Pathological addictions encompass a range of disorders that are characterized by abnormal and persistent substance use or the recurrent engagement in a specific behavior that causes significant distress to the person by affecting multiple domains of the individual’s personal and social experience (American Psychiatric Association, 2013). The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) has highlighted some overarching criteria underlying addictions that are common to substance use disorders (SUDs), which include substance abuse and dependence (either alcohol or drugs), and non-substance addiction-related disorders, which include Gambling Disorder (GD) (Caretti and La Barbera, 2004; Gabbard, 2015; Rash et al., 2016). These criteria include loss of voluntary control and maladaptive impulsive behavior over the object of addiction: people with an addictive disorder continue to use or engage in the behavior despite negative consequences for their family and interpersonal relationships, and despite potential problems in their work environment (Wareham and Potenza, 2010; Rash et al., 2016). These elements seem to indicate difficulties in the underlying mechanisms of decision-making processes, concerning how people with an addictive disorder evaluate the risks and benefits of a choice. In this vein, several investigations have shown that people with SUDs or GD cannot control their irresistible urge for an immediate reward, e.g., the satisfaction of using drugs or immediate gain, and do not consider possible negative consequences in the future, i.e., temporal discounting (Ainslie, 2001; Bechara et al., 2002; Bechara and Damasio, 2002; Reynolds, 2006; Brewer and Potenza, 2008; Mestre-Bach et al., 2016; Jimenez-Murcia et al., 2017; Steward et al., 2017). Brain imaging studies investigating the decision-making process in GD and SUDs have shown reduced activity in the ventromedial prefrontal cortex and ventral striatum, which is associated with impairment in cognitive inhibitory control and reward-related decision-making processes in both groups compared to controls (e.g., Potenza et al., 2003; Reuter et al., 2005; Tanabe et al., 2007; Potenza, 2009). Another factor that plays an important role in the consideration of addictive disorders is the presence of craving, defined as a strong motivation or irresistible desire to use (Sayette et al., 2000; Hasin et al., 2013; Sayette, 2016; Antons et al., 2020). In addition to being one of the main diagnostic criteria for SUDs, considerable evidence has shown that craving is also relevant for non-substance addictions, such as GD, and appears to be associated with more severe disease (for a review, see Mallorquí-Bagué et al., 2023).

The study of addiction spans many disciplines and perspectives, including clinical psychology, cognitive neuroscience, and sociology, which have contributed to identify specific behavioral, cognitive, and neurobiological patterns of symptomatology. Notwithstanding, there is a “puzzling” lack of agreement about the nature of the phenomenon (Pickard, 2018, p. 741; Pickard, 2020). Traditionally, theoretical models that have attempted to explain addiction can be grouped into the following main frameworks: on the one hand, the biomedical or brain disease model (e.g., Leshner, 1997; Volkow and Morales, 2015; Koob and Volkow, 2016), according to which addiction is a biological dysfunction linked to genetic factors over which the individual has no control (Adinoff, 2004; Le Moal and Koob, 2007). However, this model seems to ignore some important psychological and social aspects that are crucial for understanding the phenomenon. On the other hand, the moral model assigns responsibility to individuals who have chosen the rewards of drug use or gambling (Wilbanks, 1989). Because this perspective associates addiction with a negative moral connotation, i.e., a kind of “impurity” of the individuals involved, it has recently been challenged by other, more neutral perspectives, the so-called “choice model,” which applies the principles of ordinary choice behavior to addiction without stigmatizing it (Heyman, 2009; Foddy and Savulescu, 2010; for a discussion see Kennett et al., 2013; Pickard, 2017; Rise and Halkjelsvik, 2019). Finally, cognitive-behavioral and psychodynamic approaches highlight the role of learning and interpersonal relationships in addictive disorders. In particular, Lewis (2015, 2017) explains the addiction with the “learning model,” according to which addiction is associated with a “repeated experience” that develops into a habit through the establishment of learned patterns of reward-seeking behavior (Lewis, 2017, p. 10). Psychodynamic approaches and attachment theory, instead, underline the importance of early relational experiences. Specifically, people with dysfunctional and traumatic relational experiences that have not allowed them to build a solid self with a stable self-esteem, a reliable representation of the other, low mentalization abilities, and an effective emotional regulation might act the addictive behavior as a maladaptive strategy against suffering in order to control affects as shame, depression, anger and guilt (e.g., Kohut, 1971; Fonagy and Target, 1997; Bromberg, 1998, 2006; Johnson, 1999; Flores, 2004; Rothschild and Gellman, 2009; Schindler, 2019; Liese et al., 2020). Consistently, Khantzian (1985) suggested the “self-medication hypothesis” to describe addictive disorders.

