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

Improvements in recovery capital are associated with decreased alcohol use in a primary opioid use disorder treatment-seeking cohort

BACKGROUND AND OBJECTIVES

Comorbid substance use can negatively impact multiple aspects of treatment for patients with an opioid use disorder (OUD). We investigated if treatment for OUD led to improvements in patients' recovery capital (RC) overtime, and whether there were associated changes in co-occurring alcohol use.

METHODS

Participants (n = 133) were patients with OUD seeking outpatient treatment, who completed the Assessment of Recovery Capital (ARC) and reported drinking days per 30-day period thrice over the 6-month study. No specific treatments targeting alcohol were used. Two different models were employed to assess changes in total ARC score and adjusted odds ratio (aOR) for past 30-day abstinence.

RESULTS

Baseline mean ARC scores were 36.6 and significantly increased to mean score of 41.2 at study end. Ninety-one participants (68.4%) reported no alcohol use at baseline, and 97 (78.9%) reported no use in the previous 30 days at study endpoint. For each increase in ARC, there was an aOR 1.07 (confidence interval [CI]: 1.02-1.13) for past 30-day abstinence. Considering ARC standard deviation of 10.33 over all measurements, this equates to an aOR of 2.10 (CI: 1.22-3.62) for past 30-day abstinence.

DISCUSSION AND CONCLUSIONS

We saw significantly increased aOR for past 30-day abstinence as RC improved in an OUD treatment-seeking population. This difference was not caused by differences in ARC between study completers and noncompleters.

SCIENTIFIC SIGNIFICANCE

Showcases how RC growth may be protective of past 30-day alcohol use in an OUD cohort and adds specific aOR for abstinence per ARC increase.

Recovery Capital Correlates With Less Methamphetamine Use and Crime in the Community

OBJECTIVES

Reentry postcorrectional involvement is a high-risk time for patients with a history of addiction. We investigated whether participation in an addiction medicine clinic with active case management led to improvements in patients' recovery capital and whether there were associated changes in criminal activity and co-occurring methamphetamine or alcohol use.

METHODS

Participants (n = 136) were patients with an opioid or stimulant use disorder who had Department of Corrections involvement in the preceding year, who completed the Assessment of Recovery Capital (ARC) and reported criminal activity and days of methamphetamine or alcohol use twice over a 6-month study. Three logistic regression models were used to assess changes in total ARC with criminal activity, alcohol use, and methamphetamine use over the previous 30 days.

RESULTS

Baseline mean (SD) ARC scores were 34.1 (11.1) and increased to a mean (SD) score of 40.3 (9.4) at study end. A 1-SD shift in ARC was significantly protective across outcomes, with adjusted odds ratios of 0.32, 0.18, and 0.34 for any past 30-day criminal activity, alcohol use, or methamphetamine use. There was no significant difference in baseline ARC, crimes committed, days of alcohol use, or days of methamphetamine use for study completers versus noncompleters; however, unmeasured confounders may have had a differential impact on retention.

CONCLUSIONS

Recovery capital provides an additional framework to help address patients' substance use and criminal activity in a multifaceted way, which is especially important in the postincarceration community. Recovery capital is dynamic and has multiple areas to target psychosocial interventions.

Sex Differences in Recovery Capital Gains Post-Incarceration

BACKGROUND

People with substance use disorders are highly prevalent in the carceral system. Recovery capital (RC) is the resources available to an individual to initiate or maintain substance use cessation. Sex differences have been identified in RC during both active substance use and recovery in the general population, however, less is known about these sex differences in the post-incarceration population.

METHODS

Participants (n = 136) were those with an opioid or stimulant use disorder with past year involvement with the Iowa criminal justice system (USA), who completed the Assessment of Recovery Capital (ARC) twice over a six-month cohort study. Participants were involved in an addiction clinic that utilized active case management. Analysis of covariance evaluated changes in ARC during the study. Separate models compared total ARC and individual ARC domains, with sex as the independent variable of interest. Model means were generated for interpretation based on sex, comparing baseline and study endpoint ARC scores.

