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Esteban-Rodríguez L, Pérez-López M, Sion A, Olmos-Espinosa R, Jurado-Barba R, Maldonado-Sánchez D, León-Gayo M, Armada V, Rubio G. Agreement for Recovery: First Spanish Consensus on the Concept of Alcohol Addiction Recovery. ACTAS ESPANOLAS DE PSIQUIATRIA 2024; 52:382-393. [PMID: 39129690 PMCID: PMC11319745 DOI: 10.62641/aep.v52i4.1633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
INTRODUCTION Current literature does not dispose from a widely accepted definition of recovery in alcohol use disorder (AUD), and most proposals originate from anglophone countries. This study introduces a pioneering consensus in Spain on the definition of recovery in AUD. METHOD The Delphi method was used. The expert panel, comprising 54 multidisciplinary professionals from the Community of Madrid. RESULTS A high level of consensus (≥80% agreement) was reached for 45% of the items and majority (≥60%) for 84%. Recovery is understood as a dynamic, personalized, and voluntary process, potentially enduring throughout one's lifespan. It entails a transformative lifestyle shift aimed at achieving a significant improvement in overall quality of life, encompassing physical and mental health, interpersonal relationships, and environmental factors. The journey of recovery is marked by heightened psychological well-being, is characterized by empowerment, personal growth, existential purpose, and positive identity reconstruction. Recovery is supported by substance use management, requires proactive individual agency and involves both personal and societal responsibilities. CONCLUSIONS This study represents a milestone as it is the first consensus in the Community of Madrid on the meaning of recovery in AUD. The proposed definition of recovery could be a potential reference for similar regions within Spain or even for other countries with cultural similarities. The elucidation of a clear framework of recovery provides a solid basis for future research efforts and clinical interventions in the Spanish AUD landscape.
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Affiliation(s)
- Laura Esteban-Rodríguez
- Institute for Biomedical Research, Hospital 12 de Octubre, 28041 Madrid, Spain
- Faculty of Psychology, Complutense University of Madrid, 28223 Madrid, Spain
| | | | - Ana Sion
- Institute for Biomedical Research, Hospital 12 de Octubre, 28041 Madrid, Spain
- Faculty of Psychology, Complutense University of Madrid, 28223 Madrid, Spain
- Red de Investigación en Atención Primaria de Adicciones (RIAPAd), 08003 Barcelona, Spain
| | | | - Rosa Jurado-Barba
- Faculty of Health Sciences - HM Hospitales, Camilo José Cela University, 28692 Madrid, Spain
| | - Daniel Maldonado-Sánchez
- Institute for Biomedical Research, Hospital 12 de Octubre, 28041 Madrid, Spain
- Faculty of Psychology, Complutense University of Madrid, 28223 Madrid, Spain
| | | | - Víctor Armada
- Institute for Biomedical Research, Hospital 12 de Octubre, 28041 Madrid, Spain
- Faculty of Health Sciences - HM Hospitales, Camilo José Cela University, 28692 Madrid, Spain
| | - Gabriel Rubio
- Institute for Biomedical Research, Hospital 12 de Octubre, 28041 Madrid, Spain
- Red de Investigación en Atención Primaria de Adicciones (RIAPAd), 08003 Barcelona, Spain
- In Recovery, 28045 Madrid, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
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Lesko CR, Falade-Nwulia OO, Pytell JD, Hutton HE, Fojo AT, Keruly JC, Moore RD, Chander G. Joint effects of substance use disorders and recent substance use on HIV viral non-suppression among people engaged in HIV care in an urban clinic, 2014-2019. Addiction 2023; 118:2193-2202. [PMID: 37491566 PMCID: PMC10592031 DOI: 10.1111/add.16301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 06/19/2023] [Indexed: 07/27/2023]
Abstract
AIMS To estimate the joint effects of substance use disorder (SUD) and recent substance use on human immunodeficiency virus (HIV) non-suppression. DESIGN Retrospective clinical cohort study with repeated observations within individuals. SETTING Baltimore, Maryland, United States. PARTICIPANTS 1881 patients contributed 10 794 observations. MEASUREMENTS The primary independent variable was the combination of history of SUD and recent substance use. History of SUD was defined as any prior International Classification of Diseases 9/10 code for cocaine or opioid disorder. Recent substance use was defined as the self-report of cocaine or non-prescribed opioid use on the National Institute of Drug Abuse-modified Alcohol, Smoking and Substance Involvement Screening Test or clinician-documented cocaine or opioid use abstracted from the medical record. The outcome was viral non-suppression, defined as HIV RNA >200 copies/mL on the first viral load measurement within 1 year subsequent to each observation of substance use. We adjusted for birth sex, Black race, age, HIV acquisition risk factors, years in care and CD4 cell count. In secondary analyses, we also adjusted for depressive, anxiety and panic symptoms, cannabis use and cannabis use disorder. FINDINGS On their first observation, 31% of patients had a history of an SUD and 18% had recent substance use. Relative to no history of SUD and no recent substance use, the 1-year fully adjusted risk difference (RD) for viral non-suppression associated with cocaine and opioid use disorder and recent substance use was 7.7% (95% CI = 5.3%-10.0%), the RD was 5.5% (95% CI = 1.2%-9.7%) for history of cocaine use disorder without recent substance use, and the RD was 4.6% (95% CI = 2.7%-6.5%) for recent substance use without a SUD. CONCLUSIONS Substance use and substance use disorders appear to be highly prevalent among, and independently associated with, viral non-suppression among people with HIV.