Within this background, several investigations showed that the experience of craving in both GD and SUDs is associated with deficient emotion regulation strategies, dissociation, and impairments in self-control as well as in decision-making processes such as pursuit persistence and delay discounting, suggesting a more severe condition and a greater likelihood of relapse (De Castro et al., 2007; Tárrega et al., 2015; Serre et al., 2018; Ciccarelli et al., 2019; Schluter and Hodgins, 2021; Velotti et al., 2021). These features seem to suggest that addictive disorders are characterized by an unintegrated self, particularly affecting the systems that mediate the capacity for self-determination, self-governance, and self-concepts related to one’s social role (e.g., Reith and Dobbie, 2012; McConnell, 2016; Pickard, 2020). In this regard, the analysis of patients’ self-structure could be particularly important for understanding the different factors that might contribute to explaining the phenomenon of addiction. In this paper we will focus on this aspect. The self is a multifaceted concept that refers to a set of physical, psychological, and cultural characteristics that provide individuals with a sense of unity, purpose, and meaning throughout the lifespan (e.g., Erikson and Erikson, 1997; Habermas and Bluck, 2000; Pasupathi et al., 2009; McAdams and McLean, 2013; Marraffa and Meini, 2016; Marraffa and Meini, 2021). Recent research has observed that the experience of addiction is associated with a loss of connection to reality and a change in one’s identity, accompanied by dissociative phenomena in which people with an addictive disorder feel that an alien self is controlling their actions (Keane, 2002; McCormick et al., 2012; Reith and Dobbie, 2012; Dill and Holton, 2014; Schluter and Hodgins, 2019). Specifically, dissociative experiences in addiction refer to both a disrupted integration of memories, emotions, experiences, and thoughts, and a painful self-awareness related to the stigmatization of the social identity (e.g., Corrigan et al., 2009; Reith and Dobbie, 2012; Schüll, 2012; Matthews et al., 2017; Pickard, 2020; Rogier et al., 2021b). Furthermore, it has been suggested that addictive disorders are characterized by conflictual phenomena between a predominant strong desire to use/behave and the self-control system, resulting in a loss of agency and self-efficacy (MacKillop et al., 2011; Dill and Holton, 2014).

In cognitive psychology and personality research (e.g., Riessman, 1990; Giddens, 1991; McLean et al., 2007; McAdams and McLean, 2013), it has been hypothesized that a fruitful way of framing the structure of the self is through the narrative dimension. In this perspective, the self, particularly its diachronic dimension, is interpreted as an evolving life story through which individuals give meaning to their existence by organizing experiences into a coherent and unified representation in order to develop a stable sense of self, i.e., narrative identity (Dennett, 1993; Gallagher, 2000; Singer, 2004; McAdams and McLean, 2013). Borrowing the Jamesian tradition, narrative identity is configured as a selfing process resulting in an autobiographical narrative, constructed by the narrator/Me through the integration of complex plots involving past personal episodes, key experiences (low, high, or turning points), relationships with other characters, self-referential future episodes, and psychological states (McAdams, 1989, 1996, 2001; Conway and Pleydell-Pearce, 2000; McAdams and Olson, 2010; Marraffa and Meini, 2016; Marraffa and Meini, 2021), and which requires autobiographical remembering. Therefore, according to this model, autobiographical memory serves the core function of providing the building blocks for the construction of the self, as it enables individuals to recall information about the what, when, and where of self-referential past episodes, as well as to plan future behaviors, thus contributing to the configuration of one’s life story as told from a subjective point of view (Tulving, 1985; Habermas and Bluck, 2000; Singer et al., 2013).