RESULTS

There were no baseline sex differences in total ARC. ARC increased significantly for the group, however, males showed disproportionate growth. Females ended the study with a mean ARC of 37.8 (SD= 9.3) and males finished at 41.6 (SD= 9.3), which was a significant difference (p = 0.044); this significant difference was driven by ARC subdomains of 'Psychological Health' and 'Physical Health.'

CONCLUSIONS

People post-incarceration are at high risk for return to substance use. Treatment that is informed by sex-based differences may have the potential to decrease the differing rates of growth in RC between sexes.

Measuring recovery capital for people recovering from alcohol and drug addiction: A systematic review

Background

Recovery capital theory provides a biopsychosocial framework for identifying and measuring strengths and barriers that can be targeted to support recovery from alcohol and drug addiction. This systematic review analyzed and synthesized all quantitative approaches that have measured recovery capital since 2016.

Method

Three databases were searched to identify studies published from 2016 to 2023. Eligible studies explicitly stated they measured recovery capital in participants recovering from alcohol and/or drug addiction. Studies focusing on other forms of addiction were excluded.

Results

Sixty-nine studies met the inclusion criteria. Forty-six studies used one of the ten identified recovery capital questionnaires, and twenty-five studies used a measurement approach other than one of the ten recovery capital questionnaires. The ten recovery capital questionnaires are primarily developed for adult populations across clinical and community recovery settings, and between them measure 41 separate recovery capital constructs. They are generally considered valid and reliable measures of recovery capital. Nevertheless, a strong evidence base on the psychometric properties across diverse populations and settings still needs to be established for these questionnaires.

Conclusion

The development of recovery capital questionnaires has been a significant advance in the field of addiction recovery, in alignment with the emerging recovery-oriented approach to addiction recovery care. Additionally, the non-recovery capital questionnaire-based approaches to recovery capital measurement have an important place in the field. They could be used alongside recovery capital questionnaires to test theory, and in contexts where the application of the questionnaires is not feasible, such as analyses of data from online recovery forums.

The Associations between Remission Status, Discounting Rates, and Recovery from Substance Use Disorders

Background: Recovery from substance use disorders (SUDs) requires sustained and purposeful support to maintain long-term remission. Methods: This study investigated the association between assessment of recovery capital, household chaos, delay discounting (DD) and probability discounting (PD), and remission status among individuals in recovery from SUD. Data from 281 participants from the International Quit & Recovery Registry (IQRR), an ongoing online registry that aims to study the recovery process, were included in the analysis. Results: Lower DD rates and higher recovery capital were found among those in remission compared to those not in remission after controlling for demographics. In contrast, the association of household chaos and PD with remission status were insignificant. Overall, DD accounted for 20% of the total effect between the recovery capital and the remission status. Conclusion: This study contributes to the understanding of recovery as a multidimensional process, supports DD as a behavioral marker of addiction, and suggests areas for future research.

Changes in Work Status, Couple Adjustment, and Recovery Capital: Secondary Analysis of Data From a Congruence Couple Therapy Randomized Controlled Trial

Purpose

Employment and family/social relationships are 2 of the highest priorities among those in substance use recovery. This study examined the relationship of work status with couple adjustment and other recovery capital treatment outcomes among symptomatic alcohol, substance use, and gambling participants (N = 38) using data collected in a randomized trial comparing a systemic Congruence Couple Therapy (CCT) and individual-based Treatment-as-Usual (TAU).

Method

Change scores and associations between work status and couple adjustment together with 8 other recovery outcome variables at post-treatment (5 months from baseline) and follow-up (8 months from baseline) in TAU (n = 17) and CCT (n = 21) were analyzed.

Results

Number of those working increased with both CCT and TAU but without reaching significance in either CCT (Cochran's Q = 5.429, P = .066) or TAU (Cochran's Q = 2.800, P = .247). Relative to those not working in the combined sample, those working showed significantly improved scores in post-treatment and follow-up in addictive symptoms, couple adjustment, psychiatric symptoms, depression, and life stress. Separating the CCT and TAU groups, similar trend was found in the CCT group but was inconsistent in the TAU group.

Conclusion

Significantly greater improvement in addictive symptoms and recovery capital of couple adjustment, mental health, and life stress was found in the working vs not-working group. Compared to individual-based TAU, exploratory findings indicate that the systemic treatment of CCT showed a clearer and more consistent difference in improved working days, addictive symptoms and recovery capital. Replication with larger samples is needed to generalize these results.

