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Recovery among sexual minorities in the united states population: Prevalence, characteristics, quality of life and functioning compared with heterosexual majority. Drug Alcohol Depend 2022; 232:109290. [PMID: 35032857 PMCID: PMC8885881 DOI: 10.1016/j.drugalcdep.2022.109290] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Lesbian, gay, and bisexual individuals ("sexual minorities" [SMs]) are overrepresented among individuals suffering from alcohol and other drug (AOD) problems. However, little is known regarding differences, particularly in functioning and well-being, between SMs and heterosexuals in recovery from AOD problems. METHOD Cross-sectional, nationally representative sample of US adults who resolved an AOD problem (N = 2002; National Recovery Study [Kelly et al., 2017]). Univariate analyses tested for differences between SMs and heterosexuals on socio-demographic, AOD use/treatment and clinical/legal factors. Unadjusted regressions tested for group differences on indices of current functioning and well-being. Multivariable regressions investigated factors that differentiated groups to understand which might explain any observed group disparities in functioning and well-being. LOWESS analyses explored differences across time in recovery on functioning/well-being. RESULTS Prevalence of SMs in the US recovery population was 11.7% (n = 220). Compared with heterosexuals (88.3%, n = 1666), SMs had shorter time in recovery (OR=0.97; 95% CI: 0.96, 0.99); were less likely to be employed (OR=0.64; 95% CI: 0.43, 0.96); and more likely to have a co-occurring psychiatric disorder (OR=2.24; 95% CI: 1.49, 3.37), an arrest history (OR=1.61; 95% CI: 1.08, 2.39), and report opioids as primary substance (OR=2.50; 95% CI: 1.18, 5.28). Unadjusted models showed, compared to heterosexuals, SMs had significantly worse levels on all functioning and well-being outcomes. Adjusted models explained most differences, except for psychological distress. CONCLUSION SMs evince more problematic clinical/legal histories and face greater psychosocial challenges in recovery. Research is needed to understand the unique experiences of recovering SMs in order to better address observed functioning and well-being disparities.
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Bray JH, Zaring-Hinkle B, Scamp N, Tucker K, Cain MK. MIRRORS program: Helping pregnant and postpartum women and families with substance use problems. Subst Abus 2022; 43:792-800. [PMID: 35113009 DOI: 10.1080/08897077.2021.2010254] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Pregnant and postpartum women with substance use disorders are a highly vulnerable population, especially when this is compounded by homelessness or unstable housing, justice involvement, and/or co-occurring mental health challenges. The MIRRORS (Maternal Initiative for Reflective Recovery-Oriented Residential Services) program provided expanded and enhanced residential substance use disorder treatment, prevention and recovery support for women and children through integrated, trauma-informed care and services strengthened by a comprehensive and coordinated family systems approach. This paper describes the program and provides evaluation of the outcomes. Methods: Pregnant and postpartum women (n = 215) were assessed at 3 time points: intake, discharge and 6-months post-intake using standardized measures of family functioning, parenting, recovery capital, and other outcomes. Multilevel modeling was employed to examine individual differences in trends over time. Results: Over 80% of participants reported that the MIRRORS program enhanced their recovery treatment experience. Women reported significant improvements in general family functioning, problem solving, behavioral control, affective responsiveness, and communication. Participants also reported increased recovery capital and improved parental monitoring over time. Conclusions: Outcomes indicate that the MIRRORS program was effective in improving family functioning and reducing substance use, thus enhancing women's functioning and recovery.
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Affiliation(s)
- James H Bray
- Department of Psychology, University of Texas San Antonio, San Antonio, Texas, USA
| | | | | | | | - Meghan K Cain
- Department of Psychology, University of Texas San Antonio, San Antonio, Texas, USA
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Mericle AA, Slaymaker V, Gliske K, Ngo Q, Subbaraman MS. The role of recovery housing during outpatient substance use treatment. J Subst Abuse Treat 2022; 133:108638. [PMID: 34657785 PMCID: PMC8748296 DOI: 10.1016/j.jsat.2021.108638] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 08/20/2021] [Accepted: 09/28/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Recovery housing generally refers to alcohol- and drug-free living environments that provide peer support for those wanting to initiate and sustain recovery from alcohol and other drug (AOD) disorders. Despite a growing evidence base for recovery housing, relatively little research has focused on how recovery housing may benefit individuals accessing outpatient substance use treatment. METHODS Using administrative and qualitative data from individuals attending an outpatient substance use treatment program in the Midwestern United States that provides recovery housing in a structured sober living environment, this mixed methods study sought to: (1) determine whether individuals who opted to live in structured sober living during outpatient treatment (N = 138) differed from those who did not (N = 842) on demographic, clinical, or service use characteristics; (2) examine whether living in structured sober living was associated with greater likelihood of satisfactory discharge and longer lengths of stay in outpatient treatment; and (3) explore what individuals (N = 7) who used the structured sober living during outpatient treatment were hoping to gain from the experience. RESULTS Factors associated with the use of recovery housing during outpatient treatment in multivariate models included gender, age, and receiving more services across episodes of care. Living in structured sober housing was associated with greater likelihood of satisfactory discharge and longer length of stays in outpatient treatment. Focus group participants reported needing additional structure and recovery support, with many noting that structure and accountability, learning and practicing life, coping, and other recovery skills, as well as receiving social and emotional support from others were particularly beneficial aspects of the sober living environment. CONCLUSIONS Findings underscore the importance of safe and supportive housing during outpatient substance use treatment as well as the need for future research on how housing environments may affect engagement, retention, and outcomes among individuals accessing outpatient substance use treatment.
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Affiliation(s)
- Amy A. Mericle
- Correspondence can be sent to Dr. Mericle at the Alcohol Research Group: 6001 Shellmound St., Suite 450, Emeryville, CA 94608, 510-898-5840 (phone),
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A critical analysis of the Tidal Model of Mental Health Recovery. Arch Psychiatr Nurs 2022; 36:34-40. [PMID: 35094823 DOI: 10.1016/j.apnu.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/25/2021] [Accepted: 10/29/2021] [Indexed: 11/24/2022]
Abstract
The purpose of this paper is to critically analyze the Tidal Model of Mental Health Recovery. This examination consolidates the existing knowledge used in developing and implementing this model in order to add clarity and explores how its theory relates to practice, research, and educational activities. This paper follows Chinn and Kramer's theory analysis framework, which includes the following criteria: clarity, simplicity, generalizability, importance, and accessibility. While the Tidal Model theory meets the criterion of clarity, simplicity is impeded due to the complexity of its concepts. That being said, Barker's theory is applicable across different psychiatric nursing settings because it is general and accessible. To enhance simplicity and make this a more actionable mid-range theory, an illustration is offered to demonstrate how the theory could be utilized and empiricized with a potential population of women who use substances. It is concluded that the Tidal Model appeals not only to mental health practice, but as the literature indicates, it also supports everyone who needs shelter where they feel safe at some point in their lives.
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Bowen E, Irish A, LaBarre C, Capozziello N, Nochajski T, Granfield R. Qualitative insights in item development for a comprehensive and inclusive measure of recovery capital. ADDICTION RESEARCH & THEORY 2022; 30:403-413. [PMID: 36721868 PMCID: PMC9886235 DOI: 10.1080/16066359.2022.2055002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND Item specification is foundational to measurement development but rarely reported in depth. We address this gap by explicating our use of qualitative methods to ground and develop items for a new recovery capital measure, the Multidimensional Inventory of Recovery Capital. METHOD We recruited a diverse sample of service providers (n = 9) and people in recovery from alcohol problems (n = 23) to provide feedback on an item pool assessing social, human, physical, community, and cultural capital. Using applied qualitative analysis, we coded findings from interviews and focus groups and made final decisions by consensus regarding item elimination, retention, or revision. This process yielded a 49-item draft measure. RESULTS Only nine items from an initial 90-item list were retained in their original form. Participant feedback guided item elimination, addition, and revision for linguistic or conceptual clarity. We detected little systematic variation in feedback based on income or race; however, there were stark divergences on particular items based on recovery pathway (i.e. 12-step versus other approaches). CONCLUSIONS The high degree of alteration to the item pool highlights the importance of establishing validity with respondents. Response variation based on recovery pathway suggests the need for broad heterogeneity in respondents. Measures that are sensitive, psychometrically sound, and aligned with theory are critical for advancing research on recovery capital and related disparities for diverse populations.
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Affiliation(s)
- Elizabeth Bowen
- University at Buffalo – School of Social Work, State University of New York, Buffalo, NY, USA
| | - Andrew Irish
- University at Buffalo – School of Social Work, State University of New York, Buffalo, NY, USA
| | - Charles LaBarre
- University at Buffalo – School of Social Work, State University of New York, Buffalo, NY, USA
| | - Nicole Capozziello
- University at Buffalo – School of Social Work, State University of New York, Buffalo, NY, USA
| | - Thomas Nochajski
- University at Buffalo – School of Social Work, State University of New York, Buffalo, NY, USA
| | - Robert Granfield
- Vice Provost for Faculty Affairs, University at Buffalo – State University of New York, Buffalo, NY, USA
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Baginski BN, Byrne KA, Demosthenes L, Roth PJ. Examining Internalizing Mental Health Correlates of Addiction Severity in Patients Hospitalized With Medical Complications From Substance Use Disorder. Subst Abuse 2022; 16:11782218221115583. [PMID: 35990751 PMCID: PMC9382059 DOI: 10.1177/11782218221115583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 11/16/2022]
Abstract
Background: Comorbidities between Substance Use Disorder (SUD) and mental health
disorders are highly prevalent, yet there remains a lack of information
regarding how mental health conditions may affect addiction severity.
Consequently, this study sought to investigate the relationship between
internalizing disorders (anxiety and mood disorders) and addiction severity
in patients hospitalized for SUD-related medical complications. Individual
difference predictors and history of prior treatment for SUD were also
examined. Methods: Participants (N = 200) were hospitalized patients who consented to receive
peer-based recovery support services for their SUD. To be eligible for the
study, participants needed to have a SUD diagnosis due to alcohol, opioids,
methamphetamine, cocaine, or a combination of these substances
(polysubstance use). Participants completed self-report questionnaires
regarding demographics, mental health history, prior SUD treatment, and
addiction severity (Drug and Alcohol Screening Test; DAST-10) during their
hospitalization. Results: Results showed that patients with Generalized Anxiety Disorder (GAD)
(M = 6.68, SD = 2.97) had greater addiction severity
compared to those without GAD (M = 5.41, SD = 3.34),
P = .016. Addiction severity results stratified by SUD
type showed that the relationship was significant among patients with
Alcohol Use Disorder (P = .014), but not among those with
other SUD types (Ps > .27). Major Depressive Disorder
(MDD) and Post-Traumatic Stress Disorder (PTSD) were not linked to addiction
severity. Among those with GAD, 81.4% had previously been to treatment
compared to only 53.1% of those without GAD, P = .010. The
only participant characteristic linked with addiction severity was insurance
status. Conclusions: GAD may represent a risk factor for advanced alcohol addiction trajectories,
including greater addiction severity and severe health complications
requiring inpatient hospitalization.
