12-step interventions and mutual support programs for substance use disorders: an overview

Mode of mutual-help group attendance: Predictors and outcomes in a US national longitudinal survey of adults with lifetime alcohol use disorder

INTRODUCTION

Although attending substance use-focused mutual-help meetings online may reduce attendance barriers, associations of attendance mode with group participation and outcomes are unknown. Using longitudinal data from mutual-help group attendees, this study, after identifying differences in baseline characteristics by attendance mode, examined associations of attendance mode with mutual-help participation (number of meetings attended, involvement) and outcomes (alcohol abstinence, heavy drinking, alcohol problems).

METHODS

The Peer Alternatives for Addiction Study 2021 Cohort sampled attendees of 12-step groups (e.g., Alcoholics Anonymous), Women for Sobriety, LifeRing Secular Recovery, and/or SMART Recovery in-person and/or online within 30 days before baseline. The baseline sample, recruited in fall 2021, was 531 adults with lifetime alcohol use disorder, followed at 6 (88 %) and 12 months (85 %). Differences in baseline characteristics by attendance mode were tested using Chi-squares and ANOVAs. GEE models examined associations of attendance mode, time, and their interactions with mutual-help group participation and alcohol outcomes. The in-person only mode was compared to the online-only, and to the in-person plus online, modes.

RESULTS

At baseline, 53.7 % of participants had attended only online meetings in the past 30 days, 33.7 % had attended both in-person and online meetings, and 12.6 % had attended only in-person meetings. Online meeting attendees were less likely to endorse lifetime abstinence as an alcohol recovery goal than in-person-only meeting attendees. In adjusted models (including for recovery goal), those attending online meetings only, or both online and in-person meetings, attended a greater number of meetings compared to those attending only in-person meetings. However, online-only attendance was associated with less involvement than in-person-only attendance. In adjusted models, compared to baseline, involvement increased and outcomes improved at follow-ups. Adjusted models examining alcohol outcomes found that no attendance at mutual-help groups at follow-ups was associated with more heavy drinking compared to in-person-only attendance.

CONCLUSIONS

Findings inform efforts to ascertain benefits of mutual-help group participation by suggesting that online attendance is associated with attending more meetings, less involvement, and lower endorsement of abstinence as a recovery goal, and is comparable to in-person attendance on alcohol outcomes. In-person attendance may be more beneficial for less heavy drinking than terminating attendance.

Evaluating generative AI responses to real-world drug-related questions

Generative Artificial Intelligence (AI) systems such as OpenAI's ChatGPT, capable of an unprecedented ability to generate human-like text and converse in real time, hold potential for large-scale deployment in clinical settings such as substance use treatment. Treatment for substance use disorders (SUDs) is particularly high stakes, requiring evidence-based clinical treatment, mental health expertise, and peer support. Thus, promises of AI systems addressing deficient healthcare resources and structural bias are relevant within this domain, especially in an anonymous setting. This study explores the effectiveness of generative AI in answering real-world substance use and recovery questions. We collect questions from online recovery forums, use ChatGPT and Meta's LLaMA-2 for responses, and have SUD clinicians rate these AI responses. While clinicians rated the AI-generated responses as high quality, we discovered instances of dangerous disinformation, including disregard for suicidal ideation, incorrect emergency helplines, and endorsement of home detox. Moreover, the AI systems produced inconsistent advice depending on question phrasing. These findings indicate a risky mix of seemingly high-quality, accurate responses upon initial inspection that contain inaccurate and potentially deadly medical advice. Consequently, while generative AI shows promise, its real-world application in sensitive healthcare domains necessitates further safeguards and clinical validation.

Somebody to Lean on: Understanding Self-Stigma and Willingness to Disclose in the Context of Addiction

Substance use self-stigma is a barrier to treatment and can negatively impact individuals' well-being and treatment engagement. Given the mixed findings in previous research and the limited specific investigation into the concept of self-stigma within the context of opioid misuse, examining factors associated with self-stigma in the context of opioid use disorder (OUD) is warranted. The current study examines the influence of individual-level factors (race, sex, urban/rural status, support group attendance) on self-stigma and willingness to disclose opioid use. Data for this study were from a larger study of OUD-related stigma among adults in Pennsylvania, U.S. The current study included participants who indicated a personal past or current history with OUD were included (n = 84). Exploratory factor analysis and multiple indicators, multiple causes (MIMIC) model were used to explore the associations between demographic factors (i.e., sex, age, race/ethnicity, urban/rural status), attendance at mutual support groups, and self-stigma factors. Results indicated that sex and attendance at mutual support groups significantly predicted levels of self-stigma. Women and individuals with no previous experience attending mutual support groups endorsed lower levels of self-stigma. Additionally, attendance at mutual support groups predicted willingness to self-disclose past and present opioid use. Individuals who reported no history of attending mutual support groups demonstrated less willingness to disclose past and present OUD use compared to participants who were support group attendees. The current research findings enhance the understanding of OUD-related self-stigma by examining its relationship with individual-level factors, disclosure, and attendance to mutual support groups. The results offer insights into the influence of sex and support group attendance on self-stigma and disclosure. These findings have significant clinical implications for developing future interventions and promoting health policy changes.

Psychosocial Interventions for Individuals With Comorbid Psychosis and Substance Use Disorders: Systematic Review and Meta-analysis of Randomized Studies

BACKGROUND AND HYPOTHESIS

Substance use is highly prevalent among people with schizophrenia (SCZ) and related disorders, however, there is no broad-spectrum pharmacotherapy that concurrently addresses both addiction and psychotic symptoms. Psychosocial (PS) interventions, which have yielded promising results in treating psychosis and substance dependence separately, demonstrate potential but have not been systematically evaluated when combined.

STUDY DESIGN

Systematic review and random-effects meta-analyses of randomized controlled trials (RCTs) investigating PS interventions for individuals with comorbid substance use and psychotic disorders, encompassing SCZ and schizophrenia spectrum disorders (SSD). We included relevant studies published from MEDLINE, PsycINFO, and Google Scholar through May 2023.

STUDY RESULTS

We included 35 RCTs (5176 participants total; approximately 2840 with SSD). Intervention durations ranged from 30 min to 3 years. Meta-analysis did not identify a statistically significant pooled PS intervention effect on the main primary outcome, substance use (18 studies; 803 intervention, 733 control participants; standardized mean difference, -0.05 standard deviation [SD]; 95% CI, -0.16, 0.07 SD; I2 = 18%). PS intervention effects on other outcomes were also not statistically significant. Overall GRADE certainty of evidence was low.

CONCLUSIONS

At present, the literature lacks sufficient evidence supporting the use of PS interventions as opposed to alternative therapeutic approaches for significantly improving substance use, symptomatology, or functioning in people with SCZ and related disorders. However, firm conclusions were precluded by low certainty of evidence. Further RCTs are needed to determine the efficacy of PS treatments for people with dual-diagnoses (DD), either alone or in combination with pharmacotherapy.

