Social Recovery: The Role of Support Groups in Relapse Prevention

people meeting to share experiences

Recovery from substance abuse is all about change. A person trapped in the cycles of addiction must take action in order to free themselves from those cycles. The hard bottom line in recovery is a change in behavior: addictive behaviors must be identified and replaced with non-addictive behaviors. This basic fact implies changes in thoughts, changes in beliefs, and changes in values. These changes, in turn, imply a fundamental restructuring of an individual’s perspective on themselves, the world, and their role in the world. If behavior is understood as the end result of a series of decisions based on thoughts, beliefs, and values informed by personal perspective, it follows that – as difficult a prospect as this may be – a person seeking to recover from addiction must change everything leading to the behavior in question. In short, a person in recovery needs to do more than simply modify behavior: they need to create a new identity.

But there’s a rub. No person exists in isolation. Individuals function as the central node in a network of relationships within which they carve out their place and establish their role. This role and place determines their social identity, which is reinforced through a mutual feedback loop created by the individual, their behavior, and the responsive behaviors of the people around them. This complicates the process of recovery, because it requires the recovering individual to change not only their internal sense of self – the sum total of their thoughts, beliefs, and values – but also their external manifestation of self, i.e. their role and place in their social network. A recent vein of empirical research in substance abuse treatment takes this concept one step further, concluding that sustainable, life-long recovery requires restructuring the social milieu of the recovering addict to fully support and ensure their success.

The research indicates it’s not enough to change only oneself; full recovery requires participating in groups that reinforce the new self, created during the process of recovery. Without this essential element, the chance of relapse increases, driven by external pressure: the power of the old social group associated with addictive behavior eclipses the nascent, vulnerable self of recovery, and the hard work of recovery is lost.  Whether you join an outpatient treatment program or go to a community support meeting, social connection is critical to long-term success.

This article will discuss the ideas presented in the paper “The Social Identity Model of Cessation Maintenance: Formulation and initial evidence” by Daniel Frings and Ian P. Alvery, published in the peer-review journal Addictive Behaviors in October, 2014. It will address the traditional role of social groups in addiction recovery, the way those groups impact social identity, and the positive effect the intentional restructuring of social groups and social identity have on long-term recovery from substance abuse and addiction.

Something Old, Something New

The idea that social support facilitates recovery is nothing new. In fact, social support groups are almost synonymous with recovery: ask a random person on the street what they know about quitting alcohol or drugs, and the likely response will be something like,

“Well, most people go to AA (Alcoholics Anonymous) or NA (Narcotics Anonymous) meetings, and if that doesn’t work, they go into rehab.”

And that random person would be right. Support groups have long been an accepted component in the recovery process. They function in many ways: they may be an individual’s first exposure to recovery, they may be part of a residential rehab or intensive outpatient program, or they may be a key element of transition from rehab back to day-today life. While AA meetings and the Twelve-Step approach to recovery are widely recognized as the dominant support group paradigm, non-Twelve-Step programs such as SMART Recovery and Refuge Recovery are now widespread and offer equally viable social support options for recovering addicts.

The intriguing aspect of “The Social Identity Model of Cessation Maintenance” study is not that social support plays a big part in recovery, but the detailed discussion of the how and why social support groups work, combined with data to support the assertion that in the absence of a social system to support the newly formed sober identity, the chances of cessation maintenance – a fancy way of saying staying sober and avoiding relapse – decrease dramatically.

Why Support Groups Work for People in Recovery

A person with a serious addiction or substance abuse disorder creates a social identity that’s inextricably intertwined with their addiction. They self-identify with their substance of choice: smokers readily say “I’m a smoker,” and drinkers readily say, “I’m a drinker.” When it won’t get them in legal trouble, people who smoke marijuana readily say, “I’m a pot smoker.” The social groups associated with these behaviors reinforce these identities. People who drink hang around other people who drink. Smokers take smoke breaks at work with other smokers, and people who smoke marijuana tend to spend time with other people who smoke marijuana. The person with the addiction may be many other things in life, as well. They may establish aspects of their identity in terms of family, work, or other activities. They may be a mom or dad, a lawyer, teacher, a cyclist, or a musician. When they decide to stop drinking, smoking, or using drugs, however, they’ve usually reached a point where their addict-identity has achieved primacy, interrupted their other identities, taken control of most of their behavior, and made their life as moms, dads, lawyers, or teachers unmanageable.

The addict-identity, supported by social groups that validate and reinforce the addictive behavior, does not simply disappear when the addict decides to enter recovery. Nor do the social groups magically blink out of existence. The drinkers are there, drinking. The smokers are there, smoking. And the drug users are still there, using drugs. A person in the early stages of recovery who tries to maintain old social habits and networks fights an uphill battle: the strength of habituated social reinforcement can easily overwhelm the sober-identity they’re trying to create. The social groups may not be consciously or maliciously hostile to the sober identity, but by definition and in practice, they do not help its formation or foster its growth, either: these social groups and the behaviors that signify membership are self-perpetuating. They – meaning the collective will of the individual members – help maintain the status quo. Through sheer inertia, they have the ability to crush dissent and non-conformity without even noticing its happening.

