Pathways to long-term recovery: a preliminary investigation

Agreement for Recovery: First Spanish Consensus on the Concept of Alcohol Addiction Recovery

INTRODUCTION

Current literature does not dispose from a widely accepted definition of recovery in alcohol use disorder (AUD), and most proposals originate from anglophone countries. This study introduces a pioneering consensus in Spain on the definition of recovery in AUD.

METHOD

The Delphi method was used. The expert panel, comprising 54 multidisciplinary professionals from the Community of Madrid.

RESULTS

A high level of consensus (≥80% agreement) was reached for 45% of the items and majority (≥60%) for 84%. Recovery is understood as a dynamic, personalized, and voluntary process, potentially enduring throughout one's lifespan. It entails a transformative lifestyle shift aimed at achieving a significant improvement in overall quality of life, encompassing physical and mental health, interpersonal relationships, and environmental factors. The journey of recovery is marked by heightened psychological well-being, is characterized by empowerment, personal growth, existential purpose, and positive identity reconstruction. Recovery is supported by substance use management, requires proactive individual agency and involves both personal and societal responsibilities.

CONCLUSIONS

This study represents a milestone as it is the first consensus in the Community of Madrid on the meaning of recovery in AUD. The proposed definition of recovery could be a potential reference for similar regions within Spain or even for other countries with cultural similarities. The elucidation of a clear framework of recovery provides a solid basis for future research efforts and clinical interventions in the Spanish AUD landscape.

Effects of strength of relationship ties in recovery homes: A conundrum

Recovery homes are a widespread source of support for those attempting to maintain abstinence. For those who are able to remain in these settings for at least 6 months, outcomes tend to be favorable; however, many leave prematurely. There is a need to better understand the social integration processes that play a major role in giving recovery home residents access to available recovery-related social capital that is associated with better outcomes. The current study involved Oxford House recovery homes in 3 states and examined the strength of relationship ties among house members. We found that those who associated with peers who have higher recovery scores tend to improve their own recovery scores over time. However, we also found that those with higher recovery scores tended to create "strong" ties with similarly high-scoring alters; likewise lower-scoring individuals preferentially formed strong ties with each other. These findings suggest a conundrum: recovery home residents most in need of relational support from more recovered housemates are the least likely to obtain it. We discuss possible pathways to creating more ties between high and low-recovered residents.

The interdependence of substance use, satisfaction with life, and psychological distress: a dynamic structural equation model analysis

Introduction

Longitudinal studies with annual follow-up including psychological and social variables in substance use disorder recovery are scarce. We investigated whether levels of substance use, satisfaction with life, and psychological distress fluctuate across five years in relation to having drug-free friends.

Methods

A prospective naturalistic cohort study of change trajectories in a cohort of people diagnosed with substance use disorder and using multiple substances with quarterly and annual follow-up over five years. Two-hundred-and-eight patients were recruited from substance use disorder treatment in Rogaland, Norway. Out of these, 164 participants fulfilled the inclusion criteria. We used Bayesian two-level dynamic structural equation modelling. The variable 'drug-free friends' was assessed by a self-reporting questionnaire, while psychological distress was assessed using the Symptoms Checklist 90 Revised. Satisfaction with life was assessed using the Satisfaction With Life Scale while drug use was assessed using the Drug Use Disorders Identification Test.

Results

The main findings are that higher-than-average psychological distress at a three-month lag credibly predicts higher-than-normal substance use at the concurrent time point t. Substance use and satisfaction with life seem to have synchronous trajectories over time, i.e. as the first decreases the latter increases and vice versa. During the five years after treatment, the participants mainly experienced a decrease in substance use and increase in satisfaction with life.

Conclusion

Since the participants experienced positive and negative fluctuations for several years after treatment, it seems crucial to establish a dialogue with treatment professionals in order to create functional solutions for maintaining motivation and aiding recovery.

Personal recovery for special populations: a qualitative study exploring the role of special interest meetings within 12-step fellowships

BACKGROUND

This study explores how Special Interest Meetings (SIMs), also called topic-specific meetings (e.g., meetings for young people), support recovery in 12-Step fellowships for Special Populations like young people, women and LGBTQIA+ members. Despite their emergence to address the needs of these groups, the specific ways Special Interest Meetings contribute to recovery experiences are understudied.

METHODS

In-depth interviews were conducted with 12 participants who had attended Special Interest Meetings in 12-Step fellowships to explore the role of these meetings in recovery. The interviews were analysed using the CHIME-D personal recovery framework (Connectedness, Hope, Identity, Meaning in life, Empowerment, Difficulties).

RESULTS

Special Interest Meetings serve as recovery pathways for Special Populations, incorporating CHIME-D elements to aid recovery and address challenges. This study found four "Special Population Pathways" for recovery: Traditional, Hybrid, SIM-Only, and Outside-Sim Hybrid Pathway.

CONCLUSIONS

Special Interest Meetings address specific challenges like discrimination and exclusion faced by Special Populations in recovery. These meetings offer tailored support, deeper connections, improved recovery outcomes, and a sense of empowerment. The existence of "Special Population Pathways" emphasises the ongoing need to address diverse individuals' specific needs throughout the recovery process.

"It's time for a change. I need to. I have to": Substance misuse recovery turning points of unhoused Alaskans

Substance misuse is a pernicious health concern for many unhoused people. A deep understanding of turning points - what propels someone to take concrete action toward addressing substance misuse - is needed to inform recovery policies and practices. This study sought to identify common elements in turning points among unhoused people vis-à-vis a phenomenological qualitative approach. Twenty people (Mage = 47.47, SD = 9.75; 50% female) who self-identified as being in recovery while unhoused participated in semi-structured interviews in Anchorage, Alaska, a community with high rates of both houselessness and substance misuse. Survival (life- and health-sustaining), individual (intrapersonal), and relational (interpersonal) motivations all shaped turning points. Limitations include the possible underrepresentation of individuals using a harm-reduction approach or capturing differences by housing type. Programs to address substance misuse should consider these motivations. Future research should identify and refine turning points and work to understand how they interact with change processes.

