In this article, we review the existing research on the self-concept in alcohol dependence and recovery and describe a theoretical model of the self-concept, called the schema model, that can be used to interpret the findings from the existing literature and serve as a framework for further research studies. Next, we provide some empirical evidence from a recent study based on the schema model that demonstrates that specific content and structural properties of the self-concept are associated with alcohol dependence and recovery. We then discuss implications for nursing research and practice.J Am Psychiatr Nurses Assoc, 2007; 13(1), 31-41.
Alcoholics Anonymous World Services, Inc. ( 2001). Alcoholics anonymous: The story of how many thousands of men and women have recovered from alcoholism (4th ed.). New York.
2.
Avants, S.K., & Margolin, A. (2004). Development of spiritual self-schema (3-S) therapy for the treatment of addictive and HIV risk behavior: A convergence of cognitive and Buddhist psychology. Journal of Psychotherapy Integration , 14, 253-289.
3.
Baumeister, R.F. (1990). Anxiety and deconstruction: On escaping the self . In J. M. Olson & M. P. Zanna (Eds.), Self-inference processes: The Ontario Symposium, Vol. 6 (pp. 259-290). Hillsdale, NJ: Lawrence Erlbaum.
4.
Beck, A.T. (2005). The current state of cognitive therapy: A 40-year retrospective. Archives of General Psychiatry,62, 953-959.
5.
Bennett, G. (1988). Stress, social support, and self-esteem of young alcoholics in recovery. Issues in Mental Health Nursing, 9, 151-167.
6.
Blume, S.B. (1967). The changing effects of drinking on the changing personalities of alcoholics. Quarterly Journal of Studies on Alcohol, 28, 436-443.
7.
Brown, S. (1985). Treating the alcoholic: A developmental model of recovery. New York: Wiley.
8.
Centers for Disease Control and Prevention. ( 2004). Alcohol-attributable deaths and years of potential life lost—United States, 2001. Morbidity and Mortality Weekly Report, 53, 866-870.
9.
Connor, R.G. (1962). The self-concepts of alcoholics. In D. J. Pittman & C. R. Snyder (Eds.), Society, culture, and drinking patterns pp. 445-467). New York: Wiley.
10.
Cooper, M.L., Agocha, V.B., & Sheldon, M.S. (2000). A motivational perspective on risky behaviors: The role of personality and affect regulatory processes. Journal of Personality, 68, 1059-1088.
11.
Corte, C., & Stein, K.F. (2007). Self-cognitions in antisocial alcohol dependence and recovery. Western Journal of Nursing Research, 29, 80-99.
12.
Cross, S., & Markus, M. (1994). Self-schemas, possible selves, and competent performance . Journal of Educational Psychology, 86, 423-438.
13.
Cushman, P. (1990). Why the self is empty: Toward a historically situated psychology. American Psychologist, 45, 599-611. Cutler, R.B., & Fishbain, D.A. (2005). Are alcoholism treatments effective? The Project MATCH data. BMC Public Health, 5, 75-76.
14.
Cyranowski, J.M., & Andersen, B.L. (1998). Schemas, sexuality, and romantic attachment. Journal of Personality and Social Psychology , 74, 1364-1379.
15.
Dawson, D., Grant, B., Stinson, F., Chou, P., Huang, B., & Ruan, W. (2005). Recovery from DSM-IV alcohol dependence: United States, 2001-2002. Addiction, 100, 281-292.
16.
DeJong, W. (1994). Relapse prevention: An emerging technology for promoting long-term drug abstinence. International Journal of the Addictions, 29, 681-705.
17.
Denzin, N.K. (1993). The alcoholic self. In The alcoholic society: Addiction and recovery of the self (pp. 119-177). New Brunswick, NJ: Transaction Publishing.
18.
Dixon, T.M., & Baumeister, R.F. (1991). Escaping the self: The moderating effect of self-complexity. Personality and Social Psychology Bulletin, 17, 363-368.
19.
Drozd, L.M., & Dalenberg, C.J. (1994). The self as mediator in the psychopathology of female children of alcoholics. TheInternational Journal of the Addictions, 29, 1787-1800.
20.
Edwards, G., & Gross, M.M. (1976). Alcohol dependence: Provisional description of a clinical syndrome. British Medical Journal, 1, 1058-1061.
21.
Epstein, E., Labouvie, E., McCrady, B., Jensen, N., & Hayaki, J. (2002). A multi-site study of alcohol subtypes: Classification and overlap of unidimensional and multi-dimensional typologies. Addiction, 97, 1041-1053.
22.
Finfgeld, D.L. (1998). Self-resolution of alcohol problems as a process of reinvestment in self. Perspectives in Psychiatric Care , 34, 5-15.
23.
Forchuk, C. (1984). Cognitive dissonance: Denial, self concepts and the alcoholic stereotype. Nursing Papers, 16, 57-69.
24.
Froming, W., Nasby, W., & McManus, J. (1998). Prosocial self-schemas, self-awareness, and children's prosocial behavior. Journal of Personality and Social Psychology , 75, 766-777.
25.
