Samodefiniujące się wspomnienia u mężczyzn uzależnionych od alkoholu: rola znaczących osób w związkach

■ INTRODUCTION

Alcohol dependence is a pervasive global problem with substantial mental health, social relationships, cognitive, emotional and psychiatric consequences [1]. The worldwide prevalence of alcohol-use disorders ranges from 0.7% (Iraq) to 22.7% (Australia) with an average of 8.6% [2].
Alcohol-related impairment includes problems in executive functions [3, 4], in encoding and remembering events [5] and thus some difficulties with autobiographical memory [6-9] and self-defining memories [10-12].
Self-defining memories (SDM) refer to events that have a major impact on identity construction and maintenance [13], which are vivid, important for self, intensely emotional and recurrently recalled memories [14]. Self-defining memory includes four dimensions: specificity (distinct and tangible or general), meaning (the recalled memories hold significant personal value), content (the memories revolve around pivotal events) and affect (characterised by a heightened emotional intensity within these memories) [15]. In alcohol dependence, self-defining memories are less specific [6], negative, contain intense emotions and they reference alcohol [10]. Alcohol-dependent individuals encounter challenges in accessing positive memories or effectively encoding the related events. Consequently, this impairs their ability to maintain a positive self-image, fosters negative perceptions about the future and diminishes social cohesion [16]. Overgeneralised memories of alcohol dependence are associated with accompanying depressive symptoms [6], rumination and executive dysfunction [17].
The sense of self is seen as a prerequisite of memory and memory as a precondition of sense of self. Episodic memory constructs an individual’s personal narrative and self-perception throughout his/her lifespan, while semantic memory grants insight into oneself without the need for conscious recollection of specific experiences [18]. According to the Self-Memory System Model, memories are mental representations composed of autobiographical information and episodic memories [19-21].
In order to recall a memory in the Self Memory System Model, the working self and the conceptual self, which are the basic components of the model, work together to construct a memory from the hierarchical structure in the autobiographical knowledge base in accordance with the current purpose [21, 22]. Self-Memory System Model emphasises the important role of the self in encoding and recalling memories. Memories irrelevant to self-relevance tend to fade away, whereas those intertwined with the self and compatible with enduring personal purposes are retained and frequently remembered [19, 20, 22]. Self-defining memories indicate memories of emotional intensity that are often vividly recalled, related to other similar memories and support understanding of who one is as an individual [14].
Events and memories that individuals access when looking back affect how they feel and perceive themselves in the present. Studies have shown that telling positive memories of life history has a positive relationship with self-esteem and self-continuity [23-25]. When individuals evaluate themselves in terms of autobiographical memory, interpersonal distress is associated with negative self-esteem and success with positive self-esteem [23]. Various aspects of memories of life stories are associated with self-esteem and psychological well- being [26]. Studies focusing on self-esteem in alcohol and substance abuse have shown that adolescents and young adults with alcohol and substance abuse have low self-esteem [27-29]. Low self-esteem in alcohol-related disorders is linked to depression and other psychiatric problems [30]. As the negative self-esteem of individuals with substance-related disorders increases, so do their perceptions of being socially excluded [31]. In sum, the low self-esteem observed in alcohol dependence may be attributed to often-co-diagnosed psychological disorders and deterioration in interpersonal relationships. In addition, more general memories with negative emotional content recalled in alcohol dependence may be associated with low self-esteem.
The importance of the self-concept in alcohol dependence is emphasised as one of the key factors in understanding individuals throughout the therapeutic and treatment process as well as in achieving progress in treatment, maintaining remission and in the prevention of relapse. One way to gain a detailed insight into the self is by accessing autobiographical memories that involve events from an individual’s personal life. In this context, self-defining memories are considered to best reflect the self. The main purpose of this study is to examine comparatively the characteristic features of self-defining memories and self-representations in alcohol dependence. Additionally, the study focuses on comparing the functions of autobiographical memory and self-esteem between men with and without alcohol dependence.