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Affiliation(s)
- Catherine R Lesko
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Jarratt D Pytell
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Heidi E Hutton
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Anthony T Fojo
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Najera MS, Cavalli JM, Cservenka A. Distress tolerance and problematic cannabis use: does the form of cannabis matter? J Addict Dis 2023:1-11. [PMID: 37565482 DOI: 10.1080/10550887.2023.2244378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
BACKGROUND Low distress tolerance may result in greater vulnerability to problematic cannabis use. However, the role of the primary form of cannabis used has not been examined as a moderator of this association. While marijuana flower remains the preferred form of cannabis, the popularity of other forms of cannabis, including concentrates and edibles, is on the rise. OBJECTIVES We examined the association between distress tolerance and problematic cannabis use and whether the primary form of cannabis used moderates this relationship. METHODS Participants were 695 (67.6% male) past-month cannabis users who completed an online survey. Multiple linear regressions assessed whether distress tolerance, the primary form of cannabis used, and their interaction were related to problematic cannabis use while controlling for demographic variables and past 30-day alcohol and cannabis use frequency. RESULTS Lower tolerance for distress was associated with more problematic cannabis use. Endorsing concentrates as the primary form of cannabis used vs. marijuana flower was related to more problematic cannabis use while reporting edibles as the primary form of cannabis used vs. marijuana flower or concentrates was related to less problematic cannabis use. Individuals preferring marijuana flower or concentrates reported more problematic cannabis use at lower levels of distress tolerance. CONCLUSIONS Cannabis users exhibiting low distress tolerance or a preference for concentrates may be at greatest risk for experiencing negative consequences related to their cannabis use. Additionally, building tolerance for stressful situations, among both concentrates and marijuana flower users, may aid in minimizing problematic cannabis use.
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Affiliation(s)
- Melissa S Najera
- School of Psychological Science, Oregon State University, Corvallis, OR, USA
| | - Jessica M Cavalli
- School of Psychological Science, Oregon State University, Corvallis, OR, USA
| | - Anita Cservenka
- School of Psychological Science, Oregon State University, Corvallis, OR, USA
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4
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Pinedo M, Castro Y, Gilbert PA, Caetano R, Zemore SE. Improving assessment of alcohol treatment barriers among Latino and White adults with an alcohol use disorder: Development of the barriers to specialty alcohol treatment scale. Drug Alcohol Depend 2023; 248:109895. [PMID: 37156194 PMCID: PMC10802933 DOI: 10.1016/j.drugalcdep.2023.109895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 05/10/2023]
Abstract
INTRODUCTION The present study's aims were two-fold. First, we sought to validate a novel measure to assess barriers to specialty alcohol treatment among White and Latino individuals with an alcohol use disorder (AUD): The Barriers to Specialty Alcohol Treatment (BSAT) scale. Second, we sought to demonstrate that the BSAT scale could be used to explain Latino-White disparities in barriers to alcohol treatment. METHODS In 2021, we recruited an online national sample of 1200 White and Latino adults with a recent AUD. Participants completed an online questionnaire that included the BSAT items. Confirmatory and exploratory factor analyses were conducted to validate the BSAT. Multiple group analyses across race/ethnicity and language were also performed using the final model. RESULTS The final model consisted of 36 items across 7 factors that reflect barriers related to low problem recognition, recovery goals, low perceived treatment efficacy, cultural factors, immigration-related concerns, low perceived social support, and logistical barriers. The final model's factor structure and factor loadings held up across race/ethnicity and language. The top endorsed barriers were low problem recognition, recovery goals, low perceived social support, logistical issues, and low perceived treatment efficacy. Compared to Whites, Latinos were more likely to report perceived lack of social support, logistical barriers, low perceived treatment efficacy, cultural barriers, and immigration-related concerns as barriers. CONCLUSION Findings provide empirical support for the validity of the BSAT scale, which offers improved measurement of specialty alcohol treatment barriers and can be used to explore Latino-White disparities in a future study.
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Affiliation(s)
- M Pinedo
- Kinesiology & Health Education, UT Austin, United States.
| | - Y Castro
- Steve Hicks School of Social Work, UT Austin, United States
| | - P A Gilbert
- College of Public Health, University of Iowa, United States
| | - R Caetano
- Pacific Institute for Research and Evaluation, United States
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5
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Witkiewitz K, Stein ER, Votaw VR, Hallgren KA, Gibson BC, Boness CL, Pearson MR, Maisto SA. Constructs derived from the addiction cycle predict alcohol use disorder treatment outcomes and recovery 3 years following treatment. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2023; 37:376-389. [PMID: 35951419 PMCID: PMC9918601 DOI: 10.1037/adb0000871] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The addiction cycle has been proposed as a framework for understanding the progression of alcohol use disorder (AUD) in terms of psychological and biological domains, including reward drinking/incentive salience, relief drinking/negative emotionality, and loss of control/executive functioning impairment. To have utility in clinical practice, self-report measures of these domains that are applicable across sociodemographic groups and associated with clinical outcomes are needed. This study sought to validate domains from self-report measures and to test whether domains are measurement invariant across sociodemographic groups and associated with treatment outcomes. METHOD Secondary analysis of individuals with AUD (n = 3,092) who participated in two alcohol clinical trials, Project Matching Alcohol Treatment to Client Heterogeneity (MATCH) and COMBINE. Factor