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Kelly JF, Levy S, Matlack M. A systematic qualitative study investigating why individuals attend, and what they like, dislike, and find most helpful about, smart recovery, alcoholics anonymous, both, or neither. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 161:209337. [PMID: 38492804 PMCID: PMC11090757 DOI: 10.1016/j.josat.2024.209337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 03/01/2024] [Accepted: 03/12/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Some individuals seeking recovery from alcohol use disorder (AUD) attend Alcoholics Anonymous (AA) while others choose newer alternatives such as Self-Management and Recovery Training ("SMART" Recovery). Some even attend both, while some choose not to attend either. Little is known about why people choose which pathway(s), and what they like, dislike, and find helpful. Greater knowledge could provide insights into the phenomenology of recovery experiences and enhance the efficiency of clinical linkage to these resources. METHODS Cross-sectional, qualitative, investigation (N = 80; n = 20 per condition; 50%female) of individuals attending either AA-only, SMART-only, both, or neither. Participants were asked why they initially chose that pathway, what they like and dislike, and what helps. Responses were coded using an inductive grounded theory approach with utterances recorded and categorized into superordinate domains and rank-ordered in terms of frequency across each question and recovery pathway. RESULTS AA participants reported attending due to, as well as liking and finding most helpful, the common socio-community aspects, whereas SMART attendees went initially due to, as well as found most helpful, the different format as well as the CBT/science-based approach. Similar to AA, however, SMART participants liked the socio-community aspects most. "Both" participants reported liking and finding helpful these perceived relative strengths of each organization. "Neither" participants reported reasons for non-attendance related to lower problem severity - perceiving no need to attend, and anxiety about privacy, but reported using recovery-related change strategies similar to those prescribed by AA, SMART and treatment (e.g., stimulus control, competing behaviors). Common dislikes for AA and SMART centered around irritation due to other members behaviors, a need for more SMART meetings, and negative experiences with SMART facilitators. CONCLUSION Common impressions exist among individuals selecting different recovery pathway choices, but also some differences in keeping with the group dynamics and distinct approaches inherent in AA and SMART. AA attendees appear to go initially for the recovery buoyancy derived from the social ethos and camaraderie of lived experience and may end up staying for the same reason; those choosing SMART, in contrast, appear to attend initially for the CBT/science-based content and different approach but, like AA participants, may end up staying due to the same camaraderie of lived experience. Those participating in both AA and SMART appear to capitalize on the strengths of each organization, suggesting that some can psychologically accommodate and make use of theoretically distinct, and sometimes opposing, philosophies and practices.
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Affiliation(s)
- John F Kelly
- Massachusetts General Hospital, Psychiatry Department, United States of America; Harvard Medical School, Department of Psychiatry, United States of America.
| | - Samuel Levy
- Massachusetts General Hospital, Psychiatry Department, United States of America
| | - Maya Matlack
- Massachusetts General Hospital, Psychiatry Department, United States of America
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Bergman BG, Greene MC, Zemore SE, Kelly JF. Prevalence and correlates of 12-step and second-wave mutual-help attendance in a nationally representative US sample. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:545-555. [PMID: 38246752 PMCID: PMC10939786 DOI: 10.1111/acer.15268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/20/2023] [Accepted: 01/07/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Mutual-help organizations (MHOs) are effective community-based, recovery support options for individuals with alcohol and other drug use disorders (i.e., substance use disorder; SUD). Greater understanding of second-wave MHOs, such as SMART Recovery, can help build on existing research that has focused primarily on 12-step MHOs, such as Alcoholics Anonymous, to inform scientific, practice, and policy recommendations. METHODS We conducted a secondary analysis of the National Recovery Study, a representative sample of US adults who resolved a substance use problem (N = 1984). Using survey-weighted estimates, we examined descriptive statistics for any lifetime, weekly lifetime, and past 90-day MHO attendance; we compared rates of 12-step and second-wave MHO attendance over time by descriptively examining distributions for calendar year of the first meeting attended. We also used two logistic regression models to examine demographic, substance use, clinical, and recovery-related correlates of weekly lifetime attendance separately for 12-step (n = 692) and second-wave MHOs (n = 32). RESULTS For any attendance, 41.4% attended a 12-step MHO and 2.9% a second-wave MHO; for weekly attendance, 31.9% attended a 12-step MHO, and 1.7% a second-wave MHO. Two-thirds (64%) of initial second-wave attendance occurred between 2006 and 2017 compared to 22% of initial 12-step attendance during this time frame. Significant correlates of weekly 12-step MHO attendance included histories of SUD treatment and arrest. Significant correlates of weekly second-wave MHO attendance included Black identity (vs. White) and history of SUD medication. CONCLUSIONS Attendance at second-wave MHOs is far less common than 12-step MHOs, but appears to be on the rise. Observed correlates of second-wave MHO attendance should be replicated in larger second-wave MHO samples before integrating these findings into best practices. Enhanced linkages from clinical and criminal justice settings to both second-wave and 12-step groups may help to "broaden the base" of MHOs.
