Assessing recovery and functioning in former problem drinkers at different stages of their recovery journeys

Situational Confidence and Recovery Capital Among Recovery Residents Taking Medications for Opioid Use Disorder in Texas

OBJECTIVES

Situational confidence, that is, confidence to resist substance use in high-risk situations, and recovery capital (RC) are resources that individuals can draw upon to initiate and sustain their recovery from opioid use disorder. We assessed the associations between total, social, and personal RC and situational confidence among recovery residents taking medications for opioid use disorder.

METHODS

Cross-sectional associations between the Brief Situational Confidence Questionnaire and Assessment of Recovery Capital scores were assessed among participants (N = 267) enrolled in a longitudinal study in 13 recovery homes for persons taking medications for opioid use disorder in Texas using χ 2 tests and multivariable logistic regression.

RESULTS

Most participants were 35 years or older (51.7%), male (59.4%), non-Hispanic White (71.5%), and unemployed (66.0%); used more than one substance (77.9%); and had higher educational levels (53.8%). The majority had high situational confidence (66.7%), social (63.7%), physical (67.0%), and total (64.8%) RC. Education (model 1: adjusted odds ratio [aOR], 1.96; confidence interval [CI], 1.13-3.40; model 2: aOR, 2.03; CI, 1.17-3.51) and social (aOR, 2.08; CI, 1.11-3.92), personal (aOR, 2.06; CI, 1.08-3.93), and total (aOR, 2.98; CI, 1.71-5.20) RC were associated with situational confidence.

CONCLUSIONS

Our findings highlight the need for recovery housing operators to be trained on the relevance of RC and situational confidence to practice to improve recovery outcomes among residents with opioid use disorder. Health planners, recovery housing administrators, and policymakers should strengthen recovery residence-based services and systems to improve individual RC and situational confidence.

Understanding the Process of Drug Addiction Recovery Through First-Hand Experiences: A Qualitative Study in the Netherlands Using Lifeline Interviews

Understandings of drug addiction recovery are still being debated. Research on perspectives from first-hand experiences with recovery is rare and often contains short-term experiences in the context of a treatment setting. We aim to gain further understanding of recovery by analyzing autobiographical data from persons in different stages of drug addiction recovery who are not linked to any specific treatment service. We conducted 30 in-depth qualitative interviews with participants from various parts of the Netherlands. Participants self-identified as being "in recovery" or "recovered" from drug addiction for at least 3 months. Men and women are equally represented, and the sample consists of an equal number of participants in early (<1 year, n = 10), sustained (1-5 years, n = 10), and stable (>5 years, n = 10) recovery. We undertook a data-driven thematic analysis. Participants described that recovery is a broad process of change because addiction is interwoven with everything (theme 1); that recovery is reconsidering identity, seeing things in a new light (theme 2); that recovery is a staged long-term process (theme 3); and that universal life processes are part of recovery (theme 4). Thus, Drug addiction recovery is experienced as an interwoven long-term process, including identity change and common or universal life processes. Policy and clinical practice should therefore be aimed at supporting long-term tailored recovery goals and disseminating first-hand recovery experiences to enhance long-term outcomes and reduce stigmatization.

Wellbeing in Addiction Recovery: Does It Differ across Addictions?

Limited research has been conducted on the experiences of individuals in long-term recovery from addiction, and addictions are usually studied in isolation. However, no theories of addiction differentiate between addictions or assume that individuals will experience only one addiction. This study aimed to compare affect between individuals with addictions to drugs and alcohol and to explore how QoL changes in long-term recovery from addiction. Individuals in recovery from addiction (n = 115; 52.2% male) were recruited via snowball sampling on social media signposted by an addiction rehabilitation charity. Participants completed questionnaires about QoL (WHOQOL-Bref) and positive and negative affect (PANAS-X). The main primary addictions were drugs (76.5%) and alcohol (21.7%), with 69.7% reporting multiple addictions including food, sex, internet, and gambling. Affect and coping strategies did not differ by addiction. QoL appeared to improve with time in recovery. The high percentage of multiple addictions and greater similarities than differences between individuals with drug and alcohol addictions suggest that addictions should not be studied in isolation when studying psychological health during long-term recovery.

The growth of recovery capital in clients of recovery residences in Florida, USA: a quantitative pilot study of changes in REC-CAP profile scores

Background

There is a growing evidence base around predictors of retention and completion in a range of recovery residence models, particularly Oxford Houses and Sober Living Houses, and recovery housing is recognized as a clearly evidenced area of recovery intervention. The aim of the study was to quantitatively assess recovery capital in a sample of recovery residence clients.

