USING SOCIAL MEDIA FOR SOBRIETY RECOVERY?Preferences, Beliefs, Behaviors, & Surprises From Users

Donald S. Grant, PhD Karen Dill-Shackleford, PhD

USING SOCIAL MEDIA FOR SOBRIETY RECOVERY? Preferences, Beliefs, Behaviors, & Surprises From UsersDonald S. Grant, PhD & Karen Dill-Shackleford, PhD

WHAT WAS IT LIKE?

WHAT HAPPENED?

WHAT’S IT LIKE NOW?

WHY THIS STUDY & AND WHY NOW?

23.5 million American adults consider themselves in recovery from a drug or alcohol problem they once considered to be problematic.

74% (or 241.8) million Americans currently use the Internet.

72% (176.5 million) of American adult Internet users use social networking sites.

Social networking sites are increasingly used to keep up with close social ties. The average user of a social networking site has more close ties, and is half as likely to be socially isolated, as the average American.

Multi-platform use is on the rise: 52% of online adults now use 2 or more social media sites, a significant increase from 2013, when it stood at 42% of Internet users.

INTRODUCTION

The Office of Alcoholism & Substance Abuse Services (OASAS) estimates 10% of American adults consider themselves in recovery from alcohol/drug abuse (Rondó & Feliz, 2012). Support through social communities has long proven beneficial for compromised individuals (Davison, Pennebaker & Dickerson, 2000).  As more people engage in mediated sobriety support, the extent to which these platforms are being utilized (or even potentially supplanting traditional face-to-face (F2F) sobriety support), any possible differential in efficacy between traditional F2F meetings and computer-mediated recovery platforms, and what impact it might have on the future of F2F Alcoholics Anonymous and/or its membership are questions which currently present themselves as epochal to both 12 Step program members and healthcare professionals alike. Studies have been published investigating the differences between web-based vs. F2F weight loss support success (F. Johnson & Wardle, 2011) and academic achievement (Langenhorst, 2012), but none have yet explored F2F vs. mediated sobriety support.  This study investigated abstinence-based modality support preference (F2F or mediated), as well as variables including ease of self-disclosure, honesty, sobriety efficacy, and participant beliefs about the future of sobriety support as related to both mediated and F2F support modalities.

The National Institute on Alcohol and Alcoholism (NIAAA) claims that nearly 18% of Americans currently abuse alcohol or are alcohol dependent.

The 2009 National Survey on Drug Use and Health discovered that 86 percent of American youths by the age of 21 have used alcohol & that 50 percent are binge drinking (defined as five or more drinks in a single session for men, four or more for women).

About 3 in 10 U.S. adults drink at levels that elevate their risk for physical, mental health, & social problems. Of these heavy drinkers, about 1 in 4 currently has alcohol abuse or dependence.

The leading causes of death in the U.S. are related to alcohol, drugs & other addictionsIs increasing in the number of victims it claims each year.

Demonstrates no discrimination to race, culture, education, or socioeconomic status.

10% of individuals with substance dependence (including alcohol) complete suicideWithout some form of friends & family, legal or medical intervention, it is rare that substance dependence can be defeated.

SUPPORT GROUPS

Individuals sharing a common problem, concern or experience.Emotional recovery self-help groups usually peer-led & membership directed.For those with limited financial or insurance resources, the only viable option.Popular. In 1997, researchers estimated that more than 25 million Americans had been involved in self-help groups at some point in their lives (Kessler, Mickelson & Zhao, 1997; Wituk et al., 2000).Media exposure via “Donahue” model television programs, resulted in millions of viewers who never considered self-help groups as a possible source of support, to begin thinking differently. Increased exposure has led to increased awareness (Jacobs & Goodman, 1989).ALCOHOLICS ANONYMOUS is considered by many to be the most successful, prolific, & accessible self-help group worldwide.

Studies have evidenced that the positive correlation

identified between A.A. self-help group involvement and reduced

drinking can be partially explained “by changes in social

networks.”

Sources: Bond, Kaskutas & Weisner, 2003 Campbell & Kelly, 2006 Kaskutas, Bond & Humphreys, 2002

BUT WHAT ABOUT THE REST?

WHY AREN’T THEY SEEKINGA.A. SUPPORT?

