Maintenance of long-term recovery from substance use: a mixed methods study of self- and treatment-changers

Exploring indicators of natural recovery from alcohol and drug use problems: findings from the life in recovery survey in Flanders

INTRODUCTION

Research has established natural recovery (NR) as an important pathway to substance use recovery. Studies investigating correlates of NR have mainly focused on demographic and substance use variables rather than life circumstances. This study seeks to better understand the phenomenon of natural recovery by (i) validating the international scientific literature concerning demographic and substance use indicators of NR in Flanders and (ii) assessing the additional explanatory power of recovery strengths and barriers during active addiction, controlling for demographic and substance use covariates.

METHODS

A total of 343 persons in recovery from alcohol or drug use problems (≥ 3 months) completed an online cross-sectional survey in Flanders. Participants in NR and in recovery after following treatment were compared using multivariate linear regression models. Reasons for not following treatment were analyzed using inductive thematic analysis.

RESULTS

Higher education level, lower severity of dependence, and cannabis use as the main problem substance (vs. alcohol) were statistically significant (p < 0.05) correlates of NR. When scores for the number of barriers and strengths associated with active addiction were added, barriers (but not strengths) were significantly associated with NR. When barrier items were individually tested, having untreated emotional or mental health problems, having a driver's license revoked and damaging property were statistically significant correlates. The most reported reason for not entering treatment was not experiencing any need to do so.

CONCLUSION

The results highlight the importance of a holistic approach to recovery support across multiple life domains. Limitations and opportunities for further research are discussed.

Self-change from problems with alcohol and drugs: A scoping review of the literature since 2010

ISSUES

Self-change from alcohol and drug use problems is increasingly acknowledged in research. Despite the growing number of published studies, the most recent broad review of this dispersed field dates back to 2010. The present review narratively synthesises key findings from empirical studies and critically identifies research gaps and directions for further research.

APPROACH

Following the PRISMA guidelines for scoping reviews, a systematic search was conducted in multiple scientific databases, resulting in the identification of 56 relevant articles with explicit empirical results on self-change.

KEY FINDINGS

The scoping review presents findings related to: (i) methods and definitions used; (ii) the prevalence of self-change; (iii) indicators of self-change; (iv) the process of self-change; and (v) population views on self-change.

CONCLUSION

The review highlights the significant growth in research on self-change considering key themes as well as the need for a relational and time-bound approach to self-change in research and practice.

Multi-Dimensional Recovery and Growth Among the Homeless: A Positive Criminology Perspective

The research literature on the recovery and growth processes of the homeless population is limited and lacking-particularly with regard to the recovery and growth potential of that population, and its recovery capital (RC) dynamics. This qualitative study fills the research gap by examining the recovery process on its various manifestations, the formation of RC, the patterns of coping with distress, and the growth processes experienced. Ten semi-structured in-depth interviews were conducted with participants from a homeless hostel. The results show how a population with low or depleted RC, in a state of extreme distress, and in the throes of a bottom-up experience, succeeds in developing RC on a personal, social, and spiritual level-and through it, also reaching post-crisis growth. This study yields innovative terminology to describe the coping patterns and their development in three stages-economical coping, liminal stage of resources mustering, and resourceful coping-and a model to explain the phenomenon, and re-conceptualize it.

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.

"You have to start normalizing": Identity construction among self-changers and treatment changers in the context of drug use normalization

Identity transformation and stigma management have been widely acknowledged as significant factors in various drug-cessation pathways, such as self-change (SC) and treatment-change (TC). These processes involve the employment of symbolic boundaries within which people associate themselves with desired groups and/or distance themselves from less desirable ones. However, the relevance of the drug-cessation pathway to identity construction in an era of drug-use normalization has not yet been explored. The present study used thematic discourse analysis to compare the drug-cessation narrative and the reflected identity construction of 41 former drug users in Israel (25 SCs and 16 TCs). The findings revealed a shared trigger for drug cessation that was related to impaired functionality and a threat to their identity. However, the groups differed in other drug-cessation factors that served their identity-negotiation strategies. The SCs negotiated stigma by distancing themselves from other drugs users, minimizing drug risk, and denying the need for drug treatment. In contrast, the TCs negotiated stigma by distancing themselves from their former user identities, embracing the disease model of drug use, and confirming the necessity of treatment. This identity construction reflects continuous framing of ideals of subjectivity, such as self-regulation, which policy makers and treatment stakeholders should consider in developing services and conveying substance-use policy messages.

Personal and Environmental Social Capital Predictors of Relapse Following Departure from Recovery Homes

Substance use recovery homes represent the largest residential, community-based post-treatment option for those with substance use disorders in the United States. It is still unclear what unique factors predict relapse after residents leave such homes. This study presents results of a longitudinal study of 497 residents who departed from 42 Oxford House recovery houses. We hypothesized that the predictors of post-departure relapse would be a multi-item measure of latent recovery, length of stay, and reason for departure from the home (voluntary vs. involuntary). Predictor effects were estimated as part of a two-step model with two outcomes: (a) lack of follow-up data after departure from the house, and (b) the likelihood of relapse. Determinants of missing follow-up data included less education, less time in residence, and involuntary departure. Relapse was more likely for individuals who were younger, had involuntarily left the house, and had lower values on the latent recovery factor. The implications of these important factors related to relapse following departure from residential recovery home settings are discussed.