Recovery capital as prospective predictor of sustained recovery, life satisfaction, and stress among former poly-substance users

A Longitudinal Qualitative Analysis of the Lived Experience of the Recovery Process in Opioid-Dependent Patients Post-Detoxification

The aim of the study was to gain an in-depth understanding of opioid-dependent patients' lived experiences post-detoxification.

METHOD

The study employed a naturalistic, observational longitudinal design, involving baseline screening and tracking of patients post-detoxification, with follow-up interviews at three, six, and nine months to observe specific processes of interest. This in-depth investigation of patients at four points was new within an Irish context and novel throughout the literature.

FINDINGS

Recovery was seen as a process that was not always linear, and lapse and relapse were viewed as part of this process. Patients had great insight into "risk factors for relapse," information and knowledge gained over several years and many treatment episodes. Furthermore, the findings illustrate the role insight plays in any learning and growth experience and the emphasis that is placed upon it within the treatment journey; insight is a fundamental underpinning to any real growth and development. The current article argues that insight merits a more explicit role in the model of recovery capital.

Social Support and Resilience as Mediators Between Stress and Life Satisfaction Among People With Substance Use Disorder in China

This study investigated the potential mediating roles of resilience and social support in the relationship between stress and life satisfaction. A total of 426 individuals, who have substance use disorder, from the Shifosi and Dalianshan rehabilitation facilities in China participated in the study. They were tested using the Perceived Stress Scale, Multidimensional Scale of Perceived Social Support, Connor-Davidson Resilience Scale, and Satisfaction with Life Scale. Results showed that the serial multiple mediation of social support and resilience in the relationship between stress and life satisfaction was significant. Furthermore, the findings corroborate the important roles of perceived social support and resilience in alleviating stress. Finally, we discussed ways to enhance the life satisfaction for individuals who have substance use disorder and analyzed the limitations of this study.

Developing Substance Use Programming for Person-Oriented Recovery and Treatment (SUPPORT): protocol for a pilot randomized controlled trial

BACKGROUND

There is a lack of evidence-based substance use disorder treatment and services targeting returning inmates. Substance Use Programming for Person-Oriented Recovery and Treatment (SUPPORT) is a community-driven, recovery-oriented approach to substance abuse care which has the potential to address this service gap. SUPPORT is modeled after Indiana's Access to Recovery program, which was closed due to lack of federal support despite positive improvements in clients' recovery outcomes. SUPPORT builds on noted limitations of Indiana's Access to Recovery program. The ultimate goal of this project is to establish SUPPORT as an effective and scalable recovery-oriented system of care. A necessary step we must take before launching a large clinical trial is pilot testing the SUPPORT intervention.

METHODS

The pilot will take place at Public Advocates in Community Re-Entry (PACE), nonprofit serving individuals with felony convictions who are located in Marion County, Indiana (Indianapolis). The pilot will follow a basic parallel randomized design to compare clients receiving SUPPORT with clients receiving standard services. A total of 80 clients within 3 months of prison release will be recruited to participate and randomly assigned to one of the two intervention arms. Quantitative measures will be collected at multiple time points to understand SUPPORT's impact on recovery capital and outcomes. We will also collect qualitative data from SUPPORT clients to better understand their program and post-discharge experiences.

DISCUSSION

Successful completion of this pilot will prepare us to conduct a multi-site clinical trial. The ultimate goal of this future work is to develop an evidence-based and scalable approach to treating substance use disorder among persons returning to society after incarceration.

TRIAL REGISTRATION

ClinicalTrials.gov (Clinical Trials ID: NCT03132753 and Protocol Number: 1511731907). Registered 28 April 2017.

Building abstinent networks is an important resource in improving quality of life

AIMS

To investigate changes in social network and quality of life of a substance use disorder cohort as they progressed through treatment.

DESIGN

Multi-site, prospective, observational study of 338 adults entering substance use disorder treatment.

SETTING

Patients at 21 facilities across Norway contributed baseline data when they initiated treatment, and follow-up data was collected from them one year later.

METHODS

The cohort was divided into those who completed, dropped out, and remained in treatment one year after treatment initiation. For each treatment status group, general linear models with repeated measures analyzed global and social quality of life with the generic QOL10 instrument over time. The between-group factor was a change in social network variable from the EuropASI.

FINDINGS

Those who gained an abstinent network reported the largest quality of life improvements. Improvements were smallest or negligible for the socially isolated and those who were no longer in contact with the treatment system.

CONCLUSIONS

Developing an abstinent network is particularly important to improve the quality of life of those in substance use disorder treatment. Social isolation is a risk factor for impaired quality of life throughout the treatment course.

Recovery Capital and Quality of Life in Stable Recovery From Addiction

Quality of life is becoming an increasingly important outcome measure in both relapse prevention research and rehabilitation counseling research. Recovery capital is a collection of the people and resources believed to contribute to long-term recovery from addiction. Recovery capital indicators were assessed along with quality of life in a national sample of peer support participants in stable recovery ( n = 76) to determine which recovery capital indicators relate to quality of life at this stage. Results reveal that relapse history, refusal self-efficacy, and self-stigma significantly explained about 23% of quality of life in our sample. A discussion of recovery stages and recovery capital is included, as well as implications for rehabilitation counseling practice and research.