The methods and baseline characteristics of a multi-site randomized controlled trial evaluating mindfulness-based relapse prevention in conjunction with peer support to improve adherence to medications for opioid use disorders

Introduction

Medications for opioid use disorders (MOUD) remain the gold standard for treating OUD, but treatment initiation and adherence remain challenging. Exclusive utilization of pharmacotherapy as a treatment modality for OUD is sub-optimal, and a combination of psychotherapies and pharmacotherapies is recommended. General trends indicate the benefits of peer mentoring and MBRP separately. Therefore, we hypothesize that the combined effect of MBRP and Peer mentoring will produce synergistic improvements in MOUD adherence compared to an enhanced twelve-step facilitation (TSF).

Methods

This paper describes the methods and baseline characteristics of a multi-site randomized controlled trial evaluating the effectiveness of a combination of MBRP and peer support (MiMP) compared to an enhanced TSF in improving adherence to MOUD. Both MiMP and TSF are 12-week manualized protocols that utilize licensed therapists. The interventions are delivered in weekly group sessions that last about 75-90 minutes per session. The primary outcome is MOUD adherence. Secondary and exploratory outcomes include relapse, cravings, depression, anxiety, stress, quality of life, and pain catastrophizing.

Results

The participants' ages ranged from 21 years to 77 years, with a mean age of 44.5 (SD ± 11.5 years). There was an almost equal distribution of gender and place of residence. Overall, 51.9% (n=54) of participants identified as female and 48.1% (n=50) were male. Similarly, 51.9% (n=54) of participants resided in urban areas, while 48.1% (n=50) resided in rural areas. Participants identified as either black or white, with over three-quarters identifying as white (77.9%, n= 81) and 22.1% (n= 23) as black. Most participants randomized to the 12-step facilitation group were white (93.1%). Relationships and employment status were well distributed between categories. Over half of the participants reported some college or higher education. Over 90% of the participants made less than $75,000 per year. Some participants indicated that they had both public and private health insurance.

Discussion and conclusion

This study is innovative in several ways including combining MBRP and peer support, addressing comorbid mental health issues among individuals with OUD, utilizing manualized protocols, and evaluating of both physiological and self-reported measures in assessing cortisol reactivity as a predictor of relapse and treatment outcomes.

Association Between Religious Salience and Past-Year Substance Use by Sexual Identity and Sex Among Adults in the United States

Purpose: We examined if associations between religious salience and substance use outcomes differed by sexual identity and sex in a nationally representative sample of adults in the United States. Methods: Using data from the 2019 National Survey on Drug Use and Health (N = 41,216 adults), logistic regression models tested whether sexual identity and sex moderated the associations between religious salience (agreement on the importance of religious beliefs) and past-year alcohol and drug use and use disorders. Results: Religious salience reduced risk of alcohol use disorder, drug use, and drug use disorder for heterosexual, but not lesbian, gay, and bisexual (LGB), individuals. Three-way interactions indicated that religious salience was more protective against alcohol use and drug use and use disorder for bisexual men than bisexual women. Conclusions: Heterosexism common in dominant religious institutions in the United States might hamper the protective effect of religiosity on substance use for LGB individuals.

"Everything is kind of the same except my mind is with me": exploring cannabis substitution in a sample of adults in early recovery from an opioid or stimulant addiction

BACKGROUND

Recovery from addiction is frequently equated with abstinence. However, some individuals who resolve an addiction continue to use substances, including via substitution (i.e., increased use of one substance after eliminating/ reducing another). Substitution may play a distinct role during early recovery (≤ 1 year), as this period is marked by dramatic change and adjustment. Cannabis is one of the most used substances and is legal for medical and recreational use in an increasing number of states. Consequently, cannabis an increasingly accessible substitute for substances, like fentanyl, heroin, cocaine and methamphetamine, with higher risk profiles (e.g., associated with risk for withdrawal, overdose, and incarceration).

METHODS

Fourteen participants reported that they had resolved a primary opioid or stimulant addiction and subsequently increased their cannabis use within the previous 12 months. Using grounded theory, the interviewer explored their experiences of cannabis use during early recovery. Data were analyzed in three stages: line by line coding for all text related to cannabis use and recovery, focused coding, and axial coding to generate a theory about recovery with cannabis substitution. The motivational model of substance use provided sensitizing concepts.

RESULTS & DISCUSSION

The final sample included eight men and six women ranging in age from 20 to 50 years old. Three participants resolved an addiction to methamphetamine and the remaining 11, an addiction to opioids. Participants explained that cannabis was appealing because of its less harmful profile (e.g., no overdose risk, safe supply, few side effects). Participants' primary motives for cannabis use included mitigation of psychiatric symptoms, withdrawal/ cravings, and boredom. While cannabis was effective toward these ends, participants also reported some negative side effects (e.g., decreased productivity, social anxiety). All participants described typical benefits of recovery (e.g., improved self-concept, better relationships) while continuing to use cannabis. Their experiences with and beliefs about substitution suggest it can be an effective strategy for some individuals during early recovery.

CONCLUSIONS

Cannabis use may benefit some adults who are reducing their opioid or stimulant use, especially during early recovery. The addiction field's focus on abstinence has limited our knowledge about non-abstinent recovery. Longitudinal studies are needed to understand the nature of substitution and its impact on recovery over time.

Longitudinal trajectories of substance use disorder treatment use: A latent class growth analysis using a national cohort in Chile

BACKGROUND AND AIMS

Longitudinal studies have revealed that substance use treatment use is often recurrent among patients; the longitudinal patterns and characteristics of those treatment trajectories have received less attention, particularly in the global south. This study aimed to disentangle heterogeneity in treatment use among adult patients in Chile by identifying distinct treatment trajectory groups and factors associated with them.

DESIGN

National-level registry-based retrospective cohort.

SETTING AND PARTICIPANTS

Adults admitted to publicly funded substance use disorder treatment programs in Chile from November 2009 to November 2010 and followed for 9 years (n = 6266).

MEASUREMENTS

Monthly treatment use; type of treatment; ownership of the treatment center; discharge status; primary substance used; sociodemographic.

FINDINGS

A seven-class treatment trajectory solution was chosen using latent class growth analysis. We identified three trajectory groups that did not recur and had different treatment lengths: Early discontinuation (32%), Less than a year in treatment (19.7%) and Year-long episode, without recurrence (12.3%). We also identified a mixed trajectory group that had a long first treatment or two treatment episodes with a brief time between treatments: Long first treatment, or immediate recurrence (6.3%), and three recurrent treatment trajectory groups: Recurrent and decreasing (14.2%), Early discontinuation with recurrence (9.9%) and Recurrent after long between treatments period (5.7%). Inpatient or outpatient high intensity (vs. outpatient low intensity) at first entry increased the odds of being in the longer one-episode groups compared with the Early discontinuation group. Women had increased odds of belonging to all the recurrent groups. Using cocaine paste (vs. alcohol) as a primary substance decreased the odds of belonging to long one-episode groups.

CONCLUSIONS

In Chile, people in publicly funded treatment for substance use disorder show seven distinct care trajectories: three groups with different treatment lengths and no recurring episodes, a mixed group with a long first treatment or two treatment episodes with a short between-treatment-episodes period and three recurrent treatment groups.

