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

The impact of spiritual well-being and social support on substance use treatment outcomes within a sample of predominantly Black/African American adults

INTRO

Substance use and associated problems often return following treatment for substance use disorder (SUD), which disproportionally impact Black/African American (AA) individuals. Social support and spiritual well-being are sources of recovery capital identified as particularly important among Black/AA adults. Social support and spiritual well-being are also posited mechanisms in 12-step; thus, this study tested the effects of social support and spiritual well-being on substance use outcomes over time, distinct from 12-step involvement, among Black/AA adults post-SUD treatment. The study hypothesized that social support and spiritual well-being would demonstrate significant interactions with time, respectively, on substance use frequency and substance use consequences, above the effect of 12-step involvement.

METHOD

The study drew data from a study of 262 adults (95.4 % Black/AA) entering residential SUD treatment (NCT#01189552). Assessments were completed at pretreatment and at 3-, 6-, and 12-months posttreatment. Two generalized linear mixed models (GLMM) tested the effects of social support and spiritual well-being, above the effect of 12-step involvement, on substance use frequency and substance use consequences over the course of 12-months posttreatment.

RESULTS

Higher spiritual well-being predicted significantly less frequent substance use during recovery (β = 0.00, p = .03). Greater 12-step involvement predicted significantly fewer substance use consequences during recovery (β = 0.00, p = .02). In post hoc analyses the effect of spiritual well-being and 12-step involvement dissipated by 3.5- and 6.6-months posttreatment, respectively. The study found no significant effects of social support over time.

DISCUSSION

Spiritual well-being and 12-step involvement are associated with lower substance use and substance use consequences, respectively, in the early months of posttreatment recovery among Black/AA adults. These findings contribute to the growing recovery capital literature informing paths to recovery and sources of support outside of 12-step affiliation. However, these effects diminish over time.

Taking advantage of multiple identities to reduce defensiveness to personally threatening health messages

A host of studies have shown that self-relevant health messages may result in increased defensiveness and rejection of protective recommendations. Drawing on research showing that multiple identities offer psychological resources to deal with identity threats, we sought to examine whether the salience of an alternative identity before people are exposed to a personally relevant health message may buffer the threat and reduce defensive responses. Two studies were conducted on samples of daily smokers asked to read an antismoking message before completing a range of measures of defensiveness. Half of the participants had an alternative identity made salient beforehand (vs. no salience condition). Consistent with our hypotheses, Study 1 (N = 90) showed that this manipulation significantly reduced defensiveness to the message. Study 2 (N = 95) additionally showed that such effects only occurred when the alternative identity overlapped highly with the threatened identity. The theoretical implications of these findings are discussed.

Examination of using alcohol to cope, depressive symptoms, and perceived social support in persons with HIV and Hepatitis C

Depression is common among people living with HIV (PLWH) and some likely turn to alcohol to cope with this emotional distress. Using alcohol to cope is associated with increased alcohol use, persistent longitudinal alcohol use, and alcohol-related problems. This association is particularly concerning among PLWH who are co-infected with Hepatitis C (HCV) because alcohol adds to the damage already caused by HCV. Despite data showing the associated risks of using alcohol to cope, scant research has examined factors that might contribute to coping-based alcohol use in HIV-HCV patients, such as limited social support. Baseline data from a randomized trial of strategies to reduce alcohol use in co-infected HIV and HCV adult patients (n=110) were analyzed. Multiple linear regression models were used to estimate the association between using alcohol to cope, depression, and four aspects of social support, controlling for demographic variables. Results showed that using alcohol to cope was not significantly correlated with social support but was significantly correlated with depressive symptoms. In fact, depressive symptoms and severity of alcohol consumption accounted for nearly 45% of the variance related to coping-based alcohol use. These data highlight the central role of depression in the coping motives-alcohol use relationship among co-infected patients.

“One Out of Ten Ain’t Going to Make It”: An Analysis of Recovery Capital in the Rural Upper Midwest

Substance use and associated fatalities are disproportionately experienced by rural communities. This study used consensual qualitative research methodology to analyze focus group data from individuals in short- and long-term recovery in rural Michigan and Minnesota. Coding was conducted within a recovery capital framework to improve understanding of the resources and barriers participants experienced in their recovery. Key findings included barriers related to transportation, as well as access to and availability of sober meetings and sober living activities. Participants perceived connections to culturally appropriate treatment as particularly important. A reconstruction of social networks from those promoting addiction to those supporting recovery was also prominently emphasized. Recovery capital appears to be a useful framework for assessing how rural communities are experiencing substance use crises, in addition to identifying areas of low capital and high need in supporting long-term recovery.

Capital depreciation: The lack of recovery capital and post-release support for prisoners leaving the Drug Recovery Wings in England and Wales

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.