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Affiliation(s)
- Brandon G Bergman
- Recovery Research Institute, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - M Claire Greene
- Program on Forced Migration and Health, Columbia University Mailman School of Public Health, New York, New York, USA
| | | | - John F Kelly
- Recovery Research Institute, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
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Liu P, Korthuis PT, Buchheit BM. Novel Therapeutic and Program-Based Approaches to Opioid Use Disorders. Annu Rev Med 2024; 75:83-97. [PMID: 37827194 DOI: 10.1146/annurev-med-050522-033924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Opioid use disorder continues to drive overdose deaths in many countries, including the United States. Illicit fentanyl and its analogues have emerged as key contributors to the complications and mortality associated with opioid use disorder. Medications for opioid use disorder treatment, such as methadone and buprenorphine, are safe and substantially reduce opioid use, infectious complications, and mortality risk, but remain underutilized. Polysubstance use and emerging substances such as xylazine and designer benzodiazepines create additional treatment challenges. Recent clinical and policy innovations in treatment delivery, including telemedicine, bridge clinics, and expanded models for accessing methadone have the potential to increase access to life-saving care for people living with opioid use disorder.
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Affiliation(s)
- Patricia Liu
- Section of Addiction, Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA;
| | - P Todd Korthuis
- Section of Addiction, Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA;
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
| | - Bradley M Buchheit
- Section of Addiction, Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA;
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
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Apsley HB, Santos-Lozada AR, Gray J, Hard G, Jones AA. Substance Use Treatment Utilization Among Individuals With Substance Use Disorders in the United States During the COVID-19 Pandemic: Findings on the Role of Polysubstance Use, Criminal Justice Involvement, and Mental Illness From the National Survey on Drug Use and Health. SUBSTANCE USE : RESEARCH AND TREATMENT 2024; 18:29768357241259947. [PMID: 38881556 PMCID: PMC11177729 DOI: 10.1177/29768357241259947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 05/21/2024] [Indexed: 06/18/2024]
Abstract
This study used the National Survey on Drug Use and Health to assess a nationally representative sample (N = 4596) weighted to represent 35.2 million adults with DSM-5 criteria-determined substance use disorders (SUDs). This study explored substance use treatment utilization in 2020, emphasizing populations with high vulnerability (e.g., criminal justice involvement (CJI) through parole or probation, polysubstance use, severe mental illness, and HIV/STI). Substance use treatment was broadly defined (any inpatient, outpatient/doctor's office, self-help/other for alcohol/drugs). Our results indicated that among adults with SUDs in 2020, 7 million (20%) had multiple SUDs, 1.75 million (5%) had CJI, 5.3 million (15%) had a severe mental illness, and 1.8 million (5%) had a diagnosis of HIV/STI in the last year. Only 7% of individuals with SUD sought any substance use treatment in the past year. CJI (aOR: 13.39, 95% CI: [7.82, 22.94]), serious mental illness (aOR: 3.27, 95% CI: [1.93, 5.55]), and having both 2 (aOR: 2.10, 95% CI: [1.29, 3.42]) or 3 or more SUDs (aOR: 3.46, 95% CI: [1.82, 6.58]) were all associated with a greater likelihood of receiving treatment. Marriage (aOR: 0.43, 95% CI: [0.25, 0.74]) and having an income twice the poverty threshold (aOR: 0.53, 95% CI: [0.29, 0.94]) were associated with reduced odds of receiving any substance use treatment. Compared to those 18 to 25, older individuals had increased odds (2-4 times) of receiving treatment. Interventions are crucially needed to increase access to treatment among those with SUDs.