Is there room for resilience? A scoping review and critique of substance use literature and its utilization of the concept of resilience

Research in the area of illicit substance use remains preoccupied with describing and analyzing the risks of people who use drugs (PWUD), however more recently there has been a drive to use a strengths-based or resilience approach as an alternative to investigating drug use. This leads us to ask: what can be known about PWUD from the point of view of resilience? The objective of this scoping review is to analyze how the concept of resilience is defined, operationalized, and applied in substance use research. Popular health, social science, psychology, and inter-disciplinary databases namely: SCOPUS, PUBMED, PsycINFO, and Sociological Abstracts were searched. Studies were selected if they used the concept of resilience and if substance use was a key variable under investigation. A total of 77 studies were identified which provided a definition of resilience, or attempted to operationalize (e.g., via scales) the concept of resilience in some manner. Data were charted and sorted using key terms and fundamental aspects of resilience. The majority of studies focus on youth and their resistance to, or engagement in, substance use. There is also a small but growing area of research that examines recovery from substance addiction as a form of resilience. Very few studies were found that thoroughly investigated resilience among PWUD. Consistently throughout the literature drug use is presented as a 'risk factor' jeopardizing one's ability to be resilient, or drug use is seen as a 'maladaptive coping strategy', purporting one's lack of resilience. Currently, substance use research provides a substantial amount of information about the internal strengths that can assist in resisting future drug use; however there is less information about the external resources that play a role, especially for adults. Though popular, outcome-based conceptualizations of resilience are often static, concealing the potential for developing resilience over time or as conditions change. Studies of resilience among PWUD predominantly concentrate on health-related behaviours, recovery-related factors or predefined harm reduction strategies. Indeed, overall, current conceptualizations of resilience are too narrow to recognize all the potential manifestations of resilience practices in the daily lives of individuals who actively use drugs.

Social Network Decay as Potential Recovery from Homelessness: A Mixed Methods Study in Housing First Programming

The positive relationship between social support and mental health has been well documented, but individuals experiencing chronic homelessness face serious disruptions to their social networks. Housing First (HF) programming has been shown to improve health and stability of formerly chronically homeless individuals. However, researchers are only just starting to understand the impact HF has on residents’ individual social integration. The purpose of the current study was to describe and understand changes in social networks of residents living in a HF program. Researchers employed a longitudinal, convergent parallel mixed method design, collecting quantitative social network data through structured interviews (n = 13) and qualitative data through semi-structured interviews (n = 20). Quantitative results demonstrated a reduction in network size over the course of one year. However, increases in both network density and frequency of contact with network members increased. Qualitative interviews demonstrated a strengthening in the quality of relationships with family and housing providers and a shedding of burdensome and abusive relationships. These results suggest network decay is a possible indicator of participants’ recovery process as they discontinued negative relationships and strengthened positive ones.

Development and validation of a Brief Assessment of Recovery Capital (BARC-10) for alcohol and drug use disorder

BACKGROUND

It has been long established that achieving recovery from an alcohol or other drug use disorder is associated with increased biobehavioral stress. To enhance the chances of recovery, a variety of psychological, physical, social, and environmental resources, known as "recovery capital", are deemed important as they can help mitigate this high stress burden. A 50-item measure of recovery capital was developed (Assessment of Recovery Capital [ARC]), with 10 subscales; however, a briefer version could enhance further deployment in research and busy clinical/recovery support service settings. To help increase utility of the measure, the goal of the current study was to create a shorter version using Item Response Theory models.

METHOD

Items were pooled from the original treatment samples from Scotland and Australia (N=450) for scale reduction. A reduced version was tested in an independent sample (N=123), and a Receiver Operating Characteristic Curve was constructed to determine optimal cut-off for sustained remission (>12months abstinence).

RESULTS

An abbreviated 10-item measure of recovery capital captured item representation from all 10 original subscales, was invariant across participant's locality and gender, had high internal consistency (α=.90), concurrent validity with the original measure (r_pb=.90), and predictive validity with sustained remission using a cut-off score of 47.

CONCLUSION

The brief assessment of recovery capital 10-item version (BARC-10) concisely measures a single unified dimension of recovery capital that may have utility for researchers, clinicians, and recovery support services.

