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Hamilton SL, Jones L, Penny M, Pell C, Ilich N, Michie C, Mutch R, O’Donnell M, Shepherd C, Farrant B. Ngulluk Moort, Ngulluk Boodja, Ngulluk Wirin (our family, our country, our spirit): An Aboriginal Participatory Action Research study protocol. PLoS One 2024; 19:e0301237. [PMID: 38959283 PMCID: PMC11221671 DOI: 10.1371/journal.pone.0301237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/11/2024] [Indexed: 07/05/2024] Open
Abstract
Globally, Indigenous children have historical and contemporary connections with government child protection services that have caused significant harm to their long-term health and wellbeing. Innovative, culturally secure and recovery focussed service provision is required. This paper describes a research protocol that has been designed by Indigenous researchers led by Indigenous Elders, to explore culturally secure care planning and service delivery in out-of-home care agencies in Australia. Using participatory action research methods, we will collect data using a variety of forums, including focus groups and semi-structured interviews. These data will explore the challenges for out-of-home care agencies in providing culturally secure care-planning, cultural activity and resources, and explore solutions to address factors that influence health and can assist to redress social inequities for Indigenous children. We aim to recruit approximately 100 participants for the qualitative study and 40 participants for the quantitative survey. Study participants will initially be recruited using purposive sampling, and as the study progresses will be recruited using a mixture of purposive and convenience sampling techniques. The rich data that this study is expected to yield, will inform ways to collect cultural information about Indigenous children and ways to provide cultural connections and activities that will have benefit to Indigenous children and families, and a broad range of social services.
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Affiliation(s)
- Sharynne Lee Hamilton
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- Faculty of Health, University of Canberra, Canberra, Australia
| | - Larissa Jones
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Millie Penny
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Charmaine Pell
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Nicole Ilich
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Carol Michie
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Raewyn Mutch
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Melissa O’Donnell
- Australian Centre for Child Protection, University of South Australia, Adelaide, Australia
| | - Carrington Shepherd
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- Faculty of Health Sciences, Curtin University, Perth, Australia
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, Australia
| | - Brad Farrant
- Telethon Kids Institute, University of Western Australia, Perth, Australia
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Hennessy EA, Jurinsky J, Cowie K, Pietrzak AZ, Blyth S, Krasnoff P, Best D, Litt M, Johnson BT, Kelly JF. Visualizing the Influence of Social Networks on Recovery: A Mixed-Methods Social Identity Mapping Study with Recovering Adolescents. Subst Use Misuse 2024; 59:1405-1415. [PMID: 38738809 PMCID: PMC11191070 DOI: 10.1080/10826084.2024.2352618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Background: Social recovery capital (SRC) refers to resources and supports gained through relationships and is vital to adolescent addiction recovery. Much is known about how substance use relates to social networks, but little is known about how other dimensions of social networks influence recovery (e.g., network size/exposure, degree of conflict). Methods: This mixed-methods study sampled 28 adolescents who received treatment for alcohol and other drug (AOD) use disorder (14-19 yrs.: 71% male; M = 17.32 yrs., SD = 1.33; White 82%): 20 were recovery high school (RHS) students. Adolescents completed a social identity map for addiction recovery (SIM-AR), survey, and interview. Qualitative data were content analyzed and the data from the SIM-AR were quantified. Results: On average, participants reported belonging to five distinct groups within their network (Range, 2-9; SD = 1.63; M = 27.89 people, SD = 20.09). Of their social network connections, 51% drank alcohol and 46% used other substances, on average. Larger networks involved more conflict (r = 0.57). Participants were more likely to spend more time with groups that had greater proportions of non-substance-using members. These linkages were stronger for RHS than for non-RHS students. Qualitative analyses revealed that youth reported their recovery-oriented groups as supportive, but some reported that their substance-using friends also supported their recovery. Discussion: SIM-AR was a useful measurement tool, and, through qualitative interviews, we identified unique aspects of youths' social networks important for further examination. Research with recovering youth should examine SRC-related elements within their networks including relationship quality, belonging, and conflict, alongside the substance use behaviors of network members.