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Affiliation(s)
- Hannah B. Apsley
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, USA
| | - Alexis R. Santos-Lozada
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, USA
| | - Joy Gray
- Department of Educational Psychology, Counseling, & Special Education College of Education, Pennsylvania State University, University Park, PA, USA
| | - Gregory Hard
- MGH Institute of Health Professions, Boston, MA, USA
| | - Abenaa A. Jones
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, USA
- Consortium on Substance Use and Addiction, Penn State University, University Park, PA, USA
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Zhu L, Xu M, Ruan T, Huang X, Cen J. The role of patient volunteers in Fangcang Shelter Hospital during the Omicron wave of COVID-19 pandemic in Shanghai, China: a qualitative study. Front Public Health 2023; 11:1215030. [PMID: 37900044 PMCID: PMC10600484 DOI: 10.3389/fpubh.2023.1215030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
Objective During the Omicron wave of the COVID-19 pandemic in Shanghai, Fangcang Shelter Hospital (FSH) served as the major way in patient quarantine. Many COVID patients served as volunteers in FSH providing a lot of assistance for the medical workers and other COVID patients. The aim of this study was to explore the experiences of patient volunteers in FSH. It helps health professionals better understand their motivational incentives and barriers in their volunteer work, and improves recruiting and managing volunteers in subsequent public health emergencies. Methods This is a qualitative study using semi-structured interviews. Thirteen patient volunteers working in an FSH in Shanghai were included. Thematic analysis was applied to data analysis. Results Four themes and nine subthemes were identified. The wishes to give back to society and the responsibility of politics and religion were the main reasons for the patients to serve as volunteers in FSH. The patient volunteers served as the bridge to reduce the communication barriers between other patients and healthcare professionals. They also provided support in supply distribution and psychological counseling. They viewed voluntary work as a usual task and tried to solve the barriers in their work. In turn, the voluntary work brought them benefits in mental and physical health, as well as another chance for growth. Conclusion Working as volunteers in FSHs not only brought personal benefits to the COVID patients but also fulfilled the needs of the healthcare system during public health emergencies. The mode of mutual help between patients could be taken as an example in other public health emergencies.
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Affiliation(s)
- Lingyan Zhu
- Department of Nursing, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Mengqi Xu
- School of Nursing, Shanghai Jiaotong University, Shanghai, China
| | - Tiantian Ruan
- School of Nursing, Shanghai Jiaotong University, Shanghai, China
| | - Xiaoli Huang
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jue Cen
- Office of Administration, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
- China Hospital Development Institute, Shanghai Jiaotong University, Shanghai, China
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McCurdy LY, Kong G, Krishnan-Sarin S, Kiluk BD, Potenza MN. A non-randomized pilot study protocol of a novel social support intervention for individuals in early recovery from hazardous alcohol use. PLoS One 2023; 18:e0292293. [PMID: 37796784 PMCID: PMC10553253 DOI: 10.1371/journal.pone.0292293] [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: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Connecting individuals to recovery support services such as recovery community centers and mutual help organizations can be crucial for sustaining recovery from addiction. However, there may be barriers to engagement with recovery support services on individual (e.g., limited motivation) and structural (e.g., limited information on recovery resources) levels. This pilot study will determine the feasibility and acceptability of a novel online social support intervention (Let's Do Addiction Recovery Together!, abbreviated as LDART) that uses pre-recorded videos created by members from several recovery support services to help individuals in early recovery from hazardous alcohol use sustain motivation during recovery and introduce them to freely available recovery support services in the community. METHODS AND ANALYSIS This will be a non-randomized mixed-method pilot study. We will recruit 30 adults who engaged in past-year hazardous alcohol use and have some desire to cut down or quit to use LDART every night for a month. A subset of these participants will be invited to participate in a semi-structured qualitative interview after completing the study. Primary outcomes will be feasibility parameters such as recruitment and retention rates, and acceptability measures such as frequency of intervention use. Secondary outcomes will include self-reported changes in alcohol use, engagement in recovery support services, and quality of life at one-month post-intervention relative to baseline. DISCUSSION Results of this pilot study will inform a randomized controlled trial to examine efficacy of this intervention, with the goal of creating an accessible and scalable intervention that has direct benefits on individuals who want to cut down or quit problematic alcohol use. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT06022107.
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Affiliation(s)
- Li Yan McCurdy
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Grace Kong
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Suchitra Krishnan-Sarin
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Brian D. Kiluk
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Marc N. Potenza
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Neuroscience, Yale School of Medicine, New Haven, Connecticut, United States of America
- Wu Tsai Institute, Yale University, New Haven, Connecticut, United States of America
- Connecticut Mental Health Center, New Haven, Connecticut, United States of America
- Connecticut Council on Problem Gambling, Wethersfield, Connecticut, United States of America
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Manning V, Roxburgh AD, Savic M. Piloting the integration of SMART Recovery into outpatient alcohol and other drug treatment programs. Addict Sci Clin Pract 2023; 18:52. [PMID: 37674227 PMCID: PMC10481580 DOI: 10.1186/s13722-023-00406-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 08/15/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Research suggests peer support groups can amplify and extend treatment effects and enhance long-term recovery from Alcohol and Other Drug (AOD) problems. However, they are rarely integrated into outpatient treatment programs, resulting in a missed opportunity for peer-to-peer learning, and increased connection to others social networks where people want to reduce or cease substance use. METHOD In this mixed-methods study, we examined the uptake, participant experiences and impacts of Self-Management and Recovery Training (SMART) when embedded in three public AOD treatment programs in a pilot program in Australia. Groups were delivered initially in-person but transitioned online during the COVID-19 pandemic. RESULTS A total of 75 SMART Recovery groups were run by the pilot sites, with an average attendance of 6.5 people per meeting. Among Participants (N = 31) who completed the survey, 94% reported benefits relating to substance use (i.e., reduction/ successful maintenance of abstinence), 71% reported improvements in their mental health and wellbeing, 74% reported improvements in their physical health, and 81% reported feeling better connected with others. In-depth qualitative interviews were conducted with 10 participants to explore their experiences. Thematic analysis revealed four themes: motivation to attend, active ingredients, views on the integration of SMART into formal AOD, and the advantages and disadvantages of online groups. CONCLUSION Taken together, these findings suggest embedding SMART Recovery in AOD treatment is a worthwhile endeavour. This was indicated by a good uptake and evidence of multiple and unique benefits to participants over and above their usual care, notably, better management of their AOD use, health, wellbeing, and sense of connection with others.