Relevant to the aim of this paper, according to several authors, the way in which individuals recall and narrate their personal experiences and integrate them into an overall life story seems to reveal important cognitive and affective aspects of the cohesion of self (McAdams and McLean, 2013). In particular, recent research has shown that specific features of self-narratives can be associated with certain psychopathological conditions (e.g., Vanden Poel and Hermans, 2019). It is worth emphasizing this point, because it follows that research on narrative identity can make a significant contribution not only to the theoretical framing of the sense of self, that is associated with greater psychological well-being (e.g., McLean et al., 2010; Reese et al., 2017), but also to the understanding of psychological disorders and, consequently, to the development of effective interventions (Singer et al., 2013). As addiction appears to be characterized by a self prone to fragmentation (e.g., Reith and Dobbie, 2012), the study of personal narratives of people with an addictive disorder could be an important contribution to understanding the fragile structure of the self in addiction.

Against this background, the aim of this paper is to propose a conceptual analysis of the existing literature on the narrative dimension in addictions, in order to highlight the role of narrative as a tool for investigating the self in addictive disorders. The article is divided into the following sections: in the “Measures of narrative identity” section, we provide a conceptual analysis review of the key variables in autobiographical narratives that have been associated with disturbances in the self dimension (McLean et al., 2020); in the “Studies on narrative identity in addictions” section, we review the existing literature that has examined these variables in addictive disorders through narrative-based approaches. In the final section, “Discussion,” we offer an examination of these studies taking into account the main features that characterize addiction, and we will argue for further research on narrative identity in addiction in order to better understand the dynamics of this disorder.

Although, as we have shown above, the analysis of autobiographical narratives has provided crucial insights for the study of the self in several clinical populations (e.g., schizophrenia, personality disorders, etc.), there are still few studies investigating narrative identity-related variables in addictive disorders. To the best of our knowledge, out of a total of 18 studies identified in literature that explored narratives of addiction, only two studies have explicitly examined structural features in personal narratives of individuals diagnosed with an addictive disorder: one study focused on the assessment of narrative global coherence (Canali et al., 2021), the other on narrative complexity and its relation to recovery (Rowlands et al., 2021). As for the second variable we considered, namely agency in the framework of narrative identity, only a few studies have examined it in self-narratives of people with an addictive disorder (Altavilla et al., 2020; Canali et al., 2021) and in recovery context (Rowlands et al., 2019; see also an exploratory stud by Rowlands et al., 2020), while other investigations have proposed to analyze agency in autobiographical narratives in addiction using a sociological approach based on actor-network theory (Törrönen and Tigerstedt, 2018; Törrönen et al., 2020; Törrönen, 2023). Finally, one study has analyzed the emotional dimension in autobiographical narratives of people with GD (Altavilla et al., 2020). These investigations adopted a top-down approach by evaluating the selected narrative variables, i.e., coherence, complexity, agency, and emotion, in autobiographical narratives using a qualitative (Rowlands et al., 2019, 2021; Canali et al., 2021) or a quantitative (Altavilla et al., 2020) analysis. In this section, we briefly describe the methodology and results of these studies.

Regarding structural analysis of the narratives, Canali et al. (2021) have investigated global coherence in a group of people with GD and in a group with SUDs. The qualitative analysis was conducted on autobiographical narratives obtained through a semi-structured interview that explored the main phases of the addiction experience (onset, maintenance, relapse, desire, loss of control, control strategies and treatment). Specifically, narrative global coherence was assessed using an adaptation of the Narrative Coherence Coding Scheme (NCCS) (Reese et al., 2011; King et al., 2014; Race et al., 2015), which is based on the assessment of three main coherence dimensions: spatial and temporal context, chronological organization, and thematic coherence. The main findings of Canali et al. (2021) showed a low level of global coherence in both groups, especially in the narrative of desire, relapse, loss of control, and control strategies, compared to the other thematic areas. Moreover, Canali et al. (2021) included in the analysis of narrative structure variables the evaluation of self-projection into the future, i.e., the occurrence of sentences in which the subject imagines himself/herself in personal future scenarios, highlighting the absence of reference to the future in both GD and SUD. With regard to narrative complexity, Rowlands et al. (2021) have investigated the association between narrative complexity and recovery in a group of people who misuses drugs or people in recovering who were administered the Life as a Film (LAAF) interview (e.g., Canter and Youngs, 2015). The Narrative Complexity index was obtained by counting the presence/absence of distinct characters and related details, the presence/absence of events, e.g., relevant past personal episodes, and the presence/absence of “psychological ideas,” as emotions or thoughts; a 12-item Recovery Inventory (RI) scale was used to assess recovery. The main result showed a positive association between the Narrative Complexity Index and the Recovery Score, particularly in the category of psychological ideas (Rowlands et al., 2021).

