Visualizing the Influence of Social Networks on Recovery: A Mixed-Methods Social Identity Mapping Study with Recovering Adolescents.

Background: Social recovery capital (SRC) refers to resources and supports gained through relationships and is vital to adolescent addiction recovery. Much is known about how substance use relates to social networks, but little is known about how other dimensions of social networks influence recovery (e.g., network size/exposure, degree of conflict). Methods: This mixed-methods study sampled 28 adolescents who received treatment for alcohol and other drug (AOD) use disorder (14-19 yrs.: 71% male; M = 17.32 yrs., SD = 1.33; White 82%): 20 were recovery high school (RHS) students. Adolescents completed a social identity map for addiction recovery (SIM-AR), survey, and interview. Qualitative data were content analyzed and the data from the SIM-AR were quantified. Results: On average, participants reported belonging to five distinct groups within their network (Range, 2-9; SD = 1.63; M = 27.89 people, SD = 20.09). Of their social network connections, 51% drank alcohol and 46% used other substances, on average. Larger networks involved more conflict (r = 0.57). Participants were more likely to spend more time with groups that had greater proportions of non-substance-using members. These linkages were stronger for RHS than for non-RHS students. Qualitative analyses revealed that youth reported their recovery-oriented groups as supportive, but some reported that their substance-using friends also supported their recovery. Discussion: SIM-AR was a useful measurement tool, and, through qualitative interviews, we identified unique aspects of youths' social networks important for further examination. Research with recovering youth should examine SRC-related elements within their networks including relationship quality, belonging, and conflict, alongside the substance use behaviors of network members.

A critical review of the Social Cognition and Object Relations Scale-Global and Thematic Apperception Test in clinical practice and research: Psychometric limitations and ethical implications.

The Social Cognition and Object Relations Scale-Global (SCORS-G) has been used increasingly in multimethod psychological assessment contexts as a framework for eliciting personality information from narrative data collection techniques, the most popular of which is the Thematic Apperception Test (TAT). Although research on the reliability and validity of the SCORS system has evolved over the last decade, there are numerous psychometric and procedural shortcomings (and corresponding ethical issues) that should be considered when applying this methodology to the TAT in clinical and research settings. Chief among these concerns is a lack of normative benchmarking, variability in TAT card batteries that are administered across contexts (which limit generalization and direct research comparisons), ambiguous reliability and validity evidence (and lack of incremental validity), and redundancy in published studies (i.e., versions of the same data/samples presented repeatedly across research). There is also a dearth of information about how SCORS-G data are influenced by factors such as culture, language, cognitive functioning, and other variables that may impact narrative output, word count, and richness (and subsequent interpretation and clinical decision making). The review concludes with a discussion of the ethical implications of using the SCORS-G in clinical practice, and recommendation for a moratorium on its use until minimum psychometric standards can be established and greater clarity is achieved surrounding its use with diverse and vulnerable populations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A qualitative examination of social identity and stigma among adolescents recovering from alcohol or drug use.

Introduction: Alcohol and other drug (AOD) use disorders are stigmatized conditions, but little is known about youth's experience of this stigma, which may threaten their developing social identity and recovery process. This study investigates youth's perceptions of AOD use-related stigma in the context of their social identity. Methods: This study uses data from 12 youth (ages 17-19) who were in recovery from problematic AOD use. Participants completed a Social Identity Mapping in Addiction Recovery (SIM-AR) exercise, in which they created a visual map of their social groups, and semi-structured interview, in which participants were asked about their experience creating their SIM-AR and reflections on their social network. SIM-AR data were descriptively analyzed, and interviews were thematically analyzed for instances of stigma. Results: Using stigmatizing terminology, participants expressed some stigmatizing attitudes towards themselves and others in their network who used substances and perceived both positive and negative reactions from those who knew about their disorder. Findings suggest that youth may experience some internalized stigma and perceive stigma from others in their social networks, which may be a barrier to the development of a healthy social identity and engagement in recovery supports. Conclusions: These findings should be considered when seeking to engage youth in treatment and recovery programming. Despite the small sample, the findings suggest the importance of considering how stigma may influence adolescents' treatment and recovery experience in the context of their social environment.

"A lot better than it used to be": A qualitative study of adolescents' dynamic social recovery capital.