Goldstone, R. (1996). Isolated and interrelated concepts. Memory & Cognition, 24, 608-628.
26.
Gross, W.F., & Adler, L.O. (1970). Aspects of alcoholics' self-concepts as measured by the Tennessee Self-Concept Scale. Psychological Reports , 27, 431-434.
27.
Heath, A.C., & Nelson, E.C. (2003). Effects of the interaction between genotype and environment research into the genetic epidemiology of alcohol dependence. Rockville, MD: U.S. Department of Health and Human Services, National Institute on Alcoholism and Alcohol Abuse.
28.
Hingson, R., Heeren, T., Winter, M., & Wechsler, H.( 2005). Magnitude of alcohol-related mortality and morbidity among US college students ages 18-24: Changes from 1998-2001. Annual Review of Public Health, 26, 259-279.
29.
Ilgen, M., & Moos, R. (2005). Deterioration following alcohol-use disorder treatment in project MATCH. Journal of Studies on Alcohol, 66, 517-525.
30.
Innis, J. (1997). Relapse and alcoholism: The need for nursing research. Journal of AddictionsNursing, 9, 164-167.
31.
James, W. (1985). Psychology: The briefer course. Notre Dame, IN: University of Notre Dame Press.
32.
Kendzierski, D. (1990). Exercise self-schemata: Cognitive and behavioral correlates. Health Psychology, 9, 69-82.
33.
Klein, S.B., Sherman, J.W., & Loftus, J. (1996). The role of episodic and semantic memory in the development of trait self-knowledge. Social Cognition, 14, 277-291.
34.
Klingemann, H. (1992). Coping and maintenance strategies of spontaneous remitters from problem use of alcohol and heroin in Switzerland. TheInternational Journal of the Addictions, 27, 1359-1388.
35.
Knauth, D.G., Skowron, E.A., & Escobar, M. (2006). Effect of differentiation of self on adolescent risk behavior: Test of a theoretical model. Nursing Research , 55, 336-345.
36.
Kovacs, M., & Beck, A.T. (1978). Maladaptive cognitive structures in depression . American Journal of Psychiatry,135, 525-533.
37.
Linville, P.W. (1985). Self-complexity and affective extremity: Don't put all of your eggs in one cognitive basket. Social Cognition , 3, 94-120.
38.
Linville, P.W. (1987). Self-complexity as a cognitive buffer against stress-related illness and depression. Journal of Personality and Social Psychology, 52, 663-676.
39.
Markus, H. (1977). Self-schemata and processing of information about the self. Journal of Personality and Social Psychology, 35, 63-78.
40.
Markus, H.R., & Kunda, Z. (1986). Stability and malleability of the self-concept . Journal of Personality and Social Psychology, 51, 858-866.
41.
Markus, H., & Nurius, P. (1987). Possible selves: The interface between motivation and the self-concept. In K. Yardley & T. Honess (Eds.), Self and identity: Psychosocial perspectives (pp. 157-172). New York: John Wiley & Sons.
42.
Markus, H., Smith, J., & Moreland, R. (1985). Role of the self-concept in the perception of others. Journal of Personality and Social Psychology, 49, 1494-1512.
43.
Markus, H., & Wurf, E. (1987). The dynamic self-concept: A social psychological perspective. Annual Review of Sociology, 38, 299-337.
44.
Matto, H.C., Miller, K., & Spera, C. (2005). Ecological assessment of substance-abuse experiences (EASE): Findings from a new instrument development pilot study. Addictive Behaviors, 30, 1281-1289.
45.
McKay, J.R., Lynch, K.G., Shepard, D.S., & Pettinati, H.M. (2005). The effectiveness of telephone-based continuing care for alcohol and cocaine dependence: 24-month outcomes. Archives of General Psychiatry, 62, 199-207.
46.
McGuire, W.J. (1984). Search for the self: Going beyond self-esteem and the reactive self. In R. A. Zucker, J. Arnoff, & A. I. Rabin (Eds.), Personality and the prediction of behavior (pp. 73-120). San Diego, CA: Academic Press.
47.
Miller, W.R., & Rollnick, S. (2002). Motivational interviewing: Preparing people to change. New York: Guilford.
48.
Moos, R., & Moos, B. (2005). Paths of entry into alcoholics anonymous: Consequences for participation and remission. Alcoholism: Clinical & Experimental Research, 29, 1858-1868.
49.
Morgenstern, J., & Longabaugh, R. (2000). Cognitive-behavioral treatment for alcohol dependence: A review of evidence for its hypothesized mechanisms of action. Addiction, 95, 1475-1490.
50.
Niedenthal, P., & Beike, D. (1997). Interrelated and isolated self-concepts. Personality and Social Psychology Review, 1, 106-128.
51.
Niedenthal, P., Setterlund, M., & Wherry, M. (1992). Possible self-complexity and affective reactions to goal-relevant evaluation. Journal of Personality and Social Psychology, 63, 5-16.
52.
Nowak, A., Vallacher, R., Tesser, A., & Borkowski, W. (2000). Society of self: The emergence of collective properties in self-structure. Psychological Review, 107, 39-61.