Recovery Ready Workplaces: A key strategy for reducing overdoses and sustaining recovery from substance use disorder

In 2021, overdose deaths surpassed the 100,000 mark for the first time in the United States' history, and alcohol-related deaths continue to surpass 140,000 each year. Regulatory and societal barriers to effective treatment and prevention of substance use disorder (SUD) persist. Innovative strategies and approaches to support long-term recovery can help re-duce morbidity and mortality associated with SUD. Improving access to quality treatment and the availability of a broad range of policies and programs to support recovery and address social determinants of health, including employment supports, are key to curbing the overdose epidemic and rebuilding stronger communities. This article outlines the role Recovery Ready Workplaces can play in reducing overdoses and helping individuals sustain recovery from SUD, as well as in strengthening communities. This article describes how congressional and state legisla-tive action, Americans with Disabilities Act (ADA) enforcement and expansion, and other programmatic and fiscal policy changes at the state and federal levels will accelerate the adoption of Recovery Ready Workplaces as an element of a comprehensive response to SUD. The article also identifies existing state models and proposes specific federal- and state-level solutions to address some of the current limitations. Recovery Ready Workplaces benefit employees, employers, and the nation's economy. Recovery Ready Workplaces are a supportive tool and policy strategy to help those with SUD thrive in recovery and to bolster communities and the econ-omy as a whole.

Prevalence and Predictors of Substance Use Support Programming Among U.S. Religious Congregations

We conducted a cross-sectional secondary analysis of data from the 2012 National Congregation Study, a nationally representative survey of religious congregations in the United States ( N = 1,331). Multivariate logistic regression was used to identify congregational characteristics associated with providing substance use support programing. Nearly one-third (38%) of U.S. congregations indicated that they provided substance use support programming; approximately half (52%) of all congregational attendees were in a congregation that provided some type of substance use support. The internal factors associated with a congregation providing substance use programming include having members who are unemployed and younger, being conservative Protestant, engaging in the practice of speaking in tongues, and having the resources to support social services. The analysis also identifies external factors (i.e., assessing community needs and hosting social service speakers) as being associated with a congregation’s likelihood of providing substance use programming. Findings identify factors associated with congregations providing substance use support.

How, when, and to what degree do people with alcohol dependence recover their psychological wellbeing and quality of life? The Madrid Recovery Project

Introduction

The consensus on recovery from alcohol use disorder (AUD) has shifted toward encompassing psychological wellbeing and quality of life dimensions. However, few studies have explored the long-term recovery process and its dimensions, timing, styles, and modes. The aim of this study was to investigate the extent, timing, and process of psychological wellbeing and quality of life recovery in alcohol use disorder (AUD) patients, as well as the relationship with classic dimensions of AUD recovery.

Method

A cross-sectional study has been carried out with 348 participants with AUD, in different abstinence periods (1 month-28 years), and 171 control subjects. Participants underwent a psychological evaluation, which included self-informed measures of psychological wellbeing, quality of life, negative emotionality, and coping strategies related to alcohol consumption avoidance. Statistical analysis included linear and non-linear regression models between psychological dimensions and maintenance of abstinence, as well as matching the scores of the sample with AUD to those of controls. Scatter plots were used to explore inflection points. In addition, mean comparison tests were performed between participants with AUD and controls and by gender.

Results

In general, according to the regression models, there were pronounced increases in indices of wellbeing and coping strategies (and pronounced decreases in negative emotionality) during the first 5 years of abstinence, followed by less pronounced improvements. The matching of AUD subjects in wellbeing and negative emotionality indices with controls occurs at different times: (a) 1 year or less: physical health; (b) 1-4 years: psychological health; (c) 4-10 years: social relationships, wellbeing, and negative emotionality; and (d) more than 10 years: autonomy and self-acceptance. There are statistically significant differences by gender for the negative emotionality and physical health variables.

Conclusion

Recovery from AUD is a long process that involves improvements in wellbeing and quality of life. Four stages can be described in this process, with the most pronounced changes occurring during the first 5 years of abstinence. However, AUD patients take more time to obtain similar scores to controls in several psychological dimensions.

Parental health in the context of public family care proceedings: A scoping review of evidence and interventions

BACKGROUND

Child protective services (CPS), or their equivalent, have statutory power to remove children from birth parents in instances of child abuse, neglect, or concerns around parenting capacity via public family care proceedings. Parents who have children subject to proceedings, 'birth parents', often have complex health and social care needs.

OBJECTIVE

We aimed to review what is known about the health needs of birth parents and the interventions implemented to support these health needs.

METHODS

We searched PubMed, Scopus, and grey literature using a systematic strategy of key concepts "health", "care proceedings", and "parents". We included all publications in English that reported parental health in the context of care proceedings from the 1st of January 2000 to the 1st of March 2021.

RESULTS

Included studies (n = 61) reported on maternal health (57 %) or the health of both parents (40 %), with only one study reporting on fathers alone. We conceptually categorised parental health need (n = 41) into i) mental health, ii) physical health, iii) substance misuse, iv) developmental disorders, and v) reproductive health. Health inequities and poor access to services were described across all categories, with longstanding issues often pre-dating proceedings or the child's birth. All interventions supporting parental health (n = 20) were targeted at mothers, with some supporting fathers (n = 8), formally or informally. We grouped similar interventions into three types: alternative family courts, wrap-around services, and specialist advocacy/peer support.

CONCLUSIONS

Parents who have children subject to care proceedings have complex health needs that pre-date CPS concerns. The studies included in our review strongly suggest that health issues are exacerbated by child removal, triggering deteriorations in mental health, poor antenatal health for subsequent pregnancies, and avoidable mortality. Findings highlight the need for targeted and timely intervention for parents to improve whole-family outcomes. There are models that have been designed, implemented, and tested using relationship-based, trauma-informed, multidisciplinary, family-focused, and long-term approaches.

The role of mindfulness, meditation, and peer support in recovery capital among Recovery Dharma members

INTRODUCTION

Recovery Dharma (RD) is a Buddhist-based peer support program for the treatment of addiction that incorporates mindfulness and meditation into meetings, program literature, and the recovery process, creating the opportunity to study these variables in a peer-support program context. Mindfulness and meditation are beneficial for people in recovery, yet we know little about their relationship to recovery capital, a positive indicator of recovery outcomes. We explored mindfulness and meditation (average length of sessions and average frequency per week) as predictors of recovery capital and examined perceived support in relation to recovery capital.

METHODS

The study recruited participants (N = 209) through the RD website, newsletter and social media pages for an online survey that included measures of recovery capital, mindfulness, perceived support, and questions about meditation practices (e.g., frequency, duration). Participants' mean age was 46.68 years (SD = 12.21), with 45 % female (5.7 % non-binary), and 26.8 % from the LGBTQ2S+ community. The mean time in recovery was 7.45 years (SD = 10.37). The study fitted univariate and multivariate linear regression models to determine significant predictors of recovery capital.