Residential and inpatient treatment of substance use disorders in Sub-Saharan Africa: a scoping review

BACKGROUND

With substance use rates increasing in Sub-Saharan Africa (SSA), an understanding of the accessibility and effectiveness of rehabilitative services for people who use alcohol and other drugs (AOD) is critical in the global efforts to diagnose and treat substance use disorders (SUD). This scoping review seeks to address the gaps in knowledge related to the types of research that have been conducted regarding inpatient or residential SUD treatment in SSA, the settings in which the research was conducted, and the study countries.

METHODS

A search of three databases, PubMED, Scopus, and African Index Medicus, was conducted for publications related to the treatment of SUD in inpatient or residential settings in SSA. Articles were screened at the title/abstract level and at full text by two reviewers. Articles eligible for inclusion were original research, conducted in SSA, published in English, included populations who received or were currently receiving treatment for SUD in inpatient or residential settings, or documented demand for SUD services.

RESULTS

This scoping review included 82 studies originating from 6 countries in SSA. Three themes emerged within the literature: access and demand for inpatient and residential SUD treatment, quality and outcomes of SUD treatment, and descriptions of the services offered and staffing of these facilities. Barriers to access include financial barriers, limited availability of services, and geographic concentration in cities. Women were shown to access residential and inpatient SUD treatment at lower rates than men, and certain racial groups face unique language and financial barriers in accessing services. Studies indicate mixed success of inpatient and residential SUD treatment in sustained SUD remission for patients.

CONCLUSION

There are significant gaps in the literature, driven by a lack of longitudinal studies focused on patient outcomes following treatment and the use of a narrow definition of treatment success. Both structural and non-structural barriers, such as stigma and discrimination, are barriers to access. Further research is needed to evaluate approaches to mitigate these barriers and expand access to residential and inpatient SUD treatment.

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.

Multilevel Effects of Environmental and Neighborhood Factors on Sober Living House Resident 12-Month Outcomes

OBJECTIVE

Sober living houses (SLHs) are abstinence-based environments designed for individuals in recovery to live with others in recovery. Research shows that SLHs help some individuals maintain recovery and that certain SLH-related factors may be particularly protective. Here we assess how SLH housing and neighborhood characteristics are related to abstinence and psychiatric symptoms over time.

METHOD

Baseline, 6-month, and 12-month data were collected from 557 SLH residents. Multilevel mixed models tested associations between house and neighborhood characteristics and individual-level percent days abstinent (PDA) and the number of psychiatric symptoms (measured with the Psychiatric Diagnostic Screening Questionnaire [PDSQ]) as outcomes. Final models adjusted for sex, age, and race/ethnicity; ratings of house characteristics; and objective measurements of neighborhood-level exposures.

RESULTS

Both PDA and PDSQ improved significantly (ps ≤ .05) over time in both unadjusted and adjusted models. More self-help groups and fewer alcohol outlets within one mile were significantly protective for PDA, whereas walkability was significantly related to worse PDA and PDSQ (ps ≤ .05). For house-level factors, better ratings of house maintenance were related to significantly fewer psychiatric symptoms, whereas higher scores on SLH's safety measures and personal or residence identity were related to more psychiatric symptoms (ps ≤ .05). No house-level factor was significantly related to PDA.

CONCLUSIONS

Neighborhood-level factors such as increased availability of self-help groups and fewer nearby alcohol outlets may increase abstinence among individuals living in SLHs. House-level factors related to better maintenance may also facilitate improved mental health.

Navigating Evidence, Challenges, and Caution in the Treatment of Stimulant Use Disorders

Amidst the opioid epidemic, harm reduction-oriented approaches have gained traction, including interventions that focus on prescribing pharmaceutical-grade psychoactive substances, such as opioids, instead of illicit versions, intending to mitigate fatal overdose risks arising from the variability in potency and additives found in illicit drugs. Stimulants have increasingly been found in the victims of opioid overdoses, further prompting some to argue for the prescription of stimulant medications for individuals with stimulant use disorders. Yet, the evidence supporting this practice remains insufficient. In this communication, we critically examine the existing evidence, challenges, and cautions surrounding the treatment of stimulant use disorder.

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.

Piloting the integration of SMART Recovery into outpatient alcohol and other drug treatment programs

BACKGROUND

Research suggests peer support groups can amplify and extend treatment effects and enhance long-term recovery from Alcohol and Other Drug (AOD) problems. However, they are rarely integrated into outpatient treatment programs, resulting in a missed opportunity for peer-to-peer learning, and increased connection to others social networks where people want to reduce or cease substance use.

METHOD

In this mixed-methods study, we examined the uptake, participant experiences and impacts of Self-Management and Recovery Training (SMART) when embedded in three public AOD treatment programs in a pilot program in Australia. Groups were delivered initially in-person but transitioned online during the COVID-19 pandemic.

RESULTS

A total of 75 SMART Recovery groups were run by the pilot sites, with an average attendance of 6.5 people per meeting. Among Participants (N = 31) who completed the survey, 94% reported benefits relating to substance use (i.e., reduction/ successful maintenance of abstinence), 71% reported improvements in their mental health and wellbeing, 74% reported improvements in their physical health, and 81% reported feeling better connected with others. In-depth qualitative interviews were conducted with 10 participants to explore their experiences. Thematic analysis revealed four themes: motivation to attend, active ingredients, views on the integration of SMART into formal AOD, and the advantages and disadvantages of online groups.

CONCLUSION

Taken together, these findings suggest embedding SMART Recovery in AOD treatment is a worthwhile endeavour. This was indicated by a good uptake and evidence of multiple and unique benefits to participants over and above their usual care, notably, better management of their AOD use, health, wellbeing, and sense of connection with others.

Characteristics of a Southern Intensive Trauma- and Psychiatric-Focused Recovery Program

OBJECTIVES

Treatment of substance use disorders (SUDs) is complex, involving biological, psychological, and social factors to be considered when designing effective programs. Trauma-informed psychiatric care integrated with a developmentally appropriate intensive 12-step approach is being used at A Reprieve for Women (Reprieve), a long-term intensive residential recovery program for female emerging adults with SUDs located in Tuscaloosa, Alabama. The Reprieve treatment philosophy focuses on long-term intensive care, treatment of coexisting trauma and psychiatric disorders, and development of life skills. The purpose of this article is to outline Reprieve's programmatic features and report Reprieve's 1- and 2-year sobriety rates for women who completed the 6-month residential program and compare it with national sobriety rates for other residential SUD treatment programs.

METHODS

Reprieve provided 1- and 2-year sobriety rates and duration of treatment from 110 deidentified participants who completed Reprieve's 6-month residential program between September 2016 and November 2020. The researchers defined sobriety as complete abstinence from any addictive substances. Reprieve staff contacted program graduates to determine sobriety status following completion of the program. This research, approved by the University of Alabama's institutional review board, involved usable data points from 68 of the 110 participants.

RESULTS

We determined that Reprieve has a 75% 1-year sobriety rate and a 63% 2-year sobriety rate. The national average sobriety rate for people completing SUD treatment in residential programs is 40%.