■ MATERIAL AND METHODS

A total of 65 male participants were initially included in the study. However, five participants from the alcohol-dependent group discontinued their participation. As a result, the final sample comprised 30 men diagnosed with alcohol dependence, including 22 receiving inpatient treatment and 8 undergoing outpatient treatment at the Alcohol Dependence Unit of the Psychiatric Department at Ankara University Hospital. All participants in the alcohol-dependent group were diagnosed with alcohol dependence based on the ICD-10 criteria by a psychiatrist. Additionally, a comparison group of 30 males without alcohol use problems matched by age, and education level was included. Ethical approval for the study was obtained from the Clinical Research Ethics Committee of the Faculty of Medicine, Ankara University (Approval Number: 07-535-19).
The alcohol-dependent group consisted of 30 men between 32 and 65 years of age with a mean age of 46.17 (SD = 9.20). Similarly, the comparison group participants were between 32 and 64 with a mean age of 46.13 (SD = 9.60). The mean education level for the entire sample was 11.83 years (SD = 2.75) (Table I).
Both groups completed the Demographic Information Form and the Montreal Cognitive Assessment (MoCA) was used to assess potential cognitive impairments. Participants were then asked to recall and document three memories following the Self-Defining Memory (SDM) task and to provide an additional narrated memory (NM) from a close circle (e.g., mother, father, sibling or relative). The comparison group also completed the CAGE Questionnaire to screen for potential alcohol use problems. Subsequently, both groups were administered the Beck Depression Inventory (BDI), the Yale-Brown Obsessive Compulsive Scale for heavy drinking (YBOCS-hd for the alcohol-dependent group only), the Autobiographical Memory Functions Scale (AMFS) and the Rosenberg Self-Esteem Scale (RSS).
>CAGE Questionnaire is a yes/no response-format four-item screening tool developed by Ewing. It is reported that answering “yes” to one of the questions serves as an early warning sign for potential alcohol dependence. A “yes” response to two or three questions raises suspicion of alcohol dependence while four “yes” responses strongly indicate the presence of alcohol dependence [32]. Since two or more positive responses may indicate an alcohol use disorder, only participants who answered “no” to at least three of the questions were included in the study as a comparison group despite the potential for alcohol-related issues in any individual from the general population.
Montreal Cognitive Assessment-MoCA is a rapid-screening test for mild cognitive impairment. It was developed by Nasreddine et al. [33]. Selekler et al. [34] conducted the Turkish validity and reliability study. The cut-off score is determined as 21 in the Turkish sample. Individuals who score 21 and above are considered to have adequate cognitive functions. In the current study, it was used to exclude possible amnesia and memory disorders for both groups (with and without alcohol dependence), and participants who scored 21 and above were included in the study.
Yale-Brown Obsessive Compulsive Scale for heavy drinking (YBOCS-hd) which provides an assessment of obsessive and compulsive components of alcohol craving in patients with alcohol dependence, consists of 10 items. The first five items of the scale measure the obsessive sub-dimension, while the last five items measure the compulsive sub- dimension [35]. High scores obtained from the scale indicate that craving is high. Validity and reliability studies in Turkey were conducted by İlhan et al. [36]. It was seen that the Turkish form consists of a single dimension. The Cronbach a coefficient of the scale was found to be 0.86 in the sample of the current study.
Beck Depression Inventory (BDI) is a self-assessment type scale consisting of 21 items that evaluate somatic, emotional, cognitive and motivational symptom clusters seen in depression. The obtained score provides information about the severity of depression symptoms. Higher total scores obtained from the inventory indicate more severe depressive symptoms [37]. BDI cut-off scores are 0-9 for no or minimal depressive symptoms, 10-18 for mild depressive symptoms, 19-29 moderate depressive symptoms and 30-63 indicates severe depressive symptoms [38]. Validity and reliability studies in Turkey were conducted by Hisli [39, 40]. The Cronbach a (internal consistency) coefficient of the scale calculated for the sample of this study was 0.89.
Autobiographical Memory Functions Scale (AMFS) was developed by Er and Yaşın in order to reveal the effects of autobiographical memory functions on individuals’ emotions, thoughts and behaviours in the present and future of personal experiences [41]. The Autobiographical Memory Functions Scale contains 41 items aimed at examining the reasons why individuals think about the past within the scope of three basic functions, and each item is a five-point Likert-type scale. There are five subscales: Facing the Past (FP), Remembering the Past on a Hint Basis (RPHB), Self, Mood Regulation (MR), and Taking Lessons from the Past (TLP). The Self subscale refers to the process in which individuals review their past experiences to form their self-concept. TLP involves utilising previous experiences as a guide for shaping present behaviours and future decisions. RPHB describes how individuals retrieve memories when they encounter specific reminders or triggers. MR pertains to the selection of autobiographical memories that help sustain positive emotions or alter negative ones in a constructive way. FP involves reflecting on past experiences to gain insight, process emotions and come to terms with significant life events. The Cronbach’s a coefficient for the sample of this study was calculated as 0.79 for the Self subscale, 0.78 for the Mood Regulation, 0.83 for the Facing the Past, 0.85 for the Taking Lessons from the Past and 0.83 for the Remembering the Past on a Hint Basis subscale.
Rosenberg Self-Esteem Scale (RSS) was developed by Rosenberg [42]. The ten-item Self- Esteem and five-item of Self-Continuity subscales of the Rosenberg Self-Esteem Scale were included in the study. Turkish validity and reliability studies were conducted by Çuhadaroğlu [43]. The Cronbach a (internal consistency) coefficient of the scale calculated for the sample of this study was 0.86 for the Self-Esteem subscale and 0.63 for the Continuity of Self-Concept.
Self-Defining Memory Task (SDM) was developed by Singer and Moffitt [14]. According to this task, for a memory to qualify as self-defining, it must belong to the individual’s personal memory and exhibit specific characteristics. The traits of a self-defining memory are: it is vivid, over a year old and it still feels significant when recalled; it concerns an important issue, problem or conflict in the individual’s life; it defines who the person is and is something they would want to share with someone who knows them well; it is linked to similar memories concerning the same issue or concern and it evokes strong emotions – whether positive, negative, or both and it is frequently thought about.
Each participant was asked to write three memories in accordance with the SDM task instructions mentioned above. After each SDM, participants rated the emotions the memory evoked (12 emotional expressions, such as happy, sad, angry), the vividness of the memory, and its significance on a six-point Likert scale (0 = not at all, 3 = partially, 6 = very much).
Following the SDM task, participants were asked to write down a frequently narrated memory task (NM) shared by a significant other using the following instruction: “Please write down a frequently recalled memory shared by someone from your close circle (e.g., mother, father, sibling, relative) who knew you during childhood or adolescence.” After this task, participants were asked to rate the emotions evoked by this memory.