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Affiliation(s)
- V Manning
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Clayton, Australia
- Turning Point, Eastern Health, Box Hill, Australia
| | - A D Roxburgh
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Clayton, Australia.
- Turning Point, Eastern Health, Box Hill, Australia.
| | - M Savic
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Clayton, Australia
- Turning Point, Eastern Health, Box Hill, Australia
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Muhlner K, DeFlavio J, Ang A, Zito M, McLellan AT, Perrochet B. Demonstration of an app-delivered digital therapeutic program for methamphetamine use disorder. Front Psychiatry 2023; 14:1176641. [PMID: 37520220 PMCID: PMC10373299 DOI: 10.3389/fpsyt.2023.1176641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
This study assessed the feasibility and utility of a digital, all-virtual program designed for treatment of methamphetamine use disorder (MUD). Forty-nine adults with moderate- to severe-level MUD (per DSM-5 criteria) commenced the 8-week intervention. All aspects of the program were delivered via smartphone-based app. Intervention components included counseling (cognitive behavioral therapy in group and individual sessions), app-based therapeutic tasks, remote biological drug testing, medical oversight by psychiatrists/nurse practitioners, and contingency management procedures (including rewards for methamphetamine-free saliva drug tests, accomplishing tasks, and engaging in assigned activities). Of the 49 participants who commenced treatment, 27 participants (55%) completed the program. Repeated-measures mixed-model analyses show that participants were more likely to test negative for meth use from week 1 to week 8 (OR = 1.57, 95% CI [1.28, 1.97]; p = 0.034). Well-being and social functioning improved among the majority of participants. These results demonstrate the utility of the all-virtual, digital therapeutic program and its ability to help individuals with MUD to reduce or cease methamphetamine use. The program was efficiently implemented and was well received by participants and clinical personnel, indicating its ability to deliver comprehensive, effective care and to retain the difficult-to-engage population of persons with MUD. Of the 27 completers, 16 responded to a 1-month follow-up survey and reported no meth use in the month since completing the program.
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Affiliation(s)
| | - Jeff DeFlavio
- Affect Therapeutics, Inc., New York, NY, United States
| | - Alfonso Ang
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, United States
| | - Michael Zito
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, United States
| | | | - Brian Perrochet
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, United States
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Husain JM, Cromartie D, Fitzelle-Jones E, Brochier A, Borba CPC, Montalvo C. A qualitative analysis of barriers to opioid agonist treatment for racial/ethnic minoritized populations. J Subst Abuse Treat 2023; 144:108918. [PMID: 36403456 DOI: 10.1016/j.jsat.2022.108918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 08/17/2022] [Accepted: 10/23/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Clinical guidelines strongly recommend opioid agonist treatment (OAT) as first-line treatment for opioid use disorder (OUD). However, racial/ethnic minoritized patients are less likely to receive OAT compared to non-Hispanic White patients. Reasons for this treatment gap must be elucidated to address racial/ethnic disparities in OAT. Our objective is to evaluate perceptions of and barriers to OAT across racial/ethnic groups in individuals with OUD (not on OAT). METHODS This qualitative study used semi-structured telephone interviews of adult patients (n = 41) with OUD (not currently being treated with OAT) from the Boston area from September 2020 through February 2021. We developed a codebook through author consensus based on review of themes in initial transcripts. We performed qualitative thematic analysis of the transcripts. We evaluated patients' perceptions of treatment for OUD across the study population and analyzed differences and similarities in perceptions between racial and ethnic groups. RESULTS Across all racial/ethnic categories in our sample, anticipated stigma was the most frequently reported barrier to OAT and most patients preferred non-OAT methods for treatment. Non-Hispanic White participants had more favorable opinions of OAT compared to racial/ethnic minoritized participants. Racial/ethnic minoritized participants reported social support as the main facilitator to addiction treatment, while non-Hispanic White participants reported self-motivation as the most important factor. Racial/ethnic minoritized participants preferred treatment for OUD via non-OAT treatments and their second most preferred option was residential treatment. Non-Hispanic White participants preferred naltrexone and their second most preferred option was non-OAT treatments. CONCLUSIONS Racial/ethnic minoritized patients' preference for residential treatment and social support, along with their distrust of OAT, illustrates a desire for psychosocial and peer recovery-based care that addresses social determinants of health. Addiction specialists may improve engagement with and treatment of racial/ethnic minoritized groups with culturally tailored interventions for OUD that offer psychosocial treatment in combination with OAT, and by partnering with organizations with strong ties to racial/ethnic minoritized communities. This kind of response would reflect the structural and cultural humility that is needed to adequately address the OUD needs of these underserved populations.
