Alcohol and drug abusers' perceived reasons for self-change in Canada and Switzerland: computer-assisted content analysis

Using the social cognitive theory to examine spontaneous attempts to quit illicit substance use

Rural areas in the US exhibit high rates of illicit substance use. This study aimed to investigate the Social Cognitive Theory factors associated with spontaneous attempts to quit illicit substance use in a sample of users. A cross-sectional survey was administered through face-to-face interviews. Data was collected from adult (≥ 18 years of age) current illicit substance users who were not receiving professional addiction treatment. Binary logistic regression analyses were utilized to answer the research question. Data from 230 illicit substance users met the eligibility criteria. The mean age was 38 years, whereas the average history of illicit substance use was 14 years. Users with a higher perceived value of quitting illicit substance use were significantly more likely to attempt to quit use spontaneously. Health behavior interventions that incorporate the perceived value of quitting illicit substance use can be effective in encouraging spontaneous attempts to quit illicit substance use.

Self-stigma, hope for future, and recovery: An exploratory study of men with early-onset substance use disorder

CONTEXT

The internalizing of experience of stigma among patients with substance use disorders (SUDs) can be debilitating to recovery. Individual factors such as self-regulation and abstinence self-efficacy can impact confidence in recovery and hope for future.

AIMS

The aim of the study was to explore relationship among self-stigma, self-regulation, self-efficacy, optimism, and confidence in recovery of patients with early-onset SUDs.

SETTINGS AND DESIGN

The study was carried out on a sample of 40 male patients with SUDs. The study had a single group exploratory design.

MATERIALS AND METHODS

The Self-Regulation Questionnaire, Drug Taking Confidence Questionnaire, Substance Abuse Self Stigma Scale, Revised Generalized Expectancy of Success (GES), and visual analog scale for craving were the measures used in the study.

STATISTICAL ANALYSIS

Pearson and spearman's correlation coefficient were used to test associations between the variables. Multiple regression models were drawn to examine predictors of generalized expectancy of success and confidence in recovery.

RESULTS

Self-regulation, generalized expectancy of success (optimism), and confidence in recovery were found to be significantly correlated with self-stigma dimensions. The multiple regression model revealed self-regulation and self-devaluation as significant predictors of optimism (GES), whereas abstinence self-efficacy and values disengagement dimension of self-stigma predicted patients' confidence in recovery.

CONCLUSIONS

Poor regulatory capacities along with internalized feelings of shame, guilt, and devaluation may lead to lower levels of optimism and poorer expectancies of success from future. Patient's self-efficacy in terms of abstaining from use behaviors and disengagement from pursuing life goals can lead to lower levels of confidence in recovery from SUDs and have implications for treatment seeking.

Why Do Those With Long-Term Substance Use Disorders Stop Abusing Substances? A Qualitative Study

Although a significant proportion of adults recover from substance use disorders (SUDs), little is known about how they reach this turning point or why they stop using. The purpose of the study was to explore the factors that influence reasoning and decision making about quitting substance use after a long-term SUD. Semistructured interviews were conducted with 18 participants, each of whom had been diagnosed with a SUD and had been abstinent for at least 5 years. A resource group of peer consultants in long-term recovery from SUDs contributed to the study’s planning, preparation, and initial analyses. Participants recalled harmful consequences and significant events during their years of substance use. Pressure and concern from close family members were important in their initial efforts to abstain from substance use. Being able to imagine a different life, and the awareness of existing treatment options, promoted hope and further reinforced their motivation to quit. Greater focus on why those with SUDs want to quit may help direct treatment matching; treatment completion may be more likely if the person’s reasons for seeking help are addressed.