RESULTS

As anticipated, multivariate linear regressions indicated that mindfulness (β = 0.31, p < .001), meditation frequency (β = 0.26, p < .001), and perceived support from RD (β = 0.50, p < .001) were all significant predictors of recovery capital when controlling for age and spirituality. However, longer time in recovery and the average duration of meditation sessions did not predict recovery capital as anticipated.

CONCLUSIONS

Results indicate the importance of a regular meditation practice for recovery capital rather than engaging in prolonged sessions infrequently. The results also support previous findings, which point to the influence of mindfulness and meditation on positive outcomes for people in recovery. Further, peer support is associated with higher recovery capital in RD members. This study is the first examination of the relationship between mindfulness, meditation, peer support, and recovery capital in recovering people. The findings lay the groundwork for the continued exploration of these variables as they relate to positive outcomes both within the RD program and in other recovery pathways.

Nondrug reinforcers contingent on alternative behavior or abstinence increase resistance to extinction and reinstatement of ethanol-maintained behavior

The effects of delivering nondrug alternative reinforcement on resistance to extinction and reinstatement of rats' ethanol-maintained lever pressing were evaluated in two experiments. In both, rats self-administered ethanol by lever pressing in a two-component multiple schedule during baseline. In the Rich component, alternative food reinforcement was made available for performing an alternative response (Experiment 1) or according to a differential-reinforcement-of-other-behavior schedule for lever pressing (Experiment 2). In the Lean component, only ethanol was available. Moreover, the frequency of alternative reinforcement was manipulated across conditions in Experiment 1. Following baseline, lever pressing was extinguished in both components by suspending ethanol reinforcement, and alternative food reinforcers were discontinued. Finally, to test for reinstatement, ethanol reinforcers were delivered independently of lever pressing in both components. In both experiments, proportion-of-baseline response rates were higher during extinction and reinstatement testing in the Rich component than in the Lean component (although differentiation was not observed at the lowest frequency of alternative reinforcement in Experiment 1). Thus, alternative nondrug reinforcers increased resistance to extinction and reinstatement of rats' ethanol-maintained lever pressing, even when those reinforcers were delivered contingently on an alternative response or on abstinence from lever pressing.

Perspectives of service providers on aftercare service provision for persons with substance use disorders at a Rural District in South Africa

Background

Provision of aftercare services for persons with substance use disorders (PWSUD) within a rural context is typically met with various intersecting challenges, including unclear policy implications and lack of resources. In the South African context, service providers are expected to provide aftercare services that should successfully reintegrate persons with PWSUD into society, the workforce, family and community life as mandated by Act No. 70 of 2008, despite population diversity. Little has been established on the provision of aftercare services in South Africa and specifically within a rural context. This article explores service providers’ perspectives in aftercare service provision for PWSUD in a rural district.

Methods

A qualitative exploratory study design was conducted in a rural district in South Africa using semi-structured interviews and focus group discussions with forty-six service providers from governmental and non-governmental institutions, ranging from implementation to policy level of service provision. Data were analyzed thematically using a deductive approach. Codes were predetermined from the questions and the aims and objectives of the study used Beer’s Viable Systems Model as a theoretical framework. NVivo Pro 12 qualitative data analysis software guided the organization and further analysis of the data.

Results

Four themes emanated from the data sets. Theme 1 on reflections of the interactional state of aftercare services and program content identified the successes and inadequacies of aftercare interventions including relevant recommendations for aftercare services. Themes 2, 3, and 4 demonstrate reflections of service provision from implementation to policy level, namely, identifying existing barriers to aftercare service provision, situating systemic enablers to aftercare service provision, and associated aftercare system recommendations.

Conclusions

The intersecting systemic complexities of providing aftercare services in a rural context in South Africa was evident. There existed minimal enablers for service provision in this rural district. Service providers are confronted with numerous systemic barriers at all levels of service provision. To strengthen the aftercare system, policies with enforcement of aftercare services are required. Moreover, a model of aftercare that is integrated into the existing services, family centered, sensitive to the rural context and one that encourages the collaboration of stakeholders could also strengthen and sustain the aftercare system and service provision.

Mixed methods prospective findings of the initial effects of the U.S. COVID-19 pandemic on individuals in recovery from substance use disorder

The beginning of the U.S. COVID-19 pandemic interrupted integral services and supports for those in recovery from substance use disorders. The current study used qualitative and quantitative data to identify 1) pandemic-related barriers/stressors, 2) coping strategies employed, and 3) how the stressors and strategies predicted subsequent substance use frequency. Participants were 48 adults (40.5% female; 90.2% White) between 26 and 60 years old (M = 42.66, SD = 8.44) who were part of a larger, multi-year longitudinal study of individuals in recovery from substance use disorders. Individuals completed two interviews, one during the six weeks of initial stay-at-home orders in the state in which data were collected and the second within six to twelve months of their initial interview. Common barriers to recovery included cancelled support meetings, changes in job format (i.e., being fired or furloughed), and lack of social support. Common coping strategies included self-care, leisure activities/hobbies, taking caution against exposure, and strengthening personal relationships. The relationship between cravings at baseline and substance use at follow up was stronger for those who experienced worsening of their mental health (B = 21.80, p < .01) than for those who did not (B = 5.45, p = 0.09), and for those who were taking caution against exposure (B = 24.57, p < .01) than for those who were not (B = 1.87, p = 0.53). Those who engaged in self-care (B = 0.00, p>.99) had lower rates of substance use at follow-up than those who did not employ self-care as a coping mechanism (B = 16.10, p < .01). These findings inform research priorities regarding prospective effects of the pandemic on treatment endeavors, particularly emphasizing treating mental health and encouraging self-care strategies.

Characteristics of alcohol recovery narratives: Systematic review and narrative synthesis

BACKGROUND AND AIMS

Narratives of recovery from alcohol misuse have been analysed in a range of research studies. This paper aims to produce a conceptual framework describing the characteristics of alcohol misuse recovery narratives that are in the research literature, to inform the development of research, policy, and practice.

METHODS

Systematic review was conducted following PRISMA guidelines. Electronic searches of databases (Ovid MEDLINE, EMBASE, CINHAL, PsychInfo, AMED and SCOPUS), grey literature, and citation searches for included studies were conducted. Alcohol recovery narratives were defined as "first-person lived experience accounts, which includes elements of adversity, struggle, strength, success, and survival related to alcohol misuse, and refer to events or actions over a period of time". Frameworks were synthesised using a three-stage process. Sub-group analyses were conducted on studies presenting analyses of narratives with specific genders, ages, sexualities, ethnicities, and dual diagnosis. The review was prospectively registered (PROSPERO CRD42021235176).