Method

The study used a repeated measures self-completion of a standardized recovery capital instrument (REC-CAP) for clients retained across various houses within one Level 2 recovery residence provider whose program was based on a 12-step approach. While 823 clients participated in the baseline assessment, a sample of 267 clients was achieved for six-month follow-up interview, based on those retained in the residence. A logistic regression model examined factors associated with retention and a repeated measures marginal mixed model evaluated the factors associated with changes in recovery capital between the baseline and the follow-up assessment.

Results

Members of the group that remained in recovery residences were more likely to be older with a record of high participation in recovery groups, with greater drop-out among younger residents, female residents and those with an identified housing need. For those retained to follow-up, greater recovery capital growth was associated with employment, higher levels of social support and more recovery group involvement, as well as age and a higher quality of life. The need for family support was shown to reduce levels of recovery capital. However, those younger people who were retained reported better recovery capital growth during the initial six months of residence.

Conclusion

The key conclusion is that while recovery capital generally increases during a stay in a recovery residence, it does not do so consistently across the sample population. This has implications for how pathways to recovery group engagement are supported for women and young people and how social support (encompassing housing, employment and family issues) is provided to those populations during periods of residence. This suggests the potential need for training and guidance for house managers working with these groups.

The phenotype of recovery VII: Delay discounting mediates the relationship between time in recovery and recovery progress

INTRODUCTION

Substance use disorders (SUDs) remain challenging maladies to treat in the United States and impose significant societal costs. Despite these challenges, a significant number of individuals endorse being in recovery from SUD. The scientific understanding of SUD recovery has evolved to include not only improvements in substance use but also improvements in personal wellness and psychosocial functioning. The devaluation of future rewards (delay discounting; DD) is broadly associated with SUD inception and outcomes. We sought to investigate the relationship between DD, time in recovery, and recovery progress.

METHODS

We conducted an online assessment of 127 individuals in recovery from SUD who the study recruited via the International Quit and Recovery Registry (IQRR). The research team obtained measures of recovery progress via the Addiction Recovery Questionnaire (ARQ) and the Treatment Effectiveness Assessment (TEA). Additionally, the study collected measures of DD, time in recovery, and endorsement of abstinence in recovery (i.e., requiring abstinence vs. not). We utilized linear regression to test for associations among these variables and performed a mediation analysis to test the role of DD in mediating the relationship between time in recovery and measures of recovery progress.

RESULTS

Time in recovery was positively associated with the ARQ (p < .001) and TEA (p < .001). Furthermore, an individual's delay discounting rate mediated the relationship between time in recovery and ARQ/TEA. Of the participants, 66% endorsed recovery requiring total abstinence from alcohol and drugs. Last, through an exhaustive model selection, the study did not find an individual's endorsement of abstinence in recovery to be a primary predictor of recovery progress.

CONCLUSIONS

This study presents evidence that, for individuals in recovery, the temporal view (i.e., focus on immediate vs. future rewards) is a significant influence on recovery progress. Additionally, an individual's endorsement of abstinence in recovery was not significantly associated with recovery progress, suggesting the importance of a holistic view of SUD recovery. These findings contribute to the understanding of recovery as a multidimensional process and provide further support for DD as a behavioral marker of addiction.

Negative Recovery Capital in Gambling Disorder: A Conceptual Model of Barriers to Recovery

Recovery from any addiction, including gambling, involves continuous efforts to improve wellness despite the obstacles and challenges. The recovery capital (RC) model is a holistic conceptual framework operationalized along a continuum ranging from positive internal and external RC resources that enhance recovery to negative recovery capital (NRC) which are defined as obstacles that impede individuals from coping with their addiction. Although previous studies have conceptualized the positive side of the RC model, no study has systematically explored NRC. This study develops a model that maps and conceptualizes the elements that impede recovery from gambling disorder (GD). In the current study, 133 individuals with a lifetime GD were interviewed about the factors that have hindered their recovery. A content analysis identified 14 NRC categories that were classified into four domains: Human NRC (urges and uncontrolled urges, cognitive distortions, inaction, sensation seeking, stressful life events, negative emotions, ability to conceal, a lack of motivation to recover), Social NRC (lack of social or familial networks, conflictual or dangerous social networks), Community NRC (an environment that encourages gambling, money lenders), and Financial NRC (financial distress and debt, money as a risk factor). The discussion centers on a holistic perspective of the elements that hinder recovery from GD, and calls for intervention methods that aim to minimize NRC to provide more holistic solutions to GD and possibly other addictions.