With regard to agency, the study by Canali et al. (2021), in addition to assessing global coherence, also conducted a linguistic analysis of some personality-related variables, including agency/passivity. Specifically, agency was assessed by counting the occurrence in the narratives of action verbs, self-efficacy markers such as “I did,” and choice indications for each thematic area in both groups (GD and SUD); passivity was assessed by counting sentences with reference to automatic behavior or passive verbs. They found a higher percentage of agency in the narration of the maintenance (chronicity) phase of the disorder compared to the other thematic areas, and greater passivity in the narration of the definition of addiction and loss of control in both groups (Canali et al., 2021). Agency was also assessed in a study by Altavilla et al. (2020), based on a linguistic investigation that highlighted specific aspects underlying self-determination and self-efficacy processes. Through a textual analysis carried out with the software LIWC (Pennebaker’s Linguistic Inquire and Word Count), personal narratives about different stages of the addiction experience (onset, maintenance, relapse, desire, loss of control, control strategies and treatment) were examined in a group of 30 people with GD. The use of pronoun-related words, i.e., the first-person singular pronoun or other persons, was counted as an indication of agency. The results showed that narratives about the definition of addiction and the stages of relapse, craving, and loss of control contained fewer first-person singular words than narratives about onset, maintenance, control strategies, and treatment. Finally, the study by Rowlands et al. (2019) investigated agency theme in a group of 32 participants who previously misused substances or in recovery, using the LAAF interview to elicit personal narratives, and assessed the outcome of the rehabilitation using the RI. Specifically, the narrative material was coded by independent evaluators for the presence/absence of agency theme by assigning a total score from 0 to 3, obtained through the detection of three agency-related themes: effectiveness, empowerment, and self-mastery. A correlation analysis to assess the relationship between agency and recovery was performed revealing a positive association between the presence of agency in personal narratives and RI score (ibid.). These findings were confirmed by a second exploratory study of the authors Rowlands et al, (2020), which showed a transition to low levels of agency in narratives related to substance-using identity to higher levels of agency in narratives related to recovery identity.

The study by Altavilla et al. (2020) also included a quantitative analysis of emotion-related words, i.e., positive and negative emotions, in autobiographical narratives, and showed that people with GD used a higher percentage of negative emotion-related words than positive ones, particularly when narrating the definition of addiction, maintenance, and loss of control phases, compared to other topic areas. They also counted the use of tenses (past, present, and future) in all thematic areas of the narratives, showing a lower percentage of future tense words than present and past tense words.

