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Bickel WK, Witkiewitz K, Athamneh LM, Kuhlemeier A. Recovery from alcohol use disorder: Reinforcer pathology theory, measurement, and methods. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024. [PMID: 39155126 DOI: 10.1111/acer.15406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 06/28/2024] [Indexed: 08/20/2024]
Abstract
Recovery from alcohol use disorder (AUD) is a dynamic process that often entails periods of drinking but has been defined primarily by abstinence. Recently, a broader interpretation of recovery was developed, including meeting the Diagnostic and Statistical Manual of Mental Disorders (DSM) remission criteria and improved psychosocial functioning. This new understanding of recovery has facilitated the development of novel theories and methodologies. This paper reviews a new theoretical perspective of recovery, Reinforcer Pathology, and two novel methodological approaches in light of this broader view of recovery. Using this theoretical framework as a foundation, we propose an alternative perspective to explain the recovery process as it relates to environmental factors and valuation of the future; we suggest that changing the environment in which substances are available (e.g., increasing non-alcohol-related activities) and extending one's temporal window are associated with improved recovery outcomes (e.g., remission and quality of life). In this review, we discuss two novel methodological approaches. The first uses latent profile analysis to show that using a measure of Relative Reinforcement Value of Alcohol-Free Activities is associated with a greater likelihood of belonging to a high functioning/infrequent heavy drinking recovery profile. The second developed an online national sample and used an accelerated longitudinal design to study longer-term recovery of up to 12 years over a 5-year study period. Reinforcer Pathology theory, novel methods, and measures may further our understanding of recovery and begin to address critical questions for future studies. Subsequent randomized clinical trials should examine whether the suggested targets and interventions based on the theoretical model improve recovery outcomes prospectively. Measuring and promoting alcohol-free activity engagement may facilitate improved recovery outcomes, while novel methodologies permit an understanding of returning to use or remission across different recovery durations.
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Affiliation(s)
- Warren K Bickel
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia, USA
| | | | - Liqa M Athamneh
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia, USA
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Headid RJ, Doane TC, Cohen BD, Smith EC, Redden D, Stoner AM. Identifying components of recovery capital that support substance use disorder treatment completion. Addict Behav Rep 2024; 19:100538. [PMID: 38495390 PMCID: PMC10940757 DOI: 10.1016/j.abrep.2024.100538] [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: 11/08/2023] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 03/19/2024] Open
Abstract
Purpose Individuals who do not complete substance use disorder treatment (SUDT) have similar outcomes to the untreated. Recovery capital (RC) is the collection of one's resources that contribute to the initiation and maintenance of sobriety. The aim of this paper was to identify individual measures of RC that are associated with SUDT completion. Methods RC data for 69 residents from a men's recovery center was obtained from questionnaires administered to residents at intake and after SUDT graduation or dismissal. Participant data was divided into two groups, Graduates (n = 39, age 35.87±10.83) and Non-Graduates (n = 30, age 34.35±14.44), and retrospectively analyzed to compare RC between groups at various points during SUDT and which RC measures are associated with SUDT completion. Results At baseline all participants reported limited RC and there was no significant difference in RC between groups. At graduation, Graduates reported significantly more RC in all measures when compared to baseline and Non-Graduates at dismissal. Non-Graduates reported a significant increase in Checking and Savings at dismissal but no other measure. Conclusion Baseline levels of RC in both groups were limited and not significantly different which limited the capacity of the study to identify measures of RC associated with SUDT completion. A lack of RC at onset of SUDT did not preclude SUDT completion and obtaining RC during SUDT was associated with completion as only Graduates reported increases in RC. Future study designs should include participants with variable amounts of RC when entering SUDT.
