Constructing a Theory and Evidence-Based Approach to Promote and Evaluate Autonomy in Addiction

ABSTRACT

In this article we use theory and empirical evidence to synthesize a model for the analysis of autonomy in people with addictions. We review research on motivation and denial as accepted addiction constructs that need to be replaced with non-stigmatizing and autonomy-supportive language when seeking to ‘treat’ addicts. We present three main factors involved in relational autonomy in addiction (mentalizing, positive self-concept, and stigma), and illustrate our model by examining variations on these parameters in two case studies of heroin addicts. We conclude that a growth perspective is needed to assess functioning in populations believed to be ‘addicted’ and make suggestions for assessment.     

Resilience in Community: A Social Ecological Development Model for Young Adult Sexual Minority Women

Family support and rejection are associated with health outcomes among sexual minority women (SMW). We examined a social ecological development model among young adult SMW, testing whether identity risk factors or outness to family interacted with family rejection to predict community connectedness and collective self‐esteem. Lesbian and bisexual women (N = 843; 57 % bisexual) between the ages of 18–25 (M = 21.4; SD = 2.1) completed baseline and 12‐month online surveys. The sample identified as White (54.2 %), multiple racial backgrounds (16.6 %), African American (9.6 %) and Asian/Asian American (3.1 %); 10.2 % endorsed a Hispanic/Latina ethnicity. Rejection ranged from 18 to 41 % across family relationships. Longitudinal regression indicated that when outness to family increased, SMW in highly rejecting families demonstrated resilience by finding connections and esteem in sexual minority communities to a greater extent than did non‐rejected peers. But, when stigma concerns, concealment motivation, and other identity risk factors increased over the year, high family rejection did not impact community connectedness and SMW reported lower collective self‐esteem. Racial minority SMW reported lower community connectedness, but not lower collective self‐esteem. Families likely buffer or exacerbate societal risks for ill health. Findings highlight the protective role of LGBTQ communities and normative resilience among SMW and their families.