CONCLUSIONS

Reprieve's higher-than-national sobriety rates make it a valuable program to study. Its emphasis on the treatment of coexisting psychiatric problems and past traumas, development of life skills, and the unique needs of female emerging adults may contribute to the program's success. It is hoped that this program description and preliminary analysis of outcomes will provide valuable information for future SUD treatment program development. More rigorous study is needed to delineate the effects of specific programmatic features on sobriety.

An agent-based model of binge drinking, inequitable gender norms and their contribution to HIV transmission, with application to South Africa

BACKGROUND

Binge drinking, inequitable gender norms and sexual risk behaviour are closely interlinked. This study aims to model the potential effect of alcohol counselling interventions (in men and women) and gender-transformative interventions (in men) as strategies to reduce HIV transmission.

METHODS

We developed an agent-based model of HIV and other sexually transmitted infections, allowing for effects of binge drinking on sexual risk behaviour, and effects of inequitable gender norms (in men) on sexual risk behaviour and binge drinking. The model was applied to South Africa and was calibrated using data from randomized controlled trials of alcohol counselling interventions (n = 9) and gender-transformative interventions (n = 4) in sub-Saharan Africa. The model was also calibrated to South African data on alcohol consumption and acceptance of inequitable gender norms. Binge drinking was defined as five or more drinks on a single day, in the last month.

RESULTS

Binge drinking is estimated to be highly prevalent in South Africa (54% in men and 35% in women, in 2021), and over the 2000-2021 period 54% (95% CI: 34-74%) of new HIV infections occurred in binge drinkers. Binge drinking accounted for 6.8% of new HIV infections (0.0-32.1%) over the same period, which was mediated mainly by an effect of binge drinking in women on engaging in casual sex. Inequitable gender norms accounted for 17.5% of incident HIV infections (0.0-68.3%), which was mediated mainly by an effect of inequitable gender norms on male partner concurrency. A multi-session alcohol counselling intervention that reaches all binge drinkers would reduce HIV incidence by 1.2% (0.0-2.5%) over a 5-year period, while a community-based gender-transformative intervention would reduce incidence by 3.2% (0.8-7.2%) or by 7.3% (0.6-21.2%) if there was no waning of intervention impact.

CONCLUSIONS

Although binge drinking and inequitable gender norms contribute substantially to HIV transmission in South Africa, recently-trialled alcohol counselling and gender-transformative interventions are likely to have only modest effects on HIV incidence. Further innovation in developing locally-relevant interventions to address binge drinking and inequitable gender norms is needed.

Does knowledge of liver fibrosis affect high-risk drinking behaviour (KLIFAD): an open-label pragmatic feasibility randomised controlled trial

Background

Early identification followed by effective behaviour interventions is pivotal to changing the natural history of alcohol-related liver disease. We examined the feasibility of using transient elastography based advice and alcohol recovery video stories (ARVS) to change drinking behaviour in community alcohol services.

Methods

A feasibility randomised control trial (RCT) was conducted in three community alcohol services. Adults 18+ years presenting with a primary alcohol problem were randomised (1:1) to receive either usual care (control group) or usual care and the KLIFAD Intervention, consisting of advice tailored to liver stiffness measure and access to ARVS (intervention group). Data were collected at baseline and six months. To establish definitive trial feasibility, recruitment and retention rates, study procedure safety and extent of effectiveness were measured (Start date: 02.10.2019, End date: 30.11.2022, ISRCTN.com: 16922410).

Findings

382 service users were screened, 184 were randomised (intervention: 93, control: 91), and baseline data were collected for 128 (intervention: 71, control: 59). Six months follow-up data were available in 87 (intervention: 53, control: 34). Intervention compared to the control group had a longer duration of engagement with services (mean difference 8.6 days SD = 18.4), was more likely to complete the allocated treatment program and reduced or stop drinking (54.9% vs 43.9%) and reduce AUDIT category (71.7% vs 61.8%). There were no reported serious adverse reactions, one intervention group participant reported an increase in AUDIT category.

Interpretation

Integration of transient elastography in community alcohol services is feasible. It may improve engagement with services, retention in clinical trials and supplement the reduction in self-reported alcohol consumption. A definitive RCT is supported.

Funding

National Institute for Health and Care Research (NIHR201146).

Access to psychosocial support for church-going young people recovering from drug and substance abuse in Zimbabwe: a qualitative study

BACKGROUND

The church and other religious-affiliated organizations have promising yet underexplored potential to provide social support services for young people recovering from substance abuse in communities where drug and substance rehabilitation services are limited. This study aimed to establish the barriers and facilitators of accessing psychosocial support, the role of the church, and strategies to promote access to psychosocial support for youths recovering from drug and substance abuse.

METHODS

This was a qualitative cross-sectional study, and semi-structured interviews of 18 church-going youths and three youth pastors were conducted in eastern Zimbabwe. Data were collected using recorded telephone interviews. Data were transcribed and analyzed using the thematic network analysis technique of producing basic themes, which build into organizing themes. Organizing themes produces one overarching global theme. The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for reporting on qualitative research were used in reporting the study findings.

RESULTS

The interviews produced the following basic themes under organizing theme barriers: stigma and discrimination, parental/guardian denial, radical religious beliefs, and negative role models. Under the organizing theme facilitators, the basic themes were acceptance, confidentiality, peer and parental support, and an organized support program. The church acted as the bridge between the barriers to access to services and support seeking through innovative, inclusive projects and activities, as well as a pillar of social support.

CONCLUSIONS

Acceptance of one's addiction problem is critical to initiate seeking psychosocial support. Confidentiality, support from trustworthy relationships, and the availability of a well-coordinated recovery program enable young people to seek support. We recommend formal training church-based counselors in the ethical aspects of psychotherapy to reduce the preconceived social stigma associated with drug and substance abuse.

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.

Understanding the social and community support experiences of sexual and gender minority individuals in 12-Step programs

Sexual and gender minority individuals (e.g., gay, bisexual, non-binary, transgender; SGMI) are 2-6 times as likely as cisgender heterosexual individuals to experience alcohol or other substance use disorders. SGMI participate in 12-Step groups, such as Alcoholics Anonymous (AA), at high rates. Though social support is an established mechanism through which 12-Step programs support reductions in substance use, little is known about SGMI's experiences of the social support in 12-Step programs. This qualitative study aims to understand the experiences of social and community support among SGMI involved in 12-Step programs. This study employed thematic analysis to interpret open-ended responses from 302 SGMI who had participated in 12-Step programs. Data was from The PRIDE Study, a large, national, online. longitudinal, cohort study of SGMI. Two themes emerged about how SGMI experienced social and community support in 12-Step programs: beneficial connections and harmful environments. Beneficial connections included a sense of community, shared experiences, and skills provision. Harmful environments included marginalization, oppression, violence, and bullying. This study highlights the variability of experiences of SGMI participating in 12-Step programs. These findings suggest that many SGMI may benefit from 12-Step programs but may need support in coping with potential harms that can emerge through participation.

Does illicit amphetamine seizures quantity associated with amphetamine use disorder related admissions in Saudi Arabia?