RESULTS

32 studies were included (29 qualitative, 3 mixed-methods, 1055 participants, age range 17-82years, 52.6% male, 46.4% female). Most were conducted in the United States (n = 15) and Europe (n = 11). No included studies analysed recovery narratives from lower income countries. Treatment settings included Alcoholic Anonymous (n = 12 studies), other formal treatment, and 'natural recovery'. Eight principle narrative dimensions were identified (genre, identity, recovery setting, drinking trajectory, drinking behaviours, stages, spirituality and religion, and recovery experience) each with types and subtypes. All dimensions were present in most subgroups. Shame was a prominent theme for female narrators, lack of sense of belonging and spirituality were prominent for LGBTQ+ narrators, and alienation and inequality were prominent for indigenous narrators.

CONCLUSIONS

Review provides characteristics of alcohol recovery narratives, with implications for both research and healthcare practice. It demonstrated knowledge gaps in relation to alcohol recovery narratives of people living in lower income countries, or those who recovered outside of mainstream services.

PROTOCOL REGISTRATION

Prospero registration number: CRD42020164185.

Social recovery in substance use disorder: A metasynthesis of qualitative studies

Issues

In substance use disorder, connection to social communities plays a significant role in the recovery process. The aim here has been to identify and synthesise the qualitative research examining the process of social recovery from a first‐person perspective and how social communities assist in this process.

Approach

Metasynthesis using the following databases: CINAHL, Embase, MEDLINE, PsycINFO, Scopus, SocIndex and Web of Science. The search returned 6913 original articles, of which 18 met the following criteria: examining the experience of social recovery from a first‐person perspective and how social communities support this process, age of 18+, recovery of at least 12 months, in an English‐language peer‐reviewed journal. Review protocol registration: PROSPERO (CRD42020190159).

Key Findings

The persons in recovery emphasised communities that they perceived as being safe and non‐stigmatising. These are qualities that contributed to positive self‐change, and these communities were perceived as suitable arenas in which to confront responsibility and trust. Additionally, participants found that their relationship skills were improving due to the new social bonds forged in these communities. A sense of citizenship was gained along with a regaining of social dignity through voluntary work and giving back to society.

Implications

The pivotal role of the social community identified in this review underscores the importance of recognising and supporting persons in recovery's needs when connecting with such communities

Conclusion

We propose a four‐stage model to guide research into social recovery from a first‐person perspective and how social communities support this process.

Social Stability and Unmet Health Care Needs in a Community-Based Sample of Women Who Use Drugs

Objective

To examine the relationship between social stability and access to healthcare services among a community-based sample of adult female drug users.

Methods

We developed a measure of social stability and examined its relationship to health care access. Data came from a cross-sectional sample of female drug users (N = 538) in Oakland, CA who were interviewed between September 2014 and August 2015. We categorized women as having low (1-5), medium (6-10), or high (11-16) social stability based on the tertile of the index sample distribution. We then used ordered logistic regression to examine the relationship between social stability and self-reported access to mental health services and medical care.

Results

Compared with women in the low stability group, those with high stability experienced a 58% decline in the odds of needed but unmet mental health services [AOR: 0.42; 95% C.I.: 0.26, 0.69] and a 68% decline in the odds of unmet medical care [AOR: 0.32; 95% C.I.: 0.19, 0.54] after adjusting for confounders. The coefficients we observed reduced in size at higher levels of the stability index suggesting a positive association between social experiences and access to healthcare services.

Conclusion

Women who use drugs are at increased risk of adverse health outcomes and often experience high levels of unmet healthcare needs. Our study highlights the importance of addressing social determinants of health and suggests that improving social factors such as housing stability and personal safety may support access to healthcare among female drug users.

Changes in Social, Romantic, and General Life Satisfaction Over the Course of a Substance Use Disorder

Background: The pandemic has highlighted the importance of social connection for health and well-being. Satisfaction across domains of life is associated with substance use outcomes, such as risk of relapse and mortality. Previous work has delineated the relationship between substance use and social connections, yet there is a lack of research exploring the relationship between substance use and satisfaction with domains of life over time. Methods: We retrospectively assessed satisfaction with social life, romantic life, and general life across five phases of substance use among 339 adults, of whom 289 identify as formerly having a problem with substance use, and a comparison group of 50 who report no history of problematic drug use. We compared those whose primary drug of choice was alcohol, marijuana, methamphetamine, non-prescription opioids, and prescription opioids. Results: Those who used prescription opioids reported a larger drop in satisfaction in social life, romantic life, and general life during the course of substance use than those who used other drugs. However, we report no significant differences in current satisfaction, social well-being, or quality of life between people in recovery and people with no history of problematic substance use. Conclusions: These findings-alongside neuropsychological work on the opioid system and sociality-paint a picture that those who formerly used prescription opioids may experience lower satisfaction across life domains during the course of their substance use than those who used other substances. However, people in prolonged recovery-regardless of their drug of choice-all show similar levels of satisfaction compared to people with no history of problematic substance use.

Recovery From Opioid Problems in the US Population: Prevalence, Pathways, and Psychological Well-Being

OBJECTIVES

Research has enhanced our understanding of opioid misuse prevalence and consequences, but few studies have examined recovery from opioid problems. Estimating national recovery prevalence and characterizing individuals who have resolved opioid problems can inform policy and clinical approaches to address opioid misuse.

METHODS

We conducted a cross-sectional investigation of a nationally-representative sample of US adults who reported opioid problem resolution (OPI). For reference, OPI was compared with an alcohol problem resolution group (ALC). Analyses estimated OPI/ALC prevalence, differences in treatment/recovery service use, and psychological well-being, within 2 recovery windows: <1 year (early recovery) and 1 to 5 years (mid-recovery) since OPI/ALC problem resolution.

RESULTS

Of those who reported alcohol or drug use problem resolution, weighted problem resolution prevalence was 5.3% for opioids (early recovery 1.2%, mid-recovery 2.2%) and 51.2% for alcohol (early recovery 7.0%, mid-recovery 11.5%). In mid-recovery, lifetime use of formal treatment, pharmacotherapy, recovery support services, mutual help, and current pharmacotherapy were more prevalent in OPI than ALC. Service utilization did not differ between early-recovery OPI and ALC. Common services used by OPI included inpatient treatment (37.8%) and state/local recovery organizations (24.4%) in mid-recovery; outpatient treatment (25.7%) and recovery community centers (27.2%) in early recovery; Narcotics Anonymous (40.2%-57.8%) and buprenorphine-naloxone (15.3%-26.7%) in both recovery cohorts. Regarding well-being, OPI reported higher self-esteem than ALC in early recovery, and lower self-esteem than ALC in mid-recovery.