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Affiliation(s)
- Emily A Hennessy
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jordan Jurinsky
- Department of Human and Organizational Development, Vanderbilt University, Nashville, Tennessee, USA
| | | | - Agata Z Pietrzak
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sophia Blyth
- Harvard University, Cambridge, Massachusetts, USA
| | | | | | - Mark Litt
- Division of Behavioral Sciences and Community Health, University of Connecticut School of Dental Medicine, Farmington, Connecticut, USA
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Blair T Johnson
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - John F Kelly
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Blyth SH, Cowie K, Jurinsky J, Hennessy EA. A qualitative examination of social identity and stigma among adolescents recovering from alcohol or drug use. Addict Behav Rep 2023; 18:100505. [PMID: 37415909 PMCID: PMC10319988 DOI: 10.1016/j.abrep.2023.100505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/18/2023] [Accepted: 06/17/2023] [Indexed: 07/08/2023] Open
Abstract
Introduction Alcohol and other drug (AOD) use disorders are stigmatized conditions, but little is known about youth's experience of this stigma, which may threaten their developing social identity and recovery process. This study investigates youth's perceptions of AOD use-related stigma in the context of their social identity. Methods This study uses data from 12 youth (ages 17-19) who were in recovery from problematic AOD use. Participants completed a Social Identity Mapping in Addiction Recovery (SIM-AR) exercise, in which they created a visual map of their social groups, and semi-structured interview, in which participants were asked about their experience creating their SIM-AR and reflections on their social network. SIM-AR data were descriptively analyzed, and interviews were thematically analyzed for instances of stigma. Results Using stigmatizing terminology, participants expressed some stigmatizing attitudes towards themselves and others in their network who used substances and perceived both positive and negative reactions from those who knew about their disorder. Findings suggest that youth may experience some internalized stigma and perceive stigma from others in their social networks, which may be a barrier to the development of a healthy social identity and engagement in recovery supports. Conclusions These findings should be considered when seeking to engage youth in treatment and recovery programming. Despite the small sample, the findings suggest the importance of considering how stigma may influence adolescents' treatment and recovery experience in the context of their social environment.
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Affiliation(s)
| | - Kiefer Cowie
- The Wright Institute Clinical Psychology Program, Berkeley, CA 94704, USA
| | - Jordan Jurinsky
- Vanderbilt University, Peabody College of Education and Human Development, Nashville, TN 37203-5721, USA
| | - Emily A. Hennessy
- Massachusetts General Hospital, Psychiatry, Recovery Research Institute, 151 Merrimac Road, Boston, MA 02114-2696, USA
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Jurinsky J, Cowie K, Blyth S, Hennessy EA. "A lot better than it used to be": A qualitative study of adolescents' dynamic social recovery capital. ADDICTION RESEARCH & THEORY 2022; 31:77-83. [PMID: 37008756 PMCID: PMC10062693 DOI: 10.1080/16066359.2022.2114076] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/05/2022] [Accepted: 08/14/2022] [Indexed: 06/10/2023]
Abstract
Background Substance use recovery is a dynamic process for youth, and social networks are tied to the recovery process. The Recovery Capital for Adolescents Model (RCAM) situates the resources accessible through social networks - social recovery capital (SRC) - in a larger framework of developmentally-informed recovery resources. This study aims to investigate the social network experiences among recovering youth enrolled in a recovery high school to understand how social influences help to build, or act as barriers to building, recovery capital. Methods To gain insight into these networks, Social Identity Maps and semi-structured interviews were conducted with ten youth ages 17-19 years (80% male; 50% non-Hispanic White). Study visits were conducted virtually, recorded, transcribed, and thematically analyzed using the RCAM as an organizing framework. Results Results supported that adolescent social networks play a unique and multifaceted role in the recovery journey. Three key nuances emerged: change permeates adolescent networks throughout the treatment and recovery process; shared substance use history and non-stigmatizing attitudes play a key role in connecting with others; and SRC is interconnected with human, financial, and community recovery capital. Conclusions With adolescent recovery receiving increased attention from policy makers, practitioners, and researchers, the RCAM may be a useful way to contextualize available resources. Findings suggest SRC as a crucial, yet complex component intertwined with all other forms of recovery capital.