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Affiliation(s)
- Bryana N Baginski
- University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | | | - Lauren Demosthenes
- Department of Obstetrics and Gynecology, Prisma Health-Upstate, Greenville, SC, USA
| | - Prerana J Roth
- Department of Internal Medicine, Prisma Health-Upstate, Greenville, SC, USA
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Bryan MA, Mallik D, Cochran G, Lundahl B. Mindfulness and Savoring: A Commentary on Savoring Strategies and Their Implications for Addiction Treatment. Subst Use Misuse 2022; 57:822-826. [PMID: 35349380 DOI: 10.1080/10826084.2022.2046090] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: A central facet of the popular understanding of mindfulness practice is the non-judgmental observation of all thoughts and feelings. Savoring is a cognitive practice developed out of economics and positive psychology, which involves the conscious mental engagement with positively-valenced interoceptive and exteroceptive stimuli, which in turn amplifies the derived pleasure experience. Results: When incorporated into mindfulness-based interventions (MBIs), savoring holds promise in improving outcomes related to reward processing, such as positive affect and well-being. The growing body of mindfulness literature also suggests that the inclusion of savoring in MBIs may be key in treating disorders of reward dysregulation, such as addiction. If savoring does indeed reduce craving, this phenomenon offers a point of union for divergent neurobiological theories of addiction. Conclusion: In this commentary, we explore the existing literature on savoring and mindfulness practices as it relates to addictive disorders, posit underlying neurocognitive mechanisms, and present future areas of research.
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Affiliation(s)
- M Aryana Bryan
- Program for Addiction Research, Clinical Care, Education, and Advocacy, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Debesh Mallik
- School of Graduate Psychology, Pacific University, Hillsboro, Oregon, USA
| | - Gerald Cochran
- Program for Addiction Research, Clinical Care, Education, and Advocacy, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Brad Lundahl
- College of Social Work, University of Utah, Salt Lake City, Utah, USA
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Substitute Behaviors following Residential Substance Use Treatment in the Western Cape, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312815. [PMID: 34886541 PMCID: PMC8657596 DOI: 10.3390/ijerph182312815] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/27/2021] [Accepted: 12/01/2021] [Indexed: 11/21/2022]
Abstract
The dynamics of substitute behaviors and associated factors remain poorly understood globally, and particularly in low- and middle-income contexts. This prospective study describes the prevalence and types of substitute behaviors as well as predictors, correlates, and motivations associated with substitution in persons (n = 137) admitted to residential substance use treatment in the Western Cape province of South Africa. The brief assessment of recovery capital, overall life satisfaction scale, and an adapted version of the addiction matrix self-report measure were completed during and post-treatment. Results indicate that substitutes were employed consciously for anticipated appetitive effects, for time-spending, (re)connecting with others, and enjoyment. At follow-up, 36% of service users had substituted their primary substance(s) with another substance or behavior; 23% had relapsed and 40% had maintained abstinence. While some service users may be especially vulnerable to developing substitute behaviors, targeted prevention and intervention efforts can reduce this risk.
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Bertz JW, Smith KE, Panlilio LV, Stull SW, Reamer D, Murville ML, Sullivan M, Holtyn AF, Toegel F, Epstein DH, Phillips KA, Preston KL. Quality of life during a randomized trial of a therapeutic-workplace intervention for opioid use disorder: Web-based mobile assessments reveal effects of drug abstinence and access to paid work. DRUG AND ALCOHOL DEPENDENCE REPORTS 2021; 1:100011. [PMID: 36843907 PMCID: PMC9948824 DOI: 10.1016/j.dadr.2021.100011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 11/25/2022]
Abstract
Background Employment and improved quality of life (QOL) are, separately, valued outcomes of substance use disorder (SUD) treatment. It is also important to understand QOL changes caused by employment itself; therefore, we assessed QOL during a randomized trial of a contingency-management-based Therapeutic Workplace for people with opioid use disorder. Methods For 12 weeks, participants (n = 61) responded to QOL questionnaires in a mobile web app accessed with study-issued smartphones. At enrollment, participants were randomized to work in the Therapeutic Workplace immediately (immediate work group, IWG) or after a 3-week waitlist delay (delayed work group, DWG). Once both groups could work, wage-resetting contingencies were introduced for their opiate- and cocaine-urinalysis. Data were analyzed by (1) access to work with and without contingencies and (2) overall urinalysis-verified opiate- and cocaine-abstinence. Results DWG and/or IWG reported improvements in several QOL areas (sleep, transportation, recreation); however, they also reported increased money-related difficulties and less time spent with friends/family. These changes did not coincide with DWG's work access, but some (more sleep, money-related difficulties) coincided with the urinalysis contingencies. Greater opiate- and/or cocaine-abstinence was also associated with several improvements: sleep, paying bills, time spent with friends/family, and exercising. Surprisingly, intermediate cocaine abstinence was associated with reductions in work-capacity satisfaction and recreation. Conclusions Participants reported complex QOL differences during their experimental employment and associated with drug abstinence. Future work should help participants address issues that may be relevant to employment generally (e.g., time with friends/family) or contingency management specifically (e.g., money-related issues for non-abstinent participants).
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Affiliation(s)
- Jeremiah W. Bertz
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD 21224, United States,Corresponding author.
| | - Kirsten E. Smith
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD 21224, United States
| | - Leigh V. Panlilio
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD 21224, United States
| | - Samuel W. Stull
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD 21224, United States
| | - David Reamer
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD 21224, United States
| | | | | | - August F. Holtyn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Forrest Toegel
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - David H. Epstein
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD 21224, United States
| | - Karran A. Phillips
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD 21224, United States
| | - Kenzie L. Preston
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD 21224, United States
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Keen A, Lu Y, Draucker CB. Connecting and disconnecting: Experiences of people with opioid use disorder in intensive outpatient treatment. J Subst Abuse Treat 2021; 135:108657. [PMID: 34772605 DOI: 10.1016/j.jsat.2021.108657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/20/2021] [Accepted: 11/02/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Opioid use disorder (OUD) is a public health crisis affecting 2 million Americans. Approximately 80% of people with OUD do not receive treatment, and attrition rates in treatment programs are as high as 80%. Previous research has shown intensive outpatient treatment (IOT) has positive outcomes, but enrollment and retention in programs are problematic. To improve outcomes and increase engagement, more information is needed about how persons experience IOT programs. The purpose of this study is to describe processes that people with OUD undergo as they participate in IOT programs. METHODS The research team conducted a constructivist grounded theory study in IOT programs at two adult academic health centers within a large Midwest health care system. Study staff conducted interviews with 14 persons to elicit narratives about their experiences in the IOT programs. The team transcribed and analyzed interviews using a four-step process consistent with grounded theory methods. RESULTS Participants described the process of connecting and disconnecting as central to their IOT experience. The process included eight stages: (1) connecting with drugs, (2) disconnecting from everyday life, (3) connecting with the IOT program, (4) connecting with others in the IOT program, (5) disconnecting from drugs, (6) reconnecting with others, (7) reconnecting with self, and (8) disconnecting from the IOT program. CONCLUSIONS Connections with the IOT program, other patients, and IOT staff are central to beginning sobriety. Findings indicate that clinicians should foster connections and provide a multi-dimensional experience that enables patients to begin recovery.
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Affiliation(s)
| | - Yvonne Lu
- Indiana University School of Nursing.
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Parlier-Ahmad AB, Terplan M, Svikis DS, Ellis L, Martin CE. Recovery capital among people receiving treatment for opioid use disorder with buprenorphine. Harm Reduct J 2021; 18:103. [PMID: 34645477 PMCID: PMC8513247 DOI: 10.1186/s12954-021-00553-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 10/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background Recovery is a multidimensional process that includes health, quality of life, and citizenship. Recovery capital is a strengths-based concept representing the sum of an individual’s resources that support recovery. This study (1) describes recovery capital, (2) examines the relationship between recovery capital and treatment duration, and (3) assesses differences by gender in recovery capital among people receiving medication for opioid use disorder (MOUD). Methods This is a secondary data analysis of a cross-sectional study, with survey and medical record review components, conducted with patients recruited from an office-based opioid treatment clinic between July and September 2019. Analyses included participants receiving MOUD with buprenorphine who completed the Brief Assessment of Recovery Capital (BARC-10; n = 130). Univariate analyses explored differences by gender. Multivariate linear regression assessed the relationship between BARC-10 total score and length of current treatment episode. Results Participants were 54.6% women and 67.4% Black with mean age of 42.4 years (SD = 12.3). Mean length of current MOUD treatment was 396.1 days (SD = 245.9). Total BARC-10 scores were high, but participants perceived low community-level resources. Women scored higher than men within the health and purpose recovery dimensions. While length of treatment was not associated with BARC-10 score, experiencing recent discrimination was associated with a significantly lower BARC-10 score. Conclusions Recovery capital among individuals receiving MOUD was high suggesting that participants have resources to support recovery, but gender differences and prevalent discrimination highlight areas for improved intervention. More work is needed to investigate recovery capital as an alternative treatment outcome to abstinence in outpatient MOUD populations.