analytic methods were used to derive addiction cycle domains at baseline. These domains were then examined as predictors of outcomes. RESULTS Fifteen self-report items were used as indicators of the addiction cycle domains, with sociodemographic differences in measurement by sex, age, race, education, and AUD symptoms. Relief/negative emotionality and reward/incentive salience were significantly associated with outcomes at 1 and 3 years following treatment, and executive functioning also predicted nonabstinent recovery at 3 years. CONCLUSIONS The results support the utility of domains relevant to the addiction cycle in predicting AUD treatment outcomes and recovery among individuals who sought treatment for AUD. The addiction cycle domains were more strongly associated with outcomes than other measures clinicians might use to predict outcomes (e.g., AUD symptoms). Future research should continue to develop and refine the items and test whether the addiction cycle domains can inform treatment planning. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology, Center on Alcohol, Substance Use, and Addictions (CASAA), University of New Mexico
| | - Elena R Stein
- Department of Psychology, Center on Alcohol, Substance Use, and Addictions (CASAA), University of New Mexico
| | - Victoria R Votaw
- Department of Psychology, Center on Alcohol, Substance Use, and Addictions (CASAA), University of New Mexico
| | - Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Benjamin C Gibson
- Department of Psychology, Center on Alcohol, Substance Use, and Addictions (CASAA), University of New Mexico
| | - Cassandra L Boness
- Department of Psychology, Center on Alcohol, Substance Use, and Addictions (CASAA), University of New Mexico
| | - Matthew R Pearson
- Department of Psychology, Center on Alcohol, Substance Use, and Addictions (CASAA), University of New Mexico
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Paquette CE, Reese ED, Yi JY, Maccarone JM, Stewart ZJ, Daughters SB. Group behavioral activation with and without a smartphone app in intensive outpatient treatment for substance use disorder: A three-arm randomized controlled trial. Drug Alcohol Depend 2023; 243:109758. [PMID: 36634574 PMCID: PMC10026710 DOI: 10.1016/j.drugalcdep.2022.109758] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Reward deficits negatively impact recovery from substance use disorder (SUD). LETS ACT, a behavioral activation treatment targeting substance-free reward, has demonstrated effectiveness in reducing post treatment substance use. There remains room for modifications to extend recovery gains, and LETS ACT remains largely untested in outpatient treatment. We tested the effect of LETS ACT when delivered alongside intensive outpatient SUD treatment, with and without a smartphone app designed to extend access to treatment content outside of clinician-administered sessions. METHODS In this three-arm randomized controlled trial (N = 206; 54 % White, 67 % male), all participants received intensive outpatient SUD treatment as usual (TAU) and either LETS ACT (n = 56), smartphone-enhanced LETS ACT (n = 65), or assessments only (n = 61). Substance use days and substance related problems were assessed through 12 months posttreatment. RESULTS Generalized estimating equations indicated a significant condition*time interaction for substance use days; Days of substance use significantly declined from pretreatment until 1-month for TAU, 3-months for LETS ACT-SE, and 6-months for LETS ACT. Decreases in substance-related problems were maintained across all conditions through 12 months. CONCLUSIONS Adding LETS ACT to intensive outpatient treatment resulted in significant decreases in substance use through 6 months posttreatment, yet these gains were not sustained through 12 months posttreatment. A smartphone app did not facilitate superior treatment outcomes. Future studies should consider factors impacting treatment efficacy in outpatient settings and the utility of providing more than six sessions of behavioral activation.
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Affiliation(s)
- Catherine E Paquette
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States.
| | - Elizabeth D Reese
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| | - Jennifer Y Yi
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| | - Julianna M Maccarone
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| | - Zachary J Stewart
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
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7
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Relationship of negative emotionality, NIAAA recovery, and 3- and 6-month drinking outcomes among adults in treatment for alcohol use disorder. Drug Alcohol Depend 2023; 242:109695. [PMID: 36442440 DOI: 10.1016/j.drugalcdep.2022.109695] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 10/26/2022] [Accepted: 10/30/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND The National Institute of Alcohol Abuse and Alcoholism (NIAAA) recently released a new definition of recovery from alcohol use disorder (AUD). A patient is considered recovered if they are remitted from DSM-5 AUD and report cessation of heavy drinking. The NIAAA has also recently proposed the Addictions Neuroclinical Assessment (ANA) to guide treatment research. Negative emotionality is one of three domains of the ANA and theory proposes that AUD is maintained by negative reinforcement via the relief of negative affect. The purpose of the current study was to examine: (1) the relationship of end-of-treatment negative emotionality and NIAAA recovery, and (2) the ability of NIAAA recovery at the end of treatment to predict three- and six-month drinking outcomes. METHOD At baseline and end-of-treatment, women and men (n = 181) in treatment for AUD completed measures of negative emotionality, drinking, and were assessed for DSM-5 AUD diagnostic criteria. At three- and six-months post-treatment, drinking was re-assessed. RESULTS 22.5% (n = 24) of participants met full criteria for NIAAA recovery at end-of-treatment. Lower levels of end of treatment negative emotionality were associated with increased odds of achieving NIAAA recovery. Meeting NIAAA recovery predicted greater percent days abstinent (PDA) and lower percent heavy drinking days (PHDD) at 3-months, but not at 6-months post-treatment. CONCLUSIONS This study is among the first to report a relationship between the negative emotionality domain of the ANA and NIAAA recovery. Results underscore the importance of addressing negative emotionality in treatment. Findings also suggest that NIAAA recovery predicts positive short term drinking outcomes.