"What constitutes a 'problem'?" Producing 'alcohol problems' through online counselling encounters

Typically, health policy, practice and research views alcohol and other drug (AOD) 'problems' as objective things waiting to be detected, diagnosed and treated. However, this approach to policy development and treatment downplays the role of clinical practices, tools, discourses, and systems in shaping how AOD use is constituted as a 'problem'. For instance, people might present to AOD treatment with multiple psycho-social concerns, but usually only a singular AOD-associated 'problem' is considered serviceable. As the assumed nature of 'the serviceable problem' influences what treatment responses people receive, and how they may come to be enacted as 'addicted' or 'normal' subjects, it is important to subject clinical practices of problem formulation to critical analysis. Given that the reach of AOD treatment has expanded via the online medium, in this article we examine how 'problems' are produced in online alcohol counselling encounters involving people aged 55 and over. Drawing on poststructural approaches to problematisation, we not only trace how and what 'problems' are produced, but also what effects these give rise to. We discuss three approaches to problem formulation: (1) Addiction discourses at work; (2) Moving between concerns and alcohol 'problems'; (3) Making 'problems' complex and multiple. On the basis of this analysis, we argue that online AOD counselling does not just respond to pre-existing 'AOD problems'. Rather, through the social and clinical practices of formulation at work in clinical encounters, online counselling also produces them. Thus, given a different set of circumstances, practices and relations, 'problems' might be defined or emerge differently-perhaps not as 'problems' at all or perhaps as different kinds of concerns. We conclude by highlighting the need for a critical reflexivity in AOD treatment and policy in order to open up possibilities for different ways of engaging with, and responding to, people's needs in their complexity.

Making the hard work of recovery more attractive for those with substance use disorders

BACKGROUND

Research has led to improvements in the effectiveness of interventions for substance use disorders (SUD), but for the most part progress has been modest, particularly with regard to longer-term outcomes. Moreover, most individuals with SUD do not seek out treatment.

ARGUMENT/ANALYSIS

This paper presents two recommendations on how to improve treatment engagement and long-term outcomes for those with SUD. First, treatments should go beyond a focus on reducing or eliminating substance use to target greater access to and more time spent in experiences that will be enjoyable or otherwise rewarding to clients. Secondly, there must be sufficient incentives in the environment to justify the effort needed to sustain long-term abstinence for individuals who often have limited access to such incentives.

CONCLUSIONS

To increase rates of long-term recovery from substance misuse, treatments should link clients to reinforcers that will make continued abstinence more appealing. This work needs to extend beyond interventions focused on the individual or family to include the local community and national policy in an effort to incentivize longer-term recoveries more strongly.

Building Recovery Capital: The Role of Faith-Based Communities in the Reintegration of Formerly Incarcerated Drug Offenders

Recovery capital is an important concept in the field of addiction studies. A person’s access to recovery capital can mean the difference between the termination of addiction and successful reintegration or ongoing criminality and drug use. Increasingly, religious institutions are playing a vital role in the provision of social services, including addiction services that provide access to recovery capital. This article begins by exploring the concept of recovery capital and its utility in the successful reintegration of offenders. It then uses a case study to show how one’s religious organization plays an important role in providing the necessary recovery capital for the desistance of drug abuse and for a successful reintegration into the community. Through in-depth interviews with several persistent adult offenders, this article demonstrates that religious organizations may play an important role in providing the recovery capital that so many persistent drug offenders are lacking.

Associations between social identity diversity, compatibility, and recovery capital amongst young people in substance use treatment

This study explored associations between group memberships and recovery capital amongst 20 young adults aged 18 to 21 years in residential alcohol and drug treatment.

METHOD

Participants completed an interviewer administered research interview based on measures of recovery capital and a social networks assessment mapping group memberships, group substance use, and relationships between groups.

RESULTS

Higher personal and social recovery capital was associated with lower diversity of group memberships, a higher number of positive links between groups, and greater compatibility of lower substance-using groups with other groups in the network. Higher compatibility of heavier-using groups was also associated with having a higher number of negative, antagonistic ties between groups.

CONCLUSIONS

These findings indicate that it is higher compatibility of a lower substance-using social identity and lower-using group memberships that contributes to recovery capital. Further, positive ties between groups and lower diversity of group memberships appear to be key aspects in how multiple social identities that are held by young adults relate to personal and social recovery capital.

Abstinence at Successful Discharge in Publicly Funded Addiction Health Services

Abstinence at successful discharge in substance use disorder treatment is important to reducing relapse rates and increasing long-term recovery from substance use disorders. However, few studies have examined abstinence as an essential component of successful discharge. This study examined rates and correlates of reported abstinence (nonuse of drugs 30 days prior to successful discharge) among clients attending publicly funded treatment in Los Angeles County, California. Finding show that only 36% of clients who were successfully discharged reported abstinence. Black clients were less likely than non-Hispanic Whites to report abstinence at successful discharge. Clients in methadone treatment programs were less likely than outpatient clients to report abstinence, whereas clients referred to treatment through the legal system (Proposition 36) were more likely to report abstinence compared to self-referred clients. Findings underscore the importance of systematic assessment of abstinence in determining successful discharge and provide a basis for further examination of strategies to improve abstinence and reduce relapse.

[Out of addictions: Alcohol, or alcohol to alcohol]

Pathways from alcoholism to recovery are documented; less often are those from drug addiction to alcoholism. Biographical approaches allow analyzing how people change their uses and talk about their trajectories of recovery.

METHODS

Three hundred and forty-one people (34% women) in the Paris area were questioned on their trajectories with a biographical questionnaire. Some open questions were aimed to understand the connection they made between events in their lives, how recovered they felt and what they considered strengths or obstacles. All the participants had stopped at least one product. Their mean age was 43, and 26% were over 50.