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Affiliation(s)
- Anna Beth Parlier-Ahmad
- Department of Psychology, Virginia Commonwealth University, 401 N. 11th Street, Richmond, VA, 23219, USA.
| | | | - Dace S Svikis
- Department of Psychology, Virginia Commonwealth University, 401 N. 11th Street, Richmond, VA, 23219, USA
| | - Laura Ellis
- Virginia Commonwealth University School of Medicine, Virginia Commonwealth University, Richmond, USA
| | - Caitlin E Martin
- Department of Obstetrics and Gynecology and Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, USA
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Rowlands D, Youngs D, Canter D. Exploring Core Addiction Themes and Their Resolution in Recovery Narratives Using the “Life as a Film” (LAAF) Procedure. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2021. [DOI: 10.1080/10720537.2021.1974322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- David Rowlands
- Department of Investigative Psychology, University of Huddersfield, Huddersfield, UK
| | - Donna Youngs
- Department of Investigative Psychology, University of Huddersfield, Huddersfield, UK
| | - David Canter
- Department of Investigative Psychology, University of Huddersfield, Huddersfield, UK
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Fitzgerald C, Barley R, Hunt J, Klasto SP, West R. A Mixed-Method Investigation into Therapeutic Yoga as an Adjunctive Treatment for People Recovering from Substance Use Disorders. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-020-00228-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
AbstractMind Body Connect (MBC) is a charity which uses therapeutic yoga as a vehicle of change for marginalized populations. Alongside MBC, Sheffield Hallam University’s SHU Strength researchers carried out this study aiming to: (1) Gauge the impact of therapeutic yoga classes upon the mood state of people with a Substance Use Disorder (SUD) and (2) Explore the perceived benefits of therapeutic yoga class participation. An adapted shortened Profile of Mood States (POMS) was completed before and after each yoga class. A comparison of means with paired sample T-Test and Cohen’s D was then carried out. Participants who attended 6+ classes were interviewed. Findings were then converged. Before and after measurements of anger, sadness, tiredness, worry, confusion, energy and relaxation were taken, Classes were held at SHU for service users from a Phoenix Future’s (PF) rehabilitation centre. A single yoga class significantly relaxed participants and reduced negative mood states. Interview data covered a range of perceived benefits including the use of yogic down-regulation techniques as daily coping strategies. The MBC yoga programme appears beneficial as an adjunctive therapy for PF residents. Future SHU Strength research shall focus on the mid-long-term exercise habits of the recovery community and the impact of the MBC yoga programme upon the early recovery period of detoxification.
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Ashford RD, Brown A, Canode B, Sledd A, Potter JS, Bergman BG. Peer-based recovery support services delivered at recovery community organizations: Predictors of improvements in individual recovery capital. Addict Behav 2021; 119:106945. [PMID: 33872848 DOI: 10.1016/j.addbeh.2021.106945] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/08/2021] [Accepted: 04/01/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND While clinical interventions used to support the recovery process of U.S. adults are well understood, community-based solutions such as peer-based recovery support services delivered by a recovery community organization are not. METHODS Previously collected administrative data of 3459 participants at 20 recovery community organizations in the U.S. were analyzed using a paired samples t-test to examine intake and current recovery capital differences, and multiple linear regression models to examine the association between peer-based recovery support engagement on changes in recovery capital. RESULTS Participants were mostly male (52.1%), non-Hispanic (80.2%), White (75.5%), with an average age of 39.38 years (SD = 12.57). Participants' average engagement was 130.68 days (SD = 166.6) with a total of 4290 engagement sessions (M = 4.75, SD = 4.74) and 8913 brief check-ins (M = 5.0, SD = 5.03) facilitated. Reported health events were 0.09 recurrences of substance use (SD = 0.61) and 0.02 emergency room visits (SD = 0.26) on average. Paired sample t-test results showed a statistically significant increase in recovery capital of 1.33 points (95% CI: 0.97-1.69). Multiple linear regression models for predicting improvements in recovery capital (adjusted r2 = 0.61) found number of follow-up engagements and completed recovery plan goals were statistically significant predictors. CONCLUSIONS Peer-based recovery support services delivered by recovery community organizations assist in significantly improving individual recovery capital, as well as helping to facilitate involvement with an array of recovery support services that may contribute to other functional social determinant domain improvements and lower negative health events.
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Affiliation(s)
- Robert D Ashford
- University of the Sciences, Substance Use Disorders Institute, United States.
| | - Austin Brown
- Syracuse University, Lerner Center for Public Health Promotion, United States
| | | | | | - Jennifer S Potter
- University of Texas Health Science Center San Antonio, Department of Psychiatry and Behavioral Sciences, United States
| | - Brandon G Bergman
- Harvard Medical School, Recovery Research Institute, Massachusetts General Hospital, United States
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Shouan A, Ghosh A, Singh SM, Basu D, Mattoo SK. Predictors of retention in the treatment for opioid dependence: A prospective, observational study from India. Indian J Psychiatry 2021; 63:355-365. [PMID: 34456348 PMCID: PMC8363890 DOI: 10.4103/psychiatry.indianjpsychiatry_448_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 04/14/2021] [Accepted: 06/17/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Literature on a longitudinal study of the determinants of treatment retention for patients with opioid dependence is limited. AIM To find out patient- and treatment-related (buprenorphine-naloxone-assisted treatment [BNX treatment] versus naltrexone treatment) predictors for retention in maintenance treatment. MATERIALS AND METHODS A total of 100 participants with opioid dependence were recruited by convenience sampling. The primary outcome was treatment retention - 3 months and 6 months postentry into maintenance treatment. Multiple assessments were done for the severity of opioid dependence and withdrawal, high-risk behavior, quality of life, and recovery capital - baseline and 3 and 6 months. The secondary outcome was to assess the change observed in the above-listed variables. RESULTS AND CONCLUSIONS Bivariate analysis across retained and the dropout groups brought out significant differences for some (type of opioids and route of administration) but not for other (age, employment, and education) patient-related factors. Multivariate analysis, adjusting for the type of maintenance treatment, rendered these associations statistically insignificant. BNX-based treatment (compared to naltrexone maintenance) was the most significant predictor of treatment retention both at the end of 3 months and 6 months. Even after controlling for the severity of opioid dependence and withdrawal, type and route of opioid use, and high-risk behavior, patients on BNX were eleven times (14 times at the end of 6 months) more likely to be retained in the treatment. BNX group had significant improvements in the domains of recovery capital, quality of life, addiction severity, and severity of opioid dependence. There is a need to scale up the BNX-assisted treatment program in India and elsewhere.
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Affiliation(s)
- Anish Shouan
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Abhishek Ghosh
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shubh Mohan Singh
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Debasish Basu
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surendra Kumar Mattoo
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Molina Fernández A, Saiz Galdós J, Cuenca Montesino ML, Gil Rodríguez F. Models of recovery: influence of psychosocial factors on substance use recovery. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.1941348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Antonio Molina Fernández
- Department of Social, Work and Differential Psychology, Universidad Complutense de Madrid/UCM, Madrid, Spain
| | - Jesús Saiz Galdós
- Department of Social, Work and Differential Psychology, Universidad Complutense de Madrid/UCM, Madrid, Spain
| | | | - Francisco Gil Rodríguez
- Department of Social, Work and Differential Psychology, Universidad Complutense de Madrid/UCM, Madrid, Spain
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Best D, Sondhi A, Brown L, Nisic M, Nagelhout GE, Martinelli T, van de Mheen D, Vanderplasschen W. The Strengths and Barriers Recovery Scale (SABRS): Relationships Matter in Building Strengths and Overcoming Barriers. Front Psychol 2021; 12:663447. [PMID: 33841289 PMCID: PMC8033166 DOI: 10.3389/fpsyg.2021.663447] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/02/2021] [Indexed: 11/13/2022] Open
Abstract
There is a well-established relationship between isolation and both morbidity and mortality in the context of addiction recovery, yet the protective effects of intimate and familial relationships have not been adequately assessed. The current paper uses the European Life In Recovery database to assess the association between relationship status and living with dependent children on recovery capital of people in recovery from drug addiction, operationalised by the Strengths And Barriers Recovery Scale (SABRS). The study participants were drawn from the REC-PATH study and supplemented by a second sample recruited by the Recovered Users Network (RUN) across various European countries, resulting in a combined sample of 1,313 individuals completing the survey, primarily online. The results show that, in recovery, those who are married or co-habiting reported significantly greater recovery strengths and fewer barriers to recovery, and reported greater gains in recovery capital across their recovery journeys. Similar associations are found for participants who have dependent children living with them. There is also some indication that this association is stronger for female than for male participants. Finally, having more people that one can rely on and a greater proportion of people in recovery in the social network are both linked to greater recovery capital and greater self-reported growth in recovery capital. We conclude that this study provides further evidence in favour of a "social cure" in recovery, in which close familial ties are associated with stronger recovery resources.
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Affiliation(s)
- David Best
- Department of Criminology, College of Business, Law and Social Sciences, University of Derby, Derby, United Kingdom
| | - Arun Sondhi
- Therapeutic Solutions (Addictions), London, United Kingdom
| | - Lorna Brown
- Department of Criminology, College of Business, Law and Social Sciences, University of Derby, Derby, United Kingdom
| | - Mulka Nisic
- Recovered Users Network (RUN), Brussels, Belgium
| | - Gera E. Nagelhout
- IVO Research Institute, The Hague, Netherlands
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, Netherlands
| | | | | | - Wouter Vanderplasschen
- Recovery and Addiction Cluster, Department of Special Needs Education, Ghent University, Ghent, Belgium
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68
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Kelly JF, Greene MC, Abry A, Bergman BG. Independent effects of entering recovery as a young versus older adult on long-term functioning and quality of life: Results from a U.S. national study of recovering persons. Drug Alcohol Depend 2021; 219:108493. [PMID: 33360637 PMCID: PMC7855819 DOI: 10.1016/j.drugalcdep.2020.108493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND For physical health conditions, earlier intervention typically results in better prognoses and improved quality of life (QoL). Despite some evidence that early intervention yields better subsequent functioning too for behavioral health conditions like alcohol and other drug (AOD) disorders, less is known. This study examined the relationship between the life-stage at which individuals entered AOD recovery, demographic and clinical correlates, and its relationship to a variety of indices of current functioning, QoL and well-being. METHOD Nationally representative sample of U.S. adults who resolved an AOD problem (Weighted N = 1844). Structured regression analyses tested whether life-stage at which individuals entered recovery (i.e., as a young [18-30yrs,n = 746] vs. older [>30yrs,n = 1098] adult), was associated with current QoL, happiness, self-esteem, distress, and recovery capital, independent of confounders. Sensitivity analyses investigated effects during the first 5-years of recovery. RESULTS Young adult recovery entry was independently associated with current employment, younger age of onset for primary substance, primary substance other than alcohol, and less lifetime psychiatric comorbidity. In fully-adjusted models examining indices of functioning, no association was found between life-stage at recovery entry and current self-esteem, happiness, or distress, but an association was found between young adult recovery entry and better current functioning and QoL. This effect was even more pronounced during the first 5-years of recovery. CONCLUSION Irrespective of current age, duration of recovery, and clinical markers of impairment, entering recovery as a young, versus older, adult, is associated with better subsequent QoL - an advantage that appears even more discernable early in recovery.
