Social Identity Mapping Helps Adolescent Patients Visualize Social Influences’ Impact on Recovery

Friends, family, and peer groups can act as both barriers and resources to addiction recovery for adolescents and emerging adults. Understanding how these social influences interact with other recovery capital resources is a crucial part of the process of social identity change during treatment and recovery.

At the Cape Cod Symposium on Friday, Emily Hennessy, PhD, associate director of biostatistics at the Recovery Research Institute and a faculty member at Harvard Medical School, presented 1 approach, known as social identity mapping, for helping adolescents and young adults visualize the influence of those around are having on their recovery.

Ahead of the Symposium, Dr Hennessy discussed this approach with Addiction Professional. Dr Hennessy also explained the ways in which loved ones and peers can help—or hinder—those in recovery, as well as ways in which social identity mapping can be incorporated into a broader recovery plan.

Editor’s note: This interview has been edited for length and clarity.

Addiction Professional: How can social influences serve as both barriers and resources to adolescents who are in recovery?

Emily Hennessy: I'm going to focus on how social influences can support recovery first because there are many, many ways that social supports, and social influences can be a positive for young people in recovery. What we know about recovery is a lot of it is about social connection. For many folks, experience with substance use and addiction is a result of not having that connection, and substance use is a way to fill that gap. So, for young people that are seeking recovery, to find other young people like them who are seeking recovery and to do fun things that don't involve substance use can be a real boost to their day-to-day, and can really help them feel happy and motivated. It helps them build hope in their lives.

What we've seen through some of the recovery support services that seek to do these things is that they're not necessarily focused on just stopping substance use, but they're asking, what are some ways that we can help you do fun activities to build social connections with other peoples and begin to feel that hope and meaning again in your life. Hopefully, as a result, the substance use stops.

Another really important social connection that young people have is with their parents and their families. During this time, young people are starting to move away from their families in the sense that they're starting to find their own peer networks and social relationships, but the family plays a really vital role in setting up a home environment that's supportive of that recovery process and modeling those recovery behaviors. Just having parents and siblings that are emotionally supportive and available can help them with that social connection aspect.

The last thing I'll say about positive social connections is for young people to be connected to older adults that are in recovery, to see that recovery journey and process modeled out for them, to have somebody who may have gone through that already and can see who understands their experience and then can also guide them in ways to seek out recovery, supportive influence is another positive aspect that programs can think about for young people.

On the flip side, for young people who have friends or family members that are still actively using substances, that can be a trigger for that behavior. So that can definitely get in the way of their recovery journey, as well as things like stress and conflict, fighting between themselves and their family, between themselves and their friends, which can all be barriers to their recovery process.

AP: One of the topics in your presentation is social identity mapping. Can you explain what that is and how it helps patients in recovery?

EH: Social identity mapping is a way encourage a person to begin to think about who the social groups in their lives are, and then to actually physically map that out on a piece of paper. It's very tactile—they take sticky notes, write their group names on them, and then stick them on a piece of paper all around the word “me.” At the end of the social identity mapping process, they have something that they've created that should reflect what their social world. This includes the groups that are part of their life, and the good and the bad things about those groups. We do ask about the substance use of group members in social identity mapping, and they indicate that by putting different colored sticky dots on the map to say, this person is in recovery, which is a green color, and this other person maybe is someone who's using substances heavily, and that's a red color.

Assigning those colors can also trigger different reactions when they're looking at them once the map is completed. We also ask them to indicate conflict between groups using different kinds of lines and commonality. What I found in working with youth, at least, is that when we ask them to look at the map and reflect on their recovery and their social network, they tend to notice things. They're like, "Oh, I knew this kind of, but I hadn't really thought about it in this way," or, "I didn't realize." I had one young person who said, "I didn't realize there was just so much access to me continuing to use, but now I can see all these yellows," which is casual alcohol use on their map. And "Wow, everywhere I go, all the groups that I hang out with, I can just keep using. And so that maybe is not going to support my recovery process."

From that perspective, it can help generate insight without a clinician having to say to the person directly, "Hey, it looks like you have a lot of groups that use." The youth realize this themselves as they complete this mapping process and reflect on it, which can be very powerful personal insight to have.

AP: Do you have any other best practices that you would recommend for incorporating social identity mapping and some of the reflective questioning that patients in recovery would be going through when you're working with young people in recovery?

EH: I think it is good to situate the mapping within a larger recovery care plan and approach in a therapeutic relationship with that individual. Have a sense of who your client is, ensure that they feel comfortable answering the questions and putting the map together. One of the things that, at least in the research that I was doing with the young people, is I gave them the opportunity to keep the map, to share it with someone if they wanted to or not. Because it was a product that they created themselves, I think allowing them in that space to hold onto it if they want to or discard it, can be very powerful for a young person.

AP: Do the young people who you're working with often share this map with their family members or others close to them?

EH: It's really up to them. I think that's a conversation for them to have with their clinician. Would they want to use this as a tool to talk about some struggles that they're having with their family? Depending on that therapeutic relationship, using it in that way or allowing them to say whether or not they want to use it in that way, it could be very powerful.

AP: Is there anything else that you wanted to cover that we haven't touched on yet?

EH: The one thing that's really important to this process is recognizing that young people do have really powerful and deep insights. It’s a matter of providing them with different opportunities to generate those insights versus sitting them down and telling them that there's one way to do something.

Social identity mapping is very visual, it's tactile. We also are piloting this exercise on an iPad, allowing folks to do it electronically versus doing the by-hand version. We must recognize that young people, when given the right tools, may be able to produce some of these insights, and then they may be more meaningful to them as a result of doing so.

Reference

Hennessy E. Social identity mapping for adolescent addiction recovery. Presented at Cape Cod Symposium on Addictive Disorders; September 7-10, 2023; Hyannis, Massachusetts.