STUDY OBJECTIVES

How can the differences between one substance addicts and dual abusers be explained? Can we hypothesize a better result for the patients with a single dependence to alcohol in their lives for the following two reasons? (1) They could really be taken in charge for their alcoholism whereas the dual abusers mostly receive cared for their illicit drug problems with an under estimation of their problem with alcohol. In this case, they turn to alcohol after weaning themselves from their drug dependence so as to return to a social consumption, especially when they are given an opiate treatment. (2) Conversely could we suggest that the dual substance abusers had different trajectories from their childhood (more adverse events, more social difficulties, mental health problems), and that this accumulation explains their skipping from one substance or behaviour to another without any real recovery for decades?

RESULTS

All respondents were polydrug users. Eighty-two had been dependent mainly on alcohol. One hundred and twenty-one people had been drug addicts (mostly heroin), which they had stopped on average ten years before the survey. The last group included 138 persons who had been heroin or cocaine addicts and alcoholics in their lives, a third of whom had been dependent on alcohol before their drug addiction (35%), a tenth on both at the same time (10%) and more than half of the users (55%) had turned from drug addiction to alcoholism. The group concerning alcohol dependence includes the oldest participants, on average 49.7, and 55% of them were abstinent at the survey. Conversely, the group "with no alcohol dependence" had mainly turned to opiate treatments. Their histories in dependence and in various social statuses also showed a longer duration out of employment, in sickness or invalidity, or in prison, for the drug dependents as opposed to the "mainly" alcoholics. The population with dual substance abuse experienced twice as many adverse childhood events as the others (P<0.005): it was the case for 19.5% in "mainly alcohol" dependence compared to 38.4% in dual abuse. The recovery capital gave a mean score of 7.56±2.35 (median 7). A score below 6 was considered low. The score was significantly different according to the dependence groups: while 7.3% of "mainly alcohol" dependents had a score below 6, this was the case for 30.4% of the dual group (with alcohol and drugs), and 19% for the "mainly drug dependence" group. Controlling ages, sexes and groups of dependence in a logistic regression, the risk of having a recovery capital below six was more than four times higher for the dual dependents as opposed to the "mainly alcohol" dependents.

CONCLUSION

Some people stay for decades in drug addiction centers switching from one dependence to another. Their alcohol drinking should be addressed earlier to prevent them from turning to drinking excessively in order to wean themselves from their drug addiction.

Hitting rock bottom? Resource loss as a predictor of alcoholism treatment completion

Background Efforts to better understand the phenomenon of the 'bottom', the beginning of the process of turning away from alcohol, are important for both theoretical and practical goals. The conservation of resources theory by Hobfoll may represent a suitable framework to base these attempts around. Aim The aim of the study was to examine the role of resource loss in completing alcoholism treatment on the basis of Hobfoll's conservation of resources theory. Methods The study included 86 patients undergoing inpatient alcoholism treatment. An assessment of resource loss and gain during the previous year, as well as of the decisional balance regarding the pros and cons of drinking alcohol, took place at the beginning of therapy. Results The results of hierarchical binary logistic regression confirmed that resource loss was the only significant predictor of therapy completion, after adjustment for decisional balance, demographics and basic clinical data. Additionally, gender moderated the relationship between resource gain and therapy completion: while an increase in gain was related to a decreased chance of completing therapy in men, the opposite effect was noted in women. Conclusions Resource loss has more influence than decisional balance in predicting therapy completion, which can be translated into clinically valid recommendations based on gender differences.

The Role of Social Capital in African Americans' Attempts to Reduce and Quit Cocaine Use

BACKGROUND

Research examining substance users' recovery has focused on individual-level outcomes while paying limited attention to the contexts within which individuals are embedded, and the social processes involved in recovery.

OBJECTIVES

This paper examines factors underlying African American cocaine users' decisions to reduce or quit cocaine use and uses practice theory to understand how lifestyle changes and shifts in social networks facilitate access to the capital needed to change cocaine use patterns.

METHODS

The study, an in-depth analysis of substance-use life history interviews carried out from 2010 to 2012, included 51 currently not-in-treatment African American cocaine users in the Arkansas Mississippi Delta region. A blended inductive and deductive approach to data analysis was used to examine the socio-cultural and economic processes shaping cocaine use and recovery.

RESULTS

The majority of participants reported at least one lifetime attempt to reduce or quit cocaine use; motivations to reduce use or quit included desires to meet social role expectations, being tired of using, and incarceration. Abstinence-supporting networks, participation in conventional activities, and religious and spiritual practices afforded access to capital, facilitating cocaine use reduction and sobriety.

CONCLUSIONS

Interventions designed to increase connection to and support from nondrug using family and friends with access to recovery capital (e.g., employment, faith community, and education) might be ideal methods to reduce substance use among minorities in low-income, resource-poor communities.