Older Former Prisoners' Pathways to Sobriety

This study explores how older age shapes processes of substance abuse cessation among male substance users recently released from prison. Semi-structured in-depth interviews and brief surveys were conducted with 15 men aged 49+, released from prison in a large, Eastern U.S. city. A follow-up interview was conducted with each participant (n=15). Conventional content analysis was used to analyze these data. Aging was central to the stories men told about attaining and maintaining sobriety. Men gained clarity after forced detoxification in prison, which was often followed by a period of reflection and evaluation of their lives. Older age seemed integral for this period of sobriety and reflection to catalyze cognitive change, a phenomenon I term Sober Aged Reflection. Further, men described a heightened awareness of mortality that had come with older age, and were deeply afraid of dying in prison. This fear helped inspire a new commitment to sobriety and concordant rejection of the crime that had been linked with their drug use in the past. Finally, men revealed identities and goals that had changed with time, changes incompatible with on-going drug use. Policy implications are discussed.

Planting the seeds of change: Directionality in the narrative construction of recovery from addiction

OBJECTIVE

The dominant theoretical perspective that guides treatment evaluations in addiction assumes linearity in the relationship between treatment and outcomes, viewing behaviour change as a 'before and after event'. In this study we aim to examine how the direction of the trajectory of the process from addiction to recovery is constructed in personal narratives of active and recovering users.

DESIGN

21 life stories from individuals at different stages of recovery and active use were collected and analysed following the principles of narrative analysis.

RESULTS

Personal trajectories were constructed in discontinuous, non-linear and long lasting patterns of repeated, and interchangeable, episodes of relapse and abstinence. Relapse appeared to be described as an integral part of a learning process through which knowledge leading to recovery was gradually obtained.

CONCLUSION

The findings show that long-term recovery is represented as being preceded by periods of discontinuity before change is stabilised. Such periods are presented to be lasting longer than most short-term pre-post intervention designs can capture and suggest the need to rethink how change is defined and measured.

Intersecting motivations for leaving abusive relationships, substance abuse, and transactional sex among HIV high-risk women

BACKGROUND

Women bear a significant burden of the HIV epidemic in the United States. Women classified as 'HIV high-risk' often bring co-existing histories of intimate partner violence (IPV), drug use, and transactional sex. To help inform future comprehensive HIV prevention strategies, we aimed to explore common motivating reasons and barriers to leaving and/or terminating engagement in each of these risk-promoting situations.

METHODS

Between August and November 2014, in-depth interviews were conducted with 14 HIV high-risk women in Atlanta, Georgia who had experienced IPV in the previous 12 months, and used drugs and/or engaged in transactional sex in the previous five years. Participants were asked about histories of IPV, drug use, and/or engagement in transactional sex, and the motivating reasons and barriers to terminating each.

RESULTS

Women reported a range of motivating reasons for leaving IPV, drug use, and transactional sex. Overlapping themes included impact on children, personal physical health/safety, and life dissatisfaction. Financial need was identified as a common barrier to leaving.

CONCLUSIONS

Future HIV prevention research should further explore the perceived impact of IPV, drug use, and transactional sex on physical health/safety, life dissatisfaction, one's children, and financial need as motivators and barriers to reducing upstream HIV risk.

Exploratory Study

This article explores the cognitive process and awakening experience associated with natural recovery from alcohol or drug addiction in English-speaking Hong Kong residents. It is an exploratory study using qualitative research methods. Advertising and snowball sampling recruitment methods yielded two English-speaking Hong Kong residents, one White male expatriate from the United States and one female native Hong Kong resident who is half Chinese and half White American. Reported natural recovery process was evolutionary, occurring over a long period of time with intervals of cognitive appraisal and quit attempts. Awakening interpretations included having a greater insight about their cognitive process, addiction behavior, or emotional experience. The awakening experience played a role in natural recovery and may be used to enhance already existing interventions.

Mixed methods study of help seekers and self-changers responding to an online recovery survey

AIMS

To compare self-changers (natural recovery) with help seekers on demographics, pre-recovery problem severity, and recovery beliefs and behaviors; and to augment these quantitative findings with information extracted from the qualitative stories of a subset of self-changers to explore themes in recovery paths as informed by a nascent natural recovery literature.

METHODS

Quantitative secondary analyses were conducted with persons who had responded to a US nationwide online survey called 'What Is Recovery' (WIR) and who reported a prior lifetime alcohol problem (n = 5495). Six men and six women (with longer-term recoveries) interviewed later were asked to tell their 'recovery story from the beginning up to now'. These were coded using a narrative approach.

