Youth In Recovery Express Internalized Stigma and Resilience
Key findings
- A previously published qualitative pilot study examined the feasibility of using social identity maps with 12 adolescents in recovery from the use of alcohol and other drugs
- This stigma-focused exploratory analysis of the pilot study examined how the participants described their recovery experience and the substance use of others in their social network
- Nine participants used stigmatizing language, such as "addict" or "recovering addict," in their map or interview to describe their own or others' use of alcohol and other drugs, endorsing stigmatizing views, and/or expressing internalized stigma
- Three participants discussed the need to distance themselves from family and friends who use alcohol and other drugs, acknowledging the risk to their recovery but still feeling strongly connected to them
- Participants also discussed resilience in the face of stigma, the ways they dealt with potentially stigmatizing interactions, and feeling support from others after they disclosed their experience
Because of their developmental phase, adolescents in recovery from alcohol and other drug (AOD) use disorders may be more vulnerable to stigma than adults are. The newness of romantic relationships and working toward high school graduation and college admission or employment can complicate the tasks of developing a "recovery identity" and a sober support network.
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Researchers at Massachusetts General Hospital have found that social support within one's recovery network can counter the detrimental effects of stigma—even if the support comes from people who currently use substances themselves. Sophia H. Blyth, researcher, Emily A. Hennessy, PhD, associate director of biostatistics at the Recovery Research Institute in the Department of Psychiatry at Mass General, and colleagues explain their conclusion in Addictive Behaviors Reports.
Methods
The researchers used data from a pilot study published in Addiction Research & Theory, which assessed the feasibility of using social identity maps with youth in addiction recovery. A social identity map visually represents the participant's social network and its characteristics.
Eligible participants were 12 to 19 years old. However, enrollment occurred during the COVID-19 pandemic, so 11 of the 12 participants were recruited from high schools for recovering youth. The average age was 17.75, and 10 participants were male.
Each study visit was conducted via videoconference and consisted of the facilitated completion of a social identity map, a semi-structured interview where the participant reflected on their map, and a brief demographic survey.
Internalized Stigma
Nine participants used stigmatizing language, such as "addict" or "recovering addict," in their map or interview to describe their own or others' AOD use. Three of them used the word "clean" to designate themselves or others as abstinent.
Seven of the 12 participants used terms such as "normal" or "healthy" to compare themselves to people without mental health or substance use issues.
Participants who did not report perceiving stigmatizing experiences did not use stigmatizing language to describe their own or others' use of alcohol and other drugs. Instead, they used broader terms such as "being sober" or "recovery people."
Endorsed Stigma
Three participants perceived people in their network who used substances to be negative influences, and they often used stigmatizing terms such as "drug users," "dealers," or "not good" to describe them. However, they felt understood in these relationships despite acknowledging these friends could be a risk to their recovery.
Perceived/Received Stigma
Several participants said certain members in their social network, including family members, lacked understanding of their AOD use recovery, and they reported a lack of support. Many participants said they lost friends after entering recovery and felt isolated at times. Not all had shared their AOD use recovery with their peers, and one reported receiving criticism after self-disclosing.
Perceived Support
Four participants used disclosure to form new connections in their recovery programs or with family and friends who understand the disorder, and they felt supported by these people.
Recommendations for Clinicians
Youth in recovery from substance use need safe places to freely disclose their status to those who are likely to be accepting. Examples are recovery high schools, alternative peer groups, young people's meetings and recovery clubhouses.
Clinicians should ask each individual adolescent how they prefer to talk about their experience as they enter recovery and seek to develop their social identity. Responses can be used as a guide for engaging other youth and advertising their programming.
The finding that some youth in recovery feel more understood by peers who engage in substance use is an important insight. Clinicians should help parents and other caregivers understand why a young adult may continually interact with others who are viewed as "risky."
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