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Affiliation(s)
- John F. Kelly
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School 151 Merrimac Street, Boston, MA 02114
| | | | - Alexandra Abry
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School 151 Merrimac Street, Boston, MA 02114
| | - Brandon G. Bergman
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School 151 Merrimac Street, Boston, MA 02114
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69
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Lynch AC, Weber AN, Hedden S, Sabbagh S, Arndt S, Acion L. Three-month outcomes from a patient-centered program to treat opioid use disorder in Iowa, USA. Subst Abuse Treat Prev Policy 2021; 16:8. [PMID: 33435993 PMCID: PMC7801772 DOI: 10.1186/s13011-021-00342-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Opioid use disorder (OUD), a chronic disease, is a major public health problem. Despite availability of effective treatment, too few people receive it and treatment retention is low. Understanding barriers and facilitators of treatment access and retention is needed to improve outcomes for people with OUD. OBJECTIVES To assess 3-month outcomes pilot data from a patient-centered OUD treatment program in Iowa, USA, that utilized flexible treatment requirements and prioritized engagement over compliance. METHODS Forty patients (62.5% female: mean age was 35.7 years, SD 9.5) receiving medication, either buprenorphine or naltrexone, to treat OUD were enrolled in an observational study. Patients could select or decline case management, counseling, and peer recovery groups. Substance use, risk and protective factors, and recovery capital were measured at intake and 3 months. RESULTS Most participants reported increased recovery capital. The median Assessment of Recovery Capital (ARC) score went from 37 at enrollment to 43 (p < 0.01). Illegal drug use decreased, with the median days using illegal drugs in the past month dropping from 10 to 0 (p < 0.001). Cravings improved: 29.2% reported no cravings at intake and 58.3% reported no cravings at 3 months (p < 0.001). Retention rate was 92.5% at 3 months. Retention rate for participants who were not on probation/parole was higher (96.9%) than for those on probation/parole (62.5%, p = 0.021). CONCLUSION This study shows preliminary evidence that a care model based on easy and flexible access and strategies to improve treatment retention improves recovery capital, reduces illegal drug use and cravings, and retains people in treatment.
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Affiliation(s)
- Alison C Lynch
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA.
- Department of Family Medicine, University of Iowa, Iowa City, IA, USA.
| | - Andrea N Weber
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Suzy Hedden
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Sayeh Sabbagh
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Stephan Arndt
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Laura Acion
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Instituto de Cálculo, Universidad de Buenos Aires - CONICET, Buenos Aires, Argentina
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70
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Rowlands D, Youngs D, Canter D. Victory or defeat: narratives of recovery and chronic substance misuse revealed through the “Life as a Film”. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2020.1779829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- David Rowlands
- Research Centre for Investigative Psychology, University of Huddersfield, Huddersfield, UK
| | - Donna Youngs
- Research Centre for Investigative Psychology, University of Huddersfield, Huddersfield, UK
| | - David Canter
- School of Human and Health Sciences, University of Liverpool, Liverpool, UK
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71
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Rettie HC, Hogan LM, Cox WM. Identifying the Main Components of Substance-Related Addiction Recovery Groups. Subst Use Misuse 2021; 56:840-847. [PMID: 33745420 DOI: 10.1080/10826084.2021.1899228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Mutual-aid groups are a central part of many individuals' recovery journeys from substance addiction, and this research aimed to identify the key ingredients of a diverse range of recovery groups. METHODS Individuals from 30 different substance addiction recovery groups across the UK (N = 151, 66% male, M age = 42.5 years) completed a survey, which asked participants to provide a narrative about their recovery group experiences. Participants were also asked to rate the extent to which theorized ingredients of addiction recovery groups were offered by their group, and how important each was to them. Both qualitative and quantitative data were collected and analyzed. RESULTS The results indicated that the recovery group components suggested in previous literature were both present and rated as important. Component ratings did not differ depending on the type of group, the length of time the person had been in recovery, nor the length of time they had been involved in the group. The qualitative results identified other important components of recovery groups that had not been identified in the previous literature: presence of like-minded individuals and developing self-awareness and reflection skills. An updated list of recovery group components was thereby created. CONCLUSIONS Overall, the findings provide an in-depth, person-focused perspective on what makes an addiction recovery group successful. Asking group members directly about their experiences allowed us to refine and expand on previously theorized components. The updated components can be used as a template for developing future mutual-aid groups.
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Affiliation(s)
- Hannah C Rettie
- School of Psychology, Bangor University, Bangor, UK.,Department of Psychology, University of Bath, Bath, UK
| | - Lee M Hogan
- School of Psychology, Bangor University, Bangor, UK
| | - W Miles Cox
- School of Psychology, Bangor University, Bangor, UK
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72
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Martinelli TF, van de Mheen D, Best D, Vanderplasschen W, Nagelhout GE. Are members of mutual aid groups better equipped for addiction recovery? European cross-sectional study into recovery capital, social networks, and commitment to sobriety. DRUGS: EDUCATION, PREVENTION AND POLICY 2020. [DOI: 10.1080/09687637.2020.1844638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Thomas F. Martinelli
- IVO Research Institute, The Hague, The Netherlands
- School of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, The Netherlands
| | - Dike van de Mheen
- School of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, The Netherlands
| | - David Best
- International Center of Excellence in Policing and Criminal Justice, University of Derby, Derby, UK
| | | | - Gera E. Nagelhout
- IVO Research Institute, The Hague, The Netherlands
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands
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73
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Hanauer M, Svetina Valdivia D. Validation and utility study of the 10 item brief adult health capital scale (BACHS-10). J Health Psychol 2020; 27:332-340. [PMID: 32878501 DOI: 10.1177/1359105320953469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Current methods for assessing health capital are not accessible to clinicians. To increase accessibility, we evaluated a Brief Adult Health Capital Scale (BAHCS-10) using classical and modern testing theories. With 588 clients, we found an adequate fit for the BAHCS-10χscaled2(35)=97.19,p<.01, CFIscaled = 0.949, TLIscaled = 0.935, RMSEA = 0.077, and the SRMR = 0.060. We also found evidence of invariance across race but did find significant non-invariance across some items for gender and age. Future researchers should review items displaying noninvariance and develop optimal cut scores for the BAHCS-10 to further support clinician decision making.
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74
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Best D, Vanderplasschen W, Nisic M. Measuring capital in active addiction and recovery: the development of the strengths and barriers recovery scale (SABRS). SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:40. [PMID: 32546171 PMCID: PMC7298842 DOI: 10.1186/s13011-020-00281-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/06/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND The international Life In Recovery (LiR) surveys have provided an important message to the public and policy makers about the reality of change from addiction to recovery, consistently demonstrating both that there are marked gains across a range of life domains and that the longer the person is in recovery the better their recovery strengths and achievements. However, to date, no attempt has been made to quantify the Life In Recovery scales and to assess what levels of change in removing barriers and building strengths is achieved at which point in the recovery journey. METHODS The current study undertakes a preliminary analysis of strengths and barriers from the Life in Recovery measure, using data from a European survey on drug users in recovery (n = 480), and suggests that the instrument can be edited into a Strengths And Barriers Recovery Scale (SABRS). The new scale provides a single score for both current recovery strengths and barriers to recovery. RESULTS The resulting data analysis shows that there are stepwise incremental changes in recovery strengths at different recovery stages, but these occur with only very limited reductions in barriers to recovery, with even those in stable recovery typically having at least two barriers to their quality of life and wellbeing. Greater strengths in active addiction are associated with greater strengths and resources in recovery. CONCLUSION As well as demonstrating population changes in each of the domains assessed, the current study has shown the potential of the Life In Recovery Scale as a measure of recovery capital that can be used to support recovery interventions and pathways.
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Affiliation(s)
- David Best
- Business, Law and Social Sciences, University of Derby, One Friar Gate Square, Derby, Derbyshire, DE1 1DF, UK.
| | - Wouter Vanderplasschen
- Department of Special Needs Education, University of Ghent, Henri Dunantlaan 2, B-9000, Ghent, Belgium
| | - Mulka Nisic
- Recovered Users Network, Rue Archimede 17, 1000, Brussels, Belgium
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75
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Costello MJ, Sousa S, Ropp C, Rush B. How to Measure Addiction Recovery? Incorporating Perspectives of Individuals with Lived Experience. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-018-9956-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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76
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Johannessen DA, Nordfjærn T, Geirdal AØ. Substance use disorder patients’ expectations on transition from treatment to post-discharge period. NORDIC STUDIES ON ALCOHOL AND DRUGS 2020; 37:208-226. [PMID: 35308318 PMCID: PMC8899264 DOI: 10.1177/1455072520910551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 02/10/2020] [Indexed: 11/15/2022] Open
Abstract
Aim: There is limited knowledge about how inpatients anticipate factors that facilitate the transition between specialised inpatient treatment for substance use disorder (SUD) and the post-discharge period. This study explores factors that inpatients anticipated would facilitate such a transition period. Method: A focus group study, consisting of four group interviews with individuals in inpatient SUD treatment, was conducted to explore their expectations for the transition and post-discharge period ahead of them. The transcribed interview material was analysed using thematic analysis. Findings: The analytical process led to three themes: “Belonging”, “Intrapersonal processes” and “Predictability”. Correspondence between inpatients’ expectations and the services they are offered in the transition and post-discharge period may serve as proper support for inpatients ahead of a vulnerable phase, such as the transition and post-discharge period. Conclusions: Findings from the current study highlight overarching elements that inpatients envisioned to be facilitating, such as social support, motivation, self-efficacy, self-awareness and predictability in basic elements such as employment, housing and personal finances. Findings from this study and previous ones imply that certain factors appear to facilitate in vulnerable phases, such as service level transitions. These facilitating factors should be taken into consideration and used as steppingstones through the transition and post-discharge period after inpatient SUD treatment.
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Affiliation(s)
| | - Trond Nordfjærn
- Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- St. Olavs Hospital, Clinic of Substance Use and Addiction Medicine, Trondheim, Norway
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77
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Kowalski MA. Mental Health Recovery: The Effectiveness of Peer Services in the Community. Community Ment Health J 2020; 56:568-580. [PMID: 31807994 DOI: 10.1007/s10597-019-00514-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 12/02/2019] [Indexed: 11/25/2022]
Abstract
Peer recovery services are a community-based treatment option for people suffering from mental illness and/or substance use problems. Peer services provide an alternative to inpatient care and can help decrease costs associated with hospitalization or incarceration of the mentally ill. Yet, scant research has explored the effect of these services, particularly in rural communities. The current study assesses the impact of peer services on peer mentees' and mentors' recovery capital, quality of life, and general wellness. Consumers of peer services completed three surveys every three months for approximately 18 months. Quantitative analyses demonstrated that subjects had a marginal change in their recovery capital, but quality of life and general wellness were unaffected. Peer providers' experiences were also explored through interviews. Qualitative analyses revealed that providers have a positive outlook regarding peer services but would benefit from greater resources and additional training. Policy and community implications are also discussed.
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Affiliation(s)
- Melissa A Kowalski
- Department of Criminal Justice, The College At Brockport, State University of New York, 350 New Campus Drive, Brockport, NY, 14420, USA.
