Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2025 Nov 28.
Published in final edited form as: Addict Res Theory. 2024 Nov 28;33(4):286–293. doi: 10.1080/16066359.2024.2431598

A Qualitative Examination of Addiction Disclosure and Stigma among Recovering Adolescents

Sophia H Blyth 1, Agata Pietrzak 2, Wendy Avila Rodriguez 3, Mark D Litt 4,5, John F Kelly 2, Emily A Hennessy 2,*
PMCID: PMC12329652  NIHMSID: NIHMS2037160  PMID: 40785814

Abstract

Background.

The stigma attached to alcohol or other drug use (AOD) disorders can lead to poorer treatment outcomes. Adolescents, who are developing their social identity, may hesitate to disclose their disorder and are vulnerable to stigmatizing experiences. Adolescents’ preferred ways of discussing AOD disorder have not been explored.

Methods.

This study explores the experience of AOD disclosure in 16 adolescents with an AOD disorder (recruited nationwide in the United States from 2022–2023). Participants were 12–19 years old (M = 16.8; SD = 1.78; 56% Male, 31% Female, 13% Non-binary), had experienced problematic substance use, and used some form of treatment or recovery support. Participants completed an interview in which they reflected on their social network, their recovery, and experiences related to AOD disorder disclosure. The research team used constant comparative analysis to develop themes from the interview data.

Results.

A primary theme was the level of control participants felt regarding the persons to whom they disclosed their AOD recovery, and how that information was disclosed. Although some participants felt supported, several felt that their peers/family were overly intrusive (e.g., by questioning actions). Some participants experienced enacted stigma in interactions with others.

Conclusions.

These results support recommendations for family, peers, and youth-facing providers to engage youth in treatment. Future work should aim to increase disclosure skills and coping strategies for adolescents experiencing AOD recovery, and educational efforts for practitioners, families, and peers on ways to have conversations around AOD recovery with adolescents that best support their recovery.

Keywords: Addiction, Adolescent Recovery, Disclosure, Social Identity, Stigma

Introduction

Young people are more vulnerable to the effects of substance use than adults, and the use of some substances, such as cannabis, is highest among adolescents globally (UNODC 2024). Additionally, adolescents face many barriers to accessing treatment for the problematic use of alcohol and other drugs (AOD; (Chan et al. 2023; King et al. 2024)), including stigma. Indeed, the United Nations identified substance-related stigma and discrimination as a major barrier to accessing AOD disorder treatment (UNODC 2024). Young people are often blamed for AOD disorder, thought to be engaging in willful misconduct, and are perceived to be unpredictable/dangerous (Kelly et al. 2016; Tsai et al. 2019). This stigma may prevent disclosure about their disorder, an important help-seeking mechanism.

Stigma is the social process by which certain social groups are viewed negatively, discriminated against, or excluded based on a devalued trait or identity shared by members of the group (Link and Phelan 2001). Stigma at the individual level (e.g., shame), interpersonal level (e.g., discrimination), and the policy level (e.g., laws criminalizing substance possession) can contribute to poorer outcomes for people with AOD use (Tsai et al. 2019). Adults who experience stigma are more likely to be secretive about their disorder and experience poorer quality of life (Luoma et al. 2007; Hatzenbuehler et al. 2013; Earnshaw et al. 2019). Adolescents may face difficulties around disclosing their AOD use to others due to stigma (Ferrie et al. 2020), yet research examining how adolescents navigate AOD-related stigma and disclosure is scarce.

AOD Disorder Disclosure

Disclosing personal information to others is a vital part of building social connections, but those with a stigmatized identity may fear negative reactions when sharing information about AOD disorders (Earnshaw et al. 2021). Stigma may be one of the largest barriers to healthy disclosure. Three primary forms of AOD disorder-related stigma have been identified: enacted – observable behaviors such as discrimination towards a person with the stigmatized condition, anticipated – fear of potential discrimination or negative treatment, and internalized (or ‘self’) stigma – internalizing negative beliefs about onself and others within one’s group (Smith et al. 2016). Disclosing AOD disorder can be hindered by anticipated stigma and self-stigma, which may be perpetuated by instances of enacted stigma. Sharing one’s substance use status with others may require careful consideration of who to tell, when disclosure may be beneficial (i.e., increased social connection), and when it may be risky (i.e., rejection) (Earnshaw et al. 2021). Although research has demonstrated that adults with AOD disorders may disclose only to those with whom they have a close relationship (Earnshaw et al. 2019), less attention has been paid to adolescents’ experience of AOD disclosure.

Adolescent Experience of Disclosure

Experiencing stigma during adolescence may interrupt social development and overall wellbeing (Marcia 1966; Erikson 1968; Heary et al. 2014; Ferrie et al. 2020). Adolescents may not have yet developed coping skills or social supports to cope with the experience of stigma (Marcia 1966; Heary et al. 2014; Earnshaw et al. 2022). The need for belonging and fear of being viewed as different from peers may result in discomfort disclosing their disorder to seek support (Major and O’Brien 2005; Heary et al. 2014; Earnshaw et al. 2018; Ferrie et al. 2020). Indeed, research on adolescent disclosure suggests that while adolescents and caregivers told a range of people, they experienced both supportive and stigmatizing reactions (Earnshaw et al. 2018). Although adolescents sometimes have a choice to disclose their status to others, they also must navigate settings in which control over disclosure is minimal (e.g., school staff inquiring about absences).