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8
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Richards DK, Pearson MR, Field CA. A comprehensive examination of alcohol-related motivations among college students: Unique relations of drinking motives and motivations for drinking responsibly. Exp Clin Psychopharmacol 2022; 30:809-819. [PMID: 34735203 PMCID: PMC9278051 DOI: 10.1037/pha0000526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Drinking motives, or reasons people choose to drink, are well-established risk factors for alcohol use and related negative consequences. Recent research has shown utility in a self-determination theory (SDT) approach for describing motivation for engaging in behaviors that reduce the harms associated with alcohol use (i.e., drinking responsibly). In the present study, we examined the relationship between drinking motives and motivations for drinking responsibly as well as their unique and incremental associations with alcohol-related outcomes (protective behavioral strategies [PBS], consumption, and negative consequences) in two samples of college student drinkers: (a) a random sample (n = 507) recruited from a Hispanic-Serving Institution on the U.S. border with Mexico (Mage = 22.84, SD = 5.84; 67.3% female; 90.9% Hispanic) and (b) a convenience sample (n = 2,808) from Psychology Department research participation pools at 10 universities in 8 U.S. states (Mage = 20.59, SD = 4.18; 72.9% female; 58.2% non-Hispanic White). Autonomous motivations (experience of volition and choice) for drinking responsibly were negatively correlated with drinking motives, but these correlations were small-to-medium in magnitude suggesting nonredundancy between the constructs. Drinking motives were risk factors for alcohol-related outcomes, especially alcohol-related problems, and autonomous motivations for drinking responsibly were protective factors for alcohol-related outcomes, especially PBS. Both motivational constructs predicted alcohol-related outcomes beyond the other, but drinking motives generally accounted for more variance. These findings suggest that integrating motivation in relation to both drinking and drinking responsibly may lead to a better understanding of alcohol-related behaviors and the associated negative consequences among college students. Implications for college drinking interventions are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | | | - Craig A Field
- Latino Alcohol and Health Disparities Research and Training (LAHDR) Center
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9
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Luk JW, Ramchandani VA, Diazgranados N, Schwandt ML, Gunawan T, George DT, Goldman D. Multidimensional Quality of Life Across the Spectrum of Alcohol Use Behavior. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2022; 4:92-101. [PMID: 36545505 PMCID: PMC9757500 DOI: 10.1176/appi.prcp.20220023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Quality of life (QoL) is inversely associated with alcohol misuse and is a key measure by which recovery from alcohol use disorder (AUD) might be assessed. Yet, the determinants of QoL are scarcely known. The authors examined three ways through which demographic characteristics, familial and early life factors, and psychopathology conferred risks for QoL, including unique direct effects, developmental pathways, and clinical risk Profiles. Methods Cross-sectional data from 1095 adults (50.4% without AUD; 49.6% with AUD) who participated in the NIAAA Natural History Protocol from January 2015 to March 2022 were analyzed. Multivariable regressions, path analysis, and latent Profile analysis were conducted. Results AUD was uniquely associated with lower QoL, and adverse effects of child maltreatment history and psychopathology symptoms on QoL were of similar or larger magnitudes. Mediation analysis indicated family history of AUD and child maltreatment history were indirectly associated with lower QoL through higher attention-deficit/hyperactivity disorder symptoms, higher depressive symptoms, and positive AUD diagnosis. Latent Profile analysis of an enriched set of clinical characteristics identified four latent Profiles capturing the full range of alcohol use behavior. Latent Profiles with greater severity of familial and early life factors, psychopathology, and problematic drinking showed dose-response associations with lower levels of physical, psychological, social, and environment QoL. Conclusions A constellation of developmental and clinical characteristics disproportionately affects individuals with AUD and is negatively associated with QoL domains. To improve QoL, prevention and intervention need to target multiple factors, including history of child maltreatment, comorbid psychopathology, and problematic drinking itself.
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Affiliation(s)
- Jeremy W. Luk
- Office of the Clinical DirectorNational Institute on Alcohol Abuse and AlcoholismBethesdaMDUSA
| | - Vijay A. Ramchandani
- Human Psychopharmacology LaboratoryNational Institute on Alcohol Abuse and AlcoholismBethesdaMDUSA
| | - Nancy Diazgranados
- Office of the Clinical DirectorNational Institute on Alcohol Abuse and AlcoholismBethesdaMDUSA
| | - Melanie L. Schwandt
- Office of the Clinical DirectorNational Institute on Alcohol Abuse and AlcoholismBethesdaMDUSA
| | - Tommy Gunawan
- Office of the Clinical DirectorNational Institute on Alcohol Abuse and AlcoholismBethesdaMDUSA,Human Psychopharmacology LaboratoryNational Institute on Alcohol Abuse and AlcoholismBethesdaMDUSA
| | - David T. George
- Office of the Clinical DirectorNational Institute on Alcohol Abuse and AlcoholismBethesdaMDUSA
| | - David Goldman
- Office of the Clinical DirectorNational Institute on Alcohol Abuse and AlcoholismBethesdaMDUSA,Laboratory of NeurogeneticsNational Institute on Alcohol Abuse and AlcoholismRockvilleMDUSA
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Hagman BT, Falk D, Litten R, Koob GF. Defining Recovery From Alcohol Use Disorder: Development of an NIAAA Research Definition. Am J Psychiatry 2022; 179:807-813. [PMID: 35410494 DOI: 10.1176/appi.ajp.21090963] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objective of this article is to provide an operational definition of recovery from alcohol use disorder (AUD) to facilitate the consistency of research on recovery and stimulate further research. The construct of recovery has been difficult to operationalize in the alcohol treatment and recovery literature. Several formal definitions of recovery have been developed but have limitations because 1) they require abstinence from both alcohol and substance use, 2) they do not include the DSM-5 diagnostic criteria for AUD as part of the recovery process (i.e., no focus on remission from AUD), 3) they do not link remission and cessation from heavy drinking to improvements in biopsychosocial functioning and quality-of-life constructs, and 4) they do not distinguish between alcohol and other drug use. The authors present a newly developed National Institute on Alcohol Abuse and Alcoholism (NIAAA) definition of recovery from DSM-5 AUD based on qualitative feedback from key recovery stakeholders (e.g., researchers, clinicians, and recovery specialists). The definition views recovery as both a process of behavioral change and an outcome and incorporates two key components of recovery, namely, remission from DSM-5 AUD and cessation from heavy drinking, a nonabstinent recovery outcome. The NIAAA definition of recovery also emphasizes the importance of biopsychosocial functioning and quality of life in enhancing recovery outcomes. This new NIAAA definition of recovery is an operational definition that can be used by diverse stakeholders to increase consistency in recovery measurement, stimulate research to better understand recovery, and facilitate the process of recovery.