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78
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The Assessment of Recovery Capital (ARC) predicts substance abuse treatment completion. Addict Behav 2020; 102:106189. [PMID: 31778848 DOI: 10.1016/j.addbeh.2019.106189] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 09/13/2019] [Accepted: 10/21/2019] [Indexed: 11/23/2022]
Abstract
Recovery from addiction requires various personal and environmental resources. The purposes of this study were to determine if the Assessment of Recovery Capital (ARC) scores measured at admission could predict substance abuse treatment (SAT) completion and to identify personal and environmental factors associated with ARC scores. Participants (N = 2265) comprised clients entering a Midwestern SAT facility (August 2015 - June 2017). Logistic regression was used to predict SAT completion using ARC scores. Nonparametric group comparisons were used for personal and environmental covariates. ARC scores significantly predicted successful SAT completion (OR = 1.05, 95% CI = 1.04, 1.05, Wald z = 12.9, p < 0.001). Employment had a positive relationship with ARC scores (Kruskal-Wallis χ2 = 215.96, df = 8, p < 0.001). ARC scores varied according to primary substance (Kruskal-Wallis χ2 = 101.10, df = 6, p < 0.001); alcohol and marijuana showed the highest scores and heroin the lowest. ARC scores decreased as number of problem substances increased (Kruskal-Wallis χ2 = 70.57, df = 2, p < 0.001, rS = -0.163, p < 0.001). Living arrangement was also significant (Kruskal-Wallis χ2 = 146.36, df = 8, p < 0.001); clients who were homeless had the lowest ARC scores. A number of personal and environmental covariates were associated with the ARC scores and potentially with the outcome. After adjustment, the ARC remained a strong predictor of SAT completion. The ARC should be used in SAT facilities to guide treatment decisions and to create individualized treatment plans for clients.
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79
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Hodgkin D, Garnick DW, Horgan CM, Busch AB, Stewart MT, Reif S. Is it feasible to pay specialty substance use disorder treatment programs based on patient outcomes? Drug Alcohol Depend 2020; 206:107735. [PMID: 31790980 PMCID: PMC6941579 DOI: 10.1016/j.drugalcdep.2019.107735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/06/2019] [Accepted: 11/09/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Some US payers are starting to vary payment to providers depending on patient outcomes, but this approach is rarely used in substance use disorder (SUD) treatment. PURPOSE We examine the feasibility of applying a pay-for-outcomes approach to SUD treatment. METHODS We reviewed several relevant literatures: (1) economic theory papers that describe the conditions under which pay-for-outcomes is feasible in principle; (2) description of the key outcomes expected from SUD treatment, and the measures of these outcomes that are available in administrative data systems; and (3) reports on actual experiences of paying SUD treatment providers based on patient outcomes. RESULTS The economics literature notes that when patient outcomes are strongly influenced by factors beyond provider control and when risk adjustment performs poorly, pay-for-outcomes will increase provider financial risk. This is relevant to SUD treatment. The literature on SUD outcome measurement shows disagreement on whether to include broader outcomes beyond abstinence from substance use. Good measures are available for some of these broader constructs, but the need for risk adjustment still brings many challenges. Results from two past payment experiments in SUD treatment reinforce some of the concerns raised in the more conceptual literature. CONCLUSION There are special challenges in applying pay-for-outcomes to SUD treatment, not all of which could be overcome by developing better measures. For SUD treatment it may be necessary to define outcomes more broadly than for general medical care, and to continue conditioning a sizeable portion of payment on process measures.
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Affiliation(s)
- Dominic Hodgkin
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, USA.
| | - Deborah W Garnick
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, USA
| | - Constance M Horgan
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, USA
| | - Alisa B Busch
- McLean Hospital, and the Department of Health Care Policy, Harvard Medical School, USA
| | - Maureen T Stewart
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, USA
| | - Sharon Reif
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, USA
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80
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Bowen EA, Scott CF, Irish A, Nochajski TH. Psychometric Properties of the Assessment of Recovery Capital (ARC) Instrument in a Diverse Low-Income Sample. Subst Use Misuse 2020; 55:108-118. [PMID: 31519121 DOI: 10.1080/10826084.2019.1657148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Recovery capital is a theoretical construct elucidating the resources that support recovery from addiction. The 50-item Assessment of Recovery Capital (ARC) instrument and related brief-format versions are the predominant measures of this construct. However, some of the ARC's psychometric properties are not well-established, particularly in racially and economically diverse populations. Objectives: We aimed to determine if the ARC is a valid and reliable measure of recovery capital in a diverse sample. Methods: Paper-and-pencil survey data were collected between March 2017 and May 2018 from a low-income, racially diverse sample of adults in recovery (N = 273). Participants were recruited from nontreatment community settings throughout a mid-sized northeastern U.S. city. They completed the ARC and sociodemographic questions. To determine the ARC's reliability and factor structure, we used item-level analyses and Cronbach's alpha, followed by confirmatory and exploratory factor analyses. Results: Several items performed poorly, having means close to response extremes and problematically small variances. Cronbach's alpha for the full measure was α = .92; however, alphas for the majority of subscales were below .70. The a priori 10-factor model solution failed, preventing interpretation of the confirmatory factor analysis results. Exploratory factor analysis revealed that although the 10-factor model marginally fit the data, items did not load together as proposed. Not once did all five subscale items load highly on the same factor. Conclusions/Importance: The ARC has substantial weaknesses in its theoretical alignment, item performance, and psychometric properties with diverse populations. We recommend the development of a new multidimensional, theory-aligned measure, following a rigorous measurement development protocol.
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Affiliation(s)
- Elizabeth A Bowen
- School of Social Work, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Carol F Scott
- School of Social Work, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Andrew Irish
- School of Social Work, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Thomas H Nochajski
- School of Social Work, University at Buffalo, State University of New York, Buffalo, New York, USA
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Ruglass LM, Scodes J, Pavlicova M, Campbell ANC, Fitzpatrick S, Barbosa-Leiker C, Burlew K, Greenfield SF, Rotrosen J, Nunes EV. Trajectory classes of opioid use among individuals in a randomized controlled trial comparing extended-release naltrexone and buprenorphine-naloxone. Drug Alcohol Depend 2019; 205:107649. [PMID: 31704382 PMCID: PMC6990451 DOI: 10.1016/j.drugalcdep.2019.107649] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 09/01/2019] [Accepted: 09/10/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To advance our understanding of medication treatments for opioid use disorders (OUDs), identification of distinct subgroups and factors associated with differential treatment response is critical. We examined trajectories of opioid use for patients with OUD who were randomized to (but not in all cases inducted onto) buprenorphine-naloxone (BUP-NX) or extended-release naltrexone (XR-NTX), and identified characteristics associated with each trajectory. METHODS Growth mixture models (GMMs) were run to identify distinct trajectories of days of opioid use among a subsample of 535 individuals with OUD who participated in a 24-week randomized controlled trial (RCT; 2014-2016) of BUP-NX (n = 281) or XR-NTX (n = 254). RESULTS Four distinct opioid use trajectory classes were identified for BUP-NX (near abstinent/no use (59%); low use (13.2%); low use, increasing over time (15%); and moderate use, increasing over time (12.8%)). Three distinct opioid use trajectory classes were found for XR-NTX (near abstinent/no use (59.1%); low use (14.6%); and moderate use, increasing over time (26.4%)). Across both BUP-NX and XR-NTX, the near abstinent/no use class had the highest number of medical management visits. Within BUP-NX, the low use class had a greater proportion of individuals with a previous successful treatment history compared with other classes. Within XR-NTX, the moderate use, increasing over time class had the highest proportion of Hispanic participants compared with other classes. CONCLUSIONS Findings highlight the significant heterogeneity of opioid use during a RCT of BUP-NX and XR-NTX and factors associated with opioid use patterns including medical management visits and history of treatment success.
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Affiliation(s)
| | | | | | - Aimee N. C. Campbell
- Columbia University Irving Medical Center and New York State Psychiatric Institute
| | | | | | | | | | | | - Edward V. Nunes
- Columbia University Irving Medical Center and New York State Psychiatric Institute
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82
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Themes of agency and communion and rehabilitation from substance misuse. Drug Alcohol Depend 2019; 205:107611. [PMID: 31648106 DOI: 10.1016/j.drugalcdep.2019.107611] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 07/12/2019] [Accepted: 08/27/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Current models of identity transformation in substance misuse recovery emphasise either communal or agentic growth processes. Building on life narrative studies of addicted males, the present study proposes that agency and communion themes distinguish the narrative identities of rehabilitated substance users from active users. METHOD The 'Life as a Film' (LAAF) task was used to record narratives in an opportunity sample of 32 participants (23 males, 9 females) with ongoing or substance misuse history. Transcripts were coded for agency and communion, and external measures of rehabilitation were assessed using a recovery inventory. RESULTS Four types of narrative were revealed, according to the presence or absence of agency and communion themes in LAAF accounts. Analysis determined a significant correlation between descriptions of agency and communion and rehabilitation outcomes (0.91 - p < 0.01), showing that both identity themes are important to recovery. Participants illustrating either theme showed moderate outcomes and those depicting neither theme showed poor outcomes. Case studies were used to illustrate the instrumentality of agentic and communal growth to behavioural change. CONCLUSIONS The LAAF method demonstrated value in a narrative approach for expanding current perspectives, indicating that both agency and communion shape identity transformation in recovery from substance misuse. These findings highlight unique intervention needs corresponding with presenting narrative identity.
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Gavriel-Fried B, Moretta T, Potenza MN. Similar roles for recovery capital but not stress in women and men recovering from gambling disorder. J Behav Addict 2019; 8:770-779. [PMID: 31891315 PMCID: PMC7044578 DOI: 10.1556/2006.8.2019.73] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Understanding gender-related differences is important in recovery processes. Previous studies have investigated gender-related differences in factors associated with gambling disorder (GD), but none to date have considered both positive and negative resources related to recovery. Using a recovery capital (RC) framework that considers multiple resources available during recovery, this study examined gender-related similarities and differences in associations between positive resources (RC, spirituality) and negative experiences and states (stressful life events, depression, and anxiety) and GD symptom improvement. METHOD One hundred and forty individuals with lifetime GD (101 men) were assessed using DSM-5 diagnostic criteria for GD (past-year and lifetime prior to past-year), the Brief Assessment of RC, the Intrinsic Spirituality Scale, the Stressful Life-events Scale, the Generalized Anxiety Disorder Scale, and the Patient Health Questionnaire 9 for depression. Multiple linear regression and Bayesian statistical analyses were conducted. RESULTS RC was positively and significantly associated with GD symptom improvement in women and men. Stressful life events were negatively associated with GD symptom improvement only in men. CONCLUSIONS RC is an important positive resource for men and women recovering from GD and should be considered in treating both women and men. Understanding specific RC factors across gender groups and stressors, particularly in men, may aid in developing improved interventions for GD.