CONCLUSIONS

An estimated 1.2 million American adults report resolving an opioid problem. Given the service use outcomes and longer-term problem resolution of mid-recovery OPI, early-recovery OPI may require encouragement to utilize additional or more intensive services to achieve longer-term recovery. OPI beyond recovery-year 1 may need enhanced support to address deficient self-esteem and promote well-being.

Longitudinal Changes in Food Addiction Symptoms and Body Weight among Adults in a Behavioral Weight-Loss Program

Interest in food addiction (FA) has increased, but little is known about its clinical implications or potential treatments. Using secondary analyses from a randomized controlled trial, we evaluated the associations between changes in FA, body weight, and “problem food” consumption during a 22-month behavioral weight-loss program consisting of an initial four-month in-person intervention, 12-month extended-care, and six-month follow-up (n = 182). Food addiction was measured using the Yale Food Addiction Scale. “Problem foods” were identified from the literature and self-reporting. Multilevel modeling was used as the primary method of analysis. We hypothesized that reductions in problem food consumption during the initial treatment phase would be associated with long-term (22-month) FA reductions. As expected, we found that reductions in problem foods were associated with greater initial reductions in FA symptoms; however, they were also associated with a sharper rebound in symptoms over time (p = 0.016), resulting in no significant difference at Month 22 (p = 0.856). Next, we hypothesized that long-term changes in FA would be associated with long-term changes in body weight. Although both FA and weight decreased over time (ps < 0.05), month-to-month changes in FA were not associated with month-to-month changes in weight (p = 0.706). Instead, higher overall FA (i.e., mean scores over the course of the study) were associated with less weight loss (p = 0.008) over time. Finally, we hypothesized that initial reductions in problem food consumption would be associated with long-term reductions in weight, but this relationship was not significant (ps > 0.05). Given the complexity of the findings, more research is needed to identify interventions for long-term changes in FA and to elucidate the associations between problem foods, FA, and weight.

The role of reflective consequences in developing recovery capital for the recovering substance abuser population of Tehran city

The aim of this study is to explore the hidden dimensions of recovery capital as utilized among a sample of the recovery population of Tehran city. This qualitative study involved a sample of 27 available people, including different groups of recovering drug users and experts. In the semi-structured face-to-face interview, the focus was on the dimensions of recovery capital and contributing factors to recovery. The criteria proposed by Guba and Lincoln were applied for trustworthiness of the research data. After thematic analysis of the data, a total of 310 codes were identified. The theme extracted is the concept of reflective consequences of recovery capital, which has two main categories of passive (altruism, fear of losing existing possessions, fear of repeating past experiences) and persuasion (internal and external). The reflective consequences are the reproducers of recovery capital and can appear at all three individual, micro and mezo levels.

Resurgence of punishment-suppressed cocaine seeking in rats

Alternative reinforcement-based treatments are among the most effective for reducing substance abuse. However, relapse often occurs when alternative reinforcement ends. Relapse following the loss of alternative reinforcement is called resurgence. An animal model has been used to study basic factors that may ultimately reduce resurgence but uses drug unavailability (i.e., extinction) to reduce drug seeking. In humans, drug abstinence is thought to be a product of aversive consequences associated with drug use rather than extinction. This discrepancy is important because the environmental and neurobiological factors involved in relapse may differ between punished and extinguished behavior. Experiment 1 evaluated resurgence of previously punished cocaine seeking. In Phase 1, rats earned cocaine for pressing levers. In Phase 2, cocaine remained available, but lever pressing also produced mild foot shocks while an alternative response produced food pellets for 1 group but not for another group. In Phase 3, alternative reinforcement and punishment were removed and resurgence of cocaine seeking occurred only in rats previously exposed to alternative reinforcement. In Experiment 2, resurgence was evaluated similarly, except that consequences of cocaine seeking (i.e., punishment and cocaine) remained available during Phase 3. Resurgence did not occur in either group during Experiment 2. The animal models of resurgence developed herein could increase translational utility and improve examination of the environmental and neurobiological factors underlying resurgence of drug seeking. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Abstinence or controlled drinking – a five-year follow-up on Swedish clients reporting positive change after treatment for substance use disorders

Purpose

The purpose of this paper is to investigate how clients – five years after completing treatment interventions endorsing abstinence – view abstinence and the role of Alcoholics Anonymous (AA) in their recovery process.

Design/methodology/approach

Interviews with 40 clients were conducted shortly after them finishing treatment and five years later. All the interviewees had attended treatment programmes based on the 12-step philosophy, and they all described abstinence as crucial to their recovery process in an initial interview.

Findings

At follow-up, the majority remained abstinent. For many, attending AA meetings was still important – some described attending as a routine, whereas others stressed that the meetings were crucial for remaining abstinent. For those who reported controlled drinking (CD), this was described either as a natural step in their recovery process or as associated with worries and self-doubts.

Research limitations/implications

The results suggest the importance of offering interventions with various treatment goals and that clients choosing CD as part of their sustained recovery would benefit from support in this process, both from peers and professionals.

Originality/value

There are heterogeneous views on the possibilities of CD after recovery from substance use disorder both in research and in treatment systems. This study on client views on abstinence versus CD after treatment advocating total abstinence can contribute with perspectives on this ongoing discussion.

Addiction Recovery: A Systematized Review

Objective: Despite the fact that a practical definition of addiction recovery is necessary to conduct an appropriate intervention and research, this concept is still vague and there is no consensus over its meaning and how to measure it. Thus, this study aimed to define and clarify this concept based on the available literature. Method : The theoretical part of Schwartz_Barcott and Kim's Hybrid Model of concept analysis was used to analyze the concept of "Addiction Recovery." To find the relevant literature, an electronic search on valid databases was conducted using keywords related to the concept of addiction recovery. Medlib, IranMedex, Magiran, SID, Irandoc, Google Scholar, PubMed, Web of Science, Medline, Scopus, Pro Quest, CINAHL, Science Direct, Ovid, and Wiley databases were searched up to December 2018 without a time limitation using the following keywords: "Substance use disorders", "Drug use", "Recovery", "Opioids", "Addiction treatment", "Dependency", "Rehabilitation", Remission", "Concept analysis", "Restore", "Definition", "Meaning", and "Conceptualization". The Conventional content analysis was used on selected research articles. Results: From a total of 9520 articles, 39 were reviewed and analyzed. Five attributes were selected, including the process of change, being holistic, being client-centric, learning healthy coping, and being multistage. Antecedents are organized into 2 interacting categories: personal and social resources. Personal resources refer to the person, his/her addiction, and the treatment characteristics, while social resources refer to the family, the community, and the context resources. Addiction recovery leads to sustained abstinence, improved physical and psychological health, improved quality of life and satisfaction, meaningful living, and citizenship. Conclusion: These findings may form a basis for the theories, scales, and criteria for the assessment of addiction recovery and will be useful in clinical practices and research. Also, these findings could help health care professionals to understand the concept of addiction recovery, which is important in improving the recovering person in all aspects of rehabilitation. We will report the implementation and analytical phase of this research project, namely, "the addiction recovery concept analysis" in Iran.