RESULTS

Compared with help seekers, self-changers were younger and never married: they did not differ on problem severity, gender, ethnicity or education. Self-changers identified with 'used to have a problem' more than in recovery/recovered, reported fewer years in that status, and reported more current, non-problematic substance use. A new concept of shadow help and shadow obstacles to help-seeking emerged from the qualitative analysis. Though self-changers believed that they had overcome their alcohol problem on their own, change actually occurred within a social context that allowed access to information, normative expectations, relationships, and other opportunities that provided important resources for change.

CONCLUSION

Findings imply that the concept of help-seeking needs to be re-conceptualized to include the informal help we found in this study.

Risk perception in gambling: a systematic review

Perception of the consequences of risk affects motivation and behaviour. In gambling, distorted expectations and preferences towards outcomes are associated with significant social and clinical harms. A systematic review was conducted to examine the relationship between gambling risk perception and behaviour. Sixteen studies met inclusion criteria. Studies provided evidence that disordered gamblers hold both more optimistic overall perceptions of risk, and a mixture of more positive and more negative specific outcome expectations. Preliminary evidence suggests a range of contextual and individual differences moderate risk perception affecting decision-making. Disordered gamblers appear to sustain motivation to gamble, despite more negative expectations and experiences, via cognitive processes that result in preferential emphasis on positive over negative outcomes. Given potential differences in the perception of risk between various categories of gamblers, clinicians should take into account how gamblers in treatment view gambling as a risky behaviour. Improving the accuracy of such perceptions may reduce the propensity for risk-taking behaviours.

Self-change among Spanish speakers with alcohol and drug use disorders in Spain and the United States

OBJECTIVE

Few cross-cultural studies have investigated the self-change process with substance abusers. This study examined commonalities and differences related to the self-change process with Spanish speaking self-changers in Spain and the United States (U.S.) who reported recovering from an alcohol or drug problem on their own (i.e., without formal help or treatment) for ≥1 year.

METHOD

Advertisements were primarily used to recruit participants. There were 56 participants in the final sample (Spain, n=29; US; n=27). Participants provided demographic and substance use history information and completed the Drug Use History Questionnaire, Reasons for Change Scale, the Life Events Checklist, and a checklist for maintenance factors after recovery.

RESULTS

Significantly more self-changers from the U.S. met DSM IV-TR criteria for alcohol dependence, reported significantly more life events in the year prior to recovery and significantly more maintenance/support events in the year after their recovery than their counterparts in Spain. The majority of participants' recoveries involved abstinence. Some alcohol abusers, however, report successfully engaging in low-risk drinking with no consequences(50% Spain; 22% U.S.), and some drug abusers in Spain (23%) reported a few days per year of very little drug use.

CONCLUSIONS

The two groups of Spanish speakers represented very different cultures, and those from the U.S. came from several countries in the Southern hemisphere. The results of this study suggest that even though people speak the same language that does not mitigate against cultural differences. Additional studies of the process of self change with larger participant samples are needed to better inform the development and provision of interventions for Spanish speakers with alcohol and drug use disorders across different cultures and countries.

Predictors and correlates of reduced frequency or cessation of injection drug use during a randomized HIV prevention intervention trial

AIMS

This study conducted a secondary analysis to examine injection cessation and decreasing frequency of injection during a multi-site randomized controlled HIV prevention intervention trial that sought to reduce sexual and injection risk behavior among young injection drug users.

DESIGN AND SETTING

A six-session, cognitive-behavioral skills-building intervention in which participants were taught peer education skills [peer education intervention (PEI)] was compared with a time-equivalent attention control. Follow-up interviews were conducted at 3 and 6 months post-baseline.

PARTICIPANTS

Trial participants were HIV and hepatitis C virus (HCV) antibody-negative injection drug users aged 15-30 years. Participants who had at least one follow-up interview and reported injecting drugs in the previous 3 months at baseline were eligible for the present analysis (n = 690).

