Factors Facilitating Recovery: Gaining a Positive Identity

People with serious substance use problems lose a lot of the roles or personal characteristics that help define their normal identity (e.g. loving son, athlete, generosity, intelligence) as their dependence on their substance(s) increases, relationships wither and isolation increases. Eventually, their identity as viewed by others may become ‘a useless, dirty addict’. They will also have personal views of what they have become and these views can lead to lowered self-esteem or even intense hatred of oneself.

On the basis of qualitative research with over 100 heroin addicts who had recovered from their addiction without professional treatment, Patrick Biernacki argued that: ‘To change their lives successfully, addicts must fashion new identities, perspectives and social world involvements wherein the addict identity is excluded or dramatically depreciated.’ [1]

James McIntosh and Neil McKeganey (2002) came to the same conclusion, on the basis of their qualitative research with 70 people recovering from drug addiction, most of whom had received formal addiction treatment at some stage [2].

‘… at the heart of most successful decisions to exit drug misuse is the recognition by individuals that their identities have been seriously damaged by their addiction and the lifestyle that accompanies it. This, in turn, stimulates a desire to restore their identities and to establish a different kind of future for themselves.’ James McIntosh and Neil McKeganey

These Scottish researchers argued that successful decisions to stop using illegal drugs come from (1) a motivation to ‘exit’ use which is more powerful than the fear of stopping, and (2) a sense of a future that is potentially different from the present. This successful decision may come from rational decisions, arising from the person wanting to stop using on the basis of the unacceptable nature of what they have become, or from ‘rock bottom’ decisions. With the latter, the person knows they have no other viable option but to stop. They have reached the end of their tether. Often the person has contemplated, or even attempted, suicide.

The transition to non-addict status is by no means an easy one, since it generally involves a major disruption to the person’s life. 

‘All of a sudden, the social networks, values, activities and relationships that had defined and structured the addict’s life are removed and a potential void is created…. it is essential that this gap is filled in an appropriate and constructive manner if the individual is to stand any chances of success in sustaining his or her recovery. In addition, of course, a new non-addict identity also has to be constructed and sustained. None of this happens on its own. It has to be managed by the addicts themselves and often at a time when they are not feeling particularly robust.’ James McIntosh and Neil McKeganey

Two main strategies that the people in this study used to achieve their goals were (1) the avoidance of their former drug-using network, and (2) the development of a set of non-drug-related activities and relationships. The alternative lifestyle which these relationships and activities provide, give the person an enhanced sense of personal value and a new meaning and purpose to their life, and imbue them with a sense of hope for the future.  

‘Paid employment was especially beneficial; it occupied their time constructively, did wonders for their self-esteem and provided a network which could assist in the validation of their new identities. Relationships with non-users were also central to the recovery process; these people provided the necessary social acceptance for the recovering addicts’ new status and made it possible for them to participate in the drug-free world. They also provided companionship, which played an important part in preventing loneliness and isolation, thereby neutralising the latter’s potential to draw the recovering addicts back into the company of users.’ James McIntosh and Neil McKeganey

Patrick Biernacki discusses the transition that the recovering addict makes into the so-called ‘normal’ world, providing an indication of how ‘normal’ people can facilitate or hinder a person’s recovery journey.

‘Those addicts wishing to change their identities may first have to overcome the fear and suspicions of nonaddicts before they will accepted and responded to in ways that will confirm their new status. Gaining the recognition and acceptance of the nonaddict world often is a long and arduous process.

Eventually, acceptance may be gained by the exaddicts behaving in conventionally expected ways. Following “normal” pursuits, remaining gainfully employed, meeting social obligations, and possessing some material things will often enable nonaddicts to trust the abstainer and, over time, to accept him and respond to him in “ordinary” ways.

At the same time, the addict’s feelings of uncertainty and doubt will lessen as he comes more fully to accept the new, nonaddict life.’ Patrick Biernacki

As the process of recovery unfolds, the person starts to regain elements of their old identity and/or elements of a new identity. These changes operate at both an external level (what others perceive of you) and internal level (what you think about yourself).

Interestingly, many people in long-term recovery (and others around them) comment on their becoming a better person for having gone through the recovery process. This is not surprising, given the intense and painful journey that recovering people have taken and the great deal of self-analysis that has generally been undertaken.

[1] Patrick Beirnacki, Pathways from heroin addiction: recovery without treatment, Temple University Press, 1986.

[2] James McIntosh and Neil McKeganey, Beating the Dragon: The Recovery from Dependent Drug Use, Pearson Education Limited, UK, 2002.

The photograph used in this blog post was by Babar Bilal and has come from Unsplash, a great resource of free high resolution photographs.