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Affiliation(s)
- Jawad M Husain
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; Department of Psychiatry, Mass General Brigham, Boston, MA, United States of America.
| | - Devin Cromartie
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States of America; Department of Psychiatry, Boston Medical Center, Boston, MA, United States of America
| | - Emma Fitzelle-Jones
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, United States of America
| | - Annelise Brochier
- Department of Pediatrics, Boston Medical Center, Boston, MA, United States of America
| | - Christina P C Borba
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States of America; Department of Psychiatry, Boston Medical Center, Boston, MA, United States of America
| | - Cristina Montalvo
- Department of Psychiatry, Tufts University School of Medicine, Boston, MA, United States of America; Department of Psychiatry, Tufts Medical Center, Boston, MA, United States of America
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Hefner K, Choo TH, Shmueli-Blumberg D, Pavlicova M, King J, Fishman M, Shulman M, Campbell A, Greiner M, Scodes J, Meyers-Ohki S, Novo P, Nunes E, Rotrosen J. Time-lagged association between counseling and/or 12-Step attendance with subsequent opioid use in a secondary analysis from a randomized, clinical trial of medications for opioid use disorder. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100100. [PMID: 36644220 PMCID: PMC9838184 DOI: 10.1016/j.dadr.2022.100100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 09/16/2022] [Accepted: 09/26/2022] [Indexed: 01/19/2023]
Abstract
Introduction Psychosocial support is recommended in conjunction with medication for opioid use disorder (MOUD), although optimal "dose," modality, and timing of participation is not established. This study comprised a secondary analysis of counseling and 12-Step attendance and subsequent opioid use in a MOUD randomized clinical trial. Methods The parent study randomly assigned 570 participants to receive buprenorphine-naloxone (BUP-NX, n=287) or extended-release injectable naltrexone (XR-NTX, n=283). Mixed-effects logistic regression models were fit with opioid use as the response variable, and a counseling/12-Step attendance predictor. Differences by treatment assignment were examined. Results Any counseling or 12-Step attendance was associated with reduced odds of opioid use at the subsequent visit, whether considered individually or aggregated across type. A continuous relationship was observed for 12-Step attendance (F(1,5083)=5.01, p=.025); with each additional hour associated with 13% (95% CI: 0.83, 0.90) reduction in odds of opioid use. The strength of this association grew over time. In the BUP-NX arm, group counseling was associated with a greater reduction in odds of opioid use than for XR-NTX, (OR=0.32 (95% CI: .22, 0.48) vs. OR=0.69 (95% CI: 0.43, 1.08)). For XR-NTX, 12-Step was associated with a greater reduction in odds of opioid use (OR=0.35 (95% CI: 0.22, 0.54) vs. OR=0.65 (95% CI: 0.47, 0.89) for BUP-NX)). Conclusions Psychosocial engagement has a proximal association with opioid use, the strength of that association may grow with dose and time. Alternatively, more motivated individuals may both attend more counseling/12-Step and have better treatment outcomes, or the relationship may be reciprocal.