MEASUREMENTS

At each interview, data were collected on the number of times participants injected drugs over the previous 3 months.

FINDINGS

Twenty-seven per cent of participants reported at least one 3-month period of injection cessation. In a multivariate, zero-inflated negative binomial regression adjusting for prior injection frequency, time of follow-up and psychosocial variables, PEI trial arm and smaller session size were associated significantly with injection cessation. Trial arm had no effect on the frequency of injection among those who continued to inject.

CONCLUSIONS

HIV prevention interventions that encourage injection drug users to take on the role of peer educator may have the additional benefit of increasing the likelihood of injection cessation. Intervention group size is also an important consideration, with smaller groups having higher rates of cessation.

Continuities and changes in self-change research

AIMS

A substantial literature demonstrates that natural recoveries from substance use disorders not only occur but are a common pathway to recovery. This article reviews selectively and comments on the current state-of-the-art in natural recovery research.

METHODS

Basic concepts in natural recovery research are presented, and topical and methodological trends and changes in self-change research over time are discussed.

CONCLUSIONS

Although considerable progress has occurred in natural recovery research, several topics deserving of further research are identified, and implications for policy practice are discussed.

Self-change strategies in smokers and former smokers: Spanish adaptation of the SCS-CS and SCS-FS

The purpose of this study was to validate and adapt the Self-Change Strategies in Current Smokers (SCS-CS) and the Self-Change Strategies in Former Smokers (SCS-FS) (Christie & Etter, 2005) to the Spanish population. We also wished to analyze the differences in the self-change strategies used as a function of gender. Participants were 370 subjects (190 smokers and 180 former smokers) who were recruited by means of the "snowball" method. The alpha coefficients for the SCS-CS and the SCS-FS were .86 and .87, respectively. Both scales present satisfactory psychometric properties, so they are shown to be useful instruments to use in the Spanish population. The SCS-CS score showed that male smokers used more self-change strategies than females (46.6 vs. 11.9, p < .01), specifically, more cognitive strategies. In the SCS-CS, men scored higher than women (49 vs. 12.08, p < .01), in both the group of cognitive and behavioral strategies. The psychological mechanisms used to control the smoking habit are the same in men as in women, but the men tend to use a larger number of strategies. Treatments to quit smoking do not need to be substantially different, but they should be more intensive in the case of women smokers.

The road to recovery: where are we going and how do we get there? Empirically driven conclusions and future directions for service development and research

The term "recovery" is often used in the addiction field. However, we have thus far failed to define the term, to delineate its dimensions, or to elucidate the prerequisite conditions to this outcome. This has hindered service development and evaluation as well as changes in policy. This paper: 1. Reviews empirical findings about how "recovery" is defined and experienced by individuals engaged in the process; 2. Examines factors associated with recovery initiation, maintenance, and sustained lifestyle, and review obstacles to recovery; and 3. Discusses implications for services and research; implications include the need to adopt a long-term, wellness-centered approach to addressing substance use related problems, the importance for society to address the stigma of former addiction and to offer attractive viable opportunities to promote making significant life changes toward recovery from substance use.

Differences among substance abusers in Spain who recovered with treatment or on their own

This exploratory study compared the differences among substance abusers in Spain who recovered with treatment or on their own. Advertisements were used to recruit 58 individuals (29 self-changers and 29 treatment-changers) who had had problems with alcohol or drugs, and who had been recovered for at least one year. The groups differed significantly in severity of dependence, psychiatric treatment prior to recovery, and coping strategies to maintain recovery. Consistent with previous studies, those who had recovered through treatment had a more serious substance use history than those who changed on their own. In addition, social support was associated with maintenance of change for both groups. These findings parallel those for English-speaking populations.