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Affiliation(s)
- Belle Gavriel-Fried
- The Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel,Corresponding author: Belle Gavriel-Fried; The Bob Shapell School of Social Work, Tel Aviv University, Ramat Aviv, Tel Aviv 69978, Israel; Phone: +971 3 640 9151; Fax: +972 3 640 9563; E-mail:
| | - Tania Moretta
- Department of General Psychology, University of Padova, Padova Italy
| | - Marc N. Potenza
- School of Medicine, Department of Psychiatry, Yale University, New Haven, CT, USA
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84
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Employment recovery capital in the treatment of substance use disorders: Six-month follow-up observations. Drug Alcohol Depend 2019; 205:107624. [PMID: 31645013 DOI: 10.1016/j.drugalcdep.2019.107624] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/31/2019] [Accepted: 09/04/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Recovery capital represents client strengths associated with substance use disorder (SUD) recovery. Employment is part of recovery capital supporting long-term recovery. However, specific employment recovery capital (ERC) factors associated with SUD recovery are not well understood. METHODS The present study used retrospective logistic regression modeling to predict treatment completion at discharge and substance use at six-month follow-up from employment variables at intake and follow-up. An additional exploratory follow-up of ERC Change is further investigated. Existing clinical data from a random selection of all Iowa SUD treatment facilities receiving public funding from 1999-2016. Clients in the study (N = 8,925) were a mean age of 31.7 (SD = 11.8), mostly male (67.2%), and primarily White (86.6%). Measurements included substance use, treatment completion, ERC Change, demographic, and treatment statistical control variables. RESULTS Results demonstrated that employment variables at intake predicted greater successful treatment completion, p < 0.0001. However, the same employment variables were predictive of maintained and increased use at six-month follow-up. Further investigation showed the best predictors of post-treatment recovery was a change in employment variables including months employed increase (AOR = 1.53, 95% CI = 1.34-1.75) and days missed from work due to substance use decrease (AOR = 2.43, 95% CI = 2.00-2.96). CONCLUSIONS Researchers and providers can help improve client recovery with intervention design, consultation, and policies focused on vocational growth in addition to employment benchmarks of gross income, full-time employment, occupation, primary support, months employed, and work missed. ERC is a promising route to improve the lives for those involved with substance use disorders.
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85
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Ashford RD, Brown AM, Dorney G, McConnell N, Kunzelman J, McDaniel J, Curtis B. Reducing harm and promoting recovery through community-based mutual aid: Characterizing those who engage in a hybrid peer recovery community organization. Addict Behav 2019; 98:106037. [PMID: 31330467 PMCID: PMC6708724 DOI: 10.1016/j.addbeh.2019.106037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/13/2019] [Accepted: 06/25/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Peer-based support services are often used within harm reduction organizations, and more recently within recovery community organizations (RCO). Identifying the characteristics of individuals who engage with these novel RCOs is needed. Additionally, conducting collaborative research with communities of people who use drugs (PWUD) or are in recovery is an effective and rewarding approach that allows individuals to take ownership and play a critical role in the study. METHODS This exploratory study employs a community-based participatory research (CBPR) framework in partnership with a peer-led hybrid recovery community organization, Rebel Recovery, in Florida. Peer staff participated in all phases of the study, helping to inform the study protocol, data collection, analysis, interpretation, and results write-up. A cross-sectional survey instrument was used to collect consumer intake data. Pearson Chi-square tests and multivariate binomial logistic regressions were used to examine relationships between consumer characteristics and service utilization. RESULTS Consumers (n = 396) of Rebel Recovery peer support services had a mean age of 35.60 years (SD = 9.74). Many were experiencing homelessness (35.4%), unemployed (69.7%), high school graduates or GED holders (68.2%) and had a last year income of less than $10,000 (58.3%). The majority were users of heroin primarily (70.7%), with intravenous use being the preferred route of administration (63.9%). Exploratory analysis found that gender, marital status, and involvement in the child welfare system were significantly related to primary substance of use. Past 30-day engagement in recovery meetings had several statistically significant predictors including primary substance of use, age, housing status, annual income level, past-30-day arrests, tobacco use, and alcohol harm perception. Process findings from the CBPR methods used reconfirm the value of including peers in research involving PWUD and individuals in recovery. CONCLUSIONS Results suggest that peer-based support services at a hybrid recovery community organization can successfully engage populations that are often underserved (i.e., experiencing homelessness, involved in drug court, intravenous users, etc.). Significant relationships identified in the exploratory analysis suggest that additional education concerning overdose and the potential benefits of recovery meetings may be useful for specific consumers. Additionally, several recommendations and benefits of engaging in community-based participatory research with peer-led organizations are made for future research.
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Affiliation(s)
- Robert D Ashford
- Substance Use Disorders Institute, University of the Sciences, Philadelphia, PA, United States of America.
| | - Austin M Brown
- Center for Young Adult Addiction and Recovery, Kennesaw State University, Kennesaw, GA, United States of America.
| | | | | | | | - Jessica McDaniel
- Center for Young Adult Addiction and Recovery, Kennesaw State University, Kennesaw, GA, United States of America.
| | - Brenda Curtis
- National Institutes of Health, National Institute on Drug Abuse, Baltimore, MD, United States of America.
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Yedinak JL, Goedel WC, Paull K, Lebeau R, Krieger MS, Thompson C, Buchanan AL, Coderre T, Boss R, Rich JD, Marshall BDL. Defining a recovery-oriented cascade of care for opioid use disorder: A community-driven, statewide cross-sectional assessment. PLoS Med 2019; 16:e1002963. [PMID: 31743335 PMCID: PMC6863520 DOI: 10.1371/journal.pmed.1002963] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 10/14/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND In light of the accelerating and rapidly evolving overdose crisis in the United States (US), new strategies are needed to address the epidemic and to efficiently engage and retain individuals in care for opioid use disorder (OUD). Moreover, there is an increasing need for novel approaches to using health data to identify gaps in the cascade of care for persons with OUD. METHODS AND FINDINGS Between June 2018 and May 2019, we engaged a diverse stakeholder group (including directors of statewide health and social service agencies) to develop a statewide, patient-centered cascade of care for OUD for Rhode Island, a small state in New England, a region highly impacted by the opioid crisis. Through an iterative process, we modified the cascade of care defined by Williams et al. for use in Rhode Island using key national survey data and statewide health claims datasets to create a cross-sectional summary of 5 stages in the cascade. Approximately 47,000 Rhode Islanders (5.2%) were estimated to be at risk for OUD (stage 0) in 2016. At the same time, 26,000 Rhode Islanders had a medical claim related to an OUD diagnosis, accounting for 55% of the population at risk (stage 1); 27% of the stage 0 population, 12,700 people, showed evidence of initiation of medication for OUD (MOUD, stage 2), and 18%, or 8,300 people, had evidence of retention on MOUD (stage 3). Imputation from a national survey estimated that 4,200 Rhode Islanders were in recovery from OUD as of 2016, representing 9% of the total population at risk. Limitations included use of self-report data to arrive at estimates of the number of individuals at risk for OUD and using a national estimate to identify the number of individuals in recovery due to a lack of available state data sources. CONCLUSIONS Our findings indicate that cross-sectional summaries of the cascade of care for OUD can be used as a health policy tool to identify gaps in care, inform data-driven policy decisions, set benchmarks for quality, and improve health outcomes for persons with OUD. There exists a significant opportunity to increase engagement prior to the initiation of OUD treatment (i.e., identification of OUD symptoms via routine screening or acute presentation) and improve retention and remission from OUD symptoms through improved community-supported processes of recovery. To do this more precisely, states should work to systematically collect data to populate their own cascade of care as a health policy tool to enhance system-level interventions and maximize engagement in care.
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Affiliation(s)
- Jesse L. Yedinak
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States of America
| | - William C. Goedel
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States of America
| | - Kimberly Paull
- Executive Office of Health and Human Services, State of Rhode Island, Cranston, Rhode Island, United States of America
| | - Rebecca Lebeau
- Executive Office of Health and Human Services, State of Rhode Island, Cranston, Rhode Island, United States of America
| | - Maxwell S. Krieger
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States of America
| | - Cheyenne Thompson
- Executive Office of Health and Human Services, State of Rhode Island, Cranston, Rhode Island, United States of America
| | - Ashley L. Buchanan
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, United States of America
| | - Tom Coderre
- Office of the Governor, State of Rhode Island, Providence, Rhode Island, United States of America
| | - Rebecca Boss
- Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, State of Rhode Island, Cranston, Rhode Island, United States of America
| | - Josiah D. Rich
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States of America
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island, United States of America
| | - Brandon D. L. Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States of America
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Beneficial effects of motivational interviewing case management: A latent class analysis of recovery capital among sober living residents with criminal justice involvement. Drug Alcohol Depend 2019; 200:124-132. [PMID: 31128464 PMCID: PMC8529644 DOI: 10.1016/j.drugalcdep.2019.03.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/08/2019] [Accepted: 03/12/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND This secondary analysis uses data from a recent clinical trial conducted with probationers and parolees with substance use disorders (N = 330) residing in Sober Living Houses (SLHs). The treatment condition received Motivational Interviewing Case Management (MICM), while controls received usual care SLH residency. Both conditions improved on multiple domains, though residents randomized to MICM improved significantly more than usual care controls on criminal justice outcomes. Because MICM is designed to help ex-offenders attain more recovery capital (RC) in multiple domains, we hypothesized MICM participants that already possessed higher RC would show significantly greater improvement at follow-up than usual SLH residents with higher RC. Moreover, MICM and usual SLH residents with low RC would show no differences at 1-year follow-up. METHODS A latent class analysis (LCA) grouped participants into two patterns of RC: those with low RC and those with high RC. These classes were interacted with study condition to predict change on six Addiction Severity Indices (ASI) at follow-up. RESULTS MICM was more effective for the higher RC class, with greater improvement in drug, legal, and psychiatric outcomes for those who attended at least three MICM sessions. MICM was no more beneficial than usual care for those in a low RC class. CONCLUSIONS SLH operators should consider implementation of MICM for residents with more RC resources. Those with fewer recovery resources, such as a history of psychiatric problems or physical/sexual abuse, would benefit from a more intensive intervention to assist them with improving the amount and quality of their RC.