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Affiliation(s)
- Kathryn Hefner
- NIDA Data and Statistics Center for the NIDA CTN, The Emmes Company, LLC, 401 N Washington St, Rockville, MD 20850, United States
| | - Tse-Hwei Choo
- Department of Psychiatry, Columbia University, United States
| | - Dikla Shmueli-Blumberg
- NIDA Data and Statistics Center for the NIDA CTN, The Emmes Company, LLC, 401 N Washington St, Rockville, MD 20850, United States
| | - Martina Pavlicova
- Department of Biostatistics, Mailman School of Public Health, Columbia University, United States
| | - Jacquie King
- NIDA Data and Statistics Center for the NIDA CTN, The Emmes Company, LLC, 401 N Washington St, Rockville, MD 20850, United States
| | | | - Matisyahu Shulman
- Department of Psychiatry, Columbia University, United States
- New York State Psychiatric Institute, United States
| | - Aimee Campbell
- Department of Psychiatry, Columbia University, United States
- New York State Psychiatric Institute, United States
| | - Miranda Greiner
- Department of Psychiatry, Columbia University, United States
- New York State Psychiatric Institute, United States
| | - Jennifer Scodes
- Department of Psychiatry, Columbia University, United States
- New York State Psychiatric Institute, United States
| | | | - Patricia Novo
- New York University Grossman School of Medicine, United States
| | - Edward Nunes
- Department of Psychiatry, Columbia University, United States
- New York State Psychiatric Institute, United States
| | - John Rotrosen
- New York University Grossman School of Medicine, United States
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Timko C, Vest N, Cucciare MA, Smelson D, Blonigen D. Substance use and criminogenic thinking: Longitudinal latent class analysis of veterans with criminal histories. J Subst Abuse Treat 2022; 143:108893. [PMID: 36215912 PMCID: PMC9940453 DOI: 10.1016/j.jsat.2022.108893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 08/02/2022] [Accepted: 09/19/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The objective of this study was to inform clinical practice by identifying distinct subgroups of US veterans with criminal histories in residential mental health treatment. The study characterized veteran patients on their alcohol and drug use and criminogenic thinking. We also examined predictors and outcomes of subgroup membership. METHODS Participants were 341 veterans with a criminal history in residential mental health care. A parallel latent growth trajectory model characterized participants' alcohol and drug use and criminogenic thinking at treatment entry and at 6- and 12-month follow-ups. RESULTS The study identified four distinct classes: 53 % Normative Improvement, 27 % High Criminogenic Thinking, 11 % High Recurrence (of substance use), and 9 % High Drug Use. Compared to the Normative Improvement class, prior to treatment entry, patients in the High Recurrence class were less likely to be on parole or probation, and patients in the High Criminogenic Thinking class were more likely to be chronically homeless. Compared to the Normative Improvement class, at follow-ups, patients in the High Drug Use and High Criminogenic Thinking classes were more likely to recidivate, and patients in the High Drug Use class were more likely to report unstable housing. Depression scores were higher (nearly double) in the High Drug Use, High Recurrence, and High Criminogenic Thinking classes at follow-ups compared to the Normative Improvement class. CONCLUSIONS That the Normative Improvement class entered mental health residential treatment with relatively low alcohol and drug use and criminogenic thinking, and sustained these low levels, suggests that treatment does not need to be broadened or intensified to improve these domains for these patients with criminal histories. In contrast, findings for the High Drug Use, High Recurrence, and High Criminogenic Thinking classes, which composed 47 % of the sample, suggest that more integrated and sustained treatment may be needed to reduce recidivism, depression, and homelessness among these patients.
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Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Noel Vest
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Michael A Cucciare
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR 72205, USA; Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72205, USA
| | - David Smelson
- HSR&D Center for Health Care Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA 01730, USA; University of Massachusetts Chan Medical School, Worcester, MA 01655,. USA
| | - Daniel Blonigen
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
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Majer JM, Jason LA, Bobak TJ. Understanding recovery Capital in relation to categorical 12-Step involvement and abstinence social support. ADDICTION RESEARCH & THEORY 2022; 30:207-212. [PMID: 36275074 PMCID: PMC9585994 DOI: 10.1080/16066359.2021.1999935] [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: 07/06/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 05/28/2023]
Abstract
Background Although recovery capital represents various resources for persons recovering from substance use disorders, measures of this construct examine components that might not necessarily reflect the recovery goals of individuals who base their recovery through involvement in 12-step groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). It is not clear whether 12-step involvement is related to recovery capital, particularly among individuals living in recovery homes who utilize social networks of recovering peers for their recovery. Thus, categorical involvement in a set of 12-step activities was examined in relation to recovery capital and abstinence social support. Methods Differences in terms of general (recovery capital scores, retention rates) and abstinence-specific (abstinence social support) resources were examined in relation to recovery home residents who were (n = 395) and were not (n = 232) categorically involved in their 12-step recovery. Results Residents with categorical 12-step involvement reported significantly higher levels of recovery capital and abstinence social support, and there was no significant difference observed in retention rates between residents who were/were not categorically involved in 12-step groups. Conclusions Findings suggest community resources such as recovery homes and categorical involvement in 12-step groups are important recovery capital components that help individuals who use a 12-step approach to their recovery. Recovery capital among those involved with 12-step fellowships such as AA and NA should be assessed by examining abstinence-specific components such as representative involvement in 12-step groups and social support that is abstinence-specific.