It is important to note that, within the framework of narrative identity, other research in recent years has explored how people with an addictive disorder narrate about their life story. However, this research has mainly focused on the mere identification of the main thematic areas through a bottom-up analysis, for example, by starting with narrative material to explore emerging themes, both of narratives about the experience of addiction, e.g., awareness of the disorder in people with GD (Rogier et al., 2020), and about recovery from GD and SUDs: e.g., on identity change through a redemption narrative framework (Stoneberg, 2022); on narratives exploring social identity transition (Webb et al., 2022); on the transition process from recognizing gambling as a problem to recovery and the role of experiences, perceptions, and social factors (Vasiliadis and Thomas, 2018); on the change of narratives of people in recovery from GD (Reith and Dobbie, 2012) and on the behavioral trajectories of people with GD’s careers (Reith and Dobbie, 2013); finally, less recently, on autobiographical narratives of people in recovery from various addictive disorders (Hanninen and Koski-Jannes, 1999). Regarding narratives of the disorder, for example, Rogier et al. (2020) quantitatively and qualitatively analyzed personal narratives of people with GD by providing a matrix of simple units present or absent in the narratives and by organizing these units into specific clusters, showing that five thematic clusters were particularly relevant in the narratives of people with GD: “gambling as dissociation, materialistic thinking, escape from social difficulties, awareness, and closeness.” Regarding recovery narratives, a study by Webb et al. (2022) examined identity changes in personal narratives collected through audio/video interviews and diary narratives of six participants in recovery from SUD at different stages of their recovery process. The narrative material was analyzed using a framework analysis, which consisted of identifying major themes (e.g., “belonging” or “confidence”) based on overarching themes of social identity statements (“staying safe/passive, exploring/transitional, and self-determinating/agentic”) and grouping them into categories (e.g., “needed” or “the real self”). Results showed a general increase in agency-related themes across stages of recovery in 5 out of 6 patients (ibid.).

Finally, other studies focused on the discourse strategies [e.g., the use of subjects self/other and objects in personal narratives of SUD (Sibley et al., 2020); or the use of metaphors (e.g., Shinebourne and Smith, 2010; Malvini Redden et al., 2013) used by subjects to narrate their personal experiences, particularly in relation to their social identity].

Out of a total of 18 studies mentioned in this section, we focused primarily on 9 studies that provided crucial insights into the most relevant aspects of narrative identity. An overview of the methods and findings of these main studies is provided in Table 1: 4 studies on the specific narrative variables (Rowlands et al., 2019, 2021; Altavilla et al., 2020; Canali et al., 2021); 5 studies on thematic analysis (Hanninen and Koski-Jannes, 1999; Reith and Dobbie, 2012; Rogier et al., 2020; Sibley et al., 2020; Webb et al., 2022). These investigations help to highlight the relevance of studying autobiographical narratives, particularly the mechanisms underlying how people organize their life stories, as a tool for exploring multiple aspects of the self in addiction.

Addiction, both behavioral and substance-related, has traditionally been viewed as a neurobiological disorder characterized by compulsion and loss of voluntary control, with a pronounced impact on decision-making processes. Contrary to this view, in recent decades some authors have suggested that a core feature in people with an addictive disorder is related to a disruption of the patient’s structure of the self, resulting in an altered sense of self, and that this factor may underlie their maladaptive emotion regulation strategies, dissociative phenomena, and poor self-efficacy (Keane, 2002; Levy, 2006; Reith and Dobbie, 2012; Dill and Holton, 2014; Lewis, 2015). In this paper, we have shown that a privileged way to study the self is through the lens of narrative. In this view, an integrated and stable self is associated with a coherent life story that connects an individual’s internal and external experiences into a unified sense of self over time and through which people give meaning to their existence (McAdams, 1996; Singer, 2004). From this perspective, studies of various psychopathologies, such as schizophrenia and personality disorders, have analyzed the ways in which individuals construct and narrate their personal life stories in order to address important aspects of the processes underlying the structure of the self (e.g., Adler et al., 2012; Allé et al., 2015). Research has shown that certain narrative variables are particularly relevant in elucidating these processes: structural narrative variables, such as global coherence and complexity; thematic variables, such as agency; and affective dimensions, i.e., assessments of the emotional content of the narrative. Although, as we have seen, only 4 studies have applied narrative dimension analysis to the study of addictive disorders by focusing on these variables, we believe that, along with the other thematic analysis, they provide important insights into the debate over the characterization of addictions. Indeed, the findings of these studies seem to converge with the main themes emerging from the bottom-up analyses of the narratives of people with addictive disorders, that revealed a disorganization of the structure of the self and a lack of agency.