Procedure for encoding memories

Each participant’s self-defining memories were coded by two independent coders according to Singer and Blagov’s Classification System and Scoring Guide for Self-Defining Autobiographical Memories [15] as well as Thorne and McLean’s Guide for Coding Events in Self-Defining Memories [44]. Singer and Blagov showed self-defining memories are coded at two levels. The first level relates to the structure and specificity of the event. Specific memories include at least one discrete event, while non-specific memories are categorised as either episodic or general. The second level focuses on the integration of meaning within the memory, specifically whether a lesson is learned from the event. This level is divided into non-integrative and integrative memories. Thorne and McLean categorise memories by content into life-threatening events, recreation/exploration, interpersonal relationships, achievement/mastery, guilt/shame, drug/alcohol/tobacco use and unclassifiable events.
Additionally, researchers coded the SDMs based on Brewer and Gardner’s three self-representations [45]. According to Brewer and Gardner, memories were classified based on the self-representation they conveyed. If the individual focused solely on his/her own thoughts, characteristics and motivations, the memory was coded as “individual self.” Memories describing relationships with significant others were coded as “relational self” while memories representing the individual’s self-representation within a group context were coded as “collective self.” The goal was to determine whether participants defined themselves through personal experiences, through relationships with others or within the context of a group. Cohen’s κ coefficient between coders for the current study ranged from 0.67 to 0.82 indicating acceptable interrated reliability.