Comparison of the effectiveness of a 12 step substance use recovery program on quality of life

Substance-related disorders can adversely impact quality of life. This study assessed a 12 step program on health-related quality of life for Iranian individuals seeking to recover from substance use. The study used a quasi-experimental, two group, three stage, pre- and post-test design and collected data at baseline, and at 1 and 3 months' post-intervention. The treatment group comprised 35 participants in a 12 step program with a non-equivalent comparison group of individuals admitted to addiction treatment centers. Physical and mental health quality-of-life domains were assessed using the Short Form 36 Health Survey Questionnaire. The treatment group improved in all aspects of health-related quality of life. The treatment group improved compared to the comparison group for two of eight quality of life dimensions - physical functioning and role limitations due to emotional problems - at 1 month post-intervention. There were additional improvements at 3 months' follow up in six of eight quality-of-life subscales compared to the comparison group. The benefits to quality of life related to mental health recovery extended beyond the treatment program, indicating that the program principles were effectively implemented in daily life.

Change & Grow® Therapeutic Model for Addiction: Preliminary Results of an Interventional Study

The last years have seen a paradigm shift concerning addictive disorders, indicating the necessity to study alternative therapeutic models. In this longitudinal study, the objective was to explore the impact of the Change & Grow^® therapeutic model developed and used by VillaRamadas on certain psychological variables that frequently appear associated with addiction. A repeated measures (first and last weeks of treatment) design was used, and the psychological measurements were Beck’s Depression Inventory II (BDI-II), Suicide Ideation Questionnaire (SIQ), State-Trait Anxiety Inventory (STAI), and Montreal Cognitive Assessment (MoCA). Results include 26 (16 male and 10 female) patients. Age varied between 17 and 64 years (M = 35.62, SD = 12.60) and duration of treatment between 91 and 193 days (M = 147.35, SD = 27.05). The MoCA total result was significantly higher in the last week of treatment. The results of BDI-II, SIQ, and STAI (both state and trait) were all significantly lower. Neither duration of treatment nor self-reported motivation presented significant correlation values with the difference between measures for any of the variables. The Change & Grow^® therapeutic model appears to have an impact on relevant psychological variables in patients admitted into treatment for addictive disorders.

Factors Associated with Sustained Remission among Chronic Opioid Users

Background

Chronic opioid use is a major public health problem with significant morbidity. The aim of this study was to investigate factors associated with sustained remission among a sample of Iranian chronic opioid users in Shiraz, Iran.

Methods

This was a cross-sectional study to evaluate sustained remission among chronic opiate users aged 20-60 years. Participants included two groups: 365 people who have been in sustained remission for the past year, and 187 persons who did not achieve remission for the past one year. Then, demographic and factors related to drug use pattern and previous treatments were compared between two groups. Pearson chi-square test was used for univariate analysis and backward stepwise logistic regression was used to estimate adjusted odds ratios (AORs).

Findings

Our findings showed that sustained remission was associated with Narcotic Anonymous (NA) participation [AOR = 3.28, 95% confidence interval (CI): 2.19-4.89, P < 0.001], male gender (AOR = 2.53, 95% CI: 1.45-4.43, P = 0.001), younger age of onset (AOR = 1.63, 95% CI: 1.03-2.58, P = 0.037), higher total years of opioid use (AOR = 2.13, 95% CI: 1.42-3.19, P < 0.001), no history of imprisonment (AOR = 2.11, 95% CI: 1.16-3.85, P = 0.015), and family support (AOR = 2.58, 95% CI: 1.33-5.01, P = 0.005).

Conclusion

Participation in self-help groups can be a suitable alternative in predicting sustained remission among chronic opiate users. Chronic opioid users should be encouraged by the physicians who are involved in the treatment of drug addiction to participate in NA programs.

Resurgence of a target behavior suppressed by a combination of punishment and alternative reinforcement

Differential-reinforcement-based treatments involving extinction of target problem behavior and reinforcement of an alternative behavior are highly effective. However, extinction of problem behavior is sometimes difficult or contraindicated in clinical settings. In such cases, punishment instead of extinction may be used in combination with alternative reinforcement. Although it is well documented that omitting alternative reinforcement can produce recurrence (i.e., resurgence) of behavior previously suppressed by extinction plus alternative reinforcement, it remains unclear if resurgence similarly occurs for behavior previously suppressed by punishment plus alternative reinforcement. The present experiment examined this question with rats. In Phase 1, a target behavior (lever pressing) was reinforced with food pellets. In Phase 2, the target behavior continued to be reinforced, but it also produced mild foot shock and an alternative behavior (nose poking) also produced food. Finally, all consequences were removed and resurgence of target behavior occurred. Resurgence did not occur for another group that similarly received punishment of target behavior in Phase 2 but not alternative reinforcement. These results indicate that resurgence was a product of the history of exposure to and then removal of alternative reinforcement and that the removal of punishment alone did not produce resurgence of target behavior.

Career Adaptability, Self-Determination, and Life Satisfaction: A Mediational Analysis With People With Substance Use Disorder

Living a satisfying life is an important goal for people with substance use disorder (SUD). However, making decisions about the future, imagining future scenarios, and setting and attaining goals related to that future after treatment is a complex task. As several studies have shown, people with SUD experience multiple barriers to designing their future life at the individual, program, and social support levels. Using a life design approach, the aim of this study was to investigate the role career adaptability and self-determination play in life satisfaction for adults with SUD. More specifically, a partial mediation model focused on career adaptability and life satisfaction through enhanced self-determination was tested in a sample ( n = 134) of people with SUD. Findings suggest that career adaptability is indirectly related to life satisfaction, mediated by self-determination. These results have important implications for practice in vocational rehabilitation and career counseling for people with SUD.