In light of the mechanisms that we have shown to underlie the development and functioning of narrative identity, some features of the autobiographical narratives of people with an addictive disorder can be linked to difficulties in maintaining an integrated sense of self. One aspect that emerged from the analysis of the autobiographical narratives of both people with GD and with SUD concerns global coherence, i.e., the property associated with the ability to organize personal episodes into a unified representation by identifying causal, motivational, and thematic links between them (Canali et al., 2021). Canali et al. (2021) suggest that the low level of coherence, particularly in the narrative of craving, may reflect a difficulty in conceptualizing the affective dimension due to dissociative phenomena. In fact, during craving, the individual seems to live a strong emotional dysregulation experience in which she/he has the urgency to implement regulatory strategies to reduce distress. Moreover, an impairment in the ability to coherently organize experiences may reveal difficulties not only in affective processes, but also in the cognitive processes related to this ability. In this sense, since narrative coherence is related to the ability to establish temporal and causal links between events in order to provide continuity to the narrative plot (e.g., Reese et al., 2011), the processing of temporality represents a central element for the narrative dimension (Suddendorf and Corballis, 1997; Corballis, 2011), which has been studied in other clinical populations, such as autism (Ferretti et al., 2018; Marini et al., 2019). Interestingly, as we mentioned, in both the Canali et al. (2021) and Altavilla et al. (2020) studies, the analysis of linguistic markers related to temporal factors, especially to self-projection into the future, i.e., the self-referential ability to imagine oneself in personal future scenarios (Atance and O'Neill, 2001; Buckner and Carroll, 2007), revealed an absence of reference to the future, showing that people with an addictive disorder failed to integrate their experience with possible self-based future scenarios different from the addiction condition.

Difficulties in processes related to the elaboration of the overall narrative structure in addictive disorders could also be indicated by a lack of narrative complexity (Rowlands et al., 2021). For example, the study by Rowlands et al. (2021) found a low percentage of narrative complexity indicators related to psychological ideas, i.e., markers of reflective and cognitive processes, suggesting a reduced level of cognitive complexity and possible difficulties in reflecting flexibly on emotions and thoughts. Since reflective abilities, i.e., high-level cognitive processes involving “knowledge of the nature of experiences which give rise to certain, beliefs and emotions” (Fonagy and Target, 1997, p. 680), appear to play a crucial role in self-organization, a link with the maladaptive regulatory strategies that characterize addiction can be hypothesized. Consistent with this finding, Rogier et al. (2020) have identified the materialistic thinking domain in their cluster analysis, namely a prevalence of reference to material goods such as money rather than emotion and cognitive elements, suggesting people with GD tend to use concrete thinking more than affective and meta-representational processes.

Findings on agency in the autobiographical narratives of people with an addictive disorder may help to explain important aspects of the disorder. In the study by Canali et al. (2021), an increased use of linguistic markers associated with agency was found in both people with GD and with SUD when narrating the maintenance phase of the disorder, whereas a greater use of passivity was observed when narrating the loss of control and when defining addiction. Interestingly, although the first finding seems to contradict the prevailing biomedical view of addictive disorders, which suggests people with an addictive disorder do not feel capable of initiating and controlling their actions (e.g., Leshner, 1997; Adinoff, 2004), the second finding seems to be consistent with it, suggesting that the actions they described were perceived as automatic. The same study reported that both people with GD and with SUD tended to refer to external motivation, especially when talking about the strategies they used to control their addictive behavior (Canali et al., 2021). To explain this finding, it can be hypothesized that this apparently contradictory way in which patients report their actions (they stated that they were both active and passive subjects of their actions) may reflect a more general disorganization in the way these individuals retrieve and integrate their personal lives and addiction-related experiences. Other studies based on thematic analysis have shown that people with an addictive disorder narrate themselves as being controlled by an alien self, and by failing to recognize parts of themselves, a loss of agency seems to prevail in them (e.g., Reith and Dobbie, 2012; Rogier et al., 2020; Sibley et al., 2020). For example, people who uses substances have been shown to narrate themselves as victims of external circumstances, such as those that are familiar and contextual (Sibley et al., 2020). Similarly, findings by Altavilla et al. (2020) showed that people with GD used a lower percentage of first-person singular pronouns when narrating experiences of craving, relapse, and loss of control compared to other topic areas. These findings suggest that the loss of self-determination and self-efficacy in addictions may be related to dissociative phenomena suggesting poor integration of the self (e.g., Keane, 2002). Consistently, studies examining agency in the context of recovery have shown that personal narratives characterized by the presence of agentic identity-related themes seem to be associated with better rehabilitation outcomes (Rowlands et al., 2019), and seem to play a key role in the process of identity transformation from “passive” or “addict” identity to more agentic identity in the that underpins treatment (Rowlands et al., 2020; Webb et al., 2022).