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Affiliation(s)
- Brett T Hagman
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Md
| | - Daniel Falk
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Md
| | - Raye Litten
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Md
| | - George F Koob
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Md
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Reichl D, Enewoldsen N, Berking M, Fuhrmann L, Lang C, Saur S, Weisel KK, Steins-Loeber S. Psychometrische Evaluation der deutschen Version des Substance Use Recovery Evaluator (SURE). DIAGNOSTICA 2022. [DOI: 10.1026/0012-1924/a000301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Konsumvariablen und Abstinenz scheinen unzureichend zur Erfassung der Genesung bei Personen mit einer Alkoholkonsumstörung. Stattdessen rücken patientenzentrierte Indikatoren wie die Lebensqualität zunehmend in den Vordergrund. Um den Forderungen adäquater Messinstrumente gerecht zu werden, wurde der Substance Use Recovery Evaluator von Neale et al. (2016 ) übersetzt und in verschiedenen Stichproben mit Alkoholkonsumstörung nach Entzugsbehandlung psychometrisch evaluiert. In der ersten Teilstichprobe ( n = 135) wurde explorativ die Faktorenstruktur identifiziert sowie Reliabilitäts- und Validitätsmaße (Zusammenhänge mit Alkoholkonsum, Craving und gesundheitsbezogener Lebensqualität) berechnet. In der zweiten Stichprobe ( n = 120) wurde die gefundene Struktur konfirmatorisch geprüft. Das Verfahren erwies sich als reliabel und valide. Die im Original vorgeschlagene fünffaktorielle Struktur zeigte einen guten Fit, wenn auch in der vorliegenden Studie eine dreifaktorielle Struktur etwas geeigneter erschien. Diese Ergebnisse wurden in einer dritten Stichprobe ( n = 224) größtenteils gestützt. Trotz Limitationen (z. B. kleine Stichprobe) erwies sich der deutsche SURE als psychometrisch abgesicherter Indikator der Genesung von einer Alkoholkonsumstörung.
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Affiliation(s)
- Daniela Reichl
- Lehrstuhl für Klinische Psychologie und Psychotherapie, Otto-Friedrich-Universität Bamberg, Deutschland
| | - Niklas Enewoldsen
- Lehrstuhl für Klinische Psychologie und Psychotherapie, Otto-Friedrich-Universität Bamberg, Deutschland
| | - Matthias Berking
- Lehrstuhl für Klinische Psychologie und Psychotherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Deutschland
| | - Lukas Fuhrmann
- Lehrstuhl für Klinische Psychologie und Psychotherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Deutschland
| | - Catharina Lang
- Lehrstuhl für Klinische Psychologie und Psychotherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Deutschland
| | - Sebastian Saur
- Lehrstuhl für Klinische Psychologie und Psychotherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Deutschland
| | - Kiona K. Weisel
- Lehrstuhl für Klinische Psychologie und Psychotherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Deutschland
| | - Sabine Steins-Loeber
- Lehrstuhl für Klinische Psychologie und Psychotherapie, Otto-Friedrich-Universität Bamberg, Deutschland
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Hiernaux C, Varescon I. Spiritual Predictors of Improved Resilience in People Recovering from Alcohol Use Disorder: An Exploratory Study. ALCOHOLISM TREATMENT QUARTERLY 2022. [DOI: 10.1080/07347324.2022.2047130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Reichl D, Enewoldsen N, Weisel KK, Fuhrmann L, Lang C, Saur S, Berking M, Zink M, Ahnert A, Falkai P, Kraus T, Hillemacher T, Müller FN, Kornhuber J, Bönsch D, Kerkemeyer L, Steins-Loeber S. Association of impulsivity with quality of life and well-being after alcohol withdrawal treatment. J Clin Psychol 2022; 78:1451-1462. [PMID: 35045188 DOI: 10.1002/jclp.23316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/12/2021] [Accepted: 01/06/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Impulsivity is related to a higher risk of relapse in alcohol use disorders. However, besides drinking behavior, other recovery outcomes like physical and mental health-related quality of life are at least as important. The present study aimed to fill a research gap regarding the association of different impulsivity facets with health-related quality of life and well-being in alcohol use disorder. METHODS Individuals with a primary alcohol use disorder diagnosis (n = 167) were interviewed with standardized self-report measures at the progressed stage of their withdrawal treatment and 6 weeks thereafter. Multiple regression models were calculated to examine the association of impulsivity, craving, and drinking patterns with health-related quality of life and well-being 6 weeks after withdrawal treatment, as well as the predictive role of impulsivity assessed during withdrawal for these two outcomes. RESULTS Craving was associated with health-related quality of life and well-being 6 weeks after withdrawal. Likewise, non-planning and attentional impulsivity were associated with well-being 6 weeks after withdrawal. Motor impulsivity during withdrawal treatment predicted health-related quality of life 6 weeks thereafter. CONCLUSION Impulsivity seems to be negatively related to health-related quality of life and well-being in the first weeks after alcohol withdrawal treatment, probably to a higher extent than drinking patterns, but differentiating between its facets seems to be important. These findings emphasize the importance of treatment approaches aiming at reduced impulsivity in the early recovery process.