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Affiliation(s)
- Jordan Jurinsky
- Vanderbilt University, Peabody College of Education and Human Development, Nashville, TN, USA 37203-5721
| | - Kiefer Cowie
- The Wright Institute Clinical Psychology Program, Berkeley, CA, USA 94704
| | | | - Emily A Hennessy
- Massachusetts General Hospital, Psychiatry, Recovery Research Institute, 151 Merrimac Road, Boston, MA, USA 02114-2696
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Lee BK, Ofori Dei SM. Changes in Work Status, Couple Adjustment, and Recovery Capital: Secondary Analysis of Data From a Congruence Couple Therapy Randomized Controlled Trial. Subst Abuse 2022; 16:11782218221088875. [PMID: 35645564 PMCID: PMC9130820 DOI: 10.1177/11782218221088875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 03/04/2022] [Indexed: 11/16/2022]
Abstract
Purpose Employment and family/social relationships are 2 of the highest priorities among those in substance use recovery. This study examined the relationship of work status with couple adjustment and other recovery capital treatment outcomes among symptomatic alcohol, substance use, and gambling participants (N = 38) using data collected in a randomized trial comparing a systemic Congruence Couple Therapy (CCT) and individual-based Treatment-as-Usual (TAU). Method Change scores and associations between work status and couple adjustment together with 8 other recovery outcome variables at post-treatment (5 months from baseline) and follow-up (8 months from baseline) in TAU (n = 17) and CCT (n = 21) were analyzed. Results Number of those working increased with both CCT and TAU but without reaching significance in either CCT (Cochran's Q = 5.429, P = .066) or TAU (Cochran's Q = 2.800, P = .247). Relative to those not working in the combined sample, those working showed significantly improved scores in post-treatment and follow-up in addictive symptoms, couple adjustment, psychiatric symptoms, depression, and life stress. Separating the CCT and TAU groups, similar trend was found in the CCT group but was inconsistent in the TAU group. Conclusion Significantly greater improvement in addictive symptoms and recovery capital of couple adjustment, mental health, and life stress was found in the working vs not-working group. Compared to individual-based TAU, exploratory findings indicate that the systemic treatment of CCT showed a clearer and more consistent difference in improved working days, addictive symptoms and recovery capital. Replication with larger samples is needed to generalize these results.
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Affiliation(s)
- Bonnie K Lee
- Faculty of Health Sciences, University of
Lethbridge, Lethbridge, AB, Canada
| | - Samuel M Ofori Dei
- Faculty of Health Sciences, University of
Lethbridge, Lethbridge, AB, Canada
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Best D, Hennessy EA. The science of recovery capital: where do we go from here? Addiction 2022; 117:1139-1145. [PMID: 34729852 PMCID: PMC9209877 DOI: 10.1111/add.15732] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/13/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The concept of recovery capital (RC) has emerged in studies and discussions of the addiction recovery process and as a potential metric and marker for recovery gains. Although conceptual and applied development of the concept in the 20 years since the term was coined has increased, there remains insufficient clarity of key domains, factors and best practice research and applications for populations experiencing addiction. We aimed to review progress around the conceptualisation and operationalisation of RC and to consider future directions for a science of recovery capital. METHOD We provided a brief overview of theoretical foundations and advances, empirical measurement and application in treatment and continuing care settings. We next introduced four primary areas for addiction science to address, namely: (i) conceptual development (e.g. how RC domains are unique, but interrelated entities, valence of RC), (ii) empirical testing, adequacy of measurement and analysis, (iii) directions for novel application in treatment and recovery settings and (iv) dissemination and communication to policy, practice and lived experience groups. In this review, we also focussed on some of the challenges that must be addressed for a science of RC, which could produce long-term impact in treatment and policy. RESULTS Despite burgeoning empirical work on RC, its application and translation has been unsystematic. The field currently relies on self-report questionnaires for the development of the theory and quantification of RC. Therefore, there is an urgent need for rigorous and systematic conceptual and empirical development of RC. CONCLUSIONS A formal collaboration between scholars, practitioners and experts by experience worldwide would move recovery capital forward in an empirically driven and culturally appropriate manner, as would testing its applicability at individual, organisational and societal levels.
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Affiliation(s)
- David Best
- Criminology and Social Sciences, University of Derby, Derby, UK
| | - Emily A. Hennessy
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts, USA
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Hennessy EA, Jurinsky J, Simpson H, Nash A. Parenting to provide social recovery capital: A qualitative study. ADDICTION RESEARCH & THEORY 2022; 30:368-374. [PMID: 36310769 PMCID: PMC9616104 DOI: 10.1080/16066359.2022.2055000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 06/10/2023]
Abstract
BACKGROUND Although research demonstrates the necessity of social recovery capital (SRC) for youth in recovery, through having family that do not use substances and who support their recovery, the ways in which parents actually enact SRC have not been empirically examined. This qualitative study applied the Recovery Capital Model for Adolescents to group interview data from parent(s) of youth who resolved a substance use disorder (SUD) to explore the ways parents enacted SRC. METHOD The interviews were conducted in a prior ethnographic study in which parents of alternative peer group (APG) alumni volunteered to participate in a group interview; five mothers and five fathers of APG alumni participated in the interviews (n=10). Three investigators analyzed the interview transcripts using the constant comparative method to identify family SRC and the specific components parents supported their child's recovery. RESULTS The primary themes of parent support of SRC included locus of control, parent growth, and sober/supportive home. Locus of control included parent strategies to leverage youth's participation in treatment/recovery. Parent growth focused on the process of change parents described: from denial to developing insight and learning how to parent a child in addiction. Supportive and structured family included time spent with youth in recovery-related activities and improved communication and relationships. CONCLUSIONS Together, these themes suggest a process of parent change that supports an adolescent's recovery trajectory and increases parenting skills and coping. These themes also highlight how the APG structure enabled this process, generating potential hypotheses for future recovery-oriented research to address.