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Affiliation(s)
- John M. Majer
- Social and Behavioral Sciences Department, Harry S. Truman College, Chicago, IL, USA
| | - Leonard A. Jason
- Center for Community Research, DePaul University, Chicago, IL, USA
| | - Ted J. Bobak
- Center for Community Research, DePaul University, Chicago, IL, USA
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Hai AH, Oh S, Lee CS, Kelly JF, Vaughn MG, Salas-Wright CP. Mutual-help group participation for substance use problems in the US: Correlates and trends from 2002 to 2018. Addict Behav 2022; 128:107232. [PMID: 35042001 DOI: 10.1016/j.addbeh.2021.107232] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mutual-help groups (MHGs) are an integral component of the substance use disorder (SUD) treatment system in the U.S., and growing evidence suggests that they are effective and cost-effective for SUD-related problems. However, not much is known about the MHG participation patterns in the U.S. METHODS Using the 2002-2018 National Survey on Drug Use and Health data, we estimated the annual participation rates and examined the psycho-social-behavioral correlates of MHG participation using logistic regression. RESULTS There was no significant linear trend of MHG participation in the total US adult population between 2002 and 2018 (AOR = 0.999, 95% CI = 0.991-1.007). Among adults with past-year SUD, 4.8-7.4% of men and 4.4-6.7% of women participated in MHGs. MHG participants were more likely to be middle-aged (vs. young adults), lower education (less than high school, high school, some college vs. college or higher), lower income (annual household income <$20,000, $20,000-39,999 vs. $75,000 + ), be unemployed or not in the labor force (vs. employed), and were less likely to be Black/African American (vs. White American) and have lower English proficiency (speak English not well/not at all vs. very well/well),. CONCLUSION MHG participation rates have remained relatively stable over the past two decades. MHGs were utilized more by individuals with lower socioeconomic status indicators and more criminal/legal involvement, possibly due to MHGs' free accessibility. However, research is needed to understand why young adults, Black, and individuals with lower English proficiency are somewhat less likely to attend MHGs.
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Naserianhanzaei E, Koschate-Reis M. Effects of substance-use, recovery, and non-drug-related online community participation on risk of a use episode during remission from opioid use disorder (OUD): A longitudinal observational study (Preprint). J Med Internet Res 2022; 24:e36555. [PMID: 35994333 PMCID: PMC9446138 DOI: 10.2196/36555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/21/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Elahe Naserianhanzaei
- Department of Political Sciences, Faculty of Humanities, Arts and Social Sciences, University of Exeter, Exeter, United Kingdom
| | - Miriam Koschate-Reis
- Department of Psychology, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
- Institute for Data Science and Artificial Intelligence, University of Exeter, Exeter, United Kingdom
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Hajiha Z, Bahrami Ehsan H. Discovering the pros and cons of participation of Iranian women with substance use disorder in women's only narcotics anonymous meetings and offering strategies for harm reduction: A grounded theory study. J Ethn Subst Abuse 2021:1-21. [PMID: 34710000 DOI: 10.1080/15332640.2021.1982803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Women with substance use disorder participate in women's only narcotics anonymous meetings. Therefore, this study aimed to discover the advantages and disadvantages of Iranian women's participation in this type of meetings. Accordingly, this research was done in Behboud Gostaran Hamgam Women's Rehab Center in Tehran. The research method was a qualitative method of grounded theory, and samples of the research were chosen by theoretical sampling method. Data was collected using in-depth, face-to-face, unstructured interviews and nonparticipation observations. First, 4 women with substance use disorder who had referred to the center to quit addiction were interviewed. The researcher then interviewed 2 informant groups of the center's medical staff, consisting of 2 social workers and 2 mentors with long-term experience in the field of women's addiction, and at the end of each interview, the interviews were analyzed. Finally, according to theoretical sampling principles and achieving saturation, the researcher participated in the women's only narcotics anonymous meetings, which were held weekly inside the center, and took notes on the content of the sessions in relation to the purpose of the study. After each session, the notes were analyzed and finally, after participating in 4 sessions, saturation was achieved by the researcher. By analyzing the research data, the theme of pros of participating in the women's only narcotics anonymous meetings, and the theme of cons of participating in the women's only narcotics anonymous meetings were yielded. Using the research findings could enhance the quality of these meetings.
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Affiliation(s)
- Zoha Hajiha
- University of Tehran, Tehran, Iran (the Islamic Republic of)
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Vest N, Reinstra M, Timko C, Kelly J, Humphreys K. College programming for students in addiction recovery: A PRISMA-guided scoping review. Addict Behav 2021; 121:106992. [PMID: 34087765 PMCID: PMC8259809 DOI: 10.1016/j.addbeh.2021.106992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The health and well-being of students in recovery from substance use disorder are increasingly being recognized as a priority on college campuses. This scoping review maps the state of the existing literature evaluating collegiate recovery programming to highlight research gaps and inform policy. METHOD We conducted a systematic search of articles related to collegiate recovery programming published before August 2020. The 15 extracted study characteristics included publication type, study design, primary outcomes, reporting of behavioral addictions, mutual-help group attendance, sample demographic information, school size, ownership, and funding source. RESULTS The PRISMA-guided search strategy identified 357 articles for abstract review; of 113 articles retained for full-text review, 54 studies met criteria for inclusion. Primary outcomes were coded into four domains: clinical, recovery experience, program characterization, and stigma. Most (57%) used quantitative observational designs and 41% employed qualitative research designs. Government or foundation grants funded 11% of the studies. CONCLUSION The domains identified offer a framework for healthcare providers, college administrators, and researchers to understand and improve programs, thereby better serving this vulnerable student group.