Thus, as adolescents may be cautious about sharing their recovery with others, they may distance themselves from recovering peers by hiding their disorder. Secretiveness has implications for social support, as positive disclosure experiences can result in bonding and can increase resilience to the negative effects of stigma (Dobkin et al. 2002; Earnshaw et al. 2018; Ferrie et al. 2020; Chang et al. 2022). Concealing this information to avoid anticipated stigma may result in social isolation (Pachankis 2007; Ferrie et al. 2020; Van Veelen et al. 2020). The navigation of stigma and social identity is further complicated for youth in recovery, who are encouraged to stop contact with substance-using friends to avoid these risky relationships (Adlaf et al. 2009; Best et al. 2016; Nash et al. 2019). It may be difficult for these youth to forge new connections with non-using peers in their current environment, as these peers may avoid or actively reject them. Additionally, adolescents may struggle to find connection and identify with youth who have not experienced an AOD disorder (Jurinsky et al. 2022).

Furthermore, the terminology used to discuss AOD disorders, such as ‘addict,’ may perpetuate stigma (Kelly et al. 2016; Ashford et al. 2019; Tsai et al. 2019; Atayde et al. 2021; Alinsky et al. 2022). Treatment providers may have implicit biases towards patients and be unaware of stigmatizing words/phrases (Adams and Volkow 2020). Recent efforts have provided youth-focused providers with best practices around substance use terminology, suggesting that youth are affected by the words used to describe their disorder(s) (Adams and Volkow 2020; Alinsky et al. 2022). Yet, the terminology that adolescents prefer to use when describing their AOD experience has not been directly explored.

Study Aims

Youth with AOD disorders, especially those in recovery, find themselves in a difficult situation when disclosing their disorder. They need the social network support, but the most accepting groups may be comprised of people with AOD disorders who are actively using and thus pose a potential risk. Additionally, youth may hestitate to share information about their disorder with others who have not experienced AOD disorders. Building on Earnshaw and colleagues’ (Earnshaw et al. 2018) exploration of youth disclosure, this study aimed to understand how adolescents in recovery navigate discussing their disorder with their social network. Additionally, this study examined which phrases/terms youth preferred (or disliked) to better understand how to guide others in discussing AOD disorders with recovering youth. Ultimately, this study sought to understand how adolescents disclose their AOD disorder in the face of potential stigma, and to identify how their social networks (e.g., friends, family, treatment and recovery professionals) could best support their recovery process.

Methods

This study was based on a subset of data collected as part of a larger study assessing the feasibility of a novel tool for assessing the social network influences among adolescents in recovery from an AOD disorder, Social Identity Mapping in Addiction Recovery (SIM-AR; see (Jurinsky et al. 2022)). The Mass General Brigham Institutional Review Board (MGB IRB) approved this study. This analysis was preregistered on Open Science Framework (OSF: https://osf.io/f9g8z).

Participants and Procedure

Participants eligible for this study were 12–19 years old, and were diagnosed with an AOD disorder or were, or had been, in treatment for AOD use. Given the aim of the overall study to examine the use of SIM-AR for recovering youth, purposive sampling methods were used to recruit adolescents from addiction treatment and recovery settings, such as treatment centers and recovery high schools (RHS; (Finch et al. 2014)). We also sought participants from the broader community by advertising the study using flyers and online postings. Youth who were under 18 years of age were assented with a parent.

The sample in this analysis included 16 youth (recruited between 02/2022 and 02/2023), who were on average 16.8 years of age (SD = 1.78). Just over half were male (56%; 31% female, 13% non-binary) and the majority were Non-Hispanic White (81.3%; 6.3% African American, 18.8% Hispanic). Of the 16 participants in this study, 11 attended a RHS. Given the small sample size and potential ability to identify participants from the RHSs, we do not report participant-level demographics.

Study visits took place remotely over Zoom or in person when possible due to the COVID-pandemic restrictions. The majority were conducted individually (n = 12), but four were conducted using a group interview approach onsite at an RHS with two participants in each group. Each study visit consisted of the completion of the SIM-AR and a subsequent interview. The SIM-AR procedure asks the person to create a map of their social network, including information about the substance use characteristics of sub-networks (e.g., friends, family). The SIM-AR was facilitated using a standardized guide. Following the completion of the SIM-AR, study staff asked participants about their recovery experience, their reflections on their social networks based on the completed SIM-AR, and the stigma-specific interview questions developed for the present study. All variables collected through the SIM-AR are included in the appendix along with an example SIM-AR. The SIM-AR portion took 27 minutes on average (SD = 16; Median = 20) and the interview took 21 minutes on average (SD = 10; Median = 24). Participants received a $35 gift card for participating. SIM-AR results were outside the scope of the data analyzed in the present study but are reported elsewhere (Hennessy et al. 2024).

