Network measures of advice-seeking and resource sharing are related to well-being in recovery homes

Identifying and Characterizing Medical Advice-Seekers on a Social Media Forum for Buprenorphine Use

Background: Online communities such as Reddit can provide social support for those recovering from opioid use disorder. However, it is unclear whether and how advice-seekers differ from other users. Our research addresses this gap by identifying key characteristics of r/suboxone users that predict advice-seeking behavior. Objective: The objective of this analysis is to identify and describe advice-seekers on Reddit for buprenorphine-naloxone use using text annotation, social network analysis, and statistical modeling techniques. Methods: We collected 5258 posts and their comments from Reddit between 2014 and 2019. Among 202 posts which met our inclusion criteria, we annotated each post to determine which were advice-seeking (n = 137) or not advice-seeking (n = 65). We also annotated each posting user’s buprenorphine-naloxone use status (current versus formerly taking and, if currently taking, whether inducting or tapering versus other stages) and quantified their connectedness using social network analysis. To analyze the relationship between Reddit users’ advice-seeking and their social connectivity and medication use status, we constructed four models which varied in their inclusion of explanatory variables for social connectedness and buprenorphine use status. Results: The stepwise model containing “total degree” (p = 0.002), “using: inducting/tapering” (p < 0.001), and “using: other” (p = 0.01) outperformed all other models. Reddit users with fewer connections and who are currently using buprenorphine-naloxone are more likely to seek advice than those who are well-connected and no longer using the medication, respectively. Importantly, advice-seeking behavior is most accurately predicted using a combination of network characteristics and medication use status, rather than either factor alone. Conclusions: Our findings provide insights for the clinical care of people recovering from opioid use disorder and the nature of online medical advice-seeking overall. Clinicians should be especially attentive (e.g., through frequent follow-up) to patients who are inducting or tapering buprenorphine-naloxone or signal limited social support.

Latent profile analysis in recovery homes: A single quantitative dimension captures most but not all of the important details of the recovery process

Background: Our study explored whether latent classes adequately represented the social capital recovery indicators at the resident level and whether latent class membership predicted subsequent exits from the recovery homes. Method: Our sample included about 600 residents in 42 recovery homes. Over a 2-year period of time, every 4 months, data were collected on eight elements of recovery capital. Results: We found 5 latent classes were optimal for representing 8 elements of recovery capital. Representing 79% of the sample, 3 of the 5 latent class profiles of the means of the 8 recovery indicators were roughly parallel and differed only in level, but the remaining 2 latent class profiles, representing 21% of the sample, were not parallel to the first 3, suggesting that a single quantitative dimension of perceived recovery may capture most but not all of the important details of the recovery process. Next, using longitudinal data from homes, the distal outcomes of resident eviction and voluntary exit were found to be related to latent class membership. Resident level pre-existing predictors (e.g., employment status, educational attainment, gender, Latinx ethnicity) and house level pre-existing predictors (e.g., financial health, poverty level of typical population served, new resident acceptance rate) significantly discriminated the classes. In a model that combined both pre-existing predictors and distal outcomes, latent class membership was still the strongest predictor of evictions controlling for the pre-existing predictors. Conclusions: These classes help to clarify the different aspects of the recovery latent score, and point to classes that have different ethnic and gender characteristics as well as outcomes in the recovery homes. For example, the high levels of self-confidence found in class 3 suggest that Latinx might be at higher risk for having some difficulties within these recovery communities.

Willingness to Lend Resources is Associated with Increases in Recovery and Participation in Community Activities

Recovery homes may facilitate individuals with substance use disorders re-integration back into community settings by providing friendship, resources, and advice. Participants of the current study were over 600 residents of 42 Oxford House recovery homes. Findings indicated that willingness to share resources in the form of loans was associated with higher levels of house involvement in recovery home chapters. Active involvement in house and community affairs may influence more recovery within homes or may be an indicator of houses with residents with more capacities and skills for positive long-term health outcomes. Such findings suggest that recovery is a dynamic process with multiple ecological layers embedding individuals, their immediate social networks, and the wider community.

Dynamic Interdependence of Advice Seeking, Loaning, and Recovery Characteristics in Recovery Homes

Recovery homes in the US provide stable housing for over 200,000 individuals with past histories of homelessness, psychiatric co-morbidity and criminal justice involvement. We need to know more about how these settings help those remain in recovery. Our study measured advice seeking and willingness-to-loan relationships and operationalized them as a dynamic multiplex social network-multiple, simultaneous interdependent relationships--that exist within 42 Oxford House recovery homes over time. By pooling relationship dynamics across recovery houses, a Stochastic Actor-Oriented Modeling (SAOM) framework (Snijders et al., 2010) was used to estimate a set of parameters governing the evolution of the network and the recovery attributes of the nodes simultaneously. Findings indicated that advice and loan relationships and recovery-related attitudes were endogenously interdependent, and these results were affected exogenously by gender, ethnicity, and reason for leaving the recovery houses. Prior findings had indicated that higher advice seeking in recovery houses was related to higher levels of stress with more negative outcomes. However, the current study found that recovery is enhanced over time if advice was sought from residents with higher recovery scores. Our study shows that social embedding, i.e. one's position in relationship networks, affects recovery prospects. More specifically, the formation of ties with relatively more recovered residents as an important predictor of better outcomes.

Advice seeking and loaning of money related to relapse in recovery homes

Recovery homes help individuals who have completed substance use treatment programs re-integrate back into the community. However, it is unclear what factors determine who will succeed in these settings and how these factors may be reinforced or undermined by the social interactions and social networks between residents living in the Oxford House recovery homes. In an effort to better understand these factors, the current study evaluated (a) the extent to which the density of social networks (i.e., friendship, willingness to loan money, and advice-seeking relationships) is associated with social capital (i.e., sense of community, quality of life, hopefulness, self-efficacy), and (b) whether the density of social networks predicts relapse over time. Among the findings, willingness to loan money was positively associated with all four individual-level social capital variables, suggesting that availability of instrumental resources may be important to ongoing recovery. To test whether these house-level social network factors then support recovery, a survival analysis was conducted, finding associations between relapse risk and the network densities over a 28-month span. In particular, more dense advice-seeking networks were associated with higher rates of relapse, suggesting that the advice-seeking might represent a sign of organisational house problems, with many residents unsure of issues related to their recovery. In contrast, more dense loaning networks were associated with less relapse, so willingness to lend money could be measuring a willingness to help those in need. The implications of these findings are discussed.