Appetitive behavior 0.98 (1.16) �.17 .23��� �.24� �.14 .11
(n � 78) Social connectedness
(isolation) 2.23 (1.40) �.26� �.29� �.22��� �.07 .14 .18 (n � 81) .
Ex-smoker identity 5.18 (1.50) .66�� .25� .06 �.54�� .11 .08 �.01 (n � 81)
Smoker identity 2.30 (1.37) �.65�� �.21��� �.58�� �.32�� .23� .30�� .30�� .14 (n � 79)
Note. Coefficients in boldface represent statistically significant relationships. � p � .05. �� p � .01. ��� p � .10.
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1137GROUP MEMBERSHIP AND SOCIAL IDENTITY IN ADDICTION
cation and evaluation would relate to health outcomes, identity preference was positively associated with self-efficacy, r(77) � .46, p � .01, sharing 13% of their variance. Higher self-efficacy was related to fewer lapses, r(79) � �.23, p � .04, and less appetitive behavior, r(75) � �.24, p � .04. There was a relation- ship of statistically marginal significance between self-efficacy and greater social connectedness, r(78) � �.22, p � .06.
In addition to these relationships, identity preference was also negatively associated with social connectedness, r(78) � �.26, p � .02. There was a significant negative association between evaluative differentiation and social connectedness (representing an association between higher levels of differentiation toward ex-smokers and greater perceptions of social connectedness), r(72) � �.29, p � .01.
In support of the hypothesis that, in contrast to AA and NA members, smokers and ex-smokers identities should be distinct from one another, there was no correlation between identification with being a smoker and being an ex-smoker, r(78) � .14, p � .21.
Given the moderate (but significant) correlation between iden- tity preference and evaluative differentiation, it was desirable also to test for their unique effects. Partial correlations were conducted between identity preference (controlling for evaluative differenti- ation) and both self-efficacy and outcome measures, and also between evaluative differentiation (controlling for identity prefer- ence) and those measures. The pattern of significant relationships between variables were identical, with the following exceptions: The relationship between appetitive behaviors and identity prefer- ence was significant, rp(69) � �.26, p � .035. Social connected- ness did not have a significant relationship with identity prefer- ence, rp(69) � �.15, p � .22.
Discussion
Study 2 provides further evidence for the hypothesis that eval- uative differentiation and identity preference would be related to positive health outcomes. Specifically evaluative differentiation in favor of ex-smokers as a group (relative to smokers) was linked to greater identity preference for ex-smokers. This preference was linked to greater self-efficacy. Self-efficacy was, in turn, related to lower rates of relapse and less appetitive behavior (see Figure 1). The findings of Study 2 also address one unexpected finding of Study 1, namely, the positive correlation between levels of pre- and post quit identities among AA and NA members. We sug- gested that this may be because AA and NA members normatively describe themselves as “addicts.” The findings of Study 2 support this assumption by showing evidence of a more distinctive pair of identities among those who had stopped smoking (indicated by a nonsignificant correlation between the two dimensions in contrast to the significant positive correlation observed in Study 1). Study 2 also explored the links between social connectedness, identity, self-efficacy, and health outcomes. High levels of social connect- edness were linked to increased evaluative differentiation, greater preference for ex-smokers, and higher levels of self-efficacy. This finding suggests that the documented effects of having social connections on health outcomes may be related to changes in levels of group identity. We used a global measurement of social connectedness to capture a more generic sense of belonging and being part of the social world than is indicated by measures of ingroup identification (or lack thereof). This was in line with
research in other domains that has identified the positive health benefits of such connections (e.g., Jetten et al., 2012). Feelings of not being subjectively connected to others may be a contributing factor in the adoption of certain identities and behaviors. Relying solely on the measurement of a more specific group category would fail to capture the benefits of this generic social connect- edness.
General Discussion
There has been minimal research investigating how social iden- tities impact on people who are attempting their recovery from addiction. Social identity theory argues that through the process of social comparison people identify with similar others in contrast to a comparable outgroup (Tajfel & Turner, 1979). Such a contrast between categories heightens the possibility of ingroup norms and consequent behavior becoming salient (Turner et al., 1987) and guiding beliefs about the group and subsequently the self. This has been associated with positive health outcomes (Oakes, 1987). Through identification with others who have been through a sim- ilar experience, it is possible that people with problems associated with addictive behaviors will gain self-efficacy (Moos, 2008). They may also increasingly cease (or maintain abstinent from) such behaviors. The current article presents data from two explor- atory studies that begin to investigate developing social identities associated with recovery (“recovering addict” and “ex-smoker”) compared to the previously established identities associated with addiction (“addict” and “smoker”).