Producing “Progress” Through the Implementation of Outcome Monitoring in Alcohol and Other Drug Treatment

Outcome monitoring—a process in which clinicians use standardized tools to routinely measure client “progress” on predefined outcomes of interest over time—is increasingly being implemented in alcohol and other drug (AOD) treatment services as a way of demonstrating quality of care. However, relatively little is known about the implications and unintended consequences of implementing outcome monitoring in clinical and social practices. In this paper we draw on qualitative data emerging from focus groups with clinicians who piloted an outcome monitoring tool in Melbourne, Australia, using conceptual tools drawn from science and technology studies. Rather than acting as a stable empirical object, we argue that realities of progress are enacted multiply in relation to preexisting treatment discourses and policy, organizational practices of data collection and management, reporting tools, and clinician attitudes and practices. In particular, we trace how the tool orders the “problem” of drugs differently to the qualitative mode of ordering; how different modes of ordering progress hang together and the tensions and coordination strategies that are involved. And finally, we highlight an unintended consequence of the outcome monitoring process—the enactment of vulnerability and its distribution across the clinical relationship. We suggest that researchers, policy makers, and clinicians need to think reflectively and critically about the ways in which we and our tools and interventions are influential in producing AOD problems, what constitutes progress, and ultimately what the focus of treatment should be.

A brief report on Hispanic youth marijuana use: Trends in substance abuse treatment admissions in the United States

Increases in Hispanic youth admissions to substance abuse treatment programs for marijuana use are a growing public health concern. In this study, we investigated trends in Hispanic youth from 1995 to 2012 utilizing the Treatment Episode Data Set-Admissions of the Substance Abuse Mental Health Services Administration. Hispanic youth marijuana admissions are associated with youth 15-17 years old, in high school, and living in a dependent situation. Notably, female admissions increased at greater rates than males. Results also point to decreasing tolerance of minor marijuana use by schools and community agencies. Findings highlight the need for targeted, culturally specific, and cost-effective treatment and prevention efforts.

Conspicuous by their abstinence: The limited engagement of heroin users in English and Welsh Drug Recovery Wings

BACKGROUND

In recent years, an abstinence-focused, 'recovery' agenda has emerged in UK drug policy, largely in response to the perception that many opioid users had been 'parked indefinitely' on opioid substitution therapy (OST). The introduction of ten pilot 'Drug Recovery Wings' (DRWs) in 2011 represents the application of this recovery agenda to prisons. This paper describes the DRWs' operational models, the place of opiate dependent prisoners within them, and the challenges of delivering 'recovery' in prison.

METHODS

In 2013, the implementation and operational models of all ten pilot DRWs were rapidly assessed. Up to three days were spent in each DRW, undertaking semi-structured interviews with a sample of 94 DRW staff and 102 DRW residents. Interviews were fully transcribed, and coded using grounded theory. Findings from the nine adult prisons are presented here.

RESULTS

Four types of DRW were identified, distinguished by their size and selection criteria. Strikingly, no mid- or large-sized units regularly supported OST recipients through detoxification. Type A were large units whose residents were mostly on OST with long criminal records and few social or personal resources. Detoxification was rare, and medication reduction slow. Type B's mid-sized DRW was developed as a psychosocial support service for OST clients seeking detoxification. However, staff struggled to find such prisoners, and detoxification again proved rare. Type C DRWs focused on abstinence from all drugs, including OST. Though OST clients were not intentionally excluded, very few applied to these wings. Only Type D DRWs, offering intensive treatment on very small wings, regularly recruited OST recipients into abstinence-focused interventions.

CONCLUSION

Prison units wishing to support OST recipients in making greater progress towards abstinence may need to be small, intensive and take a stepped approach based on preparatory motivational work and extensive preparation for release. However, concerns about post-release deaths will remain.

Oxford recovery housing: Length of stay correlated with improved outcomes for women previously involved with the criminal justice system

BACKGROUND

Housing plays a crucial role in providing resources for and aiding an individual's reentry into the community following incarceration and substance use treatment. As such, this study examined the influence of recovery homes on a sample of former female substance-using women with criminal justice involvement.

METHODS

Two hundred women who had been involved with the criminal justice system within the preceding 2 years were recruited from multiple sites in metropolitan Chicago. These women were assigned to either 1 of 2 conditions: Oxford House (OH) recovery homes or usual aftercare (UA).

RESULTS

Those with longer stays in OH (6 months or more) had better outcomes in terms of alcohol and drug use, employment, and self-efficacy than those with shorter stays. Outcomes for those who stayed in OH were not appreciably different than the UA condition on substance use and employment, but fewer deaths occurred for those in the OH condition.

CONCLUSIONS

Findings suggest that length of stay of 6 or more months is critical for those in recovery homes, but it is important for us to better understand the processes through which longer stays influence better outcomes.

Challenges and Rewards of Conducting Research on Recovery Residences for Alcohol and Drug Disorders

Although research shows treatment for alcohol and drug problems can be effective, persons without stable housing that supports recovery are at risk for relapse. Recovery residences (RRs) for drug and alcohol problems are a growing response to the need for alcohol- and drug-free living environments that support sustained recovery. Research on RRs offers an opportunity to examine how integration of these individuals into a supportive, empowering environment has beneficial impacts on substance use, housing, and other outcomes, as well as benefits for the surrounding community. Research can also lead to the identification of operations and practices within houses that maximize favorable outcomes for residents. However, research on RRs also presents significant obstacles and challenges. Based on our experiences conducting recovery home research for decades, we present suggestions for addressing some of the unique challenges encountered in this type of research.