Statistical analysis

Data was analysed using SPSS for Windows version 26. Alcohol-dependent patients were compared with comparison participants on measures of depression (BDI), cognitive functioning (MoCA), self-esteem (RSS) and autobiographical memory functions (AMFS) using independent t-tests. The χ² test was employed to analyse participants’ SDM in both groups based on structure and specificity levels, memory integration, event types, mood and self-representation. The Phi coefficient was calculated to measure the effect size of relationships between categorical variables. As the emotional intensity, vividness and perceived importance of SDM in both groups did not follow a normal distribution, the Mann-Whitney U test was used for these comparisons. Inter-coder reliability for SDM coding was assessed usingCohen’s κ coefficient. Pearson’s correlation coefficients were calculated to examine potential relationships between depressive symptoms, self-esteem, self-continuity and subscales of the Autobiographical Memory Functions Scale.

■ RESULTS

Clinical characteristics of alcohol-dependent and comparison participants

There were statistically significant differences between men with alcohol dependence and the comparison group in terms of BDI (t = 4.61, p < 0.001), self-esteem (t = –2.53, p < 0.001) and mood regulation (t = –2.17, p = 0.04). Men with alcohol dependence reported higher depressive symptoms (BDI) (M = 18.51, SD = 10.06), lower self-esteem (RSS) (M = 18.70, SD = 5.18) and mood regulation scores (subscale of AMFS) (M = 23.38, SD = 6.40). The mean age at which male patients with alcohol dependence first consumed alcohol was 15.03 years (SD = 3.34). Their mean length of abstinence from alcohol was 7.16 weeks (SD = 5.53). The mean age of awareness alcohol as a problem is 12.23 years (SD = 9.77) (Table I). By subtracting the years when they recognised alcohol as a problem from their current age, it was found that they realised this issue at a mean age of 33.93 years (SD = 9.51).

Group comparisons of SDM characteristic features

Self-defining memories showed statistically significant differences between groups in terms of structure and specificity (χ² = 7.50, p = 0.02, phi = 0.20), mood (χ² = 10.76, p = 0.005, phi = 0.24), event type (χ² = 23.77, p = 0.001, phi = 0.36) and self-representation (χ² = 11.40, p = 0.003, phi = 0.25). However, the difference between groups regarding the integrating of meaning of SDM was not statistically significant (χ² = 0.51, p = 0.59). SDM of the alcohol dependent group were 43.3% general structure, 64.4% negative mood, 26.7% relationship event, 25.6% alcohol-related event and 62.2% relational in terms of self-representation. On the other hand, SDM of the comparison group were 24.4% general structure, 42.2% negative mood, 21.1% relationship event, 3.3% alcohol-related event and 38.9% relational in terms of self-representation (Table II).
Men with alcohol dependence reported less happiness (U = 3212.5, n = 179, z = -2.47, p = 0.01, r = 0.18), more sadness (U = 3221.5, n = 180, z = –2.49, p = 0.01, r = 0.19) and more anger (U = 3211.5, n = 180, z = –2.55, p = 0.01, r = 0.19) in their SDM compared to the non-alcohol dependent group. The difference between the groups in terms of vividness of memories (U = 4040.5, n = 180, z = –0.04, p = 0.97, r = 0.003) and importance (U = 3805.0, n = 180, z = –0.90, p = 0.37, r = 0.07) was not statistically significant.
Chi-square analysis was conducted to look at the characteristics of the content of the self-representations of the SDM of the alcohol-dependent group only. The difference was statistically significant according to the structure and specificity of the self-representation in the SDM of the alcohol dependent group (χ² = 9.67, p = 0.04, phi = 0.33). In the memories of men with alcohol dependence, 50% of the memories coded as relational self were general, 28% specific and 21% episodic (Figure 1). The mood of the SDM was compared in terms of self-representation and the difference was not found to be statistically significant (χ² = 8.97, p = 0.06). The difference between self-representation in SDM and the event type of the memory was statistically significant (χ² = 34.96, p = 0.000). 65.2% of alcohol-involved memories (n = 23) were relational self, 21.7% individual self and 13% collective self.