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Affiliation(s)
- Noel Vest
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 401 Quarry Rd, Stanford, CA 94305, United States.
| | - Meg Reinstra
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 401 Quarry Rd, Stanford, CA 94305, United States
| | - Christine Timko
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 401 Quarry Rd, Stanford, CA 94305, United States; Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (152-MPD), Palo Alto, CA 94304, United States
| | - John Kelly
- Harvard Medical School, Boston, MA 02114, United States
| | - Keith Humphreys
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 401 Quarry Rd, Stanford, CA 94305, United States; Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (152-MPD), Palo Alto, CA 94304, United States
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Eddie D, White WL, Vilsaint CL, Bergman BG, Kelly JF. Reasons to be cheerful: Personal, civic, and economic achievements after resolving an alcohol or drug problem in the United States population. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2021; 35:402-414. [PMID: 33764087 PMCID: PMC8184567 DOI: 10.1037/adb0000689] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Alcohol and other drug (AOD) use disorders impose a prodigious personal and societal burden. While most remit, little is known about the achievements accrued as people accomplish and sustain addiction recovery. Greater knowledge regarding the nature and prevalence of such achievements, when such achievements occur, what factors influence accrual of achievements, and how such achievements relate to other indices of functioning would support treatment and policy planning, and may instill hope for individuals and families seeking AOD problem resolution. METHODS Nationally representative, cross-sectional survey of United States (US) population of persons who have overcome an AOD problem (N = 2,002), assessing individual factors and achievements in 4 domains: self-improvement; family engagement; civic, and economic participation. Logistic and linear regression models tested theorized associations among variables. RESULTS Most (80.1%) achieved at least one achievement associated with the 4 domains. A linear monotonic relationship was observed with greater achievements accruing with greater time in recovery. Accrual of achievements after AOD problem resolution was related to racial minority status, more education, earlier age of substance use initiation, illicit drugs as primary substance used, more years since resolving AOD problem, more psychiatric diagnoses, lower psychological distress, and regular 12-step program attendance. Multiple regression analyses found greater total achievements were independently associated with greater self-esteem, happiness, quality of life, and recovery capital. CONCLUSIONS Most individuals achieve an increasing number of achievements with time since AOD problem resolution, and these are associated with gains in measures of well-being that may support ongoing AOD problem remission, and recovery. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Online recovery support meetings can help mitigate the public health consequences of COVID-19 for individuals with substance use disorder. Addict Behav 2021; 113:106661. [PMID: 33038682 PMCID: PMC7493730 DOI: 10.1016/j.addbeh.2020.106661] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/28/2020] [Accepted: 09/13/2020] [Indexed: 01/27/2023]
Abstract
For people with current and remitted substance use disorder (SUD), the COVID-19 pandemic increases risk for symptom exacerbation and relapse through added stressors and reduced service access. In response, mutual-help groups and recovery community organizations have increased access to online recovery support meetings. However, rigorous studies examining online recovery support meeting participation to inform best practices have not yet been conducted. In the absence of such studies, a review of relevant literature, considered in context of potential barriers and drawbacks, suggests the risk-to-benefit ratio is favorable. Particularly given limited in-person SUD service access resulting from COVID-19 precautions, online recovery support meetings may help mitigate a key public health problem during an ongoing, public health pandemic.
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Williams IL. An Apologetic Interpretation of Alcoholics Anonymous (AA): Timeless Wisdom, Outdated Language. Subst Use Misuse 2021; 56:1079-1094. [PMID: 33970771 DOI: 10.1080/10826084.2021.1892134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Twelve Steps of Alcoholics Anonymous (AA) has proven to be an effective aid in recovery for many people with alcohol use disorder. While constructive criticisms of AA can be beneficial to the organization, other criticisms have merely served as rhetorical devices intent on discrediting the 12-step approach. OBJECTIVES This paper examines six prominent critiques of AA, paying special attention to the premises, tone, and factual basis of the statements. Interpretations grounded in AA literature are offered to address claims or critiques around prominent themes, which are organized into two main classes: purported causes of alcoholism and factors maintaining alcoholism. RESULTS Findings reveal tenuous statements in the AA literature that appear contradictory and thereby invite a misreading. These statements, some of which misrepresent the tenets of AA and its founders, underscore certain vocal criticisms that are not entirely unfounded. While many pages of the AA literature are imbued with timeless wisdom, even the most apologetic interpretations-distilled into benefit-of-the-doubt renderings-largely falter in defending the nature of the language that originated in the early 1900s at odds with 21st century understandings of alcohol use disorder. Conclusions/Importance: The AA literature essentially presents a valid target for critics, fueling resistance to this free community-based resource that may prevent people who could benefit from AA from seeking the help of the 12-steps.
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