Important Activities Among Justice-Involved Individuals with Substance Use Disorders in Posttreatment Aftercare Settings

This study gathered data using the Important Persons and Activities instrument to record changes in popular activities over a 2-year study of 270 justice-involved individuals randomized into three aftercare conditions: self-run Oxford Houses, a staffed therapeutic community (TC), or usual aftercare (UA). Participants listed important activities during the 2-year study at baseline and at four subsequent 6-month intervals. Categorization of these activities and a descriptive analysis were conducted for Wave 1 (baseline), at Wave 3 (Year 1), and Wave 5 (Year 2). Standardized scores were computed to test differences in proportions of the #1 most favored activity across conditions. Descriptive results also demonstrated that Reading/Writing activities, and Exercise/Sports activities, were most reported at baseline. By Wave 5, Education/Work and Interacting with Others were the most reported activities. These findings indicated that solitary activities, such as Reading/Writing, may play a predominant role in early aftercare whereas Work/Education and social activities increase later on. Implications for future research of changing activities during recovery trajectories are discussed.

Social identity, social networks and recovery capital in emerging adulthood: A pilot study

Background

It has been argued that recovery from substance dependence relies on a change in identity, with past research focused on ‘personal identity’. This study assessed support for a social identity model of recovery in emerging adults through examining associations between social identity, social networks, recovery capital, and quality of life.

Methods

Twenty participants aged 18–21 in residential treatment for substance misuse were recruited from four specialist youth drug treatment services - three detoxification facilities and one psychosocial rehabilitation facility in Victoria, Australia. Participants completed a detailed social network interview exploring the substance use of groups in their social networks and measures of quality of life, recovery capital, and social identity.

Results

Lower group substance use was associated with higher recovery capital, stronger identification with non-using groups, and greater importance of non-using groups in the social network. Additionally, greater identification with and importance of non-using groups were associated with better environmental quality of life, whereas greater importance conferred on using groups was associated with reduced environmental quality of life.

Conclusions

Support was found for the role of social identity processes in reported recovery capital and quality of life. Future research in larger, longitudinal samples is required to improve understanding of social identity processes during treatment and early recovery and its relationship to recovery stability.

A critical component of the continuum of care for substance use disorders: recovery homes in Philadelphia

For many struggling with addiction, the ability to achieve stable recovery is often jeopardized by untenable housing or unsupportive living environments. Despite promising research on recovery residences, there are still significant gaps in the research on them. Using data collected from a stratified random sample of recovery homes in Philadelphia (N = 25), this study describes the organizational, operational, and programmatic characteristics of these homes and explores potential differences in these characteristics by funding source and gender of residents served. Although not licensed treatment providers, the majority of these homes operated in a recovery-oriented manner and offered a range of different services to their residents-all for a reasonable monthly fee (M = $340.40, SE = 18.60). Few differences emerged between homes that received funding from the Philadelphia Office of Addiction Services and those that did not or between those that served males as opposed to females. More research is needed to address resident outcomes and how Philadelphia recovery homes may compare with recovery residences in other parts of the country.

Exploring the Factor Structure of a Recovery Assessment Measure among Substance-Abusing Youth

To date, the measurement of recovery in the field of substance abuse is limited. Youth recovery from substance abuse is an important area to consider, given the complexities of such issues. The Recovery Assessment Scale (RAS) has been validated with mental health patient populations; however, its measurement characteristics have not been examined for individuals in substance abuse treatment. The current study explored the factor structure of the RAS with a sample of 80 substance-abusing youth who participated in a pilot aftercare study (Mage 20.5, SD=3.5; 71.3% male). Reliability analysis showed an internal consistency of α=.90 for the entire RAS measure among the youth sample. Results of exploratory factor analysis identified the following four factors: personal determination, skills for recovery, self-control in recovery, and social support/moving beyond recovery among the substance-abusing youth sample. The RAS also demonstrated sound convergent and divergent validity in comparison to other validated measures of functioning, sobriety, and well-being. Collectively, results support that the RAS has adequate psychometric properties for measuring recovery among substance-abusing youth.

Life experiences in active addiction and in recovery among treated and untreated persons: a national study

Addiction treatment can be effective but fewer than 50% of addiction affected persons are ever treated. Little is known about the addiction and recovery experience of this large subgroup. A national sample of persons in recovery (N = 3,176, 29.5% untreated) was used to begin addressing these questions to inform strategies to encourage help-seeking and to contribute to the small knowledge base on untreated individuals. Study domains were finances, family, social and civic functioning, health, criminal justice involvement, and employment. Treated persons reported significantly greater levels of negative-and fewer positive-experiences in all areas during active addiction than did the untreated group. This gap was significantly narrowed in recovery.