Group comparisons of narrated memories from close circle

Narrated memories from close circle of male participants with and without alcohol dependence did not show statistically significant differences in terms of structure (χ² = 1.22, p = 0.54), mood (χ² = 2.62, p = 0.27), types of events (χ² = 5.05, p = 0.41) and self-representation (χ² = 1.84, p = 0.39). Additionally, the emotional intensity of the frequently narrated memories from close circle of men with alcohol dependence (n = 26) and comparison participants (n = 29) was compared using the Mann-Whitney U test. Only feelings of guilt were significantly higher in men with alcohol dependence compared to non-alcohol dependence participants (U = 261.5, n = 55, z = –2.20, p = 0.03, r = 0.30).

Relationships between scale scores for both groups

In male patients with alcohol dependence, the negative correlations between BDI and self- esteem (r = –0.50, p = 0.006) and between BDI and YBOCS-hd (r = –0.57, p = 0.001) were statistically significant. Additionally, the negative correlation between self-esteem and facing the past (r = –0.41, p = 0.02) was also significant. In the comparison group, the negative correlation between BDI and self-esteem was significant (r = –0.53, p = 0.002) while the positive correlation between self-continuity and self was also significant (r = 0.39, p = 0.03) (Table III).

■ DISCUSSION

In this study, the characteristic features of self-defining memories of men with alcohol dependence were compared with those of individuals without alcohol dependence. The SDM of men with alcohol dependence are more general and more negative in terms of mood than the comparison group. However, no significant difference was observed between the groups regarding the integrative meaning of the memories. In terms of the types of events in the memories, the content of the memories of men with alcohol dependence is more about relationships, alcohol, substance or tobacco use; on the other hand, it is less about the content of achievement and exploration/recreation memories. The difference between the groups is significant in terms of self-representations and the relational self is more frequent in the memories of men with alcohol dependence. Additionally, men with alcohol dependence had higher levels of depressive symptoms and lower self-esteem and mood regulation than those from the comparison group.
In the current study, the finding that the SDM of men with alcohol dependence are more general compared to those of the comparison group is consistent with previous research in the literature [6, 9, 10, 16, 46, 47]. The greater generality of memories in men with alcohol dependence, characterised by the lack of specific or episodic events over a particular period and consisting of recurring rather than distinct events, explained by two potential factors. First, cognitive impairments, particularly in executive functioning, caused by chronic alcohol use may contribute to over-general memory retrieval. This pattern has been linked to the use of cognitive avoidance strategies [16]. Supporting this explanation, research has shown that men with alcohol dependence who had recently completed detoxification reported fewer specific memories than those abstinent for six months or longer [9]. Second, the relationship between depression and over-general memory is noteworthy. Individuals with higher levels of depressive symptoms are known to recall more generalised memories [48]. Given that depression commonly co-occurs with alcohol dependence, this comorbidity may contribute to the over-general nature of their memories. In this study, depressive symptom scores were significantly higher in the alcohol-dependent group than in the comparison group. The CaR-FA-X model explains this phenomenon, suggesting that rumination, functional avoidance and impairments in executive functioning associated with depression hinder the retrieval of specific memories [17, 48]. For individuals with alcohol dependence, the combined effects of chronic alcohol use and depression likely exacerbate the over-general nature of their memories. The negativity of the recalled memories is also frequently attributed to elevated depressive symptoms in individuals with alcohol dependence [12]. In this study, the SDM of the alcohol-dependent group were more negative compared to the comparison group, a finding consistent with similar studies [10, 12]. Moreover, the alcohol-dependent group rated the emotional intensity of their memories more negatively particularly in terms of anger and sadness.
Regarding integrative nature of meaning in memories, no significant difference was found between the groups. Integrative meaning refers to the presence of awareness in the memory that the past event has changed one’s perspective of oneself, others or the world [15]. This finding is consistent with the comparative study by Cuervo-Lombard et al. [10]. However, other studies have reported that individuals with alcohol dependence [12] and opioid dependence [46] demonstrate lower levels of integrative meaning in their memories compared to non-dependent individuals.
The inconsistency in the literature on this issue may be due to differences in sample characteristics. Nandrino and Gandolphe suggested that the lower levels of integrative meaning in individuals with alcohol dependence might be attributed to impairments in cognitive functions. Indeed, their study showed that the MoCA scores were significantly lower in the alcohol-dependent group [12]. On the other hand, in the present study and in Cuervo- Lombard et al. [10], no statistically significant differences were observed between the groups in terms of cognitive assessments. These discrepancies in sample characteristics across studies suggest that cognitive functions may influence the integrative meaning of memories.
In addition, regarding event types in SDM, men with alcohol dependence reported more memories related to relationships, alcohol and life-threatening events. In the comparison group, life-threatening themed memories were more frequently shared, followed by an equal distribution of relationship and achievement/expertise themed memories. Similar studies have reported that individuals with alcohol dependence recall more relationship and alcohol/substance-themed memories [10] while achievement-themed memories are less common [12]. Likewise, a study with individuals with opioid dependence found a higher prevalence of relationship-themed memories and a lower prevalence of achievement-themed memories compared to the control group [46]. The higher frequency of alcohol-related memories may indicate an increased tendency toward ruminations about alcohol. These ruminative thoughts about one’s dependence could impact positive beliefs about recovery and coping skills [47]. On the other hand, the lower prevalence of achievement-themed memories among individuals with alcohol dependence appears to be associated with negative emotions like shame, guilt and also low self-esteem. As seen in this study, the low self-esteem of the alcohol dependence group may support this explanation.