Semi-Structured Interview

To develop the interview questions, the research team analyzed stigma-related themes that arose from interviews with the first 12 participants recruited to the larger parent study [see (Jurinsky et al. 2022)], who were asked questions about their recovery experience without referring specifically to stigma. The interview questions used in this study were then developed using those themes, prior research on word usage and stigma, a previous interview guide used to assess adolescent substance-related disclosure (Earnshaw et al. 2018), and from personal communications with Dr. Valerie Earnshaw (University of Delaware) and Dr. Brandon Bergman (Recovery Research Institute). The present analysis includes the 16 participants who were directly asked the stigma-specific questions. The semi-structured guide prompted participants to consider how they navigate disclosing their substance use status and their preferred and nonpreferred word usage (see Table 1). Interviews were audio-recorded and professionally transcribed.

Table 1.

Interview Guide

1. When you look at your finished map, what do you see, and what does it make you
consider about yourself?
2. Did you learn anything new about your relationships and social networks through
creating your map?
3. Do any of the groups have a positive influence on your life?
 a. If so, which ones and how?
4. Do any of the groups have a negative influence on your life?
 a. If so, which ones and how?
*5. Looking at the map, who knows about your substance use or that you’re
receiving treatment? You don’t have to tell me their names, but describe who they
are in your life, like a family member, friend, teacher, etc.
 *a. (For each person discussed): How did he (/she) find out that you’re
receiving treatment? How do you feel about them knowing about your
treatment?
 *b. Do people treat you differently because they know about your substance
use or that you are receiving treatment for your substance use?
 *i. (If yes): When that happened, how did you handle it? (or similar
prompt)
 *c. Are there people in your life whom you haven’t told about your
treatment, and why?
6. What does your map tell you about the recovery journey you are on?
 *a. Are there terms and concepts you like to use to talk about your
experience with substance use and recovery?
 *b. Are there terms and concepts you don’t like to use to talk about your
substance use and recovery?
7. Did anything in your map surprise you?
8. If I had asked you to complete a social identity map 6 months ago, do you think
your map would look different?
 a. If YES, how so?
9. If you think ahead to 6 months from now, what would you like your map to look
like?
10. What would you not want it to look like 6 months from now?
Open in a new tab

Note.

*

Indicates that this was a question related to disclosure and stigma.

Analysis

The constant comparative method was used to extract categories from excerpts of the raw interview data (Corbin and Strauss 2008). Interview transcripts were transcribed and uploaded to NVivo Qualitative Management software (Lumivero 2020). Three members of the research team with an interest in analyzing stigma in this sample read the transcripts and decided on an initial codebook based on the interview questions and initial themes. This codebook consisted of two major codes guided by the thematic content of the questions: 1) disclosure and 2) terminology. After reading the quotes coded to the initial two themes, the three team members wrote memos about additional themes that arose. We subsequently added additional subcodes to disclosure: “responses from others after disclosure” and “feelings around disclosure.” Team members also categorized terminology as “preferred,” “not preferred,” or “ambiguous feelings.” Codes were added if all three members agreed on their inclusion. Using this version of the codebook, the same three members of the research team coded the remaining interviews in pairs of two. The team met on a regular basis and discussed discrepancies until 100% agreement was reached (Corbin and Strauss 2008). Team members then read transcripts of the final coded references and wrote memos on broader thematic categories that arose (e.g., uncertainty about how peers could effectively support substance use recovery). To enhance trustworthiness, the research team met weekly to discuss themes included in the results and used methods to reduce bias, such as discussing negative cases (e.g., that some participants did not provide preferred or disliked terms about substance use) (Lincoln and Guba 1986; Corbin and Strauss 2008).

Results

The qualitative analyses resulted in three major themes, which are represented in Figure 1 and discussed in turn, below: (1) Selectivity around disclosure that includes instances of anticipated stigma as well as a separate child (sub) theme of (2) Word usage and stigma; and (3) Experiences after disclosure.

Figure 1.

Figure 1

Open in a new tab

Themes of Disclosure and Word Usage Discussed by Participants

Figure created with BioRender.com.

Selectivity Around Disclosure

Participants described choosing to tell specific family and friends about their substance use and recovery, or instances when this choice was not possible. Because family was often involved in treatment-seeking, youth indicated that their family, included extended members, knew about their status. Youth also often reported telling close friends. When asked who knew about his recovery, P131 responded, ‘The friends I consider my family do. My actual family does,’ while P201 had disclosed to ‘really close friends… and my girlfriend.’

Participants were divided on whether they wanted to share their experience with coworkers. Two participants chose to tell coworkers about their substance use. One of these Sinparticipants (P145) said: ‘my coworkers are pretty aware too… it’s hard for it not to come up just because I spent so much time and so much of my life in treatment.’ Alternatively, several youth indicated that their coworkers/employers were not aware of their status, providing reasons that could potentially be attributed to anticipated stigma. P131 said ‘My work, I don’t really have a reason to tell my work that,’ while P142 was ‘scared of work people and stuff like that finding out.’

Participants often did not disclose their disorder to those with whom they did not have a close relationship. When asked who he did not tell, P140 answered: ‘my social media group and my friends… My friends are just the people that I know, and I associate with. I don’t really see them like that.’ When referring to the people he did not tell, P132 said: ‘I just don’t really care enough to tell them about that. I’m really not that close with them.’ P131 said: ‘drug friends and my sober friends, I’m not really super close with them. They’re kind of like more people I’d go with and have a good time.’