BACKGROUND

Illicit amphetamine-type stimulants (ATS) trafficking activities have increased substantially in Saudi Arabia over the last 10 years. In the period 2013-2017 Saudi Arabia seized the largest quantities of amphetamine at the global level. The current study examines whether the increased quantity of ATS seizures has an impact on amphetamine use disorder admissions.

METHOD

This is an ecological study combining two datasets, the first dataset was obtained from United Nations Office on Drugs and Crime (UNODC), and the Al-Amal Hospital Electronic Health Record System in the city of Dammam, Eastern region of Saudi Arabia from 2005 to 2018. The annual incidence of patients diagnosed with amphetamine use was the dependent variable. The independent variable was the annual reported count of seized quantities of ATS in Saudi Arabia. We used a random intercept Negative Binomial model to predict the yearly count of amphetamine use disorder admission rates.

RESULTS

A total of 910 amphetamine disorder admission patients in Al-Amal rehabilitation and addiction center, and the quantity equivalent to 200 tons of ATS was seized from 2005 to 2018. The amphetamine disorder admission rate has increased from 1.33% in 2005 to 18.27% in 2018. For each one-unit increase in the amphetamine confiscated quantities, the amphetamine use disorder admission rate increased by 49 to 88%.

CONCLUSION

The current study found that reported amphetamine seized quantities were significantly and positively associated with the increase of amphetamine use disorder-related admission rates. In 2018, both ATS seized quantities and admission rates significantly increased, nearly doubling from the previous year. Rigorous, and multidisciplinary interventional studies to evaluate factors associated with increasing abuse of ATS should be a priority for policymakers and researchers in Saudi.

Evaluation of Substance Use Disorder Readmission and Length of Hospital Stay in a Major Rehabilitation Center in the Gulf States: a Retrospective Cohort Study

Substance use disorders (SUDs) patients have longer lengths of hospital stay, and more unplanned readmissions than other hospitalized patients. We aim to evaluate SUD-related rehospitalization and length of hospital stay in a major rehabilitation center that serves countries of the Gulf States. In a retrospective cohort study for 16-year data set in Al-Amal Hospital Electronic Health Record in the city of Dammam, Eastern region of Saudi Arabia, patients received services from the SUD treatment programs in the period of January 1, 2005, to December 31, 2021. We used cause-specific Cox proportional hazards regression model to estimate risk of readmission, and general linear model to examine the association between substance use disorders and length of hospital stay. Of the total cohort, 4398 (30.17%) were readmitted within 1 year of discharge date. More than half of the cohort were unemployed patients (52.93%). Patients diagnosed with amphetamine use disorder were 1.36 higher risk of readmission compared to no amphetamine disorder (HR = 1.36; CI (1.04, 1.78) P.02). Patients diagnosed with mental disorder had 7.25 times higher risk of longer hospital stay compared to no mental health disorder (coefficient = 7.25; P < .0001). Amphetamine use disorder increased the risk of readmission. A secondary diagnosis of mental disorders among SUD patients increased length of hospital stay. As a targeted region of amphetamine smuggling in the world, policy and clinical decision-makers in Saudi Arabia and the Gulf States should consider taking proactive steps to minimize the future anticipated high demand for addiction treatment in the region.

Recovery Capital among Migrants and Ethnic Minorities in Recovery from Problem Substance Use: An Analysis of Lived Experiences

Migrants and ethnic minorities (MEM) are known to be disadvantaged concerning risk factors for problem substance use and resources to initiate and sustain recovery (i.e., recovery capital). Yet, the voices of MEM are largely overlooked in recovery literature. This study explores recovery capital through 34 semi-structured interviews with a diverse sample of MEM in recovery in two ethnically diverse cities in Belgium. A Qualitative Content Analysis using recovery capital theory allowed us to identify various recovery resources on a personal, social, and community level. While physical and human recovery resources play a central role in participants' narratives, personal recovery capital is closely intertwined with meaningful social networks (i.e., social recovery capital) and recovery-supportive environments that maximize opportunities for building culturally sensitive recovery capital (i.e., community recovery capital). Though MEM-specific elements such as culture, migration background, stigma, and structural inequalities play a significant role in the recovery resources of MEM, the largely "universal" nature of recovery capital became clear. The narratives disclose a distinction between "essential" and "acquired" recovery capital, as well as the duality of some recovery resources. The need for developing recovery-oriented systems of care that are culturally responsive, diminish structural inequalities, and facilitate building recovery capital that is sensitive to the needs of MEM is emphasized.

Discovering the pros and cons of participation of Iranian women with substance use disorder in women's only narcotics anonymous meetings and offering strategies for harm reduction: A grounded theory study

Women with substance use disorder participate in women's only narcotics anonymous meetings. Therefore, this study aimed to discover the advantages and disadvantages of Iranian women's participation in this type of meetings. Accordingly, this research was done in Behboud Gostaran Hamgam Women's Rehab Center in Tehran. The research method was a qualitative method of grounded theory, and samples of the research were chosen by theoretical sampling method. Data was collected using in-depth, face-to-face, unstructured interviews and nonparticipation observations. First, 4 women with substance use disorder who had referred to the center to quit addiction were interviewed. The researcher then interviewed 2 informant groups of the center's medical staff, consisting of 2 social workers and 2 mentors with long-term experience in the field of women's addiction, and at the end of each interview, the interviews were analyzed. Finally, according to theoretical sampling principles and achieving saturation, the researcher participated in the women's only narcotics anonymous meetings, which were held weekly inside the center, and took notes on the content of the sessions in relation to the purpose of the study. After each session, the notes were analyzed and finally, after participating in 4 sessions, saturation was achieved by the researcher. By analyzing the research data, the theme of pros of participating in the women's only narcotics anonymous meetings, and the theme of cons of participating in the women's only narcotics anonymous meetings were yielded. Using the research findings could enhance the quality of these meetings.

Using conventional and machine learning propensity score methods to examine the effectiveness of 12-step group involvement following inpatient addiction treatment

BACKGROUND

Continuing care following inpatient addiction treatment is an important component in the continuum of clinical services. Mutual help, including 12-step groups like Alcoholics Anonymous, is often recommended as a form of continuing care. However, the effectiveness of 12-step groups is difficult to establish using observational studies due to the risks of selection bias (or confounding).

OBJECTIVE

To address this limitation, we used both conventional and machine learning-based propensity score (PS) methods to examine the effectiveness of 12-step group involvement following inpatient treatment on substance use over a 12-month period.

METHODS

Using data from the Recovery Journey Project - a longitudinal, observational study - we followed an inpatient sample over 12-months post-treatment to assess the effect of 12-step involvement on substance use at 12-months (n = 254). Specifically, PS models were constructed based on 34 unbalanced confounders and four PS-based methods were applied: matching, inverse probability weighting (IPW), doubly robust (DR) with matching, and DR with IPW.

RESULTS

Each PS-based method minimized the potential of confounding from unbalanced variables and demonstrated a significant effect (p <  0.001) between high 12-step involvement (i.e., defined as having a home group; having a sponsor; attending at least one meeting per week; and, being involved in service work) and a reduced likelihood of using substances over the 12-month period (odds ratios 0.11 to 0.32).