Furthermore, in this study, SDM were coded in terms of self-representation (Brewer and Gardner), which was not included in the two coding guides. The SDM of the alcohol-dependent group were more relational self. Brewer and Gardner, who addressed the self-concept from an intercultural perspective, propose that individuals conceptualise and define their self primarily through the individual self, which emphasises personal traits, the relational self, which focuses on roles within relationships and the collective self, which reflects one’s place within a group [45]. The alcohol-dependent group predominantly defined their selves in relation to their interactions, roles and shared experiences with significant others. Stressful life events experienced in interpersonal relationships are both a risk factor for alcohol use disorder and a factor that causes it to become chronic [49]. Individuals who cannot effectively regulate negative moods caused by interpersonal conflict are at higher risk of continuing drinking. Addressing interpersonal relationships is, therefore, a crucial component of alcohol dependence treatment [50]. In this context, the finding that men with alcohol dependence exhibit a higher prevalence of relational self-representations compared to the comparison group is particularly significant.
In addition to SDM, participants were asked to recall and write down a frequently narrated memory (NM) from close circle who had known them during their childhood or adolescence. To the best of our knowledge, no prior study has utilised this type of memory in the literature. The self is shaped, regulated and reconstructed through interactions with significant others, with their perspectives playing a crucial role in this process [51, 52]. In the current study, NM were coded in the same manner as SDM. The structure and specificity, mood, event type and self-representation of these memories did not differ significantly between the groups. This finding could be attributed to the fact that only a single memory of this type was written, which may have limited the detection of potential differences. One notable finding was that the alcohol-dependent group reported significantly higher levels of guilt when rating the emotional intensity associated with their NM compared to the comparison group. This is an interesting finding. While shame was included among the emotional responses participants rated for their NM, no significant group differences were found. Shame is experienced when one disappoints other people by not fulfilling their hopes and wishes and their respect is lost. Guilt, on the other hand, is felt when one breaks one’s own rules [51, 53]. Higgins stated guilt occurs when there is a discrepancy between the actual self and the ought self from our own perspective. However, discrepancies between the actual self from one’s own perspective and the ought self from others’ perspectives are more often associated with feelings such as resentment, hurt and sadness [51]. Tice and Wallace argue that a process known as reflected appraisal often involves individuals constructing their self-concepts based on how they believe others perceive them [52]. The internalisation of perceived social appraisal may increase sensitivity to self-conscious emotions like shame or guilt, especially in individuals with alcohol dependence who attribute importance to interpersonal relationships. In particular, guilt involves a focus on specific behaviour and the perception of having done something wrong, and emotions like tension, remorse and regret related to the wrongdoing may be evoked or reinforced through the reactions of significant others. One explanation for this study finding not coinciding with the literature could be the mis-identification or mis-labelling of emotions. Shame and guilt are often seen as emotions that are confused with each other. Shame is one of the most severe emotions experienced and is not related to a single event but is a widespread emotion that covers the entire self. Guilt, on the other hand, is related to a specific behaviour and event [54]. Men with alcohol dependence possibly describe the feeling of shame they experience as guilt.
Self-esteem scores of men with alcohol dependence are lower than those of the comparison group, consistent with findings from similar studies in the literature [55, 56]. The process of alcohol dependence often involves significant losses, severe interpersonal problems, worsening depressive symptoms and a decline in self-esteem [57, 58]. It has been suggested that alcohol is consumed not only to reduce anxiety but also to enhance self- esteem and a sense of competence [55]. Research has shown that low self-esteem is associated with a biased recall of negative information from memory [59]. Memories related to achievements are linked to positive self-esteem, whereas memories involving interpersonal difficulties are associated with negative self-esteem [23]. Additionally, when autobiographical memory functions were examined, the only significant difference between the groups was found in mood regulation. Mood regulation is considered a critical component of the three primary autobiographical memory functions (self, social, and orienting) [60]. Given that individuals with alcohol dependence often struggle with emotion regulation [61, 62], interventions targeting emotional regulation like narrative therapy could contribute to the treatment process. These interventions may help reduce difficulties in emotional regulation, improve self-esteem and promote engagement with memories that have positive content.
Although the current study made several contributions to our understanding of the self-concept in men with alcohol dependence, it also had limitations that should be considered in future research. While the sample size was not unusually small for studies on self-defining memories (e.g., Cuervo-Lombard et al., Martínez-Hernández and Ricarte), it was relatively limited. Another limitation and difficulty of the study was that the individuals were asked to recall more than one memory. Additionally, the sample consisted of individuals who had recently achieved abstinence and thus, the findings may not generalise to patients with long-term abstinence. Future research could address this limitation by conducting longitudinal studies with intermittent collection of self-defining memories from individuals at different stages of abstinence. Furthermore, this study introduced the concept of narrated memory (NM) from close circles, an area that warrants further exploration. Future research could refine the instructions for recalling NM like specifying who narrated the memory and whether it should involve a frequently recounted or significant event. These considerations could enhance the understanding of how the self is shaped by what significant others remember and communicate about the individual.