REASONS WHY SOME ALCOHOLICS WON’T ENGAGE WITH ALCOHOLICS

ANONYMOUS…

Even with “anonymity” the assumed principle, many alcoholics still fear public or personal embarrassment through association with A.A.

Lack of meetings in many geographic areas.

Uncertainty (or denial) whether or not they are, in fact, an alcoholic.

Misconceptions regarding A.A. as a “cult”/religious-based organization.

Relapse.

Shame.

Co-occurring psychological disorders, emotional acuity, or physical disabilities which legitimately impede their ability to attend A.A. F2F meetings.

A MILLENNIAL SOLUTION?

SOCIAL MEDIA“SPONSORS” RECOVERY

Studies have shown that “problem

drinkers who do not use available forms of

treatment will engage

with an interactive Website”(Lieberman & Huang, 2008)

Today: There exist 1000’s of cyberspace sobriety support sites,

domains, chat rooms , & mediated sobriety recovery-dedicated based

platforms…

Available 24/7/365.

“Anonymity” ostensibly becomes 100% “possible.”

Include recovery-based websites, email, chat (text), audio/video, discussion forums, social media “walls,” & virtual meeting spaces.

Target the support-seeking alcoholic or addict either unable or unwilling to participate with such support in traditionally defined corporeal presence-based Face-to-Face (F2F) meetings.

Search term “alcoholic” on “Facebook” generates 100’s of groups pages allowing members to post/discuss commentary or artifacts (synchronously or asynchronously).

Similar opportunities exist on myriad other socially mediated platforms.

ONLINE / MEDIATED ALCOHOLICS ANONYMOUS

& SOBRIETY SUPPORT GROUP MEETINGS

“Online communication is extremely important for individuals who are

unable to meet other people in conventional settingsfor reasons of physical mobility or geographic isolation”

- Media psychology expert Dr. David Giles (2003)

Most commonly held in Internet Relay Chat (IRC) chat room settings and through dedicated sobriety-based platform sites.

Members can communicate with others in real time or at their leisure.

No visual contact between participants.

“Skype” meetings still relatively embryonic in development, but do exist; most still designed to provide audio exchange only–no visual.

ONLINE DISINHIBITION EFFECT Can cause/permit people to say and do things in cyberspace that they wouldn’t normally say and/or do in the face-to-face world (Suler, 2004).

Allows the socially anxious to be more honest and open about themselves. (HINT: This piece of the theory becomes VERY important later!)

Whitty’s (2008) work based in social presence theory suggests that lack of traditional cues in computer mediated communication (CMC) can be overcome and instead lead to “more personal intimate relationships” which can prove empowering.

Could explain why some who are reticent to engage in A.A. F2F interaction, are able to do so through mediated platforms.

"LOOKING GLASS SELF“(circa Cooley, 1902)

Central to the existence of the looking-glass self theory is the presence of a social audience; to learn about themselves, people require others to provide self-relevant information. In short: people construct a conceptualization of their own views of self, based on how they perceive that others view them.

Irving Goffman: "Self-presentation is a kind of performance"; the signals we "give" intentionally and "give off" unintentionally.

Don Grant: “In Cyberspace we are digital architects with the ability to create, curate, & manage our own image. We engage, invite, accept, follow, or create circles, then secretly judge the social media postings of our cyber “Friends,” “Followers,” those we “Follow,” or members of online groups we volitionally join. We compare, contrast, & "Like" the same posts and posters we negatively judge. We “share” & “Favor” photos, images, and tweets we secretly think are puerile-as well as their creators-& even “Follow” people we don’t know, hate, or feel jealousy toward. We propose, defend, & engage in cyber diatribes, safely cloaked behind the masked veil of computer mediated communication. Cyberbulling, “blocking,” “unfriending,” dropping, disengagement, & not “favoring “or “liking” have become the new social weapons.”

It’s all about ‘social currency,’…”

IN OTHER WORDS…An individual’s online “postings” or even entireconversations can, (should one choose), becarefully constructed, designed, edited, modified, or even anonymously presented to theinvisible membership community.

Impression management, affiliation choices, andthe ability to confidentially compare the self-presentations of other members to one’s owncan challenge or boost an individual’s self-esteem, beliefs, and social capital.

Conversely, these comparisons can feed insecurities, envy, and loneliness-or even exacerbate existing shame, anxiety or isolation.