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Affiliation(s)
- Daniela Reichl
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich University, Bamberg, Germany
| | - Niklas Enewoldsen
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich University, Bamberg, Germany
| | - Kiona K Weisel
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University, Erlangen, Germany
| | - Lukas Fuhrmann
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University, Erlangen, Germany.,Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirksklinikum Ansbach, Ansbach, Germany
| | - Catharina Lang
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University, Erlangen, Germany
| | - Sebastian Saur
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University, Erlangen, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University, Erlangen, Germany
| | - Mathias Zink
- Klinik für Psychiatrie, Sucht, Psychotherapie und Psychosomatik, Klinikum am Europakanal, Erlangen, Germany
| | - Andreas Ahnert
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirksklinikum Ansbach, Ansbach, Germany
| | - Peter Falkai
- Klinik für Psychiatrie und Psychotherapie, LMU-Klinikum, München, Germany
| | - Thomas Kraus
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Frankenalb-Klinik Engelthal, Engelthal, Germany
| | - Thomas Hillemacher
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nürnberg, Germany
| | - Felix-N Müller
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nürnberg, Germany
| | - Johannes Kornhuber
- Psychiatrische und Psychotherapeutische Klinik, Universitätsklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Dominikus Bönsch
- Krankenhaus für Psychiatrie, Psychotherapie und Psychosomatische Medizin, Bezirkskrankenhaus Lohr, Lohr am Main, Germany
| | - Linda Kerkemeyer
- Institute for Applied Health Services Research (inav), Berlin, Germany
| | - Sabine Steins-Loeber
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich University, Bamberg, Germany
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14
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Richards DK, Pearson MR, Hallgren KA, Heather N, Witkiewitz K. An application of moderated nonlinear factor analysis to develop a commensurate measure of alcohol problems across four alcohol treatment studies. Drug Alcohol Depend 2021; 229:109068. [PMID: 34628095 PMCID: PMC8671250 DOI: 10.1016/j.drugalcdep.2021.109068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Self-report measures of alcohol problems are commonly included in studies evaluating treatment and recovery from alcohol use disorder (AUD), but no prior study has examined the replicability of the measurement of alcohol problems across studies with various measures and diverse samples. Further, it is unclear which items may be better indicators of alcohol problems for patient subgroups. In the present study, we integrated data from four large alcohol treatment studies to develop a commensurate measure of alcohol problems using moderated nonlinear factor analysis (MNLFA). METHODS Data were from the COMBINE study, Project MATCH, the Relapse Replication and Extension Project (RREP), and the United Kingdom Alcohol Treatment Trial (UKATT), yielding a total sample size of 4414. MNLFA was carried out on the Drinker Inventory of Consequences (COMBINE, MATCH, RREP) and Alcohol Problems Questionnaire (UKATT). RESULTS We successfully created a 78-item commensurate measure of alcohol problems and examined differential item functioning (DIF) by study membership, time, and socio-demographic characteristics. Sixty-two items demonstrated intercept DIF, suggesting differences in rates of item endorsement for clients with the same underlying levels of alcohol problems across patient subgroups. Six items demonstrated loading DIF, suggesting differences in the extent to which the items were indicative of alcohol problems across patient subgroups. CONCLUSIONS The self-reported measurement of alcohol problems replicates across measures and diverse samples. Items with DIF have clinical implications for the treatment of AUD. Finally, MNLFA scores can be used to test substantive research questions across these studies.
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Affiliation(s)
- Dylan K Richards
- Center on Alcohol, Substance Use, And Addictions (CASAA), University of New Mexico, United States.
| | - Matthew R Pearson
- Center on Alcohol, Substance Use, And Addictions (CASAA), University of New Mexico, United States
| | - Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington, United States
| | - Nick Heather
- Department of Psychology, Northumbria University, United Kingdom
| | - Katie Witkiewitz
- Center on Alcohol, Substance Use, And Addictions (CASAA), University of New Mexico, United States; Department of Psychology, University of New Mexico, United States
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15
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Zemore SE, Ware OD, Gilbert PA, Pinedo M. Barriers to retention in substance use treatment: Validation of a new, theory-based scale. J Subst Abuse Treat 2021; 131:108422. [PMID: 34098296 PMCID: PMC8528875 DOI: 10.1016/j.jsat.2021.108422] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Few studies and no theory-based scales have addressed specific barriers to substance use disorder (SUD) treatment retention. The current study, building on the Theory of Planned Behavior (TPB), sought to (a) identify those barriers that are most strongly associated with treatment retention, and most common, and (b) develop and validate a new scale of retention barriers, focusing on TPB attitude and perceived control components. METHODS The study administered surveys to 200 participants initiating SUD treatment at a public, outpatient program in Northern California; the analytic sample (N = 156) included only those not strongly coerced into treatment. Surveys included TPB-based measures of treatment barriers; other motivational readiness measures; treatment coercion and social desirability measures; and clinical severity variables and demographics. Discharge status was collected from program records. RESULTS Item and scale analyses identified three dimensions of attitudinal barriers (i.e., Low Perceived Treatment Need/Value, Social Concerns, and Concerns about Missing Substances) and two dimensions of perceived control barriers (i.e., Personal Limitations and Basic Logistic Barriers). Results informed creation of a 19-item Barriers to Retention Scale (BRS) with 5 subscales and very good internal reliability (alpha = 0.88). While all subscale scores were correlated with treatment completion, only Concerns about Missing Substances and total BRS scores predicted treatment completion in multivariate analyses. CONCLUSIONS The present study identified core dimensions of treatment retention barriers and developed a new scale predictive of treatment completion and potentially useful as a screener and in future research. Results suggest that interventions to improve retention should focus strongly on concerns about the negative impacts of abstaining from alcohol and drugs on craving and quality of life.