Participants discussed instances when others learned about their AOD disorder after they left school or stopped socializing to enter treatment. For example, P205 said, ‘I was hospitalized, so that kind of spread the word.’ P145 said: ‘I have been in and out of treatment since I was 14, so almost everyone I know, knows I have substance use issues because it was very public.’ P132 said that his family told his friends about his situation, because his friends were worried about him. For some participants, their behavior was so visible that they felt others inferred they had a problem: ‘I was off the wires. Everyone knew about me’ (P200). Finally, one participant was not worried about disclosure to her current college friends. While she may not have yet disclosed to them, she felt that because they knew her in this new context where she was doing well, their relationship would not be affected (P144).

Word Usage and Stigma

When participants were asked about preferred and disliked terminology, some participants reported experiences that seemed to distinguish between being talked about (a form of enacted stigma) and being in conversation with, and how that might matter for language usage. When participants discussed terms they disliked, they often gave examples of others talking about them. For example, P201 said that although he did not have preferred terms to describe his recovery, he disliked it when others compared him to family members who used substances. Similarly, P140 answered: ‘when I’m talking to somebody else and they kind of address me as a addict, I kind of look at them, like, ‘What are you talking about? I’m not a addict. I am a recovering drug user.’… It’s just very stigmatizing when somebody says that you’re an addict.’ P145 also said he did not have any preferred terms to describe his recovery, but then when asked what terms he disliked, he said:

I don’t like the word drug addict. I go to [12-step group], but I don’t necessarily like the whole alcoholic thing. I just think that ‘in recovery’ is better, honestly. I don’t like those types of labels because then that becomes a part of your identity.

Yet, some participants referred to themselves using traditionally stigmatizing terms when describing their experience. For example, P205 stated, ‘People say don’t say shit like ‘drug addict’ or ‘crackhead’ or ‘junkie’, but that’s what I was. I was a junkie.’ Six participants did not have any preferred or disliked terms.

Several participants described experiencing enacted stigma from peers/family during conversations. These participants described how peers at school made assumptions about them and their capabilities and that stigma was often perceived in conversation. For example, P142 stated:

I think that people talk to me like, ‘Okay, [redacted]. Mm-hmm. Hello? [patronizing tone]’… And I’m just like... I’m fully capable just as much as the next person. I feel like people think because they know I’ve been doing it… that they have to treat me a certain way or talk to me a certain way.’

Family members were also responsible for stigmatizing interactions. For example, P140 described how his brothers would make negative comments about his enrollment in an RHS after his treatment episode:

It was when me and my brothers were arguing, and they kind of brought up how I wasn’t in a big school, I’m in a recovery school... And they’ll just bring it up just to be mean.

Some participants who described these stigmatizing interactions also demonstrated personal resilience in the situation by indicating that they were “very nonchalant” (P140), or are “a pretty chill person” (P203) or decided not to care (e.g., P145: “But then some other people, I’m like, Whatever. They can think whatever they want.”)

Experiences After Disclosure

As a result of disclosure, participants described feeling that family and close friends were supportive but could also make them feel as though they were being ‘watched.’ The perception of helpfulness as supportive or patronizing varied depending on the individual the participant was interacting with and the interaction context. Participants reflected on what kinds of responses were helpful, and some participants felt frustrated with responses, suggesting that there is uncertainty around how their peers can positively support their recovery in social settings. For example, P145 stated that ‘it honestly depends on the situation’ and was clear that because their family does not have substances at home, the interaction is perceived as supportive. But if they are out where people are using substances, attempted ‘support’ makes them feel left out:

I’ve had a few conflicts where I’m at a gathering and my friend’s like, ‘No, you can’t drink.’ But they’re drinking, and I’m like, ‘No. That’s stupid. You’re drinking. Everyone here is drinking. Why can’t I drink?’ And they’re like, ‘Well, because you’ve had these issues.’ And I’m like, ‘Well, that makes me isolated.’

Alternatively, some participants felt support from specific friends, describing a sense of ‘relief’ (P201). P144 felt that she could be ‘transparent’ with her best friend, who provided supportive feedback by reminding her it was her decision and she would have to live with the consequences.

Discussion

This study of 16 adolescents in AOD recovery explored how youth experience addiction disclosure and stigma. The resulting themes fall into the categories of the people adolescents chose to tell about their status, and the reactions they received, with additional examination of preferred/disliked terminology to describe their experience. Participants often chose to disclose their AOD disorder and recovery to close friends or family, but many were hesitant to tell acquaintances or their coworkers.

These findings are consistent with developmental research around adolescent autonomy: adolescents value having control over recovery status disclosure, a decision influenced by multiple factors (Earnshaw et al. 2018; Arbour et al. 2023). For instance, adolescents may be unlikely to disclose to groups that they perceive to be judgmental and more willing to disclose with peers demonstrating openness. This may be particularly salient for adolescents transitioning to college, where substance use is becoming less stigmatized, and thus less likely to be perceived as damaging to friendships. Additionally, developmental stage may have an effect on motivation for disclosure. That is, as youth enter adulthood and experience new settings, they may not choose to disclose their experience, as they view their past substance use to be less pertinent to their present social identity (Schoenberger et al. 2021).