Maximizing social model principles in residential recovery settings

Peer support is integral to a variety of approaches to alcohol and drug problems. However, there is limited information about the best ways to facilitate it. The “social model” approach developed in California offers useful suggestions for facilitating peer support in residential recovery settings. Key principles include using 12-step or other mutual-help group strategies to create and facilitate a recovery environment, involving program participants in decision making and facility governance, using personal recovery experience as a way to help others, and emphasizing recovery as an interaction between the individual and their environment. Although limited in number, studies have shown favorable outcomes for social model programs. Knowledge about social model recovery and how to use it to facilitate peer support in residential recovery homes varies among providers. This article presents specific, practical suggestions for enhancing social model principles in ways that facilitate peer support in a range of recovery residences.

Implementation of computer-assisted therapy for substance misuse: a qualitative study of Breaking Free Online using Roger's diffusion of innovation theory

Purpose

– The purpose of this paper is to explore the adoption and implementation of computer-assisted therapy (CAT) using Breaking Free Online (BFO) in a social care and health charity working with people affected by drugs and alcohol dependence, Crime Reduction Initiatives (CRI).

Design/methodology/approach

– Semi-structured interviews were conducted with service managers, practitioners, peer mentors and service users. Data were thematically analysed and themes conceptualised using Roger's Diffusion of Innovation Theory (Rogers, 1995, 2002, 2004).

Findings

– A number of perceived barriers to adoption of BFO throughout CRI were identified within the social system, including a lack of IT resources and skills. However, there were numerous perceived benefits of adoption of BFO throughout CRI, including broadening access to effective interventions to support recovery from substance dependence, and promoting digital inclusion. Along with the solutions that were found to the identified barriers to implementation, intentions around longer-term continuation of adoption of the programme were reported, with this process being supported through changes to both the social system and the individuals within it.

Research limitations/implications

– The introduction of innovations such as BFO within large organisations like CRI can be perceived as being disruptive, even when individuals within the organisation recognise its benefits. For successful adoption and implementation of such innovations, changes in the social system are required, at organisational and individual levels.

Practical implications

– The learning points from this study may be relevant to the substance misuse sector, and more widely to criminal justice, health and social care organisations.

Originality/value

– This study is the first of its kind to use a qualitative approach to examine processes of implementation of CAT for substance misuse within a large treatment and recovery organisation.

Psychosocial functioning of drug treatment court clients: a study of the prosecutor's files in Ghent, Belgium

Purpose

– Problem solving courts are a result of the therapeutic jurisprudence movement. Drug treatment courts (DTCs), for instance, aim to divert substance using offenders away from the criminal justice system (CJS) to (drug) treatment services. DTCs are associated with reduced criminal offending and substance use. Psychosocial outcomes of DTCs, such as employment, health and family relations, received only little attention. The paper aims to discuss these issues.

Design/methodology/approach

– This paper focuses on the outcomes regarding substance use and psychosocial variables of a Belgian DTC situated in the Ghent region, which were investigated by a naturalistic evaluation study with a pre- post-design using judicial files.

Findings

– The results show that Ghent DTC clients were diverted to drug treatment and financial counselling services. Next the Ghent DTC produced beneficial outcomes regarding employment. Contrary to criminal offending (De Keulenaer and Thomaes, 2013), substance use was not significantly reduced in the Ghent DTC sample. Yet more compliance with opioid maintenance treatment was observed. Information on more client centred outcomes such as health and social relations was lacking, precluding a full outcome measurement of psychosocial variables.

Research limitations/implications

– Future DTC studies should address more client centreed outcomes by gathering information through DTC clients and treatment services instead of solely relying on judicial data sources. In addition, DTCs should develop a clear and uniform registration system regarding these outcomes.

Originality/value

– Since the therapeutic jurisprudence movement continues to expand, discussion regarding the roles and tasks of the CJS as well as treatment and counselling services is vital. Each actor should maintain its own role and task, regarding monitoring and substantive work, to insure a “problem solving approach” that is in line with the recovery philosophy.

Understanding prolonged cessation from heroin use: findings from a community-based sample

BACKGROUND

There is abundant literature describing heroin initiation, co-morbidities, and treatment. Few studies focus on cessation, examining the factors that motivate and facilitate it.

METHODS

The CHANGE study utilized mixed methods to investigate heroin cessation among low-income New York City participants. This paper describes findings from qualitative interviews with 20 former and 11 current heroin users. Interviews focused on background and current activities, supports, drug history, cessation attempts, and motivators and facilitators to cessation.

RESULTS

Participants found motivation for cessation in improved quality of life, relationships, and fear of illness, incarceration and/or death. Sustained cessation required some combination of treatment, strategic avoidance of triggers, and engagement in alternative activities, including support groups, exercise, and faith-based practice. Several reported that progress toward goals served as motivators that increased confidence and facilitated cessation. Ultimatums were key motivators for some participants. Beyond that, they could not articulate factors that distinguished successful from unsuccessful cessation attempts, although data suggest that those who were successful could describe more individualized and concrete-rather than general-motivators and strategies.

CONCLUSIONS

Our findings indicate that cessation may be facilitated by multifaceted and individualized strategies, suggesting a need for personal and comprehensive approaches to treatment.