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Affiliation(s)
- Sarah E Zemore
- Alcohol Research Group, Emeryville, CA, United States of America.
| | - Orrin D Ware
- School of Social Work, University of Maryland, Baltimore, MD, United States of America
| | - Paul A Gilbert
- Department of Community and Behavioral Health, University of Iowa, Iowa City, IA, United States of America
| | - Miguel Pinedo
- Department of Kinesiology and Health Education, College of Education, University of Texas at Austin, TX, United States of America
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16
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Swan JE, Aldridge A, Joseph V, Tucker JA, Witkiewitz K. Individual and Community Social Determinants of Health and Recovery from Alcohol Use Disorder Three Years following Treatment. J Psychoactive Drugs 2021; 53:394-403. [PMID: 34727839 DOI: 10.1080/02791072.2021.1986243] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Prior research on recovery from alcohol use disorder (AUD) has often focused on individual-level factors that promote recovery. Given systemic health inequities, it is also important to study community-level social determinants of health (SDOH) that may promote recovery from AUD. This study extended prior work examining individual profiles of recovery from AUD to assess how individual and community SDOH at the time of treatment entry were associated with recovery from AUD three years after treatment. Data were utilized from the COMBINE study (n = 664), a multisite randomized clinical trial evaluating pharmacological and behavioral treatments for AUD. Public community data sources associated with participants' study sites were used to measure community SDOH. Multilevel latent profile analyses with individual- and community-level variables as predictors of recovery profiles were estimated. Four profiles were identified based on participants' alcohol consumption and functioning. Individual SDOH variables, such as fewer years of education and lower income, and community SDOH, including lower rates of health insurance, lower income, and greater income inequality, were each associated with lower functioning profiles. The findings highlight the importance of community SDOH in AUD recovery and the value of including both individual and community SDOH variables in research on long-term recovery.
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Affiliation(s)
- Julia E Swan
- Center on Alcohol, Substance Use, and Addictions and Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Arnie Aldridge
- Behavioral Health Financing, Economics and Evaluation Department, RTI International, Research Triangle Park, NC, USA
| | - Verlin Joseph
- Center on Alcohol, Substance Use, and Addictions and Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Jalie A Tucker
- Center for Behavioral Economic Health Research, University of Florida, Gainesville, FL, USA
| | - Katie Witkiewitz
- Center on Alcohol, Substance Use, and Addictions and Department of Psychology, University of New Mexico, Albuquerque, NM, USA
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17
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von Greiff N, Skogens L. Recovery and identity: a five-year follow-up of persons treated in 12-step-related programs. DRUGS: EDUCATION, PREVENTION AND POLICY 2021. [DOI: 10.1080/09687637.2021.1909535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Lisa Skogens
- Department of Social Work, Stockholm University, Stockholm, Sweden
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18
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Witkiewitz K, Wilson AD, Roos CR, Swan JE, Votaw VR, Stein ER, Pearson MR, Edwards KA, Tonigan JS, Hallgren KA, Montes KS, Maisto SA, Tucker JA. Can Individuals With Alcohol Use Disorder Sustain Non-abstinent Recovery? Non-abstinent Outcomes 10 Years After Alcohol Use Disorder Treatment. J Addict Med 2021; 15:303-310. [PMID: 33060466 PMCID: PMC8044251 DOI: 10.1097/adm.0000000000000760] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Four decades ago, the "controlled drinking" controversy roiled the alcohol field. Data have subsequently accumulated indicating that nonabstinent alcohol use disorder (AUD) recovery is achievable, but questions remain whether it is sustainable long-term. This study examined whether nonabstinent recovery at 3 years after AUD treatment is associated with better functioning at 10 years after treatment. METHODS Data were from the 10-year follow-up of Project MATCH (New Mexico site only, n = 146; 30.1% female, 58.6% non-White). Recovery was defined by latent profile analyses based on psychosocial functioning and alcohol consumption 3 years after treatment. Drinking practices and consequences, depression, purpose in life, and anger were assessed 10 years after treatment. Distal outcome analyses examined differences in drinking and functional outcomes at 10 years as a function of the 3-year latent profiles. Analyses were preregistered at https://osf.io/3hbxr. RESULTS Four latent profiles identified at 3 years after treatment (ie, low functioning frequent heavy drinkers, low functioning infrequent heavy drinkers, high functioning heavy drinkers, and high functioning infrequent nonheavy drinkers) were significantly associated with outcomes 10 years after treatment. The 2 high functioning profiles at 3 years had the highest level of psychological functioning at 10 years posttreatment, regardless of alcohol consumption level. Abstinence at 3 years did not predict better psychological functioning at 10 years. CONCLUSIONS Nonabstinent AUD recovery is possible and is sustainable for up to 10 years after treatment. The current findings align with recent proposals to move beyond relying on alcohol consumption as a central defining feature of AUD recovery.