A feasibility study exploring self-care and parenting for adults recovering from addictive substances

Little information is available on parental self-care while in recovery from addictive substances, and its relationship to parenting and recovery outcomes. We evaluated the feasibility of obtaining self-care and parenting outcomes for adults in long-term recovery from addictive substances, and explored potential contributing factors. Nineteen mothers and fathers who self-reported at least two years of sobriety participated in this study. Feasibility challenges included recruitment and scheduling interviews, given multiple work and personal demands on participants' schedules. Possible associations of self-care to parental efficacy (PE), parenting behaviors, resilience, and total recovery years were examined as indicators to parental functioning. The exploratory analyses showed a significant moderate correlation between PE and parenting behaviors (r = 0.45, p < 0.05) as well as total years in recovery and age (r = 0.43, p < 0.05); total years in recovery differed significantly when compared by race (χ2 (1) = 5.63; p = 0.018) and education (χ2 (1) = 3.94; p = 0.048). There was also a significant inverse relationship between total years in recovery and PE (r = -0.43, p < 0.05) and parental self-care (r = -0.59, p < 0.01). Recruiting parents (especially minorities) in long-term recovery was very challenging indicating that recruitment through community organizations was not feasible without a site champion. Preliminary findings showed statistically significant correlations among self-care, parental efficacy, age, and total years in recovery. As researchers and clinicians, it is necessary to determine the role and impact of self-care for future intervention development, however, recruitment strategies need to be modified to ensure sufficiently large study samples.

Exploring the Demographic Factors and Facilitators to Addiction Abstinence

Background:

Accumulating evidence indicates a remarkable increase in substance addiction. Substance abuse and addiction impose severe social, political, economic, cultural and health-related damages on societies. Little is known, however, about demographic factors and facilitators to addiction abstinence. The purpose of the current study was to explore the factors associated with opioid avoidance.

Materials and Methods:

This cross-sectional study was performed to record socio-demographic data and facilitating factors to abstinence in 600 interviews, according to data collecting forms, with patients who had drug abuse disorders at Shiraz city during 2016. Correlation test, T-test, and ANOVA were employed for data analysis. P value <0.05 was considered as the significance level.

Result:

There was a significant difference between mean abstinence time and demographic factors such as age, sex, occupation and marital status. Also, 53% of people reported that they had the longest abstinence time using the narcotics anonymous (NA) method. TO 33% of patients, the most important facilitating factor in abstinence according to the patient’s opinion was family support.

Conclusion:

Individual, social, psychosocial and medical variables affect the abstinence duration of substance abuse. Identifying the factors associated with longer abstinence can be helpful in designing prevention and treatment programs for variables that affect the recurrence.

Care outcomes and alcohol-related treatment utilisation profiles of patients with alcohol-use disorder: A prospective cohort study using electronic health records

Background:

We examined the probabilities of longitudinal care outcomes of working-aged patients with alcohol-use disorder (AUD) and their alcohol-related treatment utilisation patterns across the healthcare services, by using linked electronic health records.

Methods:

A random sample (n = 396) of patients with alcohol-related visits to healthcare services in 2011–2012 was collected retrospectively from the electronic health record data in the North Karelia region of Finland and followed prospectively in time until the end of 2016. Data on care outcomes and alcohol-related healthcare use were gathered from the electronic health records. Three outcome groups were identified: (1) dead, (2) present AUD, and (3) remission. Group differences in alcohol-related health service use were compared.

Results:

At the end of the follow-up period, an increased mortality rate of 22.9% was observed, and 18.4% had achieved stable remission, while for the majority (56%), the AUD remained. Most of those in remission had contact with either specialised AUD services or mental health services. Conversely, the majority of those who had died had no contact with specialised AUD services during the follow-up period.

Conclusions:

The electronic-health-record-based register analysis captured mainly individuals with advanced forms of AUD. An excess mortality rate and other negative health consequences were observed. Training providers to identify and treat earlier the less severe forms of AUD could have major benefit to patients and also reduce health system costs.

Effectiveness of a computerized motivational intervention on treatment initiation and substance use: Results from a randomized trial

As many as 80% of the nearly five million adults under community supervision (i.e., probation, parole) are substance involved; however, treatment utilization is low. Using a multi-site randomized controlled trial, we tested the efficacy of in-person motivational interviewing (MI), a motivational computer intervention (MAPIT), or standard probation intake (SAU) to encourage treatment initiation among 316 substance-involved probationers in Dallas, Texas and Baltimore City, Maryland. Ninety-three percent (n=295) of participants completed the 2-month follow-up and 90% (n=285) completed the 6-month follow-up. At 2-months, individuals in the MAPIT condition were more likely to report treatment initiation compared to the SAU condition (OR=2.40, 95% CI=1.06, 5.47) via intent-to-treat analysis, especially among those completing both sessions (RE=0.50, 95% CI=0.05, 0.95) via instrumental variable analysis. At 6-months, MAPIT approached significance for treatment initiation in both analyses. MI did not achieve significance in any model. We did not find any differential impact on substance use. The success of MAPIT suggests that an integrated health-justice computerized intervention as part of a Screening, Brief Intervention, and Referral to Treatment (SBIRT) can be used to address public safety and health issues.

Recovery Agency and Informal Recovery Pathways from Gambling Problems

This study applied a holistic, strength-based lens to better articulate the impetus for, and processes of, informal recovery from gambling problems. Two research objectives framed the parameters of the study: to explore (a) the process by which gamblers move from recognition of a gambling problem to action for recovery and (b) the experiences, perceptions and contextual factors that shape the features of this process. Narrative telephone interviews were conducted with adult residents of Victoria, Australia. Thirty-two adult participants (22 males and 10 females) were recruited from the general community. All participants were self-identified as recovering or recovered from gambling problems. Participants primarily used informal recovery strategies, rather than professional services or support groups. The impetus for informal recovery was identified broadly as either (a) dissonance between desired and actual self-image and goals, (b) an uncontrollable adverse event, or (c) confrontation and decisive action by others affected by the individual's gambling involvement. The impetus, process and goals of recovery were best described by pathways that were distinguished by agency in recovery: externally directed and self-directed. The application of a strength-based lens helped to illuminate the role of agency in informal recovery. A proposed pathways framework may inform strength-based informal recovery strategies for gamblers and affected others, and therapeutic approaches. The pathways, which have not been articulated in previous gambling recovery literature, generally cohere with pathways articulated in the alcohol and substance recovery literature.