Background: Substance use recovery is a dynamic process for youth, and social networks are tied to the recovery process. The Recovery Capital for Adolescents Model (RCAM) situates the resources accessible through social networks - social recovery capital (SRC) - in a larger framework of developmentally-informed recovery resources. This study aims to investigate the social network experiences among recovering youth enrolled in a recovery high school to understand how social influences help to build, or act as barriers to building, recovery capital. Methods: To gain insight into these networks, Social Identity Maps and semi-structured interviews were conducted with ten youth ages 17-19 years (80% male; 50% non-Hispanic White). Study visits were conducted virtually, recorded, transcribed, and thematically analyzed using the RCAM as an organizing framework. Results: Results supported that adolescent social networks play a unique and multifaceted role in the recovery journey. Three key nuances emerged: change permeates adolescent networks throughout the treatment and recovery process; shared substance use history and non-stigmatizing attitudes play a key role in connecting with others; and SRC is interconnected with human, financial, and community recovery capital. Conclusions: With adolescent recovery receiving increased attention from policy makers, practitioners, and researchers, the RCAM may be a useful way to contextualize available resources. Findings suggest SRC as a crucial, yet complex component intertwined with all other forms of recovery capital.

Measurement invariance of the University of Rhode Island Change Assessment Scale in Project MATCH: An exploratory structural equation modeling approach.

BACKGROUND: Progression through the stages of change is a proposed mechanism underlying the effects of treatment for alcohol use disorder (AUD). However, examining stages of change as a mechanism of treatment effects requires that the measure be invariant across patient subgroups, treatment conditions, and time. In this study, we examined measurement invariance of the University of Rhode Island Change Assessment Scale (URICA) in Project MATCH using an exploratory structural equation modeling (ESEM) approach. METHODS: We conducted a secondary analysis of data from Project MATCH (N = 1726; Mage  = 40.2, SD = 10.9; 75.7% male; 80% non-Hispanic white), a multisite randomized clinical trial that tested three AUD treatments: Motivational Enhancement Therapy, Cognitive-Behavioral Therapy, or Twelve-Step Facilitation. Participants completed the 24-item URICA for assessing the stages of change in relation to drinking at baseline and post-treatment (3 months after baseline). RESULTS: A 4-factor ESEM provided a good fit to the data and a better fit to the data than a conventional 4-factor confirmatory factor analysis model. Further, the URICA demonstrated scalar invariance across each patient subgroup at baseline (sex, ethnicity, marital status, education, and parental history of AUD) and treatment condition at follow-up. However, the URICA was not longitudinally invariant as the metric model resulted in a significant decrement in model fit. CONCLUSIONS: Measurement invariance of the URICA over time was not supported. Longitudinally invariant measures of the stages of change are needed to test the proposal that progression through the stages explains treatment effects.

Disclosure Attitudes, Beliefs, and Behaviors in Recovery from Problematic Alcohol Use: A US Sample

Abstract Social support has been found to positively assist in recovery from problematic alcohol use. This project examined the relationship between disclosure of alcohol recovery status to social connections, and longest period of alcohol abstinence. This cross-sectional study had (N=154) adult participants from the US who were in recovery from problematic alcohol use. Beyond demographic data, participants reported on a variety of things including medical, psychiatric and recovery history. Longest period of alcohol abstinence was associated with participant's level of openness to disclosure, belief in the efficacy of disclosing, number of social connections disclosed to and categories of people one disclosed to. The most common social connections disclosed to were close friends, support groups, and healthcare providers. Disclosing to one's parents, grandparents and children corresponded to the longest periods of alcohol abstinence. Our findings suggest that disclosing recovery status to social connections may support longer periods of alcohol abstinence.

Resumen Se ha comprobado que el apoyo social contribuye positivamente a la recuperación del consumo problemático de alcohol. Este proyecto examinó la relación entre la divulgación del estado de recuperación del alcohol a las conexiones sociales y el período más largo de abstinencia de alcohol. Este estudio transversal tuvo (N=154) participantes adultos de los Estados Unidos que se estaban recuperando del consumo problemático de alcohol. Más allá de los datos sociodemográficos, los participantes informaron sobre una variedad de cosas, incluyendo historia médica, psiquiátrica y de recuperación. El período más largo de abstinencia de alcohol se asoció con el nivel de apertura de los participantes a la divulgación, el número de conexiones sociales reveladas y las categorías de personas a las que se reveló. Las conexiones sociales más comunes reveladas fueron amigos cercanos, grupos de apoyo y proveedores de atención médica. Revelar a los padres, abuelos e hijos correspondía a los períodos más largos de abstinencia al alcohol. Nuestros hallazgos sugieren que revelar el estado de recuperación a las conexiones sociales puede apoyar períodos más largos de abstinencia al alcohol.