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Lloyd C, Page G, McKeganey N, Russell C. Capital depreciation: The lack of recovery capital and post-release support for prisoners leaving the Drug Recovery Wings in England and Wales. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 70:107-116. [PMID: 31238269 DOI: 10.1016/j.drugpo.2019.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND This article draws on the evaluation of the pilot Drug Recovery Wings (DRWs), which were introduced ten prisons in England and Wales, with the intention of delivering abstinence-focused drug recovery services. The DRW pilots can be seen as representing the extension of the recovery paradigm - so prevalent elsewhere in UK drug policy - to the prison system. This study aimed to provide a detailed account of DRW prisoners' expectations and experiences in the transition from prison to the community and explore the potential for 'doing recovery' in prison and on release. METHODS In-depth, qualitative interviews were conducted in prison with 61 prisoners across six of the DRWs. Follow-up interviews six months after release were conducted with 21 prisoners and 26 'recovery supports' (people identified as being close to the prisoners). Data from one, other or both sources was available for 36 prisoners. All interviews were fully transcribed and coded. RESULTS The majority of the 61 had long histories of alcohol and/or opiate dependence, childhood adversity, undiagnosed mental health problems and few educational qualifications. Nonetheless, many had long histories of employment - mostly in manual trades. The majority described themselves as being 'in recovery' at the time of the first interview in prison. While one of the main aims of the DRWs was to support prisoners' recovery journeys into the community, this aspect of their work did not materialize. Professional support at release was largely absent or, where present, ineffectual. Many were released street-homeless or to disordered and threatening hostels and night-shelters. Only three of the 36 were fully abstinent from drink and drugs at time of re-interview, although some had moderated their use. A substantial number had returned to pre-imprisonment levels of use, often with deeply damaging impacts on those around them. DISCUSSION AND CONCLUSIONS This research suggests a fundamental contradiction between recovery and imprisonment. In large part, imprisonment serves to erode recovery capital while, at the same time, making psychoactive substances readily available. Looking to the future, every effort should be made to divert substance users from imprisonment in the first place. Where that fails, the primary aim should be to reduce the erosion of recovery capital during imprisonment: through family support work, providing proper housing, training and education opportunities and ensuring a graduated reintroduction of prisoners into the community.
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Affiliation(s)
- Charlie Lloyd
- Social Policy and Social Work, University of York, Alcuin C, York, YO10 5DD, United Kingdom.
| | - Geoff Page
- Social Policy and Social Work, University of York, Alcuin C, York, YO10 5DD, United Kingdom
| | - Neil McKeganey
- Centre for Substance Use Research, Block 4/04, West of Scotland Science Park, 2317 Maryhill Road, Glasgow G20 0SP, United Kingdom
| | - Christopher Russell
- Centre for Substance Use Research, Block 4/04, West of Scotland Science Park, 2317 Maryhill Road, Glasgow G20 0SP, United Kingdom
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89
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Kelly JF, Greene MC, Bergman BG, White WL, Hoeppner BB. How Many Recovery Attempts Does it Take to Successfully Resolve an Alcohol or Drug Problem? Estimates and Correlates From a National Study of Recovering U.S. Adults. Alcohol Clin Exp Res 2019; 43:1533-1544. [PMID: 31090945 PMCID: PMC6602820 DOI: 10.1111/acer.14067] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/16/2019] [Indexed: 11/27/2022]
Abstract
Background Alcohol and other drug (AOD) problems are commonly depicted as chronically relapsing, implying multiple recovery attempts are needed prior to remission. Yet, although a robust literature exists on quit attempts in the tobacco field, little is known regarding patterns of cessation attempts related to alcohol, opioid, stimulant, or cannabis problems. Greater knowledge of such estimates and the factors associated with needing fewer or greater attempts may have utility for health policy and clinical communication efforts and approaches. Methods Cross‐sectional, nationally representative survey of U.S. adults (N = 39,809) who reported resolving a significant AOD problem (n = 2,002) and assessed on number of prior serious recovery attempts, demographic variables, primary substance, clinical histories, and indices of psychological distress and well‐being. Results The statistical distribution of serious recovery attempts was highly skewed with a mean of 5.35 (SD = 13.41) and median of 2 (interquartile range [IQR] = 1 to 4). Black race, prior use of treatment and mutual‐help groups, and history of psychiatric comorbidity were associated with higher number of attempts, and more attempts were associated independently with greater current distress. Number of recovery attempts did not differ by primary substance (e.g., opioids vs. alcohol). Conclusions Estimates of recovery attempts differed substantially depending on whether the mean (5.35 recovery attempts) or median (2 recovery attempts) was used as the estimator. Implications of this are that the average may be substantially lower than anticipated because cultural expectations are often based on AOD problems being “chronically relapsing” disorders implicating seemingly endless tries. Depending on which one of these estimates is reported in policy documents or communicated in public health announcements or clinical settings, each may elicit varying degrees of help‐seeking, hope, motivation, and the use of more assertive clinical approaches. The more fitting, median estimate of attempts should be used in clinical and policy communications given the distribution.
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Affiliation(s)
- John F Kelly
- From the, Recovery Research Institute (JFK, BGB, BBH), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Brandon G Bergman
- From the, Recovery Research Institute (JFK, BGB, BBH), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Bettina B Hoeppner
- From the, Recovery Research Institute (JFK, BGB, BBH), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Change in psychosocial factors connected to coping after inpatient treatment for substance use disorder: a systematic review. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2019; 14:16. [PMID: 31053153 PMCID: PMC6499970 DOI: 10.1186/s13011-019-0210-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/22/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Among the adult population worldwide, about 0.5% has illicit drug use disorder (DUD) and about 5% has alcohol use disorder (AUD). Dependency on alcohol, medication or illicit drugs are recognised as risk factors for disabling disease and early death. Treatment for substance use disorders (SUD) is important in promoting persistent abstinence and may be perceived as a valuable public health measure. The current systematic review aims at exploring how psychosocial factors connected to recovery capital and coping behaviour, change after inpatient SUD treatment. METHODS A systematic search was conducted in Campbell Collaboration Library, Cochrane Library, EMBASE, Epistemonikos, Medline, PsychINFO, Social Sciences Citation Index and SocINDEX. Cohort studies on psychosocial outcomes for adults who had attended to inpatient SUD treatment that exceeds 3 months, were included. The outcome of interest was change in psychosocial factors. The search results were identified as include, exclude or unclear by one author and then screened by the second author with a specific focus on studies recognised as unclear. Diverging evaluations of eligibility among the unclear studies were resolved by discussion. In case of disagreement, the third author decided the eligibility of the studies in question. RESULTS Findings imply an overall progress in mental health, and a potential improvement in employment status and perceived social support after inpatient SUD treatment. Additionally, findings indicate a decrease in substance use from admission to follow-up after discharge from inpatient SUD treatment. These findings are consistent with earlier research on important factors in recovering from SUD. Findings on change in self-efficacy, housing, education and Quality of Life (QoL) however, were scantly researched and were expected to be more prominent outcomes of interest among the included studies. CONCLUSION Due to the substantial resources used to provide SUD treatment, knowledge about recovery capital, like psychosocial factors that facilitate coping behaviour and reintegration to society, should be standardised and used by SUD treatment providers. TRIAL REGISTRATION PROSPERO registration ID: CRD42018087408.
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91
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Ashford RD, Brown AM, Canode B, McDaniel J, Curtis B. A Mixed-Methods Exploration of the Role and Impact of Stigma and Advocacy on Substance Use Disorder Recovery. ALCOHOLISM TREATMENT QUARTERLY 2019. [DOI: 10.1080/07347324.2019.1585216] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Robert D. Ashford
- Substance Use Disorders Institute, University of the Sciences, Philadelphia, Pennsylvania, USA
| | - Austin M. Brown
- Center for Young Adult Addiction and Recovery, Kennesaw State University, Kennesaw, Georgia, USA
| | - Brent Canode
- Oregon Recovers, Alano Club of Portland, Portland, Oregon, USA
| | - Jessica McDaniel
- Center for Young Adult Addiction and Recovery, Kennesaw State University, Kennesaw, Georgia, USA
| | - Brenda Curtis
- Treatment Research Center, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Fallin-Bennett A, Rademacher K, Dye H, Elswick A, Ashford K, Goodin A. Perinatal Navigator Approach to Smoking Cessation for Women With Prevalent Opioid Dependence. West J Nurs Res 2019; 41:1103-1120. [PMID: 30724661 DOI: 10.1177/0193945918825381] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Women who smoke during pregnancy face psychosocial barriers to cessation, and women with opioid use disorder (OUD) face amplified barriers. We pilot tested a Perinatal Wellness Navigator (PWN) program for a group of high-risk perinatal women (N = 50; n = 42 with OUD) that consisted of (a) one-on-one tobacco treatment, (b) comprehensive assessment of cessation barriers, and (c) linkage to clinical/social services. Outcome measures were assessed at baseline and postintervention. Participants smoked 10 fewer cigarettes per day (p = .05) at postintervention and were less dependent on nicotine (p < .01). Mean postnatal depression scores (p = .03) and perceived stress (p = .03) decreased postintervention. Participants received at least one referral at baseline (n = 106 total), and 10 participants received an additional 18 referrals at postintervention to address cessation barriers. The PWN program was minimally effective in promoting total tobacco abstinence in a high-risk group of perinatal women, but participants experienced reductions in cigarettes smoked per day, nicotine dependence, stress, and depression.
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Affiliation(s)
| | | | - Holly Dye
- 1 University of Kentucky College of Nursing, Lexington, USA
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93
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Abstract
Given the high co-occurrence between alcohol use disorder (AUD) and mental health conditions (MHCs), and the increased morbidity associated with the presence of co-occurring disorders, it is important that co-occurring disorders be identified and both disorders addressed in integrated treatment. Tremendous heterogeneity exists among individuals with co-occurring conditions, and factors related to both AUD and MHCs, including symptom type and acuity, illness severity, the chronicity of symptoms, and recovery capital, should be considered when recommending treatment interventions. This article reviews the prevalence of co-occurring AUD and MHCs, screening tools to identify individuals with symptoms of AUD and MHCs, and subsequent assessment of co-occurring disorders. Types of integrated treatment and current challenges to integrate treatment for co-occurring disorders effectively are reviewed. Innovative uses of technology to improve education on co-occurring disorders and treatment delivery are also discussed. Systemic challenges exist to providing integrated treatment in all treatment settings, and continued research is needed to determine ways to improve access to treatment.
