JMIR Publications

ABSTRACT

Background:

Extant literature has observed that persons affected with substance use disorder (SUD) experience different stages of readiness to reduce or abstain from substance use, and tailoring intervention change strategies to these stages may facilitate recovery. Moreover, stigma may serve as a barrier to recovery by preventing persons with SUDs from seeking treatment. In recent years, the Behavior Change Technique (BCT) Taxonomy has increasingly become seen as useful for identifying potential efficacious intervention components; however, prior literature has not addressed the extent to which these techniques may naturally be used to recover from substance use, and knowledge of this may be useful in the design of future interventions.

Objective:

We take a three-step approach to identifying strategies to facilitate substance use recovery through: 1) characterizing the extent to which stages of change are expressed in social media data; 2) identifying behavior change techniques employed by persons at different stages of change; and 3) exploring the role that stigma plays in recovery journeys.

Methods:

We harvested discussion posts from Reddit, a popular social networking site. We identified subreddits, or discussion forums, about three substances: alcohol, cannabis, and opioids. We then performed qualitative data analysis using a hybrid inductive-deductive method to identify the stages of change in social media authors’ recovery journeys, the techniques that social media content authors naturally used as they sought to quit substance use, and the role that stigma played in social media authors’ recovery journeys.

Results:

Social media content representing the different stages of change were observed, with the major part of the data being comprised of narratives representing the Action stage. Eleven categories of BCTs were identified. There were similarities in BCT use across Precontemplation, Contemplation, and Preparation stages, with social support seeking and awareness of natural consequences being most common. As people sought to quit or reduce their use of substances (Action stage), we observed a variety of BCTs, such as the repetition and substitution of healthful behaviors and monitoring and receiving feedback on their own behavior. In the Maintenance stage, reports of diverse BCTs continue to be frequent, but offers of social support also become more common than in previous stages. Stigma was present throughout all stages. Five major themes pertaining to the manifestation of stigma are identified and discussed, along with implications for intervention design.

Conclusions:

Patterns of BCT use and stigmatizing experiences are frequently discussed in social media, which can be leveraged to better understand the natural course of recovery from SUD and how interventions might facilitate recovery from substance use. It may be important to incorporate stigma reduction across all stages of one’s recovery journey.