Self-Schemas as Cognitive Foundations for Impaired Problem Recognition in Alcohol Use Disorder.

Abstract

Background: Impaired problem recognition (IPR) has been identified as the primary barrier that must be overcome in order for alcohol use disorder (AUD) treatment and recovery to be successful. However, the cognitive mechanisms undergirding IPR continue to remain poorly understood. The Self-Schema Model of the Self-Concept has the potential to identify the structural and functional properties of neurocognitive networks undergirding IPR and drinking behavior. The purpose of this cross-sectional correlational study was, first, to determine the availability of a drinking-related self-schema among individuals who met criteria for moderate to severe alcohol use disorder, in accordance with the Diagnostic and Statistical Manual for Mental Disorders, 5th Edition. In the presence of a drinking-related self-schema, subsequent goals were to 1) identify structural properties (i.e., valence and elaboration) and, 2) establish relationships between these structural properties and IPR. Methods: The sample consisted of 55 men and women, over the age of 21, recruited from sobriety courts, public advertisements, and personal referrals in a Midwestern state. Participants completed measures related to alcohol use, the self-concept, problem recognition, and treatment-seeking. Data were analyzed using descriptive statistics, Pearson product-moment correlation, and multiple regression. Results: All participants displayed availability of a drinking-related self-schema comprised predominantly of negatively valenced content. Elaboration of the drinking-related self-schema was negatively correlated with taking steps toward recovery (r= -.35, n=55, p<.01) and positively correlated with frequency of drinking (r=.41, n=55, p<.01). Negative valence was positively correlated with problem recognition (r= .49, n=55, p<.01) and ambivalence (r= .34, n=55, p<.05). Positive valence was negatively correlated with problem recognition (r= -.40, n=55, p<.01). Elaboration and valence of a drinking-related self-schema predicted impaired problem recognition (R2 adjusted=0.37, F(8,46)=4.99, p<.001). Elaboration of a recovery-related self-schema predicted taking steps toward modifying drinking behaviors (R2 adjusted=0.46, F(8,46)=6.81, p<.001). Elaboration of a recovery-related self-schema and elaboration of a drinking-related self-schema predicted frequency of drinking (R2 adjusted=0.24, F(4, 50)=5.17, p<.001). Conclusion: Findings suggest that structural properties of a drinking-related self-schema influence problem recognition, drinking, and recovery behaviors. Therapeutic interventions directed toward modifying valence and elaboration of drinking-related self-schemas may offer promising new treatment options for alcohol use disorder.