Perceptions of purchasing and payment mechanisms in alcohol and other drug treatment services in Australia: A qualitative study involving alcohol and other drug service providers and purchasers of treatment

INTRODUCTION AND AIMS

Governments across the globe invest considerable amounts in funding alcohol and other drug (AOD) treatment. Little attention however has been paid to the ways AOD service providers are chosen and how they are paid. This study sought to examine the perceptions of Australian AOD treatment purchasers and providers regarding different purchasing and payment mechanisms.

DESIGN AND METHODS

Qualitative interviews with AOD treatment providers and purchasers (N = 197) were undertaken across the eight Australian states/territories and the Commonwealth. Data were collated against six main AOD treatment purchasing and payment mechanisms (as identified in the literature), then an inductive, comparative analysis to assign codes was conducted, followed by interpretive analysis to explore emergent themes.

RESULTS

Five main themes were identified in relation to AOD treatment payment and purchasing mechanisms: (i) applying private sector principles to purchasing; (ii) innovation, sector stability and addressing client needs; (iii) performance monitoring and measuring outcomes; (iv) the threat to designated funding for AOD treatment; and (v) the costs and benefits of having multiple funding sources.

DISCUSSION AND CONCLUSIONS

In many countries reforms are taking place in the health sector consistent with New Public Management principles. These principles, when applied to AOD treatment, have included introducing competition, output and outcomes-based funding models, standards and accountability. Purchaser and providers identified both strengths and weaknesses and highlighted the overarching concern that implementation of any (mix) of these mechanisms should always be underpinned by a client-centred and not a finance-centred approach.

Recovery processes among young adults treated for alcohol and other drug problems: A five-year follow-up

Aim

Studies on recovery from alcohol and other drugs (AOD) among young adults are scarce. In the present study, young adults, previously interviewed with a focus on their recovery process shortly after they completed treatment, were re-interviewed five years later focusing on their recovery process during the last five years in relation to their former AOD problems, other problems and processes of change.

Methods

Twenty-one young adults were interviewed: 16 women and five men aged between 25 and 33 years. After transcribing the interviews, the material was analysed thematically.

Results

Three overall themes emerged: previous problems, mental illness and the search for identity. The results were discussed in relation to recovery capital, primarily focusing on human and social capital. The results indicate that the group in focus often needs professional support for mental health issues in order to reach a stable recovery.

Conclusions

Since the problems described were heterogeneous, this client group might benefit from individual treatment and extended support after treatment. Further, the results indicate that the established period of five years for a stable recovery might need to be extended for young adults.

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

Purpose

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

Design/methodology/approach

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

Findings

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

Research limitations/implications

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

Originality/value

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

The Assessment of Recovery Capital (ARC) predicts substance abuse treatment completion

Recovery from addiction requires various personal and environmental resources. The purposes of this study were to determine if the Assessment of Recovery Capital (ARC) scores measured at admission could predict substance abuse treatment (SAT) completion and to identify personal and environmental factors associated with ARC scores. Participants (N = 2265) comprised clients entering a Midwestern SAT facility (August 2015 - June 2017). Logistic regression was used to predict SAT completion using ARC scores. Nonparametric group comparisons were used for personal and environmental covariates. ARC scores significantly predicted successful SAT completion (OR = 1.05, 95% CI = 1.04, 1.05, Wald z = 12.9, p < 0.001). Employment had a positive relationship with ARC scores (Kruskal-Wallis χ² = 215.96, df = 8, p < 0.001). ARC scores varied according to primary substance (Kruskal-Wallis χ² = 101.10, df = 6, p < 0.001); alcohol and marijuana showed the highest scores and heroin the lowest. ARC scores decreased as number of problem substances increased (Kruskal-Wallis χ² = 70.57, df = 2, p < 0.001, r_S = -0.163, p < 0.001). Living arrangement was also significant (Kruskal-Wallis χ² = 146.36, df = 8, p < 0.001); clients who were homeless had the lowest ARC scores. A number of personal and environmental covariates were associated with the ARC scores and potentially with the outcome. After adjustment, the ARC remained a strong predictor of SAT completion. The ARC should be used in SAT facilities to guide treatment decisions and to create individualized treatment plans for clients.

