The effects of dynamic recovery identity on lapse risk and the role of daily recovery meetings

Aims: The social identity model of recovery (SIMOR) posits that adopting an identity affiliated with recovery (recovery identity) improves substance use disorder (SUD) outcomes. Although recovery identity has been investigated as a construct that is either static or slowly changing, evidence exists that it can change from one day to the next. The present study uses data drawn from a daily diary study on recovery community centers (RCCs) to examine the within-person association between recovery identity and drug craving, a key indicator of lapse risk. Seeing that social contact with recovery groups should increase the salience of recovery identity, we investigated the role of attending recovery meetings on the same-day association between recovery identity and craving. Methods: Daily diary surveys were administered for 10 nights to 94 visitors of Pennsylvania RCCs. Nightly reports of recovery identity, craving, and daily recovery meeting attendance were analyzed using two-part random effects modeling to examine within-person associations between recovery identity and drug craving with recovery meetings as a moderator. Results: Recovery identity was unrelated to the odds of craving occurring at the within-person level (b = 0.01, SE = 0.01, n.s.). On days when participants reported a craving, however, the extent of craving was significantly related to the level of recovery identity reported. Moreover, this same-day association between recovery identity and craving was moderated (strengthened) by same-day recovery meeting attendance, although only among days craving was reported (b = -0.04, SE = 0.02, p = .046). At the person level, recovery identity predicted both the extent (b = -0.06, SE = 0.015, p < .001) and existence (b = 0.05, SE = 0.007, p < .001) of craving. Contrary to hypotheses, the odds of experiencing craving were actually higher for those with a stronger recovery identity. Conclusions: Based on these results, not only does stronger recovery identity appear to be associated with a reduction in craving at the within-person level, but the association may depend on same-day social contact with other recovering individuals as indicated by attending recovery support meetings. These findings not only underscore the value in examining recovery identity as dynamic but also highlight the dependence of the within-person dynamics between recovery-related intrapersonal states on daily behaviors. The counterintuitive finding at the person level may indicate a tendency for recovering individuals who experience cravings to invest in their recovery identity as a protective mechanism against relapse, although further research is needed to draw firm conclusions.