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Affiliation(s)
- Emily A Hennessy
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, MA USA
| | | | - Hazel Simpson
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, MA USA
| | - Angela Nash
- The University of Texas Health Science Center, Houston, TX, USA
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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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Abstract
Although rates of alcohol and other substance use disorders in adolescents have been estimated for decades, little is known about the prevalence, pathways, and predictors of remission and long-term recovery among adolescents. This article provides an integrative review of the literature on youth recovery. A final selection of 39 relevant articles was grouped into five sections: treatment outcomes, special emphasis populations, recovery-oriented systems of care, families, and non-abstinence-based approaches. The review recommends more adolescent research in three basic areas: more research about medication-assisted treatment and recovery as well as harm reduction approaches for adolescents; expansion of research on recovery practices for youth who do not receive treatment due to personal choice or societal disparities; and more life course research, which may begin with adolescent participants and extend across the life span. Additionally, the authors suggest the recovery capital model for adolescents and the neuroscience of addiction may provide additional precision and direction for the study of youth recovery.
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Affiliation(s)
- Andrew J Finch
- Department of Human and Organizational Development, Vanderbilt University, Nashville, Tennessee
| | - Jordan Jurinsky
- Department of Human and Organizational Development, Vanderbilt University, Nashville, Tennessee
| | - Billie May Anderson
- Department of Human and Organizational Development, Vanderbilt University, Nashville, Tennessee
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Nash AJ, Hennessy EA, Collier C, Kelly JF. Young People’s Perceptions of the 12-Steps’ Role in Supporting Their Recovery (or Not). JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2020. [DOI: 10.1080/1067828x.2020.1766619] [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)
- Angela J. Nash
- The University of Texas Health Science Center, Houston, TX, USA
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Smith NZ, Vasquez PJ, Emelogu NA, Hayes AE, Engebretson J, Nash AJ. The Good, the Bad, and Recovery: Adolescents Describe the Advantages and Disadvantages of Alternative Peer Groups. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2020; 14:1178221820909354. [PMID: 32231433 PMCID: PMC7092379 DOI: 10.1177/1178221820909354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 11/16/2022]
Abstract
In 2017, approximately 1.5 million American adolescents had a substance use disorder (SUD). Adolescents with SUD risk hindering their neurological development, which can result in problems with memory and self-regulation, and in turn disrupt their education, relationships, and life opportunities. Treating adolescents with SUD is challenging. Thus, effective models that help adolescents engage in long-term recovery are needed. The Alternative Peer Group (APG) is an adolescent recovery support model that incorporates pro-recovery peers and sober social activities into standard continuing care practices. In this qualitative study thematic content analysis methods were used to explore transcripts from in-depth interviews with adolescent APG participants collected in a prior study. The aim of this secondary analysis was to get a clear understanding of adolescents’ perceptions of the advantages and disadvantages of APGs for supporting SUD recovery. Findings suggest that pro-recovery peer and adult role models, structured activities and a positive social climate that promotes fun, a sense of belonging, and accountability are continuing care elements that are likely to help adolescents resolve their ambivalence about SUD recovery and increase their motivation to engage in the hard work of recovery. These findings can inform the design of effective recovery support model services that promote long-term recovery for adolescents with SUD.
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Affiliation(s)
- Nina Zy Smith
- Houston (UTHealth) School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, USA
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Nash AJ. The Twelve Steps and Adolescent Recovery: A Concise Review. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2020; 14:1178221820904397. [PMID: 32071541 PMCID: PMC6997953 DOI: 10.1177/1178221820904397] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/13/2020] [Indexed: 12/31/2022]
Abstract
Recovery and long-term remission are the goals of treatment for substance use disorders, yet the majority of treated adolescents never stop using or resume using substances quickly after treatment. Thus, continuing care or recovery support services are common post-treatment recommendations for this group. Almost half of people who resolved significant substance use problems did so through participation in 12-step programs like Alcoholics Anonymous or Narcotics Anonymous. These recovery support programs are available online and in communities around the world. Yet <2% of these programs' members are under 21 years old. To help clinicians understand the 12-step explanatory model and facilitate clinical decision making on whether or when to refer individuals to these groups, this article summarizes the 12-step philosophy and practices and provides a concise review of research on adolescents' involvement in 12-step groups, including qualitative work that illuminates adolescents' reasons for resisting or engaging in 12-step practices.
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Affiliation(s)
- Angela J Nash
- Cizik School of Nursing, University of Texas Health Science Center, Houston, TX, USA
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