Remission from substance use disorders: A systematic review and meta-analysis

OBJECTIVE

This paper presents a systematic review and meta-analysis of available evidence on remission rates for substance use disorders (SUDs), providing weighted mean estimates of SUD remission rates. The review also explores study-level characteristics that may explain variations in remission rates across studies.

METHODS

A comprehensive search strategy identified studies published between 2000 and 2015 with follow-up periods of at least three years or reported lifetime remission outcomes for potential inclusion in the review. Remission was defined as not meeting diagnostic criteria for abuse or dependence for a minimum period of six months, as of final follow-up. A single-group summary meta-analysis was performed. Pooled estimated annual remission rates (PEARRs) were calculated. Meta-regression techniques and subgroup analyses were used to explore the association between study remission rates and key selected variables.

RESULTS

Of 8855 studies identified, 21 met the eligibility criteria. The results suggested that 35.0% to 54.4% of individuals with SUDs achieved remission, and this occurred after a mean follow-up period of 17 years. The PEARRs projected few cases of SUD remission, between 6.8% and 9.1% in any given year. Studies that reported higher remission rates had longer follow-up periods, and lower sample retention rates.

CONCLUSIONS

Results support the contention that SUDs are more likely to be "chronic" or long term disorders than acute disorders for a substantial number of individuals. However, more longitudinal research is required. Treatment geared to chronicity, such as assertive community treatment and intensive case management, needs to be more readily available for SUD populations.

Hitting rock bottom? Resource loss as a predictor of alcoholism treatment completion

Background Efforts to better understand the phenomenon of the 'bottom', the beginning of the process of turning away from alcohol, are important for both theoretical and practical goals. The conservation of resources theory by Hobfoll may represent a suitable framework to base these attempts around. Aim The aim of the study was to examine the role of resource loss in completing alcoholism treatment on the basis of Hobfoll's conservation of resources theory. Methods The study included 86 patients undergoing inpatient alcoholism treatment. An assessment of resource loss and gain during the previous year, as well as of the decisional balance regarding the pros and cons of drinking alcohol, took place at the beginning of therapy. Results The results of hierarchical binary logistic regression confirmed that resource loss was the only significant predictor of therapy completion, after adjustment for decisional balance, demographics and basic clinical data. Additionally, gender moderated the relationship between resource gain and therapy completion: while an increase in gain was related to a decreased chance of completing therapy in men, the opposite effect was noted in women. Conclusions Resource loss has more influence than decisional balance in predicting therapy completion, which can be translated into clinically valid recommendations based on gender differences.

Understanding recovery: the perspective of substance misusing offenders

Purpose

– The purpose of this paper is to critically regard the concept of recovery from the perspective of substance misusing offenders. It intended to understand how these individuals came to define recovery by asking “what does recovery mean to you?”

Design/methodology/approach

– In total, 35 semi-structured interviews were undertaken with individuals with a history of heroin and crack cocaine use as well as convictions for a range of offences. Interviews took place in both prison and community settings, reflecting a spectrum of experience.

Findings

– Whilst the constellation of recovery varied, it was at times made up of the same “stars” – and some re-occurring themes emerged; recovery was transient, fragile and unpredictable, it was ongoing, lacking a definitive end, it was more than abstinence and often involved a total psychological overhaul, recovery was about reintegrating with society and feeling “normal”.

Practical implications

– Practitioners and services need to value the individual interpretations of recovery rather than being prescriptive around what it “should” look like. The components of recovery that were raised by participants permit specific recommendations for practice to be made.

Originality/value

– This study sought the perspectives of those actually affected by and experiencing drug treatment in the Criminal Justice System. It allowed participants to tell their story without preconceived ideas or hypotheses, putting their voice at the centre of the stage. The study uses feedback from the ground to make informed recommendations for practice.

Exercise training - A beneficial intervention in the treatment of alcohol use disorders?

BACKGROUND

A growing body of evidence suggests that exercise training may have multiple beneficial effects in individuals with mental health or substance use disorders. Yet, relatively little knowledge exists regarding the benefits of exercise training to augment treatment for alcohol use disorders (AUDs).

PURPOSE

The purpose of this narrative review is to present a summary of the growing body of published literature supporting exercise training as a treatment strategy for individuals with AUDs. We will provide evidence on the myriad of ways in which exercise may exert a positive effect on AUD outcomes including stress, anxiety, impulsivity, and depression. Further, we will explore how these mechanisms share common neurobiological pathways. The role of exercise in enhancing the social environment and increasing individual self-efficacy to reduce excess and/or inappropriate alcohol consumption will also be discussed.

DISCUSSION

We will conclude with a description of completed investigations involving exercise training and provide suggestions for next steps in this innovative field of study.

Stigma and Family Relationships of Middle-Aged Gay Men in Recovery

The primary objective of this study was to explore how middle-aged gay men in recovery cope with stigma and family relationships. For gay men, perceptions of acceptance of their sexual orientation and degree of social connectedness can play a role in their recovery from alcohol and substance use disorders. Yet gay men may have a more difficult time accessing certain family-level health resources because their families of origin may stigmatize, reject or silence them on account of their sexual orientation. Semi-structured interviews were used to explore how participants in recovery constructed and coped with their experiences of stigma, family relationships, and alcohol and substance use. Participants (30 gay men aged 50-64) completed a questionnaire and interview. We used constructivist Grounded Theory method and Minority Stress Theory as a theoretical framework to interpret the data. We identified the following themes: Internalization of Stigma, Changes in Coping Strategies, and Ongoing Stigma. Future research should explore how to incorporate familial support into gay men's recovery, address ongoing internalized stigma, and develop a social response to stigma, rather than leaving it to individuals to confront on their own.

In college and in recovery: Reasons for joining a Collegiate Recovery Program

OBJECTIVE

Collegiate Recovery Programs (CRPs), a campus-based peer support model for students recovering from substance abuse problems, grew exponentially in the past decade, yet remain unexplored.

METHODS

This mixed-methods study examines students' reasons for CRP enrollment to guide academic institutions and referral sources. Students (N = 486) from the 29 CRPs nationwide operating in 2012 completed an online survey in 2013.

RESULTS

Students were somewhat older than traditional age (mean age = 26). Now sober for 3 years (mean), they had experienced severe dependence on multiple substances. One third reported they would not be in college were it not for a CRP, and 20% would not be at their current institution. Top reasons for joining a CRP were the need for same-age peer recovery support and wanting to "do college sober," recognizing that college life challenges sobriety.

CONCLUSIONS

CRPs appear to meet their mission of allowing recovering students to pursue educational goals in "an abstinence hostile environment." Findings emphasize the need for more institutions to address the support needs of students in recovery.