■ CONCLUSIONS

This study points to important results in terms of determining the characteristics of self-defining memories as a way of understanding the self in alcohol dependence. Men with alcohol dependence have defined themselves with more general and negative mood-content events and their relationships with significant others are at the forefront. Their depression and self-esteem are low and this possibly affects their self-definition. Men in the alcohol-dependent group are more inclined to associate their sense of self with significant others and define themselves through these relationships. These findings highlight the necessity of addressing interpersonal dynamics as a central component in understanding and treating alcohol dependence. The way significant others perceive an individual’s self appears to hold greater importance for those with alcohol dependence, along with the emotional weight of these interpersonal interactions. Therefore, interpersonal relationships constitute a critical area that needs to be addressed in alcohol dependence [63] as alcohol use is likely to disrupt interpersonal relationships and escalate into a significant problem. During treatment and therapy, professionals should consider that individuals with alcohol dependence frequently dwell on these interpersonal issues, which may adversely affect their prognosis.

Conflict of interest/Konflikt interesów

None declared./Nie występuje.

Financial support/Finansowanie

None declared./Nie zadeklarowano.

Ethics/Etyka

The research was approved by/Badanie zostało zaaprobowane przez: the Ankara University Faculty of Medicine Clinical Research Ethics Committee, Decision No: 07-535-19 of 8 April 2019.
The work described in this article has been carried out in accordance with the Code of Ethics of the World Medical Association (Declaration of Helsinki) on medical research involving human subjects, Uniform Requirements for manuscripts submitted to biomedical journals and the ethical principles defined in the Farmington Consensus of 1997.
Treści przedstawione w pracy są zgodne z zasadami Deklaracji Helsińskiej odnoszącymi się do badań z udziałem ludzi, ujednoliconymi wymaganiami dla czasopism biomedycznych oraz z zasadami etycznymi określonymi w Porozumieniu z Farmington w 1997 roku.

References/Piśmiennictwo