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Affiliation(s)
- Ronald J. Headid
- Edward Via College of Osteopathic Medicine-Carolinas Campus, 350 Howard St., Spartanburg, SC 29303, USA
| | - Trevor C. Doane
- Edward Via College of Osteopathic Medicine-Carolinas Campus, 350 Howard St., Spartanburg, SC 29303, USA
| | - Brett D. Cohen
- Edward Via College of Osteopathic Medicine-Carolinas Campus, 350 Howard St., Spartanburg, SC 29303, USA
| | - Emma C. Smith
- Edward Via College of Osteopathic Medicine-Carolinas Campus, 350 Howard St., Spartanburg, SC 29303, USA
| | - David Redden
- Edward Via College of Osteopathic Medicine-Auburn Campus, 910 S Donahue Dr., Auburn, AL 36832, USA
| | - Alexis M. Stoner
- Edward Via College of Osteopathic Medicine-Carolinas Campus, 350 Howard St., Spartanburg, SC 29303, USA
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Pettersen G, Bjerke T, Hoxmark EM, Eikeng Sterri NH, Rosenvinge JH. From existing to living: Exploring the meaning of recovery and a sober life after a long duration of a substance use disorder. NORDIC STUDIES ON ALCOHOL AND DRUGS 2023; 40:577-589. [PMID: 38045010 PMCID: PMC10688400 DOI: 10.1177/14550725231170454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Aim: The study explores how former patients with substance use disorder (SUD) experience the benefits and challenges of a reoriented identity and way of living. Methods: Semi-structured interviews were conducted with 10 participants who had completed treatment for SUD and considered themselves either recovered or in an ongoing rehabilitation process. Interview transcripts were analysed using the content analysis approach. Results: The analysis furthers our understanding of several purposeful aspects of a reorientation towards a sober life in terms of: (1) avoiding illegal drugs, (2) avoiding contact with the substance use relations and milieu, (3) renewing relations and social network, (4) daily occupation, (5) discovering the value of the great, little things in everyday life, (6) new coping strategies, and (7) developing a new identity. Conclusion: The study indicates that rehabilitation from SUDs should take a broader focus than just sobriety. With attention to the present findings, a focus on psychosocial aspects of recovery could contribute to a more overarching framework for SUD treatment.
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Affiliation(s)
- Gunn Pettersen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT – The Arctic University of Norway, Tromsø. Norway
| | - Trond Bjerke
- University Hospital of North Norway, Tromsø, Norway
| | | | | | - Jan H Rosenvinge
- Department of Psychology, Faculty of Health Sciences, UiT- The Arctic University of Norway, Tromsø, Norway
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Athamneh LN, King MJ, Craft WH, Freitas-Lemos R, Tomlinson DC, Yeh YH, Bickel WK. The Associations between Remission Status, Discounting Rates, and Recovery from Substance Use Disorders. Subst Use Misuse 2023; 58:275-282. [PMID: 36622296 DOI: 10.1080/10826084.2022.2161312] [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: 01/10/2023]
Abstract
Background: Recovery from substance use disorders (SUDs) requires sustained and purposeful support to maintain long-term remission. Methods: This study investigated the association between assessment of recovery capital, household chaos, delay discounting (DD) and probability discounting (PD), and remission status among individuals in recovery from SUD. Data from 281 participants from the International Quit & Recovery Registry (IQRR), an ongoing online registry that aims to study the recovery process, were included in the analysis. Results: Lower DD rates and higher recovery capital were found among those in remission compared to those not in remission after controlling for demographics. In contrast, the association of household chaos and PD with remission status were insignificant. Overall, DD accounted for 20% of the total effect between the recovery capital and the remission status. Conclusion: This study contributes to the understanding of recovery as a multidimensional process, supports DD as a behavioral marker of addiction, and suggests areas for future research.
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Affiliation(s)
- Liqa N Athamneh
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA.,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
| | - Michele J King
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA.,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
| | - William H Craft
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA.,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
| | - Roberta Freitas-Lemos
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA.,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
| | - Devin C Tomlinson
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA.,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
| | - Yu-Hua Yeh
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA.,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
| | - Warren K Bickel
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA.,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
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Positive addiction recovery therapy: a pilot study. ADVANCES IN DUAL DIAGNOSIS 2022. [DOI: 10.1108/add-06-2022-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this study is to evaluate a new programme of work designed to improve the recovery and well-being of people in early addiction recovery. The programme, known as positive addiction recovery therapy (PART), is attentive to the recovery process through the G-CHIME (growth, connectedness, hope, identity, meaning in life and empowerment) model of addiction recovery. It also uses the values in action character strengths and includes a set of relapse prevention techniques.
Design/methodology/approach
An experimental design using repeated measures has been adopted. Measures for recovery capital, well-being and level of flourishing were selected and pre- and post-data collected. Primary data analysis was conducted using the non-parametric Wilcoxon signed-rank test. Participants (n = 30) were required to be in early addiction recovery, classified as having been abstinent for between three and six months.
Findings
The results showed a statistically significant improvement in participant well-being. This was also true for recovery capital and flourishing. Whilst a meaningful increase was seen in all measures, exploratory analysis found females responded better to the PART programme.
Practical implications
This study emphasises the importance of adopting a holistic therapeutic approach, one that considers multifaceted components of recovery such as those outlined in the G-CHIME model.
Originality/value
This study evaluates a new programme of work designed to improve the recovery outcome and mental well-being of people who are in early addiction recovery.
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