Some participants depicted instances of involuntary disclosure by parents, a finding consistent with research indicating that adolescents feel that they had a lack of control over who knew about their disorder when the caregivers were the primary discloser (Earnshaw et al. 2018). When control over disclosure became compromised, adolescents in this study provided examples of increased experiences of anticipated stigma, characterized by fear or uncertainty of negative reactions from others. Such situations could further precipitate self- or enacted stigma. Therefore, it could be beneficial for adolescents to learn effective strategies for disclosure and ways to handle situations when they lack control over the disclosure.

Some youths were open about their disclosure to others and discussed responses that they considered helpful, such as friends checking in or reminding them of potential consequences. This range of experiences may have implications for youth programs, which encourage youth to share their experience with peers. For example, alternative peer groups, which aim to build social networks of recovering youth, encourage youth to share their experience to encourage accountability in others and change each other’s perspectives (Nash et al. 2019). Skill-building in this area is done through modeling effective disclosure and engaging youth in practicing disclosure during their group meetings.

Participants highlighted ways in which language influenced their emotions and perceptions. For example, participants drew a compelling distinction between being “talked about” and “being in conversation with.” The latter scenario empowers recovering adolescents by allowing them to steer the narrative, while being talked about can intensify anticipated and enacted stigma. Adolescents shared how they disliked when others used certain terms to describe them. For example, despite using these terms themselves, some participants did not like when other people used words that evoke stigma such as ‘addict’ or ‘alcoholic’ (Ashford et al. 2019). Youth often preferred referring to themselves using recovery-oriented terms, phrasing recommended in previous research, but in general, our findings highlight that parents and providers should follow adolescents’ preferences when it comes to terminology (Kelly et al. 2010; Broyles et al. 2014; Kelly et al. 2015; Kelly et al. 2016; Pivovarova and Stein 2019; Alinsky et al. 2022).

After disclosure, youth experienced a mix of stigma and support, as suggested by previous research (Earnshaw et al. 2018). Some participants anticipated stigma out of concern for what people at their job or school may perceive. Alternatively, when asked how they respond to experiences of AOD use stigma, some youth did not describe experiencing negative emotions following these experiences. For those youth, this may be because of their experience of social support from family and/or friends, which may be protective against the negative effects of AOD disorder stigma (Chang et al. 2022). The majority of these youth were in a RHS, schools for youth in recovery, suggesting that they may have had social support through staff and students to mitigate the effects of stigmatizing interactions (Finch et al. 2014).

Limitations

This is a small sample and primarily represents youth who attended a RHS. Additionally, the sample is drawn from a select region of the United States, and experiences of stigma may vary among states with differing attitudes towards AOD disorder. An additional limitation is that these respondents were primarily Non-Hispanic White. Thus, the results here may not be representative of recovering adolescents in general, and there may be missing dimensions influencing stigma experiences. Additionally, some youth may have felt uncomfortable sharing negative emotions around recovery disclosure or stigmatizing experiences. Finally, we did not collect participants’ degree of addiction severity and associated level of treatment and recovery support services. This information could have helped us better characterize their stigmatizing experience.

Conclusions

As AOD disorder disclosure and stigma have been understudied in youth, this manuscript presents a targeted analysis of youth’s experience of AOD disorder disclosure. The thematic findings that emerged highlight the need to examine AOD disorder-related stigma as a critical component of recovery in adolescent populations and have important implications for how peers, families, and providers can best support recovering adolescents. Placing greater emphasis on individual autonomy over recovery disclosure and encouraging discussions about how appropriate language usage factors into individuals’ recovery process may buffer against the detrimental impacts of stigma. Future studies should examine how forms of stigma present themselves in adolescent populations and how they may prevent disclosure. Future analysis within a larger sample should aim to assess stigma across developmental stages, as experiences of stigma may differ with age (Earnshaw et al. 2022). Further, we should empirically examine if incorporating substance use-related stigma education in youth-serving settings can promote a healthier self-concept and improve quality of life among recovering adolescents.

Acknowledgments

This work was supported by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health under Award Number K01AA028536 to Emily A. Hennessy. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Biographies

Author Biographies

Dr. John Kelly is the Elizabeth R. Spallin Professor of Psychiatry in Addiction Medicine at Harvard Medical School. He is also the Founder and Director of the Recovery Research Institute at the Massachusetts General Hospital (MGH) and the Associate Director of the Center for Addiction Medicine (CAM) at MGH. Dr. Kelly is a former President of the American Psychological Association’s (APA) Society of Addiction Psychology, a founding member and inaugural President of the American Board of Addiction Psychology, a Fellow of the APA, and a Diplomate of the American Board of Professional Psychology. He has served as a consultant to U.S. federal agencies and non-federal institutions, as well as foreign governments, the United Nations and the World Health Organization. Dr. Kelly has published over 200 peer-reviewed articles, reviews, chapters, and books in the field of addiction medicine, and was an author on the U.S. Surgeon General’s Report on Alcohol, Drugs, and Health. He has won numerous state, national, and international lifetime achievements and distinguished scientist awards for his work. His clinical and research endeavors have focused on addiction treatment and the recovery process, mechanisms of behavior change, and reducing stigma and discrimination among individuals suffering from addiction.