With regard to the affective dimension of narrative identity, the only study to examine emotions in the narratives of people with GD (Altavilla et al., 2020) showed a greater percentage of words associated with negative emotions in the narratives of several phases of their experiences. In line with the assumption that an overuse of words with negative valence may be associated with maladaptive coping strategies (Pennebaker and Seagal, 1999; Pennebaker and Graybeal, 2001), this finding seems to indicate a process of rumination, in which the individual passively compares the current situation with an unattained standard, which often occurs after dissociative phenomena (Bromberg, 2012; Altavilla et al., 2020).

Overall, the literature reviewed in this paper provides crucial insights into the importance of narrative approaches for understanding the organization of the self in addiction. In particular, from a clinical point of view, the detection of low coherence and narrative complexity, the presence of episodic memory gaps and loss of agency in the patient’s narration of her or his life story could guide the clinician’s interventions in the therapeutic process. Indeed, in the clinical setting, co-constructing new meanings with the patient also involves helping her/him to give order to personal experiences by finding causal links between events. The process of (re)organizing experience, for example through interventions aimed at eliciting and enhancing the patient’s reflective function, could help the patient to confront these acted and unthought states of the self. This process of self-restructuring, i.e., the recognition and integration of dissociated self states into consciousness, would help individuals to find more adaptive strategies of emotional regulation and to acquire a greater sense of continuity, coherence, and agency in their experience. For this purpose, narrative research has developed clinical treatment strategies focused on promoting a more coherent sense of self through the strengthening of narrative skills (e.g., Pennebaker, 2000; Freda, 2011). Some scholars have already studied the change of the narrative dimension during treatment in other psychopathologies, such as personality disorders (Arntz et al., 2012), and the effect of narrative-based exercises for the improvement of reflexive function in the context of higher education (Freda et al., 2014a,b) and for the reduction of psychological distress during difficult therapies (Martino et al., 2013). For example, Arntz et al. (2012) used linguistic analysis to examine descriptions of inner experiences elicited by an open-ended question at three different points in the psychotherapeutic process in individuals with personality disorders and in a control group of non-patients. The main findings showed a change in the use of negative and positive emotion words, first-person singular pronouns, and verb tens during treatment, with a reduction in negative emotion words predicting a better outcome. Overall, also in addictive disorders the restoration of identity as a person in recovery, the overcoming of the feeling of having alien parts of oneself, loss of self-governance, and unintegrated self-states (Weegmann, 2010; McConnell, 2016; McConnell and Snoek, 2018) could be facilitated through similar narrative-based approaches.

This paper critically reviewed 9 studies that have explored narrative identity in people with addictive disorders. By showing that narrative may represent a privileged lens for studying the self, we emphasized the centrality of certain narrative variables, i.e., global coherence and complexity, agency, and affective dimensions, in revealing important processes related to the construction of a unified sense of self. Specifically, self-narratives resulting to be less coherent and with a few references to agency, seem to reflect unintegrated self-states in which dissociative phenomena, emotional dysregulation, and a loss of self-agency are maladaptive strategies for coping with distress. The investigation of these aspects has been claimed to have important implications, particularly from a clinical point of view. Indeed, the detection of low coherence, loss of agency and high negative emotionality at specific points in the autobiographical story could be useful for clinicians in the therapeutic interventions.

VD: Writing – review & editing, Writing – original draft, Methodology, Conceptualization. DA: Writing – review & editing, Methodology, Conceptualization. IA: Writing – review & editing, Methodology, Conceptualization. AC: Writing – review & editing, Conceptualization. FF: Writing – review & editing, Supervision, Funding acquisition, Conceptualization.