CONCLUSIONS

PS-based methods effectively reduced potential confounding influences and provided robust evidence of a significant effect. Nonetheless, results should be considered in light of the relatively high attrition rate, potentially limiting their generalizability.

What’s inside is all that counts? The contours of everyday thinking about self-control

Does self-control require willpower? The question cuts to the heart of a debate about whether self-control is identical with some psychological process internal to the agents or not. Noticeably absent from these debates is systematic evidence about the folk-psychological category of self-control. Here, we present the results of two behavioral studies (N = 296) that indicate the structure of everyday use of the concept. In Study 1, participants rated the degree to which different strategies to respond to motivational conflict exemplify self-control. Participants distinguished between intra-psychic and externally-scaffolded strategies and judged that the former exemplified self-control more than the latter. In Study 2, participants provided various solutions to manage motivational conflict and rated their proposals on effectiveness. Participants produced substantially more intra-psychic strategies, rated them as more effective, and advised them at a higher rate than externally-scaffolded strategies. Taken together, these results suggest that while people recognize a plurality of strategies as genuine instances of self-control, purely internal exercises of self-control are considered more prototypical than their externally-scaffolded counterparts. This implies a hierarchical structure for the folk psychological category of self-control. The concept encompasses a variety of regulatory strategies and organizes these strategies along a hierarchical continuum, with purely intra-psychic strategies at the center and scaffolded strategies in the periphery.

Veteran Perspectives on Adaptations to a VA Residential Rehabilitation Program for Substance Use Disorders During the Novel Coronavirus Pandemic

Individuals attending residential rehabilitation programs for substance misuse are particularly vulnerable to treatment disruptions spurred by the novel coronavirus disease 2019 (COVID-19) pandemic. We describe adaptations to services within a large residential rehabilitation program for under-resourced veterans, report veterans' experiences with these changes, and outline successes and challenges encountered throughout adjustment to the pandemic. Data collected from two focus groups with nine veterans engaged in this program during the pandemic highlight experiences of inconsistent communication about residential policies, interruptions to medical and addiction services, and feelings of confinement and social isolation. Overall, these findings suggest the need for health systems to support clients in taking an active role in communications, provide additional technical and social support in transitioning to virtual health services, and offer alternative means for clients to maintain social connection during a pandemic. Understanding clients' perspectives can inform strategies to promote continuity of care and enhanced care experiences.

Perspectives on Pain, Engagement in HIV Care, and Behavioral Interventions for Chronic Pain Among Older Sexual Minority Men Living with HIV and Chronic Pain: A Qualitative Analysis

OBJECTIVE AND METHODS

The transition of HIV from an acute, fatal illness to a chronic health condition has shifted the treatment needs of people living with HIV (PLWH). PLWH, including sexual minority men (SMM), are living longer and are subject to health concerns often associated with aging. A major health concern of older SMM living with HIV who report problematic substance use is chronic pain. This qualitative analysis of 15 one-on-one interviews with older SMM living with HIV and chronic pain aimed to characterize this population's experiences with pain, engagement in HIV care, and problematic substance use. This study was conducted in a community health center in Boston, MA. We also solicited suggestions for preferred intervention strategies.

RESULTS

Three main themes emerged from the interview transcripts: 1) the impact of chronic pain and pain treatment on engagement in HIV clinical care; 2) the impact of substance use on chronic pain; and 3) response to interventions to address chronic pain and substance use.

CONCLUSIONS

These findings underscore the need for interventions that address the structural, physical, and psychological barriers to engagement in medical and self-care that affect older SMM living with HIV and chronic pain.

A Case Series: Successfully Preventing COVID-19 Outbreak in a Residential Community Setting at a Drug and Alcohol Addiction Treatment Center

Coronavirus disease 2019 (COVID-19) has reduced the capacity of many addiction treatment centers, limiting access to safe, continual treatment for people with substance use disorders (SUD) in the setting of a pandemic. Here, we describe the COVID-19 screening process of a residential addiction treatment center in rural Connecticut that has had no outbreaks, closures, or reductions in capacity since the pandemic began. Out of 420 patients screened for COVID-19 from 1 February to 1 July, five patients tested positive for COVID-19: four prior to entering its residential community setting, and one after entering the residential community, resulting in no COVID-19 spread to other patients. Patient 1 presented from home and tested positive during screening prior to entry into the community. The primary care provider for patient 2 notified staff of a recent pos-itive COVID-19 test prior to the patient's arrival on-site. Patient 3 had a COVID-19 infection in the weeks prior to arrival and tested positive during initial screening. Patient 4 tested positive af-ter coming from another addiction treatment facility that was shut down due to a COVID-19 outbreak. Patient 5 tested negative for COVID-19 during initial screening, entered the residential community, and later tested positive. It is imperative that in-person support for SUD continues during the pandemic. This case report highlights the importance of implementing a variety of tools in an effective screening process, including polymerase chain reaction screening and daily symptomology and temperature screening, which may help prevent further closures or reductions in capacity of addiction treatment centers during the COVID-19 pandemic or future outbreaks.

Community-Based Yoga for Women Undergoing Substance Use Disorder Treatment: A Descriptive Study

BACKGROUND

Women with substance use disorders (SUD) receive medication-assisted treatment (MAT) with behavioral interventions and counseling for recovery. Evidence supports the use of yoga for SUD; however few studies specifically feature women.

OBJECTIVES

Community-based yoga may add to health promotion through preferable physical activity for women in recovery. The aims of this study are to explore demographics and quantitative measures relevant to recovery and capture and understand the subjective experience of one session of yoga.

STUDY DESIGN

The study design involves Descriptive/Cross-sectional.

METHODOLOGY

Women in an inpatient SUD center attending weekly optional off-site yoga for recovery were recruited to capture first-time attendance. Survey data included Medical Outcomes Survey 12-item short-form (SF-12), Toronto Mindfulness Scale (TMS), and Brief Resilience Scale (BRS), demographics, and narrative reflections. Recruitment opportunities occurred weekly during ongoing hour-long classes.

RESULTS

Twenty-nine women (average age 36.6) with primarily opiate-based addictions completed surveys. SF-12 was below the normative value of 50 for both subscales. BRS scores showed averages on the low end of normal resiliency. The frequency of responses to writing prompts confirmed physical and mental well-being through yoga intervention. Women shared potential relapse prevention specifically attributed to the mindfulness component of the intervention.

CONCLUSION

The SF-12, BRS, and TMS are brief, valid, and reliable and can be easily incorporated in clinical practice or future research. Suboptimal SF-12 scores were found in women with SUD and, therefore important to note in the context of recovery to optimize treatment. Subjective reports from the participants find community-based yoga an enjoyable and beneficial type of physical activity. Yoga may be a viable option for comprehensive mind-body intervention for this population.

Identifying the Main Components of Substance-Related Addiction Recovery Groups

OBJECTIVES

Mutual-aid groups are a central part of many individuals' recovery journeys from substance addiction, and this research aimed to identify the key ingredients of a diverse range of recovery groups.