What does recovery mean to you? Lessons from the recovery experience for research and practice

Recovery is a ubiquitous concept but remains poorly understood and ill defined, hindering the development of assessment tools necessary to evaluate treatment effectiveness. This study examines recovery definitions and experiences among persons who self-identify as "in recovery." Two questions are addressed: (a) Does recovery require total abstinence from all drugs and alcohol? (b) Is recovery defined solely in terms of substance use or does it extend to other areas of functioning as well? Inner-city residents with resolved dependence to crack or heroin were interviewed yearly three times (N = 289). Most defined recovery as total abstinence. However, recovery goes well beyond abstinence; it is experienced as a bountiful "new life," an ongoing process of growth, self-change, and reclaiming the self. Implications for clinical and assessment practice are discussed, including the need to effect paradigmatic shifts from pathology to wellness and from acute to continuing models.

Course of recovery from alcoholism

This article represents the proceedings of a symposium at the 2005 Research Society on Alcoholism meeting in Santa Barbara, California, organized and chaired by Kamilla L. Venner. This symposium integrated current empirical research on the course of recovery from alcoholism from multiple perspectives, an aim that is consistent with NIAAA's new focus on the process of recovery. The presentations and presenters were as follows: (1) The Role of Community Services and Informal Support on 7-Year Drinking Outcomes in Treated and Untreated Drinkers, by Helen Matzger; (2) The Sequence of Recovery Events in a Native American Sample, by Kamilla L. Venner; (3) Transformational Change in Recovery, by Alyssa A. Forcehimes; (4) Social Settings and Substance Use: Contextual Factors in Recovery, by Rudolf H. Moos; and (5) A Broader View of Change in Drinking Behavior, by discussant Mark L. Willenbring. A theme connecting the presentations was that treatment is but one discrete aspect to recovery and that sustained recovery is often influenced by an individual interaction with others within a social context. Collectively, presentations underscored the need to think more broadly about factors contributing to the remission of alcohol dependence.

Self-change: A pathway to cannabis abuse resolution

Long-term daily cannabis abusers (N = 25) who without treatment stopped using cannabis for at least one year were interviewed about their past substance use, antecedents to change, and factors supportive of change. Respondents' cannabis problems decreased in the year prior to their recovery compared to their lifetime use. Respondents described their successful quit attempts through structured interviews and autobiographical narratives. The narratives were content analyzed for factors related to recovery. The reports indicated that marijuana cessation was motivated more by internal than external factors, and the most common precipitants of quit attempts were cognitive anti-cannabis factors. The major reason reported by respondents for stopping cannabis was a change in how they viewed their cannabis use, followed by negative personal effects. The most common reported maintenance factors were avoidance of situations in which cannabis was used, changes in lifestyle, and the development of non-cannabis-related interests. Cognitive and respiratory functioning were also assessed. Lastly, more than 75% of respondents reported not seeking treatment because they believed it was not needed or because they wanted to quit on their own. Directions for future research are offered.

Smokers' narrative accounts of quit attempts: Aids and impediments to success

In this study, the authors used cigarette smokers' narratives describing their quit attempts to understand factors related to the change process. Maintained quitters (MQs, n = 59) and temporary quitters (TQs, n = 47) wrote autobiographical narratives describing their most serious (TQs) or last (MQs) quit attempt. Two types of content analysis were used to analyze the reports: (a) dichotomous ratings of the presence or absence of an event and (b) computerized content analysis of event or word frequency. The valence (anti- or pro-smoking cessation) of change factors was also examined. MQs wrote significantly more affective statements than did TQs. When valence was examined, MQs made significantly more pro-smoking cessation social support, cognitive, and affective statements than TQs did, and TQs made significantly more anti-smoking cessation social support and affective statements than MQs did.

Attitudes of teenagers towards cigarettes and smoking initiation

This paper contributes to the empirical knowledge of determinants of smoking initiation in adolescents. The instrument we used was a structural equation model, which is a powerful tool to analyze causal relationships in nonexperimental studies. We used a school-based sample of 1198 teenagers from Spain. We measured the attitude of the adolescents towards tobacco. Attitudes and smoking status are related. Attitudes become more favorable to smoking, as experimentation with cigarettes progresses and pupils become older. Teenagers who have tried at least one cigarette are on average more favorable to smoking than those who had never smoked. The study's limitations were noted.