"When You Got Friends in Low Places, You Stay Low:" Social Networks and Access to Resources for Female Methamphetamine Users in Low-Income Suburban Communities

To examine access to needed resources among low-income methamphetamine-using females, we conducted interviews with 30 women living in poor suburban communities of a large southeastern metropolis. As an invisible population in the suburbs, underserved by social services, the women remain geographically and socially anchored to their poor suburban enclaves as transit, treatment and education remain out of reach. The longitudinal study included three interviews over a two-year period. Resources needed by the women were identified in the first interview and a list of available services was provided to them. In subsequent interviews we asked how they accessed the services or barriers encountered and discussed these further in focus groups. Using a social capital framework in our qualitative analysis, we identified three processes for accessing needed resources: formal, informal and mediated. Implications for policymakers and social service providers are suggested, and models for future development proposed.

An outcomes study of eTherapy for dual diagnosis using Breaking Free Online

Purpose

– In recent years there has been a proliferation of computer-based psychotherapeutic interventions for common mental health difficulties. Building on this, a small number of such interventions have now been developed to address substance dependence, one of which is Breaking Free Online (BFO). A new “eTherapy” self-help service, which was set up by the UK mental health charity Self-Help Services, has provided access to BFO to service users presenting with comorbid mental health and substance misuse difficulties. The purpose of this paper is to evaluate a range of clinical outcomes in the first cohort of service users accessing this dual diagnosis service.

Design/methodology/approach

– A number of standardised psychometric assessments were conducted with service users at baseline and post-treatment at discharge from the service. Outcome data were available for 47 service users out of an original cohort of 74.

Findings

– Statistically significant improvements were found in terms of measures of social functioning, depression, anxiety, alcohol and drug use and social anxiety. Clinically relevant gains were also identified, with fewer service users reaching threshold scores for depression and anxiety at post-treatment compared to baseline. Effect sizes also indicated that the identified improvements across the psychometric measures were robust and significant.

Research limitations/implications

– These findings provide further support for the clinical effectiveness of BFO, and also provide evidence that an eTherapy self-help service may be appropriate for some individuals presenting with dual diagnosis. Further research is underway with larger and alternative clinical populations to examine the effectiveness of BFO and also this novel eTherapy self-help approach.

Originality/value

– This paper has provided initial data to support effectiveness of a novel eTherapy service for dual diagnosis.

Does age at first treatment episode make a difference in outcomes over 11 years?

This study examines the associations between age at first substance use treatment entry and trajectory of outcomes over 11 years. We found significant differences in individual and treatment characteristics between adult intakes first treated during young adulthood (25 years or younger) and those first treated at an older age. Compared to their first treated older age counterparts matched on demographics and dependence type, those who entered first treatment during young adulthood had on average an earlier onset for substance use but a shorter duration between first substance use and first treatment entry; they also had worse alcohol and other drug outcomes 11 years post treatment entry. While subsequent substance use treatment and 12-step meeting attendance are important for both age groups in maintaining positive outcomes, relationships varied by age group. Findings underline the importance of different continuing care management strategies for those entering first treatment at different developmental stages.

Conceptualizing Social Recovery: Recovery Routes of Methamphetamine Users

The goal of our qualitative study was to gain a phenomenological understanding of routes to recovery from problematic drug use. In-depth interviews and drug histories were collected from 50 former methamphetamine users recruited from a U.S. metropolitan suburb who identified as having had problematic use of this drug in the past. Transcripts of the audio-recorded interviews were coded for common themes regarding types of recovery strategies or tools employed on the route to recovery. The common strategies used for recovery from problematic methamphetamine use in all routes were social in nature and did not necessarily include cessation of all substances. Based on our findings, we suggest a conceptualization of social recovery that focuses on reducing the social harms caused by problematic drug use rather than focusing primarily on cessation of all drug use. Social recovery may be employed as both a treatment strategy and analytical tool. More research is needed to advance the concept of social recovery for intervention, drug policy, and criminal justice implications.

"El lado oscuro": "the dark side" of social capital in Mexican American heroin using men

This article describes social capital in a cohort of 227 Mexican American men who are long-term injection heroin users. Social capital scores for current and former users were similar, suggesting equal absolute values of capital, but associated with illicit activities in current users and with cessation efforts in former users. Stable drug-using relationships provided high negative capital, whereas conventional relationships provided positive capital. Thus, social capital functions dichotomously in positive and negative contextualized roles. This study provides an alternative understanding of the dynamic interactions between individuals, environment, and drug abuse and can inform prevention and treatment interventions for an important demographic group.

What Promotes Wisdom in 12-Step Recovery?

Research investigations on twelve-step groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) have addressed a number of resources associated with 12-step recovery. However, little is known about the role of wisdom, and whether aspects of 12-step participation might increase this resource among 12-step members. An exploratory analysis revealed that participants who reported having a "spiritual awakening" and considered themselves "members" of 12-step groups reported significantly higher levels of wisdom. Twelve-step meeting attendance was not significantly related to wisdom scores. Findings suggest certain aspects of 12-step involvement are associated with wisdom and may play a role in substance abuse recovery.