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Affiliation(s)
- Katie Witkiewitz
- University of New Mexico, Albuquerque, NM (KW, ADW, JES, VRV, ERS, MRP, KAE, JST), Yale University, New Haven, CT (CRR), University of Washington, Seattle, WA (KAH), California State University Dominquez Hills, Carson, CA (KSM), Syracuse University, Syracuse, NY (SAM), University of Florida, Gainesville, FL (JAT)
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19
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Witkiewitz K, Wilson AD, Pearson MR, Roos CR, Swan JE, Votaw VR, Stein ER, Edwards KA, Tonigan JS, Hallgren KA, Montes KS, Maisto SA, Tucker JA. A Bridge to Nowhere: Resistance to the Possibility of Some Heavy Drinking During Recovery and the Potential Public Health Implications. J Addict Med 2021; 15:352-353. [PMID: 33577228 PMCID: PMC8352995 DOI: 10.1097/adm.0000000000000796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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20
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Tucker JA, Cheong J, Chandler SD. Shifts in behavioral allocation patterns as a natural recovery mechanism: Postresolution expenditure patterns. Alcohol Clin Exp Res 2021; 45:1304-1316. [PMID: 33885166 DOI: 10.1111/acer.14620] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Behavioral economics predicts that recovery from Alcohol Use Disorder involves shifts in resource allocation away from drinking, toward valuable nondrinking rewards that reinforce and stabilize recovery behavior patterns. Further, these shifts should distinguish nonproblem drinking (moderation) outcomes from outcomes involving abstinence or relapse. To evaluate these hypotheses, 5 prospective studies of recent natural recovery attempts were integrated to examine changes in monetary spending during the year following the initial cessation of heavy drinking as a function of 1-year drinking outcomes. METHODS Problem drinkers from Southeastern U.S. communities (N = 493, 67% male, 65% white, mean age = 46.5 years) were enrolled soon after stopping heavy drinking without treatment and followed prospectively for a year. An expanded Timeline Followback interview assessed daily drinking and monetary spending on alcohol and nondrinking commodities during the year before and after recovery initiation. RESULTS Longitudinal associations between postresolution drinking and spending were evaluated using MPlus v.8. Initial models evaluated whether changes in spending at 4-month intervals predicted drinking outcomes at 1 year and showed significant associations in 6 commodity categories (alcohol, consumable goods, gifts, entertainment, financial/legal affairs, housing/durable goods/insurance; ps < 0.05). Cross-lagged models showed that the moderation outcome group shifted spending mid-year to obtain large rewards with enduring benefits (e.g., housing), whereas the abstinent and relapsed groups spent less overall and purchased smaller rewards (e.g., consumable goods, entertainment, and gifts) throughout the year. CONCLUSIONS Dynamic changes in monetary allocation occurred during the postresolution year. As hypothesized, compared to the groups who abstained or relapsed, the moderation group shifted spending in ways that, overall, yielded higher value alcohol-free reinforcement that should reinforce recovery while they enjoyed some limited nonproblem drinking below heavy drinking thresholds. These findings add to evidence that moderation entails different behavioral regulation processes than abstinent and relapse outcomes, which were more similar to one another.
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Affiliation(s)
- Jalie A Tucker
- Department of Health Education and Behavior and Center for Behavioral Economic Health Research, University of Florida, Gainesville, FL, USA
| | - JeeWon Cheong
- Department of Health Education and Behavior and Center for Behavioral Economic Health Research, University of Florida, Gainesville, FL, USA
| | - Susan D Chandler
- Department of Health Education and Behavior and Center for Behavioral Economic Health Research, University of Florida, Gainesville, FL, USA
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21
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Richards DK, Pearson MR, Witkiewitz K. Understanding alcohol harm reduction behaviors from the perspective of self-determination theory: A research agenda. ADDICTION RESEARCH & THEORY 2020; 29:392-397. [PMID: 34899111 PMCID: PMC8654356 DOI: 10.1080/16066359.2020.1863378] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 06/14/2023]
Abstract
The evidence for the efficacy of harm reduction approaches to harmful alcohol use has accumulated over the past 30 years. Self-determination theory (SDT; Ryan and Deci 2017) offers a useful framework for understanding why people engage in alcohol harm reduction behaviors, as well as for delineating active ingredients of harm reduction interventions and individual characteristics that influence response to intervention. In the current paper, we sought to advance a research agenda for applying SDT to alcohol harm reduction behaviors. Specifically, we provide specific examples of the utility of SDT in advancing research on alcohol harm reduction behaviors and provide recommendations for future studies to address issues related to measurement, generalizability, temporal directionality, and causal relationships in examining the constructs of SDT and alcohol harm reduction behaviors. We also suggest that future research apply SDT to advance the understanding of how, why, and for whom harm reduction interventions are most effective. Finally, we provide recommendations for how SDT could potentially be applied to develop novel alcohol interventions.
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Affiliation(s)
- Dylan K. Richards
- Center on Alcohol, Substance Use, And Addictions (CASAA), University of New Mexico, 2650 Yale SE MSC11-6280, Albuquerque, NM 87106, USA
| | - Matthew R. Pearson
- Center on Alcohol, Substance Use, And Addictions (CASAA), University of New Mexico, 2650 Yale SE MSC11-6280, Albuquerque, NM 87106, USA
| | - Katie Witkiewitz
- Center on Alcohol, Substance Use, And Addictions (CASAA), University of New Mexico, 2650 Yale SE MSC11-6280, Albuquerque, NM 87106, USA
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Abstract
Alcohol use disorder (AUD) is among the most prevalent psychiatric disorders and is associated with enormous public health costs. Although AUD and other addictive behaviors have been described as chronic relapsing conditions, most individuals who develop AUD will eventually recover. This narrative review provides an overview of definitions of recovery, with a focus on recovery from AUD. The definitions reviewed include those developed by key stakeholder groups, as well as definitions derived from recent quantitative and qualitative studies of individuals who meet criteria for AUD and attempt to resolve their problems with or without treatment or who self-identify as pursuing or achieving recovery. The literature reviewed supports a definition of recovery as an ongoing dynamic process of behavior change characterized by relatively stable improvements in biopsychosocial functioning and purpose in life. The review concludes that definitions of recovery that rely solely on abstinence from alcohol and the absence of AUD symptoms fail to capture the multidimensional and heterogeneous pathways to recovery that are evident among individuals in general population and clinical samples.
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Kevin S Montes
- Department of Psychology, California State University Dominguez Hills, Carson, California
| | - Frank J Schwebel
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Jalie A Tucker
- Department of Health Education and Behavior and Center for Behavioral Economic Health Research, University of Florida, Gainesville, Florida
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