Employment recovery capital in the treatment of substance use disorders: Six-month follow-up observations

BACKGROUND

Recovery capital represents client strengths associated with substance use disorder (SUD) recovery. Employment is part of recovery capital supporting long-term recovery. However, specific employment recovery capital (ERC) factors associated with SUD recovery are not well understood.

METHODS

The present study used retrospective logistic regression modeling to predict treatment completion at discharge and substance use at six-month follow-up from employment variables at intake and follow-up. An additional exploratory follow-up of ERC Change is further investigated. Existing clinical data from a random selection of all Iowa SUD treatment facilities receiving public funding from 1999-2016. Clients in the study (N = 8,925) were a mean age of 31.7 (SD = 11.8), mostly male (67.2%), and primarily White (86.6%). Measurements included substance use, treatment completion, ERC Change, demographic, and treatment statistical control variables.

RESULTS

Results demonstrated that employment variables at intake predicted greater successful treatment completion, p < 0.0001. However, the same employment variables were predictive of maintained and increased use at six-month follow-up. Further investigation showed the best predictors of post-treatment recovery was a change in employment variables including months employed increase (AOR = 1.53, 95% CI = 1.34-1.75) and days missed from work due to substance use decrease (AOR = 2.43, 95% CI = 2.00-2.96).

CONCLUSIONS

Researchers and providers can help improve client recovery with intervention design, consultation, and policies focused on vocational growth in addition to employment benchmarks of gross income, full-time employment, occupation, primary support, months employed, and work missed. ERC is a promising route to improve the lives for those involved with substance use disorders.

Quality of life and better than well: a mixed method study of long-term (post five years) recovery and recovery capital

Purpose

The purpose of this paper is to compare quality of life scores in a long-term recovery population group (post five years) with a general population group and to explore how any differences might be explained by recovering individuals themselves in a small number of follow up qualitative interviews.

Design/methodology/approach

A sequential explanatory mixed method design combining quantitative quality of life measure (WHOQOL-BREF, 1996) and six subsequent semi-structured individual interviews. The quality of life measure compared long-term recovery scores (post five years) with the general population group. The subsequent qualitative semi-structured interviews explored what the participants themselves said about their recovery.

Findings

The quantitative data provide evidence of a significant difference in quality of life (WHOQoL-BREF) in two domains. The long-term recovery group (five or more years into recovery) scored higher in both the environment and psychological domains than the general population group. Of the long-term recovery group, 17 people who still accessed mutual aid scored higher in all four domains than those 23 people who did not. The interviews provide evidence of the this difference as result of growth in psychological elements of recovery, such as developing perspective, improvement in self-esteem, spirituality, as well as contributing as part of wider social involvement.

Research limitations/implications

This study provides support for the quality of life measure as useful in recovery research. The empirical data support the concept of recovery involving improvements in many areas of life and potentially beyond the norm, termed “better than well” (Best and Lubman, 2012; Valentine, 2011; Hibbert and Best, 2011). Limitations: snowballing method of recruitment, and undertaken by public health practitioner. Some suggestions of women and those who attend mutual aid having higher quality of life but sample too small.

Practical implications

Use QoL measure more in recovery research. Public health practitioners and policy makers need to work with partners and agencies to ensure that there is much more work, not just treatment focused, addressing the wider social and environmental context to support individuals recovering from alcohol and drugs over the longer term.

Originality/value

One of small number of studies using with participants who have experienced long-term (post five years) recovery, also use of quality of life measure (WHOQOL-BREF, 1996) with this population.

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.

Initiating and maintaining a recovery process – experiences of persons with dual diagnosis

Purpose

The purpose of this paper is to investigate the internal and social factors that persons with experience from severe mental illness and alcohol and other drugs problems, and who have received treatment for these problems, describe as important for initiating and maintaining a recovery process.

Design/methodology/approach

In total, 40 persons were interviewed and asked to describe factors they perceived as important for initiating and maintaining recovery. The software Nvivo was used to categorise data in internal and social factors with subcategories.

Findings

There is significant variation in how recovery emerged but involved in general having a proper social situation and finding meaning in life. Initially, the majority had a marginalised situation with need of assistance with housing, employment, financial and social support.

Research limitations/implications

The change process in the investigated group is interpreted as related to individual resources rather than belonging to a group defined as having “double trouble”.

Practical implications

The study implies that in addition to professional help to handle diagnosed problems, the group in focus also need support and interventions that address individual complex needs.