Two identity-related processes—identity preference and evalu- ative differentiation—were suggested as cognitive components through which changes in self-efficacy, levels of appetitive behav- ior, and reduced relapse may be observed. In both studies, greater levels of self-efficacy were related to positive health outcomes. In Study 1, evaluative differentiation was significantly related to lower levels of relapse and reduced levels of appetitive behavior. Identity preference was related to self-efficacy, which was related to positive health outcomes. In Study 2, evaluative differentiation was related to identity preference, which was related to self- efficacy (which in turn related to positive health outcomes). We acknowledge that the measurement of self-efficacy may be retro- spective when tested in the context of the questionnaire about both
Evaluative differentiation
Self-efficacy
Lapses over 2 years
Appetitive Behaviors
r = .36**
r = .46**
r = −.24*
r = − .23*Identity preference
ns
Figure 1. For Study 2, the indirect relationships between evaluative differentiation, identity preference, self-efficacy, lapses over 2 years, and appetitive behaviors. rs reflect zero-order correlations. � p � .05. �� p � .01.
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1138 BUCKINGHAM, FRINGS, AND ALBERY
the addiction and recovery identities. Indeed, it is likely that, as well as self-efficacy influencing outcomes, an individual’s success or failure at avoiding lapses in the past will also influence their current perceptions of efficacy (see Gwaltney et al., 2009). In addition, we demonstrated in Study 2 how feelings of social connectedness are associated with a positive social identity (as calculated through identity preference and evaluative differentia- tion). This would suggest that a subjective perception of feeling connected to other social objects may be important in understand- ing how people prefer and distinguish identities in context. Future research should disentangle such effects by adopting a longitudi- nal, cross-lag design. It could also explore the qualitative differ- ences known to be found within self-efficacy (i.e., Schwarzer & Luszczynska, 2008).
These studies introduce both theoretical and empirical evidence to suggest that the subjective experience and the knowledge of being a member of a recovery group can aid in the successful reduction and cessation of addictive practices. They support the importance of a positive social identity (differentiation between identities) in addiction recovery, and they may help to explain why some individuals remain abstinent and some do not. This is sig- nificant because the finding that generating a difference in how identities are perceived could, potentially, be used as a component in the design of matched intervention programs. However, al- though both relative levels of identity and the evaluations of these identities have been shown to affect outcomes, they may be related constructs, and the present research cannot conclude, for instance, which precedes which or why the observed correlations may be moderated somewhat by different treatment types or addictive behaviors. This is an opportunity for future research.
Another potential application of this research stems from the finding that the relationships between evaluations of identities and subsequent efficacy (and outcomes) differ among different user groups. This suggests that a one-size-fits-all approach to using the strengths of social identities will likely fail. Rather, architects of group therapies should be sensitive to how clients perceive the relationship between their pre- and postquit selves, and the rela- tionship between self-efficacy and relapse. Where identities are distinct, it may be useful to highlight evaluative differences and aim to increase efficacy. Further work should examine how dif- ferent forms of therapy facilitate identity change.
Despite the theoretical importance of these findings, we recog- nize a number of limitations. For instance, self-report can create bias, particularly in sensitive areas (Waters & Leventhal, 2006). A further development of this work would be to incorporate less reactive methods of measurement into our design; for example, those less susceptible to conscious manipulation. We also ac- knowledge the limitation that self-selection of participants for both groups have on these present studies, particularly in the context of low response rates. However, we do note that, within both sam- ples, levels of identification, evaluation, relapse, and other vari- ables ranged from high to low and also were normally distributed. Hence, although the sample may not represent true means of any variable, relationships between factors are likely to be representa- tive of the populations sampled.
Finally, our use of a cross-sectional design precludes drawing causative conclusions. Theoretically, however, our formulation builds on work into social identity and self-categorization and assumes that group identity processes precede and influence effi-
cacy and subsequently relevant behavior change. As such, one can envision a scenario in which relevant interventions influence effi- cacy and efficacy affects evaluations of identity. Moreover, it is likely that these two lines of influence operate simultaneously, creating a virtuous cycle of reinforcement. We argue that, although the current studies provide important correlational evidence to explore our reasoning, future research might also use designs to enable more causative analysis.
Conclusion
This initial research suggests that using a social identity ap- proach may shed light on why some people relapse and some are successful at maintaining recovery. Of note, it suggests that rela- tive (not absolute) levels of identity and evaluation are strongly related to both self-efficacy and health outcomes. However, it also suggests that these relationships may depend on the exact nature of the “recovery” identity as conceptualized by people with problems associated with appetitive behaviors themselves.
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Received May 17, 2012 Revision received February 18, 2013
Accepted March 4, 2013 �
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1140 BUCKINGHAM, FRINGS, AND ALBERY
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- Group Membership and Social Identity in Addiction Recovery
- Social Identities of Addiction and Recovery
- Study 1
- Method
- Design
- Participants
- Measures
- Relapse
- Self-efficacy
- Recovering addict identity
- Addict identity
- Identity preference
- Appetitive behavior
- Favorability
- Evaluative differentiation
- Procedure
- Results
- Discussionrp = partial r?–>
- Method
- Study 2
- Method
- Design
- Participants
- Measures
- Lapse rates
- Social connectedness
- Procedure
- Results
- Discussion
- Method
- General Discussion
- Conclusion
- References