Spanish Validation of the Assessment of Recovery Capital Scale in Clinical Population with Alcohol Use Disorder

Recovery from alcohol use disorder involves achieving certain resources for positive lifestyle changes, well-being, and long-term abstinence. The present study aims to translate and validate the Assessment Capital Recovery (ARC) in a Spanish clinical sample of individuals with alcohol use disorder, in abstinence. The participants were 184 patients who attended outpatient treatments. They were evaluated with the adapted version of the ARC (Spanish abbreviation: "Valoración del Capital de Recuperación, VCR") and by WHOQOL-BREF (quality of life scale), in one session. Statistical analysis included the calculation of reliability, convergent validity (relationship with WHOQOL-BREF), specificity and sensitivity, as well as validity based on internal structure (confirmatory factor analysis). VCR scores show appropriate values for reliability (α = .90), and a low convergent validity with WHOQOL-BREF (Rho = .33-.53). The VCR appears to distinguish between patients with early and stable sobriety (χ2 = 20.55, p < .01). The ROC curve indicates significant discrimination values (p < .05) for stable recovery (5 years of abstinence) and sensitivity of 85.2% and specificity of 71.2%. Further, confirmatory factor analysis suggests the presence of a single factor, with relatively acceptable values of goodness of fit and factor loadings. We used ULS parameter estimation to study VCR properties, an appropriate tool for assessing recovery in clinical populations of individuals with alcohol use disorder in abstinence.

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.

The Recovery Strengths Questionnaire for alcohol and drug use disorders

INTRODUCTION AND AIMS

The Recovery Strengths Questionnaire (RSQ) is a 15-item self-report questionnaire that assesses an addicted individual's recovery strengths. This study aimed to validate the RSQ as a measure of recovery capital.

DESIGN AND METHODS

As part of a larger study, 151 participants in addiction recovery groups from across the UK completed the RSQ. Participants also completed the Assessment of Recovery Capital questionnaire and provided some demographic information.

RESULTS

The RSQ was found to be psychometrically sound, with high internal consistency and concurrent validity with the Assessment of Recovery Capital. RSQ scores were positively correlated with length of time in recovery and length of membership in recovery groups, and the scores could be used to discriminate between those in early and late recovery. Principal components analysis revealed a two-factor structure of recovery capital. These two factors were named 'within-group recovery strengths' and 'externally generated recovery strengths', and it was found that only the within-group factor scale (i.e. resources developed within recovery groups) predicted length of time in recovery and recovery groups.

DISCUSSION AND CONCLUSIONS

These results highlight the important role that recovery groups can play in an individual's recovery, and they provide an alternative factor structure to the one-factor structure of the Assessment of Recovery Capital.

The crucial role of recovery capital in individuals with a gambling disorder

BACKGROUND AND AIMS

The concept of recovery capital (RC) describes the internal and external resources that individuals draw upon to initiate and sustain the processes of addiction recovery. This concept has been primarily applied to individuals recovering from substance addictions. In this study, the RC concept was applied to individuals with a gambling disorder (GD) to test its associations with the diagnosis and severity of GD and with levels of psychopathology as manifested in depression and anxiety.

METHODS

A sample of 140 individuals who recovered or did not recover from a GD was drawn from lists of former and currently treated individuals in five gambling treatment centers in Israel. The DSM-5 diagnostic criteria for GD, Assessment of Recovery Capital and Brief Assessment of Recovery Capital Scales adapted to Gambling, Generalized Anxiety Disorder Scale, and the Patient Health Questionnaire 9 which measures depression were used.

RESULTS

RC clearly distinguishes between individuals who have recovered from GD and those who have not. A structural equation model showed significant negative associations between RC and GD severity, depression, and generalized anxiety. The associations between GD severity and depression and anxiety were not significant. However, when omitting the path between RC and depression/anxiety, the associations between GD and depression/anxiety became significant.

CONCLUSIONS

RC plays an important role in GD severity and diagnosis, as well as in psychopathology. This study extends the concept of RC to the area of gambling and contributes to the growing body of studies that have found parallels and common denominators between substance addiction and behavioral addictions.