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Affiliation(s)
- Amy M Yule
- ., is a psychiatrist at Massachusetts General Hospital and an assistant professor of psychiatry at Harvard Medical School, Boston, Massachusetts. ., is a psychologist at Massachusetts General Hospital and a professor of psychiatry at Harvard Medical School, Boston, Massachusetts
| | - John F Kelly
- ., is a psychiatrist at Massachusetts General Hospital and an assistant professor of psychiatry at Harvard Medical School, Boston, Massachusetts. ., is a psychologist at Massachusetts General Hospital and a professor of psychiatry at Harvard Medical School, Boston, Massachusetts
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94
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Richardson GB, Blount TN, Hanson-Cook BS. Life History Theory and Recovery From Substance Use Disorder. REVIEW OF GENERAL PSYCHOLOGY 2018. [DOI: 10.1037/gpr0000173] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recovery has emerged as an important paradigm in addictions treatment but the field has yet to achieve consensus on how it should be defined and measured. The recovery construct has been extended beyond sustained reductions in use or abstinence to enhancements in global health/well-being and also prosocial community reintegration. However, few studies have included these broader domains in their measurement of recovery and few scientific theories have been advanced to explain why reductions in substance use occasion these broader life changes. This article applies life history theory to recovery for the first time to help define recovery, advance recovery measurement, and explain why broad change across multiple life domains should facilitate sustained recovery progress. We conclude with a discussion of future directions and challenges for future research informed by our life history framework for recovery.
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Affiliation(s)
- George B. Richardson
- School of Human Services, College of Education, Criminal Justice, and Human Services, University of Cincinnati
| | - Taheera N. Blount
- School of Human Services, College of Education, Criminal Justice, and Human Services, University of Cincinnati
| | - Blair S. Hanson-Cook
- School of Human Services, College of Education, Criminal Justice, and Human Services, University of Cincinnati
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95
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Bergman BG, Claire Greene M, Hoeppner BB, Kelly JF. Expanding the reach of alcohol and other drug services: Prevalence and correlates of US adult engagement with online technology to address substance problems. Addict Behav 2018; 87:74-81. [PMID: 29960132 DOI: 10.1016/j.addbeh.2018.06.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 06/15/2018] [Accepted: 06/15/2018] [Indexed: 12/26/2022]
Abstract
Online technologies are well integrated into the day-to-day lives of individuals with alcohol and other drug (i.e., substance use) problems. Interventions that leverage online technologies have been shown to enhance outcomes for these individuals. To date, however, little is known about how those with substance use problems naturally engage with such platforms. In addition, the scientific literatures on health behavior change facilitated by technology and harms driven by technology engagement have developed largely independent of one another. In this secondary analysis of the National Recovery Study (NRS), which provides a geo-demographically representative sample of US adults who resolved a substance use problem, we examined a) the weighted prevalence estimate of individuals who engaged with online technologies to "cut down on substance use, abstain from substances, or strengthen one's recovery" (i.e., recovery-related use of online technology, or ROOT), b) clinical/recovery correlates of ROOT, controlling for demographic covariates, and c) the unique association between ROOT and self-reported history of internet addiction. Results showed one in ten (11%) NRS participants reported ROOT. Significant correlates included greater current psychological distress, younger age of first substance use, as well as history of anti-craving/anti-relapse medication, recovery support services, and drug court participation. Odds of lifetime internet addiction were 4 times greater for those with ROOT (vs. no ROOT). These data build on studies of technology-based interventions, highlighting the reach of ROOT, and therefore, the potential for a large, positive impact on substance-related harms in the US.
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Affiliation(s)
- Brandon G Bergman
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, 151 Merrimac Street, Boston, MA 02114, United States..
| | - M Claire Greene
- Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, United States
| | - Bettina B Hoeppner
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, 151 Merrimac Street, Boston, MA 02114, United States
| | - John F Kelly
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, 151 Merrimac Street, Boston, MA 02114, United States
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96
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Watts JR, Chowdhury D, Holloway L. Success in collegiate recovery programs: results from a phenomenological investigation. ALCOHOLISM TREATMENT QUARTERLY 2018. [DOI: 10.1080/07347324.2018.1532776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Justin R. Watts
- Department of Rehabilitation and Health Services, The University of North Texas, Denton, Texas, USA
| | - Dalia Chowdhury
- Department of Rehabilitation and Health Services, The University of North Texas, Denton, Texas, USA
| | - Linda Holloway
- Department of Rehabilitation and Health Services, The University of North Texas, Denton, Texas, USA
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97
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Rettie HC, Hogan LM, Cox WM. The Recovery Strengths Questionnaire for alcohol and drug use disorders. Drug Alcohol Rev 2018; 38:209-215. [PMID: 30302875 DOI: 10.1111/dar.12870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 08/18/2018] [Accepted: 09/19/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND AIMS The Recovery Strengths Questionnaire (RSQ) is a 15-item self-report questionnaire that assesses an addicted individual's recovery strengths. This study aimed to validate the RSQ as a measure of recovery capital. DESIGN AND METHODS As part of a larger study, 151 participants in addiction recovery groups from across the UK completed the RSQ. Participants also completed the Assessment of Recovery Capital questionnaire and provided some demographic information. RESULTS The RSQ was found to be psychometrically sound, with high internal consistency and concurrent validity with the Assessment of Recovery Capital. RSQ scores were positively correlated with length of time in recovery and length of membership in recovery groups, and the scores could be used to discriminate between those in early and late recovery. Principal components analysis revealed a two-factor structure of recovery capital. These two factors were named 'within-group recovery strengths' and 'externally generated recovery strengths', and it was found that only the within-group factor scale (i.e. resources developed within recovery groups) predicted length of time in recovery and recovery groups. DISCUSSION AND CONCLUSIONS These results highlight the important role that recovery groups can play in an individual's recovery, and they provide an alternative factor structure to the one-factor structure of the Assessment of Recovery Capital.
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Affiliation(s)
- Hannah C Rettie
- School of Psychology, Bangor University, Bangor, UK.,Betsi Cadwaladr University Health Board, Bangor, UK
| | - Lee M Hogan
- School of Psychology, Bangor University, Bangor, UK.,Betsi Cadwaladr University Health Board, Bangor, UK
| | - W Miles Cox
- School of Psychology, Bangor University, Bangor, UK
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98
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Mericle AA, Carrico AW, Hemberg J, Stall R, Polcin DL. Improving Recovery Outcomes among MSM: The Potential Role of Recovery Housing. JOURNAL OF SUBSTANCE USE 2018; 24:140-146. [PMID: 31213946 PMCID: PMC6581465 DOI: 10.1080/14659891.2018.1523966] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/09/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Gay, bisexual, and other men who have sex with men (MSM) face unique recovery challenges. Recovery housing may play an important role in improving outcomes among MSM, but little is known about their experiences in these settings. METHODS This study examined 3-month outcomes among MSM (N=22) living in a group of recovery residences in Texas, one of which is a home specifically designated for gay and bisexual men. Upon intake, adult MSM were recruited to participate in the study, which involved a baseline and 3-month phone interview and allowing study staff to access records maintained by the program about their stay. RESULTS At follow-up, only two (9.1%) reported used of any substances in the past 30 days. The vast majority (73%) had attended outpatient substance use treatment in the past three months, and 86% reported working for pay during the past 30 days. All participants reported attending four or more 12-step meetings in the past 30 days. Use of dysfunctional coping strategies significantly decreased, however so did scores on health-related quality of life. CONCLUSIONS MSM have complex treatment needs. Recovery housing may help improve outcomes among MSM by bridging formal substance use treatment with community-based recovery support.
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Affiliation(s)
- Amy A Mericle
- Alcohol Research Group at the Public Health Institute, Emeryville, CA, USA
| | - Adam W Carrico
- Miller School of Medicine Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Jordana Hemberg
- Alcohol Research Group at the Public Health Institute, Emeryville, CA, USA
| | - Ronald Stall
- Department of Behavioral and Community Health Sciences in the School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Douglas L Polcin
- Alcohol Research Group at the Public Health Institute, Emeryville, CA, USA
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99
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Chen G. Building Recovery Capital: The Role of "Hitting Bottom" in Desistance and Recovery from Substance Abuse and Crime. J Psychoactive Drugs 2018; 50:420-429. [PMID: 30204568 DOI: 10.1080/02791072.2018.1517909] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The aim of this article is to explore the role of "hitting bottom" as a motivation to initiate a recovery process and desistance from crime and substance use disorders (SUDs), and in building recovery capital (RC). Researchers and practitioners have long been interested in why and how offenders desist from crime. Desistance and recovery from crime and SUDs have also been linked to negative turning points, such as hitting bottom, which represents multidimensional suffering with physiological, familial, social, and criminal implications. The deleterious outcomes of SUDs cause individuals to lose their social and personal resources and hit bottom. According to the conservation of resources model, in the context of actual or potential loss of resources, individuals strive to maintain, protect, and build them. Thus, hitting bottom not only provides the initial motivation for change, but also drives individuals to build personal resources. The prospects for successful recovery are dependent upon the individual's personal and social resources, or RC. This article represents a first step in examining the role of hitting bottom in building RC in the process of long-term recovery. The conclusions may have theoretical as well as practical implications.
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Affiliation(s)
- Gila Chen
- a Department of Criminology , Ashkelon Academic College , Ashkelon , Israel
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100
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Abstract
BACKGROUND AND AIMS The concept of recovery capital (RC) describes the internal and external resources that individuals draw upon to initiate and sustain the processes of addiction recovery. This concept has been primarily applied to individuals recovering from substance addictions. In this study, the RC concept was applied to individuals with a gambling disorder (GD) to test its associations with the diagnosis and severity of GD and with levels of psychopathology as manifested in depression and anxiety. METHODS A sample of 140 individuals who recovered or did not recover from a GD was drawn from lists of former and currently treated individuals in five gambling treatment centers in Israel. The DSM-5 diagnostic criteria for GD, Assessment of Recovery Capital and Brief Assessment of Recovery Capital Scales adapted to Gambling, Generalized Anxiety Disorder Scale, and the Patient Health Questionnaire 9 which measures depression were used. RESULTS RC clearly distinguishes between individuals who have recovered from GD and those who have not. A structural equation model showed significant negative associations between RC and GD severity, depression, and generalized anxiety. The associations between GD severity and depression and anxiety were not significant. However, when omitting the path between RC and depression/anxiety, the associations between GD and depression/anxiety became significant. CONCLUSIONS RC plays an important role in GD severity and diagnosis, as well as in psychopathology. This study extends the concept of RC to the area of gambling and contributes to the growing body of studies that have found parallels and common denominators between substance addiction and behavioral addictions.
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Affiliation(s)
- Belle Gavriel-Fried
- The Bob Shapell School of Social Work, Tel Aviv University, Ramat Aviv, Israel,Corresponding address: Belle Gavriel-Fried, PhD; The Bob Shapell School of Social Work, Tel Aviv University, Ramat Aviv, Tel Aviv 69978, Israel; Phone: +972 3 6409131; Fax: +972 3 6409563, E-mail:
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