METHODS

Individuals from 30 different substance addiction recovery groups across the UK (N = 151, 66% male, M age = 42.5 years) completed a survey, which asked participants to provide a narrative about their recovery group experiences. Participants were also asked to rate the extent to which theorized ingredients of addiction recovery groups were offered by their group, and how important each was to them. Both qualitative and quantitative data were collected and analyzed.

RESULTS

The results indicated that the recovery group components suggested in previous literature were both present and rated as important. Component ratings did not differ depending on the type of group, the length of time the person had been in recovery, nor the length of time they had been involved in the group. The qualitative results identified other important components of recovery groups that had not been identified in the previous literature: presence of like-minded individuals and developing self-awareness and reflection skills. An updated list of recovery group components was thereby created.

CONCLUSIONS

Overall, the findings provide an in-depth, person-focused perspective on what makes an addiction recovery group successful. Asking group members directly about their experiences allowed us to refine and expand on previously theorized components. The updated components can be used as a template for developing future mutual-aid groups.

An Apologetic Interpretation of Alcoholics Anonymous (AA): Timeless Wisdom, Outdated Language

BACKGROUND

The Twelve Steps of Alcoholics Anonymous (AA) has proven to be an effective aid in recovery for many people with alcohol use disorder. While constructive criticisms of AA can be beneficial to the organization, other criticisms have merely served as rhetorical devices intent on discrediting the 12-step approach.

OBJECTIVES

This paper examines six prominent critiques of AA, paying special attention to the premises, tone, and factual basis of the statements. Interpretations grounded in AA literature are offered to address claims or critiques around prominent themes, which are organized into two main classes: purported causes of alcoholism and factors maintaining alcoholism.

RESULTS

Findings reveal tenuous statements in the AA literature that appear contradictory and thereby invite a misreading. These statements, some of which misrepresent the tenets of AA and its founders, underscore certain vocal criticisms that are not entirely unfounded. While many pages of the AA literature are imbued with timeless wisdom, even the most apologetic interpretations-distilled into benefit-of-the-doubt renderings-largely falter in defending the nature of the language that originated in the early 1900s at odds with 21st century understandings of alcohol use disorder. Conclusions/Importance: The AA literature essentially presents a valid target for critics, fueling resistance to this free community-based resource that may prevent people who could benefit from AA from seeking the help of the 12-steps.

Exiting Alcoholics Anonymous disappointed: A qualitative analysis of the experiences of ex-members of AA

Alcoholics Anonymous (AA) is an NGO designed to support anyone who identifies as alcoholic to stop drinking alcohol. Existing qualitative research in this field has primarily reflected the experiences of those who have conformed to AA ideology and had positive experiences in AA. To address this, the current study aimed to explore the perspectives and experiences of individuals who have left AA with some degree of disappointment. The study involved semi-structured interviews with 11 ex-members of AA from America, Australia, and England, who were recruited from several private social media platforms. The study used an interactionist conception of social career involving conversion and deconversion, and data were analyzed thematically. Findings included that while participants experienced some genuinely positive aspects of AA, they retrospectively believed that they remained in AA because they had been indoctrinated into a particular way of understanding themselves. Moreover, findings highlighted participants' concerns with the people, ideology and practices within AA that ultimately led to their dissociation from the community. Our findings demonstrate a disparity between the idealistic principles in AA and the actual experiences of participants, and this is discussed in relation to the breadth of possible experiences across varying groups and AA's unregulated peer-to-peer framework.

Parents' experiences of substance use problems, parenthood, and recovery within the 12-step movement

Aim:

The aim of this study was to explore how people with earlier substance use problems narrated their experiences of becoming and being parents. The literature in this area is limited.

Method:

The study participants, all active members of the 12-step movement, were interviewed about their experiences of substance use problems, recovery, and parenthood. The data were analysed using a narrative theoretical framework seeking to answer the questions of how the parents narrate their experiences of parenthood within the frame of a classic 12-step storyline and how they present themselves as parents through these narratives.

Results:

The results show that, on the whole, the narratives conformed to a classic 12-step storyline. For example, the narratives’ turning points were often built up around experiences of “hitting rock bottom”, when the negative consequences of substance use culminated in dramatic events forcing the narrators to see the seriousness of their problems. At the same time the motivational potential of having or expecting (or wishing for future) children was downplayed by several study participants, who instead said that positive driving forces such as human relationships were not enough to break through their denial of their substance use problems. Finally, all study participants described how the process of working towards sobriety had been a transformative experience through which they had come in better contact with their feelings and emotions, and they defined this as an important resource in their everyday lives as parents.

Conclusion:

The results showed that the parents, when narrating their experiences within the frames of a classic 12-step storyline, were also able to present themselves as competent parents, empowered rather than stigmatised by their earlier experiences.

Pornography use in the setting of the COVID-19 pandemic

With the global expansion of the COVID-19 pandemic, social or physical distancing, quarantines, and lockdowns have become more prevalent. Concurrently, Pornhub, one of the largest pornography sites, has reported increased pornography use in multiple countries, with global traffic increasing over 11% from late February to March 17, 2020. While some substantial increases have coincided with Pornhub making its premium services free to countries in lockdowned or quarantined jurisdictions, countries without such free premium access have also reported increases in the range of 4-24%. In addition, pornography searches using the terms "coronavirus", "corona", and "covid" have reached more than 9.1 million. In this letter, we discuss COVID-19-related pornography-use patterns and the impact they may have with respect to problematic pornography use.

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.

Effects of 12-step mutual support and professional outpatient services on short-term substance use outcomes among adults who received inpatient treatment

BACKGROUND

Continuing care is increasingly prioritized in the treatment of substance use disorders (SUDs). Ongoing engagement in continuing care, including mutual support (e.g., 12-step groups) and/or professional outpatient services, may enhance treatment outcomes and facilitate recovery.

OBJECTIVE

This study investigates how engagement in 12-step mutual support and professional outpatient services is associated with short-term substance use outcomes in a sample of patients who completed inpatient SUDs treatment.

METHODS

As part of the Recovery Journey Project - a longitudinal cohort study - participants completed questionnaires upon admission to an inpatient SUDs treatment program, and at 1- and/or 3-months post-discharge (n = 379). Baseline data were collected by self-administered, electronic questionnaires. Follow up data were collected by phone or email. Analyses involved multivariate Generalized Estimating Equations separately modelling self-reported abstinence and percent days abstinent (PDA) over the three time periods.

RESULTS

Overall, rates of self-reported abstinence and PDA increased significantly from baseline to 1- and 3-months follow up. Engagement in 12-step activities (i.e., attended 30 meetings in 30 days, had a home group, had a sponsor, did service work) and professional outpatient substance use support were each significantly associated with abstinence and PDA. Participants who reported a higher degree of 12-step involvement (defined as engagement in more 12-step activities) were also more likely to report being abstinence and greater PDA.

CONCLUSIONS

Engagement in continuing care, including 12-step activities and professional outpatient substance use support, was highly associated with substance use. Clinical teams should encourage participation in such activities to optimize treatment outcomes.

