Recovery from Substance Abuse: The Role of Unsupportive Social Interactions

vii Chapter 1 – Introduction 1 Chapter 2 Literature Review 7 Chapter 3 – Method 57 Chapter 4 – Results 82 Chapter 5 – Discussion 119 References 133 Appendices A. Consent Form 151 B. Attendance and Toxicology Reporting Form 154 C. Social Support Questionnaire 156 D. Important People and Activities Instrument 159 E. Unsupportive Social Interactions Inventory 162 F. Cognitive appraisal questionnaire 165 G. Center for Epidemiologic Studies Depression Scale 167 H. Situational Confidence Questionnaire 169 I. Demographic questionnaire 172 v LIST OF TABLES Page Table 1 Categorical Demographic Characteristics of Participants 59 Table 2 Quantitative Demographic Characteristics of Participants 64 Table 3 Participants’ Reported History of Substance Abuse Treatment 69 Table 4 Comparison Between Fulton County Sample Sub-groupings on Categorical Demographic Variables 83 Table 5 Comparisons Between Fulton County Sub-groupings on Continuous Demographic Variables 89 Table 6 Comparison Between Richmond and Fulton County Groups on Categorical Demographic Variables 92 Table 7 Comparison Between Richmond and Fulton County Groups on Continuous Demographic Variables 97 Table 8 Internal Consistency Estimates for Dependent and Independent Variables ...100 Table 9 Means, Standard Deviations and Ranges of the Dependent and Independent Variables 102 Table 10 Selected Item Means from the Unsupportive Social Interactions Inventory 104 Table 11 Correlations Among the Measured Variables 107 Table 12 Statistical Tests of the Association Between Outcome Variables and Potential Co-variates 111 Table 13 Hierarchical Regression Equations for the Prediction of Self-Efficacy of Recovery, Depression, Treatment Attendance, and Abstinence from Stress of Recovery, Positive Social Support, and Unsupportive Social Interactions ..113 Table 14 Hierarchical Regression Equations for the Prediction of Self-Efficacy of Recovery and Depression Stress of Recovery and Unsupportive Social Interactions 117 vi LIST OF FIGURES Page Figure 1 Conceptual Model 54 Figure 2 Participants’ Substance(s) of Choice 66 Figure 3 Participants’ Acknowledgement of Substances Tried 67 vii ABSTRACT RECOVERY FROM SUBSTANCE ABUSE: THE ROLE OF UNSUPPORTIVE SOCIAL INTERATIONS By Michelle M. Schmitt, M.A., M.S. A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2003 Major Director: Kathleen M. Ingram, Ph.D., Assistant Professor, Department of Psychology It has been estimated that over 20 million individuals struggle with substance abuse and/or dependence each year. Theories of addiction and recovery have long incorporated the notion of social support and helping relationships to facilitate adjustment. However, the literature investigating the role of social support is fraught with contradictions. In addition, in substance abusing populations, researchers have just begun to investigate social support as having negative, as well as positive implications. Historically with these populations, interpersonal conflict and loss of relationships were investigated as negative life events, rather than types of unsupportive social interactions. This study was designed to explore how positive and negative social relationships are associated with adjustment among individuals struggling with addiction. Ninety-seven individuals, who were currently participants in two Drug Court programs, completed measures of global positive social support (the 6-item Social viii Support Questionnaire), recovery-specific positive social support (Important People & Activities Instrument, brief version), recovery-specific unsupportive social interactions (Unsupportive Social Interactions Inventory), recovery-specific cognitive threat appraisals, and well-being (Situational Confidence Questionnaire and Center for Epidemiologic Studies Depression Scale). Information regarding treatment attendance and positive urine toxicology reports was gleaned from treatment records. Results suggested that global positive social support accounted for the greatest proportion of variance in the well-being outcomes of self-efficacy for recovery and depression. Global positive social support eclipsed the role of recovery-specific unsupportive social interactions in relation to well-being. However, recovery-specific unsupportive social interactions were found pertinent to this population. None of the survey variables were significantly related to treatment attendance, and only self-efficacy for recovery was related to continued drug use (urine toxicology screenings). Implications for future research and interventions to enhance the well-being of individuals in recovery are discussed.