SOCIAL IDENTITY THEORY

“Getting to know other group members personally is not necessary to feel connected to a common-identity group. Instead, perception of sharing at least one characteristic (like-minded people and GOOD for those seeking self-help-especially compromised, disenfranchised, or geographically removed populations and/or those suffering from fear of self-disclosure or rejection) that connects all members is sufficient to foster attachment.“

Common-bond communities (i.e. social networking groups; addiction & mental health sufferers).

All about empowerment or disempowerment-especially for traditionally marginalized populations.

CONCERNS OF MEDIATED SOBER SUPPORT

ENGAGEMENT Confidentiality protection.

Duplicitous or inauthentic online presentation.

Encourages isolation.

Some believe that online relationships result in more weak than strong relational ties (Donath & boyd, 2004; Walther et al., 2009; Wright, 2005).

Mediated engagement allows for less of a structured “commitment” to recovery than F2F meetings.

• Potentially provides a safer place to disclose about one’s self

• Available 24/7/365

• Accessible to compromised, discriminated, geo-isolated, or anonymity anxious individuals

• Limitless possibilities to connect with TRULY “like-minded” others anywhere in the world

• Can help assuage shame, fear, mental or physical health issues which would otherwise impede the ability to engage with F2F sobriety support

• Easier to be disingenuous online

• “Suiting up and showing up” shows true commitment to sobriety

• Face-to-Face “Fellowshipping” is key ingredient to success of program

• Lack of accountability

• Relationships not genuine

• Isolation is a nemesis of sobriety

• Vulnerability to cyberbulling, “catfishing,” malware, identity theft, privacy, Internet addiction

MEDIATED SOBRIETY SUPPORT

WHY? WHY NOT?

HYPOTHESIS&

RESEARCH QUESTIONS

HYPOTHESIS & RESEARCH QUESTIONS

H1: Participants who have engaged in both mediated & F2F sobriety support will show a preference for the F2F modality.

RQ1: Will participants who have engaged in both F2F & mediated sobriety support find it easier to be more honest in the F2F environment than in their mediated participation?

RQ2: Will people in recovery who have used both mediated & F2F sobriety support be more likely to be using substances while participating in one modality or the other?

RQ3: Will participants who have engaged in both mediated & F2F sobriety support report having decreased their attendance at F2F since engaging with mediated sobriety support?

RQ4: To what degree will sobriety success be related to the use of mediated & F2F support?

MATERIALS&

METHODOLOGY

MATERIALS & METHOLODOLOGY

Participants were 196 adults in sobriety recovery who self-reported using both F2F & mediated sobriety support modalities (141 female, 55 male). They were recruited on Facebook based on stated interest in sobriety recovery. Participants were 86% White, & 86% of the age distribution fell between 30 & 59 years of age. The Sobriety Support Preference Scale was created for this project. It consisted of two parallel subscales—the Mediated Social Support subscale & the Face-to-Face Social Support subscale. Each subscale measured preferences, attitudes & behaviors in its modality. An example item is, “When I am in a crisis, I am likely to seek support through online (or F2F for the F2F subscale) recovery resources.”

From initial pool of 20 items for each subscale, 4 items were removed based on factor analyses. Remaining subscales consisted of 16 parallel items. Factor analysis (principal components with oblique rotation) suggested a one factor solution for each subscale. Cronbach’s alphas were .91 & .94 for F2F & Mediated subscales respectively.

RESULTS

H1

Participants who have engaged in both mediated and F2F sobriety support will show a preference for the F2F modality.

A repeated measures ANOVA with the variable of Modality Preference (F2F vs. mediated) revealed a significant preference for F2F sobriety support (M=7.34, SD=1.59) over mediated (M=4.58, SD=1.98), F(1, 191)=155.22, p<.0001, η2=.45.

RQ1

Will participants who have engaged in both F2F and mediated sobriety support find it easier to be more honest in the F2F environment than in their mediated participation?

Repeated measures ANOVA indicated participants felt it significantly easier to be honest in F2F (M=8.52, SD=1.92) than during mediated sobriety support (M=7.24, SD=3.14), F(1, 182)=22.70, p<.0001, η2=.11), but were more likely to lie about amount of time sober in F2F (M=2.81, SD=3.23) than mediated modality (M=1.80, SD=2.21), F(1, 180)=17.37, p<.0001, η2=.09.