Social implications

Supporting activities/peer support seem to be important for those lacking support from family. At the same time, it is important to recognise the risk of being forced into a recovery identity which might lead to worsening the situation for those who do not fit into this.

Originality/value

By using the same design as in previous studies, comparisons with other groups are possible while still keeping the qualitative meaning of the investigated factors.

Does the Assessment of Recovery Capital scale reflect a single or multiple domains?

Objective

The goal of this study was to determine whether the 50-item Assessment of Recovery Capital scale represents a single general measure or whether multiple domains might be psychometrically useful for research or clinical applications.

Methods

Data are from a cross-sectional de-identified existing program evaluation information data set with 1,138 clients entering substance use disorder treatment. Principal components and iterated factor analysis were used on the domain scores. Multiple group factor analysis provided a quasi-confirmatory factor analysis.

Results

The solution accounted for 75.24% of the total variance, suggesting that 10 factors provide a reasonably good fit. However, Tucker’s congruence coefficients between the factor structure and defining weights (0.41–0.52) suggested a poor fit to the hypothesized 10-domain structure. Principal components of the 10-domain scores yielded one factor whose eigenvalue was greater than one (5.93), accounting for 75.8% of the common variance. A few domains had perceptible but small unique variance components suggesting that a few of the domains may warrant enrichment.

Conclusion

Our findings suggest that there is one general factor, with a caveat. Using the 10 measures inflates the chance for Type I errors. Using one general measure avoids this issue, is simple to interpret, and could reduce the number of items. However, those seeking to maximally predict later recovery success may need to use the full instrument and all 10 domains.

'Pickle or a cucumber?' administrator and practitioner views of successful adolescent recovery

INTRODUCTION

Adolescent substance use disorders often involve a recurring cycle of treatment and relapse. The academic and practical definition of addition recovery for adults has been debated; yet, elements determining a successful adolescent recovery aside from abstinence have not been delineated. Thus, we sought to explore how practitioners and administrators define "success" in recovery and how they foster youth progress towards success.

METHODS

Using a qualitative design, we purposively selected and visited treatment and recovery services sites and interviewed practitioners and administrators (N = 13). Sites included recovery high schools (N = 2), alternative peer groups (N = 4), and one treatment center. Two authors analyzed the data using the constant comparative method.

RESULTS

Success emerged from the interviews in three primary themes (1) factors demonstrating success, (2) progress that highlights success, and (3) factors enabling success and two sub-themes (1) use of metaphors and (2) use of specific examples. A variety of factors and processes were discussed as indicators of success. Multiple practitioners stated that sobriety and length of abstinence were not the best success measures; yet, sobriety and education were mentioned most often.

CONCLUSIONS

A key finding of this study, which has not been addressed in existing qualitative studies of youth recovery, is that the understanding of recovery was so diverse and multi-dimensional and provided a view of success beyond sobriety, highlighting the various facets from which practitioners must operate and address recovery. This demonstrates the need for researchers to carefully conceptualize how they operationalize adolescent recovery.

Social identity, social networks and recovery capital in emerging adulthood: A pilot study

Background

It has been argued that recovery from substance dependence relies on a change in identity, with past research focused on ‘personal identity’. This study assessed support for a social identity model of recovery in emerging adults through examining associations between social identity, social networks, recovery capital, and quality of life.

Methods

Twenty participants aged 18–21 in residential treatment for substance misuse were recruited from four specialist youth drug treatment services - three detoxification facilities and one psychosocial rehabilitation facility in Victoria, Australia. Participants completed a detailed social network interview exploring the substance use of groups in their social networks and measures of quality of life, recovery capital, and social identity.

Results

Lower group substance use was associated with higher recovery capital, stronger identification with non-using groups, and greater importance of non-using groups in the social network. Additionally, greater identification with and importance of non-using groups were associated with better environmental quality of life, whereas greater importance conferred on using groups was associated with reduced environmental quality of life.

Conclusions

Support was found for the role of social identity processes in reported recovery capital and quality of life. Future research in larger, longitudinal samples is required to improve understanding of social identity processes during treatment and early recovery and its relationship to recovery stability.

Mutual dependence and the “Goldilocks group”: exploring service user dependency on mutual aid recovery groups

Purpose

– The purpose of this paper is to explore the theme of dependence on mutual aid identified in a previous paper. It is a theme which to date, has had very little empirical attention, especially in a UK context.

Design/methodology/approach

– A phenomenological approach was adopted. Interviews with service users, mentors and professional staff involved with the Learning to Live Again project were undertaken over a ten-month period of data collection. Thematic analysis was used to analyse the data.