53.
Oyserman, D., & Markus, H.R. (1988). Self as social representation. In U. Flick (Ed.), The psychology of the social (pp. 107-125). Cambridge, UK: Cambridge University Press.
54.
Peirce, R.S., Frone, M.R., Russell, M., & Cooper, M.L. (1994). Relationship of financial strain and psychosocial resources to alcohol use and abuse: The mediating role of negative affect and drinking motives. Journal of Health and Social Behavior , 35, 291-308.
55.
Quereshi, M.Y., & Soat, D.M. (1976). Perception of self and significant others by alcoholics and nonalcoholics. Journal of Clinical Psychology, 32, 189-194.
56.
Sedikides, C., & Skowronski, J. (1997). The symbolic self in evolutionary context. Personality and Social Psychology Review, 1, 80-102.
57.
Showers, C. (1992). Compartmentalization of positive and negative self-knowledge: Keeping bad apples out of the bunch. Journal of Personality and Social Psychology, 62, 1036-1049.
58.
Showers, C.J., Abramson, L.Y., & Hogan, M.E. (1998). The dynamic self: How the content and structure of the self-concept change with mood. Journal of Personality and Social Psychology, 75, 478-493.
59.
Stein, K.F. (1995). The organizational properties of the self-concept and instability of affect. Research in Nursing and Health , 18, 405-415.
60.
Stein, K.F. (1995). Schema model of the self-concept. Image: The Journal of Nursing Scholarship, 27, 187-193.
61.
Stein, K.F., & Corte, C. (2007). Identity impairment and the eating disorders: Content and organization of the self-concept in women with anorexia nervosa and bulimia nervosa. European Eating Disorders Review, 15, 58-69.
62.
Swaim, R.C., & Wayman, J.C. (2004). Multidimensional self-esteem and alcohol use among Mexican American and White non-Latino adolescents: Concurrent and prospective effects. American Journal of Orthopsychiatry, 74, 559-570.
63.
Tarquinio, C., Fischer, G., Gauchet, A., & Perarnaud, J. (2001). The self-schema and addictive behaviors: Studies of alcoholic patients. SwissJournal of Psychology, 60, 73-81.
64.
Unger, J.B., Kipke, M.D., Simon, T.R., Montgomery, S.B., & Johnson, C.J. (1997). Homeless youths and young adults in Los Angeles: Prevalence of mental health problems and the relationships between mental health and substance use disorders. American Journal of Community Psychology, 25, 371-394.
65.
Vanderpool, J.A. (1969). Alcoholism and the self-concept. Quarterly Journal of AlcoholStudies, 30, 59-77.
66.
Venner, K.L., Matzger, H., Forcehimes, A., Moos, R., Feldstein, S., Willenbring, M., et al. (2006). Course of recovery from alcoholism. Alcoholism: Clinical and Experimental Research, 30, 1079-1090.
67.
Walitzer, K.S., & Sher, K.J. (1996). A prospective study of self-esteem and alcohol use disorders in early adulthood: Evidence for gender differences. Alcoholism: Clinical and Experimental Research, 20, 1118-1124.
68.
Watson, D., Clark, L., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54, 1063-1070.
69.
White, J. (2000). Alcoholism and identity development: A theoretical integration of the least mature status with the typologies of alcoholism. Alcoholism Treatment Quarterly, 18, 43-59.
70.
Wills, T.A., Sandy, J.M., Shinar, O., & Yaeger, A. (1999). Contributions of positive and negative affect to adolescent substance use: Test of a bidirectional model in a longitudinal study. Psychology of Addictive Behaviors, 13, 327-338.
71.
Wing, D.M. (1995). Transcending alcoholic denial. Image: The Journal of Nursing Scholarship, 27, 121-126.
72.
Woolfolk, R.L., Gara, M.A., Allen, L.A., & Beaver, J.D. (2004). Self-complexity: An assessment of construct validity . Journal of Social & Clinical Psychology, 23, 463-474.
73.
Woolfolk, R.L., Novalany, J., Gara, M., Allen, L., & Polino, M. (1995). Self-complexity, self-evaluation, and depression: An examination of form and content within the self-schema. Journal of Personality and Social Psychology, 68, 1108-1120.
74.
Yakichuk, A.J. (1970). A study of the self-concept evaluations of alcoholics and non-alcoholics. Journal of Drug Education, 8, 41-49.
75.
Zajonc, R.B. (1960). The process of cognitive tuning in communication . Journal of Abnormal and Social Psychology, 51, 159-167.
76.
Zucker, R.A. (2006). Alcohol use and the alcohol use disorders: A developmental-biopsychosocial systems formulation covering the life course. In D. Cicchetti & D. J. Cohen (Eds.), Developmental psychopathology: Vol. 3. Risk, disorder and adaptation (2nd ed., pp. 620-656). New York: Wiley.
77.
Zucker, R.A., Ellis, D.A., & Fitzgerald, H.E. (1994). Developmental evidence for at least two alcoholisms: Biopsychosocial variation among pathways into symptomatic difficulty. Annals of the New York Academy of Sciences, 708, 134-146.