RQ2

Will people in recovery who have used both mediated and F2F sobriety support be more likely to be using substances while participating in one modality or the other?

Repeated measures ANOVA indicated participants significantly more likely to be drunk or high during F2F participation (M=2.56, SD=3.03) than mediated sobriety support (M=1.87, SD=2.38), F(1, 180)=8.32, p<.001, η2=.044.

RQ3

Will participants who have engaged in both mediated and F2F sobriety support report having decreased their attendance at F2F since engaging with mediated sobriety support?

Participants have decreased F2F sobriety support attendance since engaging in mediated sobriety support.

Mean reduction in F2F sobriety support was 3.11 (SD=2.76) on a scale of 0 to 10.

RQ4

To what degree will sobriety success be related to the use of mediated and F2F support?

F2F sobriety support predicts greater sobriety success, while greater use of mediated predicts less.

Tests indicated significant positive correlation between degree of F2F participation & sobriety success (r=.281, N=199, p<.001) but none between degree of mediated participation & sobriety success (r=-.093, N=199, p<.09).

CONCLUSIONS

1. The ability to seek support anytime, anywhere could prove lifesaving.

2. A sober community connection is considered vital to long-term sobriety success.

3. At this time in history, we are grappling

with the question of whether social support can take place online.

Honesty is a bedrock of sobriety support.

Another general question this research addresses is whether participants can be honest both F2F & in online social support modalities. Results were mixed.

Participants said they felt it easier to be honest when F2F. However they also said they were more likely to lie about their length of sobriety in F2F than in mediated environments, and were more likely to be drunk/high in F2F than in online environments. These results may reflect the difference between general beliefs (F2F is “better”) and reports of specific behaviors (“I do lie sometimes when F2F”). They may also reflect a greater amount of time spent in F2F recovery and thus a greater chance of lying.

Another possibility is that participants felt telling the truth when the truth was difficult had greater negative consequences for them when in the F2F modality.

This research is exploratory.

IN ADDITION…

The fact that some participants attended F2F recovery meetings while under the influence should not tarnish the reputation of 12 Step program(s) or those meetings.

The only requirement for A.A. membership is a "desire to stop drinking.” Thus, it is not uncommon for both newcomers and those who have relapsed to attend F2F meetings while under the influence.

Post hoc analyses in fact revealed those with less recovery time were the ones more likely to show up at a F2F meeting while under the influence.

LIMITATIONS

o Authenticity of data (re: subject self -presentation).

o Nascence of online/mediated recovery resources.

o Actual skill of participant to negotiate technology.

o Lack of participants under 18 years of age.

RECOMMENDATIONS FOR FUTURE RESEARCH… Replication of study in future, as Digital Natives assume majority of population to consider how they and new younger people in recovery perceive online and mediated sobriety recovery.

Further investigation of mediated relationships as technology evolves.

Studies of support groups other than sobriety- based, which offer both F2F as well as mediated opportunities to engage.

Study comparisons of other F2F versus mediated relationships, groups, potential migrations from one modality to the other, & experiences/outcomes.

More data is needed to more fully understand the self-reported honesty results reported here.

Full Study & Presentation References

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ALL BEST AND INFINITE THANKS TO:

The American Psychological AssociationAPA Division 46

Dr. Karen E. Dill-Shackleford, Chair / Research SpecialistDr. Jason Ohler, Faculty Reader

Dr. Ericha Scott, External ExaminerDr. Jean-Pierre Isbouts, Most Esteemed Mentor

Fielding Graduate UniversityMy dog “Luna”

All of You& (OF COURSE):

MY INCREDIBLY COURAGEOUS, GENEROUS, AND SUPPORTIVE STUDY PARTICIPANTS, WHO SO GRACIOUSLY AND KINDLY LENT THEIR INVALUABLE

EXPERIENCE, STRENGTH, & HOPE TO THIS RESEARCH PROJECT

Donald S. Grant, PhD; doctordeeg@gmail.com; 818-216-8778

Karen Dill-Shackleford, PhD; KShack@fielding.edu; 828-320-9546

© GrantShack 2015

USING SOCIAL MEDIAFOR SOBRIETY RECOVERY?Preferences, Beliefs, Behaviors,& Surprises From Users