That’s where support groups come in: they offer a social system that reinforces both sober behavior and the formation of a new sober identity. They offer shared norms, values, and life-strategies that encourage the sober-identity to flourish. They create a set of standards that protect the newly sober individual in their efforts to escape addiction. Their members offer advice, encouragement, and a sense of belonging. They form a protective shield behind which an individual new to recovery can gather themselves and lay the foundation for a new approach to life. In the words of Frings and Alvery,

“Much of group [support] revolves around strengthening the salience of a new social identity of ‘recovery’ and demonstrating its applicability to situations beyond the treatment setting. This involves a transition between an addict identity and a recovery addict identity. Social identity re-search suggests that the transition between identities often leads to a reevaluation of values and behaviors and is potentially a period of stress. Moderators of this stress include social support, continuity (over time) with other identities and a perception that relevant identities are compatible. Relative to addicts quitting on their own, group therapy [or a support group environment] provides these protective factors.”

Support groups work because humans are social animals and individual human identity never develops in a vacuum. Human identity is the result of practice, and recovering addicts need a place to practice their new recovery identity until they’ve got a firm grip on what it takes to maintain sobriety. They also need concrete, specific examples to guide them through the tenuous, initial stages of recovery. Experienced members of support groups provide all that, and more. It’s one thing for an addiction counselor to dispense advice on how to handle trigger situations; it’s quite another to sit in a meeting a hear fellow group member say, “I was triggered this morning, and here’s how I successfully handled the situation.”

Social Support and Recovery: Key Points

A revised, retooled, and restructured social network is a crucial component of recovery, but there’s a very interesting point to be made regarding the size and scope of social restructuring necessary to stay sober. First, it’s important to define exactly what recovery means. According to the Betty Ford Consensus Panel on Recovery, recovery is defined as “…voluntary maintained lifestyle characterized by sobriety, personal health, and citizenship.” The Ford Panel further identifies three aspects of recovery:

  • Functional Recovery: Remission of symptoms.
  • Personal Recovery: Getting a job and coping with daily life demands.
  • Social Recovery: Developing strong and supportive social networks.

The first two aspects are obvious: recovery requires the addict to cease the addictive behavior and handle the typical demands of life. It’s also obvious that elements of the previous social network must be eliminated: if you’re a recovering alcoholic, hanging out in bars is not a good idea: eliminate that aspect of your social life. If you’re a pot smoker, hanging around the smoke shop is not a good idea: eliminate that aspect of your social life. The interesting point to be made involves “strong and supportive social networks.” When rebuilding a social world, one may think the new social networks need to be as large – by number – as the old social networks. While it’s true that the bigger and more robust the new social network is, the more support it can offer, a study on social support for recovering alcoholics published in 2009 reveals that size does not matter:

“Those who added at least one non-drinking member to their social network showed 27 percent increase at 12 months post-treatment in the likelihood of treatment success, and sustaining abstinence.”

This insight is critical: it proves that social interactions are a small hinge capable of swinging an enormous door. The addition of only one abstinent member to a recovering addict’s social network can drastically increase their chances of maintaining sobriety. This is important because individuals in recovery can get overwhelmed by the apparent difficulties of the path they’ve chosen, and reading an article like this, which seems to say “I have to get a whole new social life or I’m never going to make it” might add a layer of difficulty they’re not ready to tackle. But adding one non-drinking, non-drug taking person is not scary. On the contrary, of all the challenges of recovery, it may be the most do-able.

The Path to Change

The role of social identity in addiction is impossible to ignore. We grow, develop, and become experts at particular types of behavior because they serve us well at some point in our lives – even the behaviors of addiction originally developed as survival mechanisms. The addict-identities we create to support these behaviors also served us well at some point in our lives, as did the social networks we participated in that reinforced and perpetuated these identities. If they hadn’t, we never would have developed them, and we would never have sought out the associated social groups that reinforced them. When an individual chooses recovery over addiction, it’s like hitting a reset button on all of the above. Negative, addictive behaviors must be identified and replaced, but that’s not all: the addict-identity behind the behaviors must be identified and replaced, as well. The new identity – the sober-identity, the recovery-identity, former-addict-identity – needs a safe place to grow and thrive. That safe space is a community of sober, social interactions, filled with people united by common purpose working toward a shared goal. Support groups and group therapy are effective spaces for just that: they give the recovering addict a forum in which to practice their new identity and work out the kinks before they take it out for a drive. And you don’t have to be a social butterfly, flitting from one support group to the next: one person can make all the difference.