Dr. Emily A. Hennessy is Associate Director and Director of Biostatistics at the Recovery Research Institute and Associate Director of the National Center on Youth Prevention, Treatment and Recovery at Massachusetts General Hospital. She is also Assistant Professor at Harvard Medical School. Dr. Hennessy was a Fulbright Scholar to Norway where she completed an M.Phil. in Health Promotion and focused on adolescent well-being. She completed her Ph.D. in Community Research and Action at Vanderbilt University and her postdoctoral fellowship at the University of Connecticut in the Systematic Health Action Research Program (SHARP) Lab. Her primary area of research, adolescent substance use disorder prevention, treatment and recovery, is funded by a career development award (K01) from the National Institute on Alcohol Abuse and Alcoholism. This study examines social network and recovery capital mechanisms of the recovery process in adolescents using social identity mapping. A secondary area of her research is in conducting evidence syntheses and in improving methods for evidence synthesis.

Dr. Mark Litt is professor in the UConn School of Dental Medicine’s Departmentof Behavioral Sciences and Community Health, and also holds appointments as a professor in the UConn School of Medicine’s Departments of Psychiatry and Obstetrics and Gynecology. Litt earned his M.S., M.Phil. and Ph.D. in psychology from Yale University. He has written 18 book chapters and more than 130 peer-reviewed manuscripts and articles. He has more than 140 scholarly presentations to his credit, has served on the editorial boards of fourjournals in the field of behavioral medicine, and has chaired or served on numerous NIH study sections. He is a fellow of both the Society of Behavioral Medicine and the American Psychological Association.

Wendy Avila Rodriguez, BA, MPH is a skilled program evaluator with experience in research and evaluation, technical assistance, public health education, program implementation, maternal and child health, and behavioral science. She received her BA in International Studies and Global Health, Culture, and Society from Emory University (2016) and her MPH in Behavioral Sciences and Health Education from the Emory University Rollins School of Public Health (2018). Wendy has worked in the domestic public sector through her positions at the Centers for Disease Control and Prevention and the Georgia Health Policy Center. Wendy’s areas of interest include Child and Adolescent Mental Health, Health Equity, Global Health, Racism and Health, School-Based Mental Health, and Substance Use Disorders. Her pursuit of a doctoral degree in Community Health Sciences with a concentration in Maternal and Child Health is motivated by her desire to improve the health of marginalized communities through an equitable lens as an aspiring Research Director and Research Assistant Professor. Upon receiving her doctoral degree, she would like to continue working in an academic setting where she can work in research, evaluation, and application.

Agata Z. Pietrzak, BA, is a former Clinical Research Coordinator at the Recovery Research Institute at Massachusetts General Hospital. She graduated from Mercyhurst University, where she received her Bachelor’s degree in Psychology. She is currently pursuing her PhD in Clinical Psychology at the University of South Florida.

Sophia H. Blyth, BA, is a Research Assistant in the Department of Psychiatry and Behavioral Sciences at Vanderbilt University Medical Center. She graduated summa cum laude from Harvard University, where she received her Bachelor’s degree in Psychology. Sophia is interested in the intersection of mental illness and social inequality and served as one of the directors of Youth2Youth, a homeless shelter for young adults. Sophia’s areas of interest include Adolescent Mental Health, Substance Use Disorders, and Mental Illness Stigma.

APPENDIX

Appendix: Social Identity Maps in Addiction Recovery (SIM-AR) Methods

Figure A1.

Figure A1

Open in a new tab

Example SIM-AR with legend

Table A1.

Items collected on SIM-AR

Item Range, if applicable
Social groups in person’s network, labeled with group name
Days spent with each group (0–30)
Importance of each group 1–3 (1 = lowest; 3 = highest)
Level of identification with group 1–7 (1 = low; 7 = high)
Number of group members
Alcohol use of group members Heavy, casual, non-use, in recovery, unknown
Substance use of group members Heavy, casual, non-use, in recovery, unknown
Conflict None, low, high
Commonality None, some, a lot
Open in a new tab

Footnotes

Ethics Statement

This paper adheres to all ethical guidelines required by the journal. All participants above the age of 18 provided informed consent, and youth who were under 18 years of age were consented with a parent. The MGB IRB approved the study protocol.

Disclosure of Interest

The authors have no conflict of interest to disclose. This research was supported by Award Number K01AA028536 from the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health.