Findings

– It was found that service users with very little access to recovery capital or social support are at risk of developing a dependency on mutual aid. Dependence seemed to manifest itself in two different forms – those that over engaged with the project and those that under engaged with the project. Consequently, there were a cohort of service users identified that seemed to strike a balance with the project and their life outside the project that was “just right”. They were referred to as the “Goldilocks group”.

Originality/value

– This paper explored a theme which has had very little attention paid to it. The theme of dependence on mutual aid will raise the awareness of such a threat, thus helping to identify those in treatment most at risk of developing dependency on mutual aid, thus detrimentally impacting on mental wellbeing.

Psychological changes in alcohol-dependent patients during a residential rehabilitation program

BACKGROUND

Alcohol-dependent patients usually experience negative affects under the influence of alcohol, and these affective symptoms have been shown to decrease as a result of alcohol-withdrawal treatment. A recent cognitive-affective model suggests an interaction between drug motivation and affective symptoms. The aim of this multicenter study was to evaluate the psychological changes in subjects undergoing a residential rehabilitation program specifically designed for alcohol addiction, and to identify at discharge patients with greater affective symptoms and therefore more at risk of relapse.

MATERIALS AND METHODS

The sample included 560 subjects (mean age 46.91±10.2 years) who completed 28-day rehabilitation programs for alcohol addiction, following a tailored routine characterized by short duration and high intensity of medical and psychotherapeutic treatment. The psychological clinical profiles of anxiety, depression, psychological distress, psychological well-being, and self-perception of a positive change were assessed using the Cognitive Behavioral Assessment - Outcome Evaluation questionnaire at the beginning and at the end of the program. The changes in the psychological variables of the questionnaire were identified and considered as outcome evaluation of the residential intervention. Moreover, differences in the psychological functioning between patients with different characteristics were investigated.

RESULTS

The score measured by the Cognitive Behavioral Assessment - Outcome Evaluation showed significant improvements in all the psychological characteristics assessed, and the profile at discharge was within the normal scores. Some significant differences were found in relation to specific characteristics of the sample, such as age, sex, level of education, type of intervention, and polysubstance use.

CONCLUSION

This study shows the changes in psychological profile in subjects undergoing residential rehabilitation from alcohol and how this profile may permit identification of subjects requiring more psychosocial support after discharge.

Profiles of impaired, spared, and recovered neuropsychologic processes in alcoholism

Long-term chronic alcoholism is associated with disparate and widespread residual consequences for brain functioning and behavior, and alcoholics suffer a variety of cognitive deficiencies and emotional abnormalities. Alcoholism has heterogeneous origins and outcomes, depending upon factors such as family history, age, gender, and mental or physical health. Consequently, the neuropsychologic profiles associated with alcoholism are not uniform among individuals. Moreover, within and across research studies, variability among subjects is substantial and contributes to characteristics associated with differential treatment outcomes after detoxification. In order to refine our understanding of alcoholism-related impaired, spared, and recovered abilities, we focus on five specific functional domains: (1) memory; (2) executive functions; (3) emotion and psychosocial skills; (4) visuospatial cognition; and (5) psychomotor abilities. Although the entire brain might be vulnerable in uncomplicated alcoholism, the brain systems that are considered to be most at risk are the frontocerebellar and mesocorticolimbic circuitries. Over time, with abstinence from alcohol, the brain appears to become reorganized to provide compensation for structural and behavioral deficits. By relying on a combination of clinical and scientific approaches, future research will help to refine the compensatory roles of healthy brain systems, the degree to which abstinence and treatment facilitate the reversal of brain atrophy and dysfunction, and the importance of individual differences to outcome.

Rate and predictors of employment among formerly polysubstance dependent urban individuals in recovery

Employment is a key functioning index in addiction services and consistently emerges as a goal among individuals in recovery. Research on the employment status in the addiction field has focused on treatment populations or welfare recipients; little is known of employment rates or their predictors among individuals in recovery. This study seeks to fill this gap, capitalizing on a sample (N = 311) of urban individuals at various stages of recovery. Fewer than half (44.5%) of participants were employed; in logistic regressions, male gender and Caucasian race enhanced the odds of employment, whereas having a comorbid chronic physical or mental health condition decreased the odds by half. Implications center on the need to identify effective strategies to enhance employability among women and minorities and for integrated care for individuals with multiple chronic conditions.