Systematic review of addiction recovery mutual support groups and Indigenous people of Australia, New Zealand, Canada, the United States of America and Hawaii

BACKGROUND

Addictions contribute significantly to the overall disease burden for Indigenous peoples of colonised countries. Mutual support groups are one of the most common addiction recovery resources, however their effectiveness for Indigenous peoples is unclear.

METHODS

A PRISMA-informed search was performed to retrieve empirical studies on addiction recovery mutual support groups for Indigenous peoples of Australia, New Zealand, Canada, United States of America and Hawaii. Databases searched were: MEDLINE, CINAHL Plus, PsychINFO, PsychARTICLES, SocINDEX, Cochrane Database of Systematic Reviews, PubMed, Scopus and UlrichsWeb, Informit Collections, Australian Indigenous HealthInfonet and Lowitja Institute electronic databases. Exclusion criteria were: 1) not an Indigenous focus; 2) not an addiction focus (i.e. including alcohol, other drug, gambling); 3) not a mutual support group focus; 4) not an original study; 5) not a complete study; 6) not published in English language.

RESULTS

Four studies published between 2001 and 2006 met review criteria. All studies were conducted in the United States of America with Native American Indian peoples (n = 1600) and featured Alcoholics Anonymous only. Study designs were: a retrospective analysis of survey data, a cross-sectional survey report, a clinical case study and an ethnographic study. Methodological differences precluded meaningful translation of results.

CONCLUSION

There is a lack of empirical knowledge on the acceptability and outcomes of addiction recovery mutual support groups for Indigenous peoples of Australia, New Zealand, Canada, United States of America and Hawaii. This review suggests recommendations for future research.

Twelve-Step Programs and Spiritual Support at the End of Life

Experts estimate that over 25 million Americans are in recovery from addiction to alcohol and other drugs. Many will be confronted with a serious progressive illness necessitating palliative care or hospice services. In current literature, substance use disorder has mostly been examined in relation to appropriate symptom assessment and management, opioid risk screening, and controlled substance prescribing practices. However, as hospice and palliative care (HPC) clinicians strive to provide whole person care for the seriously ill, awareness and facilitation of healthy psychosocial-spiritual coping strategies for recovering addicts should enhance such care. One of the more common support mechanisms to support recovery is the 12-step program, based on Alcoholics Anonymous. Twelve-step programs have been shown to provide effective coping strategies, not only to help facilitate ongoing abstinence but also to support other psychosocial-spiritual crises. The HPC providers may help to serve those living with addiction disorders better by assessing not only patient histories of substance use/abuse and other addictive behaviors but by facilitating their ongoing support recovery efforts. Here, we use 2 HPC cases to illustrate the value of 12-step recovery programs in patient support and provide recommendations for enhancing such healthy coping in HPC clinical settings.

Applying Behavioural Incentives to Increase Adherence to Maintenance Treatment

A significant portion of the various communities, especially developing countries, is involved in drug abuse and receive formal drug treatments. Although the benefits of available therapeutics such as methadone maintenance treatment (MMT) for controlling infectious diseases have been confirmed, treatment failure has been seen in a large range of the patients. This review addresses the importance of a less attentive behavioural approach in reducing treatment withdrawal. The executive protocol, the outcomes and challenges, and the benefits of this approach are debatable.

Lifestyle Changes for Disease Prevention

In primary care, physicians have the opportunity to address preventative causes of morbidity and mortality. Primary care physicians have a distinct opportunity to provide counseling regarding lifestyle changes and disease prevention in a variety of settings, both during the treatment of acute illnesses and with wellness examinations. Questions from patients regarding specific recommendations and interventions are common. In this article, we address barriers to and tools to encourage lifestyle changes in the areas of smoking cessation, weight loss, physical activity, mental health, and substance abuse/misuse.

Narrating the journey of sustained recovery from substance use disorder

Background

The reported high rate of relapse in the context of an ever-increasing rate of substance abuse internationally and in South Africa together with the fact that the topic of sustained recovery from Substance Use Disorder (SUD) appears to be totally neglected in extant literature and research agendas motivated the researchers to conduct this investigation. The aim was to obtain an in-depth understanding of how individuals recovering from a SUD experience and sustain their recovery in order to fill the gap in the knowledge base.

Methods

A qualitative research approach was followed, employing a narrative and phenomenological research design alongside an explorative, descriptive and contextual strategy of inquiry. Fifteen participants were purposefully recruited; and data were collected by means of individual, face-to-face interviews. Schlossberg’s Transition Process Model (1981) (Schlossberg NK, The Counselling Psychologist 1981;9(2):2-18, Schlossberg NK, Journal of Employment Counselling 2011;48:159-162, Anderson ML et al., Counselling adults in transition: linking

Schlossberg’s theory with practice in a diverse world., 2012) served as a theoretical framework and provided the backdrop to, and foundation for, the presentation of the research findings.

Results

Participants’ entry into recovery was triggered by an internal or external crisis caused by chemical substance abuse. They had to embrace a psychological mind set change, involving commitment to a new way of life in order to sustain their recovery. This, among others, was facilitated by participants’ acceptance of the concept of ‘disease of addiction’ or finding a new faith-based identity. The 12-Step programme and further education and development were found to spiritually support sustained recovery. Strong ongoing support from specialised substance abuse support and/or religious groups, interpersonal relationships with family, spouses and sponsors as well as supportive work environments played a major role in sustaining recovery. The act of helping others further helped the participants to sustain their own recovery.

Conclusion

Regardless of the pathway of recovery, there are key aspects that appear to aid sustained recovery. In grouping these according to the four S’s in Schlossberg’s Transition Process Model (Schlossberg NK, The Counselling Psychologist 1981;9(2):2-18, Journal of Employment Counselling 2011;48:159-162, Anderson ML et al., Counselling adults in transition: linking

Schlossberg’s theory with practice in a diverse world., 2012): self, situation, strategies and support, they seem to facilitate the adaptation to transition from addiction to sobriety. Internal psychological and spiritual resources in terms of self; support (from family, church and support groups); strategies to combat cravings and deal with life problems; and avoiding and managing risk-inducing situations to strengthen recovery.

Independent and Interactive Effects of Neighborhood Disadvantage and Social Network Characteristics on Problem Drinking after Treatment

Socioecological approaches to public health problems like addiction emphasize the importance of person-environment interactions. Neighborhood and social network characteristics may influence the likelihood of relapse among individuals in recovery, but these factors have been understudied, particularly with respect to conceptualizing social network characteristics as moderators of neighborhood disadvantage. Drawing from a larger prospective study of individuals recruited from outpatient treatment (N=451) and interviewed 1, 3, 5, and 7 years later, the aim of this study was to examine the independent and interactive effects of neighborhood and social network characteristics on continued problem drinking after treatment. Models using generalized estimating equations controlling for demographic and other risk factors found the number of heavy drinkers in one's network increases risk of relapse, with the effects being significantly stronger among those living in disadvantaged neighborhoods than among those in non-disadvantaged neighborhoods. No independent effects were found for neighborhood disadvantage or for the number of network members supporting reduced drinking. Future research is needed to examine potential protective factors in neighborhoods which may offset socioeconomic disadvantage as well as to investigate the functions that network members serve in helping to improve long-term treatment outcomes.