References

  1. Adams JV, Volkow ND. 2020. Ethical Imperatives to Overcome Stigma Against People With Substance Use Disorders. AMA J Ethics. 22(8):E702–708. doi: 10.1001/amajethics.2020.702. [DOI] [PubMed] [Google Scholar]
  2. Adlaf EM, Hamilton HA, Wu F, Noh S. 2009. Adolescent stigma towards drug addiction: Effects of age and drug use behaviour. Addict Behav. 34(4):360–364. doi: 10.1016/j.addbeh.2008.11.012. [DOI] [PubMed] [Google Scholar]
  3. Alinsky RH, Hadland SE, Quigley J, Patrick SW, COMMITTEE ON SUBSTANCE USE AND PREVENTION. 2022. Recommended Terminology for Substance Use Disorders in the Care of Children, Adolescents, Young Adults, and Families. Pediatrics. 149(6):e2022057529. doi: 10.1542/peds.2022-057529. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Arbour S, Chiu M, Paul S, Battistelli R, Harris H. 2023. Exploring the Recovery Phenomenon from Adolescents’ Perspective: A Qualitative Study. J Psychosoc Rehabil Ment Health. 10(1):15–24. doi: 10.1007/s40737-022-00283-7. [DOI] [Google Scholar]
  5. Ashford RD, Brown AM, McDaniel J, Curtis B. 2019. Biased labels: An experimental study of language and stigma among individuals in recovery and health professionals. Subst Use Misuse. 54(8):1376–1384. doi: 10.1080/10826084.2019.1581221. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Atayde AMP, Hauc SC, Bessette LG, Danckers H, Saitz R. 2021. Changing the narrative: a call to end stigmatizing terminology related to substance use disorders. Addict Res Theory. 29(5):359–362. doi: 10.1080/16066359.2021.1875215. [DOI] [Google Scholar]
  7. Best D, Beckwith M, Haslam C, Alexander Haslam S, Jetten J, Mawson E, Lubman DI. 2016. Overcoming alcohol and other drug addiction as a process of social identity transition: The Social Identity Model of Recovery (SIMOR). Addict Res Theory. 24(2):111–123. doi: 10.3109/16066359.2015.1075980. [DOI] [Google Scholar]
  8. Broyles LM, Binswanger IA, Jenkins JA, Finnell DS, Faseru B, Cavaiola A, Pugatch M, Gordon AJ. 2014. Confronting inadvertent stigma and pejorative language in addiction scholarship: a recognition and response. Subst Abuse. 35(3):217–221. doi: 10.1080/08897077.2014.930372. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Chan S, Markoulakis R, Levitt A. 2023. Predictors of barriers to accessing youth mental health and/or addiction care. J Can Acad Child Adolesc Psychiatry J Acad Can Psychiatr Enfant Adolesc. 32(1):27–37. [PMC free article] [PubMed] [Google Scholar]
  10. Chang Ching-Wen, Chang K, Griffiths MD, Chang Chih-Cheng, Lin C, Pakpour AH. 2022. The mediating role of perceived social support in the relationship between perceived stigma and depression among individuals diagnosed with substance use disorders. J Psychiatr Ment Health Nurs. 29(2):307–316. doi: 10.1111/jpm.12794. [DOI] [PubMed] [Google Scholar]
  11. Corbin J, Strauss A. 2008. Basics of Qualitative Research. 3rd ed. Los Angeles, CA: Sage. [Google Scholar]
  12. Dobkin PL, Civita MD, Paraherakis A, Gill K. 2002. The role of functional social support in treatment retention and outcomes among outpatient adult substance abusers: Social support and treatment outcome. Addiction. 97(3):347–356. doi: 10.1046/j.1360-0443.2002.00083.x. [DOI] [PubMed] [Google Scholar]
  13. Earnshaw VA, Bergman BG, Kelly JF. 2019. Whether, when, and to whom?: An investigation of comfort with disclosing alcohol and other drug histories in a nationally representative sample of recovering persons. J Subst Abuse Treat. 101:29–37. doi: 10.1016/j.jsat.2019.03.005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Earnshaw VA, Bogart LM, Menino DD, Kelly JF, Chaudoir SR, Reed NM, Levy S. 2018. Disclosure, stigma, and social support among young people receiving treatment for substance use disorders and their caregivers: A qualitative analysis. Int J Ment Health Addict. 17(6):1535–1549. doi: 10.1007/s11469-018-9930-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Earnshaw VA, Sepucha KR, Laurenceau J-P, Subramanian SV, Brousseau NM, Chaudoir SR, Hill EC, Morrison LM, Kelly JF. 2021. Disclosure processes as predictors of relationship outcomes among people in recovery from opioid use disorder: A longitudinal analysis. Drug Alcohol Depend. 228:109093. doi: 10.1016/j.drugalcdep.2021.109093. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Earnshaw VA, Watson RJ, Eaton LA, Brousseau NM, Laurenceau J-P, Fox AB. 2022. Integrating time into stigma and health research. Nat Rev Psychol. 1(4):236–247. doi: 10.1038/s44159-022-00034-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Erikson EH. 1968. Identity: youth and crisis. New York: Norton. [Google Scholar]
  18. Ferrie J, Miller H, Hunter SC. 2020. Psychosocial outcomes of mental illness stigma in children and adolescents: A mixed-methods systematic review. Child Youth Serv Rev. 113:104961. doi: 10.1016/j.childyouth.2020.104961. [DOI] [Google Scholar]
  19. Finch AJ, Moberg DP, Krupp AL. 2014. Continuing Care in High Schools: A Descriptive Study of Recovery High School Programs. J Child Adolesc Subst Abuse. 23(2):116–129. doi: 10.1080/1067828X.2012.751269. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Hatzenbuehler ML, Phelan JC, Link BG. 2013. Stigma as a Fundamental Cause of Population Health Inequalities. Am J Public Health. 103(5):813–821. doi: 10.2105/AJPH.2012.301069. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Heary C, Hennessy E, Swords L. 2014. Stigma associated with disease and disability during childhood and adolescence: A developmental approach. In: Corrigan PW, editor. The stigma of disease and disability: Understanding causes and overcoming injustices. Washington: American Psychological Association. p. 205–222. [accessed 2021 Nov 15]. http://content.apa.org/books/14297-011. [Google Scholar]
  22. Hennessy EA, Jurinsky J, Cowie K, Pietrzak AZ, Blyth S, Krasnoff P, Best D, Litt M, Johnson BT, Kelly JF. 2024. Visualizing the Influence of Social Networks on Recovery: A Mixed-Methods Social Identity Mapping Study with Recovering Adolescents. Subst Use Misuse. 59(9):1405–1415. doi: 10.1080/10826084.2024.2352618. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Jurinsky J, Cowie K, Blyth S, Hennessy EA. 2022. Aug 29. “A lot better than it used to be”: a qualitative study of adolescents’ dynamic social recovery capital. Addict Res Theory.:1–7. doi: 10.1080/16066359.2022.2114076. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Kelly JF, Dow SJ, Westerhoff C. 2010. Does Our Choice of Substance-Related Terms Influence Perceptions of Treatment Need? An Empirical Investigation with Two Commonly Used Terms. J Drug Issues. 40(4):805–818. doi: 10.1177/002204261004000403. [DOI] [Google Scholar]
  25. Kelly JF, Saitz R, Wakeman S. 2016. Language, Substance Use Disorders, and Policy: The Need to Reach Consensus on an “Addiction-ary.” Alcohol Treat Q. 34(1):116–123. doi: 10.1080/07347324.2016.1113103. [DOI] [Google Scholar]
  26. Kelly JF, Wakeman SE, Saitz R. 2015. Stop Talking ‘Dirty’: Clinicians, Language, and Quality of Care for the Leading Cause of Preventable Death in the United States. Am J Med. 128(1):8–9. doi: 10.1016/j.amjmed.2014.07.043. [DOI] [PubMed] [Google Scholar]
  27. King CA, Beetham T, Smith N, Englander H, Button D, Brown PCM, Hadland SE, Bagley SM, Wright OR, Korthuis PT, et al. 2024. Adolescent Residential Addiction Treatment In The US: Uneven Access, Waitlists, And High Costs: Study examines adolescent residential addiction treatment in the US. Health Aff (Millwood). 43(1):64–71. doi: 10.1377/hlthaff.2023.00777. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Lincoln YS, Guba EG. 1986. But is it rigorous? Trustworthiness and authenticity in naturalistic evaluation. New Dir Program Eval. 1986(30):73–84. [Google Scholar]
  29. Link BG, Phelan JC. 2001. Conceptualizing Stigma. Annu Rev Sociol. 27(1):363–385. doi: 10.1146/annurev.soc.27.1.363. [DOI] [Google Scholar]
  30. Lumivero. 2020. Nvivo Qualitative Management Software.
  31. Luoma JB, Twohig MP, Waltz T, Hayes SC, Roget N, Padilla M, Fisher G. 2007. An investigation of stigma in individuals receiving treatment for substance abuse. Addict Behav. 32(7):1331–1346. doi: 10.1016/j.addbeh.2006.09.008. [DOI] [PubMed] [Google Scholar]
  32. Major B, O’Brien LT. 2005. The Social Psychology of Stigma. Annu Rev Psychol. 56(1):393–421. doi: 10.1146/annurev.psych.56.091103.070137. [DOI] [PubMed] [Google Scholar]
  33. Marcia JE. 1966. Development and validation of ego-identity status. J Pers Soc Psychol. 3(5):551–558. doi: 10.1037/h0023281. [DOI] [PubMed] [Google Scholar]
  34. Nash, Hennessy EA, Collier C. 2019. Exploring recovery capital among adolescents in an alternative peer group. Drug Alcohol Depend. 199(1):136–143. doi: 10.1016/j.drugalcdep.2019.02.025. [DOI] [PubMed] [Google Scholar]
  35. Pachankis JE. 2007. The psychological implications of concealing a stigma: A cognitive-affective-behavioral model. Psychol Bull. 133(2):328–345. doi: 10.1037/0033-2909.133.2.328. [DOI] [PubMed] [Google Scholar]
  36. Pivovarova E, Stein MD. 2019. In their own words: language preferences of individuals who use heroin. Addiction. 114(10):1785–1790. doi: 10.1111/add.14699. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Schoenberger SF, Park TW, dellaBitta V, Hadland SE, Bagley SM. 2021. Jun 7. “My Life Isn’t Defined by Substance Use”: Recovery perspectives among young adults with substance use disorder. J Gen Intern Med. doi: 10.1007/s11606-021-06934-y. [accessed 2021 Sep 11]. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Smith LR, Earnshaw VA, Copenhaver MM, Cunningham CO. 2016. Substance use stigma: Reliability and validity of a theory-based scale for substance-using populations. Drug Alcohol Depend. 162:34–43. doi: 10.1016/j.drugalcdep.2016.02.019. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Tsai AC, Kiang MV, Barnett ML, Beletsky L, Keyes KM, McGinty EE, Smith LR, Strathdee SA, Wakeman SE, Venkataramani AS. 2019. Stigma as a fundamental hindrance to the United States opioid overdose crisis response. PLoS Med. 16(11):e1002969. doi: 10.1371/journal.pmed.1002969. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. UNODC. 2024. World Drug Report 2024. United Nations. [Google Scholar]
  41. Van Veelen R, Veldman J, Van Laar C, Derks B. 2020. Distancing from a stigmatized social identity: State of the art and future research agenda on self-group distancing. Eur J Soc Psychol. 50(6):1089–1107. doi: 10.1002/ejsp.2714. [DOI] [Google Scholar]

RESOURCES